The Last Minute Doula: Preventing C-Sections 1 mom at a time

Jan 6, 2011 by Jennifer More (Wolfe)

It was one of those crazy twists of fate

that Julie (not her real name) called me at 38 weeks pregnant and hired me to be her doula. She had attended one of my Meet the Doula Nights, she said, a few months ago and had been putting off hiring a doula because she wasn’t sure she needed one. As the due date approached, however, she began to feel like she wanted someone there, if not for her, to calm her husband and take some of the pressure off of him.

I greeted her husband with a warm “don’t worry, this is perfectly normal” smile

Two days after she hired me at 5am the phone rang, she was in labor. Having only met her briefly at a crowded Meet the Doula night months before, I had only a vague recollection of what she looked like. I listened to her describing her labor, contractions were 4 minutes apart and after some questioning I realized that her water had probably broken. I advised her to call her doctor and ended up meeting her at the hospital’s Labor & Delivery. I arrived only a few minutes after she did and found her in the hall doubled over. The doubt that I had that I wouldn’t recognize my client vanished as I greeted her husband with a warm “don’t worry, this is perfectly normal” smile and started talking her through her contractions. After the first one she looked up at me and said, “I am so glad we hired you!”A busy day in labor & delivery!

It turned out that this particular day was a popular one for birthing and all of the rooms were full. We ended up laboring on a gurney behind a curtain in the hall for two hours until a room could be found. By then contractions were coming fast and hard and she was dealing with them beautifully. Soon it was time to push and after pushing for about an hour we all started to notice that her perineum was beginning to swell. An exam by the doctor reveled that the baby was likely in a very low LOT (left occipital transverse position). Typically babies rotate out of this position into an OA (occipital anterior) position before birth however this baby was not budging.

OB was convinced she needed a Cesarean

I listened in on the conversation between the nurse and OB and gathered that they were planning on doing a cesarean. They came back to the client and prepared her for this seeming inevitability. The OB then recommended that Julie get an epidural to stop her pushing sensations and allow her perineum to stop swelling.

I pleasantly asked the OB if while we waited for the anesthesiologist, I could try some positioning with Julie to see if we could get the baby to turn. Her answer was short, “You have 45 minutes, then she’s getting the epidural” and she left the room. The nurse said, “Ok, what do you want to do?” I answered, “First, I wanna get this baby out of it’s lodged position in the pelvis, then get the baby to rotate.” “ok, just make sure the baby stays on the monitors as much as possible.” she said and left the room to go check on her other patients.

Just 45 minutes, please!!!

The next 45 minutes were spent first with semi inversions to get baby to move up, then pelvic tilts to get baby to rotate then for good measure, I pulled out Penny Simkin’s Labor Progress Handbook (which, by the way, I still use even after over 400 births and make it a mandatory part of all of my doula students birth bags…thank you Penny ) and put her in several other positions recommended for her baby’s presentation.

It’s a miracle???

After 45 minutes (on the dot) the OB and anesthesiologist walked in. In the hall I heard them asking about the status of the operating room. The OB introduced the anesthesiologist who started setting up for the epidural as the OB said, “I guess I’ll check you to make sure there isn’t a change.” The second her exam began her eyes widened, she looked at the nurse and said, “The baby’s right here!” Julie pushed 3 or 4 times and the baby was born. The anesthesiologist was still in the room packing up as first the cries of the baby were heard.

Conclusion

The circumstances surrounding Julie’s birth are fairly common, as doulas, and midwives, we know that position changes can AND DO absolutely help women avoid cesareans every day. What struck me as interesting was that no one, not the OB or the nurse, asked me what position changes or techniques were used to allow the baby to move into a favorable position for birth. I wondered if Julie and her husband knew how close they came to having a cesarean. I later received conformation that they did. Looking back on this birth, a couple of things became very clear to me.

First, when a surge of births happen at once at a hospital, nurses and OB’s have an amazing amount of pressure on them to get babies born and their first impulses can often be to follow the path that they see as inevitable.

Second, in these cases having a doula is much more than a luxury, and more than emotional support for the partner, they serve as a stabilizing force, 100% focused on the birthing woman, the calm in the storm of the chaos of a busy hospital.

Third, had I not remained pleasant and unobtrusive with the hospital staff I would not have been given the time I needed to help Julie turn her baby.

For more information about doulas, visit Dolphin Doula www.dolphindoula.com

For more information about baby positions, check out Spinning Babies www.spinningbabies.com

For a link to Penny Simkin’s book, visit The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia [affiliate]

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