Birth rantings…

Posted On August 11, 2009

I attended my second birth as a doula this past weekend. It was a good experience, overall. I was with her for about 20 hours, all said and done. In the beginning there wasn’t much for me to do. I just stayed with her and helped keep things light. I commended her on how well she was handling contractions and got her water and juice. We walked and walked. Then later things got heavier. Her doctor wanted to break her water, and it was after that happened that things got more intense for her. From that point on I got to do a lot of physical support. I’m still a little sore in the shoulders. It was definitely a good experience for me in that respect. I was happy to help her, and it was pretty easy to read what she wanted and what wasn’t working. I just followed her lead. She was so strong and beautiful through it, it was a really cool thing to see. I definitely caught the birth buzz in that room. There were interventions that she wanted (some pain management in the end), and part of what I have to do in this role is just leave my bias at the door. The most important thing for me to do is to empower and support her, and in that way I felt like I did my best.

In some ways it is hard though, when I watch her being given false information and false choices. A couple of examples:

This client was open to an epidural and some IV medication, but only after trying more natural pain management techniques. She wanted to try positions and walking and the physical and emotional support I had to offer, then she wanted to try the water, then maybe an epidural after all of that. In her last prenatal appointment before the birth, she called me to tell me she was going to just get the epidural and no longer wanted a water birth. I asked what changed her mind, and she explained that she’d been essentially given the choice between the water birth and the drugs, and because she didn’t want to be stuck in pain somewhere down the line, she better just go with the drugs. I was confused. We talked it over, and she realized that we could stick to her plan, there was no reason for her to make that choice now. The only thing is that when/if she chose the epidural, she’d have to stay in bed and water wouldn’t be an option any more. Apparently at her appointment her doctor told her "Oh no, you want the epidural."
Anyway, I was thinking it may have just been a misunderstanding and that the doctor was just explaining that she couldn’t do both at the same time. However, later when she was laboring at the hospital, the nurse (a friend of mine) discreetly told me that my client’s doctor expressed frustration about her resistance to the epidural, saying something like "Ugh, it’d be so much easier!" She and I were confused about that- I’m not sure what would make her job easier, but it brought that conversation back to mind, and got me thinking it wasn’t a misunderstanding at all. Her doctor probably did present it in a way that made her think she had to choose. On the epidural front- she was also told that she "didn’t have to be a martyr" and "this could go on for hours. You don’t want to be so tired later that you can’t even push!" Whatever.

They were also pretty pushy about pitocin. We had to sort of dance around them and bargain with them to keep that intervention at bay (which we ended up succeeding in- no pitocin the whole time! Is it sad that it feels a little like a victory?). Anyway, she had told me before hand that she did NOT want pitocin. When they offered it to her though (over and over), she felt kind of pressured and scared that her labor was not "adequate". I reminded her that she had a choice (they often presented these things as if they were just going to DO them, and they were just informing her. It’s so bizarre.). I said "I know you said before that you didn’t want pitocin. Do you still feel the same way?" And to that I got a surprised and stormy look from the doctor- I don’t think they are questioned very often. I also asked if there were any risks, which also seemed to catch them off guard (am I crazy for thinking they should routinely discuss risks with their patients?!). Anyway, they kept coming back, and at one point one of the residents said "Now, it’s not your fault, it’s nothing that you’re doing wrong, but for some reason these contractions just aren’t doing the job that they are supposed to… pitocin would just help you along." Now- a little context. She was at 7/8 cm. 7 to 8! I wanted to stare him in the face and say "Wow, so how’d she dilate this far with such inadequate contractions? Huh?" To make the situation even more absurd, she was having strong, piggybacking contractions AS HE WAS SAYING THIS. Thankfully our new nurse (my friend was off her shift at that point) was on our side and didn’t see the benefit to making these already frequent and strong contractions any harder. The doctors easily listened to the nurse, but not to my client. Why were they pushing this? She had been at 7/8 for about 3 hours at that point, but I don’t see how that’s abnormal or bad as long as mama and baby are healthy and heart rates are strong.

I guess the other thing is that the hospital has tubs of water available, but it’s sort of first come first serve. My client told them that she wanted that, and they just said they’d let her know if there was one available. It turns out there was one, but they never notified us. She expressed some regret afterward when I spoke with her, and that she would’ve liked to see if she could’ve tried that and gone without the epidural. Anyway. She did say that if she does this again she’s going to be much more assertive about what she wants and she won’t feel pressured in the future. It was definitely gratifying to see this woman talk like that.

Anyway, there was some drama towards the end. My client was pushing and the baby’s heart rate went down. They rushed her to the OR and she ended up with a vacuum-assisted vaginal delivery. She was told later that if the baby hadn’t come out when he did that they would have done a cesarean. I’m glad she didn’t have to go through that. I was sitting alone in her room (her fiance’s mother was the only one let in the OR with her, her fiance had apparently left the hospital), wondering what was happening behind those doors. I stared at the floor where her bed had been, and I just started thinking about how birth in this country IS scary- but not for the reasons people think. I wondered if the problem was random, or if it had to do with the epidural. I wondered why she had to be on a timeline. I wondered how often women naturally fulfill that timeline. I thought about a lot of things. I dealt with feelings of bitterness about not being in the room with her, after I had spent all day there and her family (the father of the baby, his mother and sister) had only shown up a couple of hours before. I immediately felt guilty for those feelings, and took a look at my motives. I meditated on humility and service. I realized that I was tired and hungry, mostly, and that I should rest.

She’s got a beautiful baby boy. She seems very happy. She seems happy with me, too, and I think she was really grateful for my support and company, especially given that her support at home is lacking. I no longer feel that bitterness, and I’m just glad I was able to do what I did for her. When I got home, though, I really did need some nurturing. I needed my tank to be filled, so to speak.

I am forever frustrated with certain aspects of the hospital care- their "policies", their presumptions and interventions. It’s as if they are looking at a laboring woman as something that is broken- something that needs help or fixing. I hated that they used the word "martyr" to describe a woman who chooses not to use pain medication. As if the only reason not to use it is to prove something to the world or make a point. How insulting. It’s not like women WANT the pain. But I think they know that it’s about more than that. The natural process of labor and birth is much more than a bunch of pain and a baby. I’m just tired of the lack of respect and understanding. I really don’t think that these doctors are bad people, but it seems like there’s been a huge oversight. I’m not articulating this well, but it’s just so confusing. I’m confused about all the bad information they readily give out. Why are women routinely told that they don’t produce enough milk and have to supplement, when that is only going to make their supply issues worse? It’s as if doctors have received no education about how breastfeeding works. Why are women told that their contractions aren’t "adequate", when there’s no medical reason for them to be dilating faster than they are? Why don’t doctors know about the importance of the birth hormones that are released in both mother and baby (in a natural, unhindered birth) that help to bond them? Why don’t they know these things? I have many unanswered questions. I will say, I will NEVER have a baby in a hospital if I can help it. Thank god they are there for emergencies, but yeah. I pass no judgment on those who choose a hospital birth, I think it’s really about what makes people feel safe and cared for- but for me, that is NOT it.