Why even doulas need doulas, and other lessons from my own birth

It seemed pretty simple. I've birthed 2 baby's naturally, one at home, I've attended numerous births and I myself am a trained birth professional. Not to mention my wonderful supportive and knowledgeable husband. So, all I had to do was find good homebirth midwife, and we'd be set for another calm, lovely homebirth.

Lesson #1: Even doulas need a doula. Every woman deserves to be supported by someone who is knowledgeable about birth (experientially or through training), and who's only concern is the birthing woman and her needs. Because I was on my own, I was trying to anticipate my own needs, and it kept me (among other things) from succumbing completely to my body and my labor. And once my labor did take over, I was left without an advocate.

I asked for names of midwives in the area of the country that I was moving to. I got a few recommendations. One of them called me, she seemed nice and experienced, and she took the time to talk to me and address my concerns. I spoke to her a few times before we met, and although I kept thinking that I should at least call and "interview" some of the other women on the list, I was drawn in by the ease of just continuing with this midwife and not expending the effort of calling other people, telling my whole story, asking my questions, etc... Especially since this was happening in the thickest part of our hectic and frenetic move across the world - and then across this country.

The Schwell Aliyah Adventure: A brief history of the events of the past year
(The link is to my husband's blog, if you're interested in more details and pictures and videos!)

Aliyah is a Hebrew word meaning "going upwards." It's also the word for immigration to Israel (and in fact to leave Israel and move somewhere else is known as "yerida" going down! It can be said that the spirituality of this place is uncontested.)

and I were experiencing a need to transition from our current positions into something more directly connected with our purpose. (There's a bit more background to this story, but it's not for the "brief" version!) Suddenly I was overcome with inspiration, as if the Biblical words that God spoke to Abraham were being spoken directly to me! "Lech One balmy Friday afternoon last July, I was driving through the towns of Central Jersey to buy wine for Shabbat and a birthday present for my son's 4th birthday. I was at a traffic light, going over in my head all my hopes and dreams and wondering what our next step was. Both YoramL'cha...." Go forth from your land, your birth-place, your Father's home, to the land that I will show you - and you will reap all he blessings that are your birthright.

I know this may sounds cheesy, but it literally happened exactly that way.

I called Yoram, who was bathing our 4 and 1.5 year old and I told him, "Yoram, this is it! We just have to go." My poor, exasperated husband, being splashed on, and attempting to keep one child from drowning the other, asked me, "Go where?!"
"To Israel, Yoram, we have no more excuses to push it off! We just have to go."
"Right now? Or can we discuss this more when you get home?" I conceded, told him I love him, and continued on my errands, feeling teary and emotional. I chose a bottle of Golan wine, because it has always been our dream to settle down in that region of the country.

Over that Shabbat, we talked about it, and why now, and what the immediate next step was. Yoram, being the more practical of the two of us, was concerned, but the idea of fulfilling our life-long dream at last seemed within our reach.

Over the next few months we started letting people know our plans, started the process of applying for Israeli citizenship, getting information about the upcoming Nefesh B'Nefesh charter flights, and I called the realtor who had sold us our house only 2 and a half years prior.

"Alex," I said, "We're making Aliyah in Dec, and we want you to put the house on the market."
He laughed, for two reasons. "Ayelet, I have sold a lot of houses in this community and I can't tell you how many times I've heard buyers say, 'in 2 years we'll call you to sell the house, because we're moving to Israel.' You are the first ones to actually do it!" And the second reason was, that in September of 2008, the housing market was already plummeting, and he thought we were a little crazy to choose to sell at that time. (The house, by the way, is still on the market - a lovely 3 BR house in Hillside, NJ - we are entertaining all offers!)

In late November, we discovered more exciting news, I was pregnant! Our flight date was just before the end of the first trimester, and although we were excited and happy, we couldn't help wondering how this might complicate our move. High on the list of questions was comfort. Because we were moving in such a short time frame, we had decided to move to an absorption center apartment until we could research and find a community in which to live. Absorption centers are not built for comfort. We didn't know what to expect.

When we arrived, we were greeted by Yoram's brother and sister and their families who had already come on Aliyah. The kids made cute signs and although we were exhausted, we were glad to see them! We boarded a cab from Ben Gurion airport in Tel Aviv to take us to our temporary dwelling in Jerusalem. The apartment was tight. It had one bedroom, a slightly larger common room, and a kitchen that could be occupied by two people, or by one pregnant woman at a time. And there was no oven, just a hot plate with two burners. It was not arranged to accommodate a family of 4 (and a half). Somehow we managed for almost 6 months.

During that time, we realized that our original thought of starting off renting something in the Jerusalem area before moving north in a few years, was silly. Staying in Jerusalem itself was nearly impossible due to the prices of apartments that were far too small to accommodate our family. Aside from the fact that city life was not our first choice. So that left us looking into the outlying villages, but we were wary of moving into a small community and becoming settled, only to move to an entirely different region of the country in a few years.

So we started the process of moving north. It was like starting our whole Aliyah over again! In February, we took a week long "scouting" trip up to the Galilee and the Golan, visiting different communities, talking to people about homes, jobs, schools... In the Golan, we fell in love. We knew that was where we needed to be - just as we had always dreamed.

For most of March and April we were away in the States, visiting with family, enjoying my brother's wedding, and gave me the opportunity to attend an incredible conference for business owners that affected me deeply.

When we got back to Israel, we started looking at rentals in a few of the communities we had visited. With our time at the absorption center running out, both in terms of our tolerance for it, and their housing policies, our search took on a bit more desperation than we had wanted.

A friend that we had met in the Galilee recommended we check out the "city" of the Golan Heights, Katzerin. I put city in quotes because although it is technically a city and not a moshav, or kibbutz, the entire city would fit neatly inside of Madison Square Garden! And although it has a supermarket, bank, restaurants, and schools - it is surrounded on all sides by open fields, forests and mountains. We got in touch with the handful of English-speakers in Katzerin, rented a car, and drove up to see the area on a Wednesday.

We decided to come back that Shabbat and see the community in repose. The family that hosted us arranged all our meals and somehow the entire community was informed of our coming. I felt as if they had rolled out the red carpet and struck up the band! We felt so welcomed! On Sunday we went around to look at some houses and apartments for rent and found one that seemed absolutely perfect. Three weeks later, we had moved in! (Pictures and videos of our house are on my Facebook profile: http://www.facebook.com/ayeletschwell)

Which brings us back to our birth story:

When we finally had moved in, I called the midwife, and we arranged a time for her to come and meet me. Her home is an hour away from mine. At that first meeting, we chatted, I asked her some questions, told her my history, and felt as she was leaving that something was not quite right. I couldn't put my finger on it, but I swept it away, because at that point I was 34 weeks pregnant, and my Braxton-Hicks contractions had begun to take on a more serious feel. My oldest son had been born at 36 weeks, and my daughter at 38. So I had no idea when this little one would come and I felt at a loss to begin looking for a new practitioner at such a late date. Especially with my whole story.

Lesson #2: Always trust your instincts about your provider! Whether it proves right or wrong is irrelevant! If you feel at all uncomfortable with your care provider, you are headed for an uncomfortable birth experience - if for no other reason than that tension alone! It is never too late to review other options. And although I might not have been able to find another homebirth midwife at that time, I could have settled myself into the idea of a free-standing birth center. But I didn't even look into it.

I ended up staying pregnant for the next 6 weeks. And when my labor began, it was slow - very very slow. But there were so many factors! Based on my previous births, even with a slow start, once my body switches into full-on labor mode, I go very quickly. And considering that my birth team were spread out over the country, I wanted them there. So I called the midwife on Sat night July 18th. While she was on her way over, Yoram and I went for a long walk, and my contractions picked up even more. We got home and I prepared a few things and puttered around a bit, and when the midwife arrived, we looked at heart tones, and my blood pressure and everything looked great. I started feeling uncomfortable, and wanted to be in the warm water of my pool. The midwife warned that at this point the water can slow labor and not help it along. So I thought if it slows down, I'll get out, but at least I'd be comfortable for a little.

Well, my labor did slow down, and then the kids woke up (it was a little after 6am) and then the contractions stopped altogether. I slept most of Sunday. Monday I decided to ignore the contractions, and my mom arrived that evening. She told me she was exhausted and was planning on taking an ambien to help her stay asleep through the night and avoid jetlag. My body got the hint.

In the morning, though, I woke up with those deep, low down, this-is-it kind of contractions, and I called the midwife again. She said she'd come out, but to ignore her and do something fun with my mom and the kids. So we went for a walk. When we got back to the house, the midwife had arrived, and we helped her bring her things into the house. Heart tones sounded great, baby's head was still down (but could still be felt above the pelvis) and the contractions were getting stronger, but weren't getting into a pattern. So we continued to ignore them. We all went to the pool and had a great time! (again, pics and videos on facebook! some are on Yoram's profile.)

I called the midwife when we started heading out from the pool, and told her we were going to go get some food at the pizza store. She met us there. Somewhere between leaving the pool, and walking towards the pizza store, things changed. The contractions were coming on every 5 minutes, and I was no longer in a jovial mood. But I was hungry, and I got very focused on eating some pizza. We got to the store and started to move inside into the a/c, and were told that we would have to eat outside because they were expecting a group - I was going to strangle someone! But we ordered our pizza, and sat down in a shady, breezy spot. I ate my pizza, barely looking at anyone, only slightly aware of the needs of the children, who were being taken care of by my mother and husband.

I didn't quite get through two slices when I said, "I want to go home." The midwife brought her car around and me and my mom got in. Yoram walked home with the kids. In retrospect, I should have kept moving, because somewhere between getting into the car and getting out of it 3 minutes later at my home, I began thinking of things I needed to do and people I needed to call, or didn't get to call, or what have you, and the contractions started slowing down... I got into the pool, but it was already too late. When my son decided to join me in the pool, it was over. He's so sweet, and so nurturing and helpful, but he is also very engaging and I completely lost my focus and couldn't get it back.

The the emotional turmoil set in. My grandmother's passing just a week prior, my father not being able to be here, all the stress of the previous 6 months, and the fear that after all this, I might still not actually give birth and finally meet my baby.

Lesson #3: Keep Moving!! When the going gets tough, the tough get going, right?! It works in labor too! At that point, the midwife suggested that Yoram and I take some time together, but we should have left the house and gone walking! The contractions were still there, they just needed a nudge to get back on track. Plus, getting out of that environment would have been another way to get me back into my laborland head-space. And furthermore - it might have moved other digestion-related things (ahem) that might have also assisted in moving things along.

At this point, the midwife had a startling decision. She decided that she felt my baby was at risk of being slow rescusitating, because of all the starts and stops in labor, and she felt that it was no longer safe for me to give birth at home. Yoram and I questioned her, considering that his heart rate was fine, and that he was moving around before and after contractions, and that aside from my anticipation, I was feeling completely at ease with the baby's condition. She said, she has to consider that we are 30-40 minutes from a hospital, and she doesn't want to take a chance.

I was devastated. I felt betrayed. This decision felt wrong in every way. And not having a car meant that I hadn't seen any of the local hospitals, had not prepared for this eventuality in the least.

Lesson #4: Always prepare a back-up plan. It is true that most healthy women who plan a homebirth, have completely healthy, natural births and healthy babies at home. But on the rare likelihood of transfer, I would have been much more settled into this reality had I at least seen the hospitals, made some contacts there, known what to expect. Also, depending on where in the world you are birthing, writing up a back-up birth plan for hospital transfer might be helpful - and lets go back for a moment to lesson #1 - bring your doula!!! But I'll get to that more in a minute.

I spoke to a close friend who is also a midwife, but who lives too far away to have been my birth attendant. She brought into perspective the fact that what my midwife was actually saying was that she was no longer comfortable attending my homebirth. She was "opting out."

I cried all night, and resolved with my mother and Yoram that in the morning we would rent a car and Yoram and I would go check out the hospital that the midwife had recommended, which was in the holy and beautiful city of Sefat. We thought that, at the very least, we would get some time together in the city, and maybe even buy a new set of candlesticks, since I'd soon be lighting one more candle on Friday night.

My daughter, who's 2, was miserable that night. She wasn't feeling well at all. Congested and coughing and complaining that her mouth and ear were hurting (I'm pretty sure she's growing a molar) so we put her to bed in our room, propped up on pillows. Somehow, despite being so small she took up my entire bed! So when I finally did get to sleep, it was in the smallest possible area on my bed, and I was waking up from contractions.

It's now Wed morning, July 22nd - also Rosh Chodesh Av (the first day of the Hebrew month of Av) Yoram slept in and missed the 6:15 prayer service, he might have just prayed at home, but it was Rosh Chodesh and he really wanted to be at the service. So he went at 8:30 and my mother and I walked the kids to their respective camp/playgroup. Before we left, I put a few things into a shopping bag, in case we did end up in L & D that day.

On the way there, I continued walking through my contractions, on the way back, I couldn't. By the time we got home, stopping to chat w/my neighbor who offered to drive us to Sefat, the contractions were less than 5 minutes apart and I was moaning and swaying when they came to relieve the tension and the pressure of each intense wave.

My mom called the midwife, she didn't think we would make it to the hospital, so the midwife headed here and asked if she could send someone over who lived closer and ad attended many births. Presumably a doula. My mother agreed.

Lesson #5: Be wary of inviting people you don't know into your birth space. Especially having not heeded lesson 1, having your own doula who will preserve the sanctity of your birth space no matter who's there, or where you are. Because birth is not where you physically are. You can have a serene, loving, non-traumatic birth in an emergency operating room, if that is what is necessary, as long as you are prepared and supported in keeping the experience sacred.

Yoram came home minutes later and mobilized for birth. At this point, I wish we had not called the midwife till I was actually pushing, but she was already on her way.

This is where events begin to run into each other in my mind, so I'll relate it as well as my memory permits.

I know I was in and out of the pool. The woman from nearby arrived, I only remember that she had strong hands and she massaged my lower back through a few contractions. Sometimes Yoram was sitting behind me, sometimes my mom. The room seemed too bright. The midwife came in, my tension rose - but only as much as my primal being would allow. I wanted to be darker, I went to my bed, with Yoram. I was on my knees, hugging my pillows and leaning on the wall, Yoram massaged my lower back, the midwife came in and asked if the back pain was new. I gave her a look because I couldn't say, "I don't know and I don't care." She retreated and said something else. I was pushing on my next contraction. heart tones were fine. She wanted to check me - because of her fears. She said the baby's head was very high, she said it felt like there was swelling during the contraction. After the next contraction she checked again, and said, with distinct fear, the baby's head had receeded. She wanted to call the ambulance. I could only say ok.

In my head I didn't feel right, I wanted to ask her things, I wanted some options, but my voice couldn't get through the fog of focus anymore - and Yoram was getting scared for the baby. From that moment on, I was abandoned. No one there was there for me. The modwife was concerned for the baby, and for her own skin should something go wrong - or should someone suspect that this was a planned homebirth. Yoram was concerned about the baby and whether the midwife's fears were valid, and my mother was nudged out of the way and feeling uncharacteristically helpless.

I did the next contraction on the toilet, and it felt good. I should have stayed in there.

Someone brought me a skirt, and someone else grabbed the shopping bag and somehow I made it down the stairs. I wasn't working with my body anymore, I was so confused, and no one was talking to me. The EMT's came in, and then I was on a stretcher, and they were buckling it, and I was screaming, and then the midwife and Yoram and I were in the ambulance (although, Yoram was made to go to the front, so he wasn't with me. Only the totally clueless EMT, and my fearful, useless midwife, who was calling herself the doula at this point.

The ride to the hospital was horrific. They wanted to start an IV, my eyes must have been shooting daggers. They tried to take my blood pressure, putting the automatic cuff on my arm and then forgetting it was there - it got so tight, and wouldn't go down, b/c I was gripping hte stretcher for dear life, and we were bouncing all over the place. So until I started crying that my hand was going numb, he finally took off the cuff. He tried to get a pulse-ox, but I threw the thing off my finger. Then he stuck on EKG monitors, the glue from which are still on my shoulders and ankles. I was screaming, the pressure was building, and I had no respite. No calm voices, no one to bring me back into my body and guide me. Not even Yoram's strong hands to center and steady me. I was on my own.

I screamed for the driver to stop the car and let me push without moving, the EMT in the back kept telling me he would stop after the next intersection - I found out later that he was motioning to the driver to keep going. I wanted to throw something at the driver but I was afraid to let go of the stretcher. No one was listening to me. My water broke, and I had some relief. And then the baby's head descended and was squatting on the stretcher, and everything was moving, and I just had to push this baby out. And somewhere in the darkest reaches of my mind was a small voice trying to tell me to breath, and not to push so hard - but I couldn't listen. There was no one to mirror it, no one to magnify that inner voice.

The midwife told me that I should catch my own baby, b/c I had the cleanest hands. I felt his head coming through, I felt the burn and I knew he was tearing me up inside, b/c I couldn't control his descent. And no one supported my perinium to provide counterpressure. Yoram was behind me by now. But I was barely aware of it. We stopped finally, because we had pulled into the entrance of the hospital and my baby was born, and he was blue. He gave a weak cry, and I held him and massaged him and then the doors opened and the ambulance was packed with people yelling and making a fuss and someone clamped my baby's cord! And I screamed - but it was too late because it was some plastic thing that couldn't be taken off. My poor baby, fighting to fill his lungs and they stripped him of his lifeline! And they took him away from me and I screamed and kicked and spat at them to give me back my baby - miraculously someone did and I didn't let him go again. They didn't suction him, or anything, he pinked up on his own. I just held him in my arms, and massaged his chest, and then the midwife did say something useful, she told me to give him a breath. Finally he filled his little lungs and gave a wail no thanks to the hospital staff, ambulance staff, or my own birth attendant.

They wheeled me inside, and someone started tugging on the cord to pull out the placenta and I yelled again for them to stop and let me push it out, but they didn't listen. And then a doctor was suturing me, and I asked her where I tore, and I couldn't understand what she was saying, and she wouldn't let the midwife watch. It seems that I didn't tear on the outside, but I had 5 stitches behind my perinium. All I know is that right now as I type this, it still stings.

I refused the pitocin drip, tried to nurse my baby - who was rooting but still screaming too much to latch on, and massaged my own uterus. My blood pressure did drop pretty low, though, and I knew I hadn't eaten or drank much since the morning. (By the way, he was born at 12:30 - only 3 hours from the time I arrived home with my mother.) I let them give me IV fluids, I did not want to pass out. When they asked me if I had any questions, I said, "yes, how soon can we leave?" I was told that I just need to tell the nurse upstairs, and sign out, and we can leave whenever we want.

The hospital stay was not an improvement on the experience and we checked ut as soon as they let us... but maybe that is in a future post.

My beautiful boy weighed 3.3 kg (7lbs 3oz) at birth on Wed July 22, 2009. By Sunday he had regained his birth weight plus 5 oz, b/c he's nursing non-stop! This past Wednesday, at his Brit Milah, we gave him his name: Yitzchak, after my father's father who passed from this world only 2 years ago. The name Yitzchak literally means "he will laugh" and maybe that is a lesson too. I'm not sure why my Tzachi had to be born in the way that he was. I don't know what purpose it served for me or for him. Of course I am grateful to be holding my healthy baby, but that doesn't take away the trauma of the experience - of having my needs and desires ignored, of the pain of giving birth in a moving vehicle, of the additional recovery time that I now have, and the loss of the experience I had envisioned. And that is another lesson.

Lesson #6: Don't be appologetic about your birth! This goes for having an amazing experience, or a traumatic one. Women who have had beautiful births are often afraid to talk about it, so as not to offend women who had unpleasant births. And those of us who've experienced trauma in our births feel guilty about not just being grateful to be healthy and having a healthy baby. Remember that statistically the outcome of "healthy mother and baby" is all but guaranteed in developed countries - even for women in a moderate risk category. The fact is that women who are getting regular pre-natal care, who have access to appropriate health care and nutrition emerge from birth alive and well with an equally vital infant. So it is completely valid to view the birth experience as an entity in and of itself.
If you had a wonderful birth - don't be afraid to share it! You own that experience, and it's memory will be a source of strength for you for the rest of your life!
And if you're experience was less than wonderful - it is yours to grieve, and learn from and hopefully grow from.

Part of writing this has been an exercise in letting go and forgiving those involved - and forgiving myself. But it was also important to me that I share this because this is what I do, and women like me are among the women that I serve. So in sharing my story, I hope I have also conveyed some wisdom that can be incorporated into your birth choices.

From the depths of my heart,
~Ayelet