A Perfect Birth, Almost

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Rachel works a part time job at the birth center nearest to us (an hour and half away) on the weekends. In this capacity, she functions as an on-call nurse. She will frequently debrief her birthing experiences with me. I get to listen as a neutral third-party.  One of these recent experiences illustrates what an almost perfect birth looks like from our perspective.  

A Perfect Birth with a C-Section?

You may be surprised to learn that this “almost perfect” birth ended in a C-section, but please don’t stop reading. Doulas are not ultimately responsible for medical outcomes related to birth.  Rather, the measure of a doula’s success is in the level of support and care provided the birthing mother and family, regardless of the final medical result during birth. The other thing that is worth noting from this story is that the doula seems to be a minor player. Her role is often understated, especially in episodes such as this one. However, when each member of the birth team understands their role and diligently does their part, the level of support (and morale) is almost magical. Such was the case with the following.  

When Natural Birth Gets Complicated

The expectant mother and her companion arrived at the birth center with plans for a natural, non-medicated birth. A newly minted mid-wife was in command. My wife was the attending nurse. The couple also had with them a doula of their own choice.  The labor was progressing well. Mother’s vitals were good. Baby’s vitals were also good. As dilation of the cervix neared completion, the bag of waters broke. A routine check of cervix by the mid-wife revealed a condition where the umbilical cord was underneath the baby being pushed out ahead of the baby. This is an issue because the umbilical cord provides life support to the baby until it exit the mother’s womb.  With blood flow literally being clamped by the downward pressure on cord, the baby’s vital signs began to suffer.  

A Calm Response to Emergency

The mid-wife responded calmly.  In what suddenly became a race to save a life, the midwife chose to not respond in a way that would create undue stress for mother or family. She first positioned the mother on her hands and knees, resting on her face with her back-end up in the air. The mid-wife then began pushing against the baby and uterus. This provided the counter-pressure needed so that the cord was no longer being clamped.  The baby’s vitals returned to normal. Then with that same determined calm, the midwife gave orders for the paramedics to be called. Within moments, paramedics were in the birthing room.  They were instructed not to question what was happening, but to follow the mid-wife’s instructions. Their job was to get the mother to the hospital for an unplanned C-section. The emergency team obliged without question. They loading mom and mid-wife onto a gurney in the same position: mom on her knees, resting on her face, back-end up in the air, mid-wife pushing against baby to providing counter-pressure. In this same position they were loaded into the ambulance, unloaded at the hospital, and wheeled into the operating room. No one questioned this mid-wife’s quiet resolve to keep the baby alive through this very unconventional means. When it came time for other trained medical professionals to perform their life-saving skills in the OR, the mid-wife was able to step out the way, and the baby was promptly delivered via C-section. Less than half an hour passed between the breaking of the bag of waters until delivery!  

The Doula’s Part in a Peaceful Process

So what did the doula do to assist in this birth? I pointedly asked Rachel this. The doula in this particular scenario was well-seasoned. She provided the unseen glue that made this emergent situation happen almost flawlessly. Throughout the birth, the doula was very good about attending to the woman’s needs. She was there before, during, and after the emergent situation. The key was her level of calm which matched the mid-wife’s peaceful directives. The mid-wife and nurse were focused on the key medical variables of the suddenly emergent situation. The doula continued to patiently attend to the mother and her emotional needs. When it became obvious that relocation to the hospital was eminent, it was the doula that started to pickup the family’s personal belonging. The doula answered questions that the family had about what was happening. The doula asked questions of the medical providers on behalf of the family.  

Doing What a Doula Does

The doula understood when she needed to be with the mother to provide support. Yet just as important, she understood when she needed to be out of the way to let medical personnel do the work that they needed to do. As the birth progressed to the hospital, the doula traveled with the family. She continued answering questions and providing support. The doula managed interactions with hospital medical providers. She was that constant face of support for the family. She kept everyone calm. Rachel was quick to point out that it was the doula who provided a level of support and comfort to the mother and family that Rachel could not do as a nurse. Her job as a nurse required her to be focused elsewhere.  

A Peaceful Birth Experience

So here we had books ends of the birthing experience: a mid-wife and a doula. Both exhibited the utmost calm and control in a potentially difficult situation. Both contributed to the the feeling of peace, despite the unexpected. Doulas are not responsible for medical outcomes at birth. Regardless of the outcome, the feelings of support can be greatly magnified by a doula and birth team that works together. So it is with this focus that we look at this unplanned cesarean birth as a nearly perfect, peaceful birth experience.