Clients: JMB & SB

Place of birth: St. David’s Medical Center

Date of birth: September 27th, 2010

Whoa. This one taught me a ton. Not only for my doula practices, but in patience and as a reminder of the strength of a laboring mother and her partner.

The clients called me early on Saturday morning. It was around 6am. I knew immediately it was them as I heard my phone chime from downstairs. She was almost a week overdue.

Contractions were strong, having started around 245am and they were heading into Austin and waiting on a return call from the doctor. JMB and SB sounded excited. They immediately starting doing the positions we had gone over once the contractions started, especially since she was feeling them in her back. A lot.

“Good, it sounds like labor to me. But that is for your doctor to decide, especially after they do a pelvic exam.” I told them.

In the meantime, I was gathering up my things, trying to get organized and get coffee all at the same time. Again, my husband and baby were awake to drive me to the hospital and I was there about 730am.

JMB was 1cm dilated and maybe 30% effaced.

Yikes.

She was also having major back cramps. I immediately went to massaging her back, doing the double hip squeeze while they monitored her. I could feel her muscles tense incredibly with each contraction. Once the nurses got the all clear from the doctor, JMB was up out of the bed and slow dancing with her partner. To see them together was a sight. They make a great team. He encouraged her, smiled and joked with her, supported her and she completely trusted him. Although I knew she was in pain with each contraction, the slow dancing looked sublime.

The contractions, however, were fickle. They came faster, then slower, the faster, then not for a long time. About an hour later, they checked her again. Nothing. 1cm. Her cervix was still posterior and very tender to the pelvic exams. JMB was not amused, especially when the doctor dismissed them from the hospital.

No problem, I thought. We can labor in the comfort of a house, get her to relax and help her open right up.

By 1pm on Saturday, we got her relaxed enough to sleep and the contractions were very far apart. We decided I should leave, to get some rest too, in case they went into labor that night.

Nothing. The back contractions were still intense but seemed to ease with resting in bed or in hot water. The doctor told JMB she was in false labor.

Let me get on a soapbox for a minute: I am not a doctor. I am not a nurse. I have no medical training. But I do know what it feels like to be in labor, physically and emotionally. To be told that you are in ‘false labor’ is like being told the pain being felt is not real. Also, that the contractions aren’t ‘doing anything’. They are. Of course they are. Her cervix had to become anterior and soften at some point. Just because a woman isn’t in active labor does not mean her body is getting ready, sometimes with painful early labor contractions.

Soapbox ended. I kept up with the couple throughout the evening. I rested. I prepared. Sunday morning was the same as Saturday: difficult to work through back contractions coming in at regular intervals when standing, swaying, on hands and knees….but they backed off when lying down. Again, all I could do was tell them to rest.

Sunday evening rolls around and JMB is pretty exhausted after having only about 6 hours of sleep for the past two days. They talk to the on-call doctor again, who tells them the same thing, she is in ‘false labor’. I remind JMB that her body is working towards the goal of labor and just because it is a part of labor the doctor doesn’t deal with does not mean it is not labor. Also I tell them to start thinking about their options: to wait and call their own doctor on Monday morning, call the hospital and ask about inductions; or wait it out and see if the contractions become steady even with different positions.

Sometime during Sunday evening/Monday morning, the contractions picked up. Even while lying down, they were still 5 minutes apart. They called their doctor and got into the office first thing Monday morning: 4cm! Active labor!! Hallelujah!

I arrive at noon where JMB is in bed, prepping for her epidural. The momma needed her rest. She looked worn down. As did her dedicated partner, SB.

Since again, she was stuck in bed, I did my best to help her relax to help her dilate. Pelvic, lower back massages, hip massages, effleurage on her stomach and front of her hips and feet and head massages. Although unable to sleep completely, JMB was able to recharge, even discussing feats of athleticism her and her partner have achieved together over the years. (They are uber-athletes). I would like to think my massaging helped, but really I think it was the talking about biking, running and swimming that helped her feel the most at ease. By 430pm I was famished, so I snuck away to eat, receiving a text message as I was finishing up saying she was 9.5cm! Hooray!

Really she was 10cm but had a slight lip remain. More relaxation helped her finish opening right up and by 5pm she was all ready to push. And push she did. We were worried about her being too tired, too close to getting the epidural to push correctly; but JMB is a team player, she knows how to listen to coaching. And our nurse was a coach, cheerleader and athletic director all in one. She was in charge, right under the doctor that is. We knew where the pecking order was with her and I was at the very bottom, which I knew if I didn’t play it right and defer to her, she would give me a scathing evaluation (needed for my certification). So, I asked her before I did anything. I asked her advice. I said to others how awesome it was to have such great nurses (yes, I am a suck up but I got a decent evaluation from an ‘i am the one in charge and helping the patient’ sort of nurse, so there).  So, when it came time for JMB to push with SB on one side holding her leg and me on the other, I mimicked what the nurse did (not obviously, of course). I counted for the pushes, encouraged JMB through pushing and between in the same manner as the nurse was doing.

At 532pm, a healthy baby boy was born. Just over 30 minutes of pushing. JMB and her partner did great. The new grandparents got to witness the event and when JJB was born and gave a healthy cry (a 9.9 apgar cry!), we all had tears in our eyes.

Welcome to the world JJB! Your parents were strong and determined to see you arrive safely. And my sincerest thanks to the parents for letting me witness such a long, tiring and beautiful birth. Good job guys.

My first birth as a Doula

September 24, 2010

Holding CY at the postpartum meeting with his mother, MY

As I start slowly on this journey to becoming a DONA certified doula, I will be posting about my experiences here. All names will either be changed or only initals will be used. All blogs are posted with permission from my clients. Thank you for reading about my journey.

Clients: M.Y. and J.Y.

Place of birth: North Austin Medical Center

Date: September 13th

On September 12th, I met with MY and her husband JY for their final pre-natal meeting. I love the 2nd meetings. They are more hands on and we talk about all the different position possibilities during labor. MY was having some issues with swelling and blood pressure, so her doctors conducted blood work on Friday and would let her know on Monday if she needed to come in and welcome her baby boy sooner rather than later.

I get a call not 2 hours after leaving their house on Sunday evening: “We are going into the hospital, they are inducing us tonight!” It turns out MY had a mild case of preeclampsia.

Talk about excitement! And this worked out for my first birth since I could prepare completely. I am sure with my other ones I will be running around, making sure my bag is properly packed, etc…

So, Sunday night, I prepped my bag, making sure I had my paperwork, ID, food, etc…I went to bed at a decent hour, set my alarm at 6am, and unlike my laboring client, I rested fully.

My alarm wasn’t set correctly and I get a text at 615am with the news of MY’s water breaking and that she was at 4cm dilation! Whoo hoo! “On my way!” I texted in reply.

I jumped up, gathered my things, woke up the hubby and baby who drove me to the hospital (we share a car), and, taking a deep breath, entered the Women’s Center of the hospital.

As I make my way down the L&D hallway, the midwife on duty introduces herself to me and says the parents are doing great thus far.

Great! I enter the room with optimism. MY is in bed, turned to her side and JY is comforting her. She is in the middle of a contraction. It seems intense as she grips the bed and struggles to focus. I estimate that her contractions are very intense due to pitocin or she is farther along than an hour and half ago. I immediately jump in, helping the husband out (who looks exhausted) and we get MY to focus and breathe.

When the contraction subsides, we talk. We discuss her visual point she is using, how she is feeling and what she is feeling. Intense is the main theme. Another contraction comes and again, we have to constantly help her to focus. This is at 715. She can’t get out of bed or use any sort of position that uses gravity because of her blood pressure. Laying down only makes her contractions worse and even harder to deal with, however.

We do this for a while. She decides to get Stadol, a narcotic used to help relieve the pain. But it didn’t help. It made her a little sleepy and when a contraction came, unable to stay on top of them. They were very close together and intense.

The midwife comes in and checks her around 830am. She is still 4cm dilated. The optimism in the room deflates. MY is already exhausted. The midwife watches her through a couple of contractions and they begin a real discussion of how MY is going to cope through the rest of dilation.

MY, JY, the midwife and myself all discuss the pros and cons to the epidural and a decision is made to have one. The best part of this process was the staff’s complete understanding that it was totally up to MY. The decision was totally hers. They didn’t  pressure or use scare tactics. They simply gave her facts and allowed her tons of questions in order to make an informed decision. Optimism slowly creeps back into the room as well as a sense of relief.

By 910am, the epi is administered and by 10am, MY is able to rest fully. She can still feel the pressure of the contractions but she doesn’t struggle to get through them. She is relaxing. We work on her visualizing her body working to open up for her baby boy. I work on her lower back and pelvis area, constantly pushing the pelvic bones to simulate walking and thereby, to create more room in her pelvis. MY’s darling baby boy was still pretty high in her uterus at that point (station -1) and we wanted him to boogie on down so more pressure would be applied to her cervix and so she would open faster.

And boy howdy, she did. Within an hour of receiving the epi, she had dilated to 5cm.  With this encouraging news, we went back to work on relaxing, resting, visualizing, and massaging her lower body.

For some reason, I never tired of massaging her. My hands never tired fully and I was content to keep working on her back, legs and feet. I took some breaks, but really I just stayed with MY. Her husband JY was able to get some rest as well, which was necessary as we still had a journey ahead of us.

The midwife didn’t check her again until 220pm, mainly because MY needed rest and to not break any good thoughts about dilation. When she was checked, however, she was at 7cm! We all cheered! They were not stalled and trucking right along!

Around 430pm, things started to get rough. Due to her great reaction to the epi and her progression, MY and JY weren’t as diligent with the bolus delivery of the epi as they were in the beginning. The contractions were gathering in such intensity again, we were afraid of backtracking. A big dose of epi was ordered and soon MY was back in her comfy, relaxing, visualizing state.

By 620, MY was fully dilated with the exception of a rim near the front. But the hospital staff was in no hurry. The baby could move down a little, put more pressure on that cervix rim and open her right up.

We really got to work then. We experimented with the different bed positions, raising it a little to help her baby boy by providing some gravity. I really pushed and kneaded on her pelvic bones  and we even lifted her top leg, knee towards shoulder to give the baby plenty of room to scoot on down. MY was doing a fantastic job, still focusing on opening up and handling the growing pressure.

By 850pm, MY was ready, the baby was ready and we were all ready. MY was on her back for most of her pushing and it was rough. MY was exhausted, nutritionally depleted (not having anything to eat since Sunday night) and the fact that she knew she wasn’t in the right position to be pushing. She kept saying “I want to sit up. I want to squat.” But the midwife was hesitant because of her rising blood pressure. After about an hour of pushing, the baby was a little further down, but not much. Finally, the midwife agreed to let MY sit up. They put the bed up and let her use the squat bar. By that time, we were counting her directed pushing which seemed to help her push for a longer time so her baby could move further down.

As soon as she was upright in a squatting position, the baby’s head could be seen in as little as two pushes. MY was doing great. She was able to push more effectively and for longer in the squatting position. Her temperature had gone up, so we ran for ice and placed them under her armpits to cool her down. The staff didn’t have time to get antibiotics administered so the ice was recommended by the midwife and it worked completely in cooling MY down.

By 1030pm, MY’s & JY’s beautiful baby boy, CY, was born. JY and CY went to the warmer and due to a concern in CY’s breathing, he was taken to the nursery after a brief cuddle session with MY. From there, the third stage of pushing was commenced. The placenta was tiny, just like MY’s baby (5lbs 3oz) and MY, who had let the epidural run out, was now feeling the full effects of afterbirth hormones. She was alert and ready to be with CY. But she would have to wait since her baby was taken to NICU. He was grunting a little with breathing and while it was assured that it was fairly common, MY was concerned and feeling a little lost. Family members tried to reassure her, but a new role was developed for me that I didn’t anticipate: comfort giver after the labor.

I stayed with MY as they administered more pitocin to help her uterus to contract and stop bleeding (it was understandably tired!). I helped gather their things and went with MY to the postpartum room. I went to NICU to talk to the father JY and tell him where MY was and what the plan was (ensure bleeding had stopped, MY to visit baby in NICU and then to pump). My heart went out to MY as she worried over seeing her baby. She was adamant, as she should have been. After she was settled in the postpartum room, MY (always concerned for me throughout her labor) suggested I go home. This time, I agreed. There was nothing left for me to do then as MY’s nurse was taking good care of her and they were prepping her to go see her baby. From there, she would breastfeed him, pump back at the room and finally, rest.

It turns out there was a tiny air bubble outside of CY’s lungs, causing him to not be able to breathe fully. But he responded to oxygen beautifully and over the next couple of days the bubble dissolved on its own.

The rest of the story is now fully theirs as they revel, rejoice and learn everything about their darling son. Congrats to the Y family and thank you for letting me share this experience and for being such a great first birth to attend!