As a community service, and because it is something I believe in, I offer doula support for teen births free of charge.
While meeting with 15-year-old Kyla, who was planning an open adoption for her baby, I asked her if she would be willing to share her birth and her story for publication on my blog. She gave her permission, as did every other person involved in this story. First names are used with permission.
While meeting with 15-year-old Kyla, who was planning an open adoption for her baby, I asked her if she would be willing to share her birth and her story for publication on my blog. She gave her permission, as did every other person involved in this story. First names are used with permission.
Monitors are set up as Kyla gets checked at triage.
Kyla had several bouts of prodromal labor throughout her pregnancy, and her due date had been changed several times. She was familiar with the routine of going to the hospital and going back home again before I even met her.
It was Friday, January 25, when Kyla texted me in the late evening letting me know she'd been contracting since about noon after having had her membranes swept the previous day. She was very nervous and more than anything did not want to cry wolf, but after contractions continued even through a bath, she wanted to give me the heads-up I'd asked for. After chatting for awhile, we agreed that it wasn't time for me to come over yet, but that she should carry on, try to drink as much as she could, and sleep if possible. I told her to call me when contractions were longer, stronger, and closer together. I also added that they should be intense enough to command her attention.
Kyla checked in again at 11 p.m. to let me know she was going to try to sleep. When morning came and I hadn't heard from her, I texted her to find out if her contractions had petered out over the night. It turned out that they hadn't, and she was able to sleep through some of them, but not all of them. At 10:30 a.m., she let me know that they were about 5 minutes apart and hurt more than they had before. I told her I would see her soon.
When I arrived at her home, she was sitting on the couch with her partner, Tony. She tensed her face when she had a contraction, and told me that she was feeling some back pain as well. I helped her relax, taught her how to breathe slowly in through her nose and out through her mouth, like she was blowing out a birthday candle. I also suggested that she try the hands-and-knees position over the side of her couch, since the back pain suggested to me that her baby could be posterior (sunny-side up) and this position would take some of the pressure off of her back.
As soon as we made this change, Kyla's contractions went from 5 minutes apart to 3 minutes apart, and increased in intensity. Since Kyla was planning a medicated birth, she wanted to head off to the hospital.
We arrived at the hospital at about 1 p.m., where a cervical check revealed Kyla was 3.5 cm dilated and 90 percent effaced. I told her that was great work and not to worry that they weren't immediately admitting her, but instead sending her on the one hour hospital hall walk.
We only made it about 40 minutes of walking before Kyla's legs began to hurt, and she felt more back pain. I asked her if she'd like to go back to triage until it was time for her next check, and she said yes.
It was Friday, January 25, when Kyla texted me in the late evening letting me know she'd been contracting since about noon after having had her membranes swept the previous day. She was very nervous and more than anything did not want to cry wolf, but after contractions continued even through a bath, she wanted to give me the heads-up I'd asked for. After chatting for awhile, we agreed that it wasn't time for me to come over yet, but that she should carry on, try to drink as much as she could, and sleep if possible. I told her to call me when contractions were longer, stronger, and closer together. I also added that they should be intense enough to command her attention.
Kyla checked in again at 11 p.m. to let me know she was going to try to sleep. When morning came and I hadn't heard from her, I texted her to find out if her contractions had petered out over the night. It turned out that they hadn't, and she was able to sleep through some of them, but not all of them. At 10:30 a.m., she let me know that they were about 5 minutes apart and hurt more than they had before. I told her I would see her soon.
When I arrived at her home, she was sitting on the couch with her partner, Tony. She tensed her face when she had a contraction, and told me that she was feeling some back pain as well. I helped her relax, taught her how to breathe slowly in through her nose and out through her mouth, like she was blowing out a birthday candle. I also suggested that she try the hands-and-knees position over the side of her couch, since the back pain suggested to me that her baby could be posterior (sunny-side up) and this position would take some of the pressure off of her back.
As soon as we made this change, Kyla's contractions went from 5 minutes apart to 3 minutes apart, and increased in intensity. Since Kyla was planning a medicated birth, she wanted to head off to the hospital.
We arrived at the hospital at about 1 p.m., where a cervical check revealed Kyla was 3.5 cm dilated and 90 percent effaced. I told her that was great work and not to worry that they weren't immediately admitting her, but instead sending her on the one hour hospital hall walk.
We only made it about 40 minutes of walking before Kyla's legs began to hurt, and she felt more back pain. I asked her if she'd like to go back to triage until it was time for her next check, and she said yes.
Kyla hugs her dad when he arrives.
When we made it back to the room, we found that Kyla's dad had just gotten off work and had come to visit with her. She was glad to see him and they exchanged a few jokes between her contractions. Her mom took this time to go get her bags from the car (she was sure Kyla was in active labor and would be admitted) and Tony had a short break.
When the nurse came back to perform the next cervical check, Kyla was thrilled to hear that she had made it to 4-4.5 cm and was being admitted. She was also told she could have an epidural at any time. Kyla decided to do a few more laps of walking and then told the nurse she was ready for medication. She went ahead and tried the narcotics but didn't notice any difference at all in her pain level. I helped her cope with her contractions while we waited for her IV to be placed.
Kyla benefited from counter-pressure on her hips, massage on her lower back and a lot of coaching when it came to controlling her breath and relaxing her face. We tried horse lips (blowing out the air of your breath in a raspberry sound) and a few low moans. Mostly, she tended to tense up, so I offered her my hand to hold and squeeze in exchange for doing her best to relax her face.
When the nurse came back to perform the next cervical check, Kyla was thrilled to hear that she had made it to 4-4.5 cm and was being admitted. She was also told she could have an epidural at any time. Kyla decided to do a few more laps of walking and then told the nurse she was ready for medication. She went ahead and tried the narcotics but didn't notice any difference at all in her pain level. I helped her cope with her contractions while we waited for her IV to be placed.
Kyla benefited from counter-pressure on her hips, massage on her lower back and a lot of coaching when it came to controlling her breath and relaxing her face. We tried horse lips (blowing out the air of your breath in a raspberry sound) and a few low moans. Mostly, she tended to tense up, so I offered her my hand to hold and squeeze in exchange for doing her best to relax her face.
I hold Kyla's hand as she breathes.
Kyla couldn't get an epidural until a full bag of IV fluid went in, which took longer than she was expecting. She was surprised at how much labor hurt, and disappointed that the narcotics didn't seem to help at all while she waited for anesthesia to come with the epidural. We spent most of this time focusing on breathing and relaxing. The hands and knees position was no longer an option because Kyla was back on the monitors. She felt that sitting up was better than laying down, but not as good as walking. It actually only took about 45 minutes from when she asked for the epidural to be ordered to when it was placed, but for her, it felt like a very long time. I was asked to leave the room while the epidural was being placed, but Tony was able to remain with her. She told me later than she panicked when she received the numbing shot, but was able to calm down and hold still well enough for the anesthesiologist to do his job. Relief did not begin immediately, but Kyla reported that each contraction was getting easier to deal with until finally she couldn't feel them anymore.
At approximately 5 p.m., Kyla's next check revealed that she was at 5 cm. It was around this time that the adoptive parents, Tyler and Courtnay, arrived and greeted Kyla. They asked if there was anything she wanted, anything at all. The hospital room had a TV and DVD player, and multiple people had asked Kyla if she wanted to watch a movie to help pass the time. Tyler was headed out to get some food anyway, and again told Kyla he was happy to pick up a movie from Redbox. She finally admitted she'd love to see "Pitch Perfect" again. Courtnay and Tyler hadn't seen it, so Kyla thought it would be nice if they'd like to join her and her family to watch the movie.
Of course, since Kyla had been in prodromal labor for at least 24 hours, and she'd seen the movie two times before, she didn't exactly make it through the whole thing.
At approximately 5 p.m., Kyla's next check revealed that she was at 5 cm. It was around this time that the adoptive parents, Tyler and Courtnay, arrived and greeted Kyla. They asked if there was anything she wanted, anything at all. The hospital room had a TV and DVD player, and multiple people had asked Kyla if she wanted to watch a movie to help pass the time. Tyler was headed out to get some food anyway, and again told Kyla he was happy to pick up a movie from Redbox. She finally admitted she'd love to see "Pitch Perfect" again. Courtnay and Tyler hadn't seen it, so Kyla thought it would be nice if they'd like to join her and her family to watch the movie.
Of course, since Kyla had been in prodromal labor for at least 24 hours, and she'd seen the movie two times before, she didn't exactly make it through the whole thing.
After at least 24 hours of prodromal labor, it's no wonder Kyla can't stay awake. She takes a much needed nap while her support team, including her partner, parents and the baby's adoptive parents, watch the movie "Pitch Perfect."
When the movie was over, Kyla was checked again and found to be 7-8cm dilated. She started to have transition symptoms at this time, including vomiting and the shakes. This part of labor was rough for her and only got rougher when she realized she was starting to feel her contractions again. Anesthesia was paged, but during the lag time, Kyla needed some help coping with the intense transition contractions that she previously could not feel. With a calm voice and a gentle touch, I did my best to address her fears and empower her to make it through this short (but scary) time that she unexpectedly had to cope with pain again.
I told her billions women have been doing this for all of human history and there are thousands that are out there doing it right now, right along with her. We talked about how it feels like something must be horribly wrong because how can it hurt this much, but it does and it's normal. No damage is taking place, and the shivers are from hormones and because her body is working so hard. She looked into my eyes and calmed down a touch. Once she stopped trying so hard to stop the shivering and just relaxed, it went away. Anesthesia arrived, repositioned her epidural line and increased her dosage. Pitocin was added to her IV as well, because while all of this had taken place, her next check revealed she was still at 8 cm after two hours.
Just after midnight, the doctor came in to break her water (at Kyla's request to help speed things up) and check her again. Kyla was at 9 centimeters, had no fever and baby was doing well, so the doctor told her that it was fine to just keep on keeping on.
I told her billions women have been doing this for all of human history and there are thousands that are out there doing it right now, right along with her. We talked about how it feels like something must be horribly wrong because how can it hurt this much, but it does and it's normal. No damage is taking place, and the shivers are from hormones and because her body is working so hard. She looked into my eyes and calmed down a touch. Once she stopped trying so hard to stop the shivering and just relaxed, it went away. Anesthesia arrived, repositioned her epidural line and increased her dosage. Pitocin was added to her IV as well, because while all of this had taken place, her next check revealed she was still at 8 cm after two hours.
Just after midnight, the doctor came in to break her water (at Kyla's request to help speed things up) and check her again. Kyla was at 9 centimeters, had no fever and baby was doing well, so the doctor told her that it was fine to just keep on keeping on.
Phones help Kyla's partner and mom wait quietly.
Kyla tried her best to nap again at this point, but it was hit and miss for her. Finally, we decided that everyone except for Tony needed to leave the room because the side conversations, even in whispers, were disturbing her sleep. Tony laid down on the couch and took a quick catnap while Kyla rested as well. At about 2:30 a.m., on Sunday, Jan. 27, the nurse declared that Kyla was complete and the baby was at a +2 station and it was time to push. When I returned to the room to check on Kyla, I found her giving the nurse a small practice push so the nurse could evaluate where she was at. Because of the strong epidural, Kyla felt no pain during pushing, only the pressure of the baby's head moving down, but she definitely felt the exhaustion of the late hour and how little sleep she'd gotten the night before. With all her might, Kyla worked and worked to move her baby down.
Kyla gives it her all to move her baby down.
Kyla pushed harder than she thought possible. She only could feel a slight urge, so she mostly relied on the nurse to tell her when a contraction was building, how long to hold each push for and how many times per contraction to push. Tony held one leg and I held the other, while we all encouraged her and told her how great she was doing. Indeed, each push, I could literally see the baby's head move down just a touch more than before. The nurse helped support Kyla's perineum with warm compresses and did some massage to help her stretch, which Kyla said she wanted. Kyla was making great progress, but was also getting very tired. We encouraged her to lay her head back and rest between contractions.
Then, suddenly something amazing happened. I was standing between Kyla's legs and saw that during her pushes she moved the baby more than she ever had before. Maybe two to three times more per push than what she had been accomplishing with all of her previous pushes. I got very very excited and told her that this was astounding. The nurse said, "Yes, whatever you did that time, keep doing it!" I wondered if there actually was a concrete "it" to keep doing, so I asked Kyla between contractions if she knew what it was that she'd done differently. "Yes!" she said. "I didn't curl around my baby. I stayed flat."
Then, suddenly something amazing happened. I was standing between Kyla's legs and saw that during her pushes she moved the baby more than she ever had before. Maybe two to three times more per push than what she had been accomplishing with all of her previous pushes. I got very very excited and told her that this was astounding. The nurse said, "Yes, whatever you did that time, keep doing it!" I wondered if there actually was a concrete "it" to keep doing, so I asked Kyla between contractions if she knew what it was that she'd done differently. "Yes!" she said. "I didn't curl around my baby. I stayed flat."
The new pushing position. This is what worked best for her.
Pushing continued in the new position. The baby's head was molding and Kyla's tissues were stretching. It was truly a case of slow and steady wins the race. Baby's heartrate was picture perfect the entire time. The biggest struggle was Kyla's exhaustion and mental defeat. She kept asking how much longer, and looked absolutely wiped between each contraction. It turned out that what she really needed was to hear that she could do it, but not from me, and not from the nurse. She and Tony took a moment to reconnect and it seemed to give her a second wind.
Tony comforts Kyla. His touch made a difference.
The photo to the left was taken about 8 minutes before the baby was born. When Kyla was hitting the wall, what she most needed was a little love and encouragement. Just after I took this picture, Kyla's baby began to crown and the doctor was called in.
Kyla gave another mighty push, the baby's head was out and the doctor told Kyla she need to get the baby's shoulder out ASAP. There was a lot of commotion, but Kyla remained focused and did what she knew she had to do. The doctor unwrapped the cord from the baby's neck (not a single decel! Amazing!) and pulled him out. She clamped his cord and Tony cut it, as was stated in the couple's birth plan.
Kyla gave another mighty push, the baby's head was out and the doctor told Kyla she need to get the baby's shoulder out ASAP. There was a lot of commotion, but Kyla remained focused and did what she knew she had to do. The doctor unwrapped the cord from the baby's neck (not a single decel! Amazing!) and pulled him out. She clamped his cord and Tony cut it, as was stated in the couple's birth plan.
Tony cuts the baby's cord.
The baby's APGARs were 7/9 and he was born at 5:14 a.m. after about two and a half hours of pushing. He was 8 lbs and 2 ounces.
As per Kyla's request, he was not put directly on her stomach, but instead taken to the warmer, weighed, wrapped and bundled up first.
Kyla chose to have only her partner and me, her doula, in the room with her while she gave birth, but it turns out that the rest of her support team was standing right outside the door of the birth room, watching the computer monitor to see as best as they could, how things were going. Once the baby was wrapped, Kyla got a chance to hold him.
As per Kyla's request, he was not put directly on her stomach, but instead taken to the warmer, weighed, wrapped and bundled up first.
Kyla chose to have only her partner and me, her doula, in the room with her while she gave birth, but it turns out that the rest of her support team was standing right outside the door of the birth room, watching the computer monitor to see as best as they could, how things were going. Once the baby was wrapped, Kyla got a chance to hold him.
"Oh, so you're the one who was kicking me in the ribs all that time."
Tony gives the baby his first feeding, at Kyla's request.
Courtnay meets her son for the first time, as Kyla looks on. I asked Kyla how she was doing with all of this right after this photo was taken because I couldn't help but feel for her. She told me she was happy. And I looked into her eyes and I knew it was true.
Tyler and Courtnay announce the baby's name is Bekker.
Bekker is lucky to have so many people in multiple different families, who love him so much and want the best for him. I feel very blessed to have been a part of this birth.
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