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.