Sofia was at 5 cm when I arrived at the birth center. She had been at the hospital since the afternoon and seemed fairly comfortable at 7:30 when I arrived. She had been checked in the morning at her appointment and was at 4 or 5cm then, too. Sofia seemed to not want too much attention.  She was asking how her husband was feeling, checking to see who was with my children, and so concerned about her dog that she sent her husband home to feed him.

    Things seemed pretty mellow, and Sofia was very polite, thanking me for being there and responding positively when I suggested we stretch a little and practice breathing. She expressed some concern about transition; she was afraid that she wouldn’t be able to handle more intensity. I said we could practice now, while things were more comfortable, and that she could find a ritual and stay with whatever was working for her. She liked the birth ball, stretching felt good, and when she got in the tub, she really relaxed. After a couple of hours she got out to pee. The nurses were changing shifts, and Barbara came on as Yvette went home. Before getting back in the tub, Barbara wanted to check her. She was still at 5cm.

     The mood shifted then, and I could feel the tension of Barbara's concern that Sofia was not progressing. She was told that her doctor would be called and she would most likely want to rupture her membranes (break her water) to get things to speed up. "We want to figure out what the problem is,” she said. When Sofia heard there was a problem, she got scared. Soon her doctor arrived and ruptured her membranes. She also inserted an IUPC (intra uterine pressure catheter) to read the strength of the contractions. Sofia started to crumble when she heard there was a problem. She couldn't get back in the tub because of the IUPC, and couldn't get up into one of the positions that was working for her.   Her contractions seemed a lot more intense, but the catheter wasn't showing that.  It seemed possible that she was just having a harder time because she wasn't comfortable and was afraid.  They tried replacing the catheter, thinking that it could be malfunctioning or not placed correctly.

     According to the IUPC,  her contractions were just not strong enough, so her doctor  suggested pitocin or nipple stimulation.  Between contractions, I helped with rhythmic stimulation of her nipples, and after awhile, she began to respond to her contractions with less reserve, making sound and getting lost in the sensation as they clearly were intensifying.  She couldn't get back to her peaceful state of mind, though, and started asking for something for the pain. The nurse checked her and found her cervix had dilated to 6cm, but she wasn't cheered by the news.   

     Her doctor told her she could have an epidural at this point, and Sofia wanted it NOW. They wheeled her into the other room, away from the tub, and she was barely hanging in, not communicating, very internal. By the time the epidural was in place and she was comfortable, her cervix was completely dilated. Her epidural took the edge off but allowed her to move freely, so she squatted and pushed, and after a couple of hours, her beautiful baby was born. 

     I learned an important lesson at this birth about the power of suggestion.  Sofia was very sensitive, and nervous, and when she heard there was a "problem,"  her confidence was shattered.  Although her body was still working its magic, she couldn't trust that things were going alright.  She was hearing that although her contractions felt incredibly intense, they were not strong enough. 

     I saw in this labor experience that it is extremely important for doulas, nurses, and doctors to use positive language.  Instead of naming a problem, name a solution; such as, "We would like to help get things moving for you, and perhaps your doctor can help by breaking your water."  I also see that I could have been a better bridge of communication between the nurses and the doctor.   I was there through the change of shift, and saw clearly that her contractions were getting stronger, and that she was definitely making progress.  It is up to me in that situation to communicate to the doctor what I have seen, and the changes that are occuring.   Although the IUPC results did not seem to support my observations, her body signals were strong, and my job is to help her, and the medical staff, to feel confident in that.   The most difficult part of supporting a woman in labor can be to help her feel positive, hopeful, and safe, so that her body can relax into its natural rhythm and give birth.