Ma Doula

by Stephanie Sorensen

  They called me on my cell phone a short time later to tell me that they had called their midwife for advice and she had warned them about what not to let the hospital do to Juliette under any circumstance and suggested some alternatives to try. I did not realize she was still influencing them and found it rather bold of her to be making decisions from some undisclosed location.

  Pierre and Juliette decided to try a non-medicated approach instead of the ripening agent and opted for a balloon catheter to be placed so it would stretch the cervix open and hopefully trigger labor. By morning it had succeeded in getting the cervix to dilate slightly but not appreciably. The next suggestion was to try Pitocin and then perhaps break her water if the baby’s head came down further. Again the couple asked us to leave and talked it over, and as I suspected, again called the midwife who told them not to let them break the water under any circumstance. I had never seen anything like it. I did not understand their trust or devotion toward this woman. Even though I was a friend, somehow by being a licensed midwife and certified doula, they seemed to consider me as having gone over to the “other side” and I was deemed too medical or too swayed by “the system” to be consulted on how to stay on the natural side of things.

  The nurses soon got the hang of how to approach this couple. Each step would require consultation, then consideration in private, then double-checking what I thought (but only after the midwife was called). Only then could the nurses and/or doctor come back in and negotiations would resume. I was beginning to feel like an international conflict-mediation envoy deliberating the politics of civil unrest. Many of the suggestions met with rejection as being too invasive or they simply felt that things were being unjustly and routinely rushed and asked for a few more hours of walking or sitting on the birth ball to let things work. I took to listing options for them from least to most invasive, knowing they would veto any and all suggestions unless their invisible midwife approved. I felt their midwife was calling the shots in a realm that was now outside her sphere of skill or experience.

  The nurses started asking me to ask them thus and such, hoping I had more “say” because they realized they did not have any at all.

  I do not go to any birth, at home or in a hospital, ready to do battle. I sincerely feel honored to be welcomed onto a birth team and readily defer first to Mom and her wishes and then follow her midwife’s lead. But this tug-of-war went on all night and all the next day. By evening I was called out to the nurses’ station and given an overview of the bigger picture. Baby was still doing remarkably well. Mom was okay—blood pressure and other numbers not off the charts yet. But it was time for the baby to be born. I asked what options they would propose next. Breaking her water was the least “medical” in their eyes and might speed labor up appreciably. I went back in and while slowly rubbing Juliette’s feet I told them what I had learned. I told them that they were doing great, that Baby was sounding really good and that she was actually making progress, which is not the same during an induction as it is in a term birth. They were not agreed between themselves what to do next.

  Juliette was able to eat and drink and was doing okay. She had refused all IVs and meds up until that point. I knew they would continue to call their midwife whether I was there or not, and I was frankly at my wits’ end after forty-eight hours. I proposed I go home and sleep and that they try to rest, even if it was only dozing between the rushes. I hugged them each goodbye, assuring them I would be back within fifteen minutes if they wanted me.

  I walked the short six blocks home from the hospital. I was so tired and drained that I just showered and cried until I got into bed.

  I slept in and called the hospital once I was awake. The nurse told me that Juliette had just given birth to a healthy eight-pound girl. Their midwife had come in once she heard I had left, though they were instructed to say she was just a supportive friend. She helped them try different positions that helped the baby along and they were grateful.

  Later that evening I called the couple and asked if I could visit. I congratulated them and told them how happy I was that they had been able to have the natural birth they wanted. She was nursing, which her baby took to right away. She was still five weeks early but was doing really well and did not have to go to the NICU. I was so glad all the drama was over.

  Two days later I got a call from another woman who was living in their communal house. She reported that a public health nurse had come by to make sure the baby was doing well. She looked at the baby and voiced some concern about her color, that she seemed to look jaundiced and also appeared dehydrated.

  Juliette and Pierre had read books on natural birth and said they had chosen to nurse on demand, meaning only when the baby awoke or fussed and asked for it. They had thrown out the doctor’s instructions for preemies in which he insisted they needed to wake the baby to eat every two to three hours until she reached her original due date. He had explained that their baby might act very sleepy and needed to be fed to catch up, whether she appeared interested or not. But they thought the doctor was just spewing routine medical jargon and that “nursing on demand” sounded more natural.

  The baby came five weeks early. She was sleeping up to six hours at a time. She did not cry. The baby was in trouble.

  The public health nurse took a blood sample and told them she would call back later that same day after she got the results of the tests. They dismissed the nurse as just another member of the “establishment,” turned off their cell phones, and went back to sleep.

  Their baby did have seriously high readings for jaundice and she was in the danger zone for being dehydrated. When the nurse called both cell phone numbers over and over and no one answered she did what she felt she needed to do. She called Child Protection and explained her concerns, which were bordering on dire at that point. The baby had to be rehydrated immediately and under bilirubin lights right away.

  A police car and an ambulance pulled up in front of the commune and I got another call. Later that night I went to the hospital and sat with Juliette for a while. She was nursing her baby in the NICU. The hospital gave her a room with a real bed so she could stay right there. She told me that she and Pierre just assumed newborns slept a lot and thought she would let them know when she was hungry. I explained again that preemies need an extra level of special care. She said, sounding surprised, “Oh. That is what the doctor kept telling us, too.” She was still pretty shaken by the whole experience and totally exhausted. She was going on day four without sleep. She also told me she had decided to stay in the hospital this time until everything was taken care of and they understood what they needed to do, even if Pierre didn’t agree.

  I still see them from time to time. Luna looks too big for her tiny mama to be carrying her around anymore. She is very sturdy and has gained beautifully. Juliette is feeling well and taking care of herself. It was another example I could chock up to education. I still don’t know what I could have done differently. I wanted to respect them even when our values differed and I wanted to advocate as much as possible for her wishes. I did not feel at any time that it was my place to act as marriage counselor, either. They were two adults whose ideas were different from mine, which did not make mine better or more valid. I come away from experiences like these convinced we must, above all, respect each woman we work with and allow that their points of view may not be our own. But I have also learned that I must set my own boundaries and equally respect those. I am just very, very grateful everyone is okay.

  “Giving birth should be your greatest achievement, not your greatest fear.”

  ~Jane Fraser Weideman

  Chapter 31: Cherish and Jewel

  I met Babette when I was given her referral by our agency for prenatal education, support, and doula care. Babette, a nurse, and her husband, who had a master’s degree in economics, had recently come to Minnesota from Ghana, Africa. They had been in the U.S. less than six months
when she became pregnant with twins.

  An amniocentesis test had been conducted because an omphalocele was viewed on one baby during an ultrasound just before Babette’s sixth month of pregnancy. The baby’s omphalocele could be seen protruding next to the umbilical cord at the navel during the ultrasound.

  The results from the amnio had not come back yet, but the hospital testing unit’s doctor advised Babette that her baby had a serious problem that might also involve the chromosomal abnormality Trisomy 18 and other genetic disorders, and she was told (all this through an interpreter) that because the babies were possibly identical twins, the baby’s twin most likely had genetic anomalies, too. During the same discussion—remember, the test results were not back yet—Babette and her husband were offered early interruption or termination of the pregnancy.

  After that first devastating news, Babette had gone home and Googled the list of horrors the doctor mentioned as merely possibilities. She was alone that afternoon as she watched photo after gruesome photo of babies with all the terrible complications the doctor had named. An educated woman, Babette had read everything about each lethal or fatal anomaly, the expected life span of a child with each disorder, and the complications and probability of incidence of each syndrome.

  Babette was understandably seriously depressed when we met for the first time and asked me if “the hospital would be mad at us if we don’t abort.” I told her no, that she had every right to carry her babies to term if that was her wish and that even no action was an option. She could simply let nature take its course.

  I told Babette and her husband that they could also change doctors, or even hospitals, that those were their rights in our country, and I would help them do that if they wished. I also apologized for the hospital’s actions. I told them that I strongly disagreed with the way it was presented to them, especially since the studies had not yet confirmed anything other than a small omphalocele on the ultrasound on one baby.

  They were both greatly relieved and asked me to accompany her to all prenatal visits after that, which I did. I often explained the medical reports as they came in and did home visits in between to address other concerns, like finding cribs and so on.

  Their four-year-old son was perfectly okay. He was a delightful little guy who climbed onto my lap without any invitation, sang to me in Dagbani, his parents’ native language, and thought I was his grandma, even though I was (still am) seriously pigment-challenged compared to the rest of his family. I wondered why the geneticist said that the babies could have a hereditary syndrome. I am not a geneticist, nor a doctor, but the way this case was being handled seemed particularly cruel and uncaring to me.

  When the test results came back, they didn’t tell us much more than we already knew, except that no form of Trisomy was indicated, nor Down syndrome, but other concerns continued. They told us that there was an eighty percent chance the girls were identical, though they could not be 100% sure, so they may or may not mirror the same problems, but they persisted in their theory that both babies might be similarly affected. Babette refused all further tests from that point on except for regular ultrasounds.

  In the circles of higher academia I recently noticed a startling new trend: People in the field are questioning, some for the first time, the connections between the rocket-science levels of medical technology, where tests can tell us if our as-yet-unborn child might have a gene that could elevate his or her probability of seeing symptoms of a disease by the time he or she turned five, twenty, or forty years old and the findings by these scientists and doctors that conclude that once a parent has been warned that a disease of some sort might exist, their parenting style actually changes. No longer is this baby a much-anticipated addition to their family, but is too often seen as a problematic addition to their family. Sometimes their lives stop at this unforeseen juncture and they delve into their own extensive research on the “intruder.” They no longer attend the local mothers’ groups to compare baby teeth and diapers but rather join support groups with other parents dealing with the same disabilities. I would wager that prenatal bonding, too, looks very different, even before the baby is born. Their babies are no longer treated as lovable, huggable, adorable little clones of themselves but as research subjects as parents become experts on every congenital or hereditary anomaly affecting the human race. I think pity takes the place of the funny faces and absurd sounds new parents and relatives make at their newborns. This is hardly the stuff conducive to continuum bonding.

  In her book, Testing Baby: The Transformation of Newborn Screening, Parenting, and Policymaking, Rachel Grob pleads this case on behalf of our children. Another equally brilliant work is called Saving Babies? by Stefan Timmermans and Mara Buchbinder, in which the authors question whether the benefits of these screenings outweigh the stress and pain they sometimes produce, especially given the high number of false positives. Inaccurate results can take a brutal emotional toll on parents before they are corrected, if they ever are. Finally, the American Academy of Pediatrics, together with the American College of Medical Genetics, has put in place a statement to curb the testing of children to identify genetically inherited childhood diseases and those that can occur when they become adults. They further recommend that doctors should discourage testing in children for adult-onset genetic diseases, especially if there is no preventative treatment to give during childhood, stating that the screening tests often don’t provide definitive answers, but whether they do or not, the test results may only lead to anxiety and more questions.

  Babette expressed her desire for a VBAC but she was scheduled for a C-section four weeks before her due date. The baby with the omphalocele had dropped lower than her twin and would be born first. The doctors were concerned that one of the babies didn’t appear to be practicing her breathing in utero, which could signal immaturity and the possibility that she might be better off outside of the womb where she could get their help, though they also could not tell if she never practiced breathing, especially if she had been sleeping during the ultrasound that particular day.

  To get a definitive answer as to the maturity question, the doctor now proposed another amniocentesis to assess the overall lung function of the babies. Babette was understandably worried by so much speculation. She asked me what I thought, and I told her that this one wasn’t up to me. Perhaps the doctors were right in trying to avoid additional problems, or maybe doing nothing would be right for her. I assured her I would support her in whatever she chose to do.

  She decided to have the amniocentesis, which told everyone that the babies’ lungs were, thankfully, mature so they didn’t need to be born early.

  That evening, however, Babette called to tell me she was “leaking.” The amniocenteses had ruptured the bag of water and it was not going to reseal itself. So much for letting the babies go to term. A C-section was again deemed safest at that point by the powers-that-be, though when nailed down, one of her doctors did admit to us that there really was no reason not to try a VBAC.

  I asked Babette if she still wanted a VBAC but she told me, simply, that she was tired—tired of being pregnant, tired of the questions, and tired of false hopes. She was also tired of imagining the future, the possibility of her being a prisoner in her dusty housing project, stuck at home year after year with two very sick babies and no hope of ever having a career again or of living the life they had dreamed of having in America. She wanted it over. She didn’t care what they did at this point. She had no more energy.

  I attended her birth in November that year. Both babies had acceptable Apgars and did exceptionally well after birth. The “well” baby, the one without the omphalocele, latched and nursed well in recovery. She was named Cherish.

  At her parents’ request, I accompanied the other baby, now called Jewel, first to the NICU and then to another children’s hospital the next day where I stayed for the surgery at twenty-four hours to correct the omphalocele and
the first few days in the NICU there. Babette stayed in the first hospital with Cherish. The father stayed with their four-year-old son.

  At the children’s hospital and also later in her hospital’s neonatal unit, I asked the neonatologist if he had noticed some of the same markers I had observed in Jewel. He had and had already sent more blood work to the genetics lab but hadn’t told the parents of his concern.

  The tests came back confirming a diagnosis of a very rare chromosonal imbalnce, which occurs in about 1 in 15,000 births. I had done some research, too, and the next time I visited Babette and Cherish I noted similar visual markers in Cherish, which again I didn’t mention to Babette. I called the doctor, who assured me that Cherish was fine, that twins rarely both carry this rare syndrome, and that he did not feel further testing was warranted.

  About two months later, Babette asked me to go with them to a follow-up visit at a pediatric clinic, not one of the hospitals they had already been to. A pediatrician saw us and was very happy with both babies’ weight gains, feedings, etc. I asked this doctor to refer Cherish for a genetic workup, listing the anomalies I thought I was seeing. Upon further examination he also saw them and agreed to refer Cherish for further testing.

  I told the parents I wanted to be sure so that any early interventions that might help her would be in place. I tried not to convey any deeper concerns. They agreed. The parents were called a few weeks later and told that Cherish did indeed have the same syndrome as her sister Jewel, though her chances were also only about 1 in 15,000.

  What is known today about the syndrome is that the body’s chromosome 11 gets messages to reproduce at accelerated speeds, thus causing over-growth or a form of giantism. One leg might grow faster than the other. One kidney could grow beyond the expected proportions for age and maturity. The child will have to be monitored several times a year to try to detect any abnormal growth before it becomes a major problem. Growth that is faster than normal also puts a child at a higher risk for certain types of cancers.