“Your body knew exactly how big to make her and your body knows just how to get her out. You don’t have to really do anything. Just let the rushes open you up that big. You won’t break. We were made to do this . . . ” And so it went for the next fifteen minutes or so until suddenly she had some really big rushes and Eleni said she had to poop, like right now! I told the nurse that she hadn’t been to the toilet in over an hour so we got there and convinced her she shouldn’t try to push yet. Next she got up on the bed and the nurse checked her. Nine and a half centimeters!
I used imagery alone for all five of my babies’ births, so I know that it is possible. I had not taken Lamaze or other classes, but put aside time before I fell asleep each night to visualize how each particular birth should look, how beautiful the room looked, how quiet, how calm, how the waves or rushes would rise over me and wane and how I could ride each one until the time came that I could push. I would continue to imagine my beautiful, wet, fat (they were all quite pudgy) baby quietly sliding out, and lifting her to myself, checking her cord for a pulse and reminding David to clamp and cut it. I trusted that nature had planned birth this way. I trusted that my body would and could know what to do. I knew I had cared for us well during the last nine months and I knew what I did not want interrupting such a sacred moment. The only problem was that for the last two births I had completely forgotten to fit the midwives’ arrival into the plan as I had mapped it all out in my mind. Baby and Daddy and I greeted the surprised ladies as they walked in too late, twice, just three years apart.
While attending a birth a few years ago as the assistant midwife at a free-standing clinic, I puzzled how I could redirect some of the negative energy that the mom was exuding. She was determined to have an unmedicated birth, however with each contraction she would yell or scream through gritted teeth with her eyes tight shut, “Shit! Shit! Shit!” until the rush had passed. With the next one she yelled even louder, “Fuck! Fuck! Fuuuuuuck!” until that one subsided. This went on for quite a while.
Finally I very quietly knelt down next to her and whispered, “Sweetheart, on the next contraction, just try saying, ‘Baby. . . Baby . . . Baaaaby,’ or maybe, ‘Open . . . Open . . . Oooopen.’” It worked.
She had invited her mother to the birth, who was vehemently opposed to birth outside of a hospital and sat bold upright in a chair in the corner of the room, arms crossed over her chest, lips tight shut, scowling at us the whole time. I had suggested to the mom that I could invite her mother to hang out in our little kitchen, but grandma-to-be had already staked out the birth room and would not budge. After the baby arrived, which was a very calm, very beautiful birth, this new grandma cornered me in the kitchen and thanked me for “such a professional job,” adding, “I didn’t know y’all knew so much!”
Eleni and her family were Muslim. We had written in her birth plan that she wanted only women at her birth, did not want any male residents or students observing, and that her husband might not stay for the actual birth, which was part of their tradition. Knowing this, I made sure to alert him every time a nurse wanted to do an exam and gave him the chance to leave the room if he wanted to. Even with only women present, she kept her headscarf on the whole time. I also made sure that she was covered with a sheet whenever she changed positions and had a robe over her nightgown whenever she was not in bed. I was careful about keeping the door curtain pulled so she couldn’t be seen from the hall. During exams I made it my job to hold up the sheet enough to give the doctor or nurse access, but shielding her from the other women in the room. I had incorporated this into my doula job description early on when I began working with Somali women.
Finally, Eleni could push! Her two sisters helped with her legs while I wiped her face and neck and helped her breathe. Her husband had stayed but preferred to sit nearby and pray, too overwhelmed by everything to trust himself to be any closer. I gave him an update every few minutes as the baby’s head and thick curly black hair came into view. I couldn’t see what was going on down below. It was my job to be where I could encourage her and calmly whisper in her ear, “You’re doing it, honey! You are so strong! That’s it! Okay, rest now . . . That’s it. Okay, another deep breath . . . slowly . . . you’re doing it! Wonderful job!”
Suddenly, the three doctors moved into high gear. I wasn’t sure what had happened, but I knew something wasn’t right. I stayed where I knew I was needed as I watched one of the doctors get up onto the bed and begin fundal compressions. Oh my God! I thought, shoulder dystocia—every midwife’s and doctor’s worst nightmare. They had three minutes to get the baby out. If they waited too long, oxygen deprivation could cause cerebral palsy or permanent brain damage.
I knew the doctors and nurses had the drill down and could do it in their sleep, and Eleni was still holding her two sisters’ hands, so I turned to her husband. He looked terrified. No wonder: it looked like the doctors were giving his wife CPR. I took his hand and told him the baby was stuck and that they were working to get her out, that they were trained to do this. Within three minutes, they were carrying Baby to the warmer where the NRP team was waiting. I then assured Dad that his baby was out and was getting the help she needed.
Eleni had her eyes closed but was still holding her sisters’ hands. Within a few more seconds we could hear her baby cry, at first little whimpers and then huge yowls. I told Dad to go over and see his baby and be sure and take his camera. For the family’s sake, I could go back into an “All is fine” voice and reassure them. I tried to sound like “This is all perfectly routine,” though I knew we had just been in a very scary place. They would never perhaps fully understand the gravity of the situation.
Eleni tore quite a bit, possibly from the attempts to pull the baby’s shoulder out. She needed the fourth-degree repair done in the OR afterward. She was happy that it was over and that her beautiful big girl—eight pounds—was now snuggling on her chest where they could get to know one another. We gave Baby to her daddy and I accompanied Eleni to the OR to have the repair done. She was positioned on the table and offered a shot for pain, which she agreed to as they hoisted her legs up into “candy cane” bars, which are even higher than regular stirrups, for the best position for the repair. I overheard that they were waiting for the OB to come to do the repair and asked if it was a “he” OB or a “she” OB. They said “He” just as he walked in, so I explained that it would be nice if she was draped except for the area he had to work on. Without hesitating a moment, they all flew into action looking for the sterile kit that actually has leg covers and other drapes. They had never used them but didn’t hesitate for a second when I asked. Eleni was awake during the two-hour procedure. I stayed by the head of the table and told her how well she had done and how good her baby looked. I told her that she would look really nice when the swelling went down and they had fixed the tear.
When we returned to the room Abrihet’s daddy was holding her, still looking completely bewildered. It was a lot to take in. He was happy, but his look of utter wonder stayed with him all evening. I told him he should be very proud of his amazing, brave wife. The sisters called relatives who fixed food and brought it in for all of us to eat. At one point we were all eating fragrant rice while Eleni, holding her baby, was being fed and given the proscribed spiced hot milk traditionally given to new Ethiopian mothers.
Dad looked over at me and asked, “What was all that about, anyway?” So I explained what had gone on, how when we see a baby’s shoulders are stuck behind the pubic bone, and the baby’s face has a distinct “turtling” or scrunched-up look, we know we don’t have much time to get her out because if she doesn’t get air in time, she could have brain damage. That is why they had to hurry and try different things to get her out. I explained I was glad they acted so quickly and told him they would X-ray the baby later because she might have a fractured clavicle bone (there was a strong suspicion she had because she wasn’t lifting her right arm) but, if that was
the case, babies heal very quickly and they would show him how to care for it before they went home.
Eleni was happy that she had not had a C-section. She was grateful to the doctors, whom she kept thanking whenever they came in her room. She was in love with her baby right away and was still holding her two days later when I did a home visit.
I continue to wonder if by respecting Eleni’s wish for modesty, her requirement for satisfaction with the birth was met. I seriously wonder if we had made a concerted effort to use drapes throughout their labor and births, perhaps Hadassah’s and Tessa’s feelings of “being exposed” and “humiliated” might have changed, especially after they had been transported to hospitals.
As we are beginning to see more research into what constitutes traumatic birth and even the symptoms of PTSD after some births, I wonder if we could not somehow think more about honoring or respecting mothers’ bodies differently. Many women are fine giving birth completely au natural but in the first two cases described here, I would like to think it might have made a difference.
“The source of love is deep in us and we can help others realize a lot of happiness. One word, one action, one thought can reduce another person’s suffering and bring that person joy.”
~Thich Nhat Hanh
Chapter 22: “I Don’t Want a Baby!”
I didn’t have a clue. Becca and Stan were taking every childbirth education course we had to offer and we met monthly to connect and work on a birth plan. Educated, socially conscious, laid-back, unselfconscious, thoughtful—they seemed to have it all pretty well together.
I discovered during labor, though, that there were enough obstacles to sink a ship: past sexual abuse, a history of depression, substance abuse, gender issues, fear of being unable to birth, fear of not having whatever it takes—hormones or feminine qualities—to mother a child, fear of failure and being as horrible at raising a baby as her mother had been, fear of her body failing to know what to do to birth her baby, and somehow “failing” by needing drugs or a C-section. Between contractions I learned she was absolutely terrified of the little creature she was about to produce.
Becca’s water broke around 10:30 a.m. Stan texted me to say they were going to hang out at home for as long as they could. They would call me if they wanted me to meet them at home or at the hospital should things really kick in. I agreed it was a good plan. We texted back and forth throughout the day. He also called the hospital and their midwife group and kept them abreast of their progress. Later that afternoon they went into the hospital to have the baby monitored and check in with the midwives. Contractions had started by then and everything looked great. Becca was one centimeter, but eighty percent effaced and the baby was head down with great fetal heart tones. All systems were go! I reminded them that first babies take time and we didn’t want to rush this birth.
I wasn’t too concerned that Becca was taking so very long to begin to dilate. Twenty-four hours is not unheard of for a first baby. We would like to see the cervix dilate about one centimeter per hour, but Becca was walking, eating, and drinking so there wasn’t anything to change at that point. I suggested the birth tub when she got to about six centimeters. She said the tub felt better and she was content to hang out there for a couple of hours. There was no change in her cervix, however. She had stopped drinking, though I kept offering juice and water. Nausea had set in and then Becca’s last meal made a surprise comeback. I told her that this was all perfectly normal and that her body knew exactly what was needed, but she was not at all happy. She was no longer the laid-back whatever-it-takes lady.
“This sucks!” was the next pronouncement, followed by, “Fucking awful!” and “I don’t want to do this,” which elicited the response by her partner, “You have no choice.”
An hour went by. Everything was increasingly negative. Their birth plan explicitly said not to offer anything for pain and not to ask about her pain level during labor, but when I gently offered that she might get some relief from a short-term IV medication she said she was interested. I explained that it would not stop labor, and that she would still feel the contractions, but that it might take some of the edge off and let her rest for an hour or two. The midwives had not been doing internal checks since her water broke, and we didn’t know where she was was at that point, so her midwife offered to check before giving her anything. We were very surprised to hear that she was at eight centimeters. I was elated, as was the midwife.
I explained to Becca that the meds might not be a good idea now that we knew she was so close to pushing, since they could affect the baby and we might not have the two hours we had originally thought we had for the drugs to get out of her system. I explained that we certainly did not want a sleepy baby who might have trouble breathing.
At this she surprised both her midwife and me, saying, “I am actually horrified of babies. I don’t want a baby!”
Her partner countered, “We have been talking about this for nine months and you said you had let that go!”
Um, no, I thought. You don’t just let that go that easily. What planet had I landed on? Then the rest all spewed out: she didn’t want to repeat her mother’s horrid mothering; she would ruin her baby’s life; she didn’t have enough feminine qualities to be a mother; and maybe the instincts had never been there at all.
Her midwife, Barb, took all this in and said, “Becca, you are safe here. Your baby is safe. Your body knows how to give birth. Your body does have what it takes to be a mother.”
Becca silently listened. Two more hours passed. Becca was back in bed and Barb asked to check her cervix once more, which she agreed to. Ten centimeters. We were all ecstatic, though exhausted by this point.
All except Becca. I tried to get her to drink some juice but she refused. She definitely did not want to vomit again. I explained that it was okay and that she might not have the energy to push if it took awhile.
Barb tried again. “Tell me what you are thinking.”
Becca was quiet, then said, “I’m afraid I will fail at this too, and need a C-section.”
Barb replied, “You have lots of room. Your baby is not a ten-pounder. You can do this. We’ll help you. You can try little nudges first and see if your body is ready to push.”
So she sat up, legs stiffly stretched out in front of her, took a deep breath and—blew it back out. I let her try it her way a couple of times before moving in.
“Let’s try this on the birth ball, okay? If it doesn’t feel right, you can tell us,” I said as I helped her up. Her knees had to relax and stay open and the birth ball was softer than the bed, so I hoped it would feel better to her. With the next rush I asked if I could touch her shoulders to help her relax, and breathe with her, which she said was fine. I reminded her to breathe in, hold it, put her chin down to her chest and . . . little nudges . . . at which she again blew out.
“I can’t do it,” she whispered.
I came around to her side and said, “Becca. You won’t have to do this alone. You have Stan. I have seen tons of deadbeat dads in this business, and he is definitely not one of those. He is here for you. He is going to raise this baby with you. And you have us, and many other people will also help you.”
Another contraction was building. I took her hand and said, “We will do this one with you. Let it build, okay . . . deep breath . . . hold it, push down into your bottom, there . . .” She gave a tiny grunt and blew out. Her legs were frozen in place and the push never got past her throat. I tried again. “You have lots of room for this baby. He sounds fantastic. Stan is going to hold him when he comes out. You don’t have to do anything, honey. Just breathe, that’s it . . . let it build . . . okay . . . now, deep breath in . . . hold it . . . hold it . . . and push straight down . . . yes! You are doing it, that’s it! Sweetheart, you have got it! Again, deep breath, in . . . chin down . . . hold it . . .”
We could see the head cr
owning. Then he slipped back in. I explained that she was stretching beautifully. We didn’t have to hurry this. He was doing fine. I whispered, “Just rest now. Good. You can sleep for a minute . . . that’s it.” I let her follow her body on the next one and didn’t say anything. Barb silently knelt down on the other side of Becca, ready to catch their baby as Becca took in huge breath and pushed one final grand push, which did it. He popped out into Barb’s hands.
“Open your eyes,” I whispered to Becca. “He’s here. You were brilliant, my dear!”
Barb let the cord stop pulsing and then clamped it, handing the scissors to Stan. Then she passed the baby forward to him while we let Becca recover and take it all in. We all told her how well she had done. I reminded her that she had done it without drugs, just as she had hoped, and told her she was really stronger than she had previously thought.
Stan and Becca spent the next couple of hours in bed getting to know their baby. He never cried. He was so peaceful and alert and kept looking back and forth, first at Stan and then Becca. He was beautiful. I told her how perfect he was and reminded her that she was actually really strong and had done a super job.
I met with Barb in the nurses’ station before I left later that afternoon. We both agreed we were disturbed by Becca’s reactions to labor. I said I was particularly worried about postpartum depression and was not comfortable leaving her alone with the baby, even in the hospital, much less when they went home. She agreed, so we discussed several options to refer them to, including a postpartum depression clinic and a social worker specialist who could follow them when we both signed off in the next few days.
The next day I returned for her postpartum visit. I needed to be straight with them and bring out some of my concerns. Postpartum depression and its related cousins have been taboo subjects in the past, but no more. It must be addressed. It is 100% curable and is now thought to be caused by the high levels of hormones during and after delivery that play havoc with the brain and amplify any preexisting depression or bipolar issues.
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