The Birth of Zachary
(Written by Anne-Marie Bauer, Doula)

On Sunday May 30, 1999 at 3:15 a.m., I received a call from Gayla's midwife, Cathy, telling me Gayla was in labor and to come. I had slept only three hours that night but gathered strength easily with the excitement a labor and birth brings. I had really been looking forward to this birth from the time I met Gayla. At  our first meeting, I immediately fell in love with her and prayed for her and  the well-being of her baby, as she had recently miscarried.

When I arrived at 3:45 a.m., Gayla was laboring on the toilet having recently received her initial exam: 3 cm, 95-100 per cent effaced, with the baby at 0 station and  a confirmation of a hind leak of amniotic fluid. Gayla was experiencing severe  back pain with each contraction although Cathy was unable to confirm the position of the baby's head during the exam. Palpation indicated that the baby's  body was ROA (right occiput anterior).

Only Gayla, her husband, Bill, Cathy and I were there at the house until 9 a.m. when their daughter, Ashley and Gayla's mother, Sara, and the second midwife, Debbie arrived. My role as doula see-sawed back and forth between being primary and  secondary labor support, as Bill really learned quickly how to comfort and assist Gayla as only a loving husband can. I encouraged both Bill and and Gayla  as a beautiful loving birth team that through this experience God is blessing their marriage and family. In my view, Gayla was most encouraged and best coped  with the long hard labor through others' and my audible prayers. She constantly relied upon and trusted the Lord for her strength, pleading with Him in prayer.

Because  of the intense back pain Gayla felt during each contraction, we employed several  comfort measures: massage, positional changes, visualization, prayer, heat and  cold, relaxation, and counter pressure to name a few. During the early hours, Gayla labored walking and standing up, then tried kneeling, leaning over the birth ball while I squeezed her hips, and side lying on her couch while  receiving counter pressure on her back in an effort to relieve the back pain. We also tried using the heating pad, an ice pack and a tennis ball applied to the  spot on her back where she was experiencing the most pain, which the midwife  later determined was ligament pain in the lumbosachral region. At 6:35 a.m., Gayla had a frank SROM (spontaneous rupture of membranes) and by 8:15 a.m.  requested another vaginal exam: 6 cm, 95-100 per cent effaced, -1  station.

Later  in the morning, Gayla found that the most comfortable position/environment for  her at the time was sitting upright on her soft leather couch. I massaged her legs by stroking downward from around her back, over her hips, down her thighs,  to her knees. At the same time, Bill held her hand, stroked her face and hair and spoke relaxation to her while one of the midwives did effleurage (light  stroking massage) on Gayla's abdomen. Bill also massaged her feet and later, I gave her a hand massage. During the contractions, Gayla successfully was able to relax almost completely in order to allow her uterus to do all the work of  labor. Reluctantly, Gayla tried to labor using water, both the shower and the  tub. While in the tub, Ashley provided comfort by pouring water over her  mother's body. Ashley, age 7, also encouraged her mother verbally and prayed for the baby.

Because  the labor was so long, we "pushed" fluids and food to keep Gayla energized. She  sipped juice and water and was able to tolerate a bit of toast, pretzels, cheese  and honey. Gayla was so open to our suggestions and tried everything, even if she were at first hesitant to attempt something new. Between contractions, Gayla was able to completely relax and even dozed off at times.

By 2:00  p.m., Gayla progressed to 8 cm and by 5:35 p.m. to almost complete, only an  anterior lip remained. The baby was still at -1 station. At this point, Gayla begged to go to the hospital to receive drugs. She was so tired from the long  labor and all the back pain. She cried out and that's when the "Take Charge  Routine" really helped her. We even agreed to a "plan" to take her to the hospital at midnight if the baby wasn't crowning by then. I told her she had worked so hard for so long and that God would soon bless her with the reward she so longed for - her baby. It was right around the corner, so close - she took heart and was more determined than ever to reap her reward at home. At this  time, Sara and Ashley left for the evening to await the call to return when the delivery was imminent.

We all helped with directed pushing in an attempt to get the baby's head over the anterior cervical lip. it worked! By 7:25 p.m. Gayla was completely dilated with the baby's head at +2 station with the occasional urge to push. Gayla pushed while in the tub, standing up, squatting on the birth chair and in bed on her back (dorsal lithotomy) with her knees pulled way back. Once she really felt  like pushing, around 9:00 p.m., Gayla also used self directed pushing and the Valsalva or purple pushing (holding her breath) techniques. Because she was a VBAC, she had an untried pelvis, so the pushing was long and difficult for her. She was so tired at this point, but with everyone's  encouragement and with the sight and feel of her baby's head, she pushed even more diligently. The baby's head was finally  born, but it took one midwife applying pressure on the baby's head, the other midwife's hands helping with the shoulders and me applying supra pubic pressure to deliver the shoulders - I even delivered the anterior shoulder while still  holding back one of Gayla's legs!

The  baby was born at 11:15 p.m. and was immediately placed on Gayla's abdomen. I did  the immediate infant assessment and helped initiate breast feeding. Bill was  overcome with emotion and wept audibly with joy and relief at the birth of their beautiful baby boy. Gayla was queen for a day, oh, but what a  day!

The  placenta would not come out even after 2 hours of waiting and active attempts, including the use of herbs and an attempt at manual removal. Gayla was transported to the hospital for completion of third stage, while the baby stayed at home with Sara. I stayed behind to help clean up with Debbie and finally left  at 1:45 a.m..

Gayla, Bill, Sara, Cathy and Debbie all thanked me for being such a big help and  inspiration to them. I immensely enjoyed Gayla's labor and birth of her baby boy, knowing that serving women in labor is my niche. This birth marked the first anniversary of the first birth I attended as a birth assistant. I feel this birth was the most important to me, as I know I made a positive impact on  the labor and birth of Gayla's baby. She said she couldn't have done it without me - I know she could have, but it wouldn't have been the same for her.