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.

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