Declan's birth story; My TOLAC experience

TOLAC: Trial of Labor after a Cesarean

Monday September 2nd I had a fourth NST/AFI scheduled. I asked that my doula, Kimberly, be present with me because I wasn't quite sure what would happen and I was fairly anxious. I had spent the morning with Silas and Josh at the children's museum and we drove separately so I could head to the NST while they played at the museum. I got to the hospital a little after 11 and Kimberly met me a little bit after that. When I was on the monitor it was picking up frequent and strong contractions. My OB, Dr. Thompson happened to be on call and came in to check me and discuss what she thought we should do. I was not dilated, but 90% effaced and she felt that at that point we should induce based off of the NST and also because I was 41 weeks and 6 days along. Technically I wasn't over due yet, at least not until 42 weeks, but I was also a VBAC hopeful and most providers get a little antsy when a client goes that far past their EDD.

I wasn't anticipating staying at the hospital at all. I thought I would have to come back three days later for another NST and be done. When my OB went ahead and admitted me I called Josh, who wasn't anticipating it either. The plan was to insert a Foley catheter, which has a special balloon that is filled with saline to help stretch open the cervix. The labor room I was assigned had a large laboring tub and my doctor suggested I try taking a bath to calm my nerves and get settled, which was helpful. I had no idea I staying, so I didn't have anything with me. I made a list of the things I needed and my doula said she would drive my car home and help Josh. While they were gone my OB came by to check on me. She said that she could wait to insert the Foley bulb until Josh and Kimberly returned, but I decided to just have her do it.

The Foley was painful, but Dr. Thompson got it inserted and it was weighted with a bag of saline which we referred to as "my pal sal". Josh and Kimberly arrived shortly after the Foley was inserted. Josh brought dinner and I labored in and out of the tub, on the birthing ball and in and out of bed after I ate. Around 3 am "my pal sal" fell to the floor and the Foley came out with bloody show. We assumed I was at least 3 cm dilated, but I unfortunately was not. I was only 1.5 cm, which is unusual, however that type of catheter can often squeak by is what my nurse told me. My nurse contacted my OB and she suggested we start a low dose of pitocin. My doula agreed at this point it might be helpful, so they got me started on it. The pitocin wasn't too bad and I tired to sleep as much as I could while on it.

When I woke up on Tuesday morning (officially 42 weeks pregnant) the contractions were still strong, constant and a little more intense. My OB came by around 9 am before going into the office. She checked me and I was about 2 cm dilated so she suggested a second catheter called a Hook, which is similar to the Foley, but has two balloons that are filled with saline on either side of the cervix. She told me that the pitocin in conjunction with the Hook would give me more of a chance to labor and get Declan into position. I spent the day laboring in and out of the water. My day time nurse even brought in essential oils to help relieve some of the pain and discomfort, which helped for a little while. Kimberly was able to help apply more oil through out the day. By 5 pm I was so tired and in so much discomfort that I discussed IV pain medication with both my doula and my nurse. We agreed it would be a good idea since I had been on the pitocin for so long. I agreed to dilaudid because I had a bad experience with stadol with my last labor. The dilaudid helped to take the edge off. I spent most of the evening back in the tub, which was one of the few places that helped with the pain from the contractions.

Around 11 pm Tuesday night I had such a long on going contraction that I never thought it was going to end. My doula applied counter pressure and tried to get me to relax. The resident on call came in to remove the Hook catheter, but couldn't until the contraction passed. They were right on top of each other at that point. When it had finally passed the Hook was removed, but I was only 3 cm dilated. The resident called my OB and decided to turn the pitocin off, let me rest and turn it back on after an hour. The rest was helpful and going from 24 units of pitocin to 0 was enough to let me sleep.

I was up by 4 am on Wednesday with regular contractions again. When the resident on call checked me I was still only 3 cm dilated. Her suggestion was to rupture my membranes and see if the fluid was restricting Declan's ability to descend on the cervix. My doula agreed, but reminded me once my membranes were ruptures I wouldn't be able to labor in the water anymore, so I put off the rupture. I tried laboring in the water again and was in so much pain I asked for more IV medication. They couldn't give me anymore dilaudid, but offered a half dose of the stadol. I went ahead and accepted the stadol dose. Josh assured me that whatever happened after I took the stadol he loved me and wouldn't be leaving me. He said this because when I had stadol during Silas' labor I hallucinated that he was leaving me. It was frightening and I didn't want to repeat that again.

The half dose didn't do much so it was only about a hour later that I agreed to the rupture. The pain was intense and I really wanted things to progress, so at about 5:30 the resident ruptured my membranes. There was light meconium present in the fluid, but both the resident, my nurse, and my doula assured me that it wasn't uncommon for 42 weeks. It would mean that a NICU team would be present during the birth so they could do an assessment and determine if he had aspirated any into his lungs. There was a lot of fluid and the pain was really intense about two hours later.  There was no cushion of the bag of waters for Declan's head. Although I was really afraid of an epidural and the events that followed after when I had Silas, everyone thought it would be a good idea. At that point I had been in labor for over 40 hours, with pitocin and only minimal IV drugs.

The anesthesiologist came in and it was a completely different experience from the last one. The epidural went in easily and was pretty painless. I felt some tingling in my right leg, but beside that things were okay. My OB came in to visit me around 8 am and she said she was glad I agreed to the epidural and that she would have encouraged me to have one at that point. She did a cervical check and said I was 5 cm dilated and baby was a -1 station. She mentioned that something felt a little funny during the check. She mentioned that she thought baby was brow presenting. She manipulated the baby and more fluid was released. She wanted me to labor on and she would come back and see me later on in the day.

I couldn't labor in the water anymore, but the epidural helped with the intense pain I was having. We continued to use the pitocin and I tried to rest between contractions the best I could. My doula, Kimberly had been with me for almost 48 straight hours and she needed to attend rounds at the practice she works with. I felt comfortable with her leaving since I had the epidural and she promised she was just a phone call away. A different resident came in and checked me around noon, he mentioned he felt a fore bag of water, which he ruptured. I was still 5 cm, but Declan was at a zero station. Josh and I rested off and on for a few hours and then my friend Liz came by for a while so Josh could grab a shower and pick up some clean clothes from home. It was nice to have someone with me even if I was resting most of the time.

At three my nurse checked me at my request. I was feeling a lot of pressure in my bottom. When she checked me she also told me she felt something that could have been a hand. She phoned my OB and
told her. My OB said she would be there after four and Liz had called Kimberly for me and my doula said she would be there by four as well. My nurse suggest laying the bed all the way back and upside down to encourage Declan to re position or at least let gravity pull him back down. I spent nearly half an hour inverted to encourage movement.

Kimberly came in first and I caught her up with the days events including the possible brow or hand presentation. Kimberly, Josh and I discussed how Josh and I would feel if a repeat c-section was brought up. I surprisingly was not upset by the idea. What else could I do or could I have done to further prevent a repeat cesarean? Aside from trying to manually manipulate Declan, I couldn't really think of anything. I was 42 weeks and a day, I used a two types of Foley catheters with pit without any medication pain relief for nearly 40 hours, my waters were ruptured on my own time line and I asked for the epidural after two and a half days of laboring without one.

The plan was if Dr. Thompson could manipulate him, then we would do that and if not then we would be okay with the cesarean. Josh was so supportive of everything and was such a present partner during the entire labor. He hardly left my side and gave me a hand to squeeze or a shoulder to cry on and just reminded me over and over again how strong I was and what an amazing opportunity I gave Declan to grow and choose his own delivery, which in the end he did.

Dr. Thompson came in and she checked me one more time. She said I was 6 cm, 90% effaced, and Declan was at a zero station. She said she couldn't be for sure what she was feeling. It seemed like it was a hand, but then she was certain she also felt his face, then confirmed that she felt his mouth. She attempted to manipulate him but he just wouldn't budge. Her recommendation was the cesarean but she knew how I felt about it and wanted to know my thoughts.

I told her about my view on things and she agreed. She didn't think there was anything else we could do or could have done for a different outcome and she was interested in seeing what position he really was in. We went over my requests for a natural cesarean experience and she said we could do it. Declan would have to be evaluated by the nicu team since my waters presented with meconium but once they cleared him we would have him on my chest. My nurse that day was ready to help enforce that as well. They were also prepared to give me my placenta and knew how important it was for me to have a say in what was going on around me.

Josh called our family to let them know what was going on and asked them not to come down until after I was in recovery so there would be no needless waiting. They prepped me and wheeled me back. Kimberly was not able to join us in the OR, but she would meet us back in recovery. She told me how strong I had been the entire process and how proud she was of me. I felt empowered over Declan's birthing journey and tried to focus on meeting my son.

I opted not to be sedated during the operation so I felt a lot more than I remember feeling when I has Silas. I listened carefully to my OB explain she was not using the same incision that was used for Silas and felt her pull Declan out after not only telling me he was face first in my birth canal, but had his hand on his cheek and his cord wrapped loosely around his body and neck. She said this in itself would have made it virtually impossible for Declan to be birthed vaginally and why he wasn't able to open my cervix more. I truly believe if he tried to birth vaginally it would have been a dangerous situation for both of us and his face/hand presentation were his own intervention to keep us healthy and strong.

Once he was out the nicu team evaluated him. His lungs were clear and clean and they brought him quickly to me. My nurse placed him on me and I was so shaky from the hormones that I didn't feel safe trying to hold him myself. I asked her to give Declan to Josh and he placed his cheek to my cheek and I felt his little hand reach out for me and touch my skin. I whispered my love affirmations to my son and husband and the team asked if they could take him to be measured. They did a quick weight and was told he was 8 pounds and 10 ounces, which was only 3 ounces larger than his big brother, who was only born 8 days passed his EDD, vs 15 days.

I joined in conversation with my nurse, my OB and her surgical team even through my chattering teeth. We talked about our favorite places to eat around the valley and before I knew it I was being rolled into recovery where my son was placed skin to skin on my chest before the breaks were even applied. I learned that my 8lbs 10oz baby was also 21.75 inches long (1.5 inches longer than his brother) and had a head circumference of 15 inches! I was surprised to see the amount of dark hair Declan had. It was much longer and darker than I thought it would be.

Kimberly was wonderful and stayed with us until our room was ready and helped me breastfeed Declan for the first time. He latched on easier than I thought he would and stayed close to my breast the entire time. Josh called our families and let them know the good news and made arrangements for them to come and visit us. Our postpartum room was ready to go around 7:30 and we were wheeled down with Declan on my chest as happy as could be. We were settled in by 8:15 and that is when Josh went down to meet our families.

We brought Silas in first to meet his little brother and I think he was at first confused by the fact that my big belly was not quite as big anymore. He was easily distracted by his little brother and asked to hold him right away. Josh let the rest of the family in and then they all took turns holding my newest little man.

It may not have been the VBAC birth plan I had envisioned, but it was the CBAC plan I had hoped for in the event that the VBAC wasn't a possibility. I couldn't ask for a more supportive provider, a more loving and encouraging doula, a man as devoted and amazing as my husband or a family as understanding as the one I have to carry me to 42 weeks and a day and respect and honor my wishes and requests for before, during, and after labor.

And now for what everyone is waiting for... pictures!

Laboring with Kimberly 

Preparing for surgery with Dr. Thompson

Reassurance from Kimberly

Focusing on Declan

The surgical team 

Working at getting Declan out

Unwinding the cord 

Our newest love has arrived! 

Seeing my second born for the first time

An unconventional family photo 

Our poor swollen boy... you can see where his hand was on his left cheek and where his face was pressing in the birth canal. 

Skin to skin in recovery

My doula and my nurse fawning over Declan

Mommy and daddy love their newest little guy

Thanking each other for the gift of life

Preparing to leave the recovery room

Brothers meeting for the first time!