sâmbătă, 5 februarie 2011

Intalnirea doulei cu Toma - II

Mo had a healthy, enjoyable pregnancy with no complications. She started having non-stress tests around 38 weeks of pregnancy. I asked her if they had concerns about her and the baby since in my experience non-stress tests were not offered until 40-41 weeks and usually sooner if there were concerns or a multiple pregnancy. She said there were no concerns. It was routine for this doctor/group to do them. She made it to 41 weeks and was told that she should induce because she was overdue and the placenta would not be working as well any more. She was 4 cm dilated the day that she was induced.

At one of her last appointments, she shared her birth plan with one of the doctors in the practice. In her birth plan, she wrote that she would have a doula at the birth. The doctor who attended her birth did not know about this and seemed to react strongly when Mo wanted to talk with me before he broke her water and he started her induction. He left the room and Mo, Stefan and I talked. Mo seemed concerned about the doctor’s reaction and didn’t want to start her birth off by upsetting the doctor and possibly be treated in a negative way. I reminded her that this was her birth and her body. If she wanted to go ahead with the induction, that was her choice. She nor her baby were in any immediate medical danger, so I told her that she could choose to come back on a different day and have the induction with a different doctor if she wanted to. After we talked about her choices and how she was feeling, she decided that she was ready and felt confident about having her water broke and start the induction.

The doctor came back in and was calmer. He broke her water, which was clear, and they listened to the baby on the monitor for awhile (about a half an hour). The nurse came in and she said that Mo could get up and walk around. The nurse was supportive of Mo’s desire to try for a pain medication free birth. We were told by the nurse that they would be starting Mo on Pitocin in an hour if she didn’t start having contractions. Mo did not want to have Pitocin if she didn’t need to so she got to work.

We walked the halls in labor and delivery for awhile. The nurse said that we could go out and walk the stairs too, so we did. Mo walked A LOT of stairs. What a strong women with very strong legs! This technique was effective for getting her contractions going and soon her contractions started coming regularly. After an hour, we returned to have the baby monitored for about 20 minutes. She was having contractions often enough that the nurse told her that she did not have to start Pitocin yet. Mo was happy about that and after hydrating her up with some sparkling water, she was back to the stairs. We repeated this for a few hours, walk and climb stairs for an hour, return for 20 minute monitoring and sparkling water. During her contractions, Mo would lean forward and I or Stefan would rub her lower back. Before her birth, Mo said that she thought that she would like a citrus fragrance to smell, so I had a small bottle of lime extract that I had brought with me. She would take a quick smell of it and then we would walk more.

We visited the nursery and looked at the babies who where in there. I think that the use of gravity and motion helped keep the labor going without the use of Pitocin. We also utilized acupressure points on her legs and hands to help keep the contractions going while she sat and was monitored. She also tried nipple stimulation, but either it wasn’t very comfortable for her to do, or it wasn’t working for her. Maybe using an electric or manual pump would have been easier.

I can’t remember the timeline very well, but she was checked a couple of times and was making good progress. By the time she was 6-7cm dilated walking was not something Mo wanted to do any more because her discomfort was increasing and the contractions were taking more work to stay relaxed through. I think that her back may have been hurting too. We got her set up in the shower sitting in the chair and used the hand held sprayer on her back. She was in there for awhile, but it too was not helping very much any more and she was getting tired. She had not slept well the night before knowing that she would be having the baby the next day. I remember telling her that a lot of moms feel sleepy during transition and then get a burst of energy when it’s time to push.

While Mo was interested in an unmedicated birth, she was open to the use of medication. Mo was ready for some rest and some relief from the contractions. The nurse offered her Fentanyl. Once she received her dose, Mo rested in bed and was now hooked up to IV fluids for the first time even though she had a heparin lock from the start of her birth. She wanted to talk with Stefan in their native Romanian language and asked for privacy because she felt that it was not polite to speak something other than English in front of me. I told her that I had no problem with her speaking whatever language in front of me that she wanted to, but that I would be happy to give them privacy.


Less than a minute later, the doctor and his assistant arrived. He had Mo lay flat on her back and the nurse and I each helped hold one of Mo’s legs when she was pushing. Stefan was standing by the room door away from everything. He had tears in his eyes and I smiled at his and gave him a big thumps up. And when I told Mo how great she was doing, I would look at him and smile and nod too. At the time I was worried that he was doing OK, but if I remember correctly, Mo told me later that he was just very overwhelmed at the time. Once the baby was out, he came over and kissed and expressed his love to both Mo and Toma.

The doctor was shocked that Mo had “labored down” without an epidural. He was also amazed that she was having a baby without Pitocin and without an epidural. He said “we don’t see births like this”. Mo had only been actively pushing for 5 minutes when the baby’s head could be seen and in 10 minutes the head was crowning a great deal, but still easing in and out with a little more showing each time. The doctor said, “I’m guessing you don’t want an episiotomy?” I told you what he was saying because you couldn’t hear him and you said you didn’t yet. After two more pushes, he performed an episiotomy. Toma was born a couple of contractions later. He was beautiful and Mo couldn’t take her eyes off of him.

After Toma was born, the doctor left and his assistant repaired the episiotomy and cleaned up. The nurse checked the baby at the warmer and returned him to you and you started nursing him. Before the nurse left the room, I saw the nurse change the IV bag and then she said, “Now all I’m giving you now is a little something to give you energy to help you recover.” I looked at the bag and saw what was printed on the label and she said to me, “You saw what that is.” I said, “Yes.” She said, “I’m all about healthy moms.” I said something about understanding and she left. You both heard what was happening and asked what that conversation was about. I explained that the medication in the IV was called Pitocin and it is used to make the uterus contract and is usually given to mothers who’s uterus is not contracting properly after birth and/or if a mother is experiencing hemorrhaging. The nurse had given her 2 bags of it after birth not for excessive bleeding, but because the nurse gave it to all mothers after birth. Mo later complained of her legs being very swollen. One of the side effects of Pitocin is swelling of the legs.

Once Mo, Stefan and baby Toma were nursing and resting, but before Mo was moved to her postpartum room, I went to pick up Mo and Stefan’s mothers. They were very excited to come meet the baby! We met with Mo and Stefan and visited for awhile in the recovery room. Toma was being washed and observed in the nursery.

It was an honor to attend the birth of Toma. Mo and Stefan were a lovely family to work with. I wish that I could be a part of their birth when they welcome their new child, but I know that they will be in wonderful hands with Diane.

Best wishes for a beautiful and healthy birth,
Doula

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