Quit Throwing Your Placenta Around

Mangua was laying on the dirty floor, writhing, screaming and crying.  I guessed she was 8 or 9 centimeters dilated by the little grunt at the peak of each contraction.  (although I always keep in the back of my mind that some labors just don't follow the rules and can look like that at 5 cm.)  Her lips were dry and I offered her water.  I wiped her sweat beaded face with a cool cloth and started fanning her.  It is very hot and humid here and there are no fans or AC in the maternity ward. 

Her contractions were one on top of the other as I held her hand and rubbed her back.  She calmed down considerably.

Meanwhile I looked up at the wall and had to smile at the sign I read.  Translated, it said, "To all mamas: please take your placentas home with you and bury them.  We are tired of finding them tossed in the road and under the bushes.  Thank you!"

Then I witnessed what I think of as "the last hurrah."   I've seen it over and over again in births that have not been altered with medications.  It is when there is a 3-4 minute unbearable contraction and then peace.  It seems to be the last bit of dilation and then the mama experiences what midwives call the "rest and be thankful stage."  There is such a change in demeanor at the end of that last long contraction.  The contractions sometimes do continue, but they are different.  Has anyone else seen this?

After about 20 more minutes she said, "the baby is coming!" and I supported her as we wobbled down the hall to the delivery room.

Meanwhile Leali, I had been supporting, but who was coping much more quietly, passed us in the hall with her hand between her legs.  She too was on her way to the "haus bilong karim" (the room where they are supposed to push out their babies).

Mangua and Leali both got up on delivery tables with about 12 inches between them and Mangua's water broke.  It was very stained by meconium.  A very thin, and very pale baby emerged as I fanned and encouraged her.  A boy.

Leili delivered a healthy and very vocal little girl.  It soon became apparent that Mangua's baby was not okay and needed help with breathing.  About this time, Leali began to hemorrhage.  She was weak and unable to hold her baby on the narrow table.  So my job at that point was to hold and comfort the tiny and very opinionated little newborn.  I sang to her and walked the halls while I prayed for the other baby that it would breath.  And for her mama that she would stop bleeding.

My prayers were answered.  When I left both mom's and both babies were doing great.  There was another lady yesterday too, but I'll leave her story for another day. 

 

Doula-ing with a Language Barrier

 

 

Okay.  If you ever find yourself trying to support a woman in labor when you do not speak their language, here are some ideas for you. 
 

Tips for supporting women during  Stage 1  of labor:

 

If there is any way to watch a woman be supported by another woman in her own culture, that is the best way to learn.  

 

Are there any bilingual (English and the language where you are) people that you can interview? Ask them how to support a woman.  Also, come up with a list of things you would like to be able to say and then get a translation.  Memorize those phrases.

 

Smile, love her, be with her, touch her, hug her.  Be there to hold her weight so she can achieve whatever positions feel best to her. 

 

 Use counter pressure and massage if this seems appropriate and is well received.

 

Follow her hands, she will often rub her own back where it feels good to her.

 

 Sing softly, this says... I am calm, there is no emergency, what is happening to you is normal. 

 

Offer water or other liquids to keep her hydrated

 

Mostly just be with her

 

When Labor is Slow:

 

Consider the position of the baby. If the baby is sitting off-center on the pelvis, the head may not be able to put enough pressure on the cervix for dilation.  Changing positions and moving the pelvis every 20 minutes or so may help to change the baby's position.

 

Some suggested positions would be:

·         Lunges with one foot up on a chair or something

·         Hands and knees or standing next to the bed while swaying the hips

·         Walking

 

Tips for supporting in Stage 2

 

When they are pushing, remember that asking them to squat enlarges the pelvis and unsticks stuck babies.  Most women are hot when pushing, they often like being fanned and a cold, wet cloth on their foreheads.  They are usually thirsty too.

 

Tips for supporting in Stage 3

 

 Fill up a water bottle with hot water (not too hot) and wrap it in a towel, and put it next to her.  Most mamas end up cold and shaky after birth.  Smile at her, she will be able to see that you are proud of her and that you think her baby is beautiful.

 I hope this is helpful to somebody!

 

 

 

Do You See What I See?

My last doula adventure was a crazy one.  I have seen a lot since I last updated you all.

1. I have seen two new doulas (that I have had the privilege of training) spread their wings and do very well. 

2. I have seen a baby born right on the dirty hospital floor.  Both mom and baby were fine. 

3. I have seen a woman punched repeatedly  while her baby was crowning. 

4. I have seen God answer my prayers over and over again when a mom is having a very hard time or when a baby is not breathing.

5. I have seen an HIV positive mom shunned and shamed. 

6. I have seen serious hemorrhages and babies that took a long time to breathe.

7. I've seen the midwives be very kind and show great skill in order to save a mom and baby.

8. I've seen the midwives share their own things and go the extra mile to be kind to a patient.

9. I've seen a movie on maternal death in childbirth put on for the laboring women to watch.

10. I've seen the squatting position spare many women from c sections and vacuum extractions.

Baby Heads and Doula Smiles

I smiled a lot yesterday while I was with all the laboring moms.

I smiled when Rosa pushed out a baby boy with ease.

I smiled when Rosa dressed him up super cute and I could tell she was in love with her new little bundle.  She had her tubes tied a few years ago, so he was quite a surprise.

I smiled when Helley gave me a skeptical look when I told her that her baby was coming soon and she was going to be okay.  It was a look that said "you are insane, I know I am going to die."

I smiled when Helley came back from the bathroom a few minutes later and lifted her skirt to show me what was going on.  I could see quite a bit of baby head.  She was holding a baby boy just a few minutes later.  Now she had a look on her face that said she was quite pleased with herself for having delivered her first child.

I smiled when Toola and I finally worked out a system to get her calmly through her contractions without going screaming and rolling around in panic and terror.  I had never seen a woman quite so active and creative with her laboring postitions. 

I smiled when Toola's baby girl finally emerged.  It took awhile and the little one arrived with a short cord 3x around her neck. I smiled because she was okay despite that.  I was so glad the midwife had arrived on that one, her head was halfway out before the midwife came.

I smiled when Toolah made it safely through a post partum hemmorage and when her baby girl finally latched on and nursed.

I smiled when Mallinah delivered her ten and a half pound baby boy (most babies here are between 5-7lb).  She was 44 weeks pregnant.  Yes, I meant to write 44.  She measured 44 weeks, and her dates said 44 weeks.  She had been completely dilated for hours, but the head was too high and not engaged.  She walked, she lunged, she sat on the toilet.  We had no birthball, that would have been helpful.  She was so drained and still the babe was high.  Her water finally broke and eventually she felt like pushing.  After 2 more hours I finally convinced her to squat and push.  She did and within 15 minutes there was a baby head.  The midwife was there just in time to see the rest of it's body slide out.

There were five births and 7 moms and it was just really fun as well as really amazing.  I'm getting more comfortable in my role as a doula and in trusting the mom's own instincts.  I am also amazed at what a woman can birth if she squats instead of laying on her back!

Double Doula-ing

I have been mastering the art of double doula-ing.  No, I am not talking about mom's having twins. I'm talking about two moms moving into one space so that I can support them both at once.  I would never ask them to do this, it's their idea.

It is much easier if their contractions are opposite of each other in timing.  Then I can support through the pains one at a time.  Unfortunately this is not usually the case, which leaves me trying to massage/focus on two women at once.  It reminds me of trying to pat my head and rub my stomach at the same time.

I feel rather silly looking, rubbing two backs at once, but I'm glad to be there for them.  I think it is time to train some more doulas to come along with me.

Walk that Baby Out!!!!!!!

I volunteer in the labor and delivery ward here mostly because the laboring women are not allowed to bring even one support person with in with them.  I love it though when a brave mother in law or grandma comes marching in anyway.  I never tell on them, so sometimes they manage to hide out for a hour or so. 

Yesterday this wrinkly, ancient and very wise looking old woman came bursting in.  Policy meant nothing to her.  She had squatted on banana leaves and borne 13 babies in her lifetime.  This is what she had to say to her granddaughter who was in labor with her first child.  "Get up! Walk, walk, walk,  faster.  GO!  Do want this pain to last all day? If you do, then lay down.  If not, then get up and go!"

Amen Grandma!  I have seen many other veteran mothers here offer the same advice.  I also noticed that the women who just walk and walk have their babies so much faster than the ones who just lay on their sides.  I personally was a walker in all of my 4 labors and recommend it to anyone!

Vaccuming a Baby Head

So, apart from accidently cussing and fainting yesterday...I also got to see my first vacuum extraction birth.  It was brutal, but mom and baby are alive and happy, so it seems to me it was worth it in the end.

These days, I tend to judge a birth by whether or not everyone lived.  I would love to see each mother satisfied with her experience...it just doesn't take much for these women...if they are alive in the end, they are happy.

I could hear Mavis (not her real name) yelling long before I got to the labor and delivery room.  This was her first baby and she was NOT afraid to make noise.  When the midwives told her to quiet down, ( they actually were pretty kind and concerned for her) she just looked at them and screamed louder.  She alternated biting the mattress, rolling around on the floor and throwing things.  ( So much for the "women in other countries just squat, push out a baby, and keep on working in the field" theory.) 

When I arrived she had been in active labor for 24 hours.  She had been at 9 centimeters for 3 hours.  Her baby was slightly transverse. (Basically it was laying diagonally with the side of  head and ear trying to head down the birth canal.  It is a good thing that she was one of the 30% of women in this country who had a skilled birth attendant for her birth.

I walked in to be with her and she clung to me and begged me not to leave.  She was sick of being alone and in pain.  It was one of the roughest births I have helped with so far (except for the ones where there was a death).  We worked with gravity trying to jiggle the baby down into the right position.  I had her try polar bear position alternated with standing and dancing the baby down.  Interestingly, it seemed that she naturally wanted to do those things anyway.

She was complete by 8:30 am and then started pushing.  She pushed for six hours.  At this point she was going on 48 hours of active labor and was refusing food and drink of any kind.  She was constantly falling asleep standing up, and I was trying to keep her from falling over.  She was about 100 pounds more than I was and it wasn't an easy task.  I used every "trick" I could think of.

After 3 hours, I begged the midwives to come check for fetal heart tones, something they hadn't done at all since I had arrived.  It took them awhile to hear anything, and when they did, the baby was in distress. Her head had moved into a better position to come down though.  After two more hours of pushing they brought in a broken vacuum extractor (it would only go up to half of the suction it was supposed to have) and gave her a huge episiotomy and finally dragged out a beautiful baby girl.

It was not a pleasant birth, but when I left, mom and baby were alive, healthy and happy.  Oh, and Mavis named the little girl after me.   I was so proud of her making it through....

Any Doula Tips or Tricks?

I get to go back to the hospital tomorrow.  I wait every Friday with anticipation, and I wonder what tomorrow will hold.  Some days there are babies popping out all over the place and others are quiet with just two ladies in labor and a bunch of post partum moms. 

Do any of you doulas out there have any simple doula tips or your favorite tricks to share?  Or maybe you have just been through labor yourself and know what worked for you.  Keep it simple as I tend to just use my hands and voice...and the favorite a the wet wash cloth on the forehead and a hand held fan for the pushing stage.  So far everyone of the ladies that I have assisted have LOVED this.  Please share in the comments section if you have new ideas for me.  I love to learn from others.