I don’t usually break posts up into multiple episodes, but this one is special (and thus, especially long). With my client’s permission, I am sharing not just one of her birth stories, but all three of them, each a journey and a saga in itself! To do justice to her and her husband’s courage and faith, I’ve found it necessary to make each birth its own post.
Trigger warnings: fetal distress, traumatic birth, newborn resuscitation.
On the day I would have turned 42 weeks with SweetBaby, I went to the birth of a very special client.
This client was what many doulas call a “Three-peat”; she’d asked me to attend each of her two previous births. And what births they were! Her first baby’s birth was only the sixth one I’d gone to; ThreepeatMom was higher risk going into it because of high blood pressure in pregnancy which had put her on bed rest for six weeks. An active, sardonic person by nature, bed rest had driven her a little crazy, but she handled it by reading everything I could give her on unmedicated birth and Gestational Hypertension and binge-watching Netflix. As a result, when her water broke at 38 weeks, she was astoundingly well-prepared.
Two hours into labor, though, it became clear that she was now very high risk: her BP shot up to 210/100 if she so much as sat upright. So, being the badass that she is, she labored lying down in bed with no pain meds. ThreepeatMom is a musician, and you could tell; she sang wordless music that rose and fell in volume and intensity for all twelve hours of her labor. Her husband, the most connected partner I have had the pleasure of working with, held her hands, gazed into her eyes, and recited her favorite psalms and scriptures. All I could do was rub her back and marvel at her operatic voice and the beautiful sight of a woman in labor being treated like the most precious person in the world by her husband.
But for hours, an alarm went off about every 90 seconds. The nurse only showed us how to silence it, not explaining what it meant and once even refusing an offer of help from several other nurses who rushed into the room. I was a new doula, with a new doula’s understanding of the job: I saw my role as only to support and care for the mother’s non-medical needs. The equipment and any health issues it related to were not my concern or responsibility; they were the medical staff’s. So I made it part of my job to sit beside the monitor and silence it as soon as the alarm started. What else could I do when the nurse we relied upon insisted it was not a problem?
An hour into my client’s pushing phase, the on-call OB arrived. He walked into the room, took one look at my client and the pattern on the monitor, and his face went from cheery to “WTF” to that efficient reassurance that care providers assume when something very bad is happening. It turned out those alarms had been red flags that the baby’s heart rate was abnormal. Two minutes before birth, everything they portended came to pass: FirstBaby’s heart beat disappeared.
Dr. Cheery Mc-WTF explained quickly and kindly that he was going to attach a vacuum to the baby’s head and pull as my client pushed, “just to help your pushing.” He pulled so hard his foot was braced against the end of the bed.
When FirstBaby came out, she was gray and floppy and had no vitals–no breath sounds, no heartbeat. Still, the OB flopped her quickly onto my client’s chest, handed her husband the scissors, and said, “Dad, cut the cord.” ConnectedHusband did what he was told, smiling gently as if he didn’t know what her color and tone meant. A split-second later, FirstBaby was being resuscitated in the corner. I stayed with my client and her husband, narrating for them what was happening as they realized she wasn’t crying and began to pray. FirstBaby was whisked from the room less than five minutes later, without her parents even touching her. Within four hours she was transferred to another hospital to undergo treatment preventive for brain damage due to lack of oxygen.
I visited her and her parents in the NICU, trembling and trying not to look too closely at all the tubes and wires, trying to focus instead on listening to the woman and man I had gotten to know and who were now caught in this vortex of fear for their baby. It was devastating, and I felt as if I should have been able to do more. But I was already doing everything I could.
I had a lot of questions about that birth, and I still do. Why did the nurse–a seasoned professional with years of experience–not see what was happening with the baby? How did I not know something major was wrong? Why was I the only one telling them what was happening after the cord was cut, and what could I have done differently to help that family have a safer and less traumatic beginning?
Let’s face it, as doulas, we aren’t trained or expected to monitor machines or watch out for signs of complications. That’s the job of the staff, and I was clear from the beginning NOT to step on their toes when it came to issues of medical care. But in this situation, the staff person responsible for my client and her baby had let them down. And I was not about to let that happen again on my watch.
From then on, I made it my business to understand the basics of normal and not-normal in fetal heart rates. I acquainted myself with how the monitoring equipment worked and what to watch for if it made noise. I started establishing up-front relationships with nurses, midwives, and doctors at every birth to let them know that I was aware of red flags and would be vigilant about telling my clients to ask for help if something didn’t look right. I didn’t step on the staff’s toes, but I made it clear that I knew where their toes were and would help them to stay on top of my client’s situation. And I started completing the pre-requisites for nursing and midwifery school, so that I would never again be in the situation of seeing a baby in distress and not being able to help.
Next time: ThreepeatMom and ConnectedHusband prepare for a very different birth–and get one that nobody expected.