Ma Doula

by Stephanie Sorensen

  Megan walked down to the operating room with the nurses while Dad and I donned our bunny suits and waited in the room until they called us. Dad quickly fell back to sleep. He had been doing nights for months with their other three children to let Megan rest and regain her health, so I didn’t begrudge him his naps.

  Finally we went back and were given our posts on two little swivel chairs that had been placed on either side of Megan’s head. She had ­already been given the epidural and was excited about finally seeing this baby. They were already starting the surgery when we entered the OR and Baby was born fifteen minutes later. He came out with a loud cry—a good sign, since he was so little. He weighed in at six pounds, ten ounces, a miracle, really, considering all of the problems with the pregnancy.

  Joe did really well, too. I checked in with him several times during the surgery and told him he was doing great. Then I went with him over to the warmer where he reached out to his little boy, who promptly grabbed his finger. Joe started sobbing, overwhelmed with it all. The nurse wrapped up his baby and Joe proudly carried his son back to his wife.

  In the recovery room, baby Abel latched on immediately, another miracle since I had assumed he would act more like a sleepy preemie. He nursed at both breasts before falling into a peaceful sleep on Megan’s chest.

  Her recovery went well. I did a final postpartum visit with her two days later. I had suggested she ask for a belly band, or pregnancy belt, which would both hold in her sagging tummy (which was profoundly out of shape after the weight loss) and help put her muscles back in place while she healed from the C-section. They had already delivered it from the hospital pharmacy before she left the hospital and she was again able to eat, though only miniscule portions. I also referred her to a nutritionist. Nutritionists have a wealth of information and can suggest numerous options for regaining health.

  Megan wanted to take her placenta home but Joe balked at the idea. Megan patiently explained the value of encapsulating it and the benefits it could afford her. He got more grossed out by the minute and then flatly refused to carry “that thing” home on the bus in a red hazardous materials bag. She begged. She pleaded. Finally from across the recovery room on my little swivel chair perch, I offered. I knew how much it meant to her. She could collect it from my house a couple of weeks later and I would get to see her baby again. We were all happy.

  “There is no way out of the experience except through it, because it is not really your experience but the baby’s. Your body is the child’s instrument of birth.”

  ~Penelope Leach

  Chapter 25: Tiger Mama

  How do you help a mom prepare for labor when you know the baby is no longer living or when doctors have said the baby will live only hours or days? Is it any less intense than the birth of a healthy baby? More intense? Is there any way to celebrate this short life? Is that what the mom and dad want? How do I begin to talk about it?

  I received a call from my midwife friend, Molly, late one afternoon. Years ago we had worked together and remained friends. I was in awe of her years of experience and intellect. Nothing was too small for her to research and understand in order to help one of her moms. She was constantly learning, reading, and stretching her knowledge, and it made me want to be around her and soak up some of her enthusiasm and curiosity.

  She knew I had received a grant a couple of years earlier to learn from an infant hospice in Missouri how they were able to help over 500 families with babies who had lethal or fatal anomalies. At the time I applied for the grant I had two moms who were expecting babies with serious problems. An ultrasound had revealed one baby had only half a heart. Another client was expecting twins and had just been told that one of them had an omphalocele (where the intestine forms outside of the stomach wall, sometimes including other organs), which could indicate more serious problems. I wanted to know how I could best support them. What should I say? What shouldn’t I say?

  I had seen close to a dozen babies who had died before birth, at birth, or shortly after during the years my family lived in Pennsylvania and New York. These families were surrounded by love and support the entire time, day and night, while they agonized about the best way to care for their babies. Sometimes surgery helped, but more often it didn’t. Most of the families felt that these special babies were sent to earth for a specific purpose that may not need a long lifetime to fulfill. We would all miss them terribly, but we had faith that each precious soul was not a mistake, no matter how disabled they appeared. I learned in Missouri that “each of these babies is a masterpiece from the Creator.”

  Some families thought of them as angel babies who were not destined for earth. Others felt that nature deals us both good and sometimes cruel decks, that it is part of an imperfect world that isn’t always fair, but we will learn something from it. We must.

  Aaron and Channah’s baby’s problems first showed up at a routine twenty-week ultrasound. There was an abnormality in the baby’s brain. Subsequent ultrasounds revealed problems with her heart as well. She continued to grow, though her head remained small. Her arms appeared too short, too.

  The parents decided to forgo further testing other than ultrasounds. Though they knew there were serious problems, they decided they would wait until her birth to see what was really going on. They knew she might not make it to term, that babies with multiple problems can die before birth (called stillborn). Some are born alive but cannot function once they no longer have the support of their mother’s heart, kidneys, and other systems. Others are too weak to survive labor and birth.

  Overwhelmed with all the possibilities, Channah slowly began addressing each problem, asking doctors questions and reading about each anomaly. She needed to take each step one at a time.

  She had many questions. How do you birth a still baby? How will the hospital treat us? Can we keep her with us long enough to say goodbye? Can or should she be born at home? Will the hospital whisk her off to the NICU and attempt to perform heroic procedures that we all know would probably not help the baby? Would having her at home avoid that kind of drama? Would the doctors understand their wishes?

  It was all foreign territory for them but we were impressed with Channah’s courage and her questions. She wasn’t willing to talk about saying goodbye to her baby or planning a funeral, but she was not in denial and was allowing others near her to provide the support she knew she needed. Channah understood the importance of remaining connected to her baby regardless of her condition.

  Channah and Molly worked on a birth plan. She could not plan for every eventuality, but hoped it would convey a sense of peace and acceptance to her birth team that she was finding in her own heart. She knew they were doing as much as they could for their baby without holding out false hope. No one could know the extent of their baby’s problems until she was born, and at that time she and Aaron would decide what to do next. If there was the possibility that she could be helped and that it might support her quality of life, then that option was open. If it was not a reasonable hope, then they would not want her to suffer longer only to grow worse in the end. Only a parent can make those decisions. She would have to find the right way for her.

  With humility and honor I agreed to be part of their birth team. I wouldn’t have all the right words, but I wouldn’t say a bunch of wrong things either, like “You can always have more children,” or “She would not have been normal” or “Time will heal this.” It won’t. I know the devastation, but I also know parents can survive and come out the other side able to understand others as never before, and that there would come a time when tears wouldn’t fall each and every day.

  That Monday in May was a beautiful spring day. How could we be meeting that morning to discuss death? My mind found it all surreal. Channah and Aaron were very friendly, and just . . . well, open. Molly read through the last ultrasound report and answered questions like, “What is IUGR (intrauterine growth res
triction)?” Molly explained it meant the baby was growing much slower than normal and the concerns continued: short arms, small head compared to stomach circumference, enlarged heart, and brain abnormalities. But we could not say we had a true picture of intrauterine growth restriction. The neonatologists had scheduled an echocardiogram for the baby in four weeks. It is done much like an ultrasound before birth and would give us a much better idea whether the heart could be repaired after birth or if that was not a possibility.

  The couple could decide what they wanted the birth to look like once they knew this piece of information. If their baby had a chance of benefiting from heart surgery we wanted to be at a hospital with neonatal cardiologists available at all times. Many hospitals cannot offer that. If their baby did not appear to have a condition that could be fixed, they said they didn’t want to be at a high-powered, state-of-the-arts maternity unit but would lean more toward a quiet, natural birth, possibly at home.

  On July 1, Molly picked me up. We were now visiting Channah once a week. We mostly talked about the discovery that an ultrasound had shown the baby was in a breech position (not head down). Even though her baby was most likely under three pounds and due in less than three weeks, and it was not her first baby, the neonatologist she saw wouldn’t deliver a breech baby vaginally. He was insisting on a C-section. He even went so far as to tell her at the last appointment that her baby would die if delivered vaginally because her head would become entrapped inside the cervix, that her stomach was not big enough to keep the cervix dilated. Really? The stomach should not and would not be dictating the size of dilation. The cervix does that on its own and then the baby can begin to descend through the birth canal. If at that point the baby is allowed to come out slowly, the head will come down to the hairline, which will become visible and then the midwife or doctor can assist the head by lifting the baby up, releasing the head. It will not become entrapped if the cervix is allowed to dilate naturally and the woman is helped to stay calm. This was shown in Ina May Gaskin’s 2013 movie, Birth Story.

  Channah said that she had almost asked the doctor why he was trying to scare her into a C-section. He was obviously terrified of natural birth and untrained in breech birth.

  She switched to plan B, which was to find a practitioner with hospital privileges who would agree to attend a vaginal breech birth. I called two former home-birth doctors I have known for decades and Molly called several of her contacts.

  I offered to do a belly cast for Channah as a way to remember this baby that I was convinced could not live long after birth, given the list of problems we had heard about. It was a beautiful belly cast. She was in her ninth month and as big and round as all of my other mamas, though we were told this baby was still only around three pounds. Was there too much water? What could account for her size, then? I could only wonder.

  About ten days before her due date I got the call. Channah’s water had broken and some contractions confirmed that it would be the day. Molly had thought that perhaps this baby could become overdue, citing statistics suggesting that babies with multiple anomalies often bring with them a deficit of labor hormones and frequently require induction around forty-two weeks, a full two weeks past the due date. Molly was out of town. I called her and she offered to fly back but Channah said that she was happy with me being there and to tell Molly not to feel like she had to rush back.

  I met them at the hospital. Soon a friend of Channah’s who was also a doula arrived. She had attended the birth of Channah’s first baby. I was glad for her help and loving energy. She radiated love with her caring presence. She was so good at what she did, including massaging Channah’s legs and back, I told myself that I was going to step back and just learn from her, and I did. She was more than good; she was brilliant.

  The hospital staff, however, wasn’t too good at relaying information to Channah, who had expected to be informed about her progress throughout her labor. Her baby’s fetal heart tones were exhibiting some “hiccups” that concerned them a bit, and then Channah developed a slight fever, which elicited more concerns. When she got to nine ­centimeters an obstetrician was called. He explained why they wanted to do a C-section at that point, but Channah said she didn’t feel it was really necessary.

  She wanted to understand their rationale and was trying to explain her need to understand when one of the nurses asked if she could check her dilation once more since it had been awhile. When she did, while keeping her fingers inside of Channah’s cervix, she told the other nurse to hit the emergency button on the wall as she jumped onto the bed. She knelt between Channah’s legs and whispered to the closest nurse, “Prolapse.” My heart froze.

  The umbilical cord had either washed down the birth canal or fell forward and was protruding out the vagina, ahead of the baby. Should the baby come down further, either butt first or head first, it could pinch off its oxygen supply. The room instantly filled with people. The nurse was still on the bed with her whole hand inside Channah now.

  We all knew the drill: cup the cord into your palm and extend your fingers forward at the same time, find the baby’s head (or butt in this case) and push the baby’s body back up into the uterus. Then hold him there, off of the cord. The nurse was preparing to hold this baby back from descending at all until Channah could be prepped for an emergency C-section.

  Nurses were racing to unplug the IV and anything else attached to the bed and were soon racing it down the hall to the OR with Channah and the nurse on it. No one explained to Channah why she was suddenly being taken out this way.

  I knew Aaron nor I would not be allowed into the OR, that there would most likely not be time for an epidural, and Channah would be given general anesthesia instead.

  Channah later told us what happened next. She insisted on being told what (the bleep) was going on before they could operate. As they were explaining, much too fast for anyone to take in, the surgeon came in, stood at the end of the bed and sized up the situation. The nurse confirmed that Channah was complete at ten centimeters, so this doctor, who had experience with breech births, and knew how opposed to a C-section Channah had been all along, simply said, “Well, just push your baby out.” He grasped the baby’s feet when they appeared and, while flat on her back, arms strapped down on a very cold operating table, Channah pushed her baby out.

  A nurse ran back to the room and told us the good news, which we didn’t believe at first. But we knew Channah was capable of just about anything, knew what she wanted and what was best for her baby and never wavered on that.

  I wondered to myself whether the OB thought the baby wasn’t going to make it through delivery in whatever form, or if he simply understood that this baby was so tiny, at three pounds, that we weren’t in the same danger with a prolapsed cord that we would have been with a bigger baby. Channah’s baby was brought to the warmer and intubated, whisked past her to touch briefly, and then on to the NICU, followed by her daddy.

  Channah was brought back to the room and promptly washed and dressed herself and ordered some breakfast. Then she headed down to the NICU, walking on her own steam.

  Her baby was hooked up to numerous tubes and lines by then, but Channah looked past all that, wriggled her hand under the wires and onto her baby’s tummy and began singing to her. The baby was bigger than anyone had guessed—four pounds, two ounces—and her arms were not too short. Unfortunately, though, multiple anomalies involving her liver, brain, heart, and eyes soon became apparent.

  Over the next few days the baby continued to astound us. First her IV was removed and then shortly after that, her respirator. She was breathing on her own with a tiny bit of oxygen coming in through a nose cannula. A few days after that her feeding tube was removed when she proved she could breastfeed. In the meantime, the neonatologists, pediatric cardiologists, and pediatricians continued to be ­completely stumped. Genetic tests failed to point to any syndrome or known anomaly. The genome DNA test
results were negative. There was no infection, bacterial or viral, that could be attributed to her problems. No one understood the whys, but Channah didn’t care. Once her baby’s oxygen tube was discontinued, she took her home. The power of love is mightier than all of us. Just a few know how to use such power, though, and Channah was one of them.

  It is these mamas and babies that put doulas and midwives in our place. We don’t know nothin’ when it comes to miracles. I had the honor of meeting a true Tiger Mama.

  “Women today not only possess genetic memory of birth from a thousand generations of women, but they are also assailed from every direction by information and misinformation about birth.”

  ~Valerie El Halta

  Chapter 26: Two More Amazing Births

  Two of my other moms gave birth during May that year. The first was a Latina madre giving birth to her fourth niño. She had medications with the other three, so when she went from three to six centimeters in one hour and started asking for some IV pain relief, her midwife hesitated. She ordered it from the hospital pharmacy but by the time it came fifteen minutes later, she insisted on checking Carmen just once more. Sure enough, she was between eight and nine centimeters. Fentanyl, morphine, or another short-term drug would affect the baby, though it usually only lasts between one to two hours. But the downside is that it can, and often does, make the baby sleepy or dopey, too. It can make him so drowsy that he might forget to breathe at birth, in which case we have to switch to a full-blown neonatal resuscitation, which is not without risks. We knew Carmen’s first stage, getting to ten centimeters dilation, could be over within minutes at the rate she was going. And it was.