Birth is All About the Support

I recently had the privilege of supporting another couple during their baby’s birth.  This was their first baby, it was my 20th birth as a Doula.  I am always amazed at how different every labor and birth is and even more amazed at what I learn with each one!

To start with, I met the couple in their home in the wee hours of the morning and we stayed there for a little while.  It was very quiet and calm.  Mom changed positions and walked around a bit.  She was managing very well using her breathing and inner peace.  Dad kept himself busy getting the last few items together for the hospital and giving physical support when it was necessary.  I was able to facilitate by offering suggestions and jumping in to provide physical support when warranted.

As labor progressed, it became apparent to both myself and mom that it was probably a good time to make the drive to the hospital.  The contractions were getting stronger and mom was beginning to have some shifts in how she was feeling.  I guessed that she was beginning to transition, but kept that to myself.  I’ve learned not to voice my guesses at how far along mom has progressed, although I do enjoy making a mental note and seeing if the first vaginal check at the birthing location verifies my guess!  Sure enough, the check done at admitting showed that she was in the middle of transition!

It had been a group decision, including her OB, for her to labor as long as possible at home.  This particular facility is a teaching hospital and is well known among birth advocates in the area as being one that has a high rate of interventions.  It was my client’s hope that her birth would involve as few interventions as possible.  Studies show that the earlier in labor a woman enters the hospital, the greater her chances of receiving “routine” interventions to “help move or speed up her labor”.  Taking all this into consideration, the decision was made for us to labor at home first.

Every hospital or birthing center is different and every nurse, midwife, and OB have their own philosophies.  As a Doula, I have worked with nurses who were extremely concerned with the technical aspects of managing a birth and I have worked with nurses who have advocated for my clients to have less obstetrical management during their labor and birth.  I have seen OBs who have “sneaked” an episiotomy in, and I’ve seen OBs who have surprised me by being more of a “baby-catcher” who just happens to have MD after their names!  I tell my clients that we never know what we may encounter byway of the medical staff, but that I will do the best I can to support their birth preferences and navigate the varying personalities and philosophies we may face.

I was pleasantly surprised with this one!  A previous birth that I was honored to be the Doula for at this hospital started with pitocin and ended with a c-section.  The staff had been kind and caring, but seemed very concerned with how they could manage the birth themselves.  My client was very happy with her birth and satisfied that she had done all she could to have a vaginal birth, but I was left wondering if there had been fewer students, residents, and other medical staff in the room suggesting options and sharing their opinions, if maybe she would have had a better chance at a vaginal birth.

I prepared myself and my client for birth in this facility.  I tried to reassure myself that maybe her birth would be less managed and helped her develop communication with her doctor so that she felt better supported in her decisions and hopes for her upcoming birth.  All along, though, I have to admit that I was a little scared that her birth would be filled with people coming and going and her ability to labor effectively decreased.  I did what I could to dispel her fears, while working to dispel my own.

What a wonderful surprise!  Because it was so very early (essentially still the middle of the night), the hospital was empty!  There were no nursing students and only one resident!  The nurse assigned to my client was so very supportive of the birth process and calmly went about her administrative responsibilities and care of my client.  Before long, it was apparent that birth was imminent.  The nurse had left momentarily, but I felt the need to take a quick look at what was going on.  My client was laying on her side and I gently lifted her top leg…What did I see?…A bit of the amniotic sac, about the size of a golf ball, full of fluid!  I quickly excused myself, leaving my client in the loving hands of her husband and found the nurse.  When I told her what I saw, she ran in, verified what I thought it was and called the OB on staff to let her know that birth was about to happen!  Since the OB was one not affiliated with my client’s practice, I quietly informed her that my client wished to tear rather than have an episiotomy and so she helped massage the tissue around the baby’s head as it emerged.  Everyone was verbally supportive, helping my client stay focused and calm as her baby was born.  Within minutes, a healthy, beautiful new life entered the world.

The OB was admittedly surprised with how quickly and successfully my client birthed her first baby.  She made the remark that most first-time moms come to the hospital and labor for hours and hours.  She also seemed surprised that my client did not suffer more than a minor tear during birth.

For the resident who was present, I hope that she remembers that unmedicated, minimally managed birth is possible and beautiful.

For the OB who attended this birth, I thank you for listening and supporting my client’s decision to not have an episiotomy and for speaking kindly and supportively to her.

For the nurse who was assigned to my client, I am impressed and appreciative to you for your calmness and all the emotional encouragement you gave my client so that she could be in her rhythm and work with her baby for an amazing birth.

What I will take away from this experience is this:  while I will continue to help my clients find a supportive caregiver and a facility that fits their hopes and preferences for birth, I will also remember that even if a client chooses to birth at a facility where interventions are truly the routine procedure, whatever happens, birth is really all about the support.