Back to Birth Work, Part II

This is part two of a three-part series examining an ongoing doula-client relationship and the individual births involved. Please see “Back to Birth Work” for the first installment. 

After their first baby’s terrifying ordeal, I had wondered whether I’d ever again hear from ThreepeatMom and her husband. While I didn’t think they blamed me for the complications from FirstBaby’s birth, my sense of guilt made me feel that, at the very least, I could be a reminder of the trauma they had gone through. If they had decided to simply ride into the sunset, leaving me or even the dream of a healthy unmedicated birth behind them, I wouldn’t have blamed them at all.

Instead, a year and a half after FirstBaby’s birth, ThreepeatMom texted me to ask if I would meet with them to discuss being their doula again. I leapt at the chance.

When they walked into the coffee shop that day, we hugged and didn’t let go for a long time. Finally seating ourselves at the table, all three of us had tears in our eyes. We talked through her birth. We talked about what I had known (not much) and what I had learned in the meantime (a lot). We talked about how the experience had changed each of us. And then we talked about what she wanted this time: a classic, low-intervention, unmedicated birth. Would I be willing to work with them and help them prepare for it?

Absolutely. It would be my honor.

They talked openly about how their view of what was normal had been skewed by FirstBaby’s birth. They talked about the trauma of listening to alarms all night long, of not being allowed to eat or drink or sit up, of having their baby placed under ice blankets for three days in the NICU and how she would be watched for years for signs of brain damage. They talked about feeling that they might not want to go back to that same hospital, about deciding to tour it again–and then about how ThreepeatMom passed out the minute she stepped inside the door of L&D. They talked it all out, and they cried, and I cried. And then we started over again. I gave them videos to watch to regain a sense of what normal birth is like (some of which they told me with a laugh were NOT up their alley!), books to read, we talked through which doctor and hospital they should switch to, and comfort measures in labor, and how and why they worked.

And then, at 36 weeks, they found out SecondBaby was breech.

“We’re going to do everything we can to turn him, but if he won’t turn she said we should schedule the C-section for around 38 weeks.”

I was cautious. I didn’t want to impose my own feelings, beliefs, or the choices I would make on her. “How do you feel about that?”

“Okay, I mean, it feels weird to schedule the birth, I think I’d rather go into labor and then have a C-section.”

Still cautious. “I know this is something you might not want to do because of what happened with FirstBaby, but there are a couple doctors in town who would help you try to have a vaginal breech birth if you wanted it.”

And as I had thought she probably would, ThreepeatMom said instantly, “No, I want a C-section. I don’t want to take those risks.”

I have to admit, I struggled a bit with that. While 100% supporting her decision and the reasons for it, I also knew that, having already had one vaginal birth, and with her baby in the frank breech position–the safest one for a vaginal breech attempt–she had a good chance of success if she opted to try that route. But it’s not my job to push any particular decision or agenda, so I said nothing else about it. Nevertheless, I had a sneaking suspicion something unexpected was going to happen.

While ThreepeatMom pursued moxibustion and an external cephalic version, I also started helping her plan her ideal Cesarean birth. This birth plan was not so much about what they wanted done, but about the emotional experience and level of support they needed from the staff. It was based on conversations I’d had with my own midwife about births that follow a traumatic birth, and it is something I have used with great success a number of times since then.

I also did some special work of my own. Calling on contacts at the hospital they had chosen, I passed ThreepeatMom’s birth plan directly to the head of L&D nursing so that it would be on hand and every charge nurse would know what she needed as soon as she checked in in labor. The day that they went for their ECV, I was concerned–one of the risks of the procedure is that it can cause a baby to go into distress or can even trigger a precipitous labor. So I took my laptop and sat in the cafe on the first floor of the hospital working, staying in touch with ConnectedHusband by text so that I could join them if they decided they wanted me.

The ECV passed without incident, and without turning the baby, and by mid-afternoon we were all home again. But that night as I sat on the sofa watching a movie with my kids, my phone pinged with a text.

“Hey, BLD, it’s ConnectedHusband. ThreepeatMom has been having contractions on and off for a while so she got in the tub and now they’re five minutes apart.”

I shook my head and looked back at the movie. It must be prodromal. Checked the text again. From random to five minutes apart in the tub. Weird. But probably nothing. I went back to the movie, then glanced at the text again. So strange. Unless…

Ding. Another text.

“Now they’re four minutes apart.”

Precipitous labor.

I called him. “Get her in the car and head for the hospital.”

“Well, we have to call her mom to come take care of FirstBaby. ”

“How far away is she?”

“Fifteen minutes, why?”

I hemmed and hawed. A contraction pattern that starts out five minutes apart and gets closer within half an hour means the baby will be born FAST. They might not have fifteen extra minutes to wait–and SecondBaby was breech.

“Really, CH, I think you guys need to go. She could be going really fast.”

“Okay. Let me call her mom.”

“Get everything in the car so you’re ready to leave the minute she pulls up. Put ThreepeatMom in the backseat or put the backseat down and let her be in the trunk.”

“Really? Is that safe?”

“Yes. She needs to be in polar bear.”

A few minutes later, as I changed into my hospital clothes, put on my shoes, got my bag, and left, my phone rang again. ThreepeatMom and I talked through her contractions. They were indeed getting closer and more intense–within five minutes of being on the phone she couldn’t talk through them, a classic sign of active labor nearing transition. I asked her if she wanted me to text her OB, who was a mentor of mine, and she said yes. The text was simple: “TM is in labor and I think it’s precipitous. Riding to hospital in polar bear. Please call her cell if she should do anything else.”

I made it to her hospital in seven minutes, a personal record, and met them in the Emergency Room parking lot. She insisted on walking up to L&D while CH and I carried her bags. By the time she was in the labor room and being checked, she was eight centimeters. A young nurse tried to set up an IV, telling us, “You have to have this entire bag of fluid before you can get the epidural.” A more senior nurse interrupted, “She doesn’t have time for an IV, baby’s breech. Let’s get you to the OR.”

ThreepeatMom walked to the OR. By the time she was on the operating table, she was ten centimeters.

CH was almost giddy as we put on our scrubs and masks. We arrived in the OR just after the epidural had been placed. The OB on call was one I knew of through the grapevine, an experienced and evidence-based doctor who was well-versed in woman-centered care. As the nurses prepared the incision site, Woman-Centered Doctor said, “Wait a second, let me see something…” She checked ThreepeatMom’s cervix and then raised her eyebrows and said over the drape, “You’re ten centimeters and your baby’s bottom is plus two. Do you still want the C-section?”

That moment is a freeze-frame in my memory. Plus two meant the baby was coming through the cervix–he was already being born vaginally in the frank breech position. That’s a birth that only a couple dozen doctors in the United States now know how to help with, since cesarean for breech positioning is so standard that breech delivery isn’t even taught to medical students anymore. So just by asking that question, what the doctor was really saying was, “Your baby is being born this way right now, and I will help you do this if you want to.”

ThreepeatMom lifted her head off the bed and said, “Cut me.”

It was her choice. CH and I sat by her head, talking with her, reassuring her, and smiling when the squawking baby boy with the perfectly round head was placed on her chest. We stayed with her through the long repair, talking and stroking the baby and helping him get latched on.

When we got back to the L&D room where she would recover, it was soft from the Christmas lights I had draped over the pictures, and the soothing scent of lavender filled the air. We talked for a few minutes more, and then they thanked me and I left.

It was not the birth she had planned. It was not the birth I would have chosen for myself. But it was a profound experience that taught me more about doula work than any birth since–well, since her first!  Threepeat Mom had been a powerful teacher for me, yet again. But she wasn’t done yet.

 

 

 

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