Movers and Shakers

There are two hospitals in my city, and the larger one has a birth unit called the Women's Pavilion. This weekend, that hospital put on a baby and family fair. When we doulas initially found out about it, we discussed it at our monthly meeting and were all like, How do we get in on this action!?

We had a few challenges to overcome... Not only were we trying to figure out how to pony-up $250 for a table at the last minutes, but also, in the past, this hospital has denied a table to the local ICAN group (the leader of which is a doula), and we were concerned that we'd be barred, too.

Then, a light bulb went off over the heads of one of the doulas at the table. She works with a government program and managed to secure a table (on the last day of registration - we got lucky, and got one of the last two tables available). So while the major theme of our booth was the services offered by that program, we were also able to slip-in information about other local resources (such as the doulas!) and stuff about informed consent, avoiding a c-section, nutrition, breastfeeding, and more. A whole booth-ful of doulas, dispensing lots of great info, laughing and talking with moms - it was awesome!

We doulas got together at the end of last year and applied for a Lamaze mini-grant to start a birth network - and they awarded one to us. Again, a last minute effort, but it paid off. At this point, I'm thinking, the sky's the limit - imagine what we could do if we weren't operating on the last-minute protocol...

It'll get better, as we figure things out and get a structure going. It's always a little bumpy in the beginning of any endeavor, but with so much talent and skill among us, we're slated for success. It's very exciting.

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.