Saturday, April 25, 2009

Score one for the big babies!

Earlier this week, my phone rang in the early afternoon from an unfamiliar number. It turned out to be the husband of doula client, telling me she was in early labor. Those are such fun phone calls to get! I spent the rest of the afternoon studying for my comps, checking out a couple of apartments for next year, and anticipating going to a birth...the last one for a while.

Around 7 pm I got a phone call that they had just checked in at the hospital and she was 6 cm. I knew she was a primip, but that call still sent me careening around the apartment, throwing off my clothes and throwing on my doula outfit - I grabbed my bag and was out the door in probably less than 5 minutes. I didn't think she'd go fast, but I wanted to make it if she did!

When I got there, she wasn't going fast but things were getting more intense. She couldn't sit down, or lie down - she had to be standing or kneeling by the bed, where she would lean over the birth ball and rock back and forth, and vocalize loudly. Her husband was an amazing support, a great cheerleader who said all the right things, very hands on (although she didn't always want to be touched). I just backed him up, encouraging her, rubbing her back, bringing her water. She turned to me at one point and said, "What's transition like? Because I can't imagine it getting worse than this." I said, "For all we know, you're in transition!" I suggested she try the shower and she stayed in the bathroom in the shower/tub for at least an hour. It's a tiny room so her husband stayed in with her and we just checked on them once in a while.

Noticed anything yet about this scene? She was not hooked up to ANYTHING! She had even declined a heplock for the IV (she hates needles, this was a big priority.) She was getting intermittent monitoring probably every half hour or so, but very briefly and every time the nurse would say, "You don't need to move for this. Just pay no attention to me." She could go wherever she wanted, sit, stand, rock, get in the tub - no restrictions. There was another doula working with her who got there a little later, and she said, "Oh, it's so great how there's nothing attached to her. I haven't been to any births like that lately!"

After she got out of the tub, she really wanted to know what we could do to speed things up, and agreed to have her water broken (after being checked and almost complete!) The midwife really worked proactively with mom's positioning to get the baby rotated optimally, and after a while she began pushing spontaneously. It's been a REALLY long time since I've seen someone allowed to do that! Only because she was so intent on speeding things up, the midwife did some gentle coaching on pushing. The midwife also kept her position changing - hands and knees, side - to keep the baby rotating well. In under an hour, baby was at the perineum and crowned at the end of a push. The midwife let the half-out head sit there until the next contraction - which took a little while - and just encouraged the mom to pant and let the head emerge slowly. Once the next contraction came she was out in two more pushes, crying right away, a big baby girl!

How big? Over 9.5 pounds! Over an intact perineum!

This birth was so invigorating and inspiring. This mom got almost every one of the wishes on her birth plan respected and supported by her birth team. Whenever she said, "I can't do this!" no one said "I can have the anesthesiologist come and talk to you if you want." Everyone said, "You ARE doing it, you're doing great, you're so close." She could move freely and do whatever her body told her - she was never attached to anything except her brief stint on the monitor and the occasional blood pressure. No one got in her face and yelled at her to push or counted to 10, just explained to her that the longer she could hold a push, the faster it might go. She had a midwife who paid attention to the baby's positioning and used it to guide mom's positioning. And she had a great midwife who let her push slowly and did a very controlled and gentle delivery.

So often after a birth that ends in c-section, I run through the "what ifs". This birth is one where you can easily run the what-ifs in reverse: what if she HAD been induced? Then she would have been hooked up to the IV and the monitors and could at best have only stood next to the bed. What if she hadn't been able to use the tub? Then she might have asked for the epidural. What if she'd gotten the epidural? Then she might not have been able to change positions, and would have had a big OP baby. What if she hadn't been able to push effectively? Then a long pushing stage and possible c-section (and "No wonder you couldn't push this baby out, he's too big for you!")

What if! Hopefully even if those had happened, the cascade wouldn't have gone all the way to c-section, but it's easy to see the potential pitfalls, and I am so glad it went the way it did. This mom prepared so well: by taking a class so she knew what her options were and what to expect, writing out a simple, clear birth plan with her most important wishes, and above all choosing a birthplace and care provider that matched her needs.

So score one for the big babies! And score one for women being informed, respected and empowered.

I am sad that this will be my last birth for a few months, but I'm looking forward to the fall, and to a summer practicum that will give me the skills to crunch the numbers to provide the evidence base for empowering births!


Sally said...

What a great story! Way to go, Rebecca!

publichealthdoula said...

Thanks but I didn't do much :-) The mom did all the work!!

Mollie Hartford said...

I'm glad I read this. I've heard several stories recently about some bad births, including one that did end in c-section with a "No wonder you couldn't push this baby out, he's too big for you!" comment.

publichealthdoula said...

I'm so glad I can write stories like this! I talked to a midwife recently who keeps an "inspiration file" of births she's attended so after the bad days, she can go back and read about the really good ones. I hope this story can be that kind of fortifier against some of those bad stories.

River Eden Doula said...

I loved reading this birth story. :) My last birth in March as a doula was very similar. It's so awesome when Mom’s get evidence-based care.

Jill said...

Did someone say "big babies?" ;)

This is a great story. I'm really happy for the mom.