"When Your Client’s Doctor and Family Are Unsupportive" 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. Today we're hearing from Hana Grace Lehmann who’s a doula based out of Philadelphia, Pennsylvania. Hana, thanks so much for coming on the show.

Hana: Yeah, thanks for having me!

Ajira: Tell us about yourself, Hana. We'd love it if you could share your name pronouns where you're from and where your people are from. Oh, and what you're up to these days.

Hana: Great. My name is Hana Grace Lehmann, and I use she/they pronouns. My people are from a variety of places: I'm mixed-race Filipinx-American, so my ancestors that I most connect with are from the Illocos Sur and the Zambales Mountains in the Philippines, but I was raised in South Dakota so the two main places that kind of were formative for my childhood were the Rosebud Indian Reservation and then Rapid City, South Dakota. And then I moved to Philadelphia, and so I've been here for the last 10 years and so this is my home now. And then you asked what am I up to. Well, one thing I'm up to is baking, which is dumb because it's 90° but someone sent me a really amazing recipe for morning buns and I couldn't not make them, and so even though it's been 90° for like a week. Yeah it was really dumb, but they were worth it, oh my gosh, they were worth it. And they were huge, and we shared them with all our friends.

The most exciting thing recently has been I've been interviewing a lot of midwives because I’ve felt this tug towards midwifery over the last year that at this point I'm not be able to ignore anymore. And so I’m talking to all the midwives I know about their stories and, you know, kind of trying to gather my sisters around me as I try to figure out what my path forward is in this. And I think just hearing their stories is giving me tons of just strength and inspiration especially during the uprising right now. Just like this is how we midwife hard things.

Keelia: And do you mind just sharing one or two sentences on what you mean by “the uprising” in case people are listening to this at a different time than when we publish?

Hana: Yeah, sure, so…

Ajira: It’s like in 2035.

Hana: Yeah, what is this? I mean people might know it by different, you know, we’ve been trying to figure out what our language is around talking about what's going on in the world but right now I’ve kind of settled, for the moment, at least, on you know, this is a global It's time you know this is a global uprising around the issue of race. And there has been a lot of police brutality and violence towards Black and brown bodies for, you know, the entire age of America essentially. And, you know we've hit a tipping point with George Floyd's murder, and people are responding and really want change.

Keelia: Yeah, thanks for sharing that. So this is the summer of 2020 that we’re talking with Hana. And in this midst of all this, babies are still being born, Hana is still being a doula in Philly, and we’re so grateful that we get to hear you tell this story today. Before we get started we have one more question for you just to get a better sense of who you are as a birth worker, and that is: what is something you do during a really long birth that helps you get through it?

Hana: I think once I'm in the birthing room, I don't often… I don't have a lot of rituals to, like, get pumped up again, I think because I feel like I kind of… I flow with the birthing person's energy, and like I'm like, “Okay, if they can do this I can do this.” And I also take micro-naps in between contractions. I don't like… that's just a natural thing that happens. Like if I close my eyes while they're closing their eyes, you know, I'll get, you know, five seconds of my brain just relaxing and sleeping in between, and then we go back to the ritual during the contraction.

Keelia: Although I guess you don't have the same kind of oxytocin hits the way they do.

Ajira: I mean you’re getting something, though.

Hana: Let’s talk about the real reason we do this work.

Ajira: Residual oxytocin, come on, that’s that good good. Since we were hearing about morning buns, I really want to know, what do you crave after a birth? What do you want to eat more than anything else?

Hana: Oh, this is an easy one. I always go, if I can, go get Sashimi. I just, like, crave this big, like, protein kick. It’s usually, like, fatty, and I don’t know, that’s the thing I always want after a long birth.

Ajira: Same.

Keelia: And actually a lot of my clients usually want the same thing because they haven't let themselves eat that during pregnancy. So there’s been a lot of, like, post-birth sashimi ordering in hospitals.

Ajira: My favorite one was a birth where they wanted, what was it? Eggs benedict at eight o’clock in the evening. We found it.

Keelia: That’s what we do! We find that kind of thing. Okay, so where would you like to start with this story?

Hana: I think the best place to start this story is when I first met them. So I'm using Lily as kind of a pseudonym for this client. But I met Lily at a cafe for breakfast and she actually brought her mother. Her mother was very old, probably in her mid-seventies, mid-to-late seventies at that point, and we were all having breakfast together and kind of talking about the possibility of doula support during their birth. And, you know, as we’re kind of trying to talk through like, “What does a doula do? What is kind of, you know, what are your hopes and dreams for this birth,” her mom, like, multiple times said to me, “Like, why are we even having this conversation? Like, you're going to have a cesarean anyways.” And, you know, I was a new doula. So it’s actually been about 6 years since this happened, but it’s still such an important and formative birth in my doula career that I keep coming back to it. But a few times she said that and so we did get into talking about, kind of, their family history. And essentially everyone in their family that they could remember had had a cesarean.

Keelia: Wow.

Hana: So that was kind of a foray for me into, like, how much a family story or what you've heard about birth kind of sticks with you. So even though Lily hadn’t been in the room for any of these births, this was still kind of the water she was swimming in in terms of what she was expecting from her birth. So this family, the reason why they had had cesareans, or at least, like, the strongest story in their memory, was—I think it was the story of her cousin—she had had, you know, a labor and then right at the end as she was pushing her baby out, she had shoulder dystocia. And that is a situation where one or both of the baby's shoulders get stuck after the baby's head has already emerged from the birth canal. And it can be kind of a really intense moment. A lot of times the way that it's handled in a hospital setting is that people are kind of aggressively handled. So like all these nurses jump in to, like, pull your legs back and try to get the baby out. And so it's very stressful, very intense, and it's really scary. And so this was kind of the memory that that family was holding as I was talking to them.

Keelia: Yeah. And can I just jump in here really quick to say that this particular fear around shoulder dystocia can be the reasoning behind a lot of different interventions. You know, “We suspect you have a big baby,” you know, language like that as somebody nears the end of their pregnancy, and then you can receive a lot of pressure to have a baby via cesarean birth instead of even attempting for a vaginal delivery because of this fear around it. Whereas if you have somebody who is trained in approaches to dealing with it that rely on tools such as changing position if the person is not on a pain medication, there are ways you can deal with that that don't involve the specific situation that Hannah was describing, being handled that way.

Hana: Right. And this is specifically a hospital birth. And I think another encouraging thing is that shoulder dystocia, at least true shoulder dystocia, is very rare. But as Keelia said it really does, kind of, I would say like there's trauma in the bodies of our medical care providers and they're also acting out of trying to prevent these traumas from reoccurring, right? And so there’s kind of this build-up, I think, that we see in the response to shoulder dystocia or suspected shoulder dystocia.

Ajira: So one of the things that I notice frequently that always stays with me about supporting folks in the hospital especially is how little support hospital staff have processing the experiences that they witness and support, you know, daily, sometimes one on top of the other. And it often seems to me that if they had even the most simple practices they would be less likely to be bringing past traumas or charged experiences into the room with them. And as it is now, what I often see is physicians and nurses coming into the room, being confronted by my client experiencing whatever my client is experiencing, and clearly having some kind of flashback, sometimes even visibly having a flashback, to a prior experience of something similar or, you know, even tangentwhat is the word?tangentially related, and then completely responding to their past experience and not actually what my client is going through. You know?

Keelia: Mmhmm.

Ajira: It can be so… I think in the beginning that would be very frustrating for me. I would tend to feel really annoyed. And as time has gone on I’ve managed to connect with a little more compassion around that, and find that if I'm able to support the provider with some of that, and really compassionately ask them to remember that this is this experience and that this is, you know, my client and their situation and get really specific, then sometimes I'm able to bring them out of that so that they can support my client in their specific situation, and not just lean towards, you know, full blown panic and all the prophylactic.

Keelia: Yeah, I hear that. I actually I remember seeing one OB say toI think this was the very first birth I ever supported as a doulathe OB said, “We could try this one thing that I think will, usually it would help, but I tried it earlier this week and something went wrong, so I'm afraid to do that. So instead let's go through C-section.” Like they were that obvious about, “I experienced something that was really hard for me. I don't want that same thing to happen to you. Let's not even try the in between steps.” And, yeah, same, like my first reaction was frustration that this is not the same situation. But they see those rooms of the scary things happening so much more often than I do.

Ajira: Yeah. And sometimes, like, walking out of one room where something has happened and straight into another room where, you know, potentially something similar might happen, you know what I mean? Just even in the sense that like, “This person was giving birth and it went wrong, and now I'm in a room with another person that's giving birth and all I really want is for it not to go wrong, and what I know is that the more control I have over it, the more I can hopefully avoid things going wrong.” So I think it's very natural and understandable that they tend towards wanting that because that's the one way to do birth where they have the most control, right?

Keelia: Right. Right. So, Hana, I really don't want to project my own feelings around this onto your experience, but I'm imagining in your shoes, you're sitting there in that coffee shop probably with some sense of like, “This is what my interaction with the hospital staff could look like.” But this is also pressure to doubt her abilities to birth and to… kind of leaning in the direction of “maybe cesarean is more likely anyway,” from the family, from people who she already knows really closely and trusts.

Hana: I mean I was a new doula at that time, so I definitely was more in the optimist category. I was like, “You know, like, I keep hearing these stories and in all my reading about, you know, the stats of, like, medical birth, right? And like, gah, it must have something to do with that,” right? So, like, I think I felt more optimistic about her I didn't really want… I don't know, I just didn't… It didn't even cross my mind that she couldn't do it. Which is something that has been both like a blessing and a curse for me. Like, as a doula I have, like, a deep confidence in your ability to birth. What I don't recognize is that I actually have to say that out loud, you know? And affirm that in you, and you need to hear that as a birthing person. But that is what I come into almost every birth with. Like, you can do this.

Keelia: I think that’s beautiful! I mean, if we don't believe that about our clients then who will, you know? Like that's really what we’re there for.

Hana: Yeah.

Ajira: Agreed. I think it's needed. That faith is a crucial part of it, and I think that faith that's not attached, do you know what I mean? That's not prescriptive, that's not like, “You will do this.”

Keelia: Right, right.

Hana: Yeah, it’s kind of like… It feels like you have faith with a lot of grace, right? Like this could go in many, many different directions, and you still will have done it really, really well, you know?

Ajira: Yes. Yes.

Hana: So like no matter what card you’re dealt, you know, and no matter what outcomes we have, like, you are still really powerful. Like you're a badass. And so I feel like that's part of, like, what has kept me in this work, is like, I totally… Like it never crossed my mind that you couldn't do this. And so sometimes I don't empathize as much with people who don't believe that they can do it. And so that’s some of my continuous work as a doula is to be reminded that, like, “Oh, like sometimes people don't believe they can do this.” You know? And I get to be there to kind of, in some ways, reflect the truth that, like, you already have all the strength you need inside of you. And so I think that's one of my one of my roles. But what I was getting kind of annoyed with was that Grandma kept butting in, like, multiple times, just saying, like, “Why are we even having this conversation?” So I felt kind of like, a little attacked in that moment, and it felt fatalistic. Like, “You're going to have a cesarean anyways. Everyone in our family has had this.” And I think now, like I’ve told the story many times over the years and I think as Ajira was saying, like, you develop more compassion for those who’ve experienced trauma, right? And so clearly this grandmother has lived through many really, really, really scary birth experiences, and that's what she was bringing to that breakfast table.

But it did mean that this was, like, the first time I needed to kind of actually narrate some of my boundaries as a doula. I was trained by Jackie Kelleher over here in Pennsylvania, and I remember during our training she said under what's circumstances would you say, ‘I don't think we're a good fit,’ to a client,” right? And at that point I’m like a fresh doula, so I'm like, you know, “Everyone deserves, you know, birth doula support, and I’m going to say yes to everyone. I can’t even imagine someone that would be, like, so broken that I wouldn’t be able to support them.” You know, it just, it wasn't in my mind in any way. So this is the first time where I started feeling kind of in my gut, like, “I don't know if I could do my job well or with integrity if Grandma is in the birthing room.” Because I feel like I would, one, be kind of, often you’re dealing with kind of with the reality of the medical providers but then also the reality of the grandmother in this situation, and trying to center the voice and the story of the birthing person felt like it might be really hard for me to do in that kind of situation.

So I wrote an email to them and said, “I think we could be a good fit, but I don't think I could do my job of supporting you well if your [mother] is in the room. So I can help you find another doula if this is something you really, really want, who might be a better fit for this kind of scenario. But I don't think I can do my job with integrity,” and, you know, I was anxious about sending this email because I had never, kind of, established boundaries like that before. I felt like I was a bad person…

Keelia: Nooo!

Hana: … for, you know, saying, like, you know, like, “I need to say no to you,” but I sent that off. And then I heard nothing for a long time. A really long time. And so I just assumed that, “Okay, well, hopefully she found another doula if that's what she really wanted,” you know?

Keelia: That’s so hard.

Hana: And just hoping that things worked out well for her.

Keelia: Right! Like, this, like, “Would it have been better if I had just agreed to do this with Grandma there,” and then at least she would have had someone else, or did you do the right thing to say, “This is my boundary,” and I a hundred percent think you did the right thing! I think that's amazing, especially as a brand new doula. That's a hard lesson to learn.

Hana: Yeah, just because it was new territory for me. And, you know, you kind of go back and you’re like, “Did I do the right thing? Is this okay?” I don't usually feel too bad when people say, like, you know, “I found another doula that was a better fit,” because what I want more than anything is for you to have a good fit. I think people can naturally select different kinds of doulas. We’re all really different, so I want a really good fit. But it was a new situation. After months of waiting, she emails me back! And is like, “Yeah! I want you to be my doula, and the check is already in the mail.”

Keelia: Woah!

Ajira: Wow.

Hana: “...and, like, I hear you on my mother and she’s not going to be in the room. I think you’re right about that. And let's do this!”

Keelia: Wow.

Ajira: Hang on hang on hang on, sorry, we refer to this person as the mother and the grandmother—which one are they?

Keelia: “Mother” is birthing person, “Grandmother” is parent of birthing person.

Hana: Yeah.

Ajira: I got confused for a minute, I was like, “Wait, is this the grandmother or the mother?” Okay, okay, got it. Thank you.

Hana: Yeah. So she agreed and said, you know, “It's not really aligned with my birthing hopes and dreams, and so I need to, you know, consider that.” Yeah.

Ajira: Wow. That’s really beautiful because think about what you did there, right? And I mean that's not to say that this birthing person didn't consider this before you brought it up, but I think that so much of the time birthing people don't realize what an impact the people who are in the room with them have on their experience, and they don't realize how important it is that it's not enough for your parent or partner or whatever to be like, “Okay, you can try that,” you know, or even to be like, “I guess we can do this until it's time to go to the hospital.” But to actually really actively be on board with your vision, and to be able to stand with you in faith and grace, right? And support you fully with whatever you choose, even if they don't understand it or agree with it. That's so, so key. Go on. I’m on tenterhooks over here, Hana, I’m like, “What happened next?!”

Hana: Yeah, yeah, well it was a lot of waiting and then, WAH!

Keelia: Yeah, and that must’ve been close to her due date, too!

Hana: Yeah, it was definitely just a few weeks, so we needed to kind of get our ducks in a row at that point. And I don't know, maybe, you know, doulas out there sometimes you get those clients who, like, all of a sudden are just like, “And the check’s in the mail, and, you know, we're doing this!” and you’re like, “Wait, we haven't even checked our schedule!” You know?

Keelia: Right! I know.

Hana: The other piece of this is that they wanted a birth-only package which I kind of hesitated to…

Keelia: Do you mind explaining what a birth-only package is?

Hana: Oh yeah! So with a birth-only package it means that they want you just there for the birth. So they don't really want any prenatal visits and they don't want any postpartum visits. It can be a way for people to kind of lower the cost of having a doula by centering kind of the birth experience in the room. But it can be a challenging situation for the doula to step into because we haven’t built as much of a relationship and haven't talked through, kind of, strategies and questions that they have ahead of time. And so because they requested this I was initially a little bit worried that, like, maybe they don't know exactly what a doula is. Because sometimes when people only ask me to do the birth, I’m like, “Do they think of me as a like a birth fairy, that if they give me this money that everything will work out perfectly?” And that's a big anxiety of mine, you know, as a doula.

Keelia: Yeah. Yeah, like, “You’re just here to make sure I don’t get a c-section. You’re just here to make sure I don’t get an epidural.” And you’re like, “Uhhh!” And so much of that work of what we’re there to do is done in the prenatals. It's all the conversations at a time instead of between contractions. So I hear you, that's hard, and I completely hear why offering a birth-only package can appeal to some folks, yeah.

Hana: Totally. They just think, like, “This is the most intense part of it. Let’s, you know, let’s have her there for this.”

Keelia: Yeah. Well so, you have an email exchange, a phone call, and that one in-person interaction to give you context for their story and how you're going to support them.

Hana: Yeah, and let me add one more layer to this. We did have a conversation about who her doctor was, and this particular doctor at least anecdotally… So I worked with an older doula company when I first started, and they'd been to, like, thousands of births at this time, and I had not had a birth with this doctor previously but had talked to them about this doctor, and none of them had come out of a birth without it going to cesarean. Like, they didn't have any memories of coming out of a birth with this doctor. And so this added, like, another layer of complication because I was hearing from her, that she's like, “I want a natural birth, I want to be able to have free movement during my birth,” and just hearing that made me feel like her choice of provider might not actually line up with what she valued in her birth experience. And so that was another conversation we ended up having, about, like, “Hey, you might be early enough to talk about switching to another OB. Would you be open to that? You know, maybe we can find an OB within the same hospital that might align a little bit more with your birthing hopes and dreams,” and she said, “No, I don't really want to do that, I feel really comfortable,” like this doctor is quite quite charming, you know?

Keelia: No!

Hana: And so, yeah, I know, he’s very charming, but, like, the stats are bad.

Keelia: But you could grab a beer with him!

Hana: Right! And so, you know, even though she ended up deciding, like, “No, I think I feel most comfortable staying with my doctor,” I think that was yet another moment of building trust because she felt like—I hope she felt like—I could be honest with her and we could have the harder conversations. That, you know, still her decision was the most important one, like, but I wanted her to kind of feel informed about her choices.

Keelia: Yeah.

Hana: And so that was an interesting layer to all of this too.

Keelia: Okay.

Hana: I feel like we should get to the birth.

Keelia: Yeah, tell us what happened! There are so many things that are all adding up to this big day! Okay, so how did you find out that…

Hana: I know, so much anticipation!

Keelia: Yeah, seriously! How did you find out that she was in labor?

Hana: Yeah so I was actually at another birth at the time.

Keelia: Oh my god!

Hana: I had been there for a good twenty four hours. And it was, that was a really tiring birth it was kind of at the point where it was looking like it was going to be a C-section. This baby was asynclitic and just not moving through the pelvis in a smooth way. And so after twenty four hours of being in labor with this other person, I get this call from Lily, and I run to the bathroom to take this call, and she says, “My water broke.” And there was just this long pause between her saying that and me responding because I was, I have a very strong denial bone and I was just like, “This can't be happening. This is a dream. This is totally a dream, like I’m so tired.”

Ajira: Oh I love the idea of a denial bone. That’s so perfect, a denial bone! Oh my god. I’m going to be saying that forever now.

Hana: Totally, totally, I was like, “This is not happening. Not happening.” So she calls and says that her water is broken, and the other fun twist is that she's already on her way to the hospital even though she does not have any contractions.

Keelia: Oh no!

Ajira: Nooo!

Hana: I know! And my heart is just sinking, like I just felt like the deck was stacked against us.

Keelia: Yeah.

Hana: Because, you know, if you've kind of been in birth work for a while you know that, like, water breaking to start labor especially when, like, contractions really don't start for a long time can be a really hard way to start a labor because it can be more uncomfortable, those contractions can be more uncomfortable because you don’t have that water bag to cushion the baby's head. And there's a higher chance that you will be induced once you get to the hospital.

Keelia: Much higher, yeah.

Hana: But at least around here, the common policy is to have people come in right after their water breaks no matter what the scenario is. And so this is what happened, and, you know, my insides are dropping through my butt because I’m just like, “No,” but at the same time, like, this is what’s happening. Like, it was me just saying, like, “Okay. This is the story, this is what we're dealing with,” and trying to take, like, one piece at a time. So the other birth I was at went to cesarean so that narrative is also looming over me too, right? We were talking earlier about how the trauma of what happened earlier in the week for maybe the OB comes into the present scenario. And so this was kind of the story that, you know, I was holding and processing.

Keelia: Yes. Oh we absolutely bring the same sh*t with us, you know? We have one negative experience with the nurse and then the next nurse I interact with I totally have my guard up and I'm thinking through the same thing. So yeah, that's such a great example. We do exact same thing.

Hana: We do, we do. And there wasn't a lot of time to, like, integrate that experience, right? So a little bit of time passed, that birth went to cesarean pretty shortly afterwards, and then I got to go home and they let me sleep for four hours which I was so grateful for. And then they called me around 7 a.m. and said, “Hey, we'd like you to come in, we're ready for you and then also,” twist, “We've already started pitocin.”

Keelia: Oh, the phone call after the pitocin has started!

Ajira: Oh wow. Oh my goodness.

Hana: I know! And I was like, “I didn't prepare you well.” I must not have said, I don't remember exactly what happened, but I must not have said, like, “Call me before!”

Keelia: Well and you didn’t have any prenatal meetings! Like how, where was the time to go over things like this? That’s really hard.

Ajira: Yeah. And honestly I’ve had clients where I’ve had more meetings than usual with them, and phone calls and everything else, and then they've still chosen to, you know, do things they were unsure of beforehand without, you know, reaching out to me. And I'm like, okay, that's absolutely your choice. But it does make me nervous sometimes when they’re like, “We’re going to the hospital, you take a nap, we’ll call you when we need you.” And I’m like, “When do you think you need me?”

Keelia: Right, what does it mean?

Hana: Right, right. Okay so I'm getting ready to go to this birth. My heart is falling further through my butt at this point. I'm worried about if I can do this, right? Because this is a doctor that I don't have any experience with, that I've heard bad stories about, the cesarean birth from the past night is kind of looming over me, and it feels like all the cards that can be stacked, are stacked, not in the favor of, you know, what she wanted from her birth. So I’m driving over there. I definitely have a lot of butterflies on the way over, which actually tends to happen, now that, you know, I’m seven years in, that happens every time.

Keelia: Same.

Hana: And then it dissipates, yeah, it dissipates once I get in the room and you kind of get in the rhythm of what is happening with the birth. So I get there, I come into the room, and I watch her, you know, labor for a little bit, right? And just see what natural flow they've already gotten into, and then kind of try to figure out what, you know, my role is, and I encouraged her to get on the ball at that point. The baby was pretty low so she, you know, had been feeling pressure from pretty early on even though we weren't anywhere close to being fully dilated. So we got on the ball because that kind of gives you a little bit of pressure on your bottom, it can be really comforting. So the pitocin contractions are definitely really strong but, you know, dilation takes a little bit of time to catch up and those contractions can be just in general a little sharper, is what we find.

She actually ended up laboring on the ball the entire time. That ended up being her sweet spot. We kind of fell into just a really good rhythm. It felt like we clicked in some way as a team and I think one of the reasons we did was she received my words well. And I think part of that’s because we had established trust even though we hadn't had prenatal visits. And so, you know, when I would say something like as simple as, you know, “Send the breath into places that are tight and tense,” like, immediately she would respond to that, right? And so I felt like anything I was laying down, she was picking up, which was a really fun experience for me as a doula. And her partner was really great, too. So he was an English teacher and so he brought this book of poetry with him…

Keelia: Aww.

Hana: And was reading her poems and so each of those poems, they were, they had a lot of image, like, vibrant images in them. And so he would read her a few stanzas and she would put those images together in her head, and they would actually really help with her visualization for a few contractions, and then she'd ask for another poem, and then he’d read it and so it was beautiful!

Keelia: Oh, that’s beautiful!

Ajira: That is beautiful.

Keelia: That’s like an oxytocin machine! That’s such a great idea.

Ajira: Yep, that is so sweet.

Hana: Right, right. So I was I learned a lot in that moment about kind of leaning into the natural abilities of our birth partners and support people. And I didn’t ask him about this, but I wouldn't imagine that he thought his, you know, English literature career would have been what, you know, took form in the birth room, but it did and it was the helpful thing for her. I felt like I just kind of like, tweaked some things to make her more comfortable, so kind of added heat on her back. One of my big roles ended up being holding the monitor on her belly because I just didn't want there to be any reason for, you know, unnecessary interventions or emergencies because the monitor was, you know, was pulling away from her belly or something like that because it could just be a bad reading.

Keelia: Right, so someone to… Yeah, to avoid the bad reading of it picking up birthing person’s heart rate instead of the baby’s. And I imagine to avoid the nurse coming in and checking more frequently and having to interrupt and, “Can you get in a different position so we can get the baby, and tighten the strap, and blah blah blah”?

Hana: Right. I really wanted her to be able to be in the position that was most comfortable to her. And so that meant, you know, holding that monitor there for the remainder of the labor.

Ajira: I'm glad you clarified that point right there about how it's not that the monitor prevents interventions cascading to a cesarean. It's that not having that record can create panic and assumptions that drive protocols that can lead to the the cascade of interventions, right? Because if the hospital is not seeing, like, a steady record of the baby's heart rate being a particular way then they can tend to jump to the worst conclusions. Like I've had people rush in and be like, “Something’s wrong! We’re not seeing the baby’s heart rate!” They’ll swarm in and we’ll be like, “Yeah, because she took it off to go to the bathroom.”

Keelia: Right, right.

Hana: Right! Yeah there’s always kind of this worst case scenario thinking, yeah.

Keelia: Yeah.

Ajira: Yeah.

Keelia: So you three have found this rhythm: you're holding it on, she's on the ball, you’re hearing poetry being read, and time just keeps passing? Everything is going really smoothly?

Hana: Yeah, everything is going pretty smoothly. I'm, you know, she wanted to rock back and forth but said that she didn't feel she had the strength to, so I started gently moving her a few inches side to side during contractions. We added that, and I just kind of kept coaching her breath and I end up repeating, like, the same thing a million times, you kind of figure out what works and then just stick with it. Like it never gets boring to them if it's working.

Keelia: Right.

Hana: So we kind of continue this way and she gets checked a few hours later and her cervix is dilating rapidly for a first-time birthing person. Typically what the hospital is looking for is a centimeter of dilation per hour, and she had over a centimeter of dilation per hour.

Keelia: Woah, I feel like I never see the one centimeter per hour, even!

Hana: I know! I never, never, right? Never see it.

Keelia: I hate that thing, I hate when people bring up the Friedman’s curve. It drives me absolutely crazy.

Ajira: It drives me crazy too. It's very distressing when clients are aware of it, and then it becomes like when you're taking a test, you know, and there's just this pressure of, like, you know, “Am I behind? Am I behind?” and it's like that's not conducive to birth. That's not the feeling that your birth wants in order to progress.

Keelia: Right, it works against you! But here it was happening! It was actually happening!

Ajira: Yeah, it’s completely counter. That’s beautiful.

Hana: Yeah! It was happening! I was like, “Thank God something is going right!” I mean I think it's a testament to how Lily was able to really relax.

Keelia: Absolutely.

Hana: And really, you know, trust her partner, and she really just got in the zone. It didn't really matter what was happening around her. So, she’s laboring beautifully, and then I don't remember the precise time when this happened, but not too long after that vaginal exam, the doctor comes in and we hadn’t really seen the doctor much.

Keelia: And is this the doctor that you had been worried about ahead of time or was he not on shift?

Hana: This was the doctor that I was worried about ahead of time.

Keelia: Oh, perfect! Excellent!

Ajira: Dope!

Hana: Yeah, I was like, “Oh, hello. Oh, hello. Okay. Let’s… Let’s figure.. Let’s…” you know. So I have my own anxieties that I'm bringing into this. But I don't exactly remember this conversation but the gist of it that, like, sticks in my head is that he came into the room and said, “I don't think you can do this,” and “this” meaning the birth, you know? Like vaginal birth.

Ajira: Oh my god!

Keelia: Oh god.

Hana: Yeah and so like her strip was good, and by strip, that's just the baby's heart rate on the monitor. Like, that looked great. She's dilating so fast, and handling it so well, and I don't really know how to read what he said because reading back into it, it didn't make a lot of logical sense other than the fact that I know that it's hard to see other people in pain, right? And she had, like, the labor had started to ramp up at this point. It was getting more intense, you know, she was showing that she was in pain a lot more at this point. And so I don't know if that was like, “This is my cue, to, you know, try to take some of that pain away,” you know or like, “Let's get this done,” but, you know, it's hard to say at this point, but that was the gist of it. And so again, my heart just sinks.

Keelia: Further out your butt.

Hana: Yeah, right! It’s crowning now.

Ajira: Your poor butt. Your poor butt! There’s so much heading out of there.

Keelia: Poor heart, poor butt, poor Hana.

Hana: Right, so much pressure! Yeah, and so, like, the thing to say here, I think, is that I find that my clients really trust their providers and so therefore they have a very powerful voice in dictating the reality of the birth room.

Ajira: HUGE. They really do.

Hana: And so it felt like a big shift had happened. Like, “Oh, what I thought was going really really well, it must not be. Something must be wrong, you know? Because the other person who’s an expert who’s, like, you know, gone through how many years of, you know, catching babies and how much schooling?”

Keelia: "And who was so nice to me. Who was so charming for so many months, like I feel like I have a relationship with him…"

Hana: Yeah, it just doesn't feel like there's a lot of space to push back against that reality. And so in that moment, we asked for more time, right? So we ask for some time to think about it.

Keelia: Great.

Hana: It's like what do you do? Like the doula’s, like, release door is to say, “Okay, well, what if we wait? Let's take fifteen to thirty minutes to just talk through this.”

Keelia: Yeah. Yeah. And then hopefully they get distracted with somebody else in a different room and then it turns into an hour or two hours before they even remember that you owed them a decision.

Hana: Right. Right exactly. So in that moment I was just like, “It's happening the thing that I was most afraid of is happening!” Like the whole reality of the room is shifting. But I think taking that time was good for us both. Like I asserted my voice as a doula to try to reflect back to her what had happened over the last few hours. Like, “Your body is doing this, right? Like it's doing a great job, your baby looks really good.” So all of those things, like, I kind of reiterated, you know, what was going on and kind of her options, you know? So we have… There’s a particular way we often encourage clients to ask questions about suggested interventions to figure out whether or not they feel comfortable with them or if they're necessary. And that's using the BRAIN acronym, so we ask: B, what are the benefits; R, what are the risks; A, what are the alternatives; I, what is your intuition telling you; and N, what if we do nothing? And in this case that question of what if we do nothing was really powerful, right? Like if we do nothing you're probably just going to have this baby in a few hours!

Keelia: Yeah.

Hana: You know? “You’re doing a really, really amazing job. Do you think you can do this for another two hours, and then we reconnect? It's not saying that, like, this is what you're going to do forever, or this is your final decision on anything, but can we give you another stopping point for checking in?” right? And so that's kind of what we ended up deciding on together, you know, let's wait it out a little bit.

Keelia: Beautiful.

Hana: So after that we, like, in my heart I'm like, “Please, please labor. Keep showing up for us,” you know? This dilation pattern is fantastic, let's keep going.” I don't want to, like, eat my words at that point…

Keelia: Yeah, yeah.

Hana: …and then have her like in labor for another ten hours which is totally possible, like, our bodies do different things. They, you know, babies turn and try to navigate the pelvis and, you know, labor spaces out a little bit.

Keelia: It can feel like there’s a clock hanging over you at that point.

Ajira: Absolutely.

Keelia: If there's already pressure based on nothing—or it seems like there was no reason to suspect that she might need to give birth in the OR—then of course you're going to feel that pressure.

Hana: Right. And I'm trying to, like, hold that back as a doula, because I’m like, “I can't add to this, like, pressure to, like, have this baby, right?” Like I'm trying to, like, hold back the tides in some way so that her story, the way she’s telling it can be the central experience. But things just kept moving along. So we get definitely to this point of transition where her contractions are right on top of each other. She is experiencing so much pressure at this point, especially at the peak of her contractions. We're still on the ball we're still doing our thing, she's kind of like, “I think I need to poop before this baby comes,” and, like, we’ve heard that before, right?

Keelia: Yes!

Hana: “Like no, I think that's probably the baby's head, that’s a really good sign that you're getting super, super close.” And I, I don’t know, I always tell my clients, like, “There aren’t very many things I can promise to you about birth but one of them is that you'll feel like your baby is coming out your butt.”

Keelia: Yup!

Ajira: Mmhmm.

Keelia: There are very few guarantees, but that is one of them.

Hana: Right, right. So she’s starting to feel this now, And I ask, “Should I go get the doctor? Do you feel like it's time to push?” and she says yes, so then, you know, we kind of rally the team. And we haven't been in the bed yet and so we get in the bed at that point. She's pretty tired at that point so I think we started pushing on her back and then eventually rolled to her side to push.

Keelia: Oh right because she’s been awake—she didn’t get any sleep the night before, right?

Hana: No, not at all. So like even with these clients who are like, “I want to change positions, I want to squat,” a lot of times they're just like, “I'm tired I'm going to lay on my side.” And that’s a great position to push in, right?

Keelia: Right.

Hana: So I’m glad we moved to that. It really allows, you know, the back of your pelvis to open and your tailbone to move back and out of the way of the baby’s head. Because it really didn’t, like, her contractions were super strong and it didn't really take that much time for her to push this baby out. I think it was about, maybe, 30 minutes?

Keelia: Wait! So it… it ended well!

Hana: Yeah!

Ajira: Oh my god! That’s so quick! That’s beautiful!

Hana: I know, it ended so, so, so well. And, like, those last, you know, pushing felt like it was definitely quick but some of, like, the emotional time during that time felt like eternity. Because that was where I think, like, her family’s stories were coming back to her because shoulder dystocia is something that happens right at the end, right?

Ajira: Mm, mmhmm.

Keelia: Mmhmm.

Hana: So, like, my job at that point was not even, like, really coaching her pushing. It was reminding her that she was safe, that the baby was safe, that, like, pushing into that pressure was a safe way to bring her baby to her. Like it was a good thing, to not kind of, like, shy away from it. And so it definitely felt really intense right at the end compared to the rest of her labor. The rest of her labor was so calm but that was where, kind of like, all of those family histories showed up. And so I really felt like as soon as that baby came out and was on her chest, like, we had, you know, crossed a threshold together of some kind. And they didn't know the gender of their baby at that point. They had, you know, decided not to find out, and it was a female baby. And that almost brought me to tears too because it felt like, you know, this is a kid who has a uterus, and if she ever has a baby, this is the story that she gets to tell herself as she goes through that experience, right?

Keelia: Mmm.

Hana: It’s not going to have to be the one of everybody having a cesarean. It’s like no, my mom had me vaginally, which felt like turning the shift for their family story and their family narrative.

Keelia: That’s so beautiful. Ugh, I almost wish Grandma was in the room to see it happen.

Ajira: [Laughs] Oh man, that is so, so beautiful. How does Lily feel about this story? How does she talk about her birth?

Hana: Yeah what's funny is that they didn't want to postpartum visit either but then after we had this birth together they added one.

Keelia: Aww! Yeah.

Ajira: Aww, that’s perfect!

Hana: So it was really good. We got to talk through the birth story and I think she just kept saying, like, “I can't believe I did that I can't believe I did that!” And I was like, “Yeah! You're amazing!” So I think she was in awe of herself, as she should be.

Ajira: Yes. I think that's one of my favorite aspects of the ceremony of birth, right, is how it serves as this is this rite of passage that shows you that you can do things you didn't think you could. And I always think of it in the frame of what you need to be a parent, you know? It's like you need to know that you are going to come up against hard things, against things that feel like walls, against things that feel impossible, or seem impossible, and that you're going to figure it out, you know? And that you can't really know in advance how you're going to figure it out but you will.

Keelia: You’ll be surprised by your own strength.

Hana: Right. Absolutely. You will always surprise yourself. I actually got to be at the birth of her second daughter too, so that was really lovely.

Keelia: Oh my god, that’s so beautiful!

Ajira: Aww!

Hana: Yeah, they’re some of my favorite people. Yeah, so that has been wonderful. They live far out of Philadelphia so our paths don’t naturally cross, but I do feel really connected to them.

Ajira: So when you reflect on that birth now, looking back on it, how do you think, you know, what are the things you took away from it? How do you think it impacted, you know, the way that you showed up for your clients moving forward, or even the way that you felt about yourself and hard things?

Hana: I think as I reflect on the story again, I'm reminded of the power of story and how the narratives that our clients tell themselves, and the narratives that I tell myself as a doula, the narratives that the care providers are telling themselves—those are really, really powerful. And that storytelling can be a technology of healing, too, right? So her process of telling the story to me and telling the story to her mother, right? Grandma who was at breakfast? That is a process of healing and literally changing the narrative in their family. So yeah the power of story continues to be I think a big theme of this birth. And I think the other thing that comes to mind is that one of my mentors early on said that you labor how you live. And this story was also a reminder that, like, you support how you live. The poetry that he was reading, you know, that was part of his job as an English teacher, right? Like, I, you know, again, I don't think he would have thought that that would be what came up in labor. But it reminded me, like, how to talk to partners and birth support people about the strength they already have within them.

Ajira: Mm, mm.

Hana: You’re preparing for this your whole life, you know? And, like, those gifts will show up. I think that there's kind of this myth of, like, this perfect birthing person or this perfect birth partner, and we just need to, like, crash those to the ground, and everyone's going to bring, you know, their particular life experience and skill into the birth, and you're going to use that, right? Like you don't have to be a birth expert, you just need to be yourself and, like, live in fully to who you are and that is going to, you know, really make a difference in the birth room.

Keelia: Yes. That’s so beautiful, thank you for sharing that.

Hana: Yeah.

Ajira: The thing that was sticking out to me was just, you know, and to connect back to what I was saying earlier, about how I wish that hospital providers had a little more support to process what they're experiencing. And from me that's actually one of the markers of a doula that I think has staying power versus a doula that will burn out, is one who is able to have a practice of self care that helps them to process the experiences that they have so that they're not as enmeshed with their clients’ experiences, and so that they're not taking each experience into the next one but are instead able to see the birthing person that they’re supporting as the individual that they are, right? In the context of their life, and their desires, and not combining them with every other person they may have supported. And I can see that, you know, for a surgeon it is important for them to have that barrier, that distance, right? That disconnect of not being fully connected with their patient but that's where I think there's a kind of, like, a dissonance when a surgeon is walking into a birthing room with somebody who's been in labor and has actually, is actually, like, adhering to that stupid statistic about the pace that a birth is supposed to progress at and then can just say, you know, “You can't do it.”

So two things about that stuck out to me, right? One is that, like, the complete disconnect from this particular person's experience right now, one. And then two, not having any sense of the impact of their words. Because we're conditioned from youth, right? To trust our providers. “Do what the doctor says, do what the doctor says,” and I've seen that for sure in a birth where a client was progressing through their labor beautifully, and then a doctor came in and told them a completely different story and they just flipped to the story the doctor told.

Keelia: Yeah. Yeah.

Ajira: You know what I mean? And, you know, despite the evidence of their own experience they just flip to it. And I wish that hospital providers had a little more sense of the impact of their words. In fact if I had one wish that was about hospitals it would be that all providers would take three conscious breaths before they walked into a hospital room. I think that little act alone would make such a huge difference. I wish that they would listen before they spoke. And that they would really hear what was actually happening and not be looking at the chart, you know, be like, “Based on what I'm seeing on this piece of paper as opposed to the human being sitting in front of me, this is what I recommend, or this is what I think is happening.”

Keelia: Mmhmm.

Ajira: I'm really glad that your client was able to recover from that regardless, and have the story that they were telling be the one that they lived.

Keelia: I like that as a prompt, too. If you could wish something to happen, to change in the medical system. I feel like mine would be that all hospital staff who are trying to take those few seconds to breathe before they walk into the room, have the technological and personal support that they need to even be able to show up emotionally to take those breaths.

Ajira: Mmm.

Keelia: That somehow we would value them showing up as a person more than we value them tracking everything in the computer, which is so much of their job. Or that there were enough beds, and there was enough space for people to take the time that is necessary for labor without the doctor needing to think about timelines and available beds. That there would be enough staff so that they only need to focus on a few people, you know? It's like the whole system. To me when I think about it I think it's incredible that there even are hospital staff members who show up like that at all given how much stacked against them, you know?

Ajira: Yeah.

Keelia: And every time I work with a provider who’s like that I'm like, “Thaaank yooou!” Like I have never been in your shoes, I don't understand what it's like. I just see, I see a lot of really ugly moments in this room and I know there's more behind it. And I love what you said, Ajira, thanks so much for sharing that.

Hana, I'm wondering if there's anything else you want to offer folks who might find themselves in a similar situation to any of these parts, you know, they're doing a birth-only package, or they're dealing with family who are putting different pressures on them, they’re facing a birth with premature rupture of membranes or they're facing a birth with a doctor who they're dreading—any of it. What would you say to that doula?

Hana: I think one thing that I learned from this experience was also to remember my own power as a doula, and the power of my own voice. Because I think going into it, one reason I was feeling, you know, so anxious was that I was, like, “I don't feel like I can do anything.” And I think part of that is because we're trained as doulas to be vessels, right? That's the word that we’re often given, you know, “We’re vessels for whatever you want, as the client. And yeah, I'm your advocate. I'm in your corner. I’ve put my, you know, birthing hopes and dreams away in a box, and we're here for your birth.” But that doesn't mean we also, you know, hide away our own power, right, to witness the reality of what's going on in the room, right? Like we have the power to be like, “Well, your body is really working well,” you know? “Your baby is really doing well,” you know? Just simple things of that, you know, work to kind of clarify the reality of what's going on in the room.

And so I think that that's often a really challenging line for a lot of doulas to walk, especially when they're told to be a vessel. But, you know, I think I would tell them the same thing that I tell my birthing people and my, you know, birth support people, which is that you have everything you need inside of you. And everything that has come before in your life has prepared you for this birth, and for this work. And so lean into that, you know? You are enough.

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

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