The story of Baby M’s hospital birth after a pregnancy involving Hyperemesis Gravidarum.
I didn’t think that I would need a doula
Perhaps because of my own preconceived ideas or perhaps because I had never really been exposed to doulas, I had never thought of giving birth with one present. I was raised in a medical environment, I don’t really believe in alternative medicine and I don’t trust homeopathy. I don’t want to be judgmental of other people’s choices, but just give an idea of my mindset going in. A natural birth with midwives at a birth centre or a home birth were never on my radar: I heard that epidurals could slow labour down, but I had few illusions about my level of pain tolerance during birth. My plan was to give birth in a hospital, most likely with an epidural and if necessary with a cesarean. In short, I planned to give myself over to the medical team without very high expectations about my birth experience. As everyone says, a birth rarely goes according to plan and certainly never like in the movies.
A pregnancy and some fancy Latin words
What you hear a lot less is that a pregnancy rarely goes according to plan and certainly never like in the movies. In any event, not for me. No glow, no cute little baby bump, no chatting to the baby, beatific smiles while reading notifications such as “baby is now the size of a small mouse decked out in a top hat and boots.”
Oh no. Instead, I was stuck with constant nausea (Hyperemesis Gravidarum for those in the know). Imagine morning sickness, but on steroids, as if I were reading in a car with the smell of shrimps floating around me, 24/7.
Bonus: my suffering lasted far longer than the usual 3 months, it went on for 5 months full time and then was on again off again until I gave birth. Five months of misery, hanging over the vomit bowl that I kept with me at all times, addicted to pedialyte, incapable of gaining any weight. All of the “safe” medications for hyperemesis has no effect and my pregnancy began to be considered high risk.
I hated being pregnant. If I had to start all over again.. I would have done it again, but with fear in the pit of my stomach and a good stock of Ensure that would have lasted through the end of the world. Despite all the medication, a fantastic medical team and an ultra-present family, I was sick and desperate. I began to be afraid of everything around my pregnancy. It is really hard on your self-esteem, hard on your partner who is on the sidelines, and definitely taboo. You aren’t allowed to hate being pregnant – because it is natural. You are supposed to say “it was worth it all.” Instead, I was saying “help!”
We need help, stat
Doctors and nurses have other patients. It isn’t their job to tell you what to pack for the hospital, to explain what should/could happen in detail and to help clarify the choices that you need to make. They will not be with you for the entirety of your labour, even if they really want to. Which is normal: you aren’t alone in the maternity ward. But I had come to realize that I did need all of that. My partner did too. We needed a doula.
We arrived at this conclusion a bit late and we had specific needs: a bilingual doula (my partner is anglophone and I am francophone), open to a medicalized birth experience, direct and no-nonsense. We found one via a recommendation and her approach, which was based on informed consent, really spoke to us. I had the impression that the only consent I had given was to have a child (I know, that is the deal when you decide to have a baby, but let me have my delusions). In this context, it was good to feel a bit more like I was in the driver’s seat with my hands on the wheel. At this point, even a little finger on the wheel would have been enough! And having a doula gave us the conviction that it was possible, and informed choice played a large role in the prenatal meetings, birth and post-partum.
The big day
I remember my pregnancy in great detail, but giving birth is a bit fuzzy. I had been so scared of a traumatic birth, but in the end everything happened smoothly, mostly because I felt relaxed and supported by my doula.
My labour started at 6:30 am on my actual due date. I could hardly believe it at first, this happens less than 5% of the time, and I was going to likely have an induction in 4 days due to high blood pressure. To be this lucky felt like winning the 6/49!
My contractions, which mostly felt like light menstrual cramps, were 3 minutes apart rather than the 15 or 20 minutes more common in very early labour. “False labour” I told myself. Nevertheless, I texted my doula. When I described my situation she corrected my impression that there was anything “false” about it! She said that it sounded like the beginning of real labour and that she was on her way (even though she was coming directly from another birth). She was right, the contractions started to become more intense and at 11:30 we headed to the hospital.
At triage they said that I was only 1cm. Disappointing, but my doula had warned me of this eventuality. Considering how close together my contractions were, though, they decided to admit me. Yay.
After a bit of time in the bath and 6 hours without rest from the contractions, I took an epidural (I told you…). It didn’t really provide the relief I was hoping for. The labour progressed slowly, and in the evening they started to give me oxytocin to move things along. The contractions got stronger but were manageable.
A few more hours passed and the obstetrician recommended breaking my waters – there was meconium, but the baby’s heart rate was good. Everyone reassured me that everything was ok. Every decision was discussed with my partner and doula. I had time to weigh the pros and cons of each choice – I followed my doctor’s recommendations, but wanted to understand what was happening. This wish was largely respected by the medical team and reinforced by my partner and doula.
The Ob-Gyn also suspected that my epidural would need to be re-done – the catheter seemed to have been improperly installed. For several hours at that point, I had been trying to augment the doses, to the point where my legs were numb but I was still in a lot of discomfort from the contractions (a weird sensation that my doula helped me deal with).
The problem: the only anesthetist was stuck in the operating room, and I only had one extra top-up that I was allowed to have. The regular dose was not having any effect. We decided to keep this “Joker” since we had no idea when the anesthetist might be available. For the next three hours, my partner and doula helped me manage the increasingly intense contractions: massages, peanut balls, moral support, all of this helped me stay relatively calm and avoid my increasing anxiety about when I might find some relief. Towards midnight, the anesthetist returned and re-did the epidural. Everyone was finally able to get a few hours of sleep.
Around 7 am, 24 hours after the start of my contractions, I was almost at 10cm. At 9 am it was time to push, everyone came in and got ready. Two medical students, a nurse, the obstetrician and of course my doula and the baby’s father-to-be.
Side note for those who are worried about med students and residents: this may be only my personal experience, but the two students who were there with me were extraordinary. Full of tips and tricks, very encouraging and present, they were some of the people who made a real difference in my birthing experience.
The pushing part lasted for 2 hours- I took it easy, when I felt the need to push. They gave me a bit of oxytocin to avoid dragging on too long. My doula and partner were really involved and helped a lot. When my baby was finally born, they put her on me, but she only cried once and was breathing with difficulty. The pediatric team took her to suction out her airways. I was in a total panic despite the doctor’s reassuring words. My doula went over to the other side of the room where the baby was and took photos so that I could see for myself that she was breathing. My baby came back to do skin to skin after only a few (very long) minutes. The rest is all a blur. I was worried that it would take time before I became attached to her (which would have been fine), but already I could think only of her. I knew that my labour had gone well and that physically, I had gotten off lightly- a tiny tear. My birth plan had been perfectly followed by the medical team: no episiotomy, cord blood donated to Héma-Québec, skin to skin prioritized (for both me and my proud partner) and my consent was asked for and respected throughout.
Summary
In total, the experience lasted 30 hours. My doula was with me the whole time, and came to do a post-partum visit as well. Thanks to her advice and preparation, I would like to say 4 things:
1) I would rather give birth again than relive my pregnancy. Despite 30 hours and many unexpected twists and turns, I realize I spent more time worrying about/fearing my birth than I needed to.
2) If I ever gave birth again it would be with a doula.
3) Taking care of a newborn is a bit of intuition and a lot of doubt. Having a doula by our side helped us to become more calm and confident parents. Coming from someone who is normally about as calm as a chihuahua on speed, this is worth its weight in gold.
4) A doula is not just for the person giving birth. They provide important support and tools for the partners that they can play an active and important role in both the birth and post-partum.
And a quick note from my partner:
“What struck me most about my partner’s pregnancy was the extent to which she was forced to relinquish control. Not just of her body, but also of her autonomy and of self-determinism. No matter how supportive or involved I wanted to be as a partner, there was only so much I could do in the face of forces I couldn’t understand. That sense of helplessness was difficult to accept, especially for a hyper-rational optimist who believes every worry can be reasoned out and every problem can be solved… with my help, of course.
But what she needed wasn’t more help. She needed to regain some of the control she had lost. To feel prepared for the tests of pregnancy and childbirth, to feel informed when dealing with her doctors and nurses during labor, and to be the amazing calm, collected mother she’s been in the weeks since our daughter was born. And she was on all counts thanks to having a doula. She was a source of knowledge, reassurance and strength throughout her final months of pregnancy, not to mention an experienced set of hands during our 30-hour labor marathon. Not just for my partner, but for both of us. The confidence I felt walking into the hospital, coaching my partner through her final push, and holding our baby girl for the first time stems in large part from the support we received from our doula along the way, and I’m forever grateful for that.”
