Saturday, April 21, 2012

Deciding to Do the Doula Thing

When I was pregnant with Eliza, I knew I wanted to hire a doula to be a support system during labor and delivery.

Of course, when I was pregnant with Eliza, I knew lots of things.  I knew I wanted a non-medicated birth.  I knew that I wanted a husband-coached birth (with doula support).  I knew that if I ate enough protein (carefully tracked in a notebook, of course), and did all the right exercises (prenatal yoga, but also labor relaxation practice) and read all the right books (you name it, I read it), and got plenty of sleep, and listened to my hypno-babies CD every night before bed, that I would have the perfect birth and the perfect baby.  I would have earned that, right?

And then the bottom fell out of my world and I didn't know anything.  How did I go from being a low-risk pregnancy and a fully-informed advocate for myself and my baby to having my baby die?  What had I missed? What had I overlooked?  How could this possibly have happened to me?  I had no answers.  I knew nothing.

I didn't trust myself.  I didn't trust my body.  I didn't trust my research.  I felt like such a fool.  A heartbroken, ill-advised, know-nothing fool.

It's been hard for me to figure out how to balance all of the information I sought out and readily absorbed the first time around with my cautious approach to the "if's" and "hopefully's" of this pregnancy.  As I've mentioned before, I haven't done any reading about pregnancy this time around.  I'm not doing prenatal yoga on a nightly basis.  I'm not tracking how many grams of protein I consume (although I do think about it a lot).  I'm not visiting breastfeeding groups, I'm not taking classes, and I am not going on a hospital tour even if I decide to deliver at a different hospital.

I still find that I can't really see past 34 weeks.  And yet.  I have what is known as a Viable Baby in this belly, and one way or another, this baby will come out of me sometime in the next 11 weeks.  (I'm still not sure I've fully absorbed that).  My non-stress tests start Monday, so I'm officially Almost There.

I think that the most motivating factor, though, has been the number of people I've come to know who having babies after losing a child.  Many people in my "generation" of bereaved parents, who had a loss in 2010 or early 2011, are now holding their "rainbow" baby in their arms, or anticipating having that baby any day now.  It's made it seem so much more real and possible for David and me too.

We've talked only a little bit about what labor and delivery might be like.  Would we be happy?  Would be overwhelmed by post-traumatic stress?  Would we be scared out of our minds?  We haven't said much about this because everything is unknown.  I know my OB will absolutely be there to deliver this baby (bless his heart), but I don't know which hospital I'll choose, I don't know what my emotions will be (except, probably, all over the place), and, worst of all, I don't know that we'll end up with a baby to bring home.  I'm hopeful, but it still feels like a big fat maybe.

Anyway, back to the doula thing.  We'd hired a doula for Eliza's birth--a nice lady whose website I found online.  We met up with her at Bread Co. and chatted for about an hour.  She was fairly new to the practice, so her price was lower than some others I'd looked at, and she seemed friendly and reassuring and excited to work with us.  We planned to meet again a few weeks before my due date, but that never happened since I went into labor five and a half weeks early.

The night Eliza was born, of course, we didn't even call the doula until it was all over because neither one of us thought about it.  David and I were both in complete denial that my labor was progressing so quickly (remember, I was fully dilated by the time we got to the hospital after about two hours of tolerable contractions, and I had NO CLUE that first time labor could happen that way--I believed on the whole car ride over that they were going to give me medicine to stop my contractions.  So much for being aware and informed...).  David called her after and explained what had happened and she offered to come up, but he said that wasn't necessary.  She later mailed us a sympathy card and refunded our deposit.

I wasn't sure if we would want a doula this time around.  For one thing, I've done this before, under the worst of circumstances, and managed.  For another, I have superstitiously wanted to avoid replicating the things I did with Eliza.

But after our 20 week scan, I started thinking about it a little differently.  I have no expectations for an ideal birth this time around.  But as a friend said to me last night at dinner, there's no reason to think that I automatically won't have the birth that I want.  So, in an ideal situation, I would absolutely want to have a med-free birth with a happy ending.  I would love to have another experience of labor and delivery that ends happily.  I would love to prove to myself that I can do this again, that I can trust my body and myself to have a healthy baby.  I would love to get a chance to share that experience with David.  And I know from all the research I did last time that a doula can help make that process easier for us.

I also know how scared I am.  I know that if someone in a white coat with a stethoscope tells us to do something, I would do it without question, even if it was for that doctor's convenience rather than the health of my baby.  I'm more than willing to have a c-section if that's the best choice for the Deuce, but I don't want to make that choice out of fear without understanding why it needs to happen.  I don't imagine that I will be in much of a position to make rational and informed decisions once I'm in labor with the Deuce.  And I don't want to put David in a position where he doesn't know what to do and is scared for me and scared for the Deuce.

After talking it through, it just seemed to make sense for us to have someone else there, someone who would support us no matter what decisions we make (last time I swore I would avoid induction if at all possible--this time I would really prefer not to go past forty weeks...), and someone who would advocate for us, ask questions and get clarifications.  I also would like to have someone there whose perspective of birth is happier.  Someone who can remind us both that the vast majority of babies are born healthy.

I should add that I absolutely adore my OB.  He is not only kind and compassionate, but extremely smart.  He is soft spoken and has a calm and soothing demeanor.  He also has a sense of humor.  And, most remarkably (this is based on what his patients and colleagues say about him), he's one of those doctors who can perform a flawless c-section under pressure, but who can also sit back and respect a mother's wishes to have a natural, med-free delivery.  I know he will be fantastic, but I also know that he won't be there to hold my hand throughout my entire labor and delivery.  I also know there's no guarantee I'll get the amazing nurse I had when I delivered Eliza (bless her freaking heart).  If the Deuce arrives before 37 weeks, I'll choose to deliver at a different hospital, the one with a bigger, better NICU, which is also just a bigger hospital (they call it the Baby Factory) and less natural-birth friendly.  It's true that having a med-free birth is no longer the priority it once was, I don't want to lose that opportunity for no reason but my own fear.

So we got in touch with a doula--one whose card I'd picked up when I was pregnant with Eliza but who was more expensive than the doula we'd chosen before.  I knew that she was well known in the local area, offers lots of classes, is very experienced, is also a certified lactation consultant, and a real-life friend of mine had used her and liked her very much.  She called me back right away and was very kind and sympathetic about Eliza.  Most importantly, she assured me that while she absolutely supports and helps with strategies for a med-free birth, she will support us in whatever decisions we make (after all, that's what we're paying her for). She has attended over 650 births and has worked with a couple of other people who've had babies after a loss.  Her doula services include two home visits before the birth, unlimited e-mail and phone consultations, staying with us for the duration of labor (I don't plan to do much laboring at home, so she'll probably meet us at the hospital), sticking around for a couple of hours after the baby is born, assisting with breastfeeding, and visiting us at home within a week to talk through things.

We met with her back in February for an interview, and I know you're supposed to interview a few doulas and see who seems like the bet fit, but that idea was too daunting.  She was it.  There was no way I was meeting with other people and going through our story and explaining why I wanted to hire a doula but not really talk in detail about actually giving birth...  ugh.  One interview was hard enough.  So we signed a contract and sent in our deposit.

She came over to our house earlier in the week for one of our visits, and I was relieved to discover that I still liked her.  In fact, I liked her more than I did the first time (maybe because I wasn't quite as freaked out about the whole "jinxing" thing).  David asked her a lot questions that I didn't even realize he had, and I saw how anxious he was about being able to support me and advocate for the baby and make the right choices.  I know it will help us both to have someone else there who understands (as much as she can) what we've been through and where we're coming from, but who is also more objective than either of us could possibly be.

To be honest, I was surprised that this felt like something we wanted to do.  But after our meeting, I felt positive about how things might go down.  It really felt like a move in the right direction, an acknowledgement that good things are possible.  We are all too aware that we can't predict the future, but I'm also trying to remember that we don't have to live in constant dread of the worst case scenario.  Sometimes the right thing to do is to actively assume that the ideal IS possible, and to do what we can to make that happen.  We certainly can't control much, but  I can control this decision.  I know it's not the right choice for everyone, but I'm glad to say that I feel good about it.

17 comments:

  1. I am so so glad you found a doula you like. And that you had the courage to find one.

    I would be kinda surprised if they "wanted" you to go past 40 weeks, anyway. But hopefully The Deuce will be nice and cooperative and come around 37 weeks perfectly healthy.

    For the record, I am personally comfortable delivering at one of the non-"baby factory" hospitals anytime after 34ish weeks, really. I mean, with Luke, my OB just assumed I wanted to deliver at baby factory and so I just went with that because it seemed logical after my first was a 23weeker, but now that I've been there done that, ugh...I'd rather have a homebirth and let Joe attempt a c-section then going back "there". (And I am NOT a homebirth type at all! Okay, not really, but I would absolutely trust any other hospital that has a basic level NICU in the area just as much if not more than "baby factory".) I have heard enough about their NICU from other pre-e moms that next time I will absolutely go out of my way to avoid delivering there if at all possible. It's not that they aren't competent, it's more that they are jerks, and I heard that the people who work in the NICU for the most part aren't a lot (or any) better than the people who we dealt with in the regular nursery. I thought maybe it was just me but that turned out to be the consensus from pretty much everyone who had a nicu stay helping coordinate the pre-e walk.But I can totally understand if you feel the most comfortable knowing you'll go there before 37 wks, I was the same way.

    I am so excited about you starting monitoring, the rest of this pregnancy will fly by once those appointments start! Hopefully The Deuce will be nice and cooperative for the monitors. Bring a book, though!

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  2. So many decisions, thoughts and questions to consider, along with the fear and hope and ritual and everything else. The layers of subsequent pregnancy are so thick and fraught with confusion. And in the end, we just want a live baby, something that seems so simple, so straightforward, just like everyone else gets to have. It's a lot to keep in the head and heart.

    I don't regret having our doula around with our first baby for one minute. She was so kind and smart and helped me remember all of the stuff I had learned in our natural birthing class. And even after Kari gave into the drugs after 21 hours of labor ("I hate that stupid class! I'm not even opposed to drugs! Give them to me!", she was still great to have around. :)

    We're thinking of you guys all the time and hoping the deuce keeps on marching on and on until baby is in your arms.

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  3. hey brooke,
    we delivered after the horrible loss of otis, and it absolutely impacted our plans in the way you talk about: priorities change.

    I was induced, and instead of being flipped out about my plans, I felt good that my OB knew what she was doing to take care of all of us.

    We also had a doula, and she knew where we were coming from, which was very helpful. I opted for an epidural kind of late in the game, and I am STILL glad she was there. She was very helpful with pushing and taking care of us and meds didn't change that. Also, it was one more person in the room who had an idea of options and things that might make us more comfortable. Because I knew I could override any of her suggestions at any time that just felt like a resource.

    I'm so impressed by this process of yours--making decisions for the Deuce in a really awake and informed way. Informed by fear, of course, but also informed by what's best for your family.

    xo
    ashley

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  4. I think a Doula is a great idea. In fact, I think given what you have been through, is even more reason to have one. I had entertained the idea a little bit but kinda wish I had more.

    I wasn't against meds, but wanted to at least try a med-free birth. Mostly because I wanted to feel Finn move the entire time I was in labor and know he was ok. I ended up getting an epidural and while it did allow me to enjoy the rest of his birth and really feel good during that time, I do wonder if I had a doula, if I could have gone med-free as it was less than an hour after getting my epidural that Finn was born. Go figure.

    I also think a doula will be great when you feel worried because you have those feelings of doubt in terms of trusting yourself and your body. You've been through so much, a little extra support will be wonderful.

    Glad you've got the NSTs coming up - I always enjoyed sitting there, rubbing my belly and listening to my little guy move, knowing right then, all was well. I hope they bring you peace as well and mostly help the time pass!

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  5. I love that David was so inquisitive at the appointment and that he wants to be so supportive of you and the choices you make to bring The Deuce into this world. love that so much.

    I also like the idea of the doula and having a support person there who actually knows the who/what/when/where/whys so you can get more answers in the event you end up with a delivering OB who isn't necessarily as supportive as your current one.

    11 weeks... CRAZY!!!!!! :)

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  6. Brooke- you and David will be so glad to have someone supporting you. The great things about doulas is they are there to support both of you, not just the mama. My BFF is a Doula and attended both my births. My first birth was non medicated intervention free Bradley method. Ueah we went to classes for 3 months but my husband was very prepared. That being said I was worried that a Doula would take away from relationship and process Daryl had practiced. Daryl and I could not have been more glad she was there. Her presence Allowed Daryl to focus on me and not on all the other crazy medical stuff. It also gave him a break here and there at least to sit down for a min over the 17 hours of labor I had.

    With Camille she was there for the crazy and to here me sobbing and freaking out loosing my mind. Daryl was also grieving but in a different way and she allowed him to have space to talk with his brother and be by my side. She got to hold Camille and give her kisses. Fuck, now I'm crying again. But here's the thing. Happy or sad, Bradley or no Bradley, support for the TWO people experiencing the labor process is so helpful. I am wishing you so much luck in the coming months and am happy to hear you are making plans toward the arrival of the deuce.

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  7. Congratulations Brooke, that's a h-u-g-e step. A very hopeful one and I think one that you'll definitely NOT regret (for as much as you were wondering what preparations you would or wouldn't).
    Good for you, sister.

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  8. Well, I'm unfortunately in c-section land this time around because G had some shoulder dystocia and they don't want to risk it with another baby, let alone a boy. I've gone back and forth on it, but can't contemplate if something starts going wrong and he starts going into distress.

    Other than the horrid, overwhelming grief and terror, birth wasn't too bad for me physically. I would totally have done it again if I could. I think it's wonderful you're getting a doula, that you're still making choices and not letting the fear win out. Either way, though, we support you, because dammit, this stuff is really scary. And like everyone said, all we really care about is a live baby, a baby that outlives us.

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  9. It's wonderful you are able to take this step, I'm glad you made this decision. Sending calm healthy thoughts to you always.

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  10. "And then the bottom fell out of my world and I didn't know anything. How did I go from being a low-risk pregnancy and a fully-informed advocate for myself and my baby to having my baby die? What had I missed? What had I overlooked? How could this possibly have happened to me? I had no answers. I knew nothing."

    Oh. Absolutely.

    I loved this post, Brooke. I think you've made a brave decision and I hope like crazy that the Deuce not only lives and comes home to live happily ever after, but that you get the birth you want.

    Cheering you on every single day.

    xo

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  11. I had also prepped (a little obsessively) for a drug-free, husband-coached birth the first time around. My mother has experience as a doula, so she was going to be there too. But everything went out the window when Elizabeth showed signs of major distress from the start of labor, and I had a c-section. We are not trying for a VBAC, so it's a scheduled c-section this time around...But we've taken the unusual step of hiring a doula for it. I just want someone who knows and cares about us but is not emotionally involved (read: not my mother). I want everyone else to be totally focused on baby dragon, so I feel like we need this one person who tries to make sure that my husband and I stay a little sane through the process. And also she is tasked with keeping away any clueless nurses, so I don't slug them.

    Which is a long way of saying - we have made the same decision (with different plans), and I think it's a good one.

    Enjoy the extra testing! I know that sounds weird, but I started my NSTs a week and a half ago, and I LOVE them. They are definitely my favorite two hours out of the week. It's so comforting listening to the heartbeat and getting to see her on the US monitor every few days.

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  12. I'm glad you found a doula that you like. I have no doubt she will help you get through everything just a little smoother.

    I think you should deliver wherever you feel the most comfortable at any given point the Duece decides to come, but if you need a vote of confidence for the smaller hospital, I am a nicu nurse at one of those big high risk hospitals and I think we give excellent care. But I also wanted a non-medicated me and baby centered model (instead of a strict medical model) and I choose to deliver (and hope to again) at a hospital with only a tiny nicu for babes more than 34 weeks. If Bear had been (alive!) and needed more care, he could easily have been transferred to the better nicu only two miles away.

    Yay for feeling positive about some things!

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  13. You do it Brooke. Set everything up to have the kind of labor you want , and don't feel guilty for wanting something beyond just a live baby in your arms because that is what everyone on your team wants.
    I realize I get a little sensitive about others complimenting moms who do natural births because I'm jealous. I wanted that with my baby and then she died and I just did whatever they told me to do. And then this time around I guess I could have tried it but I was induced so it began so unnaturally...I feel that is one more thing taken away from me after everything else.
    I'm glad you feel good about it. I can believe you are only 11 weeks away.
    Also, I hope you connect with your NST nurse(s). We called our NSTs "Ice Water With Alice." They really get it in there.

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  14. I think it is whatever works that will keep you sane. If having a team of 50 doulas would help, I say go for it. Your birth should be the way you want it. I want no one in the room but my husband and doctor. If I wasn't so afraid of the consequences I would love to have a home birth with no attendents at all. My cousin in law is a doula and she offered her services free of charge but I decided not to go that route. I am glad that you are making a choice to have the labor assistance that will work for you. So close. The days are moving forward. Little Deuce will be here before you know it.

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  15. so proud of you taking this huge step. i know it was hard. and i'm glad you feel some comfort in your decision. i agree that it is a good choice to have another person serving as an advocate. especially after all you have experienced. sending you lots of love...

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  16. So glad you found someone that's a good fit for you, and that you'll be getting that extra support when the time comes for the Deuce to make his/her grand debut. : ) I don't think I'd even heard of doulas when I was pg with Katie. But then we started hearing about them through our support group (we actually had one client who was a doula, & another who became a doula after her loss). I decided that if I ever did have a subsequent pregnancy, I would definitely have one.

    Through our support group, we got to know the assistant to one of the best high-risk OBs in the city, who facilitated a support group chapter at the hospital where he practiced. We heard nothing but raves from our clients about both him & her. She eventually left his practice & became a doula, specializing in high-risk pregnancies & pregnancies after loss. I would hire her in a heartbeat. : )

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