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Posted on Tuesday, February 21, 2012 4:08 PM
Every now and then in a birth there is a moment of worry. It hangs in the air like a wet bed sheet pinned to a clothesline, heavy and looming. Mama had been pushing for nearly 4 hours, and I could see her exhaustion. Laboring without an epidural, she could and did move into a variety of positions, but the position she favored was on her back, her head elevated by the angle of the bed. Her baby had crowned up to her brows -- but after 45 minutes of pushing with all of her might, she was not budging any further. The OB suggested an episiotomy. Mama asked if the baby was okay. The OB, nodding his head that the baby was unfazed by this labor, knew that Mama would not consent to an episiotomy. Then not yet, she whispered through closed eyes. More pushing. More of baby not moving. Between contractions, when the OB was not applying supportive counter pressure or copious lube to the mama's perineum and baby's head, he would glance at the fetal tracings. Each time, he was mystified that the baby was fine, fine, fine. I kept one eye on the instrument table, anticipating the appearance of a vacuum. More pushing. More of baby not moving. A riot was going on in my head, an absolute panic -- how can I do nothing? Suggest something, doula, for crying out loud!! I whispered in her ear, do you think you could push on your side, like before? No. Mama didn't think she could move. This woman who has labored ceaselessly through the night and into the dawn without medication was going to have a vacuum delivery unless someone came up with an idea. In my mind's eye, I imagined ways to flip her into some other position, an ordeal which would require a person on either side of her, plus someone to safeguard the baby whose head was already 1/3 of the way out. But it felt like everyone was at a loss and that we were all just waiting for the mother finally to exhaust herself, or for the baby to get fatigued, so that something decisive and obstetrical would have to be done. More pushing. More of baby not moving. All I could picture was this stuck baby who just needed some movement from her mother to unwedge her. For what seemed like an eternity, mama had been on her back, hitching her knees up towards her shoulders; hips, knees, and ankles had been bent at those 45 degree angles all that time. Let's stretch out your legs, I suggested. One at a time, like a jack knife. We'll straighten out one leg, then the other, alternating them. I wanted to make her hips uneven, as if she were walking up a flight of stairs. Maybe it would provide the baby with just the micromillimeter of space she needed to be fully born. If anything, I reassured her, the stretching will feel good. A contraction was building. I suggested to the mama that she stay in that jack knife - one leg straight, the other bent towards her. She laced her fingers behind her bent knee and pulled on her hands for leverage, rounding her back with the effort. Baby moved the tiniest amount, the most she done in an hour. In addition to that barely perceptible movement outwards, she rotated, just a few degrees. Between contractions, I alternated the mama to a jack knife in the opposite direction. Push this way now, I urged her. With all of her might, mama pushed. The OB's eyes lit up. There we go, he said. Out slipped baby, her whole head. A few breaths later, one shoulder came, then the other. Naked baby went right to mama's naked chest. No episiotomy, no vacuum. Good job today, to the mama who didn't stop, to the dad who fervently whispered into his wife's ears, to the nurse who read my mind and followed my jack-knife positioning, to the OB who sat on his hands and waited. Great job. |
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Posted on Monday, October 24, 2011 3:36 PM
Prior to becoming a doula, I completed a masters degree in mental health counseling, and I had a psychotherapy practice in a community health center. I've always valued my clinical training because it taught me how to be, well...clinical. I can step outside of my experience and observe a situation without emotional involvment, I can keep my clients needs and my own needs separate and healthy, and I'm not attached to a particular outcome. I also recognize that my clients are the central agents in their own experience, and my role is supplementary. Whereas I am amazed by my clients' strength and courage (always -- for real, every single time), I never would have said that loving my clients is part of my job. Love makes things messy, and clinical boundaries keep things clean. What good am I if my emotions are getting tied up with my clients', and I can't objectively help them see the end of the road? What if I get as wrapped up in something as they are -- whose job is it to unwrap us? But lately, the last few births I've been to, my heart is feeling twinges. Like for the dad who made a playlist - a separate file of songs in case things got tough - and played it after 30-something hours of labor. His wife was feeling discouraged, and he wanted to dance with her. She'd chosen an epidural and though she looked at him incredulously when he suggested it was time to dance, he moved to the foot of the bed, held her ankles like he would have her hands, and danced with her. They both laughed as he moved to the beat, attempted spins and twirls, and I found myself laughing, too -- it was one of the most loving moments I've ever witnessed, and just the lightness that the long day needed. After I got home, I found myself thinking of them repeatedly, and my heart would beat faster, and I'd catch my breath, like when a boy I had a crush on called me in high school. There was so much love in that birth room that I, too, was basking in it. I also went to a quick birth, the kind of birth where the labor is a force of nature, and there's really nothing to do but witness the process. This was the mom's second baby, after having a pretty traumatic birth the first time around. During this 2nd labor, some ghosts from the first birth lurked in the back ground. The mom couldn't tolerate anyone touching her, particularly the midwife in attendance, who happened to have played a role in the first birth as well. As she became fully dilated, she found her trembling (which is very normal at this stage) disconcerting. I coached her through some relaxing breath, which calmed her somewhat, and then I told her that sometimes the weight of a hand might calm the tremors. She nodded that I could touch her, and all I did was place my firm and steady hand on her leg, just below her knee, and I kept it there. Weeks later, in her living room, she told me that she didn't remember much about the rapid labor, but she did remember that I was touching her the whole time. She cried when I said good-bye to her, and thanked me for making such a difference in this experience. A part of me felt like in the 2 hours that it took for the baby to be born, I didn't really do much. But what I did do was bring love into the room. On edge because of a midwife they did not have an affinity with, and caught off guard by such a swift and decisive labor, all I could provide them with was gentle love. There were already plenty of clinicians on hand. Another couple gave me a gift, something they picked up in New Zealand while on a year-long trip they took around the world before they were married. Their walls at home are covered with framed images of this trip, and part of their labor distraction and relaxation plan was to watch a slide show of their trip pictures on their computer. Each time I look at their gift to me, a piece of their history that they have now asked me to hold, I feel love. And last week, a repeat client gave birth to her second baby. She was determined to birth unmedicated, and confident that she could do it, I touched her the way a doula is trained to do, and I said some of the things that I've said to other women many times before that tend to work. After she gave birth exactly as she wanted to - with touch and expressions of encouragement as the only interventions - she needed to deliver her placenta in the OR, a possibility we had anticipated. When she was wheeled out of the room on her bed, I said to my client, whose 1st birth I had been there for, who is my neighbor and whom I see at the playground and during summer concerts -- "Love you. You'll be right back. Don't worry." My brain was mini-steps ahead of my mouth, and I knew I was going to tell her I loved her, something I've never said to a client before, something even now I would not recommend ever saying again, and I didn't care. I didn't even try to stop it. So what's love got to do with it? A mother wrote on a doula's Facebook page that her doula's loving presence meant everything to her -- "The docs had to get the baby out, and it was an emergency; I could see that my husband was frightened. My doula was the only one able to look me in the eye and talk to me." I still value my clinician's training, my clinical distance. But in a birth, where medical people make medical decisions, or the birth process forces everyone and everthing else aside, sometimes my job is simply to love. |
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Posted on Friday, October 07, 2011 9:41 AM
This week's birth story comes from Bethany. What I like most about this story is Bethany's frame of mind -- it is so positive! It is easy to get attached to a due date and then feel dismay when it passes. It is also easy, in early labor, to get wrapped up in the roller coaster of "Wow, my baby is coming!" but then as the sun comes up after having been up all night, exhaustion begins to eat away at our confidence, and we ask, "How long will this last?" Not many women have confidence from the beginning that their normal, healthy pregnancy will continue to a normal, healthy birth. Certainly a positive outlook is not the only key to a satisfying birth experience, but Bethany's story definitely highlights the importance it plays. The Birth of Sadie Grace As we prepared for a natural child birth for our first child, we took hypnobirthing classes and read many books on natural childbirth. My favorites were Ina May Gaskin’s Guide to Childbirth and Henci Goer’s The Thinking Woman’s Guide to Childbirth. My husband’s favorite was The Birth Partner by Penny Simkin. I also highly recommend the movie The Business of Being Born, which started my journey towards a natural, beautiful labor and delivery. We started out with a wonderful OB, but quickly realized we were looking for the midwifery model of practice. I am thankful for OBs and the surgeries they perform in emergencies or in irregular situations, as they are trained to do! I had a normal pregnancy and was anticipating a normal childbirth, and thus decided a midwife was perfect for my needs. We switched around with a couple of midwives and even interviewed with an amazing homebirth midwife before deciding on a midwife in a community hospital, despite the large number of university teaching hospitals to choose from. The week of my “due date” my brother and sister came to town. We walked and walked all over Boston. My midwife stripped my membranes several times. And I ate 2 pineapples within 24 hours all by myself! I wasn’t restless for my baby to come. I knew she would come when she was ready and the time was right. I was at peace going beyond my due date knowing that most women go on average 41 weeks and 1 days past their due date for their first child. I said goodbye to my brother and sister with no baby yet, but had a few days to enjoy some quiet alone time with my husband before we became a family of three. Thursday 7pm: My mom and dad arrived in the evening, one week after my due date. My dad announced that he was buying us all spicy Chinese food for dinner! So “King Cheng Chicken, extra spicy” it was and it was delicious! Thursday midnight: A few hours later as I was lying in bed half awake, my water broke and I ran to the bathroom managing to “hold” most of it until I sat down on the toilet. Then, giddy with excitement I ran to wake up my mom saying “Mom! My water just broke!!” She sat up half asleep and said “Are you sure you want to go through with this??” Oh mom...as if I had a choice at that point, right?! I woke up my husband and we were both too excited to sleep. He suggested we call the midwife on call just to let her know my water had broke, so we did. The midwife asked us to come in to be checked out and then I was free to leave to labor at home as I had planned. I didn’t have any contractions at this point. We gathered our things and took our time to get to the hospital. Friday 2:00am: We arrived at the hospital. We brought our suitcase packed with labor clothing (I didn’t want to wear the hospital gown), ipod with birth playlists, birth preference sheets, scripture we had printed out to meditate on throughout labor...etc. but left it in the car thinking we would be back out shortly. 3:00am: We walked around the halls as we waited to speak with the midwife and be checked. My contractions started. They were tight, strong, and invigorating! We would stop walking and talking when I had a contraction, and then continue on. When the midwife checked me, I was 4cm. She said it was up to me to stay or go. During our walking through the halls we noticed that the room we wanted (with a jacuzzi tub and view of the Charles River) had just become available, so we actually decided to stay since I was 4cm already and we really wanted that room! 4:30am: Arrived in my labor and delivery room. No IV, no hospital gown, no monitors. I could close my eyes and pretend I was anywhere. 5:00am: I labored in the tub for a couple of hours. The minutes and contractions melted away in the water. We watched the sun come up over the Charles and marveled briefly over what was about to happen. Mostly my eyes were closed and we didn’t speak as contractions got stronger and the world around me became fuzzy and hazy. I breathed deeply and let my body take over to birth my baby how it was designed to do! 7:00am: Right before I got out of the tub, I threw up. (Husband got the trash can right in time, great catch Hunny!) And I remembered reading that a lot of women get sick during transition. Sure enough when the midwife checked me I was 7cm! The next few centimeters were a blur to me. Even if we had brought in our music from the car, I don’t know if I would have even noticed it playing. I labored on a birth ball for awhile and did some standing and rocking in my husband’s arms. 8:00am: Checked again. I was fully dilated and ready to start to bear down to bring my daughter into the world. For the next almost four hours, I worked and breathed and rested and breathed and worked and allowed my body and pushed...I tried a lot of positions. Squatting, standing, all fours, lying down, lying on my side. The midwives and nurses were amazing and supportive. They were gentle and encouraging. My husband overcome with emotion was steadfast, but quiet. He managed to say “You can do it” and “Come on, Hunny” but otherwise was at a loss for words. My mom arrived during the pushing and her high school and college cheer leading careers came back to her as she coached and cheered me on, giving me words of encouragement and strength from scripture like “You can do ALL things through Christ who strengthens you!” Each time my midwife entered the room (evidently it was a busy night for new babies!) she would gush surprise and excitement at my progress and say “WOOOOOW! wow wow wow!” Obviously I wasn’t making awesome progress for pushing for so long, but I never felt rushed or on a time table. I felt respected, in control, and supported. I remember making sounds that I had never heard myself make before. I did a lot of long, deep moaning -- almost “mooing” noises! I also tried blowing my lips, like a horse noise, as I remembered reading in Ina May’s book. And at the very end, my noises were wild, desperate, and powerful, like a mountain cat as I pushed with everything I had left to give! At one point during my pushing, the midwife instructed me to “push towards the lights” and I did. Something happened then and suddenly my pushing was more effective and my daughter was about to be born. A few more pushes and a small moment of panic when her shoulder got stuck and the midwife called for more help, and then my daughter arrived. 11:51am: My husband’s bare hands were the first to touch her coming out of the womb and she came straight up to my chest. What a miracle! It was the most wonderful surreal moment to hold my daughter on top of me and still feel her connected to me through the umbilical cord which we delayed clamping. In fact we delayed everything (first bath for a few days, shots, drops...) and enjoyed skin-to-skin contact with her while her eyes were wide open adjusting to the world. As I think back on my labor and delivery, I wouldn’t describe my contractions and giving birth as painful. There were some moments of extreme discomfort and intense tightening, but to be honest and real, if we’re talking about pain, I remember the stitching as terribly painful; the contractions and pushing were a total different kind of feeling that can almost never be described. I didn’t think they felt like ”the worst menstrual cramps you’ve ever had times 100” or any other description I had heard or read about. Childbirth is it’s own genre, category, class, and type of feeling. It stands alone and until you experience it, you cannot grasp it. (Same goes for postpartum and motherhood, but that’s another story I need to write...) |
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Posted on Friday, September 30, 2011 5:18 PM
Last week, Anderson Cooper learned about placentophagia. The gasps from his audience were audible, but yes, it's true. Women can consume their placentas after they give birth, to incredible benefits, as outlinedhere by local doula and placenta encapsulator Charity Parrot. Out of worry that even the thought of eating a placenta is enough to make readers close the window to my blog and click right back to their Facebooking, you can rid your mind of the image of a mother chomping down on her afterbirth like a mama horse in a barn. Also, not everyone sautes their placentas with onion and salt and eats it like someone would eat their dinner. Yes, some do...but more people have their placentas dehydrated and prepared into capsules, so they ingest it without taste or texture, much like they would any nutritional supplement. But this brings me to my larger wish -- I wonder how we could view birth if we could remove the Ick! factor. It's messy. Labor involves mucous, blood, vomit, and yes, poop. In prenatal meetings, my clients are closing their eyes, embarrassed by the horror of pooping on the bed. And when the time comes to labor, although most women get over it quickly, it still amounts to energy spent apologizing for what are normal events in labor. And there are those few women who actually can't get over it, and their laboring is hampered. And not only are they normal labor events, they are encouraging. Bloody mucous - scarlet red and ropey - usually is an indication that the cervix is dilating to those last few centimeters. Vomiting is a sign of the hormone surges that keep a labor progressing, as well as the indication that your body is so driven to birth that it will prioritize birth over digestion. And the poop? Well, what's behind it? A baby, descending through your pelvis and squeezing out anything in its path. Actually, doulas LOVE birth the more messy it gets! And afterwards, the baby; sometimes it looks as though it was smeared with swirling ladles of ketchup, ricotta, and maybe some brown, green, or black compost. Like placentophagia, there is little research but abundant anecdotes about what that baby goop - blood, perhaps meconium, and in particular vernix, does for the immune system of that sweet creature who can go right to its mother's waiting skin for warmth and love and bonding. It's another slippery and messy event that sometimes gets interrupted because a baby "needs" to be cleaned off, resulting in a separation of mother and baby at a crucial time. Women are inundated with hundreds of daily messages that their bodies are not good enough; our typical image of ourselves in labor is no different. A lifetime of hiding our bodies and being embarrassed or ashamed by what it does naturally has consesquence. I wish there wasn't so much focus on the frightened, inexperienced and sick patient, but rather on the healthy, mighty, and strong woman. Labor and birth would be another part of being a woman that we love and not fear. |
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Posted on Thursday, September 29, 2011 7:55 AM
This week's birth story comes from Barrett Lauck, someone who is quite active in the birth community here in Boston. While I provide home labor support for my clients, I have yet to attend a home birth. I'm particularly interested in the "hitch," as Barrett refers to it below; twelve hours of active labor without cervical change certainly would be puzzling in a hospital setting, and would more than likely invite intervention. It would be something to overcome, as opposed to what is described below, of everyone involved simply working with it and helping Barrett maintain her strength. You can follow more of Barrett's life and work over atFive Points Yoga. As I’m a prenatal yoga teacher who has worked with thousands of pregnant women over the last decade, naturally students greeted my first pregnancy with great joy and enthusiasm. Many people have asked for my birth story, so here it is! For background, I should say that I think birth is important. The way a birth happens and the way a mom and baby are treated often affects the way new parents feel about starting their parenting journey. So, my husband Gadi and I wanted to carefully consider our choices, options and alternatives in order to have a safe, healthy and happy pregnancy and birth. I could spend a whole post talking about why we chose a homebirth, but it will just have to suffice to say, that’s what we decided. We chose a woman to be with us who has been a midwife for over 20 years and is a mother and grandmother. We spent hours with her in the course of the pregnancy, getting to know her, and learning from her. When the day came, I felt comfortable trusting her to guide us through a safe birth. As an aside, we also developed a relationship with the midwives at a local hospital, who agreed to give us prenatal care on a reduced schedule along with the full care from the homebirth midwife. It felt good to us that they had a record of our pregnancy in case we or the midwife opted at any point to transfer to the hospital. So here goes: I went into labor on my due date! We never told anyone our due date because we didn’t want people to get fixated on a day, when due time is a whole month! (See my blog post about due date vs. due time for more information). On Sunday and Monday (June 26 and 27) I taught prenatal yoga classes. I was feeling very achy and couldn’t imagine another 2 weeks of pregnancy (the end of the due time window). I was really hoping that all the achiness I felt was a sign that labor was imminent, but I know how the mind can play tricks on you. As a result, on Monday I tried to rest the whole day. I read a book, I didn’t move much except to walk to my class and teach it, and I stayed hydrated. In retrospect, I think this was my version of nesting! I’m so glad I did this, because I needed a lot of strength for the coming day. I woke up early Tuesday morning, wondering if my water was going to break. I felt wet, and sure enough as I took the 10 steps to the bathroom, my water broke. It was enough to be sure it was my water, but not a huge gush. I broke a glass at the same time, so as Gadi and I cleaned up the water, we also had the task of making sure there were no shards of glass on our floor! My water broke more in the process, and with the frequent gushes, out came every towel in the house to soak up the mess! The work of cleaning up put me into labor right away, and we called the midwife to let her know. The contractions were frequent enough and strong enough that she was at our house by 9am. I found sitting on the birth ball helpful, and surprisingly, hands and knees position not as helpful. I love to teach hands and knees pose in prenatal yoga, but it made the contractions more intense, which so early in labor, I didn’t need to do. I progressed quickly and within a few hours I was in the birth pool to handle contractions better. I threw up while in the tub, which is often a sign of transition, and the second midwife arrived so that we were ready in case things kept moving fast. In this time, it’s interesting to reflect back on how I handled the labor. I think it was all physical and mental yoga practice!! Gadi bailed water on my chest or back every time I had a contraction to keep me warm and focused. I used the rhythm of that like I use rhythmic movements and breath in yoga practice. I also used spontaneous mantras. When I would feel a contraction coming on, I’d say things like, “Yes! Yes! Feeling good. No problem. Breathing. Letting go. Calming down. “ Sometimes I would say all those things in one stream of consciousness, and sometimes just one thing. I remember as things would get really intense, I’d swear, but I’d always reframe. So, I’d say, “Oh, fuck! OW! I mean Yes! Keep it coming. I’m ok. I’m ok.” Talking my way through really helped. In between contractions, I rested completely. I don’t remember thinking about anything except how to relax and let go. Though it seemed like labor was going fast, turns out there was a hitch. By the late afternoon, I was getting to a stretchy 8cm dilated, with a lip of cervix. The lip wouldn’t go away… for the next 12+ hours. We’d make progress – the cervix would continue to change, but not enough to be completely dilated and ready to push. This is where having 2 experienced midwives turned out to be critical. Anywhere else, I’d be on the clock and being diagnosed with failure to progress. At a hospital, that could have meant pitocin, narcotics, epidural, Csection, or all of the above. At home, it meant lots of different positions, resting without pushing even though there was a strong urge, homeopathics, verbal support, constant reminders that the baby was ok. The baby’s heart beat was checked frequently throughout labor and with every contraction once we got to pushing. It was always strong and steady, which helped me stay positive – if the baby could do it, I could do it. I was a bit on the clock with these midwives too, because my water had broken, but they never scared me with that. Instead, they worked hard to keep me moving forward. By 5am Wednesday morning, the lip was cleared and we were ready to push. I was tired, but had stayed pretty well hydrated and was trying to keep some calories in with honey, Gatorade and juice. The pushing was unpleasant, but I knew it would be a strong sensation of stretch. We took it slow, the midwives supported my perineum with compresses and finally, at 7:27am on Wednesday June 29, out came our baby! All 9lbs. 2oz. of him! I didn’t have any tearing, and as soon as the baby was placed on my chest, I picked him up to see that he was a boy!His name is Yona Yitzchak Reinhorn. The meaning behind his name is again, a whole other story/blog post. What I learned from our labor: - Prepare for birth. Prenatal yoga, good nutrition, regular appointments that lasted 1 hour and included discussion about everything, 8 weeks of childbirth education. It all contributed to a good birth outcome. - Put yourself in hands you trust. I don’t think I could have had an intervention-free birth with a practitioner I didn’t know. One of the many benefits of homebirth. - Use every available tool you have. I literally had a whole bag of tricks, and music for hours lined up. I didn’t use any of them, but I’m so glad I had them. Gadi would remind me of these options. In the end, with his help, I just went inside. - Don’t let anyone “estimate” your baby’s size. If the midwives had guessed I was going to have an over 9lb. baby, I would have been scared. There was nothing to be scared of because I didn’t know, and nothing about him hurt me. Last little bit: Gadi was amazing! You *need* amazing people surrounding you at birth. It doesn’t have to be your romantic partner, but I was *so* glad for all the preparation he did too! When I doubted I could go on, he said what I needed to hear. When I needed help focusing on how to relax, he’d try one of many relaxation scripts we’d developed in the months of pregnancy. When I knew exactly what I needed (hours of alternating cold washcloths on my face), he patiently sat next to me and did what needed to be done. We really did birth together! |
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