My Path to Becoming a Doula and Childbirth Educator, Part One

Thirteen years ago I was pregnant with my first child. While her father and  I hadn’t been planning to have a child so soon, I was overjoyed with the thought of having a baby. Her father is a chiropractor, recently graduated at the time and we were very committed to a natural, healthy lifestyle.  We attended Bradley childbirth classes.  I read voraciously. This was nothing new since even as a small girl, I was obsessed with pregnancy, birth, and babies. My mother had a few pregnancy books on a high bookshelf and I would climb up with the help of a chair to pull those books off of the shelf and read them.  I dressed my countless baby dolls and changed their diapers. I begged to hold any baby in my path. In my heart I always knew I would be a mother and I also knew that I wanted to birth without the help of medication.

Despite this, it seemed a hospital birth was safer. I toured a local birth center, but at the time, my insurance did not cover the fees. Being young and constricted by finances, we chose an ob/gyn who seemed open to natural birth and answered my questions about certain interventions with answers that satisfied me. He was very pro-breastfeeding and offered home remedies when I fell ill with pneumonia.  It felt like I was prepared. I didn’t know about a doula and my Bradley class instructor had offered to come to our birth or answer any phone calls/questions we may have. Our plan was to not arrive at the hospital until well into labor and to avoid all but the “necessary” interventions, like an IV port.  I watched my estimated due date come and go and politely declined the offer to be induced. To my physician’s credit, he never pushed me towards an induction, simply offered it and lamented the fact I was certainly “miserable” to be going over a week past “due”.

Memorial Day weekend was upon us and I had contractions and discomfort beginning Friday evening. I tried all non-invasive methods to go into labor: walking, intercourse, working my acupressure points.I practiced relaxation methods and different positions for labor and birth.  Saturday evening we went to see the second installment of the Jurassic Park movies. My cramps and contractions were so uncomfortable I left the movie seat and chose to stand in the back of the theater.  Later in the night, contractions would wake me up only to seem to fizzle away. When I had last seen my ob/gyn about five days previously, I was a good 3 cm dilated and 75% effaced. Sunday morning at 5:30 a.m. I woke up to hear a *pop* and felt a trickle of fluid. Upon going to the bathroom, I realized my water had broken. My husband woke up and asked if I was ok and I reassured him I was fine and that even though my water had broken, we had plenty of time and he should get some rest. I moved to the couch in the living room to rest and occasionally drift off to sleep. Contractions were coming irregularly and not settling into any sort of pattern.

About 10 a.m., I put a phone call into my ob/gyn. At the time, I thought it was polite to let him know I would probably be coming in to the hospital in labor. His reaction completely surprised me–he insisted I immediately come to the hospital to be checked and told me to plan to stay. I remember saying, “Come in right NOW? Can’t I shower and get ready first?”. His alarmed response had me second-guessing my resolve to stay home. We did take the time to shower and prepare a few things before heading to the hospital.

Some of you who are familiar with hospitals and the interventions used will know what I will say next. We arrived at the hospital to have a vaginal exam performed (I was 4 cm!), check the amniotic fluid, and told that Pitocin would be started. Pitocin is a synthetic form of oxytocin, which causes labor. I declined the Pitocin and instead asked to go home. My request was denied and my young age, naivety,  and desire to be polite kept us at the hospital, though I was sent to go walking to bring contractions on. I walked that hospital for hours, literally. We would return about every hour to be put on the external fetal monitor and over and over the nurses and/or doctor would say my contractions weren’t doing enough, weren’t strong enough, my body needed help to have my baby. Pitocin was repeatedly and sternly recommended, and I was reminded that if I didn’t birth the baby in the hospital time frame of 12 hours past rupture of membranes, I was putting my baby’s life at risk.  No one stated how much of a risk there was, just blanket statements that my baby or I could die of an infection.

I felt pressured, confused, scared, and most of all watched and on a time schedule that had nothing to do with my body birthing the way it needed. It was hard to relax because I was out walking, walking, walking and dreading each time I had to return to be monitored. The bed was not even an option for me when I was being monitored; instead I opted for the rocking chair and that was uncomfortable enough. Our families had all arrived at the hospital despite my request for them to stay home until it was closer to birthing time. Friends would drop by and ask to see me.  This also made me feel on the clock and pressured each time I walked past them in the waiting area. I honestly felt like I was wasting everyone’s time.

A nurse came in once to remove the fetal monitors and said my husband may want to have a snack since it was turning into a long day. She winked at me and said, “I know you can’t eat, but you could go with him to the cafe.” We went to the cafe and I ate a bit of a turkey sandwich and quite a bit of fruit. Those strawberries tasted amazing and the food gave me energy to keep moving forward. I had received an IV at some point and was staying hydrated myself with water and fluids.

It’s a very long story, but after the 12 hours of ruptured membranes, the pressure was incredible to receive antibiotics to ward off some potential infection. I was told child services could be called if anyone felt my baby was in jeopardy. By this point I was well into active labor, tired, discouraged, and second guessing my choices and decisions. I asked if I could shower before we started the medicine and my nurse again stepped in and made it so. She was a blessing to me. I was the only one birthing that day so that helped with feeling private as I would wander the hallways and try to “make” my body dilate according to an arbitrary schedule. I received another round of IV fluids along with the antibiotics. Being forced to stay in bed, on my back, with tight monitor belts around me gave me no way of coping with the contractions. I was tired, not having slept for a few nights, and walking for hours. My partner looked exhausted and while he fully supported natural birth, the hospital was wearing on him. My birth plan clearly stated that no medications for pain relief be offered to me, that I would request them if I felt I wanted them. Laying in the bed, dealing with the pressure of being threatened with a C-section, knowing my family was sitting in the waiting area, and hearing my ob/gyn tell me he would rather be at the mountains with his family than dealing with someone (me) who refused to use common interventions made me consider changing my options. A different nurse came in to see me struggling with emotions, crying, and trying to move to any position comfortable in the hospital bed. She offered a dose of narcotics to give me a “break”.

I requested and received a half dose of Stadol, a narcotic medicine injected into the IV with the antibiotics. My labor stalled completely. I hallucinated. Nausea struck me for the first time during my entire pregnancy. Every time my partner came near me, there were two of him.. or three or four. My nerves were shot. As soon as I could get out of that bed I began moving around again and took another shower. Labor picked up quickly and intensely once the narcotic medications wore off. Moving and standing were my best options to deal with the pain.

When transition hit, it was about 2 a.m. the following day. I was having double peaked contractions, standing up in a half squat and holding onto a chair for support. There was an emesis basin placed on the chair because with each contraction I felt the need to vomit, though, I never did. I would get through one contraction and another would hit. My ob/gyn came in to have a grave discussion with me. He felt I was on my way to a C-section, there was still the risk of infection and he wanted to administer another round of antibiotics, he wanted to do a vaginal exam, etc. etc. All I could think was there was no way I could stand to be in bed again (sitting in the rocking chair for my intermittent monitoring was horrible enough) and I couldn’t stand thinking there was a possibility more fluids and medication would cause my labor to stall. I didn’t realize I was in transition, of course. My partner didn’t, either. He and the doctor began arguing and at one point my ob/gyn asked my husband, “What obstetrical residency did you finish?”. They literally began arguing, raising their voices while I struggled with contractions coming one after another.

This was not the birthing environment I had hoped for, planned for or expected. I asked them to “take it outside”. This seemed to cause some chagrin on the part of my physician and he began more carefully stating that my baby could die due to my being a martyr. I was tired. I wanted to avoid a surgical birth at all costs. I caved and agreed to a tiny dose of Pitocin and another round of antibiotics once the baby arrived. My husband was shocked and kept asking me if this is what I wanted. No, it wasn’t what I wanted but I wasn’t getting what I wanted! The moment I was put in the bed to receive more IV fluids and meds, along with monitoring my best laid plans went out the window. In my mind, how could I deal with forced contractions caused by Pitocin when I couldn’t handle my body’s labor unless I was up and moving?  My doctor had already called the anesthesiologist who came in purportedly to simply set my mind at ease about any questions I may have. My doctor told me I could be awake for the cesarean section with an epidural or have to be put under at the last minute. I said, do the epidural. My ob/gyn had done a vaginal exam when I got in the bed and I was between 8 and 9 centimeters.

Epidurals should not be given that late in labor. I received the epidural. I stressed repeatedly to the anesthesiologist to give me the lightest dose possible and to simply have it in place in order to make everyone else more comfortable. I won’t lie, the epidural took the edge off in a way nothing else had. I dozed off in between contractions, but could still feel and move my legs and feet. I had no catheter as I could feel it when they tried to place it and I demanded it be removed and not mentioned again.

It was now close to 4 a.m. Within an hour I bolted upright in bed with the urge to push. At that moment my ob/gyn walked in and before I could say a word, he said, “It’s time to do a cesarean. Your water has been broken for nearly 24 hours and I can’t take on that sort of liability. We must get this baby out before the 24 hour mark.” I said, “I’m so glad you came in but I am ready to push. NOW. I need to push now! I was just pushing the call button.” He looked at me with complete disbelief and tried to tell me that I just thought that because I didn’t want a C-section. I told him that if he wasn’t going to catch this baby and try to force a C-section on me that I would go out into the parking lot and have my husband catch the baby. My wonderful, lovely, angel of a nurse said, “Well, Dr. — why don’t you do an exam and see if she is complete?” He couldn’t refuse that and his mouth fell open when he realized I was 10 cm and the baby was coming. He tried one more time, though, for the surgery by saying how long I had been in labor and hadn’t eaten and probably wouldn’t have the strength to push the baby out in the time he could do a cesarean. To prove him wrong and also because I couldn’t hold back from pushing, I pushed exactly as I had been taught in my birthing classes and sprayed my doctor completely down with amniotic fluid. The nurse winked at me again and said, “Looks like she has plenty of strength to push that baby out.” He agreed and began getting dressed for delivery.

I pushed approximately six times. One downside to having an epidural is the numbness that does occur makes you unaware of the need to push as needed and let your tissues stretch. My ob/gyn had every right medically to give me a large episiotomy to “help out”.  He didn’t ask, he just did it. An oxygen mask was placed on me when I began pushing but I kept taking it off as it was too distracting. I couldn’t sit up right as I wanted and as my body was directing me to because the doctor wouldn’t be able to deliver the baby in the most convenient way possible. Still, it was amazing to push. I had a burst of energy that still thrills me to think about. My daughter was born and whisked to the isolette so the neonatologist who had been called in could examine her and make sure she wasn’t in distress from that much talked about infection possibility. Her apgar scores were 9 and then 10.

To my amazement, there were now about 8 or 9 people in the room. Nurses, another ob/gyn, a pediatrician, the neonatologist. What were all these people doing in my room when I had chosen to have only the father of my child with me? Also to my amazement was the hook and thread my ob/gyn pulled out to sew me up. I ended up with a 4th degree “tear” caused by laying on my back to push and the episiotomy performed. I joked and laughed anyway and eagerly awaited the moment I could hold my baby girl. My ob/gyn kept reminding me to keep my hands above my stomach so as to not contaminate the “sterile” area he was working on. I snorted at him.

I bled too much, probably a side effect of the pitocin given at such a late stage of my labor. There was much concern about the amount of bleeding and I did, indeed feel woozy as my doctor dutifully stitched away for nearly 45 minutes. My baby was here and I was focusing on her. Despite the bleeding, the 4th degree tear, the wooziness, within an hour of being put back together, I had to urinate. No, no, I was told, that can’t be. You can’t get up and move, you’ve had an epidural. Yes, I had, but I had to pee and I wasn’t going to do it in a bedpan with a bunch of people. Tentatively I tried out my legs with concerned people all around. My legs worked!  It took two nurses helping to get me to the bathroom and on the toilet I fainted from loss of blood. A few smelling salts brought me around and I was finally tucked in bed with my baby girl and began breastfeeding her.

My daughter had been born on Monday, May 26th, at 5:34 a.m., 24 hours after my water had broken. We were kept in the hospital until Wednesday morning to watch for signs of infection. There were none. I did develop a horrible rash, however, from the antibiotics.

At my six week checkup, my ob/gyn said he wanted to address what had transpired during labor. He said he thought I really should have had a home birth, or at the least a midwife attended birth. He admitted he was uncomfortable not doing things “by the book”. I am not sure which book he is speaking of, but there must be some book that instructs ob/gyns to tell women their bodies are broken, failed, need help, etc. I wholeheartedly agreed with him that I should have had my baby at home or in a midwifery center. I did thank him for stretching outside of his comfort zone with certain things, such as intermittent monitoring, and then I told him I would never have another baby in a hospital according to medical rules. I told him I thought he was a good medical doctor, but that the medical model of birth no longer made any sense to me. We are, however, still in communication and have had discussions about placenta encapsulation, lotus birth and other “birthy” things he is not usually exposed to. I chose him to perform a necessary surgery. He is a good surgeon.

After the birth, I suffered some dark days and some disappointing thoughts about myself. Why had I chosen a hospital birth and an ob/gyn? If the father of my child and I had been so prepared, had a birth plan, and knew what we wanted and did not want, how had things gone so awry? How did I get to be within an hour of a cesarean? Many other ob/gyns would have insisted on intervention no matter how I felt. What would have happened if I hadn’t had the ob/gyn that I did, and how would I have reacted to more pressure than he had put on me? Why does a laboring woman in transition have to fight with a provider about her care? Why must a patient follow all of their rules when they do not follow them, as in the case of giving me an epidural so late in my labor? What makes it so hard to insist on informed consent, the right to refuse treatment, and not be threatened?

My husband gave me a card congratulating me and in it he wrote simply: “we did it despite the idiots”. He and I have since parted ways as far as marriage, but I fondly remember that card and sentiment behind it. I began to feel proud instead of beaten down and it was then I decided: there has to be a better way and I will find it and promote good, wonderful, special birth experiences.

to be continued………

All Rights Reserved, Knoxville Doula

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