Ilana and Aaron, their doula’s story

ISSN 0256-5004 (Print)

AIMS Journal, 2014, Vol 26 No 4

Doula Ly Malnick gives her account of Neri’s birth

As a doula, I am often asked about the relationship between the attending midwives and myself. For me this is a question of really understanding roles. I am not a midwife. My training is not clinical, and my presence at a birth does not replace the need for a midwife. I see my role as providing both emotional and physical support to the mother, and her partner, before, during and after birth.

I do have a deep understanding of the physiology of labour, and I draw on this knowledge when attending a bir th. I am always keen to work with the midwife, though I may also at times be required to suppor t my client in opposing something the midwife is suggesting.

Ilana’s bir th story illustrates a situation in which this relationship really works.

I arrive at Ilana and Aaron’s house at 10pm, having been called out just under an hour ago. It’s been a while since I’ve been at a bir th, having taken time out to look after my youngest child. How will I be? I take some time to slow my breathing, and to settle myself before I knock. I try to put aside my own judgements, my own agenda about how things should be. I want to enter into the space that Illy and Aaron are creating, feel my way into it, in order to respond fully to Illy’s needs and wishes about how her bir thing could be.

When I enter the space I see Illy labouring beautifully. Her contractions slow a little, most likely in response to the new energy in the room, and I hold back, observing quietly, finding a space for my bag and various bits and pieces, waiting to get a feeling for how I can be most suppor tive to her. After some gentle encouragement and reassurance, her contractions pick up again and Illy turns toward them, focusing on her breathing and moving her body with the energy of the surges. As she is feeling it especially in the back, she finds sacral pressure helpful, so either Aaron or I are constantly on hand to apply pressure during her contractions.

I turn my attention to preparing some nourishment for her. I offer her homemade chicken broth (a fantastic trick I learned from a midwife friend for nourishing and hydrating a labouring mum) and other bits of food. I also suggest she tries a manoeuvre I learned from Gail Tully of Spinning Babies, to help bring the baby down into the pelvis. I suspect baby might be back to back, given the contraction pattern and where Illy is feeling them, and I suggest Illy walk up and down the stairs as she labours.

After a few hours they are wondering when they should ring the midwife. I think it’s probably a good time, and Selina arrives at about 2am with a student. I welcome them at the door, mildly apprehensive. Although I’ve been well received by the midwives at previous bir ths I’ve attended, some of my colleagues have had more difficult interactions with midwives and the response to doulas is varied. I needn’t have worried; Selina seems delighted to see me.

She and her student enter the space in an utterly calm, considerate and unobtrusive way; she introduces herself and her student, Hannah, to Illy and then quietly goes about setting up her things whilst silently observing. Although the sequence of events is difficult to recall, what stands out for me the most is Selina and me encouraging Illy to keep active and changing things up ... it seems very much that her labour slows as soon as she settles into any one place or way of moving. She labours in the bathroom, she does the crab walk up and down the stairs, she does lunges using a chair, and she swings her hips in wide circles, assisted by Selina who encourages her to really give it some oomph!

After labouring awhile, she says to Selina: ‘It’s really intense!’ To which Selina replies: ‘You’re having a baby, love!’ It feels to me that her response, delivered with straightforwardness and humour, really helps Illy to let go into the intensity she is feeling.

More time passes, and Selina suggests doing a vaginal examination, explaining her reasons to Illy and what information she is hoping to glean. I remind Illy that she can refuse this, and I also suggest that if she is happy to go ahead with it, she may request not to be informed of her progress.

Illy agrees to this suggestion. Selina is respectful and warm in her approach, and I feel this is a great example of how a VE can be performed in an unintrusive way. I believe it is the only time I’ve heard from a mother that the VE wasn’t too uncomfor table!

The mutual respect and Selina’s lack of ego, despite her vast experience, mean there is no awkwardness in working with her. We completely focus on supporting Illy and Aaron. We both are able to make suggestions, and share views and knowledge, and I feel free to speak about what is on my mind. As a birthing couple, Aaron and Illy work so well together, and I feel completely inspired by them. I try to support him to do the lovely work he’s doing. He is completely available to her, breathing with her and making low sounds to encourage her to keep her energy moving downwards. There are many moments where Selina and I are hanging out in the kitchen, smiling as we listen to Aaron ‘moo-ing’ encouragingly along with Illy while she labours in the bathroom.

When Illy feels ready to push, she adopts a supported squat, with Aaron behind her. I then feel slightly baffled … the spacing between her contractions seems very long, which Selina declares to be a ‘rest and be thankful’. I had always thought this was something that can occur before the pushing stage began, so this was fascinating for me to witness.

Aaron tries nipple stimulation to encourage the contractions to pick up, at Selina’s suggestion. Selina also asks if I have anything in my bag of tricks, and so I dig out a few homeopathic remedies. It seems pretty clear, though, that this baby is in no rush! After a little while, Selina is a bit concerned about the heart rate, and encourages Illy to bear down during her contractions. We watch as baby slowly makes her way down through the bir th canal. When she inally comes there is that glorious moment, tears and smiles and laughter as the couple greet their gorgeous baby girl.

Mum and baby have immediate skin-to-skin, and the placenta is bir thed after the cord completely finishes pulsating; Selina and Hannah check the cord carefully to ensure that there is no pulse left before clamping and cutting.

The sun rises over the next couple of hours, as we focus on helping Illy breastfeed and get comfor table. As I prepare to leave, Selina approaches and offers me a hug, saying what apleasure it was to work together and thanking me for what she had learned from me. Once again, her humility leaves me completely dumbstruck! This is the lesson I shall take away from Selina, and why Illy’s bir th shall stay with me: all these tricks belong to none of us – we all learned them somewhere – but to rest in a state of openness, really to work as a team and to allow our primary concern be for the birthing mother we stand to be of greatest service.

Ly Malnick

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