Lessons for a Birth Doula

TW: mentions of blood, birth trauma, and sick babies

09/30/2023

I’m writing this currently tucked into bed, the sweetest place I’ve ever been by current standards. 3 births in the last 96 hours, maybe 10 hours of sleep between them total, has left me running on the whispers of fumes. Even running on empty, however, I am still in awe.

These 3 births created a larger picture and taught me something new about the nature of doula work, and a bit about the nature of motherhood, too.

All 3 of these births were labeled medically high risk in one way or another. A Vaginal Birth After Cesarean (VBAC), chronic hypertension turned preeclampsia, and a premature delivery at 33 weeks. Each of them had a pregnancy experience with no shortage of doctor’s appointments and anxiety, though they all walked very different paths. Meanwhile, I balanced on a tightrope of honesty about their risks while also dispelling anxiety and making room for joy, something I think all births deserve and need to have space for. 

Luckily, this wasn’t my first rodeo with a complex delivery and my first difficult support experience as a doula taught me a lot about walking that tightrope. Thinking back to the earlier part of my career, I entered this client’s home one fateful day thinking I was merely stopping by for a check-in at her request. Instead, I found a woman in full active labor on her living room floor, baby clearly not interested in waiting anymore. It was intense and the house was sweltering hot, but she embraced each contraction like a champion and within an hour her husband was loading up the car for the drive to the hospital. 

Once there, things started to change. What started as a surprise but totally normal labor ended in a placental abruption and resuscitation of the baby upon delivery. Placental abruption, for those of you unfamiliar, usually means a lot of blood as the placenta begins to tear away from the uterus wall. Baby can’t get full oxygen levels if the placenta isn’t working. This abruption was no exception. 

If I’m being totally honest with you reader, staring down the chaos of life and death all within the same few moments, I had no idea what to do. Up until that point my doula journey had been all about teaching people to let go of what-ifs, to embrace the intensity of birth and find their inner power. It’s rare, but here was a moment where the bad things that could happen were actually playing out in front of me. Where the fear was real, and I truly didn’t know if it would be okay. She was bleeding, and the baby was blue, and there was no joy here. 

In the moment, I did the only things I had the power to do. I held her hand, and I held her husband’s hand, and we existed joined in a circle together all looking over at the small human in the warming bed while waiting for a cry. Her husband would give my hand an extra squeeze as if to check in with me there was nothing he was missing, and I would squeeze back as if to say They’re both still here. I told them what was happening in the most optimistic voice I could manage, “Those three nurses are all taking such good care of her. Do you see her starting to move? Did you hear her make that small sound? She’s starting to be alert.” 

And when she did, finally, cry, we all cried with her. 

That family is doing well now, but I think about them often. In the weeks after, I would frequently consider all of the things I could have done differently. In particular I thought about all the times I told them it’ll be okay, not knowing it was true but having nothing else. I wanted to take away their fear, but I didn’t have that kind of power, so what was I really doing besides filling the space with words? To this day they tell me what a difference I made for them, but I wanted to do even more. I never wanted to have nothing but emptiness to offer ever again. There had to be a way to be strong without making a promise I couldn’t keep. 

Luckily, none of the 3 births this week were quite that intense, though they each had their moments of trial to be sure. The most looming obstacle of labor is often not the exhaustion or the pain, but the unknown. Learning how to sit in that unknown, to exist in it with hope and love, is where power can be found. And I’m happy to report I did learn the words that matter in those situations, though I couldn’t repeat them to you here. It’s a lesson my heart learned; my brain is still catching up. But I do know now that sometimes when reassurance isn’t enough, the best support you can give to someone standing in quicksand isn’t to deny they’re sinking, but to tie a rope around your waist and dive in with them.

All that confidence aside, I did find myself with a new struggle to tackle when the last of these special 3 called me just a few hours after her birth to process everything that had happened. She had moments of joy, and got the outcome she desired, but she also had moments of fear. Moments that drowned her and moments that uplifted her heart, sometimes right next to each other. I found myself once again doing the delicate footwork of a balancing act: how to celebrate her amazing achievements, how to show her through my eyes just how breathtakingly powerful she truly was, while also recognizing that there were moments she’d rather forget entirely. 

The feeling immediately pulled me back to the very day before, when labor nurses and I cheered as client #2 delivered her preterm child. It was an easy delivery (as easy as birthing a child can be, obviously) and there was so much to be grateful for, but nonetheless the room was full of emergency staff to help this small baby breathe. My client cried with joy at the meeting of her child but cried in grief just moments later as she was taken away for extra care. She was so happy and so sad at the same time, an occasion of joy that happened too early. 

My first client that same night, having delivered her baby earlier in the week, was preparing for a different battle. It was time to go home and she was grateful, ready to sleep in her own bed, while at the same time mourning having to leave her child behind in the NICU after unexpected complications. It was the beginning of a long journey healing from a c-section she had tried to avoid her whole pregnancy… but it was the c-section that brought her baby to her, safe and sound. 

Complicated. It’s all really complicated, like most of parenthood. 

As I navigated these conversations, I started to realize that some of the best comfort I could offer was truly not comfort at all, but rather permission. Permission to make space for the fact that having a baby is exciting but it’s also terrifying, even when everything goes right. When it doesn’t, the layers of grief on joy on fear on peace on… really anything, pile even higher. I see them all, and I hear them all, and all of them make sense to me. Knowing how to honor them all within the same conversation was where I found growth.

I think you’re allowed to cherish and despise your story at the same time. I think you’re allowed to love what it brought you but mourn how you got there. I think it’s normal to remember the love and support you were surrounded by, but also remember how scared you were. 

For all the moms-to-be that might read this blog, I know it’s uncomfortable to think of going through something this hard. But I think that all three of these amazing women realized that despite their fears and their trials, at the end of it all, they were still themselves, but a version that now had a new baby and a new understanding of their ability to go beyond their limits. Them, but more. And while I’m sure there are pieces of these experiences they would not choose to repeat, I learned through these three how to really honor the whole picture, and how to do it honestly. 

I can’t say everything is going to be okay. But I can say that I see my clients’ strength, that I see their care team working hard, that I see the love they share with their partner. I can tell them if the weight is too much to bear, they can rest on me because I will always have the space. 

And for this week, that’s what being a doula meant. I’m looking forward to seeing what it means next week.