This pandemic isn’t something I was prepared for. Yes, I knew it could happen in theory, but were any of us truly prepared?
I worried about what it would do to my work as a doula, what it would do to my clients’ ability to have doula support during their births.
But I care about life and death. I care about the vulnerable people in my life. I care about my clients and their families and the vulnerable people in their lives. I have no wish to endanger anyone unnecessarily.
Prenatal visits became Zoom calls. Postpartum visits became Zoom calls and phone calls. And birth support itself became virtual. This was strange, especially because one way that I often describe my work if I have to encapsulate it in “elevator speech” format is “I go with people when they have their babies to help guide them through their birth.”
So what happens when I can’t go with people as they are having their babies?
Am I useless? Or is my job description just a little flawed?
The truth is that my birth doula support begins way before the birth and continues well after the birth is over. It’s in the articles and information that I curate for my clients. It’s the way I answer their questions without judgment. It’s the positions and techniques I teach them for comfort in labor. It’s the validation I give them for how they are feeling right now. It’s the guidance I give to their partner about how to be there for them in the most meaningful way possible.
By the time they are at the end of their pregnancy some of my clients are excited about birth, when they used to be scared, some are just more confident because they know more. Some have unexpected challenges at the end of their pregnancy and need me to help them to know their options so they can pick the path that feels the best to them.
During labor, I may not be physically present, but I am still available for my clients every step of the way.
I’ve been a virtual birth doula for a couple of my clients now and do I love it? Not exactly. It feels strange to me not be able to provide that calming touch, grab that water bottle, or lock eyes during an intense moment, but there is still SO much I have been able to do while I am “at the birth”. Things like:
Listening to what discomforts they are feeling and suggesting a different position
Suggesting a massage, counter-pressure or acupressure technique for the partner to do
Letting a client cry and process some difficult moments from the birth
Talking over labor progress and thinking about possible options – everything from positions and non-invasive techniques to try, to medical interventions that may be available and pros and cons of all the options
Helping decide if and when to get an epidural
Helping to process the change to a cesarean birth and helping it to feel like a joyous and triumphant birth
Logistically, here are the things I have done to prepare for providing doula support when I can’t actually be present in the room.
Extra virtual prenatal visits to help partners feel like they have the chops to provide the physical support needed. This means trying out Spinning Babies techniques, Rebozo techniques, finding acupressure points, and trying out massage techniques with me watching so you can get comfortable doing them.
Technology – A laptop, phone, or tablet with Zoom, Facetime, Google Hangouts or any other video calling software. If using a phone, it can be helpful to have a flexible tripod like this one so you’re not spending time and effort trying to prop it up (if needed I can buy this for clients and then sanitize it for the next person). Another awesome technology tool could be bluetooth earbuds, so that partners can wear one earbud to get Cyrano-like direction from me without disrupting the person who is laboring and birthing. Clearly, those can be expensive, but if you wanted an excuse, this would be it!
Tools – I provide clients with a rebozo, which can be really helpful for squeezing hips when that’s too much for one person to do all the time and SO many other comfort measures. These Aculief wearable acupressure thingys can be good for pain relief without needing to have your partner wear out their hands providing it. I have some that I can lend to clients for use during labor and sanitize for future use. Also Sea Bands for acupressure to treat nausea can be used as intended or on the feet for an acupressure point that decreases anxiety (Kidney 1). These are fairly cheap to buy. (These ones cost slightly more, but are adjustable in pressure and length). A battery-operated fan (something like this) can be awesome too when you get to that part of labor where you’re working so hard that you’re HOT!
Old-fashioned team building – If my client is in the hospital with me on virtual doula support, I send them with a bio about me to give to their nurse(s) as an introduction to me and the support I will be giving during birth. If the situation allows, I love to “meet” the nurse to say hello and build that team feeling so we can collaborate to support you.
Following the birth, I’ve been able to continue to provide the postpartum follow-up similar to how I would do it in person. I was able to help a breastfeeding latch feel more comfortable over a Zoom call while my clients were still in the hospital. I help strategize about how to get more sleep and how much feeding and crying is normal and I can give referrals to specialists if needed.
Birth doula work is in many ways what it always was: It’s supporting my clients, the complex humans they are, as fully as I can given the situation we are in.
Last year 2 years ago, at about this time today, I gave birth for the 4th and last time. How many times have I said it was my last? Well, 3, but this time I think it’s really true. I turned 40 41 this year, I have a teenager and another almost-teenager, and the last two pregnancies were for families other than my own. I’ve done more gestating than most!
I’ve wanted to write this last birth story for a while (as you might have guessed from my edits), almost since the day she was born. But I haven’t quite known what to say. It’s not that I am at a loss for words, more that I have too many thoughts and words all jockeying for the same spot. All wanting to explain why birth is important–why birth matters.
This is not just the story of this last birth. Because the story of the last birth encompasses all the births and pregnancies before it. It can’t stand alone.
I want to tell the story of how transformative those births were for me. How elated I was after each one. Stories are powerful and we don’t get to hear enough positive birth stories. But I also fear coming off smug or preachy and that’s the last thing I want. I know how lucky I have been, not only for the genes I was dealt, but also that the path of least resistance for me when pregnant the first time (for financial/insurance and social reasons) was actually to have a homebirth midwife. For most birthing people, the path of least resistance is to use with the OB they saw for their PAP smear, at the hospital their insurance happens to cover. It would be many, many years before I fully realized the impact of choosing a homebirth for my first birth. But perhaps that’s another story…
So, please, come with me on this rambling ride and see what you take away.
My first birth taught me that no one needed to tell me how to birth. I knew what to do from somewhere deep inside. My midwife watched me and my baby carefully, but was very judicious in offering me advice or suggestions. Of course she stepped in when I needed her and offered the kind of subtle guidance that midwives tend to, so I came away feeling that I had figured it out all by myself. I also learned what an amazing afterglow you can get from a really good birth. Despite being weak and depleted in my body, I felt strong beyond belief. It’s not logical, but was a tremendously wonderful way to begin motherhood with my new daughter.
My second birth, with my son, taught me that birth can be sensual and enjoyable. This birth was almost easy. During very early labor, (shh, this is taboo) my husband and I even had intercourse because it felt right and it felt good. It didn’t seem radical at all. Contractions were still far apart (10-15 minutes) and quite mild. It was sweet and deepened our connection. Afterwards, my husband had a sudden inspiration for the middle names (yes names, we picked two) for a boy and it clicked. We had the girl name figured out, but we finally knew what the name would be if we had a boy. A few hours later, labor picked up and progressed, but it never really felt hard until I reached the pushing stage. This part was terribly short (under 5 minutes) and rather shocking, I must say, but it was really the only hard part about the labor. The same day (or the maybe the next day, I can’t remember), I was already sad that I wouldn’t ever birth again, since we had only planned to have two children.
Besides teaching me that birth could be sensual and enjoyable, the other thing that my second birth taught me was that I had an intuition, and that I could begin to trust it. My contractions started around 2 am. By 7 am, they were stronger, but still very far apart. We decided to call the midwife and let her know what was going on. Towards the end of our conversation she asked me, “What does your intuition say?” and, somewhat confused, I replied, “About when the baby will be born??” And she said, “Yeah.” And only in that instant, did I realize I had an answer. I said, “Early afternoon?” and she said, “That sounds about right.” My son was born at 12:45 pm.
My third birth was a surrogacy. I had more worries about this birth for many reasons. The first was that I’d had my first ever miscarriage with the first pregnancy for this couple. Losing that baby at about 10 weeks in a missed miscarriage was very challenging. I took medication at home to complete the miscarriage and lost what felt like a scary amount of blood. We went on to do a second embryo transfer, which stuck, but I had early pregnancy bleeding (common with IVF, but scary nonetheless) that made everything feel more uncertain for almost half of the pregnancy. This third birth was my first hospital birth and I was apprehensive about what that would be like. I don’t mind hospitals, and I’m in them all the time for my work as a birth doula, so I felt like I knew the lay of the land, but like all birthing people I was apprehensive about when would be the right time to go into the hospital and what the process would look like for me in this new environment.
What this birth taught me was that my labors are “shy” and that the hospital providers didn’t trust my body the same way my midwife had. With this birth my water broke before labor contractions started. We went to the hospital on medical advice, but labor did not get active despite waiting through the night and then trying nipple stimulation in the morning and afternoon. About 18 hours in, with no labor to speak of, the nurse and midwife began to talk about Pitocin augmentation. I knew that Pitocin could be helpful, but I was still skeptical that I needed it. After talking to my doula and my husband, we decided to ask for one hour of uninterrupted time. Everyone left the room except for me and my husband and we hopped into the shower together, where with privacy, warm water, and a few drops of clary sage essential oil on the bottom of the shower, labor began to roll almost instantly.
About 5 hours after getting out of the shower, surrogate baby #1 was born.
It was only after this birth that I remembered how in my second birth, my contractions had disappeared for stretches of time, when I was talking to a friend. It didn’t happen in my first birth, but then again no one really tried to talk to me! I realized that even calm, casual chatting was enough to make my body push the pause button on labor. I didn’t need Pitocin, I needed to turn off my brain.
This 3rd birth was intense. I really thought maybe I couldn’t do it. Maybe I would need the epidural after all. But that turned out to be the transition talking. And just like with my second birth, pushing came on suddenly and was over in under 5 minutes. I felt and sounded like a wild animal, I’m sure. And then it was over and the euphoria kicked in. (For more on this birth, see this blog post)
So finally, when it came to having surrogate baby #2 (birth #4) I knew some things. This time I was carrying for a close friend who was, amazingly, agreeable to having a homebirth, provided the pregnancy stayed healthy and low risk. It had taken a few embryo transfers before we successfully achieved pregnancy, but somehow, even though this was the last embryo and a lot was riding on it, I felt completely calm and reassured that everything would be ok. We hired a homebirth midwife and began to have visits. This was a new midwife, as my midwife for my first two births had moved away and was semi-retired. Unfortunately, despite trusting that she had solid skills, I was not clicking with her. Something felt like it was missing or off.
As a doula I tell people all the time that it’s okay to change providers, but it still felt uncomfortable to do it. I had talks with the mother-of-the-baby and she was feeling the same thing I was. We interviewed another midwife team and decided to switch care right around the start of the 3rd trimester.
I knew these new midwives professionally and I also knew a lot about myself as a birthing person, so I felt pretty confident expressing that I didn’t want a lot of hand-holding during the birth, I really just wanted experienced midwives who would recognize if something was not-normal and needed intervention. They took me seriously and when it came to the birth I felt completely in control of my care.
My first baby was 41 weeks when she was born, but the last two babies I had birthed (the boys) came at 39 weeks 1 day and 38 weeks 2 days respectively. I got the impression that I had just gotten more efficient at growing babies! My due date was 12/15 for this girl, so I assumed that I would be giving birth in the first half of December. But 38, 39 and 40 weeks came and went and still we waited. Finally at 40 weeks and 2 days, I woke up to mild contractions about 10 minutes apart and some slight bloody show. YES! I knew we were close.
Our plan was to have the baby at my friend’s house, the home of the baby I was carrying. Both of my kids wanted to be there to witness it. There was going to be quite a crowd at the birth. It would be me, my husband, my two kids (aged 11 and 15 at the time), my mom (to attend to my kids if needed), both intended parents, the sister of the intended mother (who would take pictures), the two midwives and a midwifery apprentice. It was a Sunday morning and my daughter had a volunteer shift at a Christmas tree lot from 12-3. We debated whether she should try to get someone to cover her shift, or try to arrange for someone to give her a ride if we needed to go to the birth place before she was done with her shift.
There wasn’t a really good option presenting itself, so we decided to wait and see. All morning contractions continued, but stayed very infrequent and very mild. Around midday the contractions slowed waaaaaay down. My daughter went to her shift and I attempted to nap–I’m not a stellar napper, but I did get some rest. I counted one contraction in that time, about an hour from the previous one. It was safe to say I felt comfortable waiting for my daughter to return. Clearly the babe wasn’t in any great hurry.
But, as I noted, I know my body and I knew that my body has a tendency to wait if all the ducks aren’t in a row. So we made the plan that we would pack up, head to the IPs house around 4 to get settled in, thinking that labor would pick up once everything was ready.
So when we got there, we said hi and I opted to hop in the shower with my husband. It had worked with the last baby! But… while the shower was nice, and we succeeded in getting more frequent contractions, they were only every 8-10 minutes, hardly active labor. We took a break, ate some pizza and then I went to the room that my IPs had set aside for me. I was a little discouraged, but also determined. I think I tried some nipple stimulation. No dice.
Not quite ready to give up on making labor happen, I texted my midwives in the impatient way one does when labor isn’t doing what we want it to do.
Me: “Hey, we’re all settled in at [Intended Mother’s House]. I spent some time in the shower with [husband]. We laid down for a little bit. I got out the breast pump for a little bit, but contractions are still pretty spaced out. Active labor hasn’t magically manifested like I had hoped. Still having plenty of mucus and light bleeding. Do you think a membrane sweep would help at this point? Any ideas?”
They responded appropriately, of course.
Midwife 1: Hi Scarlett… that all sounds promising 🙂 Are you worried things aren’t going to pick up or are you just wanting them to pick up now? I’m sure your body knows what it’s doing and is gearing up… I’m kinda thinking this may be a middle of the night birth? Maybe rest is the best idea?????
Midwife 2: I was thinking the same.
Me: I guess I’m wanting them to pick up sooner than later since everyone is here and waiting. You know, all the good reasons…
Midwife 1: Well… they’re not going anywhere. And we all know what happens to the watched pot!
Me: I have been resting a lot of the day, so that’s good!
Midwife 1: I think the bloody show is a great sign that it’s gonna happen soon!!
Midwife 1: You could try nipple stimulation or breast pump 15 min on, 5 min off for an hour… that’s a pretty intensive pumping schedule
Me: That is pretty intense. I’ll think about it!
Midwife 1: K!
Midwife 2: Ok 🙂 this does all sound pretty normal so far for warm up labor. If there isn’t a baby yet in the morning I could come over first thing and check you and do a membrane sweep.
Me: That sounds like a good idea. We’re gonna try some posterior baby stuff and see if that changes anything, but if nothing much is happening by bed time we’ll just go to bed.
Midwife 1: Sounds like a good plan.
Midwife 2: Sounds good.
So we did try some “posterior baby stuff” for good measure. I think I had my husband help me with a sidelying release. And then there was nothing left to do but remember that labor cannot be forced.
We went upstairs where my mom was watching the first Star Wars movie with my kids and the intended parents (IPs). We watched the rest of the movie and told everyone that we were going to go to bed and they all should too.
My mom went home (she didn’t live far), we put the kids to bed on the couches upstairs and the grown-ups went downstairs to chat a bit more before turning in. As we were talking, I was on my knees leaning over the ball and the labor contractions were starting to get stronger and more frequent. I went with it and took notice. They were beginning to come 6 minutes apart. I had this exchange with my midwives:
Me: Contractions are about every 6 minutes for the last 45 minutes and feel like they’re getting more intense.
Midwife 1: That’s sounding like the right direction! Keep us posted… How long are they lasting?
Me: Just under a minute. Like 55 seconds-ish.
Midwife 1: Great!
At around 11 we wrapped up chatting and went to bed… or tried to anyway. About the time I turned off the lamp and tried to settle in I found that I couldn’t quietly breathe through a contraction anymore. I went to my old, familiar low moaning sounds. But the contractions weren’t getting noticeably closer together so I was reluctant to call in the midwives. My husband on the other hand, well, he knows me and he knows how I birth so he began texting the midwives.
Husband: [Husband] here. Contractions are still about 50 seconds long, and coming 5-6 minutes apart, then a few that are 10 or so. BUT they are getting more intense/strong (she is vocalizing more and more).
Midwife 2: Ok- I’m going to head over.
Midwife 1: Hey [husband]. Sounds like she’s moving in the right direction. Does she want us to come over now?
Husband: She’s indecisive. She’s hoping it’s not a false alarm, but it does seem to be picking up. It may be baby’s position? Maybe one of you could come check in?
Husband: Sorry for the delayed response- rode out a strong contraction in the middle of typing.
Midwife 1: It’s not a false alarm 🙂 Good work! We’ll make our way over.
Husband: (“ok” emoji symbol)
One of the student midwives arrived first and checked my vitals. Then Midwife 1 arrived. Contractions were very strong, but felt like there was lots of space between them. This made me nervous that everyone was here way too soon, but also it felt an awful lot like my second birth had.
When Midwife 1 checked in with me, I explained my reservations and asked her if she wanted to check my cervix to find out where I was in the process. She happily obliged. When she checked me, she said I was 6 to 7 cms, further dilated than she would have guessed by looking at me.
We were filling the tub already and I was happy about the prospect of getting into it. Before the tub was ready, I started to feel my body shaking and I wondered if the birth would be very soon. My mom was on her way back, or maybe she had arrived already.
Once I got into the tub, everyone was in the downstairs room with me. My kids were on the couch with my mom. Midwives were camped out on the floor. Husband was holding my hand from the sidelines. IPs were sitting quietly. And Auntie was taking photos now and then.
The tub was hot. I took long drinks out of cans of coconut water that had frozen slightly in the fridge and it was heavenly.
I used my low, loud moans with every contraction. It was hard, but felt manageable. I would look around at the sleepy faces now and then and crack a wry joke.
Eventually, I felt like I was SO close to giving birth and right before every contraction I would think, “Is this going to be the contraction where the bottom drops out, and the baby comes out in one big, terrible push?” But then the contraction would happen, I would feel slight pressure, but nothing like the real urge to push. After what seemed like at least an hour of this (time, who knows?), I looked up at one of my midwives and said, “What do you think is happening here? Do you think it’s an anterior lip?” And she told me that she could check to see if I wanted her to. I did.
She checked me while I was still in the tub and she said that there was an anterior lip, but it was soft and moved right out of the way when she touched it, so she didn’t think it was holding the baby back. She did say that there was a bulging bag of water and that this baby might be bigger than my previous babies and just need this water to break so that the head could come down more quickly. She said that she could break my water to help us get the rest of the way.
I thought it over, and I knew that once my water was broken the next contraction was going to be The One which gets the baby out. But I’d been waiting/dreading that moment for quite some time anyway and I didn’t want to wonder and wait anymore. I was ready. She broke my water with a little prick and on the very next contraction there was no mistaking the Fetal Ejection Reflex that kicked in.
It’s hard to describe what it feels like. What I can tell you is that I yelled my head off, saying things like, “I can’t breathe!” (I could definitely breathe) and “I can’t, I can’t” (I could) and “Oh God, Oh God.” I gripped my husband’s hands and held on for dear life as the baby rocketed out of me. This part of birthing is not pleasant for me and does not feel manageable. But I don’t think it’s pain that makes it unmanageable, I think it’s the speed. In these 3 minute pushing sessions, it’s like someone opened a trap door beneath me and I’m in free fall, clutching and screaming. Thank goodness for hand-holders and the relief when the baby is finally out.
6 minutes after my midwife broke my water, at 5:54 am, all 9 lbs 1 oz of my belly buddy was out, caught by her very own mother who had gotten into the tub with me for just that reason. Sadly, the first words that little one heard from me were profane as I yelled “HOLY S&*%T!” right after I caught my breath. It was a second before I could turn around and take in the beauty of my friend, her husband and her baby, united at last.
What this last birth taught me was that as much as I really wanted one of those controlled, blissful, calm pushing phases I will not get it (not that I’m ever having another one, because I am not). I tried really hard to mind-over-matter my way into a calm and collected pushing phase, but I was spectacularly unsuccessful. The birth reminded me how wonderful it feels to have my autonomy so respected and to have complete trust from my family and my providers.
Birth matters because we are so vulnerable during our birthing times. We need tenderness, respect, and choices that are not an illusion. When we have these things, we can come through birth feeling more powerful than before even if the birth looked nothing like we wished or expected it would.
My births taught me about compassion and love. And this world needs more of both.
*Warning: this birth story contains all the gritty details, read at your own risk. 😉
I love giving birth.
The way it forces me to be completely in my body and completely in the moment is incredible. I relish the intensity of the process. Strange, perhaps, but true. It’s my style of thrill-seeking, I guess. And I feel like it’s something I do well. Author and social anthropologist, Sheila Kitzinger said once about her experience giving birth, “Now THIS was a sport I could do!” (see the video of Sheila Kitzinger telling her story here. It’s short, just 2:15 minutes) Somehow, whenever I’ve given birth, I’ve had an inherent sense that this was something I knew how to do.
So having the chance to give birth again was one of the reasons I chose to be a surrogate.
Having seen the wide range of birth experiences in my years of work as a doula, though, actually made me less confident about what might happen in labor. Perhaps I was just lucky that my first two labors went smoothly? (FYI- My two children were born at home in a water birth tub. Also, my daughter was born “in the caul” which means that my water never broke, she came out in her sac, and when my son was born, my water only broke as his head was emerging).
Having had smooth, relatively easy labors in the past made me think “I’ve got this in the bag!” But then as soon as I thought that puffed up, self-congratulatory thought, I would immediately talk myself down from that place and remind myself that birth is UNPREDICTABLE and that I had to be prepared for anything (my version of knocking on wood, I suppose). So, I hired a doula who could be there to help me strategize if things were not going smoothly. We talked and made plans for what birth in a hospital would be like for me and how to keep my brain in “birthing mode” rather than “doula mode.”
As I was reaching the end of my pregnancy, I was feeling as if my little surro-boy would come early. But then again, I thought, doesn’t every pregnant woman feel that way? I would sometimes have some fairly steady practice contractions that were not painful, but definitely noticeable. I was offered cervical exams starting around 36 weeks, but I declined them because I knew I would try to draw conclusions from the result even when I know it meansnothing.
One of the dads was going to be flying in on April 21, 2014 (when I would be 38 weeks and 2 days) so that he could be here early for whenever the baby decided to come. I figured that was early enough to plan to be here, especially considering that I could go past my May 3rd due date and he could be waiting for a long time! Well, it turns out that it wasn’t quite early enough.
Here I am, goofing off with my husband at an Easter Sunday egg hunt and brunch in the last non-labor photo before surro-boy was born.
At 7:15 pm on Easter Sunday, April 20th, my water broke while I was sitting on the couch–a TOTALLY new experience for me. I felt a little pop and then a trickle of fluid. It took a few minutes for me to determine that it really was my water breaking, but as I continued to leak it felt pretty clear that this was really happening. All of a sudden we had 1 million phone calls to make–the hospital, my doula, the dads, finding someone to take care of our children while my husband and I were at the hospital–there was a lot of coordinating to do. The hospital wanted us to come in right away, but we drug our feet for a few hours since I wasn’t having any labor contractions. We found a neighbor who could spend the night and another neighbor who could drive our kids to school in the morning. The dads decided to drive through the night to get to Portland instead of flying and my doula was on standby for when labor actually started to happen.
We got to the hospital at about 11 pm–yes, the fluid I was leaking was amniotic fluid–and once we were thoroughly checked-in my husband and I tried to get some sleep. I had some contractions over night that were mild to moderate, but only 7-9 minutes apart. At some point I stopped timing them and actually fell asleep for a few hours which was a good thing. But at 6 am we started to get moving again. My doula came at about 6 am (actually, my other favorite doula came, since my primary doula got called to another birth that was happening quickly) and a mentee doula was there as well. But nothing was really happening yet, so we talked. I think I got monitored some more and then decided to take a shower with my husband. In the shower we did some nipple stimulation (nothing major, but any touching of the nipples releases some oxytocin which is the main labor hormone) and that seemed to help get things going. But once we were out and in the room again, the contractions decreased again (in frequency and intensity). No big deal.
The dads got into town at about 9:30 am and wanted to know if they had time to check into their hotel room and freshen up before coming to the hospital. The answer was a resounding “YES” since I still wasn’t even in labor.
At some point in the mid-morning, a midwife came to see us and mentioned that they could give me pitocin to get labor going, but I said I was thinking more along the lines of nipple stimulation and she said, “Great. I was actually going to suggest that.” And she gave us a nipple stimulation protocol involving a breast pump. It was 3o minutes on and 2 hours off. We agreed to try it. Sure enough, it worked like a charm, but once we stopped… The contractions went away again. Kind of. I kept having these… half contractions? A contraction would start, but then it would plateau instead of reaching a peak before coming down again. I wasn’t sure what to make of them.
We decided to switch up the scenery a little bit and went out for a walk in the courtyard.
It was lovely outside, a little chilly, but the flowers were in bloom. My husband and I walked the maze. But labor still wasn’t really happening. Sigh.
At some point, I realized the medical professionals were getting a little uneasy and were working up to suggesting Pitocin to get my labor going. I knew that it might be necessary, and I don’t think Pitocin is all bad at all, but I really had the gut feeling that once I could get my labor going it would take off on its own. I had a conversation with my husband and my doulas. (My main doula was back by now, as her other client had given birth early that morning.) We all decided that all the hospital interruptions were probably affecting my ability to go into labor and stay there. Foolishly, I assumed this wouldn’t be a problem for me because I don’t have anxiety about hospitals, but my ability to be chatty in early labor was hindering my ability to transition into active labor. We had to commit to creating a “laborland” before it was actually there. We asked for 1 hour of uninterrupted time (this was at 4:20 pm). Everyone left the room except for me and my husband. We got into a relaxing shower and almost immediately the contractions started to come back. I went with it. It was intense, but gratifying to know that my body DID know exactly what to do. I just needed the space to do it. A midwife came in while we were still in the shower (before our hour was up!) and through the bathroom door, we put them off for another 20 minutes to equal the hour we had asked for).
When we got out of the shower my husband encouraged me to stay connected with him and shut everything else out. Usually I like sunshine and bright light, but right now I wanted the lights turned down and the window shades lowered to make a cozy cave-like atmosphere. My doulas came back in. I told everyone that I was authorizing them to speak for me so that I could be quiet and focus inward like I usually do in labor. A few times I started to talk, but I stopped myself and asked someone else to explain. I closed my eyes in a slow-dance with my husband and I sang quietly with him. We sang “I Will Follow You into the Dark” by Death Cab for Cutie and a little bit of “Let Go” by Frou Frou this helped me feel connected and drop into my body. The nurse was quietly waiting for me to be done before taking my blood pressure, but I just asked her to just sneak in and work around whatever I was doing. I had no intention of popping back out of “laborland” for a blood pressure check.
The midwife, who I’m guessing wanted to have the “Pitocin talk” with us, walked in at this point and said, “Well, this looks different. (pause) I don’t think we need to have the conversation that I was going to have!” And she left. I was relieved and I relaxed a little bit more.
Later, another midwife came on (around 7 pm I think) and she was in the room observing. She asked me a question about whether I felt like I was in labor. I said, “yes,” but it made me second-guess myself. Maybe this wasn’t active labor yet. Maybe the contractions were still too far apart? The next contraction seemed to take forever to arrive. I didn’t want to let it get to me, so I let go and kept doing what I was doing. I tried to change positions a lot and move my hips. I was afraid that this little boy was posterior (read more about posterior babies here) and I knew that could make it harder to dilate and give birth so I was motivated to try positions that would help him turn if he was posterior (or if his head was in any kind of less-than-optimal position such as asynclitic or with his head flexed instead of tucked). Here I am in an open-knee-chest position and also sitting on the ball.
I also remember moving one leg into a lunge position from the all-fours position for one contraction and doing it again with the other leg for the next contraction. I asked my doula if there was anything that I was missing that we should try. She said that I was doing most of it already, but that we could try “the dangle” so we tried that through 3 contractions. It made my arms tired for sure, and didn’t make the contractions any easier, but I was willing to make myself very uncomfortable in the short term, if it could help in the long-run. By this time I definitely felt like I was in labor! It seemed like I was hitting transition, but it seemed like it was taking longer and feeling more intense than in my other labors. I was afraid that even though the contractions were so strong, I might not be close to giving birth after all.
I asked how far apart my contractions were and my doula told me that they were 4 minutes apart (or 3?) and that if they could get a little closer together it would probably be time to get into the big tub. I was encouraged and discouraged at the same time. I knew the tub might make my contractions feel more manageable, but they were getting so intense it was discouraging to think I might not be giving birth at any moment! I had a string of contractions while sitting on the ball, leaning on the bed that felt so strong that I was having trouble staying on top of the pain. Often I wasn’t managing it, my voice would get higher in pitch and I would lose my rhythm. I started to feel nauseous and grabbed a barf bag just in case. But I never had time to throw up because my contractions had gotten so close together. I had the classic transition moment where I thought to myself, “I cannot do this.” But I didn’t say it out loud–at least not in those words–because, being a doula, I knew what my doula would say to me. She would say I was doing it. 😉 But, really, I thought, if we’re not close to giving birth at this moment, this might be the birth where I experience what an epidural is like! What I said was, “I’m not sure how much longer I can do this.” I guess I wanted them to know that I was starting to hit my limit.
Here’s what my labor looked like–moaning (loudly) and sitting on the ball.
Of course they never doubted that I could do it, but I did. I seriously doubted myself. But I also doula’ed myself. I reminded myself to stay in the moment and to stay as relaxed as possible. It wasn’t going to help to get discouraged now. My team finally said that it was time to get into the tub. I finished a contraction and started to turn away from the bed to start the long walk down the hall to the tub room two doors down, but immediately another contraction started. I moaned SOOOO loud, but droning at the top of my lungs worked THE BEST for coping with the intensity of my labor. I have pretty good diaphragm control (my theater voice) so I can get very loud without hurting my voice or getting scream-y. I tried again to turn away from the bed to walk down the hall, but another contraction hit and it hit so hard that as I leaned back over the bed, if just felt as if I couldn’t get low enough. I kept the downward momentum, kneeling onto one knee and then the other until I was on my hands and knees on the floor.
At this point, my husband and my doula asked if there was a wheelchair we could use to get me down to the tub. The nurse asked me if I wanted that and I think I just mumbled, “I don’t know.” So my people answered for me, “Yes, please get a wheelchair.” And she did. Between contractions I placed myself in the wheelchair and our nurse wheeled me rapidly down the hall. I had another contraction in the wheelchair. I pushed on the arms of the chair, lifting myself. I was trying to lift myself out of my body at that point. We arrived in the tub room. I went to the bathroom first. This was the first time that I felt really encouraged–like we were close–because my pad had lots of blood in it. And it was dripping from my body as I stood up from the toilet and I had a worried moment, asking my doula if that was too much blood. She said, “No, it’s great.” As she led me by my elbow quickly over to the labor tub.
I got into the tub. My contractions were still coming so close together–I was making unearthly wild animal noises. My voice would go from a low moan and then into a wild primal shriek. At the end of the first tub contraction I started to feel the unmistakable pressure of a baby entering the birth canal. The pushing stage had begun. And since my second baby had come out in about 3 minutes flat, I knew I needed to say something quickly. I announced to the room that the last contraction felt… pushy. And since this hospital does not allow water birth, they announced that I would need to get out of the tub that I just got into. I wondered how that was going to work, but I figured I would let them handle the details, another contraction was starting. Yep, more pushing. Holy pressure, Batman.
The midwife felt my perineum and she said, “Well, he’s not crowning. We’ll get you out after the next contraction.” My husband heard this and hurriedly explained that if this birth was anything like my last birth, the baby would be coming out on the next contraction. So our midwife just asked that the nurse drain some more water out of the tub. Sure enough, I believe this little boy was crowning on the next contraction. His head was out on the contraction after that. And right after that, his whole body was out. He had the cord wrapped around his neck, around his body and under his arm (a nice long cord, in contrast to the short cords of my own babies), so he required a little bit of untangling, but he was alert and vigorous. At 10:10 pm on April 21st he was born!
He stayed on my chest until it was time to cut the cord. One of his daddies cut the cord and then held him, skin-to-skin. I got out to deliver the placenta, which turned out to be more complicated than it usually is. (I’ll spare you the pictures of that) My placenta was having trouble detaching and I needed to push hard to help it come out. It eventually did, but I had some more bleeding than they like to see so I ended up with a lot of medications to control the bleeding. I think it may have been overkill, but I understand why they get concerned. I hadn’t gotten an IV port in labor, so they put it in postpartum to give me IV pitocin (for the bleeding) and had to try three times to get the IV in properly. I just didn’t mind at all, though, because I was still so in love with everyone who had helped me through labor. I couldn’t believe how crazy and intense it had been. Also, it felt like labor had taken a long time, but when I did the math it turned out that it was only about 5 hours from when I entered actual labor to when he was born.
These dads are amazing human beings, who are adorable and loving parents and also–I’m eternally grateful for this–they completely had my back when it came to labor which was important to me in two ways: 1) I got to have a labor with no drugs, the way I prefer, and even more importantly, 2) It meant that they completely trusted me with their baby. We all had the same goal, after all, but they trusted that I knew how to get there.
Laboring is like trying to find your way through a maze without a map or a light. It’s done by feel.
I might have been a little cocky going into this, but thank goodness I realized early that that sort of ego wasn’t going to help in labor. I let myself be stripped down, to get quiet and let the internal compass guide me as I was supported by my incredible birth team whom I know would have supported me through anything. Thank you birth team!
Every doula I know smacks her palm to her forehead whenever she hears or reads some version of the headline above.
But guess what? We hear it a lot… so our foreheads are pretty sore.
And we must be somewhat to blame. It would seem that our efforts to educate are falling very short. Of course, this perception doesn’t come from nowhere. Definitely, doulas tend to relish birth in all of its raw, primal intensity. Witnessing a birth like that or experiencing it firsthand might be what brought a doula to her work in the first place. I, myself, never fail to enjoy supporting an unmedicated birth, but then again, I’ve never failed to enjoy supporting a medicated birth either. Supporting natural (unmedicated) birth is NOT the crux of what I do.
A am awed and impressed by the birthing mother*. Always. I don’t care what the birth looks like. The person giving birth is a complex human, with a complex past and complex feelings and motivations. Her partner or other support people are multi-faceted and her relationship with this person or these people is unique. Her pregnancy is one-of-a-kind. Trying to bring a healthy human in the world is hard and vulnerable work. It takes thought, guts, control, surrender, strength, vulnerability and so much more. And that is true for anyone giving birth. Whether a person gives birth with Pitocin (a drug that causes contractions), without Pitocin, with pain medication, without pain medication, by planned cesarean, unplanned cesarean or crash, emergency cesarean, none of it is easy.
The crux of what I do is support the pregnant person and the father/partner when present.
That support starts in pregnancy. Are you planning to have an epidural? Great! Is that alone enough to make you feel secure and confident about giving birth? Probably not… Wouldn’t it be nice to have someone who is well-versed in birth (in all its forms) to whom you can ask your questions, who can send you information, and can listen to your worries and your partner’s worries and help you work through them without judging what you’re feeling? That’s just some of what I do as a doula.
As your doula, I can help you learn what to expect from an epidural, talk to you about when you might want to get the epidural, how to cope with contractions until the epidural arrives, keep you massaged and hydrated once the epidural is in place, help you change positions, reassure you when you feel nauseous or shaky, apply cool washcloths to your forehead, and translate “medicalese” to you and your partner. I can talk to you in advance about how to isolate the muscles used to push, so that it’s easier to push when the time comes.
As your doula, I am your constant. When you plan to give birth at a hospital you won’t know the nurse that will attend to you–the nurses change with the shift–and it’s not uncommon to see your OB or midwife only at the very end, when it’s time to deliver your baby. With all of those variables, wouldn’t it be wonderful to have your own, dedicated birth consultant at your side?
If in your pregnancy you begin to be faced with the possibility of induction or planned cesarean for medical reasons, you may need to change your “plan” drastically from what you imagined. What if you had a person who could help you process your emotions and talk out your options? There is such a person. You guessed it! It’s a doula.
I have attended planned cesarean births, in which I was allowed into the operating room with the mother and the father and I took pictures of the birth, held the mother’s hand or stroked her head when she needed it. I let the parents know what kinds of requests they could make of the birth team (for instance asking for delayed cord clamping or skin-to-skin contact soon after delivery). These mothers and fathers have told me how precious it was to have photographs of their baby’s first moments and their first meeting of their baby.
Perhaps I could try to list every different situation in which a birth doula could be a helpful addition to the birth team, but that could go on forever. Mostly, what I want to say is that giving birth is a profoundly physical and a profoundly emotional process. No matter how your baby comes out, that statement is true. The medical members of the birth team can get caught up in the purely physical aspects of the labor (and this can make sense, since they are tasked with the job of keeping you and your baby safe), but it’s not the only aspect that needs tending to. You and your partner need considerable emotional support also. A professional doula’s focus is on support and comfort for you, both physically and emotionally. This is something that all birthing families need. For this reason I am not, nor will I ever be, just for “natural” birth.
*Mostly I serve mothers, but a birthing father, non-binary birthing person, or person who was not planning to parent the child is equally awe-inspiring.
Well, I asked for suggestions for a new blog entry and someone helpfully suggested one of the most controversial topics in maternity care: THE EPIDURAL. Is this too much for one blog entry?
I guess we’ll find out because I’m going to take it on. But don’t expect me to come down on one side or the other. I’ve never seen this stuff as black and white and I don’t support arguing over it.
What I do support is knowing what you’re getting into (as much as possible considering we’re talking about labor here, the essence of unpredictable), whether we’re talking about getting an epidural or “going natural.”
So let’s break it down.
Pros of an epidural:
Takes the pain away, but leaves you mentally still “with it”
Allows you to rest if needed (sometimes desperately)
Relatively little medication gets to the baby
The amount of medication can be adjusted so that you can have some sensation and motor control in order to push and change positions (while remaining in the bed, of course). I have been able to help some moms maneuver into a squatting position (with a squat bar) or onto hands and knees all while under the effects of epidural anesthesia.
Most of those pros are common knowledge. The cons of epidurals are less well known:
Getting an epidural means lots of other medical things have to be done also. You will need IV fluids, your BP will be checked regularly, you will have continuous fetal monitoring, and you will probably have a catheter and a pulse oximeter (measures your blood oxygen levels). You will not be able to leave the bed (although, as mentioned, you may be able to change positions in the bed).
Sometimes an epidural doesn’t work. Or it only works on one side (if you don’t believe me, just Google “epidural only worked on one side” and you’ll come up with hundreds of thousands of hits). Or it leaves a “hot spot” where you can still feel pain.
An epidural can slow down your labor. (note: sometimes it can also speed up labor and sometimes labor stays at a steady pace). If your labor slows, you will likely receive Pitocin augmentation and it may be increased more quickly because providers are not as concerned about your pain since you are receiving pain medication.
Epidurals can cause fever in the mom, which means that she may be treated with antibiotics in case of infection. Baby may also be subjected to an invasive septic work-up to rule out infection and/or will be treated with antibiotics.
Epidurals can affect the initial breastfeeding. I’m not sure how much stock to put into this because some epidural babies latch just fine and some medication-free babies have trouble with the initial latch (and vice versa), but studies show that there is an increased risk of initial breastfeeding difficulty in babies whose mothers had epidurals.
Epidurals anesthesia can make your BP suddenly drop, which is risky for mom and baby. The IV fluids are given to head off this potential complication.
Reactions to the medication can range from the very common itchiness (usually starting at the chest and neck) to the much rarer severe allergic reaction to the anesthesia.
These actually aren’t all the cons, but I think you get the picture. Getting an epidural isn’t always easy and breezy, although for many women it is.
And you know what else is not always (or even often) easy and breezy? Yeah, you guessed it; unmedicated childbirth. I’m all for it, and I could list several items that were pros for me (but I can also see why someone would not relish this particular mode of birthing):
Allows your body to follow the hormonal “blueprint” that helps prime you for motherhood and your baby for life outside of the womb.
Increased the bond between my sweetie and I. Being able to trust that I could “lose control” and still have him there by me, supporting me was an immeasurable feeling and made me fall in love with him all over again.
Made me feel incredibly powerful. It’s incredibly powerful just to carry and grow a baby inside your body. Giving birth can intensify that feeling.
It was like a rite of passage. I came up against some big fears and I had to face them in order to move forward in labor. Though it was hard, it was also rewarding.
But the cons are many as well:
It hurts (for many or most women).
You don’t know how it will feel or how you will cope. You may worry if you will be able to cope.
You may come up against some big fears that you are not ready or able to face (this could be especially true for survivors of abuse).
“Losing control” or surrendering to the process can be difficult and/or terrifying to do.
You may cope well at first, but if labor is long, it can severely deplete your ability to handle the rest of labor.
In the end though, it comes down to this: What are your needs? What can you do to help you meet those needs? Whatever that happens to be is A-OK.
One big piece of advice, though: Make sure you are not making decisions based on fear. Fear is fine and normal, but it is not your friend when making big decisions. Take these steps during your pregnancy:
Think about your fears. Are you terrified of tearing during birth? Are you scared of how you will act in labor and what people around you will think? Are you scared about being a parent?
Talk with someone you can trust about these fears (your partner, your childbirth educator, your doula, your friend, your counselor) or write them down. Often there actions you can take that will address your fears. Sometimes even, just getting them out can make you realize that maybe it’s nothing much to worry about after all.
Having your fears addressed and your priorities in order will help you proudly chose how you want to birth. And it will help you make choices during labor, too, if (when) unexpected things pop up.
I was listening to Fresh Air on NPR on the way to pick up my daughter from school and Terry Gross was talking with Jimmy Fallon about how he came to be on Saturday Night Live. It turns out that Jimmy Fallon wanted to be on SNL almost as far back as he can remember. He said that when he would blow out birthday candles, he would wish to one day be on SNL. I was thinking, “How crazy is that?” that such an unlikely wish would come true…
And that made me think about my own crazy childhood wish, which was–get this–to be Wonder Woman. I wished that on a lot of stars before my age made me cynical. I knew the wish would never come true.
But while I never donned a patriotic swimsuit-like uniform with tall red boots and I never swung the Golden Lasso around anyone’s torso and I never, ever drove an invisible, flying jet, I did sorta get my wish.
I gave birth at home with my first child (it was a planned home birth) and while I didn’t know what to expect any more than anyone else, I felt confident and prepared for this particular challenge. I was excited for my baby and my birth. It wasn’t particularly easy or hard. It was labor. It was scary in parts–I was afraid I would tear–but I surrendered to the process. I let my primal brain take over and once my daughter emerged I felt that I was the strongest, most capable woman in the world.
I felt like Wonder Woman.
It wasn’t that I felt physically strong. Heck no! I was laid up in bed for a week having lost more blood than is usual. But I felt, as many other women have described before, that if I could do that I could do anything. I know it was the hormones talking, but what wonderful hormones they were! Over time the feeling faded away, but I was glad to experience it all over again when I had my son 4 years later. (And that birth was downright lovely. I would have done it all over again the next day if you asked me.)
But I’m well aware that not everyone has the desire or opportunity to birth the way I did. That’s not really what I’m getting at. What I’m getting at is that every woman deserves to feel this way at some point in her life. Birth (in all its forms) can be wonderfully empowering and exhilarating, but so can skydiving. So birth may or may not be your portal into the super hero world but, gosh, it wouldn’t be so bad if every new mom could start off motherhood feeling like Wonder Woman for a day.