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Denise Punger MD FAAFP IBCLC
A Physician's Personal Experience with a Doula
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DENISE'S BIRTH STORY:

A Physician's Personal Experience with A Doula

Labor and delivery was not quite what I expected. I knew it would be tough, but I thought that optimism, my medical education, good health, and family support would get me through labor with dignity. If it didn't did it really matter anyway because women are suppose to forget it all afterwards. Four years later, I have not forgotten either labor.

I wish our culture encouraged woman to talk about how the birth experience made them feel, not just the sequence of events. Both my pregnancies raised feelings in me that I never heard another women or physicians talk about. I was much better prepared the second time when I had a doula for physical and emotional support. I would be negligent if I did not share the circumstances surrounding the births of our sons. The first was a "typical" birth; the second portrays a normal birth the way birth should be for every birthing mother.

williamholdiingbabyscott.jpg

The Great Adventure

My first labor began around 4 A.M. after a long nine months. I had been awake since about 2 A.M. The early, easy, rhythmic contractions lasted over 12 hours. The beginning was not too eventful. I was hopeful and in control. When the contractions started getting stronger around 4 P.M., my husband, John, and my mother coaxed me into going to the hospital sooner than I wanted. They were getting tired. It had been a long day without sleep and not much food for all of us.

With the onset of unexpected vomiting and stronger contractions, my optimism was gone. The hospital room seemed like it was 100 degrees. When youre fatigued, starved and in pain, it doesnt matter how many years you and your husband went to medical school (not to mention that I had delivered over 200 babies 3 years prior in residency). I was also under some kind of delusion that if you were healthy, remained active, and had a good diet, you may have an easier labor.

This story would be very short if William just popped out after I was complete. My "pushing stage" lasted 3 hours. I use the term "pushing stage" lightly because I was waiting for the urge to push and never did feel it. This distressed me. Furthermore, I did not know this stage could last over 2 hours. In residency most patients would end up with a vacuum or forceps assisted delivery, or C-section if it did. It felt like one long contraction that would never end. The clock was perfectly centered on the wall in front of me to remind me how long this was taking. It was unbelievable that one contraction seemed to last 3 hours. There was no time to recover from the previous contraction, like the earlier ones.

I remember screaming (this was not in my birth plan). I remember Johns friend's, who were not invited, in the waiting room. I knew they could hear me because I could hear another laboring woman curse from her room. This affected my ability to concentrate. I never wanted his friends there, but I didnt have any initiative to ask them to leave.

I remember everyone present eagerly watching my bottom hoping a head would emerge. I was aware that they could see me push out stool, and it actually inhibited my efforts to focus. John and my mother were worn out after 16 hours, when I needed them the most. They wanted to be helpful, but not everyone can last this long. I had believed that all husbands and mothers made great labor support. In a traditional culture, this may be true. Honestly, now-a-days most men have never seen a woman in labor, and most of our mothers were sedated when we were born. Mine was. Just because we love each other and want their company doesnt make them good support. Prenatal classes teach us to pick a coach and bring that person to class, so you will both be prepared. The classes dont emphasize the importance of having an experienced female present.

After 3 hours of pushing, I was begging my obstetrician to stop the pain anyway he could. It was humbling to cry for the end. I cried for anything: the vacuum, forceps, episiotomy, c-section. It didnt matter at that point. I was in so much pain. I was exhausted. I thought I would be better off dead.

Looking back, I am really grateful that my doctor waited for William to be born vaginally, respecting my initial plan. At the end, the nurse put an oxygen mask on me. That seemed to energize me to push when they instructed me to. My mother said that the mask was laughing gas, like at the dentist. I dont know about that.

My doctor agreed to let William nurse while he repaired the tear. Sounds easy, but that wasnt the end. Why doesnt anyone ever talk about how much afterbirth contractions can hurt? It wasnt stressed in medical school or in prenatal classes. I had forgotten that women post-birth often shiver from all the changes in body fluids. So, I was still having contractions and shivering, and I was supposed to lie still for the doctor to repair the tear?! Who was my support then? Labor was over. The family focus was on the newborn.

In the next several days I felt like my body had been physically beaten. My mother went back home encouraging me that I "would feel better soon". My husband was back to work after two days. It seemed like everyone was quickly forgetting my labor.

I wondered if I was the only woman who was traumatized by her own labor. I felt alone. My mother revealed that she thought that my hollering and lack of control was abnormal behavior. She couldnt believe I begged for a c-section. At the time, I had been insulted. Now, I realize my mother had never seen another birth. She had no point of reference.

I wish I had that experienced female labor coach to tell us that my labor was normal for me, and that I did a great job pushing out a nine pounder. I wish I had someone right then and there to put this into perspective for my family. I wish I had someone that could have helped me get into different positions so that I was not lying on my back with my bottom exposed to the world for 3 hours. I wish I had someone who would have told my husbands friends to scram and give me privacy. I wish I had someone to relieve my family, so they could recoup. If I did have an experienced labor assistant, I might not have walked away from this birth experience frightened to have another pregnancy. In my mind, now I know I did the best I could under the circumstances. The shame of it is that I never even heard of a doula at that point in my life. I strongly believe a doula would have helped.

One Short Year Later

I couldnt believe I was pregnant. I wanted another baby, but did not want to endure three hours of pushing again. I shared my feelings with my midwife. She recommended I call a doula.

When we met her, my husband and I both felt better. I was going to have a second chance to prove my body was normal. The doula seemed to know how to help. After talking, she helped us to realize how common it is for men to get tired, nervous, and pale seeing their partners labor. Despite popular belief, my husband and I concluded that most men are not the best choice for labor support. John felt relieved that he could play the role of a nervous father-to-be and not have 100% responsibility for my pains, emotional status, and birth memories. He would not have to starve and hold his bladder the entire time I labored. Also, most men have never experienced pain anything like childbirth. Real men should admit that and insist on a doula. I am glad John's ego didn't get in the way of obtaining the help I needed.

I suspect that my mother may have felt hurt or rejected at the time that I asked a stranger for help, but now she realizes the importance of labor support and may even have regrets about being sedated when my sister and I were born. Thirty plus years ago laboring woman werent given a choice. But we can make choices now.

Round Two

My second labor began around midnight when I was 41 weeks. I had seven extra long days to dwell on the upcoming event. My doula let me call her any time. She was always encouraging and put my mind at ease. When I thought I was in labor, she came to my house. It was my plan to remain at home as long as I could.

At the beginning of labor I had some privacy because my family had been asleep. I didnt want anyone nagging me, "Are you sure youre having contractions?" I also wanted to cuddle and cherish William. Soon he would have to share me with his baby brother. Most expectant parents would not imagine their partner sleeping through any of labor. Experience changed the priorities. The benefit later was that John was awake, attentive and supportive to me in the early morning when Scott was born.

Early on, my doula and I walked around my block. The night air was refreshing. She helped by reminding me to sip liquids frequently. She reminded me to empty my bladder. Sitting on the toilet was especially useful. We automatically relax our pelvic muscles when we sit. Relaxed muscles meant that the baby would drop quicker. Sitting in the bathroom really seemed to make labor progress. My doula also has a calm, soothing voice, a quality that my previous coaches lacked. My doula also taught me how to listen to my body to know what stage of labor I was in. While in labor, my doula and I laughed as I ceremoniously deposited a few stretched out maternity clothes into the garbage. This was a sign of early labor. I was social and optimistic.

At about 4 AM the contractions became much stronger. My doula seemed to know exactly where to put counter pressure on my back to minimize the pain. As my family was gathering, I was irritable. I was blaming everyone for my pain. This behavior is common in active labor. My doula reminded us that labor was progressing well, and that this was normal. She reminded us of the incredible work my body was doing. Her gentle voice helped to calm all of us.

I knew I reached transition and was close to birth because I felt a trembling in my legs and buttocks, felt renewed energy, and FELT THE URGE TO PUSH! In medical school I only remember about determining dilation by an internal exam. As a physician I was never taught to observe a womans body language, mood, and verbal clues to help evaluate how close to birth she was.

We took off for the hospital. I had several hard contractions in the car. I had an intense contraction as I entered the hospital. I couldnt believe it, but I felt my babys head crowning in the lobby. I could touch his head with my hand, and I felt like pushing. I am so glad I was the first person my son ever touched outside the womb.

I had enough time in between contractions to make it to the delivery room. Scott delivered himself on the next contraction. A midwife from another group, who happened to be on the floor, caught him. Scott was nine pounds also.

I had uncomfortable afterbirth contractions and was shivering again. My doula stayed with us until I was stable and comfortable. Even though William was a natural at nursing, she was interested in making sure my breastfeeding relationship with Scott got off to a good start as well. She even came to check on us several days later. I enjoy her friendship two years afterward.

After Thoughts

What else do I remember? Being in control the entire time, giving birth without medical intervention, and hearing positive affirmations throughout my labor. This delivery helped me overcome my self-doubts. It is interesting to me that I had two boys weighing 9 pounds even. If the second was smaller, I may have associated a smaller baby with easier labor.

I am often asked why I didnt want an epidural. My review of the research has indicated epidurals lengthen labor and increase the chance of other interventions, which in turn lead to an increased chance of c-section. Epidurals deny your body the chance to experience this key life event. The effects of an epidural on the newborn are not well studied yet. I wanted no chance that it may interfere with breastfeeding and bonding.

In a way I wish my obstetrician from my first birth had been at Scott's birth. He would have seen the difference a doula could make. If I delivered babies, I would insist that all my patients consider having a doula. I really feel bad when I hear a mother tell another, "Youll forget it all anyway." Giving birth can be rewarding physical and emotional experience. You never will forget it. You can look forward to it. Plan for yours well.

Denise Punger MD, and her husband John Coquelet DO, both family physicians, live on the Treasure Coast with their two sons William (4) and Scott (2). Denise is a La Leche League Medical Associate and pursuing her IBCLC certificate. (International Board Certified Lactation Consultant)

Bernadette Clark, CD (DONA) served as Denise and Johns doula at the birth of their son. Bernadette lives on the Treasure Coast with her husband Jim and their ten children. She is a certified doula with Doulas of North America (DONA), a member of Childbirth Enhancement Foundation (CEF), and has served as a doula since 1992.

 

 

 

Reflections of My Obstetrical Training

 
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Denise Punger MD FAAFP IBCLC
4640 S. 25th Street
Ft. Pierce, Florida, 34981
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Copyright 2005