Dear Doula,
I'm a newer doula and had had three births before I had my daughter last year. I took a Hypnobirthing class and worked diligently throughout my pregnancy with my husband and my doula (who read the Hypnobirthing book, but was not as prepared as I would have liked..we later found out). I wasn't scared about labor, I was excited to get to experience it. I wanted an all natural birth and found a hospital with the lowest c-section rate in Pennsylvania (where we live) that is very mother centered, uses midwives, etc.
However, my labor was... it was back labor the whole time. For whatever reason, that possibility never really entered my mind. I was utterly unprepared to never feel a single contraction in my front; it was all in my lower back, tailbone. I labored at home from 7pm-about 1am when it was getting really intense, contractions were about 4 mins apart for a hour or more. I wanted to wait to go to the hospital as long as I could. We got to the hospital and I was 3cms.
This made me feel so foolish. I was a doula, I should have known. My hypnobirthing scripts were doing nothing. I was in crazy pain. It felt like broken glass being dragged inside my back. It was just just awful and I was bawling about how I'm a doula and this isn't the beautiful labor I thought I was setting up. I was a mess. Around 7am, I just broke down and couldn't take it anymore and got the epidural at 7cms.
I was just in agony. But even then, I was so hesitant about getting it. And now I still wrestle with it. It was instant relief, but was the opposite of what I wanted. And I especially wanted mother directed pushing, but ended up with a midwife telling me when and how to push when my baby was delivered at 6:30pm that night. It was beautiful in that moment though because once her head and shoulders were out, she told me to reach down and grab my baby. So I got to catch her and put her right to my chest.
I'm leaving out a lot of the beautiful details because I know you're busy and I I don't want to take up your time too much. She was born sunny side up which is why I had back labor and I was lucky to get my vaginal birth with only a small tear. I feel bad that I feel bad that I didn't get the birth I wanted. I was lucky.
I had my baby in July and then had my first doula client since then mid February. That birth went great, she got an epidural, happy parents, healthy baby. I guess seeing that birth just brought up a bunch for me about my own birth.
You mentioned in one of the youtube interviews you did that you had gotten an epidural and that birth workers have asked if you were disappointed, and you mentioned in that video, that no, you weren't. I guess I don't have a specific question, more just hoping you might share your birth story and talk about doula birth baggage in general.
I learned so much about how to be a better doula by becoming a mother and experiencing it myself. But I still have this disappointment in myself for getting the epidural. I know I need to process it all on my own, and I haven't found a lot of resources specific to the unique situation of being a doula and having disappointment in my own birth.
Also, any tips on back labor management is appreciated too :)
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Dear Doula Baggage,
Your letter is beautiful and touches me deeply because it is so similar to my own birth story - and many other birth workers birth stories. My postpartum time was filled with sadness, doubt and deep grief around how my birth unfolded. I was so happy to have a healthy baby, of course, but I knew it was okay to feel sad about how my birth unfolded. I once heard a wise midwife say: "A healthy parent and baby is the most important thing BUT it is not the only thing that matters" - I could not agree more. I have attended around twenty births of birth professionals (3 OBs, 4-5 midwives, a couple L&D nurses and the rest were doulas). All of them planned a medication free birth and only around 30% got the birth they wanted. I have such a clear memory in my head of one of the OBs, who delivered via cesarean, shaking her head and crying "I'm an OB, I of all people should be able to get a baby out my vagina." I knew that going in, it can be challenging for us professionals to have our ideal birth. Perhaps our minds are busy doulaing ourselves during our birth or we have stored trauma from witnessing or reading about obstetric violence. It’s complicated.
Or perhaps we are just western women - and that means we have a LOT stacked against us. The musculature of our bodies, and in particular our pelvic floor, is all messed up because we sit in chairs and in cars and are so inactive compared to how we should be. Our bodies are meant to move in particular ways for our whole lives; that physiological movement and development support physiological births. And that isn’t the case for us. As our bodies are developing we are sitting at desks at school for hours each day. We aren’t doing the movements we should be as humans - foraging, squatting all day, walking long distances. And we aren’t taught how to stay with sensation. Our culture is all about numbing, distracting, medicating. So our births are much harder (not to mention chronic pain and health issues that arise from being so sedentary). And even people who live optimal physiological lives can still have gnarly births - because birth can be an intense and unpredictable event no matter where or who you are.
Also, just real quick, I want to say back labor is NOT normal labor sensation. It is INTENSELY painful - like another dimension of pain. I’ve seen OP (occiput posterior is “back labor”) labors before and it causes the most awful pain. It’s because the back of the baby’s head (the occiput) is rubbing against your sacrum, instead of their soft squishy face or side of their head against your spine. It’s serious ouch. I’ve had two clients who had vaginal OP med free births tell me later they wish they had gotten an epidural because they couldn’t even stay present for their birth because of the pain. And I’ve had many clients planning a med free birth get epidurals with back labor. The fact that you got to 7cm with it is pretty incredible.
With that in mind about your labor, this is my story.
This is the preparation I did in pregnancy: acupuncture, chiropractic (webster technique), Spinning Babies, yoga, meditation, hypnobirthing/hypnotherapy, walking and pelvic floor physical therapy. I set myself up so well. But, a few months of doing all of this during pregnancy can not make up for a lifetime of using my body in ways that do not facilitate optimal function for birth. I've been an academic my whole life - spending much of my time sitting still and reading and writing and in classrooms. I have very tight ligaments in my pelvis, legs and back and I knew they could be an issue. And they were.
I went to 41 weeks and 5 days before my homebirth midwife came over to sweep my membranes and give me herbs to promote labor. She legally could not support me if I went past 42 weeks. So I was induced. I do not believe in “natural induction.” Just because the herbs I took and the sweep I had were not synthetic pharmaceuticals, they were still interrupting my body’s normal processes. Perhaps my daughter was positioning herself slowly into my pelvis. By inducing my labor, I hurried her in before she was optimally positioned. But I didn’t feel confident enough to have an unassisted homebirth and I didn’t want to end up with a hospital induction, so I chose home induction.
My dilation went fast. About two hours after my sweep and several doses of blue/black cohosh tincture, I was contracting every five minutes. By 11pm I was in active labor and by 6 am I was fully dilated. I was so happy - it seemed like I would get my homebirth! But then, as life does, I got thrown a curveball. I pushed at home for six hours. By the fourth hour I had radiating nerve pain down my leg. I could feel my sacrotuberous ligament tightening against my nerves and my daughters head. She was stuck. After six hours of pushing, she was in the exact same position and station that she was at the beginning of pushing.
We did all the things, all the tricks, all the positions. Nothing changed. So I stood up and told my midwife that I was at the point of being traumatized by my birth. The nerve pain was 100x more painful than the contractions. My clients often ask how they will know if they should get an epidural. I tell them “When you have moved from coping to suffering, you’ll know.” I was definitely in the suffering phase.
I also want to say - I love natural, medication free births. They are beautiful and for many people, the healthiest options. But I also love pain medication for times when it is really needed. And only the birthing person can know when it is really needed. Had I not had the option of an epidural, I very well could have delivered safely or could have become exhausted and had a major hemorrhage, who knows. I think there is a time and place for pain meds in birth, just like in other times in life. I just don't like when anything is forced on a birthing person - medication or medication free birth. It's about having options and making informed choices, which is what I did.
So anyways, we hopped in the car and drove to the hospital (it was 4th of July so magically the freeway and hospital were empty!). I remember saying to myself “Liz, trust yourself - this is the best choice for you.” I was a wise woman in that moment. I was giving my future self permission to trust my past self.
I got the epidural and started pitocin. All the nurses and doctors were SO nice to me, which is amazing since I have seen ugly transfers. No one shamed me for trying a homebirth. My doula and midwife were amazing supports. I knew I had made the right decision. We all thought I’d hang out on pit for a while, rest and push a baby out. A Fourth of July baby! How special!
But again, life had different plans. When I arrived and they checked me, the anterior lip of my cervix had slipped back over my daughter’s head. So technically I was 9.5 cm and we had to wait until I was back to 10 cm to start pushing. No biggy, right?
Fifteen hours later, I still had the lip. They had me on a peanut ball and in all sorts of positions. Each side, hands and knees, squatting, you name it. And the lip wouldn’t stay when they pushed it back. In any other hospital, it would have been a section. But I was blessed with an incredible, skilled doctor. She was young, most likely mid thirties. She started mentioning a c-section at this point and I just lost it. After all this, I wouldn’t even have a vaginal birth.
“Let me try something,” she said. She put on a glove and reached in my vagina and with two fingers I felt her feeling my daughter’s fontanels to assess the position of her head. She stopped, said “ah ha!” and turned my daughter’s head with her pointer and middle finger. I felt a release. My daughter was born vaginally about an hour later. And just like you, I reached down and pulled her out and onto my chest and it was the most magical and healing moment of my life.
My midwife told me later that she google-stalked the doctor and found out she had done a few years with Doctors Without Borders, which meant she was skilled at getting babies out without surgery - I feel like I super lucked out. In the hundreds of birth I’ve attended I’ve never seen a doctor or midwife do that successfully - a birth like mine always was a c-section.
My postpartum time was hard. I had a horrible time recovering from a second degree tear (I couldn’t sit for a month - for all my doctor’s skill in turning my baby, she had little skill in helping me not tear as badly) and I was plagued by the fact that I had needed to transfer to the hospital. I had severe postpartum depression/anxiety (I have depression and anxiety already so this was not a surprise). I spoke to many birth professional friends and colleagues about my transfer and I spoke a lot about it with my homebirth midwife. Everyone had different answers for why, but I eventually came to the conclusion that my pelvic floor dysfunction, combined with inducing my labor is most likely a large part of the reason. I also hold the possibility that I was thrown off mentally for various reasons and could not get back in the right mindset to birth my daughter at home. Perhaps it’s all of these, or none of them or other complicated factors. But I have come to the definite conclusion that no matter what the cause was, it was not my fault. And I trust the woman in labor who told her future self to trust the choice she was making in the moment. It was the right one for that time.
I have come to the decision that I will have radical compassion for myself - radical because it’s fierce and unending no matter what choice I make - because I did the best I could in the moment with the information I had. It’s the same compassion I have for my clients, for my family and for those I interact with on a daily basis. The “you” in that moment of excruciating pain chose the epidural for a reason. Trust her. She is now your teacher. She knows something you don’t know now. And it’s okay if it stays a mystery. And it’s okay if you have mixed feelings about it. There are moments my epidural plagues me and other times that I feel great about it. I just stay present with the ebb and flow of my emotions; like life, they are ever changing. It may also be really helpful for you to process this with someone. Birthing From Within has mentors that do something called "Birth Story Medicine." An experienced therapist may also be able to help you process this experience. It's important to feel supported. You don't have to go through this alone.
Pregnancy, birth and parenting change us - no matter what. We don’t get to choose how. And we don't get to choose how things unfold. I have learned that none of my motherhood journey was what I expected and that is terribly hard and terribly beautiful. My journey and experience was what it was - and now I get to transition into a different role from “Person Who Didn’t Get the Birth She Wanted” to “Person Who Shares Her Unwanted Birth Experience with Others.” This creates so much healing for me. I know that at some point, you will have a client who has a birth they didn’t plan for and you will be the guiding voice of self compassion for them. I don’t believe things happen in our lives so we can teach others a lesson, but I do think when the opportunity comes for us to support others through their pain, we use our guidance as healing for ourselves.
And tips for back labor! Oh my goodness, back labor can be so excruciating! I talk to my clients about prevention: during pregnancy follow the Spinning Babies guidelines for optimal fetal position, get regular acupuncture and chiropractic care with Webster Technique and doing prenatal yoga and walking regularly.
In the moment: hot pack or ice pack on the low back, TENS unit on the low back can help too, rebozo and Spinning Babies positioning are an option as well. I also carry a cuticle stick in my bag and push the slanted part into the place on the pinky toe where the cuticle meets the nail and press down. I switch off between right and left foot every ten minutes. It’s painful but I’ve seen it turn a baby within an hour or two (I learned this trick from an acupuncturist).
I also want to address your doula, who read the Hypnobirthing book, and was not as prepared as you would have liked. Yes, I agree with you. Just reading the book does not typically prepare someone to support a birthing person really well. One needs to do a Hypnosis-based childbirth education training, like Hypnobirthing or Hypnobabies or be a Certified Hypnotherapist to skillfully facilitate a person using hypnosis during their birth.
Hang in there, Doula Baggage, so many birth workers go through this. You are not alone.