The next week she called me demanding induction. I very calmly explained that she was only at thirty-six weeks and that I would find it really sad if her baby had to stay in a NICU (intensive care unit for newborns) and couldn’t go home with her after he was born. I told her that the next couple of weeks would ensure that he was really healthy, and that at this point his lungs were not mature yet and might need extra help breathing should he come out now. She backed down. I told her to call me anytime and stay in touch.
A Korean graduate student in my apartment building was moving out about that time and asked if I could find takers if she gave me some nice but used clothes she couldn’t take with her. China was just as petite as Song Jung. I looked in the box when I got it back to my place. I never would have been able to afford the cute sweaters and dresses, even designer lingerie from Victoria’s Secret! It was a huge success. I had found China’s weak spot! She absolutely shivered and then squealed with delight as she unfolded each layer from the box. We were definitely buddies—at last.
One evening in her thirty-eighth week China called to ask if she might have lost her mucus plug and described what she was seeing. I agreed that it sounded like it and congratulated her. I cautioned her that though her body knew exactly what to do and would certainly kick into gear on her baby’s exact birthday (which, of course, only he knew), it could still be several more days. I advised her to just keep doing whatever she had been doing—resting, eating, watching movies, and walking.
Two days later she called again, screaming that she couldn’t sleep all night and she couldn’t do it anymore, that her back was killing her and she was nauseated, and so forth. I was quite excited that this might be early labor. I was really looking forward to meeting this baby. I told her to eat and rest and call me if things changed or she got regular contractions. I also told her to call the hospital and let the midwives know. They might want to check her. I hung up and went back to our supper. By the time we were washing the dishes a very hysterical China called to say she had been on the phone with her grandma when her water broke. What should she do? I suggested she call the hospital, then let me know what they said. I knew they would want her to come in, but that wasn’t my call as a doula. I made her promise to let me know.
Yahoo! We were going to have a baby! I realized then how much I really cared about China. She was the same age as one of my own daughters and I really wanted to see her succeed, to be a good mom and get her life back on track. It wasn’t until I stopped judging her and started listening that I realized how very hard she really had it: parents on drugs, foster homes, you name it. I had to hand it to her, though—she told you what was on her mind and she wasn’t bashful about letting you know how she felt that day. There was no guesswork at all—you got the whole story whether you wanted it or not.
When I arrived at the hospital, China was almost two centimeters, ninety-five percent effaced, and her contractions were picking up. This was it. The midwife confirmed that her water had broken. China wanted to rest for a bit so she lay down and closed her eyes. All of a sudden she rang the nurse’s button and sat up. When the nurse came in China announced that the room she was in wasn’t the room she had seen on the tour of the unit the week before. That room was pink. This one was an ugly tan. I tried to ignore this comment, but she wasn’t going to let it go. She dug in her heels. She threw on a robe and said she wanted to check out all the other available rooms. The midwife took a deep breath and said, “Okay,” as she led the way.
We walked into each of the other six rooms and then backtracked through each one of them once again, China leading the way with all of us in tow. She settled on a pink room and, climbing up on the bed, ordered us all to go get her stuff and bring it in.
The rest of the afternoon and evening was uneventful. She was dilating about one centimeter every two hours and the baby sounded great. It was slow, but not unusual for a first baby. By four centimeters China asked the nurse about getting something for pain. The nurse reviewed all of her options and China chose a low dose of an IV drug to take the edge off but not make it impossible to get up or get into the tub. In the end it barely helped and wore off before an hour was up.
It also affected the baby. His heart rate flattened out to a low 100 to 110 beats per minute, which isn’t all that great. When China asked for more, the nurse suggested an epidural, but she really didn’t want that if she could possibly avoid it. I backed her up and pointed out that the baby didn’t do too well with the first drug and that I wasn’t encouraging her to get more. I suggested she try the tub at this point, got her a cup of cranberry juice and filled the tub. She really liked it. I had been telling her that being flat in bed was not the best position to labor in. In the tub she found a real rhythm on her own. I was surprised and told her how well she was tuning into her body and finding a way with each rush as they rolled in on her.
Eminent author and doula Penny Simkin talks about the Three Rs: relaxation, rhythm, and ritual during labor but I had never seen someone find it on her own in exactly this way. It happened when I was breathing with her during a rush and her head bent down and leaned forward and rested on my knees. I automatically ran my fingers through her hair from the back of her neck and then gently pulled her hair back toward me. We did it a few more times and I asked if that helped at one point and she just purred, “Uh huhhhhh,” so we kept doing it. She changed position after awhile and with each rush ran her own hands down her neck, and rocked gently forward until it passed. For the rest of the labor she found a rhythm to add to the breathing, which I found fascinating. She had tuned into some inner strength that I had not seen before and just went with it.
Suddenly, in walked the grand matriarch of her family, Grandmama, in flowing black and purple layers of some kind of robe, antique silver earrings, and a spotted leopard hat to top it all off. Regal is a modest description. She blew me away! As she glided into the room she set out bags of goodies for all of us. She had thought of everything: granola bars, bottled spring water, snacks, and cookies. Then she looked over at China and beamed, saying, “You are so beautiful! You are a goddess! You are doing this sooooo well!”
She proceeded to unpack a huge bag of baby blankets, baby clothes, baby socks, baby shoes, all brand new and all blue! Then she turned once again to China and said, “You can’t have any more kids ’cause this all broke the bank!”
China was back in bed and with the next contraction the Dowager Empress stood by and breathed with her. Then she brushed her hair and massaged her neck. I was still sitting there in awe. All this loving on China really got things going. Soon she was saying she couldn’t do it anymore and needed an epidural now! I knew she was at least nine if not ten centimeters. I explained that this was transition, the end of the very longest part of labor, that she was doing so, so, sooo well and that we would help her with each rush until she could push. I said she should rest in the few minutes in between rushes, which she did. She trusted me by now; we were finally a really great team. I let Grandmama coach her all she wanted and hung back a bit. The lady was truly stellar.
China tried a hands-and-knees position and then went back to sitting up cross-legged. I asked the midwife if they had a squatting bar, thinking that it might be just the right thing, and it was. China leaned into it, threw off her hospital nightgown and pushed! Two more pushes and she screamed. The midwife assured her she was doing it perfectly and she could feel the baby’s head. I tried to help her reach down to feel the baby’s head crowning but she shook my hand away, grabbed the bar once again and pushed her baby out onto the bed. Still squatting, she picked him up and held him to her chest. He gurgled a tiny cry and then let loose. He was tiny, perhaps all of six pounds, but sure had a huge set of lungs. We helped her so she could lay back on the pillows as I piled them up behind her. She studied her beautiful little baby as he blinked back at her and then said, “I love you so much!” We let him do the breast crawl and latch on his o
wn when he was ready. He was on within twenty minutes.
The next day I visited China one last time. I sat and held little Baby Boy (who didn’t have a name yet) while China filled out the evaluation form I have to give all mothers. When she was finished I took it and stuffed it right away in with the other papers in my bag and hugged her goodbye. I whispered in her ear, “You know, my love, now you can do anything!”
She looked me straight in the eye and answered, “Yeah, I can do anything!”
I pulled out the paperwork later that evening so I could finish my report and mail it the next day. As I was stapling the papers, I read the evaluation page. One question asked, “Overall, how would you evaluate the usefulness of having the doula present?”
The ratings went from “1: More harm than good” to “5: Was a big help.” China had written “10.” Then I saw her comment: “I love my doula. Can I keep her forever and always?”
“The most precious gift we can offer anyone is our attention. When mindfulness embraces those we love, they will bloom like flowers.”
~Thich Nhat Hanh
Chapter 13: An Unplanned Natural Birth
I was given a new referral, a mom whose obstetrician was concerned about a big baby. The midwives at her clinic had referred her to an OB because, besides the big baby, Ayana had serious diabetes. This was her second pregnancy and she was due in a week and a half. The OB suggested an induction. We were now on a high-risk track.
Many of the women at this clinic are recent refugees from Ethiopia. All of us in birth work want to make their experiences of pregnancy and birth in their new country a positive one. We have all read everything we could about cross-cultural medicine and tried to learn from the earlier mistakes when they first began to assimilate in Minnesota. One of my favorite resources is the book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, a brilliant and timely work by Anne Fadiman. All the universities and medical school programs in Minnesota now offer and require courses that concentrate on helping us understand the barriers facing diverse immigrant communities in our state, which include, especially, cultural and linguistic challenges.
I met with Ayana, who did not speak English, and learned through an interpreter that she had not attempted to get prenatal care until her eighth month even though she had state-funded insurance to cover her throughout. Coming from a district in Ethiopia that didn’t have a medical facility, many in her community were unaware of the concept of preventive medicine and how it can help pregnancies and affect outcome. During our first visit I explained the role of the doula prior to and at birth. Through an interpreter she said she was delighted to have so much help as her own family was not in the U.S. She had few female relatives here and her husband had said that his job would be to watch little Omar, their very energetic two-and-a-half-year-old boy, while she was in the hospital. It is a pretty universal assumption in traditional African societies that birth belongs to the realm of women and that men are not especially welcomed.
One father from Cameroon recently took the time to sit me down and patiently explain that African men don’t like to see their wives “like that,” meaning sweating and pushing their babies out, and that we would do well in America to explain this to our husbands and perhaps they would respect their wives more and there would be far less divorce. I didn’t agree or disagree but just listened and said, “Oh, uh huh. Hmmm,” my pat answer when our cultures clash but I don’t see any point in trying to correct what I perceive as error quite yet. Perhaps later there would be an opening to discuss this. He wasn’t ready. And since I wish to continue working with families from cultures other than my own, I have learned that I get a lot more mileage coming to this work with respect and humility than attempting to confront my perception of the differences. A very wise, timely saying from the last century that I believe is attributed to Chief Seattle says, “Do not judge your neighbor until you walk two moons in his moccasins.”
We would begin preparing Ayana’s baby’s birth now, however late in the game. I often meet with women at their clinic appointments. I get a lot of “no shows” if I schedule our meetings outside of other commitments. I am not sure why, though I can guess that with small children, in a new country, and with the language barrier, plus learning the bus system if they don’t drive, meeting with a doula, or midwife for that matter, isn’t on the top of their to-do list. Just getting to English class, getting the groceries home, and picking up a kindergartner after school is mind-boggling enough for many.
At our first meeting I showed Ayana the Doula DVD, which is perfect for the population I serve: not only are there women of color having babies in the film, but there are home births, hospital births, footage of C-sections, water births, hands-and-knees births, and mamas picking up their own babies at birth. Equally important (though I am sure that the women who made this beautiful film may not have realized it) is that my mothers can see women in America giving birth completely au natural, some wearing nighties, others with their partners in the tub with them—the options are endless. This is important because I want them to know that the birth room is their space, that they will own it, and that they can do whatever they instinctually need to do to birth their babies. They don’t need to worry that there is a certain way they have to conform to, like they have to do every single other day in American society. In the birth room they can literally let their hair down–-or their hijab.
After we watch the movie I often wonder at the look of awe I see. This has opened up a whole new world of possibilities to many of these women. They are being put in charge of something for the very first time since coming to the United States and I articulate it this way: “This is your birth. It is your body and your baby. I will not be making any decisions for you but I will support you throughout your birth. I will not leave at shift change when you get new nurses and often a new midwife or doctor. I will be your advocate for whatever your wishes are.” This is a scary prospect to some. It is exhilarating to others. For every one of these women, though, it is a new concept. They are in charge. They are often liberated by this one experience alone.
The next step is to write a birth plan. I give them a sample plan I wrote, suggesting they edit it, completely rewrite it, or throw it out and tell me what they want it to say instead. The interpreters at the clinic help us with this, too.
The birth plan is one page long. I have seen templates for birth plans on the Internet that are nine pages or more. From my experience, no nurse or doctor will sit down and read anything longer than one page. They don’t have time, and I do not want them to just skim over it. Since it is part of my job to greet anyone who comes into the room, I immediately introduce myself and then invite them to read our birth plan. It sets the tone that says this lady knows what she wants and has definite ideas. It says that she has wishes and choices and implies that because I respect that, we expect they will, too. It sends a powerful message, I believe, not adversarial but focused on her.
Mom-to-be and I usually talk about each entry on the birth plan and what each option means. After we write it, I go through a little exercise I learned in my own doula training. I suggest she look at her birth plan and if she absolutely had to, decide what ten items she would keep and which would she be able to let go of. Then, which five? And then all but one. We don’t have absolute control over how our births will go; it is our first test in the journey of parenthood and deciding what is best for our family, not for our mothers, our midwives, our best friends, or doulas. I believe there is a greater dissatisfaction with our births when we cast our birth plan in stone and then feel like we failed if we weren’t able to do everything the way we had planned.
This is a sample birth plan I like to start with.
Sample Birth Plan
· I would like my partner to call our doula at: (phone number) when labor starts. I want to labor at home as long as possible
. He/she will also alert our midwife/doctor at: (phone number).
· Who I want in the room: I want my partner and my doula in the room with me at all times. If any residents or students wish to attend our birth, please check with me first. If anyone else arrives at the hospital, please ask me first if I would like them present.
· What I want: I want to walk, use the birthing tub, birth ball, etc., and move as much as possible during labor. I want to eat and drink and wear my own clothes and not be offered pain medication. I will ask for it if I need it.
· What I don’t want: to be asked what my pain level is. I will ask for medication if I need it.
· I don’t want nurses shouting to push or counting out loud. I want to push with the urge and work with my doula during this stage.
· I do not want continuous monitoring but prefer a portable Doppler.
· I do not want the bag of water to be artificially ruptured.
· I do not want an episiotomy. I would rather tear. I would like my doctor/midwife to use oil on my perineum to help with stretching.
· When my baby comes, I want to hold him as soon as possible.
· Please delay cutting the cord. Then I would like my partner to cut it.
· I want my baby on my chest and to let him initiate breastfeeding. My doula will work with us on baby-led breastfeeding.
· I want him weighed and measured and any care done while on my bed after about two to three hours of bonding.
· I want my doula to help me give my baby his first bath in our room before we leave the hospital.
· I do not want our baby going to the nursery at all. We will room-in.
· I do not want him given formula, sugar water, or pacifiers.
· I want vitamin K and eyedrops given after he has been with me for about two to three hours. I want to hold him for the Vitamin K injection and later also for the PKU test. (The Vitamin K shot helps with any blood clotting issues, and the PKU test screens for an amino acid disorder that is rare, though disastrous if missed.)
Ma Doula Page 9
