"Welcome to the Last Three Weeks of Being Pregnant."

So sayeth the midwife to my March client, who called her tonight to tell her about the wild and wooly Braxton-Hicks she's having.

This client has been a fun one; she's a feisty go-getter who's been a research hound since day one of her pregnancy. She had a loss several years ago, which she mourned; this is a very welcomed pregnancy and baby, and she's done everything she can to improve her physical life and educate herself, working toward the goal of a birth that's as un-medicalized as possible.

Her text messages tonight have been making me grin - "Am I just being silly and blowing this out of proportion??" she asked me when her body decided to practice squeeze just one section of her stomach. I replied that it's her first time around this block, and anything new and unknown can be frightening, then suggested that she try drinking some juice, lie on her left side and do some kick counting to reassure herself that her little one is okay in there. She did, and he's moving just fine.

Carry on, mama - you're performing a miracle!

The Weight

My first paying client had her baby about a week and a half ago, and I'm 99.9% certain her little guy was posterior. She had all of the typical signs, and it was a really hard labor. In second stage, she pushed for literally hours, and it was like there was no end in sight.

I've been anxious and worried about her ever since; some things she said after the birth really concerned me that her lasting birth impression was a negative one. I feel like this is the first birth where I didn't do a good enough job as a doula, and now my client has a terrible opinion of her birth experience. I keep replying the birth in my head, looking at all the points where I could have done something and didn't - for example, I should have urged her to have her midwife palpate her belly to try to get a better understanding of the baby's position. Signs said she was experiencing a posterior baby, but her water wasn't broken until she got to about 8.5 cm's and finally asked the midwife to break it in hopes that it would bring the birth to a faster conclusion. Before that, when we asked the midwife if she could help us figure out baby's position, she said she had no real way of knowing until she could do a vaginal exam after the release of membranes, when she'd be able to feel the fontanels of baby's head.

A fellow doula (whom I'm working with in a dual-doula birth next month) tried to help me keep it in perspective by pointing out how difficult and painful it can be to labor with a posterior baby. "Does she realize how amazing she is for giving birth without any medication in that situation?"

I tried to tell my client exactly that, but I don't think she was very receptive at that point, which was less than 24 hours in the wake of the experience. She said she'd call me when they got home, but I haven't heard from her. I'm acquainted with friends of hers, and they've been kind enough to let me know how she's doing - I won't go into detail, but this poor mom has her hands full, so while I'm respectfully waiting for her to call me since that's what she asked me to do, I can't stop worrying about her.

The Weight - The Band made famous a song by that title many moons ago, and my favorite interpretation of the last verse is so very appropos right now in my doula life:

And what's all this "take a load off Fanny" riff? The whole thing becomes only a little less cryptic when we learn, in the very last lines, that the pilgrim is traveling under instructions, has, in fact, been sent by the mysterious Miss Fanny. The "weight" of the title is the load of her obligations the pilgrim has been sent to discharge. The irony, of course, is that he leaves with a heavier load than the one he brought with him - "my bag is sinkin' low."

I went into that birth thinking I had the message right - that I was educated and experienced enough to help her - but I left it carrying a heavy load of doubt in my abilities and concern that I didn't give enough. Since her birth, I've been pouring over posterior labor resources, especially Spinning Babies, in hopes that I'll be more proactive and better prepared for a posterior labor in the future.

The one thing positive I can say about my assistance was that they would probably have been worse off without me if for no other reason that no one could be expected to rub a mom's lower back continuously for the entire length that her labor ran - so at least I was able to help her husband alleviate her pain in that way.

Playing Catch-Up

Ach, I've been so out of touch lately. It's been a whirlwind since the beginning of the holiday season, and I've been struggling to keep up.

New Year's Eve, I found myself hanging out at my buddy Kim's house. It was around 1:00 PM, and she was telling me how one of the couples in her last class (which I attended) was in labor, and called her very early that morning to talk through some stuff. In the middle of our gossip session, my phone rang - to my surprise, it was the daddy of the couple we were discussing! Our conversation went something like this:

Dad: Well, we're in labor, and have been for a long time...
Me: How are things going?
Dad: Honestly, I'm not sure... I mean, we've been here since Wednesday, and [Mom] is having a hard time managing her pain."
Me: How are YOU holding up?
Dad: I'm exhausted. All of us are.
Me: Do you need some help?
Dad: [big sigh of relief] I would be grateful for anything you could offer us.
Me: I've gotta run home and get my bag, but give me 20 minutes and I'll be there. What's your room number?

(Mom told me later after the birth, "That was the shortest phone conversation I'd ever heard.")

When I got there everyone looked deflated, and the room was in chaos, stuff was everywhere. How could anyone be comfortable laboring in this environment? I thought to myself. While I helped clean up, I explained that we had a plane to catch to go to my cousin's wedding in another state, and I would stay as long as I could, but I might not be able to be there for the birth. They said it was okay, and any help was better than none!

I immediately started the work of assessing the situation; mom, dad and baby's grandmother filled me in on what I'd missed. At 41 weeks and 2 days, mom went to an appointment with her OB and never got to go home. She was admitted for oligohydramnios (based on an AFI of 4.5), induced with Cervidil (which was removed after she reached 4 cm), membranes released (SROM) at around 5:30 AM that day, and she'd been laboring for around 24 hours without any other medical interventions. The Cervidil induction was painful and frightening, and mom was happy to have it removed - but since that time, her contraction patterns were sketchy, and her tone and demeanor were like that of a woman condemned to Sisyphus' fate. "I feel like it's never going to end," she confessed.

I got mom out of the bed; dad fell into it and immediately went to sleep. Baby's grandmother went out, brought back food for the family, and went home to get some rest.

After some dinner, mom seemed to be getting her energy back, so I started to pep talk her, during which we changed positions, tracked contractions together, and focused on approaching labor one rush at a time. I knew she was still in early labor because she was able to talk easily between her contractions. Every time a contraction was nearing or had ended, she would affirm, "Contractions are good..." And I would reply, "Contractions make a baby come out," or, "Contractions go away and then we can rest." As we talked, it became clear that the intensity of her pain was due to her fear of that pain, and her feelings of inadequacy about herself as a laboring mother.

When dad woke, he was amazed by the change that had come over his wife. "You're a new woman," he said, and hugged and kissed her.

The hospital experience was a mixed bag; while the majority of the attending staff was supportive of their decisions (to varying degrees of approval and disapproving forbearance, though mostly the former), interruptions easily knocked mom out of her labor, and slowed her contractions. At one point, during a heavy discussion with the attending OB, her solid 1:00-1:30-minute / every 3 minutes contractions stopped altogether for 20 minutes. An encouraging nurse recommended that we try nipple stimulation, which helped get her back into the groove of labor, but mom would stop doing stimulation cycles (2 minutes on, 2 minutes rest with a contraction in between) and labor would slow again. Dad mustered himself long enough to convince the attending OB to get her off of continuous EFM, which he felt was interfering with her ability to relax and wasn't proving helpful (baby had a textbook perfect heart rate for the entire labor). After his confrontation with the doctor, his physical exhaustion and emotional stress got the better of him, and he was a little shaky. But the pay off was time in the tub, free from monitoring.

16 hours later, it was time for me to go. I felt terrible about it, but they were very understanding. Before I left, mom decided to try a small dose pain medication, but it was largely ineffective, so she asked to be prepped for an epidural. (For the second time, I missed a potential opportunity to witness an epidural being placed! Drat.) Even though this family was seeking an unmedicated birth, after 32 hours of labor, mom was just too tired to manage labor sensations anymore.

Baby's grandmother arrived a little while after I had to go, and 12 hours later, mom birthed her baby - vaginally!! Interestingly, they set her up with an push button epidural; she was able to chose when to have the next dose of the medicine, and she hit the button only once after the initial dose. She later told me that the rest she got during the first dose helped a lot, and then after that just having the option of pain relief was comforting.

All's well that ends well. Baby had 1/5 minute Apgars of 8/9, mom had minimal tearing (not even a 1st degree), and they're breastfeeding really well. Three days after the baby was born, they moved to another city so dad could start a new job - I wish them all the best on their new adventure, and thank them for letting me share in their happy day. (-:

What's Goin' On

I taught Kim's Bradley class, cycle 4 class 11, while she was in Williamsburg, VA; it was the "Are you ready?" class, so we finished watching Orgasmic Birth, went through the workbook materials (especially the Bradley Energy Saving Techniques article), and talked about what to pack for the hospital. Today was class 12, so cycle 4 is over, now. I'm sort of sad. Of the five cycles I've attended, even though each one is unique, this one was so inspiring. All four couples started out reluctant to speak up in class and brought with them a general air of confusion. By the end of the cycle, their final labor rehearsal was incredible - each couple was in tune with their partner, moms were relaxing beautifully and everyone left their final class with a quiet air of confidence.

Two of the four couples are due in February; both of them have approached me about doula services, but only one actually contacted me after the class ended. I'd love to attend all of their births, I think they're all going to have beautiful labors, but I'm trying to stick to one client per month. So, it'll be interesting to see what happens if both February couples want to hire me...

Oh, and I busted my ankle again leaving Kim's house - it was really dark on her front step and I couldn't see - but fortunately, it was a light sprain. It's almost healed, just a little bruised, now.

My March mom and I went to Molly Shaker's prenatal breastfeeding class, which was great. What I don't get is: why would you pay $35 for a class and then not ask any questions at the end?... There were a lot of people who just looked clueless and scared in that room; all of them were first time parents. (After Molly took that poll to see who was a first timer, I wished she would've polled the dads and other support people to see how many of them had attended a birth, that would have been interesting.) One of the great things about Molly is how her communication style is so matter-of-fact but doesn't sacrifice tact. She and Melissa are both really good at that, and I try to emulate them when I talk about birth-related stuff.

Clients, they're everywhere!

Lately, I've been wryly examining what pre-doula Erinn conceptions about doula life compared to what present-day Erinn has experienced. My top three unforeseen things about being a doula are:

1. Women want to tell me their birth stories. Admittedly, I regularly solicit birth stories during conversations - but even when someone else initiates the discussion, the mom telling the story always ends up looking at me, whether she knows I'm a doula or not.

2. I've become a conduit for information to everyone. A few weeks ago, a friend whom I was helping pick out a new computer laughed at me and said, "I feel like you're doula'ing me through this purchase."

3. The way I offer my opinion in any situation has changed dramatically. I used to just speak my mind; now I choose my words extra carefully, and always make sure I round-out the discussion by pointing out opportunities for individual choices and bringing up variances that might not have been mentioned.

I have two more potential clients, one couple from Kim's Bradley class and another who was referred to me by a local doula, Melissa. Both are planning on a birth center birth with CPM's, which is exciting - I haven't done a birth over there before, so it should be very cool, and very educational. My Bradley couple are still in the middle of pregnancy, and I don't expect them to commit for a couple of months, but the referral mom I spoke with tonight said, excitedly, "I can see we're going to be a great match," after our phone conversation today, which made me think she was ready to sign the contract!

I'm constantly amazed at the way being a doula has changed me, and how it's made my life so exciting. It truly is a gift to me when mothers and families allow me to serve them during pregnancy and labor.