Leticia

Leticia’s Birth:

In 2005-2006 I wrote about each birth I attended in a hard backed black and white composition notebook.  What a gift to come back to 8 years later and relive the births.  Believe it or not as I read I can remember each one.  Details like which room in the hospital we were in, what time of day it was, her face when she first saw her baby.  Leticia’s birth, the first Cesarean I witnessed, is one that had gotten lost in my memory.  Until I read through my journal entry May 24, 2006. 

Leti had a traumatic birth three years prior in Mexico.  She labored long hours alone on a cot in a room full of other laboring mothers, also alone on their cots.  Her husband and family were not allowed to attend to or care for the laboring mother.  A nurse checked periodically and moved the patient to a delivery room when it was “time”.  This experience left Leti feeling afraid to give birth again.  In a country she did not yet know, a hospital that was new and in a language she did not understand.  The services of a bilingual doula are a perfect match for her needs. Through the course of her prenatal care I got to know Leti well.  She attended the Centering Pregnancy group (see prior post). This group is a structured time for women to come receive individual prenatal care and then stay for a group discussion/education session.  As I got to know her I realized that my job was to accompany her through it all, early labor at home until the baby is born. 

In the last weeks of pregnancy Leti’s baby girl changed positions often vertex (head down), breech (bottom down) and transverse (sideways).  I had never seen a pregnant belly as large and “pendulous” as hers.  This was the problem, her abdomen muscles were not strong enough to hold the baby’s weight inside the mother’s body.  So her baby hung out, way out in front.  This kept the baby from settling into the pelvic bones and staying in that very necessary vertex/head down position.   

Leti’s due date came and passed.  On May 24 2006 I arrived at Leti’s apartment to find her laboring as her husband nervously rushed around getting their younger child ready for the sitter.  Leti was so excited to be in labor, finally.  Her contractions were every 2-3 minutes and lasting a minute long at least.  This was the first time I met a client at home while they labored before we left for the hospital.  I was a bit nervous about being at her place while she was obviously in active labor.  I wasn’t quite sure what to do as I was used to providing labor support only in the hospital.  Turns out I didn’t HAVE to do anything, she just needed me there.  She just wanted my company, and within an hour we made our way to the hospital. 

Once we checked in at the hospital the midwife determined that Leti’s was 4 cm dilated, but her baby was lying sideways inside her uterus.  This meant a Cesarean birth was the only way to move forward.  Leti cried, she was so disappointed,  her birth plans changing and out of her control.  She was prepped and in surgery within the hour. Her daughter Carolina weighing 9 lbs 12 oz was born just a few hours after I had met Leti at her apartment that morning. The following is an excerpt from my journal. 

“I wasn’t sure what to do in the operating room or what to say.  But I stayed close to her face quietly assuring her.  I tried to touch her- hold her hand so that I could be the human factor and she wasn’t’ just some cow on the butcher’s block. It was so sad to think this was the birth- so impersonal- so out of touch- humiliating and disconnected.  I was so sad thinking of all my dear friends who have gone through this same experience and I had no idea what sacrifice it involved.”  

I was convinced that I had failed her.

When I met with her a week later at our postpartum visit she was very emotional and tearful but not about the things I expected- she talked a lot about how hard it had been after the surgery coming home.  For her the struggle was with issues of mobility, vulnerability and not being in control of when she ate or how the house was kept. Her emotional state likely from her disappointment from labor, got directed largely at her husband who was taking care of her.  She lamented not being in Mexico with her mother and sisters.  Mexico is rich with tradition of nurturing and caring for new mothers.  Leti missed the special foods, the herbal baths, the pampering that the women in her family wanted to give, but were not able to.

 

Halfway into our visit Leti turned to me, looking me straight in the eye and thanked me for being with her.  She expressed how grateful she was for meeting her at her house early in the morning and then staying by her side through it all.  She said the one thing she will always remember, is me holding her hand during the Cesarean.  She placed a hand on her heart when she said, “and your touch told me that I was not alone.”  

This is the most powerful feedback I had received about my doula work. 

And that is when I really got it, the value of someone's presence- the simplicity of just being with someone makes all the difference. That is my calling, that is my gift and that is what I want to give the people that cross my path.

Part One: Two years ago and about 30 births into my doula career I witnessed my first Cesarean Section.

Two years ago and about 30 births into my doula career I witnessed my first Cesarean Section.  Since then I think I’ve attended about 10 more Cesarean births and about 150 births all together.  It is an amazing ratio 1:15 births, much different than the statistics a mother delivering in today’s US hospital setting faces 1:3. My amazing stats are due to the caring providers and facility in which I served.  So before I delve into the story I have to give some background on my set up.  In the early years of my doula career I worked for Maple City Health Care Center (MCHCC), a low-income neighborhood based clinic that provides doula care to all of their pregnant patients.

My Set Up:  Maple City Health Care Center circa 2004-2006

The providers at MCHCC were a general family physician and a certified nurse midwife (CNM).  Both the doctor and midwife worked tirelessly to educate their clients about what kind of birth experience was available to them here in Goshen.  All clients delivered at then Goshen General Hospital, now IU Health Goshen, a facility with caring nursing staff and dedication to honoring a supporting mother/baby experience.

MCHCC recruited me for doula training.  I still remember the conversation with Ellie the prenatal care coordinator.  She pulled me aside one day as the clinic was closing up and wondered if maybe I’d consider training as a doula and attending births with the clinic’s pregnant patients.  The majority of OB patients during this time period were undocumented women from Mexico.  These women lived in the states for less than one year, isolated from their mothers/sisters/friends back home and speaking only Spanish. Their circumstances made a good match for the labor support and translation services of a doula.

It was 2004 and there were 5 or 6 doulas each attending least one birth a month for the patients at the clinic.  We were each individually contracted with the clinic, but supported each other through regular meetings, backup coverage and a general listening ear.  It was ideal for my novice self.  There were so many layers to the work.  There was labor support and navigating hospital birthing, but also the language and culture were a challenge.  Understanding my client’s expectations and needs took intentional effort.  And I loved it.  I thrived.  I was passionate about it enough to scramble to find a sitter for my 3 and 1 year old children each time the labor call came.   

At the clinic all pregnant patients were encouraged to attend prenatal care in the Centering Pregnancy groups. The Centering Pregnancy group was adapted a model to enhance the mother’s experience of her pregnancy and improve health outcomes for her and her baby.  More information on this program is available online at Centering Pregnancy.

This format was perfect for women who were new to our area and living far from their maternal support system.  Educational topics included nutrition, pregnancy discomforts, labor support, VBAC (Vaginal Birth after Cesarean), and breastfeeding.   Ten sessions in total were all presented in English and Spanish.  This information helped women discuss their questions and concerns, process the culture of the US medical system and enable them to feel more confident in the care they were receiving and the birth they anticipated. 

The Outcome:

The effort that the providers and clinic put into offering this service demonstrated each woman is valued and respected in the healthcare setting.   The care provided by the doctor and midwife went a long way to decrease unnecessary cesarean deliveries and increased VBACs (vaginal birth after cesarean).  Doula support was utilized by many of the patients, this support didn’t always mean the birth was short and easy, but it was an experience where women felt cared for and supported.  This is the lesson I learned as I doulaed (this is a word in the birth world) Leticia through Caroline’s birth.  See my next post to read that birth story.

Birth Announcement

I received a most precious birth announcement yesterday and promptly posted it on my board.  My “office” space in the basement is a double card-table and ironing board piled with papers.  It is a humble space, but meets my needs.  The anchor of the space is my corkboard that holds all the Thank Yous, birth announcements, updated baby pics, and several memorial cards from baby’s funerals. If ever I am feeling unappreciated and unsure if what I am doing even matters, I take a few down to look over. 

Handling  the brown and blue paper decorated with monkeys, I find myself thinking back to when I first met the parents of this baby.  How young and eager, anxious they were.  Many of the cards come from Amish couples I teach in childbirth class.  The first night of class is always a bit charged with nervous energy.  I tell them it is ok to be nervous- I get nervous too.  “Imagine explaining the workings of a woman’s reproductive system to a room of 16 people you just met,” I say.  That usually gets a smile and some nodding, sighs of relief that they aren’t in my shoes.  And then I take them through a whole lot of information and laughing over the course of three nights, they come out on the other side of it less worried and a bit more ready. 

One of the most rewarding things about teaching childbirth class is getting to know the couple during the last part of their pregnancy and then gathering for brunch a few months after the baby is born, to see them again transformed into mothers.  I just attended one of these “reunion” brunches.  Seven Amish young mothers and their 5 month old babies gathered to eat, talk and fuss over each other’s babies.  I usually have to facilitate some of the discussion at first.  Easy topics like, name, birth date and birth weight.  Oh the pure pleasure on each mother’s face as she introduces her baby to the group.  I love that moment!  A few hours pass and the conversation is rolling.  Usually it’s a good dose of griping about a fussy baby or lost night’s sleep, questions about what remedy you use for this or that, topics that us non-Amish mothers seek out on the internet or Facebook. 

My birthworker brain takes note of how all the babies are snuggled on their mother’s laps, babbling and blowing bubbles with their spit.  Sure some of their labors were hard and long.  For several the hardest part about having a baby was learning to breast feed. But no matter how the birth went, if breastfeeding worked out or not- all the babies today are strong healthy butter balls on the verge of being rolley- polley.  That’s my underlying goal of the gathering really: to get the women to talk about their experiences, their babies and to see in the end that it is a treasure to have a healthy baby. 

One mother lamented today that she didn’t get to have a “real” birth because soon after she was admitted to the hospital she was on her way for a C-Section because of a breech baby.  She made this comment as her sweet 4 ½ month old baby nursed and kicked at its blanket. I got what she was saying, it is very common to grieve the loss of a natural birth.  One of the women at the table quickly pointed out that she had the natural birth that she wanted, but breastfeeding turned out to be a stressful and disappointing endeavor.  Several other mothers nodded in agreement and added comments.  They feel like failures,  as all three are bottle feeding now. 

This exchange and others like it help mothers process their unmet expectations and realities.  New mothers need a place to discuss their experiences and to hear from the mouths of their peers that they are not alone and really not so bad off.  I wish there was a way for me to facilitate new mother’s meetings on a more regular basis.  Doesn’t someone want to pay me to do that? And then they’ll come flocking in right?

Back to this birth announcement I just received. It’s from a family that inspires me to be grateful for healthy living babies and all the toil they put their mothers through.  A 3x 4 inch textured cardstock made especially for this baby’s arrival, announces baby boy Anias Levi, born January 5, 2014 on the verge of a blizzard (that blizzard part wasn’t actually on the announcement).  Weighing in at 9 lbs and 15 oz and 21 inches long, the card has little giraffes, elephants and lions on it.  I hung it up on my board, it is right in the center.  I placed it next to the obituary of his brother Ephraim, born December 12, 2013 died December 13, 2013.  You see babies aren’t always healthy, there isn’t any guarantee it all turns out like it should. 

And that is what I hold, the reality I carry, and one that I would like to shelter each one of the mothers I work with from.  Shelter them from the experience- but not the gratitude it brings.  I want them to know how fortunate they are to have a baby that wakes every 2 hours at night to feed, or that fusses and wants to be held "all day".  This awareness is the burden we birthworkers carry.  This is a burden I carry.  Through study and experience I am released from innocence.  I have seen, held and cared for babies that are no longer living.  At every birth, I hold my breath.  At the arrival and possession of each birth announcement, I exhale.   

Ordinary

If you look in the dictionary you’ll find Ordinary is something considered to be normal, routine, regular, the customary course.  In my opinion Ordinary doesn’t get the respect it deserves.   We live in a culture that values the above-average, over the top, best it can be kind of experience.  An unrealistic way of living and birthing.  Now don’t get all worked up that I’m not gushing about the beauty and mountain top moment that birth can be, hear me out.  I observe plenty of beauty, holiness and all together awesomeness at births.  I love those moments.  But I value ordinariness just as much as the once-in-a-life-time-ness of a child being born. 

It’s possibly a loaded word, this ordinary, when it comes to describing a woman’s labor and a child’s birth. Depending on where you are and who is providing care- the regular routine may not be desirable.  I’ve been in those places, seen those births.  Heck, I’ve had one of those births.  And that isn’t quite what I’m getting at.  It’s not the “normal” defined by the hospital or provider you choose.  Its “normal” as defined by nature, the regular old ordinary natural process.  Muscles contracting, hormones surging, baby descending through bone-this is the Ordinary that I watch for.

Over the course of my birth work I am convinced that there is a piece of this ordinary in every birth.  Yes every birth.  I can go back through each birth I have attended and find the Ordinary.  Sometimes it is a glimpse- one naturally occurring contraction, an uncoached urge to push, a baby that cries and pinks despite an operative birth, a mother’s swelling oxytocin as her babe suckles for the first time.  The moments are there, and I’ve started looking for them, counting them almost.  Because ordinary is the goal, ordinary means it is working. Despite our efforts to control it, to manage it, even if it has to go undercover, Ordinary happens.  

It is easy now for me to break down those moments in a birth.  Like my son taking apart his Lego creation, each moment a brick. Each brick a part of the whole no matter the size. As a childbirth teacher I explain the workings of the female human body during pregnancy and childbirth on a monthly basis.  Perhaps that repetition in presenting the birthing process has made it seem so obvious and normal to me that it IS simply ordinary.  So entrenched in my mind are the sequence of events, so many times I have seen it, that is Ordinary.

Let me give you an example:

The first birth that comes to mind is Sarah.  Sarah labored for 3 days, the first day a slow starter after her water broke.  It wasn’t painful so much at first but she was restless and anxious.  And those early contractions were close enough to keep her from sleep.  By the second day her contractions had picked up- they were closer together and stronger. She made the 1 hour drive from her home to the birth center where she hoped to give birth.  Sarah missed another night’s sleep in the course of labor unfolding.  She was getting tired and so was her uterus.  

Along with her midwife’s counsel Sarah and her husband decided to transfer to a local hospital for services the birth center couldn’t offer.  Leaving her birth plan behind was hard.  But she needed some sleep.  At the hospital she transferred care to a different midwife who ordered an epidural and some medicine to keep Sarah’s contractions coming. 

This is where I met them in the process.  Sarah hosted a childbirth class at her house two months prior and I was the teacher.  Her original midwife called me and asked me to doula them as she was not able to care for them at the hospital.  I was glad to go, it was my own son’s birthday and I felt a special connection to Sarah from our first meeting.

When I arrived Sarah was just waking from a few hours of sleep.  She was smiling and chatty.  The epidural had given her just want she needed.  Sleep.  While sleeping her body continued to work and she was ready to push.  Her anxiety resurfaced and insecurity, “Is this going to work?  Can I push out my baby?”.  The fresh midwife cheered and encouraged Sarah through the first pushes.  And she did do it, Sarah pushed.  Uterus contracting, baby descending, mother opening.  She pushed, the baby moved, one bit closer to birth.  Sarah didn’t believe it would happen, she couldn’t even feel it happening because of her epidural.  Her plans for this birth had already changed so much, she doubted she could do it.  And then she did it.  A squawking pink baby girl in her arms she washed over with relief less than an hour after her first push.  

Betsy, get to the point here.  You are waiting for the Ordinary part right?  So Sarah’s hoped for natural birth center water birth did not happen. Regardless, her body started labor on its own water breaking then gradual contractions.  Pretty ordinary stuff.  I observed Sarah work hard; muscles straining, sweat rolling, gazing into her husband’s eyes for support. Plain hard work. And then the emergence of her daughter. It happened, it worked.  And it was very Ordinary.  Remember that definition I mentioned earlier? Something considered to be normal, routine, regular, the customary course.  

And Ordinary really is quite nice. 

Experienced in Birth, Virgin Blogger

 

Finally I’m ready.  Finally going to get this rolling.  This idea for a blog has been rolling around my head for years.  To use the imagery of the topic at hand, the gestation long, labor prodromal now active. Now the birthing the blog.  Push and breath and work with the process.

b.b.birthstory is a place I intend to record and reflect the work of the last 10 years of my life.  I began birth work within my first year of motherhood.  This, you may guess, is not the ideal time to start a vocation that demands an on-call work schedule with potential heavy emotional and physical demands.  But new into motherhood and feeling freshly scorned by my Obstetrician, I answered the call to train and serve as a doula.

Doula, what is a doula?  I’ve answered that question a time or two.  A doula is a professional labor coach.  I have honed my skills in emotional and physical support of the laboring mother. Encouraging and looking out for the partner is also an important aspect of doula work. I am full of information and answers when it comes to the topic of pregnancy and childbirth.  I am not a nurse and not a midwife and I do not provide any clinical care to my clients.

Doula work led me to the doors of several local Certified Nurse Midwives (CNMs).  These midwives took me in, educated and trained me to assist them at homebirths.  After a few years of assisting midwives and doula work, childbirth education crossed my path.  Its’ been about 3 years now since I taught my first class and I am surprised to find my introvert self eager to sit down with a room full of strangers and talk about the nitty-gritty of birthing. 

I describe myself as a “seasoned” doula.  I’ve attended nearly 200 births over the course of my birth work.  At this point I turn down more work than I take on, which I know is a privilege.  I am not afraid to say no if the opportunity doesn’t suit my family schedule.  Don’t get me wrong I am still passionate about my work after all this time.  But not in the snarky, homebirth at all cost, natural is the only way to do it kind of passion.  Joy comes to me in those moments when a woman gains confidence, encouragement, dignity and empowerment through her childbearing experience.  That joy is what keeps me shuffling my kids to the sitter at the last minute or getting out of bed at 3 am to attend a birth.

My aim for this blog is to make a space to record my journey as a doula and discern how my birth work changes and guides me. I will not be divulging any kind of gossip on local midwives, poking at political hot topics,  or scandalous birth stories. I promise to protect the privacy of the people that I have served and worked along side. 

So here I go, come along if you like.