Monday, 30 May 2011

A glorious weekend

Most people that I know look forward to the long, bank holiday weekends.  We dream of the lie ins, the friends and family we'll see, the dancing we'll do, possibly even a barbecue or two (weather permitting).

This weekend was a tale of two births.  Almost two weeks ago one of my twin ladies gave birth by caesarean section as the presenting twin was breech.  Breastfeeding was nicely established and, despite the fact that I am there for postnatal support as well, they said they didn't need me.  Perfect!  I love what I do and I love it when my ladies don't need me.  So I was gently easing my way towards this weekend knowing that I had two ladies yet to birth.

Birth 1:

My client had had a caesarean section for her first baby.  Her waters had gone early and he wasn't ready to be born.  Long long labour.  Syntocinon given to help things along.  4 days after the waters, 1 tired mum, I tired dad, 1 tired Doula later... section. Gorgeous boy!

S hates hospitals.  So when she found out that she was pregnant again she wanted a homebirth.  The hospital were not keen, so after fighting for a while she decided to hire Independent Midwives.  Everything was wonderful.  She went into spontaneous labour as her waters broke on her EDD.  I arrived at about 6pm last Thursday.

The IMs were gorgeous.  We had met before be make sure we were all on the same page. 

 S was labouring beautifully in the water.  The IMs were reasonably sure that she was fully dilated.  She had the lovely purple line up her bottom.  But things were stalling.  So rest was called for.  Got her out of the pool and into bed.  Throughout the night we all tag teamed to get some sleep.

In the morning nothing had changed.  S was getting tired.  Baby was happy throughout.  In the end the decision to transfer in was made.  S opted straight for section.  The lovely Consultant explained that the baby's positioning meant he wasn't going to come out without help.  Her gorgeous son was born at 9.40am on Friday.

It wasn't an easy thing for S to have a caesarean once again, but I'm so proud of her.  She was so glorious in labour and though she wept at the thought of the section, she was strong and accepting.

I texted my next lady (who I had kept in the loop) to say that the baby was born and she should go for it.  She replied that she would give me a couple of days to recover from the first birth.

Birth 2:

On Saturday J called to tell me that she had woken with some twinges and some cramping but that all had gone quiet and she was going to get on with her day.  That evening she called to say that she was getting irregular contractions but that they were every half hour.  I sent her to bed.  I got a call at 10.30 on Sunday morning to tell me that she slept a bit but that she was still getting irregular contractions and could she do anything to hurry it up.  I told her to enjoy her Sunday and to wait because the baby would come when it was ready. 

Sunday evening I got a call around 6pm telling me that the contractions were every 5 mins thereabouts and that they were increasing in intensity and would I mind going over.  After I arrived, J relaxed considerably and things seemed to slow again.  I made sure that they had eaten and then told them to go to bed because it might be a long night and they needed their rest.  J went to bed around 10pm and P (her partner) faffed about for another hour and a half before eventually going to bed himself.  I pulled out the sofa bed and let myself drift off.

6.45am this morning P woke me.  I asked how the night went (I had woken periodically and not heard anything).  He said fine and that J was getting into the bath.  I went to see how she was doing.  She was rocking beside the bath and said "I need to get in now".  She got into the bath and her breathing changed.  J was a very vocal labourer/birther.  I reminded her that she could go to the hospital when she was ready and felt she needed to be in her birthplace.  She looked at me and said, "I don't think I can get out", then she closed her eyes and roared!  I asked P to call the Birthing Centre.

I spoke, evenutally, to the wonderful Belinda Green (Supervisor of Midwives) who asked me what I thought was happening.  (I have been at a birth with Belinda before).  I told her that I thought she was getting ready to push as she had strong poo-ing urges.  Belinda asked if she had poo-ed.  I said no, looking into the bath and said yes.  J roared again.  Belinda said it didn't sound like pushing noises but that if I thought she was close, we should go straight in.  Dad picked up the phone to call a cab.  J roared.  I looked between her legs.  Her labia was fully extended and I could see the tiniest bit of the baby's head.

 I called to dad "Hang up and call 999 NOW please" which he did and then he babbled to the controller.  I asked (rather firmly) for the phone and spoke to the controller who told me I had to drain the bath and then I had to put my hand at J's vagina and my other hand to support the head.  Meanwhile J was roaring and I told her to breathe.  The controller shouted to me "Are you listening to me? Don't listen to her, listen to me".  Then she told me to tell J to push as hard as she could.  Whilst all of this was going on, I was talking myself through birth in my head.

One half of me was calm.  'Remember, mums bodies are made to birth.  Just let it be.  If there's a cord, use your thumb.  Relax and be sure to take the baby head and face first out of the water (esp as it's draining away).  The other half of my head was screaming [add many many expletives].  My out loud voice said, "Relax J.  Good girl.  Fantastic.  Your baby is coming.".  I dropped the phone because, in fairness, the controller was doing my head in with her purple pushing directives.  J roared again and her baby slipped gently into my hands.  I turned her (yes Reader, it was a girl) and lifted her to her mother's abdomen.  The cord was short so she didn't go up very high.  A minute later a beautifully handsome paramedic arrived.  She was born a 7.19am.  J was glorious.

He was wonderful (not cos of his looks) and gentle.  He invited dad to cut the cord after it had stopped pulsating.  He was happy to do a physiological third stage.  All was calm.  The three other paramedics waited outside.  There was a shift change at the hospital but Mr Gorgeous went off to collect the Midwife.  She had not had her tea at home that morning because (as she told me) her boyfriend and flat mate had not replaced it.  She's gone into Sainsburys and as she came out she got a call to get to work quickly.  Mr Gorgeous met her at the door and brought her straight round.  She was gentle, kind and so so loving.  She was disappointed that J had to be transferred in for a retained placenta, but she gave it everything to see if they could stay home.  

As I said to my friend this morning, this job that I do makes me blessed amongst women.

Tuesday, 24 May 2011

When breastfeeding goes well but all goes wrong.

Today I spent time with a distraught mother.  She was distraught because two days ago she gave up breastfeeding.  It turns out that the baby had a posterior tongue tie and some cranial issues (tension in the neck and he's been a little compacted since birth).  She breastfed happily and well for six weeks.  Then she was told that his weight had plateaued and that she needed to feed him more because he wasn't growing as he should.  And so she began to worry.  She internalised her worry and as the stresses of life closed in (by which I mean the normal everyday stresses that have nothing to do with babies) she was told to ignore them and concentrate on feeding her baby.

She closed out the world and concentrated.  She saw Midwives, Lactation Consultants, Night Nurses, Doctors.  Eventually she went to see a Cranial Osteopath and he said "You've been at this long enough.  It's stressing you out.  You've done your best".  She accepts this as true.  She had stopped enjoying her baby and instead obsessed about feeding him.  In her words "breastfeeding [was] destroying [her]".  She cried as she told me that much as she had loved breastfeeding and how wonderful it was when it was good, she needed to be a normal person again.  She needed to go outside again and not worry that her son was being underfed.  And the whole time, her breasts poured milk.  

So much information, so much help.  How do we filter what is good from what is bad?  How do we help rather than hinder the Mums and Dads that come to us seeking advice?  Do we know when to hold back and simply hold them whilst they cry?  

I asked her how she felt about giving up breastfeeding, because I wanted to see if it was something that she had thought through.  She clearly thought I was about to persuade her back to breastfeeding.  She mounted her defence.  I wanted to be SuperDoula and help her find her way back, but I stopped asking questions and simply said "It's okay."

Inwardly, my heart broke.  The first time that I met her she was keen to breastfeed and she did so well.  When I left all was well.  Going back six weeks later the coin had flipped.  I don't know what happened to make it so.  I taught her how to hand express herself so that she could rid her engorged breasts of their milk and disperse the hard lumps that were forming in her breasts.  

I'm sure that there are those who will say that I should have pressed her harder to remain breastfeeding, but I am also sure that there are some who know when to stay silent and let things be.  It doesn't mean I'm not sad about it.  

Saturday, 14 May 2011

Hold on... I'm coming!

Why are we all in such a rush for everything?  We run for buses, trains, to catch the phone, the shops, the bank, the Post Office.

I think that we are really rather spoilt.  We live in I Want It Now street, Instantville.  Instant coffee, ready meals, packets of pre-grated cheese.  Emails, texts, BBMs, IMs, Facebook messages... oh you get the point and you want me move quickly along?  Right ho!

I talk about birth a lot.  I mean a lot.  Once people find out what I do for my "job" they all have stories to tell.  I'll listen all day to "good" birth stories, "bad" birth stories and the indifferent ones too.  I'll listen to tales of breastfeeding, why it did or didn't happen.  Advice given, sought, ignored, rejected.  I'm there.  I was having lunch with a friend recently and a young pregnant woman, on hearing what I did, came back and asked me for my three top birthing tips.  Lunch paused, cue my long-winded version of three quick tips (namely 1. Trust your body 2. Eat/drink/pee/rest and 3. Be mobile.  Gravity is your friend).

I spent the evening with a young couple and their 2 day old baby.  She was "helped" in an over busy postnatal ward after a caesarean.  Baby and breast were grasped and pushed together.  The result, painful breasts, poor latch, tearful mum, frustrated baby.  No time for sitting, waiting, watching.  And we talked. I told her that breastfeeding was like pregnancy.  Something that happened over time.  Look at the time it takes this newborn to crawl to its mother's breast.  No grabbing, no grasping, no shoving together.  Just patience and waiting.

Labour is another thing that requires patience and waiting.  Labour begins.  There may be a long latent labour phase.  There is a temptation to 'speed things along'.  Mum will have had weeks of calls and comments "hasn't that baby come yet?", "that baby really needs to hurry up and come now", "are we still waiting on that baby?", "aren't you fed up of not having that baby yet?" ad nauseum.  The baby moves slowly.  Taking time to find the right position, to turn and manoeuvre.  To slip into the birthing canal and do the dance around the pelvic bone, ready to exit and be born.  But the clock has started.  The countdown begun.  Texts and phone calls "We haven't heard anything from you for a while.  Is all okay?", the pacing in the homes of grandparents and friends.  The notes on the midwife's board.  Shifts starting and ending.

The second stage where Mum is now pushing.  "Hold your breath and push", "C'mon PUSH!!!!!!!!!" "Come on baby, stop keeping us waiting", "Get angry with your baby. PUSH that baby out!", "If that baby's not out in the next couple of pushes, we'll have to do something".

Remember, medical reasons are medical reasons and if that baby needs to be out quickly, then that baby needs to be out quickly.  If the baby needs to move with speed to suit timetables and clocks... well wait!  Let the baby come.

What about sleep?  What about having the baby at home?  Patience.  Wait.  Sleep when the baby sleeps. The house will wait.  Baby yoga, baby German, baby origami will all wait.  Allow your body to recover from the birth.  Take time to look and wonder at your baby.  Count those fingers and toes.  Watch those gradual changes.  Watch as your baby learns to sleep alone and to smile and to laugh.  Watch as your baby becomes a toddler, a child, a pre teen, a teen, a man, a woman, a father, a mother.  Time won't wait for you to slow down.  Time will march on.  But you can wait.  You can watch.  You can wonder.

I have planted some pots outside my front door.  The Wee Weapons want to know when the flowers will be big.  They want to see the results now, today, this moment.  I tell them to wait.

I have a favourite TV commercial.  A man is covered in bandages, his foot is broken.  The telephone rings.  The song plays as he hobbles across the floor to a phone that stops as he reaches it.  Hold On I'm Coming!


Saturday, 7 May 2011

Is ignorance bliss?

I got a call the other day.  It was an enquiry about my antenatal sessions.  It's always exciting when someone tells me that they are pregnant and that they want some information about the journey ahead.

We talked about the practical stuff, where we would meet, what I would cover and then WHAM! Out of nowhere she told me "I don't need to know about the birth bit.  I'm having an epidural".

And like that I was speechless.  Doesn't happen often I can tell you.  But I confess to feeling confused.  Why would the fact that a woman would want an epidural mean that she wouldn't need to know about birth?  I mean am I missing something here?  Does having an epidural mean that you hand your body over and "you gets what you gets"?  

I didn't try to persuade her of anything, I simply asked her to email me her details and requirements and that we would speak again if she wanted to go ahead.  Forgive the natural instinct in me to plan a hundred different ways to explain to her why she might need to know about giving birth and why an epidural shouldn't be her default setting.  My tongue was firmly bitten and I knew I would give her the information that she asked for and be prepared to talk about birth in her entirety.  Sadly, to date, she has not emailed or called again.  I'm reasonably sure that my palpable shock hadn't reached through the phone wires.

What have we done that women are so afraid of birth that they don't want to talk about it?  Is the prospect of a drug free birth that terrible?  

I was talking to one of the mums at school.  She has two children and is thinking of having her third next year (or at least trying for the third for next year).  Naturally (well you birth junkies will know what I mean) I asked her how her first two births were.  The first was a twelve hour labour that seemed to stall in the middle.  She arrived at hospital and was 5cm dilated.  She was still at 5cm several hours later.  She was exhausted and had an epidural.  She relaxed, her body opened up fast.  They told her to push but she couldn't feel her body and didn't know what to do or how to do it.  When she was told by the doctor (after fifty mins of pushing) that she had ten minutes to get the baby out or she was having a caesarean, she pushed and her daughter flew out.  For her second birth she stayed home longer but when she got to hospital and they told her it would be hours, she opted for an epidural again.  The baby's heart rate plummeted and he went into distress.  Again she pushed her baby out.  This labour had also lasted twelve hours.  Another of the school mums was walking with us and said, "I hope you got all the drugs!"  

There are a fair few default settings that puzzle me.  To give birth you need an epidural.  To birth twins you will not go to term and you will need a caesarean and NICU.  To birth a breech baby you will need a caesarean.  You cannot have a home birth after a caesarean.  I do not say that having these things are wrong.  I am just puzzled that they are the default setting.

The information is out there.  There are antenatal classes, blogs, facebook pages.  I tell my ladies not to google.  I think that too much information is a bad thing, but is ignorance bliss? 

Thursday, 5 May 2011

Reverting to the age of three

Today I realised that I spend an awful lot of time asking one question.  WHY?
When I meet my potential clients I ask them WHY? they want a Doula.  It's not because I don't want to be their Doula, but I want to be sure that we are on the same page.  Some, but not many, are looking for someone to "fight" their hospital battles for them.  As a Doula I am there to help my clients make informed choices.  I point them in the direction of research based evidence and encourage them to ask the WHY? question.
Then I ask them WHY? they have chosen their place of birth.  This way I begin to understand how they think and feel about birth.  Sometimes fear informs their choices and hides other options from them. They may have heard and/or absorbed all the scare stories about birth. They may feel that with all the horrors of birth they want to be as close as possible to doctors.  Research based evidence gives them the opportunity to rethink their place of birth.
Today I was talking to a couple and Dad told me that he just wanted the safest option for his wife and unborn twins.  For him the thought of a caesarean didn't scare him as much as the vaginal birth of twins. I asked him WHY? he thought abdominal surgery was the safest option.  This gave him pause for thought and he's now looking at research based evidence.
My clients often show me their list of "things to buy for the baby(ies).  They ask my advice as to what are the best things to buy.  Again I ask them WHY?  Why do you need that?  Why do you want that? Why is it an essential?  This allows them to step back and think about their lifestyle and the ways in which they want to bring up their children. 
When we talk about how birth works and what happens when they are in hospital or at home with their midwives, I tell Dad that something to keep in mind is the question WHY?  Why this procedure for my partner at this time, in her condition?  Why is this good for our baby(ies)?  Why are there, seemingly, no other options? 
We talk about the postnatal period.  My ladies often say that they are going to try to breastfeed and see how it goes.  I ask WHY? are they going to try?  This allows them to explore their relationship with breastfeeding.  Are they coming from a culture of expected failure?  How have their family and friends dealt with breastfeeding?  Are there medical reasons why they may not be able to breastfeed?  This encourages them to know where to go for support should things get tricky.
They ask me whether or not they should follow the different schools of parenting thought.  I ask them WHY? do you need to follow any/all/some of these "experts"?  This is to encourage them to remember that THEY want the best for their baby(ies) and that parental instinct is not to be sniffed at.
Remember, my job as a Doula is not to make decisions for my clients, but sometimes that is exactly what they want me to do.  So when I ask WHY? what I'm doing is asking them to think about their choices.
My youngest, now 7, still asking WHY?