My cell phone rings at exactly 3:26 AM. I reach for my phone on my bed stand – the same way you wave your hand back and forth trying to pull the string attached to the light bulb in a dark closet – hit or miss. Finally, I find the phone. X is calling. She needs my assistance. In an instant I am wide awake – adrenaline pumping. I dress and brush my teeth, pull my hair back in a low pony tail, and put on my favorite earrings – a pair of sterling silver wings that inspire me. I decide to put my game face on, which means some good lipstick and mascara. I pack a lunch, look over my doula bag, and grab my camera. I make sure I have X’s files and my doula handbook. I kiss Peter and quietly shut the front door.
I park in the women’s center parking lot and walk through the doors of the hospital. I walk down the hall pulling my small suitcase and carrying my labor ball under my arm. L&D room 7. That’s a good number, I think. It’s 4:25 AM when I knock on the door and come inside. X is laboring on the bed, she nods to say hello, she’s in a contraction, pacing her breathing and shutting her eyes, she is incredibly still. I sit down and begin to assess the situation. At the end of her contraction, she takes a deep breath and looks at me and gives me a weak smile. We go over the basics, how quickly the contractions are coming, what is her dilation, effacement, etc, etc. Before she can finish, another contraction rushes over her. I realize that between the last one and this one, less than two minutes had passed. I know that the last time the nurse checked her, which was about an hour ago, she was between one and two centimeters dilated, so I think it’s odd that she’s having back to back contractions so early in labor. Her contraction lasts 1 minute and 15 seconds. X breathes out a sigh of relief and no sooner than 30 seconds pass when another one arrives. I stand behind X and massage her shoulders, while she labors on the birth ball. It’s now 5 Am.
After some discussion with X about where her pain is during her contractions, I suggest a a rice pack for her back and she agrees. I head out the room to heat up the rice pack, as I walk out the door I see X’s L&D nurse. I ask her if back to back contractions in early labor can be a result of Cytotec use and she tells me that yes, it’s common to see this type of labor with Cytotec*. I make note of this and hope that X can endure what’s in front of her, I know, from experience, just how difficult back to back contractions can be.
Nurse L comes in at 6 AM explaining that she’s the new nurse, since the other nurse had to leave for a C-section. The nurse then has X get back in bed while she puts her on the monitors to run a strip of baby’s heart rate and check X’s progression. The nurse lets us know that X is 3cm dilated. The nurse stays in the room, she is chatting loudly and laughing with X’s husband about how their OB reminds her of Bill Cosby. X opens her eyes during her contraction and looks at me with look that says, please shut her up! I don’t think the nurse realized that her conversation was irritating to X who at this point was just beginning to have very intense contractions. I gently remind the nurse that X preferred it quiet in the room while she was laboring.
At 7 AM while X is using the restroom (an empty bladder lessons the pain of contractions), she tells me she feels the urge to push. I suggest that she move off the toilet into a different position to see if the urge push is still present in a new position. I remind X that as the baby moves down there are moments when it can stimulate those muscles. I guess, to be honest, I had a hard time thinking that in just one hour that X could have progressed from 3cm – to 10cm. Sure enough when X sits on the bed, leaning on me while her husband applies pressure to her ankle (an acupressure point that relieves the pain of contractions), her urge to push lessons. Very soon after that, though, X tells me she’s hot. I pull out a hand-held fan and hold it near her face. I instinctively know X has hit transition since face sweats are often a sign of transition.
The nurse comes in and checks X at 7:30 AM. She’s 8 cm! I gently remind the nurse that X wants to labor and birth in the tub and if they could please get that ready for her. This particular hospital has a birth tub down the hall for the rare mother that chooses to use it for either pain relief during labor (the tub is often referred to a midwife’s epidural) and or for birth. The nurse leaves to prepare the room (which was being used as a storage room). Meanwhile, X has finally started to show signs that the contractions are difficult and starts to get just a touch panicky. She also begins to grunt at the peak of her contractions, which means she feels the urge to push. I begin to realize just how very fast X is progressing and I wonder if we’ll have time to even get her in the tub. X looks at me with wide eyes darting back and forth and says, “I need to push! What can I do?” So, I suggest horse lips. It’s a breathing technique that helps a woman stay loose and not push. She says no. I then suggest that she breathe out while saying, “puuuuuuuuuuh, puuuuuh, puuuuuuh.” She’s comfortable with that and for the first time in her labor, vocalizes through her contractions.
I am now sitting at the foot of the hospital bed directly facing X. I am holding her hand while she has her eyes locked into mine. I am vocalizing with her through her contractions. You see, sometimes, by vocalizing with the laboring woman it gives her permission to feel comfortable with the low loose moans that labor brings – these noises are sounds that you usually won’t make unless well, you’re having sex, and so it can be a little unnerving to have these type of moans coming out of you while laboring in front of other people. However, every birth advocate worth their weight in gold, knows that it is exactly these types of vocalizings that help a woman’s body stay loose and open – which is necessary for the cervix to open and the baby to drop down. There is a phrase for the place that women go to while they’re laboring called, “labor land.” X was there, without a doubt. This is a time when a woman can feel most out of it and especially vulnerable, but also very high with endorphins. Eye contact and touch helps the laboring mother feel connected and protected. I will never forget this moment during X’s labor. I felt that I was carrying her, emotionally speaking, through transition.
At 8 AM, the tub is finally ready. We walk X down the hall to the room with the birth tub. I see the tub and immediately tell the nurse it will require more water, the water needs to be deep enough to cover the laboring woman’s belly. It dawns on me that the nurse might not be familiar with water births. We fill the tub more and X gets in. You can tell that she’s so glad to finally be in the tub. I encourage her to lay back and float through her contractions and remind her to keep her body loose through the rushes of contractions. She complains that she’s hot, so I grab a cold wet wash cloth and lay it over her forehead and run some cool water in the tub. The nurse leaves. Mom labors this way for about ten minutes when the she starts to uncontrollably bear down through her contractions. You better believe me, I was nervous at the point. The nurse hadn’t even called in the OB yet.
A few seconds later the nurse returns to check X’s cervix. X is 10 centimeters. The nurse says that X can go ahead and try pushing. X pushes in the tub. The nurse announces that she is going to call the OB. I am filled with relief, but then she leaves the room and tells X to keep pushing. I couldn’t believe that the nurse left the room with the mother pushing with only me and X’s husband there. I was really praying that I wouldn’t have to catch a baby at my first birth. I sit across from X holding her hand through her pushing and keeping my face near hers, and my eye contact strong. Inside my head I am praying to Jesus that the OB would arrive soon.
Finally, around 8:15, the OB shows up, along with about five nurses. No joke. I got the feeling that some of them were there simply to observe a water birth. The room was already small, but now with everyone in the room, it felt like a circus. Birth is intimate and having people in the room just to watch can at times make you feel like a science project. (We did later learn that two nurses were present simply to watch an unmedicated water birth).
The OB begins to coach X through her pushes. One of my hands is holding X’s leg back and the other hand is holding up her head. I literally cannot control my body from pushing with her while she labors. I have a front row seat and now I can see her baby’s head as it crowns – a tuft of dark hair emerges, then its whole head. The OB, in one quick move, unwraps the cord around baby’s head. With just another push, the baby’s whole body emerges. The baby is lifted out of the water and placed on the mother’s chest. I feel a wave a relief rush over me. The mother, who fought so hard to have her water birth, despite the risk of losing it all with an induction, got her wishes. I am grateful to God for being able to have such a strong mother as my first client. I feel honored and awakened inside, I have truly stumbled upon my life profession. I will always remember May 27, 2010 as the day that I was born as a birth doula.
The OB asks for the time of birth. The clock in the room is broken, none of the nurses have a watch. So I loudly announce, with tears on my face, “8:42 AM.”
*Cytotec is used as a prostaglandin, however, it is actually made and sold for the treatment of stomach ulcers . Despite that, this drug been found very useful to soften the cervix and for many women Cytotec alone can induce labor without the need for Pitocen. For a majority of women, Cytotec can have favorable results in medically inducing labor – sometimes making it feel as close to natural labor as possible. However, Cytotec has also been known for strong adverse reactions in a small percentage of women, even death. In fact, the company that makes Cytotec has recommended that it not be used to induce labor – they’ve even gone so far as to put an image of a pregnant woman on the box with an “X” through it. However, many OBs continue to use it for its cheap price and (usually) favorable results. The drug is either taken orally or inserted vaginally. If it is taken orally and a woman has an adverse reaction to it, other medication is required to reverse its effects. For this reason, placing Cytotec on the cervix itself is a better option, as it can always be removed if negative side do effects occur. Be aware however, that that reactions to the drug include uterine rupture in pregnant women which may result in severe bleeding, surgery, infertility or death. Cytotec is also used medically to induce a desired miscarriage after the first trimester of pregnancy (abortion).