Saturday, January 6, 2018

My Journey On Becoming a Doula: Part 1

Birth wasn't something that I was really exposed to growing up.  Almost every birth story I had heard was unpleasant, starting with the story of my own birth.  My mother labored with me in a hospital in South America where she was not only manually dilated by the nurse but was also given an episiotomy that cut deep into the muscles and tissues of her thigh.  When I was a few days shy of turning four and living in the United States, my mother delivered my sister.  I have no memories of the birth, most likely because my mother had an elective induction so she did not labor at home at all.  What I remember vividly is that she had to be rushed back to the hospital shortly after returning home due to postpartum hemorrhaging.  From my perspective as a child, birth was scary and life-threatening.    

I didn't have any more experience with birth or babies until High School, where I had a friend who became pregnant.  I remember her telling a group of us what a miserable experience her delivery was and how the doctor had to suck her baby out with a vacuum.  At the time, I had no idea what that meant and envisioned a suctioning device that tore the baby out of her.  That mental image stuck with me.  I began to think that babies were simply not meant to fit through a woman's pelvis. 

As an adult, I began making friends with women who had already started their families. Not one of those mothers had a positive birth experience.  I listened to stories filled with pain and emergencies; and they horrified me.  I wondered why people even bothered having more than one child after all of these terrible births.  

A smiling pregnant woman, roughly half-way through her pregnancy, taking a selfie and proudly holding her bump.  When I was pregnant with my first child I did what most first-time expecting mothers do and began reading everything I could get my hands on about what was happening inside my body.  The excitement I felt as I read about all the stages that little speck of life-dust burrowing into my uterine wall would go through was indescribable.  Armed with my trusty copy of What To Expect When You're Expecting, I fancied myself an expert on all things baby and pregnancy related.  Each month brought a new chapter to read, new developmental milestones reached, and new fruit to compare my baby's size to!  

The farther along I got in my pregnancy, the more felt I needed to become more familiar with the  delivery process so that I could start to have a more positive mindset about it.  I started watching, and became addicted, to the TLC show "A Baby Story".  Here were women with (mostly) positive and normal birth experiences.  Women like me.  I began to see and learn about things I didn't even knew happened during labor, which was a complete shock to me because I figured there couldn't be much more to it than what they taught you in Health Class.  

The more episodes I watched, the more strange new thoughts and ideas started entering my mind.  Maybe birth was not a traumatic thing that we women must accept and endure as something necessary to have a family.  Maybe birth could be a positive, empowering experience instead.  One episode even featured a mother who wanted to decline an epidural.  Now this was truly something new for me - here was a woman who was willing to embrace the well-documented pain of labor.  In fact, she was excited about and devoted to having an unmedicated labor and delivery.   To help her achieve this, she had hired a doula to attend her birth.  

Doula.  Now that really was a strange and new word for me, as I think it is for most people who have not had a great deal of exposure to birth.  As I watched the episode, I tried to puzzle out what exactly this doula was.  

She offered support, encouragement and love to the mother as her labor progressed from manageable, to a struggle, to what appeared to be unbearable.  She suggested the mom try different positions during contractions, encouraged her to walk around when things where getting started, and gently reminded her that she wanted to avoid the epidural when her resolve began to break.  Ultimately, the mother on this episode did get the epidural (and the relief on her face further cemented my own feelings about getting my own as soon as possible during labor) but the doula was not disappointed or discouraging of this.  She told the mother how well she had done and how well she was still doing and I thought, "Wow.  That's amazing."

I watched many, many more episodes of "A Baby Story" and noticed that the majority of women on the show who hired doulas were also having home births.  The women with these births seemed more comfortable and better able to manage their labors without drugs or complications than the women who were delivering in the hospitals, so I began researching natural birth.  I ditched What To Expect and picked up Ina May's Guide To Childbirth.  I learned about midwives and home birth and informed consent.  I kept seeing the word "doula" flash up here and there.  I did a Google search and ended up at the DONA International website:


a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.
I was still shaky on what exactly a doula did during childbirth, though.   Isn't your partner there for your emotional and physical support?  Does a doula take over their role?  Do they speak on your behalf to the doctor if you're in a hospital setting?  Are they like apprentice midwives?

A very happy pregnant woman wearing a black dress and standing in front of a pond, smiling and holding her pregnant belly
As I neared the final weeks of pregnancy, I started feeling very uneasy about my planned hospital birth.  I had moved on from Ina May and spent hours pouring over research articles and studies online about cesarean section rates, routine interventions, and the dreaded "cascade of interventions".  I no longer wanted the epidural that I had fantasied about, I did not want an induction or a c-section.  I had watched the documentary "The Business of Being Born" and I was no longer scared of the pain of delivery; I was scared of my consent being violated in the delivery room.  I thought back on all of the horror stories and found that the common theme WAS NOT that delivery was a miserable experience, but that women routinely have things done to them that they did not want or did not think they could refuse.

That wasn't going to happen to me.  I knew what I wanted and what I didn't.  I did my research - I was going to be able to make informed decisions about my care and my labor.  I would be in charge.  I knew my wishes would be respected because I had a good midwife and she was receptive to everything I talked about.  I was ready to have a baby. 

At my 37 week appointment, my blood pressure was slightly elevated.  This was not a big surprise to me as I was diagnosed with hypertension several years before getting pregnant.  I was very overweight and in poor health at the time of this diagnosis.  Immediately prior to getting pregnant, I changed my eating habits, quit smoking and started exercising.  I dropped almost 100lbs and, surprise, my hypertension went away.  During my pregnancy I had gained almost 70lbs back so I had been expecting a return of the hypertension.  The midwife, however, did not like that explanation.  I was sent to Labor and Delivery to have labs drawn to make sure I did not have pre-eclampsia.  When the labs came back all clear, including a 24 hour urine catch, the midwife was still uneasy.  She stated firmly that she would not allow the pregnancy to progress beyond 39 weeks.  We scheduled an induction.

In the delivery room, my world spun out of control.  All of my plans went out the window.  Intervention after intervention was done.  My husband, who was extremely supportive of my wish to have as natural a birth as possible, firmly (albeit gently) told me that I had to let all of my angst about that go - as well as let go of my intuition - and put our trust in the medical staff.  The ones with the degrees. 

I found myself agreeing to things softly as I inwardly cringed.  I felt like I couldn't decline things.  There were things that felt so wrong, that I did not want (or did want) to do but all of my concerns and wishes were overridden by protocol.  I felt defeated.  The pain after they broke my water was worse than I imagined and I held on as long as I could but ended up begging for an epidural. 

About 11 hours after the induction was started with Pitocin, my daughter's head delivered but the rest of her did not follow with the next push.  Her shoulders had firmly wedged against my pubic bone. 

A new mother sits in a rocking chair in a hospital, cradling her newborn and smiling at the camera.  Sixteen months later, I was still having flashbacks to when her head was out but the rest was not.  I would hold my daughter close and breathe in her scent while we read a book or played and I'd be thinking how everyone panicked at that moment.  I had anxiety attacks.  Nightmares.  After the rest of her finally delivered, she had to be rushed to the nursery and then was transferred to another hospital.  One with a NICU.  She was three weeks old before I was allowed to hold her.  Everything I had read about, everything I had feared had come to life.  It was like some awful, dark comedic parody of how my labor should have gone.  None of my wishes had been honored. 

I found I was pregnant again shortly after my daughter turned seventeen months old.  I was thrilled.  I was petrified.  After discussing all of my concerns with a close friend who had recently had a successful VBAC delivery at home she recommended I contact her doula. 

There was that word again.  "Doula". 

My husband was firmly opposed to the idea but saw how hard I was struggling emotionally with the thought of laboring again so consented, grudgingly, to interviewing her.  We met.  She was a quiet, calm soul who listened as I dumped a year and a half worth of pent up, unresolved fear and anger and hurt on her lap.  She accepted and validated my concerns and the guilt that I carried over for not speaking up for myself, as well as the anxiety I had to face it all over again.  I finally began to feel better about delivering a second time. 

I started reaching out to my doula when I was having anxiety attacks.  At first, I was hesitant to do so.  I was still very unclear about her role in my pregnancy.  Was she there to advise me?  Was I bothering her?  What were her expectations of me in the delivery room?  I agonized over these questions every time I reached out to her.  She was always reassuring, always asked me what I wanted and how she could best support that, always supported me and my choices even when I wasn't confident about them.  Fear and doubt still crept into my heart a lot. 

I was diagnosed with gestational diabetes and told that, even though they were fully aware of my anxieties related to another induction and my continued adamance against consenting to a cesarean section, I would need to agree to an induction no later than 39 weeks. 

My doula told me to listed to my gut.  And I did.  As much as I feared a repeat of my first labor, I knew I couldn't take the risk of losing my baby due to complications from my diagnosis.  So I signed on for another induction. 

Because I was so anxious about the induction process, my doula showed up at the hospital well before active labor had started.  The three of us, myself, my husband and my doula, all chatted and shared stories and life experiences with one another while my body started responding to the Pitocin drip.  Every time doubt crept in to my mind, I remembered that my doula was there supporting me and that she trusted me to make the right decisions for myself.  This was different than the support I was getting from my husband; while he supported and loved me unconditionally throughout my labor, I knew he was also acutely aware of how close he came to losing both me and our daughter during my last labor and, in my mind, that meant if it came between my choice or a doctor's recommendation he would probably (though not maliciously or wrongly) err on the side of caution and push for whatever the doctor wanted.  

A husband stands behind his wife, who is leaning over a hospital bed in obvious labor, and is applying counter-pressure to her hips during a contraction.I labored for several hours while she gently suggested positions to try to ease the intensity of the contractions and to help move the baby down.  I could hear her murmuring to my husband to touch me or press on my hips or snuggle in next to me, her offering to get my ice chips or a cool washcloth for my forehead.  Her presence was soothing and reassuring. 

When transition hit I lost my footing, lost control of my reserve and was unable to get back to a place where I could manage the pain.  My fear and anxiety crept in again and I broke and begged for the epidural. 

After it was placed I felt ashamed, like I had let my doula down.  Here she had worked so hard with me so I could have a baby without drugs and I caved!  I started apologizing to her and she was shocked.  Why would I apologize?  She was there to support me no matter what I needed or wanted. 

She told me how well I had done, how well I was still doing. 

A new mother (author Meagan Flaherty) cradles her newborn skin-to-skin soon after delivering poses fpr a picture with Leslie Cuffee (doula)
My doula, Leslie Cuffee*, and me after
delivering my second daughter.
Three hours later, I was holding my daughter.  I had delivered her on my side after laboring on all fours - something I had been told during my first labor impossible with an epidural.  My doula calmly told me that of course I could get on all fours if I wanted and that if I could not hold myself up then she and my husband would support me.  Just knowing that I could made me able to do it. 

I had never held a brand new baby before even though this was my second child!  I didn't know how to initiate breastfeeding or how to hold her.  My doula stayed while we settled.  She took joy in sharing all of those new experiences with us and helped me figure it all out without being intrusive. 

Once she insured we were all happy and ready to begin bonding alone as a family, she quietly packed up and left.  As I nursed my new baby, I thought about how amazing my experience had been delivering her; how healing, and empowering.  How incredibly special.  And how having a doula present changed my experience so much.  

Over the first few weeks postpartum I noticed an incredible thing had happened; all of my anxiety attacks, flash backs and nightmares I had been experiencing for the past two years since my first delivery had vanished.  During the countless hours spent nursing and caring for the new baby, I found myself reflecting upon my two very different birth experiences.  I began to have this drive - this need - to help other women in the profound way that Leslie, my doula, had helped me.  And so the seed was planted in my mind to become a part of the birth community.  

*image used with permission
Leslie Cuffee - Professional Birth Doula Services

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  1. I'm having such a proud Doula moment right now as I see your empowerment and role in th birth community unfold. I'm so very proud of all YOU have accomplished. Welcome my Doula sister. - Leslie C. Cuffee

    1. Thank you, Leslie, for all of your love and support!


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