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| The face of a mother high on oxytocin following a pain med free, or "natural" childbirth. |
I arrived around 4 a.m. "A." was upset because the midwife on call at the military hospital had challenged A about her "too detailed" birth birth plan (it was only one page in length) and told A. that she needed to give up some control. Then the midwife tossed the birth plan at the nurse as she left the room.
I set up the room with flameless candles, essentials oils on cotton balls for aroma therapy, and Scriptures A. had selected from those I had printed out. Actually, she and her husband decided where they wanted each verse posted, and he placed them around the room and bathroom.
I then went to introduce myself to the nurses, who were very kind. One apologized about the midwife right away. I asked who would be on duty at 7 a.m. and they assured me that it would be an OB who was easier to work with. They were right, as we came to learn. Before leaving the nurses' station, I explained that this was a very strong and capable woman, and having a natural childbirth was very important to her. She would let us know if she wanted meds, but as stated on her birth plan, did not want anyone suggesting pain meds or discussing them before she inquired. This turned out to be the only request which was ignored a few times.
A. was started on Pitocin (synthetic oxytocin) to jump start her labor. She had done a lot of reading and told the nurse she did not want any increases for at least an hour. The nurse agreed to check with the doctor. Dr. Lee came in to visit, birth plan in hand, and the first thing she said, "I think we can do everything you want to do as long as the labor allows", and discussed most items. This allowed A. to clarify one. Everyone was now on the same page.
We finally got A. to lie down around 6:15 a.m. to try to sleep a little. After a while, her nurse came in to give her oxygen since her baby's heart rate kept dropping a little. A. told her she was not surprised because she had asthma and it had been hard breathing while trying to sleep. After a bit more napping, A. got out of bed after the nurse removed the oxygen, and we walked around the unit several times. The hospital had a wireless electronic fetal heart monitoring, which made it possible to do so with mom on Pitocin. ALL hospitals need this for their patients. The literature is clear regarding the benefits of walking and upright positions for labor.
A. was still 1 centimeter dilated after this and her OB suggested inserting a Foley catheter into her cervix to stretch it a bit. She told A it would fall out when the cervix reached 3 to 4 centimeters. A. was unsure, so, as her doula, I asked the OB to list for A the benefits and risks of the procedure. A. considered the information and decided to try the Foley. We walked some more, the nurse increased the Pitocin, and A. began having stronger contractions. She went to use the bathroom and found sitting on the toilet comfortable. I brought in a pillow, some flameless flickering candles, and some lavender essential oil on a cotton ball. A. rested her head on the pillow behind her, and stayed on in this position for about an hour. 30 minutes into this "toilet time" she placed her legs over my thighs to elevate her feet, which had started swelling a little from the fluids and the Pit.
She managed her contractions by intentional relaxation, deep breathing, and "blowing out the pain", sometimes with moaning. I would gently support her finger tips with mine to assess her relaxation and to let her know when she was beginning to tense up so she could consciously relax.
A. had been at 1 centimeter for some time and I was a bit worried the induction would not work and that A. would end up with a C-section. I texted my husband, her pastor, to ask him to pray that A. would dilate more quickly. At the end of the hour, A. was checked and the balloon was still not ready to come out. We went over to the bed and soon she felt it slip a bit. The OB came in and gave it a tug and it came out. A. was declared to be "3".
We did some 'stomp, stomp, squats" around that time, and periodically during labor. A. got into the bed, and leaned over a peanut ball (a large exercise ball shaped like a peanut), on her hands and knees and rested. I used two weighted soft exercise balls as counter pressure for her back, as she directed from the choices. The room was dim, lighted by flameless candles and the scented with lavender and jasmine essential oils. The nurse loved coming into the room because of the scent and atmosphere. I put a little peppermint oil on A's back and inner thighs to help with pain. After an hour, with contractions increasing in intensity, the nurse checked her and declared A. was "6".
As I had promised A., we got her into the shower for the expected, most intense phase of stage one of labor -- transition. At this point her nurse came in to check on her and told A., that she had been conservative with her last exam -- A. was really a 7. This news encouraged all of us. However, from A.'s first contraction in the shower, it was clear she WAS in transition because of her emotional response to it and her sleepiness between the rapidly occurring contractions.
With A. sitting on the shower bench (well, leaning back a little against a pillow, with her legs stretched out with feet on a nursing stool) I sprayed warm water over her chest and tummy while her husband encouraged her with loving words.
Let me digress a bit here. At some point with each one of the above comfort measures and positions A. had used in her labor, her nurse would come in to teach. In early labor, A. listened to the dangers of sucking on lollipops (increased saliva and stomach contents in case a C-section was needed). I asked the nurse -- for A.'s benefit of hearing the answer -- how often they used general anesthesia for C-sections (VERY rare). Since spinals and epidurals practically eliminate the risk of aspiration syndrome (vomiting stomach contents into the lungs) A. ignored the "caution" and sucked on her lollipop. The research does not support having a woman fast during labor. In fact, doing so can interfere with normal labor and a woman's ability to complete it without additional intervention.
Since A. had reminded her nurse (who really was an excellent nurse) that she did not want to hear about the epidural, her nurse talked with her husband about it other pain meds. She cautioned him that if A. did not take something soon, it would be too late. She did just outside the bathroom door, and within A's. earshot. A.'s husband re-stated A.'s desire NOT to be offered medication. Once the nurse could see that A. was as determined as she was, and that what we were doing was working to keep labor progressing (thanks again, honey for praying for A.!), and that A. was coping -- albeit loudly at times-- the nurse did not mention the "E" word, or systemic meds, again.
During the hour we spent in the shower, A. experienced all the normal signs of transition: nausea, drowsiness between contractions, slurred, slow speech, shaking, and near the end of transition "I want this to STOP! I don't want to do this anymore!". A. went from praying "Thank you, Lord for helping me. Help me finish this labor!" to fussing about the pain, and back again. Acceptance of a woman's powerful and volatile emotions in transition is crucial for her to let go and do this incredibly demanding work.
Again, the nurse wanted A. go get into the bed to be checked and A. quickly and without reservation told her "You must be out of your mind!. I am not moving". I smiled and said, "I don't think she's ready to leave the shower yet". So, I redirected the water while the nurse checked to see if A's water had broken. It had. There was no need to check for a cord prolapse. Baby's heart rate was thumping along just fine. Thankfully, the waterproof transducers on A's belly, along with the wireless monitor allowed her to enjoy the shower during her labor on Pitocin. ALL hospitals should have this equipment!
A. had been complaining of feeling like she had to push for well over an hour, even before getting into the shower, but she was able to "blow" through them. I knew she was not yet ready, even though she voiced her frustration a little of not being allowed to push.
A few minutes after the nurse checked for SROM (spontaneous rupture of the membranes", A. said she felt like she was about to pass out. Her husband helped her onto her hands and knees (to prevent her falling and hitting her head) while I ran for the honey and a straw in my doula bag. I shoved the straw into the honey, pulled it out, and told A. to suck all the honey out of the straw -- NO ARGUMENT. She did so. In seconds, she revived, and on the next contraction "cow bellowed," "I HAVE TO PUSH!" Once again, I told her to blow (air out of her mouth) through the urge, but this time she told me, "YOU DON"T UNDERSTAND! It won't let me!" Those are the words I was waiting to hear. A. "blew out the candle" anyway, between little fusses. Strong woman!
Once the contraction was over, I turned off the shower, had her husband help me get her up, toweled her off, threw a blanket over her, and headed for the bed. The nurse came, checked A., and declared A. had dilated to "10" and she could being pushing.
A. had stated on her birth plan that she wanted to push on her hands and knees. Her OB was comfortable with this. A. rested her upper body over the same peanut ball she had used earlier to rest, and grabbed the mattress at the head of the bed. She managed to keep pulling it away from the frame, loosing her leverage. Her husband secured her arms with his hands as she pushed. What beautiful teamwork. No class taught him that.
By the way, her husband was amazing! They had attended my childbirth class and comfort measures classes, plus one held by her hospital. Earlier in her pregnancy, they read a book I had loaned them, and continued reading many other other books and articles, so he was well aware of what to expect . . . to a point. I had taken a few moments earlier in labor to remind him that he would see his wife in a lot of pain, but that God had also provided pain relief and naps between the contractions (via God-designed "morphine" known as endorphin). I gave him a list of things to say to encourage his wife, with "I love you" and "You are amazing" at the top of the list. He provided her with the "emotional medication" that often works as well as pharmaceutical meds in helping labor progress and helping women cope with the contractions. Now, he was helping his wife do what she needed to do in order to push effectively.
A. started her pushing, as most women do, a little uncoordinated while trying to figure out what her body was doing. The nurse, per her training, was wanting A. to hold her breath for a count of ten before pushing again. This can be necessary when a woman does not feel her urges to push, as happens with most epidurals. However, studies had shown that when the mother is allowed to follow her urges, she will hold her breath, if she does hold it, for about 6 to 7 seconds when she pushes. The benefit to this natural pushing is that the baby's heart rate does not dip as low, and recovers more quickly than with directed pushing. Also, when a woman is told to push out of rhythm of the urges, they experience more pain while the work is less effective. Holding to someone else's count to "10" easily gets the woman out of HER OWN rhythm of pushing with her body's urges.
I told the nurse "Let's watch A. for about 15 minutes and see how she does before we direct her". The nurse sweetly agreed (which spoke well of her because almost everything she had been suggesting throughout the labor was declined). Soon, A. was pushing in harmony with her body, taking deep breaths to oxygenate her baby between urges to bear down, and when she was resting between pushes.
Dr. Lee was lying on her side across the bed, watching the baby's descent and figuring out the maneuvers for a delivery 180 degrees opposite from a typical birth. She had done hands and knees births before, but not recently. A's nurse, Janine, was on her knees on the floor beside the bed to hold the monitor on A's upside down belly to record the baby's heart rate. What dedication! This was clearly not a typical birth scene for that military hospital. Yet, the OB and the nurse were smiling at each other at one point and agreed "this is cool!". ALL hospitals need medical and nursing staff like the ones on duty for this birth! (I still scratch my head at the midwife's attitude, though. It's so untypical for a midwife.)
In less than one hour, little Isabelle was born. Well, not really little. A. had delivered a 9 pound 14 ounce, 22 inches long baby without vacuum extraction, forceps, or C-section, so "little" is not the right word. As A. requested, no episiotomy was done.
By the way, the baby's heart rate was wonderful throughout all of the labor, even with the Pitocin, with the exception of when A. was lying straight in the bed. There IS something to getting mom off her back when checking fetal heart tones! Perhaps the induction wasn't really necessary, perhaps it was. But, this was how God wanted this labor to occur, and He used it to bless A.
Back to the birth sequence. The OB directed us how to help A. turn over on her back to receive her baby while maneuvering among the IV/Pitocin lines. Earlier during the pushing stage, she had asked how we were going to figure this out. I suggested she call the shots since she had to best view of everything. I was impressed by her attitude of teamwork vs. the "I am in charge of everything" personality exhibited by some OBs. Her approach to A.'s care had a major impact on how her labor was allowed to progress, and on all the positive results A. and her husband enjoyed. All hospitals need physicians like this!
The photo above shows the triumph A. felt. once Isabelle was in her mother's arms. After greeting her baby, her first words to all of us in the room were "I AM SO HAPPY!", followed by "Thank you, Lord!" not as an exclamation but as a prayer.
In a few minutes, still on her post natural birth oxytocin high, A. said, with a huge smile, "I am AWESOME! I did this without pain meds AND on Pitocin". Was she bragging? No. She was enjoying the empowerment God gives as a special gift to many women whose labor occurs in this manner. She was not better than other mothers, she was simply experiencing a special feeling the Lord provides many women who have accomplished this work. Oxytocin is a powerful hormone, which is released in increasing amounts during labor.
Pain medications diminish the normal release of oxytocin, so 85% of women in this country do not experience the intense feeling God planned for them to enjoy. Remember, pain meds have not been around for all of history. While women, due to the curse resulting from the Fall of Man, experience pain in childbirth, our loving God also provides something comforting during labor and very uplifting immediately after the birth. A. was blessed to enjoy this gift.
As Dr. Lee repaired a tear from the birth, A. allowed Isabelle to progress through the steps God designed babies to be able to do to finally self latch and nurse. Again the nurse tried to assist, but I explained that, as a lactation consultant, I too want to "help". However, studies showed that if we leave healthy, alert babies alone, they will progress through certain, consistent steps and latch better than if we we jump straight to attaching baby to breast. Again she nodded and let Isabelle continue without help. Sure enough, in about 30 minutes, Isabelle accomplished those steps to latch beautifully and suckle away. I showed her dad how a good latch looked so he could help assess with later feeds.
After an hour, A. gave the baby to her husband, who took it to the warmer where she was wiped down an little more, weighed, and measured. Dad got to put on her first diaper, and then held his daughter for some skin to skin time.
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| A father falls in love with a beautiful girl. |
What did A. and her husband think about their decision to have a doula? I received a Facebook message from A. several hours after I went home from the birth.
" . . . I don't know if we could've done this without you. Knowing and having someone there to guide us and empower us through our labor was the BEST decision we have ever made together (besides getting married, choosing to have Heavenly Father as our families foundation, and having babies of course :-)) Thank you so much for the amazing experience you were able to give us. We love you!!!"
In her opinion, having a doula was the 4th best decision they had made in their lives. Since it followed what it followed in her list, you can get an idea of how much support women discover that a doula can provide to help them achieve their goals for birth and breastfeeding initiation.
Even though A. had planned her way, God directed her steps (Prov. 16:9). She found, that with God's help, she was capable of more than she imagined. She found Him to be faithful, to comfort, to strengthen, and to bless in ways she had never before experienced. Yes, she had support from her husband, her doctor, her nurse, her doula, and for early labor, three amazing women: her mother, grandmother, and mother-in-law (all who had birthed without meds, including the mother-in-law who gave birth to a 13 pound baby, who happened to become A.'s husband!).
However, and most importantly, she had her GOD, the one Who created her, Who loves her -- Who gave her second birth -- to carry her through this labor which threw her into the depths of pain, and for a few moments, despair, before elevating her to heights of a type of joy she had never experienced.
Her husband learned that he, with God's help, could provide the necessary emotional support and physical comfort measures to help his wife birth their first
child.
As their doula, I was blessed, once again, to witness the partnership of a man and his wife during her labor, and the birth of a man and a woman into parents, holding the one they had come to love, but never had seen before that special day.
Thank you, A. and T. for this precious experience. I, too, "am SO happy!"
