Me as a Doula, Part II

I’ll tell you what, I learned more from the first birth than any other experience I’ve gone through in a very long time. And not just about childbirth, but about patience, strength, the way people work, and hospitals; it was one of those rare experiences that teach you a little something on every level. I had no idea what I was in for as I was crossing one of the many bridges that separate the East Bay from San Francisco. I drove blasting my radio, my every sense felt heightened.

My thoughts were a whirl with nervous ramblings. I couldn’t get the fear out of my mind that my first client might need me during Rita’s labor. I was nervous about doing a good job as a doula, and I ran through possible scenarios and comfort measures in my mind. Plus, I was a little fearful of the hospital. To begin with I felt woefully unfamiliar with hospital policies and procedures in general; plus, I had never so much as laid eyes on the hospital where Rita was delivering. I felt like I was hurling towards the great unknown.

Blessedly, the hospital was calm that night. So there was no one to observe me lost and wandering through the halls lugging my birth ball and trailing a rolling suitcase filled with a hundred items I didn’t hardly need. It probably took me fifteen slightly panicked minuets to find my way to Labor and Delivery. Rita had phone me on my drive in and let me know the room number she had been admitted to. As I passed the nurses station a smiling nurse introduced herself. She had been assigned to provide Rita with one on one care because Rita was alone. She was simply grabbing a snack while another nurse stood in for her a minute. I was so nervous that I asked for her name twice!

If the first thing I learned about work as a doula is the need for a back up, the second thing I quickly learned was that the nurse can be your biggest ally or your biggest antagonist. This particular birth I worked with nurses who were of great support to both my client and me, as well as a couple of nurses who seemed to take delight in making the both of us feel small. There can be no doubt that when I first stepped into Rita’s labor suite I felt about as out of place as a vegan in a slaughterhouse. I wasn’t sure how to slip in and get started. Thank goodness for that very first nurse!

Rita was doing wonderfully with her labor. She had found a rhythm and was sticking to it. What I didn’t know when I first got there was that she had been having regular contractions starting two days before at last being admitted to the hospital. Things were just getting going, and Rita’s tank was already running on empty. This first nurse was completely in her corner though. All of her suggestions and every word she used was calculated to keeping Rita motivated and reassured that things were going as they should.

I learned so much by watching and listening to how this nurse skillfully urged Rita on. For example, at one point Rita begged for the nurse to do something to make the contractions slow down. She felt like she couldn’t handle the intensity. This nurse gently reminded Rita that she wanted the contractions to come close together because that was the only way to bring out he baby; and the fact that they were so intense was a good sign that she was progressing. It was simple common sense, but priceless to me to hear the response.

I don’t want to give the impression that I wasn’t working. I was very hands on offering suggestions for breathing, position change, and more. I kept in mind something my doula trainer had taught me: that a good doula spends each moment reevaluating how to make a client feel safer and more comfortable. At the same time the doula should be looking for ways to speed labor. But more than any of those things, the way I was best able to server this particular client was simply to be there for her throughout the entire process.

Eventually this first fantastic nurse came to the end of her shift and said her good-byes. Her replacement had none of her compassion, none of her bedside manner, and none of her respect for a woman’s ability to naturally birth her baby. It wasn’t even that my client was completely committed to an intervention-free childbirth. But, this particular nurse’s every comment and action loudly proclaimed, “You’re too weak to do this, you might as well just schedule your C-section now.” I was shocked that a nurse could be so compassionless. And it was a true test of my diplomacy. Especially when my client decided (without the slightest prompting from me, I’ll add!) that she wanted a new nurse!

Now that was an awkward situation. However, I was pretty proud of the way my client and I handled it. I paged the nurse’s station at Rita’s request and asked that they please have a doctor come see her. Of course at that point the not-so-nice nurse (I’ll call her Jane) came in and hovered, she would not leave! She told Rita that the doctor was busy and asked if there was anything she could do help or any questions she could answer. Rita just insisted on seeing the doctor.

The doctor finally cam in after what seemed like an eternity of breathing through contractions while Jane plopped herself in a char and sat staring at us. The doctor had been delivering a baby and yet she apologized for taking so long!

Jane kept hovering

For a minuet or two everyone just looked at each other. For someone who had been so insistent on seeing the doctor Rita was oddly quiet now.

The doctor and Jane busied themselves with small talk with Rita. They talked to her about where she was in her labor and conversed about pain relief options. The doctor was preparing to leave and Rita still had not talked to her about switching nurses. I caught her nervously looking at me. I asked Rita loudly in front of everyone if she wanted Jane and I to leave so that she could talk to the doctor alone. She replied yes. Jane pretended not to hear the exchange (maybe she didn’t?) So I did something I wouldn’t have done if I hadn’t been Rita’s only support. (I would have suggested the father do it otherwise.) I said:

“Jane, Rita wants to talk to the doctor alone. Could you please step out into the hall with me?”

Jane was surprised and the doctor looked at me quizzically. Oh yea. I said it.

But she left with me. As we were walking out she muttered something and walked back to the nurses’ station before I could say anything to her (which was probably for the best.). I wasn’t sure if I should explain to her that I knew what Rita was talking to the doctor about. If there was some way I should diplomatically say she was being replaced? I left it alone, not sure it was my place. For future births I wonder if it wouldn’t be appropriate for me to suggest to the father that he explain TO THE NURSE (politely) that due to a conflict of personalities that they would like a different nurse. That way, the nurse might not feel like someone had gone behind her back. Would any experienced doulas out there share their thoughts on this? Have you experienced this kind of situation? How did you handle it?

The bottom line is that this whole experience really underscored for me how vital a doula can be to a birth team because they are the only person who stays with the laboring mother start to finish. It should never be underestimated just how vital this continuity of care is. Who knows what nurse the next shift holds or which doctor will be on call. It is impossible to guess how long a labor will last, or how many hospital shift changes it will take to get that baby born. The one constant the client can count on is the doula. We are there to be the relentless guard of labor and delivery. From the beginning contractions to the final push and beyond we are the one face that doesn’t change, that doesn’t flag in our encouragement. We are the ones who ALWAYS believe in the mother and her decisions. Can you tell I’m pretty freaking proud to have been called this woman’s doula?

This isn’t the end of my story, but Normy is up from his nap. We are deep in the trenches of sleep training over here…that’s a whole other post. Pray for us. It’s not going well!