Betsy, where have you been?

It's been awhile since I've posted.  My productivity has shifted to another project for the month.  I am busily working to rise to the challenge of writing 50,000 word first draft of a novel in the month of November.  This is a world-wide event, sponsored by NaNoWriMo.  Check out their website at: www.NaNoWriMo.org

As you may guess my novel includes birth stories! Its a non-fiction piece about a doula struggling to deal with the grief that childbearing years bring. Hmm, wonder where I got the idea for that? There is lots of other good stuff too, but only being half way through I can't give a more detailed summary.  Because I don't know all the details yet.

It's been hard to resist the urge to blog.  My pending file (not a literal file) holds the birth story of my grandfather, born at home in rural Illinois in early 20th century.  So hard to resist writing it.  But I must focus and be disciplined to reach my goal.

Thanks for understanding and for your support.  Blogging has given me the confidence to see myself as a writer and take risks. I've come a long way in one year.

Listener's Commentary on WVPE 88.1, our local NPR radio station, will play another one of my essays on Monday December 1 at 7:30 am and 12:30 pm. Tune into to hear it. This one is a story from my early years of doula work  with Maple City Health Care Center.

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. 

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.  

Unmarried Amish Teen Childbirth Class

Unwed Amish Teen

That happens?  A bit of clarification on that.  The women I refer to grew up Amish and are suspended in the stage of development called Rumspringa or “ Running Around”.  This tradition among the Amish community begins when an adolescent turns 16. During this time teens are free of all the rules and regulations of the church.  They live at home with their parents but are free to do as they please. The idea behind the practice, is that giving freedom allows the individuals to experience the “world” to better prepare them for the choice of baptism and joining the Amish church.
 The liberated teenagers experiment with driving, alcohol, technology, popular fashion, and sex. There is a continuum of how extreme this experimentation is lived out. Technically these pregnant teens in my class are not Amish.  But culturally they are. So “Unwed Amish Teen” is the term I use to distinguish them from my other students.   

What: One night Childbirth Prep Class

When: August 18 6-9 pm

Where: My basement family room

I busily prepared my home to host this group of unique expectant parents.  Looking at my housekeeping through the critical eye of an Amish woman I eliminate the kitchen counter clutter, sweep the carpets, and clean the mirrors. 

I arranged the furniture in my basement family room so that the two couples could see my marker board and the television.  DVD player queued up by my 11 year old son, materials assembled, content organized I was prepared for the evening class to arrive.

It’s 6:02 on my iPhone screen.  I anticipate an early arrival common for the first night of childbirth class, not so tonight. Two buggies slowly made their way thru my cul-de-sac and to the neighbor’s hitching post.  Relief!  They didn't back out. 

Forty seconds later my relief flopped into the pit of my stomach and became a ball of nerves.  Each buggy held a couple.  One is a young couple dressed in the Amish garb, she with swollen belly and he clean shaven baby faced- an overgrown boy.  Exiting the other buggy is a mid-life Amish man with beard and suspenders. As he ties his buggy horse to a nearby tree, his wife climbs down. Clearly they are not the other expectant couple I was anticipating, but the parents of the pregnant teen. 

I paced back into the kitchen where my husband and three children were finishing up their supper.  “There is an Amish dude with a beard and he looks like he is 40, and he is coming up the drive.”  My husband and children stared blankly back at me, they don’t understand my agitation. So I try again, “Her parents came along!  The teen mom, father of the baby and HER PARENTS- her AMISH PARENTS!” 

*Deep Breath* “Its okay Betsy, you know your stuff, if you act comfortable and calm they will be to.  This doesn't have to be a disaster.” the pep talk flashed through my mind. 

Another deep breath and I was out the front door to meet them coming up the sidewalk with a smile and welcoming handshake.  Upon introduction I remembered that it was the mother that had called to ask about the class on behalf of her daughter. She had even asked if she could come along as she would be the one supporting her daughter during the labor and birth.  Stupid me, it should have been obvious that if the mother comes the father would come too.  Amish women don’t go to meetings without the accompaniment of their husbands.  I shouldn't be so shocked that they actually did show up. Still this is a first for me.

We stood on my front walk introducing and small talking, waiting for the other couple to arrive.  As I visited with the parents, over their shoulder I noticed a beater car driving a bit too fast down the road.  He hit the brakes, spun a cloud of dust and managed to come to a stop safely in my drive. Now this, this is much more what I was expecting.  The driver stepped out dressed as a traditional American teen: jeans with holes, an Under Armour shirt, and a swoop of blond bangs across his face, cell phone in pocket.  His passenger in the car, Jolene, stepped out in a lovely bright blue Amish dress and bright white covering.  Her carefully sculpted eyebrows framed her matching blue eyes. When she smiled I saw her teeth were as white as her covering.  Her tanned face glowed with a touch of the end of pregnancy puff in her cheeks.

We all filed past my family now done eating their supper and clearing the table, to the basement.  I quickly arranged more seating and grabbed a few extra books.  Surprisingly they visited with each other with ease.  The presence of the older couple seemed to set me on edge more than the others.    

I start out with my large posters displaying the magnificent uterus containing a growing baby and begin to explain the intricate details of placentas, amniotic fluid and mucus plugs.  As I teach,  I make an effort to make eye contact with everyone individually.  Eye contact or lack of gives me a good feel for how comfortable they are with the content.  Are they tuned in and invested or grossed out and uncomfortable?  When I lock eyes with Jolene she stops me and asks me some detailed questions about the working of the placenta.

  –"YES!  She is with me here.  So I have at least one person tuned in", I think.

 Next I glance up to see the parents nodding and looking at each other and smiling.  The father shares how helpful it was for him to take a childbirth class when they were expecting their own first child 18 years ago.  “I have always been grateful to understand how it all works.”

  -"Sweet Jesus- I never get this much affirmation or dialogue with my other groups of properly married folks!" Does my smile give away my excitement? 

As I rolled through the anatomy of pregnancy and birth it became obvious the fathers of the baby were both extremely uncomfortable.  The sweet teen boy with swoopy bangs gives me a shy smile when I make a joke about not passing out when the baby is born.  The second teen father has removed his flip flops and is spinning himself side to side on my office chair, the booklet open in his lap and his eyes glued to it. 

-"This guy- Baby daddy #2 does not want to be here, and likely does not want this baby.   I’m too quick to judge him. Too harsh.  Really, how would I feel attending a childbirth class with my future father-in-law?  He needs grace.   I’ll get him to make eye contact with me and smile yet.  We've got two hours left." It's surprising how my own inner dialogue ticks along as I teach.

The words are rolling out of my mouth now.  Like muscle memory I can explain the dilating and thinning of the cervix without even thinking.  I've got the silly putty out, a warm humid room makes it challenging for me to keep it under my control.  My baby doll in one hand the silly putty cervix in the other, I apply a 4 cm dilated cervix to the crown of the baby’s head.  Working methodically through the progression of contractions and changing cervix I can’t help but notice that everyone in the room is entranced in what I am saying.  All but baby daddy #2.  Still barefoot, he has turned his chair away from me and is facing his girlfriend on the couch beside him.  Her right hand is extended and touching him on his knee. 

-"Hmmm, maybe things aren't so bleak for this couple after all. Wish I had a chance to get the back story- are they in love? Is he good to her? Will he support her once the baby is born? Do they plan to get married?", I'll likely never know.

“And now it’s the moment you have all been waiting for….the birth video.”  New level of awkwardness- the next 10 minutes these three couples will sit before my large 46 inch tv while a woman moans and sways through her labor.  Although the laboring woman is moderately dressed, she will be pushing a baby out of her vagina- while we watch.  My students tolerate the scenario well.  The grandparents-to-be, who I am sure haven’t ever watched anything on a screen this big, appear to be fascinated with the unfolding birth.  On my right the boy with the blond swooping bangs is a bit pale, but holding his girlfriend’s hand.  Flushed cheeked and sipping her ice water his girlfriend has a solid grip on his hand. 

Baby Daddy #2 noisily crunches his pretzels as the woman on the screen slips into the tub of water ready to push out her baby.  He is swaying again the way my 4 year old does when he sits in a swivel chair.  Left to right, back to the left- without even knowing he is doing it.  He feels me watching him, slows the swiveling office chair to a stop, but doesn't dare make eye contact. Still crunching pretzels.

-"I see why her mother is here tonight and planning to be the labor support for her daughter.  Baby daddy #2 is not up for the task alone. I wonder how characteristic this kind of family support is during an unexpected teen pregnancy?", I've seen this video a hundred times its a nice break for my voice. 

Drawing near to 9 pm it is time to wrap up.  Question and answer time rarely takes five minutes.  The grand-dad to be expresses his awe in all we have discussed.  “We attended a class when we were expecting her (touches daughter’s elbow) and have four children- but I still learned a lot tonight.” Smiling he turns to his wife.  Holding his gaze she adds, “It has been so long since I've thought on birthing.  This will be so helpful for us when her time comes.”  Leaning forward her gaze lands on her daughter’s swollen belly and smiles weakly. 

-I'm glad they came, somehow their presence added an ease to the group vibe. 

“My mom had 13 babies, many of my sisters have children already-so I thought I knew about birthing.” Says Jolene the Amish maiden dressed in blue.  “But I learned a lot and it makes more sense.  I’m not so scared now.” Her boyfriend, still holding her hand smiles at me and at her but doesn't say anything.  Later on he speaks his first and only words to me as he pays me with a crisp bill.  “Thanks for having us, it was good.”  

As the September days pass I instinctively look to the Birth Announcements in my local paper scanning for their names.  I expect a text message birth announcement from Jolene.  I'm disappointed, I never did get baby daddy #2 to make eye contact.    

The Last with Laura

Remember that feeling during your senior year of high school, the urgency to treasure every last?  The last pep rally, the last home game, the last bonfire- so much effort to remember and preserve the moment.  The last before everything changes.  I feel a bit like that with my birth work.  I am in the home stretch, closing in on crossing a threshold.

When that 4 am call came, “Can you come?  She is laboring and it will soon be time.” I knew I had to go.  It is one of these lasts.  Not any different than the other 30+ times in many ways.  Sweet Amish couple working to welcome their first child in their home with my favorite midwife.  I couldn’t, wouldn’t say “NO”. 

It was dark still on my early morning drive across two counties.   The roads full of first shift factory workers reporting for duty.  As I pulled into Earl and Eva’s Bremen home the spectacular sun was just breaking over the trees.  When I looked back to the east, the farm fields and silhouetted treetops softly wrapped in a low fog. The sun pushing up, orange and yellow- the new day arriving.  I stopped and took a picture.  Because that’s what you do when it is a last, capture the moment.  A perfect symbol for how I was feeling. 

The midwife greeted me with gratitude for my willingness to leave sleep to come help her.  Weariness hung on her like a soft t-shirt.  “This is my third night birth in three days.” She says with a palm to her forehead and a sigh.  I’ve worked with Laura long enough to know what this means.  My role at this birth will to be the fresh eyes, the active hand (or in this case foot) holder, the energizing encouragement for both the midwife and the birthing couple. 

Once briefed on the setup of the home and the progress of the client’s labor, I took some time to listen to Laura catch me up on all that she’d been doing for the last few days.  I am her Listener.  I have been for years, but not until recently did I realize how important a role it is for us both.  I love to hear the inner workings of her job, the agony as well as the joys. It makes me feel connected still to the clients and birthwork that seem to be drifting away from me.

Laura needs a Listener.  She has a wonderful group of friends and family that support her, I don’t mean to say I stand alone.  But I think I am different.  I know the clients, I know birth, the local culture and religion and I know Laura.  For seven years I spent 8-12 hours a week working for her practice.  During that time I had many opportunities to observe her at her best and worst, and all that is in between.  Words cannot express what I have learned from Laura.  Medically she is so sharp, spot on in her intuition and decision making.  Not afraid to tell her clients the truth of their situation even if it is not what they want to hear.  I love to hear her processing through a client’s care.

Sure she has a rough exterior.  Those of you who have had a 3 am conversation with her know she can be a bit short and gruff- ok not just at 3 am but any old day.  But what others don’t see is that underneath that tough shell she has such a soft heart.  She loves us.  The women she serves, the women that work along side her, the babies she holds.  She loves us all.  And I fear the price of that love is so high. 

A midwife’s life is often glamorized.  Saccharine sweet moments of welcoming new babies mixed in with her role as protector, guide, friend, and confidant.  It is no wonder midwives often are put on a pedestal, worshiped.  A midwife plays such an important role in the life of a woman.  She is the one ushering her through the pregnancy and birth.  And while there are many wonderful moments dreamy and ideal- there are also long lonely times, difficult decisions, bad outcomes, clients that text and call intruding into her personal life, all-consuming responsibility and a never ending list of client’s needs.  By the nature of this job, one can easily lose their footing and find themselves in need of some serious time off. I understand her need to make a change.

We are all perched on top of a cushy queen size bed.  I am sitting on my knees in the middle of the mattress at the mother’s feet.  Laura sits on the edge of the bed, head down in her hands resting until the next contraction.  The mother and father are huddled together at the head of the bed.  Her eyes are closed, their hands clasped together but relaxed, waiting. The contraction takes hold, mother tenses breathes-relaxes and then pushes.  Laura and I each hold onto her feet, helping her curl around her belly.  The bed is made up in anticipation of the birth, a waterproof plastic drop cloth covers the mattress under the fitted sheet.  It shifts and crunches with our movements. Once the push passes, the mother flops back onto her pillows and we all resume our waiting. 

At that moment I take a mental picture, all in our places waiting.  Laura so tired, so ready to sleep, yet patiently waiting.  Eva unsure and exhausted, sweating and glowing with Earl by her side.  And me, fighting the nagging notion that this may very well be the last time I am privileged to assist Laura at a birth.  Soaking in the moment, breathing gratitude for all I have learned about midwifery, birth and myself in my relationship with Laura.  Holding the moment.

Sure enough the moment passed.  Baby girl was born.  I made coffee and eggs.  Mom nursed baby.  Laura slipped up stairs to sleep.  I cleaned up.  Everyone stable and satisfied I left.  I drove home.  I cried.  I know it was our last.

When your client lives with abuse....

Within minutes after stepping through her front door, I felt it.  Stifling static tension, he sits in his leather LazyBoy watching soccer, not taking his attention from the game as I enter. She noiselessly, gracefully moves around the room as to not disturb him.  Ushering me into her bedroom for our prenatal doula meeting, no mention of her husband stoically sitting in the other room. 

She didn’t reveal and I didn’t ask at that first meeting. I knew something was amiss between them.  I didn’t get it all put together until my postpartum visit in that same bedroom 5 weeks later.  Mari’s husband, hits her, belittles her, shames her and ridicules her.  His abuse is as long lasting as it is painful.  Mari has three daughters with him and this birth brings their fourth child, first son into the family.  She is in the midst of a long and secretive process of getting protective immigration status so she can free herself from her husband’s control.  In the mean time she endures his abuse.

Once Mari is settled into the labor and delivery room he begins to complain about how cold his feet are. Five minutes pass, and he is excusing himself stating his feet are just too cold- he’s headed home to change out of his sandals and will return soon.  He lives 3 miles/10 minute drive from the hospital.  His son entered the world 15 minutes after the cold footed father left the hospital.  Aamazing considering she was 4 cm with “lazy” contractions every 7 minutes when he left.  It was the fastest labor I had witnessed.  The OB nurses were quite surprised.

It was as if her body hurried to birth the baby while he was gone.  Maybe he left on purpose as to give her this space? I’m not sure he is that sensitive or perceptive.  Was her body tuned into some kind of instinct that protected her birthing from his intimidating, dominating, demanding presence? I’ll never know.

Yessica is a client I met through the neighborhood clinic I worked for as a contract doula.  Prenatally the clinic informed me that she having a baby with an abusive boyfriend.  Yessica and I spent lots of time prenatally discussing her relationship with her boyfriend and her wishes for his participation (or lack of) during the birth.  She was clear, he was not to be present.  The physician agreed with Yessica that it would not be safe for him to be present for the birth.  The plan was to alert security once she was laboring at the hospital as to keep him from entering the labor room, all parties agreed this was the safest and preferable plan.

After three hours of active labor at the hospital, Yessica begins to give up on herself.  I am pouring myself into supporting and encouraging her.  With each passing contraction she grows more and more pathetic.  The physician enters the room to observe her status.  Noting her distress, he stays to provide support.  It becomes clear Yessica has decided that she cannot and will not do this.  She wants help, is crying for help, begging really.  But not accepting anything we offer.  It reminds me of my toddler throwing a fit.  She is rude, loud, demanding and dramatic.  All her energy goes into her protesting and fighting her labor, making it all the more painful.  At one point she is combatant, swinging and clawing at me when I try to hold her hand and encourage her further.

As things escalate, a nurse informs us that her boyfriend is waiting outside the room and wants to enter.  He has charmed his way past the front desk and is pleading for a chance to enter the room.  The physician quickly exits to talk with him outside the door.    As I anticipated there is drama that distracts us all from the process of this labor and birth.  As a doula I am concerned for my safety.  

Stepping back from the scene, I realized she is playing the role she always does.  She made herself the helpless, victim to be pitied and rescued.  Miraculously her body continued to labor effectively opening and pushing even despite her best effort to fight it.  Within minutes of the baby’s birth the boyfriend entered the room, as agreed upon.  Yessica became a different woman.  She nuzzled into him, glowing with accomplishment and hungry for his affection.  It turned my stomach.  I felt so much sadness for this little family. 

What is a doula to do in cases where abuse is suspected/confirmed? Ignore or inquire?  Pity or probe?  The social worker in me wants to get the details.  I want justice. I want her to be protected, for her to heal and to know her worth and stand up and leave.  And it is not just her I worry about, but her children as well.  Leaving an abusive relationship is a move that takes time, support, resources and planning.    

There is a cross cultural element to be considered.  Culture and religion can make it even more difficult for a woman to break out of an abusive relationship.  For so long they accept his control, his power over them.  They feel shame, blame for their situation.  Religion tells them to trust, pray, forgive and forget.  Not addressing the need for protection, healing and separation.  Culture tells them he has the right to be controlling, to treat her how he wants.  She must be an attractive, attentive and passive mate; or he will mistreat her or stray.   

To answer my own question I think it is responsible of the doula to report any abuse she witnesses if there is physical evidence of abuse (bruises, scars etc).  Often it is not that clear or reportable.  Start with asking her questions, build on the rapport gained through the labor and birth. Don't ask if you aren't willing to do something with her answers. Follow up with her health care provider.  Give her information on resources, community counseling, woman’s shelter etc.  If nothing else, use the moments of empowerment and victory from the birth to reinforce her strength and power.

Both Mari and Yessica were already connected to services in the community.  They knew there was a problem, looked for support, and connected to professionals that can help them.  Unfortunately, even with education, support and counseling they still are in ongoing relationships with men that treat them horribly.  Abuse is a bondage that is challenging to break free of.

As I write this I realize that with Amish women there is a huge barrier to accessing these same services.  The Amish church’s patriarchal system handles transgressions internally.  There is a process of confession, repentance, and forgiveness- then silence.  There is no divorce; there is no leaving unless conditions are proven to be severe or highly dangerous.  I am frustrated at the lack of protection for the abused women and children in the Amish church.  Is there opportunity for counseling, sorting out the abuse and healing?  A chance for a fresh start, and new self-worth?   Where does the cycle of abuse end when children grow up with it?  How does it carry on to the next generation?

When it comes to abuse, I wonder is my little bit of love and encouragement enough?  Does an empowering birth where a woman is respected and protected make a difference?  I’d like to think it can. So doulas, midwives, doctors, nurses, model respect for her and birthing power. Give her a safe place to bring forth life.  Pay attention to her needs, work to earn and keep her trust.  Empower her in every little detail and pray that it will ripple into her life beyond the birth.

Two Brothers and Their Mother

My pay per minute cell phone rings at 2 am.  It is Cindi calling, her voice is soft and tired. She is calling me, her doula, for moral support.  She’s been uncomfortable for a day or so with contractions every 10 to 15 minutes.  Unable to sleep she is desperate for the contractions to either stop or really start in earnest.  My Spanish is fairly choppy at this hour of the morn, but I am able to reassure her that this long start is fairly normal. 

Carlos, Cindi and I walk up to the nurses’ station as the sun comes up.   The fresh faced nurse welcomes and shows us to the room we will be spending the day labor and birthing in.  Cindi immediately gets settled in bed, her contractions irritate her every five to seven minutes.  The fatigue and lack of strong/close contractions has me worried we are in for a long one.  Carlos is fluffing pillows, stroking back her loose curls, sitting on the edge of the bed.  He can’t get close enough.  Her discomfort is obviously unsettling for him.

As I watch Carlos care for his wife throughout the day, I see his love for her manifested in tangible ways.  So genuine is his focus and attention on her.  Sitting in the closet size bathroom as she showers, his muffled words of love and encouragement slide out under the door.  As she walks he guides her from table to bed to window and table again, circling the room.  Cindi’s cervix is held up at 7 cm for hours on end.  Carlos’s attention is not smothering or controlling, but sweet and soft.  I perch myself in the upholstered chair in the corner of the room, an observer.  My hands are not needed in this labor.

Nose buried in a cross word puzzle, I give Cindi and Carlos their space.  Attentive with a sharp ear, I add a word of encouragement when needed.  I am in awe of the instinctual way Carlos cares for his wife.  Up to this point my experience with Hispanic partners has been very different.  A culture that values macho men who guard their emotions in public often makes it hard for Hispanic men to feel comfortable in a birth room.  He has not once put his own interest or needs before hers, something here is different. 

As I work my puzzle I realize this scene is oddly familiar.  Two months prior, in the same labor room, another couple birthed their second child.  It is a few days past Christmas and Guadelupe’s labor is going faster than she can keep up.  Her handsome husband Marcos is sitting in bed with her upon my arrival.  Her eyes are closed, head cocked to her left resting on his shoulder while he holds her.  Their calm appearance is a façade, fear dwells just under the surface.  This is the second labor and birth for Marcos and Guadelupe.  Their first child, a son, was stillborn: lost to an accident with the cord at 34 weeks.   They now face their biggest fear, hoping that within hours their baby will cross over into their arms alive.  I notice we are not alone in the room.  Sitting by the small table with her hands folded in her lap and a soft smile on her face, a grandmotherly Abuela (Spanish word for grandma) waits.

Guadelupe moves into advanced labor and starts to stir in bed.  Abuela steps in behind her son, Marcos,  whispers something in his ear and he moves aside.  Abuela pours comfort and compassion on her daughter-in-law.  Speaking in a Spanish motheresse she expertly rubs over her back, down her legs.  Marcos looks to me and smiles shyly watching his mother in action.  All the sudden I find myself within a moment so full of love I am overwhelmed and have to step out of the room. 

I return to find Guadelupe soothed to sleep in bed.  Abuela returned to her chair by the table, her son Marcos sits in her lap enfolded in her embrace.  How a grown man still fits into his mother’s lap is beyond me.  I felt as though I was intruding on a private moment.  His head resting on her shoulder softly talking, Marcos, did not seem to mind my presence. 

Within the hour Guadelupe and Marcos welcome a small but healthy baby girl into the room.   A joyful exuberance of tears fills the room.  Abuela wails with relief at the sight of the first girl born to her family in two generations.  Marcos and Guadelupe hold each other and weep as their baby Natasha screams pinking with new life.

I turn to up from my puzzle as Carlos comes out of the steamy bathroom.  “No me aguantes (I can’t do this anymore),” comes wearily from behind him.  Cindi, hair dripping from the shower, is moaning and swaying against the bathroom sink.  Carlos’s weary look communicates his hope that after 7 hours of lazy contractions and no progress finally something has changed.  Just at that moment, the door to the hospital room opens, in walks Abuela!  As all heads turn, she greets us with a gentle loving confidence.  Her smile seems to say, “Its ok now, I am here.” I sense the relief from Cindi and Carlos. 

Abuela, as it turns out, is the mother of both Marcos and Carlos.  I felt sheepish I hadn’t put it together earlier.  How had I missed the similarities:  handsome brothers, both so caring and selfless with their wives, obviously influenced by this strong loving matriarch.  Just as she did before, Abuela enveloped her children with love- providing a much needed boost in morale.  Once settled, she noticed me sitting in the corner, and greeted me with a hug as well.

The matriarchal family structure is a cultural feature I studied in college.  However, I had never really seen it lived out in quite this way.  I will never forget the last scene in the birthing room.  Within the hour following the birth of Cindi and Carlos’s baby boy, the whole extended family assembled in the room.  Abuelo (grandpa) and Marco’s family with baby Natasha had all been waiting in the lounge down the hall.  I faded into the background as Abuela introduced the new baby boy to his grandfather, aunt, uncle and cousin.  More tears and celebration, blessings and prayers of thanksgiving, and of course hugging.  Abuela is the queen of hugging.  My favorite photo from that birth is Abuela seated in the rocking chair with her grown sons on either side, their arms around her shoulders.  In her arms she tenderly holds her new grandson.  

That annoying client that you just can't seem to like...

A doula is a trained professional labor coach.  Characteristics like patient, kind, compassionate run the top of list when looking for a good candidate.  I meet that criteria, my personality is well suited for tense situations, able to live through the unknown moments with others.  But I’m human and I have moments where my client is getting on my last nerve, the doctor is obnoxiously demonstrating he holds the power, when I just want to punch the father of the baby in the face.

The first time I really struggled to like the client was in my early years of hospital doula work.  This mama was a young woman, 19 years old.   I stepped in to cover for the primary doula who had already been in attendance for 18 hours.  The day prior, the mama arrived at the hospital barely in labor.  Her bag of waters broke at home and she checked in at the hospital within the hour.  No contractions. No labor.  Her doula, a newbie, was eager to attend a birth and so arrived early as well.  They spent hours in the room visiting, watching TV, waiting for the contractions to start.  As evening set in her contractions started on their own.  The contractions grew in strength and crept closer together through the night hours, keeping her from a restful sleep.

Upon arrival I discovered my young new mama client to be in a foul mood.  In the beginning I felt genuine compassion. I introduced myself with a bright smile and reached out to touch her shoulder.  She tensed under my hand and felt cold to my touch.  I noticed her eyes were freshly lined with black eyeliner, her long smooth hair in place, dressed in cute tight yoga pants and even tighter tank top.  Her basketball belly looked as though it would pull her 100 lb self forward and onto the floor. No ugly hospital gown for her. The primary doula clued me in that this young mother was alone, father of the baby an older married man would not be showing up to support her during her birth.  Again I was full of compassion, what a lonely place to be during an intensely vulnerable experience.

Soon the doctor ordered Pitocin be administered to bring on stronger contractions and active labor.  It took three nurses about an hour to start her IV.  With every anticipated needle stick there was drama, wailing, delicate rivers of eyeliner streaking her cheek.  And so I doulaed her through it.  I used all my tricks to calm her: holding her, encouraging words, distraction, relaxation, visualization- she quickly drained all the compassion from my heart.  “Good Lord,” I thought “if she can’t stand to get an IV how is she going to deal with the coming labor?”  Finally the queen bee nurse came in and took charge.  A motherly figure, all business and expert at both starting IV’s in tricky veins and handling a whimpering patient, finally successful with the IV start.  As the nurse left the room, she turned to look over her shoulder at me.  She gave me a knowing glance and with a sigh, “Good luck in here, you’re gonna need it.”  Fortunately the client spoke only Spanish and didn’t understand the nurse’s words.

The contractions swelled from loosely spaced mounds on the computer display to sharp peaked mountains every several minutes.  She was drowning, struggling to keep her head above water that was the pain.  Her lack of effort irritatied me. But I continued to give her my all.  Forced compassion, in soothing tones discussed how to get her through this experience.  She decided to get an epidural and as soon as she consented, she quit trying to cope.  Mama flailed for the next 20 minutes it took to get the anesthesiologist, signed consents and prep ready. 

With painful patience I held her as she had her final freak out.  Epidural meant more evil needles, she hadn't thought that far ahead.  After the IV experience I realized her fear of needles was real, no matter how illogical I thought it to be.  So with more wailing, an anesthesiologist’s harsh words and fresh kind nurse’s able hands we helped this mother receive the pain relief she needed to move through her labor. 

Once the nurse tucked her into bed, no longer feeling the crashing waves of contractions, mama closed her eyes and fell asleep.  Relieved, I left the room for a meal and some fresh air.  The surge of irritation and struggle to maintain compassion for this mama worried me.  Of course I had moments in other labors where it took efforts to step aside my own feelings to provide good care.  Somehow this was different.  I just didnot like her.  I hated to admit it to myself. I surely didn't want her to know or sense how I felt.  I spent extra effort compensating for my dislike.

For days following this birth I was haunted by how difficult it was to like her.  I felt shame.  This new mama so lonely, isolated, and young.  I understood why she acted so much like a child.  An unintended pregnancy leading to a life of increased obligation does not a joyful birth make.  Her life is so much more complex and difficult than mine. Did she sense my irritation, my effort to be kind and caring?  I'll never truly know.

This is a dilemma all care providers face from time to time.  As birth professionals it is our responsibility to process a our reactions. Self-reflection, honesty about our own prejudices and prickles lead to better self awareness and stronger ability to care for others. I know I am not a perfect human, or a perfect doula; but I don't want my imperfection to get in the way of giving competent care.

I 

Ten years since that first birth...you are invited to my party.

Evening is settling into the neighborhood.  Families are finishing their outside chores and gathering around the kitchen table to share a meal.  I sit at the stop sign exiting my cul-de-sac.  My daughter is sitting beside me.  She’s layered in a light pink hooded sweatshirt with her orange softball team t-shirt on top, her mit rests in her lap. We wait for the oncoming buggy to pass before I pull out.  A large gloved hand lets loose of the reigns and gives me an energetic wave.  His wife quickly peeks out of the side window, a 4x6 inch opening.  I can see her young eyes behind petite glasses and pointy nose.  She recognizes me and leans past the 7 month little boy sitting on her lap with a big grin and wave. 

“Another couple from your class?” my daughter sighs with slow exasperation.  “Yup” I say while returning the buggy greetings.  I glance over at my daughter, whose game I will miss tonight.  “They really like you mom, you must do a good job.” She comments.  In that moment I am reminded all at once, the price I pay each time I leave to do birth work and the gain in each new couple I connect with.  The cost and the reward.

Tomorrow is my ten year anniversary from that first life altering birth I attended as a doula,  May 7, 2004. Every year I pause to remember.  Writing it now it seems unreal.  Ten years.  I kept count for a while of all the births I attended.  By year three I’d lost track exactly.  If I had to guess now I’d say its anywhere from 150-200 births I’ve attended as a doula or midwife’s assistant.  I have only been teaching for three years, but I am closing in on 200 couples in my classes. 

This trophy is a treasured gift from a family that
 I was able to doula through both of their daughter's births.  

Last night as I waited for the caffeine and teaching induced adrenalin to drain from my body. I imagined- what would it be like if I could gather all these families together for one big party?  What would that look like?  Where are they all today? Do they remember me?  I decided there would be three distinct groups of people in attendance. 

*Disclaimer these are generalizations and not every family fits just perfectly into my categories*

The First Year Families: 

These are families I met through my work with Maple City Health Care Center, a low income health clinic in Goshen.  The clinic gave me as much doula work and I could stand those first few years of my career.  The families were Spanish speaking Mexican immigrants, living in a new place and far from their family support system.  It was such an honor to usher them through their births, buffering them from the healthcare system, comforting them when their mama or sister could not.  All these babies are now grade school students, ranging from third grade to Kindergarten.  I bump into these families at community soccer games, the county fair, chess meets and shopping at the mall.

Usually the mother and I exchange some shy glances trying to figure out “Is that who I think it is?”.  I am the first to make the move, to introduce myself again, sometimes I remember their names or the name of their child, but not always.  Recognition flashes in their eyes and a warm smile spreads across their face.  We are quickly reminiscing; she calls over her child and introduces them.  The timid and irritated child not fully understanding what the big deal is all about, flashes me a smile and “hey” and is back to the activity at hand.

The Mainstreamers:

This group of families is sprinkled through the years of my work. As much as I love working with people in other cultures, it is enjoyable to be with families “like me” as well.  Living in and around Goshen, alumni of the same school, enjoying comfortable midwest lives I feel an ease with them.  They drive family vehicles shuttling their kids to sports, the park, and school; balancing work and home life.  These families have means, strong partnerships and resources.  They are self-empowered, informed consumers of birth.  Working with these families allows me to utilize a different skill set.  During the labor and birth I work to honor their specific birth plan.  Partners are more informed about the process and participate intentionally in it. This informed and intentional aspect draws deeper meaning to the victory of the birth and welcoming of a new life.  Doula babies born to these families pop up in my Facebook feed- growing up before my eyes.    

The Amish:

If the Amish families I work with came to my imaginary party, they fill the parking lot with their family size “minivan” model buggies.  There would be several van loads dropping off the couples from the same neighborhood or same family.  A small herd of three and four year olds run about while their mothers bounce their still-in-arms siblings.  In reality, I encounter my Amish families throughout my daily life, neighborhood walks, local grocery store, weddings, and funerals.  Last winter I was on call for a very important homebirth 5 miles from my house.  On the verge of a huge blizzard, the forecast had me sleepless at night.  I soothed myself to sleep by counting in my head all the families between my house and hers that I knew from birthwork.  Families that would open the door if I knocked, families that would buggy me the rest of the way to the birth if I got stuck in the snow.  Would you believe it was 12 places between my home and hers? Twelve families who knew me, “Betsy Black, the lady that helps at births”.  What a blessing to know and be known by those around you.

Writing this impresses upon me that this is quite an accomplishment, this web of relationships.  This way of belonging to my community, to my neighbors; it is valuable.  Lately, I struggle to know where my professional life is taking me. The insecure question, “Am I doing enough with my life/with my gifts and abilities?”  creeps into my mind in quiet moments.  I struggle to defeat that insecurity.  Today as I celebrate at my imaginary party I am overwhelmed with the richness that birthwork brings my life and the value of my work. I am important just as I am.  My work matters. I am enough.

Practicing Relaxation: "It sounds like a barn full of cows in here."

It is dusk outside.  I stand in the middle of a large living room, pacing the linoleum floor.  The lights are turned down.  I hear some soft moaning, deep breathing, “owich” (Amish talk for ouch). My timer on my iPhone is running.  It has been about two minutes since I hit the “lap” button. There is giggling coming from all directions. Yes giggling.  A male voice moans like a cow calving.

You thought I was setting up for a birth scene didn't you?  It is actually the finale of my childbirth series.  The final night of co-ed classes where I work to get everything to come together.  I've been doing this specific “relaxation” exercise for a year now.  It always starts off with laughing and ends with snoring.  It’s the perfect way to wrap up our time together.

The purpose of the exercise is to get the couple actually doing/using the techniques for relaxation we discuss in class.  It’s simple and a bit silly, and it’s the activity they look forward to the most.

Supplies- Clothes pin (the kind with a spring that pinches), Sleeping bag, and pillow.

I give the following instructions: 

To the women: “Find a spot in the house to unroll the sleeping bag and lie down on your left side.  Remove glasses and coverings. When instructed clip the clothes pin on your fingertip or ear lobe.  This is to simulate a labor contraction, while having a “contraction” focus on breathing in slowly. I then demonstrate “In through the nose *exaggerated breathing in* out through the mouth *exaggerated breathing out.”  Try to relax and tune into the support your husband is giving you.”

For the men: “Get down on the floor beside your wife.  You are the labor coach and will be using touch & words of encouragement to help her through her “contractions”.  You are to tune into the tension in your wife’s muscles and use touch to help her relax. Get her feed back on what she likes, what works and what not to do. Remember relaxation will help her “contraction” hurt less.”

Once the instructions are given, places taken, the timer starts.  Contractions last a minute long with only a 2 minute break in between.  Part of the objective is to give them a feel for the rhythm of contractions coming regularly.  I travel from couple to couple observing, guiding, answering questions.

Roars of laughter erupt from the dark of the dining room where the class clown Larry and his wife are located.  He is speaking in Dutch so I don’t know exactly what he is saying, but I get the general idea.  There is groaning, fake moaning, he coaches “push push”.  They are all having a good time, and I like what I see.  The couple is communicating, talking about what it will really be like.  She’s giving a list of aches; his hands are kneading her stocking feet.      

I turn my back and walk to the other side of the house where a couple is crunched into the bathroom to avoid being seen by anyone else.  I hear them whispering through the door.  This is the quiet couple, the ones whose cheeks shone pink anytime I made eye contact with them during class discussions.  He reminds her to breath, together they inhale deeply. 

Halfway into the exercise the giggles have settled down.  Each woman rests eyes closed, smiling.  The husbands are hard at work rubbing the lower back, pausing to lean over to ask if it feels ok.  Once they have worked through the silliness they get to some quality relaxation.  And it’s almost visible the blooming self-confidence these men have in their ability to help their wives relax.  The wives are deeply resting, almost asleep by the end of the time, despite the regular “contractions”.

And then if that wasn't enough fun- we switch.  The men get to rest and get the massage, but also have to take the clip and have the contractions.  There is much posturing and male posing about how the clips do not even hurt.  The men start in again with the moaning and groaning.  “It sounds like a barn full of cows in here.” Larry says laughing.  The whole first floor of the house is full of racket.

But.

Once the timer starts and the wives start the massage, they settle in.  They can’t deny the effect that relaxation has on their being.  It becomes quiet.  One wife 33 weeks pregnant strains to reach over her belly to her waiting husband.  She decides she can’t quite reach both his shoulders so she will take them one at a time.  I remind the women, now the labor support, to seek the tense muscles.  I hear words of encouragement, “Good job now breathe.” She says in dutch to her husband who is sprawled out on the floor like a toddler at nap time.

Eventually we have to turn the lights back on, get up off the floor, and go back home.  

Keep screaming little baby girl

This pretty much sums up the feeling...

Pregnancy and birth analogies are helpful to me in my times of not knowing and waiting.  I feel restless lately in discerning my next vocational steps.  This prayer was given to me by a special mentor when I was at a similar crossroads years ago.  I find myself drawn back to its call for screaming and crying, speaking and breathing.  The images of darkness, waiting, participating in a process that changes me but is not under my control feel all to familiar.  There hasn't been much space in my life these last few weeks for reflection, writing or birth work and my spirit is feeling the effects.  I am posting this today to give myself a bit of a spiritual jump start. 

The Midwife’s Prayer

Keep screaming little baby girl.

Keep practicing using those lungs

And do not stop,

Because hollering will help

To ease the shock

Every time you go through

Another birth.

Practice squalling

So that your voice is clear and strong

When you speak,

And when your breath

Has been knocked from you,

Practice breathing small,

But do not stop

There are miles

Of blood vessels in those lungs;

Use every inch,

And know the voices

That run in those veins,

The voices that fill your breath,

That will inhabit

Your words when you speak

And your groans when you weep

And your mouth when you laugh

And your cries in nights of wild love

And your whispers when you pray.

So keep screaming, little baby girl,

Not for that warm, dark place you lost,

But for all the darkness

You will find inside you

That will need to be spoken

With words only you can say.

--Jan Richardson

In her pause. In her pace. In her own power it is happening.

I am waiting. Sitting on a hand loomed throw rug on the floor in front of her kitchen sink. The eighteen by eighteen inch ceramic tiles are immaculately clean.  There are no crumbs along the kickboard of her floor.  I checked.

She is sitting in the lotus position, naked, soaking in the warm water of the blue inflated birth tub that sits where her dinner table usually is.  Her thick brown hair is piled on top of her head.  Calm faced she moves only as the contraction builds.  Breathing with concentration she leans back and reaches for her husband's hands, all without opening her eyes.  It is hard to trust my sense of time in a space like this.  The last ten minutes feel like an hour, the last hours feel like just ten minutes.  

Arriving only for the advanced stage of labor, I should be fresh with energy.  But it is middle of the night.  She began contracting early this morning, labored calmly through the day cleaning her house. This is her first child and she is prepared to patiently wait and work through the process. 

As I left my house in the dark star filled night I texted the midwife.  “Is there coffee?”  The midwife’s reply, “She’s making some for us now.” 

I scroll to the previous text message received from the midwife, 25 minutes earlier that says, “Jenny is 8-9 cm! I just got here.  Whenever you are able, you might head this direction. J” Seriously? Transitional and still the hostess. 

Her husband later confirmed that she set the water to boil and quickly returned to the depths of labor giving him some brief directions on how to finish the process.  The coffee was warm and caffeinated, fulfilled its purpose.

We wait; the midwife, myself the birth assistant, the husband and mama each contraction taking its time.  She rests about five minutes between each.  I am reminded how hard it can be to wait for the body to birth.  Doing nothing sometimes takes more effort than doing something.  Her bag of waters not yet broken, cushions her baby’s head from intense contact with her cervix.  This makes for a more gentle rhythm of contractions.  In this case it also means slower progress, teetering on the verge of pushing for an hour instead of minutes.

Many practitioners would encourage intervention to “move things along”.  Breaking the water, coaching hard pushing, getting the job done in half the time.  Midwives and mothers entertain this approach, enticed by the goal within sight and relief to be done.  It is a sprint to the end versus the leisurely walk. This midwife discussed with Jenny and her husband the option.  They decided to wait. She enjoyed the rest between her contractions and was in no hurry. No sprinting needed. It is a leisurely stroll.

As I waited I scribbled down some notes wanting to remember these thoughts.  I wrote, “Really, it is happening.  In her pause. In her pace. In her own power it is happening.” So I waited.  An hour and a half later the baby was born.  

Wow that was close! I'm just the driver.

“Don’t push Lisa.  I know you want to, but I don’t think having your baby in my car is a good idea.”  I can see Lisa’s outline in my rear view mirror. She isn't sitting in the seat as much as leaning over it.  Maybe she is on her hands and knees.  She is swaying and trying hard to fool me that she isn't ready to push. We had been driving down the dark deserted county road for only a few minutes before I heard a change in her breathing. 

This is Lisa and Lamar’s second child.  I met them two years ago when they took my childbirth class.  She called me a month earlier and asked if when labor started I would take her to the birth center.  I teased her telling her she'd be better off having a home birth.  Her first baby came fairly quickly.  She replied she wasn't comfortable with a home birth. I scolded back she won’t be comfortable on the drive to the birth center either.  It is only 7 miles or so, but when one is in transition, on the rutted country roads it can feel a lot longer. My jesting didn't change her mind.

Lamar is in the passenger seat in the front.  It is 2 am on a pitch black night.  Must be a new moon because it is clear and cold, but there seems no light in the sky.  Five minutes with Lisa I can tell she is in advanced labor and will be having her baby soon.  I used my handy cell phone to call the midwife and alert her to the advanced state of Lisa’s labor.  The midwife was on her way to the birth center, but about twenty minutes away.  I asked her to call the birth center and have the nurse ready to meet us at the door with the wheelchair. 

Overhearing me, Lamar tries to hide his panic.  He is a dairy farmer, a leader in the church and a kind considerate man.  I am glad to know him well: confident he can keep his cool under pressure. He turns to his wife in the back seat, “Lisa how are you doing?”.  No reply but her breathing.  A  groan.  Lamar looks back to me we have 5 miles to go. 

My mind is all business now.  Lots of business to attend to. 

1. Keep reasonable speed

2.   Avoid pot holes and massive buggy ruts in right side of lane

3.  Prevent amniotic fluid and all manner of birth goo from getting on my car’s interior

4.   Is the minimalist emergency baggie of chux pad and gloves under my car’s seat going to be enough supply if the baby comes in the next few minutes?  How will I keep the baby warm on this January night?

5. How will I see what I am doing?  It is totally dark. (in an Amish neighborhood there are not street lights or large farm utility lights)  If I have to pull over into a drive to catch this baby, how will I see what I am doing? My car's dome light is weak at best.

I keep driving. I call the midwife again.  Update on status:  “I think she’s ready to push and we are still a few miles away.  How close are you?”  I didn’t even say hello. The midwife reassures me she is on her way as well and that she thinks we’ll make it.  The nurse on duty at the birth center is an older experienced nurse who is very good at managing a quick delivery.

My attention goes to the dark figure in the back seat.  “Lisa, I know it’s hard to do but please just keep your breaths nice and slow.  Breathe instead of push, we are almost there and they are all ready for us.”  Lamar responded to my coaching too by releasing his breath as well.  Poor guy, this scenario is a Amish husband’s number one worry (well maybe not number one, but in the top 3 for sure).

 

Seven long minutes later we pull under the overhang at the birth center.  The nurse is ready at the door with a wheelchair and a shield of confidence.  We three are so relieved to arrive at the birth center with the baby yet to deliver.  The nurses’ assessment is that Lisa is indeed ready to deliver the baby.  Her cervix is all out of the way, bag of water yet unbroken.  Midwife still en-route to the birth center I offer to stay with the nurse.  She accepts, knowing my skill set and my relationship with the patients will be of use if the baby comes before the midwife. 

Shifting into doula/birth assistant mode I wash my hands and assess the room.  Where are the supplies we will need when the baby is born?  Are the blankets in the dryer warming?  Lisa looks at me pleading from the bed where the nurse has forced her to recline for the exam.  “Can’t I get up?” she says as she reaches her arm behind herself to rub her lower back.  Teeth clenched and face wincing, she is asking the nurse for some mercy.  The nurse, older and more set in her ways is not sure she wants the mother mobile.

Lisa hesitates about two heartbeats before she is up and out of the bed on her feet.  The next contraction hits before the nurse can huff and Lisa drops to her knees on the cold linoleum floor. Swaying gently, her body is pushing. I can’t help but smile, I think the nurse notices my pleasure at Lisa’s disobedience.  Oh well.

Lamar has also transitioned into labor support mode.  His face has more color now, his shoulders less tense, he offers words of encouragement and love to his wife.  The midwife arrives, smelling like the fresh air of the night and smiles brightly.  “Ready to have this baby Lisa?” 

Within five minutes of the midwife’s arrival, Lisa is holding her squealing pinking slimy sweet boy.  Lamar stands firmly beside his wife with a huge grin on his face.  They whisper his name to each other and then out loud to us. 

Lisa for the first time that night, is back to her normal self.  Her eyes find me she smiles and says, “You thought we weren't going to make it, did you?”  She is teasing me, chiding me.  I love it.  “It’s the closest I've ever come to catching a baby.” I admit. “You would have done a fine job.”  Lisa says.  I believed her.  I pointed to the puddle of amniotic fluid and general birth mess around the room and said, “Really, I just didn’t want THAT all over my car.”  We all laughed, relieved that it all had worked out.