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!

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      Her water broke at 7am, and she called me, her doula, immediately. When I got to the hospital at 11, she wasn’t yet having contractions, and nurses and doctor agreed she could go home. Thank goodness! I massaged her in her bed for a while, and she fell asleep, so I went home too.

     Doctor wanted her back at 7pm, so I met them at the hospital again, and she was having dinner when I arrived, still no regular contractions. We watched silly TV shows, laughing, and walked a bit. Around 9:30, her husband and I got serious about spleen 6 and GB 21, ankle and shoulder points. I said, “On the number, every five minutes, we’ll press and you can invite the contractions to come.“ For the next 90 minutes we did, and they came right on time, every time except when the doctor or nurse came in to check on her and talk with her.  I've seen it happen like that before but it always amazes me how this works. 

     About 11:00, things started to get intense. Her cervix was checked around 11:30 and she was at 2 ½ cm. We moved her candles into the room with the birthing tub, and she spent about an hour in there, soaking and feeling the contractions intensely. It seemed to relax her at first, but she was feeling it strongly, and very uncomfortable.The nurse suggested she get out when she wasn’t handling things very calmly. She went back to her room, and laid on the bed, wanting very firm pressure on her sacrum, and starting to ask about drugs and beg god for help. She threw up and then was asking clearly for something to take away the pain. The nurse was hesitant about giving her drugs, since she had in her birth plan preference for a natural birth, but I was expecting it. She had spoken about her past birth experience and mentioned what a relief that brought.  She attributed the drugs to getting her through the labor, but she adamently was opposed to an epidural.   I understood that although she was very wary of the medical world's tests and procedures, she chose a hospital birth over a home birth because of the option of having something to ease the pain. 

      She was checked again, and I wondered if she had progressed a great deal, and thats why things were so painful for her, but she was 3 ½ cm. She got a shot of Fentanyl, which made her a little loopy, but she complained that it didn’t take the pain away. The nurse and I were thinking the same thing, trying to get her on hands and knees to rock her belly in the rebozo, which she liked at first, but the position was intense, and she wanted to lie down. We were thinking that her baby was in an occiput posterior position, and we wanted to help the baby to turn, so things could go easier. She was asking for more drugs, but had to wait an hour and a half after the first dose, which she got around 1:00. She sat on the toilet a while, needing intense pressure on her back to manage the contractions. When she got up, the nurse came in a said one of the other nurses had mentioned the belly lifting technique in the rebozo… I tried it with my hands.

     This was the incredible thing that happened. I stood behind her, and during her contraction, I wrapped my arms around her belly and lifted that baby up out of her pelvis. It was intense and painful fro her, and I felt that baby move! She collapsed onto the bed and with her next contraction was telling us she had to poop! She was complete and ready to push her baby out, just like that. The doctor rushed in, because the baby’s heart tones were dropping as she passed through the birth canal, and she summoned her power and pushed that baby out in just a few minutes. Totally Incredible.

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      Allison and Joe called at 12:30 last night to say labor had begun, and they wondered if I would be available to show up at the hospital as their doula, when they got there.  I agreed that they could have the nurse call me in, and around 2:30, I got a call and headed over.  They had arrived about an hour earlier, and she had been at 4cm. We got in the tub a little after 3:00, and she was already at 5cm, but a bit discouraged with the number, since she had been working hard all night.   I reminded her that the number really is arbitrary, things can go slow or speed up at any moment, unlike a car trip when you can measure distance divided by miles and average speed and figure out how long until arrival….  Between contractions, she was able to fall asleep, and so were Joe and I.  It seemed like a nice rhythm to awaken every five minutes or so to breathe with her.  She had a bath pillow to rest her head on and the room was quiet and dark.

      A couple of hours had passed, and Allison got out of the tub and spent a little time in the bed. Lying on her side seemed quite uncomfortable, but she was very tired and trying to rest.  Her sounds and face were quite tense at moments, and she was struggling with the idea of continuing this way.  She was at 5 or 6 cm when the nurse checked her. Around 6:30 or 7am, we took a walk in the courtyard to soak up the morning sun and fresh air. It was very rejuvenating, and she visibly relaxed a great deal. She got on top of her sound, relaxing into lower tones.  We walked around for a while taking moments to rest in the sun and squat or half squat or lean on the benches.  After half an hour or so,  she was ready to go back in and rest.

      The doctor was to arrive soon, and I prepared them for the likelihood that she would want to rupture Allison's membranes. I was guessing she might not yet be past 7 cm, and it would be a common suggestion from this particular doctor to "get things moving" by breaking her water. We talked about the possible pros and cons of this. Breaking her water could help engage the baby's head in her cervix, which would make the contractions feel more intense.  It is a possibility that contractions would also be more effective, as the baby's head would engage with the cervix more directly. It is also a possibility that labor would not speed up, but just feel more intense.  She wasn't sure what she would decide to do.

      When the doctor checked her around 8am, she was already at 8cm, and she never mentioned breaking her water.  I was pleasantly suprised, and there was an air of celebration in the room.  Allison was happy to hear that she had made good progress,  and soon she decided to head back to the birthing tub. After a couple of hours, she was starting to feel pushy, and by 10am she was almost complete with just a small cervical lip. She changed positions and squatted, circled her hips a little, slept between contractions, and when the doctor returned around 11, she was ready to push.

    She stayed about an hour longer in the tub, working hard to push her baby out. Her energy was getting pretty low, and although she had eaten some jello and crackers and was staying fairly hydrated, being in the water was not helping her to stay energized.  She got onto the bed and the nurse and I helped lift her legs, so that she was lying down with her knees up in a deep sqautting position.  Joe said something to her that brought a huge smile to her face and gave the strength to keep at it.  She was pushing for another hour before we saw the baby's head beginning to appear.  It was a gradual crowning and her tissues stretched around baby's head.  She was incredibly patient and strong through it all.  She was rewarded with a sweet baby girl at 1:30 that afternoon. 

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        I was called at 3:30am, to come to the hospital and be a doula for Consuelo, a third time mama in early labor. She had been checked at 2cm, some time earlier, but her baby was suspected to be posterior,since she was having pretty bad back pain. Consuelo is from Mexico and speaks mainly Spanish, but understands English fairly well. I got over my shyness and got to practice my Spanish with her and her partner.

       Her husband slept for a few hours when I first arrived, so I helped by pressing on her hips and sacrum, and massaging her shoulders.  The nurse and I rocked the baby in the rebozo, and I attempted the baby churn with my hands to try and encourage the baby to turn.  Baby seemed to shift some, and Consuelo said it eased the back pain a bit, but that didn't seem to last.    She dilated at about 1cm every 2 hours, which was steady, but a bit discouraging, as her last labor, eight years ago, had been only 5 hours long.

        Around 7am, I suggested she get in the tub, since labor seemed active and strong by then, and she was getting pretty uncomfortable. I went down the hall to turn on the water, and when I returned, the nurse was there helping her to quickly get on hands and knees. There had been a drop in baby’s heart rate that lasted a couple of minutes and was quite alarming, but it soon returned to normal. We decided to wait on getting in the tub to see what the doctor thought, in light of this occurance. He soon arrived, and told her that if baby’s heart rate kept dropping like that, she would need a c-section. He showed her the monitor strip and said to be sure and call the nurse right away if it happened again, and no she could not get in the water. He thought it was just to risky. He said that later, when the next doctor's shift began, he might have another opinion and let her get in the water. I was suprised and disappointed to hear him talking in this way to her, as though she should keep her eye on the monitor just to be sure, as though a c-section was on the horizon.

       After he left, all was well, and there were no more heart problems. A couple of hours went by and the next doctor on call did indeed say that with contstant monitoring, she could get in the tub. Her friend arrived and stayed about half an hour. She was very comforting and assured Consuelo that the water would be very helpful, so she decided to get in after her exam. She was dilated to 5 cm.

        She stayed in the water for close to an hour, half the time with the jets on, and then got out and back into the rocking chair. She did try the birth ball and hands and knees briefly, but seemed most relaxed in the rocking chair with a hot pack behind her low back. Around 12:00, she seemed to reach transition. Contractions were coming on quickly and strong, and she was starting to have doubts about going on, asking for pain meds. Her husband was strong and so supportive, and together we held her and encouraged her and got her to move a little bit, getting back on the ball, on the bed, in the chair.  She had a little medicine to ease the pain, but was reaching the end of her hope.

        She soon was having a hard time not pushing, but was only 9 cm, so we kept asking her to relax, breath, and don't push, so her cervix wouldn't swell. It seemed really difficult in the bed, but as soon as she was back in the rocking chair, she relaxed some.   After another hour went by, she suddenly was pushing again, this time very seriously, and she told us she had to go to the bathroom.  I asked her to wait until she was checked, because I didn’t want the baby born in the toilet! Once she got to the bed and the doctor told her she was complete, she started pushing and her baby girl was out within 15 minutes!

 While Consuelo was in the bathroom and Rodrigo was calling the relatives, I got to hold the sweet little bundle…. Mmmmm…..

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     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!

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