A Day in the Life: Step by Step by Guide to a Doula Birth
3:22 am: Phone rings. Mrs. Johnson’s water just broke. She’s very nervous. You assure her that everything is going to be ok.
You grab your birth bag and a shot of espresso. It’s time to head to the hospital.
You quickly review the birth plan for the client. Take a look at what a sample birth plan would look like.
Johnson Family Birth Plan - Hope for a Natural Birth
We would like to try to have a natural birth if possible. We would like to avoid medications such as pitocin, epidurals, etc. If there is a need for these medications, we would like to have time to discuss the alternatives and consequences.
In order to promote a favorable cervix, we would like to try these natural techniques if possible.
- Walking in the labor ward
- Changing positions
- Nipple stimulation
For our delivery plan, we would like to promote mom and baby bonding. Please place the baby onto mom’s chest as soon as possible. Please hold off on any tests unless these tests can be done while the baby is on mom. The mom’s partner would not like to cut the cord, please do not pressure him to do so. We hope that the placental cord will only be cut after it stops pulsating.
We would like the baby to be in the room with mom as much as possible. We also hope to have a private room. If the baby is a boy, we would like to go forward with a circumcision after he is able to pee on his own.
4:34 am: You meet Mrs. Johnson and her husband in the lobby. They forgot their pregnancy bag and they look very worried. You calmly smile and say, “no worries, why don’t you get checked in and triaged. I’ll take your house keys and grab the bag. I’ll meet you up in your room in 30 minutes.”
You can see the wave of relief wash over their faces.
5:03 am: The hospital transporter just dropped Mrs. Johnson just got in her room with her husband. There are visibly happy to see you and their pregnancy bag.
5:14 am: The labor and delivery nurse arrives and introduces herself. Her name is Tracy. She is friendly and upbeat. You are sure to introduce yourself as Mrs. Johnson’s personal doula. You explain that your job is to provide physical comfort and emotional support for Mrs. Johnson. You also mention that you won’t be involved with any of the medical decisions.
5:21 am: The resident-physician, Dr. Walter arrives. She explains that she works with your regular obstetrician, Dr. Smith. She is just coming on for her 12 hour shift and will be monitoring you and your baby for any issues. She also explains that Dr. Smith is off on vacation this week and his partner, Dr. Watson will be supervising. Again, you make sure to introduce yourself politely and briefly explain your role.
Dr. Walter explains that based on her exam, the cervix is not favorable at this time. She is recommending pitocin to speed along the labor process. Pitocin is a pharmaceutical version of the human hormone, oxytocin. Pitocin acts by softening the cervix and progressing the time to labor.
You know Mrs. Johnson’s birth plan cold. She looks to you for guidance. You kindly tell Dr. Walter that Mrs. Johnson would like to try and minimize any artificial drugs. You ask her if it’s safe to wait a few hours and see how Mrs. Johnson’s progresses naturally.
You and Mrs. Johnson then take a few laps around the pregnancy ward. Her partner is just a few steps behind.
Dr. Walter answers that it is safe and that she’ll come by and check her in 2 hours.
5:28 am: Tracy comes back and has some orders written by Dr. Walter. Tracy asks if it’s OK if she starts a peripheral intravenous line (IV) and put on electrodes for fetal monitoring. She let’s you know that this is precaution in case they want to start any medications or fluids. There is no plan for that. This is a small catheter that is inserted into Mrs. Johnson’s arm vein. Mrs. Johnson looks to you for guidance.
You explain to Mrs. Johnson that everything looks great now. The peripheral IV is a precaution. In case of an emergency, the nurses and doctors need a catheter to be able to administer the drugs. The IV is a small prick. Mrs. Johnson looks at Tracy and agrees to the peripheral IV.
You also mention that the fetal monitors are there to make sure your baby’s heart is stable.
7:32 am: Dr. Walter checks in again. Mrs. Johnson is doing well. The contractions are becoming more frequent but she is able to handle it. She tells you that she doesn’t feel that she needs pain medication. You look at Mrs. Johnson’s partner and reassure that she’s doing great. You tell him to just continue holding her hand and whispering encouraging words.
Dr. Walter informs you that the cervix is progressing, but still not favorable. She brings up the option of pitocin again to speed along the labor process. Mrs. Johnson is unsure at this point. You ask Dr. Walter whether there were any signs that either the baby or Mrs. Johnson was in any distress. Dr. Walter replies no. But, Dr. Walter did say that if labor continues much longer there is a greater risk of infection. This definitely gets Mrs. Johnson’s attention.
You step in and explain that everything is about risk and benefit. Right now, there is no immediate need to make a decision about pitocin. You ask Dr. Walter if pitocin is safe. She explains that millions of women receive pitocin every year for labor and that pitocin is a natural hormone. Mrs. Johnson asks if she can think about it. Both you and Dr. Walter agree.
After 15 minutes, Mrs. Johnson feels that the pitocin is worth it. You notify Tracy and Dr. Walter.
8:43 am: Dr. Walter comes to check-in again. She checks Mrs. Johnson again. Her cervix is now fully dilated! You congratulate Mrs. Johnson that she’s moving forward with her labor. However, Mrs. Johnson is feeling much more pain.
Dr. Walter asks her if Mrs. Johnson would consider an epidural. Mrs. Johnson has read a lot about the epidural. She knows that the epidural is in her spine so the baby is not exposed to any of the pain medication. But, she also knows the epidural prevents her from walking around.
You tell Mrs. Johnson that perhaps we should try breathing exercises first to control the pain. If the pain is too much, then we can always agree to the epidural. You also ask Dr. Walter if Dr. Smith or Dr. Watson is coming in soon. With all the activity going on, Mrs. Johnson completely forgot her regular obstetrician! Dr. Walter explains that Dr. Watson is covering Dr. Smith and has been kept up to date about the progress of Mrs. Johnson. Dr. Watson is expected to come by in an hour or two.
8:54 am: Mrs. Johnson is getting too uncomfortable. Even though she wants to have a natural birth according to her initial plan, the breathing exercises are simply not working.
Dr. Walter is paged and notified. She contacts the anesthesiologist to get the epidural going. You explain to Mrs. Johnson that they are going to numb up her back and then put a needle there to give her pain medication directly to her spine.
Mrs. Johnson does great with epidural procedure. She begins feeling pain relief.
10:32 am: Dr. Walter comes in and checks Mrs. Johnson again. She says that the baby is close to being delivered and it’s going to be time to start pushing soon.
This is your moment to shine as her doula. You time your encouraging words to when the uterine contractions are the strongest. Phrase like:
“Push push push push! Right from your bottom, find your strength!”
You continue to remind Mrs. Johnson that she is doing amazing. You periodically update her partner about what’s going on with the birth.
12:45 pm: It’s been an exhausting 2 hours but you can see the baby coming down the birth canal. Mrs. Johnson is clearly tired but still pushing along. She is giving great effort with your coaching.
1:38 pm: The attending physician, Dr. Watson, and Dr. Walter come in together. After a few hours of heavy pushing, Mrs. Johnson is clearing getting tired. Unfortunately, it doesn’t seem like the baby is moving further down the birth canal.
Dr. Watson explains that it looks like there has been an “arrest of descent.” You explain to Mrs. Johnson that this happens a lot with first time moms. Dr. Watson explains that with an arrest of descent they have to think about a few different strategies to get the baby out to avoid a C-section.
The explanation happens in a whirr and you can tell Mrs. Johnson is having a tough time digesting all of this information. Scary terms like episotomy, vacuum assisted delivery and foreceps are being used.
You step in and ask Dr. Watson what other techniques that don’t involve instruments or cutting. You bring up position changes or trying massage that may help coax the baby down. Dr. Watson explains that right now there is no sign of baby distress but waiting too long is not a good idea either.
You ask Mrs. Johnson how she is feeling. She explains that she wants to try a position change like standing up before anything else.
1:53 pm: You and her partner help Mrs. Johnson stand-up in the hospital bed. You’re hoping that with gravity’s help, the baby will be coaxed out.
1:55 pm: Tracy notifies Dr. Walter and Dr. Watson that the baby is coming soon. A flurry of activity happens. You see Dr. Walter and Dr. Watson quickly put on their gowns and gloves. You can see the baby’s head inching towards the outside. Mrs. Johnson is both scared and excited. You let her know that her beautiful child is about to be born.
1:57 pm: With a whoosh and then a cry, a beautiful baby girl is born. She is gorgeous. You remember the birth plan and ask out loud if Mrs. Johnson can hold her baby right away.
You can see Mrs. Johnson’s eyes well up with joy. You also don’t forget her partner who seems a bit queezy. There is a fair amount of blood. You give her partner a strong squeeze on the shoulder and offer the chair if needed.
You also don’t forget about the placenta too! You mention it’s still pulsing and if possible, Mrs. Johnson wants the cord to be cut only when it stops. Dr. Walter is happy to oblige.
2:01 pm: The placenta is delivered without any issues.
2:02 pm: Dr. Walter and Dr. Watson explain that there is a 2nd degree tear in the vagina and that they will repair it with some sutures. Mrs. Johnson and her partner don’t seem to hear as they are preoccupied with their beautiful new baby girl.
2:11 pm: The obstetricians have left. The pediatrician team introduces themselves and takes over. They explain that they’re going to check everything over with our new baby girl. Mrs. Johnson agrees and reminds everyone that she would like the baby in the room at all times if possible
2:13 pm: The orderlies come in and clean up the room. The transporter arrives to take Mrs. Johnson to a private room. You follow along and you remember to grab their hospital overnight bag.
2:32 pm: You all enter the new room. Mrs Johnson is very pleased with how her birth went. They thank you for all of your amazing help and support. You make sure to thank them and compliment them about how strong they were. You hand them your card and mention that if they had a great experience with you to post on your yelp account and tell others!
3:23 pm: Phew! What a day! To think you’ve been up since 4:00 am. You have no time to waste. You have 2 more clients that are due soon. You have to make sure that you know their birth plans cold.