I went in at 10:30, and Rianna was pretty uncomfortable.  She is the mother of twin boys, 11years old, delivered by c-section, and a girl, 9 years old, delivered vaginally.  She was planning to have a natural birth with this set of twins.

    When she was checked soon after my arrival she was at 4 cm dilated, and 100% effaced.  She was lying on her side, and pretty uncomfortable.  I pressed on her back , which helped a little, but she complained of back pain.  I got her to sit on the ball, on hands and knees, in the rocking chair, standing, swaying, circling, and within an hour, while on the toilet, she was starting to feel some pressure.  She was 7cm, and stayed there for a couple of hours, now consistantly asking for pain medication.   Things were incredibly intense, especially the pain in her back. The rocking chair and Nubain helped her to relax for a little while, but she decided she wanted an epidural. 

    The anasthesiologists were busy, and her epidural had not yet arrived by 3:00, when they wheeled her into the operating room to deliver her twin boys.  She was at eight cm, and stretchy, opening quickly to 10 and complete.  There were three doctors there, and at least four others, including nurses.   When one of the doctors entered the room, she dimmed the lights and put on music.  What a nice touch that was, softening the sterile environment.  Rianna was determined and strong and had that first baby boy out in about 20 minutes, and the next 16 minutes later.  

    It was incredible to witness, and completely normal, safe and healthy.  The babies were snuggling on their mama'a breasts when I left, while she and the doctor and nurse juggled them onto her nipples.  Amazing work, nursing two at a time!

Comment (0)

     Patricia called at 2am to announce that her water had broken and her doctor wanted her to go to the hospital to be checked out. (There was a little green in the water, a hint of meconium.) I told her to call back if they admitted her, or she needed me, otherwise call me in the morning.

     I woke around eight and called to check in. She had in fact been admitted and was able to sleep there for a while. She was not having contractions yet. I told her to keep me posted. Around 10am she called to say that her doctor was talking about pitocin, since her contractions weren’t really happening. Patricia was feeling stressed, not wanting to have medication, hoping I could come over and work some magic.

    At the hospital, we spent the morning outside in the gorgeous sunlight of the hospital courtyard. We stretched and walked, and climbed some stairs. Patricia had amazing awareness of sensations and could feel her belly tightening, and a sense of radiating up from her circular cervix, but no crampy feeling yet, and irregular sensation.  She was already at 3cm and 90% effaced when she was checked at the doctors office days earlier, but hadn't been checked since her water broke. We talked about how she could express her reluctance to start on medication to her doctor, who was to arrive at 2 and would be looking for signs of labor and recommending pitocin if she was not satisfied. I shared with her my frustration and thought that she was only just beginning her early labor. It had been 10 hours since her water had broken, and there was no concern with the baby’s well being, so why rush?

     Around 3, the doctor arrived and recommended starting pitocin. She said 80% of women whose water had broken before labor began started active labor within 24 hours. (It had been only 13.) She was worried that Patricia would get too tired. Patricia was feeling energetic and patient, and so her doctor said she would let her go until morning, and see how things were going then. The conversation was easy and relieving of much stress!

     We went back out to walk, and this time actually hiked up a fairly steep climb on Scenic Dr. and Wimer. We took all the stairs, (numerous times!) and admired all of the blossoming and blooming flowers of various shapes and colors along the way. When we arrived back at her room around 4:00, her husband left to get his swim trunks, and Patricia sat on the birth ball. She began noticing contractions that felt stronger, more uncomfortable, and I watched the clock. I was asking her how they met, when, and about their wedding, and she talked and and had regular contractions every 5 minutes for about 45 minutes before her sweetie arrived back.

     Things were starting to shift. I suggested they order food, because she could use the energy to get through the evening, and probably wouldn’t feel like eating if she waited any longer. It was about 5:30, and I went home to have dinner with my family while they ate. I arrived back at 6:15 and she was getting pretty uncomfortable, and had decided to get in the shower. They were in there for about an hour, and when they came out, we wrapped her shivering body up in blankets fresh from the warmer and helped her back to the room where she climbed into the bed to warm up. The nurse checked her cervical dilation and she was still at 3cm, but she had asked not to be told, so the nurse kept quiet about the numbers. I did some massage to try and help her swollen feet to shrink some.

     She was having a hard time getting comfortable, and after about an hour, we started to talk about getting in the tub. The nurse let us know that baby’s heart rate had gone up into the 180’s during the hot shower, and she wanted to see that go back to its baseline in the 140’s before she got back in hot water. Later, Patricia said this was the hardest part of the labor. She was starting to talk about getting drugs if it was going to go on like this. I helped guide her into her low sounds and keep her with her rhythmic breathing, and that seemed to focus her in the moment, but she really wanted to get in the water. The nurse suggested some IV fluids to help baby relax, and as soon as that was happening, the heart tones began to drop and by 9:30, when she was checked again, baby was doing well and she was at 5cm.

     Getting up out of bed was a bit of a journey, but it felt better to move, as long as she was supported enough to be sure she wouldn’t fall over. Sometime after 10:00, the tub was ready, and she made it into the water, which helped her relax immediately, and before long she was making sounds like she needed to push! The nurse checked her, and she was at 8cm, and sounding very powerful. We encouraged her to blow through her lips, helping them to relax, and helping her perineum to let go. This also helped her to refrain from pushing with her full strength while she dilated the rest of the way. We could tell that was happening quickly and the doctor was rushing to the hospital. Once the doctor arrived, she began to push her baby out, and after about an hour, baby was born!

     Patricia knew what she wanted, and when she was given “permission” to labor naturally, she relaxed right into her steady rhythm. Her labor was fast and strong, a perfect water birth!

Comment (0)

    I called in around 5pm, and May was just getting active, not yet needing much assistance. The hospital had called earlier in the day to tell me she was in early labor and requesting a doula. Around 7pm, the nurse, Joanne called and said to come as soon as possible. When I arrived a few minutes later, May was in the tub, had recently been checked, and was at 4cm. She was making sound and starting to get focused. John was right there with her, giving her an ice pack, telling her “You’re pretty” and rubbing her back.

    Her contractions were coming pretty quick and clearly intensifying. I put some pressure on her lower back, pressed on her shoulders, held her hand. She was getting hot in the tub, so we put some cooler water in. By 8:30, she was getting louder, and contractions were lasting longer. Joanne checked her, and she could “stretch her to 6cm.” I helped her breathe in a rhythm and she asked to be guided. We all breathed the rhythm together. I leaned over the edge of the tub with my hand on her sacrum, and the pressure felt good, helped her get through the contractions.

    She mentioned feeling pressure, like she had to poop. Joanne checked her again, “just to be sure the doctor [didn’t] need to rush in.” She didn’t comment and I assumed May was still dilated to 6 cm. It was 9pm. Soon after that, she got out of the tub and laid in the bed awhile. We tried a few positions, lying on her side, squatting, facing back of the bed on her knees... She was very uncomfortable squatting, but I encouraged her to try a few like that, since they were clearly more intense.

    Awhile later, back in the tub, she was starting to comment about not being able to do this much longer, feeling nauseous. Contractions were sometimes right on top of each other. We breathed together, she stayed on top of it. John was incredibly encouraging. I mentioned that transition is like this, that things were getting more intense because progress was happening, things were speeding up, coming to the exciting part. She said that if she was not more dilated, she was getting an epidural, and Joanne checked her and pointed between the 6cm circle and the 8cm circle on her chart, indicating that she was in between. Things were intensifying quickly; she was nauseous, feeling more pressure, still in the tub.

    A little before 11:00pm, Joanne checked her again, and said she was at 8cm. “Eight!” May exclaimed. I thought you said I was at nine when you checked me last! I want an epidural! I can't do this!” With the misunderstanding that she had been at nine when Joanne pointed to the chart earlier, she had been able to handle things, but now she started to panic. We assured her that this is what transition is like, and she can get through it, that things generally speed up at this point, that when she is focused on her breath and not caught in her mind and her worry about numbers and time, she is getting through it all with such incredible strength. I suggested a way that she could not "do this anymore," by getting out of the tub and going to the bathroom, or sitting on the birth ball. She could change her situation now, try something new. Joanne asked her if she could wait half an hour and check back in, rather than rushing off to call the doctor, requesting an epidural. May didn't respond either way, but said she would get out and try sitting on the toilet.

    She did get out of the tub and got to the bathroom, where she and John spent some time alone. When they came out, she stood by the tub and he squeezed her pelvis with contractions, relieving some of the pressure. She was handling things much better, had her second wind, was again with her breath and calmer. By midnight, it seemed like the contractions were coming one right after another, and when the new nurse, Liz, checked her around 1:00, she was almost complete. Liz thought maybe the doctor could stretch her cervix open so she could push the baby through, so she went to call her. By the time she arrived, May was having 5 minute long contractions, totally complete and ready to push. She pushed for maybe half an hour, then baby Lila was born! May said, " "Everyone said I couldn't do it, but I did! I had a completely natural birth!"

Comment (0)

      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    

Comment (0)