Ma Doula

by Stephanie Sorensen

  In the meantime, it appeared that though the meds affected the baby, they didn’t do much of anything for Radiya. She was still having some big rushes every four minutes and not getting much relief from the IV. They added another bag of IV fluids when she vomited all the juice she’d had so far. We dealt with each rush together and got into a rhythm.

  “Breathe in through your nose, hold it . . . slowly blow it out . . . breathe in, slowly . . . now breathe out . . . and rest.” Her midwife encouraged her as did the nurses. They checked her again: four centimeters. The meds had worn off completely and she was asking for an epidural. I pointed out how well she was doing and talked her through more rushes using visualization, riding over each “wave” and then watching it go away. “There, you did it. Blow that one away now. You never have to do that one again. It is gone. It has done its work. Let each one open you up . . . that’s it. You are sooo strong! Think of all of your grandmothers and great-grandmothers . . . all the women all over the world that are birthing their babies tonight. You can do this . . . breathe . . . Good job. You are brilliant.”

  At 7:00 a.m. the epidural was ordered though the nurses told her the anesthesiologist was in surgery and would come soon. The nurses all left the room and I suggested Radiya get up to go to the bathroom before the procedure. She agreed and then was again surprised how much better she felt standing rather than lying on her back in bed. We got through the next rushes while she was on the toilet. Radiya closed her eyes and leaned against the wall and rested.

  The rushes seemed to be gaining strength, to me at least, so when the midwife came back to check on her I asked if she wanted to see what her dilation was before getting the epidural. The midwife said no because she was only four centimeters at the last check. While we were talking, the next contraction started and with it we both heard Radiya first breathe in and then push with everything she had. I was not surprised but the midwife seemed completely flustered. It had only been six hours since Radiya’s water broke but it became quite apparent that her body knew exactly what to do and she was following along perfectly.

  The midwife ran out to get the nurses to set up the room as I continued to support Radiya, who now had both my arms locked in her grip, resting her head on my shoulder. I was sort of half kneeling, half standing, leaning on the side of the toilet. I asked the nurse to get some pillows. Radiya leaned back on them before the next rush. The midwife came back with a flashlight and checked for the baby’s head. She was indeed ten centimeters and bringing Baby down beautifully.

  After the next rush, without opening her eyes, she asked if the epidural was ready. The flustered midwife tried to explain that it was too late to give it to her now and she is awfully sorry about that but her baby seems to be ready to be born. Then Radiya said in that case, they could do a C-section, now! I helped her with the next rush, telling her that she was pushing perfectly and would see her baby soon. She leaned her head against my shoulder again and rested, almost slept for a few minutes before the next one started. Behind us in the bathroom doorway one of the nurses was arranging a low wooden birthing stool and covering the floor with a clean Chux. I was impressed. She and the nurse helped Radiya up and we pivoted over to the birthing stool and helped lower her onto it.

  Less than ten minutes later we could all see the baby crowning. As Radiya gripped my arms even harder, her baby’s head slipped out. The midwife asked if she could keep pushing, but Radiya was asleep already. The next rush started and the midwife asked her to “push . . . longer . . . push . . . yes! Do it again . . . good! . . . push . . .” but she couldn’t seem to help the shoulders out. I instinctively moved further back at least two feet toward the wall, still attached to Radiya, hoping that it might help with the shoulder instead of leaning forward like we had been doing. It worked.

  The midwife helped Radiya lift up a very pudgy baby girl and I helped hold her there while the midwife busily assessed what looked like a lot of blood from my vantage point. I helped rub the baby’s back until the nurses took her to the warmer, where she cried right away. The midwife said we had to get Radiya up on the bed and as I helped I watched a steady stream of blood dripping across the floor. We got her positioned on the bed and the midwife rubbing her stomach at the fundus (the top of the uterus) to get the bleeding stopped. She ­explained that it looked like she tore when the shoulders came through but that the bleeding was under control now. We could relax.

  The nurse brought her baby back but Radiya insisted she needed a clean nightie before she could hold her baby. The midwife explained that the baby needed to be skin-to-skin but Radiya refused, saying she had to wash up first, so the nurse put the baby back on the warmer where she started to cry. I asked if I could hold her, which the nurse agreed to right away. I put a dry hat on the baby, wrapped her in warm blankets and hugged her close.

  This birth occurred soon after I attended the all-day summit on skin-to-skin contact held by Dr. Nils Bergman, who had been researching maternal-infant-maternal attachment (your baby attaches to you, too, not just you bonding with your baby).

  Dr. Bergman has made it his life’s mission to provide the scientific evidence for the neuroscience of optimal birth, the role of skin-to-skin contact, breastfeeding, parenting for secure attachment, and to conduct the research as needed. He further seeks to disseminate this knowledge on mother-infant togetherness by educating all health professionals both here and abroad and by empowering parents. His work promotes practical changes in health systems and facilities that enhance mother-infant togetherness.

  I was determined to get Radiya’s baby onto her mom’s chest, as were the midwife and nurses, but Radiya told us she wasn’t ready, so I continued to hold the baby close while talking to her. She started rooting and salivating, both signs telling us it was time to eat, and I believed her, so rather than letting her cry, I let her suck on my little finger while she gazed into my eyes.

  The midwife asked the lead obstetrician to assess Radiya’s tear. He was the only OB on that day, though I had assured Radiya that we’d keep her draped and not have any men in the room. She agreed to have him come in if he had to and promptly covered her head with a blanket and stayed like that until he left. He did not need to do the actual repair but made some suggestions to the midwife, who set up a tray to stitch the tear when he left.

  I was still holding the baby, who was still staring into my eyes and nursing on my pinkie. I tried again to get her to her mama but the repair was still uncomfortable enough that Radiya said I should hold her until it was over. I certainly was not going to put her back on the warmer, so I hung out with the baby until Radiya was finally cleaned up and ready. She tied up her new clean nightie. I tried to convince her to untie it because her baby wanted to nurse. She didn’t believe me until I gently unwrapped the baby and plopped her down in Radiya’s arms, where she promptly latched on and vigorously nursed.

  Dr. Bergman had also talked about alternative caregivers filling the place of the mother in certain cases, like adoption, but stressed the fact that it should be the same caregiver for at least the first two years, not numerous people coming and going. I hoped we did the best we could in Radiya’s situation, so I contacted Dr. Bergman and asked. He assured me that we did.

  Dr. Nils Bergman with his “kangaroula” wife, Jill Bergman.

  “Mothers don’t breastfeed, babies breastfeed. Babies know how if we let them.”

  ~Dr. Nils Bergman

  Chapter 30: A Commune Couple

  How would I describe them? Not shiftless, just idealists. Anarchist? Perhaps. Communists? No. But maybe Socialists. Hippies . . . that could fit, too. They were living in a community of sorts: four houses on one street, with vegetable gardens and chicken coops in between the houses—in the city. Faded jeans and unbleached diapers always hung on the lines above the chicken coops. There were usually kids playing a game of tag, running past us at the speed of lightning.

  My h
usband and I had gone to a few of their neighborhood cookouts and once to a potluck wedding. The dozens of bicycle parts that had formerly littered the drive were miraculously all put away before the wedding. I can’t crack on that wedding. It sure was better than taking out a loan to get married in a dress she’d only wear once and paying for a caterer when the food they cooked was much tastier.

  There is something to be said for living simply: no debt, no car or car repairs, no phone bills. They could and did go dumpster diving behind all the co-ops and bakeries and grocery chains and harvested all the food they needed for a week. Sure, the luxuries of life were absent, but they found hidden treasures in nature and other people. They made some good points in our conversations.

  But when it came to babies, I drew sharp lines through some of their judgmental beliefs. To boycott all hospitals under all circumstances because they are part of a “materialistic, consumer-based conglomerate and perpetuate our capitalistic policies that only enable the rich and don’t serve the poor equally” was something I couldn’t agree with. But it was exactly what Juliette and Pierre had decided: they would do without “the system” entirely and live on the fringes at the edge of the rest of the population.

  My first baby was born in a hospital but the other four were not. However, if something had gone wrong we would not have hesitated to transfer to a hospital. That’s what they are there for. There are countries all over the world where babies and mothers die every day because they don’t have the facilities we have. We had several conversations about our different views but they were not swayed by my arguments.

  So when Juliette got pregnant, they looked for and found an unlicensed home-birth midwife who shared their worldview.

  Then they asked me to be their doula. I hesitated. Did they have a plan B should they need to employ one? No. Did the midwife have any backup? No. If she needed it, what would she do? “Nothing” was the answer; they’d be on their own. They could show up at a hospital, according to her, but she would not come along. Oh, boy. I wasn’t sure I wanted to be part of this scenario.

  We continued to talk and they grew on me slowly. They rented a birthing tub for their tiny room. They ate well enough and Juliette was gaining steadily. But then she told me that she had high blood pressure and a congenital kidney problem. Holy bleep!

  I told them that I couldn’t be their doula unless they had a doctor backing them up. And she would have to find one before her eighth month. For me to be their doula and be her primary care provider at her home until we called her midwife, I would need to know that she had been screened and approved for a home birth. My scope of practice as a doula does not allow me to do blood pressure checks. I also required a plan B, a doctor who already knew her and who had hospital privileges should we need to transfer.

  I didn’t hear from them for over a week. It was clear that they were battling between themselves over priorities versus idealism. Their relationship was not a committed until-death-do-us-part arrangement. She understood my concerns. He did not. He dug in his heels and did not want to budge.

  I was worried. I was afraid they would “drop out,” even disappear, perhaps with Juliette having a possible fatal complication. It was not entirely farfetched on my part, knowing some of the medical issues and the personalities involved.

  I had received a call a week earlier from a birthing clinic asking if I could consult on a breastfeeding problem they were seeing. The couple was from the same communal group as Pierre and Juliette. The issue was that he thought she should be able to skip drinking altogether until they could find a 100% pure reverse-osmosis water source and that they could get along just fine with just raw foods they “harvested” from around the city. It quickly became obvious that he was dictating or controlling everything she put into her mouth. It turned out she had not eaten that day and possibly not the day before. She was very thin and very pale, had not taken vitamins and as soon as I started prying a little further, she simply looked to him to answer. He then tried to assure me that he had studied nutrition and that we should respect their choices.

  Their midwife, who had called me, felt that the baby was getting dehydrated and losing precious ounces that he should have been gaining by now. The father would not let us visit with her unless he was in the room. Both the midwife and I spoke to them rather firmly, hoping to wake him up a bit. Mom had already given up any autonomy she may have once possessed, though I doubt she ever had any, at least not since meeting him.

  When I called the next day to see how they were, the phone had been disconnected. The midwife went out to their house and was told by their landlady that they had moved out that morning. They were gone. Vanished. We never heard from them again.

  Juliette finally called me. She had been to a regular “establishment” doctor who, she said, cleared her for a home birth. Great! Her blood pressure and sugars were within normal range. The couple was delighted and wanted to proceed with their original plan, but as another week unfolded, things changed drastically. Juliette was sick, feeling horrible, and vomiting. She went back to the doctor and, as she edged near her eighth month, was put on several medications and a restricted diet in the hope of stabilizing both her kidney function and blood pressure. In spite of the ominous recent chain of events, her midwife told them it was still the better choice to have their baby at home.

  They had scraped together the midwife’s fee by begging and borrowing from family and friends and selling an old car Pierre had fixed up. The midwife was officially hired. I knew they didn’t have any savings and offered to barter. Pierre, an accomplished carpenter, could suggest something he could build for my family in exchange for my doula services. Everyone was happy.

  About six weeks before her guess date, Juliette called saying she was having horrible headaches and feeling really crummy. I insisted she return to the doctor and get checked out before it got any worse. She had been under a lot of stress, she admitted. Pierre was nowhere near ready for a baby. He wouldn’t pack up his tools or the mountains of junk that covered the floor of their tiny room. And though she had expressed the wish that they move their mattress onto the floor from its location on a platform built on stilts, which was too difficult to climb up and down in her eighth month, not to mention how she couldn’t do it after the baby was born, he was not doing any of it.

  Juliette blamed herself for being so picky and cranky, but they weren’t really as “together” as she had hoped they would be, especially with their baby about to be born. I could only encourage her to keep the lines of communication open with him. In the end, I told her, she had to do what was right for her and her little one, even if Pierre didn’t agree.

  The report from the doctor was not good. Her overall numbers were alarming. Her kidneys were being taxed and her blood pressure was too high. He strongly recommended that she check into the hospital that same day and be induced. He felt that her health could still recover after the delivery, though she was getting into a danger zone, and if she waited she might not come out of it without some permanent damage. He also emphasized that the baby’s health would be compromised, even at risk if she didn’t deliver soon, given the new developments.

  Negotiations with their midwife went back and forth all that day. She was willing to help them should they choose to stay at home, but I made it very clear that I could no longer be part of the team then. She countered that her job description didn’t include being with them throughout the whole labor, which was why she had recommended they find a doula, even though they had paid her several thousand dollars. I told them again that hospitals are there precisely for their kind of situation and that I felt the doctor was on their side, committed to having a healthy baby and a healthy mother in the end. The battle had begun.

  The cards were blatantly stacked against them. Her health might not recover if she didn’t deliver the baby soon, putting her at grave risk. I pointed out that her baby needed a mom and tha
t although we would like to have control over our health and our births, it was not always possible. Welcome to parenthood.

  I could not tell her what to do, but I could encourage her to think on her own, without Pierre going on and on about corporate greed and disregard for the poor and multi-billion-dollar facilities. He simply did not understand that her life was creeping closer and closer to a point of no return; her numbers were now that bad. I had never had a mother so ill in my thirty years of midwifery practice.

  I told them to call me if I could do anything for them and tried to let go. I had not been so frustrated in a very long time. I said a prayer and made supper. Later that evening Juliette called to tell me that she had decided to go to the hospital and asked if I would be able to meet them there. I said I would be glad to.

  I explained what induction meant and how that might be attempted five weeks before a due date. She had written a birth plan and we had talked about the numerous options she had for a home birth; now we tailored it for a hospital birth, including induction.

  She wanted to have her baby as naturally as she could with as few interventions as possible. I outlined the various options the doctor had for induction, explained that some interventions were more invasive than others, and that she would have time to ask questions and could ask for privacy to decide what she wanted to do. Once she was settled in her room, the doctor suggested using a ripening agent placed at the cervix that would help get things started. Then they could start a small amount of Pitocin by morning and get her into active labor. The couple asked for some time to discuss it privately. While they talked, I went down to the coffee shop.