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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Lisa and Bill lived across the street from the hospital, and were hoping to labor at home as long as possible with me there as their doula. When she called me around 5pm on Friday her water had just broken, and she reported that her contractions had kept her up most of the night before. When I arrived at their home, she was up and about, and they were both excited about things moving along. I suggested that she might like to get some rest as it could be another long night. We put on some music and I helped her to relax and lie down, and her contractions sped up and intensified rather quickly. She got up to move around, and went to the bathroom, but didn’t seem to settle in. She was anxious to get to where she was planning to have her waterbirth, in the tub at the hospital. Contractions were 4 or 5 minutes apart when we decided to walk over. They monitored and checked her, which was a bit frustrating for her, but soon she was allowed to get in the tub In the water, she was immediately in her primal power, and not afraid to make noise. Bill got in with her after about an hour, when things were getting more intense. Very soon after that, she was bearing down and asking where her doctor was. She looked right into my eyes with a question. I can’t remember if she spoke. She wanted to make sure she could go ahead with what her body was asking her to do, even though her doctor hadn’t yet arrived. The nurse and I told her to listen to her body and not hold back, and she trusted. Baby crowned and his head came out, without anyone’s knowledge but Lisa's. She helped him as he turned, and then he shot out into the water. The nurse was there to help her bring him up to her chest, and her doctor arrived soon afterwards!

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     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.

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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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