Kaitlin "She's a person, not just a high risk."
Kaitlin is a doula. I've known her for some time now, and have helped her through the beginning of her doula journey. During this time, I had met Ryan, her first son. He is a rambunctious, loving, and funny kid, whose life started earth side at 27 weeks gestation via emergency cesarean section, five years ago. A lot of Ryan's pregnancy and birth, plays into this story, the way she was treated, and the doctors fears.
Kaitlin has had type 1 diabetes for 17 years now. This condition automatically puts her into the high risk category. On top of that, Kaitlin also has a kidney condition, IgA Nephropathy, which is another check box in the high risk category. Kaitlin during her pregnancy with Ryan also became eclamptic. While many of us probably know someone who has had pre-eclampsia toward the end of their pregnancy, Kaitlin's case developed, quickly, early, and turned into full blown eclampsia. She doesn't remember a lot of Ryan's birth, due to seizing through it. Again, this is another checkbox, for high risk.
When Kaitlin became pregnant this time, she also decided she'd like to attempt a vaginal birth after cesarean, another check in the risk category, for many providers. Originally, Kaitlin had chosen a different doula, a peer that she has connected with. She had chosen a new provider and a new hospital this time around. She wanted a different experience. I was hopeful for her that this time would be different.
In February I answered my phone and there was a crying Kaitlin on the other side. She had told me that at an appointment, she had refused a cervical check (she wasn't even midway through her pregnancy) and a few days later received a letter from her provider dropping her care. I was shocked and flabbergasted for her. She was devastated and now not sure what to do.
During her tears she asked me to please be her doula. That she realized she needed a different type of expertise as this was going to be much more of a fight than we had once hoped. I of course agreed and began to brainstorm where we would head next.
Progressive Women's Health at St. Francis came to mind. In particular Dr. Steadman. She is cautious, wildly intelligent, and insanely supportive. While she would never let a client put themselves or their baby in danger, I knew with all of the right supports in place, she just might be the one to let Kaitlin try for a VBAC.
Kaitlin transferred her care there in March. On top of seeing her provider, she would also have appointments with maternal fetal medicine, endocrinology, nephrology, dieticians, and two times per week non-stress tests for baby. She was exhausted from the constant appointments, but was focused on her end goal.
Every week, felt like a win. We had mini celebrations when she passed her gestational week that Ryan was born, and one every week after that. Kaitlin asked that I attend an appointment with her, with MFM. She knew this would be the appointment that they would want to schedule her an induction. She was right. As we stood in the room with the ultrasound tech and the doctor, she began discussing when she wanted the baby out by. She started with repeat section talk, and Kaitlin reminded her she was having a VBAC. The doctor continued to give Kaitlin reasons why, and in a very respectful way, I challenged her reasons with statistics. Kaitlin was having ZERO complications so far, and I was fighting for scheduling as far out as possible, or until complications started. "She's a person, not just a high risk," I noted. We escaped that appointment without an induction date that time.
I then went with Kaitlin to the following dietician appointment. It's required to see a dietician when you have any diabetes during pregnancy usually. I watched Kaitlin in awe as she educated the dietician and as the dietician took notes. If you are reading this, and have diabetes or know someone who has diabetes type 1, type 2, or gestational diabetes, and is pregnant or planning to get pregnant, Kaitlin (after her recovery of course!) is someone to have in your corner. The entire pregnancy, including during her labor, I heard doctor after doctor compliment her on keeping everything in control, on the knowledge she had, including allowing for her to manage her own care, including staying on and adjusting her pump as she saw fit. During her labor, her care would have to follow hospital protocol, but the endocrinologist that visited, explained to her nurses and OB's to please allow for Kaitlin to get back to her own diabetes care, when she saw fit. She even corrected a doctor when they gave the wrong information. She is a wealth of knowledge ya'll!
Things however, would eventually turn out of our favor. On Monday July 2nd, at 35 weeks gestation, it was 4:40pm and Kaitlin called me. They were admitting her for a 24 hour urine culture. She was having signs of pre-eclampsia, with her history and other risk factors, they weren't going to take the normal wait and see approach. Kaitlin checked into the hospital at 8pm that night.
We started texting early the next morning, and at 8:40am she told me that they had decided on an induction that day. They had actually been pushing for a repeat cesarean section, but Kaitlin insisted on having her chance at a trial of labor.
When I arrived at the hospital, Kaitlin had been delaying the the start of the induction. This wasn't what she wanted, and she was going to have some control over it. Her cervix was finger tip dilated, and 20% effaced. They decided to start with a cook catheter first. This meant they would have to manually dilate her a little bit to get the tube through the cervix. It was a wildly uncomfortable procedure. Women attempting a VBAC, cannot have the cervical ripeners that would usually be used prior to starting a balloon or pitocin.
Surprisingly, the balloon alone, began to put Kaitlin into a contraction pattern. We were using lots of coping techniques to help get her through them. At 7:30pm Kaitlin was having contractions every 3 minutes lasting for one minute. I was hopeful that these were helping her to make change.
Evan had previously told me that he wasn't sure how he would feel during this labor process. He had fear and anxiety from the previous experience, that he hadn't yet processed yet. He did a wonderful job with supporting her. We would take turns helping Kaitlin
At 9:25pm, 8 hours after the balloon had been started, Kaitlin was "maybe 1cm" dilated. Kaitlin was tired, drained, and moaning through the pain. Earlier in the evening we had tried benadryl to help her rest, but she couldn't nap through the intense contractions. She opted for stadol and sleep at this point.
At 1:30am, on July 4th, the balloon was removed and Kaitlin was 4cm dilated and 60% effaced. The balloon had done it's job. I went home to rest and returned to the hospital at 5:30am.
At that time, they had just started pitocin. She was back to having regular contractions. While most women are allowed to eat, when having a balloon placed, the hospital would not allow for Kaitlin to eat or drink anything due to her complications. She was starting pitocin, with her body already at a deficit.
At 9:20am, 8 hours since the last cervical check, Kaitlin was still 4cm and 60% effaced.
Two doctors came in to talk to Kaitlin, both suggesting that while she and baby were doing fine, perhaps consenting to a cesarean would be best after no change. Kaitlin refused. We then started attacking the labor. For the next 5 hours, Kaitlin didn't stop moving. We did every position possible to help apply pressure to her cervix; lunges, hands and knees, in and out of the shower, sitting, rebozo work, etc.
Kaitlin was having extreme back pain with each contraction. I assumed based on what was going on, her baby was "OP", or facing the wrong way in the pelvis.
Another check, 5 hours later, and Kaitlin was still the same, 4cm and 60% effaced. She was so upset. We talked through her options and getting her some sleep. She once again, decided to have stadol. One of things about a narcotic, is that each dose tends to be less and less effective over time. While the first dose helped Kaitlin to get 4 hours of sleep, this last dose only helped her to get 45 minutes of rest or so. Kaitlin was in significant pain, due to babies position.
After a long chat about the benefits of an epidural, at this point, Kaitlin decided to get one. It was 4pm. Sometimes, when having lots of stress and anxiety surrounding labor and birth, which of course was happening with Kaitlin in this scenario, our bodies don't feel safe, and struggle to let go. Often times an epidural can help women to make progress, if this is the case.
At 10:30pm a resident came in for another check. Kaitlin was still 4cm but her effacement had changed to 80% which is significant change. The resident, Neesim, also suggested breaking Kaitlin's water. Everyone else, had been very cautious about doing this. Kaitlin's baby was still very high in the pelvis, and having water break at this point can lead to cord prolapse. All of a sudden, it was as if a lightbulb went off over Dr. Neesim's head, "What if I use the an FCG (This is a monitor used on the babies scalp. In this case, it wouldn't be used to monitor the baby, but only used to snag a small hole) to break the water, making a small little hole!" There would be less of a risk. Kaitlin agreed. Dr. Neesim helped to guide the head down and verified that the cord hadn't dropped in the way.
Dr. Neesim then squeezed Kaitlin's leg and said, "I want you to know I think you can have this baby vaginally." Kaitlin missed it I think in all chaos, but she was the first person I felt like was really rooting for Kaitlin and don't get me wrong, Dr. Steadman was certainly on Kaitlin's side, but she was playing it safe still with her words. Dr. Neesim was truly fighting right along with Kaitlin.
At the 24 hour mark of Kaitlin still being 4cm, it was the only time I started to get nervous about what the doctors were going to say next. Kaitlin's urine output was dwindling as well, which was also going to become an issue for her kidney team. Kaitlin looked at me and said, "Melissa I don't know how much longer I can do this." I assured her that she was doing it and that as long as she wanted to keep going, I would keep doing everything I could to help her feel supported and comfortable. Kaitlin had some extra medicine added to her epidural and fell asleep. I went to rest as well.
At 4:30am Kaitlin was 7cm dilated! We were super excited! However, Kaitlin's epidural wasn't giving her as much relief as one would hope. She was still moaning, groaning, and having to move her body during every contraction. Once again, anesthesia came in and gave her another bolus of medication into her epidural site.
At 8am Kaitlin was still 7cm, but the baby had gone from -3 to plus 1 in station and was 90% effaced. This was HUGE and we were all super excited.
I needed to apply continuous pressure to Kaitlins sacrum, in order for her to get through a contraction without yelping. I knew we needed to get this baby to move. The kidney team came into speak to her, and after she basically told them to go kick rocks, they decided she had enough energy to keep going and wished her well.
The morning nurse, Kathy, was awesome to work with. She helped me to navigate Kaitlin's body into different positions, to get the baby to turn. At 10am, we used a stirrup to help support Kaitlin in a long term side lying release position. Usually, it's something I may suggest a client doing during 3 contractions or so, but after another bolus, Kaitlin fell asleep in this position during the breaks, only waking for contractions. At around 11:15am, she stopped waking up. Kathy and I were hopeful that the baby had made a turn into a better position, even doing a little dancing bedside.
At noon, Kaitlin woke up. She was no longer having back pain, but described the feeling as rectal pressure. I went into the bathroom and welled up a little bit. She was on her way to proving every one wrong. I was insanely proud of her. I gathered myself up and went back out to her. We didn't call for anyone. I just encouraged her to breath through the surge and pressure with each contraction. Eventually, she asked for the doctor to come in.
At one point she said, "Melissa are you ready to catch this baby if no one shows up in time?" We both laughed and I took a peak. The baby was right there.
At 12:30pm, another resident, Dr. Twikese, who had been insanely supportive and encouraging, came in to check Kaitlin. She smiled up at Kaitlin, "Well you did it! You're fully dilated and the baby is right here. I see he has some hair."
Kaitlin and I looked into each other eyes and we both smiled. Evan came over and stood by her side.
Dr. Steadman entered the room and Kaitlin asked for her to switch positions so that she could see her. It was a testament to how much they both trusted each other during this process. Dr. Steadman reached for Kaitlin's hand and said, "I can't wait to meet your baby."
Kaitlin pushed for 21 minutes, and at 1:01pm on July 5th, Andrew Maddox let out his first, big, beautiful, cry. For 35 weeks, he was a great size at 6lbs 12oz, and looked fantastic. He needed a bit of oxygen after some skin to skin, but was then placed right back into his mamas arms.
This was an amazing feat. I need for anyone reading that to really understand the amount of advocating this took on Kaitlin's part to get accomplished. Not only with her medical team, but with her family too. At one point she said to me, "I feel like you and Dr. Steadman, are the only people that think I can do this." She wasn't allowed to drink for more than 48 hours, forget eat, she had medication that was making her feel sick running into her IV, they had her simultaneously on glucose and insulin, they were giving her pitocin, and anti-nausea meds as well. Her IV pole looked terrifying, even to me.
Despite all of this, Kaitlin had done it. She had accomplished what many told her was "crazy". She had trusted her body the whole time, knowing when it needed breaks, how to get it power, and let those who could help her do so, while ignoring the naysayers.
She might just be the toughest chick I have ever met. Kaitlin thank you for choosing me to be part of this experience with you. It was an absolute reminder, of why we do this work.
I love you. Congratulations. <3