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. 

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.  

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.