Undercover Doula

Disclaimer: I am a HIPAA-Happy provider, don't fret, details have been changed to protect privacy, or permission has been granted.

I am totally freaked out by L&D [labor and delivery] nursing.

I just finished my last clinical during this quarters' OB rotation. When the quarter started, the first thing I did was make an announcement on the doula community boards to warn them that there would be purple scrubbed nursing students roaming the halls of three major obstetrical units in the Seattle area, and to tell their clients to request that there be no students present for their births. To our credit, the nursing students were told it was an observational clinical only, and the most we could do was offer support, like be a doula!!

So the weeks ensued, and I attended a few births at the baby factory that is Swedish First Hill Hospital, where upwards of 800 births occur each month--holy crap--you know that means they put mama's on a ticking clock to make room for the next labor, at absolutely all costs. But I made the most of it, and resorted to my tried-and-true doula alter ego. I successfully avoided doing the charting and administration of procedures and injections and ordering of interventions. Phew. Ethically, I cannot phathom the role of the labor and delivery nurse [incidentally, pizzas are delivered and babies are born]. You leave a labor when your shift is up, not when the baby is born, and you meet the family in the throws of labor, not prentally where you have time to develop a trusting relationship and bond. So I'm just not on board with the whole concept.

A recent repeat doula client's newest babe--also photographed above holding dad's finger.

So on my last clinical day I attended a high risk birth, and morphed again into their doula and not the nursing student. I, alone, coached her through three hours of second stage pushing, with an epidrual, which requires a little coaching as you can't freakin' tell when you're contracting! And the nurse preceptor later tells me, "thanks for doing the pushing--I hate that part" Yikes. And ahem, I did no such thing, that mama pushed her baby out! The baby was called Joseph Michael, tribute is due here to a certain unaware namesake :)

I was later taken into a small hallway room where they keep "memory box" supplies and there was a nurse carrying what looked like just a baby blanket as if she were carrying a baby; nestled into the crux of her arm. She placed the blanket down and unwrapped it on the counter. A teeny less than 1 pound, 21 weeker baby girl was unveiled. She had just been born, after inducing her death because of spina bifida, a spinal cord deformity that is sometimes incapatible with life, as they say. Her tiny finger pads and toes looked like little tadpole digits. Her skin was sticky and transparent so that you could see the intense red of her vascular system barely beneath it. She had perfect ears and nose and eyebrows and even fingernails. She looked like a little tiny alien creature, and she was beautiful in her miniscule human way. The two nurses in the room with me were chatting amongst themselves about their various judgements they had toward the family. I listened, perturbed to the core at their very nerve, and softly touched this little being and sent her soul some reiki. I couldn't help it. Back out on the unit, I thanked my nurse for showing me the "fetal demise" and she said, "oh no problem, we get a lot of those here"...

I was then reading up on incoming patient's charts in the nurses' station, when I saw out of the corner of my eye a familiar face. A doula! I went out into the patient waiting room and chatted with long time doula, Jennifer Mendleson, we attended a birth together, ages ago now, my first home birth actually, the sixth time mom who labored for an hour and with a single push caught her own son and brought him straight out of her home jacuzzi onto her breast. It was so fun to see Jennifer there. She was waiting for her client to come out of surgery for an abdominal birth (sectioned as the L&D nurses affectionately call the cesarean). She asked me if I felt like I was undercover. I laughed. I absolutely do. I love it.

I love birth, and was happy to be a part of the one's I was assigned to, during this rotation, but now I know with conviction that I could never be a labor and delivery nurse, and that I will be a midwife. I think I could make a good birth nurse if I had to, a doula-esque nurse, but it would be ethically challenging for me to do so.

This is one of my doula babies, an awesome birth from 2007. I nanny for her twice a week now. We play, and she teaches me Mandarin. The other day she was playing on the fake phone and apparently having a conference call between my mom, President Obama, and her baby girlfiend. "Hi C. Lee, hi c lee hi clee Obama, Zoe, Obama, Maumi, (Mandarin for Kitty), Zoe, hi c lee, Obama" I love her to pieces!

Next quarter is my last in the nursing program, and my senior practicum placement is the Harborview Psych Emergency Department. Get ready to be spit on, pinned and swung at... says a few knowing colleagues. I'm totally stoked.