I told her that I could be there in 40 minutes and to wait for me. I quickly changed into scrub bottoms, a t-shirt, and tennis shoes. I grabbed my packed bag and some snacks and made the 30 minute drive to post. My adrenaline was pumping. This was my first time as an official doula. I had witnessed birth numerous times and had worked in a clinic in Haiti. However, this was the first time I was more than an observer. I called my mom on the way, who is a doula, for some last minute advice and to get cool, calm, and collected for my friend. When I arrived to her house, the TV was blaring, everyone was standing up, and Caitlin was by the door with her backpack and shoes on. She had high energy, was being silly, and was talking through her contractions. I knew we had a long way to go before it was time to go to the hospital. The neighbor went home and I turned down the TV. I told her that I didn't think it was time to go yet and that we should wait it out. I charted her contractions for about an hour. They were about every four minutes apart, but only lasting 30-40 seconds. She had a consistent pattern, which was good, but they weren't quite long enough or strong enough to merit a hospital trip. After observing her for that hour, I suggested she take a warm bath or shower and to relax a little bit, maybe even try to get some sleep since we had a long night ahead of us. She was way too excited to rest so I got her to sit on a birthing ball and bounce for a little while. Then I suggested that she put her toddler to bed so that he was tucked in by his mommy before we left and that he didn't see her in pain once the contractions got more intense. She loved on her little man for a bit and then we decided to go for another walk.
Caitlin had decided to have an unmedicated childbirth because she was unhappy with her first birthing experience. She got an epidural with her first when she was seven centimeters dilated. Afterwards, she thought that she had made it that far (10 centimeters is considered fully dilated), so why didn't she just go the rest of the way? On top of that, the epidural gave her little relief, but had side affects that she didn't think were worth the possible benefits. Because the epidural didn't work, she was given narcotics through her IV. She reported that those drugs made her thinking incredibly hazy and that she doesn't remember a huge chunk of her birth experience, including the first few hours of her son's life. She vaguely remembers a nurse holding her son to her breast to eat because she couldn't hold him herself. I was there to support her, and to help see that her decisions were respected and her hopes for this birth realized.
Towards the end of our last walk, she started hyper-contracting. It took a long time to get back to the house even though we were only about 200 yards away because her contractions were right on top of one another and she wasn't able to walk through them. This honestly freaked me out and I no longer felt confident in my ability to help her through labor. I felt rushed and panicked and suggested that we think about going to the hospital. It was three hours passed the time I first arrived and I thought I had done a pretty good job of holding her off that long. We got back to the house and I suggested she eat a snack since the hospital doesn't let laboring women eat or drink anything. I put a towel on the front seat of the truck in case her water broke on the way and packed up our bags. Things had calmed down some once I came back inside from packing the truck and my intuition told me to wait and see if that intense episode was only because of the walk and that it would subside. I once again suggested she take a shower or bath to calm down and get back into a more manageable rhythm. From the look on her face I could tell that a shower was the last thing she wanted. I found myself saying we should go then, even though I had a nagging feeling we should wait. I relented because laboring at home isn't what most people are familiar with in the U.S. Even though I'd heard about home birth and known people to labor at home for many hours before going to the hospital, and even though I knew that was what was best for someone who didn't want all the normal practices of the hospital, my culture won. The images and experiences of a hospital birth were far more numerous than the alternative. I trusted my cultural viewpoint more than my own intuition. I trusted the doctors more than my friend's perfectly healthy body.
So we left. The car ride was uncomfortable for Caitlin. She did not want to be sitting whatsoever. She had been laboring for nine hours in whatever position felt comfortable to her, typically standing, and being confined to one position was aggravating. We were both happy that the military hospital was very close. She asked me to park far away because she wanted to walk more. We slowly approached the hospital and showed our military IDs to the front desk. Someone started to get a wheelchair for Caitlin, but she politely declined it. The woman working the front desk gave her a curious look and asked if we were aware that labor and delivery was on the second floor and that the elevator was far away. Caitlin told her yes, she knew where it was and would like to walk. Caitlin would lean against me or the wall or slightly squat down during a contraction. The lady shouted at us from down the hall and again asked if we wanted a wheelchair. Again, we told her no thank you. Caitlin was quietly handling each contraction beautifully and just the thought of sitting was uncomfortable. We made our way to the elevator and triage of the labor and delivery department. She was four centimeters dilated and admitted to the hospital. We informed the staff of her wishes to move around freely, which meant not being strapped to the electronic fetal monitor or IV. It was already in her file, but she told everyone that she did not want an epidural or any other pain medication and to please not ask her. She confidently informed them that if she decided to change her plan, that she would let them know. She gave details ahead of time about what she did and did not want done to her and the staff seemed to be on board with her wishes.
Her nurse put her on a telemetry (mobile) monitoring system and Caitlin moved freely about the room. She was peeing regularly, but because she was not allowed to eat or drink, the nurse put in an IV to keep her hydrated. She was still able to move because the IV pole was on wheels. She walked, swayed, bounced, squatted, did hip circles, and breathed deep through each contraction. I rolled a tennis ball up and down her back, put pressure on her sacrum, and squeezed a scarf around her hips. I encouraged her to relax her face, neck, and shoulders and to not tense up during a contraction. I reminded her that the contractions were helping to move her baby down and out and to not fight the sensation, but to work with her body. She responded well to each suggestion and seemed to flourish with the constant support. We did not have many interruptions and she got very focused. She looked beautiful. The nurse checked her before her shift ended and Caitlin's cervix was at six centimeters within a couple hours of being admitted.
At shift change, a new nurse and midwife came in and introduced themselves to us. They asked Caitlin if she wanted an epidural. She said no, and asked that they please not ask her again. She again went through her list of wishes with the new staff members. Instead of smiling and nodding with her in agreement like the last crew had, these two wrinkled their noses at her and didn't say much. The nurse also took Caitlin off the mobile unit. We asked why this was being done and reiterated her desire to be free to move in whatever way felt natural. The nurse said that the mobile unit was not as good as the other one. I asked if she could be on the monitor for 20 minutes and then be off for 40 minutes so that she could still move around. We were told, "No way. That's just not going to happen." I asked why and was not given a solid answer. I gently told the nurse that the mobile unit had been working very well for us for the last few hours. She finally said that she didn't know how to use that one, so Caitlin would have to be on the regular fetal monitor. We continued with what we had been doing, but this time Caitlin only had about three feet of space, the length of the wires. She bounced on the birthing ball, seated just in front of the monitor. She paced back in forth in the small area of space she had. She leaned over the bed while I rubbed her back. It wasn't ideal, but we made it work. When Caitlin needed to use the restroom, I unplugged her from the fetal monitor and wheeled the IV pole behind her. She took care of business and I plugged everything back in correctly. The nurse would come in and unplug everything I had just done, plug it back in exactly how I had it, and huff out of the room irritated. She made a few remarks about how "lucky" Caitlin was that she was allowing her to be out of bed. We tried to ignore her, but I could tell her attitude and lack of respect for Caitlin's wishes was affecting her focus.
After many hours, Caitlin's cervix was checked again. This time there was no progress. We were both feeling very exhausted as it was about 2 am. We decided to shut off the lights and try to get some sleep. We awoke around four a.m. She was checked again and was still only at six centimeters. The midwife told Caitlin that her labor had stalled and that she would need to be on Pitocin, a synthetic version of the hormone oxytocin, which is responsible for contractions. We were both leery of starting Pitocin, but agreed as long as she'd be given only very small doses and the amount was not to exceed a certain amount. Because she was on the Pitocin, she would have to be catheterized. I could see how exhausted Caitlin looked and started giving her juice and crackers when no one was looking. I knew she was going to need sustenance to be able to finish the last few stages of labor. Even though she was stuck in the bed, we found positions that were comfortable and still utilized gravity. She kneeled, squatted, and got on all fours. I sat behind her and continued to put pressure on her lower back as she straddled and hugged the birthing ball. We kept her hips open and her body upright as much as possible.
Her water broke naturally as she was in a kneeling position. Even though her water had broken (which usually starts to move things along quicker), the midwife kept "upping the Pit," giving her more Pitocin, until it reached an amount that Caitlin said she didn't want to reach. She started to develop a very sharp pain all down her left side and the contractions became unbearable. Over and over again, she was told she didn't need to do it naturally and that she should just give in and get the epidural. Exhausted and vulnerable, she relented. As we were waiting for the anesthesiologist, I asked the midwife and nurse if the constant sharp pain could be from the Pitocin. They said they had never heard of that and it probably wasn't likely. I thought that she might be in transition and maybe would be ready to push soon, but no one checked to see if that was the case. However, the charge nurse came in and turned off the Pitocin and suggested the same thing in a hushed voice. At this point, Caitlin was already being prepped for the epidural. Sitting still was very difficult for her, especially because she felt like getting up and bearing down. The doctor explained that first he'd do a spinal block, a single injection of a narcotic into her back and then the epidural, which is a continuous dose of analgesic. Caitlin spoke up and said, "I don't want the epidural! Just give me the spinal block and be done." The doctor explained that the spinal block would start to wear off in 30-45 minutes and she'd have to ask for more medicine. She told him that was fine and she would let a nurse know if she wanted to start the continuous drip, as everything would already be in place. The charge nurse came back in after everyone left and said that she wanted to check Caitlin because she thought she might be ready to push. Sure enough, Caitlin was fully dilated and ready to go. The spinal block had wore off already, which did not take away the sharp side pain. We helped her get into a comfortable kneeling position, and the nurse directed her to start pushing on her next contraction. An obstetrician came in and asked, "She's going to push like that?"
Pushing brought Caitlin great relief and she later told me that she wished she would have done it sooner because it took away the pain of the contractions. She said that she wishes she would have listened to her body instead of everyone who was pressuring her to get the drugs. In hindsight, I wish I would have done the same and would have been able to speak up more. I truly believe that she probably was ready to push before the spinal block was given and that a needle into her spine, something she did not want, could have been avoided. She pushed for less than 30 minutes. I was holding her hand and was telling her that she was doing amazing and that I could see Connor's head. She was her most radiant in this moment and I got teary-eyed. Not only was I a part of a new life coming into the world, but I was witnessing a woman in her full glory. She was determined and strong. Connor was born and quickly taken over to the incubator nearby. We assisted Caitlin in changing positions to get ready for the delivery of the placenta. A nurse began to press on her abdomen and the OB pulled on the cut umbilical cord. Caitlin let out a scream, the first I'd heard in the entire process of birth. She began to cry and ask them to stop. This was incredibly painful for her. It had only been about 5 minutes since Connor was born. Caitlin still hadn't seen her baby yet. Then she began to bleed a little more than usual. I went over to be with the baby and get out of the way. I wanted to bring him over so he could nurse. Nursing causes contractions, which help clamp off the blood vessels in the uterus and stop bleeding, as well as get the placenta out. Why was no one suggesting this?
Finally the bleeding was controlled and the OB began to clean up. However the ordeal wasn't over: the doctor was missing an instrument. Caitlin still hadn't even seen her baby, let alone hold him and now a doctor was concerned he had left something up inside of her. Everyone frantically began searching for the missing piece. The doctor put one hand inside of her very sore vagina and began pressing on her uterus from the outside with the other. He did so without acknowledging that it was painful or apologizing that he had to do it. He certainly did not ask permission. Caitlin told me later that she felt like she was being raped. He did not feel the missing instrument, but ordered an x-ray of her pelvis just to make sure. Thankfully, it was not inside of her. She finally got to hold and nurse her baby 45 minutes after he was born.
Reflecting back on this experience, I believe that Caitlin's labor may have stalled for many hours because of the change in attitude from the staff. She also told me that she hadn't heard from her husband yet and was worried that she wouldn't be able to get ahold of him. The mind-body connection is incredibly powerful, and unfortunately often overlooked. Caitlin's demeanor was calm, confident, and focused when she had a nurse who respected her wishes, allowed her to be on a mobile unit, and didn't pressure her to give into society's norms. She progressed well. That demeanor and progression changed drastically when we encountered providers who were demeaning, disrespectful, and did not help facilitate an environment conducive to the birth experience she wanted (and was capable of). Now, she's not sure if she wants any more kids. The reason: the way people made her feel while she was giving birth. The birth experience is powerful, yet that truth is such a whisper in our society. The shouts say as long as you have a healthy baby, nothing else matters. I want to bring voice to those who say that it does matter. What the doctor did that made her feel raped was medically sound and indicated for the situation. I don't believe it was what he was doing with his hands that made her feel violated, but the way he treated her. He did not talk to her about what needed to be done to her. Afterwards, he scolded the nurses in front of Caitlin, telling them to never again let his patients be in any position other than laying on their backs. Caitlin felt pressured, disrespected, and like an outcast for choosing to do what felt right for her and not what everyone else thought she should do. If you are in the health care field, please remember that while something may be routine to you, it is still a new experience for the patient. Please also learn to appreciate how strongly the mind and body are connected.
"If a woman doesn't look like a goddess in birth, then someone isn't treating her right."
Ina May Gaskin
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