A Cesarean birth story told by the birthing mother and her doula

September 10-14, 2012 is Birth Week! Today’s birth story is told by two people: Ashley, the birth mother, and Andrea, her doula.

Ashley (mother): At approximately 7:30 pm on Thursday, January 26th, 2012, I was loading laundry into the washer when my water broke. It was so small at first, I wasn’t even sure that’s what it was. I tried calling our doula, Andrea, and then my partner, Kyle, but couldn’t get a hold of either of them. I panicked and called my mother who rushed right over. I was pacing around the house trying to get contractions started. I made a call to the doctor, then a short while later I heard back from Kyle and Andrea.

Andrea (doula): On the evening of Thursday, January 26, 2012, I was putting on my coat to go outside and noticed that my cell phone had a message from Ashley at 8pm. I called her and she let me know that her water had broken and that she had notified her OB, Dr. Labban. Katelynn Wren was officially on her way! We talked about walking, acupressure, and other stimulation as ways of getting labor going. At 10pm we talked again in detail about various concerns Ashley had, as well as about pitocin and the plan for going to the hospital.

Ashley: Kyle came home and helped me try different methods to start contractions. Walking worked best by far. He decided to get some sleep while I paced the hall and danced to Michael Jackson. Slowly but surely the contractions started. They got stronger after a couple hours and I experienced a few big gushes of water. I put the laptop on the floor in the doorway to your room, knelt down on some towels, and labored on my hands and knees for about three hours. A little after 1 am, I decided the contractions were close enough to head to the hospital.

Andrea: I went to bed, and at 1:22am Ashley called to let me know that contractions were picking up and that she and Kyle were headed to the hospital. I prepared to meet them there. I arrived on the Labor and Delivery floor at 2am and walked into room 2905 where Ashley was being admitted and where she would labor for many more hours.

Dr. Labban informed Ashley and Kyle that he would let her walk and stimulate labor on her own until about 5:30pm and then would talk about pitocin. Therefore we immediately went walking after her bathroom break. We chatted while laboring in the halls. About an hour later, at 3:15am, Ashley switched from walking to being on hands and knees on the bed. I warmed some socks full of rice and those seemed to help slightly with pain in her lower abdomen.

Ashley: I liked walking the halls. It felt good to do something and know that I was helping labor along. I would play a game with myself. When I felt a contraction coming on, I’d try my best to go a few more steps before stopping to moan through it.

Andrea: At 3:40am, she had routine bloodwork done. Kyle needed some rest and lay down to sleep at 4am while she tried to rest in between contractions while lying on her right side. She started feeling some pressure and I re-warmed the rice socks.

At 5:47am another cervical check revealed that her cervix was still at 2cm with similar effacement and station as before. She asked for another hour of laboring before trying the pitocin and rested on her right side with the monitor on until 6:20am. Ashley then got into the shower for pain relief and more stimulation to try to get labor to strengthen. At 6:38am, she got out of the shower and Kyle helped put her socks on — then it was back to the halls for more walking.

Dr. Labban came in around 9am and discussed pitocin, its pros and cons, and how it would be administered. As soon as he left, we discussed how at this point it would not be induction of labor, but rather augmentation. Ashleyy agreed to the pitocin and at 9:45am her new nurse, juice, squat bar, IV, and pitocin arrived simultaneously. Two different nurses tried for veins for the IV and it finally worked on the third try in the third location.

Ashley: I hated the IV and the heart monitor. As if labor wasn’t hard enough, I had to do it with tubes and wires coming off of me. Every time I went to the bathroom, I had to unplug the monitor and maneuver around the room with the IV. They made it really hard to get into comfortable laboring positions.

Andrea: At 11:15am, she had two contractions on level 4 pitocin that were the most intense yet and brought her to tears. She switched to the birth ball and asked for the television to be turned off.

Ashley: I was anxious to be near the end and just hold my baby. I wanted so bad for the nurse to check me and say, “You’re at 7! Almost done!”

Andrea: At 7:45pm I went to warm the rice socks and returned to find Dr. Labban in the room with the new shift nurse, Jackie. He wanted to get better assessments of the baby’s heart rate with a fetal scalp monitor which would also allow Ashley more movement. He also wanted to insert a monitor inside her uterus to get a more true measurement of contraction intensity in order to know if he should increase or decrease the pitocin. The conversation about these new options was extremely difficult due to extra exam pain, extra questions on all sides, and intense contractions. After discussing and questioning, Ashley agreed to the internal probes so she could have better movement. During the exam, Dr. Labban found her cervix to be at about 3cm with 85% effacement and a -2 station.

Ashley: I can’t tell you how much hearing this broke my heart.

Andrea: After monitoring the contractions with the help of the newly inserted uterine probe, Dr. Labban lowered the pitocin from 16 down to 10. The contractions had indeed been too intense, and he was wondering if lessening the pitocin would help Ashley relax a bit and let the baby come down lower. He discussed next steps if lowering the pitocin did not work. At this time, he discussed a therapeutic epidural for further bodily relaxation and also cesarean section. We were interested and excited to see what the lowering of pitocin could mean for Ashley and her baby.

At 8:45pm Kyle hit a rough patch, as most partners do at some point during a long labor, and cried a bit and talked about his stress, fatigue, and low tolerance for much more of the same. I appreciated his honesty and encouraged him to rest, take breaks, and continue to support you in your decisions. At 9:25pm the narcotic Nubain was administered. This was after a 20 minute conversation regarding Nubain vs. epidural vs. Cesarean and the pros and cons of each.

This led into an hour-long conversation and deliberation involving Dr. Labban, Dr. Brown the anesthesiologist, nurse Jackie, myself, Ashley, and then Ashley’s mother for a bit at the end. Dr. Labban was strongly encouraging a Cesarean section but repeatedly said he would not force Ashley to do anything. I include the questions she posed to Dr. Labban, Dr. Brown, and Nurse Jackie to show how well thought out and clear she wanted to be on this decision: How long would you let me labor like this on the pitocin? Is there any way to turn the baby or find out its position? What are your thoughts on an epidural at this stage? Would my body react differently to the epidural than it did to the Nubain? Would an epidural help me achieve a night of rest before undergoing major surgery? What would you do in my situation? If we go ahead with the C-section, is there a reason we need to do it right away or can we wait until tomorrow morning? Are there any options I am not aware of?

Ashley: While we were discussing and asking questions, the Nubain wore off and I could feel the contractions at their full force again. It was like something out of a comedy. We’d be talking, I’d feel a contraction coming on, and I’d have to say, “Hold that thought. *MOOOOOOOOOOOOOOOOOOOAAAAAAAN* Okay, what were you saying?”

Andrea: After questioning and listening and discussing, Ashley decided to get an epidural to see if it would help with further relaxation and dilation. She also decided to seek the counsel of her mother. This was an emotional and tense discussion, but they both were clearly communicating and listening to each other.

Ashley: I was dead weight from the waist down. I could still feel my muscles contracting above where the epidural was administered, but the pain was gone. I slept on and off for a while, waking whenever the nurse came in. At some point the epidural started to wear off on my right side. It didn’t hurt, but I could definitely feel the contractions. The nurse helped my roll on my other side. But then the baby’s heart rate began dipping again and not recovering fast enough. Changing positions wasn’t helping anymore. Nurse Jackie came in and told me what was happening. Without hesitation, I said, “Let’s do the surgery.”

Andrea: At 1:38am, I headed home to rest as well and at 4:25am received a call from Kyle letting me know that the baby’s heart rate had been sporadic a few times and that Ashley was being prepped for a Cesarean section. At 5am, I arrived at the hospital and found Kyle whose “stomach is in knots” and very nervous. During this time I read a birth-related magazine and was struck by the quote, “Birth is not only about making babies. Birth is about making mothers strong, competent, capable mothers who trust themselves and know their inner strength.” (Barbara Katz Rothman).

Ashley: Before I went to the OR, my mom came in. She stroked my hair, smiled at me, and said, “Where did this fighter come from?” Our last conversation had been tense, but it was good to know she was proud of me for sticking up for myself and doing what I felt was right for both of us.

Things moved pretty fast from there. I was wheeled into surgery, and Kyle arrived about a minute later. They let me wear my own clothes into the OR. I was shaking uncontrollably, but the nurse said it was a side effect of the medication. The surgery took a while. I could feel tugging. Kyle held my hand the whole time. At 5:30 am on January 28th, 2012, our daughter Katelynn Wren came out and cried for the first time. It is and always will be hands-down the most beautiful sound I’ve ever heard!