Doula-ing
I have a couple of pretty hard doula experiences behind me...
I had two clients who had almost exactly the same due date, and on a week where I managed to triple-book myself almost every single day in addition to their due dates. Fortunately, that all passed without incident, I am forever grateful to them for holding onto their babies a few days longer so I could get through my monstrously overstuffed week. Yay.
The rest is not so yay.
Michelle, who went into labor first, ended up having a C-section after a pretty short and easy labor, for failure of the baby to descend into the birth canal. The first shock she received that day, after being up all night in early labor, was that she was only 2-3 cm dilated - not very far along in the process at all. We discussed the possibility of going home, since she was very discouraged by how little progress she had made after a night of laboring. I didn't have the heart to tell her that that night of laboring was not very intense labor at all. She had called me the previous night to tell me she was having contractions and asked about how to time them. I could tell by her voice that she was very early in the labor process, and advised her to try to relax, take a bath or a shower, drink a glass of wine, and get as much sleep as she could. Unfortunately, she either did not or could not heed that advice, so she was pretty beat the following morning when she arrived at the hospital after pulling an all-nighter with mild and irregular contractions. :(
To add insult to injury, her obstetrician sent word through the nursing staff at the hospital that he wouldn't be coming in. At all. Probably because it was a Saturday, and he had other ideas of how he was going to spend his Saturday. This obstetrician leads my blacklist for being a sneaky, dishonest bastard, who smiles charmingly at his clients and then just does whatever the fuck he wants. Including not show up to their births if it so pleases him.
Fortunately, Michelle didn't seem terribly fazed by this. The obstetrician on duty didn't really want to let her go home at this stage, and recommended we stay for an hour or two to see where labor progressed, so this is what we did. Her labor actually did pick up rather nicely. We arrived at the hospital around 6 am, and by 11 or so, she was fully dilated and ready to push, which is wonderful progress! Unfortunately, pushing was not bringing the baby's head down, and he was still not engaged in the pelvis. So we tried some upright positions, but Michelle soon got tired and lay down on the bed, where her contractions completely phased out. At this point, she had been fully dilated for over an hour, probably closer to two, with some pushing contractions, but no progress. I was just beginning to think about what we could do to bring the baby down and just started considering the possibility of a posterior baby (a baby who's facing the wrong way and trying to wedge his head into the pelvis crosswise instead of aligning it so it fits better) when the doctor suggested a C-section, and the staff immediately started bustling to get Michelle ready for the operation. In the brief interval when everyone left the room, I suggested to Michelle that I knew some tricks we could try to get the baby positioned properly that might help her push the baby out, but she chose the C-section instead.
I was actually allowed in the operating room along with Michelle's husband, and got to watch my very first C-section, which was pretty shocking, even through I had a general idea of how C-sections worked... I hadn't realized, for example, that after they take the baby out, the flip the entire uterus+ovaries out on the woman's stomach to clean it. It was pretty disturbing to see. I also hadn't realized that when they say "lift the baby out," they actually more accurately mean "two large men tussle and struggle to yank the baby out."
The doctor, after they took William out, also confirmed that he had been posterior - facing his mom's pubic bone instead of off to one of her sides, as would have been preferable. I'm pleased that I accurately pinpointed the cause of her stalled labor, but I'm not pleased that I couldn't do anything about it.
Michelle seemed okay with her choice, and her recovery has been amazingly good. She seems to be doing a lot better than some women I've seen with episiotomies. William is a champion nurser and we were able to get him latched on basically half an hour after he was born, as soon as his mother was transported back to her room at the hospital. I was so relieved that at least there were no nursing problems, which are pretty common after C-sections, usually because moms are not allowed or are unable to nurse their babies right after birth because of the incision. We lay William almost face down, draped over his mother's chest, and he just went right to, with perfect technique, no soreness or problems for mom. Yay William! :)
For days after this birth, I was wracked by guilt that I should have done something differently, should have suggested something earlier to prevent the C-section. I spent a lot of time reading about posterior babies and what to do with them... I already knew of some techniques we could have used to try to get William to turn his little head the right way, but by the time I thought to suggest them, Michelle didn't want to try them. I'm trying to make my peace with this - it was her decision, she's healing well, William is nursing well, so all's well that ends well, right?
I also realize that managing a posterior baby is not the responsibility of a doula - it is a midwife skill, not necessarily a doula skill. I think as a doula, I did everything that I could have, and Michelle has indicated that she felt well supported throughout her birth and is at peace with her choice. I'm not at peace with the fact that I was unable to pull off a midwifery trick to save the day and avoid a C-section, but that probably has more to do with my vanity than anything else.
Still.
It would have been nice to avoid that C-section and turn the posterior baby...
I had two clients who had almost exactly the same due date, and on a week where I managed to triple-book myself almost every single day in addition to their due dates. Fortunately, that all passed without incident, I am forever grateful to them for holding onto their babies a few days longer so I could get through my monstrously overstuffed week. Yay.
The rest is not so yay.
Michelle, who went into labor first, ended up having a C-section after a pretty short and easy labor, for failure of the baby to descend into the birth canal. The first shock she received that day, after being up all night in early labor, was that she was only 2-3 cm dilated - not very far along in the process at all. We discussed the possibility of going home, since she was very discouraged by how little progress she had made after a night of laboring. I didn't have the heart to tell her that that night of laboring was not very intense labor at all. She had called me the previous night to tell me she was having contractions and asked about how to time them. I could tell by her voice that she was very early in the labor process, and advised her to try to relax, take a bath or a shower, drink a glass of wine, and get as much sleep as she could. Unfortunately, she either did not or could not heed that advice, so she was pretty beat the following morning when she arrived at the hospital after pulling an all-nighter with mild and irregular contractions. :(
To add insult to injury, her obstetrician sent word through the nursing staff at the hospital that he wouldn't be coming in. At all. Probably because it was a Saturday, and he had other ideas of how he was going to spend his Saturday. This obstetrician leads my blacklist for being a sneaky, dishonest bastard, who smiles charmingly at his clients and then just does whatever the fuck he wants. Including not show up to their births if it so pleases him.
Fortunately, Michelle didn't seem terribly fazed by this. The obstetrician on duty didn't really want to let her go home at this stage, and recommended we stay for an hour or two to see where labor progressed, so this is what we did. Her labor actually did pick up rather nicely. We arrived at the hospital around 6 am, and by 11 or so, she was fully dilated and ready to push, which is wonderful progress! Unfortunately, pushing was not bringing the baby's head down, and he was still not engaged in the pelvis. So we tried some upright positions, but Michelle soon got tired and lay down on the bed, where her contractions completely phased out. At this point, she had been fully dilated for over an hour, probably closer to two, with some pushing contractions, but no progress. I was just beginning to think about what we could do to bring the baby down and just started considering the possibility of a posterior baby (a baby who's facing the wrong way and trying to wedge his head into the pelvis crosswise instead of aligning it so it fits better) when the doctor suggested a C-section, and the staff immediately started bustling to get Michelle ready for the operation. In the brief interval when everyone left the room, I suggested to Michelle that I knew some tricks we could try to get the baby positioned properly that might help her push the baby out, but she chose the C-section instead.
I was actually allowed in the operating room along with Michelle's husband, and got to watch my very first C-section, which was pretty shocking, even through I had a general idea of how C-sections worked... I hadn't realized, for example, that after they take the baby out, the flip the entire uterus+ovaries out on the woman's stomach to clean it. It was pretty disturbing to see. I also hadn't realized that when they say "lift the baby out," they actually more accurately mean "two large men tussle and struggle to yank the baby out."
The doctor, after they took William out, also confirmed that he had been posterior - facing his mom's pubic bone instead of off to one of her sides, as would have been preferable. I'm pleased that I accurately pinpointed the cause of her stalled labor, but I'm not pleased that I couldn't do anything about it.
Michelle seemed okay with her choice, and her recovery has been amazingly good. She seems to be doing a lot better than some women I've seen with episiotomies. William is a champion nurser and we were able to get him latched on basically half an hour after he was born, as soon as his mother was transported back to her room at the hospital. I was so relieved that at least there were no nursing problems, which are pretty common after C-sections, usually because moms are not allowed or are unable to nurse their babies right after birth because of the incision. We lay William almost face down, draped over his mother's chest, and he just went right to, with perfect technique, no soreness or problems for mom. Yay William! :)
For days after this birth, I was wracked by guilt that I should have done something differently, should have suggested something earlier to prevent the C-section. I spent a lot of time reading about posterior babies and what to do with them... I already knew of some techniques we could have used to try to get William to turn his little head the right way, but by the time I thought to suggest them, Michelle didn't want to try them. I'm trying to make my peace with this - it was her decision, she's healing well, William is nursing well, so all's well that ends well, right?
I also realize that managing a posterior baby is not the responsibility of a doula - it is a midwife skill, not necessarily a doula skill. I think as a doula, I did everything that I could have, and Michelle has indicated that she felt well supported throughout her birth and is at peace with her choice. I'm not at peace with the fact that I was unable to pull off a midwifery trick to save the day and avoid a C-section, but that probably has more to do with my vanity than anything else.
Still.
It would have been nice to avoid that C-section and turn the posterior baby...