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Wednesday
Mar202013

Doulo

PS: It's important to know this family was a dear friend of our family and they invited Zack into their space. It isn't that Zack is my usual back-up. My back-up doulas are all women.

I know, you think it’s a typo, but it isn’t. It’s not doulA, but doulO. What’s the difference? 

Those of us in the birth world know what a doula is… a support person for women in labor and birth… and there are postpartum doulas as well. The doula provides a great deal of information and knowledge to the birthing couple, doesn’t make decisions for them, but reminds them of the birth plan they’d created when they were pregnant. Doulas also provide physical comfort to the birthing mom (and often her partner as well), getting her water and ice chips, providing cool or warm washcloths as needed and pressing on her back and giving counterpressure to help alleviate the back pain that can be relentless in a posterior labor.

But what happens when the doula isn’t a woman? He becomes a doulo.

My partner Zack recently became a doulo for a client of mine, Amanda, when I was too sick to attend the birth. My client’s labor was days long and my previous client and Amanda’s Hypnobabies instructor Rachel came to work with Amanda and Kevin in the early parts of her sleepless and painful posterior labor. Rachel helped Amanda with positions and comfort techniques as she knew all too well how to do, but nothing turned the kid Amanda’s pain was unrelenting.

After a day of labor, Amanda had a non-stress test at the hospital and there, they found her to be 1cm and sent her home saying labor might be starting in the next day or so. To Amanda, labor pain had already begun. For any of you who’ve had a posterior labor before, you know exactly what she’s talking about when she describes the pain as a chisel to her back.

Having worked so hard during the pregnancy for a home, vaginal birth, as time passed and the prospect of a hospital birth grew closer, Amanda had increments of acknowledging that her dreamt for birth was soon just a memory.

On day two, Amanda was getting so tired and I encouraged her to have a beer or a glass of wine and to take a warm bath and then get some sleep. She tried, but neither the alcohol nor the bath relieved her fatigue or pain. She used a heating pad on her back, but even that was barely any relief.

During all this time, she was visited by her home birth midwife and she kept her appointments for NSTs, always learning she was 1cm and still not in labor yet. The baby sounded awesome each check (and mom had a doppler so listened periodically herself) and her other vitals were fine. Her membranes had not broken; she was, for all intents and purposes, not in labor at all. Even though she had so much pain and contractions every four to eight minutes apart, depending on when you counted.

The fourth day of no sleep, Amanda had abandoned any hope of having a home birth, knowing she was going to have a hospital birth, with an epidural, because she had had enough of the suffering. (There is pain in birth, but there should be no suffering. If there is suffering, that’s what an epidural is for.) She really had given up the reality of having a home birth before the fourth day, but it was at that time she was able to verbalize it to the rest of us.

She gathered her belongings and headed to the hospital, begging for an epidural. After an NST and a vaginal exam, the doctor sent her home with a prescription to take 50 mgs. of Benadryl to help her sleep. It did nothing but make her groggy and it difficult to cope with the back pain. Another trip to L&D several hours later, for more help with the pain, she was sent home this time with an Ambien; she didn’t take it knowing it would just make her groggy again. Instead she went home and cried because they kept sending her home. She was now 2 cm.

Then the last time she trekked to the  hospital, they kept her. She was then 3 cm – the magic number the CNM said. Within 45 minutes, Amanda had an epidural that subtly diminished her back pain. I say subtly because the back pain broke through the epidural four times and the anesthesiologist had to come give boluses to stop the horrible pain from coming back again. The PCA did nothing to aid the discomfort, only the boluses.

Right before her last trip to L&D was when Zack took the case. He went to Amanda and Kevin’s and helped press on Amanda’s back, something Kevin had been doing even as he tried to sleep. Zack went over to give Kevin some time to nap, but he said he had his second wind (or fifth?) and was okay. Both the laboring partners were too tired to know what to do next since they’d been sent home yet again so recently, so Zack called me and I listened to Amanda in pain and said it was time to go to the hospital and NOT let them send her home. I gave her the words to use so they wouldn’t send her home again, even if she wasn’t “the magic number.” I told her to tell them she was not going home without a baby. That she was in excruciating pain and needed relief. I told her to tell them she hasn’t slept in days and she is not exaggerating, but telling the truth (and she was… not even naps between contractions were possible). They got off the couch and got in the car and went to the hospital, Zack behind them in his truck.

At the hospital, Zack introduced himself as the doula and the nurses kept saying they had never seen a male doula before. It was Kevin who coined the term “Doulo” and it stuck with Zack during the labor and birth. One of the nurses in triage was very confused about his being a doula and Zack off-handedly said it was okay, he’d had a baby himself. She, of course, thought he meant he was a father, but Zack tried to clear it up saying he had had the baby himself. She didn’t believe him that he’d been born a woman. Talk about a confusing moment! The topic never came up again during the labor, but it sure will during Amanda’s birth story over the years.

When I asked Zack what kind of doula things did he do he ran down the litany of chores one does while doula-ing: fetching water, ice chips, hot and cold washcloths, changing the chux on the bed (something not all doulas do; it isn’t in the standard doula repertoire), helping move Amanda’s totally numb legs to change positions in bed, rubbing her back when needed and keeping the room comfortable, atmospherically and physically. That all sounded doula-like to me!

I’ve asked Amanda how Zack was as a doula and here’s what she had to say:

"Zack really was incredible. In a birth story that could not have gone more haywire if it tried, at least without becoming a tragic story, Zack was really our knight in shining armor. By the time Thursday rolled around, which was day 3 of labor and day 4 of no sleep and little food, Kevin and Icould not really think straight any more. We were running on fumes and willpower alone. But, Zack came in and started giving us direction that we really needed, taking over massaging my back, which was by then black-and-blue because the massaging had been my only source of distraction from the back pain for days at that point, reminding Kevin what he was doing (Kevin was trying to do 4 to 5 things all at once and had been for days, poor guy), and even calling you at the appropriate times to help convince us it was really time to do certain things, like head to the hospital for the third and final time and, of course, to help make clear the reality that a cesarean was necessary by Friday (day 4 of labor) morning.

Kevin was an amazing birth partner and was doing everything I asked and more without complaint. But, by Thursday (Laboring Day 3) we were both made a bit crazy by this whole experience and Zack really brought that element of "sanity" that we needed. He really stepped up for us by handling all of the "to dos" of a Doula (doulo, in his case), but it was the moments of quiet emotional support he provided that I will forever remember.

On Laboring Day 3, while on the couch and just before our final trek to the hospital, Zack had taken over massaging my back and during one of my contractions he said, "You can do this, if you want. But, you do not have to. NO ONE will judge you for going to the hospital." While I knew that, I needed to hear it. I was holding out for this birth that we had planned LONG after I had already reached a 'breaking' point of knowing that it would probably not happen for us with that pain and drained of all our energy, all because I wanted to have this wonderfully powerful natural/home birth story to share. But, it would not have happened safely and it would not have brought me the wonder I was seeking to have caused Giovanni any harm by trying to stick it out for the sake of that story.

Zack (along with you and Kevin) made it okay for me to let go of the home/natural birth story that I hopelessly clung to and finally go to the hospital and demand that they take me. The other moment I will forever remember was on Laboring Day 4 (Friday), when I was stuck at 5 cm for 6 or 7 hours and we were slowly making the decision to have a cesarean after the Dr. & CNM both said that they did not believe I would have a safe vaginal delivery and that now was the time to make this call, before something started to go wrong for either Giovanni or I (I was not thinking at the time how we BOTH had been laboring for 4 days by that point). I was a wreck - crying over both the home birth and the natural birth story that we had lost at that point and realizing that in that next moment we were about to lose the vaginal birth story we had hoped for too, Zack came over to me, grabbed my hand, leaned over the bed bar close to me and whispered, "I know that you are upset and you have every right to be. But, you can deal with this later, and you will. But, right now, you are about to meet your son. Be here." It took me a few moments of looking into both Kevin's eyes, Zack's, and back to Kevin's again to know that Zack was right and that, while I needed to give myself the time to grieve at some point, RIGHT THEN was not it. It was time to shift gears and be ready to meet my son. And, I really needed to hear that because that moment of meeting Giovanni was so magical and I believe that I would have regretted being stuck in my selfish spiral of what I had 'given up' during those days of labor delivery rather than being present to experience howwonderful that moment of meeting Giovanni really was.

And, it was magical - despite being in the hospital, despite having had an epidural and several other interventions at that point, and despite being in the O.R. when I met him, it really was magical. And, I appreciate Zack for knowing what I needed to bring me back into that moment. Those are the things that I will forever remember and forever thank Zack for bringing to our L&D story. Things that we may have or may not have come to on our own, but they happened when they did and when they needed to because of him. And, I will be forever grateful that things went so 'wrong' so that we could still have an amazing birth story - just one involving a rare "Doulo" instead of the birth story that we *thought* we would have."

I have to say, I’m so proud of him! I mean, I taught him how to be a doula over the years… his watching me when women came to our home to labor way back in the 80’s, reading my blog for eons, listening to birth stories ad infinitum and being around my clients for the last 27 years… and he did assist me with my last few midwifery clients (and was the best assistant I ever had), but he still added his own personality when it came time for him to doulo for someone all by himself. No woman could have any better doula than my man.

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    Response: news
    Superb page, Preserve the wonderful job. Thanks.

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