essentialmidwifery

Birthy Thoughts by Jane E. Drichta and Jodilyn Owen

The Language of Oppression, VBAC Style -Jane April 10, 2013

Filed under: Uncategorized — EssentialMidwifery @ 9:41 pm
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A doula colleague of mine posted a story in a facebook group about a vbac client who refused a c-section for post dates.  Eventually the mother went into labor, at 42 weeks and one day, and she had a lovely vaginal birth, as per her plan.  However, as the mother was walking out of the hospital , the accompanying nurse told her that while she was glad she had succeeded in pushing her baby out her vagina, she had been “naughty” in not listening to her OB about the necessity of a cesarean birth.

It’s that word that gets me.  “Naughty.”  It is a child word.  Nursery school kids are naughty when they eat finger paint.  Third graders are naughty when they let their eyes slide over to their neighbor’s math test.  By the time we get to teenage curfew violations, taking the car without permission, and swigging Boone’s Farm, the transgressions have moved far beyond  ”naughty.”  At this point, they illicit  other descriptors, ones which carry more weight, and possibly four letters.

This mother had just achieved something gigantic.  Not only had she accomplished her vbac goal, but she did it on her own terms.  Now, I do not know this woman, but if she is like most of the vbac-ing mothers I do know, she probably did a whole lot of research, asked others for their opinions and apparently was comfortable waiting a bit longer to see if labor would start on its own.  She evaluated the risks, made her choice and stuck by it, even in the face of opposition from her care provider, a provider that she herself chose.  She did not hand over her power to another.  She not only claimed it, she used it, in a very visible and undeniable way. That child came out her vagina because she insisted on time. There can be no argument there. And that is not the mark of a naughty child.  It is the mark of a fully grown, capable human, exercising fully grown, capable reasoning.

And that is extremely threatening. Someone in power wanted her to do something.  She didn’t.

In conflicts of oppression, if the weaker person “wins,” there are repercussions. Without punishment, the weaker may try this independent thinking thing again.  It might even spread to others, and then we have a revolution.  A revolution would make a mess of the carefully constructed hospital system, destroying a top heavy power base that has worked extremely well for those in power for decades.  (Just decades, mind you.  Not centuries or millennia.  Maybe it is not as strong as it first appears?)

In this case, the repercussion came from the nurse.  What better way to put a new mother in her place, taking back that mature power she claimed, than to turn her back into a baby?  Babies do not threaten.  Babies drool and look cute and poop.  This mother used her adult prerogative of self determinism; let’s use child words to negate that, to cut it down into something easily contained and understood.  Something “naughty” rather than terrifying, something teensy-weensy rather than something momentous.

Or let’s not.  Instead, let’s celebrate adult women making  choices, making fully developed, reasonable, heart driven choices, that are neither outlandish nor insignificant.  Our world deserves that.

 

“False Labor”: Misnomer of Grand Proportions–Jodilyn May 21, 2012

Filed under: Birthy Thoughts,Jane and Jodilyn — EssentialMidwifery @ 4:17 pm
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The language of pregnancy and birth showcase our society’s beliefs with perfect clarity. I can think of dozens of phrases that divide mother from baby, spirit from body, mind from health, and mother from inner knowledge. I want to look at just one phrase to showcase the way we approach these linguistic faux pas in midwifery care, and how we get to the bottom of events in pregnancy that can be difficult or seemingly in need of a cure.

We can attribute the language of divisiveness to many sinister roots and spend all day railing at The Machine and The Man–but why spin in circles when we can gain some insight instead?  Something I’ve learned over the years and hundreds of births: the roots lie beneath layers of asphalt, cement, cobblestone, and packed dirt. The energy required to dig them up and cultivate new soil and plant new trees is the work of modern midwifery. Meanwhile, we like to say we “forgive” those who have attached themselves to the practices that stem from these roots because that is their only paradigm and how they were trained. While that’s fair to some extent, each of us is responsible for lifting our heads so that we can partake of a broader vision. I know it’s not politically correct—but shame on all of us who are entrenched in one way of thinking, talking, and acting. And a double shame if that tunnel vision limits the experience of something so fundamental as the birth of a baby and a mother: the building blocks of any society. (And yes, this cuts both ways–midwifery care and homebirth are not the right fit for every woman.) What makes one person or another apt to lift their eyes and stretch their perspective or practice? I would call it holistic curiosity, and it should be taught in every medical and midwifery school. Actually, scratch that. It should be taught in every elementary school.

It is unfathomable to me that any person could witness birth and think only of the moving parts and mechanics of it, but there is where the roots of modern birth and the language and rituals that surround it lie. The medicalized perspective of birthing must work very hard to connect the parts that authentic midwifery honors as inextricably bound together. There are wonderful OB’s and OB nurses who see the whole woman—this is really not a message about them, it is a message about the environment, language, and curiosity that we surround ourselves with.

Back to the misnomer we are looking into: “False Labor”. This term is typically applied to bouts of contractions a mother has between 37 weeks and the onset of rhythmical contractions that get stronger and longer and culminate in birth. A contraction is an activity of the muscle. A mother cannot make her uterus contract the way we can flex our biceps. The uterus contracts in response to internal stimulation—be it from any of several maternal or fetal hormones, movement from the baby, an orgasm, or changes in the lower neck of the uterus called the cervix.

The idea that the body would generate activity, heat, and motion for false purposes is nothing short of absurd. Every contraction has a purpose. Each one massages baby, helps baby adjust its position in the pelvis, and stimulates receptor systems for hormones we need to birth our babies. Emotionally, contractions pull us inward and force us to spend time with our bodies and babies. They pull our attention from the world, the clock, the to-do lists. They teach us lessons about control and surrender. Often times in our busy lives it is the norm to be in a state of disconnect with our bodies. Mothering needs us present in our bodies. It demands that we feel and sense and respond to these feelings and sensations in order to ensure the very survival of our species. Contractions that come and go, sometimes for nights on end, and in fits and spurts help us acquire and practice these skills.

“False Labor?” I don’t think so. The body is wise and begs the mind’s attendance in this wisdom. A provider who looks a mother in the eye and tell her that this wisdom is “false”, and demands that she separate her wise body from her knowing sense of her truths does not see a whole woman in front of her. Midwifery care, at its very best, does not get lost in the mechanics, but honors the wisdom of the whole mother and her baby. It sees them work together in harmony to bring about motherhood in its richest, fullest sense, and babyhood with the right I wish every baby on this planet had—the right to a mother who has integrated her body and mind and honors her senses, her knowledge, her gut, and her heart and can be present for her baby. “False Labor?” I don’t think so. The next time we meet a mother who is contracting in these patterns, we can stand in awe at the integration of mother and baby, spirit and body, mind and health, and mother with her inner knowledge—and know, with absolute certainty, that there is nothing false about it.

 

More Vbac Stuff-Jane April 18, 2012

Filed under: Uncategorized — EssentialMidwifery @ 1:29 am
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I’ve been doing a lot of sitting on the couch lately, working with a set of premature twins in my neighborhood.  They are sweet and cute and screechy and vomit-y, and all the things that you could reasonably expect little people to be.  It also means that occasionally, between physical therapy exercises, massage, and wiping spit-up off my shirt, I get to watch some CNN.  Like many people, both men and women, who I hang with, I was shocked to hear Democratic strategist Hilary Rosen’s comments regarding Ann Romney and her decision to stay at home with her boys, rather than work outside the home.  Now this is not a political blog, and I won’t go into my own personal beliefs here, although I will say that I value good manners from all parties. What struck me, and seemingly much of the rest of America is the fact that once again, women are being divided, and once again, we are doing it to ourselves.

This lack of cohesiveness is certainly nothing new in feminism, and regrettably, it is nothing new in the birthing community.  But, you know what they say about familiarity, and I am certainly feeling a bit of contempt right now for a situation that’s a-brewing in the Seattle vbac community.  Let me tell you a story:

Once upon a time, Dear Ones, there was a little community hospital. It didn’t have a Level III NICU, but it had nurses who would gently love your baby to sleep at the desk, if you needed a nap yourself.  It didn’t have flat screen tvs or a bath tub in every room, but the rooms were large enough to stroll around, and the showers were big enough for two.  There was an ob group there, and a few independent nurse midwives who had privileges, as well as a family practice doc or two for variety.  They had nurse anestethists, rather than dedicated anesthesiologists, and all seemed to work very well for a while.  Oh, and they did vbac.  Lots and lots of vbac.

But the only constant is change, Dear Ones, and progress must be made.  The flat screens went in, and the ob group gradually morphed into another set of personalities.  The nurses still loved on the babies, most of the independent midwives eventually left, and an official CNM group was established.  Oh, and the vbacs went away.

You might think, Dear Ones, that this is the end of the story, that this is one more rant about how the opportunity to vbac is being slowly taken away. But no.  Actually, now the vbacs are coming back!  The obs are willing to accommodate vbac on a case by case basis, depending primarily on the reason for the primary cesarean.  They are especially fond of those reasons that are “non-repeating. “  In obstetrical language, this includes a breech baby, placenta previa, and basically any other condition where you had to schedule a c-section before the labor waves hit you.  It also helps if you have had a previous vaginal birth, have no underlying health conditions, like long walks on the beach, and are a Capricorn.  (Ok, that was a bit snarky.  You caught me.)

So you would think we would be celebrating, right?  After all, isn’t any vbac a cause for celebration?  Yes.  Yes, of course.  But I’m still upset, and I’ll tell you why.

While there is some statistical difference between the “success” rates of vbacs based on the initial section, it also really really doesn’t matter.  If the Big Bad Wolf of VBAC is uterine rupture, why does it matter how the scar got there in the first place?  If we are going to be scared of scars, let’s really commit to it.  Let’s be really really scared.  Let’s have a vbac ban that is honest.  Let’s not try to hide our own fear behind a colorful wall of half examined statistics and rupture stories our colleagues told us on the nightshift.  Nights are dark and cold, and even the extra cardigan in your locker can’t protect you from half buried truths, based on old school traditions and your sister’s scheduled repeat cesarean.

Even ACOG clearly states that VBAC is a “safe and reasonable choice for most women,” who have had one c-section, and even for “some women” with two.[i]  It says nothing about “non-repeating” conditions, although it does specify that a suspected big baby, carrying twins, or going over 40 weeks are not reasons for a mother to be denied a VBAC.  (It actually says denied a TOLAC-trial of labor-but that language is another post for another time.)

And, by the way, vbac is successful  75% of the time.[ii]  This is actually a better chance than an every day, run of the mill, first time mama, who has a 67.3% chance of a vaginal birth.[iii]  And by the way, in 1965, the C-section rate was only 4.5%[iv]  Just sayin’.

Jodilyn and I have said for over a decade that 99% of a vbac happens in the mind, not in the uterus.  The  research, the personal exploration, the soul searching, the intense wanting, means everything.  A supportive provider certainly helps, as does a partner who is on board.  But at the very end of the day, it is a mother’s journey.  She needs allies, certainly, but the journey is definitively her own.  She is the one who has to fight the doubts, and ultimately believe that she is not broken.  She may be a bit bent in spirit, but eventually most women can believe that most of the time, her uterus and her mind are strong.

So what does it do to a mother who is already working through her process, when she is told that not only does she have to live with the results of her c-section, but that she didn’t have the right kind of labor before her section?  And what does it do to her faith in the medical professionals who tell her that, when she realizes this is a completely arbitrary distinction?

[i] American College of Obstetricians and Gynecologists. (1999). ACOG Practice Bulletin No. 5: Vaginal birth after previous cesarean delivery. Washington DC.

[ii] Coassolo, K. M., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Nelson, D., et al. (2005). Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks Gestation. Obstetrics & Gynecology, 106, 700-6.

[iii] National Center for Health Statistics

[iv] Taffel SM, Placek PJ, Liss T. Trends in the United States cesarean section rate and reasons for the 1980-85 rise. Am J Public Health 1987;77:955-9.

 

VBAC-less in Seattle February 17, 2012

Filed under: Birthy Thoughts,Jane — EssentialMidwifery @ 12:49 am
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It is no secret that Jodilyn and I are completely and utterly committed to vaginal birth after caesarean. We believe in the right to birth your baby vaginally, whether in your own home, a hospital, a field, hanging from a trapeze…you get the idea.  We believe in intentional birth, one that is the fulfillment of carefully considered thought and soul work, and not one forced into an impersonal mold by circumstances.  In short, we believe that everyone has the right to birth the way they see fit.

Only, what happens when you can’t? We have been so lucky here in Seattle, because while the actual number of providers doing vbacs has remained fairly low, there has traditionally been a nice mixture of types of providers.  We have homebirth midwives, hospital midwives, family practice doctors, obstetricians, and even a few perinatologists.  Unfortunately this has changed radically over the past year.

Hospital midwives who do vbac are in short supply here in the greater Seattle area, and getting shorter.  We have lost two major midwifery groups, and one extremely popular independent practitioner.  We now have only two hospital midwifery groups in Seattle  proper who do vbacs, and one of those are severely restricted due to insurance limitations.  While we do have many doctors who deliver vbac babies, they are, in fact doctors.  They may be delightful people, but they practice under many limitations, some self imposed, some practice or hospital based, and some pushed upon them by insurance companies and malpractice issues.  They are not midwives.

And midwifery care IS the answer here.  If anyone needs the focused care and tender compassion of a midwife, it is the vbac-ing mother.  The long office visits, the search for answers from her last pregnancy, the wading through pages and pages of safety studies…these are not the exclusive territory of homebirth midwives.  It is the right  of ALL midwives, regardless of where they serve, to hold a woman as the tears come during prenatal visits, to flush with anger alongside her for indignities done, and questions left unanswered.  ALL midwives should be privileged to wipe the sweat from a laboring vbac-ing mama’s face, to bring her water, to sing to her softly in the tub.  And ALL midwives should have the opportunity to discover the humility and strength that  reside in their souls in a way that is only possible when they stand silent in the birthing space, the one solitary being who truly and absolutely believes in this mother, body and spirit.

It is honor beyond measure to attend these women in their most creative time.  And I am so sad for the midwives who are being denied this.  I want our sisters back.

 

The Story Unfolds–Jodilyn July 17, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 9:59 pm
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Yesterday was Sunday.  It has been raining and although I got myself all caked in mud on Friday in the name of going to market and getting out a bit, I stayed inside Saturday and had cabin fever by 5:30am Sunday morning.  The computer seemed like a trap I had no desire to lose my toes in so I decided to go to work.  I brought my umbrella to walk there.  It doesn’t rain for 10 or 15 feet and then the showers come on and frankly, they come on so fast and so hard that by the time my umbrella is up I am already drenched.  So I was mostly wet by the time I arrived but I passed one of my favorite midwives on her way home as I walked down the hill to the hospital.  She told me it was super busy and they will be happy to have my hands.

After that there is a giant blur but I will try to break it apart.  I walked in and put my backpack down in the lounge.  As I made my way to the board to see what was happening someone handed me a baby with directions to bathe and give it shots.  Oh Happy Work!!  I love love love floating these babies in warm water, watching as they unfold and look around and kick and relax.  Not to mention the baby cuddles which come in spades as I hold them in a towel to dry them off instead of rubbing their skin which I think must feel so sensitive in the first days after birth.  I brought baby to her mother and got them skin to skin, laying down in bed and then walked back to check the board which I had not managed to do.

“Jordilyrn!”  (every midwife here has their own version of my name, this I recognized as one of the senior midwives who walks with a limp but manages to lift mothers out of bed and scrub blood and muck out of sheets and do all of the hard labor involved in working here.)  I followed her voice to the delivery room and she told me she thought this mama was going fast.  She was opening the delivery kit and I looked at the mom, walked over to the counter and put on some gloves and turned around and caught the baby.  “Oh, you are going to do this delivery?”  She asked.  “Ummmm….you are welcome to but here is baby.”  A delighted laugh issued forth as she turned around again and saw baby already skin-to-skin with mom.  I offered to clean up and suture which she gratefully accepted.   I tidied up, sutured, and then got to scrubbing while the mother enjoyed her baby and her extended family came in to admire the new arrival.  I got mom to her bed, baby bathed and in bed with mom and then went to try again to look at the board and the charts.

The hallway was swarming with pregnant women.  They rub their own backs through contractions, reaching around and pushing up and down on their tailbones.  Sometimes their mothers or aunties or sister-in-laws will be there doing it for them and sometimes they will be sitting nearby chatting with the other mothers and aunties and sister-in laws.  Who is who?  I wonder about them.  I like to have my hands on a woman’s body before she births so I have an idea of her.  I want to know her name and what number child this is and if she tested positively or negatively for STDs.  I want to feel her belly and say hello to the baby.  I want to have a sense of her hygiene and some idea if her hemoglobin is beyond the low we think of as low.  I read through as many charts as I could but another page through the hallway, “Jordilyrn!”

I follow the call back to the delivery room where a young mother (and by young, I mean she is the exact age of my own daughter) is pacing back and forth, moaning.  I assume she is a first time mother because she is so young.  The midwife tells, me, “you stay with her.”  So I do.  I pick up her chart off the counter and see this is her second child.  The first was by cesarean section birth because the baby had been lying sideways in the belly.  OK, hooray!  A VBAC! I am really good at these.  I am smiling to myself and happy to be there.  I read the whole chart.  The doctor wants regular updates as to her progress and he wants her waters broken when the baby gets low enough.  OK, out of the range of things we would do to a VBAC but I am here on their turf.  I pause and watch her and start to think this through.  My rebellious VBAC self is screaming just to let her go and to have her baby before we call.  I rub her back and she wraps her lanky arm around my neck and strokes my shoulder.  She nuzzles her face into my neck and moans.  She is a child.  I feel her body, rubbing her hips and shoulders.  I look at her mother who is watching us and her daughter cries out to her, “Auwe Mommy!” I miss my girl.  Her mom is crying, watching her daughter like this.  She wipes her tears and shakes her head and comes to her daughter who launches herself from me to her mother.  She leans on her mother as I rub her back and talk in soothing soft words.  Telling her not to be afraid of what she is feeling.  Telling her she is safe and this is ok.

As her labor progresses I ask her if she wants me to check her.  She says she does.  I go and get my favorite nurse who acts as my translator.  She speaks softly to the moms and treats them gently.  I ask her to tell the mom that if the baby is low enough we can break her water, which will make her labor more intense.  I want to know if she wants me to do this or if she prefers not.  She wants me to if I can so I prepare ahead of the exam and confirm the plan with the head midwife.  I feel the baby, so low into the pelvis, and a bulging bag of waters ahead of it.  I snag the bag gently and it opens.  But the give of the bag was too easy and I felt it pull apart and rip down.  I listen to the baby as I think about what I felt.  Baby is doing great.  When I think about things not being as robust as I would expect them to feel or be here, I wonder right away about nutrition.  I ask the mom if she eats fish, chicken, beef, or ham.  No.  She eats island cabbage and white rice for dinner.  I park that in the back of my mind.  I tell the head midwife that she is nearly complete but since it is the first time she is pushing a baby out it could be a while. I don’t want the doctor cranky with me for calling too soon.

I walk back into the room and she is pushing.  I trot back out and say, “Nevermind.  She is pushing.  Calling Dr. B.”  The midwife comes into the room as the first of the head is showing with strict directions from the doctor to call if she has not delivered within an hour.  I ask her to stay.  I don’t feel good about friable tissue.  I see the telltale sign of bleeding from behind the baby.  I know what this is now, after having seen it so many times and know that she will be shredded on the inside and I want a witness to see that I did not do it to her by not cutting an episiotomy and that I have followed the doctor’s orders.  The midwife even remarked that she must be tearing on the inside.  Baby is born with three pushes, it is a beautiful wonderful birth.  And then the bleeding starts.  It is not pulsing, just gushing.  I feel for the uterus and can’t find it.  I make a map of her belly and start my search in quadrants.  I finally locate it but it is too low down.  Something is really really not right.  I rub and rub and it finally hardens beneath my hands.

I ask the midwife to start an IV and give her fluids and synto.  She gets it up fast.  We can’t run IVs as fast as mom is bleeding.  I take gauze and go in hard, looking for the source of the bleeding, thinking that if I can compress the tear it will stop.  It hurts mom.  I tell her I’m sorry and to take deep breaths.  I see one big tear, and what looks like the uterus, or the front of the uterus, or some other organ.  There is blood everywhere and it is hard to see but I know my landmarks and that is not one.  I start packing gauze into every tear I can find.  I am screaming in my head, “Protein!”  I know this is not the time to be thinking about nutrition and that I should be screaming other things in my head.  But I am frustrated with these women falling apart.  The doctor comes in and he is friendly and kind.  Blood is pouring over the gauze I have packed in her.  I am trying to convince her uterus to stay firm and I say outloud, “I would really like this uterus to stay firm.  Mama:  talk to your uterus, tell it to get hard.  Talk to your body.  Tell it to stop bleeding.”  It sounds bananas but this really does help when we do it at home.

I am dumping a bowl-full of blood out and putting the bowl back again.  And again.  I give the doctor the summary.  What has happened.  What I’ve felt.  What I’ve seen.  He takes my position and asks for a speculum.  I do not waste time removing my gloves and my bloody hands open the door and get out the kit he needs.  He confirms that the lower segment of the uterus has come down, he can see the rectum.  Everything is in the wrong place.  The one thing I know about this is that we can get it back up where it goes.  Sure enough he pushes the uterus back up and I can see it rolling up her belly.  I lock my hand in place on her belly to hold it there from the outside.  I massage it with my other hand.  It won’t stay hard despite the massive quantities of syntocin going into her through IV.  We place a second IV and draw blood to cross and match it, then hook her up to more fluids.  The doctor meanwhile is busy trying to find an apex to one of the tears so he can start suturing.  He eventually does it by feel.

He worked for 45 minutes with myself and another doctor assisting him.  She was bleeding the whole time.

He cleans up the best he can—the room is a flood of blood and looks like a hurricane has hit it as we tore open supplies and cracked bottles of medicine and fluids.  I am eager to clean up, I know it will feel soothing.  I ask for instructions from him—how often to do vitals (I did them twice as often), how much fluid to give, when to call him back.  I made a chart to record everything and put in consults to him once every 45 minutes for the first three hours.  He leaves and she has the shakes.  I chase him down and ask him how he feels about that.  He tells me to put some blankets on her and watch her vitals.  I do.  Her blood pressure tanks.   I get the senior midwife back again and she tells me to load on a plasma replacement gel and she will call the doctor and tell him that he wants us to do that.  I love that woman.  He tells us to load her with two doses of gel and keep running fluids until her pressure normalizes.  She has no urine output despite the now 4000 units of fluid we have put in.

I spent four hours with her, scrubbing the room to a shine while taking her pulse and temperature and blood pressure.  The grand-mother had taken the baby out to be with family.  I realized she needed a family member with her so I went to find her mom.  I saw her boyfriend there and I changed tactics.  I asked if he would come see her.  He too is just a teenager and he was scared witless.  I told him just to come talk with her.  She was in a sleep when we got to the room so I woke her and told her to say hello…I would later tell the doctor that this young man was the best medicine we gave her all day long.  I watched him step over his fear to be with her and encourage her.  She was shaking and pale and he spoke gently to her.  He looked up at me and said, “I think she is hungry.”  Teenagers are magnificent, capable, wonderful creatures.  I know they are busy finding out who they are but the sensitivity and depth of empathy they display when the chips are down are palpable.

I sent him to go get her some food and he returned with the source of her friable tissue….orange soda and white bread.  Frankly, I thought the sugar would do her good so did not object but made my way to the mom to ask her to go and get some milk.  She slowly ate and the combination of his company, the fluids, the food, and time seemed to be bringing her some strength.  At the end of the fourth hour her blood pressure looked pretty darn good and there was urine output again.

For my birthy people, don’t think I haven’t wondered if I had ignored orders and not broken her water if she would have shredded.  All I can offer up is past experiences here which tell me it did not make a difference whether the water was neatly emptied on a midwife’s schedule or came flying out all over me—this is so far beyond what we know of in America.  Poor nutrition here is not fast food and snickers bars.  It is a lifetime of orange soda, white bread, fried leafy greens and white rice.  No protein.   An entire lifetime of it.

It was already two hours past the end of the shift but the senior midwife had stayed with me to see this mom through.  I learned from this mother.  At home I always tell laboring moms who are having a long labor that they and the baby each have a story to tell and a journey to make, and we will understand it very clearly when it is all over, but cannot know it before then.  So too for the midwife.  The labor will tell its own story.  If I assume that each moment is the story I will be mired in parts instead of learning from the whole.  She was dying.  Then she was not.  And she did not.  And I worked hard and sweated and used everything I had available to me, including a consult to a very good physician to make it so.   We moved her to a postpartum room close to the midwives’ desk and got her settled with her baby, who forgave her the hours she had been away and eagerly looked at her and nursed well.

As I was dragging myself toward my backpack and home, I heard it again.  “Jordilyrn!”

I took a breath.  Really?  “Can you just check one mom before you go?”  Of course I can.  I brought mom into the admissions room.  A fourth time mom.  A posterior cervix.  No bleeding, no broken waters.  Hardly a contraction to speak of.  I saw Dr. B in the hall and asked him to come translate as she had no English.  “Can you ask her if she has any concerns?  I am wondering why she is here so early in labor if it is her 4th—she must feel something is happening.”  He skips my version and asks her all of the questions I already know how to ask and he tells me she should just go home.  She lives nearby and can come back later in more active labor.  Now a fourth time mother usually has a reason for calling a provider or showing up to a maternity ward.  I put her on the CTG to get a read on baby and contractions, just making sure everyone looked good before sending her home.  They looked stellar.  After 10 minutes I unpluged the machine from her and told her she could go home, or walk-about around here, or go into town with her sister for a girls night out…the choice was hers.  I helped her sit up.  She stood and there was a puddle of water.  I looked at her.  Her face had changed.  She was sweating and looking at me like I might  have the missing piece to a puzzle she has been working on for years.  “OK”  I say, “let’s go—right there”  I was pointing to the delivery room.  She is nodding slightly and making small deep questioning Scooby-doo-like noises.  “huhhhhh?”

I would like to pause to thank the two women I have been with as a doula who had posterior cervixes hardly dilated, followed by two contractions, followed by a baby.  Thank you.  I recognized in her what I was privileged enough to see in you.  I remember the nurses yammering on and on about how you couldn’t possibly be in labor, about how it will be several hours…I resolved not to be that person.

Mom took two steps up the stool to the bed and lay down.  I put on some gloves and turned around. I placed my hand gently on moms belly.  “Ok baby, today is your day.  Now is your moment.  Come to us gently and kiss your mama who has taken such good care of you.”  Mom smiled and pushed her baby out slowly.  A lovely pink healthy girl.  She did not cry.  She just lifted her head from mom’s chest and looked around.  “Welcome, welcome” I hum.  Mom was smiling dreamily from the baby to me and back again.  Auntywas laughing and crying.  I was waiting for the hemorrhage but it did not come.  I know how to do this birth.  I relax and smile and am thankful.  So thankful.  I feel the cord pulsing.  It pulsed for 19 minutes.  Aunty cut the cord.  Placenta came easily.  Hardly any bleeding.  “Surprise!” I say, laughing.  “Happy, Happy Birthday Baby…I’m so happy you are here ” I talk to the baby as I check to see if the cord has three vessels, if she is really as healthy and strong as I think she is.   Mom names her Jodilyn on the spot.  I can’t refuse.  I’m too happy.

 

 
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