Toby's birth story...

It's a loooonnnnng read so grab yourself a cuppa (divert you mail, notify your neighbours, and get a medical certificate for work!!)...

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For us, the birth story of our son, Toby began three years beforehand, with the conception and birth of our firstborn son, Ciaran. Thus to fully understand the immensity of Toby’s arrival I need to try to summarise the previous few years.

Ciaran was conceived easily, naturally and virtually on demand. We were married, and two months later discovered that Ciaran was to come into our lives. We thought we were the luckiest couple in the world.

My pregnancy with Ciaran was easy, as far as pregnancies go. Textbook, as they say. At 40 weeks he still wasn’t eager to come into our world, and at 41+3 we attended our hospital OB (public) and were booked for induction. During that appointment I was first assessed by a student doctor, who told the OB that she thought the baby was breech. The OB then checked and agreed with her.

I’m very much a “natural birth” person, and more so at that stage, with innocence still on my side. So, to hear that my little baby had turned breech, at that late stage of pregnancy, and knowing that that would mean nothing other than a c-section, upset me no end. Obviously, it was important to do what was best for baby, but I cried. The OB continued to palpate and eventually announced that baby wasn’t breech after all, but rather had it’s head so far engaged that it was difficult to find, and confirmed it by ultrasound.

The first of a “comedy” of drama.

I was admitted for induction at 41+ 5. On the morning of 41+6 the second lot of Prostin gel was inserted, and shortly after I was examined by a doctor as the baby was showing decels in his heart rate. The room was a sudden flurry of activity as I was bundled into a wheelchair and raced upstairs to be prepped for an emergency c-section. Shane was told urgently to leave my bags - they would worry about them later. It scared me to say the least, and I remember being ran along the corridor, crying my heart out, but that is all.

In L & D I was surrounded by doctors and midwives as I was prepped, and examined by the head OBGYN. It was decided that our baby would be monitored by CTG, with his own dedicated midwife, as he was recovering from the decels well, and it was thought to be cord compression, and “normal”.

Our day was spent uneventfully - even boringly - in the L & D. Finally around 5pm I was able to identify slight pains, that were regular at 5 minutes apart. Our assigned midwife began charting, and we were excited to think it was all happening. But at 9pm a change of shift introduced us to our wonderful new midwife, Nikki. She took charge and did an internal exam. As she said - there would be a baby born, but with only 4 hours sleep under my belt, unless it was imminent it was important I get some sleep. We were disappointed to learn that I was only 1cm dilated, and I accepted Temazapam and Panadeine Forte to help me to sleep.

An hour or so later the pain was too intense to sleep any more. I spent time in the shower, wishing for two shower heads - one for my tum, and one for my intense back labour from a posterior presenting baby. I spent time bouncing on the birth ball. Eventually, Nikki talked to me about morphine for pain relief. She allayed my fears about it crossing the placenta (which it does), and did another internal exam. I was still only 1cm dilated, and she put it down to Prostin pain again, even though it was now seventeen plus hours since the last dose was administered. Nikki also explained that rarely morphine can bring about a “morph induction”, where you basically wake up ready to have a baby.

The morphine allowed me an hour’s sleep. But within that hour I woke needing to go to the toilet. By the time I urged my hand to creep up the bed, through a haze of morphine, to the buzzer for Nikki’s help, I thought I had wet myself. It didn’t pass through my drugged mind at that stage that it was my waters breaking, though Nikki knew as soon as she saw me. She coached me through the contractions, sitting by my side while I slept in between. Another internal exam showed that I was now 9cm dilated - we had had that rare morph induction, and I had progressed from 1 to 9 cm in under an hour. Nikki rushed to call a doctor to deliver, and I had the overwhelming urge to push.

My active labour is recorded as being 3 hours and 5 minutes long. Pushing a posterior baby out, through a haze of morphine and tiredness, is exhausting to say the least.

At some stage they noted meconium staining, and told me that when my baby was born he would be given to me briefly while Shane cut the cord, but that he would then quickly be taken from me for his lungs to be aspirated. I accepted this as being relatively routine - although meconium can cause serious or fatal outcomes, it’s also a routine procedure, and quite normal for overdue babies to poo before they are born. In other words, I took it in my stride.

I was eventually offered ventouse assistance which I readily accepted. I was nearing complete exhaustion, and the strength of my pushing was significantly decreased.

Our precious baby boy, Ciaran, was born at 5.45am , 30^th September 2008, weighing 3570g, HC of 35cm and length of 56.5cm. He was pushed into my arms - I think I had passed out from exhaustion the minute he was out. The most precious moment that I will remember forever, was of Ciaran opening his eyes, and looking directly into mine. It was amazing.

He was taken from me to the resus unit in the corner, surrounded by doctors. I heard counting. I saw them ‘bagging’ him. No parent should ever have to watch their child being resuscitated.

At 6.30am our son Ciaran officially lost his fight for life. Our world’s shattered into a million irreparable pieces. I cannot even explain to you that feeling of upside down-ness, and I would have been happy to have been swallowed up by the universe never to surface again!

We learned that he had an extremely rare “congenital” condition called Laryngeal Atresia - where his airway hadn’t opened in his development. Effectively his only chance at survival would have been an emergency tracheotomy, but even this probably wouldn’t have saved him due to the severity of the atresia. There are only about 52 cases reported worldwide in the past 30+ years.

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The following couple of years were a picture of heartbreak. From the moment that Ciaran passed away, before I was even off his birth bed, I had declared that we would try again. The grief of losing a baby is like having your arms cut off. With a blunt saw. It is a physical pain, as well as that of emotion and mental anguish.

We thought that it would be “easy” - hadn’t we been the luckiest couple in the world when we first wanted a child?

We were “forced” to take a three month break from TTC as I had had a Rubella vaccination after Ciaran’s birth, and I counted down the days. We began again in January 2009.

After several months of not falling pregnant we went to see our new OB of choice, Dr Susie, who recommended that due to my age (38) that I go directly to IVF. It took me a long time to get my head around this, and my phobia of needles. Still believing that we didn’t need to bring in the ‘big guns’ yet, we decided to start at the ‘bottom rung’ and work our way up. It all felt wrong - how could the universe be so cruel to us. I bagan by having a procedure to flush my tubes, which showed no “mechanical” problems. Relieving, but no help.

In April of 2009 I did one cycle of Ovulation Induction (OI), followed by three cycles of Artificial Insemination (AIH), all of which failed. I discovered then that it wasn’t as simple as moving straight into IVF, as besides other reasons, there was a waiting list at my clinic, which would delay any start for six months or so. This rocked my world - how could people not understand that I couldn’t just “wait”. I discovered that a third clinic had recently opened, and were willing to see me and start our IVF process sooner rather than later, so in November 2009 we did our first IVF cycle.

It resulted in pregnancy.

Again.. How lucky were we?

Christmas 2009 I was five weeks along, and we told our family.

But at our 7 week scan the news wasn’t good. Although our bub had a strong heartbeat, it was measuring a week behind. At this stage of a pregnancy that kind of news nearly always ends in loss, though I Dr Googled until the cows came home trying to find just one positive outcome story.

A scan a week or so later with Dr Susie confirmed that baby was falling further behind. A few days later I had a small bleed, and another scan a day or so after that showed our baby had died.

It took a long three weeks to reach miscarriage. Nobody told me that although I wouldn’t see our baby, it would be a birth and not just a “heavy period”.

When I began to spot at twelve weeks, and blood tests confirmed that my hormone levels were low enough to bleed, I was given misoprostyl to take. I contemplated it for almost a full day - it was hard to comprehend that my baby was already gone, and that I wasn’t about to cause it’s death myself. I took the tablets. I cleaned the toilet - if this is where my baby was to go to rest, then it would at least be clean. Shane was banished to the other bathroom for his needs. And then I went to the nursery, still set up in it’s entirety, and chose a special book to read out loud to my child who’s soul had already left me.

And then I lay on the couch and slept.

I woke with a small gush. Nobody told me that even at 12 weeks my waters would break. Or that everything about the next 12 hours would take me back to another time. Going through a miscarriage is not “just like a heavy period”, but rather reminiscent, in scent and sight, of the birth of a child, just perhaps on a smaller scale. It was emotionally tough as I relived the time I birthed my first born son.

Twenty four hours later and my miscarriage was all but over. Bleeding returned to that of a period. And once more I was hollow and empty. And forced back into a ‘holding pattern’ where I couldn’t do anything until my body returned to “normal”.

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We began again. I underwent four FETs all of which didn’t work. I should also mention that in many ways this became my “job”. I hadn’t returned to work after we lost Ciaran, for various reasons, and in some ways we were “lucky” as I don’t see how we would have undergone IVF if I had. Each blood test, ultrasound or treatment meant an hour’s drive one way along country roads to the clinic. Most procedures required me to be there by 8am or sometimes earlier. During winter months I was leaving home before the sun came up. Often before Shane was out of bed for work. In below zero, frosty weather, braving the black iced roads. At times this was every single day. For those who know me, you also know that I don’t do mornings.

Our clinic was fantastic, but even they were getting frustrated as we had top quality embryos that gave them no reason to doubt that they should take. Thankfully, they also believe in trying different things, and eventually I had a whole regime of vitamins added to those I was already taking, as well as Prednisolone (in case my body was rejecting the embryos), and Clexane (in case of any clotting disorders).

With just one frozen embryo left, I discovered that my FS was taking holidays which meant we had a month of nothing. I couldn’t cope with the thought of that, and talked the clinic into allowing me to do another stim cycle (which takes the best part of two cycles) to “stock up” again, over this time.

And thus, after this fresh cycle, in August of 2010, we discovered we were pregnant again.

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My pregnancy with Toby was full of denial and apprehension. I clung to whatever “signs” I could. I don’t mean necessarily physical signs - nothing could convince me that they mean anything positive, as I’d lived it all before, with never a good outcome.

A psychic I had spoken to a year before had assured me that a pregnancy wasn’t far away as she saw it being “late winter/early spring”, and felt it was close (it was August at the time). This same woman I had spoken to many, many years ago, before Shane and I had met, and she had spoke of a child “loss”. There were things that she had said, more definitive, that came flooding back to me when Ciaran died. And so I was more than willing to cling to her words. But when it didn’t happen at the time that she predicted my August/September pregnancy, it ruffled my feathers of positivity.

But now I was able to “believe” that perhaps she got the year wrong. I just needed to believe in something.

My other “safety bar” was that of an April baby. Toby’s due date was 13^th April, 2011. My mother’s birthday is 14^th April. My niece’s birthday is 6^th April. My parent’s anniversary is 4^th April. There are many other birthday’s in the first part of April, or late March. But the one that felt strongest to me was my grandmother’s birthday of the 5^th April, or even her own baby’s, who passed away, who was also an April (8^th) baby.

My grandmother had lived independently until about the same time we found out that we were pregnant, and then a series of turns put her in hospital, and eventually to an aged care home where she continued to decline in health. We were told many times that she may not last the night, but I always felt that she would be here to meet her great-grandson who was very important to her. As April drew nearer though I began to feel that she might have to leave us, in order to open the door for the safe arrival of our little one. Nana passed away about three weeks before Toby was born.

Although I was devastated at our loss of Nana I also felt quietly at ease. My feelings about why she needed to go before Toby’s arrival were more validated than I could have imagined. It was very important to me to be able to travel to attend her funeral, and although we left the decision until the day before, I was thankful that I was ok, and my OB was happy for me to travel the 350km. At the funeral, a relative who had been estranged for twenty or thirty years was eager to talk to me. It wasn’t until later that evening that I learned her reasons.

Her daughter’s (my cousin) fourth child had been born with the “same thing” as Ciaran had. I was sceptical, as we’ve had many people tell us that they know someone who “had the same thing”, but the anomaly that Ciaran suffered is so rare that there are only 52 cases recorded in the world. However, in the coming days I spoke with my cousin, and discovered that her little boy had been born with Laryngeal Webbing to a 90% occlusion. Meaning that he only had a 10% airway - Ciaran had a complete blockage. This little boy, Lewis, had an emergency tracheotomy, and lived with that until he was three when he had an airway reconstruction using rib cartledge, and is now a healthy five year old.

However, what this new information means is that Ciaran’s condition can no longer be referred to as congenital, but rather is now validated as a genetic condition that is unprecedented worldwide. In the future we will undergo genetic testing to hopefully determine the links as it may affect our family in future generations.

For me, it wasn’t exactly what I needed to hear at 37 weeks pregnant. I was suddenly no longer viewed as the “paranoid mother”, but rather that I had a “mother’s instinct”. I had already insisted, and paid top money, to have the best high risk obstetrician attend to me and my pregnancy, and had insisted that the head of the neonatology department be in attendance at the birth of our baby. They had agreed, however I knew that I was being humoured to a certain extent. Suddenly, I felt that they sat up and listened. The internal that was scheduled that week was put on hold in case it brought on labour, as it was now looking like I would be sent to Sydney or Melbourne (the major hospitals in Australia) to deliver, or in the very least that an ENT surgical team would be brought down to our hospital (also a major capital teaching hospital) for the birth. There was a lot of discussion between my doctors, the specialist sonographers and the geneticists in Canberra and Sydney. I’m sure that there was much more going on that I didn’t know about also.

I was sent for an urgent Fetal MRI at 37+2 which determined that no gross abnormalities or webbing was present. It didn’t rule out everything, or any minor webbing, but it was enough for the medical team to be confident enough to go ahead with the original plan, excluding going into labour naturally.

I was informed that I would be induced on 5^th April with our medical team in attendance. What would have been Nana’s 97^th birthday. Knowing that they had selected the date, and it was not orchestrated by me (I could never have chosen the birthday of another family member) gave me confidence that it would be ok. I was being watched over. Already in her passing Nana had given me so much.

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On Monday 4^th April I attended my OBs office for a final review. She completed a quick ultrasound to ensure that baby was still in the right position, and told us he was anterior which was great news to me as Ciaran had been posterior. I was looking forward to an “easier” time of pushing bub out. With our final instructions we headed off to hospital.

I spoke earlier of “signs”, and whilst in Dr Susie’s rooms we had another to cling to. Susie told us that her senior registrar would look after us. His name? Toby!!

At the Antenatal Ward we were redirected up to Labour and Delivery. As we were arriving, and waiting for everybody to work out who we were and why we were there, I began getting sharp pains in my lower abdomin that were difficult to walk or talk though. They never eventuated into anything though. Eventually, I was roomed and put on the CTG to trace baby’s heart rate. Any time that I was on the trace made me a bit nervous, as our previous experience had some hairy moments in it. But all was good.

The afternoon passed relatively quietly, with our biggest complaint being that there is no television to pass the time. Our afternoon midwife, Ann-Marie, was great and we really clicked, which was fabulous given that she was our middie for the birth as well.

They did their first internal examination late afternoon, and inserted the first dose of prostin gel. A second application was inserted about 11pm with more CTG monitoring. I happily took the sleeping pills and painkillers that they offered - I had learned my lesson about declining their drugs before Ciaran was born! Shane and I both had a good night’s sleep.

I was woken at about 6am to shower before being put back on the CTG and given breakfast. The doctor arrived for another internal and I was about 3cm dilated so they didn’t insert any more Prostin. All was going to plan.

The internal’s were getting progressively more uncomfortable though, which was put down to me having a long birth canal, and the doctor’s little hands (great!), so by that morning one I was beginning to dread them. That final internal at 6am nearly put me through the ceiling.

Dr Susie arrived around 8.30am to get things “on the road“. She inserted a drip into my wrist with the Syntocin, and then she broke my waters. I have no words to explain how unbearable and painful I found the procedure. Dr Susie at one stage stopped what she was doing to ask me exactly what was hurting, and to let me catch my breath. It didn’t help. I remember having hold of the pillow in my right hand, and almost pulling it apart. It certainly coped against all of my strength. I’m afraid I did my version of screaming the house down. The gave me the gas to use, but it didn’t help much at all. By the time my waters were broken I was a sobbing mess. I told everyone in the room that I hated them. And then cried my eyes out, swearing to Shane that I would never go through this again. And I hadn’t even given birth yet.

This procedure has really stuck in my mind. I don’t understand why it was as unbearable for me as it was, as everyone that I’ve spoken to describes it as being somewhere between not feeling anything much at all, and it “being uncomfortable”. For me, at this stage, it’s enough to make me fear falling pregnant again. But I really don’t understand why. I wonder if it is purely a psychological barrier. I remember Dr Susie commenting to whoever was in the room that I was a “poor girl” who had been through so much to get to this stage. It felt like a validation and I appreciated it, because even I haven’t had the luxury of allowing myself to wallow in the depth of the mud we’ve walked though. I do remember that the final moment before my waters were burst, three names flew through my mind - Ciaran! Nana! Toby! It was involuntary, and I wondered about it afterwards… it felt like I was linking the three and saying that the pain was for them to bring my Toby safely into the world for us.

Shane and I were left alone for a little while, and he held me while I sobbed my heart out, until I was eventually able to bring myself back together.

Contractions started fairly quickly, strong but bearable. Ann-Marie helped me to the bathroom, warning me to tell her if I felt pressure in my bottom. She’d been warned of my previous 3 hour labour, and didn’t want to get caught out.

She raised the bed, so that I could stand and rock through the contractions, putting my head down onto the pillow as they got stronger. Shane sat and timed them - mostly coming within two minutes apart and lasting from 40seconds up to a minute or so. This was still early first stage, though the intensity was strong.

To begin with we were all talking and having a laugh. But as the contractions increased, I had to tell Shane and the midwife to shut up, and I meant it. They were making me laugh which is painful to do mid contraction. Eventually it was simply annoying as I tried to get through each contraction.

The pain was soon getting to a point where I was thinking that I wouldn’t make it much further without pain relief and told Ann-Marie so.

She was having trouble keeping the trace on baby and decided that they were needing to use a foetal monitor on his head. I wasn’t too enthusiastic at the thought of another internal, especially as this would be done by the senior registrar, Dr Toby and I was told he was a lovely man.. A big footballer type! Dr Toby attended and completed his mission, and it was the least traumatic of any internal I had had. I jokingly (or not so?) told him he could do that any time, and that I would in fact name my child after him. I hadn’t totally lost my humor. The last I saw of him was as he headed out the door to arrange the epidural I was now demanding. Let me say that I’m still waiting on it.

By this stage I was back on the bed for the foetal monitor, and back on the gas. I was now to the point where I was, in Shane’s words, “sucking the “p” out of it!”. I was still demanding the epi, and Ann-Marie suggested morphine as a stepping stone. I reminded her that I had a “morph induction” with Ciaran. She wasn’t phased, and didn’t seem to think it would happen again, and at this stage I would have tried anything. Another internal showed me around 5cm dilated. As she injected me I was hit by another contraction, which were coming thick and fast now, with little space in between to recover.

From that point, even with the morphine, I was unable to let go of the gas, and was using it with every contraction. I said several times that the morphine wasn’t working. Perhaps it was, but to me it was making no difference to the pain level.

I told Ann-Marie that I was feeling nauseous. Within minutes I felt that I was going to be sick, and she gave me a bag. Thankfully, I didn’t have to use it. By this stage I was also shaking like a leaf, uncontrollably. I knew that I must have been in or close to transition, but Ann-Marie didn’t seem to be confirming it for me, and I was worrying that I still had ages to go and needed the epidural.

Suddenly I felt a familiar urge. It wasn’t quite a push, but I knew that the next contraction would be. I spoke the only word I could get out. “Push”. Out of the corner of my eye I remember Ann-Marie looking up from what she was doing, and saying to Shane “did she say push”. He answered “yep”. She said “does she mean she’s pushing now??”. Again he said “yep!!”. With a shocked look she jumped to action, and ran from the room to call my OB (or get someone else to), and ran back to tell me it was ok to push.

Contractions were thick and fast. Dr Susie arrived, and also Dr Zsuszoka (our neonatologist) with her team. I was trying to push, but didn’t feel like I could get the force behind the contractions. Dr Susie was telling me to push harder. At one stage I asked for the vacuum. I was only being sarcastically humorous, but she told me no, that I could and would push him out.

Finally I felt the “ring of fire” begin to burn, and it was a relief to know that he was almost here. When his head was out, Ann-Marie took my hand and helped me to feel his head, which was actually his face as somehow our bub was now posterior, but as soon as I did I had to pull my hand back as another contraction hit. Our baby Toby slid out, and was put on my chest. After just moments, Dr Susie gave him a good rub on his back to get him crying. Such a relief for us. I looked up at Shane who was crying also. He told me later how worried he’d been, and that those moments where a blue baby lay quietly on my chest were the longest for him. He didn’t understand that Toby’s color was mostly that of vernix. His AGPARS were 9 and 9, so were very good.

He had also turned posterior. Surprisingly, given the fast birth, and a posterior baby, I managed to escape without any tears or grazes, and was stitch free.

My total labour, including third stage, was 2 hours 45 minutes. Second stage was only 15 minutes.

The placenta didn’t want to birth, and when it eventually came there were no membranes attached. Dr Susie was concerned as she had never seen this happen. I don’t remember the next procedure where she had to go into my uterus to remove them. I was then given an intravenous course of antibiotics, and the concern was for my uterus with retained membranes and infection. Hopefully, it has all righted itself, and my placenta was sent to pathology to try to get reasons.

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I spent the next six days in hospital, mainly because it was easier to stay put over the weekend. Toby had some sucking issues to begin with, and once we had those sorted, then it was just the usual nipple cracks and toe curling to get used to.

While I was there though I had visits from the two beautiful ladies - midwife Sue who had cared for Ciaran after he passed away with such tenderness, and Shane and myself in the bereaved suite, and midwife Nikki who was my middie for Ciaran’s birth, and was there with us when he passed away. It was emotional for all of us, and they had plenty of cuddles for Toby. One night they even ended up “babysitting” him for me at the front desk to give me some sleep.

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Toby is now fourteen weeks old and thriving. He’s my world. I imagine that he is the spitting image of his big brother, Ciaran, as he was when he was born. I miss Ciaran from the bottom of my heart every minute of the day, and my days are filled with bittersweet moments. But I’m so blessed to have his little brother here with me now.