This is the story of my first doula experience. It was an unmedicated birth. Early labor lasted days; active labor was about 3 hours; second stage was 2 hours.
My first client was a good friend whom I had known for several years as a technical woman. I will call her Sue, and her husband Joe.
(As an aside: I am really going overboard on accepting this term, "technical woman," which I heard at the Grace Hopper Celebration for Women in Computing. There was a montage shown at the beginning of the conference with women singly, in pairs, and in groups saying, in English and other languages, "I am a technical woman," all too enthusiastically. So now, all women in computer science and engineering are "technical women," and I have a mental image of them saying, with a grin, "I am a technical woman!")
Sue was waiting for a long time to go into labor. When she had contractions every day for the last five weeks of her pregnancy, each day seemed like it would be the last: today is the day! Any day now! But alas; the little boy inside of her hung on tightly to life in utero.
After a failed induction (who knew Cervadil could just fall out?), Sue went home, sad and dejected. But she was hardly home a few hours before the light, Braxton-Hicks contractions intensified. Timing them, Sue and Joe saw they were about three minutes apart -- and they went back to the birth center.
I got the call at 10:45pm and was on my way to the birth center at 11:15pm. I was nervous, and a little embarrassed knowing I had performance anxiety. This was my first birth! How can I help my woman-friend handle her labor when I could not even handle my own labor? I remembered how scary it was to be on uncharted territory, when the pains of labor ebb and flow. I was scared she would call me on it when I tried to comfort her: "How would you know?"
When I arrived, everyone was exhausted. Joe, having been up the previous night from a combination of the uncomfortable guest bed in the birth center room and nurses coming every few hours to check on Sue, was struggling to keep his eyes open in the bright lights of the triage room. Sue stood and hummed through short, frequent contractions.
The nurse came and checked Sue, and admitted her. The room was one of the few with a large jacuzzi tub, with jets and fancy fixtures and detachable shower head, and large, warm tiles on the walls. Quietly, we rejoiced between contractions, and marveled at our excellent luck.
"I'd better really be in labor this time," Sue said. "We've hit tub jackpot." Sue climbed onto the bed and raised her rump in the air during a contraction.
The nurse came and offered Sue a sleeping pill to rest.
"If you're not really in labor, the pill will help you sleep. You'll need the rest in the morning. There's a chance that in the morning, when you wake up, you'll suddenly -- wham! -- be in active labor," the nurse said encouragingly.
"And what if she is already in labor -- what will the pill do?" I asked.
"Then she may be able to rest between contractions."
So Sue took the pill, and I dimmed the lights and pulled out the inflatable futon. Joe lay on the guest bed and was asleep within seconds. I helped Sue get settled on the rocking chair, where she was hooked up to an external fetal monitor. I lay down on the futon, and within a few minutes could hear the even snoring of my client and friend. Every few minutes the snoring would stop and the chair would rock back and forth. Then, the chair would stop, and the snoring would resume. It was graceful.
At 6:00am the nurse returned.
"Your labor isn't progressing," she said. "You are still a centimeter-and-a-half dilated, and the contractions aren't strong enough to open your cervix."
I went home to nap and to feed my son.
At 10:45am, exactly twelve hours after the first call, Joe called again.
"We've decided to have our waters broken," he said.
"Great," I replied, and reminded him of the pros and cons while pulling on my jeans.
When I arrived at 11:15am, the sunlight was streaming in the birth center's floor-to-ceiling windows onto the polished hardwood floor. Sue stood in the middle of the room, moaning, her thick, black bangs covering her eyes. Joe stood beside her and rubbed her back. Sue's membranes had not been broken for fifteen minutes, but her contractions were really working.
I put down my gear on a counter and observed a few contractions. Noticing she liked to stand, I suggested some standing positions, such as leaning over the birth ball on the bed, or leaning on Joe. I asked if her back hurt. Sue shook her head. No back labor: great.
Suddenly, Sue tore off her hospital gown and stood leaning against the wall, her elbows over her head, and moaned. Joe rubbed her back in brisk circles. This is it, I thought. Active labor, when the clothes come off.
The nurse came and started a heplock (the IV without anything going in) and monitored the baby. She left the room with the monitors still attached because she needed twenty minutes of continuous monitoring. A few minutes after the nurse left, Sue stood up off the bed, exclaiming that the bed is a terrible place to labor. Joe and I watched the contractions on the tape spike and multiply. One of two things happened: either the monitor's output was unreliable in the standing and leaning-forward positions (very likely), or the contractions intensified immensely (equally likely).
When the nurse returned, she sighed at the ruined tape but did not make Sue repeat the procedure. She asked Sue how she felt.
"The tub," Sue roared. But Sue's nurse, the one that remains in contact with Sue's obstetrician, was out, and this one could not give Sue the go-ahead to get in the tub. The nurse went back to her station. Joe and I tried to soothe Sue in other ways, but with each contraction Sue told herself and us that she counts the minutes until she can get in the tub.
I went to the nurse's station to see what was the holdup.
"Sue's nurse is at lunch," said the nurse that came to check on us. "She will be back very soon. Just hang in there. Go ahead and fill the tub with warm water so it's all ready when she gets back." Great advice! I went back into our room and did just that.
In a few minutes, Sue's nurse indeed returned, and by 1:00pm Sue was lounging in the tub, moaning with each contraction, her belly turned to the right and her head to the left. As the minutes slipped by, the door into the bathroom closed more and more, leaving us in a dark, echoey room. Every hour or so the nurse would come to see how we were doing. Once, she brought an LED candle that flickered peacefully, but Sue's eyes were closed tightly. Joe held her hand above the water to keep the heplock dry, and stroked her forearm during contractions. Sue moaned.
"Guys, I'm not kidding," she suddenly said between contractions. "I want drugs."
Joe turned on the tub and looked at me, eyebrows raised. I tightened my lips and shook my head slightly. "You're doing so well. You're rocking this," I said. Joe nodded, turning back to face Sue.
"You're doing great," he said gently to the dark, round form in the water below his face.
"I don't want to be doing great. I want to not be in pain."
I knew this would come up. Sue and I talked about pain management in detail in the weeks before the birth. She knew the pros and cons of pain medication, and, more importantly, knew how violently her own body reacts to medication. We decided to work together to have a drug-free birth. She told me, in our conversations, to question her and deny her drugs; to remind her of her birth plan; to tell her how well she is doing; to do whatever it takes to keep her from choosing an epidural or anything else.
But now, she was pleading with us. She said please. She said it over and over. She told us she was suffering (we had both read in a book that laboring women that were doing well may be in pain, but they were not suffering -- so this was particularly touching to me).
I persisted: "You're doing great. You're in transition. This is the part that sucks." And all the time I was wondering: am I doing the right thing? And I was scared: what if she says, "How would you know?"
One notable thing about her drug requests is she never asked for drugs from the nurse. This is one way I knew she did not mean it. The other way I knew is that Joe never once turned around again. He kept all of his focus on Sue, and we all moaned with her.
An epidural is a fantastic medicine that can be used at a point of exhaustion in the mom, to let her sleep. This is arguably the epidural's best use. Other good uses are later in active labor, but not too late, so that the drugs wear off before pushing, so that mom can feel the baby, and so that baby would be awake for the active part of his or her own birth.
Sue was in transition, and it had only been three hours since the breaking of her waters. She was doing great.
When the nurse came in again at 1:45, she offered to check Sue's progress. With the door ajar and more light in the room, Joe and I could see fresh blood in the water near Sue's bottom. I turned to Joe and said, "See the blood? That means the end is near." Climbing over the tub and balancing on the far edge, in a perfect model of alacrity, the nurse meanwhile checked and exclaimed: 7cm! Just then a flurry of contractions hit, and Sue was again carried off by the tidal wave of labor.
Joe and I tried to keep up with Sue's contractions. I felt distant from her; she was lying motionless in the water between contractions; the water was chilly. When I said something, I did not know if she heard me. But she was so relaxed both between and during contractions, just like I had seen in dozens of birth videos, that I thought she was doing well. Mostly, Joe and I moaned with her. A couple of times, we did not. I had no idea if it was annoying or helpful to have us make noise. Later, Sue confessed she felt lonely when she was the only one vocalizing; she appreciated us all moaning together.
The next time the nurse came in, it was 2:30, and Sue's bath water was icy cold. Sue's moans had turned into yells. She paused at the peak of the contractions, her breath held. A sharp smell trickled into the air from the bath. The nurse again balanced on the edge of the tub and checked.
She gave Sue the option of staying in the water to try to push, or getting out. Sue decided to get out. Later, she told me she promised herself that she would only get out of the water for two reasons: drugs, or pushing.
On the birthing stool, which is like a chair with no bottom, she gave her first mighty pushes. During one, her bangs temporarily parted and she looked me in the eyes as she roared. She was the strongest woman I had ever seen, and I was a little taken aback. She roared, throwing her head back, powerfully, as blood oozed onto the floor.
The nurse's shift was over. She left, and two young nurses came to take her place. They looked terrified of the raw power we had in our room. They attached monitors to Sue's belly and looked at her progress. Then, they gave her some advise to help the pushing go faster: tuck your head in; make a C with your spine; hold your breath. It is the last few moments of pushing that really moves the baby. They started to count to ten. Three count-to-ten pushes per contraction. Let's do this. They moved Joe behind Sue so she could lean back on him between contractions to rest. I sat by her knee and held a cup with ice chips and a spoon.
The baby was really coming now. Sue gripped the squat stool and pulled it up toward her head, making a perfect C with her spine, and holding her breath as Joe counted softly behind her head. I could see the head quartering. I said, "Reach down and feel your baby." Sue reached her hand down and startled, pulling it away and yelping. I laughed, my eyes filling with tears a little.
The nurses suddenly realized that the baby was not far.
"Oh!" said the older nurse. "We need to get you on the bed. I could catch the baby, but I don't feel comfortable doing it in this position, and we need to wait for the doctor." The younger nurse ran out of the room to fetch the doctor. "We need to slow down the descent to, uh, to protect your perineum. Let's get you on the bed." She looked frightened.
So Sue got up from her squatting position and put one knee on the bed. Several contractions nailed her into this position. She tried not to push. Eventually she made it on the bed, and immediately the doctor walked into the room. She did not rush, she did not waltz, but really unremarkably just walked into the room. The nurses dropped the bottom of the bed.
"What are you guys doing in here?" she asked. Baffled, we looked at her. "Having a baby? Great!" she said, and put on a gown and gloves.
Barely having a chance to sit down, the older nurse grabbed Sue's right leg, I grabbed her left leg (Joe was at her head as usual, holding her hand), and with one more mighty push, the baby was born. It was just after 4:20pm. The nurse placed the baby on Sue's belly.
"Baby!" said Sue in her normal voice.
And, as I expected, my eyes filled with tears again. But I was busy: I grabbed the camera and started recording. For a long time, the baby lay on Sue's breast, still attached. Then, Joe unceremoniously yet very paternally cut the cord, and the baby was free: a life of his own.
So, where was I useful, as a doula? I honestly did not feel I did anything remarkable. There were no heroic measures, no advice I provided nor did Sue do anything I suggested. I asked Sue later how I could have been helpful when Joe was there with her, doing everything right: holding her hand, speaking to her in that tone of voice she loves, rubbing her back, and being strong. She said with me there, he felt empowered to do these things. He followed my lead. Since I remained calm, he knew everything was going well; he provided support when I provided support; he moaned when I moaned. Hearing that, I felt strong, and useful.
And boy, was I glad Sue never said, "How would you know?"
I cannot wait to support another mom in childbirth.