Never before have I experienced something quite like I experienced this past week... and I have a feeling that it will be a long time before I do again. Between Tuesday, March 8 and Tuesday, March 15, I had the privilege (and I mean PRIVILEGE) of supporting three beautiful, strong, inspiring women as they labored hard and birthed their babies. With their permission, I want to share some of their stories and give you a look at what this week was like for me.
The first couple I supported was one that I started working with late in their pregnancy. The mother and I were in touch via phone and email prior to us meeting for the first time and deciding to work together. This woman had one of the most physically draining and taxing pregnancies that I've witnessed. Severe hyperemesis followed her for 40 weeks and with it came non-stress tests and ultrasounds twice a week, along with an OB who was on high alert. She was unsure of what her physical strength would be like when it came time for labor and birth. We dialoged at great lengths about what the best option might be for her in her specific situation. She had valid personal reasons that I won't go into detail about, that made her really question if she wanted to deliver vaginally or by cesarean. Most of all, she really hoped to avoid being induced and avoid any pitocin use. Two days before her due date, we spoke again and she shared some very real fears and anxiety she had about her due date approaching and what that might mean when she met with her OB the next day.
It was no surprise to me when early that same evening, I got a text from her saying that she was feeling some labor sensations and that it was possible she was in early labor. As the night wore on, we kept in touch and I headed to bed for a little sleep. *Side note, her mother had fast labors with all of her children and while it wasn't a guarantee that it would be the same for this woman, I know from experience with another client who's mother had fast labors that it was a definite possibility.* I got the call around 10:30pm that they were heading to the hospital and we agreed that I'd meet them there. As I joined her, she was in the middle of being admitted (labs drawn, paperwork galore, etc). She'd been examined and was 8cm dilated. Wow. Labor moved very rapidly and was not giving her much of a break to catch her breath... but oh was she handling it beautifully. I was relieved when I found out that one of the CNMs was on call and would be working with her. At around 9cm, she chose to have an epidural placed. Personally, I think that this was such a wise and timely decision. For this mother, in this specific situation, the use of an epidural gave her the chance to rest, to catch her breath, and to wrap her mind around what was happening and what was to come. At 2:40am, she was complete and instead of starting to push right away, she opted to take more time to rest and continue to let her baby move further down. Early in the morning on March 8, this woman faced her mountain of giving birth vaginally, head on, and birthed her baby boy... what a joy-filled moment it was to share with her and her husband.
Four days later, a day after her due date, another mother I was supporting gave birth to her baby girl. This couple had a few interesting twists to their story. For starters, her husband traveled weekly for his job and it just so happened that he had to leave for training out of state on March 9 and would be gone for 6 weeks. Her EDD was March 11. As you can imagine, this was a big unknown for them and I was blown away by the way they took it all in stride. The situation was absolutely not ideal, but it was reality and they dealt with it the best they could. Another twist was that around 37 weeks, this couple discovered that their OB wasn't on board with supporting their wishes for labor and delivery like they originally thought. After talking with them, I suggested thinking about switching to a different care provider. It was important to them that they deliver in the hospital they'd been planning to deliver at, so I suggested a care provider accordingly. They were astounded at the difference between the two providers. Their former provider left them feeling anxious, stressed and not listened to. Their new provider, like they were all on the same team and that they were fully supported. They'd found the right fit.
In the week and a half preceding her due date, this woman had consistent contractions that often felt like they could be labor and her baby was very low and putting great pressure in her pelvic region. There were a number of days where she and I both thought that labor was imminent and it kept us guessing as to when things were really in motion or not. On Friday morning, March 11, she had an appointment with her doctor. She and her husband decided that they'd have the doctor sweep or strip her membranes. They knew this wouldn't guarantee that labor would begin, but they thought it was worth a try since the husband was home from his training for the weekend. Throughout the rest of the day, she experienced stronger cramping than she had been previously, but she wasn't sure that it was labor. As the evening wore on, she experienced stronger sensations and it seemed that labor had started. We agreed to keep in touch but that we'd all try to get some sleep if possible. A little after midnight, her husband texted me to tell me they were planning to head to the hospital and asked if I could meet them there. I met them and we had to wait for a room to be turned over before she could get into one. Within the hour and a half that we waited, I observed her through contractions and it seemed as though she was most definitely in labor. Finally a room was available and she got changed and waited for the nurse to examine her to see how far along she was. Much to her shock (and all of ours for that matter), the nurse told her that she was 2cm and 70% effaced but that baby was very low. This was exactly where she'd been 12 hours earlier when she saw her doctor. As you can imagine, this news was disappointing and very confusing. It didn't help matters that her nurse's bedside manner left something to be desired. The couple took some time to discuss their options which were to stay at the hospital and do some walking to see if labor might pick up or to head home and try to get some rest and to come back once labor seemed to be more intense. It was a tough call to make because at this point, it was just shy of 3am and the contractions she was experiencing didn't seem like the kind she'd be able to sleep through. A different nurse came in (with MUCH better bedside manner) and she suggested going home and taking some Tylenol PM to try to help her sleep. The couple thought this sounded like a good idea. I returned home and crawled into bed around 4am.
At 5:55am, my phone rang and it was her husband. Labor had intensified greatly and not only was she tired because she'd been up for almost 24 hours, she'd taken the Tylenol PM with hopes of sleeping and had no such luck. So she was dealing with some serious contractions and was way beyond tired. I hopped in the car and made my way over to her. I was there not even ten minutes before the decision was made to head back to the hospital. I could sense her reluctance and yet eagerness to get there. While she was really hoping to avoid having an epidural, with the exhaustion she was feeling, she was open to the possibility of having one if we got the hospital and not much seemed to have changed. I encouraged her that she was REALLY handling her contractions well... breathing deeply and steadily through each one. I followed them to the hospital and she was admitted to a room. The shifts had changed and new nurses were on. The new nurse (wonderful nurse, I might add) checked her at around 7:50am and she was between 6 and 7cm dilated and 100% effaced! AHHH! Sheer joy. Literally from that moment on, whatever fatigue she was feeling seemed to disappear and she just continued to take each contraction and breathe and move through it. Over the next two hours, her OB was paged and checked in on her and she progressed steadily to 9cm at 9:25am and then complete at 9:50am. She pushed for 30 minutes and delivered her baby girl into the world. Another beautiful birth I got to witness.
Monday, March 14 rolls around. There was one more woman who I was supporting that was due any day. Something special about this birth is that it was my very first twin birth. This woman met a client of mine while in line at the grocery store and got to talking about babies and birth and doulas. My client gave her my contact information. At around 37 weeks, this woman emailed me to see if I'd be interested in meeting and supporting her. I knew that she could literally go into labor any day and that I also had two other clients who were due around the same time. Once I found out who this woman's care provider was, I felt confident that she was in the very best care that I could hope for her when it came to honoring her wishes of having an unmedicated, vaginal birth of her baby girls. I also did some asking around to a few other doulas to see if they'd had any experience in supporting a twin birth. I quickly discovered that it was not something that many doulas had experienced, largely due to the fact that many care providers suggest cesarean delivery and/or at least an epidural.
Sometime that Monday morning, I got a text from her to say that she was experiencing some cramping sensations and that she was trying to rest. We kept in touch via text throughout the rest of the day and into the evening. Thing were feeling the same and she'd been able to rest, but contractions continued to come at regular intervals. She'd discussed with her care provider that she'd go to the hospital when they were 5-10 minutes apart lasting for around a minute. I checked in one more time before I went to bed that night and didn't hear back, so I fell asleep unsure of when I'd get the call. Around 4:15am, my phone rang and it was her partner. Contractions were consistently about 5 minutes apart and they were going to get ready to head to the hospital. I got up and prepared to leave. This was going to be my first birth where my husband was away. Amazingly enough, every other birth I've supported, he's been home. I let the women I had on standby know that I'd be needing help with my girls that day.
Around 5am, I left for the hospital. I wasn't able to join her in her labor and delivery room until around 7:30, as this hospital requires that patients go through triage first before being admitted to a L&D room. I waited downstairs and had the chance to talk with both grandmas-to-be, who were also going to be in the labor room. I got a text from her partner to say that she'd been examined and was 5cm dilated. Once we were all up in the room, the next few hours were no different when it came to supporting her than it would've been had she been carrying one baby. She had wonderful focus and a deep breathing pattern established and took each contraction as it came. She and her partner worked in harmony as he supported her. One of my favorite elements to this labor were the couple's two mothers, the grandmas-to-be, sitting very quietly, respecting the space and the environment that this laboring woman had established. She was on the fetal monitor intermittently and labored in varying positions on the bed and in the shower. Sometime around 11am, her OB arrived and checked her again and she was 9cm with a tiny bit of anterior cervical lip left to go. Her OB suggested changing her positioning a bit and to give her body a little more time to fully dilate. It didn't take very long before she was complete. She gave a few practice pushes in the labor and delivery room before she was transferred to the OR (twin births take place in the OR so that if there is immediate need for a cesarean, they're in place). It was standard hospital policy that only one support person be allowed in the OR, however, this couple requested that the nurse see if an exception could be made so that I could be in there as well. I assured the nurse that I was ok with surgical environments and also suggested that I could even be waiting to go in once the first baby was born so that I could be there to support this woman for the birth of her second baby, while the father was with the first one. The nurse checked with the anesthesiologist on call and I said a few prayers and held my breath. She came back and let us know that I could be in there for the entire birth, but if there was need for a cesarean, that general anesthesia would be used (since an epidural wasn't in use) and I would need to leave immediately. So with that, the father and I gowned up, I grabbed their digital camera and we followed her into the OR.
Once in the OR, she was transferred from the L&D bed that she was on to the operating table. In addition to her OB, there were about six nurses standing by. Two of them had been with her throughout her labor and the others were there to attend to the babies once they arrived. The environment of the OR was pretty different from what she had in her L&D room- the lights were understandably much brighter and there was much more medical machinery around. It was also colder and she requested to be covered with blankets over her chest. Another difference was that the sterile environment was in effect, so the mother wore a mesh surgical covering on her head- much like a shower cap. Everyone present wore surgical face masks and caps. She had the fetal monitors on throughout the duration of her pushing. As she pushed with contractions, I remained on her right side near her head for the most part. One thing that I wanted to assure her of was that the only reason that she was in the OR was that she was delivering twins. "There is nothing abnormal. There is no emergency. The only reason you're in here is because you are birthing more than one baby," I said softly to her a few different times. With each mention, she closed her eyes and nodded in agreement. Her partner was on the other side of her and frequently bent down close to her head and whispered encouragement and excitement that their baby girls were so close. Her OB was really encouraging and at one point, had her hold onto the end of a rolled up towel while he held onto the other end. While she pushed, she played tug of war with her OB and pulled on the towel and tucked her elbows close to her body. After using this technique for a few sets of pushes, he suggested that she go back to holding behind her legs and continue to push in that manner. After just shy of an hour, baby A's head became more and more visible and suddenly, was born. With one more push, out she came and was placed on her mama's chest for a few moments. She was handed to the proud papa so that he could have some skin to skin time with her while baby B made her way. Baby B was transverse and while typically, a baby in this position would not be given the chance to be birthed vaginally, because she was the second twin, the OB was willing and skilled in attempting to turn her. Baby B's amniotic sac was ruptured and the OB manually guided her to a head down position. Since baby A had come through the birth canal, there was room for him to do this. Within five minutes of baby A being born, her fraternal twin sister, baby B, was born. What an amazing sight. I count it such an honor to have been able to have been able to bear witness to an unmedicated, vaginal birth of twins.
This week had its fair share of interrupted sleep and days of not being totally sure if I was going to be able to do what I had planned for that day. In some ways, it reminded me of the days preceding both of my own births... not sure when it would be go time. This week was also very energizing for me. After every birth I support, I come home and jot down thoughts on a document on my laptop called, "Things Noted While Witnessing Births." I will share in a future post some of those things from these three births, as well as others. For now, I'll end with this... I am most certainly a better doula after supporting these three women, their partners, and their four precious babies. This week is one that I will cherish always.