My first client as a labor doula (in training) was my cousin Ashley. She is 6 months younger than me and we have been close basically all our lives.
When she got pregnant she assumed she would (of course) have an epidural and a hospital birth and all that jazz. After doing a little research and learning that there are in fact risks to the multitude of interventions that take place during nearly every birth in the US, she knew she wanted her birth I be different. She invited me to be her labor doula and I tried to learn what type of birth she was envisioning and how I could help her to be successful in bringing that experience to fruition.
She never wrote a birth plan, but I asked a LOT of questions and she did some research into things that she wasn’t knowledgeable about before. Her “wish list” looked something like this:
No induction unless medically necessary
No pain medications (hopefully)
Labor at home, deliver at hospital
Delayed cord cutting
Skin to skin, rooming in
Laboring however it is comfortable
Delivering however it is comfortable
I asked her how long she wanted to labor at home and she said, “until they can’t give me an epidural.” I smiled and said realistically, you can always get an epidural, but it’s often not offered after a mom is in transition, or about 7 cm dilated. She said that she’d prefer to go to the hospital then.
At right before 40 weeks, she had her first contractions, which came and went irregularly, but caused her to lose part of her mucus plug. I drove to the other side of the state (long distance doula) and stayed with my parents to be close by. At 40w she had her first NST and ultrasound to measure AFI, which she passed with flying colors. I did have a hard time with “routine NSTs” and all those doctor visits (which I viewed as unnecessary and potential catalysts for an induction), but this was a great experience for me in terms of learning what the role of a doula is and isn’t. I can suggest different options, offer support and encouragement, share personal experiences and research, but I don’t make decisions. Just as a doctor doesn’t make the decision for his patient, I don’t make decisions for my clients. I advocate for them and respect their wishes and needs.
At 41 weeks, she woke up with “different” contractions. Stronger, more regular, more crampy, and complete with lower back pain. My dad and I took the twins to run errands and visit her at about noon. She wasn’t certain that this was real yet, so I left after instructing her to call me when they were closer, more regular, or she felt certain that she was in labor. As I drove away, she sent me a text message that she had some bloody show. She was officially in labor and she knew it. I left the kids at my parents’ house with my mom and dad and headed back to hang out with her.
Ashley made dinner (honey mustard chicken breasts with roasted potatoes and asparagus) and then we went for a drive to get some frozen custard. Her contractions were still 6-10 minutes apart (never really consistent) and she could chat through them. At 8:30 everyone went to bed, since we knew that this could get more intense any time.
She woke up a few times in the night with painful contractions. Then she would think, I can still sleep, and she’d get another 30 minutes of sleep before it would happen again. At 3:00 am I heard her in the kitchen and at 3:30 it was obvious that she was no longer sleeping, so I sat with her in her bedroom. I timed contractions for her and watched as they grew stronger (talking all through them to stopping for a minute while they peaked). She was handling the contractions fine and seemed to be in high spirits, so I assumed she was still in early labor and progressing at her own pace. At this point she had been in labor for almost a day, so I knew we still had a ways to go.
At 5:00 am we had breakfast. Boiled eggs, yogurt, and then her husband, Ford, went for a burrito run. She was feeling nauseous and ate a little toast while I wolfed down a chile relleno burrito. This labor was all about good food (one of the reasons we wanted to labor at home was so she could keep eating). Contractions got steadily more intense as the day went on and Ashley did get a little more nauseous with intense contractions. A big one led to her throwing up (in a trash can) while she labored in the whirlpool bathtub. I showed her how to make a deep noise during contractions (thank you Ina May) and she was vocal for hours.
At about 10:00 am her voice changed a little. She was getting louder. We hadn’t been timing contractions any more, but she was having them on top of one another. Active labor was certainly here and I was thinking that transition was around the corner. She was having contractions less than 2 minutes apart, more bloody show, needing A LOT of counter pressure, so I asked if she thought she was ready to go to the hospital yet. She said no, but during the next contraction, her husband asked the same question and she said yes. So we packed up, piled in the car, and drove the 10 minutes to the hospital.
In the ER waiting room, the receptionist was, like all ER receptionists, unimpressed with the laboring woman in the room. Ashley couldn’t sit during contractions. She had to stand up, lean against a wall or Ford, and have someone else push as hard as they could on her tailbone or lower back. I heard her mutter some foul words about the lady behind the glass, but up until then she had been very positive and nice.
She was wheeled up to L&D by a nurse that I didn’t like. First question: Will you be getting an epidural? Ashley said no and told her that she was planning on going all natural with this baby. In triage (she was obviously pretty far along in labor, they should have just given her a room) she asked the nurse for intermittent monitoring and a saline lock instead of an IV drip. I wasn’t in the bathroom when she was collecting her urine sample, but apparently that’s when she looked at her husband and told him she couldn’t do this. He was perfect and told her that only could she do this, she WAS doing this.
Pelvic exam by the on call doctor led to some frustration (5cm 100% effaced), but I tried to explain that being 100% effaced was a very big deal and that she was almost done. We finally got to her room, where she sat on the bed and was obviously in transition. I kept telling her, “This is the shortest, hardest part.” She never told me to shut up, which shocked me, and was such a pro at laboring. The nurse came back in to place the IV and immediately offered mama something to take the edge off. Of course, that sounded wonderful, but I was so proud of her when she declined IV drugs. I suggested that she make it through a few more contractions and then we could see if she still wanted something and she agreed.
Then I turned to the nurse and told her, “Ashley and Ford have planned on having a natural birth.” She got kind of huffy and said, “Through the vagina is a natural birth.” “Okay, then, a natural unmedicated birth.” She looked at Ashley and said, “I won’t offer you drugs again.” I told her thank you and she left the room.
Right after that, she had another pelvic exam and was at 8-9cm dilated. The nursing staff switched to high gear and brought in all the gear for delivery. The first nurse was gone, replaced by a fantastic nurse named Debbie who was truly stellar at getting Ashley to relax during contractions. Ashley was kind of stuck at the foot of the bed, with me rocking back and forth behind her, but Debbie suggested that she lay on her left side with her right leg in the air for a few contractions. She had a tiny lip of cervix left on one side and they wanted it to move before she gave in to the strong urge to push. After a few contractions, Ashley was given the go-ahead to try a few pushes and the cervix disappeared completely.
She rolled onto her back and grabbed behind her knees to push with each contraction. She was making a fair amount of progress, but her son was taking his time coming down. The doctor showed up right before he crowned (she had already squeaked out “Ring of Fire” between pushes) and sat at the edge of the bed. The doctor discovered that the baby was OP (sunny side up) and presenting with his hand next to his face. During a contraction, he turned the baby and then Ashley pushed him out with just a few pushes. Then, at 2:04 pm he was on her belly, breathing air and looking around while his cord pulsed. Everyone except the grouchy doctor was crying.
Sometime in the hustle right after his birth, Ashley says she consented to lidocaine (for stitching her 2nd degree tear) and she thinks the Pitocin drip in her IV as well (routine postpartum thing). She met her son Ranger and the doctor finished stitching her, clamped the cord, let Ashley’s sister cut it, then asked her to give a little push as she delivered a beautiful healthy placenta. The midwife asked if I was going to encapsulate it, which made me very happy, and I had to tell her that I was not, but I was glad she asked.
Within the hour, Ranger had his first successful latch and nursed for about 35 minutes. After he was finished, the nurse came over and weighed and measured him. Ranger was a whopping 9lbs 4oz and 21.25 inches long. Ashley had pushed for 34 minutes and the doctor believed that she would not have torn if he didn’t have his hand next to his face.
As for my part in this story, I feel so lucky and so blessed to have been there for such a beautiful experience. I was glad I could help Ashley reach her goals, and so proud of her for doing such a remarkable job. The nurse and the midwife who were there for the delivery told Ashley that they live for births like this one. They said that truly natural births are so rare in hospitals and that they were so lucky to be a part of hers. I thought that her resolve and her strength were so admirable and I honestly can’t wait for my next birth as a doula.
Happy birthday, Ranger, and happy birth day, Ashley.