by KMom
Copyright © 2000-2009 KMom@Vireday.Com. All rights reserved.
This FAQ last updated: June 2009
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
BBW Birth Story Pages
BBW Birth Stories: Vaginal Birth Under Special Circumstances
CONTENTS
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 challenges in their pregnancies but yet have gone on to give birth vaginally anyhow. Sometimes, when problems occur in a pregnancy, doctors can make you feel like normal birth is not possible anymore and that you must have a c-section, yet many women can and DO give birth normally anyhow. Hopefully, these stories will help inspire moms to keep on working for as normal a birth as possible under their circumstances.
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 or twice 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!
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.
Birth Stories: Vaginal Birth Under Special Circumstances
(also see VBAC stories)
N.M.'s Story (ID twins, gd, vaginal birth)
Kmom's Notes: 37 weeks is basically full-term for twins; her OB did not pressure her to induce early simply because she had gd. Usually, gd is more common with fraternal twins than identical twins because a double placenta tends to double the insulin resistance from hormones, but sometimes moms with identical twins get gd too.
NM also found that the gd food plan she was given as a twin mom was inadequate, a complaint Kmom has heard from more than one twinmom. Although you'd think that gd food recommendations would be fairly straightforward across the board, there are more variations than you would think. In the past, many gd food plans had too little protein and too many carbs; the most recent thinking seems to be that you get better control and fewer problems by increasing the protein amounts somewhat and decreasing the corresponding carb content as well. Significant caloric restriction for heavy gd moms is another area of controversy, and several large twin moms with gd have complained of totally inadequate caloric intake for a multiple pregnancy.
Birth Story
I was diagnosed with gd after the [glucose challenge] with a level at 140. So, they sent me to the 3 hr GTT and my fasting level was normal, my 1 hr was 202 (cutoff was 190), my 2 hr was 165 (the cutoff number) and my 3 hr was normal. I was officially diagnosed as having GD.
They gave a GD diet which was completely ill-suited for a pregnant woman weighing 270 lbs or so and expecting twins! It was lacking enough protein and had way too many carbohydrates and definitely not enough calories. I told my doctor that I was going to eat more protein and a little less carbohydrates and he said okay. Also, my doctor wasn't too worried because one of the side effects of GD is having too large of a baby, but since I was expecting twins, he said it would at the most make them weigh a normal baby's weight (my boys were 4.5 and 5.3).
I had to test my blood 4x per day (fasting and one hour after each of my meals). My numbers were fine as long as I didn't overdo the carbohydrates in one sitting. I saw that my body could not handle carbohydrates for breakfast, so I ended up eating only protein and a few hours later having a carb and protein snack. I was able to keep my numbers within the recommended range by cutting out all sugars and making sure that I ate protein along with my carbs.
I went into labor at 7:15 pm., [37 weeks into the pregnancy]. Since I didn't have any real contractions by 9:15 pm, my OB had me take 3 ounces of castor oil. His reasoning is that a twin uterus is usually so stretched out that many times it has trouble really contracting. The consistency was disgusting and I ended throwing up the first bit. I forced the rest down my throat, though. At 10:45 pm my contractions picked up and I was constantly going to the bathroom as my bowels were emptying out.
At 3:30 am we arrived at the hospital. I was immediately hooked up to a pitocin drip and two monitors, one external and one internal. I was not allowed to get out of bed. I did not take any pain medications because I had the attitude that although it was painful, I could handle it. I just breathed through each contraction. As I approached transition, I threw up. It was mostly stomach acid as my stomach was already empty. The best part is that I knew I was almost to pushing.
I started pushing at 5:10 am. No one properly prepared me for pushing, it is really hard work. I think of it as equivalent of doing 3,000 sit-ups in a row (okay, okay, not THAT bad, but definitely hard work). At 5:56 am, Baby A was born. At 6:00 am, Baby B was born. It was an incredible feeling to push the babies out! Of course, since they were tiny, I really only had to push their heads out as they had such tiny shoulders. From what I understand, the shoulders on a 7 lb baby are the hardest part to push out. But, in my case, once their heads came out the rest of the body came flying out. I only had a tiny tear which my OB stitched up. Both babies had apgars of 9/9. Don't let anyone tell you that you cannot give birth. Your body is prepared and ready to do what it needs, just have a positive attitude and believe in yourself.
Lori M's Story (fraternal twins, induced premature vaginal birth)
Kmom's Notes:
Birth Story
I had a wonderful OB. She was very sympathetic to my needs not only as a large woman, but as someone carrying twins. (With my other two children I wasn't a large sized woman so I left those experiences out.)
[As noted, I had premature labor at 31 weeks.] On Dec 10th, I went in for a routine NST (non-stress test) and fluid check on the babies. While I was hooked up to the monitor, a couple contractions showed up. The docs checked me and said I was at 3cm and 30% effaced. At 3pm they admitted me to the hospital and put me on Magnesium Sulfate. Not very fun. It burned going in and made me feel like my chest was on fire. By 7:30pm I was dilated to 7cm and 60% effaced. The stopped the Mag and gave me an epidural. We all thought I would deliver that night.
By about 9pm my contractions had stopped and I hadn't progressed anymore. They kept the epidural in for another 24hrs "just in case". On Dec 12th, I was moved to the High Risk ward and told I wasn't going anywhere until I delivered my babies. For the first 24 hours in HR, I was only allowed clear liquids and still had a catheter. After that, I was allowed to eat solids and had to use a porta-potty next to the bed. I complained for a week because I could barely fit on that to relieve myself. They finally allowed me to use the normal bathroom. Thankfully, the hospital had super-sized gowns so my bottom wasn't swinging in the wind.
There I stayed until Dec 29th. The docs did an amnio and told me my babies were mature enough to be born. They said I could wait, but they wouldn't advise it since the girl twin was taking up all the resources and it could become fatal for the boy twin. We decided to induce. I waited until 2am on the 30th for a bed to become available (all those millenium-planned babies were coming into the hospital in labor). At 8am they started a pitocin drip and gave me an epidural. I had made it VERY clear to everyone that walked into the room that I absolutely refused to have a C-section unless someone was in danger. Thankfully, this was an upwardly mobile hospital and they totally agreed with me.
So, with no further complications, no pain and minimal pushing, Baby A was born at 11:12am PST followed by her brother at 11:25am. I did not have any tearing or an episiotomy and have only had the usual cramping (like period cramping) for about 3 days afterwards.
I hope this gives some of the larger women encouragement that a natural birth is possible.
Leslie A's Story (fraternal twins, gd, vaginal birth)
Kmom's Notes: Note that this mom used 'serial induction' successfully (try inducing with pitocin but do not break bag of waters; if no labor after x hours, go home and try again later--often labor is jumpstarted in between labor tries, or the 2nd induction 'takes'.)
Birth Story
Conceived one cycle after a miscarriage (single baby). Midwife suggested that fertility is enhanced after miscarriage; thus the twins. Twins do not run in my family! Spent much of the pregnancy terrified that I'd lose one or both of the babies.
Difficult pregnancy with bleeding in first and third trimesters and pre-term labor starting at 22 weeks. On bedrest for last half of first trimester and for third trimester. Anti-contraction medication in third trimester which made sleeping and concentration difficult.
Nurse Midwife was great, no size bias, mild GD was "no big deal." Had many (10 or so) ultrasounds to check position of twins, growth rates etc. Did not have many other common tests (e.g., no amnio, etc.). I was a very proactive patient and did a lot of reading and Internet research on twin pregnancy. In addition, we took a childbirth preparation course for parents of twins as well as a Bradley course.
Midwife talked me into an induction in week 38 (considered full term for twins). Spent twelve hours on pitocin drip--no significant contractions so midwife said I could go home. Went into labor on my own four days later (38 weeks, 6 days gestation).
I called my doula after labor seemed to have started. She came over to our home and stayed with me until my labor seemed productive. We went to the hospital after I'd been laboring at home for about six hours. At hospital I walked a lot and used the whirlpool tub. Labor did not progress very fast. At about hour fourteen, my blood pressure suddenly started to shoot up (no high blood pressure before labor). Midwife strongly suggested an epidural since they bring down blood pressure. I agreed. Pitocin was also started and she broke the water of the first twin. Meconium was present so things became more urgent (pitocin turned up, etc.) Scalp monitor attached to first twin. After this point my midwife stayed by me the entire time and was very comforting and reassuring.
Was fully dilated at hour twenty-two and was wheeled into C-section room (standard procedure at the hospital for multiples) for the birth. The backup OB came into the C-section room (still carrying her purse!) and told my midwife she could handle it on her own. Pushed for three and a half hours for first baby. I was very tired so I "let" midwife use vacuum extraction for first baby who had already crowned. Midwife broke water of second twin (also had Meconium) and attached scalp monitor. After about fifteen minutes I started pushing out the second twin. After about three pushes she was born. I did not have an episiotomy, but I did have some very minor tearing which required three stitches. The placentas were fused and I had trouble birthing them so midwife had to "dig around" a bit to get them out. Our doula took video of some of the labor and the final stages of pushing and birth so I have an accurate record! I was a bit "out of it" at the time!. I did watch a bit of the actual births in a mirror, although I had to close my eyes much of the time to concentrate on pushing.
Our babies were healthy, although M. had a bit of fluid in her lungs which was suctioned out. She nursed well from the beginning. H. had a bit of trouble with latching but learned within three weeks or so.
Overall, I am pretty satisfied with the handling of my pregnancy and birth. I'm very glad that I went with a midwife (recommended by Kmom, BTW) and that we used a doula. The midwife was much more liberal in her approach that I think an OB would have been and the doula was invaluable during labor, since she allowed my husband to focus more on me and less on being my coach.
Lisa Z's Story (twins, diet-only gd, vaginal birth)
Kmom's Notes:
Birth Story
My story, despite the fact that I gave birth to twin boys, is actually rather boring (thank God!). I did develop gestational diabetes very early on in my pregnancy, and I was expecting that to happen for many reasons (family history, my weight, the fact that I was carrying twins - all increase risk). However, I was able to control my GD through diet and it proved to be not much more than a minor inconvenience during my pregnancy.
I became pregnant with the help of Fertinex and IUI (Intra-Uterine Insemination). I suffer from PCOS, and do not ovulate without pharmacological assistance. I did conceive once before with the help of fertility drugs, but it was an ectopic pregnancy, which we were able to abort with drugs and managed to avoid any kind of surgery. At the beginning of my pregnancy I weighed 308 pounds. At the end, I weighed 323. After delivery, I was down somewhere in the 280's, but alas, that was short-lived, and I am now back up to somewhere around my late pregnancy weight.
As for my labor - my water broke 2 days shy of 36 weeks. I went to the hospital and basically sat around a lot waiting for labor to start. About 12 hours after I checked into the hospital, the contractions started. A couple of hours later I had an epidural, which came out and had to be redone. Because of this, they gave me MEGA-doses of meds, which caused me to be completely paralyzed and numb from the waist down. My dh and I fell asleep until the doctor came in early in the morning to check me (which required both my OB and my dh hoisting my deadweight legs into the air so that he could examine me) and promptly announce that it was "showtime." He had me start pushing in my labor room, but once the 1st head appeared, I was taken to the operating room, which is standard precautionary procedure in multiple births.
My delivery progressed very normally - Baby A arrived after not much more pushing, and Baby B, who had been breech until then, flipped his little self around to be delivered head first. It took 23 minutes and the help of forceps, but both boys were delivered vaginally and in perfect health - 5 lbs. 12 ounces and 5 lbs 13 ounces! I took them home with me 2 days later.
Kathy F's Twin Story (insulin-dep. gd, premature labor, vaginal birth)
Kmom's Notes: These are Kathy F's 6th and 7th children. Several of her other birth stories are below. They include homebirth as well as hospital birth.
This story was very long; it has been summarized. The major summarizations were placed into [brackets], although there were minor abridgments throughout.
For those facing a complicated pregnancy or long-term bedrest, there is a terrific organization called Sidelines that can help with information and support. www.sidelines.org is the website for further info.
Birth Story
We found out we were having twins at 10 weeks during a routine ultrasound at my first OB appointment. We were ecstatic! We had wanted 7 children, but knew that my 6th pregnancy would have to be my last due to the physical problems I was having. My husband was with me, so we learned of our double blessing together! We were getting our seven after all!
At 12 weeks I started bleeding. A gush one morning frightened me very badly. I was put on partial bedrest and the bleeding changed to constant brown spotting within 24 hours. This continued until the 18th week, when all spotting finally stopped completely.
I had been thrilled with my OB's care of my last baby (#5) but this pregnancy was different. My OB was a naturally quiet person, and wasn't as communicative as I felt I needed with this unusual multiple pregnancy. I also couldn't shake the feeling that things were going to be complicated. I wanted a specialist, so at the end of my fourth month, I changed to a perinatologist. It was a very smart and important decision, and I believe it was instrumental in bringing my girls strong and healthy into the world. My new docs had me come in each week and were very proactive in their care, looking to catch problems before they arose.
Starting around the end of the 4th month (as I changed doctors), I began having constant contractions, i.e., 'irritable uterus'. Until Oct. 4, they weren't doing anything to my cervix. 3 weeks before then, I'd had a fairly new test called a "fetal fibronectin" test, where the fluid around the cervix is tested for a certain protein that apparently is always present when a woman goes into labor. If none of this protein is found, it's almost a guarantee that the woman will NOT go into labor in the next 2 weeks, but if the protein is present, there's a 17-40% chances (depending on what study is used) that the woman is going into labor in the next week or two. This protein was present for me both 3 weeks previously and in another test 1 week before the Oct. 4th date. This test, plus everything else, caused my doctors to put me on home-monitoring and complete bedrest for the duration of pregnancy. I was able to use the bathroom but that was all.
With home monitoring I had to strap on a contraction monitor for an hour and just lie there while it recorded any contractions. Then I would place the monitor into the base and 'fax' the recording to the monitoring center at the hospital where it would be checked. I never had more than 2 contractions in any given hour. In fact, I never did get to 6 an hour, which was the benchmark for labor my doctors had set. A couple of times that last week I had 3 in half an hour but then it would stop. My contact nurse agreed that I didn't fit the criteria for labor. I know it didn't FEEL like labor, and I'd had 5 children before this and had a pretty good idea of what that feels like! But this pregnancy ended as differently as everything else about it.
On Oct. 4, I got dressed and went to my regular weekly appt. I had contractions, but they didn't feel any different than usual. The week before I was barely dilated to 1 cm and not effaced at all. We did a vaginal ultrasound to see how my cervix was going. I knew there must've been big changes when the tech's expression changed from a smile to a carefully guarded one. The doctor was called in immediately and my cervix checked the usual way. Turned out I was dilated to 3 cm and 50% effaced. "Well, you're sure not going home," the doctor informed me. "We don't know where you're going, but you're not going home."
We were having an electrical storm that morning, so they couldn't air-evac me to my insurance's choice of hospital 30 minutes away, and they weren't going to risk an ambulance ride so I got to go to the hospital of MY choice right next door to the doctor's office. Once admitted I was put on monitors, and was definitely in active labor, having contractions anywhere from 5-12 minutes apart. Standard for me for the first 5 cm of dilation. I was put on Magnesium Sulfate to stop the labor, and since the Mag was somewhat slower acting, was also given a shot of another tocolytic (not terbutaline). It did the trick. Wed. night I went into labor again, had 7 contractions in an hour. They again gave me the tocolytic, raised the Mag to the maximum, which again arrested the labor even though I was not dilated to 4+. [I asked for and got a catheter because getting up brought on the contractions.]
I have a strong belief in a personal loving God, so after they did all this and left me alone in the darkened room I laid as still as I could and prayed, tears running down my cheeks. My prayer (and fear) was so intense I felt as if I was standing before the throne of God, and beseeching Heavenly Father with all my heart to please stop the labor. Please give me and the babies time. [I felt his love, but that I was praying for too much time that He couldn't give because of other complex, long-term factors.] I prayed for just a few days, just enough to let the steroids work on the girls' lungs and help them develop more completely. I felt a great peace, a great sense of surrender, and commitment to accept His will and not fight it. In a very real sense, I felt Him stop the labor. The medication I had been given was his tool. The labor stopped because Heavenly Father heard my petition and granted it. I know this with all my heart.
About 3x a day the doctor wanted a monitored reading of the babies' heartbeats. This was an extremely difficult thing to do because I had to try and stay completely still--not even scratch an itch---or the whole thing would be thrown off and I'd have to do it all again. [The sessions could last an hour or more.] My arthritis in my hips was aggravated by the pregnancy and with the Mag relaxing my muscles it made the arthritis even more painful. The pain during these days was excruciating, perhaps the worst pain I've ever experienced in my entire life. Through prayer and contemplation I was strengthened and found this time to be one of great joy and communion with the Spirit in spite of the pain. I also made a game of being as friendly and kind to the nurses as I could. Since I had to be there, I figured I might as well see if I could make their work as pleasant as possible.
While in the hospital on bedrest, my Gestational Diabetes (developed at 28 weeks) was uncontrollable by diet alone. {Kmom note: Some tocolytic drugs, while a necessary evil for some, do tend to increase blood sugar, as do the steroid shots she was given to mature her babies' lungs. No wonder she needed insulin, but it was a small price to pay for the necessary meds in this case.} I was put on insulin, just two shots a day, long-acting, and the lowest dose. That took care of the problem.
[By the following weekend, my Mag dose was lowered, I got bathroom privileges, and needed less monitoring. But the next week they increased. I told the nurse. Things were feeling different. I didn't want to admit it to myself, but I had a gut feeling my time was nearly up. Early Tuesday morning, about 6:45 a.m., I got up to use the bathroom and before I was even standing I felt my water break. I called my husband first before even calling the nurse so he could arrange for care for the other kids and get to the hospital. After I went to the bathroom, I pushed the button.] It was a funny tableau--me standing there with fluid running down my legs and 3 nurses standing in the doorway looking at me. "I think my water broke," I said. "Yes, I can see that!" said one of the nurses. Then controlled chaos ensued. We were all cheerful and joking a bit, no point in being fearful. I had been receiving the absolute best care from the doctors and nurses, the NICU was a level 3, and advances in neonatal care made the chances of everything being fine as high as they could be.
The nurse wanted to get a monitoring strip on the babies but we couldn't find them. We could find echoes of their heartbeats but couldn't pin them both down at the same time. Pretty soon the u/s tech was called in to find them. Turned out Baby B was lying transverse on top of Baby A, who was vertex. But both were fine. Because of their position and their borderline weights--barely 1500 grams---the doctor said a c-section would be best. That was fine with me! I'd already decided that whatever the doctor wanted to do, I would agree to. I knew I had the best perinatologists in the state and wasn't about to second-guess them! That was why I switched to them in the first place.
The doctor did want to give me a couple of hours without the Mag to see if the labor was going to continue. [It didn't stop, but it never got regular either. I had some HARD contractions after my water broke, but they were never regular. I was very controlled during labor, never making a peep, and that plus the irregular contractions confused the heck out of everyone. I did tell them after about an hour that labor wasn't going to stop and she'd better get the doctor and get things ready, but then I let them give me some Demerol and it became difficult to communicate. Those hard but irregular contractions (never more than 3 or 4 in any hour) had been doing a LOT, then I had a really hard one down in labor and delivery. The nurse there KNEW, especially since for once *I* didn't know, but she was right---I was not only at 10 cm but baby A wasn't interested in waiting for the doctor or the c/s! (I've always known and told the nurses when I was at ten---my contractions followed a set pattern in all my other labors, but the Mag really threw that pattern off this time.) The nurse called for the doctor, stat, and things really got moving.]
I was wheeled in the O.R. and prepped. The doctor told me that after baby A was delivered vaginally, we could still do a c/s for baby B. The risk to her was still there. But then the doctor did a quick ultrasound to determine the position, and another miracle was discovered. Baby A had come so far down the birth canal on her own, she'd given baby B enough room to maneuver from transverse to vertex (head-down)! My husband and I were thrilled; it took me a few seconds before I realized I wasn't going to have a c/s after all.
Baby A was born with one tiny push from me, and my goodness, she was protesting!! What a cry! She was LOUD!!!! The doctor told me to wait for another contraction, but they'd been so intermittent that after waiting 5 minutes or so, I just decided to push anyway. It took a few minutes, but baby B was born 9 minutes after baby A and was as LOUD as her sister!! They both had Apgar scores of 9, 9!! I'm still amazed at that. They were 3 and a half and 4 pounds, respectively, and 16.5 and 17.25 inches respectively.
They were in the NICU for a week, then in a level 2 nursery for 2 more weeks, then discharged from the hospital on apnea monitors. They were on IVs for just a couple of days while the Mag was flushed from their systems. Then when we started bottle-feeding them and they did so great the IVs were removed. They also had prongs for extra oxygen in their noses for a few days, and received small amounts of caffeine for a week or so to help them because of Apnea Bradycardia (breathing lapses and slow heartbeat) episodes. They never had to be intubated or have gavage feedings, which is amazing for 31 weekers. The girls are now 3.5 months old and are 11 and 12 lbs. They are both remarkably healthy.
There was one major complication with the twins, and I'd like to encourage EVERY parent of a preemie, no matter how big, to get their eyes checked for Retinopathy of Prematurity (ROP) both within the first weeks of birth and absolutely by the 37th week. That 37th week is critical. You may end up saving your baby's eyesight by taking the time. In my hospital, they routinely check preemies born 32 weeks or sooner. One of my babies had ROP, stage 3 (stage 4 means blindness). Laser surgery corrected the problem. Her 6-week checkup after surgery was last week and her eyes were declared perfect! It is obvious to us that she is seeing very well, is tracking, etc. ROP doesn't happen to all preemies, and happens less the older and bigger they are. But you never know, so get their eyes checked to be on the safe side! The American Pediatric Association only recommends routine screening of preemies 28 weeks or less, and 1500 grams or less. My daughter was older and bigger and would be irrevocably blind if it weren't for the more liberal policies of my hospital's NICU.
The afternoon of the delivery I had a tubal ligation, since my body is just not managing pregnancy well anymore. My last child before the twins was born at 36 weeks, and with the insulin-dependent GD and the arthritis, it just would be really pushing it to risk getting pregnant again, both for me and any future children. I've also developed a hernia, either umbilical (bellybutton) or incisional (from the tubal ligation), and will need surgery soon to correct it. [This may be from the multiple pregnancy or not but I probably won't ever know for sure.]
Both girls are very cheerful and full of smiles. We are enjoying them immensely. One is sleeping through the night consistently but the other is still waking up at least once or twice a night. Ugh. But soon they will be out of our room and in separate cribs. I'm looking forward to it! :-) Although I forgot to ask how the placentas looked because I was too drugged, they were completely separate and it is obvious by looking that my girls are definitely fraternal twins.
Mary S's Story (antiphospholipid antibody, twins, premature, vaginal birth)
Kmom's Notes:
Birth Story
I should begin by saying that I have a fairly rare condition called antiphospholipid antibody syndrome, also known as Lupus Anticoagulant (although I don't have lupus and this isn't an anticoagulant, so go figure). What this means is that my blood clots too easily while I'm pregnant. In order to keep blood clots from forming in the umbilical [cord] and killing the baby, I take two shots a day of blood thinner, Heparin, and a baby aspirin.
We found out we were having twins at our first ultrasound at 6 weeks. No twins run in our families so we were very very happily surprised to find out we were expecting two instead of one. My pregnancy was relatively uneventful until I was 25 and a half weeks and we had a scare with some BH contractions that didn't want to stop. They did a fetal fibronectin test which showed positive that the boys were more likely to be born in the next two weeks so the doctor on call thought that steroids to mature their lungs would be a good idea. Since the two shots are given 24 hours apart it's a darned good thing he did.
April 30, at 28 weeks to the day, I went in to work for the first time in two weeks after being on partial bed rest after the Easter incident. About 8 a.m. my tummy was a bit achy; I thought it was gas. I went to the restroom about 8:45 a.m. and realized I had lost my mucous plug. I called my DH to come get me, then I called the doctor's office, that was at 9 a.m. By 9:30 a.m. I was at the hospital and having fairly painful contractions every couple of minutes. They put in an IV and gave me a shot of Terbutaline to stop the contractions, then did an ultrasound. The boys were fine---baby A still vertex and baby B still breech.
Fifteen minutes later a resident comes in to check me and I was already complete. In the meantime the Terb had kicked in and the contractions had stopped. They put me on a gurney and rushed me up to an operating room (all twins are born there, and there was no point in stopping in Labor and Delivery). My DH disappeared off somewhere to be covered in paper products and they start trying to get a second IV into me.
Meanwhile my doctor shows up. I was a happy girl at this point. I love my doctor and didn't think she'd make it in time. She tells me that since I'd already had my morning shot of Heparin I couldn't have a spinal or an epidural so no pain meds for me---and if they couldn't get the breech baby out vaginally they'd have to knock me out and do a c-section after delivering baby A. Not what she, or I, wanted to do with me on high doses of blood thinner.
Sometime during all the hubbub DH was let into the room, thank goodness. So Dr says, "OK, with the next contraction go ahead and push." I'm like, "What contractions, they gave me Terb downstairs." Have you ever seen a doctor explode? It's kind of fun. "WHO GAVE HER THE TERB?!!!????" So, now we get pitocin to start things back up, it's right about 11:30 (I know this because there was a clock right over the doctor's head and I found myself watching it more than once) and about 5 minutes later I feel a cramp. She says go ahead and push, so I pushed 3 times and with a HUGE gush of water out squirms baby A at 11:30 a.m. Apparently the water shot about 8 feet out; I distinctly remember my DH standing up and looking and saying, "Oh my!" I think we soaked most of the staff. So, time to get baby B out and they tell me to push again, but he's breech so the resident doing the delivery has her hand in me up to about the elbow trying to grab him and pull him out. That was NOT pleasant, but one push later out came Will with an even BIGGER gush of water (Ha! Got the rest of them!) at 11:44 a.m.
So, less than 4 hours start to finish and two beautiful, if tiny, boys to show for it. Honestly, the worst part was them messing around and delivering the placentas and checking me for tears, all while I just wanted them to stop fooling with me so I could see my boys. Everything was fine, though, Jon was crying and breathing on his own and Will was flailing his little legs around. I didn't have any tears and didn't even get a single stitch.
I wasn't planning on natural childbirth, I was all about the epidural, but it was so quick it really wasn't bad at all pain-wise. I was too busy being worried and too rushed to have time to worry too much. Heck, the delivery wouldn't have hurt at all if everyone had kept their hands to themselves. I was up walking around less than an hour later and was able to go by the NICU to see them on the way to my room. They were little, but healthy. Both are now doing well.
You can see their web page and my full birth story at: http://pages.sbcglobal.net/atomicpossum/boys/boys.htm.
Stephanie's Story (PCO, gallstones, unmedicated vaginal birth)
Kmom's Notes: Although it does NOT occur with all PCO moms, there are some who develop problems with milk supply, even when being extremely proactive. Other PCO moms are able to breastfeed without problems; no one knows currently why some PCO moms are affected and others are not. More research is needed, but little is being done.
Birth Story
We had a very healthy pregnancy and uncomplicated vaginal delivery which I attribute primarily to two things. First, we were careful to find a size-friendly practitioner who didn't treat me as if I were a train-wreck waiting to happen. Her exact words at our initial visit (8 weeks pregnant) were, "Yes, you have some additional risk factors, but right now you're fine and we'll assume everything is going to be fine. We'll just keep a close watch on you." We chose an OB rather than a mid-wife because of my risk factors, but she was as committed as we were to having as natural a pregnancy and delivery as possible.
Second, we did everything we could to have a healthy pregnancy, following the Bradley method of education, diet and exercise. I think this really made a difference and allowed me to have an easy pregnancy. In fact, I think the fluid retention/blood pressure problem I developed could have been avoided had I been able to continue the Bradley diet. (The low fat diet I had to follow for the gallstones didn't have the amount of protein I think I needed.)
I went into labor 4 days after my due date. Latent first-stage labor was fairly straight forward and slow, as is typical in first-time mothers--about 15 hours to get to 6 cms. I didn't do anything special for pain management other than using the techniques I had learned in class and through my reading. Mostly I tried to remain physically and mentally relaxed, used even abdominal breathing, and lots of visualizations. At 15.5 hours, I got the urge to push, but had only dilated to 7 cms. The next 20 minutes were especially difficult. I had to try NOT to help my body push, and the pain was very intense as my cervix finished dilating and the baby began her descent.
Fortunately, I went from 7 cms to 10 cms during those 20 minutes and was then told I could push. It took one or two contractions to get the hang of pushing, but I pushed my daughter out in only 15 minutes! The only intervention we had was an episiotomy (2nd degree with no tears or extensions), and our daughter was and is wonderfully healthy.
We had our first breastfeeding attempt in the delivery room, and kept our daughter with us for about an hour. Then my husband accompanied her to the nursery, where she was weighed, measured, and bathed (he dressed her for the first time, with a little help from the nursery staff). She roomed in with me during my hospital stay and we came home 2 days later.
Things I didn't anticipate: how much delivery would hurt, how annoying hemorrhoids would be post-delivery, that my pelvis would hurt after delivery as my bones began to move back to their pre-pregnancy positions, and how much more I could love my husband and daughter as the days go by. P.S. We're planning baby number 2 next year!
Megan's Story (gallstones, pre-eclampsia, premature induced vaginal birth)
Kmom's Notes:
Birth Story
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!
Leah's Story (gallstones, posterior baby, vaginal birth, postpartum hemorrhage)
Name
to be used in FAQ: “Leah” Age:
21
Pre-pregnancy Weight or Dress Size: 275 lbs.
Baby Info: 7 lb., 14oz. 20 inches GIRL!
Wt. Gain in Pregnancy: initially lost 30 pounds, gained that back plus maybe 10.
Infertility Problems? I got pregnant on our first try
Any Complications: Post Partum Hemorrhage, Strep B, OP Baby (back labor)
Type of Birth: Vaginal
Birthplace: hospital Provider: OB
Breastfeeding: I breastfed for 6 months
Special Notes on Pregnancy: I had gallbladder attacks during my pregnancy
Kmom's Notes: An induction is an induction, whether it's by "natural" means or by the artificial drugs used in the hospital. When you rush labor or try to strengthen it artificially, contractions tend to be harder and you risk the baby not being in an optimal position for birth. This is what happened here.
This mom did an an amazing job of lasting through a long hard labor with an OP (occiput posterior, "sunny side up," i.e., baby facing towards mom's tummy) baby. This is not an optimal position for labor and birth, and it can be extra painful too. Fortunately, it all worked out; although many posterior babies end up being born by cesarean, some (like this one) do end up coming up just fine despite being posterior.
Birth Story
My birth story can be found online at http://www.ordinary-girl.nu/princess/birth.html
Summary:
After 3 months of marriage my husband and I decided to get pregnant. I ended up
getting pregnant on the first try. Everything was textbook except for the
gallbladder attacks that I was having (quite severe) which I had BEFORE I got
pregnant also.
I was 6 days overdue when I drank CASTOR OIL to go into labor. I ended up having
a very long labor (as my daughter was OP), and at 8cm a plateau for hours.
I
was threatened with either a c-section or an epidural. At that point I was so
exhausted and tired (it had been Sunday evening when I pushed myself into labor
and by then it was Tuesday Morning) I went ahead with the epidural and had my
daughter 2 hours later. I also had
a post partum hemorrhage.
In
a way I felt like I had failed at my attempt to go naturally, but my instructor
told me that I made the best choice with the options I was given. I left with a
good feeling, and look forward to my next pregnancy and birth. The second time I
hope I'll be wiser, more patient, and I'm definitely still going to go natural.
Karla B's Story (gd, non-induced 41 week vaginal birth)
Kmom's Notes: Note that Karla was 'allowed' to go to 41 weeks before facing a mandatory induction, although that was easier because her baby was of average size and she did not need insulin in the pregnancy. However, even so, it's unusual for gd moms to be 'allowed' to go to 41 weeks, but this story shows that there ARE providers out there who are open to this if this is important to you.
As far as losing weight after gd goes, proof is small and mostly speculative, not definitive. Certainly, Kmom strongly agrees that ALL women with gd should improve their diet and exercise levels; if this helps you lose weight, great! For some women, losing weight probably will help and does make sense. However, for some women who are chronic yo-yo dieters, yet another diet may make things worse. Losing weight should not be pursued regardless of the price (i.e., drugs or weight loss surgery often introduce more risk than they alleviate), but it certainly IS an option worth considering. However, individual circumstances and dieting history must also be taken into account. For some women, maintaining a stable weight while improving diet and exercise may be a more sensible option. For others, losing weight is probably most sensible. More on this debate will be found in the upcoming section on GD: Future Risk of Diabetes.
Birth Story
I'm happy to say I had an easy and uneventful pregnancy. At my first visit, my midwife said not to worry about weight too much, as most women seem to gain the amount that is right for them. She also explained that many women who are overweight before getting pregnant often don't gain a lot during pregnancy, and sometimes even lose a little weight. I never had any morning sickness, but during the first trimester my appetite wasn't great so I didn't gain a lot of weight. The only way that my weight really affected my pregnancy was that I sometimes had to remind them to use the larger cuff for an accurate blood pressure reading.
Around 24 weeks, I failed the one hour GTT and was referred for the three hour. I failed that too and was diagnosed with gestational diabetes. At this point I had only gained about 9 pounds, and later learned that low weight gain can be a symptom of gestational diabetes. While I was very upset to be diagnosed with GD, I decided that there were worse things that could happen in pregnancy, and that I was going to learn as much about it as I could so that I could be effective in managing the condition. The first thing my midwife said to me after I was diagnosed was, "You know you did nothing to cause this, right?" I was so relieved to hear her say this, as I had been having thoughts like, "I should have lost more weight before getting pregnant" and "Did I eat too much sugar?"
I was happy to find out that I could still work with a midwife (with occasional visits to an OB), and that I could have a healthy, enjoyable pregnancy and delivery despite GD. I learned how to test my own blood and was put on a special diet that was tailored specifically for me. I never felt deprived on the diet, and in fact sometimes had a hard time eating all the food that I was supposed to. I had very few food cravings after starting the diet too, which was a relief since I feared having to deny my cravings for sweets. During the first week of the diet, I lost a couple of pounds, but then gained them back and stabilized at a 9 pound weight gain. My dietitian expressed a little concern that I wasn't gaining weight, but my midwife wasn't worried since she knew I was getting adequate calories and nutrition. I also found out from my sister (a dietitian herself) that many GD moms don't gain any weight after starting the diet, but if they continue to lose weight, they should see their dietitian to add extra calories. I feel that as a result of the diet, drinking lots of water, and not gaining much weight, I managed to avoid some of the common complaints of pregnancy, such as swelling and constipation. I was even able to wear some of my regular clothes (mainly tops and knit pants) throughout my pregnancy. In fact, looking back, I felt better during the 2nd and 3rd trimesters than I did before getting pregnant and than I have since having my baby!
As my due date neared, I worried a little about having to be induced or have a c-section. My midwife assured me that my clinic did not routinely induce GD moms before their due dates, so that was a big relief to me. I enjoyed some of the extra attention I got (such as extra ultrasounds and hearing the heartbeat during non-stress tests). I told my midwife that I'd rather not be induced if possible, and she shared my opinion. She felt that many women are induced too early, and since their bodies aren't ready, they labor longer and harder and then often end up with a c-section. But, she said the fact was they wouldn't be able to let me go for too long because of the diabetes. She consulted with one of the OBs, and they decided that since my GD was in such great control, they'd give me a week past my due date before they would induce me. I've since learned this is pretty unusual for GD moms, so I was quite thankful for their willingness to work with me.
I also talked with my midwife about the possibility of my baby having low blood sugar and needing glucose water. I planned to breastfeed exclusively and wanted to avoid any artificial nipples. She said that if the baby did indeed have low blood sugar, I would be able to breastfeed to try to resolve the problem. Only if breastfeeding didn't resolve the problem would they consider giving glucose water. This news was also important in making me feel much more relaxed and confident about my birth plan. I'm glad my midwife and I talked about these issues, and even more glad that she and I agreed on all the things that were most important to me.
The day before I was supposed to be induced, I went into labor around 2:30am. I went to the hospital around 10:30am. The nurses and the midwife on call all seemed very impressed that I had only gained nine pounds, and they kept commenting on how great that was. I spent most of the day walking or in the tub, and the midwife spent several hours with me, helping me through contractions. Unfortunately, I had "screamers" in the rooms on both sides of me, and while I tried to ignore them, it did make me anxious about what was to come. Thankfully, I managed to deal with my contractions pretty well though, and had no medication for most of my labor. Sometime around 5pm, we decided she would break my water, at which point the contractions became much stronger and closer together. She offered intrathecal morphine (the "walking epidural"), and I decided that I would accept it (although I had been terrified at the thought of having a needle in my spine!). I went from 5cm to 10cm in less than an hour, and when I announced the intrathecal morphine wasn't helping anymore, they told me that's because it was time to push!
I pushed for 50 minutes (but it seemed like 5 minutes). Shortly before my baby was born, they asked me to turn onto my side and got out the oxygen mask because the baby's heartbeat was dropping. I never needed the oxygen since moving onto my side was enough to resolve the problem (but it turned out the baby had the cord wrapped twice around her neck). The midwife suggested an episiotomy because she feared I would tear into my urethra. I agreed and she made a small incision. Within a few more contractions, my baby girl was born at 6:45pm. She was just perfect, and was only 7 lbs 13 oz (not bad for a 41 week baby of a GD mom). (They had predicted 8.5 lbs at my 40 week appointment, so of course I had visions of a 9.5 lb baby!). She didn't have any blood sugar problems and took to breastfeeding like a pro.
So, I'm happy to say from firsthand experience that plus size women can have easy, healthy, and enjoyable pregnancies. Even though I did have a complication that labeled me high risk, it was something that was very manageable, and in the end it didn't have a negative effect on my pregnancy, labor, or delivery (and in fact I'd say it even had a positive effect in making me healthier than I would have been otherwise). Thanks for letting me share my story, and I hope it helps other plus size moms (especially those who develop GD) to feel better about their situation.
Suzanne's Stories (PCO, unmedicated vaginal births, gd with #2)
Kmom's Notes: Please note this PCO mom did not have trouble breastfeeding, nor did she get high blood pressure. PCO does not have to equal these problems! Also note that this mom went from 5 cm to complete (10 cm) within 15 minutes of getting into warm water in her first birth, and that it was also helpful in the second birth.
In her second birth, despite developing insulin-depending gd, Suzanne had several things going for her. Her first baby was born vaginally and naturally, making a vaginal birth this time more likely. She got good control of her blood sugars, plus a supportive set of providers (and when she found an unsupportive one she switched!). Her baby was average-sized, which makes them more willing to give a trial of labor. She had a midwife and doula for her birth, both of which tends to cut the c/s rate significantly, and she was able to use water for laboring as well as a standing position for pushing and birth. But SHE was the one who did it, and admirably too!
Birth Story
I am a plus size mom. I weighed 270 pounds at the beginning of my first pregnancy and gained and lost 3 pounds over the 9 months by eating healthily. I had no complications during my pregnancy or birth. Here is the birth story of my first child.
My due date was September 19, I went into labor at 4 AM Monday morning September 18th. I woke up to what felt like light menstrual cramps coming at about 20-minute intervals. I checked the time tried to go back to sleep. I dozed a little until 6 AM then decided to take our dog for a walk around the block (if it was false labor that should make it go away). The contractions didn't go away, this was the day! After the walk my partner and I went to a friend's house to labor and I decided to take a bath in their very large tub. After that we took another walk, I started around the block and the contractions were getting more and more intense. I could walk and talk between, so we were not too concerned. We got back timed the contractions, they were one minute long and five minutes apart. We thought, "Wow, maybe we should go to the hospital." It was about 10AM, I called our midwife and doula, getting pagers for each. The doula called back first. She said I was too jolly between contractions and she would be over in a few minutes.
She arrived and said she didn't think that we should go to the hospital yet. She started to help me through the contractions. My favorite spot was in a big leather chair in the family room. I would lean back, the doula would stroke my hair and my partner would push on my knees in toward my pelvis. At first I could talk between contractions but after a while I didn't want to talk much anymore. Periodically, my doula would tell me it was time to change positions and I would walk around the room. Standing contractions I did mostly hanging off of my partner's neck, with one knee locked and the other relaxed. I also spent some time leaning on a hassock on my knees. The contractions were very painful in that position, so I thought; "these must be working well." I was having double peaking contractions for a while. One would come and I would deal with it, be breathing a sigh of relief and be broadsided by another one. Once I got used to the pattern it was easier to deal with. I breathed through contractions until about 1 PM and then asked the doula, "When are we going to the hospital?" She said, "That's up to you."
I was on my way out the front door as everyone gathered stuff to bring to the hospital followed behind. My partner drove me and the others followed in their cars. The hospital was 10 minutes away and I had 3 or 4 contractions on the way. We left the car and headed for admitting. The doula was right behind us and was there as we headed for the room. It was a very long walk to the maternity wing from admitting, they offered me a wheelchair three times but I declined. I didn't feel like sitting. So we walked down the different corridors stopping for contractions then moving on, up the elevator and finally to our room. The nurse monitored me for 20 minutes with the belts and did an internal and pronounced me 5 cm dilated. During the rest of the labor a hand held Doppler was used to monitor the baby's heartbeat.
When the tub was ready we trotted off down the hall for a soak. My doula and partner stayed with me. I was trying to figure out whether the jets were helping or annoying the hell out of me when I was hit by a contraction that felt very different from the others. I made a sound that came from very deep inside me, a grunt. Lindsey recognized the sound as the one a laboring woman makes when she is completely dilated. She yanked the nurse call-cord and our nurse came running. I was completely dilated. I had been in the tub about 15 minutes, 2 or 3 contractions total. I got out of the tub. They wrapped me in a blanket and off we trotted back down the hall to my room.
The midwife hadn't arrived yet. She had been eating lunch with a friend when we arrived at the hospital at 5 cm. She thought she would have time to finish lunch and then come over. The nurse called her back and told her to get over to the hospital ASAP. We had to wait for her to arrive. The nurse kept telling me that she could deliver the baby, she was studying to be a midwife...but don't push unless you have to. So I huffed through the contractions only pushing a little at the end of each. Not pushing was the hardest part of the labor. The midwife finally arrived I could push. I held on to the edge of the bed and squatted to push. Between contractions they pushed a little stool under my bottom and I would sit and rest. Once the baby came down and stayed down I moved onto the bed with my doula at my head and my partner holding my leg up. I pushed for about 45 minutes total.
My daughter was born at 3:59PM. Her APGAR scores were 9 and 10. Total labor was 12 hours from the first contraction, 6 hours of active labor. I had 2 stitches for "skid marks" but my perineum was intact. I did not need nor want any anesthetic at any point in the labor.
Suzanne's 2nd Story: My second pregnancy and birth were totally different from the first. It took 2 years and 16 cycles of trying to conceive #2. I ended up with a diagnosis of PCO and treatment using clomid to stimulate a follicle, Hcg shot to cause ovulation, then Intra-Uterine Insemination. I found out Dec 23 that I was pregnant. What a wonderful Christmas present!
I started getting morning sickness at about 6 weeks and continued with it until I was 25 weeks along. Then I was diagnosed at week 28 with gestational diabetes. I was shocked and found that my caregivers were all working from scraps of paper and seemed unsure of the acceptable glucose levels. I called around and finally got in touch with an endocrinologist and he assured me that they were following the standard of care. I ordered a book on GD and read up. That helped put my mind at ease. Then I had a goal to reach.
I started testing my blood 4x a day, fastings and 2 hours after each meal. I also would test extra times if I was curious or was feeling a low blood sugar reaction coming on. So I would test 4-8x a day. These are the numbers that we used:
They sent me to a nutritionist who was useless. The diet she put me on...contained too many carbs in each meal and too much food overall. When I cut out all but one carb exchange (~18g) per meal I could almost control the daytime glucose numbers. That turned out to be too little food for someone in later pregnancy. They also lump in the management of fat and salt along with management of carbs and I did not have a problem with fat and salt. The whole regimen seemed to be geared to the elderly and didn't seem to apply much to me. I refused to limit my fat and salt intake (I was losing weight for-goodness-sake!); I did not have a problem with my blood pressure. I was sane about it, but did not limit non-carb foods. I consulted a friend of mine who is a nutritionist and she helped me to choose more whole foods and food combinations That was they key to keeping my numbers good. I began walking .8 mile per day, with a second walk if my numbers were off.
But I lost 12 lbs. in 3 weeks and my fasting glucose number first thing in the morning could not be changed by diet and exercise. So I had to take insulin. I started out with one shot in the evening but that didn't work. Then they had me on a shot in the morning and one in the evening. They also combined regular insulin (fast-acting) and a slower-acting type (NPH). I would load the syringe and take a pinch of flesh near my belly button, poke the needle in at an angle then inject the insulin. It is not as bad as it sounds; the poke doesn't really hurt, but the insulin makes the area of the shot sore for a little while. I had to watch out for low blood sugar reactions, which I had often (shaking, sweating, disorientation). Insulin-dependent diabetics have to eat frequently and keep in mind when the insulin will hit. The dr. warned me that my insulin needs would increase as the pregnancy progressed but they did the opposite. My dosage decreased 2 times near the end.
Getting gd felt like my dreams of another natural birth were going down the tubes. I was referred to an OB who told me, "If you have an 11 LB baby it is an automatic c-section; unless you want to sign a paper stating that a paralyzed left arm [the baby's] is OK with you." She was trying to scare me of my birth but only succeeded in scaring me of HER. I asked this OB about how she would deal with a large baby and it was clear from her answers that she delivers women in the lithotomy position and usually anesthetized When I asked about positioning she said it wasn't quick enough. Translate that as: there is no way to get you onto hands and knees with an epidural. [Kmom's note: These interventions are thought by many to increase the incidence of shoulder dystocia and birth trauma/paralyzed arm the OB is referring to. One of the hardest parts of gd is distinguishing the true risks of the condition from the doctor-caused problems that come from standard management like this.} My midwife on the other hand has delivered 11 lb babies vaginally (not that I wanted to :-)) I wanted that OB to be as far from my birth as possible. (It turns out that this OB gives that same speech to all overweight moms. My feeling is that she is a fatphobe.)
I switched to a different OB who was great and had no problem with standing by just in case the midwife needed her. She praised me on my management of the gd and was not concerned at all that the baby would be too large. From 34 weeks on I did 2 non-stress tests (NSTs) per week and had an ultrasound at 38 weeks. Everything looked fine so I was able to keep my midwife with the OB standing by just in case. The OB was fine with monitoring my insulin and NSTs and letting the midwife do the rest. That was just right for me because my nightmare was to lose my chance at another natural birth. [Kmom note: See, you can too have a midwife in a gd pregnancy! And some midwives will co-manage even an insulin-dependent pregnancy if all is well.] I delivered 6 days before the due date. [There was no pressure from my doctor], she was cool. The baby showed up as 8 lbs two weeks before his due date and they found that acceptable. Also, I was not measuring larger than expected. My gd was very well managed.
My labor started at 8 am. I had 3 contractions in a half an hour. I called my support people and they soon started arriving. I used the same doula I had with my first birth so we slipped easily into the pattern of her helping with my concentration and relaxation. We hung out at the house while my contractions got more intense and closer together. A short walk around the neighborhood was helpful in the beginning but things got going very quickly. I did some contractions on hands and knees or sitting but most were standing and leaning. I breathed normally through the whole labor. We tested my glucose level every hour during the labor. The last test before leaving for the hospital showed low blood sugar and I ate a couple of glucose tablets. This saved me from having to have IV glucose because they didn't know what the dosage was on the tablets. No IV!
When we got to the hospital I was 6 cm and went directly to the tub. I felt the baby drop as I stood to go to the room with the tub down the hall, it felt so good! The contractions were hard but the time between them lengthened and the water made the labor seem like a breeze. I went through transition with a little shaking and burping, then I was ready to push. This is where may labor got really hard. I knew that it was too late for an epidural but I would have had one if it were possible. The rest of the labor was such a breeze that there was no way I would have asked for pain relief. There is no way that I would recommend having an epidural just in case it got bad later.
I got back to my room between contractions and couldn't bring myself to get on the bed. Physically I could have climbed on, but it didn't feel right. I had planned on helping Nicholas "out" and the midwife had agreed but when we got to the room I preferred to stand for the delivery so the midwife warned me that I wouldn't get my wish. I told her I didn't care. Consequently, I delivered Nicholas standing up with one foot on the floor and one knee on the bed. I yelled, "NICK! NICK! NICK! OUT! OUT! OUT!" One nurse, in her 50s or early 60s, was very concerned about me delivering standing up. The midwife told that that is how it was going to be. That nurse came in when she went off shift and hugged me and told me she thought I was "heroic".
I pushed for a while and when I checked for the head I couldn't feel it. I almost lost hope, but buckled down to business. Soon I could feel his head and knew it would be over soon. The midwife stood behind me and passed him between my legs within seconds of his birth. Nicholas was born "in the caul" meaning he had the amniotic sac over his head. The midwife had to break the sac and suction his airway. Nicholas was born at 4:28 PM after 8.5 hours of labor with about 2 hours of it spent at the hospital. I pushed for about 40 minutes. I had a small tear where an episiotomy would have gone, it took 2 stitches. Pushing caused a hemorrhoid that has healed completely. I retained a small bit of placenta which came out at 4 weeks postpartum with a gush of blood but no other problems.
Nicholas had to be fed formula every 3 hours for the first 72 hours because his pancreas was working overtime due to my gd and he had low blood sugar. I used a Supplemental Nursing System (SNS) with a thin tube going down to my nipple from the bottle of formula. I had requested this in my birth plan to avoid having problems with nipple confusion. [He nursed every 3 hours, and while he was nursing I slipped him the tube so he would also get the formula. They added some glucose water to the formula in the SNS because his numbers didn't rise enough at first. After the first 3 days, he has been 100% breastfed.]
My partner's sisters visited me later and I told them, "Get an epidural." I regret that now that the memory of the pain has faded. I am happy and proud that I have had 2 natural births. If I had it to do over I would not choose to use pain meds. Nicholas is 4 months old now. Since he was born everyone has commented on how alert he is. I think that he is alert because he was not drugged at birth.
Laura's Story (insulin-dependent gd, induction, vaginal birth)
Kmom's Notes: Many gd moms find that their blood sugar starts to drop near the end of pregnancy; if they are insulin-dependent, their insulin needs may drop as well (it's important to watch for hypoglycemia if that happens). Traditionally, doctors have taken this as a sign of placental calcification and degradation in 'regular' diabetic pregnancies, and therefore view it as a sign for immediate delivery by induction or c/s. However, it is unclear whether this is truly a sign of a placenta in trouble or not, and especially if the same concerns for 'regular' diabetic pregnancies apply so strongly to gd pregnancies.
One alternative explanation for a drop in blood sugar at the very end of pregnancy is the alteration in hormones that occurs as the body readies for labor. GD is caused by insulin resistance from 5 different hormones produced by the placenta in pregnancy. One of these is progesterone, which tends to peak at week 32 or so and has a very strong effect on blood sugar. However, at the end of pregnancy, the relative balance between estrogen and progesterone changes dramatically; progesterone levels drop significantly in order for the cervix to start ripening and softening for delivery. It seems logical therefore that a gd mom's blood sugar might experience a significant dip as this very strong hormone begins to decrease in the last week or so of pregnancy.
However, few doctors seem to know of or consider this change in hormone balance, and since sudden placental failure is a significant danger of regular diabetic pregnancies, most OBs understandably tend to err on the side of caution. At this time, it is unclear what a drop in blood sugar/decrease in insulin needs means at the end of a gd pregnancy; unfortunately, few doctors seem to be even asking the question or trying to find out.
Also note that Laura had a doula for her induction; although research on doulas during inductions is limited, we know that they help cut the c/s rate by about 50% in non-induced labors, and one small study seems to indicate that they also cut the c/s rate in inductions very significantly as well. Although Laura had to be induced, she was as proactive as possible about it, which probably helped increase her chances at a normal vaginal birth.
Birth Story
Birth story (with photos) can be found at www.deleons.com/birthstory.htm. Below is a brief summary.
Laura developed severe gestational diabetes during the pregnancy and needed insulin to help control her blood sugar levels. Her OB wanted to induce no later than the beginning of week 39, but they were able to negotiate going a few days beyond that so as to be closer to her due date. They did a great deal of research, including a trip to the local health library, in order to be sure that the induction was necessary. They concluded it was because of the severity of her gd and because they were worried about the potential degradation of the placenta (her insulin needs went down at the end of pregnancy and one possible explanation is the placenta degrading, a real risk with regular diabetic pregnancies).
She wanted to go into labor on her own. In order to help things along, she had lots of sex and also took Evening Primrose Oil (EPO), both by mouth and vaginally [both of which tend to help production of prostaglandins]. She did not go into labor ahead of time but these things may have helped prepare her better, since she was already 3 cm dilated when arriving for her induction. She also chose to discuss her preferences on induction with her doctor, and adjusted her expectations of labor to include monitoring and potentially more intense contractions, and possibly needing medication (although she still wanted to avoid an epidural).
They chose to break her waters first, then start the pit later. They found some meconium present. She also needed antibiotics after having tested positive for Group B Strep. They called in their doula after about 4 hours or so. She helped Laura get a bit more mobility and various comfort measures going, and as contractions got extremely intense, they opted for some Fentanyl. Eventually they decided they needed an epidural, but as they were putting it in, discovered she was at 9 cm. Shortly afterwards, she pushed out her baby!
Breastfeeding was difficult at first (see the related story on her website) but eventually they were able to overcome the obstacles and breastfeed long-term.
Kathy1's Story (GD, baby's head tilted, vaginal birth)
Kmom's Notes: Kathy's long days of pre-labor ('false labor') and then stalling at 4 cm for a while was a good clue that something was wrong with the baby's position. Unfortunately, most doctors pay very little attention to this, and breaking her waters may have forced her baby into instead of through her pelvic bones. Adding pitocin on top of that poor position to strengthen contractions pushing baby down may well have caused the damage and bruising she saw in her baby after birth, although of course it's difficult to know for sure. Getting up and shifting position probably corrected her baby's position and may well have saved her a c/s.
Birth Story
Kathy1's first child was delivered vaginally at about 40 weeks after being induced on a mostly unripe cervix. She found labor tolerable until the doctor broke her waters at about 3 cm, and then contractions became very intense and nearly continuous (very common occurrence). Eventually she opted for the epidural as a result, and did get some sleep. During transition, she desperately wanted to get up and move around, but was trapped in the bed by wires etc. and began to feel panicky. She began to feel the urge to push but was not allowed to until dilation finished, and had trouble keeping from hyperventilating. Eventually she began pushing, although it was not very effective due to the epidural. After an hour and 40 minutes of pushing, her son was born, weighing 8 lbs, 14 oz. However, the amniotic sac was not delivered with the placenta as it should have been and the doctor had to go get it, which was difficult, caused a lot of bleeding, and caused her to need a lot of pitocin afterwards.
With Kathy's second child, her father was diagnosed with type II diabetes during her pregnancy, and so she opted to be tested early for gd at 20 weeks. She did indeed have it, but was able to control it through diet only. Because of the gd and the fact that her previous baby had been almost 9 lbs. without any gd, her doctor wanted to induce her at 39 weeks. Fearing a pit induction again, she tried a castor oil induction at 38 weeks instead. The following is her story.
"After having mild, non-productive contractions for 3 days, I decided to try some castor oil in hopes of starting real labor. I drank 4 oz of castor oil with equal parts orange juice about 7 pm. After about 3 hours, I began having diarrhea, which lasted for maybe 2 hours. And then about an hour after it ended, the contractions began. By 1:00 am they were VERY strong and about 2-3 minutes apart, and by 2:00 am I was settling into my labor room at the hospital. I was at 2 cm and 50% effaced.
A friend joined us at the hospital and she and I giggled and talked through the early labor while my husband snoozed. I walked the halls, taking breaks to be monitored for about 15 minutes every hour. The contractions weren't bad at all, and I was having no problem dealing with them. About 9 am I was 75% effaced and 3 cm, so the doctor broke my water to speed things up. The contractions got much harder and faster, and I was really breathing through them, but we were all still in a good mood and laughing and talking between contractions. By about 1 pm I was totally effaced and 4 cm, but my labor had stopped. I was getting very tired by then and discouraged. So I tried to rest and see if things would pick back up. They didn't. After walking and trying various things, we started some pitocin about 4 pm. The contractions got much harder, and after about an hour I started to feel panicky, as it was getting more difficult to handle the contractions.. So they gave me a bit of Stadol to try to help me relax, but it wore off quickly.
Just when I thought I couldn't take anymore, my friend Amy arrived. Amy has been an OB nurse for many years, and is now a lactation consultant and childbirth educator. Needless to say, she knows how to handle a woman in labor! I was crying when she walked in, and I started begging her saying "Please...I want an epidural!!" She said "You don't need one. You need to calm down." She got very stern with me and made me breathe with her through a few contractions. When I got panicky, she'd just get stern again and tell me to look at her. Then a strange thing happened. I relaxed and I began to feel empowered. If I paid attention, my body was trying to tell me what positions helped the contractions along. It felt better to be standing and swaying, and pacing around. I did that for a while, and Amy was keeping me focused and helping me breathe through each contraction. I was handling it!! But I was also awfully tired.
Soon they checked me and announced I was at 7 cm, but my nurse and Amy also had begun to suspect that the baby's head was in my pelvis a little funny. Amy had me squat on the edge of the bed through several contraction to open my pelvis, and I felt his head shift down into the birth canal, and the pressure was incredible! I started to panic a little again. I kept saying "He wants to come out NOW!" And Amy would calm me and say, "not yet--breathe." I was breathing and having to focus so hard during contractions, but was dozing off in between. (My husband said I was even snoring!!) Resisting the urge to push was so hard! But thankfully I went from 7 to 10 in about 20 minutes, but when I pushed, he still wasn't moving down. Amy told me to lie on my side and draw one leg up to push. The doctor didn't argue with her although his preference was to use the stirrups! So I got on my left side and drew up my leg and I pushed through 3 contractions, and with every one they were saying they could see more...they could see hair, etc.
On the third I pushed with all I had, and I remember making some kind of growling sound. His head was partly out and Amy said, "If the contraction's over, rest." And I thought "Forget that!" His head was partway out and I had some kind of fear that if I stopped and rested then, he'd be hurt in some way, so I took a deep breath and PUSHED!! I felt something pop and he came flying out onto the bed all at once (not the usual "head then body" delivery). It sure was a good thing that I didn't have stirrups because I don't think the doctor would have been able to catch him!
David's head was very bruised and the bridge of his nose and left eye were extremely swollen--further evidence that his head had not originally gone into my pelvis correctly. I am SO GLAD that I made it through without the epidural. It was hard, and a lot of work, but if I hadn't been able to squat and roll on my side and such, I just might have had an emergency c-section. And I am SO thankful that Amy was there, because she helped me fight the urge to withdraw into myself during the pain of the contractions, which was the only time when the pain would overwhelm me. As long as I could remain focused on something outside of my own body, I was able to stay on top of the contraction and handle it. David nursed right away in the recovery room, and I was amazed that he latched on immediately. He was 7 lbs, 11 oz., 20 1/4 inches long, with Apgars of 9 and 10."
Update: Kathy writes that "My son has recently seen a surgeon...and the surgeon was [able] to provide an explanation for his postpartum nasal swelling that kept him in the hospital until he was 5 days old. He suffered a broken nose due to the positioning of his head in my pelvis. This also explains the extreme swelling across the bridge of his nose and one of his eyes."
Michaele's Story (gd, induced vaginal birth)
Kmom's Notes:
Birth Story
I was 36 and this was my first pregnancy; we conceived the first month of "trying". I had a pretty easy pregnancy, although I'm overweight I'm pretty active and the swimming and bicycling I did during pregnancy really helped I think.
I had morning sickness and fatigue for the first 16-17 weeks, and I was diagnosed with GD and mild anemia at 27 weeks which was controlled by high protein, low-carb diet for the remainder of my pregnancy. I ended up taking the HMO Lamaze birth classes. I didn't bother with a birth plan since the hospital where I delivered had most of the things I wanted (like pro-breastfeeding, immediate bonding, no episiotomy, etc) as standard procedures.
Now for the birth story! Because of the GD my OB wanted to induce labor, so I chose a date and hoped against hope that I'd go into labor before that. But the morning of the chosen date rolled around and off we went to the hospital. Although I was ready, I was absolutely BAWLING my eyes out in the car because I was so disappointed that I hadn't gone into natural labor, but excited because I knew I'd have my baby soon!
We go to the hospital around 8 AM and my OB broke my waters and hooked up the internal fetal monitor, then I was given an IV and they started the pitocin drip. I was about 2 cm dilated and my cervix was soft so they didn't use any gel. The next several hours were pretty boring, I couldn't go anywhere except the bathroom and I couldn't eat anything although I was allowed to have water, juice, and tea. DH and I read the newspapers, did some crosswords, watched TV, and listened to music (I had brought a CD boombox to the hospital with me). I spoke to the anesthesiologist about pain relief options and decided to go with an epidural later if I needed it.
By about 2 PM I was really feeling the contractions and did some breathing and moved around as much as I could to find a comfortable position, at around 5PM (about 9 hours after labor started) I had them insert the epidural. I had a "light" epidural which was GREAT!! I could still walk to the bathroom and I could pee on my own throughout. I didn't ever have them deaden the pain completely. Honestly the thing that hurt the most was the DAMN automatic blood pressure cuff--YIKES!! DH was absolutely wonderful throughout, keeping an eye on all the monitors that I was hooked up to, doing some breathing with me, etc.
Anyway I was about 5 cm dilated at this point and I knew I still had a ways to go. They had been upping the pitocin all along and I was lucky that my body was responding well. The one "problem" that occurred during the next five hours was that the external contraction monitoring belt just wasn't easy to position well on my stomach so they opted to use the internal contraction monitor. So I ended up with yet another tube, this one goes in between the baby and the uterine wall and it HURT LIKE HELL during contractions.
I'm not sure when exactly transition started but it was the most uncomfortable part of my labor. Although the contractions weren't very really painful, I had a hard time relaxing in between them and my whole body would tremble. But before I knew it, the OB came in and checked me and said "time to push!"
At this point I'd like to make a plug for the L&D nurses at the hospital--I was there for three shifts and every nurse I had was just GREAT. I started pushing right after a shift change and the last nurse I had was absolutely terrific! Anyway at this point they turned down the epidural and the pitocin and I started pushing away. DH was a huge help here, counting during my breathing, and providing resistance against my legs. The nurse let me use any position I could think of--I pushed on my back, on the toilet, on my side, standing up, squatting, with the bar--you name it!! It was one of the most difficult things I've ever done physically. After about 2.5 hours of this I finally figured out an effective position (which was lying on my back with my feet pushing against the bar--absolutely contrary to any recommended position) and at 1:20 AM out came my beautiful little girl!! I had a small 2nd degree tear and came through labor much more easily than I expected to.
I held her immediately and made my first few attempts at nursing while the OB stitched me up. There is really nothing more amazing than meeting your baby for the first time!
Lisa H's Story (insulin-dependent gd, induced vaginal birth)
Kmom's Notes:
Birth Story
We arrived at the hospital Thursday at 7:15 p.m. to have a dose of Cervidil applied. Expecting that we'd be going home and then returning the next morning, there were a whole bunch of things we hadn't done yet, like doing a final tidy up of the apartment and buying groceries. Good thing I had suggested we made sure everything was in the car, including toiletries, because I was informed that once the drug was applied, I was there for the duration. [Kmom note: This differs from hospital to hospital.]
When initially examined I was 0.5 cm dilated and 80% effaced. By 10 p.m. I was 2 cm dilated and 80% effaced, but since the Cervidil appeared to be working I wouldn't have to get the p-gel application. I was put on pitocin at 3 a.m. and they gradually kept upping the dosage. In the morning there had been no real progression, so my OB broke my membranes at 9:30 a.m. I dilated from 2 to 3 during the time it took for the doctor to place the internal monitors, and I immediately went into contractions 2 minutes apart and lasting 1 minute long.
Needless to say they took me off the pitocin. By 10:30 a.m. I had my epidural and was finally able to sleep. They put me back on the pitocin at around 2 p.m. then checked me at 4 p.m. I was at 4 cm and 100% effaced and not feeling a single contraction (what bliss!). I needed to get the epidural topped up and it was a good thing that I did. By 8:15 p.m. I was 10 cm dilated and wanting to push. Half an hour of breathing to keep from pushing while they got everything ready (as I had progressed a hell of a lot faster than they had anticipated), then onto the final stretch.
After one hour of pushing, my son was born at 10 p.m., with his father and both grandmothers in attendance. The OB nurse had me doing 4 pushes during the last 15 minutes of delivery and everyone suspects that it was the 4th push per contraction that got him out so quickly. He suffered from a very minor case of shoulder dystocia (where the shoulders get stuck) but she was easily able to reach in and make the correction needed. DH was able to catch him as he emerged and he was lain on my tummy for about 10 minutes before they had to take him to the Special Care Unit.
His Apgar scores were 8 and 9, his blood sugar was fine, and he was released from the Special Care Unit by 7 a.m. Sat. morning. He was being given formula by bottle to maintain his sugars to be on the safe side, which was okay with me, as I had said it was okay if it was medically necessary. My OB said that while she was concerned about the effect of the gd on him, she knew as soon as she saw him that I had done an excellent job keeping it under control. Apparently, gd babies can be born with really fat cheeks and lots of fat on the shoulders, which contributes to shoulder dystocia. D had no signs of either. My blood sugar was 101 on Saturday morning and 87 Sunday morning, so my OB says I am 99% likely not to be a diabetic right now, but if I don't lose weight and start exercising it becomes a much more likely event. As it is, I now have a 60% chance of becoming a full-blown diabetic within the next 10 years or so.
I did not get an episiotomy but I did tear, and my OB said that I tore 'perfectly', meaning that I tore exactly as she would have cut. I had some damage from the catheter so she had to put a stitch near my urethra opening as well. I also ended up with one very tiny hemorrhoid, which should go away on its own because it was caused by the pushing.
[Breastfeeding has been difficult. My nipples are very flat and he has trouble latching on. I pumped and fed him the breast milk, which he guzzles like there's no tomorrow. He also gets formula.] He was really fussy and having a lot of gas, so we changed from the standard Isomil formula to the lactose free Soy and the fussiness is completely gone and he has had two bowel movements already. The first one was rather explosive and EXTREMELY smelly, but what else could you expect if you'd been eating something you're allergic to. I plan to supplement with formula until I am able to produce enough to meet this little guy's hunger.
[She later found out that he had a problem with his suck, which is why he had such trouble latching on.] We found out that the problem wasn't me, but with the baby---he has an overbite. We were told that while feeding him to put a finger under his chin and pull it forward, training him to move his jaw forward when sucking. By the time we were able to get him to do it consistently on his own, he refused to latch onto my breast and would only take a bottle. So now I'm pumping exclusively. But I was using one of those stupid Evenflow pumps at first, not realizing that it wasn't meant for heavy duty use, and I almost ended up losing all my production. I now have a Medela Pump In Style and it's working better.
I really feel like I got sabotaged by the hospital--first, by them giving him bottles while in the nursery, and second by not being able to see a lactation consultant while in the hospital. Still, I'm going to stick it out and pump for as long as possible because I and my husband have a number of allergies and we want to give him as much protection against them as possible.
I think part of the problem with the hospital is that I didn't have a relationship with my pediatrician (I had never met him before the baby was born) so I wasn't able to discuss what I wanted to happen with the baby regarding feeding because of the gd. I now know for sure that I am not only going to talk to my OB, but to the pediatrician and the nurses on staff and make sure that they know IN WRITING that they are not to give my next child anything in a bottle unless it is a certified emergency.
I can hardly believe that I'm actually able to hold the little critter that was causing me so much discomfort for the past few months. The look in his eyes when he sees me and hears my voice by far makes up for any problems I could possibly have had. I wish that everyone who reads this message to be as lucky as I have been with the birth of my first child. It almost makes me think I may consider going through all of it again.
Amy S's Story (diet-only gd, vaginal birth)
Kmom's Notes: Amy worked very hard to keep her blood sugars normal and to educate herself about her care options. Knowing the odds of being induced, she worked very hard to ripen and efface her cervix ahead of time, using Evening Primrose Oil, nipple stimulation, etc. In her case, it seems to have paid off. She was able to avoid induction after all, and was able to have pretty much a natural birth.
Birth Story
A little background first---we had some trouble conceiving and also had a previous miscarriage. We were finally successful when I added low-carbing to the charting etc. We did a routine pregnancy test at the R.E.'s office the day we were to start treatment, and discovered I was pregnant.
Up to about 16-18 weeks was often very scary, as I had a couple of bad bleeding episodes---placental separation, low-lying placenta, etc. So I spend a great deal of time on bedrest or restricted movement, and all problems eventually resolved. At 22 weeks was diagnosed with GD which was successfully managed with diet alone. By the third trimester I was finally feeling pretty good, everything under control---except then started the worry of induction, as my docs would not let me go late due to the GD.
So at 36 weeks I started taking Evening Primrose Oil (EPO) daily to help ripen the cervix. I also started drinking red raspberry leaf tea regularly, as it is supposed to help tone and strengthen the uterus. My cervix was great--by 37-38 weeks it was fully effaced and I was dilated 1-2 cm.
The induction was scheduled for Tuesday---exactly 40 weeks and I started getting pretty itchy the week before wanting to avoid induction. I really wanted a natural birth and hated all of the extra interventions that are necessary with pitocin inductions. I had tried some nipple stimulation on and off, but had never gotten very regular contractions, and tried it again on Saturday evening at about 9:15. Well I got one little contraction and then about 15 minutes later it felt like the baby was pounding on my cervix. I stood up and my water broke and the contractions started in earnest---2 mins. apart.
We called the doctor and the doula immediately. I knew this was major labor and wanted to get to the hospital. I probably didn't have to, but I told the doctor that I had been in labor longer than 15 minutes when she called back---I didn't want her to say that I should wait at home for an hour or two---couldn't do it.
We got right to the hospital and into our room. I was really blown away by how intense labor was and luckily we got a great nurse who really tried to help handling the pain--she had read my whole birth plan while we were headed over! They finally checked me and I was only at 2 cm and that was really disappointing cause I really felt as if I was in very active labor. The next two hours were tough; they were having a really hard time getting a tracing of the baby's heartbeat with the monitor. They kept wanting me to be laying down, which was excruciating. I was fighting going to the scalp monitor--that really scared me. By just after midnight I was begging for pain relief and was given an IV and Stadol, which helped for exactly 4 contractions. :-( Our doula arrived at about the same time and I know I relaxed a bit knowing she was there, so I can hardly credit the Stadol with anything.
At this point, labor got even stronger--my contractions were double-peaking regularly, which meant that they were 3 minutes long with just about 40 seconds in between. At about 1:30 a.m. they checked me again. I was really in need of assistance with the pain and was asking for an epidural, so they wanted to know how far along I was. I had gone from 2 cm to 6 cm in an hour. At this point my doula advised me I probably wouldn't get any relief from the epidural because the labor was going so fast. I didn't believe her and requested one sooner. The doctor insisted at that point that we use the scalp monitor to get a good tracing of the baby's heartbeat and I gave in and let her do it.
Well, I never got the epidural (I went from 6 cm to 10 cm in that hour). I was sitting up and the anesthesiologist had gotten the local in but my contractions were so long and strong (transition) that there was hardly any time for the doctor to work in between. All of a sudden I found myself pushing---it was absolutely automatic--couldn't have stopped if I had tried. After two pushes we paused and talked a moment---the doula was saying, "You are having the baby now, no epidural." It took me a moment or two to get it, but finally agreed that I was really pushing out the baby now. The nurse wanted me to lay back on the bed and rushed to put on gloves to check me. I had 3 more contractions as I lay back with lots of pushing, and apparently the anesthesiologist ran to get the OB and the nurse was holding the baby's head in, because with one final push the baby popped out completely as soon as the OB was there to catch her. (Note: catch her, not deliver her.)
She was born at 2:33 a.m., and she was placed on my chest immediately and her daddy cut the cord when it stopped pulsing. Her Apgars were 9 and 9 and she was calm and alert. We spent the first hour or two cuddling, deciding her name, and letting her try to latch onto my breast. She weighed in at 7 lbs. 13 oz and was 20 inches long. Even with that incredibly fast birth, I had no tears--just one skid mark--and was given time to deliver the placenta naturally also.
This has been the most amazing time of my life. I knew becoming a mother would be wonderful, but this is far beyond all expectations. We have had just a few bumps in the road so far. I got hit pretty immediately with a very bad postpartum depression--and needed to start medication right away. But it's a medication that is hardly measurable in breastmilk so is considered very safe for the baby. Luckily I knew I was at risk for it and knew what to do when it happened. It was a very scary time, though.
She had some trouble latching on at the hospital and they got us started with a breast shield unfortunately. My milk came in strong and she is nursing really well. She gained back her birth wt. plus 6 oz. before two weeks, but we are still using the shield much of the time. I decided it was better to keep things low stress and use the shield while I was getting the depression stuff handled, so am just beginning to try to wean her off of it now at 3 weeks.
All in all a great birth; only one hassle from anyone about my size (a comment from anesthesiologist). Had lots of support from caregivers, thanks to my being very upfront about my desires and expectations all through the pregnancy.
Anne D's Story (PCOS, insulin-dep. gd, Group B Strep, very premature vaginal birth)
Kmom's Notes: This is an amazing story of courage and endurance. This mom was SO strong for her baby. He was born extremely early, at 26 weeks. Although many babies of this age do survive, many have long-term health complications. This baby has turned out remarkably healthy, and much of that is probably due to his mother's dedication to giving him breastmilk long-term.
Research shows that preemies given breastmilk often do better and suffer fewer complications than those on preemie formula alone. (For more information and references on this topic, consult the FAQs on this site on Breastfeeding a Premature Baby and on Breastfeeding After a Cesarean.)
However, because of their inability to suck this early in gestation and the logistics of pumping/storing milk, many preemies of this age don't get breastmilk, and those who do get it often don't get it for very long because it can be difficult. In addition, many hospital Neonatal Intensive Care Units (NICUs) have policies that promote bottlefeeding, which can interfere with the baby's ability to learn to breastfeed (sucking for bottlefeeding is very different from suckling for breastfeeding). So even moms who start out pumping breastmilk often end up bottlefeeding instead of breastfeeding, or may need to bottlefeed in order to get their baby home. People do what they have to in a tough situation like this.
This mom pumped her milk and fed it by tube at first, then eventually by bottle in order to bring the baby home after he had difficulty learning to nurse. But she kept putting him to the breast, even while he was taking bottles, and eventually he learned to nurse despite all the obstacles. She pumped her milk for FIVE MONTHS, a very tiring and cumbersome task. Most women with preemies give up pumping eventually, which is absolutely understandable, given its time-consuming nature and the tendency for supply to dwindle when pumping. But this mom kept pumping long enough that her baby was able to learn to breastfeed eventually at home, and now is exclusively breastfeeding.
This is a rare and beautiful accomplishment, and a wonderful testament to this mom's dedication and endurance. This baby is doing well now, with his only current major health problem being hearing loss.
Birth Story
A month after my husband and I decided to see if we could get pregnant, I was staring at just the faintest pink line on a home pregnancy test! I have had PCOS for 20+ years and was always told I probably couldn't have babies. I had been taking glucophage for about 2 years at that point, prescribed by an endocrinologist. I was also taking thyroid replacement hormone.
At my first appointment with the endocrinologist (which was actually before my first OB appointment), I was diagnosed with GD and put on insulin. That gave me a red dot on my folder at the OB, and I had to see a doctor, not a midwife. My pregnancy seemed uneventful. I had a couple of times of major bleeding, but it self-resolved and all seemed well. I had several ultrasound examinations because of the GD. The baby was fine, and my blood sugar was great.
At the middle of my 25th week (which occurred over a weekend), I developed first some discharge, and then what I considered a stomach virus or something-----nausea, chills but no fever. I was on the phone daily with my OB office, asking about symptoms, how to handle my insulin, etc. I ended up speaking to a different doctor each time. Looking back, knowing what I know now, I would have made sure that each one knew that I'd spoken to the others, etc. to ensure continuity of care. Not that I think my treatment or the outcome would have been different, but just because now I see that the results could have been disastrous.
On Monday I still wasn't feeling right. I had an OB appointment Tuesday morning so we decided to hold off on being seen. Late Monday night I started having diarrhea and then cramps. I then noticed that the "cramps" were somewhat regular. I called the person on call, who happened to be a midwife, who instructed me to drink a large glass of fluid and lay on my left side. I did that, and all of a sudden a gush of fluid came out of me.
I thought it was urine and that I was suddenly incontinent---but then I realized it was my waters breaking. My husband had called back and the midwife told me (when he handed me the phone) to come to the hospital right away. I had gotten up to try to get to the bathroom to make less of a mess, and I felt something move down into my vagina. I laid back on the bed and my husband told me he saw a foot.
Rather than wait for an ambulance, we got in the car and he drove to the hospital, which was less than 10 minutes away. We pulled up to the ER door and walked in (another thing I wouldn't do if I had to do it over--but at the time we were numb and on autopilot and trying to HURRY). I walked right into the triage area and interrupted a patient getting evaluated and said, "I'm in preterm labor and the baby's coming RIGHT NOW!" They put me on a gurney, and I could tell they really didn't believe me when I said 26 weeks and that the baby was coming out, but then they saw the foot. I will never forget the looks on their faces. They ran with me on the gurney to L&D.
It was just before shift change, so there was nearly double the normal amount of people there. It seems an overestimate to say it was over in a matter of minutes. I was totally dilated, the baby was breech (they usually are that early in a pregnancy) and halfway out of the uterus. The doctor put both of his hands in my vagina, turned my baby around, and told me to push. I didn't think I could push. The pain of his hands was intense.
I was able to push, and the baby came out. The doctor protected baby's head with his hands (babies' brains that early are extremely vulnerable to trauma and can develop life-threatening and debilitating hemorrhages called "brain bleeds." But I didn't know that then). The doctor said, "Oh sh*t." My husband heard this, and saw our tiny little baby. I didn't see him before he was rushed out of the room. A nurse walked back in the room, and not realizing I was looking at her, made a sad face and shook her head "no" at another nurse. I thought my baby had died. She was just commenting on her emotional reaction, I suppose.
We had called and talked to the midwife when my water broke, at 6:19 a.m. by her watch. By that same watch, my son was born at 6:41 a.m. His first APGAR was 1 and his second was 3, I think. I did not find out until a couple of months later what his numbers were. I was told that he had tried to cry but he could not breathe on his own. He was intubated. We were able to see him briefly. I walked down and stood next to his warming tray, just dumbstruck by his smallness, by the horrible bruises on his legs, by the perfectness of his little body, by his little round hairy head. He turned his head when I said his name.
I stood there bleeding all over the floor, speechless. A chaplain came in and blessed him. After being stabilized, he was flown to a large university medical center. I cried when they wheeled him out to take him to the helicopter. I was discharged after about 6 of the longest hours of my life. We went home, packed a few things, and drove to be with baby. We were able to stay at a nearby Ronald McDonald House while our baby was in the NICU.
My baby spent 75 days in the NICU. He was on the ventilator for a couple of weeks before his lungs matured enough to breathe on his own. He was on some form of oxygen for most of his stay. After a few weeks in the hospital, he nearly died from an overwhelming infection that he acquired in the hospital. He was put back on the ventilator. We came to know exactly what they meant when they called in the NICU rollercoaster.
He developed retinopathy of prematurity, a condition caused when a baby's blood vessels in his retinas (back of the eye) have to form outside of the womb. (Stevie Wonder had ROP.) This eventually led to his having laser surgery on both eyes after being discharged from the hospital. His eyes appear to be fine now. After leaving the hospital we discovered that our son was deafened by the medications that he was given when he had the infection, as well as some other medications which may have had a synergistic effect.
I believe that my son has glowing health otherwise because he was and is breastfed. When he was being born, one of the first questions we asked was whether breastfeeding was out of the question. The doctor said no. Unfortunately, the lactation consultant at the community hospital where my son was born recommended a rinky dink breast pump, which we picked up at the hospital pharmacy on our way to the university medical center. We could have saved about $150 and several days of stress and heartache if she had been more knowledgeable that 1) a woman who is going to pump every 3 hours for an indefinite period needs a top of the line model, and 2) most NICUs have them already.
We stayed at a Ronald McDonald house near the hospital, and I was pumping religiously, every 3 hours, night and day, and I was not getting a drop. I finally asked a lactation consultant about it, and as soon as she saw the pump she said, "Oh well, there's the problem." As soon as I started using the hospital's pump, I was in business. A little drip here, a little drop there. Then it seemed like buckets!
I met women who gave up because it is a difficult thing to do during a stressful time. I tried to keep in mind WHY I was getting up at all hours. I decided that my job description was to pump and pray. I pumped every 3 hours. This is so very, very crucial. I know a woman who did sleep through the night and had no supply problems---but she is the only one. I met others who eventually stopped (or didn't ever start) breastfeeding because they slept through, and then had supply problems, and then gave up pumping.
My son was first fed through an NG tube (naso-gastric tube---up the nose, down the throat, into the stomach). He was fed just tiny amounts (the equivalent of about half a teaspoon). Babies born as early as him are at risk for developing a life-threatening bowel infection called NEC [Kmom note: Necrotizing Entero-Colitis]. The vast majority of the babies that get NEC are being fed formula (another reason I got up every 3 hours!) but all babies must be monitored for it.
Eventually we were able to start kangaroo care and then to try to latch on. My son showed immense interest in breastfeeding from the start. I think I was the one with the problem! Babies that premature (he was born at 26 weeks, and we started trying to breastfeed at about 31-32 weeks) can have periods of apnea and bradycardia (stop breathing, slow heartbeat). This happened several times while we were trying to breastfeed, possibly because of the positioning of his head (if their heads go forward, it closes their airway and makes them have "A's and B's." This was extremely stressful for me. In addition to being terrified that I was going to drop him on the concrete floor, I was afraid I was making his heart slow down! I was not assertive enough in asking for positioning help. I was also physically uncomfortable. If I had it to do over, I would be more assertive in asking for help from the nurses and lactation consultants. This was undoubtedly a size issue coupled with a bit of a modesty issue.
Because we had been told [by Kmom] that bottles and pacifiers would cause nipple confusion, for a long time we tried to not use bottles. We were the first family to ever try cup feeding (at which my son excelled) in the NICU. We had him fed through a tube either in his nose or mouth, which can actually cause the bradycardia (slow heartbeat) episodes he was having because of a reflex mechanism in the throat.
The vast majority of nurses were unwilling to cup feed him, so unless I was there, he got fed through the tube. Eventually I saw that we were either going to have to try a bottle or stay in the NICU for a long, long time having A's and B's and reflux. So I decided to try a bottle. My son drained it dry without hesitation. Out came the tube (and with it, the bradies). In a few days we were home. He was 37 weeks postconception, 11 weeks postnatal when we came home.
When we came home I was still uncomfortable breastfeeding him. I continued to pump until my son was almost 6 months old. If it hadn't been for my husband encouraging me to keep trying to breastfeed, we probably would not have had the success we have enjoyed, because my supply started dwindling when we got home. I was using a different (inferior) pump, and I was being less diligent about both the frequency and the duration of pumping. I went from pumping every 3 hours for about 20 minutes, to pumping whenever I could get to it, for as little as 8 minutes. We had lots of appointments in and out of the home, and I had also fallen into the mistaken belief that since I had a good supply, I could be a little lax. I neglected to consider the whole supply-and-demand process of milk production. I switched pumps, tried herbal and medicinal cures and my supply did increase, but not to where it was [before]. I needed a baby, not a pump!
Finally, after reading and reading, I decided that I was going to go in the bedroom with our baby and stay in there until we were either both totally unglued or until he was breastfeeding. I devised a way to make us both comfortable AND secure, and that made ALL the difference in the world. We had bought a foam wedge to keep him elevated after eating, and I placed my sleeping pillow on top of that. I put them next to me, and laid the baby on it so his head was at my breast level. I was basically doing a football hold with the considerable help of the foam wedge and the sleeping pillow. To this day, that is how we nurse, and my son and I both love it. It is comfortable, it is safe, and it works! We also have done belly to belly nursing while lying down facing each other, but it doesn't work as well.
Here are some things I would like to share with anyone who finds herself in a similar situation:
My [other] postpartum recovery was uneventful, especially considering the unbelievable upheaval and physical demands I was placing on myself. My blood sugars returned to normal. I had a productive and helpful talk with my OB at my 4 week checkup. I still bring the baby by and send them pictures of him. If I get pregnant again, I will want them to be my doctors, along with a high-risk OB.
Contact me if you wish. Kmom has my email address.
Michelle G's Story (insulin-dependent GD, induction, provider problems, vaginal birth)
Kmom's Notes:
Birth Story
In order for my birth story and the emotions I have related to it to make sense, I'd like to give a little background. I have PTSD - post traumatic stress disorder. It's a result of an extended period of abuse during childhood. I am rarely affected by it anymore but childbirth is an area of my life that I need to be careful with. I do best when I feel in control and understand what is happening and why. I wanted a birth where the nurses didn't do internal exams, I didn't want an IV, and I wanted to use my own BG monitor and to be in charge of administering my own insulin.
First off, the outcome, a healthy, sweet baby was realized. Matthew is our sixth baby and he is a treasured addition to our family. The way he came into the world was not as I hoped. The interventions and loss of control have triggered another PTSD episode and I believe many of the problems I experienced could have been avoided if I had been treated like an adult instead of a patient.
I was diagnosed with GD at 29 weeks. I had never had problems in my previous five pregnancies but I did have some risk factors namely being overweight and 38. The diagnosis was especially difficult to accept because my midwife who had delivered my previous three children had become seriously ill and was out of the office from my 28th week until I was 36 weeks. She worked solo in the practice so I had never seen any of the doctors in the practice. The office in general was stressed in trying to pick up her patients and deal with their unique perspective on childbirth (the majority were highly committed to natural child birth). So I basically felt like I had no one to turn to for information.
I met with one of the doctors twice for about five minutes each time. He spent the time addressing my concerns about the interventions that GD could possibly cause by going over all the reasons I might need a c-section. He seemed to not realize that I had had five previous vaginal births - the last four with no pain medication and no problems.
So I turned to the internet for information especially regarding testing and how labor and delivery was managed. In the meantime, I was finally put on insulin - this was after two weeks of extremely high blood glucose readings. It was very difficult for me to get "plugged into the system"; I believe it was due to being the midwife's patient and high risk. I don't think the office knew exactly how to handle me. My insulin and diet teaching and daily insulin management was turned over to a home health care agency that specialized in maternal home health needs. I found their care to be extremely professional and the only complaint I had was that they were a bit too cautious in adjusting my insulin requirements. I was very insulin resistant and even after 20 days on insulin (4 times a day), they still were not able to get my fasting numbers under control.
After 20 days, I was discharged back to my midwife's practice. I was told to call when my levels were over the limits and that the doctor was to adjust my insulin. The next day, I turned in my charts (BG and insulin levels) with my questions but no one ever called me. So, I took charge and began to adjust my own insulin (I was still adjusting every day). I got my fasting numbers under control and had very tight control of the postprandial numbers without ever experiencing a low. I needed 48 units of NPH at night to get my fasting numbers down to the 90's and just for breakfast - one carb. And one protein, I needed 20 units of regular insulin.
This is important to demonstrate that I did have a very good handle on how my body dealt with insulin. I found that I was extremely sensitive to stress - after yelling at my children, I had a 20 - 30 point surge in my BG levels AND they would not come down until I took an additional insulin injection.
My midwife came back to work when I was 36 weeks. I had to go in twice a week for non stress tests and ultrasounds. She basically was hands off in managing the GD and consulted with one of the doctors if I had a question.
In addition to being extremely insulin resistant, I also had great difficulty in doing the blood tests. I was testing at least 7 times a day. I used three different monitors until I finally found one that I could use successfully. The problem was that my hands would sweat profusely when I had to do a finger stick. Two of the monitors needed a large drop of blood and I was unable to get one due to this problem, so then I had to stick again - several times. A number of times, I would mess up a strip because it took too long to get the blood on the strip and the whole process became a huge stress to me (and yes it affected my BG). I finally switched to a Freestyle and had no more problems.
Well, armed with both the knowledge of my difficulties in testing and my personal experience with my insulin needs, I asked my midwife to allow me to test myself during labor and administer my own insulin (even after 9 weeks of insulin injections, I was still needle phobic and did not want to be on an IV for insulin). My midwife conveyed this to the doctor and when I went to the hospital at 37 weeks he wrote the orders allowing me to do both of these things.
I agreed to be induced because I had asthma that was uncontrolled, the GD and finally low amniotic fluid. The doctor and my midwife both felt that I had had enough and it would be better for me and the baby to proceed with the induction. I had been induced several times using Cervadil and needing to be augmented with Pitocin. Even though they were long labors, I was able to get through them fairly easily with no pain medications so I didn't expect any problems this time.
I trusted my midwife and her judgment. I had known her for almost 7 years - she had been delivering children for nearly 30 years and I respected her experience. I didn't need to fight her or convince her of my desire to have a low-key birth. Even with the interventions we were taking, I was in control of what was happening to my body. She ran "interference" for me and kept the nurses from performing unnecessary exams; she kept them from placing an IV (needle phobic and found it very intrusive) and basically asked them to let me labor in quiet and peace with minimal interruptions. I found this environment to be safe and was able to labor in peace.
The Cervadil was fairly effective this time - after 12 hours, I was 50% effaced and 2 -3 cm. I made it through 24 hours at the hospital with my labor picking up. The one snag was that after she broke my water, the baby tried to float back up, so I was restricted to an upright position in bed until I had progressed more and got the baby to be firmly engaged (I had planned to move to a tub for the rest of the labor but had to wait).
I had a fantastic nurse during this period. She was one semester away from being a midwife, but circumstances necessitated her going back to nursing. She had worked as a labor and delivery nurse for 20 years and had the same philosophy as my midwife. They were an awesome team.
It was coming up on the evening shift change and my midwife asked me to consider starting Pitocin. My contractions were slowing a bit and I was still only 80% effaced. She was sure that just a short period on it would enable me to progress enough to get off the Pitocin and into the water to labor.
During this entire period, I did eat my regular GD diet and administer regular insulin. My BG remained low and I felt very good.
The new nurse came on duty and everything I had organized fell apart. I found out through other people that she had argued with the nurse who had cared for me for the previous 12 hours and with the doctor who wrote the orders letting me test my own BG levels and administer insulin as needed. She asked me a few questions about my GD but never let me know that it was because she believed I was going against hospital protocol. This was after 24 hours of having things the way I wanted and experiencing no problems.
She basically went behind my back and got the doctor to rescind his orders. He was so bothered by the whole thing that he came in and yelled at me - "What is this I hear that you won't use the hospital's meter and you won't be hooked up to an insulin drip?"
Well, that was the end of my low-key, safe, peaceful labor. I immediately broke into a huge, hysterical crying fit. My contractions stopped for the next 6 hours or so (even with the Pitocin that should have only been necessary for a little while). My BG levels went up - of course because I was stressed but again the nurse didn't want to hear what I knew about MY GD. My blood pressure went up and she continued to nit-pick every detail of my labor.
I felt like each thing she did was a power struggle and she was determined to come out on top. The IV she inserted was the most painful one and in a very awkward place making me unable to push off with that hand. Each time I needed to use the bedpan (I can't urinate in front of others) necessitated me telling her to leave - she didn't get that after the first, second or sixth time and I found it to be so disrespectful to me. She hooked me up to an insulin drip and said "How about you don't have to do anymore insulin injections?" with a smug tone of voice, again treating me like a child.
I had to use the hospital's glucose monitor because in a side by side test, mine was 13 points lower than hers. I tried to explain how the readings varied even with the same monitor, but again I was just a patient - she was the expert (side note - the baby was checked three times in a row by the same monitor and had levels of 38, 25 and 35 - see how consistently accurate their machine was?). The test strips she used were Accucheck curved strips - the exact same one that I had no luck in using. Thankfully, my hands didn't sweat.
I decided to receive an epidural because basically my midwife had given up trying to manage my labor and there was no way I felt like I could get through transition with the nurse's support. It was an extremely painful procedure, unlike the one I had received with my first labor. I needed a second dose of lidocaine to get through it.
As soon as I sat up, I nearly passed out - my blood pressure crashed to 60 over 40 and possibly lower but I am foggy about most of the next hour. I remember someone saying "Did you hydrate her - that's the same bag of pitocin she started with" (the Pitocin was started at 9:00pm and I had the epidural around 3:00 AM - so about 6 hours with no additional fluid and another side note is that I had received no nutrition for 17 hours not even a glucose drip). I received several doses of medication - ephedrine. I remember thinking that I was going to die and I worried about the effect on the baby.
An hour later, I could finally set up and I immediately felt pressure but the nurse didn't register it. An hour later, I said that I really felt pressure and she decided to check me (she wasn't suppose to, my midwife was in the next room) and I was 9 cm but she said the baby was high. She walked out of the room to get the anesthesiologist because the epidural hadn't worked on one side when I screamed that the baby was coming. I had my hands between my legs trying to hold his head in. With the next contraction, he spilled out on the bed as the nurse arrived followed closely by my midwife.
I could tell my midwife was livid with anger - she said "well at least I'm here in time to deliver the placenta". In my spaced out frame of mind, I thought she was angry at me. The nurse said smugly that she guessed she would have to write up the delivery because she was the attendant and I thought I would throw up.
My midwife quickly stitched me up without talking to me and left the room. I later learned that she wasn't mad at me but it doesn't change how I experienced the last bit of my labor. She told me that she tore into the nurse because she had clearly stated to her that I go very fast at the end but again, the nurse thought she knew better.
In retrospect, it seems like the nurse was in charge of my labor and delivery. A person I had never met somehow had more authority than a doctor and my midwife. If I were to give any advice, it would be to contact the head of the maternal medicine unit and find out what the protocols are in handling gestational diabetes - especially insulin dependent. It's vital to know what you are up against if you have any wish to have a say in how your labor is managed.
I would also strongly encourage hiring a doula or having a very strong-willed friend along to keep pushy nurses in line and to offer support. I dearly love my husband and he would do anything for me but just couldn't deal with the medical community. I think if I had had an experienced doula, she could have asked that the nurse be changed and helped me to get my focus back on having the baby.
I also should have met face to face with the doctor so that he understood my GD. As it was, I don't believe any of the doctors reviewed my charts. I don't think any of them understood how insulin resistant I was or what factors affected it or how competently I managed it. I think if I could have done that, he would have been more likely to support me in the face of this nurse.
Unless I don't turn up with GD next time or any other high risk problem (other than age), I will definitely not step foot in the hospital again without the biggest, meanest doula I can find. :-) I seriously want someone who is not intimidated by the medical profession because I will not be treated like this again. I don't really need support to get through labor (just the last 20 minutes) but I definitely need someone to stand up for me.
Penny's Story (insulin-dependent gd, induced vaginal birth)
Kmom's Notes: Penny was not plus-sized until her first pregnancy. She states that she was anorexic in college and 'probably messed up my metabolism for life'. She had a difficult first pregnancy with pre-eclampsia and a lousy OB. However, this time she had a "beautiful delivery. I felt fulfilled and joyful instead of empty and victimized like I did when my first daughter was born."
There are several items of interest in this pregnancy. First, note the disagreement her endocrinologist and her OB had about her treatment, illustrating the point that consensus on treatment protocols is limited, even among those who regularly treat gd. Find a different provider and you may well hear different answers to your questions, or different treatment goals.
Second, note that her OB insisted on inducing labor at around 38 weeks "to avoid delivering a 9 lb baby". Her baby was born at nearly 39 weeks and was barely over 7 lbs. Had she gone to term as she desired, it is unlikely she would have had a 9 lb. baby anyhow. This shows the problem of predicting size, even in gd pregnancies. Predictions of size are off significantly nearly 40-50% of the time, according to research, yet strong interventions are often done on the basis of these shaky predictions all the time anyhow. It is questionable whether this induction was really necessary, but since she was insulin-dependent, standard procedure among many OBs is to induce at 38 weeks.
Fortunately for Penny, she had previously had a vaginal birth, making an induction more likely to work. Inductions are much less likely to work (and to end in cesarean) in women with no previous vaginal births (i.e., first-time moms or moms who have had only previous cesarean births).
Birth Story
I had problems with my first OB--the problem was not with fat phobia but with insensitivity towards my emotions. Fortunately, the OB for my second pregnancy was different, although he was in the same practice (the first OB had left the practice).
We tried diligently (ovulation predictors, temp-taking) to get pregnant for 6 months. Just as I was about to give up, we were blessed! My GP called (on his day off) to give me the results of the blood test. His wife/nurse gave me the name (and a glowing recommendation) of her OB. After reading Kmom's website and the info on finding a fat-friendly doctor, I went to interview my new OB. I went with a list of questions in hand. I was pleasantly surprised when he and his staff treated me like a normal patient. There were no groans from the nurses about having to get a larger BP cuff. There was no mention about my weight. When I asked he said we'd see if any problems came up and then talk about it. He was very open and ready to go along with any type of delivery I wanted.
During the 29th weeks, I took the 1-hour glucose test. I failed it and took the 3-hour glucose test 4 days later. I also failed this test and was scheduled to meet the dietician the next week. Until then I was restricted to no sugars or fruit. (Grapefruit was the only food I craved so I felt very deprived.) The nurse/dietician was very nice but admitted to restricting the patients' calories to the point of ketosis. I was placed on a 2000 calorie diet with no sugar or fruit, especially juice. Needless to say I was worried. Ketosis is not good for the baby. She did suggest I try the ADA-approved Brand Name Diabetic Meals in Minutes Cookbook. On my next visit, I asked my doctor if I could have a few more calories--I was starving. He gave me another 400 which seemed to help.
I had been sending copies of my test results to my endocrinologist (I have hypothyroidism). The nurse called a few days later in panic; they wanted to see me asap. They had received my glucose results and wanted to manage my gd. I was given a meter and told to test 2x day---one fasting and another reading 2 hours after dinner. I was to try to keep my fasting numbers at 90 or below (my OB said 105 was okay) and non-fasting number at 120 or below. There was a big difference of opinion between the two doctors. I was grateful when my OB deferred to the endo. I felt uncomfortable being in the middle of this heated debate.
I found out that keeping to my diet was not easy--pizza and spaghetti were big trigger foods for me and I could not eat them at all. So I began taking aerobic classes (land and water) for moms-to-be. This helped me numbers and my energy level.
Around 34 weeks, my numbers were too high. I asked my endo for another week to get them down but it didn't work. So at 35 weeks (my OB did not think insulin was necessary), I began taking insulin. It was a very easy system to learn. It was all in a "lily" pen. All I had to do was add the needle. The insulin was in a cartridge in the pen that held about 200 units. I gave myself 10 units in my thigh each evening before dinner. Everyone told me that sticking your finger hurt more and it was true. I barely felt the injection. My levels after that were great. I went to see the OB and the endo every week.
Despite this and the fact that I had practically stopped gaining weight, the OB wanted to induce me two weeks early--to avoid delivering a 9 lb. baby. I wanted to wait until my due date to induce. I felt he was trying to scare me into it. I finally conceded and asked if I could choose the day and he agreed.
My first delivery was induced and a horrible 13 hour nightmare. I was unable to receive an epidural due to a clotting problem. Narcotics only made me groggy and sick.
At 38 weeks and 5 days, we went to the hospital at 7:30 a.m. My water was broken and I was given pitocin. My labor nurse was great! I was trying to tough it out for a while, thinking I had to wait for my epidural. "Oh no," she said, "We're controlling your labor. If the epidural slows it down, then we just increase your pitocin." I asked her to please call the anesthesiologist. Then I found out, I need to have a whole bag of IV fluid first, at least an hour wait. UGH! That next hour was hard. But my nurse was wonderful. She brought in a birthing ball to help pass the time. It gave me something to do and provided lots of laughs for my DH and support people.
After I got my epidural--I think I got it just in time--things started progressing quickly. I don't think I could've survived the last two hours without it. During the hardest contractions I only felt a mild pressure. I was able to talk and laugh with DH and my family.
At 10 cm, I asked for warm compresses to avoid an episiotomy and to have the bed/chair set up (before the dr. arrived). When he got there, everything was ready, including a mirror since I was unable to see our first daughter's birth. 10 minutes later, we watched our beautiful girl arrive.
4 weeks postpartum, I went to see my endo, who asked me to check my glucose 1x every day, alternating fasting and nonfasting readings. My gd was gone! I still keep tabs on it 3x/week.
I've been nursing her for 3 months and the only problem has been that I produce about twice as much milk as I need. (Check out breastfeeding.com for info on breastmilk banking.) I have also lost about 25 lbs.
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.
Birth Story
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.
Anonymous1's Story (3 vaginal births, the last with insulin-dep. gd)
Kmom's Notes: This mom's water broke before labor with baby #1. She was told that if she had no signs of labor yet, she probably wouldn't and therefore should come in for induction the next morning. Actually, research shows that even if labor doesn't start right away, most women go into labor within 12-24 hours after their water breaks, as it did for this mom. There is usually no need to induce.
Doctors feared that going too long after the water breaks was a risk for infection, but the actual infection risk turned out to be vaginal exams and procedures, which would be increased during an induction. The main factor was not so much how long the water had been broken, but how many germs had been introduced via vaginal exams, internal monitors, and other procedures. Most midwives (and many doctors) today believe that most women whose water breaks before labor should not induce but simply wait to go into labor, which will happen for most within a day or so (as it did for this mom). However, there are occasional exceptions where a different protocol might be necessary (such as possibly with group B strep), so always consult your provider.
Birth Story
Birth #1: I was 29 during my first pregnancy. I was about 270 lbs. and had to take serophene to conceive. My cycles have always been sporadic, whether overweight or not. I conceived my 3rd month on serophene. The only problem I had during the pregnancy was some first trimester bleeding. GTT (Glucose Tolerance Test) was negative, blood pressure was fine, weight gain of 17 lbs.
At 5 p.m. on a Sunday, 14 days before my due date, my water broke. I called the doctor at 8 p.m. (when I got home) and she said I would probably not go into labor as I wasn't feeling anything, and I should come in the next morning at 7 a.m. for an induction. By 12:30 a.m. I was on the way to the hospital, arriving at 1 a.m. My first was born at 4:13 a.m. with about 17 minutes of pushing. She was 8 lbs. 15 oz. I had no drugs but did have an episiotomy.
Miscarriage: The next time I conceived was on the first month of serophene. I miscarried that pregnancy with low progesterone. It was discovered I had a 7 cm ovarian cyst.
Birth #2: The next time I conceived was on the second month of serophene and I was 32 years old, 250 lbs. I had low progesterone and took progesterone, which caused first trimester bleeding. I do not remember what my weight gain was, but my GTT was negative, blood pressure was good. Only complication was after a bad sunburn, my blood pressure went up as I was dehydrated. [Kmom note: Dehydration can elevate blood pressure or start labor prematurely----it's VERY important to stay well-hydrated in pregnancy!]
Didn't go into labor till 3 days after due date. I was at the hospital for 45 minutes before my second baby was born. Had an epidural, just in time for pushing. Only numbed me for the stitch up (episiotomy again). I pushed out that 8 lbs. 12 oz. baby in about 7 minutes.
Birth #3: I had a 6 cm cyst removed in between pregnancies. The cyst was on a fallopian tube, not ovary.
I also conceived the third time on the second month on serophene. I was 34 years old and 300 lbs. This time my GTT was positive and the gd was very tightly controlled with diet and insulin. My blood pressure was good; in fact it was often quite low. I was also dehydrated with a bad sunburn with this pregnancy. Had elevated b/p and swollen feet with dehydration. One week on bedrest and everything was back to normal.
I went into labor 2 weeks early, after losing a total of 2 lbs. over the pregnancy. I woke up at 1 a.m. in labor. Left to the hospital at 2 a.m., arrived at 2:30, and baby was born at 3:15 a.m. At 7 lbs, 12 oz., she was my lightest. She came out with my very first push. no drugs, no episiotomy, but substantial ripping. [Kmom note: The ripping may have had to do with the 2 previous episiotomies. Once cut, the area often remains weaker.]
Sharon's Story (insulin-dependent gd, group B strep, vaginal birth)
Kmom's Notes: Sharon's story shows that having insulin-dependent gd doesn't have to mean a ton of interventions, an induction, or a difficult birth. Note how much easier she found labor when standing, and how she used hot water to help her when labor started getting more challenging. Also note that sometimes, just when you feel that you've got to have that epidural, just lasting a little bit longer is enough to make it through without.
Birth Story
I'd switched providers in my 35th week. I'd started out in the Alternative Birthing Center with midwives. Lost that when diagnosed with gd. Lost the midwives when I became insulin-dependent. I didn't want to give birth with OBs on the regular maternity ward of a big teaching hospital. So I switched to a less-conservative OB with a community hospital. And I'm glad I did.
My new OB, while initially talking induction at 40 weeks, allowed me to go to 41 weeks because my numbers had been good, and I was measuring on target. (OK, I admit, my adamant desire to avoid induction had something to do with this decision.) Fortunately, I went into labor naturally two days past my due date.
I sort of knew something was up. All day Saturday, I'd been feeling what can only be described as 'pre-menstrual'. Vaguely crampy. Nothing definitive, but a sensation that'd I hadn't had in quite a while. Decided to get some things done just in case. Went grocery shopping, got a massage, made DH take my belly pictures in front of the house with the new tulips waving behind me. The thought occurred to me to make dinner something special, just in case it was my last as a non-parent. Ultimately, we went to a local restaurant for some average veal parmesan. During dinner, I threw a couple of contractions. Just like the braxton hicks tightenings I'd been having for quite a while, but this time they sort of wrapped around to my back.
At home, I counted and realized that I'd had quite a few of these tightenings, and we might want to time them. DH started timing them as I noticed they were definitely getting stronger. I was handling them OK. I discovered that being upright and/or leaning forward on something made all the difference in my pain.
When they were about 5 minutes apart, we called the doctor. The doctor on call asked if it was my first and didn't seem too concerned. Then he asked what my status was at my last appointment. We told him 3 cm and 80% effaced---his tone changed and he told us to go to the hospital immediately. I was astonished to find out it was already midnight at this point! Time definitely suspends during active labor.
Contractions in the car are no fun. I was heartily annoyed when they made me ride in the wheelchair to maternity. After weathering contractions sitting down in the car, the last thing I wanted to do was sit down again. The doctor introduced himself and checked me. I was disappointed to find out that I was still only 3 cm and slightly more effaced, but the contractions were strong and regular so they admitted me. We were committed now!
At this point, the contractions were completely radiating in my lower back. All I wanted to do was get settled into my room and into the hot shower. The hot water on my back was the perfect thing for my back contractions. DH kept me company trying to figure out the right things to say and not say. Truthfully, during contractions, I couldn't have cared less what he said. But just his presence was incredibly comforting. I don't remember how long I was in the shower, but they made me get out for my IV (antibiotics for Group B Strep, as I'd tested positive), and to run a fetal monitor strip. My (male) maternity nurse had a good touch for the IV.
It was probably about 2 a.m. at this point, and I admit it, I was hurting now. Being made to lie in bed for the monitoring was almost enough to put me over the edge. One good contraction and I felt my water break with a small gush. The contractions definitely changed at that point, and not for the better. They were sharper and hurt in the front and back now. DH was good with the counter-pressure on my back, but this was helping a lot less than before. The word, 'epidural', started creeping across my consciousness. How easy it would be. I was having trouble remembering why going natural was a good thing. DH wanted to be supportive of my decision to go natural, but he was conflicted seeing me in so much pain. At this point, I remembered some advice---always ask to be checked before making any decisions. The nurse checked me and I was 5-6. Everyone in the room was very impressed with my progress---except me. All I could think was "5 more cm of this!" I cried uncle and asked for the epidural.
And if the anesthesiologist had been standing there with a needle, I'd have done it. However, the nurse told me that I could have something in the IV while they called the doctor on call. What? No doctor available in the house right now? I declined the IV meds and neglected to answer them about paging the epidural guy while handling a few more contractions. I was feeling a little 'grunty' during contractions, and pooped a little while standing up. (I was never worried about pooping during labor. I totally didn't care. I just pointed it out to the nurse to clean up.) I asked if I could poop some more and had a couple of pushy contractions on the toilet while the nurse told me that I shouldn't try to push the poop out, just let it come out.
At this point I asked to get back in the shower, as the contractions were almost literally running me over. In the shower, I had one contraction and felt the overwhelming urge to push. I squatted down and felt the pressure move down. Uh oh. I got out of the shower and asked to be checked again. Thankfully, he didn't question me. His fingers didn't even enter my vagina when he exclaimed, "Oh!"
He called for the other nurse to get the doctor. "She's complete and almost crowning!" The contractions were different now. They didn't hurt as much, or at least I don't remember them hurting. I just had the overwhelming urge to push. Urge isn't the word. It just happened, I was along for the ride. Dh asked what that was at my vagina. He was a little astonished to be told, "That's the baby's head."
Pushing didn't hurt like I expected it to. Pressure, some stinging, more pressure. The doctor came in and gloved up and told me I could push when I felt like it. A good solid push and the doctor told me, "Hang on, the head is out." What? I really expected it to get a lot worse before the head came out. Another gentle push and I felt that amazing feeling of the body sliding out of me into the doctor's hands. It was purely happenstance that the CD player, queued up with music, came on with Stevie Wonder's "Isn't She Lovely" at just the moment our doctor announced, "It's a girl!" It was 3:05 a.m., and she was 7 lbs., 4.2 oz., 20 inches long.
I was in complete shock. We'd done it. The baby gargled a little and started crying lustily as soon as they suctioned her out. They put her slippery little body on my stomach and let her cord stop pulsing before coaxing a reluctant hubby to cut the cord. Both DH and I were fascinated by the placenta and sac as the doctor examined it and explained it to us. The next few hours passed with a couple of small stitches, a decent first pass at breastfeeding, and a terrible attempt at some sleep while they took the baby to the nursery for her initial work-up.
The baby is beautiful (of course) and seems to be taking to breastfeeding pretty well. We'll work out the parental sleep logistics soon enough. After going through it without even a Tylenol, I understand how it can be a life-changing event. I faced my greatest fear, pain, and came out on the other side. Good luck!
Sharon's Second Birth Story
I woke up Wednesday feeling kind of punky. I'd been having
some pains in my sleep and they continued that morning. Drinking a lot of fluids
and a hot shower helped some, but they were never really far away. I considered
letting DH in on the secret, but with all the Braxton Hicks I'd been having, I
figured I'd wait until they were serious. I was going to the hospital
later for an NST anyway.
So I puttered about and went in to the hospital for the NST. My mother comes to
watch DD while I'm hooked up. I had one contraction while on the
monitors...which the darn machine didn't even pick up. Oh well. We had lunch
with grandma and Isabella and I went home for a nap. I joined her, which I
ordinarily wouldn't do. I'm glad I did. Isabella woke up early and because DH
was working late, I decided to run a couple of easy errands at the mall. I
wasn't really having discrete contractions at this point, but my uterus was
feeling sort of irritable.
Walked around the mall and had a nasty fast food supper. I felt momentarily
guilty for feeding Isabella chicken fingers for the second time in one
day, but I just wasn't up to cooking. At this point, I was definitely getting
some more discrete contractions, but they really weren't more than surges of
pressure and not in a definable pattern. Still, I sort of knew something was
going on because they felt more productive than the tightenings I'd been having
for weeks.
By the time I got home, DH was waiting. He got Isabella ready for bed while I
puttered around the house a bit. After she was in bed, I finally told him that I
thought something might be up. I decided to try a bath to see if it made a
difference. Sure enough, contractions stopped completely while I was in the
bath, but came back when I got out. We didn't do the timing thing, but I was
mentally keeping track. Around 2:00 AM, they were semi-regular at about 10
minutes apart. I also had the loose stools which were the harbinger of labor
last time. But it wasn't until I decided to check myself and felt not my cervix,
but something hard and foreign that I decided to "ring the bell". I
also forgot to mention that I was 3cm dilated at my last appointment the day
before and my first labor was quite quick.
Doctor actually wasn't eager to get me to the hospital, but I asked to just be
checked. I didn't mention checking myself. So we called in my mother to watch DD
and off we went. Got to the hospital around 2:30 and entered the ER to the
smiles of the reception people. I'm thinking laboring women are about as
pleasant as it gets down there. Interestingly, this time they didn't insist on
the wheelchair, just a nurse to walk with us, which was fine.
The L&D nurse was very nice, but it was quite apparent that she didn't think
I'd be staying. Contractions were very sporadic on the monitor and I probably
didn't have that "in labor" look about me. Her manner changed
completely when she checked me and found that I was 5cm with head "well
applied." She also noted that my Group B strep came back negative, which
was wonderful news as it meant no mandatory IV.
I have to make a note about my emotional state at this point. I wasn't ready. I
*love* late pregnancy, even in August. I like wearing maternity clothes and
having the old ladies smile at my belly. Even with all the hassles of managing
my gestational diabetes, I just didn't feel like giving in. However, I was eager
to meet this new person.
We get settled into the room and I commenced laboring. I made the comment more
than once that this slower labor thing was great. Every few minutes, I'd have a
contraction which I swayed and breathed through. At this point, they weren't
painful except for a peak which got my attention, but passed quickly. In between
I paced the room and joked with DH and the nurses. The first monitor strip they
did, I asked if I could have it done in the rocking chair instead of the bed. My
contractions slowed down but felt stronger. Even so, they didn't register more
than 25 on the monitor. Stupid machines. The nurse wasn't really worried, having
been reassured by my 5cm status earlier. At one point another nurse came in and
joked with me. "Has anyone mentioned you're pregnant?"
"Gosh, really? You know, that would explain a few things." Off the
monitor, my nurse took me on a walking tour of the unit. I had only one minor
contraction and for all observers looked like nothing was going on.
But for the most part, they left DH and I alone, which suited me fine. I have to
comment about my Dear Husband. He has the knack for knowing when to joke with me
and when to just shut up and do what he's told. He is *my* ideal labor support
person. During this time, I discovered that just pacing brought the contractions
on most regularly and spent most of the early morning doing that. Contractions
were still anywhere from 2-10 minutes apart, but feeling very productive. When
the contractions got stronger I asked DH for counter-pressure on my back, which
is where I felt most of the pain. Ultimately, doing my own counterpoises with my
thumbs and sort of wagging my hips worked best. Because labor seemed to be
going so slow, I was hesitant to get into the shower and slow it down further.
Finally, I started getting tired and asked to do the next monitor strip on the
birth ball. Again, the contractions spaced out, but felt stronger. It was also
nice just to rest a bit before "bringing them on" again by walking. At
this point I was actually wondering if I was going too slow. After a bit, I
asked to get into the shower just to see what would happen. Contractions felt
*great* in the shower and came on even more regularly. I decided to get serious.
I started chanting "OK, it's time" and "open" during the
contractions and sort of mentally letting go. That's when I felt my water break
with a small "pop" and a little gush. It was probably about 6:30 at
this point.
Of course, they never just take your word for these things and wanted to test
with the strips. It was inconclusive, but they noted it anyway. The nurse
checked me for the second time that night and discovered I was a 7-8. At this
point contractions stopped and I took advantage of the breather. I made a
comment about getting back into the shower when I got a case of the grunts. This
is my term for it. You get a whopper contraction and all of a sudden the only
thing you can do is push and grunt. Nurse wryly commented that the shower
probably wasn't going to be a good idea and called the doctor.
While waiting for the doctor, contractions slowed a bit I got a good breather.
Doctor came, checked me and said I was 8 with a lip and to breathe through a
couple of contractions. Um, OK. It was about 10 minutes to shift change and they
mentioned the name of another doctor on the way in. Meanwhile, my doctor left
the room while I struggled through one contraction before feeling the
overwhelming urge to push again. I mumbled something about the lip being gone
while they paged the doctor again stat.
Another aside. Just once I'd like to give birth without the words "don't
push" being uttered. Yeah, tell that to my body.
Doctor comes in and pushes my legs *way* back and insists I hold them. I don't
like this and I refuse to hold my leg, so he's pushing it back with his
shoulder. He insists this will reduce tearing, but I'm not convinced, but in no
position to argue. This time, I really didn't get a strong crowning sensation.
Some pain, yes, but no clear sense of burning like last time. Two good pushes
and the head was out. Another good push and I felt that amazing sensation of his
little slippery body leaving me. In that instant, I had a son and all pain
disappeared. 6:56 AM. He was fussing a bit while they wiped him. They put him on
my stomach and he immediately looked up at me and stopped crying. An action
which cost him an APGAR point.
The placenta delivered quickly and easily with a small feeling of pressure and
some minor cramping. The doctor said that I tore and I'd need a couple of
stitches. I was annoyed at that because I felt that the pushing position was the
reason, but agreed to the local. Thankfully, I was mostly still numb and the
local and stitching was only a minor annoyance. I looked over to where DH was
watching them examine the baby and saw his face. My husband had a son.
We had our first nursing and he was a pro. Having a tiny newborn nursing felt so
weird after so long, but so right.
The nurse checked Domenic's blood sugar several times and had trouble getting a
reading. Finally she got a reading of 45 and they mentioned supplementing with
formula. Now, I'm a major breastfeeding advocate. I'm a confident person who
deals with medical professionals as consultants, not gods. I *know* that
colostrum is the right thing for low blood sugar. I also know that even one
feeding of anything but breastmilk can potentially change the flora in the gut.
I was even half-aware that 45 wasn't that low, but the nurses were insisting and
I did what most immediate post-partum mothers do when pushed about the health of
their long awaited baby. I gave in.
Thankfully the IBCLC came into the room at this time. Whether somebody summoned
her, or she was just there because of shift change, I don't know. But she gave
me the option of pumping some colostrum for a supplemental feeding. I did this
and was thankful that I'd continued to nurse through pregnancy because I
actually got some more colostrum (5-6cc's) to give him with a syringe. Another
blood test showed him still at 45, but people seemed content with that reading
this time. After his next nursing he was 65 and fine.
All in all, my labor was what I wish on every mother. Some might say that I have
natural births because I birth easily. Others might say I have easy births
because I avoid interventions. I'd say it's a bit of both. Being able to move
around and choose different laboring positions makes all the difference for me.
Not being "tethered" to an IV leaves me free to move as I choose.
Contractions I had in bed, or sitting down felt more painful than the ones I had
in the shower which seemed more productive. And I'd also like to say that the
emotional labor can be as trying as the physical. But every twinge and
angst-ridden moment is wiped clean in the end.
To see pictures, go to http://members.aol.com/sharondio/birthpix.htm
Dawn2's Story (diet-only GD, herpes, PROM, preemie, vaginal birth)
Kmom's Notes: Dawn was able to ask a lot of informed questions of her providers, and was able to advocate for the kind of birth that she wanted. Having a doula can be especially helpful if you are facing complications and a more medically managed pregnancy, like GD pregnancies often are. Being co-managed and attended by a midwife at her birth probably also helped her avoid an unnecessary c-section.
Dawn's baby was probably malpositioned; she had strong back labor and a long pushing stage in which she seemed to make little progress for a long while. Then she felt the baby rotate internally and suddenly pushing became more effective, and the baby was born not too long after that. Once again, fetal position makes all the difference in the world for this mother.
Birth Story
I failed the 1-hour glucose screening test, but not by much as I recall. After the 4-hour test, I was diagnosed with gd because my fasting was high and my 2-hour level was high. I was placed on a 2100 calorie food plan, which I followed but had real emotional issues with because I hadn't dieted for many years (with a stable weight), and I really felt deprived not being able to eat the sweet things that I hadn't denied myself for years. I fell right into the emotional landmines that dieting brings, and it was really hard for me.
I tested 4 times a day--in the morning and 1 hour after each meal. I had done a ton of research on gd and so was in the position of asking questions of my provider (midwife) that she couldn't answer. I was co-managed by an OB, but he used Matria, a diabetes management provider, to which I was supposed to call in my numbers and talk with a counselor each day. I really felt like no one could give me a straight answer to my questions--it was a big deal because I asked whether the cutoffs they were telling me to have were supposed to be measured in blood or plasma, and what they told me didn't match the numbers I had seen -- I felt like they were asking me to have blood glucose numbers much lower than necessary, and the stress was causing my numbers to be higher. I was really concerned about insulin and the effects of altering my baby's metabolism before birth. If the OB had insisted on insulin, I was thinking that I would consider switching providers.
As far as the GD, I did get into something of a groove, but I found that fruit affected the numbers more than anything--I couldn't have an apple without my numbers jumping up, and that just seemed so counter-intuitive that fruit could be bad for me. But I was careful to be really active, maybe even more so than when I wasn't pregnant, and my after breakfast and after dinner walks really seemed to help.
One morning just after I was 34 weeks pregnant, I woke to a little moisture, kind of like when you've had a lot of discharge the night before. After my morning walk, I noticed a little bit of brownish discharge on my underwear. I didn't think anything of it, but later, as I was getting dressed, I felt some leakage. I thought it was just urine, as my sister had had a lot of urine leakage as she got to the last couple of months. But, combined with the discharge, I thought I'd call the midwife's office. They told me to come in, which I did later in the day. I wore a pad, because all day, as I walked around, I would occasionally feel some leakage, just a little here and there like I couldn't hold urine. I had been having occasionally tightening contractions, Braxton-Hicks, for the previous few weeks, and the frequency of those did not change.
When I got to the midwife's office, she started to do an internal exam, and as luck would have it, there was a little gush at the same time. She said, "That's not urine. It's coming from your cervix. I think you're going to have to go up to the hospital for a bit." I was really surprised, because I did not expect her to tell me that my water had broken. When the OB came in, the first thing I said was "I guess we don't have to worry about her getting too big!" and he was a total jerk, telling me that gd babies may be big, but they're not mature, etc, etc, etc. Just what a woman who has just been told she's going to have a premature baby wants to hear. I also thought I might have a herpes outbreak at the time, although I hadn't had any through my pregnancy, and was planning to go on suppressive therapy for the last 4 weeks of the pregnancy. (Vaginal births are now ok for moms with genital herpes if there is no outbreak at the time of birth.) The OB gave me these options: If I was having an outbreak, or if the baby was breech, I would be scheduled for a C-section right away. If the baby's lungs measured mature after they sampled the amniotic fluid, they would induce if I didn't go into labor soon, because I had estimated that my water had broken sometime in the morning, and they wanted the baby born within 24 hours. If her lungs didn't show maturity, they would let me hang out, and give me antibiotics to prevent infection, but they wouldn't stop labor if it started.
It turned out I wasn't having a herpes outbreak, so I was sent to the hospital with instructions that I would be admitted. Baby was head down, which was good, and I was put on a monitor, and I guess I was having occasional contractions, but I didn't really feel them. My doula and I waited for a while for the results of the amniotic fluid sample, and her lungs weren't as mature as they wanted, so they started me on IV antibiotics and I waited for a room in the high-risk antenatal unit.
The next morning I wore the monitor something like twice a shift. I was supposed to be on bedrest, but was able to go to the bathroom. As the day went on, the contractions got stronger and stronger and more and more frequent, and I seemed to be passing my mucus plug in the afternoon. I called my doula around 5 pm, because I wasn't able to handle the contractions on my own any more. I didn't really feel like eating, but managed to nibble a little. I think the contractions were about every 7 or 8 minutes at that time, but I could definitely breathe through them, and though I was supposed to be on bedrest, I would stand up and kind of rock my hips during contractions, to try and help gravity move her down. The nurses "caught" me, though, and I did have to wear a monitor part of the time.
By 8 pm or so, I was in "active labor" and was wearing the monitor. I could absolutely not lie flat--it was too painful, so I generally laid on my side. My back was also beginning to hurt constantly, so my doula rubbed it with an ice pack through contractions, which had gotten steadily closer and closer together. I had a couple of internal exams, and I guess I went from 3 cm dilated at 9 pm, to something like 8 cm at 10 or 11 pm. Fairly early on, I started asking for an epidural because I was having a hard time managing the contractions, but they didn't want to give me one because I was only at 3 cm, so they gave me some Nubain instead. That helped a lot, and I was able to relax. The next time they checked me, I got a second dose, which helped but not as much as the first one. When that wore off, I started to feel like I wanted to push. The decision had been made that the midwife could manage my labor since the baby was good-sized and looked good on all of the monitoring, so I was really thrilled because I had wanted a midwife, not an OB, all along.
The moved me from my antenatal room to an operating room because there were no labor and delivery rooms available--it was a full moon and the hospital was packed. My doula and my mom came in as my support persons, and I started pushing around 1 am. I tried several positions, on my back, on all fours, I stood and tried to squat, but it really took a long time to feel like the baby was getting anywhere. It was really, really discouraging to feel like I was doing this incredibly strenuous work and the baby wasn't coming down at all. We talked about an epidural, especially after I had pushed for something like an hour and nothing was happening. I wanted one, because the back pain and contractions were very difficult. But in all of the movement, my IV had come out, and they wouldn't give me an epidural without an IV in. The nurse tried to get another one started, but was not successful after poking me I don't know how many times. They had to call in an anesthesiologist to get an IV going, and he tried several times as well--I will say it was difficult for him, too, because I couldn't stay still for very long--it seemed like the contractions came every couple of minutes, and then I had to push, so he couldn't really search well for a vein. This took another hour or two, and I pushed all while they were trying to get an IV started again. Finally, they got one started, but the baby had finally made some progress downward, so I didn't get an epidural.
At one point in between contractions, I was resting with my doula and the nurse holding my legs up (because the pressure was so intense), and I felt the baby unmistakably rotate. At that point pushing seemed to have a point, and soon I started to be able to see her head in the mirror up in front and above me, and that really motivated me. It was still somewhat slow and agonizing, and right as she was crowning was really intense, but the moment her head came out (5:12 am--after 4 hours total of pushing) all of the pain and pressure was gone--almost instantaneously. It was really amazing how quickly the pain was just . ..gone.
She didn't cry immediately, and she was taken to the warming table, and she started mewing within a few minutes. Her apgars were something like 7 and 8, which I thought was great for a preemie, and she was 6 lbs 5 ounces! The midwife saw that there had been a knot in the cord, which could have been fatal if she had gotten bigger. I got to hold her after a couple of minutes, and my mom carried her up to the NICU for observation.
There was no episiotomy, no tears and I didn't require any stitching--the midwife said that was probably because I hung out with her crowning for a couple of contractions--she didn't come out in one push. In recovery, the most thrilling thing was that I got to drink some orange juice--which I hadn't been able to have for a while! I made sure that the nursing staff knew I wanted to breastfeed and got the information as to the baby's first feeding, which was scheduled a couple of hours after I got to my room. I went to the NICU, and was able to try to nurse with a lactation consultant's help right away. She didn't latch on for long, but she did latch for a bit, and then I followed with a bottle. She was on IV antibiotics (because she was born more than 24 hours after membrane rupture) but didn't need extra heat or oxygen.
I went down for almost all of her feedings, and attempted to get her to nurse first, before giving a bottle. I was quickly given a pump and instructed on how to do that, and I think I started getting little drops of milk on Friday night (she was born early Thursday morning) which I took down for the NICU to give her in a bottle. At one point, the NICU nurse called me about a half an hour before her scheduled feeding because she was crying and the nurse thought she was hungry--so I was able to continue to try to get her to nurse first when it would be most useful. I was released Saturday afternoon, but the NICU doctors wanted to keep the baby for another day, as she had started to get somewhat jaundiced. Sunday I checked on her right away, and because she hadn't really lost any weight and the bilirubin levels had peaked I was able to take her home then.
When we got home, our routine was every 3 hours to attempt to nurse, feed pumped milk, then feed formula if she was still hungry, and then pump if she hadn't latched on for at least 15 minutes. At her one week appointment, she was above her birth weight, and because the schedule was making me crazy, her pediatrician told me I could feed her on demand. After about 3 weeks, she was nursing much more consistently, and I dropped the pumping, and about once a day gave her some supplemental formula. By the time I went back to work when she was 12 weeks old, we only supplemented on occasion, but that changed as I didn't let down well to the pump and couldn't keep up with her demands by pumping. (Tried oatmeal, fenugreek/blessed thistle, breast compression while pumping, but my supply just got lower and lower as each month went by.)
At 11 months, she's 20 lbs, we're still nursing, although I've stopped pumping, and I hope to continue nursing as long as she wants to. She gets 2-3 bottles of formula daily at daycare, and 1-2 daily on the weekends when she nurses to sleep for her naps. I was thrilled that I got the kind of birth that I wanted, although there were so many things that almost derailed us in the process! What was important to me was that I had a healthy baby, born vaginally, and that I avoided an epidural and episiotomy, and I got all of that, although it was not easy! And breastfeeding was not easy at the beginning, but I feel that we have been successful at it and am not ashamed we had to supplement--I wish we didn't have to, but the circumstances were such that we have, and she's thrived.
I hope this story is useful for someone .. .the best advice that I can give you is to research, research, research--and don't be afraid to question your caregiver. Ask for their rationale for the decisions they are advising you to make and if it doesn't make sense, see if you can get another opinion and talk about it. Get as much support as you can--I had a wonderful experience with my doula and would highly recommend getting one, even if you have a partner because they offer a neutral perspective and are there to help you get the kind of birth you want.
Erika's Story (insulin-dependent GD, premature labor, vaginal birth)
Kmom's Notes: Although it is impossible to know for sure, it is quite possible that the reduced calorie diet Erika was placed on did indeed contribute to the premature birth of her baby. Many midwives believe this happens frequently with twins; when the babies are not receiving adequate nutrition within, it becomes safer and healthier for the babies to come out early, even as preemies. Unfortunately, many doctors and nutritionists do not recognize this and continue to dictate reduced calorie diets to plus-sized women. Even the most rigid GD guidelines do not suggest such strong caloric reductions as 1300 calories, however.
Birth Story
This is a rather embittered story about over-managed GD. I'm currently in my second pregnancy and what I learned in my first has served me well so far. At 31 weeks I'm diet-controlled and with a midwife who is committed to not allowing my first pregnancy experience to be repeated. So far so good.
I had a completely normal first pregnancy until week 28 when I screened positive on the one-hour glucose test. When I went back for the three-hour, the nurse who drew my vials commented very 'cutely' to my belly, "Mama's been hitting the ice cream too hard so we have to do this test." I failed the three-hour. It wasn't until over two years later that I found out about carb-loading and how it can affect your results. I remember not eating anything past 3:00 p.m. the day before. The test was drawn late in the morning.
My OB, the only person my insurance would cover at the time, was truly unavailable for support. She rushed through all our appointments, not leaving time for questions. At week 30 she referred me to the hospital's 'gestational diabetes care clinic' comprised of three rotating endocrinologists, a nutritionist (dare I call her that?) and a nurse-educator, all of whom I saw every Tuesday. At our first meeting the nutritionist very patronizingly recommended we all eat as much aspartame as possible before introducing us to our new diet, one that I would later calculate to add up to roughly 1300 calories per day, avoiding most fruit, dairy, and carbs.
I was sent home with all of this overwhelming information, and after attempting diet control for one week I lost three pounds. The following Tuesday I was chastised by the nutritionist, "You're not eating any fruit! Your baby needs fruit!" then, accusingly, "Why aren't you gaining any weight?" Instead of working with me to up my calories in a constructive way, she recommended I be put on insulin injections immediately.
At my next OB appointment my doctor declared that because of the diabetes she wouldn't let me go past my due date and we would probably be looking at induction or scheduled c-section at 38 weeks. She then hurried from the room as usual to check on her next patient. This is when I lost my mind.
I phoned a doula immediately. We had a long talk, and she confirmed my OB's reputation for pre-emptive cesareans. I had resolved to hire her, except the next evening I went into spontaneous premature labour and had a baby four hours later. I'm convinced that the absolute panic of the 'inevitable' c-section, combined with the sudden third-trimester starvation diet caused it. My current OB, midwife, and nutritionist agree.
When I went into the hospital in labour the nurse team had no idea I was insulin dependent until I told them. They were all strangers. I have to say my labour and delivery did go off without a hitch though - no epi, no tearing, 20 minutes of pushing. My only issue was a consistent battle between myself and the nurse team over not wanting any needles in my body. They actually wanted to break my water to "speed things along!" I mean, come on, 4 cm to fully dilated in 90 minutes at 35 weeks? I don't think speediness was a problem.
My son was in the NICU briefly with jaundice and some minor complications of prematurity. He's healthy as a little horse today - 90th percentile in size for his calendar age - off the charts for his gestational age.
I learned several things from my first pregnancy. The blood lab nurse's comment combined with the horrible nutritionist caused me some serious and unexpected food issues later on. I was in therapy for anorexia at the start of my second pregnancy because I was so terrified of repeating my first pregnancy experience. I've mostly recovered now, though eating enough and testing blood sugars every day is a still a serious psychological struggle. I ended up quitting my work completely this time in order to concentrate all my effort on diet, exercise and my young son. Stress is a huge factor with my blood sugars.
My advice to a newly diagnosed GD patient would be to call a doula, educate yourself fully about the GD testing and treatment process (if you're here you're doing a great job already,) then sit your doctor down and grill them on how they see this changing your labour and delivery plans. If you're overweight do NOT let people assume you have GD because you're fat or you "eat too much ice cream." Even though obesity is one risk factor, your weight is not something that's going to change significantly prior to week 40, and no one is doing you any favors by making you worry about it during your third trimester. After being chastised repeatedly by medical personnel about my weight during my first pregnancy, it turns out my mother's birth father was type 1 diabetic - most likely the genetic reason for my impaired glucose tolerance in pregnancy.
I have a much more relaxed and non-judgmental care team this time around, so hopefully I'll be submitting a happier story in a few months!
Tammy's Story (gd, PIH, induction, vaginal birth)
Birth Story
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.
Jennifer C's Story (diet-only gd, SROM, GBS+, vaginal birth)
Birth Story
I had a history of cervical cancer and was told I'd probably never have a child. So I was prepared for us to try for a really long time before we conceived. Imagine our surprise when, four months after stopping bcp, we were pregnant!
I had a very easy pregnancy. No morning sickness and everything was going along very well. I lost 17 lbs in the first 16 weeks. By 25w, I had only "gained" 6 lbs (but was still down 11 lbs from my pre-pg weight). I had some wild mood swings, but thought it was just "because I was pregnant." At 28w, I took the 1 hour GD test and failed spectacularly -- 203 (140 was the cutoff my midwives used).
My first reaction was anger, shock, fear. I began compulsively reading everything I could about GD and the GD diet, trying to become more knowledgeable and using all the resources provided to me. I took a class, got my blood sugar monitor and began watching what I ate. As I got used to the new way to eat, I noticed my moods softening. I also got used to the idea of having GD and it was easier to accept.
My fasting numbers were always on the high side -- 103, 96, 100, etc. I never could seem to get them down no matter what I did. But none of my other numbers were ever high and my midwives were unconcerned about the fasting numbers. Despite the high fasting numbers, they allowed me to test only twice a day after being on the diet for 4 weeks.
I want to talk for a second about my midwives. I was been seen at a practice where there were 5 of them and you had to rotate between them all because you didn't know who was going to be on call when it was time to deliver. There was a midwife I loved, one I loathed, and the other three were OK. Guess which one was on duty when I went into labor? She wasn't a *bad* midwife, but I didn't like her interpersonal skills (my mom called her a "cold fish").
At 37w exactly, my water spontaneously broke at 5 am. I was admitted into the hospital at 12 noon and the midwife (M, to be cleverly succinct) immediately wanted to begin pitocin as my contractions were NOT strong and I was only 2 cm dilated. I put her off and convinced her to let me walk around awhile. At 3 pm, she checked again ... still at 2cm. She abruptly said, "Well, then that's that. Let's start that pit!" Luckily, DH and I had already agreed to do the medicine or else I would've been really mad that the decision was being taken out of my hands!
I'd like to say that things began happening very fast after that, but they didn't. I was dilating very slowly and they kept increasing the pit. My Group B strep was positive, so they began antibiotics as well. At 2 am ... nearly 24 hours after my water first broke ... I couldn't take it anymore and asked for an epidural. It took an hour to get it to me and for it to start working, and by that point, I was at 8cm. Very quickly, I went to 10cm but my contractions were coming irregularly again and the baby began showing signs of distress.
At 7:14 am, after 26 hours of labor and 45 minutes of pushing, my son was born. While I was pushing, M casually mentioned that babies born to moms with GD sometimes have large shoulders and they might have to vacuum him out. [Kmom note: This would be the WORST thing she could do! Shoulder dystocia is known to be associated with forceps/vacuum deliveries.] Then she casually mentioned that we might have to do a C-section if I couldn't get him out "soon." Luckily, that kid wanted to be born as much as I wanted him out. The cord was wrapped around his neck (twice!) and he was a little blue. But he scored 8 and 9 on the Apgar and pinked up almost immediately.
On his first heel prick test, they discovered his blood sugar was very low, so they forced us to give him a bottle of formula. (It was 9 or 14 and the doctor actually said "brain damage" if I didn't give in!!) Luckily, I convinced them to let me nurse him a little first. I really think doing that helped us establish a bond and made breastfeeding easier later. We supplemented with formula for the first week and since then, he's been exclusively breastfed.
We had such a terrible experience at the hospital overall and I hated M more and more as the night went on. I never felt like an individual, and never felt like she was listening to ME, but was on her own agenda. (I've since switched providers.)
After giving birth and bfing, I've lost more weight and now weigh approx. 40 lbs less than my pre-pg weight.
One more note: My sister and I were both 9 lb. babies, so I always expected to have a larger baby. When that baby came out at 7 lbs, I felt like he was tiny! Yet, everyone comments that he was big for being born at 37w. (If I'd gone to 40w, he would've been around 8 1/2 lbs.) I'll never know if that was because of genetics or the GD.
Eve B's Story (diet-only GD, all natural vaginal birth)
Kmom's Notes: With GD and a big mom, the doctors all worry about a giant baby. Some give very restrictive diets as a result. But it's important to note that sometimes being too restrictive is not good for the baby either. Most GD babies, even those of big moms, are still "average" in size. Overly strict control can restrict fetal growth in some women. Now, no one will ever know if this is true here.....perhaps this mom just naturally has small babies, no matter how she eats. But the baby's appearance at birth suggested that perhaps some growth restriction may have happened. A lesson in the importance of moderation, especially in the face of very borderline GD results.
Birth Story
From the beginning, I was determined to have my child naturally. My husband and I took early Bradley Method classes, and followed the daily guidelines for exercise and nutrition, swimming everyday and eating plenty of protein. At 31 weeks, I took the 1 hour GD test and failed with a 146. I wasn't too worried about it, and neither was my doctor as though I am overweight, I am otherwise healthy, eat right and exercise everyday.
Two weeks later, I took the 3 hour test. I failed the first test with a 96, and then failed the second test with a score in the 180s. (I passed the last two with very low scores.) My doctor diagnosed me with GD, and it was a huge set back to my positive frame of mind. I thought I had done everything right and really started beating myself up. Like it was my fault. Like already I was a horrible mother. She put me on a 1800 calorie diet and wanted me back in a week to check my monitoring results. In one week on the 1800 calorie diet, I lost 8 pounds. My doctor didn't like that at all and jacked my diet up to 2000.
I was religious with the glucose testing. Testing four times a day, sometimes more even when she said I could back off a bit. I followed the 2000 calorie diet, but if I still felt hungry, I would always have more as I was afraid of not eating enough protein for the baby. The GD was a huge emotional strain for me. I felt embarrassed and guilty about everything I ate. I swam laps every morning for 45 minutes, plus I would walk ever night after dinner for 30 minutes or more. I didn't touch one thing with sugar, and measured all of my portions. My numbers were consistently normal, I scored high in less than 10% of my daily testing. Even when my numbers were high, my morning numbers were never more than 98 and my 2 hour after meal numbers never more than 135.
I was terrified that I would have to be induced.... or have a c-section.. or have a a so-called "fat" baby... so I followed everything to the letter. I was hungry for information, but found no adequate resources on GD except for this website. It would be an understatement to say that I obsessed about it, and for a large part of the end of my pregnancy, the GD caused me to be stressed, worried and unhappy.
At around 37 weeks, my doctor guesstimated the baby would weigh in at full term at about 8 lbs 2 oz which I was thrilled about. The Bradley Method is clear about not restricting your diet so you can have a big health baby, so 8 pounds was exactly what I wanted.
I went into labor at 39 weeks. My labor and childbirth were text book and absolutely perfect. I was able to have a perfect natural childbirth that went amazingly fast. I had no drugs of any kind. No IV (or even a saline hep lock.) I had no fetal monitoring other than twice when the nurse put a hand held monitor on me for two minutes each time. I went into labor at 7pm, was at the hospital around 4am at 4cm. Was at 8cm by 6am and was pushing by 7am. I only pushed for 21 minutes and the baby was born with my waters intact.
The big surprise came when the baby came out. At 6 lbs, 1oz and 20 inches, he was far from small, but what you would call skinny. The first words out of my doctors mouth were, "Somebody looks like his Mommy has been on a diet." I was totally shocked.
In the days that followed, there were some complications with breast feeding because of his size. He lost the initial weight, but because he was so small, his doctor was worried about him and ended up having us supplement and at one point even return to the hospital for an overnight. In the days that followed, I have continued to struggle with breast feeding because of the initial supplement.
I have become somewhat bitter about the whole GD thing. We will never know if his low birth weight was due to my GD diet, but I can't help but feel like if I had eaten the whole milk yogurt and ice cream and other goodies as the Bradley diet suggests, he wouldn't have been born with such a low birth weight and thus the ensuing chow issues. Not that I would have used it as an excuse to eat with abandon, but I would have skipped the no carb yogurt and Wasa crackers. It makes he hesitant to trust another GD diagnosis if I get pregnant again.
In the end, I am just happy that he is healthy and that I can throw out that damn glucose monitor!
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. However, some women also just gain more than others (especially with pre-eclampsa), 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!)
Birth Story
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)
Kmom's Notes:
Birth Story
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 bp 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.
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.
Birth Story
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!
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.
Birth Story
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".
Birth Story
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.
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!
Birth Story
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."
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.
Birth Story
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.
Brianne's Story (pre-eclampsia, vaginal birth)
Kmom's Notes:
Birth Story
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 tiing 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.
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.
Birth Story
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.
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.
Birth Story
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.
VLK's Story (idiopathic thrombocytopenia purpura, mild PIH, vaginal birth)
Kmom's Notes: VLK's doctors were surprised that her blood loss during delivery was normal since her platelet levels dropped severely low. Platelets help the blood to clot properly; without them, excessive bleeding is possible.
VLK has no history of blood or clotting disorders in her family. The specialist told her they don't know why some women "get" this during pregnancy but it probably doesn't have anything to do with size. They did test for Lupus (which can be associated with low platelets) but that was negative. They did a test for anti-platelet antibodies, and that was positive. Most often, the antibodies disappear after delivery and platelet levels normalize. Her platelets did normalize after delivery although they are on the low side of normal and a bit lower than they were pre-pregnancy. VLK was also worked up by a hematologist after the postpartum period and he felt that since the platelet levels were normalized, periodic monitoring was sufficient.
More information about ITP can be obtained at the website of the American Academy of Hematologists and Oncologists, and at WebMD.
Birth Story
We hadn't planned on having children and I had had a Norplant in for about 8 years when my husband was told he had a varicocele [varicose vein on the testicle] and there was a 98% chance that he would be unable to father a child. I figured that that number was pretty close to the effectiveness of the Norplant, so I had it removed (thought it might help me lose some weight.). About 3 years later, to my surprise, I found that I was pregnant. At first, we weren't too thrilled with the idea, but my OB helped me to change my attitude with her positive outlook and support. I was concerned about my age (I would be 36 when I delivered) and my size. She ordered a CVS [Kmom note: Chorionic Villus Sampling, a prenatal test to look for birth defects], which was normal and calmed my fears regarding age-related genetic problems. She also reassured me that most of her heavier patients gained less weight during their pregnancies than her smaller patients did.
I felt amazingly good during my whole pregnancy---no nausea or vomiting or any discomfort and only when my glucose challenge test was done at around 25 weeks did anything come up in my lab work. My glucose was fine, but my platelet count was low at 85. The maternal-fetal specialist was consulted but it was decided that we would just watch the platelets (they were tested every 2 weeks, then every week towards the end of the pregnancy). As long as they stayed above 50, nothing needed to be done. There was some concern over whether or not the baby's platelets were low as they had found that I had anti-platelet antibodies in my blood and they can cross the placenta, so I was scheduled to have a cordocentesis done at 38 weeks which would give us an idea of the baby's platelet count.
When I was admitted, they took some blood from me and found that my platelets had dropped from 75 (which they had been 4 days before when drawn in my OB's office) to 11, which was considered critically low. The baby's were over 300, so it was decided to induce labor so that the baby would be born before he was too big (and possibly cause more bleeding). I couldn't have an epidural because they said I could bleed into the epidural space and possibly be paralyzed, and they said that they wouldn't even consider a c-section unless it was an emergency because of the chance of bleeding. I was given IV immune globulin and IV steroids for 3 days to try and get my platelets above 50 and then they started to induce me. Cytotec was used first, but I was "stuck" at 2 cm and Pitocin was started the next day. My blood pressure went up to 220/110 and they stopped the Pit and gave me Apresoline for the BP. When the BP came down and stayed for a while, , they attempted Pitocin again and my blood pressure went up again. This time they started me on Magnesium Sulphate. After they had been trying to induce for about 72 hours, my OB decided to rupture the membranes and that's when my labor started to really progress.
In all my labor lasted about 44 hours (not counting the time that they turned off the Pit because of the elevated blood pressure) and I received only 1 dose of intramuscular Demerol during this time. I think that I kind of put myself into a trance of something with my breathing, but whatever it was, the labor wasn't as bad as I had always thought labor would be. I had to push for 3 hours (one of his shoulders was stuck) and in the end, my OB needed to use the vacuum extractor because the baby's heart rate was starting to drop and she needed to get him out. This made me really nervous because I'm a nurse in Neonatal Intensive Care and I've seen babies with some severe neurological problems after vacuum extraction, but she got him out and there wasn't even a mark on his head! I had to spend 24 hours in the Maternal Special Care Unit because of my platelets and elevated BP, but my baby boy was healthy and his platelets were fine.
We went home in the usual2 days and I had a remarkably smooth postpartum course, other than having to wean off oral steroids over a 6 week period while my platelets normalized. I lost all the weight (13 lbs.) that I had gained within 2 weeks after I had the baby and have basically stayed the same weight since.
Having our son has totally reversed our attitude about having children, and we have been trying (so far unsuccessfully) to have another. I would like to have a little brother or sister for Adam, but I'm 38 now and we will probably stop trying if we're not pregnant by the end of the year (again, that NICU nurse "nervous" mentality coming into play!). Hopefully the Maternal-Fetal Medicine specialist was right and ITP won't be a factor in any future pregnancies.
As for doing the induction and delivery with virtually no meds, I NEVER thought that I could or would do such a thing. I always maintained that I was no martyr, but in the end, the choice was taken out of my hands and I did what I had to do. Once it was over and I looked back on it, it was the single most empowering thing I think I've ever been through. Far from discouraging me to do it again, it has probably been one of the main motivating factors in making me believe that I could have another baby!
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.
Birth Story
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.
Melanie's Story (Mild PIH, home waterbirth)
Birth Story
http://tenetti.org/clt/birthstory.html
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!!
Layla's Stories (post-dates, induction, vaginal birth with infection)
Kmom's Notes: Layla had a tough induced labor, which can be very difficult to handle. She elected to have an epidural at 1 cm dilation because of the amount of pain she had. Although epidurals increase the c/s rate in general over non-medicated births, and especially so if given before 4-5 cm dilation, in this case it helped her get through labor enough to dilate fully and push out her son. Unfortunately, somewhere in the process he picked up an infection, one of the many risks of inductions. However, all worked out in the end, and they were able to breastfeed long-term despite the delayed access.
Birth Story
I was nearly 2 weeks late and scheduled for an induction on Tuesday morning. I desperately prayed that the gel on Friday would be enough to trigger labor. I was tired of feeling like a beached whale! I did have some contractions but they were just strong enough to disrupt my sleep and make me anxious about the birth--they took my breath away and provided good practice for my breathing. An internal exam showed that I was only 30% effaced and 'fingertip dilated' (probably the nurse's nice way of saying 'tight as a clam' without discouraging me too much). The contractions from the gel were pretty hard but didn't do much.
On Monday I had another NST and serving of gel, with more contractions. I felt a lot of emotional stuff come up as I was sitting there bargaining with the Labor and Delivery Goddess to get the show on the road. I was scared of birthing the baby, afraid that something horrible might happen to him. My doula came over and we walked and talked and tried to cry the baby out. No luck. Monday night the only way I could sleep was in the bathtub. After 2 hours I was completely prunish so decided to give the bed another try. An hour later I got up to go to the bathroom and *whoosh*, a bunch of water splashed down my legs! "My water broke," I screamed and promptly woke up DH. We went to the hospital and had an internal exam, only to be told it was just bathwater. We went home with a sedative as a consolation prize.
Tuesday morning, we got up, knowing this would be the last time we'd come home without a baby (we thought). We went to the hospital to face the Pit-Dragon. I was beginning to feel demoralized now--I failed to go into labor myself, and had to face an induction. Besides my fear of the pitocin, I hate IVs and knew that I'd have to get one. But the IV went in without incident, and I sat in the rocking chair hooked up to monitors (instead of in bed) which helped a lot. My doula also came. The nurse kept upping the pitocin every 45 minutes. It was hard but manageable.
At 9:45 a.m. my first "motherf****r" contraction hit---the first one that made me curse and whimper. I thought at this point they'd turn down/off the pit. Nope. The contractions were now every 2-3 minutes, lasting 45-50 seconds. I was now in active labor, truly, and they were doozies. My doula helped me breathe, reminding me to keep my tones low. I ended up growling, like the lions on my bedslippers. DH was by my side, rubbing my head.
By 3 p.m. I want drugs. There has been no break in nearly 5 hours of induced labor. We ask for IV drugs. At 3:45 p.m. I get them, but it felt like forever for them to kick in. I am convinced that labor and delivery runs in a parallel universe with different time properties. The first 30 minutes of Nubain feel like heaven, but within an hour it wore off and the second dose didn't feel so wonderful as the first. By 6:15 p.m. I am crawling the walls. The contractions are getting harder (I couldn't imagine they could get that strong) and relentless. I want the epidural, but my exam showed I was 85% effaced and 1 cm dilated. I wailed like a keening woman, and totally broke down. My doula tried to reassure me that the effacement was great news and that once I totally effaced, it would go much more quickly. I didn't really hear her and started cursing---sailors don't have nothing on laboring women! The doctor decided she'd let me have the epidural anyways. She figured the tension and fatigue of the labor was hindering my progress.
At 6:45 p.m. I got the epidural, after 2 attempts. Trying to sit up while in active pit-labor was probably the second-hardest part of the process. Within a half hour the epi kicks in and I'm in heaven. I know that many women do deliver naturally but the epi, in my case, was the best thing possible. I was able to sleep for 2 hours during some really tough labor, the first sleep in days. My doula went home for a quick shower and some food while I slept.
By 9:15 p.m. when she returned, I woke up shivering and threw up on DH. I knew I was in transition and needed to kick the epidural up a notch. The anesthesiologist (aka Angel with a Halo) ups the dosage a bit. I was right; I was 7.5 cm and completely effaced. Baby was in the +2 position so they were fairly certain he would have no problem passing through. Doctor wants to break my waters for the scalp monitor. I refuse since there were no signs of stress. Shortly afterward, my water broke on its own and they put in the scalp monitor. By 9:30 I want to push and was fully dilated. By 10:45 p.m., L was almost crowning. Although the doc does everything to avoid the episiotomy, it become necessary because L is showing signs of distress and I'm fading fast. I'm snipped, and L is born. The doula assures me that the doc did everything right and that it was necessary.
L has serious breathing problems. After being put on my tummy for a few seconds, they take him to the heating table and start to drain his lungs. They remove several ounces of fluid (no meconium) from his lungs). He's briefly returned to me before he's whisked away to the NICU. I'm stitched up quietly. By 11 p.m. everyone except DH and the doula are gone. We're alone and I'm a mess. I try to reassure myself that L is just fine. At 2 a.m. the doctor comes by and explains that L has a serious lung infection and is in the NICU. They are running some cultures and will have a prognosis in the morning. We go see him; he's on a heating table with a breathing hood around his head, IV in arm, and a blood sampler out of his still-open belly-button. We sit there for an hour and cry. I'm only allowed to touch his hands.
By the next morning he is on a ventilator, breathing 80% oxygen. He was fighting so hard that neither the hood nor the cpat nose-tube would work for him. I was later told it took 4 nurses and a shot of morphine to intubate him---such a fighter, especially compared to his 3 pound preemie neighbors. He was removed from the ventilator by Thursday and I'm allowed to hold him then. I'd been pumping every 3 hours and sleeping in the hospital's hospitality room for NICU moms. My milk came in on Friday, and we're able to breastfeed, IV and all. We finally got to take him home the following Wednesday. One of the nurses told me that he was much more touch and go than the doctor let on. But he is a fighter and I'm convinced that he willed himself better. Such a stubborn little Taurus! Many babies with his condition are not released until 10-14 days but at 7 days he had no sign of infection. They have no idea why he was so sick. It is unlikely that it came from vaginal infection, since his water wasn't broken very long. They guess that the placenta had started to fail, and that a bacteria passed through the barrier and infected him.
While labor was tough, it was that first post-partum week that was the toughest. Sometimes I don't know how I made it, and I certainly cannot even imagine what it must be like to lose a baby. I never knew I could care so much about someone else until then. I hope this sheds some light on why I feel passionately about some things---I just don't want anyone else to go through that. But complications can set in and that is why I think it's important to really take this seriously and take control of your own process. Next time I think I may decline more of those internal exams, and maybe not opt for the gel---which might have introduced germs into the canal. But ultimately, we can only control so much, and give the rest up to whatever you think of as God. I know that my faith in the fundamental goodness of life was what helped me survive that first week.
Katie3's Story (SROM, epidural, vaginal birth with infection)
Kmom's Notes: This mom's waters broke before labor started. Her caregivers did many vaginal exams; one has to wonder if all the vaginal exams played a role in the infection she eventually developed. On the other hand, it's possible she had an infection beforehand, which caused the amniotic sac to break. We may never know. But generally, if your bag of waters has broken, it's best to avoid all vaginal exams or to have as FEW as possible, just as a precaution.
Birth Story
My water broke at 6:45 a.m. on Good Friday. I had one or two mild contractions over the next couple of hours. I phoned my doctor at around 9 a.m. and she said to come into the hospital to be checked, to confirm that my water had actually broken (although it really wasn't a question for me; my water just gushed and gushed and gushed, for several hours).
We arrived at the hospital at around 10:30 a.m. and had confirmed what we already knew---we were going to have our baby soon! I was given the option to remain at the hospital or to go home until labor picked up. Since we're a good 45 minute drive from the hospital, we decided to stay, and I was sent to the hospital room I would be staying in after delivery.
Throughout the day, contractions were about half an hour apart and very tolerable. At 3:00, I was only 1.5 cm dilated. As my doctor left the hospital, she suggested that in the morning they would start a pitocin drip to pick things up a bit. However, at about 4:30 p.m. the contractions started coming about 10 minutes apart and getting a bit stronger. By about 6:15 p.m. it was suggested to me that a shower would help with my back pain. It felt great as my husband stood for about 45 minutes, spraying me as I stood, sat, bent over, trying any position to try to help the pain.
The shower turned out to be the catalyst that kick-started my contractions to start coming about 2-3 minutes apart and about 1 minute long. My nurse called my doctor to come and see me, since labor had picked up so quickly. When my doctor examined me, I was about 3 cm dilated. At around 8:30 p.m. I requested and was given a shot of Demerol, since it was too early to proceed with my planned epidural. I was told the Demerol would take the edge off the pain (it didn't). It did make me sleep between contractions, which made them seem as though they were one right on top of another. By 11 p.m., my contractions were nearly unbearable and I was experiencing multiple peaks.
Unfortunately, the wonderful nurse I'd had during the day had gone off her shift at 7 p.m. and I had the nurse from hell looking after me. She told me she would examine me in half an hour to see where my progress was. I was given an IV with antibiotics at around 11:45 p.m. because my membranes had ruptured nearly 17 hours earlier. However, when I again requested an internal exam to see if I had sufficiently dilated to be given the coveted epidural, she told me that she either had to have a doctor examine me or else get permission from a doctor---this was NOT what she had told me 45 minutes earlier! Finally, shortly before 1 a.m. I sent my husband to the nurses' station to find someone, anyone, who would take pity on me and do the job that my nurse obviously wasn't doing. Three nurses came in and the moment they looked at me, they said, "Send this woman over to labor and delivery." I was taken in a wheelchair to the LDR wing and when I arrived, was examined by my absolutely wonderful labor nurse, K, who determined I was 6 cm.
The anesthesiologist, who had just gotten home and gone to bed after surgery, arrived in record time (wonderful man!) to give me my epidural. Never having had an epidural before, I have nothing to compare it to except for the pain I was in----it was heaven. I would have to say that it was an absolutely textbook epidural; it did exactly what it was supposed to do. The pain was gone within 10 minutes, and I went to SLEEP for the first time since 6:45 a.m. the previous morning.
The only thing I felt below my breasts was pressure in my tailbone. However, it wasn't sufficient at that point to keep me awake. The chair in the delivery room, which was supposed to convert into a cot for my husband to sleep on, was broken. My husband, who had already spent the previous six hours clutching my hand and sponging me off with a cool face cloth, had to try to doze sitting up.
One side effect of the epidural that I hadn't expected was that I started to shake uncontrollably, as though I was freezing. The labor staff brought me heated blankets (which actually don't do anything to stop the shaking but make you feel like you're in a warm cocoon) and piled them on top of me. At around 3:30 a.m. I developed a fever, in spite of the antibiotics I had been receiving by IV. Several times, the nurse woke me up to take my temperature and to check my progress; other than that, I slept through everything going on around me.
Eventually, though, the pressure in my tailbone got stronger, and by about 5:45 a.m. I couldn't ignore it anymore. At that point, I was about 9.5 cm dilated, and I felt encouraged that I was reaching the home stretch finally! AT 6:15 I was checked again and my doctor pronounced that it was time to push! Having gotten some rest, and having had the epidural, I felt like a new person. I was ready to see this baby after a long haul.
My doctor had me try a few practice pushes, and after about 3, I vomited everything I had eaten the day before. What a mess! My nurse and doctor tried to cheer me up by telling me that the pressure placed on the perineum during vomiting was one of the best ways to push! Once I got cleaned up, I felt fine and started pushing in earnest. As the contractions got stronger and longer, I started to be able to feel the pressure (but not the pain) of the contractions. It was great because I could feel when to push.
One of the things I had been worried about when I was preparing for labor was that I would tire out quickly and not be able to push the baby out. This, fortunately, never materialized, and after an hour and forty minutes of pushing, out came my son, weighing 8 pounds and 5 ounces. When his head had been delivered, my doctor discovered that the cord was around his neck and quickly clamped and cut the cord. A couple of doctors from the Neonatal Intensive Care Unit were waiting when he was delivered, because of the infection I had developed during labor.
It was discovered that my son had picked up the infection as well, and so he spent 5 days in the NICU on antibiotics, but had no long-term effects. The NICU did cultures and white cell count and he definitely had an infection.
The fact that he was in the NICU was the biggest obstacle to breastfeeding. I wasn't able to breastfeed right off the bat because he was whisked off to NICU. I didn't see him again until the next morning. The only time I ever saw him in the first 5 days was to attempt to breastfeed, and since that didn't go well, pretty much all our first encounters in those five days were struggles. He wouldn't take my nipple in his mouth; just absolutely refused to latch. He had to eat though, so they convinced me that we should give him a bottle with the colostrum I had pumped, mixed with some formula. He inhaled it. Also they gave him pacifiers in the NICU without asking me. It just made it worse.
I was stressed and I just gave up. I didn't have the support (aside from my husband) and I just did not stick with it. I definitely plan to make a concerted effort next time---to just get through whatever problems I have, to avail myself of the expertise of a lactation consultant as soon as problems arise.
My son is now a sweet, happy, and very healthy 28 month old, and we are preparing to try to conceive our second.
Kathy F's Stories (pre-term labor then homebirth, pre-term birth/gd/arthritis)
Kmom's Notes: Notes are in the birth story text.
Birth Story
[Kathy has had 5 children and became pregnant with twins after these stories. Only her 3rd and 5th pregnancy stories are included here; a summary of the other births follows. Her birth story for the twins can be found above.]
Baby #1: Kathy's first baby was born after a very medicalized labor. Her water broke, they started pitocin, she labored on her back, etc. The doctor yelled at her during pushing, gave her a routine and unneeded episiotomy, and stitched her up very poorly.
Baby #2: Kathy returned to her first doctor due to insurance hassles, "choosing the evil I knew over the evil I didn't know." The labor pattern followed the first (water breaking early), but this time she refused pit and waited for spontaneous labor. She also refused an episiotomy and eventually came to "despise" the OB.
Baby #3: My third pregnancy was a shock. My first child was 2 years, 3 months old and my second was just 5 months old. I had been nursing when my milk suddenly dried up. I couldn't figure out why. Then I started to feel like I had the flu, but it lasted for 3 weeks. I finally told my husband I needed to see a doctor, but just to rule it out I was going to take a pregnancy test first. He already suspected, he told me later, but knew I would 'handle' the news better if I figured it out for myself. He was right. I did not feel at all ready to handle another pregnancy so soon---it was the last thing I thought would happen.
When the home test showed positive, I cried and cried. We had no insurance, and I had no idea what in the world I was going to do. I stayed in a state of half-denial for several months. Finally when I was 5 months along I figured I'd better get prenatal care. I called the doctor who had delivered my first two, one of which we paid for ourselves. The gal at the office was so rude to me when I said we were not covered, that I once again was in tears. They wanted $2000 by the seventh month of the doctor wouldn't take me, no exceptions, no payment plans, nothing. It felt like they were only interested in money and not my need for care at all. I hung up and was in a terrible panic about what to do next.
I hadn't really wanted to deliver with this doctor, but thought my chances of getting in with him were better than anyone else. He was very much the kind of doctor who "interfered" with the natural process (induction, episiotomies, internal fetal monitoring throughout the entire labor---all of which he did with me unnecessarily) for his own convenience. My first child was born when I was 21 and while I thought I had read a lot about my choices, I realized after the fact that I hadn't been given much choice about anything and didn't know to demand it then. He also stitched up the episiotomy he gave me on the first birth so badly that I still have a flap of skin waving around, and could not stand to have intercourse for 3 months afterwards. Of course, he never listened to me either and even yelled at me when I was struggling to push with my first. I know now that he was a really lousy OB.
My sister-in-law (SIL) happened to come over right after I hung up with the doctor's office. After I'd pulled myself together she and I went over my options. She reminded me about our neighbors who had had a homebirth just that past year, and how fascinated we both had been with this. Then she asked, "Why don't you have this baby at home, too? Why not?" Why not indeed! It was something I had read about, but just hadn't really considered for myself. But why not? My first two births were completely uneventful and totally normal vaginal births with almost no pain meds at all. And cost-wise it was affordable for us! The more I thought about and read up on it, the more I loved the idea! So I started calling around and found a midwife I was really impressed with.
She was a bit concerned about my weight but did not restrict my diet except to suggest I eat more whole foods and stay away from junk food. Otherwise I was fine, and she saw no reason why I shouldn't deliver at home. In our state the law requires that those under the care of a midwife must see an OB at least twice, once at the beginning of pregnancy, and once toward the end. She sent me to an OB she worked with often, and he gave me a clean bill of health. We were all set. My husband was quite happy about the homebirth as well. But then, he also says that when it comes to pregnancy, I'm the boss and he just follows along! :-)
Once the decision to have a homebirth was made and a midwife chosen, all my anxiety left me and I was finally free to totally enjoy the pregnancy and look forward to the birth of this child. My monthly visits to the midwife were very restful and personal, and I always looked forward to going. The midwife seemed more like a friend and confidant than the impersonal, clinical treatment many doctors give. Her office was in her home, and the atmosphere was very congenial. She always gave me plenty of time to ask questions and gave much more comprehensive answers than I've ever been able to get from a doctor. My only anxious moments were when I had to step on the scale. I was always just barely within her guidelines about how much weight I should have gained, sometimes over, but I was mostly anxious because she felt that if I gained too much I would hurt my chances of a homebirth. This was 11 years ago, and common thinking then.
At my 30th week I was having contractions that felt different from the BH ones. We did a vaginal check and found that I was 2 cm dilated and about 50% effaced. She and the OB prescribed bedrest and terbutaline to stop the contractions for 7 weeks (until I was 37 weeks along). This wasn't easy because of my two other children, but we were able to arrange child care with my MIL and SIL, as well as friends. Another friend brought over her entire library for me to read. Frankly, I completely enjoyed the bedrest. I was very tired, was having a lot of ligament pain so that walking was quite painful, and the meds made me very tired as well as making my heart race.
The midwife gave us directions to sterilize two sets of sheets, and gave us a list of the other things we would need for the birth. We prepared all these well in advance and were eagerly awaiting our new child's arrival by the time I was taken off bedrest and medication. Another week went by without incident. Then on morning I woke up at 5:20 a.m. with a strong contraction that I felt in my back. I waited, and was hit with another strong one just 10 minutes later. I woke DH then and told him what was happening. We waited and noted the contractions at 10 minutes apart until 6 a.m. Then I decided to go for a walk to either speed things up or stop them. My daughter (almost 3) woke up and asked to go with me. I didn't get far, though. I walked maybe 50 yards and had to turn around. The contractions became so hard and fast so quickly that I was a little worried about making it back to the apartment without help. It was definitely the real thing, and I was overjoyed.
Once we got back, DH was up and showered. He had his mom come get the kids. I called the midwife; she and her assistant didn't arrive for another hour. While we waited Dh picked up and I elected to put the sterilized sheets on the bed. The contractions were coming 2 minutes apart by this time, and I was laughing at the situation, jubilant at being at home and not having to leave. It struck me as very humorous---I was able to put on only one corner at a time before being hit with another contraction. It was while I was getting those sheets on that I discovered how wonderful a labor position kneeling was. Get a corner on, kneel down and lean on the bed through a contraction, get up, get another corner on, kneel down again for another contraction. I was thoroughly enjoying making my own bed in preparation for this birth. I was going to be able to have that baby in the most comforting and comfortable surroundings I could have asked for and I was so happy!
After that I stayed on my knees through all the contractions. I t was the perfect position for me, and really made the labor so much easier. In fact, I felt for the first time that labor was only hard work, and not painful at all. With my first two I was stuck in a hospital bed flat on my back hooked up to fetal monitoring machines and IVs for the entire labor, not even allowed to walk around. The pain then and the anxiety was much higher. The contrast of this homebirth was unbelievable.
When the midwife came I was still kneeling and had my arms around DH, who sat in front of me on the edge of the bed, supporting me and pressing on the small of my back where the labor pains always hit. The closeness and intimacy of this position gave me a deep sense of being loved and cherished, and made the labor a dual effort. It was our labor, not just mine.
The midwife checked me. I was progressing fast, 90% effaced and 6-7 cm dilated. It was 8 a.m. The labor was so quiet and peaceful. No nurses running in and out, no monitors, no interference. The midwife checked the baby's heartbeat every 15 minutes with a stethoscope. That was it. There was very little conversation, just a very companionable quiet. This was my preference, to help me stay relaxed and concentrated internally. In between contractions someone would make a comment or two, but quietly. I remember once chuckling in the middle of a heavy contraction, and the midwife asked if I was always so peaceful and quiet during labor. For me, it was just that way.
I found yelling, moaning etc. to be too distracting and made me more tense. I didn't know I was much different from most women, but the midwife seemed to think so. I had learned even with my first birth that I did best if I focused entirely on my body and what it was trying to do. I worked at flowing with the contractions, sort of mentally and emotionally body-surfing on the waves (contractions), one after the other. As a child I spent many summers at a beach where body-surfing was a favorite activity, so it was an easy visualization for me and worked well. We were taught in Lamaze class to pant during contractions but when I tried it with my first it was awful! I became extremely tense and it made the contractions so much more painful. So I threw all that out the window, went "inside" myself and found my own slow quiet breathing method, and my own wave-riding visualization. It's just what ended up working for me. I also tended to use a face clock's minute hand to focus on.
Then, about 8:50 a.m. I got hit with a really long contraction that never ended. It just kept going and going and going. After waiting about 3-4 minutes for the contraction to end, the midwife asked if I needed to push. I didn't. I felt no urge at all. But she said she should check me anyway. I was fully dilated and effaced already! Dh got behind me to give me support for pushing. I pushed 3x, but nothing really happened. My water hadn't broken at all even by then. My midwife said I could deliver with the sac intact, or she could break it for me. Either way was fine. I decided breaking it would be easiest at that point so she did. There was quite a gush of water! It was like a wave for real! I was embarrassed for a fleeting moment and then there just wasn't time for that emotion. I pushed for 5 minutes until the head and shoulders had emerged. Then with a wonderful smile, the midwife helped me reach down my hands, put them under the baby's arms and lift him from me myself! It was incredible!!
It was only 8:56 a.m. when he was born, just 3.5 hours of labor. We set him immediately on my belly, and I said hello to him, calling him by the name we had chosen. He instantly flipped his head back and around and looked me STRAIGHT in the eyes! He KNEW my voice and somehow managed enough control to flip his head around to see my face at last. I swear he "recognized" me. There was that special something in his eyes that I can't describe. That's just how it felt. It was amazing and glorious! He was so alert and so very aware and the intelligence in his eyes was clear. My first two weren't anywhere near as alert, thanks to the Demerol I had had during the labor. The difference was remarkable. Within an hour I was in the shower, the bed was cleaned up and remade, and everything was done.
This birth was empowering, in contrast to the first two. I discovered that women in labor not only needed to trust themselves, but were worthy of that trust. We are perfectly capable of listening to our bodies and following our natural instincts for birth. Guidance from an informed experienced midwife or doctor is important too, because instinct alone isn't everything. But that natural ability of women to know what they need deserves to be respected by all caretakers. Midwives especially understand and practice this. I think any woman, plus-size or otherwise, should expect and require her obstetrical care people to give that respect. And doctors and nurses need to practice *listening*. I've had 5 children now, and have learned through experience what is happening with my body. The times when I have been listened to made the experience of labor and birth so much more fulfilling than otherwise. We are not sick, we are not crazy, we are not out of control. We are performing the most awesome job life gives us to do. WE need help, yes. But we still can maintain control over many aspects of labor and birth, to make our experience the best it can be. We need to study and inform ourselves enough that fear is not the decision-maker in our labors and deliveries, and find obstetrical care with whom we can communicate and who we can trust to help us make the best decisions possible for ourselves and our babies. If we do this, giving birth will easily be in the top ten most memorable and joyful experiences of our lives.
My homebirth was the best experience I've had yet. Joy was the overwhelming emotion then, and still is now when I look back on it.
Baby #4: With this baby, she was concerned about the toll the rapid-fire pregnancies were taking on her body so she elected to go to a doctor and birth in a birthing center of a nearby hospital. This labor was much more painful and stalled at 5 cm. Finally, she changed position and an extremely strong and very painful contraction hit. The doctor's assistant felt that this was probably the baby rotating from posterior to anterior. After that, the labor progressed well and the baby was born 3.5 hours later.
Baby #5: I am extremely fertile; had our first four children in 4.5 years in my early 20s. We conceived again years later while trying to prevent it; we were thrilled anyway because we wanted more children. I did not seek medical care until the 5th month. From my earlier pregnancies I knew to take a good quality supplement with folic acid and I knew the warning signs of problems and had none, so I wasn't concerned.
Finally chose an OB in my 5th month, saw her several times. At first she seemed great, but then I was diagnosed with gd. The fiasco of her care after that was unbelievable to me. She did not get the diagnosis to me in a timely manner, delayed getting me to the dietician and then sent me to one my insurance didn't cover, didn't call in the glucometer prescription in a timely manner, etc. At that point I was so disgusted with the lack of decent care I realized all my trust had been destroyed and I was NOT going to let this woman deliver my child.
The OB I switched to is wonderful! The best I've *ever* been to. Wish I'd been with him from the beginning. I switched at 34 weeks and they were hesitant at first to take me, but by the time I told my story they took me on. I saw my new OB twice, once in the middle of my 34th weeks at which he does an ultrasound himself in his office. Everything was good. My b.p. was relatively normal, 130 or so over 85-90, nothing to be concerned about. [Kmom note: Some doctors would be concerned at this b.p. but this doctor was not.] The gd stayed controlled well with diet alone. My weight had continued to gradually drop, especially after being put on the GD diet. I was given a 2300 calorie diet, which gave me more than enough to eat and plenty of energy. I ended up losing 30 lbs. I aksed my new doctor if my weight loss was a concern and he said no. The baby had been growing fine, was a good size, and the lost weight was only a sign that I was eating right. If the baby wasn't growing normally, then he would be concerned.
[Kmom note: It's not unusual for large gd moms to lose weight in pregnancy. Doctors vary in their concern over this; some view it as a sign of something wrong, some want you to be losing weight, and some simply judge it on whether or not the baby is developing well. HOWEVER, any gd mom should be checked for ketones in the urine on a regular basis---particularly a gd mom who is losing weight. Strong weight loss or lack of gain can be a sign of ketone problems, which can potentially damage the baby. It's very important for this to be checked on a regular basis in gd or whenever a mom is losing weight in pregnancy.]
I have Psoriatic Arthritis (PA), which is a rheumatoid-like arthritis accompanied by psoriasis, a skin condition noted for its red scaly patches. During a large part of my pregnancy, my PA went into high gear. My abdomen was covered with one enormous psoriatic patch that gradually migrated to my back. There was nothing that could be done for it. The medications they use for severe PA are dangerous for the baby, and cortisone creams only took the edge off the burning and itch. I found that an extra-virgin cold-pressed olive oil worked better than the standard creams for relieving the P. It didn't go away until the temperature climbed past 80-85 degrees F, normal behavior for my P (mercifully, this comes early where I live). In my 3rd month, I strained or pulled a ligament in my groin which never completely healed and only continued to worsen throughout the pregnancy. I didn't know it at the time, but I know now that this was due to the PA. My hips have been arthritic for several years but it hadn't spread until this pregnancy. This kind of arthritis also affects ligaments as well as joints and the strain on my lower abdominal ligaments was excruciating for me. At the end of the fourth month, I went to the mall to pick up something and had constant contractions the entire time. It was so severe I had to stop walking and just stand there until my uterus relaxed. I stayed away from malls and extensive walking after that. Eventually I couldn't walk or stand or even sit for more than 5 minutes at a time. By the time I went into labor, I was in pain in every cell of my body, slept only fitfully, and was extremely uncomfortable to to say the least.
Also, in my 7th month, my hay fever kicked in as it always does at that time of year. I developed allergy-induced asthma, so my family doctor consulted with my OB and gave me an injection to clear up the asthma, with the happy side-effect of developing the baby's lungs a little early. This turned out to be beneficial because I went into labor at 36.4 weeks.
Labor began at 2:30 a.m. with the loss of my mucus plug during yet another middle-of-the-night visit to the bathroom, with contractions intermittent until about 6 a.m., when they steadied to 8-10 minutes apart or so. We called the OB around 8 a.m., then my MIL (whom I had also asked to attend the birth). We were at the hospital and admitted around 9 a.m. They were wonderful labor support. Contractions were not quite steady, fluctuating between 5-10 minutes apart until noon, when they settled into a 5 minute pattern. At around 11 a.m. I realized I'd gone too long without food and requested milk and crackers to bring my blood sugar levels up a bit. I knew that the baby could go into shock and die in utero if my blood sugar levels dropped too far, especially because I had had a stomach flu the week previously, messing up my diet and blood sugar levels. I had not gotten back on track with a good balance before labor began. I knew this was a cause for concern from my personal study about gd.
My water broke spontaneously at about 2 p.m. and contractions became stronger. Dilation progressed normally through all this. I was at 4 cm when I was admitted, at 5-6 at noon, and at 2:15-2:20 p.m. I was 8 cm. I've been able to handle the labor pains by thinking of riding them as waves (as before). My husband stis by me or stands with me during this. I hang onto his shoulders and lean into him, letting him support my weight while he reaches around and applies pressure on that one spot in my lower back/pelvis region where I feel all my labor. This works better than any pain killers. I have never had an epidural, although I was tempted this time. I'm not quite as resilient at 34 as I was at 24. :-)
By 2:45 p.m. I realized I was ready to push from past experience. I never have felt the "need" to push the the pregnancy books describe. Instead I have just one long contraction. The pain reaches a peak, subsides, but only to a half-way point compared to the previous contractions, then goes back up again. This continues for 10 minutes before subsiding for about 30 seconds then starts again. This was my "sign". I told the nurse what was happening and what it meant. She immediately went into action. She checked me and said, "Well, you sure know your body!" I was indeed ready to go. The doctor had come in about 15-30 minutes before to check me and see how I was doing. He was called back and was there in moments. I was impressed with the cheerful efficiency of the staff, as it was shift-change time. There must have been four or five nurses there due to the change-over. It was like watching a well-rehearsed ballet, the way they all worked together. My doctor was incredible, and the nurses behavior toward him showed me even more how well-liked and respected he was by the staff. Everyone received the same respect and kindness from him as I did. Truly a gentleman, as well as an outstanding OB.
I pushed for 3 minutes (I was watching the clock!) and my daughter was born at 3 p.m. straight up by the room clock, but 3:02 by the official time. She just whooshed right out with only 2 or 3 pushes. I did not have an episiotomy and there was no tearing. Apgar scores were 9,9. I asked the nurse to please check her blood sugar level early. Labor had been 12.5 hours long, and I was worried. My instincts were right on, because her glucose level was at 22. Below 40 for babies is dangerous. I asked if we could just give her a bottle and wouldn't that take care of it? The nurse said yes and handed me a bottle to feed her. While I intended to nurse, I knew that my milk wouldn't be in for a day or two. The only alternative was an IV for the poor mite. I preferred the bottle to a needle!
[Kmom note: Actually, there is another alternative. Formula can be given by non-bottle methods so nipple confusion becomes less of an issue. Finger-feeding, syringe feeding, cup feeding, etc. can all be used to give a baby that needs supplementation some help without risking breastfeeding. This baby needed extra supplementation or IV glucose, being so low and particularly from being a preemie and from a mother who had been ill and thus had unstable blood sugar. But babies that are more borderline (30-40 usually, depending on the hospital's protocols) can be nursed FIRST to see if that brings up their glucose enough. Before the milk comes in, colostrum is secreted, and that is high in protein, which helps stabilize baby's blood sugar more than sugar-water does. If baby still needs more help, supplementation can then be offered by finger-feeding, etc. This baby DID need to be supplemented, but most gd babies do not need it, especially if the mom's blood sugar remains stable beforehand.]
Recovery was completely normal. I will say this----my third birth was at home with a midwife and this hospital birth rivaled that one in excellent care, as well as respect toward me and my wishes. It stands side-by-side with my homebirth as a glorious birth experience.
This baby was definitely premature and nursing was a real struggle. My nipples were too big for her little mouth, and she was unable to draw down enough milk. By the time she was 2.5 weeks old, she hadn't gained back any of the weight she had lost in the hospital. Her doctor was willing to let her go another week but I wasn't. I made the decision to give up nursing and begin bottle-feeding. This ended up being a very good choice for us because by the time she was five weeks old I had gone into a full systemic flare-up of PA, with extreme pain in every joint in my body, and could not hold her for more than a minute or two. The joint pain gradually lessened until I was in complete remission 6 months later. She is now a thriving and healthy one year-old, and has had only one ear infection in that time. I have opted not to immunize at this time, due to the psoriasis she has already started (my only child with this) and her premature birth status. The psoriasis indicates a possible immune-system problem, and I'm taking no chances.
And I've recently learned through an ultrasound that I'm 13 weeks along with TWINS!! :-) These will be our last children, I think! I intend to attempt breastfeeding again. Hopefully with a nursing pillow we will succeed, even if the PA flares up again. [Kmom note: Click here to read the twins' birth story.]
Char's Story (induction, ligament problem?, vaginal birth)
Kmom's Notes: This mom was told that she has a ligament in the way that would prevent a baby who was any bigger than what she had from being born vaginally. This sounds completely nonsensical to Kmom, but it is difficult to know the truth. It's possible she might have an anatomical variation such as this, but it still sounds dubious. However, this mom's own mother, an RN, also swears that this difference was there. Who knows? The important thing is that Char was able to have her baby, and that mother and baby are fine.
Birth Story
This was my dream come true! Except nausea, I overall had a normal time. My caregiver suggested I go in on my due date to have the baby if I didn't go into active labor by then. So on a Monday night I went into the hospital. I spent the night getting ready to have this little bundle of joy. By morning the drugs were given to start labor.
I had an erratic labor pattern the entire time. I asked for meds to help throughout the day---they didn't help much. I was still in pain. I was put on oxygen and had my pitocin stopped when my baby's heart rate quickly dropped. Thank goodness everything did return to normal. We avoided a c-section that time. My Dr. rushed in, cut off the pitocin, and the heart rate slowly went back to normal. I did finally get the go-ahead for my epidural about 8 p.m. that evening. It worked wonders. I was suddenly talking and enjoying the process now. I started to relax more.
Hours go by and early Wednesday morning I feel the need to push. (Yeah!) I had progressed all the way and the nurses called my Dr. into the room. I had several good pushes completed by then. Nurses had gotten the forceps ready. That's when the doctor noticed I had a ligament in the way. If I was going to have the baby vaginally I had to have some help and he or she had to be small.
The next push they attached the vacuum to the head of my baby. I pushed the head out, stopped for a second while the doctor did his thing, and then my baby was born. (I yelled out, "It's a girl!" at 3:30 in the morning.) I was all smiles. I waited while my husband cut the umbilical cord. Then the Dr. put her on my chest!
She was just the right size for me to have her. At 6 lbs. 9 oz. she just fit through. My Dr. later told me if she was any bigger I would have had to have a C-section. Thank goodness for little girls.
Postscript: I should have added that I have a ligament that stretches the width of my opening that interferes with giving birth. It is in the way and does not give or stretch. Most normal women do not have this ligament. I was basically cut as much as possible and still had to have a vacuum attached to help the rest of the way. My Dr. did a very good job. I do not believe that he told me that to set me up for a C-section if another pregnancy occurred. My mother (who was present) is an RN and she confirmed that there was indeed a ligament that was in the way. I do not believe my Dr. was implying I have a small pelvis either....I do know there are doctors out there who are like [that]. I really do not think this case applies.
Mina's Story (posterior baby, vaginal birth)
Kmom's Notes: Doctors predicted a big baby and ordered extra ultrasounds to estimate the baby's size. The ultrasound she had the Monday before the baby was born estimated the baby at 9 lbs. The baby was born a few days later at 7 and a half pounds. Shows how reliable estimated fetal weight usually is! Off by nearly 2 pounds in this case.
This story also illustrates the importance of recognizing the signs of a fetal malposition; in this case, she had the classic signs of prodromal labor and a stall in dilation around 5 cm despite strong contractions. When the OB broke the bag of water to 'get things going,' the baby's position became more difficult to resolve and fetal distress eventually became an issue. The mom also needed an epidural for the pain after that, which is quite common in these situations.
The baby was never able to turn, and the mom had difficulty pushing him out in the traditional semi-sitting position. Fortunately, when turned onto her side for fetal distress, this position allowed her pelvis to open enough to let the baby out, even in the more difficult posterior position. Unfortunately, an episiotomy and vacuum extraction went along with this in her OB's management.
Another effect that seems to be more common with posterior babies is difficulty nursing afterwards. Often this can be helped with chiropractic treatment or Cranial Sacral Therapy to "free up" the nerves that are used as part of suckling, but few people know of this potential resource. Although it is difficult to know if this baby's difficulties in nursing were caused by this problem or something else, nursing difficulties do seem to be more prevalent in babies who were malpositioned or manipulated strongly during birth.
Update: Mina has another birth story below, the second one a much easier birth.
Birth Story
On Tuesday, I went for my 41 week visit with my OB. Things were looking good, and I was almost completely effaced and 4 cm dilated at that point. I was told that I probably would go sometime that day or the next, which was very exciting...I'd been waiting for the baby to arrive for almost a week past my due date! My doctor stretched my cervix out and told me to go walk around the mall or something, because she was sure it would bring on labor any minute. My parents were down visiting from New Hampshire, so we decided to go home and drop off my Dad, and then Mom and I would go out to lunch and then go shopping to help bring on labor.
During lunch I started having contractions lasting about 45 seconds that were 3 minutes apart! I didn't think it was "real" labor though, because the contractions didn't really hurt, but Mom was concerned that it could be the real thing because she had very fast and easy labors. So I called my OB's office and was told [to go get checked out]...Of course, once I got to the hospital and got hooked up to the monitors the contractions stopped, so I was sent home to wait for the real thing....I had a feeling that I was going to have the baby the next day---turns out I was right!
I woke at around 2 a.m. the following morning with what I knew was a REAL contraction. It wasn't unbearable for me, but I could just tell that this wasn't just a Braxton-Hicks. I got up and played around on the computer for about an hour and a half while I timed the contractions, which were about 10 minutes apart at that point and were lasting for a minute. I knew that waking up DH at this point wouldn't be a good idea...my mom had volunteered to ride out the early contractions with me if they started at night, so I woke her up. We sat and timed contractions in the living room for about half an hour before she fell asleep on me...So I just sat and relaxed in the living room while keeping track of my contractions myself.
At 5 a.m. DH woke up and I let him know I was having significantly painful contractions that were still about 10 minutes apart, but that I thought he should just stay home rather than get ready and go to work. I sent Mom back to bed and DH went to lay down to try to rest while we timed the contractions...[The contractions stayed far apart] so I went downstairs and cleaned my kitchen while I was waiting, [and visited with my father].
That morning we were scheduled for another Non-Stress Test at L&D around 10 a.m. Because I was having significant contractions, I kind of figured that they would end up keeping me, so DH came with me to the appointment. We got there and they did the NST but also saw that I was having good contractions, so they called my OB to come and see me. Fortunately for me, the OB in my practice that I liked the best was on call that day and so she came to check me out. At that point she said I was 5 cm dilated and completely effaced, but that because my contractions weren't coming closer together that she could either let me leave and come back later in the day or she could break my water. Although I hadn't wanted my water broken artificially, I was also READY to have the baby, so I opted to be admitted and have my water broken.
Once we were admitted we were given the option of walking around for a while to see if my water would break on its own because my bag was bulging at that point. We walked the corridors for about an hour before we had to go back in to be monitored for 15 minutes...I was still at 5 cm dilated. We decided to wait a while and labor longer without having my water broken, so I got up and sat on the birth ball for an hour. The contractions were really strong and I had to concentrate and breathe to get through them....After an hour...my internal check revealed that I wasn't progressing at all, even with strong contractions that were about 3 minutes apart. My doctor asked about breaking my water again, and this time I decided to go ahead with it, hoping that it would speed up my labor and help me dilate more. [Kmom note: This decision probably cemented the baby's malposition and kept him from turning, and led to many more interventions from there.]
Of course, once my water was broken I was confined to the bed and put on the monitors all the time, so my freedom of movement was limited and my contractions became MUCH more painful. After a couple of contractions I was so tired and worn out that I decided I wanted an epidural, which I was hoping to go without but that I had decided I would consider if I felt I needed it. And I definitely needed it---I had labored from 2 a.m. to 5 p.m. without any pain relief and virtually NO rest, and knew that I still had a long way to go. I was also hopeful that the epidural would relax me enough to help me dilate.
At 5:30 p.m...I got my epidural. [The nurse] explained that it could take a while to get my epidural in because I was heavy and there was more flesh around my backbone. (She was heavy herself and had had problems getting an epidural with her previous labors.) The anesthesiologist came in and they got me up on the side of the bed hugging a pillow to my body to help me curve my back out. My contractions were really hard at that point, but I worked to stay still for the epidural. But the anesthesiologist kept hurting me when trying to get the catheter inserted in my back. I was in a lot of pain with the combination of the contractions and the pain of the needle from the epidural. He kept injecting more lidocaine [Kmom note: a local anesthetic] into my back, but the insertion of the needle was still very painful. He tried about 5 times and then called in another anesthesiologist to try. This new anesthesiologist also kept trying (about 5 times) and also couldn't get it in, so yet another anesthesiologist cmae in to try---and I was told that if he couldn't get it in, then they would have to give up. Fortunately, after a couple of tired and going in from a different angle, the last doctor got the epidural in, and the pain all went away within a few minutes. He was my hero!
Once my epidural was in and I was comfortable, DH and my family came back in to keep my company...I had been check right before my epidural and had still been at 5 cm---after half an hour of the epidural my doctor checked me again and I'd dilated to 7 cm, which was VERY exciting as I'd felt that I'd be stuck at 5 cm forever. [The epidural was placed] at around 6:30 p.m. and by 8:30 p.m. I was checked and told that it was time to push. Pushing is somewhat of a blur for me, although it was a LONG time---about 2 hours. After a while of pushing in a semi-sitting position the baby wasn't recovering from the heart decelerations and my doctor thought he had his cord around his neck. Before going to an emergency c-section, she decided to try having me push on my side. We tried me on my left side and the baby still wasn't recovering, so we flipped over to my right side. Thank God we tried the right side, because he began to recover from the contractions and pushing, and I was able to work at moving him down through the birth canal on my own.
After about 1.5 hours of pushing he was down far enough so that they could see his head well when I pushed but I was getting really tired and my doctor was concerned about the baby getting too worn out as well from the heart decelerations, so my doctor suggested using the vacuum extractor to help me push him out. At that point I had basically given up on my birth plan, and the only thing that I still wanted to avoid was a c-section, so I agreed.
It seems that once she started to "help" with the vacuum that things went fast, but I know it was still a half an hour or so before he was actually born. once they brought his head down lower in the birth canal I started to tear, so my doctor performed an episiotomy, which I also hadn't wanted, but like I said, at that point the birth plan was totally out the window. Finally his head was out, and they had me stop pushing so they could take the cord from around his neck. Then another push and he was out!!!
They whisked him over to the warmer so the pediatrician could check him out...and my doctor began to repair me, because my son came out posterior (sunny-side up) and I ended up with a 4th degree tear. So I didn't get to see my son until after they finished with me, which was about half an hour or so. But his daddy got some good pictures of him during that time, so I at least got to see what he looked like right away.
Once I got to hold him I started to try to breastfeed him, but he just wasn't interested, and didn't get interested at all the whole time I was in the hospital. We tried syringe feeding him and having me pump, but that was so time consuming that I couldn't deal with it, so I ended up switching to formula. I'm a bit disappointed that I couldn't get him to breastfeed, but I also know that my sanity is as important to my son, and that he will be healthy on formula as well. I ended up coming home but [the baby] had developed jaundice because of the bruising he sustained from the birth and from not taking in enough food to help clear the bilirubin...so he ended up having to stay in the special care nursery in the bili bed until Sunday evening, when he was allowed to come home. It was hard not being there with him, but I wasn't sleeping in the hospital at all and those two nights of sleep in my own bed were actually a good thing, as I felt better prepared to deal with taking care of the baby once he did come home.
Now that the baby is home I'm exhausted and was quite weepy at first, especially when my parents had to leave just a couple days after he got home...But overall he is a VERY good baby who doesn't fuss or cry very much, is very alert when he's awake, and who usually sleeps for about 3-4 hours at a stretch at night, so it really hasn't been too bad. I'm starting to feel more confident in my ability to care for him, and DH is being a VERY good daddy. It's amazing, but DH went from someone who couldn't be coerced into holding any baby to one who will do just about anything that the baby needs. He loves to hold him and cuddle him and has been helping with the feedings and with changing him...It's really nice for me, as I was concerned that DH wouldn't bond as quickly with the baby as I did, but he seems to have really fallen in love with him.....
In any case, things are going really well, although I'm still healing up from my nasty tear, and I'm tired and a little weepy at times...Right now I'm still getting used to being a full time mommy.
Update: Mina had another baby and this is his birth story, a much easier birth. One difference is that she got chiropractic care for this pregnancy.
On May 13th I woke up around 2:30am to go help my 19 month old get back to sleep. By around 3:20am he was back in bed and quiet, so I headed up the stairs to go back to bed myself. As I walked up the stairs I had my first "real" contraction, and I was pretty sure that this was going to turn into labor. But, I went ahead to bed anyway, figuring that I'd try to go back to sleep in case it wasn't the real thing. I continued to have 3 contractions about 10 minutes apart, and then they jumped up to 5 minutes apart at around 4am. By 4:30am I'd been having good hard contractions continuing at 5 minutes apart, so I woke up my husband and told him I was in labor for sure. We called my MIL to come and stay with my toddler (she lives about 40 minutes away) and called my parents to let them know we were going to be heading to the hospital. I then called my OB to let her know, and she told me to wait another half hour and then if they continued to head out to the hospital.
Almost as soon as I got off the phone with my doctor my contractions jumped to 2-3 minutes apart! As my mother has a history of fast labors (her last labor was only 2 hours total!), being 2-3 minutes apart made both myself and DH a little nervous. I was in a bit of denial though, and went in to take a shower, figuring that my contractions wouldn't stay that close together...I still figured this was going to be a long labor like I had with my first child, especially because I was pretty sure that the baby wasn't optimally positioned. While I showered my husband timed my contractions, and they were still coming about 2 minutes apart. Chris then decided that he didn't want to risk waiting for my MIL to arrive and try to drive me to the hospital himself, which is 30 minutes away, so he called 911 to get an ambulance to come and get me. We both figured it would be better to have the baby born in the ambulance than in our car!
It took about 15 minutes for the ambulance to get to our house, and at that point my MIL hadn't arrived to watch my son yet. So, DH sent me off in the ambulance and stayed at home until his mother got there. I had him call my friend, who was my other support person for labor, to have her meet me at the hospital, as well.
My contractions stayed fairly consistent while in the ambulance, and they were painful but bearable. When I got to the hospital they moved me into the L&D triage area to see if I was ready to be admitted to an L&D room. They put me on the monitor and pretty much left me there without checking my dilation or anything, even though at that point I'd been having contractions at 2 minutes apart for an hour or more. My friend got to the hospital and kept me company in triage until my husband got there. After being in triage for at least half an hour I finally began complaining because I was having a MAJOR urge to push with contractions, and I knew that I was most likely in transition or close to it, and no one had bothered to check me yet, let alone get me into a room for delivery! Finally, after much complaining they had the house OB check me...and I was at 8cm dilated. So, they got me ready and moved me into a room and got me admitted.
Once I was in the room and in bed my OB came in to check me...and after that short time (maybe about 10 minutes) I was complete and ready to push. They got the bed ready for delivery and then I started pushing. I pushed through 3 contractions (my husband says it was 3, although I only remember pushing through 2...but I'll take his word for it), and while it was an intense experience, it was also quite amazing. Mitchell Frederick was born at 7:29am at 19.5 inches long and 7 lbs., 3 oz. It was so wonderful to not be medicated, to be able to feel everything, and to be able to see my little boy right after he was born, instead of having him whisked away to be checked over, which is what happened with my previous birth. After I held him for a bit and looked at him he was taken to the warmer and the doctor stitched up the episiotomy that he'd made, although I doubt that I really needed it! But, everything happened so fast that I didn't really have time to talk to him about that issue.
So...I ended up having FOUR HOUR labor total, which just seems amazing to me, after having a 20.5 hour labor with my first child. And, what is totally amazing to me is that it seems that the baby wasn't in a LOA position...I was told that when he came out (according to my husband and best friend) he was facing up toward my right leg...and it was STILL a fast and easy labor! I hate to think how fast things might have gone had he been LOA! This labor and delivery was just about perfect in every way, whereas it seemed like everything with my previous labor went "wrong". I will say that this experience more than makes up for my feelings of disappointment from my first labor. This was a wonderful experience in every way, and hopefully future labors will go as smoothly if we choose to have more children!
Katie2's Story (Group B strep, SROM, induction, epidural, big baby, occiput transverse, vaginal birth)
Kmom's Notes: This mom planned a natural birth, but because she had group B strep and her water broke, she was pushed into an induction. (The value of this is debatable.) Intervention led to intervention, as they often do, but in the end, this mom was able to birth her baby vaginally.
This mother experienced pelvic pain and probably had a degree of Symphysis Pubis Dysfunction (SPD). Her baby was posterior for much of her late pregnancy but was able to turn more favorably (if not perfectly) for birth with use of Optimal Foetal Position techniques. The mother did experience many malposition symptoms during labor: the water breaking ahead of time, a long slow labor, a less-than-effective epidural, difficulty pushing the baby out once she was fully dilated, etc. However, because she had a nice roomy pelvis, she was eventually able to push out her 10 lb. baby vaginally, even in an occiput transverse position!
Birth Story
We decided to pass on the triple/quad screen. With the high rates of false positives for large women, we didn't need that kind of stress while going through additional testing just to find out everything was fine. Plus, we knew we wouldn't take any action against the pregnancy even if something did come out negative.
My fundal measurements always measured large because of the belly I started with before I even got pregnant. I had to ask my OB what I was measuring at because she never told me. By the time I thought to ask, I was measuring at 48 weeks (the day before I gave birth I was measuring at 50 weeks). No wonder no one ever said anything! I'm not sure why they continued measuring, though, maybe just as a source of comparison to my other measurements?
I had several ultrasounds during my pregnancy. Most of them were to reassure me because I wasn't able to feel much movement during the pregnancy. Turns out I just had a quiet baby (I often referred to her as "the sloth" for lack of movement). The ultrasound tech was fabulous. She was the one who explained to me that my inability to feel movement was partially my size but also because I had a front-lying placenta. It was sometimes difficult to see parts of the baby because of my size (particularly the genitals, which are more fleshy and thus harder to see). The ultrasounds never hurt, even when she had to put the wand-thingy deep into my belly button to get a good look.
At 32 weeks, my baby measured at 5 lb. 12 oz. Both the ultrasound tech and my OB said that I was going to have a big baby. This was expected, as both my husband and I were big babies. She was a big baby, too---she was born weighing 10 lbs. 3 oz.
I got through 7 months of pregnancy with very little complications, [just morning sickness through the 8th month.] Towards the end of my 7th month...probably as a complication of her malpositioning, I started experiencing very severe hip pain. When I'd stand up, it felt like I had to wait for my hips to come together again before I could walk. When I sat, it felt like my hips would spread. Because this was also associated with pain turning over in bed and the inability to bend over and lift my legs to put pants on, I suspected I may have been afflicted with symphysis pubis dysfunction [SPD], but I was never diagnosed by a professional. I was aware of the SPD, and would have gotten chiropractic care had I been able to afford it.
About the same time, I also swelled up like a balloon. Everything was swollen from the top of my head to my poor little toes. Because it is one of the symptoms for pre-eclampsia, I watched my blood pressure very carefully on each visit; however, my blood pressure never went up during the entire pregnancy. My OB, on the other hand, never seemed worried---just explained it was a side effect of pregnancy and everything would be back to normal after the birth.
Throughout my pregnancy, we consistently had trouble finding the heartbeat on doppler. However, my wonderful OB was persistent and always found it low on my right side. On the rare occasion we couldn't find it or couldn't hear it well enough, they got me on ultrasound to check. I think we all assumed the difficulty was due to my size, although nothing was ever stated outright. Come to find out, difficulty in hearing the heartbeat can be due to malposition, and this theory fits my situation. As it turns out, my baby was facing backwards---facing my front instead of my back. [Kmom note: Trouble finding the heartbeat is a classic sign of a posterior baby, esp. if they then find it low and on the right side. It can also be more difficult to find a heartbeat when the placenta is front-lying, as hers was.]
I started doing exercises to try and turn the baby. For the last two weeks of pregnancy, I watched my position carefully. No more leaning back and putting my feet up as I had been (due to excessive swelling). I sat upright at all times, Twice a day, I relaxed in the knee-chest position for 10 minutes, followed by a few minutes of pelvic rocks (however long my knees could stand it).
Something must have worked because the day before I gave birth, we found the heartbeat easily on the left side. She may not have been in the most optimal position (given my 25 hour labor) but it was better than what it had been. She was born facing my right leg, which I read is better than her facing my left leg (although facing down is optimal). [Kmom note: From her description it sounds like the baby was occiput transverse, meaning that the baby was head down but her head was facing sideways.]
Towards the end of my pregnancy...I wrote up this great birth plan. I wanted a completely natural birth. I'd read "Birthing From Within" and wanted a birth based on that idealism......then I was diagnosed positive for Group B Strep. As a result of this diagnosis, I was going to have to go to the hospital as soon as my water broke or shortly after contractions started in order to get IV antibiotics. Scratch two off my birth plan. When my water broke, I went to my OB's office, and hadn't had a contraction yet. They started me on pitocin to start contractions. At this point, the birth plan may as well have been never written--I didn't even bring it with me to the hospital.
I get admitted to the hospital at about 4 p.m., get the IV, the pitocin, and I'm dilated to 3 cm. I get an internal fetal monitor and an internal contraction monitor. I'm not wearing a hospital gown because I've opted to wear my own tank top, and I'm much more comfortable (emotionally and physically) this way. At 9 p.m., I'm in pain, tired, and still 3 cm. I ask for an epidural so I can sleep. It took way too many attempts to get the epidural in place. I couldn't get my spine arched enough to make it easier. My belly would only let me bend over so far. I finally realized that if I got my legs up onto the bed and sat with my feet together that I could get my belly down far enough to arch my back enough, and voila, the epidural line was in.
I don't sleep very well because the baby's heartrate kept dropping, so I have to wake up, rub my belly and talk to her, and her heartrate goes back up. I'm also uncomfortable with hip pain (so much for the epidural) so I have to keep switching sides; not easy to do when you have a gazillion wires hanging off your body and the lower half of said body is mostly numb.
Come morning, I'm only dilated to 6 or so, and they're worried about my amniotic fluid level. They start replacing the fluid artificially, so I have a third tube/wire going up there. At about 11 a.m. my contractions started becoming very painful. They tried retapping my epidural and it didn't work. The stupid anesthesiologist wouldn't let me get into the position that had worked the night before. [Kmom note: Another commonality among women with malpositions is an epidural that is not fully effective.]
Sometimes before noon I hit 10 cm. I started feeling like I had to poop. I kept telling my nurse I had to poop. She kept telling me that I didn't need to poop, that it was just the baby's head coming down. The contractions were coming one on top of the other and I couldn't stop bearing down, even had I wanted to. The nurse and I were fighting about my need to poop. When she left the room I told my husband to get me the bed pan. I'd been trying to poop on the bed, but wasn't able to; about a minute after getting arranged on the bed pan, I did it.
About this same time the doctor decided that I was going to need assistance from the vacuum to get the baby out. I'd essentially been pushing for two hours (I was just trying to poop!) and the baby wasn't coming down past the point she was at. The nurse told me to stop pushing and wait for the doctor, but I couldn't help it---my body was pushing by itself.
The doctor came back, set up the vacuum, helped me deliver the baby. At the time of her crowning, I definitely felt the "ring of fire" that a lot of women talk about. Then I felt a huge "swoosh" of movement and water. The doctor never told me to slow down or stop when the baby's head came out like they do on "A Baby Story," so I thought the huge swoosh came after the head. My husband later told me that her head was out and I was still pushing, and the huge swoosh was everything after the shoulders.
25 hours since my water broke, and after almost 3 hours of pushing, my daughter was born. My husband cut the cord and she was placed on my chest. It's a good thing the nurse asked if we had a camera, because both of us completely forgot about taking pictures. They took the baby over to the warming station while I delivered the afterbirth. Then the OB started stitching me up---I had a third degree tear. I'm so glad I didn't get an episiotomy, as I'm sure it would have been much worse!
The baby's blood sugar was low, so I had to breastfeed immediately. We were having trouble getting her latched, so we gave her a bottle. We also had to continue to bottle-feed because of blood oxygen level problems. Between the blood sugar and the blood oxygen levels, we really couldn't wait for my milk to come in. We ended up not breastfeeding because my nipples were too large and flat in order for her to get her little mouth around for a proper latch. We even saw a lactation consultant who reluctantly agreed it might be too difficult for her to breastfeed with a proper latch.
I never had any pain from my tear. I think I was too high on motherhood to notice. Nobody could believe I'd birthed such a big baby vaginally, without drugs (by that point everything had worn off) and wasn't in any pain afterwards. It's amazing what mommy hormones can do. I heard a lot about "big baby this" and "big baby that" particularly about eating and sleeping (my baby slept 4-5 hours at a time, 'round the clock, with about an hour in between sleeping sessions. By the time she was 2 weeks old she was sleeping 6 hours at night.)
Even though my birth plan was out the window from the word "go," I had a very satisfying birth, and have no regrets. I think the most important thing about a birth plan is to remember that sometimes it doesn't work out that way. Had I been rigid to my birth plan and things gone the way they did, I wouldn't be as satisfied with my birth experience as I am. I was talking about having another one before I even got out of the labor and delivery room into the recovery room.
It also helps that I'm head over heels in love with my baby.
Kristi's Stories (bulimia and weight swings, infection, 7 vaginal births)
Kmom's Notes: This mom has been very courageous to be so honest about her difficulties with bulimia. Her weight varied quite widely over the course of all her 7 pregnancies, from about 140 to 284 lbs.
Her weight gains varied quite a bit also and demonstrate how varied gains can be, and how they can relate to how stable weight and eating are. When she was purging and actively bulimic before pregnancy, her weight gains were 86 lbs and 110 lbs. When she started at a higher but more stable weight her weight gains were 19 lbs. and 0 lbs. When she had just lost 115 lbs prior to baby #5, her weight gain went back up to 60 lbs. With her sixth baby she had hyperemesis (severe morning sickness) and lost a net total of 23 lbs. With her 7th child, she gained a total of 30 lbs.
Obviously weight gain can be influenced by multiple factors, and gains do vary from person to person. It is not possible to clearly say 100% of the time why women gain differently. However, there do seem to be some trends. This mom had a weight gain variance from -22 lbs to +110 lbs., a very large range. Her pattern seems to echo what Kmom has observed over the years: that women who lose a lot of weight just before pregnancy or who have chronic weight variations and/or eating disorders tend to gain a great deal of weight in pregnancy; and that women whose weight is higher but more stable often gain more modest amounts. However, of course, these are just overall trends for a group of people and don't necessarily apply to all individuals.
Birth Story
I have always battled with bulimia because of the pressure to be "model-like." I was battling when my first daughter was conceived. When I stopped purging, I put on 110 pounds pretty quickly and ended up at 250 lbs. when she was born. She was born in the hospital after being induced 2 weeks late. Kati weighted 10 lbs 4 oz and was 23.25 inches long. She was a vaginal delivery with an epidural.
6 months later, Josh was conceived. I was again purging and stopped and gained 86 pounds, again reaching 250 lbs. when he was born. He was delivered at the hospital, induced 2 weeks late. He weighed 8 lbs, 14 oz and was 22 inches. He was a vaginal delivery with an epidural.
3 years later, Sarah was conceived. I had stopped purging and weighed 265 when I got pregnant. I gained up to 284 with her. She was born, induced 2 weeks late, induced 3 days in a row. The third day finally took and she weighed 8 lbs 8 oz, 21 inches. She was a vaginal delivery with an epidural.
3 months later, Brady was conceived. I had not lost a pound and was at 284 when I got pregnant. I did not gain any weight during that pregnancy. He was induced a week late, and he weighed 8 lbs 4 oz, 21 inches. He was also a vaginal delivery with an epidural.
THEN I GOT ENLIGHTENED!!! My husband had a vasectomy just before Brady's birth and then got a reversal (because we knew the vasectomy had been wrong) in Oct. 1998. I had lost 115 lbs. with proper eating and dieting and was down to 170 lbs. when I conceived our first reversal baby just 2 weeks after the reversal. I chose a midwife and decided to have my first homebirth.
It was during this that I decided to be a midwife myself and began to educate myself about everything I could. I was appalled at my selfishness and how much I had exposed my precious children to with epidurals and pitocin inductions and all. I vowed to be more sacrificial and to endure anything for any of my future children. I gained 60 lbs. with that pregnancy and went back up to 230 lbs. Abby was born on her due date, naturally, at home. I had no complications, no problems, and my recovery was amazing!
4 months later, Grace was conceived. I began vomiting at 6 weeks with her. I had never been sick before so this was a huge adjustment for me. I was sick throughout my pregnancy with her and lost 45 pounds (down to 185) by the time I hit 32 weeks pregnant. Because Grace was so small for her gestational age, they put me on bedrest hoping it would cause me to be able to keep my food down and fatten her up over the last 8 weeks of pregnancy. I stayed in bed for 2 weeks ad went into labor prematurely, 6 weeks early. I still opted to deliver at home and our very tiny lamb was born at 34 weeks, weighing 3 lbs. 11 oz. She did great, never needed a thing----my best nurser as a matter of fact! She is still tiny today, but never has been developmentally delayed. I gained 22 pounds during that two weeks in bed. And then as usual, gained 32 while nursing her.
I conceived Emma when Grace was 7 months old. I had a few scares with bleeding but all in all the pregnancy was great. I weighed 260 when I got pregnant and hit 290 by her birth. I had a horrible bladder infection when I went into labor with Emma 3 weeks early. As a result of this infection, I got severe septicemia, bacturemia, and endometritis.
When I arrived at the emergency room 24 hours after her birth, I was almost dead (my blood pressure was 35 over nothing and my pulse was 188). I was in septic shock. I had an emergency D&C because they thought I had retained placental parts, but that was wrong. The infection in my bladder traveled into my blood stream and just caused a myriad of life-threatening problems. I spent 11 days in the hospital, 4 of which were very touch and go with a fever of 104 and higher. It did not look good. Emma was great and with help (I was so out of it I don't even remember thsoe first 5 days) of my husband putting her to me, I was still able to nurse. She stayed with me in the hospital, even though she was born at home.
[These] last 3 birth were great. No drugs, no interventions, uncomplicated births at home! (Emma did need resuscitation perhaps due to the tight cord around her neck and my infection.) God was great to me and cared for and guarded me.
I have never been uncomfortable and unable to conceive or deliver due to my size and weight. I do however want to lose some of it for my own health. I am not one who believes that all should be "model thin" anymore. I know that God intended we all be ourselves and that even with good healthy eating, many of us will be heavier because that is how we are made.
I want to encourage anyone, any size, to pursue your dreams of being a mom. Enjoy a wonderful safe homebirth, and take good care of yourself during pregnancy.
Vicki2's Story (completely unknown pregnancy, natural birth)
Kmom's Notes: This is one of those rare cases you hear about where someone doesn't know they are pregnant until they have the baby.
In this case, she saw an OB about irregular periods but because of spotting they just thought the periods were becoming irregular. (Although that alone SHOULD have been treated!) The doctor was supposed to run a pregnancy test but it turned out later she did not, nor did she detect the pregnancy through a pelvic exam, even though the mother was about 5 months along. That alone is gross incompetence from the doctor; it's true that pregnancies are harder to detect early on in a big mother, but by 5 months the pregnancy should have been CLEAR to anyone competent in doing a pelvic exam, whether the mother was big or not.
The mother notes she had no morning sickness. Although unusual, some moms don't. She also felt no kicking, which is odd. Being 'overweight' does not keep you from feeling baby kicks, that's for sure! Even very supersized women feel their babies kick. It's only speculation, but perhaps this mother's placenta was anterior (in the front by the tummy), which can "muffle" the feelings of kicking, sometimes significantly. Still, even then, it's unusual she was not aware of any kicking. Perhaps she simply was not able to identify feelings of movement as "baby kicks" since she had been told she was not pregnant.
Birth Story
Starting in Dec. 2000, I was starting to have irregular periods. I had always had regular periods since I was 11. I couldn't get in to see my OB until May 2001. My father had died the day before my appointment so I was stressed and I had thought my period was brought on because I was spotting. My OB ran a pregnancy test, gave me a pap, and a pelvic. There was too much blood in my pap so they needed me to come back. However, my pregnancy test came back negative. After another pap showed everything was okay, I just put it out of my mind, thinking something else must be wrong.
In June 2001 I went on a liquid diet to help me lose weight. I was very depressed because during the whole time I had only lost 5 lbs. I went off the diet a month later and my mother and I started moving from our home to my grandmother's house. I packed during the day through the whole month of July so we could be out by Aug. 3rd. I lifted very heavy boxes never knowing I was pregnant. Once we were moved, everything was fine. I was still spotting here and there, thinking I was just irregular.
On August 25, 2001 I started fall classes at my college. After I got home I started having pains in my back. They continued from 4 p.m. until I couldn't take them anymore at 12 a.m. My mother took me to the county hospital 30 miles away where I was told I was pregnant. I couldn't believe what I was hearing. The doctor did a pelvic exam to see how far along I was and he said I was full term with a big baby. So before I could think about anything, I had my daughter at 3 a.m.
I filed a lawsuit against my doctor and won---obviously. I was probably 5 months along when she did the tests and pelvic exam. Come to find out, she never ran the pregnancy test...they were so busy they forgot about it and then they lost my urine sample.
I'm really glad I had an ER doctor that knew what he was doing. The hospital I went to hadn't delivered babies for 15 years. So many things could have gone wrong. I don't know if it was because of my weight but I never felt anything. I never had morning sickness and I never felt her kicking.
I'm pregnant again, exactly 2 years from the last pregnancy. At least this one has gotten off to a good start so far---the pregnancy was confirmed.
Stella's Story (PCOS, pre-eclampsia, precipitous labor, vaginal birth; weight loss surgery, bedrest, induction, vaginal birth)
Kmom's Notes: This mom had her first pregnancy at age 19. She had weight loss surgery (WLS), then a second pregnancy at age 32. Unfortunately, she was given no real instructions about nutrition in the second pregnancy, nor was she given extra vitamins or minerals (beyond the usual prenatal vitamin), despite the known tendency for women with weight loss surgery to have nutritional deficiencies.
Despite her difficulty with eating meat, no one monitored whether she was getting enough protein. In addition, she was not given extra folic acid (despite having taken Glucophage, which is known to impede folic acid absorption) or extra iron (despite a strong tendency for women after weight loss surgery to be anemic). At one point, there was some discussion about adding supplements like Ensure because she was steadily losing weight, but she finally started gaining weight so it was dropped.
Fortunately, the baby seems to be doing well anyhow. But this points to how little guidance is given to some women experiencing pregnancy after weight loss surgery, despite research recommendations to carefully counsel and monitor nutrition in women who are pregnant after WLS.
Birth Story
My first birth was almost 14 years ago and I remember very little now, except that I had no problem conceiving (was only off birth control pills for 3 weeks), gained 93 pounds, went into labor 7 weeks early, and still had an almost 7 lb. baby in 2.5 hours. Nobody believed me (that I was in labor in the first place---it was April fool's day, after all) and that I had to push so quickly.
13 years later, having been married to a new DH for a few years, and having wanted another baby for many years (can't figure out why I never got pregnant in all that time?), we started to try to conceive. I had been having messed up periods for about 2 years, and went to an OB about it. He pronounced me PCOS, started glucophage and provera (to induce a "real" period, in order to know when to start clomid), and prescribed clomid, even though the blood tests showed (somehow) that I did ovulate.
On October 14, he did a vaginal ultrasound, showing a small cyst on my left ovary. I took the provera, waited about 2 weeks for a period to show up (after all, I had about $200 worth of clomid just waiting to be used!), and it never happened. Now I was mad----thought for sure that the provera had messed something up! I took a home pregnancy test, just to rule that out before yelling at someone, and surprise, surprise, it was positive! According to my (new) OB, I had conceived on or around October 12, so perhaps the "cyst" the previous OB saw on ultrasound was not a cyst after all.
By this time, we had moved back to my hometown, so I visited my previous (and favorite) OB. I was concerned about having taken Provera and Glucophage, but there were no worries. My pregnancy was relatively uneventful. Baby was breech from week 32-35, and we were talking c-section. I was on bedrest for a while---low amniotic fluid. One ultrasound indicated a possible fetal kidney problem, was dilated to 3 cm and 80% effaced for about 5 weeks prior to birth, so was again on bedrest, but in the end all was well.
I have a history of precipitous labor and lived an hour away from the hospital/OB (and was tired of being pregnant anyway!), so I was induced at 38 weeks. At 7 a.m., artificial rupture of membranes by OB, 7:10 a.m. pitocin started, 8:40 a.m. first contraction. 11 a.m. (still at 3 cm), epidural administered (was a waste of time, never helped, still felt everything), 11:40 a.m. started pushing (at 8 cm dilated). 11:51 a.m. She was born!
This was such an easy birth (of course, I thought I was dying in the middle of it, but...). I wanted to leave about 4 hours later, but had to stay until the next day. Nothing hurt, except my back from the epidural. We left at noon the next day, and spent the whole weekend (she was born on Friday) at a pow-wow with my husband, my 13 year-old, and my 1/2 day old baby. It was great. I was 10 lbs. below prepregnancy weight when baby was 3 week old, but gained that and then some back, and am now about the same weight I was when I delivered, 6.5 months ago.
Now we're in the process of trying to conceive #3, our last, and being told that we'll "never get pregnant without help," which is really discouraging. We did it before, despite being told I was PCOS. My periods are back to crazy---two or three per month. The last one was so heavy I had to start norethindrone to stop it. OB wants me on that for a few months to try and regulate my cycle, and then we'll start on clomid. He says that my last baby was basically a "fluke," that I ovulate intermittently, if at all. He restarted my glucophage and upped the dosage, and just recently started me on aldactone, which really confuses me---how does a high blood pressure/heart condition medication help ME? I haven't had any tests (that I'm aware of) besides an insulin test (diagnosed insulin-resistant in October 2002), so get really upset and ask a lot of "how do you know" questions. I get discouraged, when they always want to do birth control pills to regulate---makes it hard to get pregnant that way! I wonder about aldactone (a class D drug)---what if another "fluke" happens?
Have been told to "drop some weight," which I agree wouldn't be a bad idea, but all the PCOS stuff recommends a low-carb diet, which involves mostly meat. I had my stomach stapled in 1996 and can tolerate hardly any meat, so am looking for other good ideas---there is very little information for the stomach staple-pregnancy connection, or diets following that type of surgery. I'm getting to the point where I feel my time is running out baby-wise, and would really like one more. I've done it before, both pre and post diagnosis, without help, and am lost as to why I need help this time......
As for pregnancy/nutrition guidance during pregnancy/WLS---I had no special guidance...From what I can tell, there is little to no information about pregnancy after WLS, and when you throw in PCOS/infertility into the mix, it's just an uncommon combination that not many (in the medical field) have experience with.
Sal's Story (PCOS, GD, PIH, fall down stairs, induction, vaginal birth)
Kmom's Notes:
Birth Story
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!
Angi's Story (induction, epidural, shoulder dystocia, vaginal birth)
Kmom's Notes: A case of shoulder dystocia that was probably unnecessary. Shoulder dystocia occurs when the baby's head comes out but the shoulders get stuck. Sometimes this is because the baby is bigger than average (this baby was not very large) or positioned poorly, but sometimes it occurs because the birth has been mismanaged.
Because of a history of large babies in this family, the doctor chose to induce labor at 40 weeks, a common tactic to try and avoid shoulder dystocia due to a big baby. Ironically, however, research shows that induction actually increases the risk for shoulder dystocia, even though doctors believe it decreases the risks. Many birth advocates and midwives believe that the combination of inducing labor plus an epidural plus pushing in a semi-sitting position (which reduces the size of the maternal pelvis significantly) leads to many shoulder dystocias that could have been prevented.
In this case, the mother was also encouraged to push as soon as she reached 10 cm, instead of waiting until her body started pushing for her. Some midwives believe that this may also be a factor in shoulder dystocia. Although it's impossible to say for sure (and it's always easy to secondguess after the fact), what probably happened was that the baby's shoulders had not yet rotated internally before they had her start pushing, and they got 'stuck' on the pubic bone because they had her start pushing before they rotated.
Whatever the cause, a shoulder dystocia did occur. As a result, the mother had two nasty and probably unnecessary episiotomies, the baby's shoulder got dislocated, and she inhaled fluid as she was born and had to be suctioned strongly. Fortunately, in the long run, the baby seems to have done well in spite of this difficult beginning.
Birth Story
My husband and I used cervical fluid and position indicators as our form of birth control, using condoms during fertile phases. We had planned to start trying for a baby after our 5 year anniversary, which was still several months away. By choice we cut our condom use early one cycle, as it was a weekend, etc. The next month we had the welcome surprise that we were expecting----just as we were to leave for Mexico for our anniversary vacation. I spent the majority of the trip with morning sickness and I also picked up a souvenir cold. Morning sickness lasted approximately five weeks and was the only true discomfort during the entire pregnancy (other than the expected achy back).
I worked until 37 weeks of pregnancy. My doctor and I were expecting a large baby as it runs in my family (my grandmother had an 11 pound baby and my mother a 10 pound baby). The ultrasound also appeared to confirm this at 36 weeks when it approximated a weight of just under 9 pounds. I had been having braxton hicks contractions and had lost my mucus plug by 39 weeks. At 40 weeks my dr. and I scheduled an induction, as I had not progressed past 1 cm dilation though my cervix was soft.
At 6 a.m. I was hooked up to a pitocin drip that was slowly increased as the hours progressed. At 10 a.m., my dr. visited and ruptured my membranes and the contractions became more frequent and painful. I had not intended to try for a natural labor and had chosen prior to arrival at the hospital to have an epidural. I requested the epidural at 11:45 a.m. and the anesthesiologist arrived within 5 minutes to insert the catheter. (He had visited earlier in the day to introduce himself and explain about the procedure.) The epidural took away the pain though I did still feel each contraction. I also could still feel and move my legs thought they were slightly numb.
By 3 p.m. I was 7 cms dilated and the pressure started increasing rapidly. I told my nurse about the dramatically increased pressure. She said she would check me again though it had only been 20 minutes since she checked and I was 7 cms. Upon checking, my nurse was greatly surprised that I was almost completely dilated (only a rim/lip left). She immediately called my dr (whose office was next door to the hospital) and frantically started preparing the room. After another check, a few minutes later, the lip was gone. My dr. had given the nurse permission to start helping me push when this occurred which she did.
I had an hour and a half of intense pushing. My daughter's shoulders were too large and had gotten stuck. I had a median episiotomy, two cuts, to the rectum, as I had started tearing. My baby's shoulder had to be dislocated during the birth and as she was born a gush of fluids came out as she took her first breath, which she unfortunately swallowed into her lungs.
We had planned for my husband to cut the cord, but due to the complications during her birth, my dr. cut the cord. She then gave my daughter to the nurse who whisked her away to get the fluid from her lungs. My husband said there was almost a cup and a half of fluid that was suctioned out. (Her Apgars were 8 and 8.) I was disappointed that I was not immediately given my daughter to hold as I had envisioned. It was terrifying to not be told anything while the nurses were bent over and working on my daughter. I watched them work on her across the room. My husband wasn't sure if he should stay with me or go to her. I didn't even know if I had had a boy or girl at first. I asked my husband to go check on our daughter. My dr. finally told me I'd had a girl when she was sewing the episiotomy cut.
Those minutes of uncertainty felt like an eternity, but when I was given my daughter to hold and breastfeed 20 minutes later it was the most amazing thing in the world. She immediately took to breast-feeding and greedily sucked for 25 minutes. She was a voracious eater and wanted to be fed every 90 minutes. As I write this she is not quite 3 months old and 15 lbs. already. Overall, I was pleased with my decision to use an epidural as I honestly believe I would have run out of energy to push had I felt the pain of 11 hours worth of contractions. Right after being given the epidural I was able to take a nap and let my husband go have lunch (my nurse had his cell phone number to call him back if anything changed). I was happy with the atmosphere at the hospital, as I had been allowed to bring a CD player, a glade plug-in air freshener, and was allowed to take as much time as I needed in the birthing room before being moved to my private room.
My size was never an issue with my doctor, her staff, the nurses at the hospital, or the ultrasound technician. My doctor was pleased with my initial weight loss then only gaining six pounds overall, though she did caution me to gain weight during the last trimester. I had lost 12 pounds by the middle of my second trimester. I then gained 18 and finished six pounds above where I had started.
I just wanted people to know that even if you weren't planning for [pregnancy] at the exact time you became pregnant, you can still have a positive pregnancy, birth, and fall absolutely in love with your child.
Update to Angi's story
We conceived our second child on the third month of trying. The first month that we tried, both my husband and I got the flu close to a week after my fertile cycle had passed. My period was 8 days late and heavier than normal, but a pregnancy test was negative, so I'm not certain if we had actually conceived then or not. Unlike my first pregnancy where the pregnancy itself was uneventful, this one had me visiting the hospital on three occasions prior to delivery.
The first hospital visit was just into my second trimester and was due to a slight case of food poisoning that I obtained on the last night of a five-day cruise. I was treated for dehydration and fairly severe stomach cramping after a miserable 7 hour drive home. I was given an ultrasound after the ER Dr. did a pelvic exam and could not tell if the abdominal pain was 100 percent from the sickness or if there were any problems with the pregnancy. As obstetrics was not his main discipline he wanted to err on the side of caution and do the ultrasound. I approved this for the peace of mind it would give me to see my little guy moving about. The tech would not let me see anything, however, nor would she allow my husband in the room. Apparently hospital policy in the ER didn't allow patient viewing. She tried not to be rude about it though and she did say that everything looked fine from what she could see. After, 14 hours I was released and told everything with the pregnancy was good.
The second was caused by a fall onto a tile floor at 34 weeks of pregnancy. My daughter had spilled milk onto the tile (from a spill-proof sippy cup) and as I was rushing down the stairs to answer the door for a UPS delivery I slipped on it. I tried to catch onto the banister of the staircase and break the fall but ended up twisting my arm on the way down and having to visit an orthopedic surgeon for a rotator cuff injury. Luckily, I did not land on my stomach (was falling forwards) but I pulled muscles in my groin area from doing a modified split to avoid my tummy hitting the tile. I was monitored at L&D for four hours as I had three sets of contractions after the fall, but they did not continue. Yet another unplanned ultrasound to make sure the placenta had not separated from the uterus wall was done as well as two x-rays. They wanted to do four shots but we compromised with two angles. I had a lead lined apron over my belly during the x-rays but I've looked at the pictures and you can still see my rib cage which should have been covered so I don't know how effective the lead shielding was.
The final hospital visit before the 'big day' was false labor during my 39th week where the contractions happened fairly close together and regular for several hours before starting to taper off. They did not feel like normal Braxton Hicks contractions, which I had been having off and on. During that time I lost the mucus plug and had a lot of dampness. Since I had been induced the first time I wasn't sure if I was leaking amniotic fluid. I called my Dr. whose associate was on call. He said to go in to be checked as it was 4am and he couldn't tell me over the phone based on my description if it was or not. I think I may have been overstating the amount of dampness because of being told a horror story by my husband's secretary of her almost losing her child due to a slow leaking of fluid during her seventh month of pregnancy.
Five days later we chose to induce. This decision was for a variety of reasons, but honestly, convenience did factor in the decision as we had to schedule time off for my husband and make sure relatives were available to care for our daughter while we were at the hospital. Other reasons were wanting my Dr to do the delivery rather than one of her two associates, a possible surgery looming for the shoulder injury and a little bit of fear on my part that I would be having false labor many times before the real thing and how would I tell the difference, etc. Before entering the hospital I was already 2cms dilated and 80 percent effaced and my cervix was positioned properly.
At 6am on the morning of a pitocin drip was administered. Contractions started and began to ramp up in duration and frequency within the hour. My Dr. was in at 7:30 and I was 4cm and 80 percent effaced. She broke my water then, and as before, contractions really started becoming painful then. I wanted to experience more of this labor than my last before having the epidural, so I breathed through two more hours of contractions before asking for and receiving the epidural. I was at a six on the last check before the epidural but it had been close to an hour since then. I believe that I was close to or completely dilated before it went in however and the labor I was experiencing was actually transition rather than active.
This time it was incredibly hard to sit still for the needle placement of the epidural. I was mentally kicking myself for having waited so long. The epidural did not cover my full abdomen initially, so I felt labor on one side but not the other. The nurse helped me turn to the opposite side to try and get it working. The anesthesiologist kept depressing the button to give more pain medication but it did not help. He wanted to replace the needle and I said there was no way I was doing it again, so he said he would try to pull it out a small amount and see if that would get things working. There must have been a kink in it because once he did that everything went numb almost instantly.
Unlike the first time, this time I couldn't feel when the contractions were happening. I got scared then that I wouldn't be able to push properly since I couldn't feel anything at all. Having read about epidurals sometimes forcing c-sections because of the inability to feel oneself pushing made my fears even greater. By that time, the nurse checked again to see how far along that I was. It was a good thing that she had been steadily preparing the room while the anesthesiologist was working on the epidural because when she checked I was ready. She said don't push and immediately went and called my Dr. who showed up 15 minutes later.
My Dr. had me give an experimental push and said I wouldn't have any problems. Since I couldn't feel or move my legs they did have to use stirrups. I pushed twice more and the Dr. changed the angle of my hips and had my husband and the nurse hold my legs in a slightly different position. Two more pushes after that and the baby's head was out. She took a minute for the shoulders to rotate then had me push again. That's all it took and my little guy was born after only five hours of labor with only 30 minutes of that having had the epidural.
I had told my Dr. before hand that I didn't want an episiotomy after my first experience. She agreed that they were generally unnecessary and that the three Dr's in her practice did not do them routinely as my first OB did. She assured me that it was rare for any of her patients to have them. I did end up with a slight tear but it only took 3 stitches to close. The after effects were so much nicer too. It took 10 months for the first episiotomy to fully heal and only a few weeks to feel better after the tear with very minimal pain. Granted, my second baby was a pound and a half lighter than my first, which could have had, some effect on it. I think his weight was so much less because of my health during the pregnancy. Comparatively, my first pregnancy was a breeze in relation to this one.
In relation to my birthing experience, this one was incredibly better. My son was placed on my stomach once he was born and we got a chance to meet, unlike when my daughter was whisked away immediately. My husband got to cut the cord this time. Everything was easy going and relaxed. The pain medicine didn't have any effect on my little ones appetite, he had no problems at all with breast-feeding and we are currently still enjoying that relationship which has been ongoing since his birth six months ago.
Sandy's Story (SROM, indctn, posterior vagnl birth; normal birth; SROM, Cytotec, posterior vagnl birth, possibly septic baby)
Kmom's Notes: This mother's stories are a good reminder that although more problems are associated with posterior positions, sometimes posterior babies ARE born vaginally anyhow! This mother had 2 babies (#1 and 3) who were posterior and were born vaginally. (It probably helped that both posterior babies were small.) Baby #2 (who was not posterior) was a 9 lber. and the only one who was born at 40 weeks. Note how much easier that birth was, despite the baby's larger size. A good position helps, especially in a big baby!
With both of the posterior babies, the water broke ahead of time (as it often does with posterior babies). As a result, both labors were induced. This practice is questionable. It's true that babies whose waters have broken ahead of labor are at higher risk of infection, but the strongest risk factor for infection in this situation is vaginal exams etc., which are more common during an induction. (Placing Cytotec in the vagina, for example, already exposes the baby to a higher risk for infection, which is what they are trying to prevent by inducing!)
Many midwives have found that if the mother's temperature is monitored carefully, careful hygiene is practiced, and no vaginal exams are done, infection risk is lower and it is possible to wait longer for spontaneous labor. So it is questionable whether this mother really needed to be induced after her water broke (if they had omitted vaginal exams). However, it is a common practice.
Using Cytotec at home, however, was a very questionable choice by the midwife, as it has a higher rate of uterine hyperstimulation and fetal distress associated with its use. One has to wonder if the two doses of Cytotec were associated with the baby's problems after the birth at all. It sounds from the description like the baby was feeling the affects of the drug, and as a result of being sleepy and "out of it" became dehydrated. However, there is no way to know for sure what the problem was with the baby, or why it occurred. It's possible Cytotec might have been part of the problem, but there could also be other explanations.
After baby #3 was born, they suspected the baby was either dehydrated or septic (from whatever cause) and took him to the hospital for further tests. They went through some very difficult times as they tried to find out whether he was septic or not. In the end, the tests seemed to indicate he was not, but of course they had to treat as if he might be, just in case, which was very hard on them all.
Breastfeeding in particular was very difficult to establish under those circumstances. It's an amazing tribute to the mom that she was able to preserve bfing in a situation as difficult as that! What a testament to her love and dedication. Happily, the baby is still nursing at 26 months.
Birth Story
Baby #1: I read all sorts of material while I was pregnant, but I really didn't understand how prepared I would need to be for the birth. I naively thought I could decide to have an unmedicated birth, trot off to the hospital and have just what I wanted. Wrong!
My water broke at 38 weeks. I had been to the OB's office that day and was told that the baby definitely wouldn't come for at least two weeks. Being a first-time mom, I got all excited and off we went to the hospital. Mistake #1!! The doctor said to go if it would make me feel better. I wish he had said, don't go until you're having contractions! I ended up spending a long night waiting for something to happen----and nothing did.
The next morning I was informed that it was time to induce and Pitocin was begun. In all my reading I hadn't come across "back labor" and was totally unprepared for the pain. I expected pain in the front, not the back! After several hours, I asked for pain relief and was given Stadol. This did nothing except make me feel woozy and unable to concentrate on the contractions. I didn't realize until after the birth that the baby was posterior.
When it came time to push 12 hours after the introduction of the pitocin, my OB (in solo practice) was unavailable and a doc I had never seen came to deliver the baby. I pushed just a few times, he performed an (unnecessary in my opinion) episiotomy, and I had a beautiful 6 lb. 13 oz. little girl. I required several stitches to close the episiotomy. I decided at that moment that I would do things differently next time.
Baby #2: Because of my first experience (which wasn't bad, just not what I wanted), I determined to remove myself from the hospital setting for this baby. I found a birth center and a midwife that I adored. This pregnancy was very different in that I was nauseous 24/7 for over 8 months. Because of that, I gained very little weight (15 lbs.).
I started having contractions on a Monday evening around 10 p.m. and went to the birth center shortly thereafter. My labor progressed more quickly and I had much more freedom to move about and find positions that were more comfortable. When it came time to push, I found that lying on my left side was most comfortable. My 9 lb. son was born around 3 a.m. without drugs, and I had a very small tear that required just one stitch. Three hours later, I was home in my own bed.
Baby #3: Baby #3 was conceived almost 10 years after my other children and I was 42 at the time. Had he arrived on his due date, I would have been 43 at his birth. Before we conceived this child, my husband and I had determined that we wanted a home birth.
I found a midwife practice in my area that did home births and made an appointment. At my first visit, I asked if they were bothered by either my age or my weight (around 295). They were very accepting of me as I was and I knew I'd found the caregivers for this birth.
I was very ill with this baby and spent a lot of time lying down to try and control my stomach. Several of my favorite foods made me really ill and I was unable to drink milk at all. When I could eat, I tried to eat healthfully (though I did have a thing for cinnamon sugar pop tarts...). Still, I lost 40 lbs. by the time I delivered. It was obvious that the baby was growing well, though, and so there wasn't concern about the weight loss.
Because of my age and weight, I had researched the possible problems associated with pregnancy. I was well aware of the risks and the higher probability of having a Down's or otherwise handicapped baby. Still, my husband and I decided against testing. I had one ultrasound, mainly because we wanted to know the sex of the baby and I took the GD test. We passed on all other tests.
When I was 37 weeks, on a Tuesday evening, my water broke. I settled in to wait for labor to begin. Early Wednesday morning I had regular contractions and thought we were on the way to the baby, but by mid-morning they stopped. I spent the afternoon taking some vile herbal from my midwife, hoping that labor would begin. I did NOT want to go to the pitocin route again. Still nothing happened. Around 5 in the afternoon, my midwife suggested Cytotec. I was leery, but did some research on the net and felt it was worth the risk--even with a homebirth.
At 7 p.m. the first dose of Cytotec was administered. In just a bit, a nice steady pattern of contractions began and I was pleased with my choice. I was having back labor again as this baby was also posterior but managed better this time with pressure and a heating pad. I had two friends with me as well as my two midwives, my husband, and my two older children. They all provided wonderful support.
A second dose of Cytotec (around 11 I think) sent me into instant transition. I had experienced transition before, but this was much different. The contractions were more intense and almost non-stop. Around midnight, I began pushing. Before I had felt relief at this point, but this time pushing was just as painful as the earlier contractions. I pushed for 37 minutes and birthed a second son weighing 7 lbs., 4 oz. I had no tears and felt wonderful once the baby was born. He was perfect in every way. It was very early Thanksgiving morning and I had much to be thankful for.
The baby seemed very sleepy and didn't nurse well, unlike my other babies. Looking back, that should have warned me, I think, but I was tired too and missed this clue. We went to sleep around 3. The baby woke around 5 but only nursed a few minutes before falling asleep again. Then he slept until almost noon----definitely not normal newborn behavior, at least not in my experience. He continued to sleep most of the day and nursed very little---only once or twice----and I never saw his eyes that day. By evening I was concerned as I couldn't rouse him to nurse and he still hadn't urinated. I tried all sorts of things to wake him with no results. Finally I called the pediatrician about 10:30 Thanksgiving night. He felt the baby was possibly septic or dehydrated and wanted him in the ER immediately.
Twenty-four hours after my wonderful home birth, I was at the ER with my little guy. He finally began to really cry and wake up as the doctor poked and prodded. He was admitted for testing and fluids. We went to the pediatric ward and the baby was whisked away for a spinal tap while I did the paperwork. I was in such shock that I couldn't do anything but cry as I listened to him scream during the procedure (they were two doors away). I decided that was the last time they would remove him for a procedure. After the spinal tap, the floor nurse tried to start an IV. Because he was so little and somewhat dehydrated, she made 12 attempts and was unable to get the IV in. (He was bruised on both feet, hands, elbows, etc. from this when I took him home. He looked like an abused baby.) Finally they got a nursery nurse to put the IV in his head.
It took me a long time to soothe him after all that and every time I put him down he screamed. So, I held him almost every minute of the 3 days we were in the hospital. To their credit, no one said anything when I slept with him---I was ready for a fight over it. Massive antibiotics were given through the IV just in case he was septic. The doctor had been less than thrilled that I had had a homebirth and even more unhappy when I told him my waters broke hours before labor began. Though he made me feel as if this problem had been all my fault, the nurses were quick to say nothing of the sort was true. They told me that they see lots of newborns who had been born in the hospital and who came back for just this same thing. In fact, one told me that she wished she had had the guts to have a home birth and wanted to know all the details. The nurses were absolutely wonderful.
After about a day and a half, his IV came out. I was not about to allow him to be poked another 12 times to get another IV in. They made one attempt and failed. After that, he got shots for the antibiotics. That was traumatic too, but at least I knew he wouldn't be stuck a zillion times. Of course, he developed severe diaper rash from the medicines on top of everything else.
During all this, he was not a good nurser and I was encouraged to give him supplemental formula. This I refused as I knew that it could wreck our breastfeeding relationship. I did try to give him glucose water, but he wouldn't take that either. It took several weeks for him to be a good nurser (and almost 4 weeks for him to regain to his birth weight) but it was worth the effort. We enjoyed an exclusive breastfeeding relationship for 8 months.
We stayed in the hospital for 3 days and he continued on strong antibiotics for 10 days (with several visits to the ped's office). All of the tests for infection came back negative so he probably was just dehydrated and we might have been able to avoid all that. Still, I wouldn't take the chance with my precious little one and I am thankful for the help. I am convinced that had we not gone to the hospital that night, he wouldn't have survived another 24 hours.
Twenty-six months later, our little guy is a healthy, happy nursing toddler. I have had the joy of watching my older children bond with their little brother and learn just what a baby is all about. (Nothing like seeing a birth to help a teenager decide not to have a baby just yet!) If hubby and I were a bit younger, we'd probably do it all again. I'm very blessed!
Julia's Story (prior molar pregnancy, miscarriages, vaginal birth, retained placenta)
Kmom's Notes: This mom went through hell before having this pregnancy and baby! What a dedicated mom. She had a molar pregnancy, where the baby dies but the placenta continues to grow and grow and becomes like a cancer. [She explains more about what molar pregnancies below.] After that, she had miscarriages and other problems. A very difficult journey!
What a blessing that she was finally able to have this baby, and that all went well and normally. The only real problem she encountered was a retained placenta, probably related to all the placental problems, D&Cs, and scarring from before. The baby also came out with torticollis [twisted neck---limited mobility of the neck on one side]. No one knows for sure why the torticollis occurs but best guess in this situation is that he was probably crowded internally due to problems with the placenta and was not able to grow and move freely enough near term when he was largest. Fortunately, the baby seems to be doing well now.
Birth Story
I am told that what happened to me prior to my son's birth happens to roughly one in 50,000 women. I had been married for two years when I accidentally got pregnant. I had been on a diet for a year and had lost from 230 to 149 lbs. My husband was still in school, so we weren't financially "ready" for a baby but we adjusted to the idea and became pretty excited. I was extremely nauseated constantly, but I still managed to drag myself out of bed every morning at 5:30 a.m. to go teach high school students in summer school from 7 a.m. to 2 p.m. every day. One morning at school in what was supposed to be my 12th week, I went to the bathroom and panicked to see brown spotting. I rushed to my OB who ordered an ultrasound. The tech acted very strangely, and not in a good way.
The doctor told us I had a molar pregnancy---a placental abnormality where the placenta cannot support the fetus. The fetus dies, but the placenta continues to grow, so the body still thinks it's pregnant. My uterus was filled with placenta but no baby. I had to have a D&C to scrape out the placenta.
To make sure all of the placenta was gone, I had to have pregnancy tests until the tests tested negative for 2 months. Instead of my HcG returning to zero, it jumped back up----something was growing. I had to have 6 months of single agent chemotherapy to kill the remaining placental cells. I then had to be monitored for a year to make sure nothing started to grow again and NO PREGNANCY. The placental tissue can, if not completely eradicated, deposit itself in any organ system including brain, liver, lungs, vagina, etc. If left untreated, death rates are 100%.
I tested positive again 6 months later and had to have several rounds of multiagent chemo for 3 months. Then I absolutely could not get pregnant for two years, although I had to go monthly for pregnancy tests to make sure nothing was growing.
As far as my theories as to what caused the molar pregnancy...as I said...I became pregnant by accident. Very early in the pregnancy, right when the embryo would have been implanting in the uterine lining, before I had any idea that I was pregnant, I helped my husband with his summer job. He was managing an Olympic-sized swimming pool, and part of the job was to paint the pool. For exercise, I painted in the diving well (very deep with very little circulation) for 5 hours. I used a chlorinated rubber paint that had skull and crossbones and warnings of toxicity plastered all over it. I imagine the molar pregnancy and paint were related.
My other theory is...I had been on a strict 1200 calorie diet for several months and had lost 80 pounds. I also worked out at a very high level (my body temp. was definitely elevated above the recommended safe levels for pregnancy for 30-40 minutes) on a daily basis.
The molar pregnancy was probably a combination of these factors.
After all of this trauma, I had no idea if I would ever be able to have a baby. To make a long story short, I did have many problems after the initial fiasco-----3 D&Cs in all, two subsequent miscarriages, and laser surgery to remove scarring from Ascherman's. But after I had the surgery, I got pregnant with my beautiful son, now two, on the first try.
When I got pregnant with him (four years after the first time I was pregnant), I weighed 189 pounds. I weighed 235 when I delivered him. My entire pregnancy with him was textbook. I think God thought I deserved it after everything I'd gone through!
I taught school the entire time I was pregnant (sophomores in high school, no less!!). Two weeks before my due date, I taught school all day as usual and then my husband and I decided to go to the mall that evening to find a robe for me to wear in the hospital and to get my hair cut. I told my husband that I felt "very tired." I was so tired that I wanted to skip the haircut, but my husband talked me into it by saying it might be too late if I waited because the baby could arrive. He was right!!
I woke up at 5 a.m. the next morning because my water broke. I delivered the baby 8 hours later with an epidural. One complication was that I didn't not deliver the placenta. The doctor had to manually evacuate my uterus. Even with the epidural, that was the most unpleasant part because each time he would reach up to scrape with his hand I could feel immense pressure in my abdomen. I think the reason the placenta was so securely attached was because of all the scar tissue. I had read that the chance for a retained placenta is greater when there is scarring in the uterus due to c-section or other uterine trauma.
My son was born with torticollis, literally "twisted neck." His head had been held to the side in one cramped position intrauterine. At first he could not turn his head to one side. We had to do stretches, and now, at age 2, he is fine, and you could never tell he had a problem. I wonder if his malformity was due at all to all the scarring in the uterus or could it have been my weight or a combination? [Kmom note: It's highly doubtful it was due to her weight or you'd see this problem commonly among babies of fat women, and you don't. This is the first case I've ever heard of. It's quite likely the torticollis was due to a problem with the placenta or a malposition in the womb.]
Needless to say, I am fearful of trying the whole pregnancy thing again, but...I would love to have a little SISTER for number one!
Kristi2's Story (induction, back labor, malposition, forceps)
Kmom's Notes: All the classic signs of a malposition, probably the more 'minor' malposition of a crooked or 'asynclitic' head. An "overdue" baby, back labor and sciatica, slow labor progress, a very painful labor, an epidural that didn't take fully effectively and needed frequent redosing, slow progress during pushing, difficulty getting the baby under the pubic bone---all are classic signs of a malposition.
Inducing and breaking her waters early on like this could well have sent this mom to the O.R. for a cesarean, but fortunately, the baby was able to eventually move down, and with 'help' of forceps, be born vaginally. However, if it had been managed differently, this birth might well have been easier and the mother might not have torn so badly. Fortunately, all was well with the baby despite the difficult labor.
Birth Story
I wanted to have a baby for a couple of years but was terrified to get pregnant because of my weight. Thanks to [research], I saw that there are many other overweight women who get pregnant and have perfectly normal healthy pregnancies. So I went for it and got pregnant on the third month of trying.
I had a very easy pregnancy. I was a little nauseous for the first few weeks but that ended promptly around 12 weeks and had no other problems. My blood pressure was always perfect, the baby's heartbeat was always perfect, and I didn't gain too much weight. I was due on October 30th and naively convinced myself that I would have the baby on or before that date. Sure enough, my due date came and went with no signs of labor.
On November 5th, six days after my due date, I was scheduled to have a non-stress test. By this point, I had been dealing with sciatica pain for about a week which made it difficult to walk, but had no reason to complain as I was done working and my only responsibility was to relax and go into labor. My baby was never one of those kids who would kick on command. While I was pregnant, friends and family would ask me to make the baby kick so they could feel him move and I would poke my stomach, but my son would only kick when he wanted to kick so he did not rate well during that portion of the non-stress test because he was sleeping and I couldn't get him to kick. Even though the heartbeat was perfect, he would only move when she rung a buzzer on my belly and then would go right back to sleep so points were deducted. Then I went in for an ultrasound and he wasn't taking in fluid as much as he should have so we got points deducted for that also. For the whole test, we only scored a 6 out of 10. Considering I was six days past due, the baby was estimated as weighing almost nine pounds and I was showing no signs of going into labor, the doctor decided to induce me. She said it seemed silly to risk the health of a perfectly healthy baby. [Kmom opinion: It's inducing that presents the greater risk to the baby's health!]
I had always wanted to go into labor on my own because after reading countless birth stories...it seems that when women go into labor on their own, it simply goes easier because their bodies are ready. Not less painful, just easier. I wanted to do what was best for my baby so even though it would mean being induced, I agreed and DH and I were off to the hospital.
The labor room was very nice and welcoming. I was given a large gown without even having to ask for it and the equipment was made to fit a woman of any size. During my entire pregnancy and labor, I was never treated as an overweight pregnant woman. I was simply treated as a pregnant woman. All except for the anesthesiologist who did my epidural, but I'll get to her a bit later.
I was checked into the hospital at around 1 p.m. My water was broken about 15 minutes later and I was hooked up to the pitocin by 1:30 p.m. Contractions started about an hour later and at first they were manageable. By 4 p.m. the pitocin had been gradually turned up all afternoon so the contractions were coming hard and fast. I was only dilated 2 cm, which was only 1 more than I had been that morning so I told my nurse that I was going to want an epidural as soon as I could get it. They told me I had to get to 4 cm. All labor is painful, but back labor is supposed to be the worst and unfortunately that was what I had. By 8:30 p.m. I was still only 3 cm but in a lot of pain so I started begging for the epidural. Luckily, my OB said OK, even though it was a little early. She said maybe if I could relax, I would start dilating faster.
This was when, for the first time in my entire 9 months of pregnancy, I came across a fat-phobic person. The anesthesiologist walked into my room and proceeded to tell me that due to me being "morbidly obese" she wasn't sure if she would be able to stick me with the epidural catheter, but she would give it a shot (gee, thanks!). While explaining the procedure, she called me "morbidly obese" a few more times and then said again that she would give it a shot but I shouldn't be surprised if it doesn't work. I wanted to let her have it or tell her that I wanted someone else, because I had read that a good anesthesiologist should not have a problem inserting a catheter regardless of a person's size, but because I was in so much pain, I just wanted my epidural so I figured I would argue with her after I was no longer feeling contractions. My mom actually had to leave the room because I could tell she wanted to lay into [the anesthesiologist] too, but I shot her a look telling her not to and I think she understood why. I figured if she tried and it didn't work, which I doubted, that I would ask for someone more qualified. My husband was just scared because of all the things she was saying could go wrong due to my size, but we took Prepared Childbirth Education and all the things she was saying could happen to me because of my size were things that could happen to anyone--regardless of size--so I tried to reassure him not to worry.
The nurse or the anesthesiologist's assistant must have said something to her about the way she acted towards me because when she came back in the room to administer the epidural, she was like a completely different person! She was incredibly nice and friendly to me. We actually discovered that she lived right down the street from me. SO she must have felt bad for how she treated me, but I'm not sure if she realized it on her own or if someone pointed it out. Well, lo and behold, my epidural took on the first try. From start to finish, the whole process took about 15 minutes, which according to the nurse is pretty quick for administering one. The nurse also told me that it took the anesthesiologist 4 tries with the skinny woman down the hall. So much for her theory about fat people!!! I hope it taught her a lesson.
After I got my epidural, I felt great for a couple of hours. My OB told me to try and take a nap because since I was only 3 cm, I had hours to go and I needed my strength to push. I was able to sleep for about 2 hours and then work up because I started feeling the contractions on my right side. By this time my contractions were peaking at 9 or 10 so it was pretty painful. I had to get the epidural re-dosed, but that only held me over for another couple of hours. Keep in mind, this had nothing to do with my size. The catheter was installed properly. This just happens to some people. This happened to my sister's friend, who weighs 130 lbs. This kept going on throughout the night and my epidural was redosed about 4 times.
At 7 a.m. I was 6 cm. I wanted a vaginal birth, but I knew an end was in sight because my OB will only let a woman be in labor for 24 hours so I knew either way, it would be over by 1:30 p.m. Around 9 a.m., I was feeling the urge to push, but I was only 9 cm. My OB had me start pushing anyway since the baby was only at 0 station and figured it would be a long time pushing because I needed to get him down. By this point I was in labor for 20 hours and just wanted it over with. I started crying and told my DH I didn't think I could do it anymore. By this point, I was very tired and couldn't even hold my legs or head to push so in order to concentrate all my energy into pushing, we called in my sister. She held one leg, my DH held the other, and my Mom held my head. My OB had said that my baby was acting like a cork in a bottle. I wouldn't be able to get him all the way out without help, but if I got him past my pelvic bone, she would be able to use forceps and I could avoid a c-section. I pushed for 2.5 hours and got him past my pelvic bone. With that they got out the forceps. The forceps helped get his head out and then with one more push, out came my little boy at 11:26 a.m. on 11/6, 1.5 hours shy of my 24 hour cutoff. He was 8 lbs, 6.5 oz, a little smaller than predicted, but big enough that between him and the forceps, I tore inside and out and had to get several stitches. I kept asking my OB how many stitches and she would just say, "a lot."
When they broke my water the day before, they noticed I had a little meconium so they warned DH and I that the baby wouldn't cry immediately because they had to suction him out good before they would let him cry. He cried in less than a minute, but when you're waiting to hear your new baby cry, a minute can seem like an eternity. Also the cord was pretty tight around his neck so DH did not get to cut the cord. Through 20 hours of labor, 2.5 hours in the birth canal, and a tight cord around his neck, my son was a real trooper! His heartbeat only went down once for about 15 minutes shortly after the epidural, but only to around 110 so they were not scared, and after putting oxygen on me for about 30 minutes, it went back up and stayed there for the rest of labor.
I tried breastfeeding a few hours later, but didn't have much success because I was so tired and all the baby wanted to do was sleep. That evening around 8 p.m. the nurse came in and said the baby needed to eat and asked if I wanted help breastfeeding. She showed me the proper way to latch the baby on and he took to it like a pro. I breastfed pretty much exclusively while I was on maternity leave with just a bottle of formula here and there to get him used to the taste. I went back to work when he was 9.5 weeks old and we began weaning him over to formula. I wanted to continue breastfeeding but couldn't pump enough during the day to keep up with how much he was eating, and since I didn't have the opportunity to breastfeed during the day, my milk supply dwindled and he wasn't getting enough at night to satisfy him so it became a constant battle of him being hungry, me not satisfying him, and him screaming for more. I finally decided that since I had to be apart from him all day and didn't want our evenings to be so stressful, I would switch him to formula and we are both happier for it. I felt guilty about it, especially since we had no problems with breastfeeding, but you have to do what you have to do and if I would have been able to stay home with my son which would have been my ultimate dream, I definitely would have kept it up, but since that wasn't even an option, we had to come up with another alternative. Breastfeeding is best, but it is sometimes hard for working Moms to keep up with it and they shouldn't be made to feel guilty if they stop, which is exactly how some people tried to make me feel.
My son is now almost 5 months old and a complete angel!! If you want to have a baby and the fact that you are overweight is the only thing holding you back, don't let it! I am living proof that an overweight woman can have a perfectly normal, healthy, complication-free pregnancy. We are already talking about trying for number 2 this fall.
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!
Birth Story
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.
Liz2's Stories (induction, vaginal birth; malposition, unassisted homebirth)
Kmom's Notes: Liz's first baby was induced early for suspected macrosomia. It was a very difficult labor, but she managed to do it virtually without medication, an amazing accomplishment! The baby was big was born normally and easily.
Liz's second baby was a planned unassisted homebirth. She had a nine-hour stall in her pushing phase because the baby was wedged in in a poor position for birth, but finally managed to find just the position that did the trick and turned the baby, and he was born shortly thereafter. He was also a big baby, but once he turned properly, he came out just fine.
Birth Story
Baby #1: My pregnancy with my first son was a complete surprise but a very pleasant one. My family is very mainstream when it comes to medical care. My grandfather is a family practice doctor (retired), my father was a medic in the army for a time. My mom had all 4 of her kids in the hospital, as did everyone I knew who had kids. Naturally when I found out I was pregnant I called up an OB in a nice part of town and made an appointment! Oh, if I only knew then what I know now (I'd never have thought to set foot in a hospital to have a baby, that's for sure!).
My pregnancy went along very uneventfully. I gained a LOT of weight, but my OB didn't really say anything about it. My BP stayed nice and low, all the myriad of tests came back normal. I got quite swollen towards the end of my pregnancy, but I think that was mostly due to me just sitting around and not doing much.
As my due date got closer, my OB informed me that due to the large size of my baby, he would induce me as soon as my due date passed if the baby had not arrived on its own. By this point I'd done my research (or so I thought) and knew I wanted a "natural" birth without drugs or interventions. My hubby and I had taken Bradley classes, I'd read books---my family thought I was being so progressive and so brave to try it "natural"!! I was crushed at the thought of an induction; I knew some of the risks----had I really known them all I would have refused. There was nothing wrong with me or my baby. There was NO medical reason at all to induce, but I wasn't strong enough to refuse based on my own gut feelings. My OB didn't feel inclined to wait around on us and told me so. He also used the lowest tactic in the book---he threatened me with the likelihood of a c-section if I waited "too long" and allowed my baby to get any bigger. *sigh* Next to a c-section, the induction was preferable.
Three days after my due-date, with hardly any signs of impending labor, I went in for my induction like a good little patient. My water was broken first thing, and I was allowed to walk the halls for an hour to see if contractions would kick in on their own. Of course they didn't, so the baby heart rate monitors, blood pressure cuff, and dreaded bag of IV fluids including pitocin were all attached to me. There went my mobility.
Hard labor hit with almost no warning. I went from no contractions to hard contractions every 5 minutes or so. The contractions got increasingly harder, longer, and more painful; the IV drip was religiously increased each hour by the nurse. I was determined to go epidural free, and I did. I did cave into the nurse's pressure and had a shot of Stadol during transition which did absolutely nothing for me. By that point, the contractions were almost back to back and were double and triple peaking. It was miserable. I remember looking up (with all the rigamarole attached to me I couldn't get off the bed, so I spent my labor laying on my left side) at my husband who held my hand through the whole thing and realizing he was crying just as hard as I was. Later he told me it was one of the worst things he'd ever been through, having to sit by and watch them torture me.
Transition passed very quickly. I went from 7 cm to complete and feeling the urge to push in less than an hour. It was amazing that change in sensation---the contractions went from almost completely unbearable to suddenly being very intense but focused and "productive"-feeling. I sat up and pushed unconsciously. I wanted to get up SO BAD. I told the nurse that I needed to go to the bathroom (she wouldn't let me), then I told her I just needed to GET UP. I wanted to get onto my hands and knees badly, but of course they rolled me into a semi-sitting position instead and told me to grab my knees and "try" to push.
In spite of everything, it felt WONDERFUL!! For the first time in my whole labor, I felt in control. It was extremely intense, but pushing with my contractions didn't hurt. I pushed, and the nurse suddenly realized the baby was coming. Now! There was a rush to get my OB in the room, and with just a few more pushes my son was born! Less than 15 minutes pushing time. He was born at 5:09 p.m. after a 9 hour induced labor.
He was absolutely perfect. He was placed on my chest immediately after birth and I just held him and marveled at what a wonder he was. He was extremely upset and screaming. He was dried off and his cord was cut (all while still on my chest, I wouldn't let them take him) and then I offered him a breast and he latched on and nursed like it was his sole lifeline to comfort. He roomed in with me our one night in the hospital---he never left mine or my husband's side and he slept in bed next to me. I had a very small tear that very likely would have been avoided if I'd been allowed to get up like I'd wanted to.
My son who was supposed to have been on the verge of being too large for me to deliver weighed in at 9 lbs. 13 oz. Yes, he was a big boy, but his actual birth was incredibly easy. I felt great as soon as he was born and wanted to grab him up and walk out the doors and go home. Boy, I wish I had!! I feel very lucky that both of us got off so easy, considering all the interventions.
Baby #2: After the OB-manipulated birth of my first son which resulted in a horrid induction, I knew I would NEVER have another baby in a hospital unless mine or the child's life depended on it.
When I got pregnant with my second child, I assumed I would find a midwife and have my baby at home. Long story short, between the runaround from my insurance company and my remote location out in the country, I just could not find a midwife I liked. I was so upset. I spent the first few months of my pregnancy feeling so miserable about my birth choices (or the lack thereof). I didn't want another hospital birth. I didn't want to see an OB. I felt so strongly compelled to have my baby at home that it was just overwhelming.
Feeling like I still had to have some sort of prenatal care, I decided to see a local OB who came recommended as being very hands-off while I continued hunting for a midwife. The first few appointments with the OB went OK, but it just felt so....well, wrong. All the poking, prodding, measuring and testing. It's so degrading and invasive. Pee in this cup, dear. Stand on this scale so I can raise my brows at your weight, dear. Grrrr---I didn't need that crap to have a healthy baby.
During this time I stumbled onto an option that my husband and I had been half-heartedly joking about---unassisted homebirth. Birth at home with just Mom, Dad, and loved ones present. No doctors, no midwives, no paid strangers with a bested interest in protecting their own hides at what may be the risk of the mother and child. It seemed so radical at first, and then it just seemed so right.
The straw that broke the camel's back came at my 5 month OB check-up. I declined the gestational diabetes test, and my OB just about fell over (don't women ever tell OBs, 'No'?). I pointed out that I have the right to decline any testing. She said it was mandatory. I left the office, fired her, and collected my file a few days later and never looked back.
After that I just stopped worrying. I felt WONDERFUL!!! No more OB appointments, no more stress over a midwife. Just loving being pregnant and living my life normally. After all, pregnancy IS normal. It's not an illness. I had such an incredibly easy pregnancy. I never got sore in late pregnancy, or tired, or huge and uncomfortable. Well, I got huge but never uncomfortable!
I woke up early in the wee dark hours of the morning 4 days after my 'due' date with light (but enough to wake me up) contractions spaced about every 15 minutes. I was so excited! Too excited to go back to sleep, which I really should have. My husband got up and left for work around 6 a.m. and I dozed a bit in-between contractions and eventually got up a couple hours later. And everything stopped. Blah! I felt really restless though. I cleaned the house, did laundry, and worked on finishing painting my son's playroom. I had light contractions throughout the day, but nothing major. Contractions on a ladder while painting are rather interesting, let me tell you!
My husband got home from work around 5 p.m. and like magic, labor really got going. Contractions started coming regularly about every 15 minutes. Nice moderate contractions that were about 20-30 seconds long. So, we did the natural thing---loaded up in the car with our son and drove into town to go to the grocery store and get last minute labor munchies and rent movies to keep my 3 year-old entertained. I found it so incredibly amusing to be walking around in public, in labor.
We got back home, and things were getting a bit more intense. I puttered around for a while (made a fruit salad), then wanted to go lay down and rest because I wasn't sure how long of a labor I'd be in for. Laying down on my left side felt really nice. I lit candles and just rested, breathing through contractions, thinking of my baby, sipping water and getting up to go potty regularly. This continued on until probably a bit after 11 p.m. My 3 year-old had finally fallen asleep, and the timing was great. I was just getting to a point where I wanted my husband with me (prior to that I liked the peace of laboring all alone). There was still no pain with contractions, just intensity. Contractions were about 5 minutes apart and still only about 30-40 seconds long.
My husband came in with me and I decided I wanted to get in the tub. The warm water felt wonderful, for a while, then I wanted up and out. Walked around a bit. Swayed with the contractions. Then wanted to lay back down again. I suddenly started feeling really nauseated and dispatched my hubby to go get me a bowl to puke in. He got back just in time, too! As I was throwing up, my water broke! Then it occurred to me that THIS was transition!! Holy cow!! Transition and my contractions were still about 5 minutes apart and almost completely painless. I was on cloud nine. It was about midnight or so and I just knew I'd be holding my baby in no time.
Then the first pushing-like contraction hit and it felt funny. It hurt. Pushing never hurt with my first son. It had been the only part of my entire labor that felt good. I went with my body. Pushed when it said push, didn't when the contractions rolled over me and didn't dictate any pushing. I decided to get up and move around. Tried different positions---any that were real upright put a horrible amount of pressure on my pubic bone and became very painful during contractions. I tried standing and leaning on my husband, kneeling on all fours, kneeling leaning over my bed, squatting, chest/knees, standing and leaning over a dresser and swaying my hips, everything I could think of that might offer some relief and nothing really did. I got back in the tub off and on through all this, the hot water helped a lot but then I'd start feeling claustrophobic and had to get out. I was drinking a lot, very thirsty and peeing a lot too. Made MANY potty trips through the whole labor. It was really nice to be able to drink when I felt like it.
After about an hour of this, I decided to call my best friend who---bless her----made the 40+ minute drive at 1 a.m. in the morning to come be with me (and she must have driven a hundred miles an hour because it didn't take her nearly 40 minutes to get to me!). She has no medical qualifications, just another mom and another shoulder to lean on. The support of another woman that I care a great deal about felt so nice. I knew she knew what I was going through, and she was there because she cared about me, not because I paid her to be. My husband was also so supportive. He never once doubted me and I can't even begin to describe how much his trust, love, and respect means to me.
To make a long story short, we went through 9 hours of this. At one point, my friend looked at me during a contraction and commented on the fact that my baby was completely and totally off to one side. I was getting so frustrated and discouraged by the end of that 9 hours. Pushing had taken less than 15 minutes with my first baby. I was complete, could feel my son's head inside of me RIGHT THERE and no matter what I did he would not budge. He was wedged tight, and with every contraction his head was being rammed into my pubic bones. It became more and more and more painful as time wore on and my energy ran out. I was getting so exhausted with laboring and the lack of sleep.
I was about at the point of transferring to the hospital when I got angry and decided I'd had it. Baby was coming OUT. I squatted at the foot of my bed, and with the next contraction I just hung there----and then he turned!! It was such an amazing feeling. He completely shifted position across my entire stomach. HUGE roll over!
With the next contraction he descended to completely crowning and the pain was overwhelming! The contractions were still spaced out and I felt like I squatted there forever with his head feeling like it was about to rip me in two. With the next contraction he was born completely into my husband's waiting hands and I joyfully collapsed to the floor and took him into my arms. It was about 9 a.m., 5 days after my due date.
He was a little slow to breathe, and as it turned out only my fore-waters had broken before. There was a huge gush of blood-tinged waters as he was born which really worried my hubby (he thought I was bleeding too much). The decision was made to call 911 (which in hindsight I wish we hadn't because they were not needed).
I gently worked on my son to encourage him to breathe. Turned him head down and rubbed him, talked to him, then gently sucked some mucus from his mouth and nose with my own mouth. As gross as it sounds, it was so instinctive at the time and also very effective and far more gentle than a plastic bulb syringe.
He was so calm; he literally just "woke up," opened his eyes, and started to breathe. He never cried. As soon as he was pink I offered him a breast and he nursed like a champ! Didn't let go for almost 2 hours! The EMTs showed up about 20 minutes after he was born, and by then we no longer needed them and got rid of them as fast as we could. The placenta delivered very easily, and we waited a couple hours before we cut the cord to allow it to completely stop pulsing so all the placental blood could transfer back to my son.
My "little guy" weighed 10 lbs., 8.5 oz., was 22 inches long, and had a 15 inch head circumference even with some pretty extensive moulding (OUCH!). I didn't have a single tear or skid mark from his birth. He was a wonderful, happy, completely healthy baby. I felt back to normal within a day or two of his birth. He's almost 3 now and is just such a bright, happy little guy.
After my labor was over and I was able to analyze it and put everything together, I realized he was left occipital transverse. He was head down, but curved sideways like a "c" facing left in my stomach. His spine was facing my right side and he was completely tucked over into the right side of my body. As a result, the broad side of his head was presenting (and ramming into my pelvic bones) and could not descend. I dilated very easily, but until he turned there was just no way to get him to budge, and he was VERY stubborn about turning around! He was in this position for at least the last few days of my pregnancy, I just didn't think anything of it at the time. I'm rather short-waisted, and he was so long I think that's just how he tucked himself in to get comfortable. He also had a hand up by the top of his head. He had scratch marks from his nails all down the side of his face after he was born. That may have been part of the issue as well.
I am *SO* thankful I was at home without medical intervention. Even midwives will only allow for so much deviation from the 'norm'. I've heard multiple stories from women who were forced to transfer and ended up with c-sections in cases like mine---and all of them were 'given' less time to make progress than it took for my son to be born. I am thankful I listened to my instincts. Through my whole labor I never felt like my son was in danger, and sure enough, it was obvious once he was born that although labor was rough on me the experience was very gentle for him. We joke now that he was asleep and woke up, stretched, rolled over and next thing he knew he was born! He had that exact expression on his face at birth, like he'd just woken up from a long, peaceful nap.
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