Karla - So young. So brave.

I drove down to the University of Utah hospital after dinner last night. My volunteer shift started at 8pm and I met Karla, an extraordinary, young, and brave woman an hour later. Karla’s nurse invited me into her room. As a first time mama, she was interested in my doula services. I walked into a brightly lit room to find her two teenager siblings on the couch engaged on their phones. Karla sat up in the bed and graciously greeted me. Her gratitude shined brightly from the moment we met. “Thank you for being here. I am scared.”

Karla just turned 20 years old in April. Her sister was 15 and brother 18. He still wore his work uniform: a red IHOP shirt. He came straight from his shift to accompany his sisters. These kids were Karla’s support team. They had so many questions for me: What’s a doula? What does it stand for? How long until the baby arrived? How would Karla know when it was time to have the baby? Would Karla have the baby in that room?

They pointed to various equipment in the hospital room and inquired about how it was used. I quickly realized that I likely would be supporting this grateful young squad for the duration of Karla’s labor.

I quickly shared some basic childbirth education. I described the function of contractions, stages of labor, what effacement and dilation meant and how the birth may (or may not) unfold. The siblings lost interest way before Karla. She held on to my every word.

Karla was one centimeter dilated and had a cervical ripener called a foley bulb inside of her. We talked about birth preferences and she said she’d like to “go natural” but she was going to see how it’d go. I explained that really the choice was medicated (epidural) or not but either way she’d have a natural birth. (side note: I’d like to reframe this verbiage. Culturally, a “natural” childbirth means unmedicated, or without an epidural. But having an epidural or a cesarean section is not “unnatural”. It is just medicated.)

I wasn’t there long before Karla’s contractions picked up. Closing her eyes, I encouraged her to breathe deeply and trust her body. I massaged her shoulders, her feet and offered her water or ice after each contraction. Every thirty minutes or so I suggested a new position to Karla in hopes for some comfort.

I told her she was amazing. I told her she was brave.

Around 11pm, the foley bulb fell out and she was four centimeters dilated. Her contractions intensified. I implemented Penny Simkin’s 3 R’s (Relaxation, Rhythm, Ritual) and gave her counter pressure on her hips, knees or hand. Occasionally she reached for her phone and checked in with her friends. She told me that they were telling her to “get the epidural already”. She knew she didn’t want it, but she asked me how bad the pain was going to be, as if I had a crystal ball. I encouraged her to focus on one contraction at a time.

Around midnight her older brother arrived. He looked like a deer in headlights. He had never been around birth so he too had a slew of questions for me.

At 2am , Karla’s midwife checked her cervix. She had progressed, but only one centimeter, to a five. Karla didn’t hide her disappointment. She questioned her ability to do this without an epidural. The University of Utah is the only hospital in the state that offers Nitrus Oxide, so I encouraged Karla to try it. She agreed. The gas took the edge off of the contractions, but only minimally. However, it did buy Karla some time.

The midwife checked her cervix again an hour later and she was still at a five, with greater effacement. The next few hours were brutal. Karla continued to change positions. She stood and leaned over the counter. She sat upright in the hospital bed with her feet down in the “princess pose”. She laid on her side. With each contraction, she closed her eyes and tried hard not to fight the sensation with her moans and breath.

The girl was worn out. And sick.

Karla vomited several times. She shook. I assured her it was totally normal. By 3:45am she wanted to quit. For temporary relief, the nurse offered her a dose of fentanyl, a narcotic that takes the edge off the contractions for a short time but does not numb her body like an epidural. She was becoming desperate so she tried it. It helped her relax in between contractions but as promised, the effects did not last for long.

Fifteen minutes later, Karla declared she wanted an epidural. The anesthesiologist came in and routinely gave Karla the information about the procedure and side effects. She looked at me for approval. I reminded that it was HER birth journey, and there was no right or wrong way. I reminded her that an epidural is safe, and would provide total relief. Since she needed rest and was in so much pain with each contraction, she agreed and signed the paperwork. Moments later, the nurse said that that Karla’s midwife wanted to check her before she would have an epidural.

“No problem,” said the anesthesiologist. He continued to prep for the procedure. Karla’s midwife gave her a cervical exam and calmly said “Karla, you are a nine”. Karla’s eyes widened and filled with tears. “Really, a nine?? I am almost in labor?” Her nativity touched me. The midwife kindly responded, “You are in labor now but when you are ten centimeters you will be ‘complete’. Your cervix will disappear, and it will be time to push. You are very close.” I appreciated that the midwife then said, “You are welcome to have an epidural if you wish. It is up to you.” Karla looked at me. “What do you want?” I asked. “I want to do it without it. Can we say no for now?” Of course! I looked straight into her eyes and reminded her how amazing and strong she was, and that she was going to meet her baby girl soon.

With this news, Karla had renewed energy and determination. She managed each contraction with breath and focus. And by 4:45am, she proclaimed she was ready to push. The midwife checked her and she still had a little cervix intact, so with a hook the midwife ruptured her membranes (broke her water) which often speeds things along. Ten minutes later, the sensation to push was back, and Karla was complete.

The nurse paged the pediatric team who attend births in case there is an issue with the baby. I woke up Karla’s sister and laughed when Karla said her brother could keep sleeping. With the lights still dimmed, the team assembled. It was go time. Karla grabbed the back of her knees, I held one leg and the medical assistant held the other. Karla pushed to the count of ten with each contraction.

Four contractions and twenty-six minutes later, Karla’s baby girl was born at 5:26 AM. Karla sobbed “I did it!” She was so proud of herself, along with every person in the room. She truly dug deep and her strength never wavered.

The next thing she said was to me. “God bless you. You are an angel.” It was my turn to tear up.

The baby girl arrived into our world with little fuss. The nurses placed the baby on Karla’s chest for skin-to-skin while her little sister cut the umbilical cord. The pediatric team never even touched the baby. Karla did not need stitches which is remarkable for a first time mother.

I know Karla may have birthed her same healthy baby with or without medication, or me at her side. However, I am confident that my doula services helped her achieve her “natural” birth, which she was so proud to have accomplished. Her bragging rights and deep satisfaction will be with her for years to come.

Amazing work sister!