Thursday, January 21, 2010

Katie's birth

Posted with her permission, here are my memories of Katie's labor and birth. Please note: these are the thoughts of a doula-in-training, so if you're male, or just uninterested in birth details, feel free to skip this one. :)

Katie called me on Friday evening (around 6pm) to let me know that labor had started. It sounded like it was very early in the process, but since she lives just down the street from me, I went over to say hi and see how she was doing. It was very early labor…her contractions almost stopped just because I showed up. :) I hung around long enough to watch her breathe through one, then headed off to Artists’ Night with some admonitions to “do something fun and then go to bed early. And call me when things change and you want me.”

It was fun to go to Artists’ Night from there because I was late and everyone had been speculating on the reason that neither Katie, Daniel, or I was there! I didn’t stay too long because I wanted to take my own advice and head for bed. I was expecting a call sometime in the wee hours of the morning.

Sure enough, Daniel called around 4:30am. He thought that Katie’s water might have broken, but wasn’t sure because there wasn’t much liquid. I asked some questions and then said I’d be right over. I was so excited! One of the things that can be tricky for me, as I head to a birth, is figuring out how to channel all that excited adrenaline so that I am only projecting calm and happiness when I get there.

There was no question that Katie’s water had broken, and her labor had definitely changed. No longer “early labor”, she was active, and in pain. My primary concern for Katie, before labor, had been her childbirth class. It was a Lamaze style class taught by the hospital, and I was worried that it was entirely inadequate to address and prepare for the reality of labor. I hadn’t wanted to sound negative during our meetings, especially since Lamaze just isn’t my field of expertise, but I did suggest that having some Bradley tricks up our sleeves might be a good idea, too. Unfortunately, my worries were not unfounded. Maybe an hour after I arrived, Katie worked her way through a contraction and then ground out “I am so angry about that class! Holding ice cubes in your hands does not compare!” No. No, it doesn’t.

So I tried to help Katie find something that would work for her. She labored leaning on two different birth balls, walking, standing and swaying, circling her hips, sitting on the toilet, and standing in the shower. She tried some different breathing techniques – sort of a combination of Bradley deep breathing and Lamaze patterns – and while that was hard for her to do, it did seem to help her get on top of the pain.

I think the most amazing part of Katie’s labor was this time, as I watched her grapple with anger and a sense of betrayal, and then emerge on the other side with focus and intensity. Instead of letting poor preparation get in her way, she chose to find her own path through her labor, and it was a beautiful thing to see.

The toilet and the shower were the hardest places for Katie to labor, because both ramped up the intensity of her labor. Initially as she realized this, she wanted to try other things, running away from the intensified pain, but she responded really well to my reminder that, in this case, pain was a good and productive thing. Accepting pain is so hard to do, yet Katie did this with grace.

Around 8:30 or 9am, Katie started to lose some of her poise. She was shaking and saying that she couldn’t manage the pain. I didn’t think she was really in transition yet, but I was starting to wonder if it might be time to head for the hospital. Right then I wanted so badly to have more training, even to be a midwife, so that I could check her and know where we were. She’d been in labor for 17 hours and active for 5, and I really wanted an idea of how much further she had to go. Since checking her myself wasn’t an option, I suggested that perhaps she could check herself. “Just reach up inside, and tell me if you feel your cervix or if you feel your baby’s head.”

I think I shocked her a bit, but she did agree to try, and the result told me everything I needed to know. “Oh, its a head, its a baby’s head…” and she dissolved into tears. The ease with which she determined that convinced me that she had to be past five centimeters, and based on everything else I was guessing more like seven. So I suggested that we get ready to head to the hospital.

Heading for the hospital is a little bitter for me, because I wish that we didn’t need to go. In this case, Katie was coping so well at home, comfortable in her own dim surroundings, and I hated to take her away from this into the bright lights and brisk nurses and electronics of Kaiser triage. And yet the hospital was Katie’s choice and Katie’s desire, and it was my job to support her in that choice. So we went. In the worst rainstorm we’ve had in years! (Edited to add: said rainstorm has now been trumped by the current one!)

Thankfully, triage wasn’t too bad for Katie. One of the nurses there, Deborah, was a nurse I’d met during Ingrid’s labor, and she was quite good. Brisk and no nonsense, but also kind. Katie was measuring at 6-7 cm (I could have jumped up and down, I was so pleased at being correct!) and she was transferred into the labor room pretty quickly.

And then she labored, and labored, and labored some more. Around 2pm they checked her again: 7cm. Poor Katie was so discouraged. I think she thought that she’d be about done by then, and it is so easy to think “all that work was for nothing”. Of course it isn’t for nothing, but it feels that way. At that point she asked her midwife, Hilary, if having narcotics would help her relax and finish dilating. I was so impressed with Hilary’s response. She stood by Katie’s bed, looked her in the eye, and gently said “Well, it might, but I think that you’ve been doing a pretty amazing job relaxing all by yourself.” And then she moved away, and then out the door. I felt like she was gently trying to help Katie stick with what she really wanted, by proving emotional support and then making herself slightly unavailable for giving narcotics. Katie didn’t ask again.

Those last few centimeters are the hardest – for the woman in labor, and also for me. There comes a point, around 8 or 9 cm I think, where there just isn’t much that I can do to help. And I remember what it is like, and how much it hurts, and all I want to do is fix it. And I can’t. And so I practice sitting still, just being present, offering the occasional encouraging comment, and carefully locking all my own emotions away so that nothing spills out to make it harder for Katie.

Another (granted, minor) difficulty for me was all the people in the hospital waiting room. By this time Katie was so far into labor land that I’m not even sure she was aware of it, but there were about twelve people sitting in the waiting room, waiting for the baby to be born. And wanting to know what was going on. I felt some unreasonable pressure to keep them informed, even as there just wasn’t much to inform them of! It wasn’t how I would have chosen to labor, and I found myself feeling angry for Katie (even though I know she wasn’t angry herself!) wishing that they’d all go home and leave us alone to finish this hard work!

Compounding everything was the fact that Naomi’s heart rate started showing some decels around 2pm, and these got worse as the hours progressed.

Around 4pm Katie started feeling the urge to push. I had thought/hoped that pushing would be somewhat simple for her, because she was in such good physical shape. But it wasn’t. Katie had a hard time connecting with the pushing urge and figuring out how to push effectively. Fatigue may have played a role, and also fear of pain. Whatever it was, pushing just didn’t click. Ideally, we would have tried a bunch of different positions until we found one that worked for her. But Katie started pushing right at a shift change. A new nurse came in and took over. She was nice enough, but she had her ways of doing things and she just wasn’t interested in trying anything different. She got Katie on her back, legs up (Daniel and I on either side, holding her legs), and instructed purple pushing. By which I mean that she stood there and shouted “pushpushpushpushpush! Ok breathe! Now pushpushpushpushpush!” Ugh.

Hindsight is 20/20, but how I wish that I’d chosen that point to stand up and get pushy myself! I knew that pushing like that wasn’t going to really help Katie, but I also didn’t want to cause a problem. Fights in the delivery room help no one. And so I was silent, and Daniel was silent, and Katie was silent, and it was only after it was all over that we talked and discovered that we had ALL HATED THE NURSE. Next time, I’ll discuss that kind of situation in advance, and I’ll be ready to stand up for my client, even if it means requesting a different nurse.

Pushing was awful for Katie, and it was a tense time for all of us because of Naomi’s heart rate. The decels were bad enough to warrant an internal monitor, but because of technical problems they had to insert FOUR different monitors. By the time they got to the fourth one, I was so angry I actually had to go take a walk to cool off. I knew that it was important to know what was happening with Naomi, but I also knew that the technology was causing more problems than it was fixing. The need for utter and complete control over myself and my emotions is, I think, the most difficult part of assisting at births.

The actual delivery was both fascinating and frightening. Naomi’s heart rate was dipping into the 40s, and it was abundantly clear that she needed to come out right away. But she just wasn’t coming. Usually, the baby’s head bulges against the perineum as it gets ready to come out. The perineum stretches (and sometimes tears) under that pressure. But this time it looked different. The perineum didn’t seem to be under that much pressure. Naomi’s head was right there – she just wasn’t pushing against it very hard. It was like she was stuck, somehow, further up. I think Hilary must have thought that, too, because her supervising doctor tried to hand her the episiotomy scissors and Hilary said “Actually, I don’t think that’s going to help right now.” She was incredibly cool under pressure, even from her supervising doctor! Hilary’s choice, instead, was to use the vacuum. Which is much less awful than I had thought – it is actually just a soft donut shaped cap that suctions onto the crown of the head, and adds just a little extra assistance to the mother’s pushing. (In fact, if they pull on it too hard, the suction releases and it simply comes off.)

And then it was over, and Naomi’s body slid out, and in that split second before they passed her up to show to Katie, I thought “no wonder she was so stuck – her arms are wrapped around her chest!”

Because of the heart decels, the cord was cut immediately and Naomi was passed off to the pediatricians to be checked over – but after that first eternal moment of silence, Naomi cried loudly and it seemed clear that she was just fine. The pediatrician gave her back to Katie almost immediately.

I stayed just until Katie was stitched up and cleaned up (there was some tearing, probably due to the need for a quick delivery and that massive girth of arms and chest!), took a few pictures with the new family, and then left. Which is also hard to do, because I’ve invested so much into the labor and delivery, and it feels strange to just walk away after all that.

It was pouring as I ran out to the car, and once I got in I just sat there, listening to the rain, and then crying really hard for a few minutes as I came down from the adrenaline peak that I’d been living on. I think that for future births, I need to keep this adrenaline issue in mind…I wasn’t safe to drive for a good fifteen minutes or so. Another thing to consider for future births is the difficulty with “re-entry” into normal life. Labor is surreal, and you can’t just pop out of it and be fine and normal and ready to go back to regular life. For both Ingrid and Katie’s births I needed the next day to ease back into reality before being ready to be 100% Mom again. After Ingrid’s birth I thought it might just be because it was so incredibly long, but Katie’s was 25 hours start to finish (and I was only there for 15 of those hours) so now I think that it has more to do with the fact of labor than the length.

Right after a birth I have so many conflicting and overpowering emotions: primary among them being “that was amazing!” and “why do I do this?” But after a day or two “why do I do this” becomes “when can I do it again?”

Katie, thanks for asking me to be there with you. It was a wonderful day.

One final note: I have started a doula training course through Childbirth International. While I’m in training, my fee will only be $250 (mostly to cover the costs of childcare for my kids). If you, or someone you know, would like my assistance during labor (and before – I think relationship and education are really important), please let me know!


Elena said...

"There comes a point, around 8 or 9 cm I think, where there just isn’t much that I can do to help."

I suspect that that's probably the place where you helped the most.

For me, just having somebody there, and knowing that she knew what the pain was like, and knowing that she had survived it... that made all the difference in the world.

I think it's a wonderful thing you're doing, Emily.

And many, many congratulations to the Peckhams!

Amber said...

Wow, that was fascinating to read, I'm so glad you wrote it. I'm not sure I could handle the transfer to the hospital part of being a doula. And yes, the hospital prep classes are worse than worthless. All they do is prep you for your epidural at the door, and good luck if you want to do anything differently.

I'm also struck by how completely different my labors are - well, at least the last two. I just don't experience pain like that... do I have some sort of bizarre pain tolerance or is there just something about me that makes it so much easier? I wonder how odd I am in this. It seems like I'm quite out of the norm though. I kind of wish you could be there for one just to see how different it is! Of course, past performance is no guarantee of future success! *grin*

Thanks again for writing this - I'm so fascinated by what you're doing!

Emily (Laundry and Lullabies) said...

Well, Amber, if Emma gets her wish and you do have another one...I'd love to be there. :) I wonder if there would ever be a way to actually make that happen...?

Jessica said...

I love reading your reflections on your job. They're always so thoughtful.

And I agree with Elena: those are the times you just want someone there, being calm, and allowing you to draw on her peace.

Sarah said...

I'm so excited for you that you've officially started your training. That's awesome!

Dave ended up being the only one with me at Mirren's birth, though that wasn't how we had it planned (she came so fast that no one else had the chance to get there!) and I know that just having him there and steady and present helped more than anything else.

Blessings to you as you pursue this--I think you'll be great at it.

Amber said...

Well, I imagine it is a matter of when rather than if we have another one... and this time I am somewhat hoping for is a girl, if only for Emma's sake. Although I am finding my boys to be easier than my girl, but who knows how much of that is just personality.

It would be hard for you to get up here, especially with how late I've been the last two pregnancies, but who knows!

Myrnie said...

I'm glad you could be there for her- it's so important to have an advocate there during the birth. During my two deliveries, I was almost useless- I was sure the nurses thought I was stupid, since they were all telling me what to do. I was in pain, and my husband was upset I wouldn't talk to him, he thought I was mad at him! :) (the second was a natural childbirth that lasted 3 hours TOTAL.) It would have been wonderful to have someone knowledgeable there to talk to the nurses. This was a beautiful birth story, thank you for sharing! Good luck in your training.

Anonymous said...

What a great story - I read it from top to bottom twice! I especially liked your thoughts on handling the adrenaline from experiences like this, and about the difficulty of re-entry into normal life afterwards. Thanks for sharing this. Aunt Sharan

Katie said...

Well, they're all right: just your presence helped me more than anything else could have Emily! (Well, I think an epidural probably would have helped the pain even more, but it would have also done some other things I wasn't interested in, so...). Your presence didn't fix the pain, or take it away, but nothing really could have done that. And so just having someone there who understands and can be stable for me, like you were, is the best thing in the world. Honestly.