My first experience as a Doula!

At the start of this entire experience, I never thought I would be so exhausted at the end. It wasn't from sleep deprivation, it was from being so physical on my feet and from all the mental work of keeping the ideas flowing! I have been ravishingly hungry since! So here's the story!Thursday night I responded to the email for a couple in need of a doula immediately. The couple had been planning a home birth with the Health Foundations Midwives. They were now at 42 weeks gestation and had a non stress test that showed the fluid to be cloudy. This now meant that the couple was not going to have the home birth they had planned on and would be birthing at a hospital with an OB that they had never received care from. They chose St. John's. This couple was very well informed, but had never prepared themselves for this possibility. Goodbye home birth, hello induction (a dry run as my mother-in-law calls it). I spoke with the couple on the phone Thursday night. I tried to avoid talking about my own personal experience excessively, but they seemed to enjoy my personal perspective, as I had a similar start to my birth experience. I spoke with the dad, who stated he was having a tougher time with the change of plans than the mom. We processed the feelings of distrust in the hospital system and birth plan expectations. I spoke breifly with the mom, who was very upbeat and positive. She was game to get the "show on the road". The indution was planned to start with Cervadil (she was 1 cm) for 12 hours, then to start Pitocin the next morning. We agreed that we would touch base at noon on Friday. After touching base the next day, they asked that I join them around 2 or 3pm. When I arrived, the mom had been on Pitocin for a couple of hours, but had just started to feel the contractions. I requested a birth ball from the nurse, who was very kind and helpful. The mom was able to communicate with ease. This was nice, as is gave us a chance to get to know each other. After about 2 hours the contractions became more intense and she would pause to breath deeply through it. Due to continuos monitoring needs we were only able to pace the room. This worked. I encourage the mom to draw figure 8's with her hips. She liked leaning forward through the contractions. We put the birth ball on top of the bed so she could do so. She also liked sitting on the birth ball and leaning back into her partner. I was then able to do the double hip squeeze and could encourage her to sway her hips. Her partner and I encouraged fluid use and food frequently and the bathroom every couple of hours. Six hours after I had arrived, she was checked. At this point she was 2-3cm and 90% effaced. She was getting very frequent contractions and was having a hard time staying on top of them. I encouraged using a low tone of voice to dissipate the intensity. They nurse gave her the go ahead to get in the bath tub at this point. I filled the tub, but unfortunately the water would not get very hot. Upon entering the water, she did instantly relax. The water was not hot enough though, and this quickly became a problem. She became cold. This was a low point for both the mom and dad. At one point she said, "I have a tub at home, it has a warmer and everything..." She got out of the tub and went to the bed. We had made a fort of sorts by raising the headrest section, filling it with pillows, then letting her lean over the back of the bed so she was essentially on all 4's. A midwife from Health Foundations arrived during this time. The mom was really ramping up, feeling that everything was too much for her to handle and that she couldn't go on. The nurse seemed to be a little irritated by the fact that the mom wanted to call it quits for the night, but she just kept saying that she was so exhausted. The nurse wanted her to take morphine and some benadryl type drug to sleep. The mom really didn't want morphine...this became a back and forth conversation until the baby's heart rate dipped a few times and the nurse became concerned and quickly shut the pitocin off. The mom eventually agreed to take the benydryl type drug and we all went to our respective locations to get some rest.I returned on Saturday around 12 noon. (I made sure to bring the dad some good coffee from the "outside" world, which he greatly appreciated.) Overnight, the mom had continued to dilate to a 5. She was started on Pitocin once again. I used this opportunity to process with the mom how she felt about going back to labor land, now that she had had a taste and was on the cusp of returning. She expressed some concern, saying that she was at her breaking point the day before. I offered some observations from that first time and suggested that this time around, she really try to keep all sounds that she make as low and deep as possible. We also talked about trying change the terms used for the feelings of labor, for example, instead of calling the contractions painful, lets call them powerful. I found this to be extremely helpful later on in heavy labor. I used these charged words (low, soft, powerful, melting, open) as my main focus when making up guided imagery stories. While her contractions were still manageable we made sure to order lunch. (A tip for St. Joe's when ordering food- one meal coupon is good for 2 entree's, 2 sides, beverage and a dessert). Shortly after, the nurse came in and broke the bag of waters. This confirmed that there was indeed meconium in the fluid, and a pretty good amount. At this point the nurse spoke with the parents about the fact that the baby would most likely be intabated directly after the birth. This meant that the parents had to let go of their desire to let the cord stop pumping before clamping and they would not get to have the baby on the mom's chest right away. They did a great job rolling with all of the changes that their situation presented them with. As the contractions intensified we rotated through a variety of positions.
Highlights were:1) A birthball on the bed so the mom could stand on the floor and drape her body over the ball. The dad kept his face near her at all times and spoke encouraging words to her. I hung out at her hips and would guide them in a figure 8 pattern, would do the double hip squeeze, or I would push directly above her sits bones with the heel of my hands. Thankfully, the wall was there to brace my butt against, so I could provide a good amount of pressure.2) The pillow fort. We reclined the top third of the bed pretty high, then filled it with pillows ( at least 4). The mom then went on all 4's letting her torso melt into the bed. I was again able to provide a good amount of hip squeeze and sits bone pressure and could guide her hips in a figure 8. She really liked this position when she knew that she should be standing but was too tired to. 3) Walking the halls and leaning into her partner slow dance style.4) Marla's food tray trick! This was a HUGE helper. There were points during her labor that she just plain needed to rest. I set her up in this position and she was actually able to sleep during her contractions. I tried to keep a 40 min time limit on this position.
At any point during her labor that I saw tension in her body, I would place my hand there and ask her to relax into my hand. If her sounds started to escalate, I would essentially "om" as low and controlled as I could. She picked up on it well. It was really sweet to see her partner doing so as well. There was a point (not transition) where it was really getting intense for her. She happened to be in Marla's position. Somewhere out of the blue, a doula started to use my mouth and the most sensical birth story seemed to spill out. I stepped away from myself for a moment to acknowledge this. The mother really seemed to respond to my excessive use of the word low, soft, open...she was singing her baby his birth song, being a mama is hard work and she was doing a great job. Many times throughout her labor, I reassured her that she was doing everything so well. I could usually coax her out of a position (like Marla's) by asking her to try to urinate in the bathroom.
Her midwives (who do not have hospital privileges) showed up around 6pm. At this point she was about a 7. I stepped out of the room to order food for the couple before the kitchen closed. I made sure to order the mom a protein entree and a carb entree, a couple of sides and most importantly, cheesecake. When I returned to the room, they had inserted the squat bar and had the mom propping her feet up high on the top corners of it. The top third of the bed was raised up high, the bottom third dropped down low. So now it gets crazy...the mom, in mid contraction says "I need counter pressure on in butt, now!" I look around the room and nobody is jumping to attention. The midwives have their hands tied, the nurse is messing with the monitors, sooo I gab a couple of washcloths, put them over my hands and give her the pressure. As I am doing this, I am thinking AHHHHH, this is where the baby comes from, what am I doing on this end!!!!! When I had the chance to, I put gloves on and continued to do this for awhile. She was checked at 8pm and was an 8. She went to her side in the Marla pose one last time. Her labor sounds started to become grunts. She said "Oh no! I am pushing! That's so bad, this is so bad, I am not supposed to push. She asked the room if it was bad that she was pushing and crickets replied. We called the nurse and she confirmed that her cervix was gone. During this check, the mom's left leg ended up on my right shoulder. I grabbed the squat bar to help distribute the weight. Well, she wanted pressure to push against her top foot, so I crossed my left arm over my chest and provided the pressure. As it turns out, she wanted the same pressure against her bottom foot, so now my right leg is draped over the corner of the bed...good thing I am into body balancing. This is how she begins to push her baby out. The doc came in asked that we rotate her to her back, then helped to deliver an 8 lbs baby boy. She pushed for about a total of 40 min! There was a bit of tension in the room as his lungs were cleared, but all turned out well and a healthy baby was laid across his mama's chest a few minutes after birth. The doc stitched her up and delivered the placenta, then left. As he got down the hall, a gush of blood came from the mom. In one fell swoop, the nurses called him back, the dad whipped off his shirt so he could provide skin to skin while the mom was assessed. She was not hemorrhaging, thankfully! I thought is was so sweet to see the dad there, shirtless as this little baby tried to latch onto his hairy chest. Shortly thereafter, the baby got the real deal and latched on to his mama. I took this opportunity to feed her some well deserved cheesecake!
I thought that as the doula, I would be a lot more clunky during this first birth, but I was amazed at the confidence that came out of me in the time of need. I never once doubted my self, felt unsure, or at a loss. I was also surprised at the moments that made me emotional during the birth. It wasn't the actual delivery, it was the yearning in the mama's guttural noises, it was the surrender and vulnerability that a woman is faced with, a nurses soft voice, elegantly inserted into the pockets of a laboring mind, speaking the voice of calm reality. These things exists in all mothers. These are the fibers that connect all of womenkind, and most importantly, the fibers that spark life. This exists in all of us. Men women, mothers with birth experience or not, we have all been a part of this process. We have all been born.