Ma Doula

by Stephanie Sorensen

  When I entered their room the next day, it was crammed with visitors and their baby was having a difficult time nursing. Becca was obviously nervous about baring her breasts in front of so many people. I sidled up to Stan and suggested there were too many visitors and that I thought they would understand if they were gently asked to go. So we cleared out the room, which was quite a relief to Becca. Stan’s parents had hoped to hold their first grandchild during the visit but it was definitely too soon to be passing him around.

  Becca needed time to bond first. He really was having a hard time latching on and was screaming when it didn’t work. I finally asked if I could look in his mouth after we tried several different positions. It was a good guess. He, in fact, did possibly have a very tight frenula which meant his tongue was not able to fully protrude beyond his gums in order to wrap around the nipple and properly latch. I suggested they mention it when the hospital pediatrician came by later in the day and have it checked out.

  We also put together a list of resources should they want extra support. I explained that postpartum depression could appear anytime during the first year, not just at the beginning. And then it was time to say goodbye. I hugged both of them and wished them the very best.

  I worry about their journey, whether they will become stronger now that they actually accomplished birth, and whether Becca would realize she does indeed have what it takes to birth a baby and be a mother. They have a long road ahead of them.

  What makes some first-time mothers confident that they can birth their babies naturally and others almost as confident that they will fail and everything will go wrong? When is confidence or a lack of it developed in the psyche? Is it inherited or acquired? Or both? When is the seed planted that will invade the totality of the human mind’s consciousness and unconscious regions either positively or negatively? Can one choose or find the will to change direction? Do we get that choice?

  “Speak tenderly to them. Let there be kindness in your face, in your eyes, in your smile, in the warmth of your greeting. Always have a cheerful smile. Don’t only give your care, but give your heart as well.”

  ~Mother Teresa

  Chapter 23: And Then There Was Rose

  My phone rang early one Sunday morning. I often volunteer at a women’s shelter run by Mother Teresa’s nuns, the Missionaries of Charity Shelter. There are seven beds, ready at a moment’s notice for any woman who is homeless and pregnant in Minneapolis. Sister Rosetta was calling to ask me if I could come and help decide what they should do for one of their guests who had recently given birth. They didn’t know what they were seeing, but wondered about postpartum depression.

  I visited later that morning and tapped on Rose’s door. Her two-year-old, Hannah, was bouncing up and down in her playpen, grinning from ear to ear. Rose had Luke, only a week old, in her lap and was giving him a bottle. He looked clean and had on a cute little outfit. Rose was dressed and her hair looked nice, too. It wasn’t quite what I was expecting.

  I had met Rose before Luke was born when I worked at the shelter earlier that year. She was usually upbeat and friendly. Hannah was a handful, spunky and bright. I picked up Hannah and sat down on the end of the bed and asked Rose how things were going. She told me about the birth, how Luke was such a good baby, how she was looking into a permanent situation for her little family with her social worker, and so on. She mentioned that she didn’t want to go back east to an abusive father and addicted boyfriend. She really wanted to go back to school and get her life back on track. I encouraged her and told her that she was still young and could do so much.

  I finally said I wanted to talk about what we call “baby blues” or depression, because it is very real, especially after birth, with all the other stresses in her life. I knew she had a history of mental issues, though I didn’t know specifics. She admitted that she felt frustrated trying to keep her kids quiet at bedtime and that she couldn’t always let Hannah run loose when she had to feed the baby so she had to plop Hannah into the playpen where she would scream bloody murder while everyone else was trying to go to sleep. Then she mentioned in passing that they had not given back her meds after the birth, even though she had asked for them at her postpartum appointment. I asked what they were and it turned out she had been treated for bipolar disorder.

  I could not believe she had fallen through the cracks in the system just like that. Of course she had agreed to try to hang on without meds during the pregnancy, if at all possible, and she had been okay, but as soon as she delivered Luke, she knew she should go back on the program she had been on, which had worked well for her. Yes, she was depressed now, but felt it could all be sorted out. She was also prepared not to breastfeed her baby, though she would have liked to, knowing the medications were not good for him. She was willing to forgo nursing in order to be a more-together mom who needed to take care of both her kids and also happened to need meds.

  Sometimes women only exhibit symptoms of bipolar disease for the first time after having a baby. If they are referred early they can work with a doctor and have it under control quickly. Too often women fear sharing their feelings when they don’t seem to be in line with what is “expected.” They’ve just had a beautiful, healthy baby. Shouldn’t they be happy? Grateful? Cheerful? They shouldn’t be crying all the time, or having scary thoughts or flipping out, should they? They often fear their baby will be taken away—some fear the baby won’t be taken away.

  Again: postpartum depression is 100% curable. Research has now found that the flood of hormones released immediately during and after birth account for many of the mood swings and problems women run into. The sooner they get help, the shorter the time it will take to overcome this period. If we don’t talk about it, it will remain a taboo subject and each woman will continue to believe that she is the only person on earth to have ever felt this way. The fact is that it is far more common than we thought before. And there is more help than ever.

  Postpartum depression can occur anywhere from the first days or weeks after birth up to anytime during the first year after having a baby. If not treated, the symptoms can get worse and postpartum psychosis can become an issue. What is crucial to remember is that:

  1. It is 100% curable;

  2. Help must be sought early; and

  3. No one will fault the mother for not being cheerful and happy or having it all together.

  I think it has become even more prevalent in our Western society because we don’t have an intact extended family system for support any longer. In other cultures, women are cared for after they’ve had a baby and are never left alone. They are free to rest as much as they need and don’t have to cook, clean, tend other children, do laundry, or lose sleep, much less go back to work within weeks of delivering. We are doing a disservice to our mothers in the U.S. by ignoring this important aspect of care. Many countries—France, England, Denmark, Sweden, and Holland, to name a few—offer all mothers a helper in the home for up to a year, paid for by the government, to take the workload off new mothers so they have the time needed to bond with their babies and recover. These governments understand that this investment will pay off in the long run with healthier, happier families.

  I suggested a plan for Rose. I asked her to call her neighborhood church lady friends and find someone who could watch her children for a few hours later that evening. Then I told her I would go with her to the hospital and we’d ask for her meds. I suggested she try to “keep it together” because I told her if they decided to admit her and I had to refer her babies to foster care then I would be depressed, too. I was hoping they would believe me that I would be in contact every day with Rose and she wouldn’t be alone at the shelter at any time, either. Supervision is important for someone using strong medications but I reasoned that she had been on the meds before and tolerated them well. Rose readily agreed and started calling. I went home and took care of what I needed to finish up there (
including doula backup for the night for my other clients) and then later that day I picked up Rose and we went to the hospital. I had packed some snacks, thinking we would be in the emergency room for hours. This was one of the biggest medical centers in the city and was known for its waiting room marathons.

  Rose had given birth to Luke at the same hospital earlier that month, so I knew her records were there. When we got to the emergency department we settled in on a couch by the TV for the long haul and I went up to the desk to register. I couldn’t believe it when the receptionist told me they would call the resident doctor on the psych ward and had a room we could wait in all ready. Wow, talk about service! So we picked up our coats, snacks, and bags with magazines and followed her to a little room.

  We chatted about some of the original things Hannah had come up with since Luke was born. Then Rose asked me if I noticed anything funny about the room. I looked around and said, first, there weren’t any cupboards with meds or equipment.

  “Right. What else?” she asked me. I noticed the two chairs were bolted to the floor.

  “Oh, I see. What else?”

  “Well, there’s a window in the door.”

  “That’s right,” she agreed, you couldn’t hurt yourself in this place.

  “Oh, I get it,” I said. She explained that she was a veteran of the psych wards and could spot the program a mile away.

  I told her that I was glad she wanted to get her life back on track and that I really admired her for setting goals like school for herself. We agreed that Minnesota had more programs than most states for scholarships and other possibilities. We talked about some of her ideas about different colleges and how to find out more information.

  Before long a nurse from “upstairs” came and introduced herself. I was immediately impressed by how respectful yet straightforward she was. Rose talked about not being able to get a new prescription even though she had asked for one and said she was more than willing to be compliant, take her meds, and attend therapy or whatever else they recommended. Therapy could address many of her problems and give her the help and support she needed during the time ahead. Then I told the nurse about Rose’s living situation and that I thought it was an ideal arrangement for her to start back on her medications while staying there. Soon a doctor came in and introduced himself. The nurse filled him in and he readily agreed that our plan sounded fine to him, too.

  We both thanked them profusely. They were really concerned, respectful, and listened. I don’t know what I expected, but I was amazed. We were a really great team, all rooting for Rose to do well, all doing what we did best, coming together to support her. I was so grateful. It changed my perception of the big, impersonal medical center.

  Rose returned to the shelter and I checked in with her by phone daily. A few days later, I met her and took her, along with Hannah and Luke, out to lunch. It was scattered, like any meal with two little guys vying for attention always is, but we did manage a nice visit.

  Rose still has her ups and downs (don’t we all?), but I don’t know if I have ever been so proud of a young mom before. I know I haven’t met many with as many obstacles in front of them and yet could overcome so much. We are still in touch. She has her own apartment now. She is truly another amazing woman who I have been honored to know.

  Steps to take if you have symptoms of depression or anxiety during or after pregnancy:

  1. If you are having thoughts of harming yourself or your baby, it is very important to get support immediately. Call 911 or go to the nearest emergency room. Though it can be scary to ask for support the first time, they can help keep you and your baby safe and help you take the first steps toward getting better.

  2. Tell someone you trust how you are feeling. It is important that you feel safe with the person and that they support you in a nonjudgmental way. Ask them to help you find support. Examples of someone you can tell:

  · Your partner

  · A family member

  · A friend

  · A healthcare professional like your doula, midwife, or doctor

  · A pastor or someone at your church

  Other Resources:

  · Jenny’s Light: http://www.jennyslight.org

  · http://www.mayoclinic.com/health/postpartum-depression/DS00546

  · http://www.babycenter.com/0_postpartum-depression-and-anxi-

  ety_227.bc

  · http://hcmcmn.org/index.php?content=mother-baby-day-hospital&clinicid=393

  · Hennepin Women’s Mental Health Program, Minneapolis, MN: Dr. Helen Kim, MD

  · http://www.maternaloutcomesmatter.org/

  · http://everymothercounts.org/film

  “A wizard is never late, Frodo Baggins. Nor is he early. He arrives precisely when he means to.”

  ~Gandalf in J.R.R. Tolkien’s The Lord of the Rings

  Chapter 24: There’s a Placenta in Our Freezer

  My husband didn’t know there was a placenta in our freezer. He would have freaked out and then insisted I bleach the whole refrigerator and freezer and I would never have heard the end of it.

  One of my clients had a scheduled C-section. There were multiple medical problems on board, not the least being that she had had bariatric surgery earlier that year, lost over 150 pounds and then got pregnant. She had one complication after another after that. She was very nauseated during the entire pregnancy, had been bleeding on and off into her eighth month, remained anemic, and had dizziness throughout, causing her to fall several times a week.

  Bariatric surgery essentially reduces the size of the stomach, making it almost impossible to eat large quantities of food. In her case Megan could barely eat at all, which served the purpose of losing weight, but in the process her body became depleted of much-needed nutrients. She tried liquid diet supplements like Ensure, which didn’t help much, even when she could keep it down.

  Her hair started falling out, she couldn’t maintain enough red blood cells, and she became dangerously anemic. By the seventh month, her baby’s growth had all but stopped.

  The doctors considered inducing labor so the baby could be born six weeks early and begin to get nutrients pumped into him via IV after his birth. There were tests to see if her hormone levels were mimicking labor, which would let them know that preterm labor was a possibility.

  This was baby number four so it wasn’t possible for her to rest much during the day. At night, joint pain became unbearable, probably caused by the extreme anemia and vitamin deficiencies. A chiropractor was able to help a bit and had some good suggestions as far as nutrition. Megan tried yoga and meditation, too.

  The day before she hit the thirty-nine-week mark, her water broke about 3:00 a.m. She had never been allowed to let the bag of water break spontaneously with the other three births. When she called me she was sure she couldn’t give birth without medical interventions. I congratulated her and for the hundredth time told her that her body really could do it and she was stronger than she thought.

  I had sent her this quote the week before:

  Promise me you’ll always remember:

  You are braver than you believe,

  Stronger than you seem,

  And smarter than you think!

  ~Christopher Robin to Winnie the Pooh

  I told her to let her doctor know, who in turn wanted her to go to the hospital immediately. I met her in the hospital triage wing of the labor and delivery floor. Like a mini-emergency room, the nurses there could decide if a mom was in early labor and could be sent home without setting up a whole birthing suite, or if she was active labor and they could transfer her to a proper labor room that at that hospital included a large tub, birth ball, and all the works.

  They first confirmed with a test strip that the water bag had broken. Then they Velcroed the monitors onto her stomach to watch the baby�
��s heartbeat, which was great, and the rushes, or contractions, though there weren’t any yet. We hung out and visited while her husband snored away on a lounge chair. Breakfast was served, then later lunch while we continued to flip the channels on the television suspended in a corner of the room. Later that afternoon the official neonatal team of doctors descended on the room. They explained that they had hoped contractions would start on their own but since they had not and we were at about twelve hours out, they were hoping to talk about some options for birth. She could get Pitocin through an IV or in conjunction with a cervix softener like prostaglandin or Cervidil. Or they could do a C-section, which was their suggestion since she had one previously.

  As a doula it wasn’t my place to suggest either direction. I had done my best at our prenatal visits to extol the obvious benefits of vaginal delivery and enumerated the very real risks of surgery, but at this point Megan was so sick, so undernourished and anemic, she could not imagine summoning the strength to endure labor.

  She had thought the stomach surgery would solve all of her weight issues, not understanding the havoc it could wreck on a body, much less a pregnant one. She chose the Cesarean route.

  She woke up her sleeping husband, Joe, and asked him if he wanted to go into the OR with her. He had not planned on it. It had never even occurred to him. It sounded overwhelming. What if he fainted? There’d be a lot of blood, right? What if he had to leave? He was working himself into a panic attack. So I got out my phone and found some photos of C-sections. I pointed out that there is a huge drape that separates us from the actual operation, that it is bright in there but relatively quiet. I also told him it takes only about half an hour and that he could go over to the warmer and be with his baby and then bring him over to Megan and get to know him after he was wrapped up. He studied the pictures and finally said he could do that.