Archive for the 'doula' Category

Riding that endorphin high

I attended my first homebirth in the wee hours of the morning a night ago – mom stoically sat in the birth pool, the only sign that she was working hard was light tapping of fingers and the occasionally quiet moan.  As soon as that birth wrapped up – about 6am – I get a phone call from my actual client.  “I think I’m in labor”.  Wee ha!  I go home, catch three hours of sleep, shower, then quickly shuttle kids off to grandma.  As kids are pulling out of the driveway, I get another call.  “My water just broke – we’re headed to the hospital.”  She was a trooper –  always had planned on an epidural but it didn’t take well and there were a couple of hours of really rough labor.  I got to earn my money, which always feels good.  Baby born right before midnight.  Both beautiful births – and I needed it.

Today is my little girl’s birthday – and driving home after a couple of births was the perfect way to kickstart it.  Now I’ve got to clean furiously for a birthday party this afternoon that I haven’t had the chance to plan.  Funny thing is I’m not even tired.  Ahhh…birth hormones (yep, the doula gets them too).  Don’t you love ’em?

My birth-hero

This article in the Seattle Times illustrates perfectly why I love my doula trainer, Penny Simkin.  She’s not just a great role model for birthy-types; her gentleness, passion and openness makes her a great role model for anyone.  Thank you for a lifetime of work, Penny!

On Safari

Daddy (to Mommy): I’m going to go return these movies real quick.

Siena (to Daddy): Where ya goin’?  Ya goin’ ta Africa?

Life’s been busy but I haven’t forgotten about you.  I actually just finished up my last certifying doula birth today – a five hour induction with a happy mom and baby.  All three of my births so far have been inductions, and all three have been under 6 hours.  I wonder if other doulas have the same experience of fast labors?  I know having a doula has been proven to speed up labor…crossing my fingers my track record will last…

I’ll be back to make a real post soon.

Having sex late in pregnancy does not induce labor, researchers say

http://www.npr.org/templates/story/story.php?storyId=16618423

My loving hubby called me to let me know that there was a story on NPR about new research on labor induction via sex.   (The guy doesn’t really get my fascination with birth, and listens for hours on end when I talk about things like placentas and episiotomies and my thoughts on the management of the second stage of labor, yet calls me when a story like this is on!  Love him!)  Click on the above to listen then come back here.

As a doula, when my clients get uncomfortable in the last few weeks and start talking about how they can’t take another day of being pregnant, I have been listing out natural induction methods.  Sexual stimulation is always one of the things I mention.  (I don’t mention herbal methods of induction or castor oil, as I feel they are out of my scope of practice and should be discussed instead with their care provider as they are more controversial.)  I always assumed sex was the best method of my natural induction bag of tricks – semen has natural prostaglandins in it, nipple stimulation is often involved in sex and can bring on contractions, and orgasm contracts the uterus as well.  Given that the study and the speaker on the NPR story are from the medical (vs. the midwifery) model of care and I heard a couple of red flags, I think it may change how I talk to my clients during the last few weeks of labor.

In the past, here was my “normal” speech:  “I can hear how uncomfortable you are.  Would you like to hear ways to ease your comfort, or ways to encourage labor to begin?  (Client chooses to hear labor encouraging methods)  There are a number of ways to encourage labor to start naturally.  You can try…”

Here I think will be my “New and improved” speech:  “I can hear how uncomfortable you are.   You may have heard about many ways of encouraging labor to start on its own, such as walking and sex.  New research is showing that while these methods should work in theory, they actually do nothing more than increase your contractions for a few hours and get you excited, then peter out leaving you physically exhausted and emotionally frustrated.  Although it may be disappointing to hear that there is no good way to help labor along, it might be helpful to remind yourself that your body does know what it is doing.  The physiology of how labor begins is a very complex process, and even induced labor in the hospital does not mimic naturally occurring labor very closely.  Did you know that there are many chemical reactions that occur in the mother’s body to begin labor starting several days before you feel it, but that the very first reaction actually occurs in your baby’s brain?  So in fact, your baby will choose when s/he will be born.  How cool is that?  In almost every case, a mother will go into labor on her own, given the chance to do so.  And there are real benefits on waiting – a healthier baby and an easier labor being the big ones.  Your body is gearing up for labor, and the discomfort you are experiencing now will actually make labor shorter and easier when it does occur.  I know you are uncomfortable.  There is not a mother this far along in pregnancy that does not feel your pain, and I’ve been there myself.  My theory on it is that we are designed to be this uncomfortable in the last few weeks in pregnancy so that we actually look forward to the pain of labor when it begins.  But the good news is there are things you can do to ease your discomfort.  You can try a warm bath, hands and knees and other positions, hot and cold packs, massage, and distractions such as movies, shopping, dining out, visiting friends, baking, and starting a big project that you may or may not be able to finish before the baby comes.  Or you can practice your breathing and other coping techniques we’ve learned together and hone them so they’ll work better for you during labor.  Keep in mind that your body knows what it is doing and try to forget about due dates and other arbitrary timelines – you will go into labor when you and baby are ready.”

I’m starting to understand just how deeply the thought that we can somehow magically jumpstart our labor effects the mother.  When she tries something then fails over and over, it teaches her that something is wrong with her body and she learns to distrust herself.  She believes that her body is incapable of going into labor, so induction looks better and better.  And coupled with our culture telling moms that “37 weeks is full term” (can we just all stop saying that please?) and “I’m past my due date (at 40 weeks plus one day instead of at 42 weeks)”, unless the mom is steadfast in her resolve opts for induction, thinking that at least it will all be over and at least she can choose her doctor and her due date.  And we all know that an induced labor is not only physically more painful, but also usually comes with many more interventions because induced labor must be monitored more closely.  External fetal monitor, the IV (pitocin), perhaps internal fetal monitor or interuterine pressure catheter all have cords wrapped around mom, so mom is in more pain yet tethered to a bed where she cannot move to cope well.  And with induction, the increased likelihood of foreceps/vacuum assisted birth or cesarean birth all come into play.  And a mother who wanted a natural labor and got anything but (whether it was a few extra cords, or an epidural, or an assisted or cesearean birth) begins to resent her care providers, herself and possibly even her baby.

As a doula, having a mom second-guess her birth experience is absolutely the last thing I hope for my clients.   I want a mom feeling empowered about her decisions, whatever they are.  So while I will never try and stop a mother from doing what comes naturally *for her*, I’m going to stop with the old wives’ tales induction speech.  Sometimes learning to walk the “evidence-based practice” walk is hard, but it is well worth it.

Baby Number 2 Born!

I spent last night with my second doula client helping her be as comfortable and emotionally supported during her labor as possible. As per my usual policy I’m not going into extensive detail here for confidentiality reasons. But here is the factual rundown:

– 19 year old primipara (first time mom), financially disadvantaged but marriage full of love. A pleasure.

– After weeks of on and off exhausting prelabor, 39 1/2 week induction: membrane strip in office, 3 hour later AROM (artificial rupture of membranes) that brought on good contractions nicely and steadily increased. Mom worked through them beautifully relaxed and rhythmically vocal.

– comfort measures I provided: foot massage, leg rub, back massage (lots of this – my arms are tired!), reminders to find her breathing rhythm, tub, reminders to change position, and some position suggestions

– this was never intended to be an unmedicated labor, although mom went further than I think she had assumed would happen and got into a nice strong labor pattern, making it through a couple of rough patches to find her rhythm again

– light epidural at 4-5 cm where mom was able to move her legs and still felt milder pain with the contractions. When they got continously worse, the nurse was called in and we learned there was a button she should have been pushing (to our memory, this wasn’t mentioned – oops!) Still breathing a bit through contractions but able to get some rest, if not actual sleep.

– after only 6 hours of labor, mom is complete, and pushes beautifully for 45 minutes to an hour – after losing strength “I can’t do this just get the baby out” she feels that baby’s head and is laughing and pushing stronger than ever. Doctor almost not gloved up for delivery and mom almost delivered baby herself – baby is 8 3/4 pounds!

– No Pitocin augmentation necessary. Only minimal repairs (1st degree).

– this was my first time supporting a partner – he was a really great calming and loving presence for his wife and charmingly emotional – he held her hand, had loving words whispered in her ear, and shared lots of gentle kisses and touches and had some beautiful tears when the baby was born – which got me teared up too!

– this was also my first time being the primary breastfeeding support. Baby has great instincts and sucking refexes, and would latch on perfectly but would release after 5-6 sucks – I was stumped and called in the reserves and the nurse suctioned baby out as he was quite plugged up. By that time baby was getting sleepy but would wake right up in dad’s arms. By the time I left, baby had a good latch.

I got home just as Rich was waking up to go to work. Kids were shuttled off to a friends where I got a blissful 3 hours sleep. Funny thing is – I’m not tired. Can I do it again? PLEEEZE?

Counting the days till my next client is due – on call after Thanksgiving.

So, what is it like being a doula?

Already after just having three clients, I’ve had to deal with a number of tricky situations.  Without divulging any information about who my clients are/were, I’ll tell you that already I’ve dealt with physical abuse, single parenting, teenage pregnancy, eating disorders, even  murder just to name a few.

Sounds miserable, right?  Only it isn’t.  Absolutely it isn’t.

The think the thing I love the most about my job, I am finding, is that I get to come into someone’s home and assume only the best about them.  A family might be in a tough situation financially, but they love and support and love each other better than most of the people I know in my own “real” life.  Someone might have more abuse than anyone should ever have to endure in their past, but are obviously very intelligent, introspective people.  Everything people assume about poverty, abuse….is so entirely wrong.

In almost every culture, there exists an archetype of the poor, wise man – the wise cobbler, or the sage at the top of the mountain.  Here in America, we only view our poor as stupid and ignorant.  It makes me angry that we can’t see this is wrong – and with these images we are actively oppressing our brothers and sisters most in need.

Rich often teases me that I’d be the world’s worst policewoman.  “Excuse me, sir…could you tell me the reason you were going 125 miles per hour?  Oh, well, that’s perfectly understandable – it is a rather beautiful day, and that’s a great driving song on the radio there…”

But being a doula is not being a policewoman.  I’m not a mandatory reporter, and I don’t have to solve all of a family’s problems.  But when I step foot into a home and a young family who has very little spent probably most of their money in making me a real smoothie with fresh fruit, I realize the sacrifice they are making and it is the best tasting smoothie in the world.  When I get to treat a teenager as an adult and respect and support the decisions she makes for her unborn child, I feel blessed to have that role.  And when I help a single woman through a birth that she didn’t think she could get through – but she does (however she does it) – I can see all that she is capable of and have hope for her future.  And it rekindles my love for humanity.

As a human, I have many flaws.  But is it a flaw that I see the best in people?  I see it as a gift.  Just keep me away for a job in law enforcement for everyone’s sake.

Back from birth

Everyone congratulate my client on her beautiful birth (she does read here)! I’ll share the full birth story at a later date (once I’ve shared it with Mom) but here’s the quick run-down:

– Cytotec for 5 hours which did very little to get labor going

– Water broken and immediate active labor (possibly immediate transition!)
– Asked for epidural 45 minutes later – anesthesiologist busy with another mom and didn’t make it in for 45 more minutes

– Anesthesiologist arrived as mom was pushing so no epidural

– 3 pushes and he was out
– Beautiful babe almost 8 lbs. healthy as can be! Mom and baby are doing great and she’s rightly very proud of herself seeing as she’s the only person she’s ever known to give birth naturally…she looked very strong and beautiful and used her voice and body well. Yea Mom! For all intents and purposes, this was a very intense 1 1/2 hour labor.


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