The Family Birth

For most of my internship in CA, my phone volume was so high that it scared me. I was terrified of missing a call from a client or a midwife. Even when not on call for the birth center, I was often on call for my clients. I designated certain ringtones to these numbers so from afar, or even while in the shower, I could tell who was calling. Yes, my phone comes to the bathroom with me every time.

I hate being woken up when I don’t need to be up. I had to send quite a few texts and emails to family members while away to remind them about the time change and my strict obligations to my phone volume. So imagine the joy I felt when awoken by surprise on an early Monday morning, to a non-urgent ringtone, “Ugh, who the hell is calling me again so early?!” Shockingly, it was a California number and not my best friend Robyn (who operates before the sun). There were two laboring women at the center, and they needed extra hands.

When I arrived, I was surprised by the number of people connected to one laboring woman. To my recollection there was the husband, the doula, the soon to be grandmother and grandfather, the mother-in-law, and maybe a sister? I’ve lost count; most were not serving a role vital enough for me to remember. The laboring mother was struggling- crying between contractions, murmuring to her mother that she couldn’t do it, and not finding her groove. The midwives were discussing the lack of positive energy and the expectations they were feeling from the family. They even spoke to the family members telling them to not enter the birthing suite with their negative energy.  There were too many questions, too many interruptions, too much worrying that something was wrong, and not enough faith. Ultimately, she ended up transferring to the hospital because she was stalling in her progress and dilation had remained unchanged for many hours. In my eyes, her will to push through the birth had stalled and she seemed more emotionally drained than physically.

Extra participants at a birth is an interesting topic. On one hand, our friends and family know us better than anyone else. They know what you want to hear, they know how you may want to be held or encouraged. Yet most adults are not familiar with birth. They do not know that the timeline of birth can be both long or short, and still be considered normal. They may enter with their own expectations, doubts, and anecdotes. In a world where everyone fears the worst scenario, they may search for things that are “wrong” or “abnormal” as a way to protect their loved one. Their intentions are good, but sometimes they can be counterproductive. The midwives at SCM says that each non-essential person at a birth extends the labor time by one hour. Sometimes the additional energy, whether it be positive or negative, can still impede progress.If the team isn’t committed to creating a positive vibe, they can place unnecessary pressure on the mother to make something happen, not realizing that sometimes the best way to make something happen, is to step back and let it go. (Perhaps this is true in many areas of life…)

On the flip side, I also had a client who's mother was instrumental in the success of the birth. She was just the right amount of involvement and encouragement that the laboring mother needed. She also had that magic touch of being able to get her to daughter to drink a smoothie that neither I or the husband could convince her to do. Most importantly, she was a huge fan of out-of-hospital births and I think brought her own positive experiences with her, and innately trusted the midwives too.

When in labor, the woman has to remain mentally dedicated to the task at hand; she has a job to do, and it doesn’t involve tending to anyone other than herself. Her mind needs to be on doing the work of labor and not being distracted or uncomfortable by someone unwanted in the room. Labor and birth is an intense and intimate time- you’re naked, bodily functions are out of control, fluids of all kinds are being lost, you’re making sounds you’ve never heard before...you’re working!! This is hard, amazing work and it requires rhythm and grit. It also requires everyone there to believe in the awesome power of this soon-to-be mama.

The Induced Birth

My client was 41 weeks when I received a frantic call following her nonstress test earlier that day. Due to some concerning results, she was being transferred out of the midwives’ care to the hospital for an induction under their partner OB/GYN. They had been planning a home birth, so this drastic change to a medicalized induction was far from what they wanted. All of their planning was washed away, and they were now left to navigate very unfamiliar waters. I later learned that once a client is transferred out of care prior to starting labor, the doula intern doesn’t have to accompany them for further labor and delivery as we are employees of the practice. However, in my eyes, they had lost their midwives, their home birth, their entire plan and I felt that something needed to remain constant. I helped them pack up and we all headed to the hospital in the evening to begin the induction.

Over the span of the next 40 hours, I saw the whole spectrum of interventions. Lorri Walker, the CEO and Head Baby Catcher at SCM, calls interventions the snowball effect- they just keep building up. And boy, do they ever. Foley bulb induction, to artificial rupture of the membranes (increased risk of infection now), to non-progressing/ineffective contractions, to Pitocin, to an epidural, to constant fetal monitoring, to antibiotics because now mama had a fever. There were other steps along the way, too numerous to count, and probably most we all wished could be forgotten.

After 2 nights of no sleep (aka 41 weeks + 2), I felt that there was no end in sight. Please, please, I thought to myself, don’t let this end in a c-section. That was all I could hope for by the second afternoon, as I groggily gazed out the window to the gorgeous view of Newport Beach. I felt like we were fighting against that snowball, which now felt like an avalanche. It was my only goal for her, and all I could do was feed her courage and reassurance. Yet, the time came- 10 cm dilated and time to push. Despite having no feeling below the waist, my client found that beautiful, effective push. Forty-four hours after arriving to the hospital, she pushed her baby out. Nobody knew the gender prior to the birth, and during the span of our stay I had changed my mind from predicting it was a boy to a girl:

“Seeing how stubborn this baby is to come out, I’m thinking she must be a girl now!”

Sure enough, a baby girl was born. No less than 15 people were there in the room, armed for every bad scenario possible. However, that little girl cried out all on her own and her mother and I burst into tears. I cried so hard for them, grateful for the long road to have ended so happily.

This was a such a challenging birth for me. I felt stuck between worlds- the doula world with clients who hated the healthcare system and needed an advocate, and my soon-to-be-world of nursing, which recognized the procedures of the hospital, and empathized with the nurses’ normal duties. I toed the line, prompting my clients to ask questions and evaluate their options, while also helping them process the realities of birthing in the hospital, and specifically, as an induction. With the valid medical concerns present, there really wasn’t much room for choice; the interventions were necessary based on the results of the NST. This was a hard reality for them to face, but one they needed to if they were going to let this birth continue joyfully, or be weighed down with stress and conflict. I tried to validate their feelings of disappointment, while helping them release these sentiments and adjust their expectations.

Did the sight of a healthy baby wipe away the disappointment of the birth story? No, I don’t think so. For some people, I’m sure it would have. It didn’t even wipe it away for me, despite my obvious joy and relief. Who knows how it would have turned out if the NST was normal and they labored at home- would she have been slow to progress? Would she have gotten exhausted? Would the comfort of her home and midwives spurred a faster labor? All questions we cannot answer. Yet, the story does matter to me. How she will remember the birth matters- we have only one chance to support the mother in her amazing feat. I hope she will remember this birth the way I do- with fierce determination, courage, and teamwork.