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This FAQ last updated: June 2009
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BBW Birth Story Pages
BBW Birth Stories: Pre-Eclampsia Birth Stories
Over the years, many women have requested a section for birth stories of plus-sized moms.
Women of size often come into pregnancy with so many fears imposed on them by others that it's important to have reassurance that other large women have indeed done this before.
Pregnancy books and most websites do not fulfill this need; mostly they are filled with warnings about "obesity" and pregnancy, admonitions not to get pregnant until you lose weight, dire predictions of disastrous pregnancies filled with complications, or horror stories designed to scare you into weight loss compliance.
Although there are many birth stories online, most are of women of average-size. While these are also helpful to read, many women of size have longed for a collection of stories of just plus-sized pregnancy----birth in all its beauty, and birth in all its variety in women of size. It is so important for us to see that many of our fat sisters have traveled this journey before us.
This is a collection of BBW (Big Beautiful Women) Birth Stories collected by Kmom over the years. Stories have been separated into various categories (vaginal birth, c-sections, twins, VBACs, etc.). Because some stories fit more than one category, many will repeat on different pages. Some stories are already up on the web in a more complete form elsewhere; with the mother's permission, Kmom has linked to these sites and urges readers to click on the link and read the more complete story.
Unless specifically requested, all identifying information has been removed or changed to protect the privacy of the participants.
All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
This particular FAQ presents the stories of moms who have had blood pressure concerns. Some of these simply had borderline b/p in pregnancy, some had pre-existing hypertension before pregnancy, and others had b/p problems accompanied by other symptoms that indicated pre-eclampsia or other problems. Although the FAQ is titled "Pre-Eclampsia Birth Stories," it really covers any story where blood pressure was a significant concern.
More stories will be added over time, so keep checking back if you are interested in reading further stories. If you are interested in sharing your birth story, click here for more information, birth story format, and submission guidelines.
New birth stories are always welcome; Kmom updates the birth stories FAQs about once a year so be patient for your story to show up. If you do submit your story, please carefully follow the format and directions given in order to shorten the amount of work involved for Kmom. Kmom's family will thank you!
Terms and Abbreviations
Most moms will recognize most of these terms, but women new to reading about childbirth may be puzzled by some of the terms and abbreviations used in these stories. This section briefly defines some of these in order to help women understand the stories better.
Pre-Eclampsia/Elevated Blood Pressure Birth Stories
DocMoms's Story (mild pre-eclampsia, induction, vaginal birth)
Kmom's Notes: This mom had quite a large pregnancy weight gain, but this sometimes happens when women lose a lot of weight before pregnancy; their bodies go into the 'regain' and 'storage' mode common after diets, plus gain for the pregnancy as well. Pre-eclampsia can also predispose to high weight gain from fluid retention as well. However, some women also just gain more than others, so it's hard to say for sure what the cause was here.
Although it's very difficult, here's proof that some women can do an induction without an epidural. A lot depends on the type of labor, the position of the baby, and the coping techniques/support of the mom (studies show doulas really help!), but it's quite an accomplishment to do a pitocin induction without an epidural! (And Kmom should know!)
My pregnancy was pretty uneventful until 23 wks when I had a Urinary Tract Infection (UTI) and few contractions with it. I kept working and things went well until about 33 wks when I started feeling pressure down low in the pelvis. It felt like the baby was pressing down. I mentioned this to my doctor and she said decided to check my cervix and said that I was 50% effaced and 1cm dilated so I was placed on bedrest for 2 wks prior to returning to work. Someone directed me toward Sidelines, the support group for high-risk pregnancies. I must say that this was a very positive experience for me. I also received valuable information concerning birth from the book called "Birthing From Within".
I did well for another week at work, then my b/p started rising. I had baseline b/p of 120s/70s, but then it rose to 130-140s/80-90s. I had a lot of swelling in my hands, feet, and face. On the Wednesday before Thanksgiving at 38wks, they sent me for lab to check for pre-eclampsia since I had gained 10 lbs. in one week. The labs were ok, so I went home with instructions to take it easy. I went back to the doctor on Nov. 29th and had gained another 7lb.--all fluid, but b/p was ok, so back to work for a few days. We had 2 Non-Stress Tests and biophysical profiles as well. At 39 4/7 weeks my b/p shot up to 160/108, so to the hospital for monitoring and induction on Dec. 7th. I had planned for a natural, doula-assisted delivery, so I was initially disappointed.
My induction started at 0630 with a Pitocin-drip, but the contractions weren't too bad. At 0920, I had my bag of waters artificially ruptured and labor began to progress. It is really a weird feeling having all of that amniotic fluid rush and then trickle out. I labored without medication and it was very difficult, but my husband and doula were wonderful. She had a way of talking me through the contractions as my husband massaged my back, feet and legs. I also had back labor which was relieved by a heat pack made of rice stuffed into a sock and microwaved. This made the back labor thing much better. I received Stadol to take the edge off of contractions, but I could still feel them. I was just too afraid to get an epidural.
I began to push at about 1530 and my beautiful daughter was born at 1749 hrs. Labor lasted about 11.5 hours and I pushed for about an hour. I had a 3rd degree tear secondary to mild shoulder dystocia (stuck shoulders), but my daughter did well throughout all of this and maintained her heartrate. She never had decels or any fetal distress.
She weighed 7lb. 15 oz. She had a head full of black hair with brown eyes. She was placed on my chest and immediately went to the breast to suckle. I held her for approx. 20 minutes prior to them taking her over to get her ID tags and Vit K, eyedrops, etc. Her Dad was able to go with her for this. I had some complications after the birth including loss of my IV, so not Pitocin was available to help the uterus to contract. This caused a significant amount of hemorrhaging. Also, I had a Magnesium drip because of my high bp that caused my bp to plummet after the bleeding. My doctor and her staff did a great job at correcting these issues quickly. I know that God and his Angels were in the delivery room that day. So, despite all of the complications, I am wonderfully blessed to have a cherished little one in my arms.
Erica's Story (high b/p, induced, vaginal birth)
I fell pregnant accidentally when I was at University when I was 20 years old at 270 pounds. I was very nervous and worried about having a baby, which I think contributed to the high blood pressure. I didn't have any problems with the pregnancy except when I worked. I worked part time on my feet and could only stand for 5 hours at a time. I got terrible back pains, so bad I couldn't get out of bed at night to use the bathroom. I would crawl on the floor. I didn't have back problems prior (even when I worked) so I think it was just the pregnancy or pregnancy plus being overweight.
A week before my due date my OB was concerned about my blood pressure and sent me to the hospital. I was kept overnight and my blood pressure was okay. I think my b/p went up when I would visit the OB. I was also afraid of being examined, which I still have a problem with today because I am embarrassed about being overweight. My OB never said anything negative about being overweight, it was never an issue.
2 weeks overdue the OB decided to induce because he was afraid of pre-eclampsia. We used the gel first then the next morning they put in a drip which *worked*. Labor was terrible, I think it was the induction. I was planning to go "natural" but opted for pain relief once I couldn't mange the pain. I was also in labor alone; having a support person --I've heard-- can help with pain management. I was also worried about being "modest". The hospital had a sheet like thing draped over me and only my legs were really showing, even in the stirrups.
She was born 25 hours after the first gel induction. She was healthy and fine and so was I. She's now 6 years old and I'm due with my second child in a few months. I'm now 27, over 330+ pounds, and my blood pressure is fine. There is no reason this pregnancy won't be "normal". Although I'm still worried about the modesty thing again, I'll be at a different hospital.
Franny's Stories (PCOS, induced vaginal birth, posterior, forceps; cesarean for breech baby; home VBAC)
Kmom's Notes: Another case where the baby's position makes the birth difficult until it is fixed. In this mom's first birth, it was probably the combination of the hands-knees maternal position and the doctor using forceps that helped the baby to turn and be born vaginally.
Franny's second baby was breech. This may reflect a tendency among women who have had prior malpositions to have future malpositions as well. This may reflect a pelvic misalignment more than anything else, and we speculated that regular chiropractic care could help prevent position problems in the future.
She got that chiropractic care in her 3rd pregnancy. Did that help her to a vbac? Hard to prove. It's notable that this was the only pregnancy of the three without a malposition, so the chiro care may well have helped. However, she might have had a VBAC even without that care. It's more like an extra step to take, just in case.
Another notable thing about Franny's story is that she was told that she had to sign up for an elective repeat cesarean because her hospital didn't offer VBAC anymore. Fortunately, there were other choices in her community, and rather than being forced into unnecessary surgery against her will, Franny gave birth at home with a good midwife. And then she had the strength of will to write about it for her local paper!! She put those local doctors on notice that women will NOT be forced into unnecessary surgery!
Baby #1: I gave birth at the hospital where I worked at the time. I am an RN; I was working OB at the time and delivered with my 2 best friends as my nurses.
My B/P was elevated at my 38 week appt. and being the beginning of July and very hot and busy on the hospital floor where I worked, my MD sent me home with bedrest. I was swelling, but not spilling any protein and my labs were ok. I got a Non-Stress Test (NST) and baby looked fine. The next week we scheduled my induction because B/P and swelling continued and my cervix was favorable (ripe).
I entered the hospital at 6 a.m., my IV was inserted and pitocin began. I was having contractions, but they weren't anything. I was 4 cm when I started out. I walked the halls and rocked in the rocking chair. My husband and his parents were there. I worked on OB at the time and a Radiant Warmer Representative was there to in-service the staff on a new Warmer. I stood in the hallway with my IV pump and listened to his in-service at 9 a.m. By 9:30, he was done and I was tired, feeling contractions, but they weren't uncomfortable. I thought, if this is going to last all day I'm going to try to get some rest.
I went back to bed, got hooked back up to the monitor and my contractions were every 2 minutes, palpating moderate, but not uncomfortable. I had been laying down for 15 minutes and just got my eyes closed when I had 3 strong contractions that I had to use my breathing techniques through (I had coached so many other labor patients that I felt like I could do it). Then my water broke. Talk about warm soup down your leg! The contractions got really strong then. I was 5 cm. Got up to the bathroom to get cleaned up and got some pain medicine, Nubain 10 mg. I got back in bed, turning side to side and in 2 hours I was 8 cm. The contractions hurt, but they ended and knowing there was an end to every pain was a relief in itself. Back rubs, ice chips, and a cool washcloth over my eyes helped tremendously.
At 1 o'clock in the afternoon I started pushing. I pushed sitting up, lying on each side, on the toilet, standing up, squatting, and regular old lithotomy. I just couldn't get him to budge and I had pretty bad back pain. He was posterior. After 2.5 hours of pushing, I got on my hands and knees and pushed every other contraction because his heart rate was dropping. Finally, my doctor came in and I got a spinal in case I would have to go for an emergency c-section. They got me all set up for delivery and the doctor used forceps. After 3-5 contractions with pushing and pulling, we got him turned face down and delivered at 4:35 p.m. He was a bit exhausted and got a little oxygen, but cried well and after an hour of stitching, mom got to feed him. He nursed for 20 minutes like a trooper.
Baby #2: I was due 4/7. We knew dates for sure because we got pregnant with the assistance of Clomid and Glucophage for PCOS. My pregnancy really went quickly and pretty smoothly. From about 28-34 weeks baby was breech except for one brief period. Around 34 weeks I started doing the routine to turn her---lying on the ironing board, used a moxibustion stick at home, homeopathic pulsatilla, prayer, relaxation, imagery, talking to the baby, flashlight, music, the whole nine yards. I was on the verge of a breakdown about 35 weeks...called my midwife crying, "What am I going to do?"
We had talked about delivering breech and they weren't really sure. I had an appointment on Friday 3/14 for a consult with the OB (he's probably in his mid-50s and still does some vaginal breech deliveries) who backs up my CNM and possible External Version. We had planned to deliver at a birth center. That was all I was planning. I was thinking positively, I was relaxing and working on the imagery I was planning to use for labor...this baby was going to have a peaceful delivery and I was going to have a healing, positive birth.
I am a RN and work as a prenatal care coordinator for a community health clinic. I do home visits, education and referral for pregnant moms on the Medicaid program. I have worked as a doula in the past, but don't have time for it at present. I teach childbirth classes and had a class on Tuesday 3/11 from 5-7. Talked with a couple for about 30 minutes after class, then drove home, picked up my son at church (my husband is a pastor). We came home, I [ate] and read my email. I had just got Ina May's new book via Fed Ex that day and while my son was winding down...I started reading in the recliner. I had been sitting there about 15 minutes when I felt warm and wet---I jumped up so I wouldn't get the recliner wet and freaked out, "OH NO, that can't be my water!" When I pulled down my pants in the bathroom there was a lot of blood. Now of course, I'd just worked about a 12 hour day, moving constantly, and not really noticing much movement from the baby. In class that night we talked about Cesareans and abruption was going through my mind. I'm absolutely losing it, my heart was pounding, I was shaking all over, I'm shaking now just remembering how I felt. I read Prenatal Parenting early in my pregnancy and I had worked really hard on remaining calm and talking to the baby, taking fetal love breaks, especially when I'd had a rough day---now when she decides to come, I'm a mess.
I called DH on his cell phone. "Come home now, I'm bleeding." It was about 10 p.m. My son could tell I was worried because he was right there. "Mommy, are you ok?" (Side note: The next evening at Bible Study he asked for prayer for Mommy because she "Pooped blood in the toilet and it looked like Koolaid." He's still talking about that night!) DH got home, helped me find my midwife's phone number and we called her. She was a voice of complete calm, "I'll meet you on OB. It's probably just your water." DH has never driven so fast in his life! Now I was nearly a month early, I had just gotten finished saying that night at class that I would probably go close to my due date, I was too busy to have the baby early, I had home visits scheduled through the end of March, blah blah blah. I had no bag packed, had no comfort items gathered, had only 2 outfits for baby clean...I didn't have the crib pained, had no mattress, didn't have a pediatrician picked out, had not pre-registered at the hospital, I was going to deliver at the birthing center for heaven's sake!!----I WAS NOT READY!!!!
We got to the hospital and up to OB. They wanted me to change my clothes, I wanted heart tones. 130s, but very little variability...My midwife cam in and did a quick ultrasound, the baby's head was under my right rib cage, her bottom was inside my right pelvis, and her feet were over my cervix. My midwife sat on the bed with me, held my hand, and said, "We are not comfortable with delivering her vaginally this way, you need to make some decisions." DH went down to sign me in. When he came back I bawled in his arms for a few minutes then collected myself. My midwife and I talked about VBAC and she said that the doctor still did VBACs and was very pro-VBAC and had a good rate....I think she said ~80% success rate for VBACs. I made it clear that if the baby was OK, she was to be with me at all times. If she was not with me, DH would be with her. My midwife said that the pedi on call was a stickler about the baby going to the nursery, but she would do what she could.
DH's parents arrived to stay with my son during the birth. IV started (after 3 tries), into a gown, consent signed, we went to O.R. After the anesthesiologist got my fluids in (she about froze my arm off pushing about 700 cc in 10 minutes), she sat me up for my spinal (again, third time was the charm). The doctor was at my feet, my midwife at my side, and nurse on the other side. They were all awesome!---kept trying to recruit me, though. I laid back down and felt everything go to sleep, boy that is a funny sensation. With [my first child], the spinal took the pain away, so it didn't feel so weird. With no pain, it just feels like they put lead in and made it all go to sleep, kinda pins and needles sensation. They put my catheter in (gave me the option not to have it at all, but I figured I'd probably not want to get out of bed for a little bit once the spinal wore off and I knee it was also in place to make sure my bladder wasn't nicked during the surgery, so I got it).
I informed everyone that if my baby was ok, I wanted to keep her with me. I got this weird sense of humor and was defensive by joking about things, I was kinda strange. My BP bottomed out at 60/40 and my heartrate was going nuts in the 120s. She gave me something for my BP and I felt a little better. DH at my side, they started my baby's birth; tears rolling down my face, I asked him to pray with me. DH prayed from the moment he placed his hand on my face until we heard them say, "Here's baby." My heartrate came down to the 90s while he was praying and the anesthesiologist said, "Wish we could bottle that."
During prenatal ultrasounds, we had a brief peek to see girl parts, but never saw them again (breech), so I was not getting my hopes up. I knew that they would see sex before she was even out, but they weren't saying anything! After her birth, the doctor made the comment that he went in and felt limbs, he grabbed two and started to pull them out, but had an arm and a leg, had to go back and find a matching set. She cried quickly and after a peek at her, to the warmer. The pedi checked her over and I kept talking to her, "Keep crying," "Hello Amy," etc. I had tears streaming down my face and into my ears. They wrapped her up and handed her to DH; I got to touch her. The anesthesiologist held her face right next to mine so I could talk to and kiss her.
The doctor held a section of cord up for me to see. "See why she wouldn't turn around?" She had a true knot in the cord that was really pretty snug. He felt that she was lucky to be here and that she would have probably not tolerated the version we had planned for 2 days down the road. Now, I have seen true knots before, even after vaginal deliveries, and everything was okay, but I also assisted a twin delivery where one twin had a knot and was stillborn, the other was ok.
The anesthesiologist offered Demerol to help with cramping and I refused because I didn't really want to see my supper again. I asked to have my placenta and the anesthesiologist said, "Well, what on earth for?" I said, "Because it's mine!" I got my placenta in the freezer, going to plant it with a Magnolia tree outside Amy's bedroom window. (I had a Magnolia tree outside my window growing up.)
The pedi took her to the nursery. DH followed and picked up our son and my in-laws so they could see her and 10 minutes later when my surgery was over, the nurses and doctors took me to recovery, and my midwife went to get Amy. I got her to the breast within about 45 minutes after delivery. She was cuddled up with her head on my breast...My son came in and asked me, "Did you get your miracle, Mommy?" More tears. He got to see her, my in-laws were in the hallway looking in, and DH was walking around with my placenta in a bucket under his arm. Back up to the OB floor at 2 a.m., got my morphine [Patient-Controlled Analgesia] pump and slept off and on through the rest of the morning with Amy on my chest. [We] ended up skin to skin for quite a bit of that time. They checked me often, but basically left me alone, never asking to take her to the nursery for her admission bath, etc. I got out of bed for the first time around 10:30 a.m. the next day, got to oral pain meds and my IV out around noon. Kept Amy with me around the clock and nursing went well. Went home Thursday afternoon around 3:30 p.m. I refused her Newborn Screen on discharge and brought her back that Saturday.
OK, the last thing I wanted was a cesarean. But what I was praying for was an empowering, positive, healing birth and even though I didn't have the natural birthing center birth, that wasn't what I was praying for. Next time I will be more specific, but I did get control in my birth experience, I was hyperaware of what I was feeling emotionally, physically, and mentally, and I feel I was so prepared for coping with pain that it has made my recovery super rapid. As far as healing, in that I feel like I can delivery vaginally without the medical need for management. I have not had that yet, but our daughter is named for 3 very special women, 2 very dear to me. Amy's birth was healing to me in that way, a healing I didn't even know I needed, but God took care of nevertheless. Positive, a resounding yes, I have a beautiful baby girl with a perfect round head, she has dimples just like mommy and lots of dark hair.
Did I get what I wanted---no, but I did have control over what I did get. Did I get what I needed---definitely. I will no longer feel sorry inside for women who had to have a cesarean, but instead I will ask how they felt about their birth. That is so much more important. A cesarean is not fun, it's not natural, it can be unnecessary, but it does sometimes save lives, and it is a birth of a precious little one, and an event that is no less memorable or special...Sometimes we just need to be reminded of it.
Amy was 6 lbs., 14 oz., 20.5 inches. She is a good baby, nursing well. At three weeks of age she is 8 lbs. 5 oz., solely breastfed, and I have an additional feeding built in for pumping. I love the Lansinoh Ziplock bags for breastmilk storage, and the Avent pump is great. It's like "I can't believe it's not electric!"
Update: Franny went on to have a home VBAC too. This is her VBAC story.
10 days past my due date I was miserable and called my midwife for help (this pregnancy lasted more than 2 weeks longer than my first and 6 weeks longer than my second...I felt like I was pregnant forever, add to this that I took off work for maternity leave at 38 weeks and I felt a little like an elephant, in more ways that one). My midwife recommended that I see the Chiropractor and get a massage. I chose the latter and by evening (Wednesday) my contractions had started.
I went about my normal activities, fixed supper, went to church, bathed the kids, put kids to bed, went for a walk. Contractions were regular, but not very strong, more like annoying. Thursday AM we were to drive an hour away to see the midwife...I didn't think I could handle being in the car that long, so I told her to head our way. (She has 7 kids of her own, the youngest just turned 1 in November). I napped and felt like they were fading away and she said she'd just drop in to see how I was. I had gone into work for a bridal shower on Tuesday and one of my co-workers, an OBGYN Nurse Practitioner said I should just go to the hospital and have another cesarean since I was so far over my due date...had a lot of mental work to do to get over that.
Midwife arrived at 3 and I told her what I was thinking/feeling and she helped me get rid of it and by 3:30 my water broke. By 5, my doula and our friends that were going to watch our kids were present and I was starting to get uncomfortable. Around 7pm, I was 4cm (the first time my midwife ever had her hand in me). I got in the tub ( borrowed a spa in a box from a friend) and got hot, then had to get out to cool off. I had just attended a Michel Odent conference and had his words in my head. If a woman gets in the tub at 4 and makes no rapid progress after 2 hours, he recommended a cesarean. I kept thinking that I didn't have the urge to push, so had I made progress? After dark (9ish?) I got back in the tub and was very cold, my husband found a space heater and was holding it on me next to the tub and jokingly went "oops" faking dropping it into the tub and it took me over an hour to get back into a regular pattern. Had to get into the shower to get warmed back up and they encouraged me to drink some really salty hot broth.
By 11 I was loud and hurting, they also tried to cram a peanut butter and jelly sandwich and juice down my throat...PB is NOT easy to get down with 'labor mouth'. I was all over the place position-wise, remember enjoying a forward leaning position. I starting pushing around midnight, although my midwife said I wasn't *really pushing* until about 1 or so. Was in the tub when I started to push, but kept a rim of cervix and got out to the birth stool so the midwife could help hold it while I pushed. While on the birth stool I remember saying, "I give up. Take me to the hospital, Help me" and they gave me some homeopathy. When she was crowning I got back in the tub.
The midwife said I have 'a large perineum' and so it felt like crowning took FOREVER. I remembered what It was like with Daniel and I realized that I ever got to the point where I could push past the pain and make progress...I finally figured out the pushing thing this time...but the pushing into the pain to make progress, then the contraction ending and feeling the baby slide back up and knowing I'd have to push back through that pain again with the next contraction was nearly overwhelming. I was on my knees in the tub, resting my head on the side of the tub, Aryn put his arm along the back of the tub so I could rest my head and I accidentally bit him...didn't even realize I was doing it until he flinched.
I got to the point where I felt like my urethra was going to explode and I reached down to support my labia and felt her head...It didn't take long from that point...it was so empowering to realize how close I really was. Once her head was out, her body followed quickly, the midwife just allowed the water to catch her. Once she was out, I flipped over and reached for her. Within seconds, I was pulling her up so I could see her, unlooped 2 nuchal cords and brought her out of the water to my chest. She opened her eyes and looked at me and started to whimper. No lusty painful scream, but more like..."Wait a second, what just happened?"
I felt between her legs and discovered she was a girl, but waited until our son came into the room to lift her out of the water for him to see and announce. I was convinced I was having a boy because my pregnancy was so much like it was with Daniel...Instead I have a little girl that looks just like her big brother. I was out of the tub about 30 minutes after her birth and we left the cord attached for about 2 hours, at that point we were able to cut without clamping and it fell off when she was 4 days old. I had a small 'scuff', but nothing worth messing with suture-wise. My midwife had a herbal bath to soak in with Abby and it felt wonderful...had to learn the hard way to strain out the herbs though :-0 clogged the tub.
Abby nursed very well and my milk was in by 24 hours. She never lost weight. Was 8-5 at birth, 2:04am Friday, October 14th and was 8-9 on Monday evening. Abigail has been a joy, a wonderful baby. Sleeps through the night (started at about 1 month) and was smiling by 6 weeks. She does have some gassy spells, but they are brief. Will definitely do it again!!! But will wait until Abby is in preschool or Kindergarten...a newborn and a strong willed 2 1/2 year old is just way too much for me!
This was an editorial I sent to our local newspaper after my daughter's birth explaining my decision and outcome in relation to the release of 2004 C/S rates. Several of the OBs in our area were really ticked and found out that I was the Childbirth Educator at the local Medicaid clinic and were not happy. Our Medical director wanted me to assure him that I was not teaching or encouraging homebirth in my class. I replied that I simply told my story and that I did not believe that homebirth was an option for our clients for 2 reasons...they can't afford the out of pocket expense of homebirth and local docs refuse to provide back up.
The results are in and 2004 saw another increase in surgical birth rates -- 29.1 percent of women delivered their babies by cesarean last year, according to a National Center for Health Statistics report released last week.
I chose not to become a statistic
Some doctors cited the reason for the increase was that more women are having elective cesareans, but keep in mind that "elective" does not mean that it was the woman's choice.
Earlier this year when we discovered we were expecting our third baby, I visited my OB/GYN to begin prenatal care. I was informed that we would be forced to have a cesarean if our baby was born at their hospital simply because I had a cesarean with my second child.
The cesarean rate has increased astronomically in the past 30 years: 5.5 percent in 1970, 16.5 percent in 1980, and 22.7 percent in 2000. The World Health Organization states that the cesarean rate should be 10 percent to 15 percent. Our bodies have not changed in 30 years, but medical management has. Although some babies have been saved by surgical delivery, a look at maternal and infant mortality rates show that nearly 30 countries lose fewer moms and babies than the United States and most of those countries have lower cesarean rates.
Having a vaginal birth after cesarean (VBAC) carries nearly half the potential complications than repeat surgery. Due to a 0.5 percent to 1 percent risk of uterine rupture, The American College of Obstetricians and Gynecologists has put very strict guidelines on VBAC, stating that the doctor and operating team need to be immediately available.
American Academy of Family Physicians guidelines noted that there are other problems that occur more often, and they found no evidence suggesting better VBAC outcomes based on the availability of resources. American Academy of Family Physicians went on to state that policies for VBAC "appear to be based on malpractice concerns rather than on available statistical and scientific evidence."
So, how'd I do it? I hired a midwife and kept my OB/GYN as backup. I found a doula -- someone trained to provide emotional and physical support during labor... and obtained a portable hot tub for pain relief. I ate well and read to educate myself. When labor started, my midwife came to me, and my daughter was safely born at home in water.
I'll do it again with my next baby. As long as doctors and hospitals do not allow alternatives, such as midwives, birthing centers and natural options for pain relief, more informed women who want to be able to make their own decisions will join me.
Linda O's Story (pre-eclampsia, induced vaginal birth)
Kmom's Notes: "Linda" was induced for rising b/p at the end of her pregnancy. After her waters were broken, like many women she found the pitocin contractions very difficult to deal with. In this situation, epidurals can indeed be a blessing! Although possible, it is very difficult to do a pitocin induction without pain meds or an epidural. Also, in these circumstances, an epidural may have benefited her high blood pressure (one of the possible side-effects is lowering of b/p, which can be problematic but in this case probably helped). Finally, the jaundice the baby had is also a possible side effect of pitocin, one that needs to be watched for after a pitocin induction.
Never felt discriminated against due to weight, I should mention. We discussed it at the first meeting, but she just said she'd watch my weight gain, which was well within normal range. In the opinion of my OB, just being a large woman was not an indication of a high-risk pregnancy.
Thursday: Went to OB, who checked my BP (it had been rising slowly), and found it to be 160/90 (norm for me 120/70) and immediately was admitted to the antenatal unit of the maternity floor to try and get some rest to lower the BP. BP didn't go down during the day, so OB decided to induce me slowly with Pitocin. Took Pitocin all night, with increasing contractions, but still not very bad. I had been about 2-3 cm dilated and 50% effaced already, so things were already moving along!
Friday: OB is disappointed I didn't react more to the drug--I'm still 3 cm, but now 100% effaced--she breaks my waters, contractions really kick in. I hold out 2 hours, doing Lamaze breathing with DH, but the pain gets to be too much--I got an epidural around 8 a.m. or so. Felt SOOOOO much better. What a godsend! Now I totally understand why so many women get them. I still had many hours of labor ahead and the pain was just awful. I couldn't even focus. But afterward I could relax and get ready for the pushing ahead--we (DH, Mom and I) all took naps and waited.
By 1 p.m. I was about 8 cm dilated--ready to start pushing around 4 p.m. The epidural wore off a bit and I was given just a bit more to get me through--turns out it was a bit too much, since I couldn't feel my muscles as much as I needed. But the pushing went well anyway--pushed for about 20 minutes and almost got her out. OB decided to give me a rest and let the epidural wear off a bit--waited about 30-45 mins., then pushed again and E arrived! Just before she came out, she had a quick dip in heart rate, so the OB really jumped in and helped me with getting her out.
I couldn't believe how beautiful she was when they laid her on my tummy to hold. She had some meconium in her lungs and had a bit of trouble breathing well--she did cry, but not lustily enough, so she was suctioned, given some chest PT, and then showed her to me briefly to hold and try to nurse (she latched right on, the smart girl!). Then they whisked her off to the nursery for the routine checks--DH went with her while I was sutured, etc. It turns out she needed more suction, got some oxygen, some more chest PT, and was then fine. Her Apgars were 8 and 9 in the delivery room, so I wasn't really worried. DH tried to be the daddy and not the doctor, but he did worry, although he managed to stay out of things and let the other pediatricians do their work!
Saturday and Sunday: I had to stay in bed for 24 hours, getting magnesium sulfate via IV as a precaution to treat the mild pre-eclampsia I suffered and prevent seizures. They brought E to us (private room, DH could stay) every few hours for feedings. She knew just what to do with the breastfeeding--amazing. Was moved on Saturday evening to a regular room and had DH and E with me most of the time.
Monday: I was checked out on Monday morning (got an extra day due to the mild pre-eclampsia), but E had to stay. She's a bit yellow and was getting more and more yellow, so they decided to put her in the neonatal ICU and have her get double phototherapy. I start pumping to get my milk to come in.
Tuesday: We spend whole day with E in the NICU, breastfeeding every few hours, and supplementing her with formula (she was very dehydrated).
Wednesday: E comes home! We have a very wonderful and tiring first day with her, feeding her every 2 hours (we had to wake her up each time with wet washcloths and feet tickling!). She is still yellow, but improving. What a beautiful little girl!
All in all, it was a good experience. I never felt my weight was a big factor for any of the hospital personnel and I felt I was treated appropriately and professionally. Would I do it again? Not sure--I love my daughter, but 4 months of colic and an acute lack of sleep is perhaps enough!
Monika's Story (pre-eclampsia, postdue, 2 homebirths, posterior/compound position)
Kmom's Notes: Be sure to visit this site. Very interesting story, great photos!
This is the story of two homebirths despite some high blood pressure and postdue concerns. The story (with graphic photos) can be found at http://members.home.net/mcmahan/. Below, Kmom summarizes the gist of the stories.
"This mom is a mid-sized BBW. She is not self-conscious at all about being in the very graphic photos, and the photos of baby #2 coming out are just AWESOME. Not bad considering the photographer is the teenage babysitter! Details about the births:
-First baby: high b/p concerns at end of pregnancy; used herbs (their site contains details for those interested). Mom was also almost 3 weeks past her due date when she finally goes into labor. Despite all this, they had a homebirth, though the labor was not easy (the baby was posterior) and the baby passed meconium. After the birth, the midwife was concerned about possible meconium aspiration, so they transferred to a hospital and had a hard time negotiating the bureaucracy and hassle there, but in the end all turned out well.
-Second baby: similar concerns with high b/p but all lab tests are reassuring and the herbs again seem to help. Baby similarly overdue, posterior at first, but this time mom's hands/knees position flipped the baby to anterior shortly thereafter and back labor ceased. Baby was large (10 lbs. 6 oz, considered 'macrosomic' by OB standards; most OBs would have called for an early induction or elective c/s), and did birth in a compound position (hand by head), yet despite baby's size and position, baby was born without any damage or trauma to mom or baby because of the careful handling from the midwife. The baby's older sister (not quite 2 years old) is present for the birth; shortly after the birth she demands that the baby be nursed immediately and that socks be put on his cold feet. ;-) The sweetest photo is of the 2 children, tandem nursing (nursing one on each side) after the birth.
Please note that even very big babies can usually be born without problems *IF THE PROVIDER IS WELL-VERSED IN BIRTHING BIG BABIES*, if mom has full freedom of position for laboring and pushing, and if the provider is patient and doesn't force the issue. Baby size does NOT have to mean a ton of intervention.
The photos are very graphic but beautiful; if you are not sure how birth happens or if you have a hard time visualizing that happening with you, I'd recommend going to the site and checking it out. You may not be choosing homebirth, which is also fine, but reading a variety of birth stories while you're pregnant is very important. And the very graphic photos really help show what happens in birth."
Jen S's Story (PIH, induction, c/s)
Kmom's Notes: Some women love their c/s, some are indifferent to them, and for some women, they are a total violation. For some women, it is almost akin to a rape. Jen feels this way about her c/s, and she certainly didn't get much support or help from the staff. Her wishes were often disregarded and it's a testament to her dedication that she was able to keep breastfeeding despite all the intervention from the hospital.
Jen took a Bradley childbirth education class, which is often helpful. However, there are a few doctors and hospitals where this is viewed with great hostility and the staff may hold it against you. The doctor she had was supportive, but she did not get that doctor for the birth. Kmom also wonders about the position the baby was in and if that affected the labor. Like many women who experienced a traumatic hospital or c/s experience, Jen plans a totally different birth next time.
Dh and I studied very hard. We read everything we could get our hands on and even some more. We were taking articles to class to share with the teacher. The classes were terrific. I really enjoyed hearing other birth stories. I couldn't wait to see what mine would turn out to be like. I was committed to a natural, drug free birth. Most of my friends thought I was insane. But I kept insisting that I was going to do it. I felt like it was best for the baby and for me. DH and I felt we had fully prepared for the birth of our first child. We took the responsibility of being parents very seriously as we learned everything we could. Our ultimate goal was to have a safe and satisfying birth, a healthy child, and a healthy nursing relationship fostered by immediate contact with mother and baby.
But I wasn't as smart as I would have liked to believe. Looking back now, I can see some major problems in my plan for a natural Bradley birth. My first problem was that I thought that because I had read and studied and knew so much that I would be in control, no matter what. My next problem was the doctor I chose. I really wanted to have a female doctor. The only one in my area had just gotten out of school. (Maybe she would have been the best choice?) And the other practice in town that all my friends went to were not only men but they belonged to my church. I couldn't go to them! So I decided to drive an hour away to see a woman doctor that I knew personally. My friend, who now lives in Oregon, was her nanny for two years. I felt like I trusted her. Besides the hospital was supposed to be one of the best. The problem with her was not really her at all, but it was the practice she was in. There were eight or nine other physicians in practice with her. So anyone could deliver my baby. How it turned out, the one doctor I never met was the one who delivered B!
DH and I wrote our birth plan and presented it to our doctor. We worked very hard on our plan and made sure that we hit all the major basics we wanted covered, being careful not to overwhelm our doctor. (This was a stupid idea we had. I now believe that a birth plan ought to be what you want it to, and if it is "too long" for your care giver to read, then you should find another care giver). I made a special appointment for DH and I to sit down with my doctor to look over our carefully designed birth plan. After presenting this to our doctor and complete discussion on every point, we felt satisfied that we were prepared for our Bradley Birth. I can remember her saying to me though, "I just hope that I am there." That should have been a clue to me that not everyone else would be so willing to let us participate in the birth of our child.
My next problem was that I was overdue. Despite every trick in the book, that baby was not ready to come out. I was eight days past my due date when my doctor decided that I should undergo several tests to see how the baby was doing. I should have canceled that appointment. My doctor decided that induction of labor was necessary due to several factors; an ultrasound found I had low amniotic fluid, my blood pressure was elevated and traces of protein were found in my urine and I had enormous swelling ankles and feet. DH and I talked it over. I had an idea that she would want to induce me and I couldn't see a way out of it at the time. I trusted her decision and besides, I really was anxious for that baby to come. It was kind of exciting. Needless to say, my birth plan was practically thrown out the window right at the start, but I was still optimistic.
The plan was for me to come in that night and start with prostaglandin on my cervix. Twelve hours later, they would start pitocin. But DH and I wanted to go home first (one hour away). We went home, ordered pizza, picked up some movies and I called some friends and my Bradley teacher to tell them what was going on. D's advice was to stay home for the night and get some sleep. There wasn't any real reason to go that night. I was tired from staying up the night before playing computer games and I should have listened to her. But . . . I was too excited. My plan was to go to the hospital and sleep there that night, get up early and walk the next day until the baby came. Boy, was I in a dream world! I should have listened to her and stayed home. But I really didn't want to call my doctor and explain, DH was hurrying me to get off the phone and I kind of wanted to go. So we went. By the time we got to the hospital, the doctor on call was irritated we had taken so long to get there. She wasn't interested in talking to us about the birth plan we were so proud of and determined to use. Her exact quote was, "You can stand on your damn head for all I care."
When we arrived in our room, the nurse had the bed, fetal monitor and IV all laid out for us. We refused the IV and allowed the E.F.M. for a little while. Then I was started with prostaglandins put on my cervix. Although I didn't realize it immediately, my contractions started within an hour or two. The nurse had explained to me that I might have some cramps. That's what I assumed they were. But they were my contractions. I didn't realize that they wouldn't feel like typical contractions. Right from the beginning the contractions started coming everyone to two minutes, sometimes right on top of each other. I felt them as pains in my lower back. I couldn't sleep and I couldn't rest. The nurse kept coming in the room to adjust the E.F.M. (which she said I HAD to have on if I was in bed). Within an hour of these contractions, I was lying in the bed and totally overwhelmed. They were taking my entire concentration to try and relax. When I was hooked up to the E.F.M., nothing was being picked up to suggest that I was having any contractions. I was starting to worry about what would happen when my "real" contractions were going to start. There was never the tightness in my abdomen, only severe back pain.
And since it was next in my doctor's plan and my labor did not seem to be progressing, the pitocin was started by seven the next morning. After awhile, I started asking for pain medications. An epidural was suggested but I said, "Oh no! I'm not having an epidural!" So I went on some more. The contractions kept coming but not registering on the monitor so my pitocin was turned up on a regular basis. I asked for pain meds again. I still refused the epidural but settled on stadol. This drug knocked me out. DH said I fell asleep immediately. I cannot remember much of anything, because I was in and out of consciousness. I couldn't tell what was real or what was a dream. It felt horrible! It was like a nightmare. The pitocin was still turned up again and again and when I couldn't sleep anymore, I tried to deal with the contractions (I'm not sure I even realized I was in labor yet).
After 16 hours of this, I was begging my husband for an epidural. I had changed my mind about the epidural when they told me I couldn't have any more stadol. DH tried hard to get me to relax and not have the epidural but I was tired and out of my mind and determined! So in came Dr. D and gave me the epidural I swore I'd never have. I can remember asking the nurse about how I compared to other women who requested epidurals. I wanted her to tell me that most women need one much sooner than I did and that I was really strong for waiting for so long. But she said, "Oh, other women usually get an epidural about the same time you did, at a three or four." I really felt bad after that. I was felt like a failure then and I feel like one now. After all my classes and education and relaxation exercises, I couldn't get any further with a natural birth than a woman who had planned on a medicated birth her entire pregnancy! Well, after I had the epidural, I dilated from three to nine. I wonder now if I was in transition or if the epidural had just helped me to relax? I wish I had a doula or my Bradley teacher there because maybe things would have gone differently.
My real doctor (not the one on call) had come by to check on me. She asked me if I minded if they could use an internal monitor. I didn't care. I was stuck in the bed, I had an IV, blood pressure cuff, oxygen mask, E.F.M. and I can't remember what else! I figured at least I'd get some equipment off of me. This was also the time when an internal pressure catheter was put in place. My husband describes the scene as very quiet as the nurses quickly stopped the pitocin when they finally saw my contractions show on the monitor (which were still in my back every one to two minutes and still had never shown up on the E.F.M.) My contractions were out of control. My husband still worries about the pitocin being turned up and up and up. He was relieved that the pitocin was stopped because he was worried about my uterus rupturing.
Once my epidural was in place, I fell asleep again. I was told to push an hour later although I had no urge. My nice nurse was finished with her shift and I then had a not so nice nurse assigned to me. DH and I were left to push the baby out by ourselves. I pushed and pushed and slept in between contractions. I wasn't working very hard. DH would watch the monitor and tell me when the contraction would start, then I would take two breaths, and push as hard as I could. DH watched the monitor and would tell me what number I reached. The next contraction, I would try to beat my previous record. About two hours later, the doctor on call came in and checked the baby's position. He was at a zero, maybe. The doctor told me that I would probably not be able to push the baby out and that I would need a cesarean. He gave us a long lecture on how he wouldn't be making any extra money and he wasn't trying to go home early. He said that he would be there all night anyway and so I could push for ten more hours if I wanted to but in his opinion, the baby was too big and would never come out. My choice was to try some more or hurry up and have the c/s because there was another lady who was going to have one and if I didn't go right away, I'd have to wait for them to finish up on her first.
Now this is where we NEEDED another support person there for us! I was in no condition to make any discussion. I didn't know what to do. DH wasn't in any better of a position. He didn't know what to do or say. He was looking to me for the answer. So, we agreed to the c/s. The biggest mistake of my life! I remember them giving me papers to sign before they prepped me and thinking that I wanted to say "Never mind, I don't want to do this," but feeling like it was already too late. The reason for the c/s was "failure to progress." One question I had before I was signing the papers was if I would be able to hold my baby right away. The nurses promised me that I would and told me that they try really hard for moms to have extra time with their babies when they are born via c/s. I felt satisfied with that answer and was feeling relieved that all of this would soon be over! Little did I know that the nightmare was just getting started!
My long awaited natural Bradley birth was not going to happen. Instead, my child was to be surgically removed from my body. I have heard women describe a c/s as an experience that is comparable to rape. I know that is a strong, intense and even insulting word of comparison but I have to agree. At least for me it seems to be comparable in the definition of the word. Maybe it is not for some women who truly need a c/s or for those women who really didn't care one way or the other. But for me, or for someone who expected a natural birth, it felt like a complete violation of my body that has left scars inside and outside of my body. I can never get rid of these scars, only learn to live with them. They will be with me for my entire life.
When someone has a c/s who did not want it, there are similarities to that of a rape in the feelings of violation, abuse and powerlessness. Just think, you are whisked away from your loved ones, drugged and paralyzed, forced to lie on a table with your gown pulled up over your breasts, exposing your naked body for everyone to see, your sexual organs are threatened and literally cut in a climate of total fear. You are afraid and helpless, left vulnerable and at the mercy of the total strangers around you, all the time wishing that it wasn't happening. Or in my case, just struggling to survive! I really hope that this is not taken offensively. I know it is an extreme analogy.
The c/s was the worst part of my labor. I was wheeled into the operation room (I remember it was very cold and there was music blasting, De Peche Mode, I think) and then I was made to scoot myself onto the table. The table was skinny and flat and hard! It was painful for me to lie on my back. I wanted them to hurry up so I could lay on my side again. Then I was so worried that they would not give me another epidural. I kept asking to make sure they knew that my previous one was wearing off. They hooked me up and my lower body went completely numb. My legs felt heavy and hot. My arms were not strapped down like a lot of hospitals routinely do. They were laid on little platforms and I had my IV and blood pressure cuffs in place. DH finally came in with his sterile scrubs on. Now I just laid there and waited.
When the anesthesiologist told my husband to announce the sex of our baby, I was so happy because I thought it was almost over. DH told me the baby was a boy. I was trying to see the baby but they didn't hold him up for me. I must have been losing blood or something because I felt like I was going to pass out. I felt horrible! I had to keep my eyes closed and concentrate on staying awake. I kept saying that I was going to pass out but nobody said anything to reassure me. I didn't hear the baby cry but I didn't worry. I guess I couldn't because I was busy concentrating on staying awake. Finally he cried and DH brought him over to me. I could only open one eye and peak at him. I said "Hi B.." I knew that DH was taking pictures and I could see them later. Then DH and the baby left. I was alone or at least without any one person I felt like I could really trust.
There must have been a nurse with my name because when the other doctors were giving her instructions, I couldn't understand what they were saying, I only heard my name. I kept saying "What? I don't know what you are saying to me. Huh?" It was awful to feel that way. What makes me mad now is that nobody in that room tried to treat me with any respect or dignity! They completely ignored my comments and failed to help relieve me of distress and confusion! I was still very uncomfortable and just wishing that they would hurry. Then I started to shake. I had no control over it. I was also freezing. But all my complaints and worries went unanswered. It was as if I was not there or like I was just a piece of meat lying the table and nobody cared or even wanted to listen to me. Then as they were finishing up, I felt horrible cramping. I don't know what it was exactly or how to explain it but with everything else, I couldn't handle it anymore. I started to cry and yell at them to leave me alone! I told them I was finished and to let me go! They said that they were almost finished and that I could get on the gurney and go to recovery soon. I thought that I was going to be made to lift myself off the operating table myself. This made me more hysterical. "I can't get off the table. I can't!" But they told me, "You have to, there is no choice" It was terrible! I was so upset! The anesthesiologist at my head wiped some of my tears away and finally told the nurses "That is enough." I think they were pushing on my very tender and sore, newly stapled stomach. I also believe that they might have been pushing a little bit more than necessary because they didn't like me, but that could all be in my head.
As I was being wheeled into recovery (they did lift me onto the gurney) I was finally given a blanket to help me get warm. In recovery, I was still hysterical. I think my blood pressure was extremely high and my pulse was like 200! (That was a number I saw anyway). I was still on my back but I was paralyzed and couldn't roll over no matter how much I wanted to. I cried and cried and finally asked for my husband. The nurse told me to stop my crying and that she was not going to get him unless I stopped. She said that he had been crying too and that she couldn't have both of us crying in there. This made me feel better as you could have guessed! Thankfully, DH came on his own to see me. He had tried earlier but they wouldn't let him in the OR again. Once he was with me, the nurse changed her attitude and was nice to us.
I must have had been in the recovery room for over an hour. I remember begging to leave. I feel so guilty for not asking for my baby but honestly, I can't remember even thinking about asking for him then. I guess I had all of my energy concentrated on myself right then. But now that I know what my baby was going through, I am kicking myself for not remembering to have the nurses bring him to me. We went to my own room and I had to scoot myself onto my bed. That was HARD. But once I was in my own bed, it was the most comfortable bed I had ever been in! The nurses were getting me settled and DH went to get B. When they brought him to me, it was like, "Oh yeah, I had a baby!" I felt so relieved then. I held B and I just wanted to take off all of his clothes and look at him! DH said, "Why don't you nurse him?". And I was like "Oh yeah, I wanted to do that." So I tried. It was a little awkward at first but B did beautifully. Our first time nursing went well considering that it seemed to be filled with interruptions. I had nurses coming in and out, DH was trying to gather our things from the labor room, and our family was calling us like crazy!
Then one particular nurse came in (she was specifically assigned to B, I think). She was upset that I was trying to nurse him. She was trying to tell me that he had very low blood sugar levels (due to stress during delivery) and that my nursing him would mess up the test levels. I was very confused and I didn't know what she was talking about. She said that B had a very stressful beginning because he wasn't breathing on his own for the first two minutes after delivery. I didn't know that! I looked at DH but he was quiet. We hadn't even been together long enough to catch up on what had happened. So I asked the nurse to explain to me more of what happened.
When B, he was not breathing. They bagged him for about two minutes and were about to put him on a respirator when he finally started breathing on his own. This must have had been why they took him to the nursery instead of leaving him with me as they had promised. And then he had low blood sugar, and to add disappointment on top of disappointment, he had been given a bottle of formula while I was in recovery to bring up his sugar levels. DH hadn't had a chance to tell me any of this yet but while I was in recovery, he saw all of this happening and he was banging on the glass, begging them to bring the baby to me. They obviously didn't listen. They were so intent on him having that formula that he was fitted with a NG tube to force the formula because he was throwing it up.
So when I finally was able to see B, he was on their schedule of formula feedings in an attempt to bring his blood levels back to normal. I didn't know anything about it so I agreed to let him have a bottle. I was allowed to nurse for 15 more minutes and then it would be time for a bottle. I tried to feed him the formula, but he kept spitting it up. The nurse came back and took him away to the nursery, promising to bring him back when he needed to eat next.
I woke up the next morning without ever seeing my baby. And when they brought him to me, he had another NG tube in place (due to throwing up the formula). They told me that if his blood sugar didn't go up within so many hours that he would have an IV. I asked if I would be able to try and nurse and the answer I got was, only if the baby REALLY wanted to. I nursed anyway.
All of this made me so mad! Especially after the lactation consultant visited me later that day. She seemed confused as to why they didn't let me try to bring his levels up with my colostrum. I wasn't allowed to try; I was actually discouraged from nursing at all! The next time I have a baby (and if I can help it, it will not be in a hospital) things will be different!
Update: Jen S. had a VBAC with her next baby, and a much more empowering birth. This story is in the BBW VBAC Stories section.
Meleah's Story (white-coat high BP, induction, epidural, vaginal birth)
Kmom Notes: Restricting salt has not been shown to improve blood pressure in pregnancy (except in a very few salt-sensitive individuals and those with kidney disease). Many midwives feel restricting salt actually worsens blood pressure and the risk for pre-eclampsia.
My husband is in the military, and we found out I was pregnant (much to our delight) while we were overseas. After some difficulty being able to acquire care, I was finally able to be seen at a military facility on base, which is where I received most of my prenatal care, though it was the second obstetrician I'd seen (my first OB was only seen one time, and was a civilian provider off base... an interesting experience in and of itself.) While we were overseas, this particular provider only casually mentioned my weight in the context of only needing to gain 10 to 15 pounds, but never made it an issue. My appointments were always normal, other than BP spikes that corrected themselves (I have big-time white coat syndrome) until we left to come back to the U.S., 6 months into the pregnancy.
My third provider was only temporary, as we spent some time with family after returning before we had to move again. I saw him for approximately a month and a half. He never overtly made my weight an issue, but he seemed to be quite alarmist. I have always had 'white coat hypertension' and get very nervous around doctors, and particularly so in his case. I kept track of my BP on my own at home, but it would always skyrocket during visits, prompting him to send me to the hospital for labwork and a non stress test. My BP was normal as soon as I got to the hospital and the labs and non stress tests were always normal, and the doctor would reschedule me for another appointment the following week as a result, at which time the whole process would start again. This repeated weekly until we moved.
My fourth provider was the one who delivered my son, and was even more alarmist than the previous one, and very interventive. I started seeing her at around 8 months. Her attitude seemed to be that I was high-risk and needed more interventive care. I went through the same cycle of BP spikes and normal labs and non-stress tests as with the previous provider. Even though my blood pressure always normalized and I never had any symptoms of pre-eclampsia (no headaches, vision problems, abdominal pain, edema, etc.) or even protein in my urine, she essentially assumed that I had PIH and Pre-eclampsia anyway. She put me on Labetalol for my blood pressure and told me to stay on home bed rest and reduce my salt intake.
A little over two weeks before my due date, I went in for what would be my final OB exam. They estimated the weight of the baby at 8 lbs. 5 oz., and then told me that if he got any bigger, I "may not be able to have him naturally." She then stripped my membranes (and told me AFTERWARD), made an appointment at the hospital for me to be induced (and told me AFTERWARD) and said I would be induced in four days, "if I made it that long." I was shocked and felt rather violated and "out of the loop," so to speak. It seemed from that point on that I didn't have any control over my son's birth at all, on top of her instilling the fear of not being able to push my son out and the worry caused by all the non-stress tests and the blood pressure situation. What should have been an exciting and wonderful time, two young soon-to-be parents spending their last few days together as just a couple anticipating the arrival of their first baby, was instead full of anxiety.
My induction started at 12:30 pm, two weeks and one day before my due date. I was already 2 cm and effaced, so I didn't need cervidil. We went in and my OB immediately broke my water, put in internal monitors (my son still has a scar on his scalp from it), put in my IV with pitocin and, I assumed, administered antibiotics for my GBS. From that point on, I was confined to the bed and only able to get up to go to the bathroom, which had to be nurse-assisted.
My contractions were strong but manageable for a few hours, and then quickly progressed to being off the charts with several peaks and no break in between. I got my epidural (which I had been hoping to avoid) after about ten hours. The epidural worked for about an hour, allowing me to get some much needed rest, but then stopped working properly. It did nothing after that other than make my right leg painfully numb.
After about 15 total hours of laboring, I was fully dilated and feeling the urge to push. It took about 45 minutes of pushing to deliver my son, with my OB using a vacuum very briefly at the end. (To this day, I'm not sure why she did this... I don't remember any circumstances necessitating a vacuum delivery.) I ended up with a fourth-degree tear, much of which I attribute to the vacuum pulling my son out faster than my body was able to cope with.
My son was born at 8 lbs 9 oz and 22 in, exactly two weeks before his due date. As they whisked him off to be cleaned up, I learned that my doctor and nurses had FORGOTTEN to administer the antibiotics for my Group B Strep. Luckily, it didn't cause any problems for my son, and we were both just fine, aside from the relatively painful recovery from my tear.
All of that aside, I had a comfortable pregnancy. I had only moderate morning sickness in the beginning, and though I gained a lot of weight, I remained pretty comfortable throughout. I did not experience a lot of the aches and pains that I hear so many other moms experience, and I was actually LESS moody while I was pregnant... go figure!
My son is now nearly 9 months old and doing great, and I have lost all of my pregnancy weight. My husband and I are considering having another baby soon, and having made ourselves much more aware of our options, we will definitely be looking to have a midwife attend the pregnancy and birth rather than an obstetrician, circumstances permitting.
Paula's Story (gd, severe pre-eclampsia, induced premature vaginal birth)
Kmom's Notes: Paula's first pregnancy was complicated by primary hypertension, which she was on medication for. Primary hypertension can often become worse in pregnancy, becoming pre-eclampsia despite medications. This is what happened to Paula. In addition, she developed gestational diabetes (diet-controlled) at about 18-20 weeks. Had her pre-eclampsia not worsened, she would have been induced at 38 weeks because of the gd and blood pressure concerns combined. As it was, when her pre-eclampsia worsened, they elected to induce at 36 weeks instead. Induction probably succeeded so early because she was already partially effaced and dilated before they began, although they did nothing to ripen the cervix ahead of time.
Between pregnancies she developed overt diabetes. Because her PCO is very significant, she and her doctor elected to have her take Metformin (Glucophage, 2000 mg per day) throughout her second pregnancy (but not for nursing). Although her blood pressure remained a concern (and she was "maxed out" on 3 blood pressure medications through the pregnancy to keep it under control), she did not redevelop pre-eclampsia in the second pregnancy, which she credits to the Metformin. They did add insulin during the pregnancy later on. Paula was induced at 38+ weeks because of the type II diabetes. She felt she had a terrific doctor for her pregnancies, very size-friendly. Not all of the doctors in the pregnancy were as size-friendly, but her primary doctor was "GREAT".
Baby #1: I was induced 4 weeks early due to severe pre-eclampsia. I was given magnesium sulfate and pitocin at 6pm on Thursday. I was already 80% effaced, and 2cm dilated. By 6am Friday I was 100% effaced, and dilated to 3-4 cm. The broke my water and I began having contractions with in an hour. I dilated quickly to 10cm by 9:30am and delivered vaginally at 12:03 pm. Labor in all was about 6 hours. I only required one internal stitch for a small internal tear.
I did learn through this whole process to listen to my body. The labor nurse was trying to get me to push differently then what my body was telling me. She wanted 3 shorter pushes when my body wanted 2 long ones. When I finally listened to my body I delivered very quickly. After discussing this with my OB I did what my body told me and had much better pushes then what I had been having.
I did have some problems breastfeeding at first due to the fact that she was 4 weeks early and didn't want to latch on very well. She had been tube fed, finger fed, and cup fed and like the 'instant gratification' that provided, versus having to 'work' for her food. [But nursing did work out in the long run, despite the slow start and the severe PCO.]
Baby #2: Our second child was conceived through an injectable cycle. I was 410 when I conceived this child. [I was on Metformin before the pregnancy and remained on it for pregnancy.] My OB had actually read up on the use of Metformin in pregnancy and was going to suggest it to me if I wasn't already on it. I had approached him before my first appointment because both my RE (Reproductive Endocrinologist) and Endocrinologist wanted me to stop UNLESS my OB agreed to let me take it.
There are so many benefits to taking Metformin during pregnancy, and I really wanted to avoid the pre-eclampsia that I had with my first pregnancy. I also did not want to risk going off of Metformin because of the dramatic decrease in miscarriage rate while on it. The fact that there are no known deformities or problems while taking Metformin in pregnancy made me feel comfortable enough to take it. I know some doctors will not give Met in pregnancy because they are uncomfortable with the fact that no US studies have been done, but all of the information coming from other countries seems to indicate that it is safe.
[I was induced at 38+ weeks, due to the diabetes.] I arrived at the hospital at 1 p.m. and began the paperwork and all. The IV was started around 3 p.m. with Pit; I didn't need any prostaglandin gel because I was already 2 cm and 50% effaced, baby at -1 station. The Pitocin was started; they increased it every 30 minutes.
Around 6 p.m. I began having contractions about every 2.5-3 minutes. They were tolerable and I could breathe through them easily enough. We were waiting for the doctor who was supposed to show up around 5 p.m. for AROM (breaking the waters). Finally around 7:30 p.m. he arrived and ruptured my membranes, the contractions slowly began to get worse, and the baby was doing okay. Around 8:40 p.m. we had a scary deceleration where her heart rate dropped from the 140s to 75 with internal monitoring so we knew it was an actual drop. The intern came rushing in to do 'fetal scalp stimulation' which brought her heart rate back up. I then was told I had to lay on my side and that seemed to keep her heart rate up.
The contractions while on my side were getting pretty uncomfortable and combined with the drop in heart rate I decided to get the epidural. The funny thing is that while sitting (for almost an hour) to get the epidural I couldn't feel the contractions at all, and even had to look at the paper to see if I was still having them. Talk about positioning making all the difference.
Once back on my side I could feel the contractions again until the epidural took full effect. About 10:30 p.m. I felt like I had to urinate with every contraction, but that was all I was feeling. I figured it was just the pressure form the contraction. Finally at 1 a.m. I asked the doctor to check me. My bladder was so full he couldn't feel the baby. I was straight cathed (catheter) and checked and was 7 cm. About 10 minutes later I felt like I had to push. [Kmom note: A full bladder can impede labor progress! It's important to pee every hour or so in labor.]
I waited 2-3 more contractions and decided it was time to call the nurse. My nurse was gone to lunch and another nurse (who waited another 3-4 contractions before coming to the room) told me I was only 7 cm 20 minutes ago, and I really didn't have to push; that the epidural should be working fine and I should be able to get through the contractions without any problem. I told her my last one went from 5 cm to 10 cm in 45 minutes and I felt like I had to push. The stupid woman still wasn't going to check me. I insisted and she reluctantly checked me. I was at 10 cm and it was time to push.
The doctor got to the room and got the stirrups up. I began pushing and he was going to check to see where the baby was. He asked how long it took last time; I said 1.5 hours of pushing. He commented it wasn't going to take as long this time. I could feel her head almost crowning at this point, then with the next push she was crowning and out. I pushed for a total of maybe 5 minutes, and out she came. So much for not having to push. Her apgars were 8/9 and we got to nurse her right away. It was such a different experience from my first.
Apparently I am 'wired' a little differently than most and with an epidural I am mostly numb except for the vaginal canal and perineal area (my epidural last time did not work completely properly either). I didn't realize this was any different from 'normal' until they went to put in a stitch (I needed 2). I could feel the needle and began in with "OWIE OWIE", and the doctor asked, "You can feel that?" I told him I couldn't feel my toes but I could feel that. So with one stitch left, they just put it in without any numbing agent (with my permission). I figured I would get stuck once with a stitch or once that I would feel with the Novocain and either way I was going to feel it.
I know that one of my BIGGEST concerns [before my pregnancies about my size] was that the monitoring belts would not fit around me. Not only did they fit, but the contraction monitor actually worked! I know they used an internal monitor last time as soon as possible because they did have a hard time finding a heartbeat without my laying in a very uncomfortable position and then holding the monitor there. I just figured that if they didn't get the heart rate all the time it was really no big deal, that the fading in and out (which includes the rate dropping sometimes because of the monitor) was just because I was moving or the baby was moving. With my second I just assumed the same thing until they got the internal monitor on.
My doctor is GREAT! [Very size-friendly.] I wish I could say that for all of the doctors in the practice. I had one who complained every time that she saw me because they told her to measure me. She didn't understand why they even bothered to measure me because I was so "off the charts". I may have been off the charts, but I did grow according to the curve they use, so it was useful in following the growth of the baby. I can't think of anything differently my doctor did with me that he doesn't do with every other woman. I did see him more frequently, but that was due to the type II diabetes and insulin monitoring than anything.
I am nursing; it's the only way to go for me!! I always tell everyone I am too lazy to bottle-feed; there is too much work involved. [I stopped the Metformin for nursing.] I would LOVE to be back on the Metformin, but my doctors are not comfortable with women taking it while breastfeeding. I know there is the same issue in pregnancy, but I can actually find information on Met in pregnancy but I can't find any on Met and nursing. I did realize the other day that I was on Met while I was breastfeeding #1, but she was almost 2 years old and I was in the process of weaning her. I think once this one is eating more solid foods, I will start the Metformin again even though I will still be breastfeeding.
Denice's Story (mildly elevated b/p, vaginal birth)
Kmom's Notes: Just being large should not qualify you for a 'high-risk' label. Although large women have somewhat increased rates of pre-eclampsia (high b/p) and gestational diabetes, the vast majority still do not develop these problems and no doctor should assume that you will have problems with them simply because of your size. It's smart to be aware of the possibility and be proactive about it, but be careful about doctors creating self-fulfilling prophecies.
My story is pretty simple. After one year of trying, my husband and I conceived our daughter. I weighed 300 lbs. and was a little concerned. My doctor was great and really never mentioned my weight. She did list me as high-risk and was sure that I would have blood pressure and gd problems.
Everything went smoothly until the last week when my blood pressure was elevated a little and she sent me home from work to rest. One week later my water broke in the morning and 14 hours later my daughter was born. The staff at the hospital treated me well and I never heard anyone mention my weight. The only thing at the hospital that didn't fit well was the gown and the "one size fits all" panties they give you after birth.
I had an epidural after 8 hours of labor and that went pretty smoothly. The doctor had some trouble getting the needle positioned correctly, but it didn't have anything to do with my size. I had to push for almost two hours but that is not unusual for a first-time mother. It probably would have gone faster if the nurse had asked about my flexibility earlier. (Even at my size my knees can go back to my ears!) Once I changed positions she came out in under 30 minutes. She was born perfectly healthy and scored 9s on her apgars. We did have to admit her back to the hospital two days after she was released for jaundice and dehydration because my milk took some time to come in.
GAMom's Story (high blood pressure, PROM, transverse malposition, c/s)
Kmom's Notes: This mom has not been evaluated for either PCOS or thrombophilia but may have some autoimmune problems affecting her fertility; test results have been contradictory. Progesterone supplements in the beginning of pregnancy seem to have helped this pregnancy continue. She also took low-dose aspirin for part of the pregnancy.
In a follow-up question, she noted that the hospital did not tell her to have her staples out at 3-4 days; she waited until her 2 week postpartum checkup to have them out! Ouch.
My husband and I had 3 miscarriages (all between 8-10 weeks). We really
wanted a baby. My OB-GYN was great. He immediately put me on progesterone suppositories due to prior miscarriages. We had our first ultrasound at 7
weeks. You could see the sac and heart forming. Our next ultrasound was at 15 weeks and you could see the babies heart beat. I was SOOO relieved. My
husband was great. I still didn't want to get all my hopes up. We got pregnant when we weren't supposed to. It had only been 2.5 months since our
last miscarriage and the doc wanted to run some tests. Oops! :-) We had our first round of tests and it came back with levels increased. Our doctor
informed us that it was probably just a false positive but sent us to a perinatologist anyway. We saw him once a month for quite a few months. Boy,
do we have great ultrasound pictures. Our baby girl developed quite
over the time. All measurements were great and on target. Two amnios were attempted but the needle wasn't long enough. And MAN, did they hurt!!!! They monitored closely and took precise measurements to ensure the baby was okay.
We were finally released from him and seeing our doc every two weeks.
Everything was fine. Our baby had been head down since January at every visit. My blood pressure starting to rise a little to about 140/80 and
150/90 toward the 33 week. My doc put me on bed rest and then it soared higher. He released me back to work and it was fine. At the next visit it
was a little higher ( I was seeing him every week now) and it put me on home rest, not bed rest. It did much better. I went out to dinner with my
husband on Friday night and that night my water broke. It was just leaking and I really couldn't tell much difference between that and going to the
bathroom a good bit. By morning around 8,, we called the doctor and he sent us to the hospital. My water had definitely broke.
Because it had been broken for a while they wanted me on bed rest there. They hooked me up to all
the monitors and the baby was fine, but I was not in labor. they did and ultrasound and she had turned transverse. All things considered, we opted
for the c-section. The epidural was easy and I was awake for the entire thing. My beautiful baby girl was born that night at 8 thirty. She was
healthy w/ apgars of 8/9. She roomed in w/ us for Sunday and Monday. Monday night I put her in the nursery because we were going home on Tuesday. She
choked on them (they fed her a bottle!) and turned blue. As upset as I was, it ended up being good because she needed oxygen. Her O2 levels were in
the mid 80's. They put her in NICU and gave her antibiotics, oxygen, and
lots of tests. She also had to go under the bili lights after that test came back. I was in there as much as they would allow. She nursed well, but I never did have milk that came in. She got a lot of colostrum though.
Within three days she went to the intermediate nursery on an apnea monitor and
oxygen. they couldn't wean her off the oxygen and she had a few apnea episodes. After it was finalized that her lungs just weren't completely
developed because of her prematurity and high birth weight for her prematurity, we PITCHED a big fit. To make a long story short, she came home on oxygen
and has been great ever since. She is now 8.5 months old and still on the monitor, but no oxygen since 1 1/2 months. She now weights 20 pounds, 29 inches tall and is a very HEALTHY baby girl.
I wish all the supersize moms had as great a doctor and experience as we did.
Michele's Story (triplets!, classical c/s)
Kmom's Notes: These triplets were not conceived with fertility drugs. With higher-order multiples, a classical (up-down) incision is often used.
My husband and I had just gotten married when I found out I was pregnant a month later. Around Christmas time I started bleeding and called my OB's office. I hadn't seen the OB yet because he likes for his patients to be at least 10 weeks at the first office visit. When I called the OB's office he had me come in for an ultrasound. I was given a vaginal ultrasound since I was only about 8 weeks pregnant. I thought I was having a miscarriage so imagine my surprise when the u/s tech asked me if I was taking fertility drugs! I told her no, I was not, why do you ask? To which she answered, well, you are having triplets!
My first reaction was to cry (from relief that I wasn't having a miscarriage and from shock). The tech went and got my husband who came in and saw me crying and assumed the worst. After he was told our "baby" was in fact 3 babies, he screamed, "WHAT!!!!", loud enough for everyone in the waiting area to hear! The tech informed the doctor what she had seen on the u/s and we were ushered into his office for the standard speech on what could happen, such as we could lose one or all of the babies, complications, etc. I was sent home on 2 weeks bedrest with bathroom privileges only. By the end of the 2 weeks the bleeding had stopped (it was caused by me helping my husband lift the 100 lb. headboard onto our waterbed which caused a small tear in the lining of my uterus).
I worked until 20 weeks of pregnancy. I wasn't ever put on bedrest again, but my OB did advise me to take it very easy. Basically, all I did for the rest of the pregnancy was take my husband to work each morning, come home, eat, go to bed for more sleep, eat lunch, rest again, pick my husband up, eat again, and go back to bed! On weekends I went to garage sales with my mom to stock up for our soon to be larger family. I had about 15 u/s/ during my pregnancy, non-stress tests done 3x a week during the last month (during all of these I have 1 contraction), and developed pre-eclampsia. I was so swollen I couldn't wear any shoes except for velcro strap flip-flops. They would varely fasten and 2 weeks after the girls were born you could still see strap marks on my ankles!
At 34 weeks I developed a cold and couldn't sleep laying down. I tried to sleep reclining on the couch for 3 days, but that didn't work so I finally went in to the hospital ER on Saturday. I was admitted to L/D because of the protein in my urine, where they did a 24 hour urine catch. After the urine was analyzed the doctors decided to deliver my girls. My OB, the Pediatrician, and the neonatologists who were going to be there were all out of town for the 4th of July. My OB's partner, plus another OB who offered to assist, the Ped's partner, and the neonatologist's partner all were there for my delivery.
I was given an epidural and then I was taken into the OR at about 9:30 and the girls were born at 10:03, 10:04, and 10:05 a.m. I experienced a window from the epidural where I could feel it when they clamped back my bladder so as soon as all the girls were born I was given Demerol by IV. Within 2 hours of their birth the nurses got me up and took me to see my babies. I did have a spinal headache caused by the epidural, which the nurses diagnosed. I was given a blood patch to clear that up (a blood patch is when they draw blood from your arm and inject it into the back to clot the hole that was punctured in the spinal column from the epidural, which causes spinal fluid to leak, causing a spinal headache).
I was in the hospital for a total of 6 days. Two of my babies came home after 2 weeks and the third came home after 3 weeks. All three were very healthy and only needed to learn to suck and gain weight. That's my story and I'm currently pregnant with child #4 (just one this time!).
Gina Marie's Story (pre-eclampsia, induction, fat-phobic doctor, classical c/s)
Kmom's Notes: Gina Marie was induced at 37 weeks because they suspected a 'big baby'; between 8.5 and 9.5 lbs. at 37 weeks by ultrasound. Because her baby was in the wrong position her labor stalled and she had a c/s. Her consulting OB chose to use a classical incision for the operation and was very insulting about her size; her c/s and recovery were a horror story.
In most cases, ultrasounds are very inaccurate for measuring 'large' babies near term, although in this case it was accurate. Inducing early for macrosomia (big baby) is clearly shown in research to INCREASE the rate of c/s without improving outcome at all, and anecdotally, many large women's c-sections are probably caused by this common practice of inducing early. However, Gina Marie's case is complicated by her blood pressure and edema at the end of pregnancy, and the size of her baby at 37 weeks made the decision more complicated. In most cases, inducing early for 'big baby' is clearly shown to worsen outcomes, but occasionally in selected cases can be helpful.
However, her midwives did little to prepare her cervix for induction, making an induction less likely to succeed, and the induction at 37 weeks resulted in fetal distress for her baby after it was born. Also, her baby was malpositioned, which is probably why labor did not progress. It is a difficult question whether the decision to induce helped or hurt her chances at a normal birth experience. Waiting even one more week might have helped her body and her baby to be more ready, yet the concern over blood pressure and edema was a real one.
Regardless, insult was added to injury when she encountered a very fat-phobic surgeon who was very unkind and discriminatory, and did a 'classical' up-down incision unnecessarily on her. Most very large women can still have a low-transverse (side-to-side or 'bikini') incision with careful management, or they can have an up-down or slightly higher side-to-side skin incision and a low side-to-side uterine incision. The reason given for a classical incision on very large women is to prevent infection in the moisture-prone area underneath the fat fold ("apron"), yet it should be noted that this classical incision infected badly---using a different incision didn't help! It is Kmom's anecdotal observation that the large women she has seen with classical "up-down" incisions have tended to have more problems than those with the "bikini" incisions. Regardless, nursing techniques (using a cool blowdryer on the incision, plus extremely strong antibiotics for very large women) can often help avoid many cases of infection in transverse incisions, making these practical even for large women. The decision to do a classical incision on Gina Marie was dubious at best.
Furthermore, the OB pressured her strongly while in labor (which is improper) to have her tubes tied in order to prevent her from having any more children. This is unethical and unprofessional, and much of her poor treatment after that may have been from the OBs attempting to punish her when she refused to have her tubes tied. She was later told that the classical incision would make it too dangerous to attempt to have another pregnancy at all, so one wonders if the doctor tried to prevent her from having more children by using this incision and accompanying scare tactics. [By the way, it's not true that a classical incision precludes subsequent pregnancy at all. It does raise the risk of rupture somewhat and most doctors will not permit the woman to try for vaginal birth subsequently, but it does not prevent you from having more kids. Many women (including some large women--see other stories) have had subsequent kids after a classical incision. This was pure scare tactics to frighten her out of having more kids.]
Gina Marie wanted to share her difficult story so that other large women can be aware of some common pitfalls to watch out for. She says, "I didn't have a good, normal birth story. In fact, my son's birth was absolutely horrible. However, there are some important things that I learned afterwards that I think large women need to know and need to be on the lookout for, and they will be evident by the end of my story."
Before I went to the hospital, I had this idea of what childbirth would be like, and it definitely did not include the experiences that I have had. There is a happy ending---I am alive, in possession of all of my faculties, and I have a gorgeous healthy baby boy. But I went through hell to bring him into this world.
I started out with the local midwifery practice (five midwives) for a lot of reasons. Number one, they seemed to be the most size-accepting. Number two, they were the least expensive. Number three, they were the only all-female practice, although I learned during the birth that female doctor does not necessarily mean understanding, sympathetic doctor. During labor, I was transferred to their backup OB practice. This practice consisted of eight doctors, only two of whom have a decent bedside manner.
I had an easy pregnancy for 8 months, except for the heartburn and the initial nausea. I had no real problems until the last month or so. I gained about 6 lbs. during the entire pregnancy. I ate right and exercised and really made an effort to take care of myself. Then, in my last month, I got really bad edema in my feet and legs, so severe that I was put on bedrest for two weeks. My blood pressure started spiking occasionally---not to the dangerous imminent stroke level, but enough to be worrisome. The highest reading I remember was 150/100. I felt like a sausage. I could wear one pair of shoes---my cross trainers---and only if I put them on first thing in the morning.
At 37 weeks I had an ultrasound to determine the baby's size and position, because it was difficult for the midwife to tell through my big belly. The ultrasound technician determined that my baby was between 8.5 and 9.5 pounds. The midwives consulted with their backup OBs, and they informed me that they felt it was in my best interest to have an induced labor---that I had a lesser chance of a c/s if they induced then. They were concerned that the baby would grow too large if I was pregnant for another three weeks. I went into the hospital on a Wednesday morning, and the midwives induced labor with Cervidil [Kmom note: a prostaglandin insert]. They applied Cervidil to my closed, hard cervix around 1 p.m. and I was in active labor by 7 p.m. My water broke around 11 p.m.
Sometime the next morning, they gave me a pitocin drip. I asked for and got narcotic painkillers. Finding veins has always been an ordeal for me, and it took three different phlebotomists about 10 sticks to get an IV started. I had 3 possibles, and the veins blew. I eventually dilated to 7 cm and stopped. Because of the problems with the IVs, the put in a central line on Thursday night when I was having heavy active labor. A central line is an IV in the jugular vein. It was really traumatic. I had to have a plastic sheet over my face while they were inserting it so that the area around my jugular would be sterile, and I had to lie flat on my back, which is terribly uncomfortable for a woman in labor. So, I was on my back, I felt like I was suffocating, and I was having contractions every minute or so. I could feel myself slipping out of reality. This was the worst physical sensation of all of it.
They decided at this time that the pitocin had done all it was going to do, so they took me off of the drip. They determined that if I didn't deliver on my own by morning, it would be the best course of action to give me a c/s. They thought it would be best if I could be sectioned with only an epidural, but after inserting the damn thing right after putting in the central line, they determined I could not breathe adequately while laying flat on my back for the epidural to be effective during surgery. Still I had the epidural and the accompanying fluids all night Thursday night. Friday morning, I still had not dilated past 7 cm, even though I had been contracting every minute or so for 24 hours. I think that the epidural slowed the labor further, and it didn't really do much for the pain. The fluids that accompany the epidural to keep the blood pressure from dropping inflated my feet and legs like the Michelin tire man. By morning, I could not lift my legs.
Kmom note: One of the known risks of pitocin is to increase swelling and retention of fluids. The fluids necessary with an epidural often tend to cause significant swelling in a woman who has undergone a long induction with pitocin. This (in addition to her previous swelling) made for a severe problem.
The OB came in and told me that she felt a c/s was warranted because my contractions were of sufficient power and duration that I should have pushed out the baby if he were able to come. His heartbeat had not wavered on the fetal monitor, but he had also not moved beyond a -2 station. I think what happened is that instead of facing forward or facing the rear, he was facing my left, and his shoulders were hung up on my pelvis. I could feel his little behind right below my ribcage all the way through labor. He never dropped down.
Kmom note: A malpositioned baby could certainly have caused many of the problems she encountered---stuck at 7 cm, a high and unengaged baby that would not move down, little progress despite painful and strong contractions, etc. And being stuck in bed due to the induction meant that she could not employ other methods of turning the baby, such as position changes, etc. This is one of the potential problems with induction.
This OB was the meanest, most evil bitch I have ever met. Even though I had shopped around and shopped around for pregnancy care that was not fat-phobic and would take into account only the facts of my health and not assumptions, the OBs backing up the midwives were not nearly as enlightened as the midwives were. So when she came in to discuss my surgery, the OB sat down and asked me if I wanted my tubes tied while she was in there. I was shocked and told her no, that this was my first child, and I didn't want to make decisions like that at the moment. And she countered with a speech that boiled down to "you are too fat to have any more children, you shouldn't even be having this one, and if I had anything to do with it, you wouldn't be." Then she discussed general anesthesia, and the dangers. Granted, fat people do sometimes have problems with general anesthesia. However, it was a little heavy-handed for her to instruct me to discuss funeral arrangements with my husband before I went into surgery. She asked me if I was an organ donor, and then said it didn't really matter. (I don't know what the hell this was supposed to mean. I guess she was implying that my organs were probably not acceptable or something.)
Kmom note: It is unethical to pressure a woman to have her tubes tied while in labor. In fact, in many places it is forbidden, deemed a decision made under duress. It was *extremely* inappropriate for this OB to be pushing this decision just because of the mother's size, and especially unethical to do it while she was in labor. However, OBs have had a history of doing this to women they don't approve of having children, from welfare mothers to minority women, etc. This is supposed to be totally unacceptable now, but it is still done to some women (including fat ones) at times. The other remarks and treatment she received were extremely unprofessional. This may have been a case of the doctors 'punishing' her for not going along with them.
I was given the prognosis of 'guarded'. It was my impression that she had never dealt with a patient my size before and that she didn't like fat people to begin with. I was scheduled for a c/s for 11 a.m. on Friday. Despite being a scheduled section, the OB chose to make a high vertical incision---a "classic" c/s incision----because she was not sure about operating under my belly "apron". This kind of incision precludes a VBAC. Later I learned that a bikini incision could have been done if I'd had a more experienced doctor [i.e., more experienced with fat women]. Part of me still feels like she did this kind of incision to punish me for being such a fat pig.
Kmom note: Even very large women can usually have a bikini cut or a modified version thereof. Only rarely is a classical incision necessary, but some doctors persist in using a classical incision on fat women anyhow. The concern is for infection, but with proper nursing techniques and special attention to prevention, infection can usually be avoided even in very large women, as noted.
My legs were so swollen from the epidural fluid and the previous edema that they were worried about blood clots in my legs. They wrapped up my feet and legs in ace bandages up to my thighs. They wheeled me down to the prep area for the Operating Room and the team of anesthetists gave me an arterial line (yet another big traumatic stick). My husband was there while they were prepping me for surgery, but the poor guy was as overwhelmed by the fatigue of being awake so long and the shock of the guarded prognosis and the business about funeral plans. He was sobbing loudly and disturbing the doctors. A nurse led him away.
I could hear my baby's heartbeat on the fetal monitor until they took it out a couple of minutes before they wheeled me into the operating room. He was strong and steady and never wavered, and I was grateful for that. I was halfway convinced that I was going to die. I remember thinking that it would be all right as long as my baby was OK. While they were strapping me down for the surgery, the 15 or so people in the room introduced themselves to me. The pediatrician and her staff came over and I told them to be sure and take care of my baby, no matter what happened to me. The nurses swabbed my belly with betadine and put the anesthesia mask over my face and I went out.
When I woke up there was a greenish light over my head and people were calling my name and telling me not to cough while they removed my ventilator tube. I don't even know how long I was in surgery. I found out later that I lost 2 liters of blood during the surgery. I have a 12 inch incision down the middle of my belly, starting about 4" above and 1/2" to the left of my navel and running parallel to it. The first time I saw the stitches, I thought they had sewn my navel shut. They told me later that they were prepared to keep me on the ventilator for 12 hours after the surgery, but I was up in the operating room on the first attempt at waking me. Basically, I handled the anesthesia like a normal person would, despite their dire predictions. As soon as they took me to the recovery room, they told me that my beautiful son was born at 12:27 p.m. and that he weighed 9 lbs, 7.3 oz.,, was 21.5 inches long, and had apgars of 8 and 9 and a full head of blond hair. We named him Jacob Baruch after two of his great-grandfathers. Baruch means Blessing in Hebrew, and he is a blessing in my life.
They took me to the ICU. I couldn't see my baby for 24 hours because he was in NICU (Neonatal Intensive Care Unit). He was born in respiratory distress because of the narcotics, and he was also getting antibiotics because my water had been broken for so long. Late on Saturday afternoon, the neonatal nursing staff bent rules and rolled my boy up to see me in an isolette and let me hold him for a few minutes. I cried and cried. He had been screaming until I held him, and he immediately soothed and looked up at me. I swear he knew me. It was hard to hold him because I had wires and tubes everywhere, and so did he. I wanted so badly to breastfeed, but I couldn't because of all the stuff I was getting in my IV. A lactation consultant came and brought me a breast pump and I diligently tried to establish a milk supply, but the most I could manage was getting the inside of the breast shell wet. I was told that I would have to pump and dump for 3 days because of all the drugs in my system.
During the second day I was in ICU, I developed a fever. I was getting some very strong antibiotics through my IV, so they figured it wasn't an infection. The fever didn't go away within 24 hours. Monday morning they decided that I might have had a pulmonary embolism, and sent me to nuclear medicine for tests on that. They injected some kind of radioactive dye so they could see an embolism, and this made my hypothetical milk unusable for another 2 days. Well, I didn't have a pulmonary embolism. The OB said that i was was possibly microscopic blood clots from the surgery causing the fever. I was also having difficulty breathing when I wasn't sitting straight up. They determined my oxygen saturation level was low, and the bad OB who had been so mean to me said it was because of sleep apnea (which I had never had a problem with before or since). The next OB to come on shift after her did a blood count and determined that my hemoglobin was low, and I had a transfusion of two units of blood. I perked up immediately. This relief OB also prescribed some Lasix for me to help with the swelling, and I eliminated 6 liters of water in 24 hours. From the time I entered the hospital until I left, I lost 47 lbs. (and only 9.5 of it was my baby!).
I got up and started walking around about 3 days after the surgery, and it was incredibly difficult because of the incision and because I was so swollen. My feet were so swollen that it hurt to stand on them. I couldn't wear any shoes at all for a month after the surgery. I was released from the ICU into a regular room, and finally I was allowed to have my baby in my room with me so I could see him and feed him and care for him. I still had to sleep with oxygen and have my oxygenation level checked several times a day, but I felt like a regular patient, and I had more privacy, etc.
I kept trying to pump breastmilk for my baby, but was unsuccessful. I was also feeling horrible, could barely move, etc. and the OB said that she could give me medication that would make me feel much better and help me recover faster but it would make whatever milk I produced unusable for as long as I was on it. So I made the choice to take the medicine and feel better, since I had been unable to produce anything anyway. My breasts produced the occasional drop or two for a few weeks afterwards, but once I was out of the hospital and could safely nurse my son, he didn't want to take my nipple. This was really hard for me, because I strongly wanted to be able to breastfeed. I had been so sure that I would that I bought no bottles or pacifiers, only a breast pump and pads and a nursing bra. Because my baby and I were separated for so long, because I could not put him to my breast due to the drugs in my system, because I had undiagnosed thyroid disease at the time, and because I had traumatic bloodloss during the surgery---all of these things worked against me. My son was also born with a tongue-tie, which would have hindered his latching on if I had been able to offer it to him. It seems that breastfeeding was just not in the cards for us.
Kmom note: A tongue-tie can be fixed with a small procedure and doesn't have to preclude breastfeeding. However, significant blood loss and resulting anemia is known to affect milk supply negatively, as does low thyroid. The problems she had getting any milk were probably a combination of no nursing access from the baby (a pump is not as efficient as a baby), her undiagnosed hypothyroidism, and the anemia affecting her milk supply. In addition, any medicine she took to help with the swelling may have also affected her ability to make milk.
I should mention that while I was in the hospital trying to get my blood oxygenation levels to an acceptable level and getting IV antibiotics and anti-inflammatories, every doctor in the whole evil practice came by my room to bitch at me for being fat and to talk about diets. Some were less aggressive and insulting about it than others, but they all felt it was completely important to tell me that I am too fat. "Have you ever considered dieting?" was how they all started out. Like any fat person in America could possibly get to be 30 years old without dieting at some point. Like I haven't been informed by family, friends, strangers, and doctors that I am fat fat fat fat fat and I need to diet for my entire life. As is this was a completely new discovery. I felt particularly betrayed when the lead midwife came in and gave me the speech. When I first became pregnant, I told her that I was worried about my eating habits and I wanted to take care of myself and give my baby good nutrition. I kept a food diary for two weeks and showed it to her on my next visit. It was a faithful diary. She praised me for the variety and content, told me that I was doing a good job of eating healthy low-fat foods. She suggested that I eat more protein, but otherwise did not criticize my eating habits. So it was a shock and a betrayal when she came in and told me that the best plan for my life was a really strict diet. The bitchy cruel OB got in on the act, which is hardly a surprise, and laid it on with a trowel. Not only did I need to diet, but if I did not do so, I would be dead before ten years, because women my size don't live past 40. My child would never love me because he would be so ashamed to have a fat mama. Fat women are bad mothers who can't keep up with their children, and their children suffer for it. By obstinately continuing to be fat, I would show myself to be an unfit mother.
I was so sick that I took her verbal abuse, but I am consumed with anger every time I think of it now. The nicer OB who discovered my anemia in the ICU came in and recommended Sugar Busters (which I had previously never heard of and I am still skeptical about. Steak, eggs, and cheese are great, but carrots and apples are bad for you? This was surreal advice). He was nicer about the whole deal because he said, "Let's be realistic. You're never going to get below 200 lbs. But I would like to see you considerably smaller than you are now." He then went on to ask me about my lowest weight since reaching puberty. I don't think it was the appropriate time for stern lectures, but at least he tried to take me reality and my feelings into consideration. It just gripes my ass that all of these health professionals who deal with pregnant and postpartum women every single day could not see that obstetrical complications are a risk factor for postpartum depression, and by lecturing me, they were adding to the stress level in my life. Talk about kicking a woman when she's down.
Once I got my blood oxygenation levels to an acceptable level and they were getting ready to release me, my incision opened. I had developed pockets of sero-sanguinous fluid underneath my incision, and the bottom four inches of it opened. That was a horror show. The wound oozed great gouts of syrupy fluid when it was pressed. It was 4 inches long and 2 inches deep and draining such that it soaked an abdominal pad in 3 hours. They packed it with gauze and bandaged it, and kept me in the hospital for observation for a couple of extra days to make sure that no infection would develop and that the wound would not open further.
After the doctors and nurses left from packing my wound, I was afraid to move. I was afraid if I turned over, my guts would spill out. I didn't know that people could go home with gaping holes in the belly like that, and I thought I was going to have to stay in the hospital for several more weeks. I started crying and really broke down. Did I get any expressions of sympathy or understanding? No, I got an offer of antidepressants. I prefer to get psychoactive drugs from psychiatrists, not obstetricians, so I refused. I was really angry and insulted that after all I had been through, feeling less than perky and chipper about everything was interpreted as a chemical imbalance that could be fixed with drugs.
Once I finally got home, I had home health care nurses for two solid months to help with changing my dressing, and they were terrific (both of them were BBWs). They were maternity specialists so they had seen lots of opened c/s incisions, and they assured me that skinny women got opened incisions too. My wound never opened down to the fascia layer so even though it was deep, it was not as bad as it could have been. One of the nurses gave me advice about caring for my child, and also recommended the OB/GYN I am seeing currently. My husband also helped change my dressings. I never dreamed that I would be asking such a personal task of him. It's so...unsexy and gross. My husband was such a trooper through all this. He kept joking that now he knew me inside and out. The wound eventually abscessed, but the home health care nurse caught it early so it was not as bad as it could have been. When she saw it, it was a red place the size of a quarter. By the time I got to the emergency room that afternoon, it was as big as my hand. The nurse saved my life because she acted so quickly. I was in the hospital again for two days receiving IV antibiotics.
At my postpartum appointment, I complained of being cold all the time and that I had lost my sense of smell. I could not tell when my son had a dirty diaper because I could not smell it. Eventually they discovered that I had hypothyroidism (Hashimoto's disease) which I probably had for some time but at a sub-acute level. My internist believes it was triggered into active stage by the trauma of Jacob's birth. [Kmom's note: Childbirth can trigger thyroid problems, but it's often missed by doctors. It's good that this was caught by her internist.] I also had a CAT scan to rule out a brain tumor. I saw the hateful OB for postpartum checks but not since. I saw a counselor for my postpartum depression and I described this OB as having the bedside manner of a prison guard. The counselor immediately knew which OB I was referring to. Evidently she has this reputation all over town, and it's not just me.
The new OB (recommended by the home health nurse) is wonderful. She is a recent graduate and much more size-accepting. She was shocked that I had a vertical incision. The hateful OB informed me that the kind of incision that they made in my uterus will make it incredibly dangerous for me to attempt another pregnancy. Instead of a bikini cut near the thicker bottom of the uterus, they cut along the length of it at the top where it expands more. Therefore, a subsequent pregnancy could cause the uterus to rupture and I would die horribly from a hemorrhage. Sex becomes much more ominous now. The new doctor said that although she wouldn't recommend another pregnancy for me because of all the surgical complications, it was by no means a death sentence. She said that she could manage me if I became pregnant again. [Kmom's note: As noted, a classical incision does NOT preclude future pregnancy. This may have been another attempt by the OB to keep her from having more children.]
As if I didn't have enough to deal with, the insurance company refused to pay all of my bill. We have been round and round with the insurance company over this for almost 2 years now and still owe the hospital several thousand dollars. I was laid low by postpartum depression and the Hashimoto's disease. It took me almost a year to get to my old self. But I have a gorgeous, healthy, smart little boy who is nearly 2 years old now. He is strong and beautiful, and despite the dire warnings, he does love his mother. I managed to finish my MSW degree eventually after all this too.
Warnings for other women:
Kmom's postscript: It's very important to take time to emotionally heal after a difficult birth. Most women are told to 'be grateful you had a healthy baby' as if their feelings about their labor and birth don't count. Of COURSE you are grateful to have a healthy baby, but at the same time it is perfectly fine to be less-than-thrilled about the labor or birth, while still fully loving your baby. In addition, if you have a particularly traumatic birth or poor treatment by your providers, it's extremely important to fully work through and grieve it completely. This is not a fast process, but it IS a very healing one, and is particularly helpful before moving on to another pregnancy or deciding to end your childbearing years. In order to help this process along, there is a list of books that can help on my Book Recommendations FAQ on this website. I highly recommend checking these out; healing is not an easy process but it is a vital one and it will bring growth and benefits to many facets of your life, whether or not you choose to have further children.
Sandra's Story (HELLP syndrome, low amniotic fluid, pre-term c/s)
Kmom's Notes: HELLP syndrome is an extremely serious problem. HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. (Hemolysis is the breakdown of red blood cells, and platelets are the blood cells involved in blood clotting.) HELLP syndrome indicates liver and blood complications.
This was a difficult pregnancy from day one. I suffered from 'morning sickness' the entire time (also known as hyper emesis) and we found out at 20 weeks that my amniotic fluid was low. The doctor was concerned the baby wouldn't grow properly. I had to drop to part-time work status to try to increase it. The week of Xmas I was at 30 weeks (due date was March 1st) and started swelling bad. I knew swelling was common in pregnancy so didn't think much of it. At my next few weekly ob/gyn visits my blood pressure was steadily increasing, protein was spilling in my urine, and I started gaining weight after no gain for the first 30 weeks. They started monitoring me closely because I was showing classic symptoms of pre-eclampsia (which is a pregnancy-induced disease). When a woman gets pre-eclampsia her body becomes 'allergic' to the baby inside of her and it starts shutting down the mom's major organs.
We spent the next couple of weeks seeing different doctors with different opinions on what was happening with me. We visited labor and delivery several times for monitoring because of my symptoms. Because my blood work kept coming back normal they didn't officially diagnose me with pre-eclampsia. Finally on Jan. 12th the doctor we saw informed us that we would be delivering within a week and sent us to labor and delivery. As you can imagine we were in shock. We were only 33 weeks along. I was given a Celestone steroid shot that day to help develop the baby's lungs. I had to get the second shot the next day and it didn't take effect for 36 hours from then. We prayed I could hold out that long but my symptoms were getting worse. I believed I could hold out for a couple of weeks with close monitoring but it wasn't meant to be.
On Wed. the 17th we went in for a nonstress test and an OB visit. My blood pressure was up 189/97. They sent me straight to labor and delivery. I stayed all day hooked up to the monitors and was told they were admitting me for overnight observation. That evening a doctor came in and did an ultrasound to check the fluid and it was so low (it was at 3, and 5-17 is normal but they want it over 10) and my blood pressure was so high that it was decided that I would need to give birth right away.
An IV was put in (after 4 painful attempts) and I was put on magnesium sulfate (which turned out to be a terrible poison) to prevent seizures caused by pre-eclampsia. It made me VERY sick. I had to be transferred to a high-risk hospital with a NICU 35 miles away. Once we got there and got in my room I got very sick and blacked out. It scared the HELL out of me. They wanted to give me a few hours to rest before they induced me. My mom and husband were with me and we all tried to rest for a few hours before they started pitocin.
They took more blood and started pitocin around 5:30 a.m. I contracted for about 3 hours and they checked me. I hadn't dilated at all. They kept turning up the pitocin. My dad arrived around 11:30 right as contractions were getting more painful. My blood work started coming back showing my liver was shutting down and my platelets were very low. I was diagnosed with HELLP syndrome. I was very sick!!!
About 4:00 I was checked again and still hadn't dilated at all after close to 11 hours of contractions without pain medication!!! I was so frustrated, sick and exhausted I almost cried. The anesthesiologist came in and said he wanted to place an epidural but my platelet count was so bad and if it was any worse he couldn't use an epidural. They did STAT blood work and I was okayed for an epidural. They made my parents and husband leave the room regardless of my protests. During the placement, I was feeling very faint and as soon as he finished I blacked out again. My blood pressure went very low and they had to pump me full of epinephrine to raise it. My baby had shown no signs of distress until then. His heart rate dropped too low and as I came to I was told we were heading in for a c-section. I was prepped immediately for surgery.
It was scary in the O.R. Once they made the initial incision they allowed my husband in. He sat by my head and talked to me and I was okay (but I kept throwing up). Ryan came out crying and didn't stop for at least 20 minutes. It was the most beautiful sound I ever heard. My husband stayed with the baby as we had agreed. Once he and Ryan left the O.R. (I got to kiss Ryan first) I started to panic. I tried to run but my legs wouldn't move. My memory of the surgery is all round yucky. My mom came in and sat with me during recovery.
My son was born on Jan. 18th at 4:46 p.m. I was 34 weeks pregnant that day. He weighed 3 lbs., 8 oz. and was 16.5 inches long. He had quite a bit of strawberry blonde hair. He was given oxygen right away but looked good. His apgars were 8 and 9!!!! My mom and dad and husband all got to see him and touch him but not hold him. I didn't get to see him until the next afternoon.
The first night was difficult. I was put in a shared room so no one could stay with me and my roomie had her baby in with her. I was trying to recover from surgery, magnesium sulfate, and deal with not having my baby all alone. The next day around 3 p.m. I was taken to the NICU to see him and I got to hold him for the first time. He was the most beautiful thing I'd ever seen. Sure he was a preemie and kind of funny-looking, but all I could see was how beautiful he was. I spent 6 days in the hospital and visited him often. My husband stayed with me every night after the first (they moved me to a private room). Leaving the hospital without my baby on Monday was the hardest thing I ever did.
In the weeks since his birth we have been under an amazing amount of stress but we're hanging in there. I'm pumping breastmilk every 3 hours but not producing enough for all of his feedings. They say stress will do that. We visit him every day and every time I leave it hurts. He is doing amazingly well. He was only given help breathing the first night. He had an IV for several days but it came off within the first week. He is learning to suck and has been given some of his meals by bottle. He tried to breastfeed for the first time today. He latched on and sucked a little but not hard enough. The doctors are calling him a "feeder and grower" which means he needs to learn to suck, gain weight, and learn to regulate his body temperature and then he can come home. They are guessing another 2 weeks but it could be sooner. We can't wait. I love him more than I thought imaginable. He is our little miracle boy.
He came home on February 5th after 18 days in the NICU. He weighed 4 lbs. 4 oz. He eats every 2 hours. His parents are exhausted but thrilled to have him home!!!! As terrible as my pregnancy and delivery was I don't regret a single minute of it. I got a beautiful angel out of all that suffering!!!
Heather3's Story (gd with glyburide, HELLP Syndrome, c/s)
I began my pregnancy with mild chronic hypertension. I began taking Aldomet to control my BP when I told my primary care physician that I wanted to get pregnant. I became pregnant the first month we tried and flew through the first 25 weeks with only a bit of morning sickness and some headaches at the beginning of the second trimester. Then I failed the one-hour glucose test and was sent for the three-hour test, which I also failed. The OB used a very conservative scale for the glucose and I was sent to an endocrinologist to evaluate whether or not I would need insulin. I began the diet given to me by the OB's nurse and was to have lab glucose levels done once every two weeks.
The endocrinologist I saw was the most caring, informed, down to earth physician I have ever met! Although at the first visit the nurse made the comment that she would probably be in later to teach me to give myself insulin (I almost cried!). The doctor told me he believed that I would be fine without insulin, had me begin testing 4x per day, and changed from an exchange diet to a carbo counting one. My blood sugars were never over 105 fasting and always below 120 (usually in the 100 range) two hours after meals. The OBs wanted the fasting sugars lower.
At my follow-up with the endocrinologist I relayed the information from the OBs and went armed with a study in the October 2000 New England Journal of Medicine on the use of glyburide in gestational diabetes. According to the study, glyburide did not cross the placenta in any of the women studied and the outcomes were nearly identical to those of women treated with insulin. The endocrinologist was quite receptive to this and said I would be the second patient that he treated in this manner. It did the trick and my blood sugars were very stable for the remainder of my pregnancy. I took a very small dose, 2.5 mg to start, and down to 1.25 mg once a day for the last four weeks of my pregnancy.
My blood pressure became slightly more elevated at about 34 weeks and I was put on modified bed rest. I lost 11 pounds between my 20 week and 38 week visits due to the gd diet and after being put on bed rest lacked swelling anywhere. I began developing what I thought was bad heartburn. I complained about it every visit for two weeks. Finally I reached 38 weeks and the doctor felt it was better to have the baby before there were more blood pressure problems and I had started to spill some protein in my urine. We scheduled an induction for Thursday of that week (this was Monday); he said to be on the safe side he wanted some labs and to check in the next day.
After an agonizing night of abdominal pain, I received a call that my platelets were low, and they wanted me to come to the hospital for repeat blood work and possibly to be induced. The first doctor told us they would put something in to soften my cervix that night and induce me in the morning. The second doctor talked to me more about what my low platelets meant and told us about HELLP Syndrome. My platelets were 52K, and normal is about 150K. The main concern is that I would bleed and be unable to clot. She elected to induce me that evening.
They told me I might not be able to have an epidural and that they would be starting me on magnesium sulfate. The chief of anesthesiology decided he would place the epidural and it was done shortly after the pitocin was started. Unfortunately, it didn't work, which I discovered in the middle of the night when they broke my water at 1 cm. Although they tried giving me more medication it became apparent that I was getting no relief! After an agonizing night, the anesthesiologist came back and replaced the epidural---after that I was in heaven! It was short-lived though, since the doctor coming on-call was one I had seen often. He told me we'd be having this baby sooner or later that morning. He checked me, said there was meconium, and sooner meant now, via c-section. I heard them in the hall concerned about blood because my platelets were now about 46K. The nurse came back and told them they had none of my blood type (AB+) on hand. A very frightening thing to hear!
Our daughter was born less than 20 minutes later via c/s. She did not breathe immediately but took only a bit of supplemental oxygen to get going. She was small, particularly for the baby of someone with gd, 6 lbs. 1 oz. and measuring 20.5 inches long. Because of the magnesium sulfate, I was kept in labor and delivery for 24 hours and monitored around the clock. Our friend who is a childbirth educator/doula/lactation consultant was there for the birth. She made sure I was able to breastfeed the baby after she was born and that they brought her to me every two hours even though I was not on the mother and baby unit.
On day four in the hospital, the nurse came in the middle of the night and told me I needed to start supplementing the baby with formula. Although she was a great latcher, my milk had not come in and she had lost more than 10% of her body weight. I gave her that bottle in the middle of the night and called my lactation consultant friend in tears the next morning. She came and we started feeding my baby formula from a spoon or small cup. I also started pumping very small amounts of milk after feedings. We spent 6 days in the hospital because of my recovery and the >10% wt. loss by the baby, plus jaundice.
After we came home, I tried just breastfeeding, but she again lost weight. The lactation consultant hooked us up with a Haberman Feeder, a special nipple that requires the baby to suck the nipple like at the breast and with variable flow. I fed her at the breast during the day and then from dinner time on supplemented her after each feeding with formula. I was determined that I would breastfeed this baby!
Between two and three months we were able to exclusively breastfeed with a combination of pumping and the herb fenugreek. When I went back to work my supply decreased but we have worked on building it back up. She receives 4-8 ounces of formula per day and the rest breastmilk, either at the breast or expressed. I found a good sitter close to home and work and am able to go home each day at lunch to feed her. It has been exhausting but I am convinced it is the best thing for both of us! At 4 months we are both doing well!!
Melanie's Story (Mild PIH, home waterbirth)
My midwife was wonderful. She never said a word about my weight or weight gain. However, she did make sure I was eating a variety of nutritious foods. When I developed PIH near the end of my pregnancy she worked with me on resolving some fears I had that might be contributing to my elevated blood pressure.
My husband and I took the childbirth class offered by my midwife. As well as labor coping techniques, she taught us what my body was going to do. From what hormones are released and their functions to the physiology of my pelvis and uterus and exactly what changes they go through. I feel having a deep understanding of what my body needed to do and how it did it, helped me to let go and get out of the way and not try to control anything.
I believe having a water birth was essential for having the birth I wanted for my baby. The water supported me and kept me from becoming exhausted. I highly recommend water birth.
(Summarized from the website story): My labor began while DH and I were watching TV at 9 p.m. I wasn't sure it was labor. What I felt was a very subtle ache, low in my pelvis. I wasn't going to call it a contraction because it just as easily could have been a gas pain. A few minutes later I decided it was a gas pain because I had to go to the bathroom. But when I saw that it was loose stools, I thought, "Well, maybe the 'cleaning out' process has started." [This continued for a while.]
At 9:30, the contractions were coming about 5 minutes apart. They were strong enough that I had to get up and start pacing. I paced through a couple of contractions and finally decided it was time to tell DH this was it. He looked very excited and ready for action. He wanted to know what he could do. I asked him to start filling the tub and to pick up the clutter in the living room. After a few more contractions, I told DH I was skipping the excited phase and going straight to the serious phase....The contractions were still about 5 minutes apart. I was trying different things to get through them. Pacing, sitting on the birth ball, and perched on the corner of an office chair. I seemed to do the best on the chair so I sat there.
By 10:00, I was becoming very vocal. I was trying to keep the sounds low and guttural, but some came out screeching. The sensations were low and pulled at my back. Because they were so strong, so fast, I was getting a little scared. I was worried that I would have 12 hours of labor like this because I had 12 hours of early labor with my first. DH started timing contractions. They were 3 minutes apart and lasting 1 to 1.5 minutes. We decided to call the midwife at 10:30. She said she would be there within a half an hour. While we waited for her, I decided I wanted to get into the hot tub and see if the water helped. It did somewhat, but I didn't get the complete relief that I had read water would give. DH was pressing on my lower back with each contraction and that made it bearable. I was getting very loud. I thought briefly of the neighbors and worried that they would think someone was dying and call the police. But another contraction came and I didn't care anymore. My legs started shaking really bad and I thought, "This can't be transition already."
The midwife arrived at 11:00. She sat through a few contractions with me in the hot tub and then asked me to come inside. She didn't want the baby to be born out in the cold. We went in and she checked Fetal Heart Tones (FHT). The baby was doing good. Then she asked if she could check dilation. I said OK. As she was checking, I almost told her not to tell me how dilated I was. I didn't want to get discouraged with the force of the contractions if I was only at 2 or 3. But before I could say anything, she told me I was at 8 cm. So this was transition!
I got back on the office chair to continue laboring. The midwife sat in front of me and rubbed my legs and gazed into my eyes. DH sat behind me to press on my back. Sometime around 11:30, DH realized he hadn't set up the temp sensors on the tub correctly. He was messing with it and every time a contraction would start, I'd yell, "Push, push!" and he'd run back and push on my back.
At midnight, the tub was full enough to get in. This time the water was heavenly. DH got in the tub with me and continued the back pressure. With the water supporting me, I was able to completely relax. I started to go into myself. There was nothing in my universe but the water and the pull of the contractions. My higher functions were repressed. When I wanted DH to get out of the tub, I couldn't speak. I just flicked my head in a "go" gesture and grunted, and he got out.
I labored on all fours with my forehead resting on the edge of the tub. The contractions were very powerful, but only overwhelmed me when one would start before the previous one had finished. (I remember thinking, "Not fair.") DH and the midwife were mostly silent. The few times they did say something brought me out of myself and suddenly the contractions were painful....
After awhile (I couldn't see a clock and I had lost my sense of time), I started trying some small pushes. The contractions gradually changed and slowly I stopped vocalizing. While I pushed, I moved back and forth between all fours and sitting upright. Only about half of my pushes felt effective----meaning, I only felt the baby move down some of the time. I think that is because feeling that movement scared me. It was so powerful and huge. Something in the way I breathed or grunted told the midwife which pushes were working and she would say, "That's it. Just like that." Hearing her voice reassured me now and encouraged me to push well.
I'd been pushing for some time (I don't know how long, but it felt like quite awhile) when the midwife suggested I get out of the tub and let gravity help bring the baby down. I really made an effort to get out but as soon as the water wasn't supporting me, I felt exhausted. The baby's head felt like it was between my legs and I thought I would squish it if I stood up. I decided to stay in the tub and resolved my mind to push better. I knelt more upright and pushed and grunted. I could feel the baby moving down with most every contraction. The midwife asked if she could check the FHT again. I pushed my belly up out of the water. The baby was doing great. Then the midwife wanted to check how far down the baby was. As she did, I felt the water break. A small pop. She asked if I felt that. I asked, "Was it clear?" She said, "Yes."
I kept pushing. The midwife said she could just see the head. In my head, I was starting to panic a little. I was wearing out and I thought I would never get the baby out. I pushed and pushed. I could feel the baby move backward every time the contraction stopped. But slowly, the baby came down. I felt a small sting as the head started out. It hurt more and more and I was sure the head would pop out any second. Then the midwife told me the head was just coming out and I'd be done soon. So I knew it was going to burn a lot more. More pushing and grunting and breathing. The burning was concentrated upward. I was afraid I was going to tear through my urethra. I reached down and felt my baby's head. The midwife let me know as each feature came out. There's the forehead. The eyes. An ear. The nose. And the head's out!!
The midwife slipped one loop of cord from around the neck. I relaxed and caught my breath. (And to be totally honest, I thought, "Just pull it out. I can't do this anymore.") I pushed some more and my baby slithered out of me. The midwife scooped him up. I saw a little penis and said, "I know why he didn't want to come out." We had been sure the baby was a girl and had said "she" and "her" through the whole pregnancy. But here was our little boy. The midwife put him on my chest. He gave a little cry and DH and I said hello and soothed him. Then he just looked at us and calmed right down. He was born at 3:44 a.m. He was gray, so we rubbed him until he pinked up. At about 5 minutes old, I put him to my breast and he latched on perfectly. [The midwife clamped the cord and had me cut it.] We nursed for a half hour.
Now it was time for the placenta. Always my least favorite part. DH took my son and I proceeded to push out the placenta. The contractions hurt so bad. Worse than anything during labor. It took three contractions and pushing mightily over a half an hour and the placenta came out. The membranes were still attached and the midwife had gone to the bathroom, so I just sat waiting for her. I didn't know if I should pull on them. When the midwife got there, she slowly twisted the membranes and they detached and came out. She showed us the placenta. The cord was attached well and in the center. She showed us that there was a dead gray spot. It was about 10% of the placenta. The midwife said that probably happened when I had PIH. I'm really glad it didn't last any longer than it did.
As I got out of the tub and dried off, I felt great. Totally energized. I felt like I could do it all again.
The midwife check us over. My son was perfect. 9 lbs. 6 oz. and 21 inches. I had a second degree tear on the bottom, not the top. She gave me 3 stitches. She said instead of closing the wound she just brought the edges together. I think that made all the difference in my healing. I healed quickly and without any itching or pain.
The midwife told me I pushed for 1.5 hours. She told me I was beautiful and that I did a wonderful job. I don't think I could have found a better midwife. She gave me exactly what I needed through the pregnancy, labor, and birth.
She went home at 6 a.m. We went to bed and stared at our son!!
Amy2's Story (elevated b/p, induction, problems with epidural, vaginal birth)
Kmom's Notes: Amy had trouble with her epidural in this story. Her anesthesiologist was very rude to her about her size, and when the epidural catheter came out of her back, they blamed this on her weight. In truth, this is related to weight in some ways, but not quite as they painted it.
Epidural catheters do migrate more often in heavy women, but research has found that this can be greatly minimized or eliminated if they just tape down the catheter to the back AFTER the woman resumes lying down. It is taping the catheter to the back before lying down that seems to create the problems, and pulls on the catheter line. Researchers were able to completely eliminate problems with epidurals in their large patients in this study simply by taping them down after the woman lay back down again!
So the problem here wasn't really Amy's size but the lack of knowledge from her anesthesiologist of how best to care for a larger person in this situation. This problem likely causes many cases of inadequate pain relief in larger women.
At my 41 weeks prenatal visit, my doctor decided to induce me due to elevated blood pressure. I got to my hospital room at 12:00 pm, I was started on pitocin and magnesium sulfate. At 8pm my doctor decided to stop the pitocin and start again at 8 the next morning. The next morning the pitocin and magnesium sulfate were started again, and at about noon they broke my water.
4 hours later, I asked for an epidural. The anesthesiologist was very rude. He said, in a very condescending tone, that it would take him awhile (because of my weight) to find the epidural space. This could very well be true but he didn't have to be such a jerk about it.
An hour after getting the epidural I could feel the contractions again. I kept telling my nurse and she kept saying I shouldn't be able to feel them. Finally I got her to have the anesthesiologist come back up. They found that the epidural catheter had come out of my back; they said that happens sometimes with overweight women. Anyway, I got another epidural and by 7:30 that night, right as the epidural wore off, I was ready to push.
My daughter was born at 8:25pm. It could have been sooner but I was scared and wouldn't push at first. My doctor didn't have time for an episiotomy so I ended up tearing, which I didn't think was that bad. I was healed in less than a month; I have heard a lot of women who had an episiotomy say their healing time was much longer.
We are currently considering another child. I weigh more now than I did when I got pregnant with my daughter, and was a little apprehensive about having another baby until finding this site.
BonaDea's Story (BP issues, induction, c/s)
Kmom's Notes: Whether this induction was "necessary" because of her BP issues is debatable. BP issues are a significant concern, especially with protein in the urine, but the rest of her lab work came back fine, so many providers would have been comfortable just watching her carefully, not inducing right away. Many midwives feel that careful attention to nutrition, extra protein, and salt to taste will help resolve many of these borderline cases that occur near term. However, her doctor wanted to err on the side of caution so he induced.
Breaking the waters so early in an induction, especially when the baby's head is up so high, is very questionable. The baby's umbilical cord can prolapse (come down ahead of the body) or get compressed against the mom's pelvis, causing fetal distress or even worse. This sounds like it might have happened here, given the baby's fetal heart rate problems after the water was broken. So the mom ended up with a cesarean---but was it really necessary? The cesarean became necessary at that point, but it's possible it might have been avoided had things been managed differently. However, hindsight is always 20/20 and no one can ever know for sure.
She also had trouble getting an epidural placed. It is harder to do an epidural on a person of size because there is more fat on the back, making the bony landmarks harder to find and the epidural harder to place properly. However, obviously there was an issue here simply beyond her size, because after 18 difficult tries with the first anesthetist, a second anesthetist was called and he got the epidural in on the second try. A different angle due to the second guy's height may have been the key, or simply a difference in skill level and experience with larger people.
But the moral of the story is, if a procedure is not working repeatedly with one medical staff member, don't keep suffering! Request that another medical staff member be brought in to try. Oftentimes a change in personnel results in a faster and less painful placement. There is no need to suffer through repeated tries; simply request that someone else try instead. Don't be shy about requesting this because of your size; requesting a different staff member is the rule of thumb for people of average size too, whenever there is a difficult placement issue. It's not always the fault of the first person or the fault of the patient; sometimes it just helps to have another person's vision, skills, and input. But don't keep suffering through repeated failed attempts; if something doesn't work more than a few times, ask for someone new.
During the pregnancy, I made due to exercise, eat small
frequent meals and drink at least 64 oz almost every day to avoid most
common overweight pregnancy issues. I had lost weight until about 29 weeks and
then put on what I lost bringing me back to where I started.
I didn't get gestational diabetes, urine always came up clear of sugar and protein, no Group B. It was only after we had a super busy and stressful 3 weeks that my blood pressure started to go up a little, just out of normal range. I was able to level it out, but then after some more stress it went back up.
They did blood work and a 24 pee culture test for pre-eclampsia. The blood work came back fine, but the urine culture showed some protein this time, so they decided to induce me after the weekend.
We went into the hospital Monday morning, they got me hooked
up and started on the pitocin. A couple minutes later the doctor came in to
check me and break my water. I was still the same 1-2 centimeters I had been
with no effacement and her head was still up. As soon as he left the room the
contractions got real bad and close together, so I requested some pain meds
after using the bathroom. While I was in the bathroom, the baby's heart rate
went a little funky.
They were debating weather to call a c-section at this point, but everything leveled out and I was already 4 centimeters in very little time. He had them shut off the pitocin and called in the epidural guy. From what I've heard and seen on many episodes of baby story, the epidural was more scary than painful, so I wasn't hesitant at all. He was a taller guy and needed the bed way up high to do his thing. I could tell I wasn't getting the right angle for him, not being able to hunch over correctly.
At some point I had asked him if there was anything I could do to make things go better. He said he "didn't want to say," which translates to, "You're too fat." He stuck me around 15-18 times along with 1-3 shots of [lidocaine] every time. Not to scare anyone, but it hurt just as bad as the contractions which I was not expecting at all.
[He made about 18 horrific tries.] Finally he called in a
second anesthetist who was a shorter man. He lowered the bed and we tried again.
I could feel the difference in my angle right away. He got it on the second try.
Over a week later, my back is still in a lot of pain, not to mention black and blue. If I had it to do over, I would have let him know I wasn't able to get the right position. I would have also requested someone else after 3 tries. Didn't know that was an option.
As painful as it was/is though, I don't regret getting it.
Would have had to get it anyway. I had severe shaking with every
contractions from there, but no pain and I was able to rest a little. About
noon, the nurse went to catheterize me and the baby's heart rate went down again
while I was on my back, so back on my side until the doctor gets there. I'm at 8
centimeters already, but her head is still up high so they called for a
After what seemed like forever on that operating table, we heard our daughter's first cry. It was more beautiful then I ever imagined. The rest of her was delivered at 2:42 pm. Brown/blonde hair; 6lbs 10oz 19 1/2in and perfect. We got home on Thursday and everything has been wonderful.
From a plus sized point of view: It was never an issue with my
doctor's office. My unexplained infertility was blamed on my weight (from
another doctor's office and myself). Everything else had checked out perfect. We
did finally conceive naturally, but while taking an oil supplement ( I tend to
run a little dry down there).
When it came to any procedure that couldn't be done easily, it was blamed on my size over any other reason. Such as with a certain ultrasound measurement (something in the heart). Everyone was really nice not to say anything, but the report stated it was due to my "excessive maternal habitus." I know plenty of thin women from my web group that also couldn't get that same measurement either.
Same with the epidural. With the first guy I believe the problem was our height difference. He had the bed all the way up. But when I asked what I could do differently, he as politely as possible said he didn't want to say what the problem was. The second guy came in, put my bed down. I was able to hunch over correctly and he got it on the second try. A week later and I'm still all black and blue and in a lot of pain from that incidence.
MichelleATX's Story (BP issues?, induction, c/s)
Kmom's Notes: A good example of the importance of using the correct-sized BP cuff!! And of hiring a non-interventive provider, one who is watchful for problems but does not expect them automatically or over-react to them.
I prepared for pregnancy by doing hypnobirth tapes, psyching myself up for a vaginal birth without drugs. That's not anywhere near what I ended up with.
At my second OB appointment, I was told my blood pressure was high. I felt fine and didn't pay too much attention. At my third appointment, I was again told my blood pressure was high and put on a low dose of a HBP [High Blood Pressure] medication. The medication gave me an annoying cough. At subsequent visits, my BP was all over the place--usually normal, as when it was taken by the OB's head nurse, sometimes high, usually when taken by the other nurses. Or what I thought were nurses. Late in the pregnancy, I found out the two "nurses" who repeatedly got high readings of my BP were not nurses at all, but nursing students. I also learned that they weren't always using the right, extra-large blood pressure cuff because sometimes, they just couldn't find it. Late in my pregnancy I was sent up to L&D twice for monitoring because of a HBP reading in the OB's office. Both times, L&D was unable to find anything wrong with my BP and I was sent home. I was put on bedrest the last month, with a home monitor and though I ignored the bedrest and continued my activities, I never once had a HBP reading. It didn't matter that my readings were so inconsistent--I was labeled high risk and GH [Gestational Hypertension] and that was it.
When I had my first glucose test, I failed it by 4 points, after having had a large breakfast at McDonald's. No one told me to fast! When I took my 3-hr test, I passed with flying colors. Doctor advised me to follow a diabetic diet anyway because she wasn't convinced the test was right. Diabetes does run in my family but it is typically late onset. OB suggested that we repeat the GTT later in the pregnancy but she didn't bring it up again and I didn't remind her. Blood work that day did find that I was anemic, but I conveniently forgot to take my iron supplements--they made me too sick.
Throughout my pregnancy, I was told that I was measuring very big. I was given numerous ultrasounds and each time, the tech told us that the baby was right on target, though on the smaller side of normal for development. OB continued to tell me I was big. Each u/s with the tech, we were told baby was normal, placenta looked great and that I had plenty of amniotic fluid. The last couple of weeks, the OB told my husband and I that the baby was measuring very small and that it was possible my placenta wasn't nourishing him sufficiently. She said, "We may find that it is better for him outside of the womb than inside if your body isn't taking care of him, in which case we'll try inducing but your cervix isn't ripe and you may need a c/s. We don't like performing c/s on women of your size because the risk of complication is higher and there can be problems healing."
I went in for an OB appointment on Monday, March 28, for a NST. Baby continually wiggled away and their machine wasn't picking up his heart rate or the contractions I was having every 5-7 minutes (and had been having for a week). I was sent up to L&D where I was reluctantly put in their triage room. The nurses were terribly rude and disappeared for long periods of time. I'd been there nearly an hour before I was hooked up to any machines. Their machines did confirm that I was having regular, though pain-free, contractions and baby's heart rate was okay. OB decided to have me admitted so that I could be induced the next morning. At that time, I was fingertip dilated and told my cervix was not very ripe. I was at 38 weeks.
That night, I was told I couldn't eat anything after 6PM. Between 8 and 9PM, I was told that baby was having "decelerations," his heart rate would drop for anywhere from 5 seconds to a minute, then come back strong. One of the nurses came in to fiddle with the fetal monitors and said baby was probably moving away from monitor and it wasn't picking him up. I was told that they would be giving me pitocin in the morning, but not Cytotec, the cervical ripener, because of the decelerations. I was told I had till 10PM to eat anything if I was going to eat. I had my husband raid their kitchen for whatever was available--a turkey sandwich and crackers with peanut butter. I was still starving, but the only thing left in the fridge was a ham sandwich and I keep kosher so that was out.
In the morning, they started me on a high dose of pitocin at 7:35AM. I was still having regular contractions, but no pain. I was now measuring at 1cm. Because of my GH, I was told not to get out of bed except to go the restroom. I was to stay in bed, on my left side. I was miserably uncomfortable and my hip began to hurt terribly. At 12:15PM, I felt a twinge of pain and suddenly felt as if I'd wet myself--my water broke. A sickly sweet smell filled the room and the OB told me the clock was ticking. The monitors were having a hard time picking the baby up so they opted for putting me on a catheter and putting the baby on internal monitors, which was terribly painful--I was only dilated to 2 cm. I began having contractions every 2 minutes, most of them off the charts, but was doing very well with labor. No screaming, no gnashing of teeth. I thought, "I can do this!"
The OB came in several times that afternoon and told me I wasn't progressing and that a c/s may be necessary. After 5 hours of labor, I told my husband that if they were going to do a c/s anyway, I may as well get an epidural and be ready for the surgery. I continued to hope that I would progress and be able to have the baby naturally, though. Having been repeatedly told they didn't like doing c/s on large women, I commented to my husband, "That sure seems to be all they talk about." At midnight, I measured at 4 cm. I was told that if I didn't open another cm in the next hour, we'd be doing a c/s. At 1AM, I was a 4.5 cm, 5 if they painfully stretched me.
The OB on duty said she was pretty sure that the baby had lodged his head in the birth canal incorrectly. I asked if I could change positions or, better still, get up and walk around. They refused because of my HBP, even though I hadn't had a HBP through 5 hours of unmedicated labor. They started prepping me for surgery. I cried to my husband because I was terrified of being cut open. I was terrified of the risks because of my size, I was terrified for my baby who was too large, then too small.
What I was most unprepared for with the c/s was that my body would shake from the anesthetic and that I would be freezing, even with warm blankets piled around my head and shoulders. When the baby was being taken out, I remember this dull pulling sensation from deep inside me that made me grunt with each pull. It reminded me of the disemboweling scene at the end of Braveheart. I heard our son cry. It was 2:53AM and his grandmother's birthday. I heard my husband laugh as our son promptly peed on a nurse and then got to see our baby for the first time. He was whisked off pretty quickly so that they could begin to sew me up.
That's when more surprises were in store. I was unprepared for the dull ache as they OB put everything BACK, shoving my innards into their rightful place. The anesthesiologist turned up my meds but the pain had me grunting and I threw up. It seemed to take so much longer getting everything in than it had to take everything out. Our too-large-then-too small-baby who supposedly wasn't being fed by my placenta was fine. He weighed 5 lbs 6.8 oz, 18 inches long and didn't have a thing wrong with him. He wasn't too big--so much for GD--and he wasn't too small or unhealthy--so much for a failing placenta.
I was soon in recovery and trying to breastfeed our baby. I was able to sit up immediately and wasn't in too much pain, but was still freezing. I held the baby against my chest and he pushed himself up on his arms, lifting his little head to look around. He was so strong! I began to feel very weak because I hadn't eaten since Monday night and it was now Wednesday. I hadn't even been allowed water and had been limited in my ice chips. Baby's blood sugar was low and they kept coming in to prick his poor feet. They insisted on giving him formula, but he wouldn't eat. I told him that if they'd let him sleep, he'd eat when he was ready. My colostrum quickly came in and after that, I refused to let him have anything but the breast, which angered a nurse or two. His sugars improved and he was fine.
We were released a day early. He had a touch of jaundice but it was clearing up on its own with breastfeeding. I was okay the first few days, but on the 8th day, the day of his bris, the incision nearly killed me. I underestimated what a toll the surgery had taken on my body and by the end of the day, I was sore and tired. I returned to bed. I continued to heal pretty well, but my incision looked lumpy, almost as if I lump of fat had been left poking out among the regular skin. And when I would go to the bathroom for a bowel movement, the first elimination sent a stabbing pain through me, deep inside between my rectum and my vagina. It felt like a knife was being plunged into me. That continued for 3 weeks, then cleared up on its own.
It's 7 months later now and I'm pregnant again. I really want to have a vaginal birth this time. I'm not the scared new mom I was. I'm not afraid to challenge now or ask questions. And I'm actively looking for a health care provider who is more interested in treating me as a patient and a woman and not just as a number on the scale. I know my body can do it. I know my baby can do it.
Brianne's Story (pre-eclampsia, vaginal birth)
I developed pre-eclampsia towards the end of my pregnancy. I was diagnosed at about 36 and a half weeks and was put on bedrest. I only had a mild case, but my doctor was very concerned and wanted to induce labor as soon as my cervix was favorable. At 37 weeks, I was a fingertip dilated and the doctor pushed the cervix to 1 cm. At 38 weeks, she pushed it to 2 cm and also stripped the membranes. At that appointment (a Tuesday), we made an appointment for an induction on Thursday. To our great surprise, however, I went into labor on my own on Tuesday night.
DH and I went to bed at about 11:30. At 12:40 I woke up, thinking I was having very painful digestive cramps. After a few minutes I realized that these were actual contractions. I woke DH up and we started timing them and trying to do some of the things we had learned in our Bradley class. Because there was no early stage (I went straight into hard, painful contractions), because the contractions were somewhat erratic, and because they didn't seem long enough to us, we just figured it was false labor. Finally, at 5:30 a.m., I decided we should call the doctor. I started to think that even if this wasn't the real thing, with my high blood pressure, the doctors were not going to be happy about my continuing in this state indefinitely. We called and the doctor on call said it did not sound like false labor to him and we should come in. He also said that because I had pre-eclampsia, they did not want me to labor at home for too long.
We arrived at the hospital at 6:30 a.m. The first thing that happened is that they put me on Magnesium Sulfate (a.k.a. "Mag"). I didn't know anything about this drug (and am very angry at my OB for not warning me about it ahead of time). It was for the pre-eclampsia--to prevent seizures and keep my blood pressure down. It's very standard I believe. It had the effect of making me feel extremely physically weak and mentally and emotionally out of it. Also, it made me very very hot. I kept complaining about being hot and they kept turning down the temperature in my room. DH told me later that it was freezing in there! Fortunately, it did not make me nauseous as it does for some people.
I also discovered I was only 3.5 cm dilated; only 1.5 more than before I had gone into labor. Since I had already bee in active labor for 7 hours by then, at this point I decided to get an epidural. As it turns out it was a good thing I got it (although it didn't come until I had been in labor for 10 hours) because with the Mag, I honestly don't think I could have done without it. At some point they gave me pitocin because my contractions were spacing out, maybe due to the Mag and/or the epidural. At about 5 p.m. I was ready to push.
I pushed for about an hour, but the baby just did not move. So they pumped up the epidural and let me labor for about another 90 minutes to see if he would move down more with the contractions. He didn't. I pushed a little more and then his heart started to decelerate. At this point, my OB used forceps to bring him down in the birth canal (they really pumped up the epidural for that!), but I finally pushed him out. I had asked to hold the baby right away, but because of the heart rate deceleration, they wanted to give him a little oxygen right away. It was actually quite a while before I got to hold him, I think. Everything is fuzzy because of the Mag, and I do remember feeling so weak I was afraid I would drop him. Also the OB told me that I couldn't breastfeed him until I was off of the Mag (the next day this was contradicted by the nurse, lactation consultant, pediatrician, and my OB's partner) and not being able to nurse him right away was a very big disappointment to me.
In addition, I am frustrated by how much the Mag affected me. I had to stay on it for 24 hours after the birth. Only after I came off did I realize how out of it I had been and how much it had dampened my emotional responses. However DH was completely wonderful and our baby is absolutely beautiful.
An additional possible side effect of the Mag that I am still dealing with is that my milk never really came in. At two days, the baby developed hypoglycemia (low blood sugar) and was admitted to the special care nursery (NICU), where he was given an IV and formula. (Incidentally, we were allowed to try to bring up his blood sugar levels by nursing first, but it didn't work.) He was there for a day and a half, during which time I pumped and also nursed when I could be in the nursery for a feeding. The doctors and nurses in the nursery kept telling me that when my milk came in, I could take him off supplement, but as of a week after his birth, I had only a trickle. Although I have worked very hard with a lactation consultant and have been chained to my pump for weeks, I still have not been able to generate anything like an active supply and my baby gets more formula than breastmilk. Although I think there are a number of causes of this problem, I think I got off to a bad initial start in part due to the Mag. This is a side effect no one in the hospital told me about.
Adele's Story (PROM, induction, c/s)
Kmom's Notes: It would be interesting to know if this baby was malpositioned. Having the waters break ahead of time, having little progress despite hours of active labor (even with pitocin), getting 'stuck' between 4-7 cm, and the baby staying up high and never engaging are often signs of a baby that is malpositioned. The baby was undoubtedly head-down, but may have been facing the wrong way (sunny-side-up/posterior), with its head tilted to the side (asynclitic), or with its hand/arm beside its head (compound). At this point there is no way to know for sure, but the pattern seems to be consistent with many malposition stories.
It's also not uncommon for women who have been through an induction and c/s to have their milk come in relatively late (this happened with Kmom's first baby too--she can relate!). It's unclear whether this is due to the anti-diuretic effects of pitocin (it tends to make you retain water in your tissues) or the effect of the cesarean (many c/s moms have their milk come in a bit later than normal). It may also be influenced by a tendency for cesarean babies to get more bottles and formula than babies born normally, and for nursing access to be delayed.
Breastmilk supply is very contingent on supply and demand; it works best when babies are nursed shortly after birth and very frequently thereafter. When babies are given lots of bottles and pacifiers, the 'demand' is much lower and the body tends to respond by producing less. Fortunately, however, in this case the mom was encouraged to pump a lot, which probably helped preserve their breastfeeding possibilities. Many moms in this situation are not given breastpumps or any instructions/encouragement.
First of all, I have to say that I had a wonderful and very caring doctor that I wouldn't trade for the world. When I went in for my first appointment I asked him about my weight and he said that it probably wouldn't be a problem and I had a few more risk factors than an average-sized person, but he'd keep a close eye on me and expected that I would do fine. I asked him about a c-section because my very skinny sister had to have all 3 of her children by c-section and he said that he expected I would do fine and delivery vaginally. After this first appointment I don't think we ever talked about my weight again!
When my blood pressure went up towards the end of my pregnancy he wasn't surprised because the same thing happened to that very skinny sister of mine and he said these things sometimes run in families. He ordered the non-stress tests 2 times a week until I delivered just to be sure the baby was okay. Besides it being a pain to go to the hospital 2x a week it was no big deal.
So, my water broke 4 days before my due date with NO labor pains whatsoever. So my doctor check me into the hospital and they induced my labor. Long story short, after 15 hours of active labor I only dilated to 4 and the baby still hadn't dropped down. So Dr. A said, "Let's do a c-section," and all I felt was complete and total relief! Dr. A was my sister's doctor also and she had the exact same problem with her deliveries which is why she always had to have c-sections, so he said it was very well something hereditary and had little to do with my weight.
So my son was delivered by c/s weighing 10 lbs, 7.5 oz. Very big baby--we all have big babies in my family so this wasn't surprising either. Because my son was so big some of the nurses at the hospital said I must have had GD and the doctor didn't catch it, but I asked Dr. A about this and he said he tested me for it 3 times and it was never a problem and I just had a really big baby. My sister's babies were all 10 lbs. too.
My milk didn't come in and because my son was such a big baby they had to test his blood sugar and that was all wacky so we fought that for a whole week. We had to give him formula until my milk came in which was 5 days later with me pumping like a crazy woman. After 2 days my son also developed pneumonia for some reason. He came out of it fine, but it was very stressful especially with the blood sugar problems and me not getting my milk in for so long. But we got to come home after 7 days and after that it was fine.
All in all, I had a positive experience. I did have a few nurses say things about my weight, but all in all they were very nice and by the time I got to that point I didn't care what they thought anyway! I think having a caring doctor is the biggest comfort because you can check everything out with him so you don't care what they think! It helped with my sister having the same doctor because he knew what problems she had as well and we knew it had NOTHING to do with her weight because she's so darn thing! :-) I think that helped a lot. I am having another baby soon and we are planning another c/s; I am glad and relieved. I just hope and pray my milk will come in at a timely fashion and we don't have any other complications. I hope the same for all of you.
Sal's Story (PCOS, GD, PIH, fall down stairs, induction, vaginal birth)
I have PCOS and took Glucophage in order to ovulate. All was well during the first trimester. At 16 weeks of pregnancy I had an extremely abnormal AFP level. Then at 20 weeks I developed pregnancy induced hypertension. After 16 weeks of bedrest my OB recommended that we induce at 36 weeks if an amniocentesis showed mature lungs. The night before the amnio we were preparing for the baby and I fell down the stairs (14 steps), fracturing my spine in 3 places, breaking my tailbone, and injuring my shoulder. The injuries were evaluated and found to be stable and not in need of surgery (thank goodness!). The amnio was performed and my doctor missed on the first attempt, had success on the second attempt, and the lungs were immature. However, the amnio triggered contractions so I had to spend a day in L&D. My blood pressure skyrocketed even on complete bedrest after my fall and my OB decided it was necessary to admit me to the hospital and begin an induction at 37 weeks.
I went into the induction dilated at 1.5 cm and effaced 75%. Now that I was in the hospital they no longer allowed me anything by mouth and insisted I take only IV pain meds. I was given 2 mg of Stadol and a dose of phenergan---it made me intensely disoriented and miserable and the baby had a couple of significant decelerations. Once it wore off I decided pain medicine was not a good friend of mine!!!! After a full day of pitocin and contractions I had no progression! The pit was discontinued for the night and begun again first thing the next morning. My OB then broke my amniotic sac to try and get things moving and cranked up the pitocin (even on the max dose the day before I never went into labor).
After several hours of contractions I had only dilated to 3 cm! Two hours later I was only at 3.5 cm; however now I was really uncomfortable so they let me get an epidural. I was terrified of the epi due to my recent spinal fractures, however, I had wonderful relief with it. A catheter was placed in my bladder and internal monitors were placed on the baby's head and in my uterus to have better monitoring. The pitocin was then increased above the normal maximum level and I was very closely monitored.
Once settled I took a good nap with my only discomfort being rectal pressure with each contraction. Two hours later I awoke to increased pressure and I was 7 cms! The pressure continued to increase (but no pain) and another 1.5 hours later I was complete and +1 station, ready to push! When I began pushing the epidural was turned off and I became intensely nauseous and the pain was intense from both the labor pain and my back injury. Due to breaking my tailbone [in the fall], my birth canal was very swollen, so every time I pushed the baby down he popped back up! It didn't take long for me to become miserably overwhelmed with pain and I began vomiting. At this point I begged for help!
The nurse called the OB and he immediately performed an episiotomy and used the vacuum to assist in the delivery. The vacuum fell off and the OB had to cut even further with the episiotomy. However, the baby came out after a few more pushes along with the OB's help (and vacuum!). The baby was born healthy as can be and fully mature. He was 7 lbs. 14 oz., 19.5 inches with Apgars of 8, 9, and 9!
Just after delivery I began bleeding and they had to give me lots of pitocin and massage my abdomen to get my uterus to cramp down properly, however it responded well to treatment. I developed hyperlactation [too much milk---kmom], most likely due to my PCOS, and with help from the lactation consultant we are doing WONDERFULLY and the baby is now gaining weight appropriately! My blood pressure and severe edema went down quickly a few days after delivery and within a week I had lost over 20 pounds!
Anna's Story (PCOS, PIH, induction, malposition, TOL c/s)
Kmom's Notes: Anna feels that her doctor wrongly attributed her blood pressure in pregnancy to "chronic hypertension" because of her size. In fact, her blood pressure was normal before pregnancy, was normal in the first several visits, and then started to rise. However, when she asked about pre-eclampsia, he told her she had chronic hypertension and she felt that this assumption was based on her size and not on the facts. After her pregnancy, her follow-up visits record very normal blood pressure readings. Obviously, she did not have chronic hypertension, and the higher BP was due to pregnancy.
This was Anna's second child. Her first had been born by cesarean, and she was hoping for a Vaginal Birth After Cesarean this time. Because of her rising BP, Anna's labor had to be induced, which strongly lowers the chance for VBAC in most cases. However, women *do* have VBACs with induction; unfortunately, her baby was slightly malpositioned, which made it difficult to be born vaginally. Because the doctor did not know how to help the baby re-position, a repeat cesarean became the wisest choice at that point.
Anna showed great strength of character by demanding that the anesthesiologist re-do her anesthesia for the cesarean! All along, they were not taking her seriously when she told them she was not getting good relief with the epidural. They also did not take her seriously because their monitors showed her contractions weren't very strong. (Many large women report that contraction monitors do not accurately measure the strength of their contractions.) When the anesthesiologist tried to tell her that her epidural was sufficiently strong for a cesarean, she fought back and PROVED that she still had feeling and needed more. Reluctantly (because doing a spinal after an epidural does have risks), he did a spinal, and she was able to have a 'good' cesarean experience. If she had not been so assertive, she probably would have been one of the unfortunate few (like Kmom) to feel their cesarean surgery. Standing up for herself like this in the face of their disbelief was amazing.
Having experienced secondary infertility due to PCOS and three miscarriages, we were delighted and frightened to find we were expecting again. I had pre-eclampsia in my first pregnancy, so they monitored me closely as a result.
About 4 weeks prior to the due date, having seen my blood pressure increase slowly with each visit, my
perinatologist wanted me admitted for possible delivery. My ob/gyn, who seemed
convinced ( despite the fact that my first couple of BP readings with this pregnancy were
normal) that I was chronically hypertensive, disagreed. He sent me for observation to the maternity floor of the hospital, but
told the nurses that if my BP stabilized, I was to be sent home. After six
hours on my left side, I did see a bit of a decrease in BP, so they sent me home to follow up the next Tuesday with the ob/gyn.
On Tuesday, I went to my appointment, and my BP was 175/110. That was the highest it had been, and I argued with my ob that I was ready to deliver. He begrudgingly sent me to the hospital, again for "observation". After several hours without a change in my BP, he decided to go ahead and induce labor. Cervidil was inserted and a pitocin drip started, and just a couple of hours later, my labor began.
The nurses were wonderful. They monitored me closely, and tried very hard to encourage my plan of a natural, drug free labor and delivery. After twelve hours of no sleep, they finally convinced me to do something for the pain. My cervix had only dilated to 3, I was progressing very slowly, and I was already exhausted. I hadn't eaten since 6 AM the day prior, since once I was admitted to the hospital, I wasn't allowed anything but ice chips. I agreed to some narcotic relief, the doctor decided to break my water, and I finally slept fitfully for about two hours. The pain seemed to be getting worse, and upon inspection, I had progressed to 5 cm.
The nurse asked about an epidural, and even though I had strongly desired a natural birth, I felt
totally wiped out and needed some relief. Finally, with the epidural, the pain subsided, and I was able to get some bit of sleep. It seemed to me
that the epidural wore off quickly, and twice, the nurse called to bring someone in to give me a little more medication. The third time, with the
pain seeming to me to be very intense, a new anesthesiologist came in and told me that based on my 'strip', the contractions weren't that bad and I
should be fine with what I had. He also noted that I hadn't progressed past the 5 - 6 cm point in quite some time, and said that if the pain did
continue, I could call back. After about 45 minutes, the nurse who was taking care of me stood up for me and demanded that someone come and give me
more meds for the pain. The anesthesiologist came back, and another round of drugs was administered.
About 5 that evening, February 14th, after having been in labor about 21 hours, I felt like there was something passing - there was no pain, but I felt for sure something was coming out of me. Seconds later, the feeling passed, and the nurse checked under my gown. She became quite frantic, scooped up the waterproof pad that I was laying on, placed it on a table out of my view, and ran to get another nurse. I became extremely concerned, and my husband didn't seem to know what was going on, and when the other nurse came in, they both agreed that my doctor needed to be called immediately. Apparently, I passed an extremely large blood clot, and after the doctor came, he deemed me okay to continue with the labor.
After several more bouts of trying to convince people that my epidural wasn't working, and the pain was really bad, the nurse confirmed that my labor seemed to have stalled. I had been at the 6 - 7 cm point for a long time, so the doctor was called in. At 2 AM on February 15th, the decision was made by the doctor, myself and my husband to go ahead with the c-section. The baby's head wasn't in position, and I was so exhausted that I felt if the time to push came, I'd be in a terrible predicament. The anesthesiologist tried to convince me that my epidural was just fine, but I proved to him that my feet and legs were totally feeling, and the contractions were absolutely being felt. I refused to go into surgery until something else could be done, so he agreed to a spinal. I am certain that had I not demanded something else, I would have felt the scalpel make the cut.
At 2:34 AM, on Thursday, February 15th, after 31 hours of labor, our second daughter was born via c-section. She had APGARS of 9 and 9, and after a few minutes of introductions, she was taken to the nursery. She remained there for a few hours. I insisted on stitches instead of staples, so I didn't have to have the staples removed, which I found uncomfortable after my first c-section. She and I went home four days after surgery, and except some minor drainage from the incision, I healed well.
I believe that the ob/gyn made a call regarding my increasing BP based on my weight. I kept close track of my BP, and I know it was normal up until about 4 months into my pregnancy. I learned during this labor and delivery that if you don't speak up, you won't get what you want. I hope I remember the lesson in other areas of my life!
Laurin's Story (insulin-dep. gd, pre-eclampsia, induction, c/s, wound problems)
Kmom's Notes: Laurin experienced the classic signs of pre-eclampsia---sudden severe weight gain, spilling protein in the urine, swelling, high blood pressure, etc. This is potentially very serious, and induction is the usual response.
She also experienced a baby malposition. The doctor said that the baby's head was turned to the side, making the baby either occiput transverse or asynclitic (depending on what the doctor meant exactly). Breaking the waters typically makes it very difficult for the baby to rotate to the most optimal position for birth, and they often get 'stuck' as she did here. Usually breaking the waters does not hurt, but Laurin experienced significant pain. This probably was due to the fact that she was only 1 cm dilated, or the doctor may also have tried to manually stimulate the cervix at that time as well, which can sometimes help. However, in Kmom's view, this painful procedure should only be done after asking permission, and when it is not, many people believe this borders on assault. Unfortunately, doctors rarely ask permission to do this or have the patients give informed consent.
A seroma is a pocket of fluid that can collect underneath an
incision after surgery. Although women of all sizes can experience this,
it does tend to be more prevalent in women of size. Research shows
that suturing the subcutaneous layer, and/or putting in a surgical drain can
lower the risk for wound complications like this in larger women, although they
cannot *guarantee* that there will be no problems.
My daughter was due on June 22, 1998. I had planned to work until June
12, but by June 1 I was so swollen and exhausted I begged my doctor to release me from work on June 5. He agreed without any prodding. I had
my 38 week doctor’s appointment on Saturday, June 6, the very day after I stopped working. When I got weighed, the nurse exclaimed that I had
gained 25 pounds IN A WEEK!!! And my usually 140/70 blood pressure was “sky high”, as they put it (but I can’t remember exactly what it was).
Then they tested my urine, and found I was putting out large amounts of protein. My doctor immediately diagnosed preeclampsia and sent me home
to pick up my husband and my “hospital bag” and ordered that I go to the hospital to have my labor induced right away.
When I got to the hospital, they hooked me up to a fetal monitor, an automatic blood pressure cuff that takes your blood pressure like every five minutes, an IV drip of magnesium sulfate (which prevents seizures in pre-eclamptic patients) and pitocin, and they catheterized me. The only problem with that is that mag sulfate tends to counteract the effectiveness of pitocin, so I was not having the strong contractions I should have. And there I lay for approximately the next 36 hours, having only minor contractions and not progressing in the slightest. About 24 hours into my non-laboring labor, one of my doctor’s associates decided to try and speed things along by breaking my bag of waters. I found this to be the most excruciatingly painful event from my entire birth experience, but that could be because I was only 1 cm dilated. It was horrible! After she did that, she also inserted an internal fetal monitor, which was a wire attached to the baby’s scalp. I have to say, after the pain I went through with breaking the bag of waters, I began to wonder whether I was cut out for this birth stuff! All of my friends said that part was a piece of cake!
Breaking the bag of waters worked to a certain extent, but I still only dilated to 3 centimeters. This baby wasn’t going anywhere! The doctor said the baby’s head was turned slightly and was stuck in my pelvis. She didn’t even get to the –3 station. So, at about the 32nd hour, they decided that I needed a cesarean section.
I had some difficulties when they tried to give me an epidural—I was so swollen that the anesthesiologist could not find the proper area and said if he missed, I could be paralyzed. Not something I wanted to hear! So then they decided to give me a spinal block instead and I was wheeled into the operating room while DH waited in scrubs outside until the spinal had been administered. That went through without a hitch, and DH was invited into the OR to be with me during our baby’s birth. He stood at my right shoulder and tried to keep me awake during the surgery. Baby was born about 5 minutes later, beautiful and very healthy. The nurse brought her over for me to see, and I kissed my newborn daughter on the forehead and they took her away to get weighed, etc. while my husband tagged along, video camera in tow.
I didn’t have much pain from the cesarean section. The nurses were amazed at how quickly I could sit up and was walking around. I tend to think it’s because my abdominal muscles were already used to lifting a lot of weight. I still had to take it slow, but all in all I thought the cesarean was a cake walk.
I was released from the hospital 48 hours after the c-section. Everything was fine with my recovery and my DH and I were enjoying our first baby. Then one night, three days later, I was getting into bed (slowly) in the dark and I felt a huge gush of fluid pour out of my incision. I was so afraid it was blood! But it wasn’t—it was more like water, but sort of had a yellowish tinge. I called my doctor and he said to go to the emergency room immediately. It turned out that I had developed a seroma, or a pocket of fluid, behind the wound, and it had burst, thereby partially opening the incision. The staples had to be taken out in the ER. Then I had to be readmitted to the hospital for another two days while they watched me for infection. Since they couldn’t re-staple the incision, it had to be allowed to heal by itself, and the wound was 17 cm long and 6 cm deep! This involved packing the wound twice a day with lots and lots of gauze soaked in a mixture of saline solution and hydrogen peroxide and covering the whole mess with a lot of surgical tape and abdominal pads.
This was by far the worse thing about my daughter’s birth, because for the next 12 weeks I had to have home health nurses at my house twice a day to attend to my wound. I felt like a prisoner of my house—I couldn’t leave for more than a few hours at a time. It’s the thing I’m most afraid of for my current pregnancy—if I end up having to have to have a c-section that the wound would become compromised again. My doctor assures me that knowing what they know now, they would insert drains and take special care in sewing up the inner layers to avoid a situation like that.
As for size bias, all of the doctors and nurses were great and very supportive with the exception of the first nurse I encountered on my first day. She was a skinny little thing from Thailand and kept making remarks like “Were you always this big, or is it just because of the baby?” “Your hands look like catcher’s mitts” and “Are you going to go on a diet when the baby is born?” After several hours of dealing with her unkind remarks, I asked my husband to get the head nurse and I told her the remarks my previous nurse had made. Arlene, the head nurse for that shift, reassigned my previous nurse and she herself became my nurse, and she was the best one I encountered.
Lori's Story (insulin-dep. gd, rising b/p, induction, vaginal birth)
Kmom's Notes: This is an interesting story of a mom who had to have some interventions but fought off others, and with the support of her midwife (acting as a doula), was able to have a vaginal birth because of her hard work and careful choices. Because of her rising blood pressure, she needed to induce, but they essentially used 'serial induction' (where you delay breaking the waters and if the pitocin etc. does not have much effect at first, you stop and try again another day). They induced over 3 days, and she fended off many OBs who wanted to break her waters earlier. Amazingly, she did the induction without an epidural.
Although it's impossible to be sure, it sounds quite likely that her baby was malpositioned somehow. Intense pain without progress, back labor, labor stalling at 4 cm---these are common with malpositions. Her midwife put her on her side, and it looks like this might have turned the baby somehow into a more favorable position, for labor progressed after that. There is research that shows that side-lying (or all-fours) can help turn most malpositioned babies; it seems to have worked here. However, if they had broken her waters earlier, this may have put the baby into 'deep transverse arrest'---where the baby is gets so stuck in its malposition it cannot turn fully.
The baby's small size (just over 5 lbs. at 38 weeks!) could be from simple genetics, or a side effect of poor placental function due to high blood pressure. It could also be from too-aggressive insulin treatment. Some research has questioned extremely aggressive insulin treatment, noting an increase in small-for-gestational-age babies in this group. However, there's no way to tell for sure why this baby was smaller.
The midwife acting as doula probably also strongly increased her chances at vaginal birth too. Although small, one doula study found that women who had medically-necessary inductions with the support of a doula had a MUCH lower chance for a cesarean compared to those induced without the support of a doula. Moms who must be induced might want to strongly consider hiring professional labor support like a doula.
When I was thinking about getting pregnant, I considered dieting, but much of what I had read (including on this website) convinced me that crash dieting before being pregnant would not be good. Instead I concentrated on keeping my weight stable and eating well. I got pregnant the second month of trying, and the first part of the pregnancy was uneventful.
My husband and I took a Bradley class which scared me about drugs and some hospital practices, and I developed a desire for a natural birth although I did want it to happen in a hospital. I was concerned about unnecessary c-sections, because I am the kind of person who questions everything. If I had to have a c-section, I wanted to come away from it feeling that it had to happen. Because of all this, I was in the process of switching from my OB practice to a midwife I liked. However, that is when I got diagnosed with GD, and it did not respond to diet. The fasting numbers stayed high, so I started insulin.
I was very depressed---I was not going to be able to have my midwife in charge of the birth, and I was probably going to have to be induced, have an IV, the whole nine yards! The people at the high risk clinic I now had to go to said I had greater than a 50% chance of having a c-section, so I tried to mentally prepare myself.
[Kmom note: The c/s rate in insulin-dependent gd moms IS higher (unacceptably and probably unnecessarily so), but this rate of 50% they quoted her is excessively high. Most studies don't show c/s rates this high for GD moms, even those on insulin--it's usually between 25-40% or thereabouts, with a few studies on either side of these ranges. True diabetics (type I or II) do tend to have a c/s rate of about 50%, but it's not usually quite so high in gd moms. However, perhaps it was true that in THAT clinic, the rate was 50%---which says a lot about that clinic's practice!---but readers should not infer that the c/s rate is 50% for all insulin-dependent gd moms.
This is also an ironic comment on the purported benefits of insulin treatment, one of which is supposed to be a lower c/s rate due to a smaller baby. Although some studies have found a lower c/s rate in the insulin-treated group, most have found that the c/s rate is actually much HIGHER in this group, often even when macrosomia is reduced. This is probably due to the 'high-risk' mentality and interventions applied when insulin is used.]
In fairness, I have to say that I didn't get a lot of comments on my weight from the doctors and such. I mostly heard about it in the context of my risk of Type II diabetes later; that I should diet and exercise. When I was in the hospital it was never mentioned except that they were looking for the large gowns, but it was all matter-of-fact.
My midwife offered to be with me anyway---run interference with the hospital staff, etc., like a consultant. I gratefully accepted. During the last ten weeks I had two non-stress tests weekly, went to the clinic once a week, and had acupuncture to try to control my BP which had started to rise. The midwife and I were planning to try to get my cervix ready for labor with Evening Primrose Oil (EPO) and try to induce labor with acupuncture/castor oil just before my scheduled medical induction.
But we didn't get the chance---when I went in for my routine 38 week visit, my b/p had shot up and they wanted to induce starting that night. After some discussion we agreed. My midwife was a realist; she didn't try to hide the fact that we were going into a situation with the odds stacked against us. My cervix was not dilated or ripe at all, and with my high b/p the medical staff would be very eager to section me at the first sign of distress. We'd just do our best.
We checked into the hospital Friday evening and I got the Cervidil (a prostaglandin insert). Saturday morning they started the Pitocin and ran it all day---nothing happened. Saturday night I got Cervidil again and fended off an OB who wanted to break my water. Sunday morning I got the Pitocin again and fended off another OB who wanted to break my water. (The general OBs on call were trying to do things contrary to the perinatologist's ideas.) Early Sunday afternoon I finally began to have contractions and my water broke! I now had 5 bags on my IV: saline, glucose, insulin, Pitocin, and Magnesium Sulfate (for the b/p).
The contractions got intense and I started to vocalize through them--I had my husband in front of me and a doula behind me applying counterpressure (back labor, ick). At some point during all of this I had an internal monitor placed. I hadn't wanted it, but those belts just did not work on me once I was having contractions.
I was at about 4 cm, and a couple of hours later I was still at 4 cm. I was very discouraged---for some time it had taken all of my skill to get through it, and I was losing confidence. I said to the midwife, "Oh God, if I am going to have to get an epidural I'd just as soon get it over with..." She helped me stay in the present and reminded me how fast things can change. She suggested a small shot of Fentanyl to help my back and wanted me to change positions. I agreed to try her plan. The Fentanyl didn't seem to do anything for the contractions, and the position change (she suggested I lie on my side) seemed to intensify things. I think the baby may have been turning. I went from vocalizing to downright screaming during the contractions---forget Lamaze and Bradley and all those other MEN! This went on for about half an hour (kudos to my husband who was a rock---love but no pity) and she checked me again---I was ready to push! "Well, no wonder!" everyone said, and we got ready to push.
Pushing was hell for me; some people said it feels better at that point but not for me. I screamed during every push (what a sore throat I had the next day!). [Kmom note: Perhaps there was some malposition left, as this can make pushing slow and extra painful.] I pushed her out in about an hour. At the very end she started to show a little distress, and the midwife urged me to push harder and harder. She later told me that the distress wasn't bad yet, but she didn't want the baby to be born with depressed breathing because they would take her away.
So at last she came out---what a feeling! The midwife actually ended up delivering my baby because the perinatologist was called away to a c-section. She was much smaller than we thought at 5 lbs. 4 oz. The ultrasounds were wrong; they said she was average. She had to have lots of glucose tests but she was very healthy. She and I were both a little spacey from the magnesium sulfate but other than that I felt pretty good. I got up in half an hour and went to the bathroom. I had one small tear, smaller than the episiotomy, from having to push her out fast at the end.
Despite the days in the hospital and the stress, the birth is a very positive memory for me. I feel lucky to have the outcome as good as it was given the circumstances. I believe that the midwife and not letting them break my water too early were instrumental in saving me from a c-section. The other factor was just luck. I'm also glad I didn't get the epidural because I would never have been able to push her out so well, and they would have needed to use vacuum or forceps when she was distressed. I hope to have another baby in a few years, and I know I might not get so lucky the second time, but I'll never forget the experience of feeling the baby come out. I'm glad I got to do it at least once.
Leslie's Story (3 prior cesareans, VBA3C with 13 pound baby)
Kmom's Notes: Some doctors will tell women they'll never VBAC if the baby is too big. This woman had a VBA3C with a 13 lb. baby! She had a "CPD" VBAC with a 12 lb. baby (baby #3) but went on to VBAC with an even larger baby--and no shoulder dystocia. So much for "CPD"! And she had a VBAC after not one but TWO 'failed' trials of labor! And with pre-eclampsia!
Her first cesarean was an elective cesarean for breech after a failed external version. Her second cesarean was after a trial of labor (27 hours, all unmedicated) that was found to be a surprise breech. Her third cesarean was a year later (another 'failed' trial of labor), this one with the 12 lb. baby. She had labored at home ending in transport, this time after 30 hours of unmedicated labor (including 5 hours at 9 cm). It's impossible to say for sure, but given the malpresentations (breech) she'd had with the first two babies, and the 3rd labor stalling before completion, it's quite possible she might have had a malposition (posterior or asynclitic or compound) with the third baby.
In her fourth pregnancy, she actually found a doctor willing to 'let' her VBAC 'even' after 3 prior cesareans, 'even' after a prior very large baby, and 'even' in the face of significant pre-eclampsia. It was not an easy birth, yet despite a number of complications that seemed to make her dream of VBAC impossible, she kept trying and ultimately had the VBAC. When asked why she chose VBAC, she said, "I chose VBAC because I've always believed in doing everything as naturally as possible, and I wanted to experience vaginal birth."
Friday morning I went in for my first appointment in almost 2 weeks. My BP was up (160/110) and I had protein in my urine. The doctor told me to go home and rest, do a 24-hour urine sample, and return to the hospital the next day for a BP check. Saturday at the hospital my BP was 170/111 but went down to normal as long as I was resting. They called my OB and he said I could go home but was on absolute bedrest until my Monday morning appointment.
By Sunday I was starting to freak out because I kept hearing toxemia horror stories from people. So I called my doctor. He said that if I were someone else he would have sent me in to be induced on Friday, but he knew that I would stay in bed and he knew that I really didn't want to be induced. He said he would have been happier inducing me but wanted to give me a few extra days to go into labor on my own (since I had told him it would be Sunday). He said that he had planned to tell me on Monday that I had until Wednesday to go into labor naturally. He also told me that due to the high BP I would have to stay in bed during labor which really upset me as all my plans for VBACing and avoiding pain meds involved walking and being upright.
DH was at a birthday party with the kids at the time so I told the OB that when he got home we would talk over possibly going ahead with the induction. Well, I went into labor at 4:30, shortly before DH and the kids arrived. The doctor called to check on me around 5:30 and said he wanted me in the hospital right away so he could monitor the BP. So there went another part of my birth plan---staying home as long as possible---out the window. I ate some eggs and milk and yogurt before I left because I figured they would starve me at the hospital, and we went on, arriving there around 6:30 p.m.
They checked me and found no dilation at all and a very posterior cervix. My water had also broken and my contractions were hard and difficult to manage almost immediately. I had to be hooked up to a fetal heart monitor, a contraction monitor, a BP cuff, and an IV for fluid and antibiotics for Group B Strep. All I could do was lie on my side. I was panicky and could not cope with the pain at all. After 7 hours of what certainly felt like hard labor to me, I had made NO PROGRESS at all. And due to the ruptured membranes, GBS strep, and high BP, the OB had said that if I wasn't progressing by that point I would need pitocin augmentation.
I have had 2 long and completely unmedicated labors before, and was able to cope with them by walking, changing positions, etc. When I had to get up to go to the bathroom I could see that I would have been much more comfortable upright. But lying down, I couldn't cope with the pain, and I couldn't imagine coping with the added pain of pit contractions. Also, everything was going so wrong that I felt sure I was all set for another c/s anyway. I thought to myself that it was ridiculous to suffer for 12 more hours only to end up with a c/s anyway. Also, my ideal birth had been so completely messed up by this point that an epidural didn't seem like much. So I said that if I had to have pit I was having an epidural too.
Bless my husband's heart, he was trying to do the right thing. I said, "I can't DO this anymore," and he said, "That's what the Bradley book said you would say. That's normal." I said it was normal when you hit the self-doubt signpost at transition but not at 1 cm. I said I was serious! And then he suggested I just try some pit contractions, but I was afraid that I would be in agony for hours if I had to wait until after the pit for the epidural. So I got the epidural first, then the pit. This was all hooked up shortly after 1 a.m. and then we rested for a while
2 hours later when I was checked I was at 7 cm. I truly believe this was one of the situations where the epidural was beneficial, since it enabled me to relax. By 5 a.m. I was at 9, and at 7 a.m. the OB said I could push. However, he also told me that my baby's head was big and that it was well behind the pubic bones. He said that all he could feel was bone and that the head would have to mold incredibly to fit through. Then he left the room and told the nurses (he told me this himself later) that I could push but to be ready to do a c-section at noon!
I myself did not believe I would be having a VBAC at this point, but I had a very supportive labor nurse. Of course, just to add to everything else, I had to push semi-sitting----they wouldn't let me get upright because of the BP. I had counted on squatting so I really did think that was going to be the last straw. Anyway, she held one leg and DH the other. We got in at least 3 pushes for every contraction. I was able to push effectively despite the epidural, or I would have had it turned off. I had no trouble feeling where to push.
For a long time his head did not move. She turned me on my side between contractions so the head could descend through the available space. There was very little resting time between contractions and pushing was very hard work! Finally, she had people come in and start setting up for delivery. When the OB came in he said, "I love it when I'm wrong." I still did not believe it would happen. But getting his head through the pelvis was the hard part, apparently. The next thing I knew, his head was out and I started to cry because I knew it was really going to happen. The rest of him was born really quickly---what a strange feeling!!
I had an episiotomy and 3 tears---one in the sphincter, one inside, and one near the urethra. The sphincter is the main place I have felt discomfort. I really did not realize a vaginal birth would be so painful afterwards! It does seem to get better faster [than a c/s], though.
The baby ingested a lot of meconium, so it was nearly an hour before I could hold him, although I could see him the whole time. And of course we were all dying to hear the weight, since baby #3 was 12 lbs. The neonatologist said he was sure that it would be more than 12 pounds. He was born at 9:01 a.m. on Monday, at 24.75 inches, with a 16 inch head, and at 13 lbs., 5 ounces!!!!!
My milk came in last night and he is an enthusiastic nurser. He's a sweet baby, very alert, talks a lot but rarely cries. He is already much-loved by his siblings.
Polly's Story (PIH, elective c/s)
While I was pregnant, I visited this site many times and I often read the testimonials of other larger-than-average women who had delivered babies. I hope that my simple words can calm you like those stories did me.
I lost over 100 lbs. before I got pregnant by using a liquid diet. I weighed 324 and lost to 217 lbs. When my husband and I tried to get pregnant, it took only two months. We were thrilled! I went to a high-risk OB because he took my insurance and because I had a history of hypertension, although at the time of conception my pressure was normal. It was an extremely wonderful experience. He NEVER mentioned my weight or my weight gain as a problem during my pregnancy. He was always concerned about my history of high blood pressure, but when that came to pass, his attention to it was perfect. Even though I was 36 at the time, I refused all prenatal testing. I knew that God's hand was on this and whatever was going to happen was His will. My husband and I put our faith in Him and opted to pass on all of the testing.
The nurses were wonderful in his office. I often had to remind the lab techs to use a larger blood pressure cuff on me to get a more accurate reading, but they soon remembered on their own. I had to go more often than most women due to my rising blood pressure. I also had more sonograms than usual due to the uncertainty of my conception date. (As is often the case with some women with irregular periods, I had trouble dating my due date. The early sonograms turned out to be beneficial as they are more accurate than later ones!)
As my blood pressure was 190/100 or most often 150/90, I went to the doctor more often. I had to often go through testing (blood work, urine tests, ultrasound, and fetal monitoring) to make sure that it was not toxemia. Mine never was. In the 8th month, I began going to the doctor twice weekly and finally had to start doing fetal monitoring for about one hour twice weekly. It was the most uncomfortable thing that I have EVER experienced! However, it is so reassuring to hear that little heartbeat and 'hear' him moving.
Anyway, four weeks before I was due, my doctor put me on limited activity and I quit work to stay close to home. After several visits to the hospital for hours of fetal monitoring, my doctor, husband, and I decided to do a c/s one day when my pressure was 160/90. I was 38 weeks. My doctor was afraid to induce labor because nurses had a horrible time tracking my son's heart rate because he moved so much. (Turned out I had too much amniotic fluid which gave him room to swim! While this is not a good thing, my doctor said that in my case it was not alarming.) He did not want to give me medications and not be able to tell the effects on the baby. So within an hour I was cleaned up and ready for a c/s. I had absolutely NO problems. The procedure went great, the baby was (and is) fine, and I had NO pain whatsoever.
During my visits to the hospital and doctor's office I never encountered any discrimination of any kind. All of the equipment fit my body type fine except for the pressure cuff. (I have since learned that it isn't that uncommon for people to need the large size cuff.) All of the hospital gowns, lovely disposable undies, and surgical equipment were fine. I even worried about getting onto and off of the surgery table. That went fine. Those nurses are used to women flopping here and there. There is even a special 'board' to scoot you from the c/s table back onto the gurney.
I think it is so important to find a doctor who you are comfortable with and who is not judging you. I am the type to listen to doctors and think they know everything. I know that some of you are not that way. But if you are like me and hinge on every word of a doctor, I think that it is VITAL that you find one who can make you feel comfortable and who is experienced with a wide range of circumstances. During my pregnancy, I thought about studies which find that overweight women have higher risks of complications. I hope and pray that your pregnancy is not haunted by such thoughts. I found great comfort and peace in knowing that God would overcome. I hope that your pregnancy and birthing is pleasant, and one day a fond memory for your family.
Megan's Story (gallstones, pre-eclampsia, premature induced vaginal birth)
Summer of 2002 and it was HOT! [I] started swelling and showing signs of pre-eclampsia at about 32 weeks. Doctor told me to drink a gallon of water a day to make sure I stayed hydrated. Other than that, no bed rest or any special instructions.
Woke up [one] Wednesday morning...with terrible epigastric pain. I went to work feeling horrible and started to drink my gallon of water but couldn't keep it down. I left work early and called the doctor's office. They called back about 2 hours later and when I explained the situation to them, they said to go to the Labor and Delivery floor of the hospital for IV hydration. I received 1.5 liters of fluids before I passed a small amount of urine, my blood pressure was climbing, and they admitted me to the hospital. Thus began my nightmare!
I had an abdominal ultrasound and found that the pain I was having was from gallstones. Each day for the next four days, besides being poked, prodded, and drained of enough blood to float a battleship, the doctor on duty would come in and tell me that I was going to be induced that day. What an emotional rollercoaster!
After four days of Magnesium Sulfate and two betamethazone injections, I was induced on Saturday at around 5 p.m. The labor and delivery were actually the easiest part of my whole hospital stay. I was given medication for vomiting and it knocked me out for a while and then [was] given Stadol for my gallbladder pain, which also knocked me out. When I started having back labor, I was given my epidural and I slept for a while.
When the doctor checked me at around 5:15 a.m., I was only dilated 5 cm but I was having a lot of pressure. He checked me again and told me to push while he was checking me and I went to 8 cm. My son was delivered about 8 minutes later!
He was having a little trouble breathing so he was taken to the NICU after a quick peek and I didn't see him for more than 24 hours because I couldn't get out of bed. After that, my blood pressure kept going up and up and I was being given IV medication, couldn't have visitors except my husband, no TV, and couldn't open the shades for fear the sunlight would overstimulate me. I had these bumpers taped to the bed rails in case I went into seizures! My platelets were next to nothing from the pre-eclampsia and each blood pressure check (every 15 minutes) caused my arm to bruise terribly.
I was transferred to the postpartum unit and was put in a room with a girl who was taking her baby home. My primary doctor called me on the phone and told me that I was not allowed out of bed unless my blood pressure was under 160/90. Every time the nurse came to take my pressure, I'd be so anxious about it being high; it almost always was. Every cell in my body was aching for my baby and I couldn't see him.
My pressure started to stabilize over the next couple of days and on Thursday, my eight day ordeal was over! As happy as I was to leave, I didn't want to leave my son there. I was not supposed to drive for two weeks but starting the next morning I was at the hospital for about 6 hours a day until he came home 13 days after his birth.
He's [now] a happy, healthy baby with a very happy mommy!
Tammy's Story (gd, PIH, induction, vaginal birth)
I conceived easily the first month I was off birth control pills. We had some concerns about my health in the beginning because I have had high blood pressure my entire adult life, however, it has been under control with medication for several years. I also have been glucose intolerant for a couple of years. I was not as responsible as I probably should have been in that I did not consult my doctor before I got pregnant. I simply stopped taking the birth control pills and things happened naturally. My blood pressure medication had to be changed after I conceived in November 2003.
In March a new obstetrician joined the group who was treating me. My primary care was changed to her. I really liked her and she had a lot of experience treating gestational diabetes. She gave me guidelines to follow in checking blood sugar and my diet that the other doctors had not. I was checking blood sugar five times daily with the goal of keeping fasting sugars under 105 and two hours after meals under 120. As long as I followed the diet, 75% of my results were within these goals with 95% being within 10 points.
Actually, the obstetrician and my primary care physician disagreed on my diabetic status. My regular doctor did not think I was diabetic and felt that starting insulin would cause me to have low sugar numbers and actually make it worse. She did agree to prescribe insulin if I wanted it. The obstetrician thought I needed it. I decided to follow the diet closely and monitor my blood sugars. As I stated earlier, the numbers were never terribly high and actually improved as the pregnancy continued.
After 36 weeks, the obstetrician had me coming in on Mondays and Thursdays for fetal monitoring and ultrasounds every Thursday. She was concerned about the possibility of fetal death even though the baby was doing great every time.
When I was in the office on Monday, 7/19, I was doing great 96 great fetal monitoring results and blood pressure 123/78. We decided to deliver the baby the following week. I had an appointment with my regular doctor on Wednesday, 7/21. My blood pressure was 170/107. She called the OB and they sent me to the hospital. I was hospitalized until Friday for a pre-eclampsia work up.
I was having no swelling (wore rings and pre-pregnancy shoes until delivery), no headaches, no protein in urine, etc. My blood pressure was high but everything else was normal. The baby appeared fine on the monitor and ultrasound. This was a special ultrasound because the technician was more thorough than others that I had. We were finally able to tell that I was having a girl. I was discharged Friday, 7/23, with orders for bed rest.
I did fine over the weekend and my husband stayed busy working on the nursery. I saw the OB again in her office Monday, 7/26. I am now at 39 weeks. My blood pressure was stable and we decided to continue with our plan to induce labor the next day. I had dilated 1.5 cm and the monitor showed some mild contractions.
I was at the hospital at 6:00 AM July 27. The doctor explained that I was to be induced with cytotec. This is supposed to be a kinder and gentler way to induce than pitocin. I was given the first dose about 8:00 AM. When the doctor came back about noon, nothing had happened so she gave me double the dose I had earlier. After a few hours I was having some cramps 96 like with my period- and my back was hurting. I was not having anything that seemed like labor pains. It was hard to judge from the fetal monitor whether anything was happening or not. I guess because of my size, the external monitor did not work very well.
When the doctor came back about 5:00 PM, I had dilated to 3 cm. The doctor explained that I needed to dilate 7 more cm which could take 3 hours per cm and 3 hours for pushing. Meaning the birth could be another 24 hours away. I told myself it won 't take that long. I was determined to have my baby soon.
The doctor decided to break my water and insert an internal monitor about 5:30. That did it. Fast and hard contractions started immediately. They were coming less than two minutes apart and the monitor showed them peaking at 110.
My epidural was ordered a little after 6:00 PM and was in and giving me relief by 7:00. While turning around to get the epidural, I pulled the monitor out. When the doctor came back to reinsert it about 7:00 PM, I had dilated to 6 cm. She said she usually had the nurses page her when a patient got to 6 so she would not be leaving the hospital.
I got so comfortable with the epidural that had trouble staying awake. The nurse checked me again about 8:00 PM. When she pulled the sheet back she said I had a lot of bloody show. The next thing she said was, "You're ready." I had gone from 3 to 10 cm in about 2 hours.
Pushing was hard work but went well. After a little over an hour of pushing, my beautiful daughter was born at 9:29 PM. I wanted to touch her but I was afraid to at the same time. The nurses moved her to a warmer beside my bed while the doctor was sewing up my episiotomy I could see some of what they were doing but I couldn't see her very well.
Finally the doctor brought her back to me and I saw that her right leg was crooked below the knee, the foot is sideways, and she only has three toes. Everything else was normal. At that point I was not capable of reacting to a problem. I had my baby and she was beautiful.
Sometime the next day an orthopedic surgeon saw her and reviewed her X-Rays with us. Several bones in her lower leg and foot are missing. He talked to us about referring her to a Shriner 's Hospital. He assured us that this was not caused by anything that my husband or I did.
I look back on the pregnancy as the most wonderful thing that ever happened to me.
MH's Story (pre-existing hypertension, induction, c/s)
Kmom's Notes: It can be very hard on a woman emotionally to have general anesthesia for a cesarean. For more information about the issues this can bring up, please see the FAQ on Emotional Recovery After a Cesarean on this site.
My pregnancy was pretty good. Because of controlled [pre-existing] hypertension (not pregnancy-induced), I was labeled high risk. That was okay with me actually, as hypertension is something that can be scary in pregnancy. I had 3 level 2 ultrasounds until the last 5 weeks. Then I had one at the doctor's office every 3-4 days, with a non-stress test. During my 39th week visit, the doctor did an u/s and said the baby was well over 8 lbs. Because of the hypertension, I was going to be induced during my 40th week if I had not gone into labor already. So, because I was very adamant that I wanted *my* doctor to be the one that was there during delivery, and he was on call the next couple of days, we decided to start the induction that night.
I was given Cervidil in hope that my cervix would soften, as I was not dilated at all, and just a bit effaced. Pitocin was started the next day at 5:00. I started having contractions about 9:00, but nothing strong at all. My doctor checked me at 12:00, still nothing. Checked again at 5:00, and still, nothing. At this point, we had to decide how to proceed. I could go home and see if anything happened over the weekend, with a scheduled c-section if I didn't go into labor myself, the pit could be turned off, and started up the next day ( but my doctor didn't want to do that, and neither did I), or a c-section then. We chose the c-section.
After I was prepped, the anesthesiologist came in and attempted to give me a spinal. After 5 attempts, he said he didn't think it would work. I said try it two more times, and then I'd agree to a general. It didn't work. I was knocked out completely. The next thing I remember was waking up, being moved from the operating table to a bed, then I turned to my left, and my husband was standing there with our beautiful little boy! I was in a lot of pain, as the morphine did not work. I was given a Demerol drip, and that did work.
Yes, I think I was pushed into the c-section. I am going to try very very hard next time for a VBAC. And, I will flat out refuse to be worked on by the same anesthesiologist. It is because his ineptness that I did not see my baby be born.
Sherie's Story (PCOS, hypertension, PROM, induction, compound presentation, c/s)
Kmom's Notes: A short cord and baby's hand by the head could definitely cause a long hard labor.
At about 3 in the afternoon, at 37 weeks along in my first pregnancy, I started spotting. I had never had spotting or had any kind of bleeding at all during the whole pregnancy. I knew that this was most likely the mucous plug and some blood caused by the cervix beginning to dilate. I had no contractions and thought it would most likely be awhile before labor started. I went to take a shower during the shower my water broke! I called my husband to come home from work, we ate a light dinner and about 5:30 we went to the hospital.
My contractions were 2-3 minutes apart and I was dilated to a 3cm when I was checked shortly after I arrived. They put external monitors on me to track the contractions and the baby's heartbeat. The baby was moving around so much that we couldn't keep track of the heartbeat and they inserted a internal scalp electrode. They told me that I needed to be dilated to 6cm before they would give me an epidural. They said if given to early it could slow down labor. About 9 pm I was checked and had dilated to 4cm. I was having extreme pain and the nurse gave me Stadol. After that wore off I was checked again at about 12am and was still a 4cm. The nurse had me go get into a warm water bath to try to relax. I got ice chips and more Stadol. At 4am I was checked and was 5cm. I had nausea and threw up twice. I sat and rocked, I couldn't walk because of the extreme pain of the contractions and the nausea. My doctor came to check me at 7am and I was still 5 cm. At 9am my doctor said I could get the epidural, I was 5cm.
I had contractions all day and threw up 3 more times. I was given pitocin about 2pm because my contractions had slowed way down. At 6pm I had dilated to 7 cm and was exhausted. My doctor wanted to do a c-section because the water had been broken for more than 24 hours, I was exhausted and wasn't progressing despite the pitocin and my epidural wasn't working any longer also the baby's heartbeat showed he was stressed and needed to come out. I was so tired that I snored during the c-section, I could hardly keep my eyes open and when they showed me my baby I was so out of it I could hardly even look at him. He didn't cry much and he was so small, he didn't look like I thought he would. My husband wasn't allowed in the surgery because it was an emergency. They let my husband hold him a few minutes after he was born.
Later I found out that I had 4 large fibroids and the cord was unusually short. Also my baby had his hand up by his head and had a bruise under his eye were his hand had been. I was just glad it was over and that my baby was healthy and doing well. He had apgar scores of 7 and 9.
It was disappointing to have the c-section. It took some time to accept and come to terms with those feelings.
Kathie's Story (borderline BP, induction, c/s)
Kmom's Notes: As far as her borderline blood pressure goes, it's very suspicious that Kathie's bp was always very normal at the hospital during monitoring and high at the doctor's office. Either the doctor's office was not using the correct size cuff, or Kathie experienced "white coat hypertension" (elevated bp readings from the stress of seeing a provider, or in this case, a hostile provider).
A doctor automatically ASSUMING from the start that you are going to have high blood pressure, gd, and/or a c/s simply because you are large is a BIG RED FLAG that this doctor is fat-phobic. Almost always, these doctors create a scenario that make these women have highly interventive, difficult births. Beware of the self-fulfilling prophecy of your provider's expectations! And never hesitate to switch providers if your intuition is uneasy. It's NEVER too late to switch providers---even in labor!
I became pregnant in August of 2000 with my first baby. I went to my ob and was officially told I was pregnant and due April 16, 2001. My OB showed signs of being fat phobic at that very first appointment and I should have changed immediately! However, I decided to stick it out and ended up regretting it all through my pregnancy.
At the very first appointment she told me that I would have pregnancy induced hypertension and most
definitely I would have GD - all because of my weight. I believe my highest blood
pressure reading was 150/85 at which point she made me have fetal monitoring every week for the last 4 months of my pregnancy. Funny thing was I always
had a normal blood pressure at the hospital when I was being monitored (117/70). The "high" blood pressure in my opinion was brought on by my
I believe now looking back on it that she wanted to find something wrong with me during my pregnancy to prove to me that an overweight pregnancy was, in
her opinion, an unhealthy pregnancy. And I never had GD...as a matter of fact my numbers were great...I think my test came back with a number of 100.
Anyhow, April 16th came and went and I wasn't even dilated or have a soft cervix or anything. My OB insisted that I needed to be induced because of my weight...she didn't want the baby getting too big. Also I was swelling quite a bit and she said that all the water gain wasn't good either. So, on the evening of the 17th I went to the hospital and was given Cervidil. This was supposed to soften my cervix and get it ready for inducing in the morning. This actually brought on slight contractions, but nothing that was really painful. The next morning (the 18th) I woke up around 5 am. I had to go to the bathroom and when I stood up all this liquid came out! My first thought was I didn't know I had to go that bad! Anyway, I made to the bathroom and I went for what seemed like a really long time. I thought did my water just break? I thought I had better mention it to the nurse. She checked me and said that I had in fact broken my water. I was only dilated about 1/2 cm at that point.
They immediately started me on pitocin. They increased the amount every 15 minutes or so, which I believe is very common. Boy did this bring on the contractions hard and fast! I finally understood what my OB meant when she said I wouldn't be able to talk through them! My contractions were coming every minute or minute and a half and I was still only dilated to 3 cm. This was around 12 noon. A few times during the morning I had to be placed on oxygen because the baby's heart rate dropped, but they were able to get it stabilized and I didn't have to remain on the oxygen for very long. This was very scary! I had no idea what was happening to my baby! The nurses were wonderful! They never got panicked or anything and that in turn kept me very calm.
At around 3 pm I asked for an epidural...my contractions were coming every minute and lasting probably 45 - 60 seconds, but I was only dilated to 4 cm. My OB came in and checked me a few times during the day. She did say that I should have had the baby by now. She didn't know what was slowing things up. What I found very irritating about her during all this is she didn't speak to me. She didn't ask how I was or how I was feeling. She would come in and talk to the nurse and completely ignore me! Ugh! So frustrating. If my husband or I would ask a question she would give a cursory answer and walk out! I believe this was a reflection on how she felt about me because of my weight!
The nurse came in and told me that it would be a few minutes before I could get my epidural because the dr. was in surgery! So they gave me a shot of I believe it was called new morphine? Any way...it was to take the edge off the contractions. It worked, but I remember thinking with each contraction...boy I'm glad they gave me that shot...it still really hurts but can you imagine how much it would have hurt with out it??!?! Finally around 4 pm the dr. came and gave me my epidural. Sweet relief! However, only half my stomach was affected by the epidural...I could totally feel the contractions on one half and not on the other. So the dr. came back and gave me some more medicine.
After that it was just a big blur. I laid there until 8 pm when the ob came to check on me...I was still only dilated to about 5 or 6. She kept saying to the nurse she should have had this baby by now. I was confused because everything I had heard about inducing was that it gets the job done fast. To be honest I was too exhausted to ask what was wrong...I had been up for 2 days by this time. I just wanted it to be over!
Finally at 3 AM on Thursday (the 19th) they checked me and I was still only dilated to 8 cm. The ob said she would do a c-section because it was coming close to being 24 hours since my water broke. (Oh yeah...they did start me on antibiotics earlier - about 12 hours after my water broke). Finally my son (8 lbs. 15 oz. 21 1/2 inches.), was born by c-section at 4 am with my hubby by my side...that is until he got woozy and almost fainted and had to leave! Men!
I honestly believe that the OB made me lay there for almost 3 days before she decided to do the c-section because of my weight. She told me way at the beginning of my pregnancy that I would probably have to have a c-section because I was overweight. I think, again, that she wanted to prove her point.
Nicky was sent to the NICU 2 days later because of rapid breathing. They kept him for 4 days and did blood cultures. There wasn't any infections. He does however have a very small ASD and VSD (Ventricle Septal Defect and I can't remember what the ASD stands for.) Anyway, the cardiologist said they are so small that there is no need to worry. I took him to the cardiologist in Dec. of 2001 and she said that he is doing so well that she doesn't have to see him for a year! He is growing and gaining weight like crazy!
Kristen's Story (low progesterone, pre-eclampsia, vaginal birth)
Kmom's notes: Kristen's doctor was worried about the possibility of shoulder dystocia because her baby was good-sized. The doctor had the nurse "push on [the mom's] stomach" near the end. This could mean either of two things. Either the nurse pushed near the top of the mom's stomach (her fundus), which actually is a strong risk factor for causing or making shoulder dystocia worse. Or the doctor had the nurse push down on the mother's pubic bone, which can sometimes help fix shoulder dystocia if it occurs, but which no research shows actually helps prevent shoulder dystocia. Fortunately, in this case, everything was fine anyhow, as it is most of the time with big babies.
A second note: the first anesthesiologist who placed Kristen's epidural only got a one-sided result. That should have been an indication to replace the epidural, if "fiddling" with it a little did not fix it. But the mom was too scared to do this because the initial placement had hurt so much. Fortunately, Kristen's OB came in and ordered it replaced by a new doctor, and the second anesthesiologist did a much better job. He got the second one placed in one try instead of five tries. Lessons to be learned----if there are difficulties getting the epidural in, don't be afraid to request a different anesthesiologist. Sometimes one doctor is better than another, or one doctor just "gets" your anatomy better. Second lesson---if you don't get good pain relief with the epidural, definitely ask for it to be replaced. Don't continue to suffer with a bad epidural. Had a cesarean been needed, a poor epidural could have caused a world of problems and pain (ask Kmom!). So don't be afraid to ask for a different anesthesiologist or a new try at the epidural if it's needed.
I have to start out by saying I love my OB. She’s a wonderful lady. Sure, we bicker like sisters, but I know she will do anything and everything to protect me and my child. I suffered multiple miscarriages before getting pregnant with my daughter. We waited until I was 10 weeks before I had my first OB appointment because I always miscarried before that, but I’d have blood work drawn several times a week to test everything known to man. We still are unsure why I suffered the miscarriages or what allowed me to carry my daughter, but I am thankful my body finally got it right.
Each pregnancy, I had low progesterone. I’d go on progesterone supplements (suppositories) and hope for the best. When I arrived at my 10 week appointment, my BP was slightly elevated, but I attribute that to me being so nervous for actually making it that far. My OB told me she wanted me to only gain 18 pounds because the extra weight could make the pregnancy harder. I surprised her in the end and only gained 7 pounds. But that was pretty much our last discussion about weight for my entire pregnancy (except when I gained 4 pounds over Christmas…but really, who doesn’t???)
My pregnancy was pretty uneventful until my 29 week appointment. My blood pressure was elevated and I had trace protein in my urine. My OB, being the eternal optimist started telling me I’d be lucky to make it to 34 weeks at this pace and put me on modified bed rest. I went back a week later and my pressures were OK. A week later, they skyrocketed again and I was put on complete bed rest at home and medication for my pressures. I’d go back and forth on the protein in my urine, sometimes trace, sometimes 2+. My swelling got pretty bad. We argued if it was simply pregnancy-induced hypertension or pre-eclampsia (her thought being I had 3 out of 4 signs of pre-eclampsia…if it looks like a duck and sounds like a duck then it’s pre-eclampsia!). But my blood work remained OK.
Each week became a milestone and a relief to be done. Finally, at 35 weeks my OB decided I should have another u/s to check baby’s size. The Perinatologist (great guy) became mildly worried in my u/s. The baby measured over 8 pounds and I was only 36 weeks. My OB began to worry I couldn’t push out a big baby. So then she continued watching my pressures and checking my cervix weekly (Non-stress tests began bi-weekly around 32 weeks). At 38 ½ weeks, it was determined that was as far as my OB was comfortable going as my daughter was just getting bigger and bigger.
My husband and I checked into Labor and Delivery on Mother’s day evening. They placed cervidil and I was approximately 1 cm and 50% effaced. I didn’t sleep that night. Hubby slept like a log. At 5:30 AM, they pulled the cervidil and let me shower. Then they started the pitocin. Ugh.
Pit sucks. I was OK for a few hours. 9:30 AM my OB checked me and I was 1– 2 cm (she’s conservative on her checks). She asked if I wanted to do this or go home. Yeah, I was done. “Do it woman.” She broke my bag of waters and I was committed to this roller coaster ride.
At 11 AM I was approximately 3 – 4 cm and my OB ordered my epidural. My epidural experience sucked at first, but got better. The anesthesiologist had a hard time placing it and poked me 5 times. The pokes hurt worse than the contractions. He told me my back was “puffy” and he couldn’t get a good stick. He finally placed it. And 20 minutes later I had relief….on HALF my body. I was numb on my left side and totally felt everything on my right. He offered to replace the epi, but I was terrified because of how much the pokes hurt.
So I labored with ½ of an epidural for quite a few hours. The pitocin was increased and my contractions got worse. At 3 PM I began begging my husband to just let me get a c/section and that I didn’t want any more children. That’s when he began to panic. My OB came back and checked me and flipped that I was in so much pain. She insisted I have another epidural placed and found a different anesthesiologist. After 1 poke that I didn’t even feel, I had almost immediate relief. He cranked the epidural because he felt so bad for me. I proceeded to fall right asleep as soon as my OB checked me (7 cm).
Slept for an hour and woke up complete. That’s what I’m talkin’ about! I whispered for the nurse to turn the epidural down slightly because I couldn’t feel ANYTHING, she did it before my OB noticed. I started pushing at 4:35 PM and my daughter was born at 5:02 PM. I did have a nurse push on my stomach at the end to help push her out (they were worried about shoulder dystocia). I had an episiotomy and some minor tears, but all went well.
My daughter was a bit out of sorts when she was born (I still say from the botched epidural, but my OB disagrees. Ultimately I don’t care why, only that she is fine now) and was worked on by some NICU nurses to perk her up a bit with oxygen.
I had it easy. My best advice to people is to be an informed patient and be comfortable with your caregiver. I wish I had not been so wishy-washy with my epidural, but the mind works in mysterious ways when under stress.
Breastfeeding was an interesting adventure. My daughter did a weird lip thing when she latched on at first, which hurt. My MIL is a lactation consultant, so she helped work through that. When I had to return to work 12 weeks post-partum, I suddenly had supply issues (they were in my head…I didn’t want to go back to work so I subconsciously figured if I couldn’t get milk for her, I could stay home). I struggled for several months after going back to work, pumping as much as I could. We had a terrible case of thrush at 5 months and struggled with supply after that until I was prescribed a dose of Reglan…WOW, what a difference! Yep, but then we got a surprise…We’re expecting #2. I exclusively breastfed until our daughter’s 6 month check up and then supplementing with formula. I still breastfeed twice a day, but because of the pregnancy, am limited.
As I type this, I can’t wait to do it all over again in 4 months when my son will be born and join his then 13 month old sister.
Jenn Lynch's Story (PIH, possible GD, failed induction, c/s)
I was put on disability at 5 months for PIH. Every time I went to the doctor something else was found. I had high BP, borderline diabetes, polyhydramnios, and protein in my urine. At 38 weeks they decided to induce me.
I went in to Kaiser at 8 p.m. on Sunday. They decided to start with pitocin because I had not had any contractions so they were not sure if the baby could tolerate labor. If she had problems they could turn the pit off easily. I was on pit through the night and I would get contractions and then they would peter out. They would turn it up and the same would happen.
About 3 p.m. Monday they turned it off and let me shower and eat, then at about 10 p.m. they put Cervidil on my cervix. They did this every 4 hours until morning. I was dilated to 2 cm. At about 4 a.m. Tuesday, they started the Pit again. I was having contractions and they were petering out again. They were about to send me home at noon on Tuesday when my darling daughter broke my water. We heard it on the monitor. It was weird. It was a thump and then a pop and then whoosh I was all wet. There was no turning back now.
I settled into a good contraction pattern but they were not strong enough so they kept upping the Pit. I could not eat. Because of my BP I could not have the broth they provided because it was too salty and they were worried about my blood sugar so the jello was out too. I was confined to tea and ice chips.
At about midnight on Tuesday I had enough. I did not intend to get any pain meds but I had not intended on being induced and in labor for this long so I asked for an epidural. It did not work. It numbed everything but my tummy. They tried again and it still did not work. I started to vomit but I was just bringing up bile and eventually dry heaves as I had had nothing to eat. By this point I couldn't even have ice or tea because I was vomiting. I was developing a fever. My water had been broken for a while. I still had not dilated past 2 cm.
They shut everything off, gave me a shot of Demerol, and mercifully let me sleep. At about 7 a.m. the anesthesiologist came to say goodbye as it was shift change and he introduced me to the replacement. He said he will help you get through the surgery. It took me about 5 minutes before I really got what he said. After all that I was just a little bit out of it. So when my night nurse came in (she was an angel), I asked her about it. I don't think she was supposed to tell me, but she did anyway. I was so tired and exhausted at this point I just wanted it over with, so I agreed to the c/s.
They gave me a spinal and it worked beautifully. I managed to stay awake for her birth. I asked if she had hair and then passed out on the table. My husband said I was snoring. [Kmom note: They often give the mother a dose of drugs to 'relax' her after the baby is born, but it often is so strong that it knocks women out for some time or makes the immediate postpartum time fuzzy.]
My daughter was born at 10:55 a.m. Wednesday. She was taken to the nursery in the company of my mother-in-law. Her blood sugar was low and my mother-in-law had to choose a bottle or an IV. She chose a bottle. By the time I saw her and was transferred to my room the baby was sleeping and not interested in nursing. When I did try she would either go to sleep or pull her head away from me and scream.
I never did manage to get her to feed properly. She became jaundiced and we had to put her under [bili]lights. If it hadn't been for the fact that her pediatrician was my husband's old pediatrician, we would not have been able to bring her home. But he arranged for a home delivered light. We breast and bottle fed for 6 weeks but my milk never came in. I would pump and pump (rented a hospital grade machine) and got nothing. That was more of a disappointment than the birth itself. The lactation consultant was no help as my daughter would nurse fine in her office.
Bonnie A's Story (pre-eclampsia, difficult c/s, poor treatment, difficulties bfing)
Kmom's Notes: This mother had a difficult experience---be forewarned. Although not really plus-sized in the past, she learned from this experience what fat-phobia can be like.
This mom had severe edema, and her blood pressure raised strongly by the end of pregnancy. Her labs seem to indicate she had developed pre-eclampsia. She was induced with a bunch of Cytotec, a fairly new induction agent that can cause severe problems in some women. The usual dose is 25-50 mg, and may be repeated once or twice (even that is controversial), but this mom received 275 mg over 2 days. She was also on Magnesium Sulfate to control any possible seizures from the pre-eclampsia, and mag sulfate may counteract induction meds, so that may be why she did not seem to respond to such a large dose.
She experienced severe discomfort from all the mag sulfate she was given. She also had terrible itching. She may have had a reaction to that and all the pain meds she was given; itching is a common response in women who are sensitive to the drugs. However, she was also given a sponge bath by a mean nurse who did not wash her off; the itching may have come from that, or it may simply have exacerbated a meds sensitivity. Whatever the cause, she had a very difficult time with itching.
When they did the cesarean, they had a hard time getting the baby out. This is common with malpositions, and a malposition may also help explain why she did not progress in dilation much (esp. with the mag sulfate on board). The baby had significant bruising on her shoulders and arm, which may have simply been from the doctors wrestling her out during the c/s, or it may have been because the baby was malpositioned. There's just no way to know for sure.
This story is extremely long but nearly all the details have been included because it is such an important story documenting the poor care that some women experience after birth. Many of her post-partum attendants were callous, uncaring, and even vindictive at times. They sabotaged her breastfeeding with bottles and enforced separations; when she pumped, they dumped her colostrum down the sink rather than give it to the baby! They gave her poor advice on positioning and did not catch the problem of back-arching that the baby had. If not for some last-ditch help from one last lactation consultant, breastfeeding would not have worked out at all.
But the worst thing of all was how the mother was made to feel incompetent, hardly permitted to hold her baby, and generally disempowered in her new role as a mother. What she needed was gentle guidance, understanding, and empowerment instead, especially after such a difficult birth. Fortunately, her relatives and an occasional nurse or lactation consultant did give her some nurturing and some assistance, and eventually things worked out.
This story is harder to write than I thought it would be. At the time, everything just happened so fast and I became so helpless. It was exactly what I thought it would NOT be.
Let me start from the beginning. I am married to an immigrant. When we first married, the stress of filing all the immigration papers and some of the complications that arose really told on my health...including an 80-lb weight gain. I had never really been overweight, and it came on like a ton of bricks. I thought I would lose the weight once the stress of the papers was over, but I didn't. There was always something new. I weighed about 240 and was "normally" about 160. I had gone from a size 10 to a size 20. I finally decided that I may never lose the weight and so we agreed to try and become pregnant in spite of it.
My pregnancy went well. Only a little morning sickness, and I wasn't even overly miserable until the last 5 or 6 weeks. I had some pretty severe edema, but everyone said it was just the summer heat. My blood pressure stayed close to my usual 104/60 (although the nurses always remarked how low it was...like because of my weight they could not believe I was healthy.) I found out at my 20-week ultrasound that it was a girl, and everything looked fine. We decided that day to call her Natalié Yolanda.
My husband and I attended a waterbirthing class, and decided that was definitely the way we wanted to birth. I began working on a birth plan, and reading everything I could get my hands on about natural childbirth...I became very non-intervention minded, and was determined to do everything as natural as possible. My birth plan reflected this. At 32 weeks, I changed midwives because I just felt like I never really made that "connection" to the midwife I had been going to. She had made several comments about me needing to be walking at least 5 miles a day (in spite of the fact that I have a detached tendon in my ankle and my pregnancy aggravated this). I just felt that she saw my weight as a big problem. I can't tell you why. I also decided I wanted to birth in a hospital "just in case". The jury is still out as to whether that was the right decision!
I went to a childbirth class at 37 weeks...a natural childbirth class that talked more about the feelings and communication surrounding birth than the actual event. The theory being, you cannot dictate the event but you can dictate your environment and reactions, to a degree. The class was incredible and my husband and I loved it. We became anxious for her arrival. From the beginning, I met resistance with my natural birth plans...from co-workers, from family, from friends. No one was overtly negative, but people just kind of alluded to the fact that I would be "screaming for my epidural" in no time.
Well toward the end, I was completely miserable. The swelling started to get really bad...I was already wearing shoes 2 sizes bigger and now could barely wear those. I got a double chin, couldn't wear my thumb ring on my wedding band finger, and even my toes had little creases in them from the swelling. I looked like a balloon person with sausage feet. The midwives had me going in every 4 days for non-stress tests, and the first 2 were fine. By the 3rd, the baby was fine but my blood pressure was getting worrisome at 192/78. I weighed almost 300 pounds.
When I took the results to the midwives' office, they explained I would have to be induced because it looked like I was developing pre-eclampsia. They offered to try and wait but I agreed to an induction because they said there was no way my condition would get any BETTER, and this way I had a chance at my natural birth still. After many misgivings, I checked in Tuesday for a cytotec induction. I wasn't crazy about cytotec after all my reading, but it seemed like a better option than pitocin, which would keep me on an IV stuck in bed and from what I'd heard, give me nightmare contractions.
When I got to the ER, they had to call for a wheelchair...and when it arrived, I could not fit!!! It looked really narrow to me but maybe that is just because I was so large and swollen. So I waited, mortified in front of my husband, while they sent for the "large" wheelchair. That one looked normal to me! So they wheeled me up to the 14th floor, tossed a nightgown at me and had me get into bed (just like all the stories I'd read). And you know what? It was a lot harder to resist anything they told me than I thought. I obediently put on the nightgown (which could not close in back and exposed me completely), peed in a cup, and got into bed to be hooked up to all the monitors.
They [ended up giving me 3 doses of Cytotec over time; 25 mg, 50 mg, then 50 mg again.] Only a few contractions. I was only 1/2 to 1 cm. dilated...they said I was getting a "softer cervix" with each dose. I was losing a lot of blood and mucus. They sent me home anyway. So home we went, with strict orders to collect every drop of my urine for 24 hours in this plastic bin they gave me (yuck!). Well that was no fun, and 24hours later I was at the hospital lab turning in my urine and getting blood drawn. The midwife had told me this was to see if I was going to be "high risk" for the next try at inducing me 2 days later on. So we checked back into the hospital on Thursday for a second try at the cytotec...knowing if it didn't work I was stuck with pitocin. I cried and cried Wednesday night because I knew my chances for getting the birth I "wanted" or anything close to it were not very good.
When I checked in Thursday, I remembered to ASK for the large wheelchair. There was another pregnant lady checking in for induction at the same time, and she looked about normal weight. She got to walk up! They would not ALLOW me to walk up. I was terribly embarrassed, because we even rode the same elevator. The cytotec routine went the same on Thursday, with one big exception: when I arrived on the 14th floor, they told me my urine results were great and I could walk around and even go outside if I wanted. The midwife on duty, C----, was my least favorite of all of them because of her unhappy demeanor and seeming favor of interventions (she acted like Pitocin was an inevitability) during our meeting a few weeks before. She was her usual serious self, and never smiled back at me or acted even slightly compassionately. The nurse told me to go to the café and get something to eat while I still had an appetite. So after my initial monitoring and first dose of cytotec, my husband and I went down to the café, then went out to walk the halls and heard my name paged over the hospital intercom to return to the 14th floor. My midwife said, "We read your results wrong. Your protein count is 472 and the max is 300. You must get in bed NOW and I have already ordered the Magnesium Sulfate IV." I was stunned and burst into tears. I was obviously doing just fine walking around, and now they realize they read my charts wrong. She explained I was at high risk for liver failure and seizures and I became so upset that my doula asked if we could have a minute alone. She was sterile and commanding in her explanations.
My doula took me in the bathroom and comforted me and I tried to process the information I had just learned as quickly as I could. I couldn't quit crying and I told my husband to call my mother NOW. I just wanted my mom. The midwife opened the door to the bathroom without even knocking and told me I needed to get in bed, NOW. I was pissed at that point. I had been doing fine out of bed for hours; she could at least give me a moment's privacy with my doula to process the horrible news. After all, I was weeping! My doula told her firmly we would be there in a minute. I was very grateful for her support. She then answered me that she did not know about my chances for a Cesarean anyway at this point, but that we could ask for Dr. M----- and he could advise me forthrightly.
I finished up in the bathroom and got in bed, and they immediately began strapping on monitors, prepping me for the IV, and explaining to me that I was probably going to get sick from the Mag Sulfate since I had just eaten (gee, thanks guys for telling me to go eat!!!). The midwife dutifully explained that I could only have one small glass of ice chips per hour, and no food. That sure made me mad. They wouldn't even let me drink water!! This was turning into my worst nightmare. I felt like a prisoner. And to make it worse, my baby was their prisoner too, by default. They stuck my hand with the IV line. Thank God, the nurse, named J-----, was very compassionate because at that point I felt all alone in the world. They rolled in the bag of Mag Sulfate and I started to cry all over. They promised to give me something in the IV first to help with the nausea. When they hooked up the Mag, it was exactly how everyone has described...it was hot and burned the veins in my arm. It truly hurt. I asked for ice packs and my mom and sister (who had arrived by then) helped hold the ice to my entire forearm and wrist where it was aching like someone was scraping my bone. My husband fed me ice chips and I tried not to cry. Dr. M----- came in the room and told me we would see what kind of progress I made between then (it was almost noon) and 5pm. He said he felt I had at least a 50% chance of being able to have a vaginal birth. Of course, waterbirth was out of the question at this point because of the Mag and the IV and blah blah blah.
Once the Mag hit, I felt nauseous and a little out of it. I began to feel tired and irritable. I was thirsty...the ice chips didn't seem to help. And they had given me 50 mg more of the cytotec - my 2nd dose that day - and in spite of the nausea I began to feel some sharp hunger pangs. This made me even grumpier. The slightest loud voices or people eating in my room made me furious. After a few hours, I figured out that the "hunger pains" were actually contractions. After my 3rd dose of cytotec, they got even worse. I had managed to avoid a catheter until this point, and when I went pee I was losing all sorts of goopy, bloody mucus. The nurse, J----, informed me that my cervix was much softer and she thought it was about a 2. My midwife decided she needed to check too. She made me put my fists under my hips and dug around, asking me to tilt my pelvis because there was so much "flesh" in between her and the cervix (??????). I took it as a fat reference, but I was used to it by now. I was cautiously happy because at least a 2cm estimate meant progress.
By 4pm I was having to breathe through the contractions and I reserved some hope that my body was working after all. My arm was the most painful thing....whenever the Mag released (it was on some kind of timer) it hurt like little demons running up my veins. When Dr. M---- came in at 5, he told me that my cervix was "up somewhere in Montreal" and the baby was at least 9 or 10 pounds. He said my cervix was tipped posterior and it wasn't even 1cm. Oh. He said that I would have to have a Cesarean because my blood pressure was already too high in a reclining position, and if I was allowed to labor much more normally I could have a brain hemorrhage or seizure or blah blah blah. I was stunned. He said they had to get the baby out NOW. I just could not compute the information...but it is not like I had time. Instantly, my room was invaded by teams of people to prepare me. My family was shooed out except my mom and my husband were there at some point. The wicked midwife (I might mention at this point, she was the only MW in the practice I didn't care for and now I knew why!) was brushed to the side and I felt like she was more of an uncompassionate nurse or pawn than a true midwife.
My mom hugged me over the side rail of the bed while I cried silent tears. I was so scared I could barely breathe and I couldn't believe this was happening to me. My mom prayed for me and my sweet husband hovered with a very worried look on his face. My husband and doula changed into scrubs. I suddenly felt like I was in some alter reality and was watching everything from outside my body, like a dream. I wanted more than anything to be NOT pregnant and my mind searched frantically for some way out of this. But there was none. My insides were quaking and I just tried to keep calm.
Some lady came in with a plastic case and I thought it was an epidural, but it turns out they were there to shave me!! I was too terrified and out-of-it from the Mag to ask why the hell they were shaving me for a Cesarean. When they finished, it was time to go to the operating room. No one explained anything to me, and I was shocked when they told me I had to WALK to the operating room. I had been told all day I wasn't allowed out of bed! How incredibly perverse. So I walked down the hallways to the O.R., pushing my little IV stand. I secretly wondered if it was because it was inconvenient to get the "large" wheelchair. My mom took a photo. It is really pathetic.
In the O.R., I was terrified. It looked just like everyone describes...Sterile, cold, and little trays of scary-looking tools. I looked my husband in the eye and I was afraid I was going to die. I think I said something to him about taking care of the baby if I died. While we were waiting, I remember my doula asking me if I was still having contractions. She understood how I felt; I could see it in her eyes. That made me cry from deep in my soul; my body was trying so hard and I felt like I was betraying it, and the little baby inside me. The anesthesiologist got called away on some emergency and my husband, my doula and I were left there with me sitting on the operating table to ponder my fate. I cried the whole time. It ended up being a blessing in disguise though, because by the time the anesthesiologist got back, I was a little more calm. Dr. M----- walked in and took one look at my face and said, "You are really scared, aren't you?" I just nodded. The anesthesiologist was a very nice and patient man, soft spoken with kind eyes. He talked me through the spinal and it wasn't that bad. The Mag Sulfate hurt more than the spinal, in truth. The instant the needles were in it started to take effect.
They heaved me around to the "cross" position (with much grunting - I was SO afraid they would drop me!) and inserted the catheter...I cried out more than once because I could still feel. Catheters hurt! Then they tied my legs together and tied my arms out in the "cross" position. The anesthesiologist checked me several times to make sure my nerves were deadening. My doula kept me centered in the midst of my fright and told me to feel myself breathing. That helped a lot, because you feel like you are dead or dying. The partition went up and they started cutting. The thing that surprised me the most was that I could still feel!! I could not feel pain, but I could feel things moving around inside, the knife cutting. Then, of course I felt it when they brought her head out. I heard all sorts of exclamations about how much hair she had. They had a hard time getting her body out because she was so big and broad. They pushed and pulled on the baby and I so hard that I thought I would fall off the table. Dr. M----- made a joke about having shoulder dystocia from a c-section. Well I thought it was a joke...it turns out later that her whole shoulder and arm was black from bruising. He also joked about delivering a 3-month-old. They all made bets on her weight.
Once she was out, I remember asking if it was "still a girl" and they said it was. I asked if she was OK. I couldn't see her because the "baby team" that handles the Cesarean babies was hovering around her. In maybe 4 or 5 minutes I could turn my head while they were suctioning me out (sounds just like you are at the dentist) and stitching me up. I saw a very pink baby with a head of wild black hair, screaming her lungs out. I felt relief she seemed well and then I just sort of detached from the situation. I heard them talking about how much meconium had been in her water and how even the placenta was stained green. Someone made a comment about how my fallopian tubes looked like chicken's feet. That irked me. My husband was given the bundled baby and tried to show her to me, but I could not really see her and was not coherent enough to tell him to lean her down further. He took her out of the O.R. while they finished sewing me up to show her to my family and tell them I was OK. I remember them putting a shot of pitocin in my IV and my doula telling me how remarkably fast they had finished sewing me up. Then they all heaved me onto another bed (again, it felt like they were going to drop me...and I know I was not handled very easily) and started rolling me out. I thought they took me directly to my room, but I found out weeks later that I went to Recovery. I must have blacked out because I have absolutely no recollection of this.
I remember them wheeling me to my room. The baby was in the warmer on the other side of the room and my family was crowded around her. My sister was videotaping. They were giving her shots, slicing her heel for the PKU test, and putting Erythromycin in her eyes. She was intermittently screaming and I remember feeling so drugged and helpless. I wanted to see my baby but I couldn't even raise my voice to say anything, and at this point I was completely resigned to the hospital machine. After doing her PKU 4 times (they kept saying they weren't getting enough blood), shooting her up with Vitamin K and Hepatitis B vaccine, weighing her (9 lbs 8 oz) and generally torturing her, some lady brought her to my bed. Not my husband, not my family, but some lady who talked too fast and acted like the God of my baby...all in a very nice way. She held my baby girl in front of me for what seemed like eons, while I struggled with everything in me to keep my eyes open and seem alert...the drugs were overpowering. She talked and talked and to this moment I cannot remember what about. I assume nursing.
When she finally let me have the baby, she said I was too drugged to hold her and I would have to try nursing lying down because of my swollen belly and my "large size." They messed with my bed, moved me over, propped me up on pillows, and took my gown off to my waist. Then they put little Natalié Yolanda down beside me and she told me to move my arms out of the way. She took my breast in one hand and my little baby's brand new head in the other, and tried to force us together. I was humiliated and I remember just looking away once she told me to move my arms out of the way. Natalié cried. She wouldn't be peaceful, and she certainly would not just let me hold or bond with my baby.
Unfortunately, all the activity made me vomit - I knew it was coming and warned them just in time to get the baby off my lap and a little bowl in front of me. I heaved and vomited about 20 times. It was awful. They tried again. Natalié showed no interest in eating and after she was manipulated and shoved into my breast enough times, she was inconsolable and the lady lifted her out of my bed and I don't remember what happened after that. I was told I could not hold her because of the drugs, that I could drop her. I just wanted to close my eyes and wake up in another world where this was not happening.
The rest of the night was a blur. A gruff nurse named K---- took over and stripped me and lathered me up in my bed and began to wash me down everywhere. I could feel my IV and catheter line tugging as she heaved my heavy, swollen body over this way and that, soaping me down. It was like she thought because I was big, I couldn't feel. I remember wanting to ask why she didn't rinse me when she began toweling me off, but I just couldn't get the words from my brain to my mouth. Then she began stripping and washing Natalié in this little metal bowl. I vaguely remember my husband getting the video camera and Natalié was screaming again. Poor thing. I tried to stay awake and watch the first bath but I couldn't even keep my eyes from rolling back in my head. I felt so sick. I faded in and out. They moved us to a different room, and then the nurses changed again. I found out later the gruff nurse did not want to attend me, and that is why she was so mean. Great. The new nurse was nice, and held the bowl for me while I threw up over and over and over. It hurt so badly. I felt so detached from my baby at this point I barely noticed her sleeping in the bassinet beside me. I felt sad and USED somehow.
The next day was a blur of having more than one person calling themselves "lactation specialists" come in my room, and proceed to try and instruct me in the complex art of breastfeeding. I would hesitantly take off my gown, and they would take my baby in one hand and my breast in the other, and get in a pulling match with Natalié. My little one was a back-archer from the start, and strong as a horse. She would throw her head back and resist the pushing until she shook with the effort, screaming hysterically. They would be pulling my breast, rolling my nipple painfully and manipulating us to no end. I gritted my teeth and finally told one of them it hurt when she was tugging at my nipple, and was shocked when she said that it "couldn't hurt" and that she "had to!" At no point was I allowed to simply hold my own baby and try to feed her on my own.
I began to feel like a failure. I cried whenever I moved it hurt so badly. I could feel the catheter and was not able to sit up at all because of the pain it caused in my urethra. One of the "specialists" told me if I could not sit up in the bed, there was no way Natalié could try and nurse. So I cried and brought the bed up as high as I could. Of course, then the pushing match would start again. I was told over and over to please just keep my hands out of the way. I have no idea how someone could be expected to succeed in this position. I was mad at how hard they were forcing Natalié. She became instantly hysterical whenever they tried. They would eventually sigh and give up, put her in her crib, squalling, and go off to find a bottle of formula. Then they would cup feed it to her at my insistence; I knew she should not have artificial nipple if she couldn't nurse. She would slurp it down, burp, and peacefully go back to sleep. Since she wouldn't nurse, they rolled in a pump and instructed me how to start pumping my breasts so that my milk would come in. All the focus was on my milk. I would pump and pump, and get a few cc's of colostrum from each breast. Instead of feeding it to Natalié, they would wash it down the sink and give her formula. When the shift changed and I got a really nice nurse, I asked her if I could please feed it to Natalié. She was kind and helped me feed her the little bit I got during her shift. The formula made Natalié spit up a lot. I know now that new babies do not need near as much food as they were forcing down her. No wonder she showed no interest in nursing! She was not hungry.
The Dr. had come that morning and mercifully told them to stop the Mag Sulfate. He also prescribed Lasix, which I knew from my days at the racetrack was a strong diuretic. He did say the catheter had to stay in though, which disappointed me. During this day the nurses and "specialists" started becoming concerned about Natalié's whistling while breathing. She had a real wheezy sound to her breath, especially when upset but also when resting. They brought up a specialist from Pediatrics who said she was OK once he checked her over. Later in the day, she was wheezing much worse so I asked them to take a look. The nurse was very concerned and told me they had decided to take her down to the intensive care nursery for testing. She assured me it would not be long, and she would let me know what was happening. I didn't want to part from Natalié, since I had finally gotten to hold her, but I also wanted her to be OK.
They wheeled her off and I sent my husband with her, since I was stuck in bed with a catheter. During this time, I was going crazy with itching. All over my body, I developed sores and itched until I made wounds in my skin. Eventually, I couldn't take it anymore and asked the nurse if she thought it was some sort of allergic reaction to the painkillers they were giving me in my IV. She said she didn't know but could give me Stadol for the itching. I didn't want that so I asked if there was anything else. She said Benadryl. So I told her to do it...I needed relief. The Benadryl knocked me out like light. I could not even talk; my tongue was so heavy in my mouth. I hated it...at one point, I was sure I would die of thirst but I could not lift my voice to call the nurse and I had no idea where the call button was. A lady from my work came to visit me and I couldn't even keep my eyes open to acknowledge her. I found out later she was alarmed because I was so incoherent.
When the Benadryl finally began wearing off, I had more visitors. This went on for hours. No word on Natalié. My husband had been gone for hours and the nurses had changed shifts. He came back once in a dither because they wanted to give her a bottle and a pacifier and he knew I didn't want that. I said NO! And he said it was for some kind of test. I said NO...they could tell me what kind of test but otherwise no. He left. The new nurse knew nothing of my daughter and I asked her to please find out. My husband stopped in once to tell me everything was OK and they had run tests and she was fine. The nurse asked me if I would like a sponge bath, and it hit me.... that was what was wrong with me!! That gruff nurse had used soap and not rinsed me off! I had dried-on soap all over my body. I did not even remember until that moment. I told the nurse and she agreed to just use water so we could get the itching to stop. It worked! But now I had sores on my face, chest, and arms from itching. I was so embarrassed because two of the sores were on my face, and one on my chest right between my breasts. They looked like boils. I already looked so ugly with my sweat-matted hair, swollen face and body, and now I had big red sores on my face...this made me ashamed to have photos taken. I grieved this bitterly when I was back home, that I did not have photos of me and my new baby.
It was evening by now. My sister finally took her leave and as
soon as she stepped out of the room, hysteria began to set in. My family was
gone, my husband was gone, and my baby had been gone for almost 10 hours! I had
to pump, and when I did I began to cry as I knew my baby was missing the
precious colostrum my body was making to give her immunities. I called the nurse
and asked her about my baby. She didn't know. She did give me a number for the
nursery. I called and was told the nurse in charge of my baby was busy and I
would have to call back in half an hour. I began to cry. The harder I cried, the
more I thought. The more I thought, the harder I cried. Where was my baby? Was
she OK? How was she eating without me? Formula? By some miracle, my sister had
decided to bring some blankets from her car up to my husband; she came back and
found me a dripping, crying mess. I
called the nursery again, and they told me she was already on her way up to me. I calmed down. My sister decided to wait with me. The clock ticked. Over 40 minutes passed. When I told her about how long they had had Natalié and what had happened, she went out to find out what was up. She came back to tell me that Natalié had indeed been moved up to my floor, but to the nursery there. They had her hooked up to all sorts of monitors and told me that I could not see her because she could not be brought to me, and I could not get out of bed because of my catheter. I went ballistic.
My sister left again and told them that I was going to flip out if I could not see my baby. She must have moved heaven and earth, because they unhooked Natalié from all of her monitors and brought her to my room. This horribly mean, huge woman with an inch of makeup on named J---- was her nurse and would not hand her to me. She held her in front of me and lectured me on how many babies they had to take care of more important than mine, and that she didn't have time to cater to my wants to see my baby, and that she was their responsibility until the head Nurse Practitioner signed off on her. I lost it - I told her not to be rude to me and to please just let me hold my baby. She said, "I am TRYING not to be rude to you. You have to understand that we are busy. We have babies much more important than yours, with much worse problems." Blah blah blah.
I didn't even hear her mouth talking after that. I went off. I said, "This is MY baby. You have had her for 10 hours. You did not even tell me she was OK, or what was wrong, or if I wanted to feed her. Someone took her from my room with an assurance they would be right back, and now you are telling me she is your responsibility. She is MINE. You can't just take her." I was sobbing uncontrollably. She tried to argue with me and raise her voice. My nurse, my husband, my sister, and this woman were all crowded into my tiny room, looking at me. She was still holding my baby! I said, "Just give me my baby," over and over. After much lecturing about how I only had 5 minutes, she handed me Natalié. I just buried my head in her and took deep breaths. The 5 minutes was no joke and she was back to take her quarry. I asked how long until I could have Natalié back. She said the head Nurse Practitioner came on at 10, and she would evaluate her then. She haughtily said that Natalié would probably be released, but no guarantees. I told her I would wait until 10:30 before I started calling and asking. My loss of control had made its mark though; her pride was stepped on. She was not going to be doing me any favors.
I waited with my sister, a lifesaver, and we made lists of questions to ask and what we would do. We called my doula and a friend who used to work at the hospital for advice. At 10:15, there was a knock and K--, the head Nurse Practitioner, had come to see me. She was nice but extremely patronizing. I apologized for losing it with her nurse, and tried to outline my frustration coherently. She said she had come to see me that afternoon, but that I was sleeping. This made me mad...they woke me every hour for blood pressure and temperature checks anyway! I guess she came when I was out on the Benadryl. She also defended herself that everything had been explained to my husband. I was baffled at their ignorance; my husband is obviously foreign and has heavily accented English and no knowledge of medical terms. She said they had no idea (right!). She in turn explained to me that Natalié's esophagus was weak; that the cartilage rings had not hardened fully. She said that she was getting plenty of oxygen, the tests showed, and so she would release her to me when she got back to the nursery. She said the condition was somewhat common, and not dangerous because the esophagus was not closing completely. She also said her little nasal passages were swollen from all the aspirations. Apparently, they had aspirated her a 3rd time in the nursery for fluid her lungs. She was having a hard time breathing. The "test" with the bottle was to see if she could both breathe and suck at the same time; basically, to check and see if her nursing problem was physiological.
The huge, horrid nurse brought Natalié back to me about an hour later. It was almost midnight by now. She triumphantly told me that I could have her in my room, but only on the condition of "supervised feedings". I was surprised and asked what this meant. And she said, every 2 hours she would come and "supervise" while I tried to nurse Natalié. I asked her why, and she said that they were concerned that Natalié would starve without enough food, because I didn't want her to have a bottle or formula. I was shocked. I agreed, though, because all I wanted was to hold my baby. I took her out of her bassinet and laid her on my chest and dozed while looking at her sleep. I was completely on my guard for whoever wanted to steal her away again!
That mean nurse did indeed come to "supervise" her feeding. I apologized to her for my outburst in an attempt to smooth her ruffled feathers if we had to get along in the middle of the night, and she had the power to take my baby away from me. She eventually warmed up a little and tried to "help" me feed Natalié by trying nipple shields and this odd syringe and tube contraption that fed formula into the nipple shield so the baby would supposedly get the idea to latch on. Nothing worked, of course. I was very quiet and listened while she went on to tell me she had not had enough milk for her son and had to supplement with formula, and it was no big deal, and she had no idea what the lactation people were so worked up about anyway. She told me that giving a bottle or formula was fine, and would not cause any of that "nipple confusion" nonsense they were so worried about. She was very opinionated about it.
I finally just gave up. They broke me. I was running on only a few hours of drug-induced sleep, had been medicated within an inch of my life, was in severe pain from my section (I cannot take narcotics so I requested only 800mg of Ibuprofen), and felt rejected by my own baby and totally inadequate for not being able to figure out how to breastfeed my child. So, I let the nurse bottle feed my little Natalié. And thus began my resolve to get the hell out of that hospital. I kept pumping my breasts anyway, in hopes that maybe when I got in the privacy of my own home I could do it. I had no idea just how bad letting her have a bottle was.
A different nurse came on duty in the middle of that night,
and I begged her from the first moment to let me have my foley catheter out. She
said the Dr. had specifically written on my chart not to remove it, but she
promised to ask him first thing. It was hurting my
urethra every time I moved, and by morning it was aching whether I moved or not. She was an angel. True to her word, she came in about 5 or 6AM and snipped the line and mercifully yanked it out quickly as I yelped in pain and grabbed myself. All I cared about was it was out and I was free! She also helped me to get a bigger gown that fit my body, and helped me find my own underwear since the disposable ones the hospital gives you only work if you are a size 12 and under. She was super nice about it, and I cheered up a little.
She then went off duty at 7AM and I got a not-so-nice nurse. The Dr. came in and said I could shower and get out of bed and I almost hugged him I was so grimy at this point. She not-so-nice nurse made a big show of telling me I had only 5 minutes in the shower. I secretly thought...once I get in there, what are you going to do to get me out? The Dr. had told me to remove the pressure dressing from my incision while in the shower. When I started to stand, it was harder than I thought it would be. I was dizzy and weak and the incision hurt so bad I welled up with tears. But I was determined to get my shower so I smiled wildly (I must have appeared half-crazy) and got in the bath as quick as possible. The shower felt soooo good. I lathered my hair and body over and over and had just started working on the incision dressing when Ms. Not-so-nice came to tell me to get out but hey! I still had to take off the dressing...Dr's orders you know. The only thing was, I stupidly tried to hurry and it came off with a 2x2 section of my whole skin on one side. It hurt so bad! After I got out and showed the nurse, I asked her for some Neosporin or A+D ointment so it wouldn't get infected and maybe a couple band-aids. She said she would have to ask the Dr. for permission! I was incredulous. What bullshit. I told her forget it, I would ask my own mother to bring me some.
A nicer lactation consultant came that day, and she brought me
a bottle of sterile water to mix with the colostrum I pumped to feed Natalié. I
never fed her formula again! They moved me to the 12th floor that day and I
think they sort of forgot about their "monitoring" of my feeding, so I
kept feeding her only my colostrum and water. I fed it to her in the bottle when
they were looking, and in the cup when they were not. I was largely ignored once
they moved me to the 12th floor, because I was no longer considered
One of the midwives from my clinic came to see me - M-----, the one who had been there the day of my first induction. She brought Natalié a little stuffed pink bear and sat and talked to me for a while. I so wished I could have had her for the birth. She was sympathetic to my wishes for a natural birth and was careful to tell me what was going on and why; she understood I needed to process and grieve my losses of what I had hoped birth would be. I know things probably wouldn't have gone any different with her than with the midwife I ended up with, but at least I would have felt supported instead of like the enemy was in my camp. I felt special that she remembered to come see me and decided that my initial judgment had been correct: all the midwives in my practice were great except the one I got.
That night I was awake most of the night. I held Natalié all night and plotted my way out of that place. It felt like jail. Starting at 7AM with the nurse shift change, I asked every 30 minutes when I could go home. My diligence paid off (squeaky wheel gets the oil?) and the Dr. came 'round about 9 to tell me I could go home if I wanted to that bad. I thanked him profusely. He told me to come back on Tuesday (it was Sunday) to get my staples out...By 12, I was signed out...after about 6 lectures and 20 signatures, I was free. All I wanted was OUT, where I could get to know this precious little baby I hardly knew but already loved. It took them almost an hour to find the "large" wheelchair. I just kept asking. I had this feeling of urgency...I was so afraid they would find some reason or other to keep me or Natalié there.
The next few days were tumultuous and difficult. I had a severe bladder infection from the catheter and it hurt like heck every time I peed. I had to call the Dr. for antibiotics. Fun, more meds. Natalié would not nurse any more at home than in the hospital, so I pumped constantly and was nauseated from the Ibuprofen. My mother was a godsend and helped out. I could still barely walk.
We tried breastfeeding almost every time but she would try to
latch on, then rear back and cry wildly and gasp. I was afraid she couldn't
breathe. I would then feed her my milk, which came in the day I escaped the
hospital, from a bottle. I was over-engorged and my breasts were dripping
constantly...it was painful, miserable, and sad because I didn't know why I
couldn't feed my own baby. I began to get discouraged after a few days and was
weeping over the thought of having to switch to formula. I considered
pumping and bottle feeding, but I was so miserable and it didn't seem practical.
I followed my sister's advice and decided to make a final last-ditch effort and call her friend, who was a lactation consultant, post-partum doula, and general baby expert. After my previous experience with "experts", I didn't expect much. But I had met this woman before and liked her very much so I decided to do it. She agreed to meet with me. We had been emailing for a day or two, and her responses were so helpful, I knew that this was it: if she could not help me, it was over.
My mom taxied us out to her office about 45 minutes away on a miserable pouring rain day. But once in her office, she handed me a nipple shield. I looked at it dubiously. She told me how to put it on (something the hospital staff never did, they just shoved it at me) and she took my baby from me and checked out her mouth, tongue and nose. She declared her perfect and then showed me how to hold her. She explained that back-arching babies have to have their arms and legs spread in order to "open up" to nursing. She showed me how to hold her. With one try, Natalié latched on and nursed without stopping for 20 minutes. I think I smiled the entire time. My mom and I were exclaiming over and over, "Look at her, look at her!" She was nursing like she knew all along. Well of course she did!
I was struck with gratitude for this wonderful woman who saved my relationship with my baby and made me realize that it was not my baby or I who was defective, but the people at the hospital! Imagine, in about 4 minutes our whole world was righted. Why couldn't someone at the hospital simply shown me how to hold her instead of telling me to keep my hands away? Was a back-arching baby so rare? I doubt it. I grinned all the way home and our lives changed forever that instant. I began to heal, and Natalié was calmed.
Since then, our only sorrows have been those of the past. Why did I let all that happen? How much was really necessary? How much was fact and how much perception? Did the interventions cause the problems, or was I saved because I had interventions? I have cried and cried, and writing this story has taken me 7 weeks of soul-searching. All I know is this: never again.
Even if I have to have another cesarean, I will never again
lose control and dignity. I will be informed, firm, and if that means being a
"bad patient", so be it. I certainly had some bad nurses! On the flip
side, I had some wonderful nurses. I can't believe the power that one person on
a 12-hour shift has over your life when you are helpless. I can't even remember
the names of some of my co-workers after having been off work a few weeks, but I
can tell you the name of the nurse who left soap on my body to dry after my
Cesarean. I am struck by the power they have to affect your life and your memories.
I am also struck by the prejudice against fat people. I had never been "fat" in my life, until recently before my pregnancy. But by the time I gave birth, at 300 lbs., I felt like I was living in an alter reality. I can tell you, as someone who used to be "normal", that you ARE treated worse...it is not in your head. When I was thinner and considered pretty, I was almost always treated with respect. Bloated, ugly, and with boils on my face, I was treated with barely even courtesy. It is like you don't count. Several times I heard muttering about the nurses having to get the larger arm cuff for BP counts. I can't imagine with over half the US population of women being a size 14 and over, that it would be THAT unusual. When you roll this treatment into the whole hospital experience, it just adds insult to injury.
I am not sure what I will do with the next one, but I can tell you that it will be different. I would like to try a homebirth and I still desperately want my waterbirth. But those fears haunt me...I have a lot of thinking and praying to do.
I love my daughter more than anything in this world and would
do it all again for her. I am just so deeply sorry her start in life was so
abrupt, so tragic, and so stressful. I wish I could take it all back and be more
knowledgeable, healthier, and have been able to save her from nurses, probing,
bottles, formula, separation, and everything else. I pray every day that she
feels secure and loved.
And I am eternally grateful to the woman who made it possible for me to nurse my baby. Thanks for taking the time to read my story.
Bonnie A's Second Birth - Home Waterbirth VBAC
first birth was a cesarean - ostensibly because of malposition/macrosomia (big
baby), failure to progress (I was induced 2 times over a 3-day period because I
was at 41 weeks), pregnancy induced hypertension (they were taking my BP with a
cuff that was too-small and was giving a false-high reading), and pre-eclampsia.
The pre-eclampsia was based upon edema (the only thing that was actually true: I
did have edema), and protein in my 24-hour urine collection. However, during
that 24-hour period I was losing my mucus plug, and mucus is chock-full of
protein...you make the deduction.
The cesarean, in my opinion, was completely preventable with better prenatal care, such as nutritional information. Also, all but one of their "reasons" was bogus...only the edema was true, and edema never killed anyone. The baby was never under any stress either...her heart tones etc were always strong. Having wanted a natural waterbirth, the whole thing was a real shock and had real after-effects...nursing problems, PPD, and a general sense of failure and anger. I know that I was definitely categorized as high risk for at least 2 reasons: being overweight (irrelevant if healthy) and because the midwife who I got stuck with was probationary and was covering her butt.
Hence, the big victory with this birth. I researched and interviewed for this birth...and I found what I needed.
Blessing ~ A home waterbirth VBAC journey
Today Naomi is ten days old, and I think I am ready to begin writing her birth story. Well, our birth journey is probably a better expression. The last two weeks have been a revelation for me - physically, mentally, and spiritually. I think that there has been a lot of old wounds healed, and also some new hurts discovered. The birth took place in my mind and soul just as sure as it took place in my body. Here is where our story begins...
At 1am on Tuesday, November 4th, I got up to use the restroom, and discovered that I had what seemed a broken water sac. I hadn't fallen asleep yet, and was a little dismayed that labor might be starting when I was tired. I called my midwife, who asked me some questions and then told me to go back to bed. I tried, but it was no use. I called my mom to let her know also, then I went downstairs to fold laundry and do what I could around the house. My 23-month-old, Natalie, woke up and was upset so my husband and her came downstairs with me and promptly crashed on the couch. The contractions had been coming all evening, but after I felt the gush of water I knew they were different. I didn't bother timing them.
I called my mom and asked her to come keep me company, since Natalie needed Jorge. In hindsight, I should have taken something and gone back to bed and called no one! But being a first-time labor (Natalie was c-sec with no labor) I had no idea what I was in for!
I labored all night, easy contractions that felt like menstrual cramps but I could breathe through without too much trouble. I continued losing water with each contraction - it was a light pink color. My midwife called me to check on me (or I called her, I really can't remember) about 8am and said she would come check on me. She arrived around 9 and did not do a check - she said that it really seemed as if my water had broken, it was obvious I was still in early labor and there was no point in introducing anything into the vagina. Seemed OK with me. She told me to rest and to walk. I was so tired when she left again that I laid down and tried to sleep. I woke up with most contractions but slept until 11, and then slept again until 1pm. Little did I know this was the only sleep I was to get! I found my husband and asked him to walk with me outside - it was a cold, crisp, sunny day. We walked around the block and around some other streets, for about 30 minutes. I walked through some contractions, and had to stop and hold on to him for others. They were coming very regularly at about 4-5 minute intervals. As soon as we came home and sat down with my mother and sister, though, they slowed down again. So I ate something and we set out again, this time for about 20 minutes. The contractions came harder and every 4 minutes. We returned, and again - back to 7-8 minute intervals. By now it was after 4pm though, and starting to get dark.
My midwife came again to check on me, and this time she went ahead and did an exam. OUCH! it hurt. I was only at 2 cm and 50% effaced. I tried not to be disappointed...after all, it had seemed too easy so far and I never had gotten beyond that with Natalie. I labored here and there and everywhere around the house, eating toast and yogurt and lots of water with lemon. We had a snafu with my family at this point...my mom had been taking care of Natalie all day and had had no sleep either, due to my 1am call. She invited my little sister over to help her with my daughter, and I had not wanted anybody in the house once labor started getting serious - and the pain were getting stronger. I told my midwife this and she felt that if my mom would not listen to me, that she should talk to my mom. Whew! Blowout. It ended in my mom leaving in a whirlwind talking about not being wanted, my little sister leaving with tears in her eyes, and the midwife following. I had told my mom that of course I wanted her here for the birth, that she was just real tired and it would be better for everyone if she slept when she could. She told me my friend who is a doula and birth photographer would be there around 7:30 - only a half hour away. That seemed bearable.
This whole scenario really distressed me and I cried after they all left. I felt guilty and responsible, but also angry because I had been so clear that I wanted no one in the house...it was really hard for me. I had to really concentrate on letting it go, welcoming my new baby and trying not to be distressed that my family was up in arms at such a poignant moment in time. I called my doula friend and as I had suspected, she had actually told my mom she was leaving a town 2 hours away at 7:30! So I braced myself for some alone time. It was a real paradigm shift for me - I began to realize that this was my birth and I may HAVE to do it alone. The contractions became stronger and I began having to vocalize through some of them...at first I was doing OK but then I began to worry. My midwife had gone to a function about an hour north, and said she would check in around midnight. That seemed fine, because we thought my doula friend would be here...
But she (my doula friend) called in a panic a bit later, and said she had a blowout on the freeway! She would have to get the tire changed etc. and wouldn't be here until at least 11pm. I felt so bad for her, at night on the freeway. I told her to keep safe and again braced myself for the time alone. I was surprised that instead of embracing that time, fear began to creep in. I think it is because the contractions became significantly stronger during this time.
My husband couldn't really be there for me because he was taking care of Natalie...who was doing well, but not where she could hear me vocalizing with some of my contractions, "oooouuuch!" So, I called my midwife again and asked her if she could come back. She said things were wrapping up where she was and she would head back down. It would be 45 minutes to an hour.
The time went by quickly and she was there before midnight. I was glad, as the contractions were getting stronger and stronger. Finally, she needed to get some sleep and asked me what I thought about calling my back-up doula. I did that, only to find out that she was at another birth! So we went back to square one. Around this time, my first doula/friend called and told me she had gotten home OK, but just couldn't come down at this point. She asked me what I thought about her partner, if she could make it. I said great! as I know this lady and like her a lot. She called back and said her partner unfortunately wasn't available because her husband had to work and she had no one to watch her children. Wow.
I was in enough pain to want my mom at this point, but as a support to me...not as a caretaker for Natalie or anything else. I thought that if she had gone straight to bed when she left, she might have gotten 6 or so hours of sleep and might be willing to come back. With Natalie in bed and the house quiet, I could just ask her to stay with me. I decided to call, and if she said no we could just find another option. She was hesitant, but said she had gone to bed and gotten some sleep, and she would come.
I kept laboring, but I was screaming with each contraction. Amanda (my midwife) was asleep on the couch downstairs. My mom arrived and I could hear her puttering around in the kitchen, getting herself some tea. She came upstairs and was like a different person - it was wonderful! She was soft and supportive and prayed with me through some contractions. She told me to close my eyes and talked about heaven and gave me some great visualizations. It really helped. This went on until the midwife came up after about an hour and a half to check vitals. She asked me if I wanted her to check me and I decided I needed to know. I was at a 5. I remember it was 2:20AM. I was encouraged...this was much farther than I had ever been before. I was also thinking that had I gone to a hospital, I would already be being prepped for a c-section, since it had been over 24 hours since my leak started. How dumb; we were fine, our temp normal, heartbeat and bp totally normal - baby totally healthy. She went back downstairs and I labored like this through the night, with my mom supporting me and Natalie asleep with Jorge. During this time, my lower back/sacrum area started to be super painful with each contraction, and so my mom was giving me counter pressure...that helped a lot.
By the time it was light, I was really miserable. I got in the pool a few times during the night...it was wonderful to have it. It did not make my contractions any less painful, but it was wonderful to relax in the water during my "breaks". After a while, Amanda came back up and my mom went downstairs and I could hear her making food for people. By this time, I was totally crazy during most contractions...Amanda called her assistant and she became part of the total scene. About 1PM (I am not positive on the time) my doula/friend arrived...just in time for Amanda to check me and see that I was at a "stretchy 8". I was encouraged but sooo tired, and I was screaming through every contraction...focusing was out the window, along with breathing and whatever else I was supposed to be doing. I remember around this time, Amanda said to me, "Well, this is probably as strong as the contractions are going to get." and I replied something along the lines of, "Good, because I can't take much more!" I was still joking between contractions, as I had been the entire time...I guess it was just my way of dealing with it.
Well haha - she and her assistant traded off doing some back massage and double hip squeezes while I labored on the bed on all fours with my rear end in the air...kind of undignified, but I was in so much pain I just ignored the indignity (I was naked). Finally, Amanda asked me what I thought about breaking the rest of my water sac. She explained that it was bulging out 4" out of my cervix, and was preventing the baby's head from really engaging strongly. The leak had made the sac mushy - it was not nice and tight and therefore was not breaking with the pressure, just acting like a weak cushion. I have never thought AROM was a good idea, but I could see in this case how draining the sac and letting the baby's head engage would push open my cervix so I could be complete. Plus, I was exhausted and faster sounded better at this point. I laid down, and all I can say is, I have never experienced anything more painful in my life up to that moment. I did OK at the beginning, but then I began screaming...not just yelling, but truly screaming. It took a few minutes, because the sac was so slack it was hard to hook. Finally, the gush came and I started to cry - I was broken. I began to feel hopeless, but was just glad it was over. My doula friend laid on the bed with me and talked soothingly, and I began to feel a little better.
Then my next contraction hit. I truly thought I was going to die. Not get any worse...yeah, right! Oh my God, I could not deal...I screamed and writhed and cried...and then I threw up everywhere. Talk about instant transition...from that point on, the labor became a blur of pain and exhaustion. I began to feel hopeless, pretty bad...I was beyond fear, just tired and felt like the contractions weren't really going anywhere, doing anything. They no longer felt constructive, they just HURT. This went on for about an hour and a half. They asked me if it helped to push and I tried a little and it didn't make any difference. Position didn't help, nothing...they would ask me how I felt and I would say, "I don't know, it just hurts." I could feel their frustration with this statement, especially when they asked me where and I would pretty much gesture to my entire lower body. I *was* having blood and fluid come out with most of the contractions at this point. This was a bad moment in my labor...I spent a few contractions just with my husband and I would look up into his eyes and cry...I felt so hopeless. He was very compassionate, and he would well up with tears too. I absolutely HAD to have counterpressure with my contractions, and he would hold my hands while I pushed against him with all my might and screamed.
Amanda checked again and said there was a tiny lip...not much of one. I never thought I would do this, but I asked her to push the lip back through a contraction. Supposedly this is very painful, but at this point I couldn't imagine anything *more* painful...I just wanted it to be over. She did this through a few contractions - my pain-meter was maxxed out so if it actually hurt *more*, I don't remember. Then I began to push. It was around 4pm. They were checking vitals constantly it seemed like - and my breaks between contractions were only what seemed like a few seconds sometimes. It really annoyed me when they checked fetal heart tones, but I knew they had to. A few times when they took too long (it was mostly the assistant doing it at this point; Amanda was helping me) and a contraction would start up, I would fling her hand away and yell, "No!"
I began to push in earnest. First on my feet, then I felt like I was going to
collapse, so I went down on the bed on all fours. After a while my knees hurt
and I went in the other room, and tried it there because the bed was lower to
the ground and more comfortable to sit on. They got that bed ready with a shower
curtain because the *other* room had been the "birthing room" we
prepared. they kept asking me if I wanted to have the baby in my room. I was not
very helpful; I was crazy with pain and exhaustion. I would just say,
"Yeah, I don't know, whatever," and go back to screaming. I finally
went *back* to the "birthing room" and leaned over the bed frame with
my upper body and stayed on my knees. I stayed like this a long time, holding my
mom's arms and pushing against her with all my might. I was sweating so much
that I couldn't open my eyes. They kept trying to get me to lift my upper body
so they could pad the bed frame with a cushion - I was pushing against it with
my upper chest and breasts sooo hard. I kept telling them I was too tired, I
couldn't. In between contractions, I would just lay on the bed frame. They began
to worry I wouldn't have enough strength to get through, so they brought
Gatorade and basically force-fed it to me between every contraction. I am
convinced this is why I did not pass out with exhaustion. Amanda came back
around to my head to show me how much of the head she could see with every
contraction...an attempt to encourage me I am sure. I was so tired...every
contraction was a reach beyond my own strength.
Finally my knees hurt too bad and I rolled over on my back. I pushed like that for several contractions, and they would tell me they could see the head, and "all that hair" etc. Finally I asked Amanda, "Please just tell me if the head at least is past the cervix." She laughed a little, and said, "oh yeah, WAY past." Then, when I could listen, she explained that with every contraction there were 3 pushes: The first one got you back to where you had been with the last one, the second one past and the third was the most important, where you made actual progress. I listened and I tried so hard...but everyone knew I would never get her out on my back. I could actually feel her head progress and then slip back with every contraction, and I was so discouraged. I could not get her past my tailbone. They kept saying, you have to get off your back, you have to get in the pool, don't you want a waterbirth? Even my husband said, "Honey are you sure? You really wanted your waterbirth" and I kept saying, "I don't care, I don't care..." With each contraction my legs were shaking so hard I couldn't control them and then my muscles would seize up and I was getting so exhausted.
Finally, I heard someone say, "You are not going to get the baby out like this. You have to get in the pool. Come on, we will roll you over." And all the sudden that seemed okay. I had not been able to imagine sitting up and moving, even with help; the baby was in my vagina and I just could not move. But I said, "OK" this time, and they grabbed my arms and literally rolled me into the pool, which was next to the bed. I splashed in like a giant whale and immediately felt better. My mom sat in front of me and supported my upper body and I began to push with everything I had in me. A few of these and the burning started - I knew it was the "ring of fire". Another big surprise...I had thought it would burn in my perineum, and I am sure it did...but it burned UP, and I started crying and screaming that my clitoris was ripping. It hurt so bad. Amanda said she would try to support it...I could feel her stretching out and supporting my perineum. Once I stopped pushing and she said, "Bonnie, you have to push through it, you have to" and I would say, "I can't I can't" and she would say very authoritatively, "YES, YOU CAN" and I would pray and push. I was so far beyond my own strength, I would just pray, God please help me push and I would hold my breath and then scream as it burned like I had sat on the sun itself. Finally, I felt a kind of pop and Amanda said, "wait wait quit pushing" and she checked for a cord. A second pop quickly followed. I figured her head had come out and I still needed to push out the shoulders, but she said, "keep pushing," and then I heard, "Grab your baby Bonnie, pick up your baby!" and there she was, in the water in front of me. I picked her up and looked at her, and I just couldn't believe it was over, and I had done it. God really did it, because there is no way I could have pushed in my own strength - I was way past my own capability.
I sat down in the pool and began to shake...I had not an ounce of strength. I literally could not keep my own legs from floating to the surface. My vagina was pulsating with pain and it surprised me that it hurt so badly. I heard, "Talk to your baby, Bonnie." And so I did. I offered her the breast but she just wanted to look at me. She did not cry at all...this was concerning to the midwife and I could hear some sideline conversation about it, but I knew she was OK. It did not bother me at all. After about 5 minutes, Amanda said, "Aren't you going to check and see if it is a girl?" and I felt the cord and said, "It's a boy?!" and everyone laughed. I was so tired...how silly, the cord was even still attached! I felt it was a girl and I said, "Ruby Isabella Naomi" (although we did change the order of the names later to avoid confusion, since we planned to call her Naomi). My sister brought in Natalie, and she got to see/touch the new baby. She kept saying, "baby, baby"...it was a precious moment.
I pushed a tiny bit, and felt cord slither out. Amanda felt and said the placenta was right there, all I had to do was push. I asked her if I could wait, "just a minute". She said sure. I finally pushed it out and then they cut the cord (Jorge did it) when it was all closed up and gave the baby to Jorge...they had him take his shirt off and carry her skin-to-skin with a towel over her. During this time they had prepped my bed, and so they helped me stand up and walk to my bedroom - about 15 steps. I could not believe how weak I was. I could barely stand up, let alone walk. It wasn't really pain (other than my vagina), it was simple exhaustion. I was shivering really bad too. They had me drink more gatorade and my sister went to make me a sandwich - I was so hungry. At this point, my doula left as she was already late for something but had stayed because the baby was so close to coming out.
They got me situated in bed, but then I said I had to pee. I couldn't sit on the toilet so I tried standing up in the shower. I tried everything - even turned the light off, but I just couldn't pee. Finally I couldn't stand up anymore so I gave up. They asked to check my bottom and very gently inspected me. There was blood everywhere and it was falling out of me every time I moved, so I assumed I was ripped from stem to stern.
Amanda looked up from examining me, and said, "Here's the deal: your perineum is intact." I said, "What???" I could not believe it. She said I had a few labial tears up by my clitoris, and a few tiny tears down by the perineum, but nothing that was serious at all. She said I could let it heal on its own, or they could kind of match up the skin and "tack it together" to be sure it healed in the right place. I thought about it and opted for the tacking...I knew they would take much care to do it right, and I did not want to risk infection - I am very prone to vaginal infections. So, they took the anesthetic and even though she told me each time she would stick me, it HURT! Not that bad, you see...but after what I had been though, any more pain was like, well, salt in the wound. I was a real baby. My sister sat beside me holding Naomi and my hand, and once she was like, "You are going to have to let go a little" because I was squeezing her so hard! It seemed to take forever.
was laying there, eating my grilled cheese sandwich, and nothing had ever tasted
so good! I had to pee sooooo bad though, and every second it was getting worse
because they had made me drink so much Gatorade after the birth. I began to
whine incessantly...and I kept asking Amanda, "How much longer?" And
she finally snapped, "I don't know, Bonnie!" I said, "I am sorry
I am whining, but I have to pee soooo bad." They told me the reason I had
not been able to pee was because my urethra had been swollen shut. They said
that almost all the swelling had gone down, and I should be able to pee when
Thankfully, I was able to pee when they finished and felt much better after. I even took a short shower and felt like a new person. Amanda went over post-partum stuff and I finally got to sleep - after a second grilled cheese sandwich! I didn't call anyone until I woke up about 6 hours later. I remember asking my midwife why the birth stories never told you how bad it hurt, and she said, "Because people forget." I couldn't imagine forgetting.
But, none of it was a bad feeling in my mind - I was so grateful for everyone who helped me get through and so enamored with my new baby...surrounded by family and love. I never could have done it without each person there: My older sister Lisa helping to calm Natalie when I was screaming, my husband, my mom, Patti my friend and doula, and of course Amanda and her assistant, Marie. It was truly wonderful, in spite of all the pain.
Not everything in life feels good, and one thing I can tell you: this pain was productive; it had a beginning and an end and a purpose. My c-sec was terrible; I was powerless, had no choices, had my baby taken from me and was filled with drugs. I was in unfamiliar surroundings, with an uncomfortable bed and was not allowed to eat, even after the surgery. Loving family could come and go; my husband was there; but they would not give him a bed or even a decent chair and so he was beyond exhausted. There was simply nothing in the world that could compete with my own bed and a grilled cheese sandwich after the birth.
I have lots of thoughts and theories and reflections, and will write them separately. But one thing I can say to those reading it: It is worth every second. My baby's heartbeat never went below the 120's - even in the pushing stage after 38 hours of labor with ruptured membranes. My BP was 120/68 when I was 8 centimeters dilated and in horrible contractions. I am telling you, my cesarean for PIH and Pre-Eclampsia was a complete farce. It's true, I was healthier this pregnancy...but had I had good home care instead of getting my BP taken by MEDwives and doctors who were trying to scare the crap out of me, I never would have had "high" BP in the first place...which by the way was still way lower than most c/sec's for the same reason. They looked at me, saw an overweight woman with a 9+ lb baby, and said, "cesarean." Of course, they did not tell me this directly and I did not know how to read the signs.
My greatest triumph in this is not even me; it's my baby. I knew her, smelled her, saw her, and coherently held her right away. She was alert, no drugs. She was not terrorized by needles and heel pricks...she was not deprived of 1/3 of her blood by having her cord cut too soon...she was not washed and scrubbed within seconds of being born and robbed of her soft vernix. She was not placed in a warmer all by herself under bright lights for over an hour because I was in recovery. The list goes on, as she was aspirated so many times they bruised her nostril passages and when she couldn't breathe, of course they had to take her for tests - and bottles of sugar water and formula...
I am telling you, if that is all I got out of this VBAC, it would have been worth it. But I personally got soo much more. The "fast-food" society we live in has come to birthing: if it is not ready by a certain time or within certain "averages", well then, it is a medicated/extraction/c-sec birth for you! Hop to it! And I am wondering where these "averages" come from...well hospitals of course. Where they induce and monitor and interfere like crazy. I mean, I cannot imagine letting someone tell me what position to be in or clothing to wear - what I can or cannot eat or drink - if I can or cannot shower or go to the bathroom. What is wrong with us to allow and even welcome this kind of treatment? It is very disturbing.
Anyway, my beautiful baby is now 3 weeks old and perfectly healthy. We went to the doctor the other day...and the staff there was so amazed I had her at home, they actually sent people out to look at us and/or meet us, "This is the lady who had her baby at home," like I was some kind of anomaly of nature. They always asked, "Weren't you scared?" and "Was it an accident?" and I answered, "No, what scares me is the hospital; those are the brave people. We only go there when we're sick," and "No, after 42 hours of labor, it was definitely NOT an accident!" And of course then they were even more shocked.
I feel so bad for people who don't know about the wonderful option I had. Until I was almost complete (10 cm), I never even considered a hospital or drugs...and even then, it was for the pain (too late anyway for painkillers) and not because of any danger to me or the baby. And I realized, if I went, I would be an *automatic* c-section, probably with a general. Great, knock me out and cut me open and take my baby, after I had already *almost* made it. No thank you! That is what helped me those last few hours: I had already come so far; was I going to throw it all away? I decided I would try until I passed out. And of course, God helped me make it.
That is the story of Naomi's Blessing. [To see pictures of Bonnie's cesarean compared to her VBAC birth, see www.pattiramos.com/bonnie.html. ]
Mary Ellen's Story (PIH, premature labor, vaginal birth)
Kmom's Notes: The definitions of the various conditions where blood pressure is high in pregnancy can be blurred. This may have been a case of pre-existing hypertension rather than Pregnancy-Induced Hypertension, because PIH doesn't usually come on so very early (and if it does, it usually escalates to something more serious). However, whatever this was technically, it all worked out in the end and there were no serious complications from it, aside from the baby coming a little early.
I was diagnosed with Pregnancy Induced Hypertension relatively early in my
pregnancy due to borderline blood pressure readings at the fist few visits with the OB. I was requested to monitor my blood pressure at home twice a
day and to record my readings for the dr. As my pregnancy progressed the readings became slightly higher and the doctor was concerned that I might
develop pre-eclampsia so we kept a very close watch on my blood pressure.
At about 24 weeks into the pregnancy my OB suggested that I cut back my work hours and spend most of my time off of my feet which I did. (At this point I was also suffering from Pubic Symphysis pain.) At 33 weeks the Dr told me I needed to be home off of my feet, on bedrest full time. My blood pressure readings were consistently around the 140/90 range, sometimes higher.
At 36 1/2 weeks my DD decided it was time for her to make her entrance to the world. On Tuesday, July 10th I woke up at around 5am not feeling all that well. As the morning progressed I started to feel worse, but not horrible. I just had a little crampy feeling, more like a stomach ache, it didn't feel like contractions and I never thought that I could actually be in labor! At around 10 am or so, I lost my mucus plug. They had told us in LaMaze that this could happen up to 2 weeks before delivery, and since I wasn't due for 3 1/2 weeks, I didn't concern me too much.
Shortly after 12 I had my first big, painful contraction and at the same time my water broke. (Or, the contraction forced out the water?). I panicked. Was that really a contraction? Did my water really break? Nah, I thought - it’s WAY too early! After about a half an hour I decided to call my doctor and risk him telling me I was crazy. Better to be safe than sorry right? Well of course when I called the office they were closed and I had to call the emergency number. My DR called me right back and I explained what had been happening. He said that he was at the hospital and I should come up to be checked.
I called DH who came right home from work while I packed a few things “just in case”. Then we proceeded to the hospital. Off to L&D we went where we were greeted by a nurse who was expecting us. She told me she’d put us in a room and I should get undressed, but she wasn’t starting my paperwork because she was sure I was going home. She said that at 36.5 weeks it was too early for me to be in labor. I undressed, she took a urine sample, made me comfortable and told me my DR would be in shortly. At 3:30pm my DR came in to check me internally, he said I was 5cm dilated! I don’t know who was more surprised me or the DR! He told my DH, “You’re going to have a baby today, by 10pm”.
Right away they started me on an IV and hooked me up to a blood pressure
cuff that monitored my blood pressure readings. The nurses were having trouble monitoring the heartbeat and they asked for an internal monitor
which my DR set up right away. Since my contractions had become regular (I guess from my water breaking) and they were considerably painful I decided
to go with the epidural and they called for the anesthesiologist.
It took the anesthesiologist THREE tries to get the epidural inserted. On her third attempt I told her that if it didn't work that I didn't want her to try another time. The position I was in was very uncomfortable and it was making my contractions feel worse. She told me she got it on the 3rd try and then they catheterized me. The catheterization was about the most painful part of the whole labor/delivery experience in my opinion. Even after 3 attempts at setting up the epidural, it wasn’t very effective. I could still feel the contractions and when my OB came in to check my progress I could feel the internal and I almost went through the roof with the pain.
By 4:30 I was at almost 8cm, and still there at 6:00, so my DR decided to give a little Pitocin to restart my stalled dilation. Once the Pitocin kicked in I dilated to 10cm and I realized my epidural wasn’t helping at all. At 9:00 it was time to push and at 9:26 my beautiful darling daughter was born. She weighed in at 5 pounds 6 ounces and she was 18 ¾ inches long.
In hindsight I would have been better off without the epidural. It didn't help my pain at all and it only made me less mobile between the epidural catheter and the bladder catheterization. I have to say that the treatment I got at the hospital and from the L&D nurses was exceptional.
Dawn's Story (borderline blood pressure, possible IUGR, homebirth)
Kmom's Notes: Compare Dawn's first two stories to Dawn's third story. Even with vaginal and pretty much natural births, she still had a lot of intervention and a lot of trauma at the hospital.
I think Dawn said it all when she noted, "I chose to go the home birth route because I believed in the natural ability of women's bodies to give birth, and felt that the hospital impeded the process at almost every turn. I wanted to give birth in a safe, comfortable environment where I could experience it as the full rite of passage that it is, and where I could assume that I would be treated with dignity and respect."
[Kmom note: This is Dawn's third child. Here are summaries of her first two stories.]
Baby #1: My first baby was born when I was twenty, with a female OB, in a hospital. I had read a *lot* about birth, and went in armed with a wonderful birth plan that seemed to go out the window when the OB insisted on an IV... and then broke my water when I got "stuck" at 8... to find meconium in the fluid. From there on out, it was intervention hell. Internal monitor, transfer to delivery room, up in the stirrups, butt in the air, pushing uphill, baby's heart rate dropped into the 60's, doc said, "I have to cut to get her out" and cut an episiotomy (at least she asked) baby was rushed over to the warming tray and DEEP suctioned. We were thrilled we had a little girl ( 7 lbs, 6 oz, 21 inches, and I had no drugs or epidural) but I was so incredibly disappointed with the birth. I had very little support afterward, I felt like I'd been through a war, and when I had the guts to take out a mirror and look at my stitches, I felt like Frankenstein's monster. I had severe PPD after this birth, including anxiety attacks that I was sure were heart attacks. It took months to recover psychologically, and we couldn't have sex comfortably for a year afterward.
Baby #2: Second birth, three years later, I decided to go with a group of certified nurse midwives in a hospital that had labor-delivery-recovery rooms. It seemed like a great solution to the intervention train ride I'd been on with my first, but at my "routine" 16 week ultrasound, they discovered that our baby boy's kidney was enlarged, and I had an ultrasound a month thereafter until the 38th week, when they did an amnio to assess lung function and decided to induce because his kidney was still enlarged. There was plenty of fluid, and he seemed healthy otherwise, but they wanted to be safe. So we went in and I was given prostaglandin gel on cervix periodically all day, but nothing much happened, so they sent my husband home with the promise to start pitocin in the morning. I took a shower, and when the nurse came in to check the baby and found his heartbeat "high" (170) she called the midwife, who checked me and found me at 6 cm!! I was shocked.
She broke my water (and the pain increased tenfold) and I called my husband and my best friend. They
were running around, getting me out of my nightgown and into a hospital gown "in case they have to do a c-section" they said, worrying about the
heartbeat, trying to get a PH level from the baby's scalp, all while attempting to put in an IV, and I was writhing on the bed, literally screaming in pain from being poked, prodded, and the contractions now coming one right after the other. Finally, an OB walked in, she rolled me on my left side, made everyone else leave, and breathed with me for fifteen minutes. The baby's heart rate went back to normal and never went high again! My husband showed up with my mother in law, who was NOT invited to the birth, and then my friend showed up. I got stuck at 8 again, but felt the urge to push, so the midwife held my cervix back and I pushed out my son, 7 lbs, 11 oz, in about 15 minutes. Again, no drugs or epidural, and this time, no episiotomy, for which I am grateful, but still too many interventions for me. Ironically, the first thing he did was pee on the midwife!
But we still had to get his kidney checked, and I had the horrific experience of holding down my screaming 2 week old and sobbing while they put in an IV so they could do a dye test to check his kidney function. The result? He was perfectly fine. Except for the induction-jaundice he developed, which the pediatrician was sure was "breastmilk" jaundice, and he told me I HAD to stop breastfeeding for 24 hours. I was sobbing as I called around looking for an electric breast pump to rent. We made it through those 24 hours, to "prove" it wasn't my milk, and ended up putting him on home phototherapy (a little blanket with a bilirubin light inside) and it cleared up. I wish I hadn't had the first ultrasound, though, because that intervention snowball never would have gotten rolling in the first place.
Baby #3: [This time] I chose to go the home birth route because I believed in the natural ability of women's bodies to give birth, and felt that the hospital impeded the process at almost every turn. I wanted to give birth in a safe, comfortable environment where I could experience it as the full rite of passage that it is, and where I could assume that I would be treated with dignity and respect.
I had a prenatal appointment scheduled for June 1 at our new house, where all the midwives would practice getting here (all three of them), and we would go over our last minute plans of how we wanted the birth to go. On the morning of May 31, DH said upon leaving the house, "Today would be a good day, it's Thursday, you know." We'd been joking for a few weeks that she needed to be accommodating and be born on a Thursday (he has Fridays off) so that he could take the entire following week and not have to go back to work until the next week. I laughed and said, "No way, she has to wait until June now, today is my sister's birthday, I don't want her to have to share!"
Instead of sleeping in, I decided to get up and get started on the things on
"the list" that needed to be done around the house. (Alas, the last day I
would have to sleep in and I missed it!!!) After breakfast I started not
feeling so well, having to run to the bathroom every half an hour or so.
After about the third time, it suddenly occurred to me that this was probably a
good sign that labor was going to begin at some point, maybe not today, but
soon. Either that, or the Thai food we'd eaten the night before hadn't
agreed with me! I hung around the house, kind of anxiously anticipating
something, almost as if I could feel it in the air.
Sure enough, contractions started that afternoon. Nothing major, a little bigger and more intense than the Braxton-Hicks I'd been experiencing, in fac t they were so far apart and weren't so bad that I wasn't sure they were "real " contractions at all. The hardest part was not knowing for sure! I pick ed the kids up in the afternoon from school, and noticed that I was having a hard time concentrating on what they were saying if I was having a contraction. Hmm... that was a good sign. Maybe these were "real" then ! I tidied up when I got home, got a few last minute things together for the birth (just in case I'm really in labor, I told myself!) and started preparing dinner.
Contractions weren't really close together, anywhere from five minutes, to eight minutes, and sometimes fifteen minutes apart. No real pattern. DH called at five, and I told him, "Well, you *may* be a daddy today." Even though I told him not to, he canceled his last client and came right home. I was afraid that it wasn't really labor, and I didn't want to disappoint him if it wasn't really it! I had contractions through dinner, through clean- up, through kids' baths and bedtimes, but again, they were anywhere from five to eight minutes apart, and while they were uncomfortable, I *still* doubted if I was really in labor.
Finally, I called the midwife around 8:30 p.m., just to give them a heads up . I didn't want to have to wake anyone up in the middle of the night if I didn't have to. I gave her all the information, and she told me that she would call all of the other midwives, and told me to sleep if I could, and i f they got worse or changed, to call her back. DH and I decided that distraction was a good idea, because both of us were too excited and anxious to sleep, so we played Yahtzee until 11:30 p.m. or so. (I haven't played it in years!) We went to bed, and I curled up with DH and the contracti ons started spacing themselves out. Ten minutes apart. Then fifteen. I was sleeping between them, but then I'd have a contraction and it would wake me up and I would grab DH's hand, which would wake him up, and he'd breath e through the contraction with me until it was over and I fell asleep again. It was a good system, and I think the sleep did me good. It did us bot h good.
At 12:30 a.m., interestingly just as it was becoming June, my contractions started picking up. They became stronger, and started waking me up every five minutes. In fact, I wasn't so much sleeping between them as I was zoning out. At 1:00 a.m., DH gently suggested we call the midwives. I hesitated. I was *still* doubting that this was "it"! Maybe they would sp ace out again between, like they had before, how did I know? At 1:15 a.m., DH was suggesting it more strongly, and after my next contraction, when I sat up and had to arch my back to keep the pressure off of my lower bac k through it, I decided that it might be a good idea. He called them while I was in the bathroom, and I when I came out he said they were on their way. As soon as I knew that, I was somehow able to rel ax some more, which made the contractions seem a little more bearable. Of course, that made me think that maybe this wasn't really "it" and they would slow down or stop when they showed up! My fear was of being the little bo y who cried wolf (or the woman who cried labor) but in the next forty-five minutes before they arrived, the contractions were coming regularly and were fairly intense, and I became pretty sure (finally!) that this baby was going to be born on June 1.
The midwives arrived at about 2:15 a.m., and of course wanted to check my progress, but I didn't want to move. Things were starting to pick up and it was becoming uncomfortable. I did anyway, of course, and she checked me b oth before a contraction (about 4 cm) and during a contraction (which hurt beyon d belief, but I was 5-6 cm during) and after that, contractions seemed even
closer together and were getting to an intensity I could barely remember fro m my other two births. DH was having a hard time getting me to focus, and both of the midwives were giving pretty good directions (keep my voice low, relax my forehead, breathe, etc) and I tried hard to listen and follow their instructions, but things were getting fuzzy.
I have no idea how much time passed, but the pain went from "Wow, this reall y hurts" to "Oh my god, I'm going to die" so quickly that I didn't even have a chance to breathe. The midwives were still telling me to breathe through them, DH was having me focus on his face, look into his eyes and breath e with him, and while everyone around me was saying how good I was doing, I felt like I was falling apart. Not only was I in pain, but suddenly I was really afraid. They had checked me at what felt like minutes ago, and I w as only at 4, so these contractions couldn't possibly be as intense as they fel t like they were, and I must just be acting like a baby. My fear (and of course I was doing the labor math in my head: this kind of intensity at 4 cm, times 1 cm per hour, that means at least 6 more hours like this?!) was that I couldn't possibly handle this much longer.
Then my water broke. I'd never felt that before. With both of my other births, my membranes had been artificially ruptured. I remembered the feeling, but this was different. This was pressure that broke the bag, an d I said, "You guys, I think my water just broke," and oh my god, I remember contractions getting more intense after that in my previous births, but this was beyond anything I'd ever experienced. It felt as if the water breakin g was pushing the baby down, it felt like the baby was coming, and not just coming, but coming *right now*!
I saw the midwives' faces, and the first question out of my mouth was, "Is there meconium" She said, "Yes," and my heart sank. "A lot?" I asked. "A good amount" she said. They were setting up suction equipment, and I thought, wel l, this is the thing, then. This is the thing that had to go wrong. Then, I couldn't think anything anymore. It all happened too fast. She decided to see how far along I was then, and she said, "Oh, you're a stretchy 7." Close to transition, then. I felt like I was dying. The baby's head was now *so* low in my pelvis, I was starting to have the urge to push, but knew if I sai d anything they would tell me to breathe through it. I was afraid I couldn' t do it anymore.
Then they couldn't find heart tones. They were using the Doppler, but no matter where they put it, they couldn't find her. Finally, they heard something faintly, and thought that maybe the uterus was tipped too far back, so they wanted me on my hands and knees so that the uterus would tip forward and they could check it from underneath. I was saying, "No no no" when she suggested it, but she was firm, and DH helped flip me over I was amazed how good it felt to be on my hands and knees. I thought, this
is great! Why didn't we do this before?? The baby was low, really really low, but I was in so much pain that all I could do was grunt and moan. I had t wo contractions like that, while they were frantically checking for heart tones from underneath, and could feel myself starting to push through them, unable to stop. It didn't occur to me to say that maybe they couldn't find heart tones because she was too far into the birth canal!
The midwife had me flip back over and that's when I gasped and said, "The baby is *right there!*" She said, "Ok, I believe you," reaching for a glo ve, and suddenly I felt the familiar stretch and burn of the baby crowning. S he was shocked and said, "There's a head!" Both Michael and I reached down to feel her head, wet and full of hair. They checked for a cord, and suctioned her there on the perineum because of the meconium. As soon as her head wa s out, I was lucid again. One more little push and she was up on my belly. They suctioned her again (Delee), making sure to get any meconium before she aspirated it into her lungs. She was pale at first, but began to cry and pink up. She was born at 3:43 a.m. Apgars were kind of scary (5 and 7) . I was shocked at how tiny she was! She was the smallest baby I'd ever see n, aside from a preemie.
After the initial worry about her breathing (which
fine and clear from that point on), we slowly got to know her as I kept her
warm on my belly and the midwives did what they needed to do, checking her,
checking me, having me push to deliver the placenta (within about fifteen
minutes after she was born). The placenta was small, too. My 7 year-old, w
room is right across the hall, woke up when she began to cry. He came int
our room, and I told him to go get my 10 year-old. I was sorry they missed i
but we all nearly missed it, it went so quickly at the end! They were
thrilled to see the baby, and crowded around to say hello to her. She's a
perfect little peanut, and looks just like DH when he was a baby. (Pics at:
waited about half an hour to cut the cord (it was STILL pulsing!) and DH
cut it with his knife and said a blessing. (I forgot to get pictures of
that, which I'm still SO mad at myself for!)
Then I cleaned up while Michael held her, and then we settled back into bed and napped and snuggled for a half an hour or so while the midwives cleaned up and made some calls. They wanted her checked out by a doctor as soon a s possible (which was standard practice for them anyway, but because of the meconium and because of her size, they were insistent that it be right away), so they made an appointment for us, and one of the midwives said she'd go with us. My son had gone back to bed, and my daughter was out helping the midwives prepare things. She was the biggest help to them, and is an even bigger help to me now.
After the doctor checked her out and gave her a clean bill of health, I think we all relaxed a little bit. She weighed in at 5 pounds, which is smaller than the minimum average (which is about 5 and a half pounds) and was 18 and a half inches long. Her head circumference was 12 and 3/4, which is on th e small side and is probably why I had no second stage of labor. I didn't h ave
to push her out, she just kind of slid right down the birth canal and into the world! Her size is a mystery. The doctor said it could have been m y blood pressure, which was borderline at the end, that may have affected placental function, and she may have been meant to be a small baby regardless. The good news is that she's healthy, and is nursing like a pr o, and hasn't left my arms (or someone's arms who loves her) since she was born.
I shudder to think what may have happened if we had delivered in a hospital. The meconium alone would have had her in the nursery for "observation" for 12 hours or so . Her size would have probably had her in the NICU, just as a precaution. It certainly could have been warranted. There are a lot of babies who are small who have a hard time holding their temperatures, who
have hard times breathing. I was so grateful to be at home, with people who knew what to look for, who were willing to watch her and wait. She passed every test, and handled it all on her own, and they were satisfied with that and so was I. It was a relief and a blessing. She is a possible IUGR (intrauterine growth retardation) baby, probably SGA (small for gestational age) but so far doesn't show any negative effects. (Note: at 7 weeks, now, 50 days old, she is 9 pounds!!)
I can't tell you what a healing experience it was to have a baby in my own bed. In spite of the pain (which was much more intense, not only than I remember, but than I'd experienced before) and my fears of falling apart, which I would have had in or out of a hospital I imagine, I was able to have a positive birth experience, when I'm nearly 100% sure that it would have been a snowball of interventions in a medical setting that probably would have traumatized me, the baby, and my husband. I felt confident that although there were things we had to take seriously and pay attention to, the midwives would respect the normal process, and trust in my body and the baby's, and they did. It was a gift, a blessing, and a truly amazing experience for all of us.
Jan A. Heirtzler's Story (borderline BP, pelvic pain, homebirth)
Kmom's Notes: To find out more about pubic pain in pregnancy, check out the FAQ on this website on Pelvic Pain.
Friday night is "Craft Night" in the Heirtzler household: we have my sister and brother-in-law, and my brother, over for dinner, and then go upstairs and work on various projects (and sometimes just play games). Last Friday was no exception, and we played "Star Wars" monopoly until 2 in the morning. If only we had known...
I woke up at 7 on Saturday morning, having to pee (as usual). And then I noticed the mucus plug as I got up. Oh my God, I thought, while I tried to reassure myself that lots of women lose the plug and then walk around for weeks before going into labour. I woke up David anyway, though, and shortly thereafter, started feeling mild contractions, maybe 30 seconds long and 10-15 minutes apart. Bad timing, wee one! Not only was Cilia, my midwife, going away for the weekend for a conference, my mother had several speaking engagements for that Saturday! However, we paged Cilia anyway, as well as the backup midwife, just to let them know that things were in the works. Mom said she would be over around 2, and Cilia started back to New Hampshire from her 4-hour drive to New York!
Things went pretty slowly all day, with contractions going from 10 minutes apart to 4 minutes and then back to 10. We decided to go for a walk, and went to the health food store, where no one noticed I was in labour, and when David got hungry, to a local cafe, where the proprietress did notice and wished us luck - she was very interested in our homebirth plans. The walk got my contractions to about 4 minutes apart again, and they were pretty steady by the time we got home. However, we walked in the door to find not only Cilia, my mother and sister, but also the backup midwife, her assistant, and her 11-year-old daughter! I was in an irregular pattern to begin with, but this did nothing to help... soon my contractions pretty much faded out completely.
We went upstairs to hide from the crowd, and Cilia checked my blood pressure and wee one's heart rate; the latter was fine, though my b.p. had been spiking high since about week 32. She suggested that I rest for awhile, and sent the others away -- she also went home and told us to call if anything changed. Well, I wasn't really in the mood to nap (silly me), and we had wanted to make a plaster cast of my belly once I started to show, but had put it off, thinking we had plenty of time. Ha. So Robyn (my sister), David and I jumped in the car and went to the craft supply store to pick up the plaster wrap and such. I think it was around 3:30 then.
We got home and started doing the cast, and my mom arrived shortly thereafter, much amused and perplexed by the proceedings. The cast took about 30 minutes to do, and I think it turned out pretty neat -- I haven't actually seen it dry, just when we took it off me.. Will post pictures to the website when I have a chance. Things were still going slowly, so my brother and brother-in-law came over for dinner that night (we got subs from a local place) and hung around until later (maybe 9-ish?) when we decided it was probably time to go to bed. I could only keep the contractions going by moving around a lot, and was starting to get tired.
I didn't get a whole lot of sleep that night, either; I'd have about 30 minutes of sleep before being woken up by another stronger contraction, then a couple more maybe 5 minutes apart. That kept up all night, so I don't think I got more than 3 hours of sleep total. Sunday was a lot like Saturday -- hurry up and wait. We tried to keep things moving with me climbing stairs, etc. but were not making my progress. Cilia came by around 3 pm to check my cervix -- at least the contractions had been doing some good, as I was 5-6 cm dilated and somewhat effaced. (The internal was really not that bad -- I think she must have an excellent technique.)
That was encouraging, but contractions were still very irregular -- they'd get closer and more intense, and then back off again. Mom said all three of her labours were a lot like that; she went 48 hours (in the same pattern) with me. We gave up trying to keep things going after talking to Cilia again at around 10 pm. By that time, we were all pretty exhausted, and just wanted a good night's sleep.
I slept fairly well from 11 until 2 am... and then things kicked into serious mode! When I woke up at 2, I thought at first I was in for more of the same, but it was not to be. Contractions got very strong, very quickly, and it soon became apparent that this was "it." We called Cilia at 2:30 and she was there by 2:50. An internal revealed that I was in fact in transition, at about 9 cm and quite well effaced, so we did the best we could to ride out the increasingly uncomfortable (not yet *painful*) contractions. They got stronger and longer, and closer, and at 4:30, she suggested that I might try pushing.
You can see pictures of the birth support Cilia uses on her website (which I made) at http://www.birthchair.com. I think it really did make a big difference in pushing; I was uncomfortable everywhere, of course, but much less so on the chair. Not to mention the positive effects of gravity :) I don't really know what was more painful: contractions during transition or the actual pushing. I pushed for about 80 minutes, probably less effectively than I could be, and then Cilia said I could feel his head if I reached down.
The videotape best captures the sense of "Wow!" that I felt; I immediately had a concrete goal to reach for, and changed pushing appropriately. After that it was only about 8 minutes until he was born... 8 very, very intense minutes! It stung rather a lot when his head crowned, but after that, he slipped out very easily, and started crying right away!
Stephen Glenn (for my mother's late father) Lewis (for David's father's father) Heirtzler was born at 6:08 am, with Apgars of 10 and 10. We were all surprised by how small he was -- just 6 pounds, 2 ounces. It appears his cord was much smaller than normal, so although the placenta was a good size, he was getting a bit less than he otherwise might have.
It's been 14 months since his birth, and we're still happily nursing. Thinking about number 2 next year, too :)
Misha's Stories (PIH, induction, c/s, then 2 VBACs despite malpositions)
Kmom's Notes: The OB blamed this mom's stalled first labor on the size of the baby (which he thought was over 9 lbs.), but the baby was just over 6 and a half pounds. Because big moms measure larger than smaller moms and can have bigger babies, many docs assume that all babes of big moms will be big and are quick to assume that any problems are due to this.
The joke was on the OB. After having a cesarean because her first baby 'was too big,' Misha went on to have 2 VBACs, one with a 9 lbs plus baby!
Baby #1 (Alexandria Paige): At 22yo, I went into my first pregnancy very excited, but also very naive. I signed up with an OB, ' cuz isn't that what you're supposed to do when you're pregnant? I'd scarcely even heard of a midwife, and certainly not in any modern context. I looked forward every month to prenatal visits, and took every word from the doc's mouth as law. His office gave out copies of What To Expect When You're Expecting to every newly pregnant mama (how generous), so everything I knew about pregnancy and birth was learned from that. I skipped the c/s parts ' cuz of course that wasn't going to happen to me so why waste my time.
After a couple rocky incidents (suddenly getting asthma/being hospitalized for it in the 5th month., and a breast cyst in the 7th) things seemed to be fine and we were getting very excited to meet our baby. Just over a month before my "Estimated Due Date" I came down with symptoms of Pregnancy-Induced Hypertension. I was put on left-side bedrest, and became bored out of my mind watching the OJ trial. I went to twice-weekly BP checks at the doc and played the victim to a tee, loving all the extra fussing over and attention.
Eventually, after a few wks. of this, it was wearing thin. I thought I would "never" go into labor, and was begging the doc to do something. He agreed to try to induce w/ prostaglandin gel. I knew nothing about the risks of forcing a baby out too early, and certainly didn't have any good objective info on drug risks, etc. I figured everything would just happen, the doc would be there just in case something happened to me or the baby, and my body would simply give birth. Oh I would try to do it naturally, but wouldn't feel guilty if I didn't.
at 38 wks. I went in for an application of gel. It took 4 tries a few days
apart, and at 39 wks. it finally threw me into hard labor. 4 hours after the
application, I started contracting and it took only a few minutes for them to
become only a couple minutes apart and brutally painful. My doctor came in and
said, "I'm sending up the anesthesiologist to give you an epidural.
Otherwise you'll be too tired when it comes time to push." I was so happy!
The epidural was great (or so I thought at the time). I could lay there pain
free, sleeping, talking to hubby and family, and just wait for my baby to come.
The rest of the story is pretty simple. As soon as I had the epi, they started pumping me w/ pitocin (again I had no knowledge of any risk - all along the line, we had been encouraged to just sign whatever they gave us - "you don't need to read all that fine print"). About 12 hrs. after labor had started, and being stuck at 5cm for 5 hrs., my doctor came in and informed me I was having a c/s. I started crying, and the anesthesiologist., who was trying to get me to sign papers, said "What are you crying for? You need to stop that so I can get you to sign these." I was scared, and esp. frightened of being awake for the surgery.
I was wheeled into the OR, my husband was not allowed in till after he'd started
cutting (during which time I was freaking out - I NEEDED my husband w/ me), and
I laid there w/ my arms strapped out as on a crucifix, barfing through the birth
of my first child. I heard "It's a girl," and started crying
again. I caught a quick glimpse of a pale little face buried in a receiving
blanket as she was taken to the nursery. Back in my room after being stitched
and stapled, I shook violently despite all the warmed blankets piled on me, and
thought I was dying because the epidural had gone too high and numbed my chest,
causing me to feel like I couldn't breathe. I was finally able to hold and nurse
her 3 hrs. later. The recovery was miserable and painful. As a result of
the pain meds I was taking ( and no one telling us [ that it would make
our daughter so sleepy that she would sleep too long between nursings]) in
addition to my failure to seek breastfeeding help, she was supplemented by one
month and weaned by 3 months.
One side note - during the time when my dilation was "stuck", my OB told me the baby was over 9 lbs. and that was why she wasn't coming down. After they weighed her (all 6 lbs. 11 oz.) I heard him say "Boy, was I ever off!"
I have found one thing (besides my daughter) to be thankful for in having gone through this experience. If I hadn't, I may never have learned all I have about birth and the way it can and SHOULD be, and in turn never would have been able to help reach out to other women who start their pregnancies as I did.
Baby #2 (Samuel Nathan): Sammy was our 2nd term baby. I had had an unnecessary cesarean for my first, and that, along with a couple other things, shaped my decisions for his birth. We had been experiencing secondary infertility for 3 years when he was conceived, and had also lost 2 babies to miscarriage over those yrs. - one at 5 wks. and one at 11.5 wks.
that period of time, my sister-in-law (SIL) attempted a VBAC. She had a young,
inexperienced OB, and had had a terrible first birth experience in a military
hospital, with a very scary placenta abruptio, ending in an emergency c/s.
Sometime around term, she began experiencing some mild contractions and went to
the hospital. They tried to send her home but she and my brother refused to go
b/c that was what had happened w/ their first birth ( and she had begun
abrupting in the car on the way home), so this time they were too scared to
leave w/o a healthy baby in their arms. She eventually ended up with pitocin and
an epidural, and during a fetal scalp sampling, it was discovered that the baby
was low on oxygen, and an emergency c/s revealed a catastrophic uterine rupture.
Mom and baby both lived and are healthy, thank God (though no more babies for
I tell this story b/c it was a big part of my preparation for VBAC. For a long while after SIL's rupture, I was not at all sure I was going to go for a vaginal birth. I was very scared of rupturing, and as yet did not realize the full impact that the interventions have on the uterus. I started talking to birth savvy friends, and began to lean more towards VBAC. After becoming pregnant in fall '98, I joined the ICAN list and started to soak up info like a sponge. I began to feel more confidence, and less fear. Throughout my pregnancy, however, I was still hanging onto fear from the miscarriages. I was very afraid of losing this baby too.
As 40 wks. approached, I started really freaking out. My OB was a fairly decent, hands-off type, in practice by himself in a small town. He was very respectful of how educated I was on birth, and was fine w/ almost all of my birth plan requests. But the problem at this point wasn't him, it was me. I started envisioning a stillborn baby, this baby I'd been awaiting for 3.5 yrs. The night before my 41 wk. appt., he didn't move for an hour. I drank OJ, etc., nothing. I flipped out, and the next morning we decided to break my water the following day.
Ironically, contractions started during that night, and continued all the way up till I got to the hospital the next morning, so apparently he'd decided it was time as well! When I got to the hospital I was at 2cm. As my doc broke my water, he said "Feels like baby's posterior!" Alarm bells rung in my head, but it was too late. Contractions were very mild, but regular, for several hrs. As the afternoon wore on, they picked up, and at one check I was 4cm. B/c of his posterior position, labor became pretty excruciating - my lower back was in agony during contractions. I'd been coping by leaning on the birth ball on the edge of the bed, and dh putting heavy counterpressure on my lower spine, but it wasn't long before I had to just lay on my side on the bed, drifting in and out of awareness. I asked for something to take the edge off, and got Stadol every couple hrs. Around dinner time I was checked again and was heartsick to hear "4cm" again. About a half hr. later my doc came in and checked me himself and said "a good 5cm, stretchy to 6". Whew, that was more like it!
The next several hrs. are very hazy in my memory. The back labor was very painful and I think I sort of zoned out in order to deal w/ it. Finally at 2am I was complete, and began pushing. The back pain during the pushing was unbearable and I got a weak spinal at that point. It didn't help much, but eventually my doc was able to turn the baby in the birth canal. That helped a little, but the pushing was still going very slowly and painfully.
2 hrs. of pushing he was starting to crown, and at that point his heartrate
started to bottom out after contractions. Thanks to the ICAN list, I'd learned
that late decels can genuinely be dangerous, so I knew they weren't just using
this to justify more interventions. It was at this point that everyone started
to bustle around and I heard my doc say to me, "It's a c/s or forceps - we
gotta decide NOW." We chose forceps, and minutes later Sammy was out. He
was blue and limp, and it was very frightening. They whisked him over to the
isolette and gave him some O2 and massaged him, which got him going after a few
minutes. I kept hollering out, "Is he ok? Is he ok?" but no one
answered. Turned out his first apgar was 6. It was a scary few minutes, but once
they put him on my chest, I had time to sit back and realize, I did it! I cannot
even begin to describe that feeling. "On top of the world" is an
understatement. I felt like dancing around the room and shouting at the top of
my lungs - it was the most exhilarating feeling in my entire life!
In retrospect, I realize that my own fear led to me making choices that made for a very difficult labor and delivery w/ lots of intervention. I later read that Stadol can cause fetal and neonatal respiratory distress, and this caused me much guilt. After reading many birth stories, I feel that I was very lucky to have had a VBAC that time, mostly due to my doctor's patience and my own determination. But, on the positive side, it was a learning experience, and showed me how strong I (and any birthing woman!) could be!
#3 (Bridget Grace): When our 2nd child (VBAC #1) was 4 mths. old, we
moved from MI to NC. Since it had taken 3 yrs. to conceive him, we were shocked
to find ourselves expecting again when he was only 6 mths. old! In my heart I
wanted a home birth this time, but wasn't ready. I halfheartedly picked an OB
group on my insurance list, and went for one visit at 12 wks., mostly b/c I
wanted the u/s they use routinely at 12 wk. visits to date pregnancies, b/c I
wasn't exactly sure when this conception had taken place. It turned out that my
dates were accurate w/ my suspicions. Anyway, after the u/s as we were talking
to the OB, I pretty much came out and told him I knew a lot about birth and I
was not going to agree to many of the routine things they do, and that I
expected to be a partner in my care, not a patient. His response was basically,
well that's fine to a point, but as soon as you start talking things that don't
make sense, then we'll have a problem. I knew at that point that I would not be
coming back. As we drove out of the parking lot I cried and told dh, "I
can't do this. I can't fight my way through this pregnancy." His reply was,
well, we'll just do whatever it takes then.
After combing the phone book, I came to find out that my insurance would cover the CNM practice in 45 min. away. They have a freestanding BC, but due to hospital/doc politics (read: B.S.) they were not "allowed" to do VBACs there. We would have to birth at the hospital. Still, we were thrilled, and really enjoyed our visits there, getting along great w/ 4 out of the 5 midwives. What a world away from OB care!! The pregnancy continued fairly uneventfully.
Tuesday, Sept. 5th, I had a midwife appt. I'd had a little pink mucous that morning, so I had her give my membranes a sweep; I was 3cm, baby at -1 station. At 41w4d, I told her, in all seriousness, "This baby is never coming out." Through the afternoon continued to lose my plug but still figured it was just the exam and that I had days more to go. 9pm, while reading bedtime story to my daughter, noticed that I was having contractions that I had to stop and breathe a bit through. They were consistently about 10 min. apart, and continued that way till 2am when I laid down on the couch and managed to get a little sleep. They hadn't gotten any closer or harder to handle so I didn't want to call and wake up midwife; I was still in denial that this could be the "real thing". I had told dh to just go to bed and rest, if I needed him I'd let him know. Woke up during contractions a few times, then woke up for good at 4:40 w/ more show. Contractions were now 6-9 min. apart so I told dh, maybe you'd better call in to work "just in case." I was starting to think *maybe* this could be it.
6am I called mw on call and told her what was going on, she said call back when
they got to 5 min. apart. 7am I sent dh to McDonald's ' cuz all I could think
about was their pancakes and eggs. While he was gone, laid down to nurse my son
back to sleep. About 5 min. after he left, while I was still laying there w/
Sammy, I felt a pop and thought wow, what a weird baby movement! I unlatched him
and got up, and immediately felt my panties get soaked. Ok, I guess this really
IS it, haha. Called mw again - this time call was returned by our favorite, J.,
who was now on call. Told her contractions were 6-8 min. apart now, so we would
probably go to the birth center first to have her check us, to see if we needed
to walk around a while before going to the hospital. Dh got home, and after that
contractions got to about 3-6 min. apart, so we left as soon as my parents
arrived and called J. on the way to let her know we'd go straight to hospital
Get into 8am traffic between Raleigh and Chapel Hill, and contractions widen out again to 10+ min. By 9:45 we're all checked into our room, and contractions are few and far between. J. and I agree it is probably "fight or flight." We get hooked up for a 20 min. strip on the monitor, and get my saline lock set up (GBS+). Everything looks great, so J checks me, 5cm. Yay! But - gotta get those contractions going again. We walk, and walk, and walk some more. J. recommends nipple stimulation, so dh and I start trying that. A few tries between walking, over a couple hrs. time, starts working. J. asks if I want to get into shower, might help relax and keep things going, and will work as nipple stimulation as well. My room doesn't have a shower - there are only 2 rooms w/ showers, and they were taken when I got there. She goes to the desk and comes back w/ a triumphant look - got you a room w/ a shower! So we move - which was great b/c my first room was little and dingy and prob. wasn't helping matters. This room w/ private shower was much nicer. After we switched rooms contractions never slowed again except by a couple minutes each when I'd lay on the bed to be monitored a few min. every half hr.
By this time it was maybe 3pm and things were getting more intense. Contractions were about 4 min. apart, and starting to spread around the sides of my back. I started to realize what most women mean by "back labor" - my back labor w/ Sammy was due to him being posterior, and was sheer hell b/c his head was smashed against my lower spine w/ every contractions. This was more like a muscular pain on the sides. MUCH preferable and more bearable! But still, started needing counterpressure on back during peaks. J. would stand behind me and stroke my hair and face, then during the worst would push in on my hips. After each contraction ended would say you're doing so great, etc. Dh would take turns when J's hands got tired. I started saying I can't do this anymore, so J. suggested shower again. That helped immensely. Dh stood behind me for counterpressure on back, and the heat from the water made it easier to cope. Finally got too hot and felt closed in by shower, so I got out again. Contractions had gone to 3 min. and I was 7cm now. It was maybe 4:30ish. I do remember laying on the monitor between contractions and saying very calmly to J. and dh, "I'm going home now, you guys call me when the baby gets here." J. laughed and said, lots of women say that towards the end, so that's a good sign! I said, but I mean it. LOL. Leaned over birth ball for a few contractions, then tried - briefly - sitting on ball. NOT! Made the pressure on my bladder/cervix/rear end unbearable. I made them pull me off quick.
At this point the back pain was becoming extremely hard for me to relax through - using the term "relax" very loosely, as much as one can relax in hard labor. What I mean is that I was really having a hard time not totally fighting against the contractions now. I was saying during every one, I can't do this, I'm done, I don't want to do this anymore. J. was being very encouraging, yes, you can, you're so close! But I knew I had reached my limit. She said, well, you can have an epidural -I did NOT want epidural. We talked about a shot of Nubain and decided that was the most preferable to me. It was very difficult for me to accept that this was the right thing for me to do, but I was getting out of control and knew I couldn't push effectively w/ the back pain. I was whining b/c I really didn't want pain meds at all - and I had come SO far! J got in my face and said this is your decision to make - an adult decision - you need to make it, and be ok w/ it. Either way. I don't want to hear you regretting it after, if you're going to do it, you need to decide that's the end of it. Oddly enough, this was great - it gave me the presence of mind in the middle of the pain to just get the decision over with. She had to check me first, 8cm - yippee!! So my L&D nurse gave me the first part in my lock, and the 2nd under the skin. It immediately took the edge off the back pain while still allowing me to feel everything else during contractions.
This was about 6pm. J decided she had time to run and grab a bite for dinner. Dh and my nurse were there w/ me. W/in a couple min. I started feeling these spasms through my pelvis and was grunting w/ them. When they talk about "pushing urge", I always figured I'd feel the head in the canal and feel the need to push it out, or something similar (I had not had a pushing urge w/ my first VBAC). This was more like the dry heaves, but lower - waves of muscle spasms that I could not stop. Nurse turns to me and says why are you making those noises - what are you feeling? I tried to explain but it was difficult, so she said, " I've gotta check you." She got down there quick and said, "Oh, you're complete, we gotta get J. back here NOW." She flies to the phone and barks at someone to get J.
Before I know it, J. is flying through the door and yelling over my roaring noises to stop pushing - I told her I CAN'T!!! She's trying to get the oil so she can support/massage the perineum. She's hollering over my noises that I need to try to get a little control or else she won't have time to help keep me from tearing a lot, but Bridget had other ideas. Finally she got ready, and by then the baby was crowning - definitely learned the meaning of the term "ring of fire"! It stung pretty bad, and all I wanted was for that to be over, so I really started working hard w/ the urges - I think I was growling get out of there! or something like that. Luckily I didn't have to worry about pushing through the ring of fire b/c my body was giving me absolutely no choice in the matter! During crowning J. said reach down there, feel the head - so I did, and it was all crumpled from the molding, very odd feeling, but wonderful. Her head came out after a few huge pushes, and J. said ok now you HAVE to stop pushing - the baby had a nuchal cord, not really tight, thank God. Once she got it free she said ok, push the body out; that stung as much as her head. She flipped the baby around and straddled her against her body (we did not know the sex yet and J knew we wanted to discover it ourselves) and just worked w/ her a minute to make sure she was going to cry well and stuff, suctioned her, etc., then after a minute she laid her on me and we saw that she was a girl! That was such an awesome moment! After the cord stopped pulsating dh cut it, which he did not get to do w/ our first 2.
My parents brought the kids in right away, that was neat, but I was bleeding pretty bad and my dad got queasy (wimp <g>). J told me to try to push the placenta out, b/c baby wasn't nursing yet and I was starting to bleed worse, so I did, it was quick and painless. I had a 2nd degree tear, which was pretty uncomfortable being stitched up, but wasn't surprising - I'd been 8cm at 6pm, and she was out at 6:31. No one, including me, had thought the baby was going to be particularly big - I didn't measure large, and everyone who palpated said, oh this baby won't be really big. Nurse asked what my guess was, I said around 8 lbs. - she said 9 lbs. 5 oz. and dh and I almost fell over! She had NO coning whatsoever, beautiful round little head full of black hair. It was fun making the hospital staff's jaws fall when they heard she was 9,5 w/ a 15 min. 2nd stage.
Postscript: We really loved the compromise between good prenatal care and old-fashioned midwifery, but unfortunately our CNM practice is no longer taking VBACs (due to BC staffing constraints in having to go to the hospital to attend them). So we will be planning homebirths from now on, as I will no longer consider returning to an OB unless medically necessary. I look forward to birthing my next baby in my big bath tub!
Kmom's Note: Misha did go on to have more VBACs, at home!! One in the bathtub, one not. For those stories, see the BBW Birth Stories: VBAC Stories FAQ.
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