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.