Friday, October 24, 2014

Cleaning Up: My Checklist

Standing in front of her deep laundry tub, the cement floor beneath my socked feet is as cold as the frozen earth outside.  A ten gallon bucket full of dirty towels, a set of queen size sheets and night gown awaits my attention.  The battery powered lantern I brought with me casts shadows all around. Latex gloved hands work quickly to accomplish the task. 

Typical Amish laundry tub, wringer and spinner.
My post-birth laundering takes me to a variety of types of wash rooms.  Dark empty basements full of spiders with just a garden hose for water.  Bright sun filled, well organized and perfectly clean laundry rooms one step out of the main living area.  Vanity sinks that are too small to hold the bulky towel I am wrestling to rinse, without flooding the floor.  Bathtubs that cause my back to ache from leaning over to get to the spigot.  This folks is the adventure of home
birth.  Each set up different, most without electricity, all with their unique challenges. 

Have you ever doused a bloody towel with hydrogen peroxide?  It bubbles and foams like a mini volcano.  My boys would love this, well until they realize its birth blood. Cold water rinses out the blood, hot water for the meconium (black tarry baby's first poo) stains.  Tomorrow the new mama’s “maid” will come to help with the actual washing of this load.

My great great Grandmother Annie Kaufman tended the birthing and dying of her rural Amish and Mennonite community.  The thought of her distracts me, and for a moment we work side by side set to the task. Once spot cleaned, I scrub, wring out and set it to soak.  Treating all post-birth laundry is one of the jobs on my Birth Assistant check list. 

My other tasks following a birth?  You would likely guess things like tidying the birth room, cleaning and dressing the baby, restocking the midwife’s bag.  There are also clerical responsibilities of charting, filling out forms for birth certificate, and newspaper announcements. Sometimes I sit bedside and do some teaching- what to expect in the next 24 hours, how to care for the newborn and mother. 

One of my favorites is fixing the post-birth feast.  Pancakes, peanut and butter sandwich, reheating leftovers with a side of fruit, yogurt and juice.  I regularly hear my fried eggs and buttered toast are the best.  My ego takes that with a grain of salt, almost anything will taste amazing after a birth.   

If you check my resume I am far over qualified for my job of cleaning, cooking and laundry.  Being over qualified though, doesn't make it less enjoyable.  My attention to detail allows a new mother and father to rest and enjoy their new baby instead of tidying the house. My extra set of hands gives time for the midwife to focus on the clinical postpartum details. A birth assistant is a part of a team.  A team with a worthy goal. And it makes all the scrubbing and soaking worthwhile. 

Wednesday, October 8, 2014

The Poisonous Bloom


Turning south out of her lane I asked Nina how she felt about the approaching birth of her third child.  The next five minutes fill with her anxious weary words. “I just don’t know if I can do it again, the baby seems so big this time, I’m older and so uncomfortable, what if it won’t fit.  I dread the pain.”

“But your second daughter’s birth went so smoothly, nothing like the first.” I calmly reflect.  Eighteen months after her first traumatic birth, a second daughter Hannah Joy entered the world.  Hannah’s arrival was peaceful, calm, hard work, and victorious.  Nina’s second birth gave her a taste of how birth should be. So why was she still feeling such worry and doubt? The shadow her initiation into motherhood loomed large in her mind.  A black inky seed planted by Doc at her first birth, continuing in poisonous bloom. 

Nina’s fears trigger my own flashbacks from that first birth.  All of a sudden I’m no longer sitting in my parked car waiting for her to exit from the Chiropractor.   It’s five years since past now.  Seated side by side I drive my doula client Nina actively laboring to the hospital one county over.  Joe sits behind us, his face masked with false confidence.  Each mile traveled we are closer to the birth of his first child.

She labored patiently, opening about one centimeter per hour.  Her textbook progress pleased the nurse who checked in to adjust monitoring bands, smile for a few second and dash back to the desk.  Joe nervously tended to her needs. Walking side by side his arm around her waist, the powerful wave of contraction crested she leaned into him hard. 

By mid-afternoon the nurse pronounced Nina complete- 10 cm.  Nina was promptly saddled into the bed and encouraged to stay put.  After taking a few notes the nurse stated she was going to call “the Doc”.  “It is Sunday and I think he’s out fishing, I hope I can get ahold of him.”  She says more to herself than to us.

Turning to leave the room the nurse pauses with her hand on the door pull.  “Have her start to push.” She directs to me.  It was so casual the way she laid it there at my feet. The block I would stumble over and resent not seeing. This request to push started the official game clock.  A clock with a strict time limit, of which I was unaware. 

Nina was uncomfortable in bed, but didn’t feel any urge to push.  This natural urge referred to as “pushing pains” among the Amish, didn’t seem to come.  In my wisdom and experience it is best to welcome the rest a woman’s body takes at this point.  Rest because there is much work to come. 
I encouraged her to wait if she could and breathe through the contractions.  She was eager to push so we tried it a few times.  I could see she was at the threshold of the pushing stage, but just not quite ready to step over. 

Just the three of us in the room for that stretch of twenty minutes or so.  Joe holding one hand and I the other.  The nurse bustled back into the room dragging in the warmer and medication cabinet through open double doors.  “How’s she doing?” she asks as she bangs around the room her back to us.

“She’s doing well, getting good rest.”  I reply.  The nurse stops what she is doing and turns to me, “The Doc is on his way and will be up soon.  He wants her to be pushing.”  She directs me this time with more force and I begin to sense there is urgency in accomplishing this task. 

I’m in doula overdrive.  I coach her pushing.  The contractions are consistent and strong but only every 5 minutes.  She’s a “good pusher” as we birthy folks would say.  Strong, young and eager to meet her baby, she does good work, moving the baby lower with each push.  In this stage of birthing the baby’s soft malleable head is moving down in the mother’s body as she pushes.  Down through the boney opening of the pelvis, down through muscle and tissue.  Down during a push and sliding back in during her rest.  Two steps forward. One step back.

Normal.  Totally, absolutely normal.

Doc blusters into the room.  Camouflage pants and a grubby t-shirt.  His chubby short hands are rough and ugly.   He is only interested in the nurse’s assessment of the situation and addresses all communication to her.  No acknowledgment of my presence- I can handle that.  No acknowledgement of his patient- this irks me.  Look your patient in the eyes when you ask how she is doing!  Stop and shake the hand of this father to be who trusts your hands to safely deliver his first born.  Your ugly hands. 

He looks over the computer printouts of contractions, gathers his information from the computer display instead of the patient.  Gruffly he turns and exits the room.  I reach out to the nurse, who seems quite accustomed to his manner, to translate what just happened.  What can we expect?
“He’s going to change and scrub up.” She says busily preparing a sterile set up for the birth.  Drapes, spotlights, all manner of routine ridiculousness occupy her attention.  I am so glad I am there to look Nina in the eyes: to encourage her, to breath with her. 

Doc re-enters the room looking like one of Snow White’s dwarfs decked out in sky blue scrubs.  Directly he proceeds to do a vaginal exam.  Broadcasting his assessment without fanfare,  “That baby is too high up in there.  How long has she been pushing?” he asks the nurse who has now perched herself at his right hand.  She looks over the computer record to find his answer. 

“Only about thirty minutes.”  I say.  And for the first time doc turns and notices me sitting to his left.  “And WHO are you?” he is nearly snearing. “I’m her doula, and she’s only really been pushing about thirty minutes.” The nurse interrupts from the computer station across the room, “She’s been complete for an hour now- so pushing for an hour.”

“Unacceptable, she can’t do this,” doc grumbles under his breath.  I try again to interject that this labor is progressing at a normal rate and she HAS made progress in her half hour of effort. He doesn’t even turn his head to acknowledge my input. 

“Get the vacuum out” he says to the nurse.  My stomach lurches- this baby is way too high to get a suction cup on her soft head.  Would he really use it now?  She has time yet, the baby shows no signs of distress.

But she doesn’t have time.  The game clock, set and marked by Doc has run out of time.  The details of what transpired in the next 20 minutes include but are not limited to inappropriate clinical application of vacuum suction to an infant’s scalp, violation to the integrity of mother’s vagina.  Actions causing permanent emotional and physical trauma for this new mother, father and infant.  It brings tears to my eyes to this day, what I witnessed him do to her. 

When it plays over in my mind, like all traumas do, I am watching-frozen in disbelief. Washed with guilt I am unable to intervene or change the outcome. Frozen. Powerless. Afraid.

Janae Lynn 9 lbs 6 oz was pulled from her mother’s body around 5:35 pm that hot August Sunday.  She entered the world with a large purple/blue bruise on the top of her head.  This bruise remained inflamed and swollen for her whole first week.  Ripped open and then roughly repaired, her mother Nina had been initiated into motherhood. According to doc- this is just the way it is.  Unfortunately, he speaks his truth, this is how Doc does birth.  How many hundreds of times has he done this to Amish women over the years?  Women who trust his authority.  Women bound by their religion to turn the other check, leaving him protected of any legal repercussions from inappropriate and irresponsible clinical actions.

“She’s such a big baby.  It was so hard for her to fit through.  It may not work out so well the next time.” Doc says, finally looking Nina in the eyes.  Addressing the pale faced new father, “You saw how hard that was for her?  She wouldn’t have done it without my help.”  Doc is gloating.
I want to kick his shins, push him down, scream and yell, pour out justice for the violation I had just witnessed.  But I didn’t, couldn’t.

Nina exits the Chiropractor’s office waddling up to the passenger door and I return to the present moment.  Sunshine pushes through the windshield, yet the dark trauma of Janae’s birth hangs onto us both.  Our drive home is made in silence.  

Nina birthed her third child today.  He was welcomed into the waiting hands of a midwife at our local birth center.  I was not there to witness her victory, but tears come when Doris’s mom calls to tell me “It is done.”  She worked hard and she pushed out a 10 lb baby boy!  Several hours later, Doris calls me while I’m driving to town.  Her weak voice reports, “He is here.  It was A LOT of work. And I think this is it for me.”  Still tired from the task, reeling from sleep and blood loss, she isn’t celebrating yet.


So I celebrate for her.  The brilliant noon sun resonates off the yellow and orange maple leaves as I pass.  Appropriately bright, hopeful and celebratory color and it fills me with light.  I needed her victory too.  I needed to remember that there are providers that CARE about their patients.  That a woman’s body is capable of the task, that dignity and respect for a mother during her birth is not too much to ask.  I anticipate the moment when I will hold this “buster” of a baby tonight.  Ten pounds of celebration, wrapped in a sweet cotton cloth.  Nesteling him in my arms, I will hold him close.  Touching his soft dark hair I will whisper pray for his mama and hope of her healing.