Cherish Birth » AK and RK's Story

In Delilah's Words

AK (mom) and RK (dad) contacted me on 1 August, hours after I came home from a birth. I was very tired but riding the wave of joy that follows a birth, when she asked me to teach them a private class and be her doula. After checking with my husband if it would be okay with him for me to take a second birth in one month, I agreed, with excitement!

I felt connected to RK and AK almost immediately- they were warm and interested students of my childbirth classes, with many questions and a fast grasp of complexities. We got to talk about lots of minute details that ordinarily my classes never get into, and it was interesting and fun to spend time with them and for me to both teach, about birth in general, and learn, about them and their perspectives. Their birth preferences more closely described the sort of birth usually had at home or in a birth center, than a hospital, which given how committed they are to natural living, was not surprising. I have never before had a client (much less a husband of a client) who chose “-9” on the Pain Medication Preference Scale. Even I, a committed homebirth mama, would consider myself about a “–8”! I began praying for their birth, and asked several of my friends to join me in praying for their birth, that it would be an experience they would remember with rejoicing.

Monday, 22 August

AK was 40 weeks, 2 days, and had some nausea and vomiting for several hours. She didn’t have any pain, fever, diarrhea or contractions- so it seemed unlikely that it was labor-related, even early labor- more likely a tummy virus.

Tuesday 23 August

The next morning, she called me and told me she was feeling much better, had not vomited since the previous day at 2:30 p.m. and had slept all night, eaten with great appetite, and overall felt much betteRK

The next call I received was at 8:15 p.m. when I arrived home and there was a message on my machine, saying, “Delilah, this is AK. We are going to the hospital. I will call you later K” I had kept my cell phone with me at all times, and she hadn’t called, so I was scrambling to figure out what was going on! I called their midwife, KZ, and she filled me in. Apparently AK had had some chills, which KZ had asked if she had fever and she had said no. But after actually taking her temperature, she found that in fact, she did have fever- just so low-grade (under 100F) that to the touch, she thought she had none. They decided to go to the hospital and get blood work done to see if by any chance she had a bacterial infection, perhaps a UTI or something of that nature, and needed antibiotics to recover quickly so as not to be feeling ill during labor since it could begin at any time.

AK called me from the parking garage of the hospital before going inside, between 9-10 p.m. and basically said what KZ had already told me. I asked her if she wanted me to come be with them, but she did not think it was necessary. I told her to please keep me informed about what the blood test results were, even if they came at midnight- to call me. The next phone call I received was RK calling me, very agitated, at 11:15 p.m.

He said although they didn’t really know what kind of infection was causing the fever, as a precaution, the doctor was recommending immediate labor induction and was sending them straight to L&D, and asked me to meet them there ASAP. I asked him if he had been asking all of his questions, like benefits/risks, what the alternatives were and what would happen if they waited, etc. and he said “some” and encouraged me to arrive as quickly as I could. I assured him that I would get there as fast as I was able, and encouraged him to wait to make any decisions until I got there, if the answer to the “is this an emergency, or do we have time to talk about it” question was that it would not be dangerous to wait.

I got off the phone, threw clothes on (skipping my usual pre-doula-work shower), emailed for prayer support because the statistics on a first-time mom with an unfavorable cervix being induced and ending up with an unmedicated vaginal birth are dismal, and made phone calls to arrange for childcare for my children for the next day and night, in the event that the birth went long. I was in the car by midnight, and called KZ, their midwife. She said she was en route to the hospital also, and we agreed to meet in the employee parking lot and salvage as much of their birth plan as possible, even if parts were not possible with an induced labor. I was very grateful she wasn’t out of town, because I knew our chances were much better with her than any other care provider at the hospital that they could have ended up with!

At 12:25 a.m., KZ and I arrived in the hospital employees’ parking garage. We tried to go in the way she usually goes to work, but the doors were locked because it was so late, so we ended up having to walk several blocks (me carrying my birth bag and purse), and it was still over 90 degrees. We were both sweating by the time we arrived, not to mention having seen several extremely large bugs. Yikes!

12:45 a.m. A security guard stopped us as we tried to go up the elevators to L&D. KZ had not brought her employee ID and was arguing with him about our right to go upstairs on the basis of her driver’s license, when I caught his eye and realized that he was totally shining us on- just giving us a hard time. In retrospect, it was pretty funny, but at that moment, I would not say she was amused.

From 1 a.m. until 2 a.m. was a very interesting experience. Dr. L, OB, and Julie, RN were in and out of LDR #1 with RK and AK, KZ and me. The consent to induce labor had not been given when we arrived (as I had kind of thought it had, from what they said on the phone, that it already had been).

Dr. L was recommending induction starting with an oral dose of Cytotec (misoprostol) and four hours later, a second dose, then proceeding with Pitocin if the Cytotec did not succeed in starting labor. She also recommended an IV with antibiotics and also that AK stay NPO (nothing by mouth) other than ice chips. She was basing these recommendations on several things that could potentially be but also might not be the case- that possibly A’s fever indicated that the placenta was giving out, or that she had an infection of the amniotic fluid and the baby was just surrounded by infected fluid and they should “get the baby out now while she is still healthy” because there was no guarantee that the baby would still be healthy later. Since AK was still 1.5 weeks away from 42 weeks, the potential that the placenta would be post-term already was possible but not a huge concern, and AK did not have any of the risk factors or indications of chorioamnionitis (ruptured membranes for an extended time, tenderness or pain, high fever, baby’s or mother’s heart tone abnormalities). Although these were not the most likely causes for a low-grade fever, since they were possible, Dr. L felt the most conservative course of action was to treat the situation as though that was the case, because any chance of that being the case was too much risk for her comfort.

AK and RK asked KZ and me for our opinions. KZ felt that they needed to decide for themselves and left us alone to discuss our options. I offered the information I knew about their options, including the risks/benefits of the other induction drug options, suggested some other questions which they might want to ask the doctor so that they could feel confident in making a decision based on complete information of all their options, and then assured them that I felt confident in their ability to make the decision with which they would be most comfortable. I reminded them that there are no choices which are without risk- that they needed to choose the set of risks that would give them the most peace, about which they could confidently say, “I made the best decision I could have made, given the circumstances.”

After two more conversations with Dr. L (her answering questions and then going out to let them discuss it again then coming back!), RK and AK- mainly RK- decided that since the baby had appeared to be completely healthy on the monitor for the two hours they were there, and since there was not a pressing medical need for the induction, and since the risks associated with induction (given how unfavorable AK’s cervix was) were not risks AK and RK were willing to assume without there being an already existing (rather than potential/”just in case”) condition, they were going to go home.

Dr. L had them sign some paperwork stating that they were leaving against medical advice, and wrote them a prescription for over the counter antibiotics to take in case the infection was in fact bacterial. One of the Triage nurses came over to inquire of AK and RK “just where we thought we were going”- I don’t think anyone could quite believe we were leaving! Then RK got the car while AK, KZ and I waited at the door of the ER, and RK and AK drove KZ and me to our cars, and we all went home. AK even called me to make sure I had gotten home safely, which I did, at about 3 a.m.

Saturday morning, 27 August (41 weeks gestation)

AK called and said she was having some bloody show. I asked if she had had a vaginal exam at her appointment the day before, or had sex, and she said no- so I said great! That probably means we’ll be having a baby in the next two or three days! She wasn’t having any contractions, but I told her I was still looking for a baby before Tuesday.

She felt very good about her appointment the day before, and was so happy that they had not gone ahead with the induction on Tuesday. She had not had any more fever or vomiting, and was still pregnant five days later, so felt very confident that an induction would have been unwarranted and unnecessary and if it had led to an outcome they didn’t want, she would have regretted having agreed to it. I was glad they had made the choice that was right for them, and that they felt good about their decisions, and told her to keep me posted.

Saturday night, I took my kids to the mall to buy Vanessa some shoes for school, and AK called. I thought she must be in labor! But actually, she was just calling to tell me she had thought about her “support person” birth plan, but was too distracted and emotional to be able to put it down on paper and was hoping we could just talk about it. I told her I would be happy to do that, once I was home and could take notes.

We talked for a little while, though, while Vanessa tried on shoes. She felt emotionally “weak” not strong, and anxious, and distracted, and ill at ease in general. I asked her some questions, like did she have a sense of something being “wrong”, or was it more of an “overwhelmed” type feeling- was the reality of her life about to change coming over her, was she afraid of pain or the unknown, etc.

The kind of free-form anxiety she was experiencing seemed to me, to be very normal when one is about to become a mommy, and I told her that everything she was saying made me more sure that she was going to go into labor very soon. When I came home and told my husband about AK’s call, he responded, “Oh, so she’s nine months’ pregnant? That’s what it sounds like to me!”

After I got the kids settled, I called AK back and took notes of what she hoped to receive from me in her birth. I went to bed with my phone on my nightstand, and instant messaged my sister that I wouldn’t be surprised if I got a call in the night. I also emailed my CBE clients for Sunday afternoon to tell them that I might be at a birth and have to reschedule their class, and would call them if that ended up being the case.

Sunday morning, 28 August (41 weeks 1 day)

First thought upon waking: “Wow, it’s morning?! Is this thing on?! Yep, the phone works… so I guess not yet!”

I went ahead and got ready for church and my class, to proceed with the day as normal and wait to hear from AK. I did not want to be one of those annoying people who calls a nine months’ pregnant woman and says “no baby yet?!” all the time- even though I was really tempted!!!

As I was leaving for church, it occurred to me that maybe something had happened quickly or unexpectedly, so I called KZ just to make sure I hadn’t missed anything. I had such a strong feeling it would be soon!! KZ hadn’t heard anything either, but she agreed that with the bloody show, it should be in the next day or so. They were going to the lake but would be within an hour’s drive away, so we were both on high alert!

At church I told my pastor that I might or might not be at Bible study the next night, but that I had a very good reason. There were some Gideons who made a presentation at the worship service, and I took that opportunity to dedicate two Bibles, in RK and AK’s names, in celebration of the expectation of their firstborn child arriving soon.

When I arrived home from church to change clothes and go to my class, AK had called and left a message. She had had a few contractions, but only one or two per hour. I told her I would call her after class, or she could call me during, if she needed to.

8:10 p.m

My childbirth class ran long and I was driving home from teaching it, when my cell phone rang- it was AK, calling to say she was in early labor! Yay! Her contractions were still irregular and widely spaced, 10-15 minutes apart, and she wasn’t sure how long they were. I asked her to have RK check the duration, and call me back. I called Kurt to tell him, but he already knew because she had called my house first. I picked up dinner on the way home. My whole family ate dinner and talked about AK’s baby coming and the plan for the next day when I was gone, it was so wonderful how supportive they were and how excited they were for her birth. As I prepared to help AK, RK and Rachel become a family, I was acutely aware of the blessing of my own precious family.

8:45 p.m.

RK called while we were finishing up dinner and said the contractions were 30-45 seconds long, but were getting closer together- more like 6-13 minutes apart instead of 10-20 minutes apart. I encouraged him to make sure AK ate and drank if she at all could (because later in labor she wouldn’t want to, and once at the hospital, it wouldn’t be an option even if she wanted to!), and to try and relax and rest if she could, because she would need her energy later. Since the contractions were still short, I told him I was going to go ahead and finish dinner, put my kids to bed and take a shower before I came over, because it sounded like I had time and he was doing well at being with her for now. He asked what time they should expect me, and I said since I lived about 30 minutes away from them, that I should be there by 11 p.m., which sounded fine to him.

10:15 p.m.

I was out of the shower and getting ready to brush my teeth, my sister (who had come over and was helping out with Virginia, who wasn’t keen on Mommy leaving and wouldn’t go to sleep!) came upstairs and said RK was on the phone and AK felt like she wanted to push. I talked to him for a few minutes, trying to get a sense of how things were going- it sounded to me, from what he described, more like the bag of waters was the pressure she was feeling, not that she was having a precipitous labor and was ready to push the baby out. However, I couldn’t be sure over the phone, obviously.

I encouraged him to have AK get in the tub and relax, and to resist the urge to push and drink some water- that I would hurry- and to call KZ and see if she were willing to come check AK at home just in case, to save them a trip to the hospital in early labor if they were then going to want to leave again because it wasn’t time to be there yet. (They had certainly already proven that they would leave if it weren’t time for them to be there yet!)

10:42 p.m.

I was on I-635 near Miller Road, about ten minutes from their house, when RK called again, and said he had spoken with KZ and they were just going to go ahead to the hospital and asked me to meet them there instead. They were ready to put their things in the car and go, so I went south when I got to I-75 instead of north! I called KZ and we agreed to just park in the ER parking lot and save ourselves the late-night trek through the hospital district, and that we hoped AK’s baby was positioned well. (Little did we know!)

11:03 p.m.

I arrived at the hospital and went to the nurse’s desk to ask which LDR room we would be in so I could put my things down and then go wait at the ER entrance for AK so RK could go park the car. I stood around until KZ arrived and we found out that we would be in LDR#1 again. We set our things down and went to Triage- the condescending male nurse who had come over to ask AK and RK just where they thought they were going, the previous Tuesday night, was on shift again. He made a smart remark.

11:20 p.m.

KZ and I met AK at the door of the ER while RK went to park the car. As they pulled up, we said to each other, “she’s smiling…!” AK said the car ride wasn’t bad. So I knew it was going to be a long night!

We went to Triage, where KZ and the RN had to discuss the current (ever-changing) procedure for getting a private patient checked in. The RN had an unfortunate attitude. I was unimpressed with either of the Triage employees I saw in action. They took AK’s vitals and then we went to L&D East. Basically as soon as RK arrived at Triage, I took AK and RK down the hall to LDR#1 while KZ finished dealing with the paperwork and the uncooperative, condescending Triage folks- I definitely got the better end of that bargain. I didn’t think that making a woman in labor listen to that stuff was conducive to her feeling relaxed and emotionally “safe and protected” so she could let her body work. I feel sorry for the folks who had to stay in Triage to be cared for by those bureaucratic nurses who were so focused on policies not patients, instead of having the East team like we did!

11:30 p.m.

We were in the room, and I asked what the plan was- RK said the plan is, if we are at least 4cm, we stay, otherwise we go hang out elsewhere until later.

11:40 p.m.

Julie (same nurse as Tuesday night- unobtrusive, gave us lots of space, which was very appreciated) did some external EFM, baby’s heart tones were in the 120’s.

Midnight

KZ did a vaginal exam and found that AK’s cervix was completely effaced, and baby was at +1 station- but she was only dilated to a generous 2cm. However, as KZ finished the exam, AK’s water broke (no amniotomy hook or anything- just spontaneously broke from the exam- so probably a bulgy bag was indeed the “pushy” feeling AK had been experiencing) and there was moderate meconium present. This changed the plans a bit- even at 2cm, with ruptured membranes, it was not likely that we would leave. Also, protocol is that with moderate meconium, Mom has to be on internal EFM. KZ promised to keep AK as mobile as possible and AK agreed to the EFM.

12:21 a.m.

AK was on hands and knees, leaning over the top of the raised head of the bed, RK attempting to read Scripture in Spanish. I was sneaking sips of apple juice to AK whenever the nurse was not looking and hiding the little juice box behind a potted plant in between sips, and staying in physical contact with AK- words of encouragement and physical touch being her primary love languages.

12:35 a.m.

Julie came and drew blood and placed AK’s saline lock. We had a bit of bleeding- Julie thought a vein was not going to be a very good vein, but turns out it was more like a hose! AK did fine through this process, said it wasn’t very painful, except when a contraction started. Later the port hurt, the warmth of the rice sock on it helped a little, but during placement, it was fine except during contractions. Julie hung a bag of fluid on the IV pole so it would be ready if needed, but it was never required. A few minutes later, the nurse anesthetist came in and introduced herself, talked about AK’s pain medication options, etc. and AK was very pleasant to her, but said something along the lines of not to hold her breath waiting for AK to need her, she might as well go take a nap because she wasn’t going to be needed… something like that.

1 a.m.

AK got out of bed and stood beside the bed, leaning onto it, swiveling her hips and praising God during contractions- I praise You, Adonai, King of the Universe!

1:15 a.m.

I encouraged AK to empty her bladder, but Julie said no when we asked about going to the bathroom. I was concerned that AK might end up with a bladder catheter- she had had one on Tuesday night when she had come in with the low-grade fever, and said how much it had hurt, and bled, and… of course, the more things hooked up to her, the less mobility she would have. We compromised with a stool with a bedpan resting on it, by the bedside. AK liked how it felt to sit there, but was not able to use it for its intended purpose. She did a few contractions on it though- praising Adonai, calling out names of God in praise- Yahweh, Jehovah, Yeshua, Rapha, Father.

1:30 a.m.

AK tried semi-sitting/semi-reclining in the bed while KZ and I each rubbed a foot with the almond massage cream she had brought. This gave a long, eight minute break between contractions- RK and AK both dozed, while KZ and I chatted. I love picking the brains of care providers whose knowledge I admire, getting to hear a wide range of experiences and approaches to different situations. AK had a contraction, then a long break- from 1:27 a.m. until 2:07 a.m. she had only about five contractions. She rested well between the contractions, and we were glad, but she did need to get more contractions going to avoid any protocol to augment labor, so it was time to shift positions after that. As she moved back to standing beside the bed, leaning over the birth ball, which was on the foot of the bed, she felt the baby moving down. At this point, she began to usually prefer ice chips to the apple juice, due to heartburn.

2:15 a.m.

AK had KZ and me giggling- she began chanting to the baby, “1-2-3 OUT, Rachel! You can DO it, daughter!” We asked her if Rachel was going to come out ready to be a cheerleader to follow Mommy’s example, and RK answered us with a resounding NO! We were instructing the baby, “It’s too early for you to be a cheerleader yet, honey, sorry, your Papa is too conservative for that…” This was a nice moment with lots of laughter and goodwill, just the four of us (plus baby Rachel!) in the room. Then AK switched to addressing her cervix directly and had us giggling again- “Okay, Cervix, Open! That’s your only job, you have only to OPEN! You don’t have to push, I will do all of that, you are doing a great job, you already effaced, so the only thing I ask of you is just you open, and I will do the rest!”

2:30 a.m.

AK tried sitting on the bedpan/stool again, with KZ and me taking turns rubbing her back. FHT was in the 130’s-140’s, which is where it stayed pretty much all of labor. With the internal fetal monitoring going on, we had a good read on the baby the whole time, but the (external) monitoring of the contractions was pretty useless most of the time. KZ and Julie both adjusted it numerous times but just couldn’t get it to really give much of an accurate reading. We could watch AK and know when a contraction was beginning and ending just as well, so it wasn’t necessary anyway.

At one point, AK yawned and was trying to excuse herself but couldn’t come up with the word “yawn” in English and KZ asked her if it was a good sign that labor was progressing, if AK was losing her English! AK made a little hand gesture at me that looked like she was saying something about smoking- maybe even smoking an illegal substance- she had to surreptitiously point at the potted plant for me to “get” that the gesture was meant to be a straw/the apple juice, not smoking! Oops! She had been preferring the ice chips for awhile so I had stopped offering the juice. She swished it around her mouth before swallowing.

2:40 a.m.

AK and I were in the “slow dancing position”, swaying and squatting during contractions, while she sang in Hebrew and blessed God in Spanish- between and during contractions! At one point, KZ sang along with her in Hebrew. I wished I knew the song. It was so inspiring to serve her and thank God for every contraction with her.

2:45 a.m.

It had been almost 2.5 hours since AK had used the restroom and since I am used to encouraging moms to empty their bladders every half hour, I asked KZ how possible it would be to unhook the EFM so she could go to the bathroom, since the bedpan idea didn’t seem to be working. Going way above and beyond, KZ got her unhooked and we walked AK to the bathroom- after we left her alone in there, she was able to void. We were waiting for her to call us in, standing outside the door, celebrating her success- and laughing at ourselves for our pride in her accomplishment, KZ even sang the “Pee-pee in the Potty!” celebration song to a conga tune/rhythm- and AK felt much more comfortable when it was done.

3:00 a.m.

All hooked back up to the monitors. AK said that since coming back from the bathroom, the contractions were now hurting only in front, not in her back anymore- so that was good news, we were hopeful it was a sign of good positioning. She was very tired, so since her back wasn’t hurting anymore, decided to try side-lying again and try to rest between contractions.

I went to heat up the rice sock in the midwives’ microwave and saw the nurse anesthetist in the hall. She asked how AK was doing and I said awesome- she agreed that she doubted she would be needed in that room! When I came back with the rice sock, I told AK that even the Nurse Anesthetist did not think she would need pain meds! RK was reading my Bible and resting, and AK was dozing between contractions.

During the contractions, she wanted me to do the single hip squeeze (the other hip was against the bed) and put the hot rice sock on her shoulders, then ice chips when it was over, then rest until the next one. The contractions were still a good 4-5 minutes apart, so she had good rest in between. KZ went to get the waivers for the Vitamin K, antibiotic ointment, hepatitis vaccination, etc. that RK and AK did not want so they could sign them.

3:15 a.m.

When KZ got back with the waivers, I went to the staff restroom. When I came back, AK was having a monster contraction that went on and on- about 2 minutes long in total.

3:30 a.m.

When AK started getting the chills, KZ asked if she could do an exam. She was 3 cm between contractions, 3-4 during, baby still +1 and 100% effaced. We encouraged AK that she was done with early labor now and things would move faster from that point. The contractions were still relatively far apart- anywhere from 4-7 minutes, but lasting 90-110 seconds long when they did come. We started using the cold washrag during contractions about this time. KZ went to get coffee. It smelled really good. She offered me some but I was content only to smell hers.

3:45 a.m. to 4 a.m.

AK had three contractions in this 15 minutes, during two of which she felt like pushing, so we blew threw them, slowly saying “Hah! Hah!” She asked me if it was going to be ten more hours. I told her I doubted it, but couldn’t predict the future. Julie came in and checked her blood pressure, which was 105/63.

4:00-4:30 a.m.

AK getting more serious. She moved from semi-sitting to left side to right side. Every time she moved, she had a big contraction- but still long breaks in between. We unhooked her again so she could go to the bathroom at 4:25 a.m. After getting re-hooked up, she stayed standing and leaning over the birth ball on the bed, dancing through a few contractions.

4:45 a.m.

Back to right side-lying, needed another cup of ice chips- a whole cupful already? That’s a lot of ice chips! We were back to chanting, “Open, Cervix! Open! Abre’!,” during contractions. At one point, RK read Proverbs 31 and when he was done, remarked, “AK, you are that woman. Except for you have to work on the weaving scarlet cloth part.”

5:03 a.m.

Decels in the 60’s-70’s- the only time in the whole labor the baby had decels. We quickly got AK to switch positions, she said she felt the baby moving down, gave her some oxygen. Baby’s heart tones were back in the 120’s-130’s within a minute or so. KZ did another exam, and AK was dilated to 5 cm now, and baby was back to 0 station from +1, but felt different- we speculated maybe anterior now, maybe changing positions again? KZ couldn’t feel her head well enough to tell for sure.

5:30 a.m.

Took the oxygen off since baby had been perfectly fine since the one incident. AK was still in the left side-lying position, contractions still widely spaced- strong when they came but a good five minutes apart.

5:52 a.m.

AK had a contraction that just went on and on- peaked then started easing, then went back up, started coming back down, the back up, before finally going away altogether. It was about eight straight minutes with several peaks, sometimes more, sometimes less, but continuous pain of some magnitude.

6:00 a.m.

AK felt pushy, and after that contraction, we wondered if she might be complete- did an exam, she was 7 cm, 100% effaced, and back to +1 station. I assured her that this was transition but that meant this was as hard as it gets- and she is doing beautifully, her body was working perfectly, the baby was doing great.

6 a.m. to 7 a.m.

As AK passed through transition, from 7 cm to 10 cm, during contractions frequently she sang to Adonai. At one point, RK was singing with her, at another point, KZ did.

She and I spoke what felt almost like a litany, sometimes my leading and sometimes she did- I might say, “This contraction is not as strong as God!” And she would reply, “God is stronger than this contraction!” Or, she might begin with “I can do this!” and I would respond, “You can, and you ARE, doing this! You are almost done!”

We said, in our call and response pattern, “The joy of the Lord is my strength!” and “God is…” my rock, my hiding place, my resting place, my safe refuge, my shepherd, my hope, my redeemer, my defender… And I would say it, then she would repeat it back to me, emphatically. We said “YES!” to the contractions, when they came, we thanked God for each contraction. Sometimes we said a single word to one another- Strong! Powerful! Productive! Purposeful! Occasionally, she would tell me, “Delilah, it hurts!” And I would agree, that “Yes- it hurts- and that is good, because it means her cervix is opening the door, Rachel is coming!” And she would say back to me, “Yes! Open, open! Come to me, Rachel!”

During moments when it was too intense for her to answer back in the call and response pattern, I firmly told her that this contraction was productive, it was bringing Rachel to her arms, it was healthy, it was doing good work for her, to let it come- not to fight it, to let her body work. As the contractions were ending, she would begin to shake and try to keep herself from shaking, and I would remind her to let it go- that it is okay to shake- just let her body go. Let it work. Let it, let it, don’t fight it- release.

KZ suggested the word “melt”- and melt was my new favorite word! “Let this muscle just melt into the bed.” I would touch where she was tensing and say let this part melt- let it go. Then we would all rest between contractions, with the room completely silent and lights dim.

7 a.m.

Completely dilated, 10 cm and ready to push- and now that it was okay to push, not a single pushing contraction! She had almost twenty minutes without a strong urge to push, and in the semi-sitting position, only one contraction. This was shift change, we said goodbye to Julie and hello to our new nurse, Lana.

Julie and one other lady, a resident, had popped in occasionally throughout the night but not very often, and usually very quietly and unobtrusively. As the sun came up and the day shift began, there were a lot more people in and out of the room. Some of the sense of intimacy and privacy, of it just being KZ, RK, AK and me, alone in the room for hours on end, was gone- there was definitely a different energy during the day.

7 a.m. until 8 a.m.

AK “flipped like a rotisserie chicken”, according to KZ- pushing on her right side, on her back semi-sitting in the “C” position, on her left side, and back again. She tried on hands and knees once or twice as well. She was very enthusiastic about getting to push, and was putting a lot of effort into pushing- and even was gung ho to offer to push even without a contraction- “I can do more, if you want!” We could tell she was pushing effectively, because when she bore down, the fetal scalp electrode wire from the EFM moved and came out- but after around 45 minutes of pushing hard during her contractions every 4 minutes or so, and the baby was still around +1, and she was getting frustrated.

8 a.m.

Rachel stopped in to say hello- it was so great to see her, and she was encouraging to AK, how well she was doing at pushing, how calm and focused and moving to different positions... she was on hands and knees at that time. AK and RK had benefited a lot from the experience I had gained at Rachel’s birth at that hospital, so it was a joy to me, to get to introduce them to one another.

The contractions spaced out a little, only coming every 5-7 minutes. She had the best pushing contractions on her sides, but felt the power of her pushes best in the “C”- she had the least pain on hands and knees. We ended up sticking with the side-lying, just switching from side to side, because we needed more contractions to get the baby out! I did a whole lot of back counter-pressure and hip squeezing during this time.

8:20 a.m.

Dr. T came in to check on how things were going. He was absolutely hilarious. It was interesting, the different “climate” having his male energy enter the room produced. He was cracking jokes, teasing, and aggressively coaching A to push (which we had not been doing so much, since she had specifically requested we not, in her birth plan- but he hadn’t read it). However, she didn’t seem to mind, and in fact, whether it was coincidence or not, I don’t know, but she did move the baby forward during the push he coached her on! His personality was like a whirlwind, and he whirled back out after that one contraction, but after he was gone, it began to feel more like we were going to have a baby imminently.

8:45 a.m.

RK answered his cell phone for at least the third time, I heard him saying that he was in the delivery room with his wife. I kept wondering why he was still answering the phone at a moment like that?! Voice mail! But he didn’t have an irritating ring tone, so I don’t think it disturbed AK as she worked. Shortly after that, he came and sat beside AK, but I don’t think he ever looked, though he did begin encouraging her to push as we promised her the baby was becoming visible. KZ got the mirror set up, and once AK could see the baby’s head, she re-doubled her efforts, which had already been intense!

9:20 a.m.

Rachel Eliana was born! She was straight OP- born looking right up at us, bless her heart. KZ suctioned her on the perineum, she had a lot of gunk, but she was crying within seconds of being born. They immediately clamped and cut the cord and handed her off to the pediatric team. Since she had been born face up, and AK had had a mirror, she got to see her baby’s face before she was whisked away, and since she was crying already, it was not a fearful moment, wondering if she were okay. Rachel’s APGAR scores were 9 and 9. She weighed 6 lbs 7.9 oz and was just lovely! RK went over to watch them work on the baby and take photos.

9:35 a.m.

AK birthed the placenta and they started the Pitocin drip. She had a second- degree tear, which KZ repaired. AK’s blood pressure was 116/60. She ended up wanting to see the placenta after all, so we had a look at that- it was a small placenta and small cord- but this was a small baby and AK is not a large woman, either. Everything was great!

10:00 a.m.

Still a small trickle of blood, KZ looked for the source. Her uterus was firm and it was not coming from the repair. The Pitocin was not flowing well but KZ got it going better.

10:05 a.m.

RK went to get the grandmothers from the waiting room while AK and KZ tried to get Rachel latched on to start nursing. The grandmothers were delighted with their perfect granddaughter and expressed their love and approval to AK of the great job she had done. RK bragged to them of how AK had needed not a bit of medication, done it all natural. He was so proud of her! AK’s mom very briefly got to hold Rachel, long enough to carry Rachel from one side of the bed to the other while AK turned over to her other side to try nursing on the other side.

10:25 a.m.

Lana took the baby from AK, and Rachel expressed her displeasure at that state of affairs- loudly. RK and the grandmothers went with Lana and Rachel to the nursery. (They asked if they could delay, but Lana said if they don’t have the babies in the nursery by one hour postpartum, that they get chewed out.)

AK told KZ and me, “I am feeling overwhelmed with happiness in my heart. I want to bless you both, I praise Adonai that he has blessed us today!” And she went on to bless KZ and me individually- her joy was so strong, it was just so precious to me. This was one of the best moments I have ever had as a doula.

I said goodbye to KZ and told her “Let’s do this again sometime!”, and then accompanied AK and RK to their post-partum room and got them settled in with all their things. AK insisted that RK pay me right away, even though I said at the postpartum visit would be fine. And then I went home, tired and happy, and took a nap.