RSS Feed

Category Archives: Doula

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!)

Goodbye 2012

I like stats.

Firsts in 2012:

  • First dad to leave me in the dust on the drive to the hospital.  You know who you are, J.S.
  • First missed births.  I missed one due to dengue fever and one because I was away for the weekend (she birthed early).  I’m ever indebted to Angie and Laura for doula-ing in my place.
  • First time supporting back-to-back births.
  • First hospital waterbirth.
  • First time driving 1000 miles for a birth (which I missed, so that’s three missed births this year.  Painful.).

I am excited to see what 2013 has in store for me!  My doula availability is booking quickly and my first Hypnobabies class is filled to maximum capacity.  And how could it not be an amazing year with this adorable pumpkin as the first baby I snuggled in the new year?  He also peed on me three times.  I’m sure it is a sign of good things to come.

IMG_0915

I have only one resolution.  I will not miss any births.

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.

When you pass through the waters

I’m reading Michel Odent’s book, Water and Sexuality.  If you aren’t familiar with Odent, he is a French surgeon who began to explore birth as a midwife.  He noticed women were drawn to and influenced by water during birth.  You don’t need to be around birth long before you notice that phenomenon.

He is also incredibly provocative.

He tosses about Japanese tradition, Greek mythology, sexual theory, and futuristic aquatic adaptation.  In the same chapter.

Like I said, provocative.

IMG_2686In terms of waterbirth, he describes how women are drawn to the water and will sometimes enter the tub before it is barely filled.  In Odent’s observations, the presence of water “releases the brakes” on birth; inhibitions melt and the neo-cortex turns off.

I started thinking about a question I ask all my clients:  If you could birth your baby anywhere in the world, without worrying about logistics or safety, where would your fantasy birth take place?

I knew many women included water in their answer but I decided to find out how many.  I pulled my last 50 client files and went through each one of them.

38 out of 50 said they wanted to birth either in water or near water.

Some of the answers were creative and specific.  Here are a few:

  • A cottage by the ocean in a rain storm
  • Floating on a bamboo raft in Hawaii
  • In a tree house over the ocean in Fiji
  • By Bull Sluice on the Chattooga River in the daytime
  • On a blanket at the ocean in Italy
  • In a Swiss Alps cottage with the sound of water

Three women mentioned dolphins and four mentioned mangoes.  Is there some symbolism in those images?

My favorite was a woman who would birth at a coral reef at night.  Probably the scariest place I could imagine but for her it was a peaceful, safe haven.

Only 12 did not involve water.  So what did those 12 answer?

  1. At home in bed near a fire.  Dim lights.
  2. At home with candles
  3. At home in the living room.
  4. Home
  5. At home in bed.
  6. At home beside the fireplace.
  7. Somewhere comfortable and private
  8. Hospital (interesting, at her birth she spent much of her time in the hospital shower)
  9. Mountain top
  10. Outside
  11. and 12.  No answer

I don’t have a big revelation in these numbers.  I’m not surprised by them.  Personally, it’s difficult for me to imagine having a “land birth.”  At my first birth, when the midwife said the tub was ready, I stripped my clothes off in a room full of people and almost dove headfirst into the aquadoula.  The tub created a boundary around me, it gave a physical space that was mine.

Not everyone wants to immerse in water, certainly.  Still, ocean sounds, waterfalls, and thunderstorms resonate in many of these fantasy births.  We grow our babies in water, we dream vividly of it in pregnancy, and it may release the brakes in our births.

IMG_0790

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.  

Doula Availability

I have two openings for November and one opening for early December.

I’ll go on break for the end of December through mid-January.  I’m trying my hand at travel doula’ing for a birth in Vermont in early January.  Will there be snow?  Maple syrup?  Snow?  I love Vermont!

If you know anyone interested in a doula for Nov/Dec, send them my way for a free consult.

Don’t forget to come out to Saturday’s Blessingway.  I’m hosting this month.  Natalie is teaching us infant massage techniques and will share her blissed out homebirth story.