Firsts

I'm still new enough to the doula profession that many births bring me a "first:" first VBAC, first stillbirth, first twins, first delivery out of bed, first hemorrhage, etc. Many firsts have yet to happen in my experience. I am waiting for my first water birth, home birth, breech birth (right!), car birth and birth in an unruptured placenta.

I was already going to write about how my most recent client was my first client to have preeclampsia. She was diagnosed yesterday, nearly 2 weeks past her due date, and promptly admitted to the hospital.

Last night began her induction. She had gotten a gel earlier in the day. Around seven they began cytotec. At 11 she was contracting regularly so they opted not to go another round with cytotec and instead began a low dose pitocin drip.

After all this she remained dilated the same 1-2 centimeters she had been for weeks. They sent her spouse home to sleep, gave her Ambien and a little morphine so she could sleep, and sat back for the pitocin to start its long work.

At 1:00 my client suddenly found herself in serious discomfort and was quickly given the epidural she requested. When the doctor checked her at 4:00 she was complete. She called in her spouse and after less than 1/2 hour of pushing, delivered her healthy baby.

This is what her spouse told me over the phone this morning when he called to say the baby had been born. I assumed the call was for me to come in to the hospital because she was getting uncomfortable with contractions. When I heard a baby crying in the background my heart jumped. I thought her blood pressure must have risen precipitously and they'd had to do an emergency c-section. No.

Everything was okay. She just didn't call me. It was the first birth I've ever missed.

I visited them this morning. It sounds like two things accounted for my full night's rest. First, when things got uncomfortable, they did so quickly. And just as quickly the epidural eased her pain and she rested some more. Her spouse didn't even know she was getting an epidural. He was at home, resting up for the long haul.

Second, my client was very dopey. She said that between the Ambien and the morphine, she had a difficult time even understanding what was going on. She slept when they said sleep and called her spouse when they said it was time to call. No one said call the doula.

Her spouse said this morning that they'd much rather have had this kind of birth than one where they really needed a doula. Indeed, that was the birth we all were anticipating.

I have been replaying the night over and over. Despite their reassurances to the contrary, I can't help but feel like I failed in my job. I saw her at the hospital early yesterday evening, before they started cytotec. At everyone's urging -- the mother's, the doctor's, my own id's -- I went home to rest up.

No one thought this would be a quick birth. I have been an many an induction where the first 24 hours are all sitting and waiting for contractions to even start.

But I do not like leaving clients alone for this very reason. One never knows what will happen. Especially when cytotec, that jackhammer of a drug, is involved. Yes, she could have had 24 hours of cytotec and never responded. I have seen that before. Or she could have done what she did, jump all over it.

I don't think the birth would have gone differently. No one is saying it went poorly. But the thought of my client laboring alone haunts me.

I know this won't be my last missed birth, but I hope it's the last I miss from letting my guard down.

Breaking in

I have met with 2 college students in the last year who have an interest in birth. More specifically, they want to learn more about being with women in birth.

This is a golden opportunity in any circumstance. Here it seems even more precious. Both students plan on attending medical school.

You're with me, right? Imagine having their first images of birth be complete, holistic, respectful. For comparison, I have the stories some physician friends and clients have told me about the births they witnessed during rotations: panicked teen mothers, women with no prenatal care showing up in the ER, families fighting in the halls or delivery room. And, of course, no sense of birth as a continuous process. Instead, they saw the snippets of cervical exams, pre- and post-epidural mothers, and a few dozen babies being caught, pulled, extracted from the mothers.

The problem is, it is very hard to find clients willing to add another body to the birth room. I can't blame them. I certainly wouldn't want an additional person at my birth. One of the primary reasons most clients contact me is that they want to preserve a high degree of intimacy around their birth. It is often a concession to that wish to add even a doula to the plan. I can barely bring myself to raise the question: "Would you be receptive to a prospective doula observing your birth?"

I do raise the question, but couch it in very deferential language. I make it clear that my expectation is that they'll say no, but I always as just in case. I have never had someone say yes. Even the clients who were pretty immune to crowds -- who had 6 family members in the birth room and even permitted an EMT trainee to observe -- did not want another doula in the room.

So what do we do? How do we, who have access to amazing women and amazing births, who frequently work with physicians, midwives and nurses receptive to the supportive, respectful birth, who can introduce budding caregivers to birth as a normal, healthy process, how do we do this?

Renewal (or, the best news I've heard in a long time)

Yesterday a baby girl was born, alert, eyes-open, a healthy 7 lb. 6 oz., to my former clients whose first child was born still nearly two years ago. I know many of you have followed their story. I couldn't wait to share this happy new beginning.

There are all kinds of families

Family construction is an interest of mine. I thought this was a short and (perhaps too?) sweet account of 3 people's decision to make a family.

Baby Surprise

So a few (many?) weeks ago I promised a birth story. It's brief, as mine are these days -- all in the interest of client confidentiality.

However, I love sharing the happy ones, especially if they stick in the back of someone's mind at a future birth and inspire them as they've inspired me.

The short version is this: my client, at 41+ weeks, began having contractions the night before she was to get induced. We all arrived at the hospital happy things started on their own. More joy as she was found to be well into labor (5-6 cm). This was not her first baby and she appeared to be on the fast track.

An hour later, she was 8 centimeters. Then pushy. But, whoops, still 8. So she worked hard to manage those intense contractions from a very low baby. More time -- hours, in fact -- still 8 centimeters. The confident promises of a baby by lunch were replaced by those birth platitudes: things take their own time, the baby is fine, she'll come when she's ready, don't look at the clock, we'll change positions...

And still 8 centimeters. The exhausted, discouraged mother got an epidural, a little sleep, went through more painful contractions as the epidural bolus wore off, then was complete.

Friends, in half an hour's time, she pushed out the biggest baby I've ever seen. 10 3/4 lbs. Fat rolls on his legs and neck. Cheers and tears all around.

Sometimes things DO come in their own time and for good reason. Patience is such an integral part of a good birth.

Hand Washing is Alive and Well in Holden Women's Hospital

I was at a birth a while back and was struck by the proliferation of hand-washing signs. The door to each patient's room had an 8.5x11 image of a faucet and bubbles. In the hallway restroom I counted 3 reminders, each a coloring page completed by a child and laminated AND a more professional sign encouraging visitors to wash hands.

Of course this is a good thing. I'm always happy to comply and appreciate the reminder. I didn't pay attention to whether nurses and doctors were following their institution's advice.

_________________________

The birth stories continue to trickle in. Thanks all. It is very touching to read them.

Cervical length as C-Section indicator.

Sorry I don't have time to reflect on this. Mainly I find it interesting and am, as yet, without opinion...