"We have a secret in our culture, and it's not that birth is painful. It's that women are strong." - Laura Stavoe Harm

Monday, July 25, 2011

How (and Why) I Became a Doula

Those of you who know me, will probably have realised that I'm really passionate about birth. I can remember the beginnings of that when I was seven. My Mum was pregnant with my little brother, and I loved learning about how the baby would be born. I was also fascinated with the job of the midwife, back then my Mum was lucky enough to have a midwife that worked on caseload - so she saw the same midwife for every appointment, the birth, and postnatally. I remember deciding I was going to be a midwife. I wasn't at my little brother's birth, but I came to the bedroom to see him shortly after he was born, and I remember how it felt to see and hold him for the first time.

Somewhere along the line, that initial interest was sidelined and by the time I was 16 I had decided to be a lawyer. I wanted to be a just lawyer, always on the side of integrity. I studied pre-Law at college in the States. I ended up having to leave college and move back to Scotland due to lack of money, and a year later I was back in the States and married.

I became pregnant with Cora at age 20, and I devoured all the information I could find. The internet was a source of info, but connections were so slow back then, it was more difficult than now! I read lots of books, like Henci Goer's "The Thinking Woman's Guide to a Better Birth", and Ina May Gaskin's "Spiritual Midwifery". I decided early on to hire a doula, because home birth wasn't an option for us due to the legal status of midwifery where we lived. I found and hired one, and went through my hospital birth with her. Thank goodness she was there, because it was a bit of an uphill struggle, and I ended up conceding to things I didn't want to like an IV.

After Cora was born, I decided I wanted to become a doula. There were no training courses anywhere near me, so that wasn't something I could do. However my doula was gracious enough (and her clients) to allow me to shadow her. So I watched her work, and learned, and read her coursework from her training. I continued to read, and read, and read. I began attending births when I was pregnant with Calvin and continued after he was born.

In 2006 we moved to Scotland, and I got in touch with some local doulas. I didn't really pursue working but as time went on people began to find me. When I was pregnant with Maia I set up the Grampian Homebirth Support Group (now "Choices for Birth in Grampian") with my wonderful friend Charlie, who is a Natal Hypnotherapy teacher. The group is still running, and seems to have times when several women come, and times when none do. But clients have found me through there, as well.

Until very recently I still thought I wanted to be a midwife "when I grow up", but I'm not so sure anymore. I like being a doula; in fact, I love it. I love that all I need to focus on is supporting the Mum and Dad (or other partner), I don't have to spend hours writing notes, or checking blood pressure, or listening to the fetal heartrate, or balance following protocol and guidelines with respecting the woman's wishes. I just be there.

I think the key to a good birth experience is to feel in control, able to make informed decisions, and that those decisions are respected by your caregivers. Disappointment is different to regret, and I think regret often is where trauma comes in. I want no woman to ever have to regret decisions she made or did not make in labour. I want every woman to feel like her caregivers understood her, and how important this day was to her - not just another day at work like it may be for them. I hope and pray that I never lose the joy at being asked to be at a birth, how I feel that it's a blessing to me and not a job. I always want to feel lucky that a woman thinks enough of me to ask me to be at such an intimate event, that she will never forget.

I love my job.

Sunday, July 24, 2011

An Amazing Story

With permission, I am posting one of my recent doula baby's birth stories here. I hope you enjoy it.

"Dear Skye

This is probably going to be quite a long story, but I'm happy to be able to tell it to you. My name is Amber, I'm 28, and have 3 children. I'm a doula - I can only assume that by the time you're reading this letter, your Mum will have told you what a doula does, but if not, go and ask her now! I first met your Mum and Dad when they came to my house to discuss home birth. Your Mum had rung me to ask some more information, after being a bit put off by her midwife, and came to borrow things like books, DVD's, and my birth pool. I remember that conversation with your parents because your Dad was so quiet! At that point I don't think he was entirely convinced about wanting your Mum to have a home birth. I let your parents know I was a doula, and they said they were going to talk about whether they wanted one or not.

A few weeks later I got an email from your Mum asking me to be her doula. I was thrilled! I thought your Mum and I got on well, and I was looking forward to supporting her and your Dad. She was almost 38 weeks then, so I went on call very shortly after that for her. We kept in touch regularly about her plans for birth and before we knew it your Mum was at 42 weeks. This tends to be the time when they encourage women to go in to the hospital for induction, but your Mum firmly believed that you would come when you were ready, so she stood her ground and kept planning a home birth. I was really proud of her for standing up to the consultants, it sounded like they weren't very nice to her at all, but she wouldn't be bullied into changing her mind! You've probably figured this out by now, but your Mum is a very strong woman and an inspiration.

On the morning of Friday 1st July I had a text from your Mum that said "had about four shows now, definitely mucus plug, am sure am getting regular mild contractions" - she had had a sweep a day or two before where they try and encourage labour to start, so I was hopeful that this was the day. We spoke on the phone that afternoon and then evening, and when your Mum couldn't talk through contractions we decided I should come over. I arrived at 9:30pm, I remember the drive to the house because the sun was shining, the sky was blue, there was great music on the radio - I was on such a high, what a beautiful day to have a baby! I got there and your Dad was asleep, I was impressed that he had the pool filled, cover on, just ready and waiting. Your Mum and I pottered about a bit making peppermint tea and things, then we headed outside. We walked around the garden slowly, stopping for contractions, and I would put pressure on your Mum's hips which she really liked. The contractions were definitely coming closer and seeming more intense, so at about 10:30pm I suggested maybe calling the midwives soon. In a rural area they can be an hour or more away, depending on who's on call, so I thought it best to call with plenty of notice. So your Mum called the midwives, I remember when she was on the phone she had a contraction and still clung onto the handset - I told her it was OK to put it down so she could lean on her hands like she wanted to! I think the midwife arrived about 45 minutes later, and things definitely slowed down. It's quite common for labour to slow down when something interrupts the flow of things, and that definitely happened. This midwife was called Michelle, and she was lovely, but quite business like I think! She was only on call until 1am, so at that point Rose arrived.

Your Mum was getting really tired, so we ended up going in to her 'nest', in the dining room, which was a mattress in the corner with beanbags, pillows, and duvets all over it. She was able to rest between contractions and then during a contraction would come up on her hands and knees so I could press her hips again. It was dark and we were doing really well with that, your Dad went and started lighting candles and getting the pool back up to the right temperature, and shortly afterwards your Mum got in. I think it really helped, the water seemed really relaxing to her, and within an hour or two she seemed to be feeling a little bit 'pushy'. Rose wanted to do an examination to see how far dilated she was, she was quite insistent, but your Mum wasn't ready yet. Rose called the second midwife out because she lived far away, and she arrived about 2hrs later.

At about 7am your Mum got out of the pool to try and go to the loo, sometimes a full bladder can stop the baby descending properly. She wasn't really able to go, but decided on the way back that she was ok to have an examination now. She was found to be 10cm, and the bag of waters was bulging, so Rose asked your Mum to push during a contraction and that broke the waters. Rose said you were Occiput Anterior (facing your Mum's back, which is what we want). For the next few hours your Mum was pushing every which way, in all sorts of positions! We were walking around the house, stopping during contractions so she could push. She wasn't sure how to push, which I thought was a bit odd to be honest, because normally women just push, it's called "fetal ejection reflex" and when the baby hits certain parts of the birth canal it becomes impossible to not push. But your Mum wanted us to direct her on how to push, Rose asked me if we'd gone over pushing in our preparation and I said no - I think she disapproved of that!

Around lunchtime, your Mum allowed the midwives to do another examination. They found that there was a lip of cervix, very thin, but there, and they weren't sure the position of the head. They felt it might be Occiput Transverse (looking to the side), but weren't sure. Things had slowed down a lot again, so after getting some toast, I decided to have a wee sleep. I slept for 30 minutes and then woke up and came to see what was happening. Your Dad had gone to bed as well. Another midwife had arrived to relieve Rose and it was decided that it would be best for your Mum to transfer into hospital. Policy is to be blue lighted in, so if you've grown up to be a drama queen, now you know why! You liked lots of attention even when you were being born! As soon as the ambulance arrived, I left the house for the hospital. Surprisingly, I beat the ambulance there, and walked out of the shop just as your Mum was being wheeled in. We were in room 3 I think, but I can't be sure of that. The first midwife was called Jenn, she was very nice. Your poor Mum had been very sick throughout her labour and was very dehydrated and exhausted. They soon hooked up a drip in your Mum's hand and started giving her IV fluids to rehydrate her. Unfortunately she carried on being sick right up until the end, but at least we knew she wasn't dehydrated.

Your Mum was using the gas and air through contractions, which she had started back at the house before she left. It wasn't really helping enough once she was restricted to a hospital bed, and she was so exhausted I didn't think it was a good idea to try and get her up on a ball beside the bed or anything. The Doctor came in and examined her and thought that you were Occiput Posterior (back to back), so they decided to put your Mum on another drip with a hormone called Syntocinon which is the artificial version of oxytocin (also known as 'the love hormone'). They hoped that this would bring your head down a bit so your Mum could push you out. They also gave your Mum, at her request, a painkiller called Remifentanil which is patient administered. It goes in through an IV and your Mum had a button to press whenever a contraction started, and it just lasts a minute or two. It made your Mum really sleepy between contractions, especially as the night wore on.

At about 7pm, the shift changed, and the new midwives came in. There was Sian, a lovely Irish woman, and a student midwife called Taryn. They were both lovely, and Taryn did a lot of the care because she is in her final year of the midwifery course. Your Dad and I chatted to her a lot in the last few hours when your Mum was sleeping between contractions. They re-examined your Mum about 8pm or so and found her to be fully dilated, no lip this time. So the policy is to let a woman 'labour down' for 2 hours, then push for 2hrs, and if no progress then the Doctor has to reassess. So that's what we did, all the while your Dad and I were comforting your Mum, rubbing her back, wiping her brow, getting her ice chips, keeping the sick bucket handy: you name it, we did it! Soon it was time to push again, and your head kept moving down but going straight back up with contractions. Apparently they could see a sliver of your hair, and they knew it was dark! After 2 and a half hours, about 12:30am, they said it was time to talk about getting some help. Your Mum was very scared, she had researched forceps and ventouse delivery and had said to me days before this that she'd rather have a c-section than forceps. However a c-section is major abdominal surgery and requires a lot more recovery, and has more implications for future pregnancies, so she consented to the forceps delivery. Because they needed to turn your head first, we had to be in theatre, because that could have made you distressed - and that would have required an emergency c-section. I asked if I could be in theatre with your Mum, having been there for 27+ hrs at that point, and after Sian asked the theatre team, they said yes. This was a bit of a milestone I found out later, as they had never let a doula in theatre before.

Taryn took me to get scrubs on, so I had a nice green uniform and hairnet. I came back into the room and they wheeled your Mum off into theatre. I was allowed to go with her, and your Dad had to go and get his scrubs on then. I was surprised at how theatre looked, it was a big room with a very tall ceiling and looked like any other hospital room. It was very bright, unsurprisingly, and I think that's why your Mum kept her eyes closed the whole time until you were born. They gave your Mum a spinal anesthetic, which numbed her from the top of her bump down to her toes. This was just in case they needed to do the c-section. I felt in the way because they obviously had their normal roles they were doing, but I wanted your Mum to know I was there so I kept stroking her hair or holding her hand, whatever I could do. Your Mum kept asking when your Dad would be there, she really needed his support I think. They don't let the Dad in until they're just about ready to start the procedure, I was surprised at how long it took - it must have felt an eternity to your Dad! Eventually they brought him in, and he looked so worried, I wished there was something I could do about that. All I could do was rub his back a bit to let him know I was there for him as well.

First of all, the Doctor had to use a ventouse to turn your head. It's a little suction cup, and they put it on and she began pulling. I was surprised by the force at which it looked like she was pulling! Having looked it up on the internet since, I think the force they applied with that and the forceps must have been much more controlled than it appeared, but to the untrained eye it looked almost barbaric. The Doctor successfully turned your head into the correct position, and they inserted the forceps. They were in two parts, so they inserted the first blade onto one side of your head, then the other blade, and locked the handles together. They began to pull with your Mum's contractions, they had her pushing at the same time. It didn't take very long for your head to be out, a few contractions maybe. I asked the Doctor if he could allow your Mum and Dad to discover the sex themselves. On the next contraction you were born, at 1:08am! The Doctor held you up so your parents could see that you were a baby girl. You were fine so you went almost straight onto your Mum's chest, your Mum suddenly 'woke up' and was very alert. She was so thrilled you were here! There were tears all around, your Dad was crying with happiness, and I had tears in my eyes too. You were beautiful, though it was plain to see the side of your head that had been presenting, no wonder it was so difficult for you to be born! The forceps hadn't left even a mark though. You had long fingernails and plenty of dark hair. It was amazing after 28hrs to see your Mum so happy with you cuddling up to her.

After a short while I was taken out to change, so I got back into my normal clothes and waited for you in recovery. Your Dad soon joined me and we had tea and toast, it was very welcome as both of us had really neglected to take care of ourselves because we were more concerned with supporting your Mum. I remember your Dad saying something about sometimes it's just time to abandon the hippy ideas! So I guess he thinks I'm a hippy too, but I'm ok with that. I think he is probably glad I was there. When your Mum came into recovery, you were cuddled up skin to skin on her chest. After about half an hour I was able to have a quick cuddle before I left to drive home at 2:15am. I had never been so tired in my life, but it was so very worth it Skye. I hope you've enjoyed reading my account of your birth, your Mum was amazing throughout the whole thing, you're very lucky to have her! And your Dad was a wonderful support for your Mum as well, it's plain to see how much he dotes on you already.

Love from Amber x"

Sunday, July 17, 2011

Continuous Support in Labour

I think if you're reading this blog, you probably have a fair idea of the benefits of continuous support in labour. Nevertheless, I'm posting a link to this study because I found it fascinating. I think what really intrigues me about it is this:

"Effects were strongest when the caregiver was neither a member of the hospital staff nor a person in the woman’s social network, and was present solely to provide one-to-one supportive care, such as a doula."

I wonder then, does that mean I shouldn't be a doula for my friends? What is it that made the subjects of this study do better when the person was not part of their social network? Perhaps we should just interpret that to mean that an untrained friend is not of as much benefit as a trained doula?

Regardless of how we interpret that part, I think the results are clear and consistent with other studies. Having a doula, in general, has a dramatic impact on birth outcomes. I hope that one day it'll be a reality in this country that every woman who wants a doula, has one!


Welcome to my new blog. I hope this will become a useful resource for pregnancy and birth related information. Please, if you have a birth related blog, let me know about it in the comments so I can take a look. Look forward to blogging more soon!