"When COVID Hits, and You Can Only Support Your Client Through the Phone" Transcript

Ajira: You’re listening to Doula Stories, a podcast where we use storytelling to encourage, inform, and love on doulas.

Keelia: Each episode we’ll hear a story about what happens in the birth room from the doula’s perspective. I’m Keelia, she/they…

Ajira: And I’m Ajira, she/they…

Keelia: And we’re so glad you could join us for today’s story.

Ajira: Before we get started today I wanted to name that we omitted mentioning the land that we're on and that's something that is important to us both so we like to acknowledge today that we are on unceded Ohlone territory, AKA San Francisco Bay Area in California. We will not forget again.

Keelia: We also wanted to explain what today's episode is going to look like. We mentioned this in the intro, but basically some of our stories are going to be shared by doulas who are guests on this podcast, and some of them are going to be in a different format, which is what we're doing today. We realized that only featuring doulas as guests telling stories with the birthing person's permission would narrow it down to only a handful of doulas who have a close enough relationship with the birthing person who they supported where they could ask for their informed consent then share that story. And it also narrowed it down to births where the birthing person and the doula had similar versions of that story. So we wanted to make sure that this podcast is a platform where we could hear The Good the Bad and the Ugly stories that are out there as well things that were challenging for a doula maybe in their relationship with the birthing person, things that they couldn't share with the birthing person. But to do that and protect the doula’s and the birthing person's anonymity we’ve set up this other format which will be Ajira or I collecting a story from a doula and then sharing it with each other anonymously. So today I have a story from a doula named Sam.

Ajira: Yay! I’m excited to hear Sam’s story.

Keelia: Yeah! Yeah they're really cool.

Ajira: Awesome.

Keelia: I guess all you need to know to start off is that our doula’s name is Sam, they use they/them pronouns. How fun would it be if whenever I'm saying something word for word that they've told me I use a different voice?

Ajira: What would be hilarious.

Keelia: [In attempted British accent] ‘allo! I’m Sam!

Ajira: [In actual British accent] ‘allo!

Keelia: [Still in attempted British accent] I’m a buthwukuh! [In normal accent] What you all don’t know is that that’s actually exactly how Sam’s voice actually sounds! And nobody knows that but me.

Ajira: So you’re Sam?

Keelia: Well right then I was. [British accent] Now I’m Sam. [Normal accent] Now I’m Keelia.

Ajira: [British accent] ‘allo, I’m Sam, I’m a buthwukuh.

Keelia: The thing is you’re so much better at the British accent because you actually lived in the UK for many years, so I picked the wrong one.

Ajira: I mean I’d offend my ancestors I think if I got it wrong, given that some of them are Brits.

Keelia: [British accent] Brits.

Ajira: [British accent] Brits.

Keelia: Okay I'll stop insulting our beautiful UK comrades over there.

Ajira: No worries.

Keelia: Alright. So Sam is a seasoned birthworker, and I bring that up because it's relevant to this story. They had been a birthworker for years before this happened. And this happened really recently. Right now it’s the summer of 2020, and part of the reason why we wanted to share this story now is because a lot of doulas are learning how to provide virtual support, and this, after years of providing in person support, this is the first time that Sam had to provide virtual support.

So the kind of birthworker that they arejust so we can get to know them a little bit betterit's really important to Sam to take a trauma-informed, anti-racist, inclusive lens to this work. Those things are the very top of their value system. They also aren't just a birthworker they identify as a full-spectrum doula, which means they support birth of all outcomes. And another thing that's pertinent to this story is that another core value of theirs is that they're very cognizant of meeting people where they're at, and not having an agenda when it comes to their birth. They often say, “This isn't my birth, it's the client’s birth,” and while Sam will acknowledge that many births the client is making a decision that Sam would make if they were in that position, Sam really tries to be aware that they don't want their own opinion to bleed into their support in any kind of way. So what they tell people is, “I don't have an agenda for your birth. I just want you to feel really well-informed to make the decision that feels right for your body, your baby, and your family.” So that's what kind of person they are. Obviously you can tell they're very very cool.

Ajira: Very very cool. I mean, they low-key sound like they could be me. Ooo.

Keelia: Ooo, inception podcast. I also asked them a question to get to know them better as just a birthworker, and I asked if they had any top birthing hack that they recommend to other birthworkers, and they started sharing one and then they got so excited and they shared like four, so I'm going to go through them just because they're all really helpful and they're really quick. One is a reminder to birthworkers to stretch and move our bodies at births.

Ajira: Yes!

Keelia: So they will sometimes set a reminder to go off every two hours to remind them to move their body and drink water. Another tip they have is every time you offer the partner or the birthing person water, you make sure you're drinking water yourself; every time you're offering food, you're making sure you're snacking as well.

Ajira: Mmhmm.

Keelia: Another tip they got really excited aboutthey were like, “Oh and another one! Oh and another one!”they bring some Tiger Balm, which is like a type of balm, you can Google it. It smells like peppermint and they smear a little bit of it right underneath the birthing person's nose when they're really nauseous.

Ajira: Ooo!

Keelia: And it can help their nausea, and it can also right now while people are having to give birth wearing masks during COVID-19, sometimes the smell of the mask is our huge turn-off to a birthing person and they will smear a little bit of the Tiger Balm right inside the mask or right underneath their nose.

Ajira: Oh my god, I love Tiger Balm, I’ve never used it that way.

Keelia: Yeah, I had never thought of that either. I bring it with me to births all the time and I've never used it that way. And then the last tip they had was one of their favorite pairs of boots that they wear to births, they're really squeaky which is really distracting to a birthing person. So if it's in a hospital they'll nab a pair of those booties that you have to put on over your shoes if you have to go to the OR and they’ll just put those on their boots at the beginning so that they're not distracting the birthday person that way.

Ajira: Ohh. Good idea. Goodness!

Keelia: I know! A wealth of wisdom.

Ajira: Sam is a treasure trove.

Keelia: Thank you, Sam!

Ajira: Thank you, Sam.

Keelia: Okay, Ajira, are you ready for this story?

Ajira: Oh my god I’m so ready! I have no idea what Keelia’s about to share from Sam’s story. So like, I haven’t heard Sam’s story, I don’t know who Sam is, please tell me what the story is.

Keelia: That's a great cover, Ajira, we all know it's you. So Ajira-I-mean-Sam met this client really early on in her pregnancy. So the birthing person uses she/her pronouns, identifies as a mom, the partner uses he/him, identifies as a dad. So Sam and this mom had met really early on and right from the beginning Sam was excited because it's so fun to get to share such a long journey with a pregnant person where you really know their story by the time they go into labor. They instantly hit it off. There were several things immediately where Sam was like, “ugh,” like, “this is just the perfect client for me.”

There were a few things that Sam really loved about this client. One is that the client would text Sam in these, like, three-paragraph-long texts, and Sam was like, “Yes! This is how I support people too.” So Sam would, like, write back three pages of texts and they would communicate like that. Which, until Sam said that, I hadn't realized that was, like, not normal? Because I'm definitely that kind of person too. So maybe I just, I don't know, I write texts the way I write letters.

Ajira: Maybe you’re sam.

Keelia: Bum bum bummm. I’m not.

Ajira: No we’re just going to spend every episode being like, “Maybe you’re Sam!”

Keelia: It’s going to be one of us, yeah.

Ajira: Anyway, back to Sam. Go on.

Keelia: Back to Sam. So the texting thing was a nice bonding experience, and Sam also just loved how right from the start this mom... Well, first, she was well aware of the risks of giving birth in a hospital. This mom was a person of color and already was very skeptical of the system and was considering either a birth center or home birth. And that's a lot of the work that we do right at the beginning, right? When we have that conversation about, like, “Tell me about your provider. Are they good fit for you?” and if you have someone who’s saying like this mom was saying to Sam, “I want a lot of autonomy in my birth,” that Sam didn't have to do that extra work of the hospital may not be the right fit for,” you know? This client already came to them saying, “I know I don't want to give birth in the hospital.”

And this mom also really owned the internal work that she knew she had to do before giving birth. She was very upfront about, “These are the traumas in my past that I feel could affect this experience, and I want to actively work through them,” which was just such a clear sign to Sam of, “This is how I can support this client moving forward,” you know?

Ajira: Yeah. That’s beautiful.

Keelia: Yeah. On top of that these parents were just really sweet, and Sam looked forward to prenatals. So they got to have in-person prenatals for several months and a few things started going wrong right off the bat. So Sam starts helping this mom pick their birthing location and she eventually settles on a stand-alone birth center, so this is not a birth center that has an association with the hospital, it does its own thing. And she felt really great about that midwifery care, but pretty early on complications started arising. The first was that this client found out that she has something called hypermobility which I had never heard before. Do you know what this is?

Ajira: Yes I believe it's what people sometimes call being double-jointed.

Keelia: Yes. Yeah, so the way Sam described it was that it's like you're double jointed in your your whole body, which I had never heard of. And by chance Sam had actually recently had a client with this exact same condition and had seen a really smooth birth with it. So this didn’t concern them that much right up font. But the reason it can be problematic is that near the end of pregnancy as your body releases a lot of relaxxin, which is the hormone that literally relaxes your joints to that the baby can more easily move through the birth canal, it can make your body too loose and then you can injure yourself easily.

Ajira: Yeah.

Keelia: It can also make it harder for you to heal after birth and you're more likely to have premature rupture of membranes or prom.

Ajira: Woah, I didn’t know about PROM with hypermobility. That’s interesting.

Keelia: Yeah. Yeah, I know! They said that that's more likely even well before your due date, so you're also at higher risk of having premature birth. So at the beginning of this mom's pregnancy, it wasn't as big of a thing. Then she also tested positive for gestational diabetes

Ajira: Ohh.

Keelia: And with that diagnosis, she was no longer able to give birth at the birth center. So already she has this huge disappointment of, well, one, like, you could have a more challenging birth, or you just have these extra risks to pay attention to you. Then also you have gestational diabetes, and you don't get to give birth in the space that you've always wanted to give birth at, you actually have to be in the hospital. So she adapted. Like I said earlier she was really upfront with Sam about, like, “Okay these are the things about the hospital that I'm scared of. Let's work through them.” So she—Sam felt like she was making Sam’s job easy. Even though that meant that for Sam, they were providing a lot more support than they would have a normal client because things kept going wrong, it felt like… Sam was just so happy to do it.

Ajira: Yeah.

Keelia: So all of that has happened and then COVID hits.

Ajira: NOOO! I mean, I was there, and I’m like, “NOO! NO COVID!”

Keelia: I know! I know, we were all supporting people, and then they got this announcement at some point, right? So as the pregnancy went on, Sam could see this client trying to adapt. So, “Okay I have gestational diabetes, no problem, I'm going to start swimming. COVID hit, okay, I can't swim anymore, I’m going to try and find exercises to do at home.” But because of her joint condition, that was also, she was really limited by that. And then COVID and not being able to have Sam with her. So Sam said that at first it felt like, you know, every month there was something coming up, and then it felt like every week, and then it was just one thing after another. At some point Sam also found out that one of the reasons why their client really didn't want to give birth in the hospital is because she had a huge fear of needles.

Ajira: Mmm.

Keelia: So this client is going to be giving birth in a space where already she hasn't felt safe her entire life; she also has this fear of needles and now fear of COVID-19 which she could get in the hospital; and she can't even have all her support people with her. So what Sam did was start addressing each of these specific things. They talked a lot about, “What are the birthing person's plans around being triggered?” And setting things up so that they have a plan for what to do when that happens. So Sam is recognizing and then communicating that at this point this is not a case of if you get really triggered. It's when. And what are our options in those situations? So they got really into the nitty-gritty. For example—well, I should say they got really into the nitty-gritty, but Sam was really clear with me that that didn't mean prying into her background, into why she was so afraid of hospitals, or why she was so afraid of needles. It just meant, “I understand that this is something I can support you in.” And Sam kept coming back to how if Sam were to poke and pry into that it can be really irresponsible as a support person to do that. We don't need that information we just need to know what that person is going to need when things come up.

Ajira: We don't need that information, and we… I think it's disrespectful to insist on or try to manipulate or dive into that because people will share what they'll share. And I think what we can do, and what I'm hearing Sam was doing, is just really talking through, like, “Okay, we know that this is something that's charged for you. So how do we, how do we notice when you're activated, and then how do we get you grounded again, you know? And let's practice those things before we're actually in the moment,” which I love. And for the longest time it seemed like I was the only doula who had these kinds of conversations with my clients, so I'm so excited to hear about every birthworker who is doing this, kind of like, trauma-informed work. I think it's so, so needed. And if you're a person of color, or you're Black, or you’re indigenous, and you live in the United States, you need a trauma-informed approach to support.

Keelia: Right. Right, that it's not this… What I often hear is, it can be confusing, of like, “Does that mean that I treat everyone as if they are traumatized, and assume that their trauma looks like abcd?” Like, no. Having a trauma-informed approach does not mean assuming that you know what their trauma looks like.

Ajira: Yeah.

Keelia: It just means being really thoughtful around, how can we provide care that doesn't re-traumatize someone, take away their dignity, disempower them in any way?

Ajira: Mm. Mmhmm.

Keelia: I asked Sam for some really tangible examples because I kept thinking if I was in their shoes, that would just feel like so much. Like how can I hold all that for someone at once? And Sam said that one thing they did was actually reach out to another birthworker who they knew specialized in this kind of trauma-informed approach. And I definitely do that too. When I'm supporting someone and I feel like I don't have all the resources or all the training that I need, I gather my people and, you know, we share what we think can help somebody.

Ajira: Yeah, same.

Keelia: One thing that Sam did was, for example, acknowledge with the birthing person, “Okay, you're afraid of needles. Here's what it looks like when you get to the hospital and they're going to try and give you an IV.” The client had a lot of fear on that specific process so Sam was able to say specifically, “This is each step of what that will involve. How do you think we can support you best, virtually and in-person?” They developed a very specific plan of, “We're going to have Sam on an iPad so that we can see their face big enough instead of on the small screen. We're going to have airpods: one in the birthing person’s ear, one in the partner’s ear so that we can both hear what they're saying as they coach us through this.” So Sam knew as soon as the IV became an issue that they were going to call them, they were going to be on the phone and then Sam would walk the client through a meditation while the client would hold her husband's hand. And she also, in the other hand, she had a rock that was really grounding for her, just to have something physical she could access at any point…

Ajira: Mmhmm.

Keelia: …to help her come back to her body. That was just for the IV. So that's one example. Sam also went over some general techniques of, “If you're starting to feel triggered, traumatized, you can use something called The Five Things Game where you look around the room and notice five things that you can see and you say them out loud. ‘I can see my water bottle. I can see a pen. I can see my husband.’ You know, just that practice alone can really help.’

Ajira: Mm.

Keelia: And I know you, Ajira, you have a version of that where it's five things you see…

Ajira: Yeah, it’s Five Four Three Two One. So five things you see, four things you hear, three thing etc. It's a good way to really ground yourself in the present moment.

Keelia: Yeah I can also totally see myself trying to use that and totally messing up the order of like, “Five things you see, four things you taste… WAIT, four things you sm—WAIT…”

Ajira: I always—it doesn't really, the other ones don’t really matter as much, but I always do one thing you taste.

Keelia: Yeah, it has to be, it has to be one.

Ajira: Because I’m like, so, you know, you might have just taken a bite out of some, you know, smorgasbord, but you may also have not eaten for, you know, two hours and just only had coffee, so…

Keelia: I can taste my nasty-ass morning breath, that’s it. Oh my god.

Ajira: Exactly.

Keelia: Or maybe you’re like, [in a French accent] you have a very sophisticated palate, and you are like, “I can taste a little bit of thyme, some salt and pepper…” Oh my god. So Sam said they just offered them a lot of different suggestions—you could say a smorgasbord of suggestions—of what might be helpful, thinking that then their client can just hear all the options, say, “These things work best for me.” Usually clients pick the things that are closest to what their practices already are in life, right? You labor how you live. As doulas we have tons of ideas and we just want to make sure the client is matched with the right ones, right?

So some things that Sam was learning along the way were, like, how helpful it was to have practiced setting up a stand for the iPad, you know? If they were going to put the iPad on the little table that can be raised up and down, you know, and be wheeled around? So the plan was, put the iPad—basically, put Sam—on top of the table and then we can wheel them around wherever it is that we're laboring and still see their face. So practicing that; making sure there was a way that the iPad or the phone could be suspended so that somebody didn't have to hold it all the time; having earbuds; having a speaker so that they have the option to do both, or maybe they want to be listening to music through the speaker and they also want to be listening to Sam through the earbuds.

There was also some, like, “Do you feel comfortable with me watching you through the video or not?” You know, Sam wondering if that would make them uncomfortable. Or do you want me to be present in the room virtually when you're having conversations with the OB or with a nurse?” And in this specific example, the client felt comfortable with Sam being there via video chat for basically the entire time and also invited Sam to be present for basically all of the conversations they had with the medical staff. And Sam said that was really helpful to feel like they could provide better support, and just to get a better sense of the room, you know? The energy of what was going on.

Ajira: Yeah.

Keelia: Especially with inductions, it changes so much hour to hour that, you know, if you’re just popping in every once in a while it can be much harder to gauge the energy level and how the birthing person is doing.

Ajira: Yeah.

Keelia: So mom starts having high blood pressure readings on top of everything else.

Ajira: Ugh… god no.

Keelia: I know!

Ajira: Diabetes, and then they’d had a blood pressure reading…

Keelia: That’s right, she had started having high blood pressure readings and then they stayed high so she had to go in and get induced, which was just… it just felt like the cherry on top, Sam said.

Ajira: Mm. Yeah.

Keelia: But again, Sam was so impressed with how this mom was able to accept it, do the work right there, with Sam on the phone, and just be like, “All right. Where do we go from here?” When I was giving those examples of, you know, getting the IV, that was all happening, you know, the plans that they had put in place earlier on for the last several months of prenatal visits—they were using everything. They were pulling out all the stops, everything they had to try and get through what would probably be, you know, three to five days of an induction process. Sam did a lot of work with them to make sure they knew what an induction could look like and even in the best of times, you know, even when it's not COVID, when you can have your doula present with you, it's a long, hard road.

Ajira: Yeah.

Keelia: And it was just going to be especially so because of all these other things that they were dealing with.

Ajira: I think sometimes people have the impression that an induction is sort of like a switch you know?

Keelia: Mmhmm.

Ajira: I think sometimes that impression is not… I don't think medical providers go out of their way to disabuse folks of that notion. And when you imagine that the induction is going to be something like you walk in they turn the switch on and then you’re in labor, you have a baby, it can be really…

Keelia: Mmhmm.

Ajira: ...really heartbreaking to get to the reality of it, which is that you’re probably going to be spending at least twenty four hours, but more likely, in my experience, like, three days of, you know, having all kinds of, like, backwards and forwards and backwards and forwards. And usually by the time that you’re using chemicals to help that process along, it’s just a lot. It’s exhausting, it’s a lot of hurry up and wait.

Keelia: Yeah.

Ajira: And it can be really uncomfortable. Especially if you’re determined to do it without any pain medication because the contractions that are induced with chemical support tend to be more painful for most birthing people to experience.

Keelia: Right.

Ajira: And I think that’s simply because, you know, you don’t get the advantage of the cocktail that your body naturally produces in response to itself, right? It knows it's releasing oxytocin, and then endorphins, and then, you know, so it kind of gets into its own, like rhythm.

Keelia: Yeah.

Ajira: But when you're using something, you know, a chemical that your body’s not producing itself And you don't get the benefit of those other pain-relieving hormones that you produce.

Keelia: Yeah. Exactly. And oftentimes even if you have the smoothest induction where the medications do help your own hormones kick in immediately, and your labor does start off, that could still be after two days of being in the hospital, you know? Like, it could take multiple days before your body even starts labor, and then a while longer before it starts active labor, and then a while longer before you start pushing. So, in my experience, even once things start happening people feel like they've been in labor for days when labor hasn't even started yet, right? So Sam is doing their best to prepare the birthing person for all of this, and this mom was taking it all to heart, doing everything right. So, like, early on during their prenatal visits, Sam would say, you know, “The more you work on these strategies of, you know, mantras, and meditations, and ways to center yourself, ground yourself in your body, the more you do that leading up to the birth the more accessible those strategies are going to be for you once you're in labor.”

Ajira. Yes.

Keelia: So she had put in all that work and Sam got to see how well that was working.

Ajira: Oh my god, I love Sam already.

Keelia: Right?

Ajira: Yeah. I mean that's exactly right. It's like it's not enough for you to choose comfort measures off a list and then forget about it until it's the birth. You have to practice them at the very least so that by the time that you are in labor there's a familiarity there instead of it feeling like, “What?” you know? Which is something that may well happen because when you're in labor you're in another place. So things that aren't already familiar to you may seem very much not worth the effort, you know what I mean?

Keelia: Yeah.

Ajira: Like if somebody’s like, “Hey, do you want to try some kundalini yoga positions?” and you’re like, “I don’t fucking know what a kundalini is, so… no.” You know?

Keelia: Yep.

Ajira: Meanwhile, that might’ve really helped, had you had the opportunity to practice and familiarize yourself with it, so ack. Love Sam.

Keelia: Love Sam, and also love this birthing person!

Ajira: Love this birthing person.

Keelia: Like, okay, here—here is the best part that I’ve been waiting and waiting to share with you. So Sam had explained to this mom during their prenatal visits how, if in the case of an induction, you need extra time, you know, for your own hormones to kick in, basically you don't need to write off your own body. And it's easier for it to catch up if it has natural oxytocin flowing. Do you know where I’m going with this?

Ajira: No. Are they going to… are they going to have sex in the hospital?

Keelia: Yah! Well, kind of.

Ajira: Yes! Oh my god.

Keelia: I know! I know. So they bring this up with many clients, and I do too…

Ajira: Me too.

Keelia: ...that if you use your vibrator that can help!

Ajira: That can help!

Keelia: You know, cuddling, using nipple stimulation. And this client was like, “Yes, no problem,” packed the vibrator and then in the hospital said to the nurse, “Okay, I understand that you want to start me with a Foley catheter. Could you give me fifteen minutes of privacy beforehand?” And the nurse didn't understand and was like, “I don't know why,” and she just didn't give an explanation, she just said, “I need fifteen minutes before we start that procedure.” So she, like, did her thing and was just, like, was really doing everything she could to try and bring ease into this process.

Ajira: I mean that’s perfect.

Keelia: Right?

Ajira: That’s perfect! Think of, like, how you’ve naturally lubricated the passage for that Foley catheter, come on.

Keelia: I know.

Ajira: And you’ve also given yourself an orgasm hopefully that will flood your body with endorphins and help you experience pain with a little more ease…

Keelia: Yes.

Ajira: Plus you have the oxytocin. Oh my god I love this person.

Keelia: I know. I know, and I've heard stories of people who, like, at the last minute, to try and bring on stronger contractions, they do the electric toothbrush trick if they don't have a vibrater but they do have their electric toothbrush. Which is great but it's also not clean so, like, better if you put a condom on it. Sorry that's like the sex educator and me being like…

Ajira: What does it even—is it even strong enough?

Keelia: I mean…

Ajira: I’m like what kind of toothbrushes do y’all have?

Keelia: Magic wand now makes toothbrushes. No, it depends…

Ajira: Oh my god, no, my toothbrush wouldn’t do jack.

Keelia: Yeah. It depends, it depends on the toothbrush, I think, and it depends on the body.

Ajira: Yeah, I mean I was gonna say. Admittedly my toothbrush is not actually electric, so that might be the problem.

Keelia: Yeah. I also know somebody who used their own vibrator and went through three sets of batteries because that's how long they used it during their labor and it really worked for them.

Ajira: Wooooow.

Keelia: I mean what a way to stay centered. But what Sam said, and I totally agree with them, is that they’ve brought this up with many different families and it's, like, funny, but how many people actually take it to heart, you know?

Ajira: Not many.

Keelia: And here was somebody who actually did, And I feel the exact same way, whenever I say, you know, “Turn up the shmoop,” even then people are like, “Oh, I don't know if I could do that in a hospital room.” Like this really is your space, you really can ask for privacy. So I love that this working person was actually like, “Yeah, no problem,” got their vibrator out and did their thing.

Ajira: Yeah, me too.

Keelia: Yeah. So that was on day one.

Ajira: Yesss.

Keelia: They started with a typical combination of: they did the Foley bulb, they did miso—miso stands for misoprostol, it's also called cytotech—and they had some contractions at different points. For every little procedure Sam was calling in and they were doing the full Sam giving meditation, birthing person holding her partner's hand, using the rock… every time something came up, Sam was there.

Ajira: So they were in a good flow, huh?

Keelia: Yeah, as much as you can be when, when it’s virtual.

Ajira: Yeah.

Keelia: The things that were helping with that flow were, again, being present during conversations with the OB and nurse, and also just trusting that the birthing person would change something if whatever was going on wasn’t working for them. So, like, there were multiple times where Sam was, you know, providing this beautiful, in-detail meditation of imagining that you're on a beach and hearing the waves, and all that they could see through the iPad was the back of the person putting the IV in, for example. So they're just… they feel like they could be talking to a room full of people who are rolling their eyes at them, right? You don’t have that immediate feedback of what's working and what isn't. Whereas when we’re in the room, we can say something and immediately sense if that was exactly what that person needed to hear or not. Sam was operating from more of a place of faith and trust that the birthing person would let them know what needed to change. But they still felt like, yeah, they were finding a flow that was working for everyone.

Day two comes, and what Sam said is that no matter how much we can stress to clients that you should be prepared for three to five days before you meet your baby, nobody really believes that. And I can understand that, right? That until you really experience that lack of sleep, you can't know what it's like, or until you've had the umpteenth time of the machine going off and interrupting your meditation or your rest… It's just really hard to know how you'll behave in that kind of situation. It's such a challenge, it’s such a waiting game.

So it had been a while, and Sam heard their client start saying things more along the lines of just pure frustration and feeling like nothing was really working. So she was saying to Sam things like, “I feel like I'm trying everything, and every single thing that I've wanted to happen has not happened. This pregnancy it's just been one thing after another. I feel trapped in my own body. I know I could move forward with having a vaginal birth, I know it's a possibility. But every little thing they do to me is starting to feel like a mini trauma.”

Ajira: Mm.

Keelia: Yeah. So Sam just checked in, you know? That's such a strong cue for us. They just reflected and affirmed and validated. They said, “You know, what you're saying is so real. You have had one thing after the other come up for you, and you really have had all of your choices so limited throughout this entire process. You didn't even want a hospital birth, right? You wanted to give birth at home or in a birth center, and with each thing you’ve just rolled with it with such a great attitude and you've worked through at each step of the way. It makes so much sense that you feel overwhelmed, it's so discouraging to be this far along and to still feel like your baby is still so far away.”

They did a great job of affirming, and then they asked, “Is there something in your realm of choices that you feel could give you some sense of autonomy?” Because that was her original statement to Sam at the beginning of this pregnancy, was, “I want to feel autonomy during this birth process.” And this is when the client brought up cesarean.

Ajira: Mm.

Keelia: At this point the OBs had actually not brought up cesarean, and I'm with Sam on this, like, I'm used to cesarean being brought up so early in an induction process that it can feel like fear-mongering.

Ajira: Yeah.

Keelia: Like, it's still more than likely that this will be a vaginal delivery. It could be a completely uneventful vaginal delivery that just took a while to get started, right?

Ajira: Yeah. Yeah.

Keelia: Like that’s the best case scenario. But once they bring it up then it can feel like, alright, well, maybe if they bring it up again the next day…

Ajira: Yeah. Yep.

Keelia: …then the client can start feeling like, “Okay, this is kind of been the track the whole time,” when it hasn’t been, right? That’s just the narrative that they’re sowing.

Ajira: Yeah.

Keelia: So the OB actually hadn't brought that up, but the client was bringing it up. So the mom said to Sam, “I'm kind of thinking about what it would look like if I just got a cesarean right now.” And Sam responded, “Well let's talk through that. What would that look like? If you wanted to do this, this is what it would mean, versus this is what it could look like otherwise.” And as the conversation kept going Sam ask, “You know, now that we're talking about this, what's coming up for you? What are you feeling in your body? What's your intuition telling you?” and I just love that that was their prompt. I feel like that is the easiest way to help somebody get grounded, is reminding them that your body is involved in this process. So her response was, to Sam, “I think if you were to tell Tell me that I had to move forward with having a vaginal birth I would have a breakdown.”

Ajira: Mm.

Keelia: “That, to me, just doesn't sound like what I want or need right now. And when I think about having a cesarean I'm afraid but the relief of getting to choose that for myself and knowing that I'll finally get to meet my baby and just knowing that this will finally be over that gives me so much relief.”

Ajira: Mm.

Keelia: And Sam was like, “It sounds like you know what you want, what you need for yourself. That is a really really really valid choice.”

Ajira: Yeah.

Keelia: Just without blinking, that was Sam's response.

Ajira: Yeah.

Keelia: Sam checked in with the birthing person's partner too, and he said, “You know, obviously surgical birth makes me nervous—it’s more complicated, has higher risks than a vaginal birth—but, you know, hearing what my wife is saying I really understand where she's coming from and I fully support that.” This conversation was all happening virtually and no one else was in the room, so what Sam told them was, in their experience, especially with OBs, if a birthing person presents an idea that isn't coming from the OB then they tend to resist. Sam was kind of like, “FYI the doctor might give you some push back.”

Ajira: Yeah.

Keelia: And then the client felt like she had all the information she needed and they hung up the phone. So Sam wasn't on the phone during that conversation with the OB, but the birthing person said, you know it was exactly what Sam predicted. They got a lot of pushback and the birthing person Advocated for herself every step of the way just as she had this entire time and Sam again was just glowing with pride for her. So they moved forward with the cesarean…

Ajira: Yeah!

Keelia: Yeah! And, you know, they had talked to thoroughly about what to expect from the procedure. They called Sam right afterwards and Sam said that the way that they looked coming out of the OR, it was just pure relief.

Ajira: Mm.

Keelia: The baby was so healthy, and these parents were just obsessed with their baby, you know? Sam was supporting them with breastfeeding virtually and that it just looked—it looked like a golden hour.

Ajira: Aww, that’s lovely.

Keelia: I know.

Ajira: How did, how did Sam feel about it afterwards?

Keelia: Yeah. They had this immediate feedback of just seeing, as soon as that decision was made, they could see how their client felt and just having heard their client say, you know, “If somebody said to me that I had to go through with a vaginal birth, I would have a breakdown.” It was just so clear the kind of support they needed.

Ajira: Yeah.

Keelia: Sam said that they, they kind of walked away with the same value that they already hold so closely which is: it's not their birth, as the doula. Like they really had empowered this client to know, to fully understand what her options were.

Ajira: Yeah.

Keelia: And they were just astounded with how this bithing person was able to recognize and ask for what she needed throughout the entire process. Through the pregnancy, through the birth, and then at the end when there was so much pressure for what she should want…

Ajira: Yeah. Yeah.

Keelia: …how this is supposed to happen. And Sam said, “I can't tell you how many births I've been to where they pushed through to day three or day four of induction and I'm over there wondering as the doula, “Would they have been happier to have a cesarean on the first or second day?”

Ajira: I've also seen, just like you described, you know, I've had clients who stuck in there with their induced or spontaneous labors, four, five, six days to the point where you can see, like, they haven't slept in days, often if they’re laboring in the hospital, not able to eat, although I’m always offering my clients food, I don’t care where we are but…

Keelia: I know, same.

Ajira: …but finally choosing a cesarean and I think the difference for me is about, you know, my clients using it versus being manipulated or pressured into it. The distinction that, that's in there is more so about having birthworkers who are willing to share their clients when their clients are asking for something that is not celebrated…

Keelia: Yes. Yes.

Ajira: …on Instagram as the, as the go-to way to do it, you know?

Keelia: Yes. Yes. I think that's really what I keep coming back to in hearing the story, is that the moral or the lesson here is not, “And so when an induction goes this way and your client brings up being triggered and brings up a cesarean, then that's definitely the thing for them,” right? Like anytime anyone tries to turn birth or really any issue into a black or white issue, I'm like, we're missing something here.

Ajira: Yeah.

Keelia: Like this just means you have to be so in tune with the person you're supporting and what they need. Because we can all think of examples, or… I can definitely think of at least one example of an induction that looked exactly like this, up to the request for a cesarean, and then while they were waiting a few hours for the cesarean to happen, they changed their mind again they had another two days of induction, and they ended up having a vaginal birth which was just so victorious.

Ajira: Yeah.

Keelia: But that was right for that client, this was right for this client.

Ajira: Yeah.

Keelia: Like there is just no way that we can hear something and then say, “Now I know what to do next time.”

Ajira: Absolutely.

Keelia: There’s not going to be a next time. There’s not going to be this same baby being born, this same person giving birth in this way.

Ajira: No the takeaway is really that we need to listen to our clients and it's not over that's what I think is the take away.

Keelia: Yeah, and Sam agrees with you. Sam agrees with you.

Ajira: I thought they might. I think, I think it’s like, it’s also there has got to be room for people to change their minds. In, in everything but especially in this. I want to stay, like, especially the first time that you go into labor and give birth but even every time after that. Because every time is different. It's amazing to me because I'm thinking about another client who had a really really long birth, and then was absolutely determined not to have any kind of pain medication, went in for an induction was on miso for hours and hours and hours, switched to pitocin for hours and hours and hours, and was amazing, clearly a powerful amazing, amazing person. And then on day three I think, they asked for an epidural. And the reason I bring it up is not because they asked for an epidural. The reason I bring it up is the shame that came up for them…

Keelia: Mm.

Ajira: …that made me think that they may have been better off asking for it the day before, or the day before that. But they had held out because they had these conversations and heard these stories from loved ones that basically convinced them that it was a sign of weakness to cave and agree to an epidural, you know?

Keelia: Throw in the towel, yeah.

Ajira: Yeah, exactly. So my client, you know, cried, and didn't want me to lend family members in because they were like, “I don't want them to see that I…” you know, and I was like, “You have nothing to be ashamed of. You figured out what you needed and you asked for it. There's no shame in that.”

Keelia: Right.

Ajira: But obviously see me saying anything like that doesn't make much of a difference, but I wanted my client to know that I didn't feel that her choice was invalid or that her feelings were invalid.

Keelia: Yeah.

Ajira: And I was proud of her for doing it despite the fact that she knew that people she loved and respected didn't want her to make that choice.

Keelia: Right.

Ajira: I think it's really important that, as birthworkers, we continue to confront, you know, whatever our ego is coming up with about the choices that our clients make so that we can continue to divorce ourselves from that and not be attached to how a birth should look.

Keelia: Right. Right.

Ajira: Because as Sam would say, it’s not our birth.

Keelia: Yeah. Yeah, and I actually say that explicitly…

Ajira: Me too.

Keelia: …when I'm having prenatal visits with these clients where I'm saying, like, “By the way, even though this is the plan, if you end up changing your mind for a good reason—for whatever reason—you're not going to have your doula sitting in the corner pouting about it. I will never be rolling my eyes at your decision. I am a hundred percent behind it. And that also includes me informing each client about what that choice means. If it's a conversation around who's weak or who's not, who's a better parent, I'm completely uninterested in that. As long as the parent is aware of the different risks associated with it and, you know, makes their decision informed, that's what I'm here for. That's part of our job, right?

Ajira: Yeah.

Keelia: I want to make sure everybody knows what the associated risks are with him or intervened with birth if there are unnecessary interventions. But I'm not going to shame someone for making that decision.

Ajira: No. And when there is a necessary intervention I still think it's vital that my clients understand what the potential impact or ramifications are of the choices that they're making, you know? Because, you know, everything about every step of the birth affects every other step of the birth.

Keelia: Yeah. I would also love to share what Sam's closing thoughts were, what their takeaways were…

Ajira: Yeah! Yeah, please.

Keelia: …which is very along these same lines. The reason Sam wanted to share this birth story is because they wanted to reflect on how important it is for us to check ourselves, as doulas, as support people, around what we think is right or wrong for someone, and how important it is to meet people where they're at. So how can we make sure they have the room and space in their decisions to weigh the different effects of their choices? And just how can we prioritize their mental health as well as their physical health?

Ajira: Mm.

Keelia: And then the second thing they mentioned was that we should keep practicing asking questions and not giving the answers. We're not there to make choices for people, we’re there to be a mirror and to help them connect with themselves to do it feels right.

Ajira: Yeah.

Keelia: And then the last thing they said was, “I think there's a line. Sometimes I get the sense that especially for folks who are raised socialized as female that they hit points of needing permission to do something, and the reality is they don't need f*cking permission. But sometimes they do need us as doulas to broach that subject for them, to be like, “Hey, if you are considering xyz, that's a valid thing.”

Ajira: Yeah. They don't f*uckin’ need permission.

Keelia: Give yourself permission.

Ajira: But sometimes they could use a reminder.

Keelia: Yes, they don’t need permission, but sometimes they could use a reminder.

Ajira: Gosh, what a beautiful story. I’m so, so happy to hear that Sam’s first virtual experience brought so much with it. It sounds like they had such a great plan and a great rapport with this client, and were able to really support them to have the birth that they wanted, you know? That they could look back on and feel good about because they got to make the choices that were best for themselves and their families and their babies.

Keelia: Mmhmm.

Ajira: Yeah.

Keelia: Don’t you wish I had done the whole thing in a British accent?

Ajira: Yes I think that would be a really nice, in fact, if you're listening to this podcast please let us know on Instagram…

Keelia: Oh god. What accent.

Ajira: ...if you think a story told in a different accent would be fun.

If anything from today’s episode resonated with you, leave us a review on iTunes or your favorite podcast listening app, and follow us on Facebook or Instagram @doulastories. If you’re a doula and you have a story to share, email us at doulastories@gmail.com.

Keelia: This episode was produced by me, Keelia Alder, and our music is by Rick Bassett. Special thanks to Sam, for sharing their story with us, and of course to my cohost who’s quite smashing, really, Ajira Darch.

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