Marissa called me when she was 34 weeks pregnant with her second baby. Her first delivery had not gone the way that she had hoped and she REALLY wanted this delivery to be different. The problem was that she had NO supports for her birth. The father of her baby was incarcerated and she was not close to any family members in the area. She hoped that I could help her achieve a better birth experience this time around. When I met with her we discussed her previous delivery and why it had been so traumatic. Marissa explained the chain of events that led to the delivery of her son six years ago. Apparently her water had broken spontaneously but her contractions never began. Hours later she was advised to come into the hospital for a Pitocin augmentation. Every fifteen minutes the nurse would increase the Pitocin dosage and a few hours later she had such intense pain that she asked for demerol (although she had wanted a natural childbirth). Hours later she was still contracting and making little progress and the demerol was wearing off...that led to the epidural. The epidural futher slowed the labor and now she was unable to walk to bring the baby down faster...36 hours later she pushed out her baby boy. Although she was happy to have her son, she was so exhausted and drugged that she could not fully appreciate the moment and bond as much as she had hoped to. This time she wanted no Pitocin and no pain medication and hoped that I could help her stay strong throughout her natural childbirth journey.
A week later I met Marissa at her tiny apartment. She was clearly trying to make the best of an extremely poor living situation and I was immediately glad that I had agreed to be her doula for free. She really needed the help. Marissa introduced me to her 6-year old son Edward who was very outgoing and sweet. After seeing all of Edward's coloring books, Marissa and I got down to talking about her delivery and her hopes for the birth of her daughter.
I met with Marissa one more time before her delivery and we became very comfortable with one another. I could tell she really trusted me and was ready to work with me during her delivery. We talked about her concerns and her hopes for the delivery. We discussed her ideal birth and her worst-case scenarios. I baked her a bunch of cookies and she and Edward enjoyed those as he practiced his spelling homework with me. She said that she was more nervous this time around than her first delivery but she was ready to have her baby girl.
About a week later Marissa called me in the middle of the night. Her water had broken and she had just called the midwives at the hospital to see whether or not she should come in. The midwives told her to wait until she had contractions and to hydrate, eat and rest. I reassured her that this was the right thing to do and she agreed although I predicted that she would not be getting too much sleep that night. Sure enough when I called her at 9am the following morning she told me that she had only slept 1 hour the night before. There was just too much anticipation! She still wasn't having any contractions and I could tell she was nervous that this delivery would be like the last. I told her to walk around a lot and just try to get things moving and to call me when she was ready to go to the hospital. I was out shopping when she called at 1pm. She was frustrated. Still no contractions and the midwives were asking her to come into the hospital for a Pitocin augmentation. Over the phone I tried to reassure her that just because she was getting Pitocin did not mean this birth would be the same as her last. A bit before 3pm I arrived at the hospital where she had just been admitted. Her midwife had just checked her and said that she was 3cm and they wanted to start the Pitocin in the next 30 minutes. We both got settled and then the Pitocin drip started. Slow at first but increasing every 15 minutes. Luckily we were given a monitor with a remote tracker so we were able to walk around the labor floor to help move the labor along. We walked and walked and walked. Between walking she rocked in the rocking chair and I massaged her. She tried sitting or laying on the bed when she became really tired but the pain was much more intense when she was laying down. So we walked some more. The midwives and nurses switch shifts on the 7's so the new midwife came in around 7:15pm to check on Marissa. She said that things seemed to be progressing well but that she predicted we still had many more hours of labor left so she would come back around 2-3am to check her dilitation. I was surprised because it seemed to me that Marissa was entering transition and as a mulitp would probably deliver shortly thereafter. The midwife left the room and Marissa and I continued our routine...less walking now and more swaying during contractions. Marissa was very uncomfortable and said "I think I need the epidural." I reassured her that she was doing a wonderful job and she was doing everything she could for her baby. Although she asked a couple more times for the epidural, I could tell she didn't really want it. An hour later she said that she needed to go to the bathroom. I led her in there and asked "are you sure you don't have to push?" She said no, she was sure that she just needed to use the bathroom and I left her to it. Five minutes passed and I heard a yell from the bathroom, "the baby is coming OUT!" I got the nurse and the nurse got the midwife and we moved Marissa onto the bed just in time. Shaelyn was born a few minutes later pink and vigorous.
Marissa had done it. Shaelyn was born naturally (if you don't count the Pitocin) and I was so proud. I could tell she was pretty darn proud of herself too.
Friday, February 27, 2009
Tuesday, February 24, 2009
Big News!
I am officially going to be a midwife!
Last weekend I received my acceptance letter for the Nurse-Midwifery program at Yale. I honestly could not believe it. I cried when I opened the letter and am still in a state of shock. It was the only school I applied to because I was not planning on applying to schools until next year (but Yale has no prerequisites so I figured I'd give it a shot).
I truly believe that I have found my calling and I am so fortunate to be able to pursue it so soon. In May of 2012 I will be a certified baby catcher. So cool :)
Last weekend I received my acceptance letter for the Nurse-Midwifery program at Yale. I honestly could not believe it. I cried when I opened the letter and am still in a state of shock. It was the only school I applied to because I was not planning on applying to schools until next year (but Yale has no prerequisites so I figured I'd give it a shot).
I truly believe that I have found my calling and I am so fortunate to be able to pursue it so soon. In May of 2012 I will be a certified baby catcher. So cool :)
Sunday, February 15, 2009
Rosa
Rosa was not your typical client.
One of the wonderful things about my research job is the opportunity to meet the amazing doctors and nurses who work with the babies at the Brigham who are born with conditions that make their new lives very difficult. These individuals are so compassionate and recently started a Palliative Care Program for the babies who may not survive past infancy because of a prenatally diagnosed condition. Back in October I contacted one of the Nurse Practitioners in the department of Maternal-Fetal medicine and offered my doula services for free for moms who are faced with delivering a baby with a known birth defect. She responded immediately that she had a mom due to deliver in the next few weeks that could really use the help of a doula.
Rosa was a 21 year-old woman from Puerto Rico who was pregnant with a baby diagnosed with Alobar Holoprosencephaly-- a severe brain malformation that is often fatal. Along with this difficult diagnosis, Rosa herself had a very difficult medical and family history. Because Rosa had a history of sexual abuse, severe depression and some learning disabilities the doctors and nurses were concerned with her ability to cope with the birth of a very sick infant. I was warned that she presented with a very flat affect and never laughed or cried. Admittedly this would be a tough client. I mulled it over for a day...would I be able to keep it together enough to help enhance this woman's birth experience?
The next day I agreed. I would help Rosa when she came into the hospital. It wasn't long. Three days later I was at her side in her birthing room. I was called when she was in active labor and her epidural had already been placed. She spoke only Spanish (and her nurse spoke no Spanish) so my initial job was to relay messages to her nurse--what she was feeling, was she comfortable, did she need anything, etc. Rosa and I chatted for awhile, she was very comfortable with her epidural and her boyfriend looked so worried and was not speaking at all (I think she was just so relieved she had someone to talk to). We even joked around a bit and to the great surprise of her nurse- I got her to laugh! After awhile she wanted to talk about the baby--would she be born alive? would she be able to hold her? what would the doctors do to help the baby? I tried my best to answer her questions but really I did not know what to say much of the time.
About two hours later tons of doctors and nurses were coming into the room. Specialists from fetal medicine, the neonatology team, ob/gyns and their interns, respiratory therapists, pediatricians... it got very crowded. Turns out the Spanish translator who was supposed to be present during the whole labor decided not to come in that day so that job fell on me. I translated for every specialist and every nurse while trying to stay focused on Rosa and her needs. To be honest it was exhausting and exhilarating all at once.
The baby's heart rate began to drop to the point where the doctors would have decided on a C-section in a normal case. Since this baby had such a poor prognosis, however, they decided to let mom labor longer than usual and really try for a vaginal delivery so that she could spend the next few days with her sick baby, not recovering from surgery. About an hour later mom was pushing. The special photographers also came into the delivery room to take pictures of the baby right after she was born in the event that she didn't live past the delivery room.
The pushing stage actually went very quickly and soon Rosa was the proud mother of Daniela, a 5lb8oz baby girl. Although Daniela did not cry immediately, the neonatology team took her over to the warmer and stimulated her for a minute and she let out a nice strong cry. As Daniela cried, I looked over at Rosa who also had tears streaming down her cheeks. I congratulated her on her beautiful baby and she sobbed intensely.
Sadly Daniela's strength did not hold up very long and she was unable to breathe without oxygen after ten minutes. The neonatologists asked me to confirm with Rosa that she wanted them to intubate the baby. After I explained the process of intubation to Rosa and assured her that it would not hurt Daniela, she agreed. After intubation Rosa was allowed thirty seconds with the baby on her chest. Just enough time to give her a kiss on the top of her little head.
The chaplain entered the delivery room and I translated the baptism of Daniela right there with dad by my side and Rosa still on the bed. It was a tearful baptism for all twenty of us in the room. Shortly thereafter, Daniela was put into an isolette and wheeled to the NICU.
The whole experience is one that I will never forget. It was the most intense experience of my life and I felt blessed to be a part of it. My heart goes out to Rosa and her family and my thoughts are always with Daniela who continues to live against the odds of medicine.
One of the wonderful things about my research job is the opportunity to meet the amazing doctors and nurses who work with the babies at the Brigham who are born with conditions that make their new lives very difficult. These individuals are so compassionate and recently started a Palliative Care Program for the babies who may not survive past infancy because of a prenatally diagnosed condition. Back in October I contacted one of the Nurse Practitioners in the department of Maternal-Fetal medicine and offered my doula services for free for moms who are faced with delivering a baby with a known birth defect. She responded immediately that she had a mom due to deliver in the next few weeks that could really use the help of a doula.
Rosa was a 21 year-old woman from Puerto Rico who was pregnant with a baby diagnosed with Alobar Holoprosencephaly-- a severe brain malformation that is often fatal. Along with this difficult diagnosis, Rosa herself had a very difficult medical and family history. Because Rosa had a history of sexual abuse, severe depression and some learning disabilities the doctors and nurses were concerned with her ability to cope with the birth of a very sick infant. I was warned that she presented with a very flat affect and never laughed or cried. Admittedly this would be a tough client. I mulled it over for a day...would I be able to keep it together enough to help enhance this woman's birth experience?
The next day I agreed. I would help Rosa when she came into the hospital. It wasn't long. Three days later I was at her side in her birthing room. I was called when she was in active labor and her epidural had already been placed. She spoke only Spanish (and her nurse spoke no Spanish) so my initial job was to relay messages to her nurse--what she was feeling, was she comfortable, did she need anything, etc. Rosa and I chatted for awhile, she was very comfortable with her epidural and her boyfriend looked so worried and was not speaking at all (I think she was just so relieved she had someone to talk to). We even joked around a bit and to the great surprise of her nurse- I got her to laugh! After awhile she wanted to talk about the baby--would she be born alive? would she be able to hold her? what would the doctors do to help the baby? I tried my best to answer her questions but really I did not know what to say much of the time.
About two hours later tons of doctors and nurses were coming into the room. Specialists from fetal medicine, the neonatology team, ob/gyns and their interns, respiratory therapists, pediatricians... it got very crowded. Turns out the Spanish translator who was supposed to be present during the whole labor decided not to come in that day so that job fell on me. I translated for every specialist and every nurse while trying to stay focused on Rosa and her needs. To be honest it was exhausting and exhilarating all at once.
The baby's heart rate began to drop to the point where the doctors would have decided on a C-section in a normal case. Since this baby had such a poor prognosis, however, they decided to let mom labor longer than usual and really try for a vaginal delivery so that she could spend the next few days with her sick baby, not recovering from surgery. About an hour later mom was pushing. The special photographers also came into the delivery room to take pictures of the baby right after she was born in the event that she didn't live past the delivery room.
The pushing stage actually went very quickly and soon Rosa was the proud mother of Daniela, a 5lb8oz baby girl. Although Daniela did not cry immediately, the neonatology team took her over to the warmer and stimulated her for a minute and she let out a nice strong cry. As Daniela cried, I looked over at Rosa who also had tears streaming down her cheeks. I congratulated her on her beautiful baby and she sobbed intensely.
Sadly Daniela's strength did not hold up very long and she was unable to breathe without oxygen after ten minutes. The neonatologists asked me to confirm with Rosa that she wanted them to intubate the baby. After I explained the process of intubation to Rosa and assured her that it would not hurt Daniela, she agreed. After intubation Rosa was allowed thirty seconds with the baby on her chest. Just enough time to give her a kiss on the top of her little head.
The chaplain entered the delivery room and I translated the baptism of Daniela right there with dad by my side and Rosa still on the bed. It was a tearful baptism for all twenty of us in the room. Shortly thereafter, Daniela was put into an isolette and wheeled to the NICU.
The whole experience is one that I will never forget. It was the most intense experience of my life and I felt blessed to be a part of it. My heart goes out to Rosa and her family and my thoughts are always with Daniela who continues to live against the odds of medicine.
Thursday, February 12, 2009
the client that wasn't
I know now that being a doula is all about being flexible. You have to be able to roll with whatever happens or you will become frustrated. Alicia's birthing (see previous entry) was not actually supposed to be my first doula experience. Even before meeting Alicia I had met with another young woman named Maria from Puerto Rico. Only 20 years old she was here with very little family support. She had an Aunt in the area and the rest of the family and the uninvolved father of the baby were back in Puerto Rico. She spoke no English and seemed pretty scared and overwhelmed by the whole prospect of birthing and raising a baby with limited supports (rightfully so!)
Her midwife suggested that she should have a doula with her during her birth experience to support her and help her express herself to her medical providers (who would most likely be only English-speaking). I gladly met with her and offered my services for free. Since I speak fluent Spanish the communication wasn't a problem but she still didn't seem 100% psyched about having a doula. I asked her if this was what she really wanted "si, si" she assured me. OK...
Over a week past her due date, I began to worry about how she was feeling. I knew that when I met her at 36 weeks she was already really anxious to get the baby out. I called her on the phone and she said that she was still pregnant and REALLY hoping to give birth that week. I again explained that she should call me at the onset of labor and give me a heads up when she was going to the hospital. She agreed.
Well...a few days later, I noticed her name on the hospital census (my other job involves working with the newborns at the hospital she was supposed to deliver at). She had given birth that morning! No call! I was shocked at first, then upset. I had put aside a lot of time to be there for her delivery (I had even skipped out on watching my boyfriend's marathon so that I could be in town in case she delivered). Then I went up to the post-partum floors to see her and the baby and get the story. I saw that little girl and melted. A beautiful 7lb baby looking so peaceful. Her mom apologized profusely for not calling---"everything just happened so fast! I was throwing up and I had no control over my body."
Birth can take us by surprise. I guess you just have to roll with it.
Her midwife suggested that she should have a doula with her during her birth experience to support her and help her express herself to her medical providers (who would most likely be only English-speaking). I gladly met with her and offered my services for free. Since I speak fluent Spanish the communication wasn't a problem but she still didn't seem 100% psyched about having a doula. I asked her if this was what she really wanted "si, si" she assured me. OK...
Over a week past her due date, I began to worry about how she was feeling. I knew that when I met her at 36 weeks she was already really anxious to get the baby out. I called her on the phone and she said that she was still pregnant and REALLY hoping to give birth that week. I again explained that she should call me at the onset of labor and give me a heads up when she was going to the hospital. She agreed.
Well...a few days later, I noticed her name on the hospital census (my other job involves working with the newborns at the hospital she was supposed to deliver at). She had given birth that morning! No call! I was shocked at first, then upset. I had put aside a lot of time to be there for her delivery (I had even skipped out on watching my boyfriend's marathon so that I could be in town in case she delivered). Then I went up to the post-partum floors to see her and the baby and get the story. I saw that little girl and melted. A beautiful 7lb baby looking so peaceful. Her mom apologized profusely for not calling---"everything just happened so fast! I was throwing up and I had no control over my body."
Birth can take us by surprise. I guess you just have to roll with it.
Tuesday, February 10, 2009
My First Birth
Right after I finished doula training I sent out an email to all of the midwives at Brigham and Women's to offer my doula services for free for their patients. I didn't receive too many responses from the midwives at first and was a little bummed that they would not want to utilize my doula services. After all--I had just finished the doula training and was SO excited to go to my first birth.
A few weeks later I was at work when I received a call from Alicia (names of my clients will always be changed for their privacy). She explained to me that she was 39 weeks pregnant with her second baby and she had gotten my name and phone number from her midwife. A couple of minutes into the phone conversation I noticed that she was breathing heavily and pausing at times. Oh yes, she was having contractions.
Alicia explained that her husband was out of the country and that she was afraid that she would have to leave her 6-year-old home alone when she had to go to the hospital. Her mother was there with her for another few days but after that she would be all alone. Between what seemed to be intensifying contractions, she asked, "Will you be my doula?"
I tried to hold back my excitement and I told her that I would love to be her doula and I would help in any way that I could. About 8 hours later she called to tell me that she was headed to the hospital and I soon joined her there.
I entered the triage area of labor and delivery and immediately met Alicia's mother who was in the waiting area while her daughter was being admitted. Minutes later we were led into the triage room where Alicia was visibly contracting every four to five minutes. The contractions were extremely intense and sweat was beading along her hairline as she breathed through each one. I introduced myself and quickly got to work helping her get into more comfortable positions and coaching her through the breathing during contractions. Her mother and I made a dynamic team and together we were able to focus her on the ultimate goal and relieve some of her pain.
Alicia was amazingly strong and did not ask for pain medication once. She said more than once "Erica [the baby] is going to kill me" but never questioned her ability to labor naturally. Once we were moved into the official labor and delivery room, we had more space to move around and labor in upright positions. The labor progressed extremely rapidly and four hours later a very healthy 9lb5oz baby girl was born. I will never forget the intensity of the experience and how natural I felt helping a woman through labor. Although I had never been to a delivery before, I seemed to know exactly what to do to help Alicia achieve the birth experience she wanted. When her mother asked me how many labors I had been to after Erica was born, she was shocked when I told her this was my first one. Alicia's labor and Erica's birth truly confirmed that this was my calling. I couldn't wait to help with more deliveries.
A few weeks later I was at work when I received a call from Alicia (names of my clients will always be changed for their privacy). She explained to me that she was 39 weeks pregnant with her second baby and she had gotten my name and phone number from her midwife. A couple of minutes into the phone conversation I noticed that she was breathing heavily and pausing at times. Oh yes, she was having contractions.
Alicia explained that her husband was out of the country and that she was afraid that she would have to leave her 6-year-old home alone when she had to go to the hospital. Her mother was there with her for another few days but after that she would be all alone. Between what seemed to be intensifying contractions, she asked, "Will you be my doula?"
I tried to hold back my excitement and I told her that I would love to be her doula and I would help in any way that I could. About 8 hours later she called to tell me that she was headed to the hospital and I soon joined her there.
I entered the triage area of labor and delivery and immediately met Alicia's mother who was in the waiting area while her daughter was being admitted. Minutes later we were led into the triage room where Alicia was visibly contracting every four to five minutes. The contractions were extremely intense and sweat was beading along her hairline as she breathed through each one. I introduced myself and quickly got to work helping her get into more comfortable positions and coaching her through the breathing during contractions. Her mother and I made a dynamic team and together we were able to focus her on the ultimate goal and relieve some of her pain.
Alicia was amazingly strong and did not ask for pain medication once. She said more than once "Erica [the baby] is going to kill me" but never questioned her ability to labor naturally. Once we were moved into the official labor and delivery room, we had more space to move around and labor in upright positions. The labor progressed extremely rapidly and four hours later a very healthy 9lb5oz baby girl was born. I will never forget the intensity of the experience and how natural I felt helping a woman through labor. Although I had never been to a delivery before, I seemed to know exactly what to do to help Alicia achieve the birth experience she wanted. When her mother asked me how many labors I had been to after Erica was born, she was shocked when I told her this was my first one. Alicia's labor and Erica's birth truly confirmed that this was my calling. I couldn't wait to help with more deliveries.
Getting Started
Birth is a messy and beautiful process. It is the kind of thing that makes some people cringe with disgust and others cry with joy. Regardless of your stance, however, most would agree that witnessing a birth is an unforgettable experience.
For some reason, I was never under the impression that birth was gross, not even as a little girl. I was always fascinated by pregnancy and birth and wanted to learn more and more about it. My mother told me that I had "baby-dar" because I would always spot babies on the streets, in restaurants, at the library, in the doctor's office. I was hooked. I constantly thought to myself- babies are amazing. They are these little people that did not exist on earth just a short time ago.
After working with newborns for three years, I still feel that way.
I'm not over it- the amazing process of pregnancy and birth and witnessing the miracle of a little person coming into this world that moments before did not exist on its own.
As I guide my clients through their deliveries, I share my enthusiasm with them for the birthing process. I think it helps. When you put aside the fear that labor is all about pain, you realize that labor is all about bringing a new life into this world. Yes, it can be painful...but it can also be amazing. By focusing on the baby, the new person you are going to share your life with, you can give into the strength of the contractions and allow nature to take its course. The course might be long and it will probably be tiring, but it will definitely be worth it.
I am a doula (a labor support companion) and an aspiring midwife. I may not have my own babies yet but I have a lot of babies that I consider "my babies," I have watched these little ones come into the world and I have shared the experience with their mothers and fathers and grandparents. It's a pretty great job. I can't complain.
For some reason, I was never under the impression that birth was gross, not even as a little girl. I was always fascinated by pregnancy and birth and wanted to learn more and more about it. My mother told me that I had "baby-dar" because I would always spot babies on the streets, in restaurants, at the library, in the doctor's office. I was hooked. I constantly thought to myself- babies are amazing. They are these little people that did not exist on earth just a short time ago.
After working with newborns for three years, I still feel that way.
I'm not over it- the amazing process of pregnancy and birth and witnessing the miracle of a little person coming into this world that moments before did not exist on its own.
As I guide my clients through their deliveries, I share my enthusiasm with them for the birthing process. I think it helps. When you put aside the fear that labor is all about pain, you realize that labor is all about bringing a new life into this world. Yes, it can be painful...but it can also be amazing. By focusing on the baby, the new person you are going to share your life with, you can give into the strength of the contractions and allow nature to take its course. The course might be long and it will probably be tiring, but it will definitely be worth it.
I am a doula (a labor support companion) and an aspiring midwife. I may not have my own babies yet but I have a lot of babies that I consider "my babies," I have watched these little ones come into the world and I have shared the experience with their mothers and fathers and grandparents. It's a pretty great job. I can't complain.
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