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 

Ordinary

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

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

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

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

Let me give you an example:

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

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

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

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

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

And Ordinary really is quite nice.