Ma Doula Read online

  “Anyone who thinks women are the weaker sex never witnessed childbirth.”

  ~Anonymous

  Chapter 1: “Now You Are Our Sister”

  In the late 1970s and ’80s I volunteered through Macalester College in St. Paul, Minnesota, to work with the Hmong refugee population when they began arriving in the Midwest in the late 1970s. That was at the end of the Vietnam War era. The Hmong had assisted U.S. troops in the jungles of Laos and incurred the wrath of the communist Pol Pot regime in doing so. I learned to speak Hmong (never mind that I had flunked French two years in a row in high school) and acted as a liaison in the Minnesota justice system, in hospitals, and at funeral homes.

  I immersed myself in the Hmong culture, attempting to find ways to make their assimilation less painful, if possible. I marveled at the resiliency of an entire society uprooted by war and replanted half a world away from the only home they had ever known.

  Our family remained intertwined with our Hmong friends over the ensuing decades. Our children grew up with their children, also becoming bilingual, which greatly surprised the Hmong. I tried to explain that while I was calling landlords and bill collectors, teaching English classes and scheduling appointments for everything from prenatal exams to visa and citizenship hearings on their behalf, that their grandmas were watching my kids and constantly talking to them in Hmong. I said I was not surprised they picked it up. I pointed out that if I were to keep one of their babies for any length of time and they heard only English, they too would speak mostly English. That met with a decidedly negative response. I was firmly told that Hmong babies are born knowing Hmong. I couldn’t convince my new friends otherwise. Over the years we have laughed and cried together, birthed their babies and buried their elderly, often casualties of the war that continued to rage inside of them in spite of the fact that they were here in the U.S., thousands of miles away from the carnage.

  When we moved back to Minnesota from the U.K., we saw the amazing transformation that had taken place with the arrival of over 70,000 African immigrants in Minneapolis and St. Paul. I was intrigued. That winter I began researching what I needed to do to update my credentials but found I had lots of time on my hands. I wanted to rediscover this global market I had returned to.

  I heard about a Somali marketplace that had opened. I thought it might be a good place to start to learn about these people who I had never had a chance to know before. I found very quickly that they were as curious about us as we were of them. Every day for the next weeks and months, I took a bus over to Karmel Mall. After a few weeks I was on a first name basis with some of the grandmothers who “manned” the little stalls at the mall. I asked one woman named Fadumo how to say “midwife” in Somali. Now I could introduce myself, but some Africans spoke Arabic, or Oromo, or Amharic or Swahili. I couldn’t tell yet by their dress who was from where, Jordon or Kuwait, Egypt or Pakistan, Somalia or Kenya. It turned out that many stopped in other countries on their long journey away from their war-torn countries. Some settled down temporarily and moved on once they had enough money to try to catch up to relatives who had the good fortune to be in the U.S. I even met some Somalis who spoke no English but were fluent in Swedish! They had been offered only Swedish visas when they approached the consulates to escape from Somalia.

  Fadumo and I became close friends. Also a grandmother, her little stall boasted beautiful fabrics from around the world, including wedding robes, matching hijab and underslips, perfumes, jewelry, henna kits for decorating women’s hands, arms, and feet for special occasions, an assortment of tea sets, and drapery and carpets for transforming an American apartment into a true Muslim home. I found a Somali-English/English-Somali dictionary for the times we hit a wall trying to communicate something to each other. We spent hours asking each other questions about the other’s culture and other times just compared what we planned on cooking for our husbands that night.

  Fadumo had been a licensed massage therapist while her family lived in Nairobi. I found her a book on baby massage, which she pored over for weeks. At lunchtime she would often order a platter for two from the mall’s halal restaurant and bring it back to her little stall and, sitting on the floor on a carpet, she would teach me how to eat goat meat and spaghetti Somali-style with my hands, or I should say, with my right hand, since the left hand is reserved for unclean things, not for eating. Over the next few months, more often than not, we would both end up reduced to giggles. She had never had to teach a grown woman how to eat!

  As I continued to visit her, I was approached by several students who asked if I could proofread their college homework. I gladly did, having learned some editing and proofreading while working for a Hmong newspaper years earlier. Soon I had a handful of students asking for help with their papers.

  One woman, Halima, who was studying for her master’s degree in economics, told me she was expecting baby girl number four! She laughed when she told me she only makes girls and that they hadn’t figured out yet how to make boys. I asked if her husband was disappointed or if in their culture he could take another wife in order to produce boys. I knew that in the more orthodox or Hassidic branches of Judaism, after a proscribed number of years, a man could divorce his wife and take another if she had not produced children for him, and I knew of similar customs in other countries, so I was concerned. Halima said he couldn’t blame her or be unhappy with her because it is Allah who chooses what kind of baby to send couples. They are taught to be grateful for whatever gifts He sends, so no, her husband would not be sad this time. Then she asked me if I would be her doula. I was honored.

  We continued to meet over the next months, discussing diet among other topics. Unfortunately, many Somalis have adopted our SAD diet, the Standard American Diet, packed with fats and calories and few nutrients. Their former culture had a wonderful diet full of fresh fruits, vegetables, meat, and very little dairy or wheat. Many now eat the white bread, pastries, cookies, candy bars, snacks, soda, and other nutrient-deficient junk foods they find at their neighborhood stores and fast-food restaurants. Their lifestyle, of course, is no longer one of nomads or camel herders who worked hard to eke out a living off an arid land, and now are often sedentary much of the time. This is taking its toll: diabetes and obesity are now rampant in their community.

  Finally one night Halima called to let me know she was on her way to the hospital. We had both been so excited about this baby’s arrival and the day had finally arrived. I got to the hospital as the nurse was checking her. She was five centimeters already! This wasn’t going to be long. Between contractions, or rushes, as I now call them, Halima introduced me to her mother, Ubax, an elderly aunt, Deqo, and her sister Sahroh. All were dressed from head to toe in wraps of one sort or another. Men were not especially welcomed at births. This was women’s work.

  Halima wore a hospital gown instead of the traditional robes, though she still wore two headscarves. We were quite a team, breathing together, the grandmas happily catching up on gossip in one corner, Halima walking around the room, then trying to sit on the birth ball (a rubber exercise ball) for a while. I like getting moms up and out of bed because gravity helps babies move down the birth canal. Sitting on a birth ball not only keeps things progressing, but often aids in turning a baby into the optimum mother-baby face-to-face position for birth. Babies who begin labor “sunny side up” have a harder time and often will not turn making the descent-down-the-birth-canal stage harder. Some babies are turned halfway between the two presentations, with the head in an “acyclic” position (turned to the side), which often holds things up, literally. Lying in bed can actually slow labor down or even stop it in some cases. By being on a birth ball not only does gravity help, but a mom can rock her hips side to side and in a spiral or circular motion, which greatly aids in engaging the baby’s head properly. When that happens and the baby’s head molds to fit the birth canal it also helps slowly stretch the walls of the vagina, which can in turn pr
event tears.

  Things were going smoothly with short naps between the rushes. Then Halima started shivering. I assumed it was transition, but when the nurse took her temperature, we saw that it had shot up. She continued to shiver as I piled on warmed blankets. Darn it, I thought, and just when everything was going so well. The doctor ordered blood tests right away and started an IV with antibiotics “just in case” the fever was a sign of infection. The doctor started suggesting interventions should we not be able to get the fever down. Within half an hour the baby’s heart rate jumped up, too, and more interventions to speed things along were offered.

  Halima and I had agreed that in the event the staff offered treatment options as we went along in the birth, she would suggest she have a few minutes with her family to discuss any suggestions first. It was time for that. The nurses and doctor all left us to deliberate. Halima again made it very clear that she did not want drugs and certainly not a C-section unless things looked too risky. I explained that I could not decide what was best for her, but that an infection could get nasty, that the IV was not a bad idea, and that she could probably ask for a little more time to see how things worked out. She agreed with this plan and let the nurses know. She started to drink more juice to help with the fever and build up her strength. She continued to dilate, which was good. The next check told us she was at seven centimeters. Then we were alone again.

  She started to feel better. I had peeled back the blankets, was sponging her down with lukewarm washcloths, and brought her cup after cup of juice. Suddenly she said she wanted to push. I was surprised and thought it was just the pressure of the baby moving down, but when she yelled, “I am going to push!” I knew nothing was going to stop her. I rang for the nurse and she came into the room.

  When this nurse had taken a blood sample earlier for the lab, she hadn’t put enough pressure on the site when she removed the needle and blood had spurted all over the bed and the floor. The grandmas clicked their tongues and shook their heads: not a good nurse. Now she sauntered back in, saw the black curly-headed baby crowning, and whipped on a pair of gloves. Actually, she only managed to get one hand covered, which she used to support the baby who was coming out. She held her other hand above her head so as not to become contaminated, I guess, and left the baby lying in a puddle on a Chux pad. I could tell the baby wasn’t breathing, and in slow motion wondered, Who is going to do something? I grabbed the end of the sheet and started wiping off the baby girl’s face and rubbed her down to get her to breathe. I lifted her up with both of my ungloved hands as the nurse stuck a bulb syringe into the baby’s mouth with her one gloved hand and we both moved together over to the warmer, which had been turned on earlier. I continued to rub and the nurse kept suctioning for the next few seconds, which felt like an eternity. The baby started pinking up by then, though I didn’t think she was really breathing well yet just as the NRP (neonatal resuscitation program) team ran into the room and started to work on the baby, who cried within the next few seconds. The doctor was there in time to watch Halima push out the placenta. The second, or pushing, stage had lasted less than five minutes.

  Things finally settled down and Halima was happily nursing her fourth little girl, whom she named Maryan. I was standing next to the bed just taking it all in, so very thankful that everything turned out okay. The grandmas were talking quite loudly at this point so I asked Halima what they were saying. She listened for a minute and told me, “They are saying they wished they had had a doula at their births!” I found out that they had spent most of the waiting time retelling the stories of their own births, even when Halima was trying to rest. She told me later that even their woman-chatter was comforting at the time.

  Then the grandmas came over to where I was standing and started stroking my arms and my shoulders, then my head and my hands. Without moving a muscle, I asked Halima under my breath, “Halima . . . uh . . . what are they doing?”

  She explained, “They say you are like a holy person who has made the pilgrimage to the Haj in the East, and you love us and treat us like your own family. Now you are our sister.”

  “Around us, life bursts with miracles—a glass of water, a ray of sunshine, a leaf, a caterpillar, a flower, laughter, raindrops. If you live in awareness, it is easy to see miracles everywhere. Each human being is a multiplicity of miracles. Eyes that see thousands of colors, shapes, and forms; ears that hear a bee flying or a thunderclap; a brain that ponders a speck of dust as easily as the entire cosmos; a heart that beats in rhythm with the heartbeat of all beings. When we are tired and feel discouraged by life’s daily struggles, we may not notice these miracles, but they are always there.”

  ~Thich Nhat Hanh, Vietnamese Zen Buddhist monk, teacher, author, poet, and peace activist

  Chapter 2: Sometimes It Does Take a Village

  I was filling out Tiana’s paperwork as I signed her up for our doula program. At the same time, I was gathering information about her wishes for her baby’s birth, which would eventually evolve into a proper birth plan.

  I asked her who she wanted to be at her birth. She answered that she wanted her mother, her stepmother, her mother-in-law, her brother, her husband, and her husband’s sister. I put my pen down and gave her my little canned speech about not inviting everyone because you might end up feeling like you’ve got all these people watching and waiting for you to “perform” rather than just making the birth room yours, making it a sacred space wherein to welcome a new little soul to earth. I have also learned from experience that sometimes relatives are not all that helpful. Often, during labor, they will start telling all of their own birth and labor horror stories—definitely not helpful—or start suggesting interventions, like an epidural, that they used and thought was the best thing, while you are trying your darnedest to at least try to go naturally. Some mothers-to-be have been begged by their own mothers or best friends or mothers-in-law to please let them be there for the birth, and if moms-to-be aren’t assertive enough to say no, soon the entire congregation is attending the birth.

  I had my say, for what it was worth, and finished up the paperwork. That done, we watched the DVD called Doula that I like to have first-time moms see because it shows diverse families, what they wanted for their births, and how a doula tries to create the birth experience the parents want. There are home births with siblings present; home water births with dad in the pool, too; hospital water births; hospital medicated and un-medicated births; au natural births and moms dressed in their own clothes; unplanned Cesarean births and planned C-sections.

  Thinking she was empowered with all this information, I ended our first meeting and encouraged Tiana and Zion, her husband, to read as much as possible and suggested checking out some of the videos on my resource handout.

  Our next couple of meetings went well as we got to know each other. Zion asked insightful questions about birth and labor and was really getting “charged up,” as he put it, for his son’s birth. Tiana was less vocal. I wondered if she was just plain scared, because most of her answers to my questions about how she was preparing for their baby were all, “Yes,” “No” or “I dunno.”

  Then as week thirty-eight was quickly approaching I gave her a sample birth plan and suggested she change it to fit her expectations. She never worked on it, which was okay, but I had been hoping she would take a more active role in her birth. I did learn that her mom had four very fast natural births, so she thought she would try that. We were at her thirty-ninth week appointment when she asked if she should just show up at the hospital on her due date and wondered how they “start it up.” The midwife we were seeing that day laughed and said, “Remember when we went over the signs of labor starting? Well, we wait until your body tells us it is ready. You will see some spotting, though that doesn’t always have to happen first, or your water breaks, or you have contractions that don’t go away when you try to rest.”

  Tiana thought about that a minute and then
frowned. “You mean I gotta wait for that? It ain’t just gonna all be over on my due date?”

  Whoops. I thought we had been preparing better than that. Tiana was still in high school and at one appointment had told me about the birth classes the school also held for young moms, so I had thought she had plenty of childbirth education, but I was wrong.

  The midwife patiently went over the basics of early labor again and reassured Tiana that it was all perfectly normal and that often first babies decide to arrive after their official due date, which is in fact only a guess date. There is no magic formula to predict when each baby will be born.

  “Shit!” was her response. Tiana was tired of being pregnant. She was tired of heartburn and swollen ankles, uncomfortable nights and constipation, all normal side effects of pregnancy. She had been all geared up for this pregnancy to be done with on her due date, which was now one week away. Her mother was going to come up to be with her on that day and needed to go home shortly afterwards. Tiana got dressed and left, a very unhappy mom-to-be.

  When I worked at a freestanding birth clinic where we didn’t have drugs even if our moms wanted them, every single woman who chose to birth there had done her homework, had read every book on the market, viewed every YouTube video out there on birth, had interviewed every midwife within a 200-mile radius, and was ready for just about anything. The problem was not convincing them to birth naturally or be willing to go through a twenty-four- or thirty-six-hour first-stage of labor; there the problem was convincing them that when we see meconium or another serious complication, it is time to consider transferring to the hospital.

  A week later I met with Tiana again. As soon as the midwife came in the room and started to measure her belly, Tiana asked if she could schedule an induction. The midwife asked why.