#21: Doulas and Don’ts: My Cautionary Tale

Just over a year ago, the love of my life came into this world.

Most of you that know me know that there were complications when my daughter was born. I’ve been hesitant to share the details of this before, because it implicates myself and others in our poor decision making, and frankly, how it put my daughter’s life at risk. But now, more than ever, I feel like this experience needs to be shared. It is emotional clutter of the greatest kind, and has dragged me down for the last year. I’ve beat myself up over and over again about the way Joely suffered and almost didn’t make it in her first days of life. I need to let this go, but as a way of doing penance, I wanted to serve as a warning to other new moms.

When I got pregnant, I knew from the start that I wanted to achieve a natural birth. I didn’t want to be medicated, didn’t want a cesarean delivery, and certainly wouldn’t get an epidural. I planned to labor as much as I could at home, and at the last minute when I was very close to giving birth, I’d head to the hospital to safely deliver. There was even a time where I deeply considered having a home birth, despite the fact that it is illegal to have a midwife attend one in the state of Kentucky. I wanted nothing to do with the hooked-up, overly medicated and doctor-controlled environment of modern births I’d seen and heard about. And everything I’d read suggested that I hire a doula, since studies had shown that women with doula-attended births had better pain management outcomes than those who didn’t. So I did.

I met my doula when I was about 25 weeks pregnant. She seemed wonderful. She was so well-educated, was very “crunchy”, and was also a lactation consultant. I felt I’d hit some sort of jackpot, since she could help both during and after the birth of the baby. I explained my goals for my birth, and she seemed very jazzed.

At around 30 weeks, I was diagnosed with gestational diabetes. This isn’t abnormal for women with PCOS, since they usually have insulin issues. Many women with GD end up having larger babies, and this obviously terrified me as a first time mom. When I took this information to my doula, she eased my fears, and said that, essentially, it is a diagnosis that far too many women get, and had I let her know beforehand that I was taking the test, I could have prepared for it in such a way that I would have passed it. She also told me to generally disregard the information that the dietician gave me, and just to eat healthy in a way that made me feel good.

The other issue with gestational diabetes is with shoulder distocia. Many babies from moms with GD are born with larger shoulders, which are difficult to pass through the birth canal. This can lead to injuries or even death of the baby. When I relayed my fears about this to my doula, she basically stated that it was something doctors only talked about to “frighten” their patients into a cesarean delivery, and that she’d never seen a “true” case of it.

As my pregnancy went on, there were many times where my doula contradicted the suggestions and warnings of my obstetrician. When I was tested for Group B Strep, (a bacteria that the baby can pick up in the birth canal that requires moms to get antibiotics while in labor), she stated that I could get treated on an outpatient basis, and not need to go in right when my labor started.

To anyone who works in the medical field, I’m sure warning bells have been going off like crazy. Unfortunately, I was an extremely naive first time mom who trusted a doula who is well-respected by my community. From the start, my doctor was the enemy, someone to be dodged and avoided, my appointments and checkups to be feared, and my birth plan was to avoid my ob’s intervention at virtually any cost.

There were some wonderful things my doula did for me. She instructed me to sit on a birthing ball instead of a couch during my pregnancy. She walked me through what would likely be the course of labor and delivery, what to expect, etc. . She offered me some used cloth diapers and showed me her setup in her own home. We developed a relationship of trust during my last trimester, and I felt that she would be the right person to guide me through labor and delivery.

My water broke on Sunday, April 7th. I’d spent the weekend in a cleaning frenzy, not knowing that I was just padding my nest for the coming baby. I called my doula to let her know, and she encouraged me to rest as much as possible. I know my doctor was firm when telling me to go in right away if my water broke because of my Group B strep positive diagnosis, but my doula was experienced. She would never suggest for me to stay home if it were unsafe, so I called Colin, told him the news, and he came home from work. We ran to the store, and walked around, hand in hand, grabbing some light snacks for labor, some diapers and wipes, since we didn’t have any yet, and relished the last time we’d get to be out and about together.

I laid in bed that night waiting for contractions to come. They didn’t. I couldn’t sleep in anticipation of my little girl coming, and by the next morning, I still wasn’t feeling any contractions. But hey, my water had broken! I was on my way!

I got up, did a light yoga session, and called my family to let them know my water was broken. My mom and sister wanted to come down immediately, and asked when I was going to the hospital. I told them to wait, that I was going to labor at home for a bit, and that I’d keep them updated. Both Colin’s mom and my own mom seemed a little upset that I wasn’t going in yet, and pushed me in that direction. But I wanted a natural birth, and wasn’t having contractions yet, so I shoved off their suggestions, and said I’d call them when I went in. After telling my doula that I wasn’t feeling contractions, she suggested that it was time for me to do some walking and nipple stimulation with a breast pump, both of which were proven to bring on contractions.

It was at this point, since the urging of my mothers was nagging at the back of my mind, that I brought up that I was Group B strep positive again to my doula. (Most doctors recommend going in immediately after the waters break in these cases, since there is no bag of waters to protect the baby from anything inside the birth canal, and no later than 12 hours afterward.) We’d hit that point, and gone beyond. But she reassured me that the World Health Organization says you can go in up to 48 hours afterwards, and that I’d be fine to stay home. Again, I trusted the word of my doula, and walked around the neighborhood, hand in hand, with my sweet husband. I finally started contracting a bit while using the breast pump, but they were painful, irregular contractions that caused me to be unable to sit comfortably. I did this until the early hours on Tuesday morning.

By sunup Tuesday morning, I was exhausted, both mentally and physically. I’d slept maybe 5 hours in the course of two days. I texted my doula and said that we weren’t having any regular luck, and she stated she’d come over. At 5am, she said that I needed to go take a bath, let Colin get some sleep, and try my hardest to get a good nap in, because we needed to get my contractions going before the deadline of 48 hours. It was also at this point that she stressed the need for us to be “creative with the truth” with the doctors when we arrived at the hospital, because if they found out when my water really broke, they would take me or an immediate c-section upon arrival. We rehearsed what time we would tell the nurses on intake several times throughout the day.

I took a bath and a short nap, as directed, and woke up having fairly regular contractions that remained uncomfortable when I sat down. I ate a nice big breakfast of eggs and wheat toast, and let Colin sleep through the day. My doula and I chatted about all sorts of things. I vented my fears, talked about co-sleeping, and my contractions got closer and closer together. I started not being able to talk through them. And eventually, I became unaware of much outside of my own head. I stood at my wooden cabinet full of DVD’s, just moaning and swaying through each contraction, really starting to feel the pain, but working through it. My doula alerted Colin, and sent him for some supplements for me post-birth, and had to call him home; my contractions were very close. At 5pm on Tuesday, we were ready to head to the hospital.

A wild car ride through 5pm traffic later, I was walking to L&D, stopping every few feet to have a contraction. When I got there, my contractions were extremely painful, and the nurses kept asking me questions to which I’d already answered on my pre-admit paperwork. To this day, I truly cannot remember which member of our party answered when my water broke. I was very deep into my contractions, but I’m fairly certain that both Colin and my doula said that it was 5am that morning. Colin acted as he was instructed all day long by my doula, who she trusted. I may have chimed in at that point as well, but my memory of much more than pain at that point is very fuzzy.

From that point on, I was on antibiotics. I was being monitored, and the baby seemed fine. I, however, was not. I was unable to sit down, which I now know is a sign of the baby being caught in the birth canal, but then, I didn’t know at all. My doctor was out of town, and a midwife at my practice was attending the birth. The first moment she saw me, I was screaming through a very painful contraction, and she immediately offered me a cesarean. I arrived at 7 centimeters, so why would I do that now? I was almost there! I refused, and kept on screaming, holding on to Colin’s neck for dear life, and sobbing between contractions.

Finally, at about midnight, after hours of hard labor, I gave in. I was working on about 8 hours of sleep in three days time. I couldn’t sit down, and my legs were about to give out. I requested and was administered an epidural.

After this, all three of us took a nap. My whole body was shaking in response to my low blood pressure from the epidural. But I slept. I awoke at around 3:30am, revived and ready to see my baby. I was still regularly contracting, but just couldn’t feel it. The nurses suggested I start some pitocin to jumpstart the contractions, and since I couldn’t feel anything anyway, I agreed.

At about 5:30am, I was feeling the pressure of the regular contractions. I knew it was time. I really loved the nurse I had overnight, and was determined to pop this kid out before she left and a new one replaced her at 7:30. They turned off my epidural so I could have a better grasp of where to aim all my push power, and we started to push.

And push.

And push.

We pushed. I pushed through the shift change, and saw another doctor for the first time since I saw the midwife the night before. He gave a glowing smile, and told me I was doing great, and that he’d pop back in to see me shortly. I pushed some more. I couldn’t believe the pain I was in. It felt like my insides were being ripped apart. But obviously, I was getting close. At around 8:40am, proclamations could be heard that they could see the head! “My god, look at all that hair!” I heard the nurse squeal. They rushed to grab the doctor, who appeared. I desperately wanted this baby to come out. I was tired, unmedicated for pain, and couldn’t seem to get this kid out fast enough.

I pushed as hard as I could, over and over again. I heard some muffled, concerned voices. “PUSH YOUR BABY OUT!”, one nurse screamed. Three nurses piled on top of my belly, trying to push, begging me to push with them. I couldn’t breathe. “I can’t breathe!”, I tried to say. A nurse screamed in my face, “IF YOU CAN TALK, YOU CAN BREATHE! PUSH YOUR BABY OUT, NOW!!!”

I felt a needle in my perenium. I screamed. I felt pressure, and without my glasses, saw the doctor and nurses scurry to the side of the room. I didn’t hear a cry. I just heard nurses talking in low voices, someone yelling, calling for the NICU, and suddenly, the room was empty except for my doctor, stitching up the slice he’d made, me, Colin, and my doula.

“Where’s my baby? What happened?”

“If you pray, now would be the time to do it”, my doula said softly.

For the next 15 minutes, we sat in relative silence. My body was screaming from the rush of endorphins after birth. I was high, but saw my husband crying. My sister walked in, looking excited, saying congratulations and looked around, confused.

Finally, a nurse came in. “She’s alive. A doctor will be in to check with you shortly.”

Breathe.

A doctor comes in. “She lost oxygen at birth. She had shoulder distocia. We’re not sure the extent of the injuries… We know the brain was impacted, her liver, her kidneys… It will take time to know the extent of the damage.”

A swift kick to my stomach made me breath again. I looked at my husband, bewildered. What had just happened?!

My doula took her bags and left.

We were moved to the recovery rooms. I saw my family. I didn’t cry. I was too high on the love potion that occurs post birth. I chatted with my family, laughed, and only a few hours after visiting hours were up did I realize what was really happening.

I showered my bone-tired body, and walked to the NICU. My daughter was attached to everything imaginable. When she was touched, every monitor seemed to go off, screeching, warning us not to get close. Doctors asked if they could treat her with a cooling cap to decrease the cell death in her brain, and of course we agreed. It seemed that they knew what they were doing.

I later found out that our sweet girl was septic from the Group B strep. Even for an oxygen-deprived baby, she wasn’t active enough. They knew something else was wrong. She was treated with antibiotics, anti-seizure meds, and a host of other treatments to keep her comfortable.

I left the hospital the next morning. I begged my own doctor, who had just returned, to release me early. I felt fine, just tired, and wanted to sleep in my own bed. I realized that I needed to start pumping instead of breastfeeding if I wanted my child to be breastfed at all.

My doula loaned me one. She made a mixture to help the inflammation from my episiotomy. I asked if we could have done anything differently, and she said that “If you’d had a homebirth, she’d be fine. We would have hung you up by your toes to get that baby out.”

My nerves were shot. I felt fully responsible. She suggested I sue the delivering doctor for malpractice, though now I can’t remember what she suggested as the reason.

A few days later, the doctor said that Joely had made enough of an improvement that I could try to nurse her. My doula was thrilled. We met at the NICU, and I attempted to nurse my girl. No luck. She simply wouldn’t latch. Doula pulled out a little device that dripped milk into the baby’s mouth as she suckled, which would give her the nutrients she needed even if she wasn’t properly latching. Joely’s NICU doctor came in, and was very upset. “Joely could aspirate on that! “, she exclaimed. My doula actually had the nerve to fight the doctor at this point, saying that it was nothing more than a slow drip, that she’d be fine.

The NICU doctor was so upset that she called Colin and I back to meet with her alone. She stated that Doula was no longer allowed in the NICU, and that there were plenty of hospital-affiliated LC’s who could work appropriately with the doctor for Joely’s care. We obviously agreed and apologized.

I realized pretty quickly after this that my doula did not respect doctors. They were the enemy. And from that point on, I was extremely hesitant to even see her face to face.

I want to make this very clear: I am not writing this to “out” my doula, although frankly, she should never work again. She gave me medical advice over and over again. She contradicted and undermined not only my doctor, but Joely’s NICU doctor after she had saved my daughter’s life. She is the sole reason I didn’t go to the hospital within twelve hours of when my water broke.

The purpose of this post was to strongly urge new mothers to understand the role of a doula in your pregnancy and birth experience. Doulas are NOT medical professionals. They are there to support your labor. I know many other doulas who understand and embrace their support role, and would never dream of undermining a doctor. If I am ever blessed with another pregnancy, I will hire another doula, and attempt another natural birth, because I really believe our bodies were made to birth babies without *unnecessary* intervention.

In my case, I was so afraid of intervention that I lost sight of what truly mattered: a safe delivery. Please, ladies, listen to your doctor. Do research. Know your limits. Don’t make the mistakes I made. Be an advocate for your own birth experience, but also understand what can and does go wrong. My daughter almost paid with her life for my own folly. It is through the sheer brilliance of her medical team and scientific breakthroughs that she is with us today.

Don’t see your doctor as your enemy. See him/her as your partner in the care of your body and your baby’s birth. Ask them questions. Prepare yourself for possibilities ahead of time. But don’t fight them. They have seen things that happen to women like me, and work tirelessly to prevent them. Let them help you!

My daughter defied every single obstacle put in her way. Doctors thought she had severe brain damage, and her MRI came out with a tiny little bruise normal for babies born vaginally. She was on anti-seizure medication until 7 months of age, and she has never shown a single symptom of seizures since. She says “mama”, “dada”, “hi”, and occasionally says “Bella”, which is her dog’s name. She cruises, crawls, plays, dances to music, and is generally a miraculous thing to behold. My child is beautiful. Her birth was a mess.

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**Edit**

After reading some of the comments, I wanted to make something perfectly clear: if I have additional pregnancies, and if my medical professional suggests that something needs to be done for the safety and health of either myself or my child, I will not hesitate. This experience has taught me that doctors are NOT the enemy. That being said, there’s nothing wrong with hoping to have a non-medicated birth, if that’s something your care provider thinks is well within your limits.

Personally, at my 6-week checkup, my OB stated that there was no reason I shouldn’t have vaginal, non-medicated births in the future, as long as the baby was healthy. But if my OB suggested I have a c-section or get induced for any health-related reason, I would be happy to comply with those requests, as she obviously has the care of my baby and me in the front of her mind.

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