Jean called last night at 10:50 to say that she was leaking a lot of fluid and thought her water might have broken.  When I asked her how much fluid, she said, “I am gushing, and there is a little blood in there as well.”  I said it sounded like her water had indeed broken and yes, she should call her doctor.  I advised trying to get some rest, and asked if she had any cramping.  She reported having “some mild menstrual cramps.”

I was awakened at 5:00 in the morning by my cheerful cell phone jingle.  Jean was calling to say she had been having contractions since we spoke last night, and was starting to feel pretty uncomfortable.  I told her I would get up and make my way over in the next hour.  When I arrived around 6:00, she was on the floor in her bedroom, trying to find a position that felt good.  We talked a little about her night while she had a few short contractions, less than a minute each.  She labored with contractions close to five minutes apart for a while, but they were short and manageable.  Around 8:30am, her doctor called to check in and I told her that Jean was just getting active, with her regular contractions lengthening and coming a bit closer together. 

She tried many positions and found that walking in circles around the spiral staircase felt best.  For a while, she seemed to dance around in circles,  taking breaks to rest in the easy chair.  Then she got very calm, kneeling on the floor, leaning forward over the couch, while I put pressure on her sacrum, and practically napping between contractions.  She started feeling nauseous, and soon threw up her breakfast of some sort of mush.  Not long after, we went outside for some fresh air and she and her husband walked a bit in the gorgeous spring morning light.  He was right by her side the whole time, holding her, massaging her back, feeding her, and offering his sincere encouragement and admiration.

A little after 10:00am, when her contractions were clearly intensifying and she was in a pretty steady rhythm, kneeling on the floor with pressure, then water, then rest, she asked when we should go to the hospital.  She was interested in getting in the tub to help her relax, so we gathered her things in the car and drove five or ten minutes to the Ashland Community Hospital’s Birth Center.  When we arrived, she was monitored and checked, was dilated to 5cm, and things were obviously intensifying.  After a half hour or so on the EFM, we moved into the tub room and she sank into the water with a sigh of relief.  It felt great, but was a little hot, and she was still getting very uncomfortable with the contractions.  It was about 11:30 by then.  We tried cooling the water off, but she decided to get out around 12. 

She was at 7cm around 12:30,  and having a hard time getting comfortable in the bed.  She finally settled in on her side, getting up on all fours with some contractions.  She started  feeling a lot of pressure and was doubting that she could continue.  She asked if she was in transition and was also asking about pain medication.  The nurse told her about Nubain, that it should wear off at least an hour before baby was born, and that it could have an affect on baby’s cry, causing baby to make a shriller sound.  We  talked about waiting on any meds until she was checked again, and the nurse went to see if the doctor was on the way.  Jean was feeling lightheaded, like she might pass out; pleading for a nap, exhausted.  Her husband and I started feeding her juice and crackers, Gatorade, and toast, hoping to give her a little nourishment that could revive her.   After her snack, she felt somewhat better, but was worried that she could feel her body pushing and tightening and afraid of her cervix swelling because she couldn’t relax.  The nurse checked her and said that she did feel a little swollen and should refrain from pushing.  We focused on helping her blow her breath out in a rhythmic pattern, and tried to keep her on the rhythm.  Her husband was by her side breathing with her while I stood on the bed, leaning my weight on her back with each contraction.  I could feel what a struggle it was for her to not push, and she just could not get comfortable in the bed, so she soon got back in the tub.   

In the water, her urge to push was getting more and more undeniable, so I went out to get the nurse. I wanted her to listen to her body, suspected that she was complete by the sounds she was making.  The nurse checked her and she was practically complete, she held back the final lip of cervix while Jean pushed right through, then she went to call the doctor.

By 2:30, the doctor was there and Jean was pushing with such power and determination that it was clear her baby would be born any minute.  I snapped a few pictures as his (huge!) head was crowning.  He emerged into the water and straight into his ecstatic mother’s arms.  She pulled him up to her chest with an elated expression of deep love and gratitude, relief on her face. Baby boy was born at 3pm exactly, and weighed 9lbs. 9oz!

Jean's mind had many doubts as things intensified and were almost beyond what she could manage, but her body knew what to do.  She moved into every possible position, intuitively knew when it was time to get in the water and which positions seemed most effective.  She knew when her cervix started to swell, and knew when she had to push her baby out.  Once she set her mind to it, the power of her will was strong and carried her right through her incredible healthy, natural birth. Georgeous.

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      The birth center at Ashland Community Hospital called at 10:45 today with a VBAC patient dilated at 2 or 3 cm, whose water had just broken. They said she had requested a doula, and asked me to come right in.  Five years ago, Julia had labored with her first baby to 8cm, then the doctor realized the baby was breech and did a ceasarean section.

       When I arrived at 11:45, Julia was in the bathroom with her husband. She was pretty uncomfortable, and wanted to get in the shower. They stayed in there together for about half and hour, until things had obviously intensified, and she just wanted to go lie down.  We wrapped her in a warm blanket and helped her back to the room.  She was starting to panic, to say she didn't think she could do this.  She was afraid, and unsure if she could go on, if things would be okay, if she could deliver this baby vaginally.  We helped her focus on her breath, its rhythm, and assured her that things were intensifying because everything was going the way it should.  Her body was making space for baby to pass through.  The nurse checked her again and she was now at 5 or 6 cm. 

       In the bed we tried a few different positions, but she just couldn’t get comfortable, and was having a hard time staying on top of her breath. Her father, husband and I coached her with every breath to find her rhythm, to stay with it, to reassure her that things were going just as they should. I found a place to press on her lower back, which felt good when she laid on her side.  She seemed to stay with her breath as long as she had consistant support, but she was having a hard time handling her dicomfort.  I thought she could be in transition, and although, as a VBAC patient, they would not let her give birth in the tub, I thought it could help her to get in a relax for a little while.  She agreed and I went to turn on the water.

     By the time I got down the hall to the tub room and turned it on, the nurse signaled to me that her cervix was dilated and she was complete.    Very soon, Julia was having a hard time not pushing. Her doctor was on the way, and the nurses were getting ready.  She pushed her baby out in about half an hour with incredible strength and even moments of humor.  I held her leg, and took pictures as her little one was crowning and emerging into the world.  It was 1:50 pm, so I was there for only about three hours before the birth. Julia had been in labor since 5:30 am.

     This was my first successful VBAC experience.  I felt a layer of doubt and fear, as though she had some expectation, formed through her experience, that her baby could not come out of her vagina.   She had the support she needed, though, and her body and baby worked their magic! The baby was at least 9 lbs. and gorgeous!

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      At the Ashland Community Hospital's Birth Center, doula care is provided for any laboring woman who requests support, and the service is at no extra cost.  A doula is a woman, experienced with birth, who provides constant physical and emotional support for a laboring woman.   She can be there as a main support person, if the woman has no family or partner with her, or she can be there to assist the husband or mother.   She will make suggestions about position changes, offer massage, and share her knowledge of the birthing process. She is there as a guide, and her main purpose is to help the woman feel safe and relaxed, so that her body can drop into a rhythm and give birth.   The nurses at the Ashland Hospital provide excellent labor support, but are also responsible for taking blood pressure, checking cervical dilation, keeping records, and caring for other patients.   Since they  cannot always provide constant support,  they have  hired a team of skilled and compassionate women to stay present with their patients.  It is an incredible gift to women, and unique for a hospital to provide this service.

     This Oregon hospital's progressive program began in 1995, as a way to support Spanish speaking women.  Originally, the doulas were fluent Spanish speakers and were there to translate, in addition to offering labor support.  A couple of years ago, the program expanded to include support for all women, and now there are doulas on call 24 hours a day, seven days a week.   Many of the current doulas speak Spanish, but not all are fluent. 

      Having a doula present greatly reduces the need for medical interventions and greatly increases the chances of a woman remembering her birth as a life transforming accomplishment.   You can see photos and read a little about the doulas, including myself,  on the Ashland Community Hospital website: http://www.ashlandhospital.org/Page.asp?NavID=175    

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