A Doula Project

On a snowy Saturday, last February, I taught a couple a childbirth preparation class on line.  Shortly after the class, the mama sent me an email expressing an interest in hiring a doula.  We set up a call.  A few weeks later, the contract was signed and deposit paid.   They were my first clients who worked for a company who offered doula services as a benefit.

My client worked with the midwives at the University of Utah.  At the end of her pregnancy, the midwives recommended an induction.  On May 8th, at 11:40am, my client texted that they received the call and were headed to the U for a 12:30pm induction. At 1:30pm the mama was admitted to the hospital, hooked up to an IV and began cervical ripening measures.  The nurse gave her a pill of Cytotec and placed a foley balloon in her to soften and open her cervix.

By 7:15pm, she was 3cm dilated. Her partner reported that she had dinner and was starting to feel some contractions, but nothing painful yet.  The nurses gave her another dose of the Cytotec and waited. We texted two hours later and the plan was that the nurse would check her cervix at 11:30pm and then maybe start Pitocin.  My clients promised to keep me posted, which they did.  At 3am, my phone rang.  The mama was 5 cm dilated.  She had an epidural and was trying to get “comfy”.  I hopped out of bed and headed to the hospital.

Their baby did not wait for my arrival.  He had plans of his own.  At 3:23am, my client texted that they they were prepping for delivery. I did not see that text until I was in the elevator headed up to the second floor of labor & delivery.  When I walked in at 3:50am the partner was holding the baby!

My first thought was, “Am I in the right room?”  I was SO surprised!  Later, the dad told me that after the birth he thought of me and felt badly that I missed the birth.  Turns out, I arrived just in time.

My client had a severe vaginal tear.   A few doctors and nurses were at her feet and she was essentially alone.  Her partner was holding the baby on the couch next to her.  He was mostly focused on the baby. My client needed me and so my doula work began.

After I dropped my bag, I went to her, took her hand, looked at her directly in the eye and began breathing.  Her epidural was not effectively working and she were experiencing massive sensation.  Her tear was high up in the vagina and the provider was trying very hard to keep her comfortable.  It was not working very well. Breathing helped.

The doctors paused for a bit and waited for the anesthesiologist to come in to assess her pain.  The anesthesiologist confirmed that the epidural pulled out during the birth.  The nurse suggested Fentanyl which was not an option for my client as she did not want opioids.  Instead, she opted for a local anesthetic.  She dug extraordinarily deep.  Her baby, meanwhile slept on his dad’s bare chest.  They were very very content together.

For almost two hours, my client focused on her breath.  Amazingly strong and determined she did not complain or give up.  I know the repair was intense and everyone was so happy when it was completed at 5:50am.

I pieced the birth story together.  The baby was born at 3:36am.  He arrived into this world, very very quickly weighing 8 pounds and 5 ounces and was 19 inches long. He was born perfect.

Together, the four of us moved from the Labor and Delivery room to the Maternal Newborn Care unit.  At 6:45am, when all of the logistics wrapped up, the nurse put the baby on my client’s chest for breastfeeding.  He latched on immediately.  He looked like a natural.

I left a couple hours later and in reflection, I realized how important my role as a doula is at every birth.  No one knows if mama and partner will be separated like they were at this birth.   If they are, the birthing mama needs companionship and care.  The support of a trained doula is fantastic, but even a friend or a calm presence  in the birth room would be helpful.  This experience impacted me deeply and has me thinking about the importance of doula support and how our country can improve accessibility.

In my postpartum meeting, my client said that she would not have hired me had her work not paid for my services.   She was deeply grateful that I was with her the day her son was born  She told me that she could not imagine what it would have been like without my support.

Most Americans do not hire doulas.  I suspect primarily because of expense.   According to Evidence Based Birth, as of 2012, 6% of people surveyed used a labor doula (Declerq et al., 2013), which was up from 3% in a 2006 national survey.  While the trend is headed up and more and more doulas are used in the past decade, I know the numbers are still very low.

Birth trauma is any physical and emotional distress a mother may experience during or after childbirth.  During the birth, she may feel afraid, helpless or unsupported by those around her.  Over 45% of first time mothers report some degree of trauma during their birth. Forty-five percent! Trauma is tricky because as Cheryl Beck said in 2004 “trauma is in the eye of the beholder.”  Something that happens at one woman’s birth may be processed traumatically while the same event happening to someone else might be processed as normal.

Doula support may be that difference between a mother experiencing trauma or not. Research shows that hiring a doula helps minimize the risk of a traumatic birth.  I know my presence helped this mama and it was possible because of her company benefits.

I feel a new initiative brewing.  I want to to work with companies to increase benefits to pay for doula services.  I’d also like to collaborate with existing organizations like “The Doula Project” out of NYC to train friends or family to witness a loved one’s birth.  If a certified doula is not in the budget, I believe that having someone to hold a mama’s hand has to be more beneficial than leaving them alone.