intensely trivial



Another birth story

One of the things I do for my doula clients is to write up the notes I take at their births. During births, I write down the things the nurses also chart, such as the findings from internal exams, blood-pressure readings, and the time of various events. But unlike nurses, I am with my clients continuously from start to finish, taking breaks only to go to the bathroom. I know them personally, too, so I have a good idea of their dreams and fears related to the birth of their child and the growth of their family. Anyway, it all boils down to noticing a lot of details that round out the story and trying to keep my heart and eyes open to many things besides the numbers on the monitor.
After the birth, I write up these timelines, filling in details from my memory but trying to leave out my own interpretations of things as much as possible. I want the mother’s understanding of the birth to be validated, not corrected by how *I* felt about it. It’s her birth, not mine.
A client who recently gave birth gave me permission to share her story with you. I’m just basically pasting the timeline in here, with identifying information changed. I do have ulterior motives in sharing this particular story and, at the end, want to comment on some things.

Prenatal information

Lily and David were expecting their third child. Lily’s pregnancy had been a surprise. Early in the pregnancy, she lost the sight in one eye, presumably as a result of the pregnancy. She was also diagnosed with gestational diabetes. She controlled her blood-sugar levels through exercise and eating right, and she continued at her job until the day she gave birth. Before the weekend, she had seen her OB, who had stripped her membranes. She had called me Friday morning, excited and thinking she would go into labor over the weekend, but she didn’t. She had an appointment with the OB on Mon. evening, the night before the baby was born, but he had to postpone. Tuesday morning, she left instructions at work and went in to meet with her OB. Upon checking her cervix, he found she was 7 cm dilated, even though she had not felt intense contractions. Lily and David had planned to pick up snacks for the nurses on their way to the hospital, but her OB advised Lily to go straight to the hospital, fearing that if her water broke, she would have her baby immediately and be unable to get to the hospital in time. So they went to the hospital. Lily called me from there. The OB wanted to give Lily a small dose of pitocin to get labor going.

Birth

10:40 a.m. — I arrive at the hospital. Lily is on an IV with antibiotics for her Group B strep. She is laughing and chatting, sitting on the birth ball beside the bed. Piano and guitar music comes from a CD player in the hot-tub room. Lily’s nurse, Cami, is setting up a pitocin pump and explaining that the OB wants to get labor moving. Lily asks why he wants to use pitocin if she’s progressing, and Cami says the OB is just in a hurry.

10:56 — Lily has a contraction at least once every 3 minutes. She’s still happy, calm, and communicative. Her water hasn’t broken yet. She’s interested in using the hot tub during her labor, and the nurses start filling it.

11:04 — She’s still on the ball. The charge nurse is trying to get the baby on the monitor. The baby’s heart rate looks great. Lily says the contractions are all down low. During them, she just leans over onto David and breathes quietly. David massages her back vertically and some on her shoulders. Lily wants him to push down on her shoulders and then do small circles.
Contractions pick up quickly. Soon they are about 2 ½ min. apart. Lily is still on the monitor. Cami says the OB is insistent on using pitocin, and Lily refuses politely. No one mentions pitocin after that.
David and Lily talk about possible names for the baby. During contractions, Lily likes counterpressure on her lower back. She does a great job providing feedback for David and me about what works and what doesn’t. She is very controlled during contractions.

11:36 — I notice she’s working slightly harder. There is some shaking during contractions, and she moans quietly sometimes. David and I keep doing what we’re doing.

11:38 — After a strong contraction, Lily says, “I felt like I needed to push on that one.” By this time, Cami has the hot tub ready, but if Lily is going to be pushing soon, the hot tub will probably not be an option. Lily’s mom stops in for a little visit, and Lily tells her she thinks it’s going to be soon.

11:41 — Contractions are only about 1 ½ min. apart now. Lily is definitely working harder now but is still in control.

11:48 — During a contraction, Lily involuntarily bears down, and I can tell she’s about to all-out push. I hurry out to the nurses’ station between contractions and let Cami know; Cami calls the OB to be there to catch the baby. Cami says she wants to check Lily’s cervix to be sure she’s fully dilated, and Lily says, “No.” Cami doesn’t try to change Lily’s mind. By the time the next contraction comes, Lily is really pushing, even though she is still sitting on the ball. She roars with the intensity of the contraction. Her water breaks, and suddenly there’s a pool of clear amniotic fluid on the floor around her feet. Lily says, “There’s something down there,” meaning at her perineum.

11:53 — When the contraction is over, I help her get up on the bed in a position she likes. When she stands up from the ball, I can see the baby is crowning. Lily climbs up onto the bed, arms first, and then legs, so she can get into a hands-and-knees position, and by the time her knees are on the bed, the baby’s head is out. Pediatric nurse Carla hurries in to prepare for a newborn. David cups his hand over the baby’s mouth to protect her from inhaling fluids. Cami catches the baby as the rest of her body slips out.

11:55 — Official time of birth. Cami and Carla tag-team on taking care of routine newborn procedures, such as bulb suctioning. The baby looks great. Meanwhile, Lily is resting her head in a pillow while the two nurses and David handle the baby. The umbilical cord is slightly shorter than normal, so Cami just rests the baby on the bed instead of passing the baby up to Lily. Cami holds the umbilical cord, being sure it has stopped pulsating before she clamps it and has David cut it.

11:57 — The OB walks in, putting on his delivery outfit, and says, “I’m late!” With assistance, Lily turns over in bed so that she’s on her back in a more restful position now. She holds the baby briefly, and then Carla takes the baby to the warmer to do an initial exam. We take off Lily’s baby monitor and the contraction monitor – she sure didn’t need those for very long. Everything is very quiet; even though there was a lot going on in the last few minutes, everyone is staying calm. Even the baby isn’t crying much. The OB waits for the placenta.

12:10 — With a little push from Lily, the placenta slips out. The OB begins repairing a small second-degree tear. He puts pressure on her uterus to make sure it’s contracting well.

12:15 — The OB finishes repairing the tear in Lily’s perineum and congratulates her and David.

12:20 — Carla has finished her exam of the baby, wraps her in a blanket, and hands her to Lily. The baby weighs 6 lbs. 14 oz. and is 20 ¼” long.

12:30 — The baby is curious about Lily’s breast. She tastes and tests it about 10 minutes and then latches on well and breastfeeds continually for a good 20-25 minutes.

1:00 — Jamie, another baby nurse, comes in to check on the baby’s blood sugar. This is more of a concern because of Lily’s gestational diabetes. It’s 29, lower than it should be, so Jamie gives the baby some formula through a little tube (supplemental nursing system) while she’s latched on to Lily’s breast.

1:20 — Lily’s mom is back in the room, and Lily has a meal delivered from food services: pork roast, potatoes, and green beans. Lily calls their oldest child at her school to tell her the good news. Everything has settled down, and everyone seems to be doing well, so I go home.

A few comments, in no particular order

1. If you were following the times, you noticed this birth went really fast. The time I spent with this couple at their birth was quite a bit shorter than my average. This was Lily’s third birth, which makes a huge difference. The speed of her birth is not really that unusual for a multiparous mother.

2. The most astonishing and inspiring thing to me after this birth was over was the fact that Lily refused two different proposed interventions: A) pitocin augmentation and B) an internal exam. I’ll address each of those in a bit. First, let me say Lily is a very respectful, non-loud woman. But she demonstrated a core of steel, and she is both well informed about birth and in touch with what is happening in her body.
A) Regarding the proposed pitocin augmentation, Lily asked good questions, which is every patient’s right: “Why does he want to use pitocin?” The nurse’s answer (“He’s just in a hurry,” or something to that effect) was unusually honest. Some L&D nurses seem to invent reasons that don’t make sense in order to protect doctors who propose medically unnecessary interventions. Pitocin was not medically necessary in Lily’s birth: She was already contracting, and there was no medical reason for her baby to be born soon. All patients, pregnant or not, have “the right to exercise self-determination and autonomy in making all medical decisions, including the decision to refuse treatment” (Marsden Wagner in Born in the USA, p. 173)
B) Regarding the internal exam that Lily refused, I am sorry to say this is the first time I have witnessed a client of mine both refuse to be checked and have her refusal honored. I was so proud of Lily for saying no. She didn’t remember this after the birth; it happened when she was fully dilated and involuntarily pushing already, but nurses almost always insist on checking mothers’ cervixes to make sure they’re actually fully dilated instead of letting mothers follow their bodies’ natural urges to push. There are some good reasons for this, but I believe most unmedicated women really do know when they’re fully dilated — not rationally, but in the primal, animal part of their brain that is in charge of giving birth. Quoting again from Marsden Wagner’s excellent book Born in the USA: Every patient has “the right to bodily integrity. Any form of nonconsensual touching or treatment that occurs in a medical setting constitutes battery” (p. 173). That’s right. It was a relief that Lily didn’t have to deal with that. I am so thankful for Cami, who honored Lily’s words.

3. It is unusual to be 7 cm dilated and still going about life, not feeling like you are in labor. The really difficult part of Lily’s labor lasted less than an hour. Even if you’re getting ready to have a second or third baby, don’t plan on such an “easy” labor, but if you have one, then be thankful. 🙂

4. Even though Lily had to use a supplemental nursing system with formula to raise the baby’s blood sugar initially, that was the only time she had to. She was confident in her ability to breastfeed, having successfully breastfed two babies already, and her baby didn’t have any more blood-sugar issues.

5. A fear with gestationally diabetic mothers is that their babies will grow too big. This baby was simply average. Especially with the newest announcements about gestational diabetes, pregnant women absolutely must eat healthily and stay active! According to my doula trainer, Sally Riley of the Academy of Certified Birth Educators, the proper diet for a mother with gestational diabetes — basically a low-carb, high-protein diet — is actually the one every pregnant woman should follow. Lily faithfully followed dietary guidelines and made a point of exercising regularly. Good job!!

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Comments

  1. * Morgan says:

    I am so proud of you all. David’s intuition to help catch is brillant! Lily, well she’s one of my all-time favorites if doulas are allowed to have favorites. I am SO glad that you were there for them. And Lily raved about you and was so thankful for you when we talked. 🙂 You’re just awesome. 🙂

    Posted 7 years, 5 months ago
  2. * manhattandoula says:

    Morgan, thank you!! 🙂

    Posted 7 years, 5 months ago
  3. * Natalie says:

    As always, thanks for the story. I found the OB nurses respectful of my not wanting an internal exam, too. We had it in our birth plan and so they didn’t ask. I think I’ve read that stripping the membranes can lead you down a slippery slope, though. After reading that in your story, I was afraid it was heading toward a dire ending. Lovely birth!

    Posted 7 years, 5 months ago


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