Tuesday, November 08, 2005

Intuition, Trust and Red Flags


It’s funny how, over the years, I’ve only been given the births that I can handle. Each birth prepares me for the challenges of the next. What amazing gifts these women give to each other.

When I began my life as a doula, I was still breastfeeding my one-year-old son. I knew that I could only manage six hours away from him. For me - I couldn’t stand the breastmilk backlog! For him - hey, he needed me. For the first year, the births were amazing. I was never needed for more than six hours. I was only faced with long births once my son was able to go longer between feeds. Though I do remember pumping midway through long births for a few years...

Each birth has taught me an amazing lesson. For example - the very first birth I attended as a solo doula was a 4 hour vaginal breech birth. Being a new doula, I was nervous about the possible challenges with this birth - I’d read my medical text books! But my client was unperturbed - she had been born breech herself. So, when she went into labour and her husband was nowhere to be found, she called to say we should meet at the hospital, then called her doctor and asked him to pick her up on the way. Then she actually made the doctor take her through McDonald’s drive-thru so she could pick up a Big Mac! “Why not!” he said. Well, that baby came so easily and swiftly. “It wasn’t as bad as a rowing workout!” said my client after that baby was born. Wow! That was my first lesson in trusting the client.

At that point, I realized that our internal knowledge is strong. My client’s birth had gone smoothly because she wasn’t concerned for her or her baby’s safety. She wasn’t being irresponsible or foolhardy either. She just totally trusted her body to work well. I believe she would have had a sense if something was wrong - and would have acted on it. That’s just the way things work. Problems only arise if the woman’s intuitive sense is blocked, or if she is forced to second-guess herself. That results in fear, which further complicates matters. But those are things that we discover during our prenatal visits.

You might argue that we can never anticipate when a medical emergency is going to happen - that some emergencies come out of the blue. Well, yes, sometimes the course of a labour can change in a moment. But it is never without warning signs. The problem is, women’s intuition is not being honoured, and caregivers aren’t continuously with the woman, and miss the warning signs. As an experienced doula, sometimes I’m the only person who is consistently there, knowledgeable enough and detached enough to see these warning signs.

I was with a woman in labour at St Pauls. On paper, things appeared to be going well. She was at 5cm, unmedicated, had intact membranes, and was rocking back and forth on her hands and knees. But she was worried. She kept having images of the baby pushing his head out of the pelvis. The staff were busy with the shift change, laughing and joking. The new doctor on shift, who I know well, asked if I had any concerns. I went into the hall with her, and told her about the woman’s image of the baby. I also told her that I had a very strong intuitive sense that something was wrong. I “felt” a bad odour coming from the woman. The smell was so subtle, but ominous. The doctor went back into the room and couldn’t smell anything odd. I said I just knew that something was different, that I couldn’t shake the bad feeling that I had. The doctor stayed in the room for the next hour, monitoring the woman’s contraction pattern by using her hands, listening carefully to the baby’s heartrate. After an hour of seeing the baby’s heartrate climb, she asked the labouring woman what she thought - intuitively. The woman looked at her doctor - “Intuitively? I think I need a cesarean. But that’s crazy, isn’t it?”

“No, we’ll do it,” said the doctor, “I trust women’s intuition.” And, yes, you guessed it - the smell in the OR was terrible. My client had a massive uterine infection. I was right, I had smelled the change in her body. And the woman’s sense that the baby didn’t want to come vaginally, that he was pushing away from something, was correct. The mum and baby did very well after the surgery, but it had been a close call.

Babies are great with red flags. They madly wave those red flags. Our problem is that we often don’t recognize what the baby is doing. When we trust our instincts, and listen carefully to what a labouring woman is saying, we can learn so much more than is available to us through vaginal examinations or heartrate monitoring.

Think about how often the baby’s heartrate must dip during pregnancy. If mum lies in such a way that the baby’s umbilical cord is compressed, the baby kicks up a storm, mum rolls over, all is well. If mum is sitting in a deep sofa, which the baby finds uncomfortable, she’s forced to stand up and stretch. During pregnancy, we hardly realize all the things that we do in a day in response to the baby’s needs. We dance with our baby throughout pregnancy, an ongoing interplay. We keep our baby safe.

One woman in labour kept saying that she had an image of a rock climber, with the ropes wrapped around his chest, one hand on the taut rope on the rock wall. Her husband laughed and said, “You’re remembering our first date!” “No, it’s an insistent current image,” she said. She reached full dilation and started to push. Every time she pushed, the baby’s heartrate dipped (sometimes that’s an encouraging sign, sometimes it’s not...) Well, after three hours, the baby hadn’t descended at all. In fact, the baby had popped out of the pelvis. The obstetrician said his classic line. “That baby’s not even in Vancouver! He’s so high, he’s in New Westminster!” My client talked about her image of the rock climber again, and agreed to a cesarean birth.

Well, guess where the umbilical cord was? Wrapped around his chest like a rock climber. And he had his right hand clutched onto the taut cord, just like his dad had done on the first date. The couple laughed and laughed, feeling great about their decision. “I’ll trust you next time,” said the dad.

I’m so thankful for the lessons I have been taught by my clients and their babies. I have so many examples of how trusting a woman’s inner knowledge, trusting the baby’s red flags, and being continuously present, can positively affect the outcome of a labour. Women are empowered when their inner knowledge is honoured. It makes them more confident and results in joyful parenting.

But I’ll dole out the stories slowly. It’s time to call a new mum and have her teach me some more...

- Jacquie Munro, Vancouver Doula

1 comment:

Ahavah said...

Hi! I've recently found your blog while searching for doula blogs - it was linked from someone else's site. I'm also a doula, and I enjoy reading along.

I love this entry! A new mother's power is so amazing. Thank you for sharing.