Doula, Doula, wherefore art thou, Doula?

*LOL*

Okay – enough people have asked about the doula client that I’ll write the whole thing out….

I’ll start with the birth story, then explain why I’m debating if I want to get certified.

 L was due 2/13. Dad was out of the country until 2/1, and once he was back, they immeadiately went into the rush of SIL’s wedding (which was on 2/3), so they both had late nights the 2nd and the 3rd.

I got called the first time the morning of the 4th (Sunday, around 4am) – L had been having regular contractions, and she thought her water broke, and so they went into the hospital, but labor stalled and they determined that her water had not broken, and sent her home. When they checked her then, she was about 3cm/50% – so, her body was definitely warming up for labor. They also noted that she seemed to be a little low on amniotic fluid. I suggested to her that she was most likely dehydrated, which was starting to bring on her labor a little early, and suggested that she REST and DRINK as much as possible.

So. Monday – she goes to work, still having on and off contractions – and she hasn’t been getting much sleep.

I get called again Tuesday morning, they are at the OB’s, she’s 4cm/75%, contractions 5-7 minutes apart, and they want her to check in. (9:30am)

They check in, and since she was Group B Strep+ (and she didn’t get retested that morning as I suggested to confirm that she was still +), they set up her IV for a bag of fluid and pennicilin. I started getting a little concerned at that point, because she was SO dehydrated that they could barely find a vein to insert the IV into, and I was worried that loading her up with fluid would cause her labor to slow down (assuming that it was dehydration related). They finally call in an anethesilogist (spelling, I know), who after three pokes, was able to get a vein – and she gets the first bag. (10:30am). She’s laboring pretty good, having some back and hip pain, and she’s TIRED (yet another source of worry). She’s labored out of bed the entire time – slowdancing with R, squatting at the end of the bed, leaning, the whole nine.

So – She’s laboring, I’m doing counterpressure and hip presses, and the bag of fluid don’t seem to be slowing her down any. The doc comes in, checks her – 5cm/100% – say’s that he’s spoken to her doc, and they want to break the waters. (Should I have encouraged her to question this??) I let her know that it will increase the intensity of her contractions as she’s going to lose that cushion of water, but that hopefully, it will allow labor to move along, and encourage her cervix to dilate. She agrees to having her water broken (11:15ish), and after about 3 or 4 contractions, she’s asking for an epidural.

Now – she had always leaned towards an epidural from the start. I fully educated her (and reminded her) of the side effects, and the potential cascade, but she was TIRED. And – I was concerned that even if she DID labor all the way through – working off of little to no sleep for the last 4 days, AND no food for the last 16 hours at this point – things wouldn’t be pretty once we hit 2nd stage.

So – she gets her epi @ noon, but it doesn’t fully take – so now she can only feel the contractions on her left side – and she’s starting to run a fever. Now – two of her friends (who were there much later) told me that they were feeling a little sickish – maybe something flu-like – and they were all together all weekend. So – she has a fever, but she’s shivering, AND her whole body aches……..esp. her back.
Alex has been doing fine the whole time – heart rates going variable as it should. She requests, and gets a second epi @ 1:30ish. By 2:45pm, it’s fully kicked in, and she’s not feeling anything. Now – they kicked me out of the room for both epi’s (hospital policy), and by the time I get back into the room after the second Epi, they’ve also hung a bag of pitocin, and they are giving her tylenol suppositories to try to manage the fever, and inserted a catheter. She’s also working on a pretty nice headache now.

They come and check her again at around 4:30ish, and she’s 6, and Alex is showing a bit of a caput[1] – which is a little disheartening for her. I remind her that the epi may have slowed down labor, and that her body may be acknowledging that she’s tired, and slowing down to give her a chance to rest. She sleeps on and off for about the next hour or so….

Around 5:30, the doc comes in, checks her again, and starts talking section – the ‘slow’ labor, the fever she’s running, and Alex has gone through a couple of decels….so – they are starting to ‘manage’ a bit more. They insert an internal contraction monitor, and up the pit. He tells her that they need to see some progess, or it’s going to be definitely a section. L starts crying at this point – she already felt that she ‘wimped’ out because of the epi, and now she’s seriously wondering if it was a bad choice. I try to soothe her by assuring her that she’s done really WELL, and that her exhaustion (and lack of food!), made getting the epi a wise idea – just so that she could rest.

They come back to check her around 6:45ish, and she’s gone up to 8, and Alex still has a caput. They are realllllly starting to push a section now, telling her that because of the caput, they aren’t sure that he will be able to descend fully. I’ve had her upright as much as possible so that his head is pressing in the right spot, but even with the pit, her contractions are – iffy. She’s had *thinks* 3 bags of fluid by now, and so I’m strongly suspecting that she was having early labor due to dehydration, and her body and Alex aren’t really ready…..

Her doc – at least the doc that was actually going to deliver her, not the doc who had been seeing her all through her pregnancy – becaue THAT doctor  (her actual doctor) was out of town, and the TWO other docs that came in were just covering for her REPLACEMENT while he was in surgery –  comes in around 8:15 or so, and she is still 8, Alex hasn’t descended any further, he still has a caput, and the epi is starting to wear off, and she’s still tired – and he tells her that they are strongly pushing for a section, because he doesn’t feel like waiting would make any difference. L is not happy – but she’s worn down at this point. She’s – defeated isn’t the right word – she was exhausted. So – she agrees.

Alex is born at about 8:45 that evening.

My overall feeling?

It wasn’t time for her to go into labor. She was tired, and dehydrated, and stressed, and she went into labor – and since she wasn’t comfy with laboring at home she went into the hospital a little too early.

I think – because of her exhaustion – that the epi was a good idea because it DID give her a chance to rest – but I also think that 64 oz of water and a big meal might have done the same thing.

I wasn’t there for the discussion – if there was any – of the need for pit, but by that point – I’m sure her labor had slowed down – and since they had broken her water, they needed to keep things going.

I feel like I was a good doula in that I helped her though her labor before the epi, and that I suggested things to her to do, and I reassured her, and both mom and dad said that they were MOST pleased with what I had done and that I kept them sane and calm ……

But at the same time, I feel like I failed her because she had a c-section. But – the things that I could have influenced were in the past – I couldn’t sit on her and make her drink and sleep. I couldn’t stop her from desiring an epi – despite the sideffects that she knew about. I feel like – it was really out of my hands, and I did the best I could with what I had, and… therefore I’m sorta rockish.

But – I’m still. Not happy.

 [1] Caput – generalized swelling of the scalp tissue, just fluid, soft, crosses suture lines, that disappears within a few hours or days.

So. That’s the story, that’s the tale.

Why am I debating if I want to get certified? Because, now I’m debating if I want to be a doula – or if I want to go directly into midwifery. I feel like I let her down because I WASN’T as strong of a part of her prenatal care. I felt like I let her down because she called the doctors before she called me. I’m wondering if I – if I have the – distance – to stand to one side, and watch these women that I call clients be subjected to what I KNOW is a lower maternal standard of care. And I don’t think I do. And in my mind, that is what being a doula would be to me….only doing half of the job that I need/want to do.

So I’m confused, a little. I LOVED helping her, being there – supporting her, talking to her, soothing her – doing all that felt SO right and so good. But – I felt like my hands were tied, somehow.  I’m still in awe and in love with birth and labor and babies.

I went back to the hospital *thinks* 3 days after he was born – well, it was the middle of the afternoon, so 2.5 days old, really. He was the loveliest little boy – so tiny and sweet and soft and warm – and heavy. No – solid. He was so tiny and so DENSE all at once. And I was overjoyed because look! A new human – the newest person I’d ever held in my life!  And yet, I was so sad, seeing all the fur still on his ears (and according to mom, his shoulders, legs, and back), and smelling his tiny head and smelling nothing but sharp chemicals and sour milk.

*sigh*

I know that I don’t know yet but a fraction of what a good midwife would know. And I know that I know a good bit more about labor and BIRTH than most people know. I’m fully aware that I know little to nothing about pregnancy and the process – though, I’m certain I have more in my head than I am aware of.

This is the first time I’ve really – put all this into words… I’ve been mulling over the emotions and my reaction to it for a while – one of the reasons I’ve been so quiet lately (besides the new internet pretties and the incredible busyness)…. I’ve been thinking about my whole life-plan.