To Doula or Not To Doula?

If you’re like most people, your first thought is probably: what is a doula?  A doula (pronounced doo-luh) is, in the most basic sense, a labor assistant (read more here).  I had never heard the term until a friend of mine used a doula nearly six years ago for her first labor and delivery.  I thought it a strange word at a time, and the concept itself seemed rather foreign as well.

When I was pregnant with Eli it didn’t occur to me to hire a doula.  A couple friends recommended it, but I figured, “well, my body is going to do this the way it’s going to do this, how would having someone I barely know there with me be of any help?”  Again, a naïve sentiment, but only in hindsight.  And only because my labor and delivery with Eli didn’t go well.  Had it gone well I probably wouldn’t have considered the idea this time around, either.

But here we are.

Initially I had an interest in hiring a doula because I knew I was going to be delivering at a hospital that is: 1) not very labor friendly in general, and 2) was not going to be supportive in the least of my attempt at having a VBAC.  I felt like having a doula on my side, helping to coach me along, would help to offset some of the anxiety I was feeling about my less-than-ideal birth location.

Why didn’t I just switch care providers/hospitals?  Long story short my husband, son and I had temporarily re-located to Michigan for seven months as my husband had work there.  I knew we’d be returning late in my pregnancy (34 weeks) and I love my OB in L.A., who had said from the get-go he would be supportive of my VBAC attempt.

Well, we’d barely been back in L.A. two weeks when our well-laid plans began to crumble.  My OB started telling me that I couldn’t say VBAC at the hospital and that we were at least going to have to schedule my c-section to make it look like we were “playing by the rules” (the hospital, for reasons I do not understand, had deemed me a mandatory repeat c-section). 

Then the avalanche of negative feedback kicked in.  How reviled is this hospital?  The first doula we interviewed refuses to attend births there because they are so labor unfriendly, but was willing to make an exception as a favor to a good friend of mine.  Then, three days later, at my first chiropractic appointment here in L.A., the chiropractor asked me why I decided to deliver at that hospital. 

“I really like my OB, and it’s where our insurance covers us,” was my reply.

“Well, your insurance also covers you delivering at X, Y, and Z hospitals,” he responded.  “How badly do you want a VBAC?”

I didn’t have to think long.  “Very badly.”

“I hate to tell you this, but you’re at the worst hospital in L.A. for what you’re trying to do.”

I couldn’t ignore the growing pit of anxiety in my stomach.  It felt so late in the game to make a switch this major.

Two days later I switched OBs and hospitals.  The following day I learned that my original OB threw out his hip and was going to require surgery and would be out for 6-8 weeks, minimum.  In other words, I would have had to switch OBs anyways.

The decision felt right.

The hospital I am now delivering at has midwives on staff 24-hours a day.  I decided this would suffice as support, that I would simply call a midwife in if I was struggling, or if this baby happened to be asynclitic as well. 

The reassurance that the hospital was now behind my decision to attempt a VBAC meant my anxiety levels came down, a lot.

I decided I didn’t need a doula anymore.

Well, for about a week.  Then I began to realize that while yes, my anxiety levels had dropped and I felt better about the environment I would be delivering in, I still was having some serious self-doubt about my ability to deliver this baby without medication (not an absolute requirement, but strongly recommended when attempting a VBAC). 

I wanted someone there with me that had been through this before, that could suggest techniques, reassure me in my moments of waning confidence, and generally offer guidance.

Doulas are a varied bunch.  There is a wide range of experience.  Some doulas specialize in massage or hypnobirthing or acupressure or… 

After speaking with a couple doulas, I found one close to my age, Gracie Davis.  She isn’t the most experienced doula I spoke with, but she had a c-section with her first and a VBAC with her second.  She immediately understood where my self-doubts were coming from, and having someone that “got it” suddenly became the most crucial form of “experience” in my book.  Her demeanor is so calming.  She has already worked hard to familiarize herself with my previous birth experience, my concerns, and my hopes for this upcoming birth.  We’ve talked about how she’ll communicate with me, what she’ll suggest, and how she should interpret my responses to her. 

I never imagined I would “need” so much extra assistance to get through this process.  Sometimes I feel like I should be able to buck up and just do the damn thing.  But knowing that had I been better educated AND had a doula last time that my labor and delivery experience may have gone differently … well, I want to know I did everything this time around, for the baby and for myself.

Hello, Fear and Anxiety

There are a lot of topics I’ve been thinking about lately, wanting to write about.  But when I sit down and try to compose my thoughts, they come out incomplete, disorganized, at times incoherent.

Sure, I had the flu, am still getting over this damn flu (I’ve never had a cough quite like this…), and am now 36 ½ weeks pregnant, which let’s be honest, disqualifies me from putting together a coherent thought, let alone several strung together.

This was frustrating me, greatly, until I realized the underlying issue: What I am really thinking about, almost constantly these days, is my upcoming labor and delivery.  I hate to admit that I am more nervous this go-round. 

Here I thought that after having my first child I would feel like a “pro” of sorts when it came time for the show, but instead, in my wavering confidence over “should I or should I not attempt a VBAC?” and “What if I end up having another emergency c-section?” or “What if there are complications?”  or… I find myself steeped in uncertainty. 

I want my baby girl here, in my arms, without going through the unknown adventure that lies ahead.  It’s hard to believe now, but before I had Eli I was all confidence about the process, looked forward to it, even.  Sure, I was nervous, didn’t know how gracefully I would/would not handle pain, didn’t know what exactly to expect.  But I never doubted that things wouldn’t go smoothly, that I wouldn’t be able to birth my son naturally.  My pregnancy had been uneventful, save for the typical ailments, and so there was no reason in my mind that things would change once we got in the delivery room.

Naïve?  Yes.  But looking back I long to be that person again, so sure about the process, so certain that my body would do what I wanted it to.  I have no true reason to think that things won’t go well this time.  Again, my pregnancy has been uneventful, complication free.  My heartburn/indigestion is starting to drive me bonkers, the sleepless nights are chipping away at me, but I know these things are temporary and so they are (mostly) easily dismissed.

I have been seeing a chiropractor in the hopes of keeping this baby in a good position, and so far all is well.  Nothing indicates a problem at this point.

And yet…

There is a part of me that can’t let go of the first experience, that is petrified that things will take a wrong turn somewhere and that I will end up in the operating room, again.  That I won’t get to see my baby being born, won’t get to hold her, see her for several hours after her birth.  These are the thoughts that eat at me the most.

The fear is irrational, but isn’t being pregnant a sure and sometimes constant path to irrationality? 

Then there’s the thought of leaving Eli while I am at the hospital.  The truth is, I have not been separated from him for more than five hours, ever.  It’s not my preference that this has been the case, it’s just the way it’s worked given our distance from family and my determination to breastfeed the first year.  So my anxiety not only involves giving birth, it also includes being apart from my firstborn for an extended time.

I am quite sure that in a few weeks I will look back on this time and think to myself, “Well, that was a waste of time and energy, letting yourself get worked up over nothing.”  But in the moment I cannot help it.  I sit here and watch baby girl drag her foot along my increasingly scary-looking stomach (holy stretch marks, veins, and bruised looking belly button this time around, yikes).  I make pacts with her:  “Be nice to Mom, okay?  Let’s just get through this together,” or, “Please don’t get stuck in there.  I promise you’ll like it out here.  Really.” 

I wonder if she senses my anxiety.  Unlike Eli, who was quite mellow even in the womb, she is active and I often feel like she is trying to beat her way out of my stomach already.

We are on the cusp of our next chapter together.  Part of me can’t believe this pregnancy is nearly over.  It has passed so quickly I often feel as though I haven’t slowed down enough to marvel at the process.  Then my brain takes over and wishes her here, now, so I can sit assured, knowing all will be okay. 

I’ve realized that the impending labor and delivery process probably never gets any easier, no matter how many children you’ve had, or how well the process has gone previously. 

I just get disappointed when I let my previous experience cloud my confidence, rattle my nerves.  I know my body is capable of doing this the way it is meant to, and I hope to report very soon that we have welcomed our newest addition: a healthy baby girl.

To VBAC Or Not To VBAC

Sometimes it can't be avoided: serious topics. And I'm struggling to find much humor in this one.

At my last OB visit, my OB-of-the-day (there are four in the practice) wanted to talk about my upcoming labor and delivery.

An aside: this is my temporary OB as we have re-located for my husband's job … we are supposed to be back in L.A. before babe #2 makes her appearance. And a little refresher: Eli was born via c-section due to an abruption. There was also an issue of my pelvis "not opening," or so I was told, so I was also labeled as “failure to progress.”

At the visit, my OB told me that since my pelvis didn't "open" last time there isn't much chance of it doing so this go-round, and that I should seriously consider having a scheduled c-section.

I listened to her reasons and came home. My OB back in L.A. has told me I'm not the best candidate for a VBAC (vaginal birth after cesarean), but in previous visits, told me he would at least let me try.

As the hours after my appointment passed I found myself becoming more upset and emotional. I do not want another c-section if it can at all be avoided. I realize if it's scheduled, meaning: if I don't have the 20+ hours of labor, the abruption and THEN the c-section that my recovery will, in fact, be better. But it will still involve a surgical procedure and me being stuck in bed the first day attached to a catheter and those funky inflating leg warmers to ward off blood clots. I won't be able to immediately bond with or breastfeed my baby. I won't be able to hold her. This is devastating to me, again. Then there are the risks of having a c-section in the first place, and those do not diminish for repeat c-sections.

What I kept wondering was: Why are my healthcare providers so convinced my body isn't capable of doing this?

I went online and decided to do some research.

I posted a thread on Mothering.com (home of Mothering magazine). I know this particular crowd is pro-VBAC, homebirth, midwife, natural birth, etc., and I figured if there was an audience that would encourage and support me in my endeavor to have a VBAC this would be the place.

I laid out my birth experience and asked if any women had had a similar pelvis issue and gone on to have a successful VBAC.

It's worth noting that Eli was asynclitic before I went into labor, meaning he was head down, but slanted off to the side a bit. He was like that for several weeks before he was born, didn't flip for the longest time and was actually quite lodged in there. It was for this reason he was born with torticollis and plagiocephally (an issue with neck muscles; he also had a flat spot on his head). Well, come to find out his position was most likely responsible for my unyielding pelvis, as this is a common “side effect” of having an asynclitic baby. It's amazing what you can learn in an afternoon.

I dilated to a nine during my labor. Were it not for the abruption and had I been handling the sciatic pain (due to his asynclitic position) better, basically, if I had had more time (and no epidural), it's tough to say whether or not he could have been born naturally.

What I do know, after my frenzied research period, is that there are things I can do before I go into labor and even after I do, to encourage an optimal birth position for the baby and to prep my pelvic floor. I can visit a chiropractor, continue my yoga, hire a doula to assist me during labor with stretches and positioning to encourage the baby to move into a good position. Most of all, I will do whatever I can to avoid getting an epidural, as that hindered my ability to move around, thus ending any hope of assisting the opening of my pelvis.

These are all things I didn't know during my first labor, but none of them are absolutes. This baby may not be asynclitic. My pelvis may open if she is in the proper position. Will I have another abruption? There is no way to know. It is the one factor I cannot prepare for and the one big risk I will be taking in attempting a VBAC. Because I have already had one, statistically I am at greater risk of having another. That is frightening. Will it keep me from attempting a VBAC? I don't think so.

The point I’m trying to get at here is that if I only listened to my healthcare providers I would continue to believe that my body isn't "right," that it isn't capable of delivering a baby without surgery. In my heart I do not believe this. I was almost there last time. Had I been better educated (and supported) perhaps things could have turned out differently. That's the beauty of hindsight, and it means I will be better prepared this time.

I would like to think I've moved past my c-section. In most ways I have. All I have to do is look at Eli, at what a beautiful, smart, sweet boy he is, and I know the c-section, in that instance, was the right thing to do, it is what needed to be done to insure the safety of both of us. My problem is that without getting into the next labor, seeing how the conditions play out, I can't say with any certainty it would be the way to go next time.

Sure, if we get a few hours in and some of the same hurdles present themselves and we are not getting around them, well, I wouldn't hesitate to get the c-section. But if I can try and birth my daughter naturally, hold her, feed her, walk around with her on the same day she is born, well, that makes me tear up just thinking about it.

All I can say is be your own advocate. If you don't like what you're being told, do your own research and seek out the experiences of other women. Obtain and read your medical records. I guarantee they will tell you things about your medical history you did not know.

Ultimately, as was the case during my first labor, some conditions and issues cannot be prepared for and if that is the case, I will do what is best for the health of the baby. At the end of the day that is all that matters. But it doesn’t mean I don’t deserve a choice or a say in how my next birthing experience unfolds. I will prepare myself and hope for the best. It is all I can do; it is what I have to do.