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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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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    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!"

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