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Dear Super Nurse

Dear Super Nurse,

I smiled when I realized that you were going to be my client’s nurse!  Experience has shown me that you are something special indeed.  And this birth was no different. 

You never left my client’s side.  Unbelievable!  You didn’t go to the nurse’s station and monitor from afar.  I don’t think I’ve ever known a nurse who stayed in the room the whole time (except for a few quick births!). 

You were accommodating and patient.  You held the monitors in place–I know your arms were tired! 

You never suggested pain medication.  You gave my client confidence.                            

Your voice was quiet.  You didn’t “count to 10” with each push. 

Once the baby was born, you gave the new mama space to know her baby without extra distractions.  You kept the lights dim. 

A nurse can make or break a birth experience.  She can bring tension into the room or focus too much on “the way it is always done.”  Or, she can remember that this birth is the first one of its kind.  That this day will never be forgotten.  That the birthing woman isn’t stupid or without a voice.  That the birth partner is also part of the experience. 

Thanks Beth at Greer Memorial.  You’re wonderful!

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Extraordinary Nurses

Many families worry about which nurse they will get during their birth.  The nurse is a wildcard.  We can pick our midwife or doctor.  We can pick our doula, our birth photographer, our childbirth educator.  We can pick our hospital.  We don’t get a choice in our nurse(s).

I’m so happy that nearly all the nurses I’ve worked with in the last few years have been amazing.  Occasionally, one nurse really stands out and shapes the birth in extraordinary ways.  Like Beth two years ago.

This time, I’m bragging on Mona.  I adore Mona at Greer Hospital.  She’s been a rockstar for many of my clients.  Mona played a big role in this birth.   And she caught the baby before Dr. Polo Shirt could arrive at this birth.

So I knew I could relax when I saw Mona walk into the birthing room.

monaWhat made her support so extraordinary at this birth?

  • She kept interactions with the mama at an absolute minimum.  Mama stayed in the tub and the door to the bathroom remained closed 99% of the time.
  • She used a handheld doppler for quick listens to the baby’s heartrate while mom was in the tub.  She also used a handheld monitor while mom was pushing.  My client didn’t have anything strapped around her belly.
  • She ran interference when the doctor preferred that the mom get out of the tub sooner rather than later.
  • She stalled when another nurse prompted that the mom needed a hep-lock.  The mama never did get that hep-lock.
  • She applied hot compresses on mom’s perineum when baby was crowning.
  • She patiently and quietly guided this first-time mom and then called the doctor in a few minutes before the baby was born.
  • After the birth, she didn’t fuss with the baby or try to talk to the mother.  She stepped back.  After an hour, she still didn’t fuss with the baby or suggest taking her.  In fact, when I left, mama was breastfeeding her baby and blissfully devouring her own lunch tray.

I love this nurse.  She is a strong and quiet presence.  If you give birth at Greer Memorial and Mona walks into the room, relax.  You’re in very good hands.

(Also, I hope she doesn’t kill me for blogging about her!)

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.

Norie’s Birth at Greer Memorial (first-time mom, arrives fully dilated)

I was honored to witness this birth. The words that came out of this mom’s mouth during transition were “yes, thank-you, peace, love.” It was beautiful to watch. Here, she shares her story and offers excellent tips for expectant families. I love her “in case I ask for an epidural” plan. I also appreciate how she describes the Hypnobabies Special Safe Place tool. –Julie

“Child,” said the Voice, “I am telling you your story, not hers. I tell no one any story but his own.”

The Chronicles of Narnia, The Horse and His Boy

When you get pregnant, people assume you want to hear their birth stories. And I suppose that you do want to hear them, until they get to the part about 30 hours of labor, 15 stitches or how they were cursing out their husband to get the drugs. Personally, I could have done without hearing some birth stories I was told. I guess people just want you to hear what you may be “up against.” I am thankful to have grown up with a mother who likes to remind me that she gave birth four times naturally. And I guess hearing that enough somewhere down the line had an effect on me. I think at some point long ago, I began really believing that God made my body capable of giving birth without intervention. I believe birth is natural and though it may hurt, the reward is worth doing it all over again and again. Having those beliefs engrained in me was vital, and it’s never too late for others to start believing the same thing.

So here, I want people to read my story and see that while giving birth is natural, at the same time, you don’t have to do yoga, be a member of La Leche League or have your baby in a pool in your living room in order for it to be considered natural. (And just as a side note, all of those things are great…I may even try a couple, but they aren’t crucial when it comes to giving birth naturally.) A woman who desires to give birth naturally can do so in a hospital and have a wonderful experience, provided she is prepared and surrounded by a caring support team of people who fully understand her desires for her birth.

And I am blessed to have been one of those women…

My birthing time began somewhat uneventfully. There was no gush of water that soaked my pants in the mall and sent people into hysterics like in the movies. Actually, it was just some leaking, and at the time, I didn’t know what it was exactly. So of course, I googled it. I read about tears in the amniotic sac that can heal themselves, how some women leak cervical fluid and how fastidious hygiene can keep you safe from infection and from going to the hospital where you may be admitted. And after reading way too much and spending entirely too much time concerned about it, my doula put my fears to rest. She wasn’t worried, which meant I didn’t need to be. And that’s kind of how it is with her. I was trying to describe her to someone the other day, and I think I put it best when I said, “She’s like the definition of peace embodied in a person.” Talking to her, you realize she knows what she’s talking about because you also realize that if she didn’t know, she’d be the first to tell you. I could go on and on about her, but having her with me is another story that I can tell another time.

Fluid continued to leak out of me for a couple of days. It was Thursday when it started, four days before I had predicted having her. Yes, I had my own date separate from that of the doctor’s “due” date. My guess date was May 28th, Memorial Day. For months and months I had been telling myself that was when Emma Jean was going to come. I didn’t really have a reason for that date, I just felt like she would come at the end of May and Memorial Day seemed like a good day to be born on…especially if you’re a future Olympian. 🙂

Anyway, it was early Sunday morning (12:00am) when I started to feel some pains in my lower abdomen. I wasn’t really sure what they were, but I felt like something was getting started. I tried to sleep and told myself rest is important, but there was no use. At 1:00am I was writing down my pressure waves (contractions), how long they were lasting and how often they were coming. By 2:00am I woke up my husband and told him to come to another room with me. I told him he could lie down and sleep but that I just wanted him near me because I thought I might be beginning my birthing time (labor). I don’t think he really thought it was happening, and I can’t blame him because how can you really tell? How was I supposed to be sure? So during the next couple of hours I was moving around, sitting on my birthing ball, pacing, swaying, talking to myself (“Relax, breathe, pray” and “Peace”) and just kind of staying within myself. Charlie was making sure I drank water, reading me Psalms and getting in touch with our doula.

Here’s the part where everyone wants to know, “Ok, seriously, how bad did it hurt?” And much to people’s dismay, it’s really hard for me to describe. I think because I was using hypnosis, my entire birthing time was dream-like. People who read this will probably think, you mean, nightmarish? And no, I mean dream-like. I mean that my thinking brain had shut down and because I had a place to go to, a place I had visualized many times, a state I had practiced being in, I went there and I decided I would stay there until all of this was over. So the pains were not in the forefront of my mind. I felt them, I expected them but they didn’t consume me. I was able to relax into them instead of running away from them and it made all of the difference. I will say the most vivid pains I remember during this time happened when I tried to lie down. My husband suggested I try to rest since I’d been up for several hours, and although this would have been a good thing for me, every time I stopped moving and tried to lie down, it took me out of my zone and the pain was much more present. So instead, I moved around, talked to myself and listened for 4 or 5 hours. I think I listened to my Easy Birthing Guide (from my Hypnobabies CD library) 6 or 7 times through. Charlie just put it on repeat, and I think hearing those birthing prompts, the positive reinforcement and just hearing it over and over, really helped me stay within myself, in the zone. I honestly don’t remember what was on the track at all but having that playing repeatedly gave me something to concentrate on, which in turn relaxed my body and comforted me. Needless to say, I pretty much paced, swayed, etc…my way through my birthing time until my doula said she thought it was time to head to the hospital.

And then came the ride to the hospital. Here, I can answer the pain question better. It was terrible. I had to sit upright with my knees touching the dash (we installed the car seat behind the passenger, not smart, put it in the middle) as we drove for 25 minutes to the hospital. I couldn’t move, all I could do was breathe and moan as we hit every single light on Wade Hampton. It was terrible. It was the most present and non-dreamlike state I was in during my entire birthing time, and it is the reason that next time, Lord willing, I won’t be getting in a car at all. But I told myself the whole ride this wouldn’t last forever and that we would make it there…and we did.

Upon arriving at the hospital, I remember walking from the car through the lobby, to the elevator and into labor and delivery. I took my time on that walk knowing that where I was going was a different environment than my home had been. My home had been dark, comfortable, relaxing and this place was bright, unfamiliar and different. So as I walked in and up, for about 5 minutes, I got my breathing, relaxation and everything else I had at home back on queue knowing that I needed to be in the same state in order for this to continue progressing. I trusted that my doula and my husband would take care of answering questions, filling out papers and finding our room. And that’s what they did, except for the filling out of papers. We miraculously avoided that altogether during this time; for whatever reason, the nursing staff felt like the papers could wait until later…turns out they can.

I walked into the room and got up on the bed, for those of you reading who know yoga moves, in a child’s pose. I will never know why I did that, I just trusted my body to know what it was supposed to do. And that’s just what happened. My butt was in the air, my face was resting on pillows and my arms were outstretched. Also, in the very far reaching corner of my mind, I prepared myself for getting an IV, something I knew was policy considering me being positive for Group B Strep. But God knew the desire of my heart and totally answered my prayer: no IV. For whatever reason, the nurse didn’t push the issue. The nurse checked me, I never heard the results [she was fully dilated] and not long after, the doctor checked me. He said and I will never forget it, “Norie, if you want to have this baby now, you can,” in a familiar non-chalant manner. In my head I kind of laughed to myself, ya, Dr. Stafford, I would! However, that didn’t necessarily mean I knew how to. But then my body once again took over and big pressure waves started coming. My doula said to me, “Norie, let your peace build with those waves and then when it can’t build anymore, breathe all your peace down.” And for whatever reason, that made complete sense to me. I visualized big waves building up, up, up, and when they couldn’t get any bigger, I visualized my peace coming on top of them and smashing them down. I know it sounds weird, it sounds weird to me now, but at the time, it made perfect sense. So as the waves built, I peace-ed my baby out. And I will say that during this stage, I was definitely more aware of pain in a sense. I remember as Emma Jean’s head was coming, feeling a burning sensation, different than anything up until this point. But at the same time, what is pain when you know that on the other side is life? I mean, yes, I felt pain but I knew that I was having a baby so it wasn’t something I cared about. All I cared about was breathing Emma Jean out and into this world where I could finally hold her in my arms. Somewhere during this stage my doula jumped up on the bed and grabbed both of my hands and as I breathed peace, I squeezed her and was able to let my peace go down further. Also, toward the very end, I remember feeling Emma Jean coming out and my doula leaned in and reminded me of my “aah-aah-aahs” that helped me slowly, gradually and not forcefully breathe Emma Jean out. I’m glad I let out those aahs because I feel like they were a part of the reason I didn’t tear. And as I let my peace crash down one more time, my body trembling, heart racing, brow sweating, I felt a huge release and Emma Jean emerged. I was overwhelmed. She was passed underneath me, so when I opened my eyes after the last push, there she was, my baby girl. I picked her up carefully, rolled over and held her close.

Charlie helped dab her off, and I can’t remember much else. I couldn’t take my eyes off of her. I didn’t want to. I do remember the doctor asking me for one more little push and there was my placenta, which I now realize why no one ever tells you about the afterbirth, because who really cares about that when you’re holding a new life?

And so there it is, my first birth story. I am so thankful to serve a God who allowed for me to have such a wonderful first birth covered in so much grace and mercy.

Here are a few things that I believe made a huge difference for my birth. I don’t think these are necessities for all women. However, I do believe in preparation and I believe God sees our preparation and may choose to honor it, so I think it’s best to be prepared:

  1. Pray (from day one of finding out your pregnant all the way through your birthing time, there cannot be enough prayer)
  2. Have a plan (I used Hypnobabies, but not because it was my first choice. In fact, I didn’t even know what is was really when we got into it, I just knew that I needed a way of going about birth whether that was Lamaze, the Bradley Method or whatever.)
  3. Create a birth plan (this is something that you hand to your doctor weeks before your birthing time and something you definitely give the nurses at the hospital when you arrive. It’s just an outline of the things that you desire out of your birth, things that you do have a say in. Honestly, I think the birth plan helped me more than anyone just to be confident with the decisions that we were making.)
  4. Be in as good of shape as you can be (when I found out I was pregnant, I was already in pretty good shape. And I made a commitment to try and stay in the best shape I could all the way until my birthing time. I definitely could have done a better job with this, especially during my last trimester, and I think that the longer you can stay active the more it will help you during birth. I don’t think that anyone is ever too far behind because walking is low impact but can strengthen your legs, which you will want to be strong. Also just doing squats and lunges can make a huge difference as well. And though I am not a good example of this, swimming is probably the best for you and baby, even if that just means getting a kickboard and kicking for 45 minutes. Not only will it strengthen your legs, improve cardio, it also helps baby get into a better position for your birthing time.)
  5. Drink Red Raspberry Leaf Tea (I’m not normally a tea drinker, but a dear friend of mine gave me some of this tea and told me that it would help tone my uterus on top of a bunch of other great things. So I thought why not? And I pounded the stuff back for the few weeks before my guess date, and I just believe it helped me. If at the very least, it made me believe that I did have a toned uterus and could give birth naturally, and to me, that was worth it. But I believe that it actually did do the trick and postpartum has made a huge difference in cramping, etc…If you don’t mind the taste, why not? It can only help.)
  6. Write Things Down (I wrote down a list of things that I wanted to do early in my birthing time, like take a walk, bake something, etc…of course I began my birthing time at 1am so many of those things I didn’t get to do but they were there in case I had been able to do them. I also wrote down a ton of Psalms on notecards for my husband to read to me during my birthing time. Writing them down beforehand was great because I felt comforted as I read each of them then and once more comforted when Charlie read them to me later. The other thing I wrote down were things I would say to myself in case I asked for an epidural. I knew I didn’t want an epidural, so I wrote down all the reasons why. Then I cut each one out and put it in an envelope entitled, “In case I ask for an epidural.” We never opened it, but it was there in case I had needed to be reminded of, “Norie, you can do this. You’ve wanted to do this your whole life. Billions of other women have already done it.” Or “God made your body able to do this, just trust in Him.” And so on and so forth. I think it was wise to have that envelope because even though I could say to myself, I’m not going to ask for drugs over and over beforehand, you never know what you are going to do in the moment. And I knew the only person who would be able to keep me from doing it, would be me, so I knew I had to write those out myself.)
  7. Tour the Hospital (the day we were supposed to tour the hospital is the day we had Emma Jean. In our defense, we had tried to tour earlier that week but they were too busy for us. But I think that it could only have helped because it lets you know the environment you will be stepping into as you arrive from a very different environment [most likely your home]. It’s important to know where you are going in order for it to be a smooth transfer that does not alter where you are mentally.)
  8. Do your kegels! Kegels are an exercise that work your pelvic floor muscles, also known as your Kegel muscles. The best part is, you can do them anywhere, anytime and no one will even know you are doing them. Just google Kegel exercises to find lots of information about them and how to do them.
  9. Have a support system (For me, this consisted of my husband, my doula and a physician that I knew, 100%, understood my desires for birth and was going to do everything he could to make those happen. For others, they may choose family members or midwife. But whoever you choose to have with you during your birthing time, it’s essential that they understand your desires for your birthing time and are willing to do whatever it takes to make those come true.)
  10. Visualize what you want: good things! (It is super easy for me to sit and think about how things can go wrong in any situation. For my birthing time, it wasn’t any different. If I let myself start worrying about having a c-section or Emma Jean turning the wrong way, all of the sudden I was visualizing it happening with crazy detail. So I really had to take time to practice visualizing good things happening. I visualized giving birth in different positions, I visualized breathing/relaxing into pain, and ultimately I visualized things going well. This visualization practice was part of Hypnobabies, but I will say that whether I had done Hypnobabies or not, I would have used visualization to reinforce having a wonderful birthing time. I’ve been an athlete my whole life and used visualization many times in order to practice being successful. And when I look at my birthing time from an athletic perspective, it just makes sense that I would practice positive visualization. After all, I would never practice visualizing striking out so why would I visualize something bad happening during my birthing time? I think it’s often easier for us to expect things to go badly, that way, we won’t be surprised or letdown if they do. But it’s like my doula said, “What if everything goes great? What if everything is wonderful?” So don’t dwell on the negative “What if(s)…” but instead choose to see your birthing time happen in a wonderful way even before it ever does!)

A first time mom “Peace-d” her baby out

I was honored to witness this birth.  The words that came out of this mom’s mouth during the most intense part of her birthing time were “yes, thank-you, peace, love.”  It was beautiful to watch.  Here, she shares her story and offers excellent tips for expectant families.  I love her “in case I ask for an epidural” plan.  I also appreciate how she describes the Hypnobabies Special Safe Place tool. –Julie

“Child,” said the Voice, “I am telling you your story, not hers. I tell no one any story but his own.”

The Chronicles of Narnia, The Horse and His Boy

When you get pregnant, people assume you want to hear their birth stories. And I suppose that you do want to hear them, until they get to the part about 30 hours of labor, 15 stitches or how they were cursing out their husband to get the drugs. Personally, I could have done without hearing some birth stories I was told. I guess people just want you to hear what you may be “up against.” I am thankful to have grown up with a mother who likes to remind me that she gave birth four times naturally. And I guess hearing that enough somewhere down the line had an effect on me. I think at some point long ago, I began really believing that God made my body capable of giving birth without intervention. I believe birth is natural and though it may hurt, the reward is worth doing it all over again and again. Having those beliefs engrained in me was vital, and it’s never too late for others to start believing the same thing.

So here, I want people to read my story and see that while giving birth is natural, at the same time, you don’t have to do yoga, be a member of La Leche League or have your baby in a pool in your living room in order for it to be considered natural. (And just as a side note, all of those things are great…I may even try a couple, but they aren’t crucial when it comes to giving birth naturally.) A woman who desires to give birth naturally can do so in a hospital and have a wonderful experience, provided she is prepared and surrounded by a caring support team of people who fully understand her desires for her birth.

And I am blessed to have been one of those women…

My birthing time began somewhat uneventfully. There was no gush of water that soaked my pants in the mall and sent people into hysterics like in the movies. Actually, it was just some leaking, and at the time, I didn’t know what it was exactly. So of course, I googled it. I read about tears in the amniotic sac that can heal themselves, how some women leak cervical fluid and how fastidious hygiene can keep you safe from infection and from going to the hospital where you may be admitted. And after reading way too much and spending entirely too much time concerned about it, my doula put my fears to rest. She wasn’t worried, which meant I didn’t need to be. And that’s kind of how it is with her. I was trying to describe her to someone the other day, and I think I put it best when I said, “She’s like the definition of peace embodied in a person.” Talking to her, you realize she knows what she’s talking about because you also realize that if she didn’t know, she’d be the first to tell you. I could go on and on about her, but having her with me is another story that I can tell another time.

Fluid continued to leak out of me for a couple of days. It was Thursday when it started, four days before I had predicted having her. Yes, I had my own date separate from that of the doctor’s “due” date. My guess date was May 28th, Memorial Day. For months and months I had been telling myself that was when Emma Jean was going to come. I didn’t really have a reason for that date, I just felt like she would come at the end of May and Memorial Day seemed like a good day to be born on…especially if you’re a future Olympian.  🙂

Anyway, it was early Sunday morning (12:00am) when I started to feel some pains in my lower abdomen. I wasn’t really sure what they were, but I felt like something was getting started. I tried to sleep and told myself rest is important, but there was no use. At 1:00am I was writing down my pressure waves (contractions), how long they were lasting and how often they were coming. By 2:00am I woke up my husband and told him to come to another room with me. I told him he could lie down and sleep but that I just wanted him near me because I thought I might be beginning my birthing time (labor). I don’t think he really thought it was happening, and I can’t blame him because how can you really tell? How was I supposed to be sure? So during the next couple of hours I was moving around, sitting on my birthing ball, pacing, swaying, talking to myself (“Relax, breathe, pray” and “Peace”) and just kind of staying within myself. Charlie was making sure I drank water, reading me Psalms and getting in touch with our doula.

Here’s the part where everyone wants to know, “Ok, seriously, how bad did it hurt?” And much to people’s dismay, it’s really hard for me to describe. I think because I was using hypnosis, my entire birthing time was dream-like. People who read this will probably think, you mean, nightmarish? And no, I mean dream-like. I mean that my thinking brain had shut down and because I had a place to go to, a place I had visualized many times, a state I had practiced being in, I went there and I decided I would stay there until all of this was over. So the pains were not in the forefront of my mind. I felt them, I expected them but they didn’t consume me. I was able to relax into them instead of running away from them and it made all of the difference. I will say the most vivid pains I remember during this time happened when I tried to lie down. My husband suggested I try to rest since I’d been up for several hours, and although this would have been a good thing for me, every time I stopped moving and tried to lie down, it took me out of my zone and the pain was much more present. So instead, I moved around, talked to myself and listened for 4 or 5 hours. I think I listened to my Easy Birthing Guide (from my Hypnobabies CD library) 6 or 7 times through. Charlie just put it on repeat, and I think hearing those birthing prompts, the positive reinforcement and just hearing it over and over, really helped me stay within myself, in the zone. I honestly don’t remember what was on the track at all but having that playing repeatedly gave me something to concentrate on, which in turn relaxed my body and comforted me. Needless to say, I pretty much paced, swayed, etc…my way through my birthing time until my doula said she thought it was time to head to the hospital.

And then came the ride to the hospital. Here, I can answer the pain question better. It was terrible. I had to sit upright with my knees touching the dash (we installed the car seat behind the passenger, not smart, put it in the middle) as we drove for 25 minutes to the hospital. I couldn’t move, all I could do was breathe and moan as we hit every single light on Wade Hampton. It was terrible. It was the most present and non-dreamlike state I was in during my entire birthing time, and it is the reason that next time, Lord willing, I won’t be getting in a car at all. But I told myself the whole ride this wouldn’t last forever and that we would make it there…and we did.

Upon arriving at the hospital, I remember walking from the car through the lobby, to the elevator and into labor and delivery. I took my time on that walk knowing that where I was going was a different environment than my home had been. My home had been dark, comfortable, relaxing and this place was bright, unfamiliar and different. So as I walked in and up, for about 5 minutes, I got my breathing, relaxation and everything else I had at home back on queue knowing that I needed to be in the same state in order for this to continue progressing. I trusted that my doula and my husband would take care of answering questions, filling out papers and finding our room. And that’s what they did, except for the filling out of papers. We miraculously avoided that altogether during this time; for whatever reason, the nursing staff felt like the papers could wait until later…turns out they can. [Mona was her nurse.  Mona is AMAZING!]

I walked into the room and got up on the bed, for those of you reading who know yoga moves, in a child’s pose. I will never know why I did that, I just trusted my body to know what it was supposed to do. And that’s just what happened. My butt was in the air, my face was resting on pillows and my arms were outstretched. Also, in the very far reaching corner of my mind, I prepared myself for getting an IV, something I knew was policy considering me being positive for Group B Strep. But God knew the desire of my heart and totally answered my prayer: no IV. For whatever reason, the nurse didn’t push the issue. The nurse checked me, I never heard the results [she was fully dilated] and not long after, the doctor checked me. He said and I will never forget it, “Norie, if you want to have this baby now, you can,” in a familiar non-chalant manner. In my head I kind of laughed to myself, ya, Dr. Stafford, I would! However, that didn’t necessarily mean I knew how to. But then my body once again took over and big pressure waves started coming. My doula said to me, “Norie, let your peace build with those waves and then when it can’t build anymore, breathe all your peace down.” And for whatever reason, that made complete sense to me. I visualized big waves building up, up, up, and when they couldn’t get any bigger, I visualized my peace coming on top of them and smashing them down. I know it sounds weird, it sounds weird to me now, but at the time, it made perfect sense. So as the waves built, I peace-ed my baby out. And I will say that during this stage, I was definitely more aware of pain in a sense. I remember as Emma Jean’s head was coming, feeling a burning sensation, different than anything up until this point. But at the same time, what is pain when you know that on the other side is life? I mean, yes, I felt pain but I knew that I was having a baby so it wasn’t something I cared about. All I cared about was breathing Emma Jean out and into this world where I could finally hold her in my arms. Somewhere during this stage my doula jumped up on the bed and grabbed both of my hands and as I breathed peace, I squeezed her and was able to let my peace go down further. Also, toward the very end, I remember feeling Emma Jean coming out and my doula leaned in and reminded me of my “aah-aah-aahs” that helped me slowly, gradually and not forcefully breathe Emma Jean out. I’m glad I let out those aahs because I feel like they were a part of the reason I didn’t tear. And as I let my peace crash down one more time, my body trembling, heart racing, brow sweating, I felt a huge release and Emma Jean emerged. I was overwhelmed. She was passed underneath me, so when I opened my eyes after the last push, there she was, my baby girl. I picked her up carefully, rolled over and held her close.

Charlie helped dab her off, and I can’t remember much else. I couldn’t take my eyes off of her. I didn’t want to. I do remember the doctor asking me for one more little push and there was my placenta, which I now realize why no one ever tells you about the afterbirth, because who really cares about that when you’re holding a new life?

And so there it is, my first birth story. I am so thankful to serve a God who allowed for me to have such a wonderful first birth covered in so much grace and mercy.

Here are a few things that I believe made a huge difference for my birth. I don’t think these are necessities for all women. However, I do believe in preparation and I believe God sees our preparation and may choose to honor it, so I think it’s best to be prepared:

  1. Pray (from day one of finding out your pregnant all the way through your birthing time, there cannot be enough prayer)
  2. Have a plan (I used Hypnobabies, but not because it was my first choice. In fact, I didn’t even know what is was really when we got into it, I just knew that I needed a way of going about birth whether that was Lamaze, the Bradley Method or whatever.)
  3. Create a birth plan (this is something that you hand to your doctor weeks before your birthing time and something you definitely give the nurses at the hospital when you arrive. It’s just an outline of the things that you desire out of your birth, things that you do have a say in. Honestly, I think the birth plan helped me more than anyone just to be confident with the decisions that we were making.)
  4. Be in as good of shape as you can be (when I found out I was pregnant, I was already in pretty good shape. And I made a commitment to try and stay in the best shape I could all the way until my birthing time. I definitely could have done a better job with this, especially during my last trimester, and I think that the longer you can stay active the more it will help you during birth. I don’t think that anyone is ever too far behind because walking is low impact but can strengthen your legs, which you will want to be strong. Also just doing squats and lunges can make a huge difference as well. And though I am not a good example of this, swimming is probably the best for you and baby, even if that just means getting a kickboard and kicking for 45 minutes. Not only will it strengthen your legs, improve cardio, it also helps baby get into a better position for your birthing time.)
  5. Drink Red Raspberry Leaf Tea (I’m not normally a tea drinker, but a dear friend of mine gave me some of this tea and told me that it would help tone my uterus on top of a bunch of other great things. So I thought why not? And I pounded the stuff back for the few weeks before my guess date, and I just believe it helped me. If at the very least, it made me believe that I did have a toned uterus and could give birth naturally, and to me, that was worth it. But I believe that it actually did do the trick and postpartum has made a huge difference in cramping, etc…If you don’t mind the taste, why not? It can only help.)
  6. Write Things Down (I wrote down a list of things that I wanted to do early in my birthing time, like take a walk, bake something, etc…of course I began my birthing time at 1am so many of those things I didn’t get to do but they were there in case I had been able to do them. I also wrote down a ton of Psalms on notecards for my husband to read to me during my birthing time. Writing them down beforehand was great because I felt comforted as I read each of them then and once more comforted when Charlie read them to me later. The other thing I wrote down were things I would say to myself in case I asked for an epidural. I knew I didn’t want an epidural, so I wrote down all the reasons why. Then I cut each one out and put it in an envelope entitled, “In case I ask for an epidural.” We never opened it, but it was there in case I had needed to be reminded of, “Norie, you can do this. You’ve wanted to do this your whole life. Billions of other women have already done it.” Or “God made your body able to do this, just trust in Him.” And so on and so forth. I think it was wise to have that envelope because even though I could say to myself, I’m not going to ask for drugs over and over beforehand, you never know what you are going to do in the moment. And I knew the only person who would be able to keep me from doing it, would be me, so I knew I had to write those out myself.)
  7. Tour the Hospital (the day we were supposed to tour the hospital is the day we had Emma Jean. In our defense, we had tried to tour earlier that week but they were too busy for us. But I think that it could only have helped because it lets you know the environment you will be stepping into as you arrive from a very different environment [most likely your home]. It’s important to know where you are going in order for it to be a smooth transfer that does not alter where you are mentally.)
  8. Do your kegels! Kegels are an exercise that work your pelvic floor muscles, also known as your Kegel muscles. The best part is, you can do them anywhere, anytime and no one will even know you are doing them. Just google Kegel exercises to find lots of information about them and how to do them.
  9.  Have a support system (For me, this consisted of my husband, my doula and a physician that I knew, 100%, understood my desires for birth and was going to do everything he could to make those happen. For others, they may choose family members or midwife. But whoever you choose to have with you during your birthing time, it’s essential that they understand your desires for your birthing time and are willing to do whatever it takes to make those come true.)
  10. Visualize what you want: good things! (It is super easy for me to sit and think about how things can go wrong in any situation. For my birthing time, it wasn’t any different. If I let myself start worrying about having a c-section or Emma Jean turning the wrong way, all of the sudden I was visualizing it happening with crazy detail. So I really had to take time to practice visualizing good things happening. I visualized giving birth in different positions, I visualized breathing/relaxing into pain, and ultimately I visualized things going well. This visualization practice was part of Hypnobabies, but I will say that whether I had done Hypnobabies or not, I would have used visualization to reinforce having a wonderful birthing time. I’ve been an athlete my whole life and used visualization many times in order to practice being successful. And when I look at my birthing time from an athletic perspective, it just makes sense that I would practice positive visualization. After all, I would never practice visualizing striking out so why would I visualize something bad happening during my birthing time? I think it’s often easier for us to expect things to go badly, that way, we won’t be surprised or letdown if they do. But it’s like my doula said, “What if everything goes great? What if everything is wonderful?” So don’t dwell on the negative “What if(s)…” but instead choose to see your birthing time happen in a wonderful way even before it ever does!)

August Expected

When I was pregnant with Cedar, I thought it would be miserable to be 9 months in August.  But I loved it.  Relished it.  And admittedly, lazed in it.

  • Swimming in cold rivers
  • Long, highwaisted sundresses
  • Henna on my feet
  • Blackberries
  • And afterwards, not worrying that my newborn would be cold
  • Sitting on the porch swing with a naked baby
  • Easy-to-nurse-in clothes

Ah, such sweet memories.  And then, one of my favorite August births was my sister’s homebirth.  Oh, and there was Jenni’s surprise homebirth–another favorite!  And roller-derby Coral, who tripped over her giant newfoundland and began a fast and furious birthing.  Lara’s first birth, 0-10 in a few hours.  I love August births.

Guess what?

I have no doula clients for August this year!  Where are they?  I’m looking at that empty calendar and wondering what the month will bring.

Will they be homebirths?

First time parents?

Planned cesarean?

Super-speedy or slow as molasses?

Start-and-stop or get down to business?

Twins?

Will they need me much or will I simply witness?

Will I make some blunders?

It is so personal, the matching of family to doula.  But once paired, I put great faith in our shared purpose.

I wonder who will teach me and whom will I serve in the powerful month of August.

August rushes by like desert rainfall,
A flood of frenzied upheaval,
Expected,
But still catching me unprepared.

      –Elizabeth Maua Taylor

Karla’s Hypnobabies Homebirth

A long time ago, in a land far away…I was 22, and very pregnant.  I was 30wks and just miserable, tossing my cookies every other hour and dealing with an incredible amount of kidney pain. I had nephritis, which is the buildup of fluid surrounding the kidneys. This landed me in the hospital several times for IV fluids and pain meds. I think my OB was just as frustrated as I was and induced me at 36 wks.  Pitocin was started at 6am, epidural at 8am, and a 6lb baby boy was born at 11:20am via episiotomy and 3rd degree tear. I nursed him, held him, and fell in love with him instantly. He was a beautiful gift and at that point, the way in which he entered the world was of no concern to me. About an hour after his birth, a nurse came in to tell me she was taking him for his first bath. I declined.  She told me that I had to give her the baby and she would bring him right back…after tears and prying him from my arms, away she went with my babe.  I would not hold him again for 5 days.

We asked multiple nurses to bring us our son, but no one seemed to know where he was or refused to tell us. Three hours later, after sending my husband on a search for our child, I learned that Tanner was placed in NICU for breathing difficulties. I will never forget the social worker walking into my room and handing me a polaroid photo of a naked baby sprawled out on a flat bed with tubes coming in and out of his body. This was not the baby I had given birth to…and I told her so! I demanded to see my baby, but they refused to allow me a “visit” until he was stabilized!

Late that night, I was finally wheeled into the NICU to see this baby, which they claimed was mine. I really could not believe it…how does a baby go from perfectly healthy to being so sick in such a short time? All we could do is cry as we listened to the nurses explain all of the POSSIBLE problems that he MIGHT have. I asked to hold him and was told that I couldn’t even touch him. Although I was young, and knew nothing of childbirth, I knew my baby needed me.  As soon as the nurse turned away, I put my finger in his tiny hand and whispered my love in his ear. Every time I touched him the monitor would show that his breathing rate would slow down.  At first I thought it was just a coincidence, but after ten minutes of steady breathing rates, I alerted the nurse. She scolded me for touching him and stated that it was just a short hiccup and would speed back up soon. She was correct, the minute I removed my hand from his body, the alarms went off and we were ushered outside. For five days we prayed, we pumped, and we hoped that this nightmare would end. Then one morning we came to “visit” and we found that he had been moved to newborn nursery. When we asked why he had been moved they explained that they couldn’t find anything wrong with him and promised that we could take him home after 3 days of observation and weight gain. We were so happy to be able to hold and nurse him that we didn’t complain. We brought him home 9 days after his birth. The trauma of the whole ordeal didn’t really hit me until I became pregnant again 13 months later.

Our second pregnancy was a bit of a surprise.  I was rather scared that this would be a repeat of my fist pregnancy and birth. So I made it clear that this baby would not leave my side…no matter what! I developed nephritis again and went into preterm labor at 27 weeks. I was 5cm and having steady waves. So they shot me full of drugs, tipped the hospital bed upside down, and told me to cross my legs! I was sent home on bed rest and held out untill 36 weeks. I was induced again, epidural, and the whole nine yards. But this birth was different, much fuzzier and hard to remember. Immediately after giving birth I was given the option of sterilization via a tubal. The OB had been working on me for several months…filling my mind with every terrible birth scenario she could muster. She told me that every future pregnancy would be more traumatic and every baby would come earlier. Prenatal appointments overflowed with her sympathetic phrases, “Baby girl, some women are just not cut out for this. Their bodies are just not meant for this. You’ll have two children and for that you can be thankful. We don’t want to put you at risk, your life is more important.” And those are just a few that I can recall! I can still hear her calling me “baby girl” as if I was a child and she the adult that knew what was best for me! Unfortunately, her psychological warfare tactics worked.  She convinced me that I just wasn’t good at being pregnant.

I agreed to the tubal while nursing my newborn son, placenta still attached. To be honest, the next thing I remember was seeing my husband feeding our son a bottle and being very angry! Dawson was such an easy baby, so sweet and cuddly. He made me want more babies and regret my decision almost immediately. I would live with the grief of my decision for many years.

God’s grace abounds, and what seemed like a terrible decision lead us to foster and adoption(a big long story for another time). We were blessed to be able to adopt our two lovely daughters and growing our family in a different way.  Adoption is a beautiful picture of God’s love and we are so thankful that we have these girls to love.

Fast forward 8 years…I am a midwife’s assistant and reading every midwifery and birthing book that I can get my hands on. Knowledge is powerful, and it begins to open my mind to the possibility of having another baby.  I consulted with my midwife about my previous pregnancies and she seemed to think that we could resolve the nephritis and constant “cookie tossing” with  good nutrition. This was a huge encouragement for me. After seeing so many beautiful home births, my heart ached to experience what these women did…to have a peaceful and gentle birth. I grieved over the loss of a birth that I didn’t even know was possible at the time.

My husband and I started to do some research into tubal reversals.   We found that many women all over the country are getting reversals.  The stats for success were high and the cost was affordable.  On March 22 2011, ten years after Dawson’s birth, I had the reversal. We became pregnant on June 7th, 2011!

I am convinced that the key to holistic treatment is prevention.  Thankfully, Elizabeth (my midwife), suggested I start a whole foods prenatal and milk thistle for nausea.  Taken in the months prior to pregnancy, milk thistle strengthens and increases healthy liver function which helps to control morning sickness.  Although I only had a month on the milk thistle, it actually worked to control my nausea. During my first two pregnancies, I “tossed the cookies” 5-6 times a day for nine months, with this pregnancy I only threw up a hand full of times. When the morning sickness started to get to me, I used my relaxation techniques, increased vitamin B and protein. I did resort to calling in a nausea RX, but found it to be of little help. By week 18 the nausea was better and at week 20 it was totally gone! Around the same time my kidneys began to become a problem.  I started taking stinging nettle, which repairs kidney damage and improves function among other things!(one of the best herbs for pregnancy) It did the trick and within a few days the kidney pain had subsided. After a month on stinging nettle I felt great. This was a huge success for me, I felt like my body was strong and knew what it was doing…very encouraging. I could be good at being pregnant!

Every prenatal without signs of pre-term labor or kidney pain was also an encouragement. I kept thinking, “I’m doing this and doing it well!” Around week 35, we had some cause for concern. I began to have consistent practice waves about 4 mins apart and needed to use my Hypnobabies for some of them. Elizabeth came over to check on me (all gussied up as it was date night with her hubby) and reassured me that they were simply practice waves. I was only 1cm and about 60% effaced, for which I was extremely happy. We both were a little concerned that I wouldn’t make it to 37 weeks, which is required for homebirth. So she told me to take it easy, gave me a shot of hard liquor, and put me to bed. My hubby was determined to help me make it to full term and kept insisting that I would. He would tell me to go listen to my “Baby Stay In” cd and remind me of our goals. This was so helpful; to have his support… it was priceless. The waves continued. Bed rest was not very restful for me, it made me feel defeated. I was very angry at my body for not cooperating and began to struggle with fear.  Hubby stepped in again to remind me of how strong my body was and that I was doing a great job. He was a total superhero, taking care of our four kiddos and waiting on me hand and foot. The ladies in our church rallied around us, bringing us meals and taking my kids for the day.

Around week 37 the waves became intense again. They felt very strong and seemed to be about 3 mins apart.  We called Elizabeth and she came over to check things out. I was 5cm and stretched to 7cm, 90% effaced, and 0 station. I was so tempted to have her strip my membranes or break my water…all of these waves were becoming annoying and I really wanted to see this baby! The waves spaced out and nothing happened.

Week 38, and yes we were counting! Waves would come and go throughout the nights and so would the phone calls to Elizabeth. I was frustrated; I am a doula, why can’t I figure this out? Why is my body teasing me this way! Elizabeth reminded me of what was best for baby and it was to wait this out. I held out until just two days before my guess date…then I pulled out the bag of tricks! If you would like to know what is in the bag of tricks, contact me via email! 😉

Finally, just one day before my guess date…I awoke to strong waves at 2am. I figured it was another tease, so I went back to bed, put on my “Come Out Baby” cd and fell asleep. At 5am I felt a POP and his head slam into my cervix. I leaped out of bed and ran to the bathroom. It was on! This was TRANSFORMATION…I yelled for hubby to call Elizabeth and fill the pool. Then I started making weird phone calls to friends and family. I even left a message on an answering machine while having a wave…I don’t recommend that! It felt as though time was standing still, everything was moving in slow motion.  Elizabeth came, set up and observed me.

WARNING: This is where my memory gets really sketchy!

I walked over to the birthing pool and my water gushed. I turned on my Hypnobabies and instantly felt better. The waves were so much easier with the cd! The pool wasn’t full at all, but the warmth of the water was sooo soothing and instantly the pressure felt as though it had changed. I remember using my cues, looking at my “special place” beach scene, and floating back and forth in the water. At some point things changed, and Elizabeth and the apprentices joined us in the room. I heard a cue, on the cd, about every 30 mins feeling like only 5mins and from then on things moved very quickly in my mind. I asked for counter pressure on my back and moved to the side of the pool so that hubby could support me.

Thousands of thoughts raced through my mind between waves. Little did I know that these thoughts were not staying in my head, I was saying them out loud! Crazy things came out of my mouth!

“Get that hose out of the pool, it looks like a snake!”

“I hate Ina May!”

“There is nothing orgasmic about this!”

“I think I might cuss, I’m sorry.”

“Lord be merciful to me.” (I thought I was praying this to myself!)

All the while I wasn’t feeling any pain, just intense pressure and an opening feeling that I really can’t describe. I could feel every move he made inside of me…I knew where he was and that he would be here soon.

Pushing began and my hubby supported me on the side of the tub. I remember pulling on the shoulders of his shirt for leverage.  The squatting position was great and I had no desire to move from it. I pushed his head down and felt a little ring of fire, but as soon as the wave left he moved back up. I told Elizabeth what had happened and she reassured me that everything was just fine. I pushed again, bringing his head out partially and held him there for quite some time…there seemed to be a pause in my pushing here. Elizabeth asked me if I would like to feel his head and I gave her a stern “NO!” Another couple pushes and his head slid out. I reached down and felt it and an instant connection happened. I felt this wave of love and compassion for this babe that had only made a partial entrance into my world. I said, “That wasn’t that bad!” Again there seemed to be another pause. I was so intoxicated by the experience that I wasn’t thinking about pushing out the rest of my little guy. Elizabeth seemed to bring me out of it when she said I would need to give it a couple big pushes for the shoulders. I felt another ring of fire and with the assistance of some stealth like moves from Elizabeth, out he came. His arm had been positioned across his chest and the umbilical cord was wrapped around several times. I turned around and cradled my new baby, somewhat in disbelief!

 

We did it!  It’s a boy! Silas was born just over 3hrs after my birthing time began! Our four children ran down stairs to see their new brother. They looked on with awe at the miracle that had just taken place in our home. The room was flooded with love and thankfulness. After recanting my hate for Ina May, I moved to our bed to get cleaned up and rest with Silas.

Silas was 9lbs 4 oz and 23 in long! I gave birth to one BIG baby without any interventions, meds, or pain!

Honestly, I have never felt anything so good in my entire life. Thanks to Hypnobabies for the tools and my wonderful midwife for her talented hands!

Karla Costner is a certified Hypno-Doula who serves women in the Upstate!  Visit her website to find out more:  www.brilliantbirth.wordpress.com 

Dolphin Bay

In Thailand, we stayed at The Juniper Tree which is about 3 hours south of Bangkok.  It is located on a quiet stretch of the Gulf of Thailand.  It caters to missionaries and their families; accepting only donations for room/board.  

We stayed in a 3 bedroom cottage.  Outside our front door was a grassy playground and a pool.  The pool was somewhat scary since there was no gate.  But we didn’t lose any kids. 

 

 

 

 

 

 

Beyond the pool was an exercise room, a kids activity/video room, dining hall, and then the ocean.  We were served a yummy breakfast with french press coffee, fresh fruit, eggs, and assorted goodies.  Lunch was a Thai meal.  Dinner was western style food.  Ice cream, coffee, and tea was available all day!

Norah made friends within hours of our arrival.  Here she is with her twin from Sweden.  I bet you can’t even tell them apart.

 

Sunday school on the beach:

I loved that it was ok for kids to be kids.  The missionary kids were free-range indeed!  More free-range than I’ve ever witnessed in America.  When they finished eating, they left the table to play while the adults talked.  I wasn’t quite ready to send Norah to the beach by herself but I probably would have gotten there with a little more time around these families. 

We traveled by song tau to Khao Sam Roi Yot National Park.  A song tau is a pick-up truck with benches in the back and a metal covering.  Super cheap and fun transportation.  The girls adored the lack of carseats or seatbelts.  And I witnessed Noelle nurse on a song tau, fishing boat, tuk-tuk, plane, elephant.  Ok, I’m just kidding about the elephant.  We didn’t ride any this trip.

The national park was lovely.  The name translates “mountains of 300 peaks.”  We climbed and climbed, saw monkeys, played in the sea, took a boat ride, got really dirty and sweaty.  Asher and I napped on the beach while Noelle and Zach went caving for an hour.  At least that is what they said they were up to.  We ate food that I thought was a little sketchy.  Oh, and I threw a stick at a dog that was looking at me funny.  Then I had to search around for another stick because he was still looking at me funny.  Lesson:  don’t throw your weapon.  Especially if you’re going to miss. 

In our leisurely moments (which was all the time!), we played.  Scott kayaked in a crappy, beat-up rental.  It cost like a dollar to rent the thing. 

 

And we rented a moped to scoot about when we could escape the kids.  See, if I’d fully vested in that free-range thing, we’d have just left them to their own devices!  We also fell in love with Blue Beach, an outdoor restaurant down the road.  They served the best Thai food with mostly organic ingredients.  And they served alcohol, had wi-fi, and toys/bikes/rabbits/koi pool for the kids.  So we opted out of a few meals at Juniper Tree to splurge on Blue Beach. 

There was one disaster.  Asher got a zhu zhu pet stuck in his hair.  After many tense moments and screaming, he was left with a bald spot.

Thailand Summary:  we lazed around (as much as parents of little ones can), ate lots of food and ice cream, drank gallons of strong coffee, explored a few places, talked and talked and talked.  Norah made lots of friends.  Cedar and Asher played.  We were so spoiled.  The Juniper Tree even did our laundry.  Scott wanted his shirts sent to the laundry just so they would be pressed “for once in my life.” 

I don’t iron.  I don’t.  Don’t judge me.

Next up, either the Thai tooth fairy, or cloth diapering away from home, or traveling with kids.  Not sure which I want to tackle next.   

 

Doulas and Cesarean Birth

I’m certainly no expert on etiquette in the operating room but I’ve learned a few helpful things for us non-medical folks over the years. 

100% of the time, when my client makes the cesarean decision, she is told that only her partner can go into surgery with her.  I’ve learned to question that policy.  Usually I’m still left alone in the L&D room staring forlornly at the remains of their labor scene.  But perhaps six times now (and three of those happened this year) I accompanied the couple past those double doors.  To the operating room. 

1)  How can a doula get an invitation?

Ask.  Ask quietly but with confidence.  Let them know it isn’t your first rodeo.  Ask everyone.  Ask the nurse.  Ask the OB.  Ask a passing nurse in the hallway.  The first answer will probably be “no.”  The nurse and OB usually defer to the anesthesiologist.  Why this god of the operating room gets to make the call, I have no idea.  But s/he does.  I’ve found that the nurse and OB often “forget” about my request.  So I ask again. 

I remember talking with an OB after a vaginal birth once.  I mentioned that I was never allowed into the OR at this particular hospital but XYZ hospital down the road usually let me.  She replied, “Huh!  I never thought about inviting the doula to come back.  I bet that would be good for the patient.  You be sure and ask me next time that happens.”  P.S. I remember a previous birth with her when I DID ask.  She said, “no.”  Sigh.  See, they “forget.”

“Would you ask the anesthesiologist to make an exception and let me go with my client?  I’ve been allowed to back before. ”  Repeat.  Repeat again. 

Before the cesarean, the client may want to make her special requests to the OB (delayed cord clamping, dad to announce gender, keep the placenta, etc).  Of course, you might also remind staff of these choices in the moment.  Just in case they forget.

2) What will you wear to the party?

Usually I’m given the same paper scrubs as the dad.  They may be huge.  I’ve had to tie knots in the back of the shirt 1980’s style.  Once a kind nurse brought me cloth scrubs in my size.  It was wonderful!  Mainly because I was wearing the same color and fashion of all the other masked nurses and had more freedom to move about the OR.  Doula undercover. 

You’ll also get a fancy shower cap, mask, and covers for your shoes.  Strangely, no gloves.  But there is usually a hand sanitizer pump just inside the operating room.  I use it just to be on the safe and clean side. 

3) Confessions of a wallflower

You will be ushered to a stool beside the mom’s head.  Maybe once or twice, I was directed to stand.  This is the time for grace.  No tripping over your feet or craning your neck for a view.  Prove to the anesthesiologist and/or nurse anesthetist that you’re one of the cool kids.  Sit.  Meekly.  Hands folded.  No snapping pictures yet.  Perhaps a nod to the medical staff. 

Mom will be lying flat on her back with her arms outstretched.  Often her arms will be strapped down.  There will be a curtain between mom’s chest and her belly.  When I’m standing, I have to stand on my tiptoes to see anything on the other side.  I do not recommend standing on tiptoes.  See earlier mention of grace. 

 

4) The popular kids in the room

Sitting/standing behind mom is the nurse anesthetist and/or anesthesiologist.  This person is monitoring mom’s vitals.  You want this person to like you.  This is the aforementioned god of the OR. 

The OB is below the curtain with his/her surgical assistant(s).  Sometimes a student and an attending are chatting in the background as in the picture below.  Classy.

Mom’s labor and delivery nurse is there.  Often with an L&D nurse who is on cesarean duty. 

Near a baby warmer is a pediatrician and a baby nurse.  See them in the background?  Try to look beyond the bloody gauze in a hanging shoe organizer bag.  No, it isn’t really a shoe organizer bag.  But it surely looks like one hanging there.

5) When the party is in full swing

Once the surgery is underway, I sort of inch my way out of the stool and move away from mom’s head.  I want to get some pictures of something other than a blue curtain.  This part is when I’m in ask-forgiveness-rather-than-permission mode.  This part is also how I’ve managed to watch and photograph from below the curtain.  Just call me Sneaky McSneakerson. 

During this time, partner stays right by the mom.  There isn’t any physical support that can be offered during this time.  Mom can’t have ice chips or a cool cloth.  Her partner’s presence is THE essential support.

Of course the big moment is when the baby is lifted up over the curtain for mom to see.  Often the partner is instructed to stand up to see this moment.  The curtain is usually lowered a bit. 

The OB passes the baby to a nurse.  Baby goes to the warmer for the pediatrician to check.  This is standard for cesarean.  I switch places with the Dad so he can follow baby while I stay near to mom.  I pass the camera to Dad. 

And I giggle/cry/oooh/aaaah with the mom about the amazing baby.  I describe what I see happening over at the warmer.  “Aww, baby just got her first rectal temp. check.”  Good stuff.  If it is taking a long time, I will grab the camera back and show mom pictures of her baby. 

Post-birth, I’ve also noticed that many moms experience pressure in their abdomen.  Sometimes they are shaky or feel dizzy/nauseous.  Blood pressure might drop.  There isn’t much I can do except encourage and normalize her physical feelings.  Or speak to the nurse anesthetist about what she is feeling. 

6)  Making your moves

Dear super doula, you can be a game-changer if you play the cards right and all the stars are aligned.  You can sometimes get almost-immediate skin-to-skin contact for your client.  If the pediatrician and the nurse anesthetist/anesthesiologist agree, your humble request may be granted.  You may have to pinky swear you’ll hold the baby in place especially if they are unwilling to unstrap mom’s arms.  And swear on your great-grandmother’s tomb that you will not let the baby get cold. 

When your wish is granted, unsnap mom’s gown at the shoulders, expose some skin.  There may be monitors stuck to her chest.  Ignore them.  Place baby skin-to-skin on mom’s chest, cover baby with a blanket, and then you or partner hold the baby there.  Sometimes, against the hopes and dreams of the medical team, the precocious baby will even latch on to a breast while the OB sutures away below the curtain.  Babies don’t know hospital policy. 

It is tough to see since I pinky swore baby would stay covered by the blanket, but the picture below is a baby skin-to-skin.

However, please be attuned to mama during this time.  She may have been vocal about skin-to-skin before the surgery.  But a cesarean is a pretty big deal.  And if she doesn’t feel able to hold her baby just then, encourage dad to hold on to baby (and not to let go!). 

7)  Last dance and farewells

Cesarean births can be a tad bloody.  Expect to see bloody guaze, perhaps some blood on the floor.  Sounds of suction.  The smells can be strong especially if the OB uses a cautery.  And it is a little unnerving when the OB and nurse count the instruments and gauze to double-check that nothing was left inside.  I have plenty of pictures to illustrate my point but I think I’ll spare you. 

Sometimes birth partner and doula are asked to return to the L&D room or recovery with the baby.  If the nurse says to put the baby in the warmer in the room, I suggest dad strip his shirt off and do his own skin-to-skin with his offspring.  Makes a nice picture for mom to see later.  

Dad should be clear about mom’s wishes for possible baby procedures.  If he isn’t sure and it is not an emergency, he would be wise to delay until mom is there.

At some point soon after, everyone is reunited.  If I’m told the policy is only one person in recovery, I pretend I didn’t hear.  Yep, I develop strange and sudden hearing loss.  I melt into the background (those nurse scrubs sure could help!) or become indispensable to someone.  I have not yet been kicked out of a room after the one-person-policy has been stated.  The same technique works for epidural placements.  Just pretend the rule doesn’t apply to you.  “Hmmm?  Who are they talking about?  Not me, surely.”  Or write intently in your client folder and don’t make eye contact.  Be invisible.  

Your job is now breastfeeding initiation.  The L&D nurse or recovery room nurse will focus on mom’s blood pressure and other vitals.  Sometimes mom needs to lie almost flat until her bp stabilizes.  But babies can still nurse.  You may need to hold a breast and hold a baby because mom might be weak or shaky.  One client tells me she remembers very little of this time but she is thankful that someone was there to (literally) support her and baby.

I hope that helps some!  Does anyone else have insights into the world of cesarean birth?  Was your doula able to accompany you?  What could have made your cesarean birth better?  What can you add?

*And a big special thanks to the families who let me share these pictures!

ETA:  By request, I’m adding a better picture of the shoe organizer.  🙂