In an article recently posted by the doula organization DONA International called “Commentary: Nurses, Doulas, and Childbirth Educators—Working Together for Common Goals,” Amy L. Gilliland wrote, “. . .one of the biggest challenges our doulas have experienced is trying to build relationships with hospital staff and forge a place for ourselves in the case room and on the birth support team.” The article went on to eloquently state, “Birth is an experience parents and especially mothers will remember forever. The behavior and acceptance of the hospital staff coupled with the interactions they have with birth doulas will make the difference for each woman and her childbirth experience. This can result in a safe, woman-centered and empowering birthing experience, or one filled with tension, resentment and disempowerment . . . the choice is yours.”
Stacy got out of the tub and decided to walk around for a while. Finally, baby was ready to come. I let Becky stand by Stacy’s head to coach the pushing stage. I helped by holding her leg and massaging it when it started cramping. After some serious pushing the perfect, beautiful little guy arrived. Then I pitched in to help the nurses clean her up and change the bedding, her little boy on her chest the whole time.
I went home and slept, ate, and napped again and tried to get back to feeling normal. I did the laundry, thinking no one else could go into labor until I had clean clothes hanging and ready to go.
The next morning the chocolate bars and Cheetos lady called to tell me that her water broke but there were no contractions yet. I shouted my congratulations into the phone and told her I would meet her soon. Her first birth was induced, heavily medicated, and basically a blur, so I knew that much of this birth process would be new to her.
We walked the halls, danced, and did circular exercises on the birth ball until she got discouraged and asked for an epidural. She agreed to try the tub first, which she really liked. Then she got back to bed and explored the range of available meds with her nurse. She was able to rest and continued to dilate. It was getting close. The meds were wearing off and she asked for more but before the next dose arrived she shrieked: “I gotta shit!”
I laughed and hugged her and said, “Honey, that’s your baby coming!”
She insisted even louder, “No it ain’t!” and started pushing really well. I helped her sit up so she could push more effectively and helped her rest between the rushes. After one rush she looked over at me and said, “Today is the day my momma died.” I hugged her again and told her that I was sure her momma could see her and would always be watching over her.
She named her chubby baby girl after her mother. Her three-year-old slept through the entire thing, rolled up in a lounge chair in the corner of the room, his tiny teddy tucked under his chin. He had quite a surprise when he woke up.
The next day, I gathered up the diapers and baby clothes I’d been collecting for her. I would visit later that evening. It is kind of sad when I say goodbye to my moms. We have been through so much together. In a way we have bonded and they may have become closer to me than they have ever been able to be with another woman. I wonder if I miss them more than they miss me. I think so, mostly because they are now very busy sleep-deprived mamas, entertaining friends and family who come to visit the newest member of the tribe and many also shortly return to school or work.
I am sure they will never forget the memory of their births, though. And if they look back and think of those times as wonderful, powerful, sacred, holy, and blessed, even if I am just a fleeting shadow in that picture, I have done my job well.
“The two most important days in your life are the day you are born and the day you find out why.”
~Mark Twain
Chapter 17: An Arabian Night
Anushe’s birth had been going particularly well. The room was full of women, old and young, all beneath their burkas, robes, skirts, and lacy slips. Sandals were piling up by the doorway. I didn’t understand a word of what was going on. It was just a very jolly celebration of life: a baby was going to be born tonight. This could have been happening four hundred years ago, or a thousand; in this hospital or in a tent in a desert. The scene has always been the same: low lights, grandmas sitting on the floor on rugs retelling their own labors, younger women tending to the midnight snack, the smell of fresh hot naan bread, and warm sweet tea filling the room.
The only thing in the picture that didn’t exactly fit was me. But Anushe was adamant that she would have a doula. I had gotten to know her over the past weeks and, though she didn’t speak much English and I didn’t know any Urdu or Farsi, we understood each other. Her husband, a taxi driver in the city, had translated at most of our meetings. I explained that my job was to ensure, as best I could, her wishes for the birth, which were mostly that she wanted to eat and drink during labor, that she didn’t want to be checked a lot, and that she did not want drugs at all. This wasn’t her first birth so she knew what she was asking. I assured her that, along with the nurses, we would honor her wishes and let her know if we became concerned about anything along the way. The hospital had interpreters in abundance. We had a birth plan.
She dilated about one centimeter per hour, which is average. I could tell by her breathing when things started getting stronger, though. The discussions also heated up at one point, though I didn’t have a clue what had changed. It turned out that some of the younger women were telling her how much easier an epidural would make labor. The opinions flew back and forth for a while as I sipped my tea. Finally, Anushe turned to me and said she wanted to try it. I conveyed her message to the nurses and she got set up for her epidural. She was at six centimeters when the anesthesiologist came in. When it was all in place, she leaned back in bed, grateful for a break from the rushes.
At one point her husband made an appearance and she turned toward him and let out a long string of something. I assumed she had said something like, “I am doing just fine. You go home and keep the kids happy. And make sure they all bathe tonight . . .”
He nodded and left. I was surprised when he was back only fifteen minutes later with a huge, hot, dripping Italian meatball hoagie, which she proceeded to devour. She had perhaps two bites left when the nurse came back in the room, looked at the remaining morsel, frowned at me and said with obvious disgust, “You know that is going to come right back up!”
I just shrugged and said, “I am ready,” pointing to an emesis basin on the nightstand.
A few minutes later it seemed the epidural simply wore off. We were back to square one again, breathing together, with Anushe singing a funny little “Whowhowhoooooooo” song after each rush. Then her breath caught and she pushed.
I hit the nurse button and said, “We are pushing in room 4245” but at the same moment I could see the little head crowning. I don’t really remember a second push. He was just here—pink and squealing and grabbing at the air.
I started patting him off with a corner of the sheet as the nurses flooded into the room and took over. (The hoagie did not make a second appearance, by the way.) The same nurse scowled at me again as if this precipitous second stage was my fault.
When Baby and mom were cleaned up and tucked back in bed with fresh sheets I settled into a chair in the corner and started to fill in my statistics report. Anushe kept rubbing her head, retying her scarf, then taking it off, and then asked for a cool washcloth. She was getting a whopper of a headache, which I explained was a common side effect of the epidural.
The women in the room all joined the conversation and I didn’t think much more of it, though we let the nurse know and asked for something to help with the headache. One of the grandmothers looked through the cupboards in the room and, finding a bath towel, wrapped it tightly around Anushe’s head. Another grandmother took the sleeping baby from her and settled in a chair with him. Another woman pulled out a cell phone from the yards of skirt fabric and started a very lively conversation with someone at the other end.
Soon more people were coming into the room. There were older men and their wives and they all started chanting. It was obvious to me they were reciting surahs (chapters from the Quran) because every few words was “Allah.” This went on for a couple of hours, growing louder and louder. I finally prepared to leave, promising to come back for a postpartum visit in the morning. On my way out I asked one of the younger women if this was what they did at all births. She said, “No, this isn’t normal at all. She has a jinn who is giving her a migraine headache. He entered her after she gave birth. They have to ask Allah to send the jinn away. It is like a devil.” Oh. Wow. The Arabian Nights flashed through my brain in that moment. They believed there was a genie loose in here. My heart skipped a beat and then started racing.
I didn’t know what to think. Anushe was just resting with her eyes closed, not in any dire pain it seemed, but just resigned to whatever the elders were doing. She obviously was not overly anxious by this turn of events and seemed to know what was going on around her. I decided not to mention this latest event to the nurses, thinking they would just go ahead with the usual protocols anyway—blood pressures, temps, fundal massage, and so on, which is what they did.
When I returned in the morning Anushe was sound asleep, as were two other women who had spent the night with her. The baby was nowhere to be seen. Rather than wake them, I went out to the nurses’ station and asked if the baby had gone to the nursery. The nurse told me that the dad had taken the baby home with some of the grandmothers, explaining that his wife should rest for the day and he would pick her up the next morning. I couldn’t believe it. Didn’t they know their baby needed to nurse, and that she needed him close? The nurse said that the family told her they had formula at home and went on to explain that the hospital couldn’t refuse the family if the mom was in agreement, so that is what they did. It was so bizarre! No wonder she had a baby every year, if this was her version of breastfeeding. And it was no wonder she ovulated right after each birth, following the Muslim injunction to shun birth control, but also ignoring the Quran’s recommendation that all babies be nursed for two years, which would have naturally spaced their children.
I visited with Anushe when she woke up. I didn’t want to register my unhappiness but tried to tactfully ask if she would be nursing once she was back home, which she convinced me she would. She fully trusted that her aunts were taking great care of her baby for her until she had weathered this uninvited intrusion by whatever had visited the night before. I asked if she wanted me to visit her at home in a week, which she said would be great.
The following week I went to their apartment in the housing projects. One elevator serviced all twenty-eight floors. I played sardines with at least thirty other people crammed into it on the way up, trying in vain not to rub up against one of the Muslim men, thus causing him to have to immediately wash again before prayer.
I was relieved to see that Anushe was nursing Abdulahai (pronounced ab-DOO-luh-hi) and he was already filling out his little pudgy frame. I didn’t bring up the demon possession again. She said she was happy with her little boy after having two girls. Then she told me that her first two children were also boys, by her first husband who had died back home. They were eleven and twelve years old, still babies in my book. I could instantly picture my own two boys at that age. How could she stand being away from them? She explained that their father’s family was taking very good care of them and she was hopeful they could come to the U.S. in the next couple of years.
As we sat down to eat lunch I realized that I didn’t have a clue what these people had been through.
“Waking up this morning, I smile. Twenty-four brand new hours are before me. I vow to live fully in each moment and to look at all beings with eyes of compassion.”
~Thich Nhat Hanh
Chapter 18: Rhoda
I received Rhoda’s referral for a doula late in her thirty-seventh week. She had gone to a few childbirth classes but was not super prepared for this birth. As we talked at our first meeting, I realized she had other priorities. Addressing the abuse issues in her relationship was paramount. Getting the help she needed for her depression came next. At least she knew when to ask for help. We had work to do, though, to prepare for her baby, so I offered a plan: I could meet her at her prenatal appointments twice a week and spend time afterward covering the childbirth education series and talking over any questions she might have. She was easy to talk with and very open about her situation. I knew we would work well together.
Her baby had experienced a concerning amount of tachycardia, a racing heartbeat, in his seventh month. She had been admitted to the hospital at that time so they could figure out what might help her baby. When she was discharged, she was referred to a high-risk clinic that would closely monitor him. There was some talk of inducing her at thirty-eight or thirty-nine weeks. By going to her prenatal appointments I was able to meet her OB, a wonderful woman, and ask my own questions about their birth plan. I was glad I could tell her OB that I was looking forward to supporting her at this birth and working together. I get a lot of mileage out of using the word “support” with doctors. It tells them right away that I respect their role at the birth and that I do not have a natural-birth-only agenda.
With a “high risk” label already in place, Rhoda’s options were a bit narrower than I would have hoped for. I knew I would be with Rhoda 200% more of the time than any other single caregiver during this birth, and that number would go up with each additional hour of labor.
Rhoda had warmed up right away at our first meeting. I asked the clinic if I could use one of the rooms after her appointment to watch my doula video with her so she wouldn’t have to figure out how to add one more appointment to her busy schedule. She was still in therapy, went to a support group, and the high-risk pregnancy meant extra OB visits, ultrasounds, and monitoring. They were very accommodating and we agreed to do it again with the breastfeeding videos at her next appointment at the clinic. I hoped to bring up the subject of induction, too, before it was scheduled, so she would be prepared.
We met again the following week and talked about her birth plan and what she expected from me as her doula. This gave me a chance to tune into her expectations and talk about what her labor might look like and how we could work together to help her to be comfortable without medication, which was her wish for this birth. The nurse gave her all the information for the following Monday’s induction and answered all of her questions. We had our breastfeeding class, watching two of my favorite teaching videos, then she tried different nursing positions with my baby doll, Tofiq, before we packed up to wait for her taxi.
While we were waiting, she told me that she didn’t feel right about being induced. Her baby looked great through all the last tests the clinic has ordered, so what would be wrong, she asked me, to wait another five days and see if she went into labor naturally? I explained that she had a valid point, but that she would need to ask her OB what her thinking was. The doctor may have just assumed that because Rhoda’s pregnancy was considered high risk the baby would be better out so he could be treated if there was an issue, thus an induction was warranted. But did the doctor really have a valid reason for inducing at what might be two or even three weeks early? The last thing I wanted, which would reflect badly on all doulas, was to have Rhoda say her doula told her she might not have to be induced, so I was extremely careful how I worded my response.
I explained that there were a few sides to this puzzle. First, they wanted to do everything possible to ensure that her baby was okay, so they turned to all the available technology (interventions) to be sure they “are doing everything possible.” That also would hold up in court and protect the hospital from “not doing enough” should a suit ever be filed. Second, their hospital was being watched, just like every other hospital, to see if they were attempting to limit or lower their C-section rates and thus attract more clients (money is the motive here)
. Were they perhaps thinking that her chances of having a C-section might go up with every week until her due date? I didn’t know. Third, there might actually be data from studies that show that this kind of pediatric heart problem has a better outcome when they don’t wait until term. Rhoda’s doctor hadn’t told us that—yet. So I proposed she ask and find out what was really going on, and she could ask for one more week to see if labor would start on its own. I could not, as a doula, encourage her to push for waiting for labor on its own.
I may have the experience and knowledge from my years working as a midwife, but the doctor doesn’t know that, and it is not in my “scope of practice” as a doula. I also knew that this particular hospital keeps abreast of the very latest research and may have a very good reason based on “best practice” that I would not have even heard about yet.
Rhoda said she would call me that night. I was surprised and glad that she had come up with questions on her own. I somehow imagined she was of the school of thought that dictates, “Doctors know best, just do whatever they say.” Again, all I could tell her was, “Welcome to parenthood, my dear. This is the beginning of many tests of your strength and courage.” I assured her that I thought she would be a great mom.
After the conversation with her doctor, Rhoda felt that they truly were doing what was in her baby’s best interest. I assured her during our phone conversation that we parents frequently doubt, after the fact, that we have made the right choices, but this is the new territory all parents find ourselves in. We have to make choices that are best for us and our family. Sure, we will make mistakes, but we have to work with what we know at that moment. I believe our kids know, or will know, that we did our best, always, for them.
Ma Doula Page 12
