As part of my Birth Doula Certification process I am required to write a 500-700 word essay about each birth I attend, describing the progress of labor, the mother’s emotional response, my role as doula, and what I learned from the experience. The hardest part was keeping it under 700 words! So, here is my first one – it’s brief and somewhat “technical”, but tells the story in a nutshell. And yes, I do have permission from the birth parents to post their story, but I have removed their identifying information.
Elective Induction on December 31, 2010
Doula: Amy McCollum
Mom and Dad were admitted to the hospital around 6:30 am, excited but with a realistic expectation of the work ahead. I arrived at 7:00 am. The first cervical check was at 8:30 (3 cm dilated, 90% effaced, -3 station). After discussing options with the midwife, they decided to start a low dose of Pitocin. Every 30-45 minutes, the dosage was gradually increased. Contractions began to come regularly, but not very strongly. Mom remained cheerful, chatting with me and her husband and alternating between standing, walking, sitting on the birth ball, and sitting up in bed. Around 11:00, contractions became stronger, requiring that Mom stop and focus on her breathing and relaxation. At 12:00 pm, a cervical check revealed that no progress had been made. The decision was then made to rupture the membranes (around 12:05 pm).
The contractions immediately increased in intensity and frequency and Mom became very serious. She moved to the bathtub through 5 or 6 contractions, which were very intense and painful, but she quickly found a rhythm of moaning and rocking. Between contractions she waited quietly for the next. I asked her how she was feeling during the contractions and she said she felt like she was tensing up, pushing her feet hard against the tub. I encouraged her to relax her legs and focus on letting go and not fighting against the pain. After only a few contractions, she expressed worry about having a bowel movement in the tub, so I recommended a move to the toilet. She labored on the toilet through 3 or 4 contractions, continuing her moaning/rocking routine, but seemed to be panicked and losing control. At this point, she began grunting and pushing. I felt the need to “take charge” and move her to the bed and get the nurse (even though it had only been about 45 minutes since her last cervical check of 3 cm, I suspected that things had progressed rapidly). The nurse did a cervical exam to reveal that in the short span of about 45 minutes, Mom’s cervix had changed from 3 cm to 8 cm with the baby now at 0-station. She continued to have the urge to push and needed help to regain control. Her husband and I held her hands and I asked to her to mimic my breathing, which helped. The nurse called for the midwife and began preparing the room for delivery. As requested by the nurse, I helped Mom to avoid pushing by using a “blow out the candle” technique. The midwife arrived about 5 minutes later, at which point dilation was complete and pushing began. The midwife massaged the perineum and instructed Mom to push as slowly and steadily as possible whenever she felt the urge. She willingly followed instructions and although she was clearly in a great deal of pain, she was serious about the work at hand and pushed through 3 or 4 contractions, managing about 3 good pushes per contraction. Her 8 lb., 10 oz. baby boy was born at 1:05 pm. She immediately held him to her chest to enjoy skin-to-skin contact and early bonding. Throughout the process I made sure that Mom stayed hydrated, held and massaged her hands, kept her cool with cold, wet cloths, and helped her stay focused and in control and to get into comfortable/beneficial positions.
Once the membranes were ruptured, things progressed so rapidly that there was hardly time to use the variety of techniques I learned during training. I quickly realized that the thing Mom needed most from me was to help her stay calm and in control and that I couldn’t be timid about making suggestions or taking control when necessary. The positive feedback I received afterward increased my confidence about my ability to be a good doula, but I realize how important hands-on experience is. I have greatly benefited from my reading and training, but the more births I attend, the more I will learn and the better doula I will be.
I am just so excited for you, Amy! You are great at taking control of a situation, staying calm, being firm and just knowing what a person needs when they need it. Can’t wait to read more entries!
Thanks so much Sarah!
Ok, this probably goes without saying, but you help mom’s-to-be without pain meds or epidurals? Do you doola in instances where the mom/parents want that?
I loved reading your post and the process….you are definitely where you are suppose to be! So very excited for you and all the mom’s-to-be you’ll be helping!
Great question, Kelly! I am happy to help any woman to achieve whatever birth experience she wants. Some women go into it knowing that they will probably want an epidural and I totally understand! Since it’s really not a good idea to get an epidural too early in labor, she still has a bit of work to do to get there and I can help with that. Even after she gets an epidural, she and her partner can still benefit from continuous support during labor and after the baby is born and I am more than happy to provide that.
Having said that, research (and personal experience) has shown that women with the support of a doula require less intervention in general – less Pitocin, less epidural anesthesia, less use of forceps or vacuum extraction, much lower c-section rates, etc. In fact, in clinical trials comparing women who had epidurals with women who instead had doula support, both groups rated their decrease in pain as the same (a doula had the same pain-relieving effects as an epidural – without the risk or expense!). I think we women have been asked to give birth without the support we really need and that has led to the need for more and more medical intervention. Maybe all we really need is an extra set of hands to hold, a compassionate, experienced woman to sympathize and to lean on, someone whose sole purpose is to help you have an amazing birth experience that you will remember with joy.
That’s the main thing – I want women and their partners to have wonderful birth experiences that empower them to set out on the most demanding of journeys – parenthood! However they choose to get there – I’m here to help!