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Blooper #12 and #13

I added two new bloopers.

12)  At a homebirth, the mom was deep in her hypnosis.  I was pressing a warm rice sock on her lower back.  I looked down to see rice spilling all over the carpet.  It seems my stitches were less than precise.  I had to use two ponytail holders to twist up the split seam.  Thankfully, I remembered to remove the ponytail holders with their metal attachments before microwaving the sock.  Otherwise, this blooper would be more serious.  If I’m going to continue sewing my own rice socks, perhaps I should add a sewing kit to my doula bag.

13)  In my Hypnobabies class, we were discussing perineal counter-pressure.  At the end of the class, I reminded them of the birth rehearsal we would be doing the next week.  I mentioned we would practice positions, techniques, and counter-pressure.  Never noticing their uncomfortable faces, I continued on until a doula who was auditing my class (and had taken Hypnobabies for her own birth) interrupted, “What Julie means is we’ll practice counter-pressure on your lower BACK; not your perineum.”  There was a collective, “Whew!”  Right.  Different counter-pressure altogether.

At some point, I need to wonder if it is a savvy business move to admit to these blunders.

Doulas and the Long Labor

Have you attended a long labor yet?  By long, I mean, a birth requiring labor support for more than 24 hours.  And really, 24 hours sounds lovely compared with some of the lengths I’ve attended.

I will do just about anything to prevent a long labor.  But it has taken years to find ways to recognize the signs that a long birth is on the horizon and to keep the mom engaged in the follow-through.

Recognition:

In my experience, long births are tricksters.  The waves are coming closer together.  Mom is releasing adrenaline and the tell-tale signs of transition appear.  She may even feel little urges to push at the peaks of the waves.  The doula often thinks, “This is it!” and transports to the hospital  or calls the midwife only to find out mom is 2cm.  In a little while, the waves space out.

This repeat building toward transition and then puttering out is one sign of the long labor.  At one birth I attended, the couple went to the hospital three times because of this pattern.

Another sign may be that the waves are short.  Perhaps less than a minute long.  While I have attended one or two births that were characterized by consistently short waves the entire labor, this pattern is unusual.  Or perhaps, the waves are at first long and then later they last less than a minute.

The mom may complain of back pain.

The final sign is instinct.  I have learned to pay close attention to flashes of memory or insight that come during birth.  I remember once I arrived at a birth and when I greeted the mom, immediately a memory of a former student popped into my consciousness.  I dismissed it.  What followed?  I was completely tricked by a birth that lasted over 50 hours.  Guess what?  The birth was almost identical to that former student from two years before.  Was this some magical power?  No, of course not.  My instincts probably picked up on subtle clues prenatally when I felt baby’s position.  Instinct is a powerful assistant.  When we listen.

Reasons:

Most of the time, long labors happen because of baby’s position.  The top two are:

Posterior–baby is facing mom’s belly.

Asynclitic–baby’s head is tilted toward her shoulder.

It may also be that baby is still high in the pelvis (not engaged), baby’s chin is not tucked, or baby’s hands are up.

Prevention:

Until recently, I tended to be a little bit tentative when encouraging techniques to reposition a baby.  I didn’t want to ask the mom to do something that would increase her discomfort and I wanted to trust birth, all that jazz.  A doula is meant to soothe and help with discomfort; not make things more intense!  But an ounce of prevention…

There are many techniques in the doula playbook.  They have names like:

  • The Miles Circuit
  • The Rotisserie
  • The Abdominal Lift and Tuck
  • Walcher’s Trochanter
  • Rebozo
  • Psoas Resolution
  • Open Knee-Chest

Sometimes it is hit or miss to find the one manuever that works for this labor.  Please remember to remain balanced during this process of elimination so that the birth team rotates rest and nourishment with the calisthenics.

Which brings me to:

I believe a long labor was avoided with one of my clients.  I recognized the signs:  waves varied from long and close together to short and spaced.  Over the course of about 9 hours, I rotated rest, nourishment, techniques.

The techniques that I thought should work, didn’t.

I encouraged the couple to have some private time and I sat in my car thinking it through.  I wrote down what I knew about this birth and what we had tried.  When the couple was refreshed and rested, I decided to try the Pelvic Floor Release.

I don’t use this technique often.

After a nice bath and rest, I asked the mom to give it a try.  With dad and I supporting her, she began.  She completed three waves on her right side and then we switched to the left.  Around the second wave on her left side, I heard the change.  Her waves became powerful and long.

We followed the Pelvic Floor Release with the Rotisserie but I’m not sure it was necessary.  Within an hour, we were on our way to the hospital where she 8cm!

Conclusion:

From now on, I will arrive at births with techniques a-flyin’.  Perhaps I’ll carry a clipboard and wear a whistle.

No!  These manuevers are still interventions.  We should practice watchfulness and instinctual awareness.  IF they are needed, we should keep our tone positive and tread oh-so-carefully into the birth space.

However, we should not be afraid to move from gentle support to a more firm encouragement.  We’ve seen the result of a long labor and we want to avoid that if possible for our clients.

 

Just in Case

Just in case, you don’t have a birth worker friend, here is a glimpse into our lives:

Middle of the night text:  Labor is beginning 

Birth worker brain turns on and begins the sequence.

Get up and throw a load of clothes in the washing machine just in case I need to leave early.  Norah will need her Artios shirt for school.

Try to go back to sleep while thinking through all the possibilities and scenarios.  Prioritize.

Next day:

Call my mother and ask if she can take Norah to Artios, just in case I’m still at a birth.

Text friend and ask if she can pick up Norah from Artios, just in case.

Facebook a friend and ask if she can keep Cedar, just in case this birth goes long.

Pack doula clothes and bag and place in car, just in case I need to leave from somewhere else.

Just in case I’m needed while we’re out to dinner as a family, drive two cars.

Pack a lunch for Norah just in case I have to leave quickly and won’t have time.

Pack two bags:  one for Norah and one for Cedar, just in case they need extra clothes.

Lay out clothes for the girls just in case Scott has to dress them before he leaves for work.

Fill up the gas tank, just in case.

Put Hypnobabies student phone number list in car just in case I have to reschedule class.

Pay two bills that are coming up just in case I’m not back by the due date.

Check the phone 50 times just in case I didn’t hear a ring.

When I’m still waiting 30 hours later, text, facebook, call, and email everyone again to let them know all is well but stay on alert, just in case.

We are a delightful people to befriend.  Go hug a birth worker today.  She’ll probably ask for your contact info to add to her list of people to call for help.  

When your doula is not invited

Years ago, when professional doulas first entered the birthing room, there was mixed reaction.  As expected, some care providers thought they were at best superfluous.  At worst, dangerous.

I remember when I first began working as a doula, I was hurt and surprised by the commentary on midwife and L&D forums.  I didn’t know I was doing anything controversial or threatening.

Now, most care providers speak words of welcome and praise for doulas.  They may not mean it but they understand that patient-as-consumer is becoming the norm.  Some providers really support doulas.  I get many of my referrals from some of the larger OB practices.  I even found one hospital-based practice (not local) that requires doulas for moms planning an unmedicated birth.

So I was surprised when I heard from a fellow doula that she was not allowed to attend a birth with a midwife.  It seems that this midwife uses a pool of house doulas from which her clients can choose.

Why?

I really don’t understand.  Why would a midwife refuse to permit the client’s contracted doula to attend her birth?

I can only speculate.

Fear that the doula will talk about something the midwife is doing?  What is she doing?

Are the house doulas trained in some special way?  Are they answering to the midwife?  Assisting her?  Because your doula should be working for you.

Are the house doulas paying a finder’s fee to the midwife?

Has she had a horrible experience with a doula?

Something else that I’m missing?  Because I’m truly stumped here.

I can’t remember being blocked from a birth before.  I’ve never encountered an OB who said a doula couldn’t attend.  A few times, midwives have told my clients that doulas were fine but not necessary.  Once, at St. Francis, I had a grumpy nurse say that only one person was allowed in the delivery room and that I had to leave.  The dad requested a new nurse and we carried on.

So this one is new.  What do you do when your doula is not invited?  I know it can feel challenging to break up with your midwife or OB.  You can interview the house doulas and ask some careful questions.  Choosing a doula is (or should be) an intensely personal choice.  There is a good chance you won’t resonate with the house doulas.  But maybe you will.  At the very least, this situation would be a red flag.  If the midwife doesn’t “allow” choice in who attends your birth, are there other areas she doesn’t allow choice?

Now, the midwife, admittedly, can decide who is present.  The couple, admittedly, can decide whether to hire the midwife.

This doula, admittedly, can decide who to recommend as a care provider.

Doula Misconceptions: The Bodyguard

I’m not one.

Although I think it would be cool to be a bodyguard.  Bodyguards are nimble and sharp.  They have gadgets and get to wear sunglasses all the time.  I’d love to have a job where I get to be tough and intimidating.

Have you met me?

100% not a bodyguard.

When I hear someone say that they are hiring a doula to protect them, I assume a problem.

Before I get any wordier, let me sum up this post:

If you think you need protection from your midwife or doctor, that is a problem.

And it won’t be fixed by hiring a doula.  Even one who looks intimidating and wears a sassy shirt that says “Meconium Happens” or “Doulas Do It With Enormous Balls.”

In fact, making a doula your bodyguard will only create a bigger problem:  tension, or outright hostility, in the birth room.

When I encounter a woman who is making a strategy to protect herself from her care provider, my first impulse is not to don my doula super-cape.  It is to listen carefully and begin asking questions.

“What makes you feel like you cannot trust your care provider?”

“Have you spoken with her about your birth wishes?”

“What are your lines in the sand?  What interventions/procedures/actions would damage your birth experience?”

And after listening carefully, “Would you be willing to change care providers or even birth environments to avoid your lines in the sand?”

Because here’s the thing:

My job is not to protect my client.  Let’s be honest.  What power do I have at your birth?  None.  I would be laughed at or dismissed if I tried to speak for you.

Who holds the power?  You do.

Sometimes a perk of hiring a doula is that care providers behave differently at your birth.  If you are serious enough to hire a third party to witness and attend your birth, most care providers assume you’re pretty serious about things like informed consent.  I brag that I’ve never seen an episiotomy performed.  Why?  I think it is because I’m present.  Simply that.

Now, what if a doctor or midwife pulls out some scissors and prepares to cut an episiotomy without my client’s knowledge?

  • a)  I wring my hands in the corner and cry “poor, poor perineum.”
  • b)  I crack my knuckles, scream “not on my watch,” and knock the implement of destruction from the care provider’s hands.
  • c)  I quickly say, “Jane, Dr. McCutterson is going to cut an epsiotomy.  Do you consent to that?”

In a situation like the one above, a doula acquires informed consent for her client.  And, yes, that is a form of protection.  But I’ve only had to pull out the “do you consent to that?” card a handful of times.  In unexpected situations, I’ve gone to extreme lengths to hold my client’s space so she can birth without interference.  But never openly; always with smiling sneakiness and a humble attitude.

So, if I’m not the bodyguard, then who am I?

In addition to my role as support person, I’m your P.R. person.  I’m working the room like a politician to schmooze everyone over to your team.  I’m complimenting nurses, bragging on how amazing you are, quietly creating a birthing atmosphere of peace and positive energy.

Most of the time, if I do my job well, the need to play the “do you consent” card won’t be there.

The doula should be a powerful influencer while disappearing into the wallpaper.

It is what an excellent servant does.

Before you decide to hire a bodyguard for your birth, maybe switch to a care provider you trust.  Then hire your doula to do what she’s meant to do:  serve you.

The Jedi Midwife

The last 9 months, I’ve been birthing new understanding about the power of words. As often happens, many areas of my life have carried the theme lately. Most notably, Star Wars.

You heard me. And I’ll come back to it.

My ears have been listening and my senses attuned to authority figures and their use of words.

  • A parent says, “I know you love your brother and want to make amends.”
  • A nurse says, “I want you to think of me as the Wicked Witch.”
  • A teacher says, “I can tell you are all listening carefully.”
  • A doctor doing a blood draw says, “It is going to feel tight and then tickle.”
  • A midwife says, “This is going to hurt.”
  • A mentor says, “You will make the right decision.”

What we say and how we say it matters.

This article written by a physician gives several examples of doctors influencing their patients with words. There are some crazy medical stories out there about patients cured and killed by words.

I’ve been reading all sorts of stories about linguistic placebo. And practicing on my kids, “Let me give you some magic medicine for that boo-boo” and “Your brain will tell your body that the carsickness is gone. Your tummy will settle. You will rest your eyes and sleep now.”

In January, I was poked and tested as we tried to diagnose my mystery tropical illness. A nurse said, as she was holding the syringe, “this is gonna burn.” Wow. It hurt so badly! Then came the flu test. I’d never had a flu test nor seen anyone else have one. I had no idea what was involved. The nurse practitioner said, “this is really going to be uncomfortable.” I panicked. How far into my nose was she going to stick it? I started sweating and saying, “Wait, wait!” I made her give me a minute while I found prepared my hypnosis cues. Good grief. It was not a big deal at all although I almost passed out from anxiety. If she had instead said, “I’m going to swab the inside of your nose and it will tickle some” the whole thing would have been a non-incident.

Give me expectations of pain and my imagination will run wild.

Cedar will freak out if I say, “It isn’t going to hurt.” Because her toddler brain only hears, “going to hurt!” When adults are anxious or groggy or in pain, sometimes our brain only hears in shorthand, too. Instead of using negatives, “this won’t hurt” could we say, “this will feel tingly?” Or could a nurse rub the IV site and say, “I’m going to numb your skin and you will feel cold on your arm.” Why must it feel like a “bee sting”? Who sits still and welcomes a bee sting?

You can see why birth language is so important. We have a few midwives in my area who don’t fancy hypnosis. That would be ok except that they speak words that undermine it. (!!) A midwife, whether she likes it or not, is an authority figure. She says, “I’ve never seen hypnosis work,” or, says to a woman using hypnosis, “This is going to hurt” or “Push past the pain” or “You might feel a burning sensation.” A woman in hypnosis is highly suggestible. What do these statements do?

Interestingly, I rarely see OBs interfere with hypnosis. Maybe they are curious or maybe they just don’t care.

I love quiet midwives. The ones who murmur, “you’re doing wonderfully well.” The ones who don’t assume they know what the birthing woman will feel next. What if she isn’t hurting and you tell her she will feel a burning ring of fire? Or that her pains will become more intense? Do you think that will impact her? Go hang out on any birth hypnosis forum and read how care providers derail births with their words.

So what does this have to do with Star Wars? Scott and I decided to watch the Star Wars Trilogy recently. I realized that this linguistic placebo is like a Jedi mind trick. I have seen this in action. I call her The Jedi Midwife.

You remember the Jedi scenes in the Star Wars movies? The Jedi speaks gently, “We are not who you are looking for. You will let us go.” And then the storm trooper says, “You are not who I am looking for. You can go.”

Linguistic placebo.

It works at births. The midwife whispers, “your cervix is dilating easily.” The woman’s instinctual brain intuits the message. And her cervix melts away.

I’ve seen it happen. Happen in ways that were as mind-blowing as some of the medical stories about the power of words. I’ve seen The Jedi Midwife influence the birthing woman’s body with her words.

I can’t give away all The Jedi Midwife’s tricks lest one of her clients is reading. And I realize there are other care providers (midwives, nurses, and doctors) who use their Jedi powers. I’ve simply seen The Jedi Midwife use them most, so she gets the title on my blog. :)

What can you do if your care provider does not know the Jedi tricks?

  • Help your doula and partner understand the importance of words. Teach them about the force. :) Sometimes the medical care providers will catch on as they hear your team saying, “She’s doing so well” or “your body knows how to birth.”
  • Put it in your birth plan. Perhaps you don’t make it Star Wars themed (and certainly not Padme style!) but you could write, “Please do not tell me what I will feel or discuss pain.”
  • If you’re using hypnosis, play it up. Most care providers know little about how hypnosis for childbirth works. If you give them some “rules” they may take the high road and not say anything. (Those who have their mouths open all the time generally have their ears shut.
    Barriss Offee)
  • Ask for silence. Have music playing. Turn the lights out. People are quieter in such an environment. If you’re using hypnosis, have the scripts playing out loud. It might even put your care provider to sleep. I remember a hospital birth at which the nurse kept sneaking into our room to sit on our couch. She said our room was so peaceful and smelled so relaxing. She didn’t speak. Just crept in and chilled on the couch.

The more we learn, the more we discover how much we do not know.Yoda

Negotiating Laborland

She could take me down with her pinky finger.

Her body was strong.  Her mind was sharp.  She carried a gun.

Thankfully not during her labor.

Her motto was “To serve and protect.”

When I walked into her home, shaking off the adrenaline from my speedy drive, I found her deep in her labor dance.  She was leaning over her bed and swaying her hips.

Things had moved rapidly since I’d visited her that morning.  That morning we had laughed about her spacey contractions and she prepared to go shopping.

It was 4pm.

The first words she said, “I’m not strong like you.  I can’t do it.”

“Crazy talk.  You are MUCH stronger than I am.  And you ARE doing  it.”

Her husband, who also carried a gun, was mastering the fine art of the double-hip squeeze.  I caught his eye and sent him telepathic messages:  she is close.

And she was.  I arrived during mom’s transition stage; when her body was releasing adrenaline to prepare for pushing.

And there was a problem.  This beautiful police officer, in that strong police officer voice that I’ve spent a lifetime respecting says, “I want an epidural.  I am not leaving this room.  I’m absolutely not getting in the car.  I can’t.”

I look to her husband but he is suddenly very involved in double hip-squeezing.

I’m on my own.  My usual pep talk with murmurs of encouragement fly out the window.  This woman is practical.  I give it to her straight.

  • A) I’ll call a midwife and we’ll have the baby right here.
  • B)  I’ll call an ambulance.
  • C)  We will walk to the hospital you did not want to use (1 mile away)
  • D)  We walk downstairs, get in the car, and drive to your hospital and your doctor.  (45 minutes away)

Negotiations begin.

I know we don’t have time for negotiations.  I channel my inner police officer.

I send Dad to load and cool the car.  He also fortifies himself with a Red Bull.

When Dad returns, I give him “the look” and I run to transfer my things to their car.  This birth will be my first time driving the getaway car!  Usually I follow in my car but this one is too dicey.

Somehow Dad gets her into the car and we’re off.

I’m driving two police officers to the hospital.  And one is pushing!

Holy cow, what a ride.  Mom is on her knees with her faced smushed up to the window.  Dad is still rocking the double-hip squeeze.  I’m handing back a chux pad in anticipation of her water breaking.

We were still a good 25 minutes from the hospital when the pushing sounds began.

Then I hit stupid Wade Hampton Rd.

When I pull up to the hospital doors, I jump out, grab mom, and bolt.  I hear knocking and look back to find Dad stuck in the backseat which can only be opened from the outside!  I rush back and let him out.

We get upstairs, there is flurry, there is some chaos.  Mom is a VBAC so there is extra flurry and extra chaos.  I catch the eye of a nurse I know and mouth “which room?” while Dad deals with check-in.  She points and I go.  As soon as we walk in, Mom’s water breaks.  I strip her clothes and toss on a gown.

She crawls into the bed on her knees.  Baby crowns.  I hear one of the nurses say to another, “I’ve never done one in this position.”  Too late.

The nurse receives the baby, mom flips overs and takes baby.  No one clamps the cord until the OB arrives 10 minutes later.  I guess the OB has to have something to do, right?  She doesn’t even get to suture since Mom’s perineum is perfectly intact.

Baby was born 15 minutes after we pulled in.

This woman’s first birth:  a 40 week induction + cesarean + NICU.

Second birth:  a quick birth without assistance.

I think that women can be just completely surprised by the change in them from giving birth—you have something powerful in you—that fierce thing comes up—and I think babies need moms to have that fierceness—you feel like you can do anything and that’s the feeling we want moms to have.” –Ina May Gaskin, midwife

To be astonished

Let me keep my mind on what matters,

which is my work,

which is mostly standing still

and learning to be astonished.

–Mary Oliver

Redux: Birthy Posts from the Past

So You Want to be a Doula (2008)

Preparing for a Smooth Hospital Birth (2009)

Doulas and Cesarean Birth (2011)

Dads and Doulas (2010)

Sacred Moments (2011)

I Heart My Perineum (2010)

A Word or Two about Homebirth (2009)

Accepting Your Birth Environment (2009)

Why I Wish Doulas Didn’t Exist (2008)

 

New Blooper Added

Added number ten to the Blooper Page:

 

10) I was the first to arrive at a homebirth.  When I walked in, I noticed all the signs of labor:  childbirth books open on the floor, half-eaten dinner on the table, hypnosis script playing, tub full of water.  But I did not find signs of the couple.  I searched every room in the house.  Looked in the backyard and garage.  Called out, “hellooooo?”  Where were they?  Ambulance transport?  I called the midwife who was on her way and said, “What is going on??”  She was as shocked as I was.  Then the dad pokes his head down the stairs and waves.  I hang up with the midwife and rush upstairs.  And still couldn’t find them!!  Looked in all the rooms again.  Turns out I was standing three feet away (twice!) but didn’t see them in a tiny space around a corner.  P.S. she had her baby an hour after I walked in the house.

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