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Diary of a Doula

Doulas are trained professionals who provide support to the mother before, during and after baby’s birth. Clinical studies have shown that the presence of a doula tends to result in shorter labors, fewer complications and smoother transitions into breastfeeding. Melissa Espey-Mueller is a birth doulaor labor coachand founder of North Dallas Doula Associates (northdallasdoulas.com) as well as a mother of five. She chronicles one of the hundreds of births she’s attended.
I get a call around 5pm from a mom who sounds like she’s in full-blown active labor. She’s having contractions every two to three minutes, and it doesn’t seem like she’s getting a break. I know that her cervical exam at the doctor’s office was 1 centimeter, and I encouraged her to head to Café of Life Chiropractic for an adjustment and an induction massage. Chiropractic care throughout pregnancy helps restore balance to the pelvis and the muscles and ligaments that attach to it, and an induction massage helps trigger labor. She did both around 3pm, and I’m surprised at how quickly they got the ball rolling.
I know this mother is committed to having a natural birth, and I have this in mind when I recommend a warm bath to see if it might slow down and spread out her contractions so she can possibly get some rest. Meanwhile, I get myself organized. Shower, have some dinner, pack my “birth bag” and wait to hear from her again.
It isn’t long before she calls and says she can’t rest. I know she’s making unusually fast progress, so I encourage her to head to Baylor University Medical Center where she plans to deliver.
I hop in my car and drive as quickly as possible to the hospital. On the way I’m thinking, “Is she close to delivery, or is her discomfort being caused by a baby who’s wedged himself into the pelvis crooked or facing the wrong way?” My mind is focused on the tools I have to help this mama accomplish the birth she hopes for.
When I get there, my phone rings. It’s the mama, who we’ll call Leah. “My plan has changed,” she says. I tell her I’ll be up in the room in a minute. When I get there I see the anesthesiologist, and Leah looks at me and says, “I’m sorry, I got the epidural.”
What are you sorry for? I ask. I can’t believe this mom is apologizing to me for making a choice about her own birth. This is your experience, I tell her, and you should feel like you’re in charge of it. I remind her what I taught in childbirth class, that there is a clear difference between pain and suffering. When we experience discomfort, such as a neck ache, we might take a Tylenol, a warm shower or bath; all of those things help us manage the pain, but they usually don’t take the pain away completely. We use these tools to keep us out of suffering mode.
I do believe in a woman’s ability to birth naturally. Close to 95 percent of the births I attend deliver without the need for pain medication, and I have attended hundreds of births. I also believe that the pain of labor has a purpose: It is telling us something. It is up to the woman feeling it to decide how long she wants to “listen.”
I believe Leah is already in suffering mode. She is five centimeters at the time of her epidural, and 30 minutes later she is at seven. Her labor is moving quickly, and soon we will find out why the pain for her is unmanageable.
The doctor checks her cervix and she is now 9cm, but her baby is “OP.” The most common position for a baby during labor is head-down with the back of the head (occiput) facing the mother’s front (anterior). When the back of the head is facing the back of the mother (posterior), the baby's position is called Occiput Posterior or OP, which occurs in 15 to 30 percent of labors. This explains why Leah couldn’t get ahead of her contractions – not is only is her birth moving rapidly, but her baby is in a more uncomfortable position. There is a difference between pain and suffering, and when things don’t happen “naturally” in birth – such as an induction using synthetic hormones or the position of the baby – it can be hard to have a natural birth. As a doula, I trust a woman’s ability to follow her instincts.
A doula is very much like a personal trainer for birth. When you go to the gym to work out, you’ll have good results. But if you go to a personal trainer, you’ll probably have better results. I’m always thinking at a birth, how can I make this faster and easier for this mother? I know it will help Leah if she can get on her hands and knees to allow gravity to pull down the heaviest part of baby’s head, changing him from OP to OA position. Since she decided on the epidural, however, I have to improvise. I quickly put her into a pretzel position, which is a side-lying stance with the outside leg bent up toward the belly and the back leg pulled far back and straight behind the mother. This position basically crowds the baby out of its position and helps encourage rotation. I switch her sides every 15 minutes.
When a baby is OP, it causes a bone-on-bone effect and can increase the duration of labor and pushing. I suggest using a hospital sheet for a tug-of-war. I hold one end and she holds the other. When she pushes, I pull and it brings her from lying flat on her back to an upright squat position, which helps open her pelvis.
Finally, Leah gives one last, strong push, and her baby rotates to the OA position, is born vaginally and welcomed into his mother’s loving arms.