"Dangana, it means courage"

3 times in the same week, I received messages from women in my community, wondering if I would be willing to provide doula services, for a young, pregnant, unwed, woman of color, at a discounted rate.

The women that reached out to me knew that regardless of Catherine's educational background, her polite demeanor, her professional appearance, her spongelike desire to learn all things about pregnancy, birth, and childrearing, that each year in the United States, about 700 to 1,200 women die from pregnancy or childbirth complications and that black women are three to four times more likely to die of pregnancy or delivery complications than white women.  That statistic climbs if you are under 26 and rises again if you are unwed. Catherine needed an advocate. 

I met Catherine and her partner Kodjo at a local starbucks. I was elated to find out that Catherine had done tons of research and switched obgyn practices, to one that delivered at Manchester Memorial Hospital, which better aligned for her desire to have an unmedicated birth.  Kodjo was sitting quietly, but intently listening.  I asked Kodjo, "How do you feel about Catherine's desire to give birth in this way?".  Kodjo's eyes lit up.  "Where I am from, everyone gives birth this way. They trust their bodies. This is what's normal.  I am going to nursing school in hopes to become a midwife." 

We discussed lots of birth-y stuff and I talked to them about things I wasn't sure if they had thought of yet. They both kept notes and at our next meetings, had made decisions, or asked more questions about each topic. Catherine did more reading and asked more questions than probably any other client I have had. 

On the evening of August 8th, Catherine texted me that she thought her water broke. After a few more questions, and some movements, we determined that her water was in fact broken.  Catherine wasn't having any contractions, so I told her it would be best to try to go to sleep and rest as much as possible, until contractions began. 

The next morning I went to Catherine's house to check in on her. Her contractions had started to get into a pattern and had intensified, but not nearly enough to head into the hospital. We tried a few things to help bring them closer together. 

As the day once again started to head towards evening, we decided to head on in. When we arrived to the hospital Catherine was 3cm dilated. Her contractions were coming every 6 minutes or so. 

A decision was made to have Catherine pump, in hopes that it would bring her contractions closer together.  It didn't really help with her contractions, but Catherine pumped A LOT of colostrum, which later would be helpful for her baby. 

At 10:30pm, 28 hours after her water had been broken, a decision was made to start pitocin. Catherine's temperature had become slightly elevated and getting a baby out vaginally was more important to her, than staying without any labor augmentation. The nurses started with the absolute smallest amount, and it wouldn't take much to help Catherine's contractions get closer together. 

At 1am Catherine started to have a lot of pressure in her bottom.  We decided to go for a walk, where Catherine began to become nauseous and vomit into a container in the hospital hallway. Vomiting is very common during the labor process.

After that Catherine felt much better. She was managing her contractions well and not on any pain medication, but I could tell she needed a bit of a break. I suggested that she get in the tub.  Manchester not only has a tub in the "spa room", but there are also two other rooms with their own larger tubs in them. We happened to be in room 12, which has one of those tubs. 

Catherine was able to relax and get some relief while she managed contractions coming every 2.5 minutes. At around 3am she decided to get out of the tub.  As she rolled around on the ball, smiling with each contraction, and me talking her through her self doubt, she said, "This is like when you are little and you want to stay up with your friends at the sleepover and you're like 'I can't do it!' and they are all like, 'yes you can!" 

This is when change began to happen. She began to huff just a little bit louder and she became very internally focused. She hated the feeling of constantly having to have a bowel movement, but that was her only complaint.  

At 9am there was chatter about how long they would let her go for and they decided to do another check. She was 7cm dilated, 80% effaced, but the biggest number was that baby was now at +2 station. Which was a huge change from the -2 when we had arrived the previous day. 

I talked with Catherine about doing everything we could to let gravity help dilate her cervix, now that we knew baby's head was well applied.  She was tired.  She hadn't had a full nights rest in a few days, her contractions had been coming 2-3 minutes apart for 12 hours and it was certainly a test of wills. 

I made her a promise, that if we got her upright, this would all move much faster.  It was a risky promise! I certainly do not have a magical crystal ball. Catherine agreed to walk in the hallway.  She was contracting every 2 minutes or so while upright. She was moaning and squatting as moved through the space, but was still joking in between. 

At one point she looked at Kodjo, who was grinning ear to ear, and she laughed at his excitement.  He replied, "I know that you are in so much pain, but I am really enjoying this process! I'm proud of you."  

At 10:30am Catherine said she had an urge to push. I told the nurses and we waited for them to arrive.  Catherine's mother was in the room as well at this time, and I could tell she was feeling very nervous about the lack of medical professionals in the space. 

I think the most unexpected thing for people in labor, is how often you're left alone.  Most nurses do not stay by your side, and most obgyn's check on you every few hours, if that. They all have jobs to do, that don't make you their primary focus, until a baby is crowning.  Catherine's mom was even more surprised when they checked her and she was 9cm's dilated and everyone once again left. 

At 11:10am Catherine took her first push. I called in the nurses again and it was confirmed, that she was fully dilated. On her 3rd push, we saw the baby's head, and the nurse called back in the doctor. "You're a great pusher!", the nurse exclaimed. The nurse and Catherine hadn't been jiving well since shift change.  She wasn't reading Catherine's cues to be quiet and honor the calmness that she had created. Catherine's eyes were rolling every time she spoke. 

Another push and the doctor decided to suit up and the nurse called for the "backup" nurse, which is a basically a nurse for the baby post birth. 

At this point everything slowed way down. Catherine wasn't pushing with as much force as she had been, and everyone was cheering her on about how she could "finally meet her baby".   We would watch the baby's head come almost out and then watch Catherine clamp down.  The nurses in the space were having side chatter about her unwillingness to push, and a nursing student, who was witnessing her first delivery, who seemed stinking elated about it, had her opinion of this birth quickly changed, when the nurse whispered, "Is this the first birth you've seen?" the student nodded yes and the nurse replied, "Well this isn't normal. I don't know why she just won't do it. We should have had a baby already." 

I was an easy 12ft from the nurse by my clients side and I heard the entire interaction. I was pissed for lack of better words. There's nothing abnormal about any birth or any pushing. Every person does this their own way if they aren't being forced somehow by others.  People do it when they are ready and Catherine, wasn't ready. 

I went up to Catherine's head and stroked her hair. I rubbed her cheek and she rested her head on the top of the bed. The obgyn and nurse in the room, were saying, "Your body is giving you a big break in between contractions because it knows you need it to get your baby out for the next push." They were not intune with Catherine at all. 

Catherine was having contractions still every 2 minutes. She was choosing to not push. She was choosing to breathe through them. I continued to comfort her.  5 contractions later, I watch her lips curl up just a little bit, and I now knew that she had an actual urge to push, and wasn't just being told that now was the time to do so. 

She pushed one more time and the same thing happened, she clamped down. I looked over at Catherine's mother, who had her hands in her head and you could feel the worry pouring off of her.  I spoke softly to Catherine, and she whispered, "All of a sudden I have so much anxiety, about having this baby." 

This is something that happens with so many birthing people, and none of us talk about it. I don't think I have even mentioned it until now. 

Sometimes labor and birth aren't actually about the baby. I know that may sound crazy as you read it. When providers and family members turn this process only into that, the woman loses herself a bit.  She often needs different end goals. She needs to feel powerful and strong. She needs to feel proud of herself and for others to feel that way too. 

No one in the room was doing that for Catherine. I changed the language. I reminded her of her power. I reminded her that when she completed the process the pain would be over. I promised her food, which had been withheld due to the pitocin. I promised her sleep.

With her very next push, instead of watching her pushes I buried my head in the crease of her arm and quietly said, "Push for this to be over. Push for sleep. Push for nourishment." Catherine once again was back in the right headspace and was moving her baby. 

The obgyn's, the nurses, and her family were still cheering about seeing the baby and I just stayed as close to her ears as possible promising the end of pain, food, and sleep. I could tell that she was only listening to me and that it was working. 

I looked up at the obgyn and said, "Change of plans. Do not pass the baby through Catherine's legs. Kodjo will receive the baby until Catherine's ready." Catherine nodded and then she barred down.  With one quick set of pushes, Catherine had reached her goals; she had birthed on her own terms and without pain medication. 

Catherine set her bum on her heels and put herself in an upright position. She wrapped her arms around my neck and gave me a hug. I told her how proud I was of her.  Behind her Kodjo's eyes were welled up, her mother was crying, and the nurses were stimulating the baby to cry on the bed.

Catherine then, when she was ready, turned herself around and her eyes filled with joy and she met her baby for the first time and that's when their connection began.

The baby's name had been a secret and so I asked, "May I now know her name?" and Kodjo replied, "Dangana, it means courage."  At that point I cried too.  It was the perfect name for this baby. Her mother her entire pregnancy advocated for herself, changed providers, dismissed worries about the size of her pelvis, didn't panic when there were concerns about measuring small, she faced everything and everyone with confident courage about this pregnancy and when the time came she was courageous enough to control her birth, even when being ecouraged to do something else. This baby had felt courage from the inside, for it's entire life.

Catherine, thank you for allowing me to be present during such an empowering time in your life. I will forever be thankful.