The OB overseeing Makda’s labor at this point said it might help and he was familiar with it, but then added that a small vacuum extractor might also help. I assumed he was more familiar with the latter intervention by the way he was explaining it. I couldn’t resist putting in my own two cents at this point and said, just as an aside, “Ina May was at my twins’ birth at The Farm in 1982.”
The resident practically hopped up and down and said, “Really? I just saw that video! That was you?”
I said, “Yes.” Later that night he came by with another young intern to meet me. When did medical school ever look like this? It was very encouraging.
Makda and I walked, and labored, and breathed, thought about giving up, walked some more, and took a long bath. The only sound was the water slowly trickling over her belly in a dark, quiet bathroom and our breathing in unison, and then blowing each rush away . . . forever. Finally fully dilated, we tried different positions for pushing. Hands and knees worked well, and the doctor was in agreement with staying there, especially if it would help with big shoulders, but Makda wasn’t sure it was working. The nurse checked and the baby hadn’t come down any further, even with some really good pushes. Then the doctor checked and became concerned that he couldn’t feel the lines in the baby’s head. He wondered if he had turned somehow and could even be breech, so they rolled in an ultrasound machine to check. The head was still down, but posterior. That explained the back labor but didn’t explain why he wasn’t budging the least little bit. The doctor was fine with Makda pushing when she had the urge, but it didn’t look like she was getting her baby to move. At this point he ruptured the bag of water, hoping that would help with some progress. What happened next was a surprise. Until then the baby had sounded great, with nice variable heart tones. But the water was full of meconium. That meant Baby was not happy.
The heart tones continued to look good, but all the pushing wasn’t doing much good. Finally, the doctor suggested trying the vacuum that might help the baby’s head to move, which he was sure by now was acyclic, or turned to one side and aiming down the birth canal at an awkward angle. Makda agreed to it right away. We all just wanted to see this baby out at this point. So that was tried and after three attempts, the doctor gave up on that too. Baby didn’t move. We had tried different positions and just about every trick in the book by then. All of a sudden I looked over at the monitor at the same moment that one of the nurses announced as calmly as possible, “Fetal heart tones fifty . . . sixty . . . fifty . . .” which meant that our baby was in trouble. Serious trouble.
Back to hands and knees and monitors. I was the only one on the side of the bed by the oxygen port in the wall so I took the liberty to unravel the tubing, plug it in and turn it up to ten liters as I passed the mask to the nurse who had Makda breathe the oxygen. We tried having her on her side, then the other side, then upright. Nothing helped for long. After every contraction the baby’s heart rate fell dangerously low. The doctor wondered out loud if the cord was being pressed somewhere next to the baby’s head, both preventing further descent and causing the low heart rates. He explained all of this to Makda and asked if she would be okay with an emergency C-section because the baby wasn’t doing well and we didn’t want to wait further. She agreed.
The moment she consented, the staff went into high gear. She was asked to sign a consent form. Compression bags were put on her legs and a sterile cap covered her hair. The IVs were all detached at the pole, tossed onto the bed and monitors were shut off. A fetal scalp monitor was threaded in through the cervix to listen to the baby directly. Every minute counted. He still sounded okay, which I was glad I could tell her. I helped Makda pant through the contractions and take deep breaths as they passed. I tried to sound calm and quiet, hoping to diffuse the sense of panic around us. As Makda was being wheeled out of the room the interpreter and I were each tossed a set of scrubs, hats, booties, and masks, which we caught mid-air. We wiggled out of our clothes and into the scrubs as fast as possible, then ran down the hall to catch up to Makda.
While she was prepped for surgery I was able to tell her what was happening. The IVs were all reattached, the epidural line was transferred to the operating room, her belly was scrubbed, and then covered with a sticky sterile sheet that would stay in place during the surgery. Within ten minutes the doctor started the first incision. I explained that she would feel pulling as they held back each layer of skin and muscle and then they’d be ready to lift out her baby. I told her he still sounded good, the best yet since we left the room. A few minutes later I told her to expect some tugging and pressure. Then I reported seeing lots of curly hair and before I could say more he let out a huge cry as they lifted him up. He looked pink and didn’t even need to be suctioned. Because of the earlier meconium, the resuscitation team was on hand but he did better than anyone expected.
Soon he was in the warmer. I lifted Makda’s sheet so she could see him as they cleaned him up and checked his breathing. He was doing great. I whispered in her ear that he was beautiful, and that we were all very proud of her. In a very few minutes Makda was holding her baby boy who was suddenly perfectly quiet, blinking and looking at her.
Finally she was wheeled back to her room—this little hospital didn’t have a recovery room so we settled back in where we had started. The interpreter called Semere and explained that his son was finally here and he should come when he could find someone to watch the little girls. Makda instructed the interpreter not to tell him that she had a C-section because she was afraid that he would race to the hospital and get in an accident. She asked me to explain to him what happened and why when he arrived.
About an hour later he came with their two little girls. They were dressed alike and their daddy had even fixed their hair. One was holding a huge bunch of flowers and the other had two balloons on strings for their new baby brother. An aunt was also along to watch the girls so Semere would be free to visit with his wife. I explained to him briefly that the doctor was concerned about the baby and after trying several interventions, decided to do the C-section. I gave him a very brief outline and told him we would talk more when I came back the next day. I did say that I was very glad we got the doctor we did and that the whole staff had been great, exceptionally caring and competent. I told him we had been very lucky. I told him, too, that he had a very brave wife and he should be very proud of her. I hugged them both goodbye and went home.
When I returned the next day Makda was walking around the room, taking care of her baby. He was nursing well and she looked wonderfully well and happy. She had a few questions as she was trying to process the rushed chain of events before his birth. We talked about it all again, and I told her that we were all very grateful for how supported she was and the great medical team she had.
The midwife part of me still tries to analyze alternative possible scenarios and what we might have done differently. The doula part of me knows I was there to try to bring a calm and balance to her birth that she would always remember. I wanted her to feel that she had done a smashing job in spite of the problems and that she was an amazingly strong, beautiful woman who was on this incredible journey of motherhood.
We visited over lunch in her room, so very grateful that little Azmera was here. She marveled that he was so peaceful and nursed so well. I reminded her what a good mama she was and that the older we get, the more laid back we often are, which babies seem to reflect.
Penny Simkin. PT, CD(DONA), childbirth educator, birth doula trainer, author (see resource page).
“One is constantly having to balance the high expectations of modern healthcare with the need to repsect the human soul.”
~Penny Simkin
Chapter 16: Doulas and Nurses
A call from Belem was the beginning of a very busy few days. As the Amharic translator, she called to let me know one of “my” ladies was in labor. I rushed to the hospital and found out that not only had
Keleme not called me, but she had been in labor for over twenty-four hours! All of her thinking flew out the window when labor started, totally confusing her as to who she should have called when the time came.
Keleme, her midwife, and I were trying to figure out how to help her rest for a bit. She was exhausted and hadn’t eaten or had enough to drink during labor. Her midwife suggested some IV fluids along with a muscle relaxant so she could sleep for a bit. It worked. Three hours later, after the drug wore off, she had a beautiful little five-pound boy, her first baby, with only three pushes! He was tiny but nursed immediately.
By 2:00 a.m. I was on my way home. I showered and slithered into bed—it felt so good—and fell asleep, only to wake up to the phone ringing at 7:00 a.m. It was my lady from Laos. Her water broke an hour earlier. She timidly asked if she should go to the hospital yet. “Yes” I told her. “I will meet you there. Remind me which hospital. Good. Okay, honey. We’re gonna have a birthday party today, aren’t we?” She was also a first-time mama. I grabbed her file. Yes, I thought this was early, though only two weeks. Not bad. I got dressed and called a taxi.
As I rode up in the elevator to the birth center my phone rang. Another mom was letting me know she just lost her mucus plug. I congratulated her, hoping she would be a bit more excited about her second baby than she’d been in our meetings and told her to keep me informed, day or night, reminding her that it could still be several more days before labor started.
The rushes had started by the time I entered Der’s room. I scrubbed up at the sink then went over to the bed to hug her. Der was as stiff as a board, obviously very nervous. The monitor was blaring away and something else was beeping in the room. I hit the nurse button and asked if someone could turn off all the noise. They did. I massaged Der’s hands while we chatted about what to expect next.
Der insisted she could give birth to her baby without drugs. We walked around, she sat on a birth ball, drank juice, munched on snacks, and walked around some more.
Her husband was even more reserved than Der. He sat in a corner and didn’t say a word.
The nurse checked her and announced “Five centimeters. Great!” and left us alone again. Less than ten minutes later, during a rush, Der suddenly held her breath and pushed for all she was worth.
I knew that, in spite of being told she was only five centimeters, she knew what she was doing, even though it was her first baby, so I hit the nurse button again and tried to calmly say, “We are feeling a bit pushy down here and I think you ought to come now!”
Nurses rushed around setting up the room. An instrument cart and baby warmer were wheeled in from the hallway where they had been on stand-by draped with sterile sheets. Chairs went out the door and the bottom half of the bed was removed. Stirrups popped up, though I showed Der how to sit up and hold behind her knees with her hands and we didn’t use the stirrups at all (I avoid them if at all possible). Another push and we could see Baby’s black, curly, long hair. Her husband still silently watched all of this from his corner. I helped her rest and slow her breathing after the rush and she appeared to instantly go to sleep. When she woke with the next rush she pushed the little head out. It was perfectly round, barely cone-shaped at all. The rest of the baby slid out and Der immediately reached for her baby and started talking to her little girl in Lao. I had never heard her speak it since her English was so good. I asked what she said to her little girl and she laughed and said, “Oh, I just said, ‘Hi, I’m your mommy and this is your daddy.’” We were able to keep Baby on her mother’s chest skin-to-skin for a couple of hours, both covered with pre-warmed blankets. It was a wonderful birth.
I got home, showered, warmed up some leftovers and caught up on paperwork. I won’t remember when what baby was born or the dates or weights if I don’t write them down. Finally I decided I needed a nap before my husband got home. I had hardly seen him that week and was looking forward to having supper together.
The lady who had called me while I was in the elevator going to Der’s birth called back as we were getting ready for bed at midnight. She was having contractions but they weren’t regular. They had been coming and going for two days and she was done. She wanted me to know she was going to the hospital right then and insisting on being induced and wanted me there, too. She would start week thirty-nine in two days.
She had already hired and fired two doulas before me. She had numerous issues with them but for some mysterious reason decided I was okay. I learned that it was close to the two-year anniversary of her mother’s death and she was angry that her mom couldn’t hang around long enough to help her with her kids. Just the week before, at one of her prenatal appointments, we met at a clinic I had never been to, in the north part of the city. The entire area reminded me of Harlem in the 1960s. This was Harlem before gentrification. It was a very scary place. I had no idea we even had such pockets of poverty in Minnesota.
She was in the waiting room with her partner and their three-year-old that day. The little boy was snarfing down a whole bag of mini Milky Way bars and the mom was munching on Cheetos. After ten minutes she said to the little guy, “Okay, baby, let’s trade” and they exchanged bags and continued noshing. This was lunch. Really. I didn’t go into my nutrition spiel because I was absolutely sure her doctor had already had that conversation with her, probably many times.
She calmed down while we talked on the phone. I reminded her that was still two—or could be even three—weeks early and I really didn’t want to see her deliver prematurely and not be able to take her baby home from the hospital with her if he ended up in the NICU. She finally agreed and asked what she could do to hang on a little longer. I agreed that it is hard to wait when you are so uncomfortable but she’d be okay and would soon see her baby boy. I tried to encourage her and told her again to feel free to call me any time.
I slept like a log. I needed it. When I got up I called my single mom, Stacy, who was due the day before. She told me she had been contracting all night but the rushes weren’t yet five minutes apart. Her water hadn’t broken. I offered to go to her house or meet her when she decided to go to the hospital. She was doing well, she told me, had girlfriends over, and said she would stay in touch.
Within an hour Stacy called back to tell me she couldn’t handle it at home anymore and asked me to meet her at the hospital. She got there before I did and let me know she was already three centimeters as I walked in with my pink “Happy Birthday” tiara on. It always makes people laugh, so I bring it when I think we need a bit of comic relief. Stacy put it on as she got in the tub. I turned on the jets—it was a real Jacuzzi!—and she sighed with pleasure as she relaxed into it. So cute!
I noticed when I got to Stacy’s room that a friend was guiding Stacy through the rushes beautifully. I held back a bit and just watched how she was able to calm Stacy and saw that they were really a great team. I brought in a bath stool and put it by the tub and invited the friend to just be there for her. I learned that Becky, a mom herself, was studying infant massage. I left them alone and busied myself cleaning up the room a bit. Then I walked down to the nurses’ station and asked our nurse if we could order breakfast, which she agreed to right away. The hospital had twenty-four-hour cafeteria service and would deliver a tray to the room a half-hour after getting the order.
As her doula, I could have just ordered her breakfast and not asked her nurse’s permission. I could also have just turned off the beeping machines at the last birth. I don’t have to get the official okay either just to unplug monitors to take my client to the bathroom. But I have discovered that by setting the tone with these completely benign protocols I can get an awful lot of mileage with the birth team. I often try to find one or two ways of deferring to them early on in labor. It is a kind of body language that almost suggests subliminally that we can work together just fine and that I am not there as a raving advocate for my lady, ready to do battle on her turf. Somewhere alo
ng the line doulas, and midwives too, for that matter, have been seen as radical militants, and many health care professionals are not happy to see us. I am trying to change that image by looking for ways to work together and earn some respect for our profession. So far it has worked very well. They can tell right away that I have a relationship with the mom that they don’t have, especially when a nurse suggests something and the mom wants my opinion on it. That could set me up for becoming a referee, which is not who I am. I just know that the nurse would go right back to the nurses’ station and inform all of the other nurses that they’d “Better look out for that doula back there, guys.”
A few years ago I was at a birth with a first-time mom and the baby was definitely not tolerating labor well. His heart rate decelerated with each rush and took a whole two minutes to recover before the next rush. Finally, his heart rate stopped going back up all together. Her doctor was worried and asked her to consider a C-section since she wasn’t even dilated to six centimeters yet. She did not want a C-section, she wanted a natural birth, which we had talked about for weeks. She turned to me, with the whole birth team looking on, and said, “Stephanie, tell me what to do!”
I told her, “Dear Felicity, I wish I knew what to do, but if this was my birth, my baby, I would go for it. I would have a Cesarean right now.” She couldn’t see the doctor’s face from where she was but I could. He was visibly shocked that I would be on “their side.” I had never considered sides; I just assumed we all wanted the very best for this sweet lady and her baby, though he had assumed otherwise.
Ma Doula Page 11
