Every birth is a learning experience.
Some lessons are joyful discoveries; like when we arrive at the place of birth and my client is much further along in the labor process than we expected or we meet the nurse and we all feel an immediate connection. When the partner whispers, “I see what you mean by shift now,” as he observes the one he loves the most moving from early to active labor. Or when the Dad who passed out while his wife was getting an IV placed, watches the entire birth with wonder and awe and doesn’t even feel queasy. These reminders that birth is magical, mystical, and awe inspiring fuel the passion I have for this work and keep me from “slowing down,” as I continually reassure my husband I am going to do… next year.
Other lessons are hard won; they prod me to reflect and pause. To reconsider my calling at times, if I am being honest. Ranging from tragedy to difficult moments, from misunderstandings to complete breakdowns in communication. Every circumstance, an opportunity for growth, understanding, and possibly, change. The good that can come from such moments is rarely seen as “good” in real time. I experienced just such a lesson as my client weathered a breakdown in communication with their OB/GYN during their planned, medicated hospital birth.
Laboring off and on for a few days is completely normal for a first time mom, expected even! It doesn’t change the discouragement and exhaustion that tend to creep in to know that this is just how it goes sometimes…I had visited several times over the past forty eight hours, and it was clear by the way she was moving, breathing, and chatting that things were still in the early labor stage and the baby was not yet engaged in her pelvis. I double checked the way she was utilizing her TENS, reminded them how to proceed by hydrating, eating and resting, and then tucked her into the “flying cowgirl” position, a position that allows “rest” while opening the top of the pelvis so that a baby can descend and engage well. At home, I napped, knowing the call would come sometime in the wee hours, and when it did, I agreed to meet them at the hospital. She was done. She wanted the epidural that she had planned for.
We all arrived and were set up in a room before 6 am. The nurse was wonderful. Gregarious, gentle and attentive, she put my client at ease immediately. The disappointment was obvious when the nurse mentioned she would be changing shifts soon. I asked if she would be back on tonight. She said she would and reminded us that we could request her if baby wasn’t here by then. I made a mental note to do just that! Currently 4 cm with an epidural on the way, I anticipated an evening birth. The new nurse was kind but there wasn’t the same connection. The epidural was placed pretty easily as Dad stepped out. He had passed out during the IV placement in triage and was also exhausted. I suggested a breakfast taco run, in addition to swinging by their house to grab a few forgotten items. I encouraged them to settle in and nap until I got back.
Returning within the hour, I was met with tears and anger when I entered the room. “She broke my water and ordered pitocin!” Her husband added, “I didn’t even know what she was doing until it was done!” I stood in shock. I was literally gone for an hour! A brief reminder of the rights and the importance of communication was all it took for Dad to gather himself. He called the nurse and asked to see the OB immediately. As we were waiting, we processed what had happened, which was beyond changing now, and determined how we could move forward. I reminded them that this was a very common practice as epidurals tend to slow labor down, and it is something that would have likely happened eventually. Inside I was fuming. I had never met this Dr. and I immediately made some quick internal assumptions. It didn’t help that she didn’t even acknowledge my presence in the room when she entered.
“You broke her water and ordered a drug without our consent. We were not part of a conversation. We want to be consulted and made a part of every decision.” I was so proud of this new Dad and the advocacy skills he used to make their needs known! They had taken my Evidence Based Birth© Childbirth Education class and knew their rights. He communicated so well! The OB looked taken aback and looked at my client. Apologetically, she expressed that she thought she had made it clear what the next steps were and that was what she was doing. I felt so awful for my client. She quickly said that maybe she just hadn’t understood. Clearly trying to avoid upsetting the OB. She is the sweetest person on the planet and always concerned about the people around her, more than herself! English is her second language, and although her English is exceptional, her biggest fear was that the possible language barrier would impact her care. My heart hurt for her and I was so frustrated, she should not be the one apologizing! Unfortunately, these situations happen so often in the hospital. The OB left and the nurse came in to reassure us that the pitocin would be a very low dose and would just be used to get the contractions closer together. Everyone agreed to it, and when she left, I encouraged them to try and rest while they had a moment.
The room finally went quiet and I had just enough time to shoot off a quick text to my backup doula, telling her that I would not be needing her. When she asked who the Dr was and I responded, she gushed, “Oh, I just LOVE her! She is so kind and thoughtful.” When I texted back, “that has not been our experience.” She went on to give me several scenarios to back up her claim.
I was incredulous for a moment but that text was the catalyst for some thoughtful reflection in this brief window of calm. I truly believe we are given opportunities for growth in every difficult circumstance, and I spent a moment recalling a similar scenario that I had with a hospital midwife years ago. This midwife acted very much out of character during my client’s VBAC attempt and I spent the majority of the labor trying, in my head, to understand her behavior. I loved this midwife and the way she practiced normally, so my thoughts were generally fueled by charity. “She must have had a really hard day.” “Maybe things are going on in her family.” “Perhaps she is feeling pressure from hospital management.” None of these thoughts changed the way I felt about her behavior, but they changed the way I was feeling about “her.” What was the difference?
Every birth is an opportunity to act in LOVE.
One of the important parts of Evidence Based Birth’s© Childbirth Education is recognizing and acknowledging the roadblocks, difficulties, and stressors that hospital staff can be experiencing and learning communication skills to make a patient’s needs, wants, and grievances known without creating division or animosity, but facilitating unity and understanding. This can all happen without sacrificing a person’s dignity or feeling of worth, on both sides! Trying our best to think and act through the lens of love (or charity) can change things. It may not change a situation, but it certainly will change YOU.
I was grateful for this reminder, and this moment. Moving forward, I was, I believe, better able to serve this client and her husband as they labored for the next ten hours. I was no longer fuming, but intentional and peaceful. Helping her move into different positions, reassuring her of her courage and stamina, and reminding her to request her favorite nurse when it was 6:45 and she began to feel that pressure indicating it may be time to push!
Our first nurse swept in the room with joy. “I get to be here for the BEST part!” She was blessedly a “hands off” nurse who responded so gently with encouragement after chatting with this sweet momma who expressed her desire to “not be yelled at.” “Of course, I won’t yell at you.” It was a beautiful time of anticipation and progress. I casually mentioned that nurses catch babies all the time… “I certainly CAN, but I am definitely not supposed to!” She oversaw progress until we could clearly see the head full of hair emerging with every effort, and then made the call.
While I would love to say that the OB came in the room a different person than she had been at 8:30am, I cannot. But I can say that I looked at her through different eyes. And what I saw made me feel for her, not be angry at her. She took one look at my client and remarked that she had left the charge nurse to deliver her last patient’s placenta because she was told this patient was ready. The nurse smiled and said, “just wait until you see her push, the baby is right there.” And he was. It only took about another twenty minutes during which another nurse entered to say, “the patient in the next room is pushing, and she says she can’t stop.” to which this OB replied, “Of course she can’t stop, I wouldn’t expect her to, she is unmedicated.” Thankfully, I think my client was blissfully unaware of these comments. The doctor’s directions were now given firmly and succinctly. She gave it her all and birthed her son.
During our celebratory squeals of delight over a healthy baby boy being placed on his momma’s chest, the nurse, who had read the birth plan, reminded that a 3-5 minute cord clamping delay had been requested. The shoulders of the OB drooped and she gave her a quick look of frustration as she quickly began repairing the significant tear, and repeated to another nurse who came in requesting her that she could not leave this patient yet. The juxtaposition and irony of this OB’s defeated posture and the absolute exhilaration and delight of my clients is not lost on me. The new mom kept thanking this OB, the nurse, me and anyone else in the room. Suddenly, I no longer felt anything but compassion for this provider, sadness for the system she works in, and conviction that though I find it difficult to live out my vocation as a doula in the hospital setting, I will continue to try and make a difference.
Doula Rachel 