Birth With A Doula
A Physician's Personal Experience with a Doula
by Denise Punger, MD, FAAFP, IBCLC
The original version of this article was inspired by and written for Mother to Mother, October 2000, was updated for Midwifery Today's Birthkit, Fall 2003, and Attachment Parenting International's Annual Baby Issue, Winter 2005.
Labor and delivery were not quite what I had expected. I knew it would be tough but thought that my optimism, medical education, good health and family support would get me through labor with dignity. If it didn't, it didn't matter anyway because women are supposed to forget it all afterward. Four years later, I have not forgotten either of my two labors.
I wish our culture encouraged women to talk about how the birth experience made them feel, not just the sequence of events. Both my pregnancies raised feelings in me that I had never heard other women or physicians talk about. I was much better prepared the second time when I had a doula for physical and emotional support. My first birth was a "typical" birth; the second portrays a normal birth the way birth should be for every woman.
The Great Adventure
My first labor began around 4 a.m. after a long nine months. The early easy, rhythmic contractions lasted over 12 hours. In the beginning, I was hopeful and in control. When the contractions started getting stronger around 4 p.m., my husband, John, and my mother coaxed me into going to the hospital sooner than I had wanted. They were getting tired. It had been a long day without sleep and little food for all of us.
With the onset of unexpected vomiting and stronger contractions, my optimism was gone. The hospital room felt like it was 100 degrees. I was fatigued, starved and in pain, and it didn't matter how many years I had attended medical school or that I delivered over 200 babies in residency. I had been under some kind of delusion that if a woman was healthy, remained active and had a good diet, she might have an easier labor.
My "pushing stage" lasted three hours. I use the term lightly because I was waiting for the urge to push and never did feel it, which distressed me. I didn't know this stage could last over two hours. In residency, most patients would end up with a vacuum or forceps-assisted delivery or cesarean section if it did. It felt like one long contraction that would never end. There was no time to recover from the previous contraction.
I remember screaming, which was not part of my birth plan. I remember everyone eagerly watching my bottom, hoping a head would emerge. I was aware of the possibility of them seeing me push out stool, and it actually inhibited my efforts to focus. John and my mother were worn out after 16 hours, when I needed them the most. I had believed that all husbands and mothers made great labor support. In a traditional culture, this may be true, but today most men have never seen a woman in labor, and most of our mothers were sedated when we were born. Mine was. Prenatal classes teach us to pick a coach and bring that person to class, so you will both be prepared. The classes don't emphasize the importance of having an experienced female present.
After so many hours of pushing, I begged my obstetrician to stop the pain anyway he could. It was humbling to cry for the end. I cried for anything: the vacuum, forceps, episiotomy, cesarean section. It didn't matter at that point. I thought I would be better off dead.
Looking back, I am really grateful that my doctor respected my initial plan and waited for William to be born vaginally. At the end, the nurse put an oxygen mask on me, which seemed to energize me to push when instructed.
My doctor agreed to let William nurse, while he repaired the tear. I had forgotten that post-birth, women often shiver from all the changes in body fluids. Still having contractions and shivering, I was supposed to lie still for the doctor! Why doesn't anyone ever talk about how much afterbirth contractions can hurt? Labor was over, and the family focus was on the newborn. Who was my support then?
For the next several days it felt like my body had been physically beaten. My mother went back home, telling me that I would 'feel better soon.' My husband went back to work after two days. It seemed like everyone quickly forgot my labor. Feeling alone, I wondered if I was the only woman who was traumatized by her own labor. My mother revealed that she thought my hollering and lack of control was abnormal behavior. At the time, I had been insulted. Now, I realize my mother had never seen another birth and had no point of reference.
I wish that there had been an experienced female labor coach to tell us that my labor was normal for me, and that I did a great job pushing out a nine-pounder. I wish that someone could have helped me get into different positions so that I was not lying on my back with my bottom exposed to the world for hours. If I had had an experienced labor assistant, I might not have walked away from this birth experience frightened to have another pregnancy. Now I know that I did the best I could under the circumstances. The shame of it is that I had never even heard of a doula at that point. I strongly believe a doula would have helped.
One Short Year Later
I couldn't believe I was pregnant. I wanted another baby, but didn't want to endure three hours of pushing again. When I shared my feelings with my midwife, she recommended calling a doula.
My husband and I both felt better when we met Bernadette. It was a second chance to prove my body was normal. Bernadette seemed to know how to help. She helped us to realize how common it is for men to get tired, nervous, and pale seeing their partners labor. John felt relieved that he could play the role of a nervous father-to-be and not be 100 percent responsible for my pains, emotional state and birth memories. He would not have to starve and hold his bladder for the entire labor.
At the time, I suspect that my mother may have felt hurt or rejected that I asked a stranger for help, but now she realizes the importance of labor support. She may even have regrets about being sedated for my sister's and my births. Thirty-plus years ago, laboring woman weren't given a choice. But today we can make choices.
My second labor didn't start until my 41st week, giving me seven extra days to dwell on the upcoming event. Bernadette let me call her any time. She was always encouraging and put my mind at ease. When I thought I was in labor, she came to my house. It was my plan to remain at home as long as possible.
One night around midnight, my labor finally began. Because my family was asleep, I had some privacy and time without anyone nagging me, "Are you sure you're having contractions?" I also wanted to cuddle and cherish William. Soon he would have to share me with his baby brother. Many expectant women might not imagine their partners sleeping through any of labor, but for me, experience changed the priorities. The benefit was that John was awake, attentive and supportive to me in the early morning, when Scott was born.
Early on, Bernadette and I walked around the block. The night air was refreshing. She helped by reminding me to sip liquids frequently and to empty my bladder. Sitting on the toilet was especially useful because we automatically relax our pelvic muscles when we sit. Relaxed muscles meant that the baby would drop quicker. Sitting in the bathroom really seemed to make labor progress. Bernadette had a calm, soothing voice, a quality that my previous coaches lacked. She taught me how to listen to my body to know what stage of labor I was in. We laughed as I ceremoniously deposited a few stretched out maternity clothes into the garbage. I was social and optimistic—a sign of early labor.
At about 4 a.m. the contractions became much stronger. Bernadette seemed to know exactly where to put counter pressure on my back to minimize the pain. As my family gathered, I was irritable and blamed everyone for my pain a common behavior in active labor. Bernadette reminded us that labor was progressing well, and this was normal. She reminded us of the incredible work my body was doing. Her gentle voice helped to calm all of us.
I knew I had reached transition and was close to birth because I felt renewed energy, a trembling in my legs and buttocks, and the urge to push! In medical school, I remember determining dilation by an internal exam. As a physician, I was never taught to observe a woman's body language, mood and verbal clues to help evaluate her closeness to birth.
We took off for the hospital. I had several hard contractions in the car and an intense one while entering the hospital. I couldn't believe it, but I felt my baby's head crowning in the lobby. I could touch his head with my hand, and I felt like pushing. There was enough time in between contractions to make it to the delivery room. Scott delivered himself on the next contraction. A midwife from another group, who happened to be on the floor, caught him. Scott was a nine-pounder also.
I had uncomfortable afterbirth contractions and was shivering again. Bernadette stayed with us until I was stable and comfortable. William had been a natural at nursing. Bernadette wanted to make sure my breastfeeding relationship with Scott got off to a good start, as well, especially since I'd be tandem nursing now. She even came to check on us several days later. After seven years after, we enjoy each other's friendship, and I've supported her through a pregnancy, and we co-operate together to support other child-bearing woman. In a way, I wish the obstetrician from my first birth had been at Scott's birth. He would have seen the difference a doula could make. If I delivered babies, I would insist that all my patients consider having a doula. In anycase, I tell everyone who is pregant and listens to me long enough to hire a doula. It really makes me sad when I hear a mother tell another, "You'll forget it all anyway." Giving birth can be a rewarding physical and emotional experience one that you will never forget.
If you enjoy this article, you will enjoy the book Permission to Mother which includes the updated version.