With growing knowledge of the importance of doula care in improving health outcomes, it is no surprise that people are leaning into the principles of birthwork to be of service to the birthing people in their lives. At the core of mother of two Anglete “Angel” Le Noir’s decision to pursue doula training in the past year was the desire to honor the “thin and transparent line” between the role of mother and doula. After her training, she would go on to assist her daughter, Olivia, through her birthing experience—a process that would unfortunately involve birth trauma, and ultimately exemplify the interplay between the two roles.
Like Angel, her eldest daughter, Olivia, works in healthcare and is currently working towards becoming a registered nurse. Angel notes that she has always been in “impeccable” shape and never had any health complications. While pregnant, Olivia did in-depth research to select her obstetrician, which included touring the very-limited number of birth centers in Alabama. She looked into hospitals that were breastfeeding friendly with low cesarean-section rates and open to alternative birthing practices. She also had a solid birth plan that she wanted to do everything to honor. As her mother, Angel wanted the best for Olivia’s pregnancy and birthing experience. “The calling to become a doula grew louder because I wanted to make sure I was her advocate to ensure her first pregnancy and delivery experience went as smoothly as possible.”
As Olivia’s pregnancy progressed, Angel witnessed a shift. Olivia’s solid birth plan became one on shaky footing. “Olivia developed a complication called ICP, which turns out to be quite common.” Intrahepatic cholestasis of pregnancy (ICP) is a common liver disorder that happens during pregnancy. It is not dangerous for the birthing person, but it can be dangerous for the baby as they get closer to delivery. Unfortunately, ensuring the safety of the baby meant that Olivia’s birth plan could no longer be honored. “Her dream for an unmedicated and unassisted water birth turned into a scheduled induction and because she was now deemed high risk, she was not allowed to labor and deliver in the water as she hoped. It was a devastating blow to an already stressful and emotionally taxing pregnancy for her.”
It was difficult for Angel to remain in doula mode when the conditions surrounding Olivia’s pregnancy triggered the maternal instinct to intervene and protect. Olivia honored this, and hired another doula to establish some sense of balance. In the days leading up to Olivia’s induction date, Angel packed her doula bag with items to create as relaxing of a birthing environment as possible. Olivia wanted the room dark, with light coming from flameless candles and aura light. She wanted a diffuser filled with her favorite essential oils.
With time, the line between mother and doula would become more nebulous. The morning after Olivia’s induction date, a shift nurse came in to check on her cervix. While the nurse had on gloves, she had acrylic nails and was not as gentle as the nurse who checked her the night before. As Olivia screamed in pain, Angel found herself entering “mama bear” mode. Her concurrent role as birth advocate would push her to establish a boundary. She informed both the charge nurse and the obstetrician that Olivia did not want that particular nurse to perform any future cervical checks.
As nurses increased the pitocin dose the next day, Olivia’s cervix remained at only three centimeters and her baby was still high up. Angel again found herself resting on her knowledge as a birth worker. She walked Olivia around her room and the department, and massaged her back. She guided her through positions that would facilitate the baby’s descent and progress the labor. When her second doula arrived, she joined Angel to coach her through stretches and poses. Her other doula would hope to return the next morning, when Olivia entered active labor.
While Olivia hoped for an empowering birthing experience, her experience within the hospital would be more mixed than positive. As Olivia felt the contractions coming on, Angel noted her “intensified focus and incredible strength”. As a mother herself, the experience was all too familiar. “She went into that sacred trance, listening and moving her body in perfect harmony and rhythm, talking to her baby through the contractions.” Dismally, things would quickly take a turn for the worst.
Angel found her healthcare professional hat taking over—she was again striking a balance between her role as mother and doula. She remained encouraging, calm, and optimistic. Unfortunately, Olivia’s dilation did not progress fast enough for the team—as her contractions intensified, her dilation only progressed 1 centimeter even though they used a foley balloon to manually dilate her. A foley balloon is a device that is placed into the opening of the cervix and water is injected to inflate it to promote the physical dilation of the cervix to a certain size. After the foley balloon only progressed Olivia to 5 centimeters, they decided to break her water in hopes of it speeding up the labor.
Things would take another critical turn. While the labor did intensify and seemed to progress in a positive direction, the baby’s heart rate began showing signs of distress with each contraction, which prompted one of the nurses to do a cervical check. During the check, the nurse could feel signs that the baby’s cord descended down the birth canal. Olivia was experiencing umbilical cord prolapse, a dire emergency that came with a strict time frame to remove the baby. The team called for an emergency C-section, with very little time for Olivia to consent. The dire need to ensure the delivery of the baby would limit their care of Olivia and ability to honor her wishes for her labor. Olivia was rushed to an operating room with the nurse’s hand still inside to prevent the cord from further compression during the contractions. Rather than observing a physiological birth, Angel stood as what felt like a passive bystander in the other room until her grandson’s delivery.
The early postpartum period gave Olivia time to rest, and Angel time to reflect and ensure her safety. “I made sure my daughter and grandson were not disturbed and that they were in total peace and solitude. I attended to both their needs. I made sure to keep my daughter well nourished, hydrated, calm, and rested.” Angel and Olivia are walking away from the experience with a deep sense of gratitude. “I felt scared, yet prepared for this sacred journey with my daughter. I am forever grateful to the Mama Glow Foundation, Latham Thomas, and my beloved doula sibs for their words of encouragement, love, wisdom, and shared experiences.”
Olivia’s birth trauma was devastating, but Angel knew that the ancestral knowledge with which she was endowed gave her the capacity to write a story of nurturement in its place. “As I look into my grandson’s eyes, I am overjoyed with gratitude and pride. As I watch my daughter bond with her son, I am so full of love. She is experiencing that higher level of love and joy I hoped she would. She has been enjoying a successful breastfeeding journey as well.”