I Massage Uteruses For a Living

Pictured from the birth of my daughter, the CNM does a newborn exam on Zoe, while the Birth Assistant stands by and charts.

I’m a doula, I assist with childbirth education classes and I’m also a birth assistant (BA).  I’ve gotten a lot of questions about what the difference is between a doula and a birth assistant.  So here’s an explanation of what I do as a BA, next time I’ll tell you what I do as a doula.

As a Birth Assistant, I work for a privately owned birth center assisting the nurse midwives with the births at the center.  I’m on call most nights of the week from 7 pm to 9 am. I also take 24 hour shifts during the weekend.  Does this mean I work a birth every night? No, except we won’t talk about this past weekend where I worked  four births in 48 hours.   When a mother is near complete and or ready to push, the midwife calls me and tells me it’s show time.  Usually, I’ll get a call in the middle of night.  (Thanks to oxytocin levels being higher at night – this explains why most women labor at night).  I’ll quickly throw on clothes, brush my teeth, put on my watch, put my phone in my back pocket, grab something to eat (I’m pregnant and hungry all the time) and drive away, as fast as I can, to the birth center.  From the time of the call, till I arrive at the birth center, it usually takes me twenty minutes.

When I arrive at the birth center, I walk into the birth room, I evaluate how much time I have before the baby is born. I’ll look over the mother’s chart and read just a touch about her (if I do not know her already from the birthing classes I assist with).  From there, I’ll prepare the room for the birth.  This means double checking certain important (in case of emergency) equipment, the oxygen tank and mask, endotracheal tubing, opening up the emergency kit and having it available for easy access. (Part of my training for this job included Neonatal Resuscitation Training and certification as well as training and certification in adult and infant CPR.)  I also make sure the washing machine is full of soapy water with plenty of bleach, that towels are warmed and ready and that the delivery instruments are in place near the midwife.

After reviewing and signing off on our birth checklist, I pull out further charts that we will need after the birth and begin to fill in the necessary information (if there is time).  If not, I stand close to the midwife and see how I can best assist her.  I know that fetal monitoring needs to occur every five to fifteen minutes depending on ROM (rupture of membranes).  I will use the Doppler and check the baby’s heart tones and chart that information.  I will also make note of the last time the mom had her complete vitals taken.  If it’s time for that to be done, I’ll take blood pressure, check pulse, temperature and respirations of the laboring mothering, which is easier said than done when a woman is laboring naturally, in transition and or in the tub.  My responsibilities also including  pouring olive oil on the perineal area as the baby’s head crowns or helping the mother move into a better position for pushing. (This is where my doula training and experience is really helpful.)  For instance, when mom is pushing I help her target her pushing so that it’s more effective. I remind others that are with her how to best serve her when she’s pushing.  There are also times when it’s my job to remove poo, clean vomit (if we don’t catch it in time) or quickly clean up an area if we have SROM (spontaneous rupture of membranes), replacing dirty chux pads with clean ones. Yes, I’m wearing gloves and an apron.

Once the baby is born, I make note of the time, announce it and chart it – writing “SVD” on the chart (spontaneous vaginal delivery).  The baby is placed directly in its mothers arms. Either I or the midwife will wrap a warmed towel on the newborn and assist with stimulating the baby to breathe, which includes vigorously rubbing the baby’s back till we get a nice lusty cry, making sure the baby turns pink and looks well flexed. From there I put a fresh, dry, warm towel on the baby (removing the wet one) and a warm hat on its head. I’ll also check its temperature, listen to its heart tones and respirations – all while the baby is still in its mothers arms (the midwife will soon do a newborn exam).   I bring the mom juice to drink immediately after the birth of her baby, as well.

After that, it’s usually time for the birth of the placenta.  At the birth center we practice delayed cord clamping.  Once the cord has stopped pulsing (around five to ten minutes, usually) we clamp the cord and ask dad or another family member to cut the cord.  We then have the mother push out her placenta.  I chart the time the placenta is birthed and then I assist the midwife with taking cord blood for lab work. After that is finished, I will bring the mother more juice,  check her temperature, pulse, respirations, blood pressure all while the midwife massages the mother’s belly to evaluate her bleeding and determine how well her uterus is clamping down. If required, we will provide measures to stop and or prevent excessive bleeding (most of the time this is not necessary).

The next step is for the midwife to assess the mom’s perineal area.  I will turn on the overhead light, hold a flash light for the midwife  (most births at the center happen in a dimly lit, candle lit room) and give her gauze, gloves, change the chux pads. If stitching/repair work is necessary, I will draw up lidocaine, bring sterile gloves, and instruments for the repair.   I will remain with the mom while she is getting her repair work done helping her stay comfortable and in a peaceful place.  Once the repair work is complete, mom is stable and her uterus is firm and contracted and her bleeding is determined to be normal, it’s time for the midwife to give the newborn exam.

The newborn is examined right on the bed next to mom.  As the nurse midwife exams the newborn, I’ll stand near her and chart the details she gives me.  If parents are planning on using vitamin K and or erythromycin eye ointment, I will draw up the shot for vitamin K and the dosage for the eye ointment and bring that to the midwife.

From there once mom and baby are both stable, the nurse midwife begins charting the birth. I will stay in the room with the family and every 15 minutes check the mother’s bleeding, massage her uterus, take her blood pressure, pulse and respirations.  Also, every 30 minutes I’ll check the newborn’s temperature, pulse, and respirations.  If anything seems out of normal, I’ll have the midwife come in and double-check.   Once mom is settled and comfortable and the baby show signs of hunger, I assist the new mother with breastfeeding and latch instructions.  After baby has fed really well, I’ll help new parents dress their newborn, and show them how to properly swaddle their sweet, tiny cherub.

For the next two hours, the evaluation and charting continues.  In order for the mother to be released from the birth center she must stay at least two hours from the time of birth, stand and walk easily, use the bathroom without difficulty, eat a meal, and remain in a stable condition, the baby must have nursed well and have strong, stable vitals.  Before the family leaves, I sit down with them and go over detailed postpartum recovery instructions, answering any questions they have, I also have them confirm that the information on their birth certificate form is correct and sign any remaining forms.  After that, parents bring in the car seat.  I show them how to place their newborn in the seat, and give tips on making sure the baby is secure.  I remind parents, before they leave to call the next day to schedule their three-day postpartum visit.

Once the family has left, I clean up the room, tub (if used) and bathroom(s). I restock supplies, clean instruments, change sheets, do the laundry and complete all the charting, lab work and birth certificate forms.  On average, I’m there for about 6 hours, though I am getting faster, with practice. It really depends on how long the family desires to stay.  Sometimes, the longest part is waiting for the load of sheets and towels to dry.

That’s in a nutshell what I do as a Birth Assistant.  In another post I’ll explain what I do as a doula.  Thanks for reading, and happy birthing.

Tags: birth assistant, birth center, Doula & LCCE, Midwife, Natural Childbirth, newborn procedures, pushing