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.  

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.  

Preach it!

On the third night of three classes the topic at hand is labor support.  As a doula with hours of experience I find this night the most enjoyable.  I have lots of entertaining examples that get people laughing.  By our third night together everyone is more comfortable with each other and they know what to expect from me.  (I should say as a bit of a disclaimer here that my clients in classes are almost always married and heterosexual, so I am going to refer to husband instead of the more inclusive partner cause that’s my audience when I give this talk.)

About six months ago I found myself starting to talk about a little discussed detail of the childbirth process.  This detail is the opportunity for growth in a marriage that awaits the expectant couple.  When a husband and wife journey through a labor to birth together it is an opportunity for them to reach a new level of trust and intimacy.  Over the years of listening to women reflect on their births,  I notice this theme emerge.  Vital to how they experienced their birth is how their partner supported and responded to their needs.   It is the base on which her memory of labor/birth is built.  Women with short, easy labors whose husbands worried more about the thermostat than holding her hand reflect on the disappointment and abandonment by their partner.  Not the ease and gift of a short labor.

Fellow birth workers, is there anything more beautiful than to see a partner support and self-sacrifice to accompany their loved one through the long hard hours of work all to see the tears of relief at the birth of their child?  This gift is obscure in our culture. Though addressed in labor support information, it isn’t spoken loud enough in my opinion.

I am convinced now more than ever that the love and care a woman receives while she is at her most vulnerable is so important.  So I preach it.

“I’m gonna get a little preachy here for a minute guys.” Is my intro before I launch in.  “When your wife is in labor and birthing your child it is a rare opportunity for you as a husband to show her how much you love her.”  The men shift in their seats, but I’ve got their attention.  “When a woman is in labor she is vulnerable in a way that doesn’t happen every day.”

 I turn to the women then and say, “so let yourself be vulnerable, cared for, consoled. Give him a chance to care for you in a very special way.”  Back to the men, “no matter how nervous or scared you may be men, care. for. her.  Hold her hand, tell her you love her, wipe her brow, fuss over her, leave no doubt that you are present in that moment with her.”

 Then I ease in some humor, “Fellas I don’t want to hear tales later about how you slept on the cot, watched the baskeball game on tv, or played your DS.”  They laugh a bit and it eases the intensity of it all.  By now the women are pink cheeked and stealing looks at their husbands, reaching over to hold their hand.  It is working!  I am setting the expectation level high, I am speaking for her. What she wants to say but doesn’t know how.  I am a figure of respect and authority on the topic and they are eating it up.  Dramatic pause for a long breath…

“Often after a birth the husband holds a new respect for the strength of his wife, men I want your wife to have a new respect for you in how you love her.”  BAM!  a great closer.  “Okay, sermon over.”
*smile and sigh*

When I check in, the non-verbals are strong.  Smiles, glances across the room, sips of coffee in anticipation of what I am going to lay on them next.  They are listening and it is soaking in.

My presentation continues on with clear ideas of how to give this care that I have now led their wives to expect.

 The list is short and I’m no pioneer in putting it together:

1.       Listen to her 

2.       Talk to her 

3.       Be there for her

4.       Touch her

With each task I give examples.  I have a basket of “tools” that they can use.  A hot water bottle, fuzzy socks, lotion, chap stick.  Yep its that simple, “Really guys it’s the little things that add up over the hours.”  As I wind down its time to check in.  “So is this a job you are up for? Do you think you can handle it?”

And then we go around the circle and I have each wife tell us just what is it that your husband will do well at when it comes to supporting her.  Occasionally I get a blank look, one time the poor wife couldn’t grasp for anything- yikes.  I get answers like foot rubs, encouragement, sense of humor, “He will keep me from worrying.”  I can see his shoulders rise as he inhales confidence. 

I then turn to the men, “What is it your wife will need most from you?”  They smile, a chance to get her back.  The Amish are not fond of speaking of this kind of thing in front of each other.  They likely squirmed a little at what their wife was going to say about them.  Now it is their turn.  A listening ear, foot rubs, encouraging words, to just be there.  It’s blooming right in front of me, like an early summer peony, their awareness of the emotional task that lays before them.

I leave our last session together hopeful for the couples.  I am excited for all that lays ahead of them.  The hard work of it accepted and now the depth of the task laying before them better understood.  They are often more confident, comforted by the information and ready to face it together.

*Special thanks to Stephanie Price who formatted much of the content I use in class and graciously passed both the information and the opportunity to teach on to me.*

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.