Why do we need yet another person present for the birth of a baby? Won't another person take the place of the baby's father and interfere with his relationship with the mother? What is a "doula" anyway? These and many other questions are asked whenever a doula is mentioned.
The following story illustrates how a doula can enhance the birth experience for mother, father, and caregivers.
Birth Story of Arthur Alan
Written for Margaret, John and especially Arthur, by Elaine Montgomery, their doula
The birth of Arthur Alan was for me, the doula, a truly reaffirming experience. Once again I was exhilarated by the ability of a woman to concentrate and focus her efforts on the remarkable task which brings a new life into the world. A new baby, a new family, should be celebrated. Memories may be of hard work but they should be of extreme effort which produces the thrill of tremendous accomplishment.
This adventure began one day when Margaret was looking quite squeamish. I asked about the pregnancy and in the process asked if she might like someone with her for the birth. She and John decided this was a good idea. I arranged for a colleague to be my back-up and the four of us met to discuss Margaret and John's birth plan. As a couple they were very flexible but wanted to avoid any unnecessary interference, especially an episiotomy, and any pain medication. During her first birth Margaret's doctor has agreed to avoid an episiotomy if at all possible, however at the time of birth an episiotomy was performed without telling Margaret it was to be done or giving any explanation why cutting was necessary. To avoid the episiotomy we discussed perineal massage during the last month of pregnancy and got some perineal massage oil to use before labour.
Margaret's membranes ruptured at 0315. She phoned to say contractions were mild and she and John were going to hospital to be checked. I met them at the hospital.
The nurse, Joan, was excellent. She said everything was fine and the doctor would be called to get an order for discharge. This was a good opportunity to meet the nurse. She was off duty at 0700 but was returning again in the evening (12 hour shifts.) We would meet again and it was good to get acquainted before Margaret was in active labour.
At 0600 we had all been up for three hours. John suggested an early breakfast. Margaret had a few hard contractions so we lingered over food. After an hour we decided to return to our respective homes to sleep for a few more hours and await active labour.
By 1645 contractions were regular and we all returned to the hospital. After initial monitoring Margaret was able to get up and walk. During contractions she stopped with each tightening, leaned on John and concentrated. She was managing very well.
By 1830 walking was becoming difficult and Margaret wanted to go to the bathroom. Now she was more comfortable sitting than walking. She voided then did not want to move. The bathroom was relatively small so I stood beside and behind her to rub her back. John sat on the stool in front, leaned his forehead against hers, and held both her hands. Between contractions I gave shoulder pressure and massaged her head. The doctor, Rose, decided to stay at the hospital. Joan, the nurse from the previous night, returned. The team was assembling.
Contractions were now every three minutes and Margaret continued to concentrate and breathe deeply. At some point she whispered "Shh," when someone talked. From this time on she kept her eyes shut between contractions. We tried not to disturb her. Once I stepped out of the bathroom to throw my sweatshirt on a chair. Margaret said "where are you going?" I had broken her concentration.
Immediately after this I switched from hand back rubs to massaging with a back rub stick (a long wooden handle with two tennis balls at the end). Margaret didn't want this. The familiar "Don't touch" ended all back rubs. I was physically close but no longer did any massage. Rose had asked if Margaret and John would mind if there was a resident present. "No," was the answer, "As long as he does not do the birth". Joan had a student nurse with her. Margaret remained on the toilet for over an hour. She had reached an almost hypnotic state. The entire team checked in periodically, Joan doing fetal heart tones, Rose observing for signs of pushing. Everyone had become very quiet and no one was in a rush.
As Margaret began to show definite signs of transition I asked her if she would like to return to bed. "Not yet," she said. A few contractions later she said "Bed now, quick like a bunny." Zoom!! She was up and onto the bed. John and I could hardly keep up. She flopped on the bed on her left side. John sat in front. I tried to cover her with her gown and a sheet. No. She was too hot.
After a few minutes in bed Margaret was beginning to push. At 2005 she was fully dilated. She wanted to stay on her back. John and I traded sides. He held her right hand, I held her left. Gently she pushed. Everyone remained silent. Margaret pushed gently and effectively while remaining in her hypnotic state. Any encouragement was given by hand pressure. At one point John reached for something, maybe a kleenex, and lost contact. Margaret jumped, as though startled with an electric shock. "Where are you!!" she cried.
Rose and Joan quietly set up for the birth. Rose applied warm oil compresses to the perineum. As the head crowned we said quietly, "Listen to Joan." The head was gently guided out. Arthur Alan was born at 2020. There was only a slight tear to the perineum. John accompanied baby and Joan to the warmer while Margaret and I quietly discussed the birth. After her perineum was stitched, Joan brought the baby back and he begin to nurse. The new family was complete.
Several aspects of this birth were notable and remarkable. The quiet was unusual. From 1830 when Margaret sat in the bathroom until the birth there was no extraneous noise or talking. Communication was by touch, eye contact and body language. Once we realized that any talking interrupted Margaret's concentration all of us reminded each other to stay as quiet as possible. This included keeping the door shut, not turning on any noisy machines and using only absolutely necessary words. The atmosphere created was one of intense peace.
This labour reinforced how important a doula can be to both mother and her partner. Both John and I were in constant physical contact with Margaret during the last two hours. She was very aware if either of us moved. Any movement disturbed her concentration, yet each of us fulfilled a different role. Margaret and John created a space where she was safe to allow herself to enter the almost a trance-like state which was achieved for the two hours. He gave her the strength and concentration which she needed. As we said later, John gave Margaret strength, I protected their space.