Ma Doula

by Stephanie Sorensen

  Even before the birth, Babette confided to me that she felt she was doomed to spend the rest of her life in the housing project with two severely handicapped babies. She had hoped to go back to work after this pregnancy. She had planned to first become proficient in English and then apply to graduate school for any credits she might still need to transfer her degree from Ghana to the U.S.

  I applied for a grant and got an English independent study course for her to do at home, which she and her husband have both completed. I explained that she could find daycare for her babies, she would be able to go back to school, and that in the U.S. her babies will go to school even if it is an adapted program.

  When I last visited the family they seemed happy, but I felt that Babette had not bonded as well with Jewel, who was having some additional problems (further surgery had been recommended). Babette was very unsure about agreeing to the surgery. At one point she and I were alone in the kitchen and she said, “I just want to go back to Africa and leave the babies with him. He can put them in daycare.” I asked if she just needed a vacation or whether she wanted to run away. She said, “Both.”

  I spoke with a clinic that addresses postpartum depression because of my concerns about Babette. Months earlier, when we went to the OB testing unit at the hospital week after week, she was routinely asked at each visit, “Are you depressed?” This became a running joke between us. She didn’t think she was depressed. She should know–she is, after all, a professional, a nurse with a degree. She told me that the babies were in God’s hands and that she was happy she had been blessed with two. She said God would take care of them, even if they were handicapped. However, I realized as the reality of caring for these two sweet, beautiful little babies day after day began sinking in, I thought it might be time to ask for extra help for her too. I am grateful this family is living in a country where multiple resources are available to help them in the years ahead.

  “Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn’t dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your timeline.”

  ~Gloria Lemay

  Chapter 32: Filsen

  Through the years I’ve gotten to know the staff at many hospitals throughout the Twin Cities’ healthcare system, but I hadn’t had any clients deliver at one particular county hospital for quite awhile. I assumed they kept informed of “best practices” and were interested, if not actively invested, in being known as a “baby friendly” birth facility.

  I was wrong. There were no midwives in this hospital. Although my client had a birth plan, it was generally ignored. Even some of the information the doctor gave her as labor progressed simply was not true. As a doula, it is certainly not my place to challenge a nurse, much less a doctor, on their own turf, but this was crazy. Still, I could not say anything.

  Filsen’s water broke at noon. She was admitted into the hospital where she was promptly popped into bed and monitored. She was experiencing slight contractions but nothing appreciable. Throughout the afternoon, Filsen was told that they hoped she would get into active labor with good contractions on her own but if she didn’t, they would start Pitocin. They assured her it would be started at the lowest level. By 4:00 p.m. they were saying that there was a risk of infection if she didn’t get the Pitocin and hurry up having her baby. I told her that I understood that twelve hours was closer to the time to start considering hours and risks. She was GBS (group B strep) positive and was already on a penicillin IV drip, so what was the rush? One clinic I worked at gave most moms forty-eight hours after their water broke, and I know of another where they have waited as long as seventy-two.

  When the IV was put in, Filsen was told not to eat anything. Really? When she asked why, she was told because of the IV. Huh? She said she was thirsty, so they said she could have milk, but just little sips. I had told her when she first called me that she should eat before she went to the hospital because she would need the calories for the upcoming marathon. I was glad she did.

  By 6:00 p.m. the doctor announced that it had been “close to ten hours since” since her water broke (it had in fact been only six) and “we are very worried about infection, so we’d like to start the Pitocin because that might take awhile to start working.” Filsen managed to put them off until 9:00 p.m. Then the Pitocin was started. She was still not allowed to eat. I suggested she ask for juice or popsicles, but they didn’t bring any when she asked.

  The Pitocin was cranked up every half hour. The nurses did not tell Filsen what they were doing. They just appeared to be checking the monitors and pushed a few buttons here and there. Filsen’s first baby had been delivered by C-section, then she had VBACs. I wondered if the Pitocin wasn’t being ratcheted up a bit too fast and furiously for a mom who’d had a C-section. They had kept her in bed the entire time, though I reminded her to go to the bathroom every hour and finally got a birth ball for her to sit on, reminding her that gravity would help both with establishing contractions and dilation.

  The Pitocin starting working so well that Filsen was soon having a contraction every two minutes and sometimes two at a time (called coupling). I helped her breathe through them and held the bag when she began vomiting. Finally the nurse turned the Pitocin down.

  The doctor ordered another round of penicillin, explaining that they were still afraid of infection. She was four centimeters dilated in spite of the whopper contractions. She was finally brought ice chips. What era are we in, anyway? I wondered. I did not tell Filsen what I was thinking. I didn’t think it would help but would instead undermine her faith in the doctor she had chosen.

  So we visited, and breathed, and chatted and rested. It was obvious around 3:00 a.m. that things were changing. I had Filsen sit up first. I got pillows and made sure she was comfortable. I just knew she’d be delivering flat on her back with stirrups if that was how they found her when they all arrived. We didn’t call the nurse until she started feeling pushy. I asked about a squatting bar and was told they didn’t have any. At some point one appeared. It was put aside, but at least one nurse knew what Filsen wanted.

  Filsen was hanging on until she got to ten centimeters and she could push. The doctor explained that they needed to see exactly how strong the contractions really were, so they placed an intrauterine pressure catheter inside, between the baby’s head and the uterus. This is not an easy procedure when a woman is near the end of her first stage of labor. The contractions looked just fine. Duh.

  When Filsen took a deep breath and we all knew she was going to give it all she had on that first push, the nurse told her to wait and proceeded to break down the bed and help the doctor to gown up. There were actually three doctors in the room at that point. I was a bit confused by this, but didn’t ask. The baby’s head crowned on the first push and popped out on the second. The shoulders were slow coming and the doctor didn’t want to wait, or didn’t know she could wait for another contraction, but started pulling on the baby. The cord was over one of the baby’s shoulders, which didn’t help, but instead of rolling it over the shoulder and arm, she kept pulling the baby, who did come out then.

  The doctor went to put the baby onto Filsen’s stomach while asking her, “Do you want the baby up here now?” but at the same time a nurse stepped in and said, “She should be crying more” and whisked the baby over to the warmer where she cried right away, without suctioning, and remained there.

  Filsen had only briefly seen the back of her baby’s head before she was taken away. I encouraged Dad to head over there and touch his baby. When I looked over there again, he was taking pictures of her while the nurse set up the vitamin K shot, eye ointments, and footprints. No one had held the baby yet.

  I wedged myself into the last remaining space near the warmer, hoping to help Dad hold her soon. I asked the nurse what the Apgars were and while I was no
ting it on my chart she raised her voice and said to me in no uncertain terms, “You know, you are in my way and I have to finish up doing things over here.”

  The three doctors were busy repairing two tears. As I listened, I realized that the doctor actually doing the stitching was being coached step-by-step by one of the other physicians. I started to wonder if she had ever sewn up a repair before, based on the fact that her mentor was repeating each step and pointing out landmarks down there as they went along. It was a teaching moment.

  Finally the stitching was finished and Filsen was cleaned up a bit. The doctors left the room, leaving Filsen completely naked on the bed. I found a gown in a cupboard and covered her the best I could. Throughout the birth I had tried to keep a sheet handy, knowing that modesty is pretty important to most women.

  Baby was given her vitamin K shot, eye ointment, footprinted, and heart-monitored briefly, before being wiped down with a dry cloth. She had been fussing during all of this, understandingly so, but started howling her protests against the washcloth. She still had not been cuddled by anyone.

  When the nurse finally gave the baby to Dad, he took her to Filsen’s mom, who was waiting patiently. Grandma held her for a bit, though Filsen had not even seen her baby’s face yet. It was about forty-five minutes after the birth. All of this was unacceptable in my book.

  Then one of the nurses took the baby to Filsen and, without unwrapping her, positioned her for breastfeeding. I stepped up at this point ready to help, but the nurse pushed baby up to the nipple and started giving Filsen pointers about how to get her to latch. I quietly told Filsen, “She can just get used to your smell first or just lick for a bit,” but the nurse was determined to get the baby latched on immediately. I knew it could take awhile, and babies will actually lead breastfeeding themselves and latch on in their own time it we stay out of it.

  The poor baby had been kept away from the breast during her crucial first hour but now she was being encouraged to “perform” ­immediately. So wrong. I didn’t volunteer the information that I was also a certified lactation consultant and educator because I was already on the wrong side of this nurse. The nurse had other things to do and was already miffed with me, so she busied herself elsewhere.

  When I returned the next day, the baby was sleeping in a little cot next to Filsen’s bed. A bottle was propped in the corner of it. I asked why it was there since all during her pregnancy Filsen had said she was going to breastfeed. She said the nurses had told her she should give the bottle of formula to the baby after every breastfeeding since she didn’t have any milk yet.

  The baby was getting colostrum, I explained, and her milk would come in. Her baby wouldn’t go hungry. I went on to say that using the bottle would cause the baby to suck less on her breasts, which would cause the breasts to make less milk.

  Babies can experience nipple confusion from being offered a plastic nipple after their little brains have already imprinted their first experiences at the breast. Breast, bottle, bottle, breast. What is all this supposed to feel like, anyway? they may wonder. Many babies go on strike at this point. Others find that the formula flows faster and they don’t have to work at it as hard, so they opt out and prefer the bottle, causing their moms to offer the breast less and less until their milk starts drying up, having gotten the message that the demand is not there to make more of a supply.

  Baby-friendly hospital? Uh, no . . . in so many ways.

  “We’ve put birth in the same category with illness and disease and it’s never belonged there. Birth is naturally safe, but we’ve allowed it to be taken over by the medical community.”

  ~Carla Hartley, Ancient Art Midwifery Institute

  Chapter 33: El Doula Diario

  I had been waiting for Alegra to call for many days. I was very glad that her midwife wasn’t anxious about her approaching week forty-one. I had seen far too many inductions that year, though there is very little evidence that we are preventing post-dates complications by doing so, and there is even less proof that we aren’t actually introducing more possible side effects by inducing at what only might be a post-date baby. Unless a mom is charting basal temperatures and knows exactly the date of conception (the only other reliable predictor would be artificial insemination or in vitro conception), we could very well be inducing a premature baby. Too many times I have seen induced babies who still have all the signs of prematurity: ears flat against their head, lots of the creamy vernix skin coating, furry little bodies, and so on. True post-term infants have long fingernails and often peeling skin. The placenta may have patches of calcification. We are still waiting for some direction, called “best practice” on this one about when, if ever, it is truly warranted to induce a so-called “late” baby. Opinions still vary widely among obstetricians. The whole topic is being revisited at this time, with good reason.

  For ten days I had not ventured too far from home in case Alegra’s call came, either before the guess date or like now, after. I had planned suppers around what my family could easily assemble should I be gone when they got home. I learned that one the hard way: One year when turkeys were super-cheap after Thanksgiving I bought one, thawed it for two days in the fridge and stuffed it with homemade dressing. I got it into the oven, set the timer, and went to start a load of laundry. One hour into baking the phone rang. A baby had decided it was a good day to be born. I turned off the oven, made room in the fridge for the giant roaster and quickly scribbled directions on how to continue cooking it once someone came home. Since then, I keep a steady supply of salads in the house, often homemade tabouli, cous cous, a freekah or quinoa dish that can be eaten cold, hummus or pesto, and washed raw veggies.

  I checked my doula bag for the umpteenth time: Massage tools, olive oil, lavender and pine scents, a can of champagne to set in ice water for counter pressure for back labor (it works really well and we can open it to celebrate later!), mint gum, toothbrush, toothpaste, snacks—for me: dates, raw almonds, apples, trail mix, and honey sticks for mom, paperwork and two pens, a sweater—hospitals can be really cold at night—my rubber kneeler from a discount garden store for me to use by the tub or birth ball and for mom to use in the tub if she wants to stay on hands and knees for any length of time.

  I also carry a book, should she fall asleep; my I.D. badge; a purse with money and I.D., and my “hospital shoes.” I don’t like the idea of street shoes bringing in all their germs so I change into my comfy canvas shoe/slippers. I try to have some handmade baby hats along too, since a group of grandmas are constantly donating them to our office. Also in the bag are a nail clipper, battery-operated “candles,” umbrella, phone and charger, socks, and my headache medication. I also have my hairband-type party tiara that says “Happy Birthday” in big pink letters. I have been known to tell a partner, “I don’t need to wear this the whole time, but you do,” and they usually put it on!

  I got a call at 6:00 p.m., sure it was Alegra, but it wasn’t. It was a desperate doula. Could I be with one of her ladies for a couple of hours until she got out of her college English exam? Sure. She was grateful.

  A first-time mom, nervous about not having any support, Mary Smith was sleeping when I arrived. So were about nine other bodies camped all over the floor, each rolled up in sheets or blankets. It looked like she had support: sisters, brothers, girlfriends, and girlfriends’ boyfriends were all sacked out.

  Mary was not yet in early labor but the medical personnel were keeping her because of some concerns with her high blood pressure. They were talking about using Pitocin in the morning. When the nurse came in to check her blood pressure and temp she woke up and I introduced myself. I assured her I would stay until Julie, her doula, could come. When the nurse left, Mary told me that the pile of blankets on the floor closest to the bed was her partner and she wanted him at the birth. The FOB (father of the baby) would not be coming. I told her that was fine and that she was doing really well. Her contracti
ons were weak but they could pick up. I also said it would be great if she could rest. I got her some juice and a straw and encouraged her to drink most of it. She did and went back to sleep. I pulled a chair up to the bathroom door and opened it just enough to read by the light. Less than two hours later Julie came to relieve me.

  As I opened the door to my apartment the phone rang. I hoped it might be Alegra, but it was a mom who wasn’t due for another month, asking what she should do: she had pelvic pain, fever, chills, and felt really crummy. I asked Carmen to call her midwife and let me know if they wanted to see her at the hospital. It might be a urinary tract infection, but as a doula I was not about to diagnose what it might be. She called back to tell me she was going to be seen in the emergency room and asked if I could come. I told her I would meet her there.

  At 7:30 p.m. they were just hooking up Carmen to the monitors and had her in the maternity triage area. A woman was screaming in the next room and nurses were running every which way. It looked like they weren’t going to get her up to the labor and delivery unit in time. Our nurse’s pager went off and she left. Carmen and I visited until she came back, but not before we heard a very lusty cry from the baby in the next room. The nurse explained that they would monitor Carmen for about half an hour and then call the doctor to come and assess what was going on. Blood was drawn and they had her give a urine specimen. We hadn’t had time to visit for two weeks, so it was nice to catch up. I just wished she felt better.