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: Supersized Moms (300 lbs. plus)
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 the births of so-called 'supersized' women. There are many stories from women who are 'mid-sized', but women who wear size 28+ often are even more anxious to hear stories from women in their size range. These are the women most often attacked and vilified for 'daring' to be pregnant 'at their size', and many fear that their prognoses will be especially poor. Therefore, these are the stories of supersized women who have dared to challenge this perception. Their experiences will present both inspiration and some cautionary tales to be wary of.
More stories will be added over time, so keep checking back if you are interested in reading further stories. If you are interested in sharing your birth story, click here for more information, birth story format, and submission guidelines.
New birth stories are always welcome; Kmom updates the birth stories FAQs about once a year so be patient for your story to show up. If you do submit your story, please carefully follow the format and directions given in order to shorten the amount of work involved for Kmom. Kmom's family will thank you!
The term 'supersized' is a difficult one to use, as it potentially carries a lot of emotional baggage with it. Some women find it emotionally devastating or offensive to be so described.
Yet the term 'supersized' actually comes from the fat-acceptance community itself; it was invented there many many years ago to help describe different sizes of large. In the fat-acceptance community, it does not denote anything negative or derogatory; it's just simply a qualifying descriptor to enable people to discuss how different sizes of "large" handle things or are challenged in everyday life.
Kmom had mixed feelings about having a separate section for "supersized" women. "Mid-sized" women have enough bias and hassle about their size; "supersized" women have even more. Creating a separate section for their stories may feel like a condemnation or a judgment upon their size, and that's the last thing that Kmom wants to do.
Yet many, many women have written Kmom and asked for stories specifically of moms over 300 lbs. because they felt all the stories they were seeing were from mid-sized women. They really wondered if women over 300 lbs. even became pregnant, let alone have healthy babies or normal births.
The answer is: YES, THEY DO! The risks for complications do tend to be a bit higher as the weight increases, but Kmom has heard from many women in the 300+ range (and some in the 400+ range) who have had successful pregnancies and births. She does not have birth stories here from all these women, but she has heard from quite a number in the 'supersized' range, including those with complications and those with completely normal pregnancies and births.
Defining 'supersized' is tricky, emotionally-loaded, and ultimately rather arbitrary. Kmom has chosen to use the most-commonly seen definition in the size-acceptance community, that of being over 300 lbs., or over about a size 26-28 (USA sizing). Of course, some women may be very tall and 300+ lbs., yet not be a size 30 or more, and some women may be short and 280 lbs. yet a size 28 or 30. So the defining line is a bit gray; some leeway in the definition has been used. Women who were very close to the cutoff of 300 lbs. have also been used, but may or may not truly qualify as 'supersized'. Kmom herself falls in the gray area between these two categories, but technically falls under the dividing line.
Again, Kmom apologizes if anyone is offended at being classified as supersized (she's not crazy at being so close to the cutoff herself!), but at some point an arbitrary definition had to be decided upon. If you fall above this arbitrary demarcation, it does NOT define you as a less-worthy person, one who will experience problems in pregnancy, or one who is 'too high-risk' to contemplate conceiving. It simply is an attempt to respond to a frequently-expressed need among Kmom's readers for reassurance about pregnancy in the larger of large sizes. Please take the definition with a grain of salt and in the spirit intended.
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.
Jameel's Story (Supersized, Group B Strep, Homebirth)
Kmom's Notes:
Birth Story
Mike and I have been married eight years. When we met, we both had office jobs. But about three years later he decided to become an over-the-road truck driver. This worked out really well for our relationship, but when we lived in the Midwest, he was only home on the weekends. In the Fall of 2002 we moved to the East Coast, and by the next summer we decided to start trying to have a child. Mike got a trucking job that had him home four days a week and by September of 2003 we were pregnant.
A couple of years before, I had read a book called Birthing From Within and decided then that I was interested in having a child, as long as I could have it naturally, at home. Before that I hadn’t realized how much fear I had had about birth. I think I thought an over weight person automatically equaled an unhealthy person, and therefore, a complicated birth. It was really important to me that the birthing experience be positive, and a homebirth seemed like the best way to accomplish that. The feeling that this decision was the best choice for me was very strong, and I was looking forward to additional research on homebirths and its issues. I discussed it with Mike and he seemed fine with the idea – probably because he had never thought about it before, and had no idea what to expect.
Shortly after we were pregnant I started looking for a midwife. I found “Vee”, a Certified Nurse Midwife who specialized in homebirths. She had worked in hospitals for years and then later decided to open her own practice. I asked her if she had any concerns about my weight, and she didn’t. She provided all the care and services I needed throughout the entire pregnancy.
I only wanted one or two ultrasounds, and we decided we wanted to be surprised with the gender. I had all the standard tests throughout the pregnancy, most of which came back normal. I was concerned about getting gestational diabetes (because of my weight and family history), but my sugar levels were always fine. I did test positive for Group B Strep, so Vee and I discussed possible issues that may arise because of that. We determined that if my water broke early during the labor process it would be necessary to monitor my temperature to see if an infection was getting into my uterus.
The baby was due on June 15, 2004. About a week before the due date I woke in the middle of the night with what I thought were contractions. They were 13 minutes apart, and felt like muscle cramps in my lower abdomen. However, as soon as I sat up, they stopped and didn’t return – false labor. This happened again around the 18th or so. On June 20th, around 7PM, I started having real contractions that felt more like menstrual cramps. They weren’t that painful and I was actually able to sleep on and off that night. Mike called his boss and told him he wouldn’t be in the next week.
By Monday the 21st I felt like I was officially in labor. The surges were regular, lasting about 30 seconds every five minutes or so. However, they weren’t that much work as I was able to walk around between, make phone calls, answer e-mails, etc. I called Vee around 4PM, described the symptoms and she said I should give her a call around 7PM to see how I was doing. A little later Vee came over and checked my cervix and the baby’s heartbeat. She didn’t want to place a number on how dilated I was (because she knew I would be doing the math to try to figure out when this baby would arrive!), but she said everything was progressing along fine.
By then labor was a bit more work. I had figured out that sitting or lying down through a contraction was much more painful than standing. When I had to go to the bathroom, if I would have a contraction while sitting on the toilet, afterwards I would feel so sick I would vomit. This happened twice and I realized that sitting through a contraction was not for me! And if I laid down too long, the surges would slow down or not be as intense. I thought that would delay things too much, so I would get up and walk around, thinking that would speed up the arrival of the baby. I would sit on the edge of my bed, and when a surge would come along, I would stand up, lean on the arm of our treadmill and Mike would rub my back.
By midnight or so, Mike and I were tired, and we needed some kind of feedback from Vee on how much longer this would take. She checked me again, and said that I was still in the early stages of labor and it may be a while before the baby would be born. We decided that I needed some rest, so I propped myself up in a chair knowing things would slow down a bit, but maybe I could get some rest. Mike went to sleep and Vee went home and told me to call if I felt things were changing.
Around 4:30AM on June 22nd I was tired. By this time I realized that I had been a bit arrogant about how much work this would all entail. I remember thinking that I had assumed that this would be easier than it was, and I needed to face the fact that if I wanted this baby out this was going to be hard work. I remember thinking that, although I knew the Lord had been with me throughout this whole experience, my faith in Him was going to carry me through this. My need for prayer kicked in right then.
I called Vee who suggested that I get in a bath to see if that would feel good to me. I was reluctant because I didn’t want to go through the trouble of changing positions again. But I realized something had to change, so I tried it. What a difference! I filled the tub, laid down on my side, and had the shower spray hot water down on me. The surges were very mild and I was actually able to sleep for a few hours.
By 7AM or so, Vee came back and I told her how wonderful the water felt, although I was sure I hadn’t progressed since I wasn’t that uncomfortable. She checked the baby’s heartbeat and my cervix and said that I had dilated almost twice as far, and my cervix was extremely soft. We decided that the birthing tub was the way to go. Mike and Vee started setting up the tub in our bedroom, while I labored next to the treadmill.
They filled the tub with warm water, and crawling into it was heaven! I tried going through contractions in several different positions until I found that leaning over the edge of the tub while kneeling was the most comfortable way to labor. Mike put a warm wet towel on my back and would hold my hips whenever a surge would come along. One of my kitty cats chose a spot on a chair near the tub and we all patiently waited as I labored along. I remember reminding my husband that I’ll need verbal reassurance and support with each surge. At one point he told me that I looked like Sara Connor. “Who is Sara Connor?” I asked. “From the second Terminator movie,” he said. “You look wild.”
Later I felt my water break and called Vee over. She said that I needed to get out of the tub so she could check to make sure my water was clear. I stood up and had a very painful contraction which sent me right back into the water. A few minutes later I tried standing up again – another contraction. She decided to check me while I was in the tub. She checked the waters, my cervix and the baby’s heartbeat. “Jameel, you’re having this baby before lunch!” she said. “What time is it now?” I asked. It was 11:30AM. I shooed my cat off of the chair and used that to crawl out of the tub onto the bed.
I started to feel the urge to push with each contraction once I was on the bed. I tried pushing while on all fours for awhile. Then Mike sat on the edge of the bed while I leaned into his lap. Vee and her assistant, “Ann”, sat behind me constantly monitoring the baby’s heartbeat. All my pushing took a lot of focus and I remember that I didn’t want to open my eyes or be otherwise distracted. Mike would constantly say reassuring things to me, and the midwives were telling me how well I was doing after each push.
After some time I asked her how much of the head was out. She suggested that I reach back and feel, but I didn’t want to. She said she could see the hair. I asked, “Can you see the forehead?” and she replied, “Not yet.” I exasperatingly said, “This is taking too long. In the movies this part is always faster.” She reassured me that this is taking exactly how long this is supposed to take and everything was progressing nicely. So I continued to push with each surge. My focus was to muster the energy to get two good pushes in with each contraction. She asked if I wanted to try a different position, but I was too tired to move around. Ann brought me a cup of orange juice but it was too sweet. I just wanted ice water. I felt her put a cool cloth on the back of my neck, but for some reason I wanted the cloth on my feet instead (??).
I could feel the head coming out more and more, and that motivated me to want to try to push more than twice with each surge. I tried to push a third time and maybe a fourth time, but I was tired. Vee suggested that I wait until I have another contraction before trying to push again. But I wanted the baby out! Finally, Vee suggested that I try a different position again. I turned around and put my back to my husband’s stomach. He held me up while I pushed. I’m not sure how many pushes it took, but it didn’t take much. I felt the baby slide right out and she put him on my chest.
I remember my first thought was, “Oh, well that wasn’t so bad.” Then my second thought was, “Why did I just think that?” I immediately had this burst of energy while I looked at the baby. He was trying to open his eyes, but the light on the bedside table was too bright. We turned off the light and his eyes opened right up. Then I felt another contraction, much milder. Vee said that it would stop once I pushed out the placenta, but I was in a funny position on the edge of the bed, and Mike was pinned behind me. Finally, Mike wiggled out, sat me on the bed, and I was able to sit up. He helped cut the cord and I pushed out the placenta. I laid on the bed to look at the baby. “It’s a boy!”
Quinton Alexander was born at 2:02PM on June 22, 2004.
Since I’ve had the baby, many people have told me that they think I was very brave. That makes me laugh, because I feel like I made the easiest birthing choice. I’m trying to imagine going through all of this in a hospital, and I just can’t. Would I have been able to try so many different positions? Would I have been encouraged to do something to speed things along? And how would have that affected the outcome? And I know that I wouldn’t have felt as comfortable there than in my own home.
Could something have gone wrong? Sure. But I believe the chances of that are greatly reduced by allowing my body to labor the way it wanted to. Also, I trusted my midwife, and I trusted my body that whatever could have happened, would be manageable.
The whole experience was wonderful. The baby is beautiful and healthy. I thank the Lord for all the wonderful blessings he has given my family.
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."
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!
Kathy2's Story (induction, vaginal birth)
Kmom's Notes: It's very common to elect an epidural very late in the dilation process when the pain seems overwhelming, get into position for it to be administered, get it, and then be completely dilated and ready to push shortly thereafter. There are several possibilities here: the position that you have to get into for getting an epidural (spine curved over) often finishes the last bit of dilation needed and a simple position change might have eliminated the need for an epidural; or the epidural relief relaxes the woman enough to finish dilating quickly. Probably it's a little bit of both. But often just when a woman needs the epidural most, she's nearly done, and assuming that epidural position can often finish the process for some women without getting the drugs. It's a trick many professional labor support people know to try before actually resorting to the epidural.
Birth Story
My official due date came and went with absolutely so signs of impending labor, so Dr. T scheduled an induction for October 18. We were supposed to report to the hospital at 7:30 am on Monday, October 18, but they were full, so we couldn't come in until 2:00 pm. They gave me prostaglandin to soften the cervix. At 7:00 pm they started the pitocin. For two hours nothing happened. Finally, a little after 9:00 pm, the contractions began. By 11:00 pm I needed to concentrate during the contractions. By midnight I had to start using my breathing exercises through contractions. At 1:00 am, I was between 3 and 4 cm! As the nurse checked me, my water broke.
Contractions started to pick up almost immediately after my water broke, and I asked hubby (DH) to call our doula, H. H and the nurse provided suggestions on different laboring positions, and DH provided my emotional support. DH was completely wonderful, angelically patient, and absolutely perfect throughout the entire experience. During the interval from 2:00 am to 5:00 the mood started to get more and more serious, as my contractions kept getting stronger.
At 5:00 am I was at 6 cm but the baby was still very high at -3 station. The contractions became a lot more uncomfortable, and I started to doubt that I could make it much further without pain medications. By 5:30 am I asked for an epidural. They told me that there was an anesthesiologist on the floor, and that he would be here in about ten minutes. Well, ten minutes took over an hour.
The anesthesiologist arrived at 6:30 am, and it took him quite a while to set up. I had to sit up and hunch over and not move a muscle as he was injecting needles into my spine. This was torture, because I was having transition contractions one on top of another. Finally, at 7 am, the medicine started flowing. But instead of feeling less pain, I felt the urge to push. I was 9 cm with only a lip of a cervix left. It was difficult to blow through the contractions instead of pushing like my body wanted to do. Fortunately, at 7:30 am, I was 10 cm and ready to push! The epidural deadened my pain, but I still felt some pain and a very clear urge to push. I guess I was a good pusher, because at only 7:45 the nurse told me to STOP pushing because we had to wait for Dr. T to deliver this baby!
Finally, at about 8:10 Dr. T had arrived and set up, and I could start pushing again. After one or two contractions, the head was out. After one more "light push", my son was born -- 8:15 am. He cried lustily for a few minutes, long enough to assure everyone that he was breathing just fine, then he settled down. His APGAR scores were 9 and 9. He was 9 lbs., 3 oz, 19 1/2 inches -- a big baby, and perfectly healthy. We were discharged two days later, to go home as a little family.
To all of you who are contemplating pregnancy or are recently pregnant and concerned that your weight dooms you to a problem pregnancy and/or an unhealthy baby, let me tell you that at my experience has been almost entirely problem-free in spite of my weight -- 350 lbs at delivery (yikes!). Other than low progesterone early in pregnancy, I had a completely normal pregnancy. And other than needing to be induced for being 11 days overdue, I had a completely normal delivery. And my baby has a perfect bill of health. I wish everyone the best of luck in their pregnancies. Here's to happy, healthy babies!
Bfing: I had a lot of difficulties with breastfeeding at first. In fact, this proved to be BY FAR the most difficult aspect of bringing my baby into the world. We had a lot of difficulties with latch on, as he would not open his mouth very wide and my nipples did not protrude as much as I would have liked. Also, my breasts are very full and poorly supported, so I couldn't figure out how to manipulate them into his mouth. Then when I got engorged, my breasts turned into two huge rocks. He lost a full pound off his birth weight. I consulted a lactation consultant and things improved for a little while, but then they fell apart again. I eventually resorted to using a pump and bottle-feeding him my expressed breast milk. This was extremely difficult on me and I spent a lot of time crying. With lots of additional support from several lactation consultants, we eventually got him back on the breast and he has been eating well and gaining well since about 2.5 weeks. He is now 10.5 weeks old and exclusively breast-fed. I plan to continue exclusively breastfeeding until at least 6 months, maybe longer.
In this adventure, I learned a few things the hard way. First, be as prepared as possible before-hand with information on breastfeeding. I found "Nursing Mother's Companion" to be indispensable. Read it before the birth of your baby because you won't have time afterwards. Second, get competent help as soon as you THINK you might need it. If you are having any kind of difficulties, they will usually get worse unless addressed properly. Third, experiment a lot with different positions and different kinds of support pillows. Advice that works well for a small-breasted woman might be useless for you. The only thing that I found worked for me was the cross-cradle position using the large nursing pillow from Baby Becoming. I could have spared myself a lot of pain if I had read Kmom's breastfeeding FAQ before he was born, as this document told me most everything which I had figured out the hard way. This advice is pertinent to all women, but especially critical for large-breasted women because a lot of common advice doesn't work "off-the-shelf" for us.
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.
Shawn's Story (c/s, posterior)
Kmom's Notes: The circumstances of the labor suggests that this baby might have been posterior and gotten 'stuck'. Shawn confirms that her baby was indeed 'sunny side up' but that this was not noted in her medical records. This is not unusual; many doctors don't see posterior position as relevant and fail to note it in records or mention it to parents, yet many other providers feel that it is the cause of many c-sections. Positioning often helps facilitate rotation, but Shawn was not able to try these.
Birth Story
When I went to see my OB about fertility treatments, I remember one of her first comments being, "You really should try to lose some weight prior to beginning treatment...but I have had patients close to your size who have conceived." "Whatever," I thought, "just give me the prescription." After the first cycle of Clomid, we conceived and we were both surprised and elated. MY OB was skeptical, however, and ran at least 3 progesterone tests and two ultrasounds before she was convinced.
My physician had not been derogatory in our visits, but I was concerned about her pessimistic approach to my care. After my second U/S the technician was able to see the baby's heartbeat. What a sigh of relief! Prior to seeing the U/S the doctor kind of walked back and forth past me as though she was preparing to give me bad news. When the U/S Technician finally put the report in the doctor's box she appeared amazed that it turned out so well and then stuttered over the words "Have you rescheduled your OB appointment yet?" Of course I hadn't because a week prior, she had told my to wait to schedule the appointment until after the U/S (as if to say if it's bad there will be no NEED for an OB appointment) So much for positive thinking!
After a great 'start OB care' appointment the doctor commented "things look really good, but because of your low progesterone I don't want you to get your hopes up until after the first trimester." I thought I would never get the green light that my pregnancy was fine. Although the pregnancy had been progressing fine and all signs were good, she was treating me as though the pregnancy was a risky one. Her attitude when I visited her was usually apathetic. I remember feeling that she just couldn't believe that someone my size was having such a healthy pregnancy. Nine UNEVENTFUL months later...to the day (my original due date had been 11/20, but was changed to 11/13 after my third U/S), I began my birthing journey:
Wednesday: False labor pains begin at 2:00 AM and continue on and off throughout the morning and afternoon. About 3:00PM I lost the first of what would be several parts of my mucous plug followed by general crampiness for the rest of the day and evening.
Thursday, 12:00 AM: Contractions begin at 7-10 minutes apart. I figured it was more false labor pains since I had not had a bloody show (but ultimately learned that these were in fact the real thing). I called my midwife when the office opened at 9:00. She thought I may be right in assessing the pain as false labor. I had not slept all night from the pain and she prescribed a sleeping pill. She said, "If it's false labor, the pills will stop them and you'll sleep, but if it's the real thing, you won't be able to sleep through the contractions." I decided not to take the pill just in case. I didn't want to be in pain AND groggy! At 2:00 PM my water broke (although it wasn't as much water as I had expected) and the midwife asked me to come in to be checked. Once there, she confirmed that it in fact my water had broken and then informed me that the fluid was stained with meconium. She also stated that I was only 1 cm dilated and at this point I had been in labor for over 13 hours. She recommended pitocin to get things going. I'd learned that those moms induced with pitocin had very hard labor pains and my midwife confirmed that this may be the case. I told her that I wanted to try it without an epidural and knowing the c/s rate for overweight women, reminded her how important it was to me to wait as long as possible before a C-section was considered. We then left for the hospital.
4:30 PM Contractions still irregular and topping off between 70 and 80. I am confined to bed with external fetal monitor. I am told that I may be able to walk the length of the bed if the baby responds okay to the contractions. So far so good.
8:00 PM After 18 hours of labor, the pain is more than I can handle. I admit defeat and request the epidural.
10:00 PM According to the monitor, contractions are double and triple peaking at 100. I breath a sigh of relief that I can't feel anything but pressure. Midwife checks and I'm still only dilated 3 cm. She waits for a contraction and stretches the cervix another 3 cm to 6!
Friday,12:00 AM: Midwife tells me there have been a few drops in the baby's heartbeat and asks to insert an internal monitor for more accurate readings. Realizing this would confine me to the bed but wanting to do what was best for the baby, I reluctantly agreed. Midwife discovers that my bag of waters had not completely ruptured and may have been delaying the baby's drop into the pelvis. She breaks the sack and the baby moves to -1 station. (NOTE: looking back, I realize that if we had know this back at the office, I may have avoided using the pitocin altogether since the unruptured sack was preventing the baby from moving down into the pelvis, thus stimulating more productive contractions.)
3:00 AM Dilated 6-7 cm. I am exhausted and disappointed, but ask to be given more time before considering a C-section.
4:30 The midwife brings in the doctor-on-call to evaluate. The baby had several heartbeat decelerations after contractions and she was concerned. I am dilated 8 cm and he tells me to push although I have not yet felt the urge. It is unproductive and a C-section is recommended. I begin to cry from the exhaustion and disappointment, but after 28.5 hours, I agree.
5:10 AM Our darling daughter is born. We had chosen not to learn the sex of the baby and although we both wanted a girl, we felt very strongly it was a boy. When the doctor announced "IT'S A GIRL" I cried and cried and cried. She was suctioned well and the meconium had minimal effects on her. Apgars 8 and 9. My husband left to go video the baby for me and I was whisked off to recovery.
I invested a lot of time developing my birth plan and although this is the farthest from my dream birth, my daughter far surpasses any hopes I had for my baby. There were times during the months following her birth when I thought I could have done something differently to lessen the need for the c/s, but in time I have learned to focus less on the way she arrived, and more the sheer joy she brings me and my husband now that she is HERE! I wish all of you the best in your pregnancies and pray that each of you have an uneventful labor and delivery.
Aliza's Story (1 terrible vaginal birth, 1 terrific vaginal birth)
Kmom's Notes: This mom had a terrible birth experience the first time around. Although the birth was vaginal, it was very traumatic and the treatment very poor. (Vaginal births can be very traumatic sometimes. Nancy Wainer Cohen calls these "vaginal cesareans", and they too often need healing.) It's also interesting to note that the poor treatment she received was at the hands of on-call hospital midwives who handled her birth; in her second birth she had the private OB she saw for prenatals in both pregnancies. Proof that on occasion, midwives aren't always better!
Aliza worked very proactively the second time around to change things. Between pregnancies, she sought counseling for food/body issues and really gained more trust and respect for her body. She used her supportive and size-friendly OB for birth too (not just prenatals), hired a doula (professional labor support person), worked on body trust, and actively did positive visualizations of birth, etc. It really can make a difference!
Birth Story
I'm originally from Melbourne, Australia, although I've been living in Israel for the past ten years. The system here is quite different from the States. The public health system allows you to see a ob/gyn throughout your pregnancy and then one registers at one of the local hospitals and your baby is delivered by a midwife who just happens to be on call. You can even have a number of midwives throughout a single delivery as they change shifts every 8 hours. One may also see a private doctor at own expense throughout one's pregnancy and may also take this same dr. for the delivery at the hospital where the dr. has "rights".
First Pregnancy: My first pregnancy resulted in a miscarriage at about 10 weeks in March 1993. After that I tried naturally to conceive including losing a significant amount of weight which my dr. said would help ovulation resume. When that didn't help and I was feeling desperate, I finally said I wanted help. My son was conceived on my first round of Clomid.
Second Pregnancy, First Birth: From the very beginning of the pregnancy I was pessimistic. From the third week (one week after conception) I had severe abdominal pain which my dr. could not diagnose and said that it was too early in the preg. for him to do anything -- either it'll continue or it won't. By the end of the fourth month, the pains subsided (I had basically been experiencing the pains whenever I moved and had quit my job and put myself on bed rest) and I then began questioning my dr. about all the problems I assumed would happen as a result of my weight. My dr. was okay in that he said that certain problems would be more likely; however, we'd deal with *if* they came up. Regarding my weight, he had said originally that I would probably put on less than thin women and he would like to see no more than a 6 kg gain. I lost steadily in the first few months and my the end of the ninth month, I'd gained a total of 8kg which was fine with him.
During the last six weeks of my second pregnancy (first birth), my BP went up a bit and I had to be monitored every two days (b/p, NST, u/s). This constant worrying and not knowing what would happen worked havoc on my sanity and by the time I was induced at 42 weeks, I was a mental mess. The treatment in the hospital was vastly different from my private dr. They made me feel bad as if it was my fault that my BP was up, as if no thin women ever had elevated BP in late pregnancy.
The labour itself was extremely traumatic in a number of respects. Firstly, the hospital staff made me feel like they were doing me a favour and I was induced at 10:30pm, half an hour before the shift change, so as to accommodate the oncoming shift, despite being exhausted from a very emotional day. Secondly, queries by myself, my husband or my labour coach were dismissed as bothersome. Any efforts on our part to create a different kind of labour experience were met with disdain if not direct opposition such as a desire to remove the monitor temporarily, to walk around the labour ward, to change positions etc.
Finally, I don't feel as if I received any support from the staff to boost my confidence in my ability to birth my baby. This feeling was increased when my failure to progress, after having spent 7 hours at 6cm dilation, was met with the on-call dr's saying "either labour progresses in the next half hour or you'll go for a c/s" and saying again after having gotten an epidural (for which I had to wait 3 hours, which took me to 10cm in a matter of minutes) that if the baby wasn't delivered in half an hour I'd again be taken for a c/s.
Fortunately, my son was delivered in exactly 30 minutes weighing 4.32 kg. I don't know if the dr's response was due to my weight or not. The placenta took more than 40 minutes to be delivered and then the midwives were not sure if it was complete. By the time the dr. checked it, I was hemorrhaging, and he had to do an emergency manual D&C without any anesthetic (100 times more painful than childbirth), then I went into shock and had to have a blood transfusion.
Needless to say, I was traumatized. I felt as if I'd been physically and emotionally raped. My body had been invaded, pushed and shoved, pulled and manipulated. It took me many months to realize the extent of the trauma I'd been through. I don't know how much of my experiences with the medical staff was due to my weight but another significant factor that cannot be ignored is the fact that I am an English-speaking immigrant in a Middle Eastern country - the cultural gap is significant and the attitudes towards birth very different. I do know that they definitely did nothing to reassure me that it wasn't my fault and at my six week check-up I discussed these events with my private dr. who reassured me that it had nothing to do with my weight.
Third Pregnancy, Second Birth: My second baby's birth was an extremely exciting and spiritual event and this is my birth story. After my first baby 2.5 years earlier, I was terrified of labor. My son's birth was preceded by 6 weeks of medical intervention which left me feeling like my body was awful and couldn't function as it should have and that my size was the cause of all the problems.
It took a long time but by the time my daughter was conceived, I had begun to like my pregnant body. As the pregnancy continued my self-esteem grew and that confidence was boosted by a completely uneventful pregnancy. For the first time ever I felt like my body wasn't betraying me and I began to respect my body. So although as my due date approached I began to feel anxious, I tried to get in touch with my body and show respect for the process that was happening inside of me. On Friday afternoon I took a bath in lavender oil to help me relax and continued with my visualizations which I'd been doing in the last few weeks - imagining my uterus opening up and allowing by baby to be born through it.
My water broke at 4:30 am the following morning, the day before my due date and since I didn't have any contractions I followed my doula's instructions to stay at home and waited. I spent a lovely day with my family and friends until early evening when I contacted my doctor who asked me to come in. I arrived at the hospital some 16 hours after my waters broke and had managed to induce contractions using nipple stimulation for a half hour in the car on the way in. I was 4cm dilated and 80% effaced and barely feeling the contractions.
My OB gave me a hospital room to rest in for the night and said he'd see me in the morning or when anything started happening. I sent my husband to my brother's house nearby and told him to get some sleep. I decided to try having a shower to see if that would help move things along. By the time I got out of the shower a short time later, my contractions were strong and I was feeling shaky in between the contractions. I was a little nervous so I called my doula who said it was time for her to come.
At 1:15 am my husband and doula arrived at the hospital. For the next three hours I experienced strong but irregular contractions. I varied my positions and walked a lot to accelerate labor but by 4:30 I was only having contractions every 15 minutes. By now, I'd been up for 24 hours so I decided to get some rest. After sleeping for two hours, my OB returned and checked me. I was now 5cm and 100% effaced and very disappointed and very fearful of repeating the scenario of my first birth with a pitocin induction, stalled labor and baby in distress. Since I had discussed these fears with my doula and OB during the pregnancy we had worked out how I would handle such a similar scenario and thus when my OB said he had to use pitocin to get labor going I knew I would get an epidural to help me with the pain.
It was 9am by the time the pitocin was started and my epidural was already in place. The labor went very quickly from then on and although despite two attempts with the epidural, it was not working as it should. By 12:35pm I was 9cm dilated and felt the need to push. For 25 minutes my doula worked with me to help me concentrate on not pushing and at exactly 1:00pm my OB said "okay, push" - the words I had been waiting for. Exactly 6 minutes and three contractions later my beautiful daughter was born. She was delivered straight onto my stomach and my husband cut the cord. A few minutes later the placenta was delivered and I had one stitch to repair a very minor tear. My daughter nursed immediately and we were left alone to bond and rest. A short while after the birth I hopped of the bed, freshened up and walked to the maternity ward full of energy albeit tired.
My doula had been a wonderful source of emotional support and physical help. She knew what my concerns were and was able to help me through the fear as well as rub my back between contractions and give a lot of encouragement. My OB was wonderful also in that he gave me the space to try for the type of birth I wanted. My OB treated me, throughout, like any other pregnant woman and made no comment about my weight. When I asked him about having a higher chance of GD or PIH he said that we'll deal with that if and when we need to. At no time during the pregnancy or labor did he make me feel handicapped by my weight but rather was tremendously encouraging and positive. My husband was there the whole time and I cannot imagine going through birth without his continued presence and support. Throughout, I felt surrounded by people who were caring and considerate of my feelings and what I was going through and they all helped me make this birth experience the best it could be.
Charlie's Story (fraternal twins, c/s)
Kmom's Notes:
Birth Story
Basically a regular pregnancy... we were a bit concerned at the beginning because of the size I was becoming (rather early). Also because of my age there were concerns that the baby would have problems (down's syndrome, spina bifida, etc) so the clinic did test for AFP.... The results came back high, which led to more concerns and we were scheduled for an ultrasound. At the ultrasound, we found out that the reason the AFP was high was because there were 2 babies, not one, which was a great relief.
The pregnancy was generally uneventful, other than the fact that I was miserable through most of it because of my size and it being a twin pregnancy. I had horrible heartburn most of the time, sciatica (which I have still)... no morning sickness to speak of, although if I got too hungry that would turn into nausea if I took too long to get around to eating and then smelled food.
The doctors initially suggested to me that if we made it through to 7 months that would be great and then we'd see how it was going, since twin pregnancies generally wind up being pre-term. However 7 months came and went and I remained pregnant and miserable. Then they suggested 8 months and they would consider induction since I was so uncomfortable... didn't happen. 9 months.... They tell me, "Well, lets just let nature take its course... " I said, "that's how I got this way to begin with!!!" They still didn't induce.
Finally (since I was going in to be seen about twice a week by then) I had been experiencing some liquid leaking for a couple of days and mentioned it, thinking it was a new kind of incontinence problem (another side-effect of the twin pregnancy), and they checked it, found out it was amniotic fluid and decided to let me go and have my babies. Originally they indicated that we would try and have them vaginally, but since the boy baby hadn't turned (as we had hoped he would) they just went ahead and did the c/s to avoid their chins possibly locking on exit.
That was 2 1/2 years ago. We think (every once in a while) about having another baby, but since the fact that we HAD twins was entirely my fault (the older you get the more predisposed to having multiples) and now I'm 38, I don't think we'll be having any more... Two is plenty and we have a boy and a girl and they keep us pretty busy. Who knows???... next time it might be triplets!!!......and then I'd really be up the creek.
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.
Ann's Story (transverse presentation, c/s)
Kmom's Notes: Ann experienced some size-phobia and hassle from a previous provider, and decided to switch mid-way through her pregnancy. Unfortunately, her baby settled into a transverse position (shoulder/side first) and her doctors' policy was not to attempt external version. Because the baby did not change position on her own, Ann needed an elective c/s.
Birth Story
Ann's story can be read on her website at www.adairmedia.com/ann/elizabeth.htm. She had a pretty ordinary pregnancy, but had a c/s when her baby was found to be transverse. Because it was an elective c/s (no labor beforehand because of the danger of cord prolapse in a transverse presentation), the baby had some troubles breathing at first and spent quite a bit of time in the NICU (neonatal intensive care unit). Ann also had to have an unusual vertical incision due to the baby's presentation. Recovery at first was tough but all is well now. Breastfeeding got off to a rough start, but they persevered and are now breastfeeding exclusively.
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.
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.
Gina Marie's Story (pre-eclampsia, induction, fat-phobic doctor, classical c/s)
Kmom's Notes: Gina Marie was induced at 37 weeks because they suspected a 'big baby'; between 8.5 and 9.5 lbs. at 37 weeks by ultrasound. Because her baby was in the wrong position her labor stalled and she had a c/s. Her consulting OB chose to use a classical incision for the operation and was very insulting about her size; her c/s and recovery were a horror story.
In most cases, ultrasounds are very inaccurate for measuring 'large' babies near term, although in this case it was accurate. Inducing early for macrosomia (big baby) is clearly shown in research to INCREASE the rate of c/s without improving outcome at all, and anecdotally, many large women's c-sections are probably caused by this common practice of inducing early. However, Gina Marie's case is complicated by her blood pressure and edema at the end of pregnancy, and the size of her baby at 37 weeks made the decision more complicated. In most cases, inducing early for 'big baby' is clearly shown to worsen outcomes, but occasionally in selected cases can be helpful.
However, her midwives did little to prepare her cervix for induction, making an induction less likely to succeed, and the induction at 37 weeks resulted in fetal distress for her baby after it was born. Also, her baby was malpositioned, which is probably why labor did not progress. It is a difficult question whether the decision to induce helped or hurt her chances at a normal birth experience. Waiting even one more week might have helped her body and her baby to be more ready, yet the concern over blood pressure and edema was a real one.
Regardless, insult was added to injury when she encountered a very fat-phobic surgeon who was very unkind and discriminatory, and did a 'classical' up-down incision unnecessarily on her. Most very large women can still have a low-transverse (side-to-side or 'bikini') incision with careful management, or they can have an up-down or slightly higher side-to-side skin incision and a low side-to-side uterine incision. The reason given for a classical incision on very large women is to prevent infection in the moisture-prone area underneath the fat fold ("apron"), yet it should be noted that this classical incision infected badly---using a different incision didn't help! It is Kmom's anecdotal observation that the large women she has seen with classical "up-down" incisions have tended to have more problems than those with the "bikini" incisions. Regardless, nursing techniques (using a cool blowdryer on the incision, plus extremely strong antibiotics for very large women) can often help avoid many cases of infection in transverse incisions, making these practical even for large women. The decision to do a classical incision on Gina Marie was dubious at best.
Furthermore, the OB pressured her strongly while in labor (which is improper) to have her tubes tied in order to prevent her from having any more children. This is unethical and unprofessional, and much of her poor treatment after that may have been from the OBs attempting to punish her when she refused to have her tubes tied. She was later told that the classical incision would make it too dangerous to attempt to have another pregnancy at all, so one wonders if the doctor tried to prevent her from having more children by using this incision and accompanying scare tactics. [By the way, it's not true that a classical incision precludes subsequent pregnancy at all. It does raise the risk of rupture somewhat and most doctors will not permit the woman to try for vaginal birth subsequently, but it does not prevent you from having more kids. Many women (including some large women--see other stories) have had subsequent kids after a classical incision. This was pure scare tactics to frighten her out of having more kids.]
Gina Marie wanted to share her difficult story so that other large women can be aware of some common pitfalls to watch out for. She says, "I didn't have a good, normal birth story. In fact, my son's birth was absolutely horrible. However, there are some important things that I learned afterwards that I think large women need to know and need to be on the lookout for, and they will be evident by the end of my story."
Birth Story
Before I went to the hospital, I had this idea of what childbirth would be like, and it definitely did not include the experiences that I have had. There is a happy ending---I am alive, in possession of all of my faculties, and I have a gorgeous healthy baby boy. But I went through hell to bring him into this world.
I started out with the local midwifery practice (five midwives) for a lot of reasons. Number one, they seemed to be the most size-accepting. Number two, they were the least expensive. Number three, they were the only all-female practice, although I learned during the birth that female doctor does not necessarily mean understanding, sympathetic doctor. During labor, I was transferred to their backup OB practice. This practice consisted of eight doctors, only two of whom have a decent bedside manner.
I had an easy pregnancy for 8 months, except for the heartburn and the initial nausea. I had no real problems until the last month or so. I gained about 6 lbs. during the entire pregnancy. I ate right and exercised and really made an effort to take care of myself. Then, in my last month, I got really bad edema in my feet and legs, so severe that I was put on bedrest for two weeks. My blood pressure started spiking occasionally---not to the dangerous imminent stroke level, but enough to be worrisome. The highest reading I remember was 150/100. I felt like a sausage. I could wear one pair of shoes---my cross trainers---and only if I put them on first thing in the morning.
At 37 weeks I had an ultrasound to determine the baby's size and position, because it was difficult for the midwife to tell through my big belly. The ultrasound technician determined that my baby was between 8.5 and 9.5 pounds. The midwives consulted with their backup OBs, and they informed me that they felt it was in my best interest to have an induced labor---that I had a lesser chance of a c/s if they induced then. They were concerned that the baby would grow too large if I was pregnant for another three weeks. I went into the hospital on a Wednesday morning, and the midwives induced labor with Cervidil [Kmom note: a prostaglandin insert]. They applied Cervidil to my closed, hard cervix around 1 p.m. and I was in active labor by 7 p.m. My water broke around 11 p.m.
Sometime the next morning, they gave me a pitocin drip. I asked for and got narcotic painkillers. Finding veins has always been an ordeal for me, and it took three different phlebotomists about 10 sticks to get an IV started. I had 3 possibles, and the veins blew. I eventually dilated to 7 cm and stopped. Because of the problems with the IVs, the put in a central line on Thursday night when I was having heavy active labor. A central line is an IV in the jugular vein. It was really traumatic. I had to have a plastic sheet over my face while they were inserting it so that the area around my jugular would be sterile, and I had to lie flat on my back, which is terribly uncomfortable for a woman in labor. So, I was on my back, I felt like I was suffocating, and I was having contractions every minute or so. I could feel myself slipping out of reality. This was the worst physical sensation of all of it.
They decided at this time that the pitocin had done all it was going to do, so they took me off of the drip. They determined that if I didn't deliver on my own by morning, it would be the best course of action to give me a c/s. They thought it would be best if I could be sectioned with only an epidural, but after inserting the damn thing right after putting in the central line, they determined I could not breathe adequately while laying flat on my back for the epidural to be effective during surgery. Still I had the epidural and the accompanying fluids all night Thursday night. Friday morning, I still had not dilated past 7 cm, even though I had been contracting every minute or so for 24 hours. I think that the epidural slowed the labor further, and it didn't really do much for the pain. The fluids that accompany the epidural to keep the blood pressure from dropping inflated my feet and legs like the Michelin tire man. By morning, I could not lift my legs.
Kmom note: One of the known risks of pitocin is to increase swelling and retention of fluids. The fluids necessary with an epidural often tend to cause significant swelling in a woman who has undergone a long induction with pitocin. This (in addition to her previous swelling) made for a severe problem.
The OB came in and told me that she felt a c/s was warranted because my contractions were of sufficient power and duration that I should have pushed out the baby if he were able to come. His heartbeat had not wavered on the fetal monitor, but he had also not moved beyond a -2 station. I think what happened is that instead of facing forward or facing the rear, he was facing my left, and his shoulders were hung up on my pelvis. I could feel his little behind right below my ribcage all the way through labor. He never dropped down.
Kmom note: A malpositioned baby could certainly have caused many of the problems she encountered---stuck at 7 cm, a high and unengaged baby that would not move down, little progress despite painful and strong contractions, etc. And being stuck in bed due to the induction meant that she could not employ other methods of turning the baby, such as position changes, etc. This is one of the potential problems with induction.
This OB was the meanest, most evil bitch I have ever met. Even though I had shopped around and shopped around for pregnancy care that was not fat-phobic and would take into account only the facts of my health and not assumptions, the OBs backing up the midwives were not nearly as enlightened as the midwives were. So when she came in to discuss my surgery, the OB sat down and asked me if I wanted my tubes tied while she was in there. I was shocked and told her no, that this was my first child, and I didn't want to make decisions like that at the moment. And she countered with a speech that boiled down to "you are too fat to have any more children, you shouldn't even be having this one, and if I had anything to do with it, you wouldn't be." Then she discussed general anesthesia, and the dangers. Granted, fat people do sometimes have problems with general anesthesia. However, it was a little heavy-handed for her to instruct me to discuss funeral arrangements with my husband before I went into surgery. She asked me if I was an organ donor, and then said it didn't really matter. (I don't know what the hell this was supposed to mean. I guess she was implying that my organs were probably not acceptable or something.)
Kmom note: It is unethical to pressure a woman to have her tubes tied while in labor. In fact, in many places it is forbidden, deemed a decision made under duress. It was *extremely* inappropriate for this OB to be pushing this decision just because of the mother's size, and especially unethical to do it while she was in labor. However, OBs have had a history of doing this to women they don't approve of having children, from welfare mothers to minority women, etc. This is supposed to be totally unacceptable now, but it is still done to some women (including fat ones) at times. The other remarks and treatment she received were extremely unprofessional. This may have been a case of the doctors 'punishing' her for not going along with them.
I was given the prognosis of 'guarded'. It was my impression that she had never dealt with a patient my size before and that she didn't like fat people to begin with. I was scheduled for a c/s for 11 a.m. on Friday. Despite being a scheduled section, the OB chose to make a high vertical incision---a "classic" c/s incision----because she was not sure about operating under my belly "apron". This kind of incision precludes a VBAC. Later I learned that a bikini incision could have been done if I'd had a more experienced doctor [i.e., more experienced with fat women]. Part of me still feels like she did this kind of incision to punish me for being such a fat pig.
Kmom note: Even very large women can usually have a bikini cut or a modified version thereof. Only rarely is a classical incision necessary, but some doctors persist in using a classical incision on fat women anyhow. The concern is for infection, but with proper nursing techniques and special attention to prevention, infection can usually be avoided even in very large women, as noted.
My legs were so swollen from the epidural fluid and the previous edema that they were worried about blood clots in my legs. They wrapped up my feet and legs in ace bandages up to my thighs. They wheeled me down to the prep area for the Operating Room and the team of anesthetists gave me an arterial line (yet another big traumatic stick). My husband was there while they were prepping me for surgery, but the poor guy was as overwhelmed by the fatigue of being awake so long and the shock of the guarded prognosis and the business about funeral plans. He was sobbing loudly and disturbing the doctors. A nurse led him away.
I could hear my baby's heartbeat on the fetal monitor until they took it out a couple of minutes before they wheeled me into the operating room. He was strong and steady and never wavered, and I was grateful for that. I was halfway convinced that I was going to die. I remember thinking that it would be all right as long as my baby was OK. While they were strapping me down for the surgery, the 15 or so people in the room introduced themselves to me. The pediatrician and her staff came over and I told them to be sure and take care of my baby, no matter what happened to me. The nurses swabbed my belly with betadine and put the anesthesia mask over my face and I went out.
When I woke up there was a greenish light over my head and people were calling my name and telling me not to cough while they removed my ventilator tube. I don't even know how long I was in surgery. I found out later that I lost 2 liters of blood during the surgery. I have a 12 inch incision down the middle of my belly, starting about 4" above and 1/2" to the left of my navel and running parallel to it. The first time I saw the stitches, I thought they had sewn my navel shut. They told me later that they were prepared to keep me on the ventilator for 12 hours after the surgery, but I was up in the operating room on the first attempt at waking me. Basically, I handled the anesthesia like a normal person would, despite their dire predictions. As soon as they took me to the recovery room, they told me that my beautiful son was born at 12:27 p.m. and that he weighed 9 lbs, 7.3 oz.,, was 21.5 inches long, and had apgars of 8 and 9 and a full head of blond hair. We named him Jacob Baruch after two of his great-grandfathers. Baruch means Blessing in Hebrew, and he is a blessing in my life.
They took me to the ICU. I couldn't see my baby for 24 hours because he was in NICU (Neonatal Intensive Care Unit). He was born in respiratory distress because of the narcotics, and he was also getting antibiotics because my water had been broken for so long. Late on Saturday afternoon, the neonatal nursing staff bent rules and rolled my boy up to see me in an isolette and let me hold him for a few minutes. I cried and cried. He had been screaming until I held him, and he immediately soothed and looked up at me. I swear he knew me. It was hard to hold him because I had wires and tubes everywhere, and so did he. I wanted so badly to breastfeed, but I couldn't because of all the stuff I was getting in my IV. A lactation consultant came and brought me a breast pump and I diligently tried to establish a milk supply, but the most I could manage was getting the inside of the breast shell wet. I was told that I would have to pump and dump for 3 days because of all the drugs in my system.
During the second day I was in ICU, I developed a fever. I was getting some very strong antibiotics through my IV, so they figured it wasn't an infection. The fever didn't go away within 24 hours. Monday morning they decided that I might have had a pulmonary embolism, and sent me to nuclear medicine for tests on that. They injected some kind of radioactive dye so they could see an embolism, and this made my hypothetical milk unusable for another 2 days. Well, I didn't have a pulmonary embolism. The OB said that i was was possibly microscopic blood clots from the surgery causing the fever. I was also having difficulty breathing when I wasn't sitting straight up. They determined my oxygen saturation level was low, and the bad OB who had been so mean to me said it was because of sleep apnea (which I had never had a problem with before or since). The next OB to come on shift after her did a blood count and determined that my hemoglobin was low, and I had a transfusion of two units of blood. I perked up immediately. This relief OB also prescribed some Lasix for me to help with the swelling, and I eliminated 6 liters of water in 24 hours. From the time I entered the hospital until I left, I lost 47 lbs. (and only 9.5 of it was my baby!).
I got up and started walking around about 3 days after the surgery, and it was incredibly difficult because of the incision and because I was so swollen. My feet were so swollen that it hurt to stand on them. I couldn't wear any shoes at all for a month after the surgery. I was released from the ICU into a regular room, and finally I was allowed to have my baby in my room with me so I could see him and feed him and care for him. I still had to sleep with oxygen and have my oxygenation level checked several times a day, but I felt like a regular patient, and I had more privacy, etc.
I kept trying to pump breastmilk for my baby, but was unsuccessful. I was also feeling horrible, could barely move, etc. and the OB said that she could give me medication that would make me feel much better and help me recover faster but it would make whatever milk I produced unusable for as long as I was on it. So I made the choice to take the medicine and feel better, since I had been unable to produce anything anyway. My breasts produced the occasional drop or two for a few weeks afterwards, but once I was out of the hospital and could safely nurse my son, he didn't want to take my nipple. This was really hard for me, because I strongly wanted to be able to breastfeed. I had been so sure that I would that I bought no bottles or pacifiers, only a breast pump and pads and a nursing bra. Because my baby and I were separated for so long, because I could not put him to my breast due to the drugs in my system, because I had undiagnosed thyroid disease at the time, and because I had traumatic bloodloss during the surgery---all of these things worked against me. My son was also born with a tongue-tie, which would have hindered his latching on if I had been able to offer it to him. It seems that breastfeeding was just not in the cards for us.
Kmom note: A tongue-tie can be fixed with a small procedure and doesn't have to preclude breastfeeding. However, significant blood loss and resulting anemia is known to affect milk supply negatively, as does low thyroid. The problems she had getting any milk were probably a combination of no nursing access from the baby (a pump is not as efficient as a baby), her undiagnosed hypothyroidism, and the anemia affecting her milk supply. In addition, any medicine she took to help with the swelling may have also affected her ability to make milk.
I should mention that while I was in the hospital trying to get my blood oxygenation levels to an acceptable level and getting IV antibiotics and anti-inflammatories, every doctor in the whole evil practice came by my room to bitch at me for being fat and to talk about diets. Some were less aggressive and insulting about it than others, but they all felt it was completely important to tell me that I am too fat. "Have you ever considered dieting?" was how they all started out. Like any fat person in America could possibly get to be 30 years old without dieting at some point. Like I haven't been informed by family, friends, strangers, and doctors that I am fat fat fat fat fat and I need to diet for my entire life. As is this was a completely new discovery. I felt particularly betrayed when the lead midwife came in and gave me the speech. When I first became pregnant, I told her that I was worried about my eating habits and I wanted to take care of myself and give my baby good nutrition. I kept a food diary for two weeks and showed it to her on my next visit. It was a faithful diary. She praised me for the variety and content, told me that I was doing a good job of eating healthy low-fat foods. She suggested that I eat more protein, but otherwise did not criticize my eating habits. So it was a shock and a betrayal when she came in and told me that the best plan for my life was a really strict diet. The bitchy cruel OB got in on the act, which is hardly a surprise, and laid it on with a trowel. Not only did I need to diet, but if I did not do so, I would be dead before ten years, because women my size don't live past 40. My child would never love me because he would be so ashamed to have a fat mama. Fat women are bad mothers who can't keep up with their children, and their children suffer for it. By obstinately continuing to be fat, I would show myself to be an unfit mother.
I was so sick that I took her verbal abuse, but I am consumed with anger every time I think of it now. The nicer OB who discovered my anemia in the ICU came in and recommended Sugar Busters (which I had previously never heard of and I am still skeptical about. Steak, eggs, and cheese are great, but carrots and apples are bad for you? This was surreal advice). He was nicer about the whole deal because he said, "Let's be realistic. You're never going to get below 200 lbs. But I would like to see you considerably smaller than you are now." He then went on to ask me about my lowest weight since reaching puberty. I don't think it was the appropriate time for stern lectures, but at least he tried to take me reality and my feelings into consideration. It just gripes my ass that all of these health professionals who deal with pregnant and postpartum women every single day could not see that obstetrical complications are a risk factor for postpartum depression, and by lecturing me, they were adding to the stress level in my life. Talk about kicking a woman when she's down.
Once I got my blood oxygenation levels to an acceptable level and they were getting ready to release me, my incision opened. I had developed pockets of sero-sanguinous fluid underneath my incision, and the bottom four inches of it opened. That was a horror show. The wound oozed great gouts of syrupy fluid when it was pressed. It was 4 inches long and 2 inches deep and draining such that it soaked an abdominal pad in 3 hours. They packed it with gauze and bandaged it, and kept me in the hospital for observation for a couple of extra days to make sure that no infection would develop and that the wound would not open further.
After the doctors and nurses left from packing my wound, I was afraid to move. I was afraid if I turned over, my guts would spill out. I didn't know that people could go home with gaping holes in the belly like that, and I thought I was going to have to stay in the hospital for several more weeks. I started crying and really broke down. Did I get any expressions of sympathy or understanding? No, I got an offer of antidepressants. I prefer to get psychoactive drugs from psychiatrists, not obstetricians, so I refused. I was really angry and insulted that after all I had been through, feeling less than perky and chipper about everything was interpreted as a chemical imbalance that could be fixed with drugs.
Once I finally got home, I had home health care nurses for two solid months to help with changing my dressing, and they were terrific (both of them were BBWs). They were maternity specialists so they had seen lots of opened c/s incisions, and they assured me that skinny women got opened incisions too. My wound never opened down to the fascia layer so even though it was deep, it was not as bad as it could have been. One of the nurses gave me advice about caring for my child, and also recommended the OB/GYN I am seeing currently. My husband also helped change my dressings. I never dreamed that I would be asking such a personal task of him. It's so...unsexy and gross. My husband was such a trooper through all this. He kept joking that now he knew me inside and out. The wound eventually abscessed, but the home health care nurse caught it early so it was not as bad as it could have been. When she saw it, it was a red place the size of a quarter. By the time I got to the emergency room that afternoon, it was as big as my hand. The nurse saved my life because she acted so quickly. I was in the hospital again for two days receiving IV antibiotics.
At my postpartum appointment, I complained of being cold all the time and that I had lost my sense of smell. I could not tell when my son had a dirty diaper because I could not smell it. Eventually they discovered that I had hypothyroidism (Hashimoto's disease) which I probably had for some time but at a sub-acute level. My internist believes it was triggered into active stage by the trauma of Jacob's birth. [Kmom's note: Childbirth can trigger thyroid problems, but it's often missed by doctors. It's good that this was caught by her internist.] I also had a CAT scan to rule out a brain tumor. I saw the hateful OB for postpartum checks but not since. I saw a counselor for my postpartum depression and I described this OB as having the bedside manner of a prison guard. The counselor immediately knew which OB I was referring to. Evidently she has this reputation all over town, and it's not just me.
The new OB (recommended by the home health nurse) is wonderful. She is a recent graduate and much more size-accepting. She was shocked that I had a vertical incision. The hateful OB informed me that the kind of incision that they made in my uterus will make it incredibly dangerous for me to attempt another pregnancy. Instead of a bikini cut near the thicker bottom of the uterus, they cut along the length of it at the top where it expands more. Therefore, a subsequent pregnancy could cause the uterus to rupture and I would die horribly from a hemorrhage. Sex becomes much more ominous now. The new doctor said that although she wouldn't recommend another pregnancy for me because of all the surgical complications, it was by no means a death sentence. She said that she could manage me if I became pregnant again. [Kmom's note: As noted, a classical incision does NOT preclude future pregnancy. This may have been another attempt by the OB to keep her from having more children.]
As if I didn't have enough to deal with, the insurance company refused to pay all of my bill. We have been round and round with the insurance company over this for almost 2 years now and still owe the hospital several thousand dollars. I was laid low by postpartum depression and the Hashimoto's disease. It took me almost a year to get to my old self. But I have a gorgeous, healthy, smart little boy who is nearly 2 years old now. He is strong and beautiful, and despite the dire warnings, he does love his mother. I managed to finish my MSW degree eventually after all this too.
Warnings for other women:
Kmom's postscript: It's very important to take time to emotionally heal after a difficult birth. Most women are told to 'be grateful you had a healthy baby' as if their feelings about their labor and birth don't count. Of COURSE you are grateful to have a healthy baby, but at the same time it is perfectly fine to be less-than-thrilled about the labor or birth, while still fully loving your baby. In addition, if you have a particularly traumatic birth or poor treatment by your providers, it's extremely important to fully work through and grieve it completely. This is not a fast process, but it IS a very healing one, and is particularly helpful before moving on to another pregnancy or deciding to end your childbearing years. In order to help this process along, there is a list of books that can help on my Book Recommendations FAQ on this website. I highly recommend checking these out; healing is not an easy process but it is a vital one and it will bring growth and benefits to many facets of your life, whether or not you choose to have further children.
Erin's Story (classical c/s, 2 repeat low transverse c/s)
Kmom's Notes: Erin's first c/s was done with a classical (up-down) incision. Although she cannot be sure, she believes this may have been due to fat-phobia on the part of the doctor. Her subsequent doctor saw no reason to do a classical incision on her and her subsequent c/s have been done with a low transverse incision (bikini cut, horizontal just above the bikini line).
Erin's first doctor's decision to do a (probably unnecessary) classical incision took away all her future birthing choices in the eyes of the obstetrical world. She greatly desired a VBAC but because of her previous classical incision, her doctor would not agree to a trial of labor, although he was very sympathetic to her dilemma. Although some women with classical c/s have gone on to have VBACs, the rate of uterine rupture is somewhat higher with a classical scar, and it is extremely difficult to find a provider who will attend you if you try for a VBAC after a classical c/s. Although there are some who will, most will not, and Erin was not able to find a provider for this pregnancy who would try.
Birth Story
On Sunday, I spoke with my OB on the phone about refusing the c/s and he said I'd have no care from him if I did that. So Monday I started calling around but no one was interested in me at all. They all thought I was crazy. I kept taking calls until Wednesday afternoon, and though some wanted to take me, they just couldn't let me labor in good conscience. Wednesday I had a check-up with my OB. I asked if there was any way to wait until early labor to do the surgery and the answer was no. After the appointment, we waited for my best friend to get off work and then proceeded to the local Outback steakhouse. I wasn't going into that stupid surgery without a really good meal first!! I always have to wait 2 days until I can eat real food after my c/s. I had a big dinner. My friend stayed overnight to help with the kids---we had a slumber party. My DH got up early Thursday to buy me breakfast because I couldn't eat after 6 a.m.
I was in good spirits upon arrival to the hospital and they were expecting me in L&D. The nurse seemed nice enough and wanted to get a tracing on the baby's heart rate so she tried to fit the monitor belt around me which was uncomfortable (I'm quite large), but she finally got enough after 45 minutes and a wiggly baby. She said I'd had 1 contraction during that time. Guess that was supposed to make me feel better? I was very swollen so she took 2 unsuccessful tries to put my IV in. It hurt a bit but all the memories of what was going to happen to me in the next 2 days came flooding back. I was crying and she kept saying, "Does it hurt?" I was like, "No," but I couldn't really talk. Finally my husband told her I didn't want the c/s. She was pretty sympathetic and started talking about the baby. I guess I calmed a bit after that and she got another nurse who finally got the IV in. They started fluid almost immediately.
My OB was delayed. The anesthesiology team arrived; there was an older guy and a younger guy (in training). I got prepped and numbed in the site of the injection, leaning over curled. I felt at least 3 needle sticks and it was quite uncomfortable (later everyone who looked said there were 6 definite holes in my back). They were apparently having trouble getting the needle into the epidural space. This was my 3rd epidural and I'd never had a bit of trouble with the other 2. Now this! My mom said I sat rock still for over half an hour and by the time they were done there was blood running down my back. I so wished my husband had been permitted to be there; he would have insisted they stop or get another team to do it. Immediately after they put a test dose in I felt numb. So they were wondering if it was a spinal instead of an epidural! I was very numb. I was very upset and they kept talking about me in the third person. Finally I convinced them it was a spinal and I wasn't very happy about it, and the older guy keeps telling me how superior the spinal is for pain relief. At one point the young guy takes a syringe and draws fluid up from the catheter. He says it looks clear. I was like that's my spinal fluid, put it back in!!! I was thinking, well maybe this was for the best (I kept remembering the horror stories about bad epidurals). My numbness wore off before 5:30 but they wheeled me into the O.R. and I got onto the table. It was very uncomfortable and they tilted the table and had something under me.
Finally I see the doctor and of course a med student wants to observe. Great. One more person to see my baby before I do. My husband arrives with the older anesthesiologist who wants me to be brutally honest after the surgery with him about the epidural vs. spinal. The young anesthesiologist guy starts to put something into my back catheter and says "45 mg?" The older guy says "Sure." So the young guys says, "Or 100?" And the older guy says "Sure." I'm thinking, "Great."
Anyway it took immediately again and as soon as they prepped the site of incision I was ready. I remember smelling my burning flesh as they cauterized the "bleeders". I remember the doctor and assistant saying how good everything looked. Finally the baby's out! The older anesthesiologist said he'd let me hold her but he's nowhere to be seen. I'm starting to feel numbness and tingling in my hands which I know is wrong. I starting moving and shaking them (I had told them I didn't want to be taped down). They bring the baby close to me; I can't hold her because my hands are numb. She pooped when she came out (meconium) and has this muted cry, not like my others. My husband holds her and I start to feel really funny. Very uncomfortable all over and feeling like I need to run away NOW! My chest feels heavy and I don't feel like I'm breathing. They tell me they're putting my uterus back in. I say, "How much longer?" They say 15 minutes. I don't think I can take it. I feel nauseous. They young guy holds the tray next to my head and I throw up twice. I'd do it more but I can't because I'm too numb to even throw up!!! My arms are really flailing now and the young guy says if you don't be still I'm going to have to put you to sleep. I say, "No! I don't want to go to sleep." He says, "You have to calm down then." As if I can control any of this!! It's his fault! I didn't know what was happening and I really thought I was going to die then and there. My doctor asks if I'm okay, that they were almost done. I don't remember much else but my DH told me he let them give me a little something to calm me for a few minutes because I was apparently trying to get off the table and was actually moving my stomach. I know I was trying to move my feet. I kept saying, "I can't feel my feet!!!"
Finally I remember being back in my room. I told my husband to go ahead and take the baby to the nursery; she'd pooped again and he could give her a bath. I certainly was in no shape to hold her, and didn't really want to either. We'd previously decided to forego the bath so she and I could bond immediately. So much for that. Also I'd asked the doctor not to announce the sex; I wanted to find out for myself. Well, he forgot. Mom says when they brought me in I was still flailing and she was scared. I'm told they can't use the catheter that's already in place for pain relief because the dosage would be so small it wouldn't be useful. They hooked morphine up to my IV. I was already hurting. I really don't remember much here. I could move pretty soon and we went on to Maternity. By now it's about 10 p.m. and we hadn't called very many people. We figure they can wait until tomorrow. I do call the kids and tell them they have a baby sister. I don't remember when I saw the baby. I know she was beautiful. I tried to breastfeed and it seemed she was doing well considering the size of her head was about half the size of my breast!
The hospital stay was really sucky. I remember seeing the doctor the next morning and he immediately asked if I remembered anything about the surgery. He said he asked the anesthesiology team what in the world they did to me, that was not my personality! He said there was really no or nearly no scar tissue and the surgery itself went really well. I was not up to visitors at all but got plenty. I was sore and grouchy and felt so confined in that stupid room. There weren't enough nurses so my requests were ignored or put off. I was upset when they removed the morphine drip because I had to ring the nurse for pain meds. The back catheter was to stay in for 24 hours and wash with saline. The nurse wouldn't remove the urine catheter until the back came out and forget the IV. It was really impeding my ability to breastfeed comfortably because of the way the hospital gown was made (ties instead of snaps). The IV was threaded through the arm of my gown. I didn't have real food until Saturday lunch. I begged the doctor on call to let me go home. We left Saturday at 4 p.m., less than 48 hours after the surgery. I was so grateful to him! He remembered me crying to go home after I'd had one of my previous babies.
This recovery has really been a bear. I was so sore, much more so than last time, and the first time too, I think. I still have numbness right above and down to the incision site, and in the back where I sit down. The baby has been so sleepy that she doesn't latch on for very long or suck for very long. I'm pretty sure my milk came in anyway but it has since dwindled to nearly nothing because my sweet kids gave their sister a cold by kissing her in the hospital. She slept for 2 days straight when she was catching the cold. We finally got her to take a bottle and she seems to be doing fine. Still not staying latched on long enough to increase my milk supply. This is extremely depressing for me. It's like, I couldn't have anywhere near the birth I wanted and now I can't even nurse her?!
I do look at all 3 of my babies and feel so blessed that they're healthy, strong, beautiful, and smart. I really couldn't ask for more. Well, I did, but what good did that do? My experience was horrible and if anyone's looking for anymore reasons not to have an "elective" c/s, I've got plenty! I will regret this the rest of my life, but we're both fine and very healthy physically.
Atheena R's Story (induction, vaginal birth)
Kmom's Notes: Another case where the doctor induced early because the 'baby looks like it's going to be big'. The concern here is needing a c/s because the baby is 'too big' to fit through, or the shoulders getting stuck as they come out (shoulder dystocia, a potential emergency). Research shows that inducing early for 'big baby' does not improve outcomes or lower the rate of shoulder dystocia, and often actually raises the c/s rate strongly, sometimes to >50%. However, inducing early for macrosomia continues to be standard procedure anyhow, especially with larger women, who tend to have larger babies as a group. [Also note that her baby turned out to be not particularly big.]
This mother also tore excessively during the birth. Kmom wonders if this is because the doctor did manage to start an episiotomy after all (episiotomies tend to result in much greater tearing, and the doctor apparently did already have the scalpel in hand), or if she tore so much because she pushed so hard to try to avoid an imminent episiotomy. Repair of this led to a great deal of intervention, including sedation, intubation, and catheterization. Different care might have been able to avoid all this intervention, although it's hard to say for sure.
Birth Story
At my 39-week appointment, the doctor I saw said that my latest ultrasound indicated that my baby might be large, so she explained the dangers of shoulder dystocia and suggested I get an induction that weekend. I said okay. Then as I was driving home from the appointment, I was in a haze. "Hmm. I'm having a baby this weekend. Hmmm."
I went in Sunday for a Cervidil treatment, which did nothing, so they sent me home. Before I left, then inserted another Cervidil application, which came out a few hours later when I lost my mucous plug (although I didn't know that was what happened at the time).
The next morning I went back to the hospital, and was on pitocin ALL day. I had contractions, but they weren't particularly bothersome. When I described them as 'bad menstrual cramps', the nurses were a little discouraged. I was not really dilating or effacing either. That night they turned the pitocin drip down so that I could sleep, but Tuesday morning bright and early they cranked it back up. A series of doctors from my OB group dropped by during the course of my delivery. They had an on-call system and I think I went through 4 of them during my stay. One of them was the doctor with whom I had most of my appointments, an older man who seemed to know everything about the childbirth process. He was surprised to see me there, felt my tummy, and said, "You know, I really don't think this baby is going to be that big."
Tuesday around 5, they were just about ready to send me home again as a 'failed induction' when my water broke. I was VERY happy, because the pitocin drip was getting a little tiresome by then. According to my birth class, I thought a baby was supposed to be delivered within 24 hours of the rupture. I could not WAIT to get the whole labor thing over with.
During the night, however, I still didn't dilate or efface much. I think I was about 75% effaced, maybe 4 cm. Wednesday morning came, and I met yet another doctor. He told me his goal was to have me delivered no later than sunrise Thursday morning. The thought of 24 more hours of constant contractions was a little too much to bear, and I burst into tears.
Since my water had broken, they were able to use the internal monitors, and discovered that my mild contractions were actually quite strong---they just didn't bother me. Wednesday, I also got a new nurse. She told me that I needed to get up and move around a bit, and that would help labor progress. Until then, I had been told to sit in bed and not move. My DH had a dentist appointment that after noon and was agonizing over whether to go (he had broken his tooth a week before and this was the first appointment he could get). We decided he needed to go and I'd page him if by some miracle it actually looked like I was going to give birth.
When he got back, he had smuggled contraband! Donuts! I hadn't eaten in 3 days (except popsickles and jello), so after my first pain shot (a synthetic narcotic), I had half a donut. 5 minutes later I vomited donut and jello all over myself. [Kmom note: This is one of the possible side effects of this type of pain medication.] I didn't eat again, and after my second shot, I made a point of asking for an emesis bucket, so I was prepared for when I vomited.
By now it was around 6 p.m. and the contractions were actually becoming a little painful. And I couldn't tell if I needed to use the bathroom, or if I needed to push. I was given a choice: I could get pain medication now but not use the bathroom, or I could go to the bathroom and then get the meds. I told them I might need to push, so she checked, and sure enough, the baby was on its way! I was given the shot, threw up, but the next 30 minutes were a blur. I remember the lights being turned down, the nurses yelling, "she's pushing, we need some help in here!" One of the nurses suggested that my DH and I each hold one of my legs back until they set up the bed for delivery. Finally, everything was ready and I remember snoozing between contractions.
On my birth plan, I had indicated that unless there was a compelling reason, I didn't want an episiotomy. The doctor said he was going to do one, and I think I said I didn't really want one. He told me that the baby's heartbeat was dropping a little, so if it didn't come out on the next push, he was going to do it. I think he had already given me the local. Well, at the next contraction, I pushed with all my might, and SWISH, out she came! I may be making this up, but I swear I saw the doctor put down the scalpel in shock before he caught the baby. They wiped her off a bit, then put her on my chest. As I was looking down at her, I felt another "WOOSH" and I actually said aloud, "Oh, that must be the placenta." (Nobody told me it was coming, and I'd sort of forgotten about it with all the excitement.)
She was very cute. But apparently they were not able to repair the tearing in the delivery room, so my DH got the baby (he was crying----DH, not the baby!) and I was carted off to a surgical room for stitches. The doctor kept telling me to relax, but after the delivery, I didn't really have enough control of my muscles to relax. The next thing I knew, I was in a recovery room. Apparently they had sedated and intubated me without letting me know. I couldn't talk for about 20 minutes because my throat was raw. They had also inserted a catheter, which was actually causing more discomfort. I had to beg them to take it out, and they wouldn't even consider it for 24 hours.
Other than that, things went well. No one made me feel bad about being bigger than average, except that I had to specially request the larger hospital gowns. Basically, I was able to forget that I was a larger woman and concentrate on the fact that I was a pregnant woman, and then a new mommy.
Laurin's Story (insulin-dep. gd, pre-eclampsia, induction, c/s, wound problems)
Kmom's Notes: Laurin experienced the classic signs of pre-eclampsia---sudden severe weight gain, spilling protein in the urine, swelling, high blood pressure, etc. This is potentially very serious, and induction is the usual response.
She also experienced a baby malposition. The doctor said that the baby's head was turned to the side, making the baby either occiput transverse or asynclitic (depending on what the doctor meant exactly). Breaking the waters typically makes it very difficult for the baby to rotate to the most optimal position for birth, and they often get 'stuck' as she did here. Usually breaking the waters does not hurt, but Laurin experienced significant pain. This probably was due to the fact that she was only 1 cm dilated, or the doctor may also have tried to manually stimulate the cervix at that time as well, which can sometimes help. However, in Kmom's view, this painful procedure should only be done after asking permission, and when it is not, many people believe this borders on assault. Unfortunately, doctors rarely ask permission to do this or have the patients give informed consent.
A seroma is a pocket of fluid that can collect underneath an
incision after surgery. Although women of all sizes can experience this,
it does tend to be more prevalent in women of size. Research shows
that suturing the subcutaneous layer, and/or putting in a surgical drain can
lower the risk for wound complications like this in larger women, although they
cannot *guarantee* that there will be no problems.
Birth Story
My daughter was due on June 22, 1998. I had planned to work until June
12, but by June 1 I was so swollen and exhausted I begged my doctor to release me from work on June 5. He agreed without any prodding. I had
my 38 week doctor’s appointment on Saturday, June 6, the very day after I stopped working. When I got weighed, the nurse exclaimed that I had
gained 25 pounds IN A WEEK!!! And my usually 140/70 blood pressure was “sky high”, as they put it (but I can’t remember exactly what it was).
Then they tested my urine, and found I was putting out large amounts of protein. My doctor immediately diagnosed preeclampsia and sent me home
to pick up my husband and my “hospital bag” and ordered that I go to the hospital to have my labor induced right away.
When I got to the hospital, they hooked me up to a fetal monitor, an automatic blood pressure cuff that takes your blood pressure like every
five minutes, an IV drip of magnesium sulfate (which prevents seizures in
pre-eclamptic patients) and pitocin, and they catheterized me. The only problem with that is that mag sulfate tends to counteract the
effectiveness of pitocin, so I was not having the strong contractions I should have. And there I lay for approximately the next 36 hours,
having only minor contractions and not progressing in the slightest. About 24 hours into my non-laboring labor, one of my doctor’s
associates decided to try and speed things along by breaking my bag of waters. I found this to be the most excruciatingly painful event from
my entire birth experience, but that could be because I was only 1 cm dilated. It was horrible! After she did that, she also inserted an
internal fetal monitor, which was a wire attached to the baby’s scalp. I have to say, after the pain I went through with breaking the bag of
waters, I began to wonder whether I was cut out for this birth stuff! All of my friends said that part was a piece of cake!
Breaking the bag of waters worked to a certain extent, but I still only dilated to 3 centimeters. This baby wasn’t going anywhere! The doctor
said the baby’s head was turned slightly and was stuck in my pelvis. She didn’t even get to the –3 station. So, at about the 32nd hour,
they decided that I needed a cesarean section.
I had some difficulties when they tried to give me an epidural—I was so swollen that the anesthesiologist could not find the proper
area and said if he missed, I could be paralyzed. Not something I wanted to hear! So then they decided to
give me a spinal block instead and I was wheeled into the operating room while DH waited in scrubs outside until the spinal had been
administered. That went through without a hitch, and DH was invited into the OR to be with me during our baby’s birth. He stood at my
right shoulder and tried to keep me awake during the surgery. Baby was born about 5 minutes later, beautiful and very healthy. The nurse
brought her over for me to see, and I kissed my newborn daughter on the forehead and they took her away to get weighed, etc. while my husband
tagged along, video camera in tow.
I didn’t have much pain from the cesarean section. The nurses were amazed at how quickly I could sit up and was walking around. I tend to
think it’s because my abdominal muscles were already used to lifting a lot of weight. I still had to take it slow, but all in all I thought
the cesarean was a cake walk.
I was released from the hospital 48 hours after the c-section. Everything was fine with my recovery and my DH and I were enjoying our
first baby. Then one night, three days later, I was getting into bed (slowly) in the dark and I felt a huge gush of fluid pour out of my
incision. I was so afraid it was blood! But it wasn’t—it was more like water, but sort of had a yellowish tinge. I called my doctor and he
said to go to the emergency room immediately. It turned out that I had developed a seroma, or a pocket of fluid, behind the wound, and it had
burst, thereby partially opening the incision. The staples had to be taken out in the ER. Then I had to be readmitted to the hospital for
another two days while they watched me for infection. Since they couldn’t re-staple the incision, it had to be allowed to heal by
itself, and the wound was 17 cm long and 6 cm deep! This involved packing the wound twice a day with lots and lots of gauze soaked in a
mixture of saline solution and hydrogen peroxide and covering the whole mess with a lot of surgical tape and abdominal pads.
This was by far the worse thing about my daughter’s birth, because for the next 12 weeks I had to have home health nurses at my house twice a
day to attend to my wound. I felt like a prisoner of my house—I couldn’t leave for more than a few hours at a time. It’s the thing I’m
most afraid of for my current pregnancy—if I end up having to have to have a c-section that the wound would become compromised again. My
doctor assures me that knowing what they know now, they would insert drains and take special care in sewing up the inner layers to avoid a
situation like that.
As for size bias, all of the doctors and nurses were great and very supportive with the exception of the first nurse I encountered on my
first day. She was a skinny little thing from Thailand and kept making remarks like “Were you always this big, or is it just because of the
baby?” “Your hands look like catcher’s mitts” and “Are you going to go
on a diet when the baby is born?” After several hours of dealing with her unkind remarks, I asked my husband to get the head nurse and I told
her the remarks my previous nurse had made. Arlene, the head nurse for that shift, reassigned my previous nurse and she herself became my
nurse, and she was the best one I encountered.
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 thin 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 initally 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 Cervadil 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.
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.
Adele's Story (PROM, induction, c/s)
Kmom's Notes: It would be interesting to know if this baby was malpositioned. Having the waters break ahead of time, having little progress despite hours of active labor (even with pitocin), getting 'stuck' between 4-7 cm, and the baby staying up high and never engaging are often signs of a baby that is malpositioned. The baby was undoubtedly head-down, but may have been facing the wrong way (sunny-side-up/posterior), with its head tilted to the side (asynclitic), or with its hand/arm beside its head (compound). At this point there is no way to know for sure, but the pattern seems to be consistent with many malposition stories.
It's also not uncommon for women who have been through an induction and c/s to have their milk come in relatively late (this happened with Kmom's first baby too--she can relate!). It's unclear whether this is due to the anti-diuretic effects of pitocin (it tends to make you retain water in your tissues) or the effect of the cesarean (many c/s moms have their milk come in a bit later than normal). It may also be influenced by a tendency for cesarean babies to get more bottles and formula than babies born normally, and for nursing access to be delayed.
Breastmilk supply is very contingent on supply and demand; it works best when babies are nursed shortly after birth and very frequently thereafter. When babies are given lots of bottles and pacifiers, the 'demand' is much lower and the body tends to respond by producing less. Fortunately, however, in this case the mom was encouraged to pump a lot, which probably helped preserve their breastfeeding possibilities. Many moms in this situation are not given breastpumps or any instructions/encouragement.
Birth Story
First of all, I have to say that I had a wonderful and very caring doctor that I wouldn't trade for the world. When I went in for my first appointment I asked him about my weight and he said that it probably wouldn't be a problem and I had a few more risk factors than an average-sized person, but he'd keep a close eye on me and expected that I would do fine. I asked him about a c-section because my very skinny sister had to have all 3 of her children by c-section and he said that he expected I would do fine and delivery vaginally. After this first appointment I don't think we ever talked about my weight again!
When my blood pressure went up towards the end of my pregnancy he wasn't surprised because the same thing happened to that very skinny sister of mine and he said these things sometimes run in families. He ordered the non-stress tests 2 times a week until I delivered just to be sure the baby was okay. Besides it being a pain to go to the hospital 2x a week it was no big deal.
So, my water broke 4 days before my due date with NO labor pains whatsoever. So my doctor check me into the hospital and they induced my labor. Long story short, after 15 hours of active labor I only dilated to 4 and the baby still hadn't dropped down. So Dr. A said, "Let's do a c-section," and all I felt was complete and total relief! Dr. A was my sister's doctor also and she had the exact same problem with her deliveries which is why she always had to have c-sections, so he said it was very well something hereditary and had little to do with my weight.
So my son was delivered by c/s weighing 10 lbs, 7.5 oz. Very big baby--we all have big babies in my family so this wasn't surprising either. Because my son was so big some of the nurses at the hospital said I must have had GD and the doctor didn't catch it, but I asked Dr. A about this and he said he tested me for it 3 times and it was never a problem and I just had a really big baby. My sister's babies were all 10 lbs. too.
My milk didn't come in and because my son was such a big baby they had to test his blood sugar and that was all wacky so we fought that for a whole week. We had to give him formula until my milk came in which was 5 days later with me pumping like a crazy woman. After 2 days my son also developed pneumonia for some reason. He came out of it fine, but it was very stressful especially with the blood sugar problems and me not getting my milk in for so long. But we got to come home after 7 days and after that it was fine.
All in all, I had a positive experience. I did have a few nurses say things about my weight, but all in all they were very nice and by the time I got to that point I didn't care what they thought anyway! I think having a caring doctor is the biggest comfort because you can check everything out with him so you don't care what they think! It helped with my sister having the same doctor because he knew what problems she had as well and we knew it had NOTHING to do with her weight because she's so darn thing! :-) I think that helped a lot. I am having nother baby soon and we are planning another c/s; I am glad and relieved. I just hope and pray my milk will come in at a timely fashion and we don't have any other complications. I hope the same for all of you.
Nick's Mom's Story (low fluid levels, induction, difficult c/s)
Kmom's Notes: It is controversial how best to manage a pregnancy with low amniotic fluid levels near the end of pregnancy; low fluid levels may simply reflect a need for more hydration from the mom or it may be an indication of incipient problems. This induction may or may not have been necessary, but the doctors felt that they didn't want to 'take a chance' given this couple's long and difficult journey to parenthood. The long, non-progressive labor suggests a subtle malposition of the baby, but it is impossible to know for sure. This mom did a wonderful job of coping with a very difficult situation.
Note: There are cuss words in this birth story; if you are offended by this, you may want to skip to the next story.
Birth Story
On a Monday, we had a NST (Non-Stress Test) to check on Nicholas and how he was doing. My OB was concerned because his fluid levels had dropped from 12.3 the week before to 7.3 on Monday. So he checked my cervix; not much effacement and certainly no dilation (and after all those trips to the hospital for premature labor!!). However, he still felt strongly about inducing; he didn't want to take any chances after coming this far as we worked so hard getting pregnant, keeping this pregnancy, and staying healthy. So I assumed he meant, "Let's induce in a week." He said, "No, tomorrow at Noon." I wasn't prepared. DH and I were holding hands during this entire meeting. I was frankly scared to death. This was NOT how I envisioned having my baby. So my OB talked to me about all the risks of induction, and that it meant I might have to have a c-section etc., and the risks that go with that. Then they sent us home.
I got home and had a meltdown. I really needed to do that. Once that was done, I realized there was much to do to tie up loose ends both at work and personally, so I did all that. I needed to spend time with DH as I had an "Oh Shit" moment, realizing that we would not be just 'us' anymore. The next time we walked back into the house we'd be a family. It was scary and fun at the same time to think about that. DH was restless, as I was also that night. We went to dinner to talk about things.
Both of us were not comfortable with the ultrasound at the NST for various reasons. We didn't know the tech, she didn't know us, the machine was different, and we wanted a second opinion. As anxious as I was to have this child, I didn't want to rush things that didn't need to be rushed. I knew the ramifications of being induced, being a doula. So the next morning we got up, showered, loaded the car, and headed to the hospital. We got there early and headed to our Perinatologist's office to talk to him. He fit us in right away and listened to us. He then called up my high-risk OB and we conferenced. We just stated that we wanted a second opinion, period. So they did another ultrasound, with the same machine that we had been using for 8 months and with the same tech (who knew my body and who we trusted). The results were a bit better but the perinatologist was still concerned. We talked about the risk of just waiting it out. He said that with less fluid, the cord has the chance of compressing and that could mean a bad outcome for our baby. We didn't want that at all, so we went ahead with the induction.
So we checked into our room and discussed the induction plan. They inserted 25 mcg of misoprostol (Cytotec) in my cervix. They left us to our own devices, let me eat, and we got settled in. There was no progress in 3 hours, so I walked, rocked, danced, etc. 3 hours later, still no progress, so we got another dose of misoprostol. 6 hours later, still no progress so they wanted to start Pitocin. I said, "No, I don't think so---I know that pitocin on a cervix that isn't effaced is a disaster, I want to wait some more." So we waited another 4 hours, still no progress, so I consented to one more dose of misoprostol. We left it in overnight, and I awoke to annoying contractions. I thought, "Thank God, something's happening!" So I was checked and I had effaced to 80% but no dilation.
So my peri came in and said, "Let's insert a catheter in your cervix and insert a balloon. We will start labor on its own that way without pitocin and let labor go on its own there, you have enough misoprostol in your system. I asked about pain management then, as I knew this would be uncomfortable. My peri said, "It's not as bad as your lamanaria." Well, bullshit, it was horrible to say the least! No anesthetic, and it took a half hour to get in there, and contractions started whammo! The idea is that when the balloon and catheter fall out, you are at 3-4 cm, labor progresses, you go to complete, you push, you have your baby. Well, this didn't work like it was supposed to. I got to 2 cm dilated and my water broke, so the catheter had to come out and the clock for infection was started. Pitocin was started.
The contractions then were horrible. By now it's Wednesday, I am tired already, and it's midafternoon. They don't want to check me tons as my bag of water is broken and we don't want infection. I am now running a fever so they check me and I am between 3-4 cm dilated, cervix is still 80% effaced. They start me on antibiotics, check me for Strep B (I am negative). I ask for Fentanyl and get it. This drug sucks, it doesn't help take any edge off, it just makes me feel out of control and it doesn't let me focus or keep on track. My contractions are big and powerful; 3-4 minutes apart, and 2 minutes long with double peaks. I am now sitting on birth balls, rocking chairs, and laboring on the toilet. The entire time, DH has not left my side, has breathed with me, and the support he has given me is phenomenal. During one of the contractions, he tells me, "I do NOT see how any woman could do this without the help of a doula---I wish we had two here. This is so hard, I now know what you do, and you must be really good at this as I feel like a dork." I smiled at him, and don't think I could have loved him any more. He kept apologizing to me regarding the pain I was going through, and I said, "This is a labor of love."
My contractions Wed. night have changed. I think for sure that progress has been made, I am now shaking and have this overwhelming urge to push. I go to the toilet and have tons of loose stool, and I still need to push. So I call the nurse (this is where the parade of doctors comes in). This on-call doc checks me and says, "You are still 3-4, let's turn your pit up." I said, "No, you don't! My contractions are 3-4 minutes apart as it is, with 2 minute-long contractions---do you want to blow up my uterus?" So he goes to consult with my peri, who says, "We need to get them more powerful, why don't you have an epidural now?" So I am thinking, "Okay, epidural is one step closer to a section. Shit, what do I do, I am so tired." So finally after talking to DH, I know I need to sleep. I have been at this now over 36 hours, and so I say, "OK, let's do it," thinking this will take away my pain and I can sleep.
The epidural goes in smoothly---all this bullshit about fat women who have a hard time having them inserted is crap. Now if they take, that's another story. Mine didn't take. It numbed me from under my breasts down to my navel. From my navel to my vagina and legs, I was totally awake. I could walk, I could bend my legs, etc.---it was horrible. I kept telling them that.
[Kmom note: It is harder to put it an epidural on larger women because it's difficult to estimate the distance needed to get to the proper space. However, a good anesthesiologist should be trained to adapt for both easy and harder cases. Also, recent research shows that often the problem is taping down the catheter *before* the woman moves to lying down; this tends to dislodge the catheter a little, and especially so in large women. This tends to make the epidural patchy or less effective. Researchers were able to cut the rate of epidural problems by taping the catheter down *after* the woman lies down, and the improvement was particularly marked in large women. It's impossible to know if this was the problem here, but it's a good possibility.]
They decided to give me morphine via the epidural---this took the edge off, but only a little. Then they turned up the pit and from that point on, I literally thought I was going to die. I could only whimper and breathe. I couldn't talk, focus, or anything. I was thirsty and they only allowed me ice chips, which was another indicator this was going south and I was going to be sectioned. The parade of docs kept coming, each one checking me, and shaking their heads and saying, "I am sorry but you are not progressing."
Dr. S marches in my room at 5:30 Thursday morning and tells me she is sectioning me via Midline incision. She noticed my age and asked me if I wanted more children. Now what kind of an asinine question is that to ask a woman who is writhing in pain. [Kmom: The kind that allows them to prevent more fat women from having babies, which they often believe is 'too risky'. OBs used to do this regularly to minority women as well.] I said I was not sure at this point, then that I wanted no more children. She said, "Well, let's sterilize you then while we are in there." DH was just waking up at this point (I had forced him to lay down and sleep), and I said, "Honey are you freaking hearing this??" I told her to get my peri down here ASAP. I wanted to feel no more pain--I was miserable. They gave me more morphine.
The entire time this was going on, Nicholas was a trooper, no decels at all---he was tolerating labor better than I. My peri came down at 8 a.m. and I was sobbing by then. He felt I could do this vaginally and said, "Let's give this one more day since you are not infected. Your baby is well, I hate to do a section on you---I want you to birth vaginally." So I mustered all my strength up and said okay---I knew that regardless tonight I'd have a baby. DH's family came up to be with us and took turn laboring with me so DH could get a break. This was the hardest labor I think---I was having contractions 1-2 minutes apart, lasting 2 minutes long, with double peaks. They kept dosing my epidural but it wasn't doing much but numbing the section between breasts and navel.
Thursday night rolled around, still no progress. So I said to my peri to please just section me. I couldn't take anymore, we were coming up on the 58th hour of labor and I had had it. He agreed it was time. He said, "Obviously something is not right, and your pelvis isn't cooperating." [Kmom note: Or more likely, the baby was subtly malpositioned!] So I called my mom and told her what was going on and I just melted down. By then I was scared, angry, and out of control. Little did I know what was in store for me.
I asked at that point to have the pit turned off---they were going to section me at 9 p.m., and I wanted to rest. The other on-call doc said, "Leave it on, just in case." I then lost it. There were at this point (no joke) 15 medical personnel in my room plus my family, and NO one listened to me except my family. I screamed, "THIS FUCKING HURTS!!!!!! I AM HAVING A GOD DAMN FUCKING SECTION. TURN OFF THE FUCKING PIT NOW OR I WILL RIP MY IV OUT MYSELF." Everyone stopped and looked at me, and the pit was quietly turned off. 5 minutes later the contractions stopped. Nicholas was still doing beautifully, and wouldn't you know it, I think the epidural worked a bit more as I didn't feel so much pressure.
My peri took another look at the catheter in my bladder and said, "Here is part of the problem." So they re-cathed me, as it wasn't drawing enough urine off. My bladder was totally empty for the first time in 3 days; that was a huge relief in itself. 9 p.m. came and I had dozed, my family fretted, and I was going between being relieved and freaking out. At 10 p.m. they took me down to the O.R., DH was given scrubs, and they took my old epidural out and put in a new one to numb me, lower this time. This kind of worked---I could feel a patch about 4-6 inches long way down deep in my pelvis near my vagina. They said they would take care of things.
At 10:15 p.m. they started the surgery. While I didn't feel the cut, I felt all the tugging. [Kmom: It's normal to feel tugging and pressure, but it shouldn't hurt.] When they inserted the retractors, it was then I started screaming, hot white pain came ripping, and I felt I was going to throw up. It was too late to go backwards. They had to keep going, and they just started pumping in the drugs to me, and I kept yelling. At 10:30 p.m., Nicholas was pulled from my body. DH saw him take his first breath, and it was just overwhelming. Nicholas started to cry as soon as he was out of my body. His Apgars were 8 and 9, and he was perfect.
I stayed in the hospital 4 more days. The recovery was slow. I developed blood clots postpartum and was put on Warfarin (Coumadin). I chose to stop breastfeeding as I didn't feel that Warfarin transmitted through breast milk was safe for my son. It was my choice.
Maria's Stories (SROM, induction, c/s; dumped by midwife at 35 weeks, hospital VBAC)
Kmom's Notes on Pregnancy: This mom has PCOS, which sometimes can create an excess level of fear and vigilance in the providers about blood sugar problems and big babies. Women with PCOS do have more of a tendency towards blood sugar issues, but to worry about this at 35 weeks when all previous tests have been negative and there is no history of a big baby is ludicrous.
Because this mom questioned the validity of a test like this so late in pregnancy, the midwife released her from her care, leaving the mom virtually without options. However, Maria took lemons and made them into lemonade; against all odds she found an OB who was supportive of VBAC and supported her in labor despite never having met her before labor.
And that big baby the midwife feared? He didn't even weigh 7 lbs at birth. So much for the heavy mom with PCOS must equal heavy baby theory!
Birth Story
Baby #1:
October 17th, 2004; 7:30 am- My water broke. I got up to pee and suddenly thought I was peeing on myself. I peed and then it just kept coming down and I knew this was it. I called my grandmother to let her know that my water had broken. I then tried to call my Obstetrician, Dr. D, but no one ever got back to me after I paged the On-call doctor twice. I didn't know what was going on. I called my mom. She came and picked up me and Chris. We walked out of my mother in laws apartment with a suitcase, a birthing ball that was fully blown and some other things. By now it was 9:30am.
We got to the hospital and we were there by 10:00am. I was triaged pretty much right away since I was leaking everywhere. I was put on a monitor for 30 minutes and was told that I was having sporadic contractions by the resident. Well duh, I knew that. I can feel them! The resident then checked me and I was 3 centimeters dilated, 80% effaced and she said my water had definitely broken. I was going to be admitted and I thought YAY! We're going to have a baby today!
I was given a room in Labor and Delivery and Dr. P came in and introduced herself. She came in and checked me once I was settled in and confirmed that I was at 3 centimeters, but she was not happy that my contractions were not regular and said to me "We have to put you on Pitocin now". I began to argue with her, "There's nothing else that can be done? Cervadil? Nipple Stimulation? Nothing?" I thought she was insane. I asked her to call Dr. D. I didn't want this. She came back saying that she was not answering her phone. I was sure something else can be done before Pitocin. I refused the pitocin at first and she said to me that either I went on Pitocin or I am risking the lives of both me and my baby, since there is a risk of infection with ruptured membranes. So after talking with my mom and grandmother, I opted for the Pitocin.
Here I was, 6 hours into having been put on Pitocin and Dr. P comes back. She decided to check me again and I was at 6 centimeters and completely effaced. She then said to me, "I don't like your progress on the pitocin and I think we might have to do a cesarean if this continues." Then Dr. Psaid " I believe you should get an epidural. You will feel more comfortable and if a cesarean becomes necessary, you will be able to see the birth of your baby. I also feel that the epidural will help you tolerate these contractions better so that you can be able to dilate quicker." So I asked Dr. P, "What are my other choices?" And she said, well, if you don't dilate, then we will have to do a cesarean under general anesthesia." I tried to argue with her even more and she said to me, "I'm the doctor, you're the patient, so we are going to do what I want to do". So at the time, I thought, Wow, I don't want that! So I got the epidural.
I made sure that the Attending Anesthesiologist was the one who did my epidural. I have back problems as it is, and didn't want any residents screwing with my spine. After the epidural, Dr. P comes back in, and says to me, "Look how happy you look now!" and then says to the nurse and my family, "Isn't she so happy?". I just rolled my eyes at her and made a fake smile. I could still feel the pressure of the contractions, but not the pain at this point. She also insisted that since we were not getting a good reading on the fetal monitor and now I'm in bed anyway, we should put it in Internal Fetal Monitor on my baby's head.
A couple of hours went by, and it was now like 8 pm. Dr. P came in and checked me again and I was 7 centimeters. She said "We might have to do a cesarean if this continues, we will increase the pitocin now." I was starting to get mad. I didn't want this. Dr. P instructed the nurse to increase the pitocin every 30 minutes and that she will be back to check me in an hour. She came back an hour later and said I was at 7-8 centimeters. Dr. P then said to me, "It looks like we are going to have to do a cesarean because you're not progressing fast enough and it's been too many hours since your water broke." I said to her "NO, I am NOT having a c-section! It hasn't even been 24 hours since my water broke! I want more time!" So after arguing with her for about 10 minutes, she finally said, "Ok, as long as the baby looks ok, we will let you continue to labor." She then told the nurse to increase the pitocin again.
About 10 pm, my daughter's heart rate began to fluctuate during a contraction, so then they lowered the pitocin. A bunch of doctors and nurses came running in and Dr. P told the nurse to decrease the pitocin and see if that works, of course this was after having another argument with me. This happened two more times after the pitocin was decreased once. Dr. P then said to me that my baby was under distress, and since I'm "Failing to Progress" and due to "Fetal Distress" we were now going to do a cesarean. I said to her, I do not want a cesarean, I am scared. I started crying. She kept insisting that this would be the best thing for and my baby. I didn't trust her at this point.
I did not believe her. I went into the Operating Room in tears. Here I was shaking, cold in this unfamiliar place. Krystina was born at 11:06pm on October 17th, 2004. She weighed 5lbs 12 oz and was 18.5 inches long! It was less than 24 hours since my water broke, and to this day I feel that I was butchered. I am pregnant with my second child and I'm now seeing midwife and strongly considering to have a homebirth after a c-section. I cannot see myself giving birth in a hospital and having everything go downhill. I strongly feel that Dr. P has taken something away from me. I can't seem to completely explain it. To me, Dr. P, is Dr. Knife.
Since this has happened to me, I now tell women to make sure they are fully informed before going into labor and to look at their choices in childbirth. Ask around about your Obstetrician and the doctors that go on call for your obstetrician. That was a mistake I made. I didn't know that Dr. P went on call for Dr. D. I know that Dr. D would have let me have my natural birth and let labor go on its own without forcing the knife on me. No one should have to be forced into a cesarean unless it's absolutely necessary, not cause you have been in labor for X amount of hours and now the doctor wants to go home. Birth is a natural process.
Baby #2:
My story really goes back to October of 2004. My daughter was born by c-section and it was one of the worst experiences in my life. The hospital staff was very mean to me. They did not consider any of my wishes after I was told my birth plan would be followed I was given pitocin and practically forced into an epidural. I had a very horrible experience overall and dealt with Post Partum Depression. I was c-sectioned for failure to progress and fetal distress. My daughter was born with an apgar of 9/9 after I was told that her heart rate was going too low for it to be "safe". I later found out that a lot of what I was told during labor was false information. After giving birth, my ultimate goal was to have a VBAC and prove the OB who cut me wrong.
Two weeks before I gave birth, my midwife told me that she won't be able to be my care provider anymore due to some of my health issues [PCOS and hypothyroidism]. I was disappointed, upset and had no idea where to turn. I failed the One Hour Glucose test the 2nd time I took it, and was refusing the 3 hour glucose test so she told me that I needed to see an OB.
On November 7th, I began to have contractions that were lasting on and off. At this point, I was still sorta seeing the midwife till I could get to the OB's office the next day when she would be in. As the night progressed, the contractions began to get closer together and were somewhat stronger. Around midnight, I took a warm shower and they came to a halt. I woke up at 4am to some strong contractions on November 8th, but didn't think too much of them. I tried to get some more sleep, but I just couldn't, so I stayed up for a couple of hours. Around 8am, contractions started to pick up a little, and soon after, the midwife called me to check up on me. She instructed me to go the OB's office to get checked out. I called the OB's office and they told me to come in around 12:30. I called my grandmother and she picked me and and DH up and we headed into the city. I also called M (one of my Doulas) to have her meet us at the OB's office. We got to the OB's office and the office manager told us to go straight to Labor and Delivery.
We got to the hospital but didn't go upstairs right away. I stayed downstairs and dealt with the contractions in the lobby until M got there. In the meantime, I called my other Doula, E. We headed upstairs and I was admitted to triage upon arrival. I wasn't checked till we had been there a couple of hours and they picked up contractions for a couple of hours. Upon arrival, the nurse wanted me to change into a gown, but I refused the gown and said, "No, I want to stay in my ICAN t-shirt." So then the whole "What if there's an emergency" argument started and I said, "So cut it off." M said "There won't be an emergency". I had to laugh at that.
The one resident was so pessimistic and must have told us the risks of a VBAC so many times, I wanted to kick him. When I was checked, it was about 2pm. I was 3 centimeters dilated. I was admitted. We got a room in Labor and Delivery and Dr. D2 (the OB) came in to check on me about an hour later. I was 3-4 centimeters and so she decided to break my water. I was slightly hesitant about having my water broken however, she did say that my bag was bulging and it would break at any moment so I agreed.
After my water was broken, contractions began to pick up and got a lot stronger. I think I was handling them very well. At 10pm, I was checked again and was only 4-5 centimeters, so Dr. D2 said that as much as she knows I wanted to avoid pitocin, she just wants to give me the minimum and see if that will help me progress, cause I am taking a long time to progress. M and E were a great support in all of my labor. I remember the most helpful thing that they did was the Rice Tube Sock. I was dealing with a lot of back labor and it helped a lot. I found that swaying, the rocking chair, and standing helped through a lot of my labor as well.
Around 3 am, it had felt like I had been in labor for days, and I felt like I needed some sleep, so I requested an epidural, not so much for the pain, but to make the pain disapear so I can get some rest. The Anesthesiologist came in and I signed all the paperwork, and he did the epidural. It lasted an hour. I was right back to feeling the pain again, the epidural did not go in right. I was begging at this point for another epidural or something cause I needed some more sleep. Around 8am, I got another epidural and Dr. D2 came in and checked me again, I was 5-6 centimeters.
There were a few times I had doubt in my mind that I would get my VBAC, and I know I said at one point "My grandmother did this 8 times, I CAN do this!" At this point, I didn't know what would happen since I had so little progress. She said I would be checked again around noon. I don't know how the time flew between 8 am and noon. I did take a nice long nap though. I also had to fight with the nurses about not getting a catheter. I allowed them to put one in the first time, and it hurt so I begged to have it taken out. The nurse said she will only take it out if I can pee on the bedpan every so often, or it has to go back in. They increased the pitocin slightly after the epidural began to work. I must have really shocked the nurse, cause she said to me at one point that not many people can go on a bedpan with an epidural in place. I told her that I wasn't many people. I just don't like the feeling of the catheter.
At noonish I started to feel a lot of pressure so they got the resident in and he checked me. I was 8 centimeters with a lip! WOO HOO!!! That's where I "got stuck" last time. So instead of laying on my left side, I switched to my right for a little while to even out that "lip", and the baby's heart rate dropped a couple of times, so they asked me to move back on my left. It was like 12:30 or so when he checked me.
At about 1:15 or so, I began to feel a ton of pressure, like I had to poop, so I told them to get a doctor in there now cause this kid is coming out. I don't think anyone believed me, but I felt my baby trying to push his way out. The resident checked me and said I was complete so they would call Dr. D2. I had everyone yelling at me telling me not to push, but I couldn't hold back, I was giving little pushes because it hurt if I didn't push. Dr. D2 came and was very encouraging. YAY! Now I can push! I don't know exactly how long I pushed for, but I got see my baby's head crown!
Matthew Alexander arrived into the world on November 9th, 2005 weighing 6lbs 10.4 ounces and was 19.5 inches! His Daddy got to cut the cord and his birth was witnessed by my mom, my doulas and my husband. Ended up with a healthy baby boy; my sugars were checked during labor, and only elevated once which was cause I had a popsicle.
I was very glad that I ended up with Dr. D2. She pulled a lot of strings to help me get my VBAC, whereas another OB would have given up on me. She had the belief that my body could do it and it did and I am very thankful to her. I did not get to meet Dr. D2 until I was in actual Labor, but she turned out to be the best thing for me.
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.
Heather2's Story (classical c/s, incision infection)
Kmom's Notes: Another case that may possibly be a malposition; the mother had little dilation but lots of prodromal labor. Labor stalled at 4-5 despite pitocin, a common problem seen with malpositions. The mom was admitted still in early or latent labor; instead of sending her home to rest and see if she progressed, they admitted her and forced the issue with pitocin and an early epidural. Apparently no attempt was made to see if baby was malpositioned or to try and help labor along in any way except with drugs.
Because of her size, the mother was given a vertical incision, although this is highly questionable. A few old-school doctors still feel that vertical incisions will infect less and are better for fat women. This does not seem borne out by experience or research, yet some large women are still being forced to have these incisions, which are more risky for the mom and for any future pregnancies she might have. Certainly, a vertical incision did not prevent infection in this mom! She experienced significant trouble with her incision, something a number of fat women with vertical incisions report.
She also experienced the surgery without full anesthesia, something Kmom has also experienced. This is a major trauma and can result in Post-Traumatic Stress Disorder or long-lasting fears for any future births or surgeries. There are organizations now to deal with "Surgical Awareness" during other types of surgery with general anesthesia, but VERY little information or acknowledgement is available when this occurs during a cesarean with an epidural. In fact, hospital staff members rarely believe it and generally gloss over it afterwards. Although regional anesthesia is indeed more difficult in larger women, this problem does not occur because of size, since many very large women have had epidurals that have worked just fine, and many skinny women have experienced epidural failure during surgery as well.
Finally, to add insult to injury, her milk never came in. This could have come from many causes. Women with inductions then cesareans, as noted before, tend to have more breastfeeding problems in general. Blood loss during surgery could have been the problem (through anemia), or the drugs given during surgery, or the lack of access to the baby (she didn't get the baby until the next day, presumably after multiple bottle feedings). The treatment for infection afterwards may also have impacted frequency of nursing, or it's possible that the treatment or drugs may have impacted nursing as well.
Birth Story
After an uneventful pregnancy (beside Group B Strep), I thought I would have an uneventful delivery too. Boy, was I wrong. I had been having contractions at about 10 minutes apart for 2 days when I finally got to L&D. I wasn't in a hurry to get there, as I had been long and closed with no dilation 2 days earlier. When I was admitted, I was 80% effaced and 2-3 cm dilated and the contractions were spreading out and becoming milder.
My doctor wasn't the one on call (it was a Saturday) and I wasn't too thrilled with the one who was. She started me on pitocin to get the contractions going and I was pretty much forced into an epidural at 2-3 cm before I wanted it. 12 hours later I was 90% effaced and 4-5 cm. The contractions only picked up a little bit and I was beginning to wonder if she was going to leave me lying there with no progress forever. She finally decided to take me back for a c-section and I was happy we were going to get this over with.
They got me back in the OR and got the epidural kicked up (it had worn off an hour earlier). No sooner did they get that going and she made the first cut. She never checked to make sure I was numb or anything. It felt like fire cutting through me and the woman did not believe me when I told her I was feeling that. She said it was just pressure. HA! My whole abdomen felt like it was on fire and my guts were being ripped out. When she pulled him out I screamed it hurt so bad. After that she finally said, "I think she has more feeling than she should." I wanted to slap her. I heard him cry and then I saw the mask. The next thing I remember is them pulling me from the OR table to the bed and the nurse pushing down on my stomach. After a double dose of Demerol, I was out until the next morning.
The pain was tolerable. I wanted to get up and move around as soon as possible, so I lost the Morphine drip and off I went. I went home the next day and things were going well-----until 5 days later. I was hurting so bad I walked like the hunchback of Notre Dame. I was oozing lots of light red watery stuff from my incision. Off to the ER I go and have to be admitted for IV antibiotics to help the massive infection in my incision.
My incision is up and down due to my weight, the DR says. For a month and a half I had to have a home health care nurse come in and pack the huge hole that was in my stomach. The infection was so bad, it wouldn't heal. Now, 3 months later, I still have a small hole that will never close because of where it is located. Now I am told that if I had the horizontal incision, the infection wouldn't have been so severe, and that my weight shouldn't have had anything to do with what direction the incision went.
It has been a long road, but I am finally healed and have the prettiest little boy in the world.
Jen C's Story (induction, unknown malposition, c/s)
Kmom's Notes: Again, classic signs of malposition that the OB missed. Days of 'false labor', very intense labor pains, uneven dilation, feeling pressure despite an epidural, early need to push, fetal distress, etc. Unfortunately, the doctor blamed the problem on the 'layers of fat' keeping the baby from going through the pelvis (what nonsense!) instead of recognizing the baby's obvious malposition. She then told the mom that if she lost weight, she 'might' be able to have a baby vaginally. Although the doctor is almost certainly meaning well, it is yet another form of underlying fat-phobic attitudes. Although a doctor may not show any overt fat prejudice, there still may be underlying assumptions that reflect unconscious size bias. Assuming that layers of fat can keep a baby from coming through is indeed size-phobic. Women much larger than this mom have had vaginal births!
Birth Story
My original due date was March 6th. My OB was supposedly the best where I am from; my family doctor referred me to her. I kept having false labor and the doctor kept and eye on the baby's guessed weight (she thought the baby was between 7-8 lbs). She decided not to induce as I had no prior problems in my pregnancy. I had no PIH, no GD, no edema, nothing. But I did have horrible morning sickness, which caused me to lose about 15-20 lbs in my first trimester. I had anemia, which I was put on iron pills for, and I had low cholesterol. In the end I had acid reflux so bad it would keep me up at night (I never had it before my daughter, and to this day there are certain foods I cannot eat without taking an antacid prior to eating it). Generally I was very lucky, a very uncomplicated pregnancy. My hope was to have this baby vaginally. Not once did it cross my mind that I would have to have a cesarean----boy was I wrong!
I had 'false labor' on March 13th and went for the hospital for the 4th time, only to be told it was seriously trapped gas, which I was given some nasty liquid for. They asked me if I wanted to stay overnight or come back in the morning for a Non-Stress Test. I decided to go home and tried to sleep with it on my mind. I got to the hospital the next day, had the NST which proved the baby wasn't doing so good in her environment, so my doctor called back the nurses and told them she wanted to have an induction that day (the original induction was supposed to be the next day). Around 11:30 a.m. she came in and asked how everything was going. I told her I was miserable and just wanted to have the baby already, so she broke the bag of waters and started me on pitocin and had the antibiotics for Group B started as well. [Kmom note: Breaking the bag of waters probably set the baby's malposition for good and made it very hard to resolve.]
The major contractions didn't kick in until 1:30 p.m., although right when she broke the bag of waters I had a major contraction. She joked and told me that was what a REAL contraction felt like (my doc was kind of cold, so this little joke was a surprise to me and even made me smile). I decided on Fentanyl for the pain; I had already gone over the birthing plan with my doctor and told her NO EPIDURAL! The pain became too intense for me and I remembered what one of my friends had told me---that you cannot get the epidural after you're dilated so many cms. I was about 4 or 5 and I told them I wanted the epidural, which shocked my OB but she got the anesthesiologist in there and I had no more pain. UNTIL the baby started descending later on and I kept telling my absolutely wonderful and caring nurses that I felt like I was 'going to pee'. They checked the catheter and were puzzled. The anesthesiologist upped my dosage of epidural but it did no good. By this time I was shaking, my BP was extremely low, and I was so cold the nurse brought in 4 warmed blankets and covered me and turned the heater on ('transition!').
I kept complaining about having to go pee, the nurses were still puzzled and still checking my catheter when I finally shouted, "You don't understand, I have to PUSH!" They checked me once again and said that I was dilating strangely (had been at 6.5 cm for a couple of hours), more so on the left side than the right side. Apparently the left side was completely effaced but the right side wasn't. One nurse thought I was dilated 8 cm--I was overjoyed to hear that, thinking only 2 more cm to go! But another nurse came in and told them I was still only 6.5 cm. I was tired and frustrated when the baby's heartbeat started dropping and my OB said to me, "We're going to have to do a cesarean, the baby's in distress." I asked her why the baby wasn't progressing and she told me that the baby's head wasn't going through my pelvis, and told me that layers of fat were (possibly) stopping her from descending. Being in labor and tired, I totally misread/misinterpreted what my OB was saying and started crying, saying I didn't want a cesarean.
I was prepped for a cesarean and taken to the OR across the hall from my room. It seemed like forever that they were prepping me and I kept asking where my fiancé was because he wasn't by my side. When he got in there, the OB asked me, "Can you feel us cutting into you?" and I told her no. By 9:22 p.m. my daughter was born. She wasn't breathing at first so they had to give her oxygen. Her Apgars were 4 and 7. I got to see a glimpse of her for about 3 minutes (this really upsets me to this day) and then she was whisked away to the NICU, and I was sewn up and wheeled to recovery. In recovery, I was so drugged up I had no clue what was going on. My nurses were constantly checking on me due to the high fever I had (105 degrees). [Kmom note: A fever is very common after an epidural.] Luckily it went away pretty quickly and I recovered with a 'score' of 100%. The nurse attending told me she had never seen anyone get a perfect score on their recovery and was quite impressed. All I wanted was to see my baby! Four hours later I got my wish, but the memory is non-existent since I was on antibiotics, pitocin and morphine.
Getting up the next morning to walk wasn't too easy. I hunched over and protected my stomach, thinking my guts were going to fall out. But my doctor did a wonderful job. Both of us were allowed to leave the hospital 3 days after her birth. I tried breastfeeding her in the hospital but I was nervous as my mother (who didn't really breastfeed either myself or my younger sister) kept telling me 'how to' breastfeed my daughter, not to mention my daughter wasn't too happy that it wasn't coming out fast enough for her. So when I got home, I reluctantly gave her a bottle of formula, my fiance next to me, my father and his girlfriend watching. She was so happy that she was getting something and seemed content. It really relieved me. I pumped for 2 weeks thereafter, and eventually couldn't make a schedule and my milk dried up. She is not 1 year old and not quite walking yet, but very active and very squirmy.
I have plans to have another child. When I saw my OB I asked her what the possibility of having a VBAC was. She told me that it was fine, as long as the baby isn't over 7 lbs. [Kmom: Baloney! The critical issue is not the baby's size, but getting it positioned well!] She also told me (not naggingly, I might add) that if I lost the weight before having my next one, I may be able to go through a VBAC with a bigger baby. Although I thought she was the best possible doctor for my cesarean situation, I didn't care too much for her bedside manner and I hope to find a more suitable doctor. I don't know if she was fat-phobic; she never really commented on my weight, but that comment she made right before the cesarean still unsettles me a bit. I am just hoping that I can find someone who is very fat-friendly and willing to work with me. [Kmom: She should try a midwife first. Although there are bad apples in any barrel, midwives are much more likely to be size-friendly, and research shows that she would have a greater chance for a VBAC with a midwife.]
Amy3's Story (switched to birth center midwife, vaginal birth)
Birth Story
When I found I was pregnant I began my search for an OB... my first doctor took one look at me and before ever reading my medical history lumped me in the high-risk category simply because of my weight...didn't matter that my blood pressure was fine, blood sugar was fine, etc... I stayed with that doctor was a few months and became increasingly upset with how I was being treated... I was told I would have to have an IV, continuous monitoring, wouldn't be allowed to walk during labor, and even was told my weight would most likely force a c/s!
By this time I had been reading more and more books on pregnancy and couldn't see anything that would give that doctor cause to do those things... I was perfectly healthy! So I found a different doctor to switch to... that doctor was the same way! Very frustrating! I didn't know there were options to an OB though so I stayed with that doctor for a few months as well... blood pressure still fine and I passed my 3 hour glucose test with flying colors!
While under that doctor's care I found a book about water births and midwives... that sounded so ideal!!! Unfortunately because I was on state insurance there were very few midwives in Houston that I could see... and none of them would take me, again because of my size! I started getting so depressed, but I wouldn't give up!
I started looking outside the Houston area and found a wonderful midwife in Austin... I explained on the phone that I was a large woman and she said it wasn't a problem... she had experience with other BBWs and she herself was a BBW too and had no problems during her own pregnancy and birth... she understood how closed minded OBs could be... I went up to see her for my 7 month visit and never looked back! She even was willing to let me labor and deliver in water, exactly as I wanted!
I continued seeing her through the rest of the pregnancy and still had no problems... I started seeing her every week at 36 weeks and when I was at 37 I had started dilating... she told me to hold it in since birthing centers aren't allowed to deliver babies under 38 weeks... I went back for my next appointment at exactly 38 weeks along and I had dilated further... she said it could be any day!
Because I had to drive myself 3 hours to her office I was really tired and decided to get a hotel room that night and go home the next day... good thing I did because at 11pm that night I started having contractions about 10 minutes apart... within a half hour they were 5 minutes apart! I met her back at the birthing center and we turned on some relaxing music and joked around a bit... just sat, drank red raspberry tea and talked...the contractions moved along quickly and soon were about 3 minutes apart... at that time I felt I was ready to get in the water... it felt SOOOOO good! I knew all along that I wanted NO medications, so being able to use the water was a god-send!
During transition the contractions were so bad I thought I would die, but I never once regretted not using meds... I felt my water break finally while in the tub, such a strange sensation! I started feeling a lot of pressure and thought I had to go to the bathroom... she helped me out of the water and I went into the bathroom and found I didn't need to go, but I did throw up... when I came back out the babies head was crowning... she said I could back in the water if I wanted, but it hurt so bad I couldn't make it down the steps so I settled for leaning against the futon in the front room and after only 7 hours of labor and 20 minutes of pushing my beautiful little girl was born! I had no tearing, no episiotomy, no complications of any kind. It was, in my mind, the perfect birth.
I know without a doubt that had I stayed with an OB and delivered in a hospital it would've ended a LOT differently!
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!
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.
MH's Story (pre-existing hypertension, induction, c/s)
Kmom's Notes: It can be very hard on a woman emotionally to have general anesthesia for a cesarean. For more information about the issues this can bring up, please see the FAQ on Emotional Recovery After a Cesarean on this site.
Birth Story
My pregnancy was pretty good. Because of controlled [pre-existing] hypertension (not pregnancy-induced), I was labeled high risk. That was okay with me actually, as hypertension is something that can be scary in pregnancy. I had 3 level 2 ultrasounds until the last 5 weeks. Then I had one at the doctor's office every 3-4 days, with a non-stress test. During my 39th week visit, the doctor did an u/s and said the baby was well over 8 lbs. Because of the hypertension, I was going to be induced during my 40th week if I had not gone into labor already. So, because I was very adamant that I wanted *my* doctor to be the one that was there during delivery, and he was on call the next couple of days, we decided to start the induction that night.
I was given Cervidil in hope that my cervix would soften, as I was not dilated at all, and just a bit effaced. Pitocin was started the next day at 5:00. I started having contractions about 9:00, but nothing strong at all. My doctor checked me at 12:00, still nothing. Checked again at 5:00, and still, nothing. At this point, we had to decide how to proceed. I could go home and see if anything happened over the weekend, with a scheduled c-section if I didn't go into labor myself, the pit could be turned off, and started up the next day ( but my doctor didn't want to do that, and neither did I), or a c-section then. We chose the c-section.
After I was prepped, the anesthesiologist came in and attempted to give me a spinal. After 5 attempts, he said he didn't think it would work. I said try it two more times, and then I'd agree to a general. It didn't work. I was knocked out completely. The next thing I remember was waking up, being moved from the operating table to a bed, then I turned to my left, and my husband was standing there with our beautiful little boy! I was in a lot of pain, as the morphine did not work. I was given a Demerol drip, and that did work.
Yes, I think I was pushed into the c-section. I am going to try very very hard next time for a VBAC. And, I will flat out refuse to be worked on by the same anesthesiologist. It is because his ineptness that I did not see my baby be born.
MichelleATX's Story (BP issues?, induction, c/s)
Kmom's Notes: A good example of the importance of using the correct-sized BP cuff!! And of hiring a non-interventive provider, one who is watchful for problems but does not expect them automatically or over-react to them.
Birth Story
I prepared for pregnancy by doing hypnobirth tapes, psyching myself up for a vaginal birth without drugs. That's not anywhere near what I ended up with.
At my second OB appointment, I was told my blood pressure was high. I felt fine and didn't pay too much attention. At my third appointment, I was again told my blood pressure was high and put on a low dose of a HBP [High Blood Pressure] medication. The medication gave me an annoying cough. At subsequent visits, my BP was all over the place--usually normal, as when it was taken by the OB's head nurse, sometimes high, usually when taken by the other nurses. Or what I thought were nurses. Late in the pregnancy, I found out the two "nurses" who repeatedly got high readings of my BP were not nurses at all, but nursing students. I also learned that they weren't always using the right, extra-large blood pressure cuff because sometimes, they just couldn't find it. Late in my pregnancy I was sent up to L&D twice for monitoring because of a HBP reading in the OB's office. Both times, L&D was unable to find anything wrong with my BP and I was sent home. I was put on bedrest the last month, with a home monitor and though I ignored the bedrest and continued my activities, I never once had a HBP reading. It didn't matter that my readings were so inconsistent--I was labeled high risk and GH [Gestational Hypertension] and that was it.
When I had my first glucose test, I failed it by 4 points, after having had a large breakfast at McDonald's. No one told me to fast! When I took my 3-hr test, I passed with flying colors. Doctor advised me to follow a diabetic diet anyway because she wasn't convinced the test was right. Diabetes does run in my family but it is typically late onset. OB suggested that we repeat the GTT later in the pregnancy but she didn't bring it up again and I didn't remind her. Blood work that day did find that I was anemic, but I conveniently forgot to take my iron supplements--they made me too sick.
Throughout my pregnancy, I was told that I was measuring very big. I was given numerous ultrasounds and each time, the tech told us that the baby was right on target, though on the smaller side of normal for development. OB continued to tell me I was big. Each u/s with the tech, we were told baby was normal, placenta looked great and that I had plenty of amniotic fluid. The last couple of weeks, the OB told my husband and I that the baby was measuring very small and that it was possible my placenta wasn't nourishing him sufficiently. She said, "We may find that it is better for him outside of the womb than inside if your body isn't taking care of him, in which case we'll try inducing but your cervix isn't ripe and you may need a c/s. We don't like performing c/s on women of your size because the risk of complication is higher and there can be problems healing."
I went in for an OB appointment on Monday, March 28, for a NST. Baby continually wiggled away and their machine wasn't picking up his heart rate or the contractions I was having every 5-7 minutes (and had been having for a week). I was sent up to L&D where I was reluctantly put in their triage room. The nurses were terribly rude and disappeared for long periods of time. I'd been there nearly an hour before I was hooked up to any machines. Their machines did confirm that I was having regular, though pain-free, contractions and baby's heart rate was okay. OB decided to have me admitted so that I could be induced the next morning. At that time, I was fingertip dilated and told my cervix was not very ripe. I was at 38 weeks.
That night, I was told I couldn't eat anything after 6PM. Between 8 and 9PM, I was told that baby was having "decelerations," his heart rate would drop for anywhere from 5 seconds to a minute, then come back strong. One of the nurses came in to fiddle with the fetal monitors and said baby was probably moving away from monitor and it wasn't picking him up. I was told that they would be giving me pitocin in the morning, but not Cytotec, the cervical ripener, because of the decelerations. I was told I had till 10PM to eat anything if I was going to eat. I had my husband raid their kitchen for whatever was available--a turkey sandwich and crackers with peanut butter. I was still starving, but the only thing left in the fridge was a ham sandwich and I keep kosher so that was out.
In the morning, they started me on a high dose of pitocin at 7:35AM. I was still having regular contractions, but no pain. I was now measuring at 1cm. Because of my GH, I was told not to get out of bed except to go the restroom. I was to stay in bed, on my left side. I was miserably uncomfortable and my hip began to hurt terribly. At 12:15PM, I felt a twinge of pain and suddenly felt as if I'd wet myself--my water broke. A sickly sweet smell filled the room and the OB told me the clock was ticking. The monitors were having a hard time picking the baby up so they opted for putting me on a catheter and putting the baby on internal monitors, which was terribly painful--I was only dilated to 2 cm. I began having contractions every 2 minutes, most of them off the charts, but was doing very well with labor. No screaming, no gnashing of teeth. I thought, "I can do this!"
The OB came in several times that afternoon and told me I wasn't progressing and that a c/s may be necessary. After 5 hours of labor, I told my husband that if they were going to do a c/s anyway, I may as well get an epidural and be ready for the surgery. I continued to hope that I would progress and be able to have the baby naturally, though. Having been repeatedly told they didn't like doing c/s on large women, I commented to my husband, "That sure seems to be all they talk about." At midnight, I measured at 4 cm. I was told that if I didn't open another cm in the next hour, we'd be doing a c/s. At 1AM, I was a 4.5 cm, 5 if they painfully stretched me.
The OB on duty said she was pretty sure that the baby had lodged his head in the birth canal incorrectly. I asked if I could change positions or, better still, get up and walk around. They refused because of my HBP, even though I hadn't had a HBP through 5 hours of unmedicated labor. They started prepping me for surgery. I cried to my husband because I was terrified of being cut open. I was terrified of the risks because of my size, I was terrified for my baby who was too large, then too small.
What I was most unprepared for with the c/s was that my body would shake from the anesthetic and that I would be freezing, even with warm blankets piled around my head and shoulders. When the baby was being taken out, I remember this dull pulling sensation from deep inside me that made me grunt with each pull. It reminded me of the disemboweling scene at the end of Braveheart. I heard our son cry. It was 2:53AM and his grandmother's birthday. I heard my husband laugh as our son promptly peed on a nurse and then got to see our baby for the first time. He was whisked off pretty quickly so that they could begin to sew me up.
That's when more surprises were in store. I was unprepared for the dull ache as they OB put everything BACK, shoving my innards into their rightful place. The anesthesiologist turned up my meds but the pain had me grunting and I threw up. It seemed to take so much longer getting everything in than it had to take everything out. Our too-large-then-too small-baby who supposedly wasn't being fed by my placenta was fine. He weighed 5 lbs 6.8 oz, 18 inches long and didn't have a thing wrong with him. He wasn't too big--so much for GD--and he wasn't too small or unhealthy--so much for a failing placenta.
I was soon in recovery and trying to breastfeed our baby. I was able to sit up immediately and wasn't in too much pain, but was still freezing. I held the baby against my chest and he pushed himself up on his arms, lifting his little head to look around. He was so strong! I began to feel very weak because I hadn't eaten since Monday night and it was now Wednesday. I hadn't even been allowed water and had been limited in my ice chips. Baby's blood sugar was low and they kept coming in to prick his poor feet. They insisted on giving him formula, but he wouldn't eat. I told him that if they'd let him sleep, he'd eat when he was ready. My colostrum quickly came in and after that, I refused to let him have anything but the breast, which angered a nurse or two. His sugars improved and he was fine.
We were released a day early. He had a touch of jaundice but it was clearing up on its own with breastfeeding. I was okay the first few days, but on the 8th day, the day of his bris, the incision nearly killed me. I underestimated what a toll the surgery had taken on my body and by the end of the day, I was sore and tired. I returned to bed. I continued to heal pretty well, but my incision looked lumpy, almost as if I lump of fat had been left poking out among the regular skin. And when I would go to the bathroom for a bowel movement, the first elimination sent a stabbing pain through me, deep inside between my rectum and my vagina. It felt like a knife was being plunged into me. That continued for 3 weeks, then cleared up on its own.
It's 7 months later now and I'm pregnant again. I really want to have a vaginal birth this time. I'm not the scared new mom I was. I'm not afraid to challenge now or ask questions. And I'm actively looking for a health care provider who is more interested in treating me as a patient and a woman and not just as a number on the scale. I know my body can do it. I know my baby can do it.
Pam K's Story (false gd diagnosis, induced for suspected macrosomia, c/s; postdates induction, c/s; home waterbirth VBA2C!)
Kmom's Notes: This is typical treatment for larger women in many ways. Because bigger moms do have slightly larger babies as a group (and obesity is a risk factor for really big babies), doctors often estimate that their babies are going to be huge. In the first story, the doctors kept raising the estimated birth weight; from 8 lbs., to 9 lbs., to 10 lbs., then to 11 lbs. They tried to talk her into an elective cesarean, but when she refused they induced for suspected macrosomia. As is so often the case, the induction ended in a cesarean, and the baby was not macrosomic after all.
Despite having a really wonderful OB for her second pregnancy, Pam ended up induced for post-dates with baby #2. Inductions of VBACs often end in cesarean, and hers did too. As she discusses below, she had a difficult experience with a nasty spinal headache afterwards.
With baby #3, Pam chose homebirth, with unofficial back-up from her wonderful OB. She became very proactive about nutrition, and she occasionally monitored her blood sugar to be sure it was still normal (it was). In this pregnancy she did not go "postdates" and feels that perhaps some nutritional changes were part of that, although we'll never know for sure. Pam went on to have a VBA2C at home, in the water! She chose a hands-and-knees position to push out her baby, which often is a good position for larger women.
Pam is a doula who works to help support other women in their births, and is also a member of ICAN, the International Cesarean Awareness Network. Choosing truly VBAC-supportive providers was a key part of her preparation for baby #3. Had she seen a traditional OB, she almost certainly would have been told she had no chance at a VBAC, between being supersized and her history of a "failed" trial of labor, possible GD status, borderline "big" babies, and tendency to go postdates. Yet she went on to have a wonderful VBA2C anyhow. It's important to remember that many women with one "failed" trial of labor do go on to have VBACs later on, and that women of all sizes can have VBACs.
Birth Story
Birth #1: My pregnancy as a whole was non-eventful until the end of
my sixth month when I "failed" the GTT and was labeled a gestational
diabetic. This of course skyrocketed me in to the high risk category and I spent
the remaining 3 months testing my blood levels four times a day and
following an eating program that controlled my supposed GD quite nicely.
(Subsequent review of my records revealed that I was indeed misdiagnosed. Also,
despite the fact that I informed anyone who walked into my room that I was GD,
my levels were never once tested over the entire time I was hospitalized.)
MY OB practice was a two doctor partnership with a third back-up for emergency
or unusual situations. The primary OB, a woman, was very accepting of my desire
for a natural birth and though I know she did not agree with all my plans, did
not overtly discourage or sabotage me. However, At 38 weeks she informed me she
would be leaving town in two weeks for Easter and proceeded to do an unauthorized membrane strip. I responded not at all--not even
a cramp--but she assured me I would deliver before she returned from her
vacation. I made my next appointment with her partner who was not nearly as
encouraging as she was and indeed seemed to be a bit hung up on my weight.
However, my 39 week Bio Physical Profile was perfect, I had dilated to 2 cm and
there was no reason to hurry things along.
At 40w6 day I had another BPP, again perfect, but this time
the perinatologist called my doctor and said I was "ready" as he
estimated the baby to be over 11 pounds. (This man never ever spoke to me face
to face. He would talk to my husband, to my doctor, and to the technician if no
one else was there--all in my presence, but never to me) Each week, the
estimated weight of the baby had crept up--at first it was "over 8 pounds
at term", then "over 9", "over 10". Over 11 made me a
bit nervous, and I agreed to an induction if my cervix had shown no signs of
progressing. Surprisingly (not) I was still at 2 cm, so after a great dinner, my
husband and I headed into the hospital the Thursday night before Easter for
Cervadil. My doctor (the male) showed up and offered me a cesarean because of my
size and GD diagnoses and estimated weight of baby. I was very surprised but
refused graciously. I did not see him again until my daughter was delivered.
Friday morning, 41 weeks pregnant, I truly believed I would have this baby with
no pain medication and be home in time for Easter dinner. The pitocin was
started several hours later than they had told me, but I did manage to have a
few mild contractions and had a fairly nice day visiting with out of town
friends and hanging with my husband. My doula was in and out, finishing up
errands so she would be available when I needed her. Finally, around 9 o'clock
Friday night, with no change whatsoever, the pit was discontinued. Of course, I
had not been fed all day and the nurses were not in the least bit concerned
about that, so our friends ordered me a pizza and shared some birthday cake from
my favorite bakery. I was then moved to a larger room. Sent everyone home around
11 or so , to rest up for phase two. I was awakened about midnight by a
resident who explained that my doctor had called from his car on the way home
from the theater (and wasn't he so considerate, thinking of me while he was out
on the town!) and suggested a Foley catheter to inflate my cervix. I agreed and
was thrilled to be at 4 cm on Saturday morning!
Saturday we started the pit again. Cranked it up pretty high throughout the
course of the day, but I tolerated contractions with ease. I did everything I
could think of to help such as walking (the miles I put on that telemetry
unit!!) nipple stimulation, even sucking my thumb. [Kmom note:
There may be an acupressure spot on the roof of the mouth; some theorize that
sucking the thumb can help stimulate labor sometimes.] Nothing seemed to
help. Of course, I was sneaking the occasional peanut butter cracker and juice
as I was NPO for the duration. [Kmom note: NPO is the abbreviation of the
Latin words for nothing by mouth.] This time, they did not turn of the
pitocin. We continued through the night and into Sunday--Easter Sunday when I
expected to be holding my baby at Easter Dinner. The most memorable moment to me was
receiving an Easter Lily from the Baptists women's guild. I was Catholic,
delivering at a Jewish hospital. I was quite amused by the blending of beliefs
and still have pictures of that beautiful lily.
Sunday I saw the back-up doctor for the first time. He suggested rupturing
membranes and I agreed. (In retrospect, I should have walked out days ago, but I
was naive.) He left, a resident did the deed and inserted internal monitors and
I stood up and had a real contraction--I actually had to stop and breathe! I
then proceeded to have what my doula described as "transition-like"
contractions for the next twelve hours. It was obvious the staff was tired of me
as they pretty much left us alone. I insisted on laboring in the shower,
complete with telemetry and birth ball. After 12 hours with ruptured membranes,
I was still at four cm and told I could either have my cesarean now or wait
another 12 hours but it was no longer an option. I looked around the room--at my
husband, so tired, so scared, yet so supportive, at my doula who had been with
me for four days with only brief breaks and who had given up her Easter with her
family for naught, at my mother who was due to leave for Florida within the
week--I gave up. I won't go into the circus that ensued over the next few hours
situating everything, but to illustrate the experience, my father showed up as I
was being wheeled into the OR and I truly believed I was going to die. My father
has a major aversion to hospitals and I honestly did not expect to see him until
I was home.
And so , I finally saw "my" doctor, in the operating room, as he
performed major abdominal surgery on a perfectly healthy mother and perfectly
healthy baby. Neither one of us had shown any signs of distress, despite my not
having had real food or drink for several days, despite the massive amounts of
pitocin dripped into me, despite ruptured membranes. My daughter was delivered,
by this man who was annoyed at his shortened lunch hour, while I lay on the
table unable to feel myself breathe. My memories of that morning are interwoven
with images of the Salem witch trials, where they would crush supposed witches
with large cinder blocks. She weighed 8 pounds, 15 ounces and had
apgars of 9 and 10. He told me he had made the incision in a place that should
not be aggravated by my "flap" and apologized for the size of the
incision as he had anticipated a much larger baby. Then he was gone. He is still
my mother's GYN and still encourages me (through her) to plan elective cesareans
each time I am pregnant.
The story of my physical recovery is short, but the emotional healing has been
slow. Nearly five years later, as I anticipate the birth of my third child, I am
still haunted by those visions of being crushed while my child is cut from my
body. And that is how I remember the so-called birth of my first-born.
Birth #2: When my first child turned one year old, we decided it was time for our second and immediately conceived. I assumed I would have a natural birth this time, despite my prior cesarean, and found a caregiver who would support that. Dr. B was the ideal OB. He was a strong proponent of natural birth and truly supported me in every decision. My pregnancy was noneventful, except for the usual stressors of selling our house, quitting my job, buying a house, etc. Medically, things were perfect.
When it came time to test for Gestational Diabetes, Dr. B
examined my results from my first pregnancy, shared concern that I was
misdiagnosed, and asked if I would be willing to forgo the one hour GTT for the
three hour. Sure. Results were a bit odd, so I repeated it. All clear! One
possible risk factor eliminated! He did not consider my weight an issue, other
than contributing to my personal discomfort, and was even willing to allow me to
weigh myself at another place to minimize my binge triggers. He frequently
consulted with me concerning my pregnancy, making it clear he considered me a
partner in this, not a patient.
As the end of pregnancy approached, I chose to allow vaginal exams as I needed
some reassurance I was progressing. Imagine my thrill at 38 weeks when I was
dilated to 2 cm! Then two weeks later I was at 4!! That was as far as I had
progressed with my first four day induction. I began to believe I might really
do this. Dr. B discussed some natural methods of induction with me, emphasizing
it was totally up to me. I tried castor oil numerous times, intercourse, and
even the cohoshes at his suggestion. I experienced a few mild contractions and
some major diarrhea, but no real progress.
At 43 weeks, Dr. B asked me to have a Bio Physical Profile. He
assured me he would interpret the results himself, with me, and not let the
"expert" at the U/S center influence him. He was very aware of my
mistrust of that particular doctor. I agreed and we scheduled the BPP for
Thursday, January 28th. This was my husband's 32nd birthday, his goddaughter's
(who would be the godmother of our baby) 16th birthday, and ironically, Dr. B's
anniversary. I had hoped that our baby would be born on this day, keeping up the
family tradition.
My mom met us at the hospital for the U/S and we had our 21 month old daughter
with us as well. The technician was one I had met several times in different
capacities and was very comfortable with. There was no sign of Dr. S--my
nemesis. The baby looked wonderful and responded well, BUT my fluid levels were
virtually immeasurable and my placenta was rated as very deteriorated. OF
course, we all focused on the distressing news instead of the positive--the baby
was FINE!! So, a flurry of phone calls ensued and that was when we realized the
mistake in selecting that day for the U/S.
Dr. B was out of town and his back-up was less than
satisfactory. First, she refused to talk to me on the phone, instead sending
orders through various nurses and secretaries. My mother had left by this time,
and we were trying to deal with a toddler and figure out what we needed to do.
Finally, I managed to get through to the receptionist who apparently was as
annoyed as I was and had Dr. B call me on his cell--out of town, on his
anniversary. After discussing the situation with him, we decided it was not an
emergency, and I agreed to let his back-up examine me and agreed to an IV to see
if we could increase fluids. My largest concern was that his back-up did not
have privileges at the hospital I had chosen to birth at, due to a paperwork
mix-up. I simply prayed that I would not go into labor until he was back in town
that evening. By this time, my husband had left to take our daughter to his
mother's and I called my doula to be with me. I agreed to an oxytocin challenge
to see how my baby tolerated contractions, thinking perhaps I could actually
jump start labor that way and by this time, I was coherent and sure my baby was
fine. Interestingly enough, I did n ot even see my "doctor" until
after all the tests, IVs etc and even then she was abrupt and unfriendly. All
was well, so I dressed and left quickly, with instruction to call Dr B in the
morning.
Managed a few contractions that night, but in the morning called Dr B and agreed
that given the info at hand, we should probably induce. Dropped my daughter off,
had a quick lunch and went to the hospital. Spoke with Dr. B who then said,
"well, I'll stop by the desk and get things started and be back in a
bit." Shortly after that, another doctor walked into the room, said he was
there to get things started, proceeded to examine me and lecture me as to why I
should not consider a vaginal birth. I was apparently a bit irate, especially
when he reported I was at 1 cm and the nurse said "But Dr. B found her at
4." At that point, he stalked out of the room. Several minutes later he
came in with a very distraught head nurse who apologized. They were very busy
that day and she had handed him the wrong chart! I was not his patient. This was
not reassuring, but reminded me to be vigilant throughout this birth.
Shortly thereafter, we got the pitocin started and I began contracting. Within about 12 hours, I progressed to 7 cm. Twelve hours later, I was still at 7 cm. 3 hours after that, I was still at 7 cm. I had done everything I knew, with the help of my two doulas and my husband and my mother. I walked, I ate, I labored in the shower. Dr B was a great support--I found out later that he had to stay at the hospital throughout my entire labor as this particular hospital did not have residents or an OB on call at the time. He never gave any indication that he was impatient or would rather be doing anything except babysitting me for the weekend.
27 hours after my induction started, Dr B came in and asked if
we could discuss my options. He laid them out, simplest to most interventive.
Continue as we were and see what happened. Increase the pitocin. Consider an
epidural to see if that would relax me and allow me to dilate. Consider a
cesarean. I asked his opinion. He said, "I think you are headed down that
road." I looked around the room at my "support" team and
nobody met my eyes. Nobody told me I could do this, that I was fine and my baby
was fine. They had lost faith and so did I. I said "Let's do it" and
cried. Dr. B hugged me and said "Next time!" Everyone except my
husband left and I cried and cried. (He told me later that he was very surprised
I gave in. He did not expect that and had no idea I was so tired and discouraged
as I had been handling labor quite well. I wish he had told me that at the time.
It would have made all the difference.)
Preparing for the cesarean was a bit of an adventure. I had a great
anesthetist--2 in fact, but they had a terrible time getting the spinal placed.
(We had decided on a spinal as I reacted quite strongly to the epidural
previously.) Eventually, they got me numb, and at Dr. B's request allowed my
mother and both of my doulas in addition to my husband into the operating room.
My mother and husband were at my head on one side, my doulas had a front row
seat at the foot of my bed. I have to say that I was very disappointed with
their interest in the surgery as opposed to ME, but as a doula, I also
understand the unique opportunity they had. (In retrospect, I think one of the
biggest problems was that everyone kept thinking of me as a doula and not as a
laboring woman.)
The surgery was noneventful, the baby was easily delivered, screaming all the way and promptly peed on everyone and everything. I was able to see him briefly and DH went with him to the side of the room where the warmer was. My mom went back and forth, so I was left alone a bit more than I would have appreciated during the repair. Fortunately, Mary, one of the anesthetists, was super and made sure the have DH bring the baby over as soon as possible. She had him hold D up to my cheek and I was able to stroke and cuddle him while he was still a bit messy and fresh. He was perfect--weighed nine pounds even and showed no signs of postmaturity, despite a severely calcified placenta (I saw it--it was pretty bad!)
I was able to hold him on the way back to my room, but felt very woozy and out of it. In fact, once I was in the room, the nurses became very concerned and took the baby (who then pooped on everyone) and began working on me. I remember fading in and out and Mary apologizing as she inserted an IV without gloves on. Apparently my blood pressure dropped significantly and they were a mite worried. I recovered fairly quickly, and settled down to bond with my baby. DH called immediate family members, then I sent him home for sleep. D and I had a wonderful night napping and cuddling, and I swear he smiled at me. Interestingly enough, I didn't call anyone for several days. It was very difficult for me to integrate this birth.
I developed a spinal headache which was far worse than
anything I had ever experienced, and challenged our breastfeeding relationship,
but I had good nurses and a great lactation consultant so was able to work
through that. I also had my first experience with Therapeutic Touch, courtesy of
the hospital. I stayed longer this time, but once the headache was under
control, I was eager to get home and begin life as a mother of two. Recovery was
relatively easy, as with my first cesarean, though not something I would choose
to deal with when caring for a newborn and toddler.
In retrospect, this birth was much more difficult for me, because despite being
educated and prepared, I still allowed others to influence my decisions. I
cannot blame my choices on ignorance or naiveté. I simply relied on
people who did not see my needs, only strengths, and this was a fatal flaw. I
learned a lot over the next three years. After about 10 months, I discovered
ICAN online and have become very involved since. I have continued to search and
to learn and to grow and heal. Now, my son is three years old, I am nearing the
end of my third pregnancy, and I have realized the ultimate lesson for me: I
cannot birth in a hospital. I am planning a homebirth and hope to have a third,
triumphant story to share within a few months.
Birth #3: I was "officially" due on April 16. I began experiencing the dreaded nighttime prodromaling syndrome. I was fortunate that it was mild----starting around midnight and ending with sunrise. Each night was a bit more intense, and I was surprised at how much the contractions hurt. I had expected to sail through "natural labor" after my experience with Pit, so I was a bit humbled, but fortunately was able to readjust and soon began celebrating the fact that my body was working on its own!!
Monday night, April 22, the contractions were strong and frequent---I was in the birth tub humming through them. If I had been a first time mom, I would have been at the hospital!! In fact, the continued into the morning and we decided to take the kids up to my SIL as I was unable to focus with my 3 yo around (he really wanted into the tub with me). I called my friend Karen to come over as I did not feel comfortable being alone and sent DH off with the kids. Of course, things slowed down significantly once we did all that! My MW suggested I keep my OB appt. and agree to a vaginal exam so we could get an idea of progress. Karen and I went to lunch, the to the appt. while DH tried to get a half day of work. Contractions were about 10 minutes apart and manageable.
At the OB's I discovered I was leaking something. We still were uncertain as to whether it was amniotic fluid or simply very watery mucous. It smelled like birth and I was concerned that the OB would notice. Fortunately he did not. He was very excited about the condition of my cervix and offered to strip my membranes. I agreed and he immediately said I had progressed another cm. (to 3 cm). He told me to go home and keep contracting and that he would probably see me before my next appt.! Karen and I went to the pool and swam and walked a bit, then she headed home to be with her family and I went to bed.
Of course, laying down made it very difficult to deal with the contractions, so I popped in my imagery birthing tapes and was able to sleep a bit. Finally, around 10 p.m. I found myself bolting from the bed with a contraction, so I headed to the tub, then the shower. Soon I was needing someone with me, so called to my DH who was snoring away. He did not hear me and I was mighty PO'd. I managed to get myself out of the shower, to the toilet, and discovered a HUGE amount of mucous. I have NEVER seen such copious mucous and was a bit disconcerted. (Dh eventually was fishing it out of the birthing tub.) Finally got his attention and decided to call Karen back over. Moved back to the tub and continued to hum through the contractions. Shortly after Karen arrived, I decided it was time to call the MW as she was 2 hours away. Things got a bit hairy at this point because the MW did not think I could be very far along. It was a bit of a circus with my trying to tell her I really was progressing and then throwing the phone to DH during contractions. She finally suggested that we time the contractions for an hour---she wanted them 4 minutes apart and lasting a minute apiece.
I was royally pissed off as I thought one of the benefits of home birth was not having to deal with the numbers game, but did not know how to get my message across. Part of the problem was that we had anticipated DH being able to assess dilation a bit, but he was not experienced enough and I could not tolerate him hunting for my cervix at this point. Anyhow, I moved from the toilet to the tub again and we began timing. Within about 15 minutes I decided we had better prepare for transport as I was not going to have the baby without an attendant, so sent DH to wash the car seat cover (yes I was really prepared, LOL) and Karen continued to squeeze my hands as I moaned through the contractions----closer and closer together. Shortly after that, I threw up and announced I was in transition. Karen commented that I wasn't acting like it between contractions but I was certain and soon felt very pushy. The odd thing was that I was totally calm and collected between them and was reassuring both DH and Karen that I was fine. I remember Karen asking if I was pushing and telling her that I was not, but my body was a little bit.
I announced that we were to call the MW and if she was not coming, we were leaving. The good news was that she had left already. I was most definitely pushing involuntarily at this point and probably could have delivered if I was willing to work with the contractions, but I could not STAND the sensation that accompanied any attempt to push. It was the most intense tingle I have ever felt----very orgasmic and simply too much for me to cope with. I spent the next two hours panting through my contractions while laying on the bed.
The MW arrived, examined me, and told me I was 9 with a lip. (I believe I was complete earlier but lying down and panting had raised the lip.) She told me to start pushing and I refused. I did eventually try to push side lying but I hated it, especially when she tried to hold the lip back. I moved to the tub on a forward leaning kneeling position and this helped somewhat. I had a bulging bag that the MW said seemed to be interfering with my progress so I agreed she could rupture it. It was very difficult for me to allow her inside and it was very difficult to push through that tingling sensation. My one "complaint" is that she was not more verbally supportive. Instead she said things like, "Well, I just can't help you then," when I would tell her that I did not like having her fingers in me, etc. I understood she was trying to help, but it was so hard-----positive encouragement would have gone a long way! I eventually was able to give a few puny pushes and she noticed some meconium, so I upped the effort a bit. She also ruptured the bag, which I did not notice at all. (Later she said she had to really tear it---and the baby still brought it all out with her, even stripping the amnion from the cord----the kid was determined to be born in the caul!)
Finally I was able to push past the tingle and as soon as I felt pain--the ring of fire---there was no stopping me. THIS I was prepared for! I remember saying, "Oh, the ring of fire, I can do THIS!" and two pushes and she was out. It was so amazing to feel her crown and emerge, followed almost immediately by her body. Good thing she was small--I could not have stopped for anything.
MW brought her right up onto my back and checked her over to make sure she had not swallowed any meconium. She was so alert and peaceful---just looking around. I remember asking what we had, and DH saying nobody knew yet. I told him to LOOK! It was his baby! And he tearfully announced it was a girl. She was born 5:58 a.m. Wednesday, April 24th weighing 7 lbs. 14 oz.
She responded well (Apgars 9 and 10) and soon I was climbing out of the tub, with my baby still attached to the cord and the placenta still inside---too weird!! DH and I cuddled her on the bed for a bit, then I delivered the placenta. I really did not have any contractions, so that was a bit of an effort and I did actually lose a fair amount of blood (4 cups), so my midwife did give me a Pit injection as we had discussed in advance. I also did a lot of nipple stim. to help contract. After the Pit, I had some wonderful afterpains and fortunately, the bleeding stopped without having to transfer.
Approximately 2 hours later, DH cut the cord, I nursed, peed, and the MW finished the paperwork, the cleanup, fixed us breakfast. She and Karen let themselves out while we slept in our own bed with our new baby. I cannot imagine this birth happening any other way---I could never have done this at the hospital, even with my oh so supportive OB. I can honestly say I feel complete now. I have completed a chapter in my life. I am eager to see what is next for me, but am also very content to simply be for a while---a feeling I never had after my first two babies. I would do a few things differently next time, but would not change this birth for anything!
GAMom's Story (high blood pressure, PROM, transverse malposition, c/s)
Kmom's Notes: This mom has not been evaluated for either PCOS or thrombophilia but may have some autoimmune problems affecting her fertility; test results have been contradictory. Progesterone supplements in the beginning of pregnancy seem to have helped this pregnancy continue. She also took low-dose aspirin for part of the pregnancy.
In a follow-up question, she noted that the hospital did not tell her to have her staples out at 3-4 days; she waited until her 2 week postpartum checkup to have them out! Ouch.
Birth Story
My husband and I had 3 miscarriages (all between 8-10 weeks). We really
wanted a baby. My OB-GYN was great. He immediately put me on progesterone suppositories due to prior miscarriages. We had our first ultrasound at 7
weeks. You could see the sac and heart forming. Our next ultrasound was at 15 weeks and you could see the babies heart beat. I was SOOO relieved. My
husband was great. I still didn't want to get all my hopes up. We got pregnant when we weren't supposed to. It had only been 2.5 months since our
last miscarriage and the doc wanted to run some tests. Oops! :-) We had our first round of tests and it came back with levels increased. Our doctor
informed us that it was probably just a false positive but sent us to a perinatologist anyway. We saw him once a month for quite a few months. Boy,
do we have great ultrasound pictures. Our baby girl developed quite
rapidly
over the time. All measurements were great and on target. Two amnios were attempted but the needle wasn't long enough. And
MAN, did they hurt!!!! They monitored closely and took precise measurements to ensure the baby was
okay.
We were finally released from him and seeing our doc every two weeks.
Everything was fine. Our baby had been head down since January at every visit. My blood pressure starting to rise a little to about 140/80 and
150/90 toward the 33 week. My doc put me on bed rest and then it soared higher. He released me back to work and it was fine. At the next visit it
was a little higher ( I was seeing him every week now) and it put me on home rest, not bed rest. It did much better. I went out to dinner with my
husband on Friday night and that night my water broke. It was just leaking and I really couldn't tell much difference between that and going to the
bathroom a good bit. By morning around 8,, we called the doctor and he sent us to the hospital. My water had definitely broke.
Because it had been broken for a while they wanted me on bed rest there. They hooked me up to all
the monitors and the baby was fine, but I was not in labor. they did and ultrasound and she had turned transverse. All things considered, we opted
for the c-section. The epidural was easy and I was awake for the entire thing. My beautiful baby girl was born that night at 8 thirty. She was
healthy w/ apgars of 8/9. She roomed in w/ us for Sunday and Monday. Monday night I put her in the nursery because we were going home on Tuesday. She
choked on them (they fed her a bottle!) and turned blue. As upset as I was, it ended up being good because she needed oxygen. Her O2 levels were in
the mid 80's. They put her in NICU and gave her antibiotics, oxygen, and
lots of tests. She also had to go under the bili lights after that test came back. I was in there as much as they would allow. She nursed well, but I
never did have milk that came in. She got a lot of colostrum though.
Within three days she went to the intermediate nursery on an apnea monitor and
oxygen. they couldn't wean her off the oxygen and she had a few apnea episodes. After it was finalized that her lungs just weren't completely
developed because of her prematurity and high birth weight for her prematurity, we PITCHED a big fit. To make a long story short, she came home on oxygen
and has been great ever since. She is now 8.5 months old and still on the
monitor, but no oxygen since 1 1/2 months. She now weights 20 pounds, 29 inches tall and
is a very HEALTHY baby girl.
I wish all the supersize moms had as great a doctor and experience as we did.
Ellen2's Story (elective c/s)
Kmom's Notes: Ellen wants to share her story so that other supersized women know that "You don't have to have something wrong when you have a pregnancy" just because you are supersized. She feels it's important to share her story so that other supersized women won't feel the way she did when she first got pregnant. It was sad and lonely, she says.
Birth Story
I missed my first period in March. Usually my cycle is very regular. I went to an OB/GYN. He did both a urine and blood test to see if I was pregnant. Both came back negative. He prescribed Birth Control pills to get my cycles regulated. The next month nothing happened again. I called my Dr. and he said to keep on taking BC's and eventually I would get back on track. I began to feel really sick, nauseous all the time. I was stopping the car so I could vomit. I would be sick if I ate, then sick if I didn't eat. I had blinding headaches. I had to be bedridden in a dark, cold room to make them go away. I thought I had some sort of terminal illness!! I was ill like I'd never been before.
In May, I called my Mom who is an RN at our local health dept. I asked her if she could run some tests on me, any kind of tests to see what was really wrong with me. She did some tests, checked the obvious stuff, then suggested a PG test. I told her I could not be PG, the dr. did a blood test and put me on BC....but she insisted----and the simple urine test came back positive! I don't really know if I was too early, or the lab confused by blood, or if I wasn't quite PG then when the OB did the blood test. Well, I decided to make my OB appt. a few towns over where the big hospital is. I felt doomed that I or my baby was going to have problems because of my weight (that is what my family and doctors had said). If either of us needed help I wanted to be at the big hospital.
My mom came with me, and when we talked to the doctor my Mom started crying, saying that he needs to categorize me as "high-risk" and asking if I was going to die. He told her that large people have babies all the time and for us not to borrow trouble. He didn't see any reason why I couldn't have a normal pregnancy. He wasn't going to classify me as high risk because I wasn't. I loved him from that point on.
All the rest of my PG was pretty uneventful. I had normal appts, tests, and readouts. Sugar test, blood pressure, everything was perfect. My sickness and headaches went away soon. I did, however, towards the end have the pelvic pain pretty bad, like in the a.m. when I woke up. I had more ultrasound (not vaginal) than other people because it was easier for them to see how I was progressing that way. (I don't think they ever did figure out how far along I was exactly!) My due date was Nov. 28th, they said.
I started to eat only lean meats and fresh veggies and fruits from our farmer's market. I drank mainly water. I swam 6 days a week at our gym in the indoor pool. I think all this helped me get through without being miserable.
Close to my due date, the doctor said I was showing no signs of labor, that my cervix looked just like it did 6 months ago. He said we'd wait another week. Meanwhile I had an ultrasound and they told me my baby was 10+ pounds and at this stage she would gain a 1/2 pound every week. By Dec. 10th I was scared, and still had no signs that I was near ready. I asked if he would induce and he said that since I had not dilated or effaced ANY, he didn't feel like this was a great idea. He said we could wait ANOTHER week and see. At this point I wanted to get the baby out by whatever means possible. I was scared I had a huge monster growing inside that refused to come out! So I opted for a c/s. Four days later I was in the hospital having my c/s (bikini cut). The epidural and surgery went fine. My girl was perfect, weighing 9 lbs. even. {Kmom note: So much for the 10-11 lb. baby!] 3 days after that, I went home.
This is when we started having problems. In the hospital, I was earnestly trying to breastfeed. My nipples are both slightly inverted and she would not latch on. I wouldn't let anyone give her a bottle, my pedi said she would be fine with the nutrients she had in her until we both got bfing under control. I tried everything to get her to latch on. I wore the shields nonstop to help draw the nipples out, nothing was working. I don't think my milk ever came in. We were both frustrated, and after a few days, especially when I noticed her getting a little jaundiced, I felt she wasn't thriving and I started with formula and the bottle.
In a way, letting go of bfing was a big relief for me. I was suffering from severe Post Partum Depression, I was exhausted, I was extremely swollen (my shoes and rings would not fit me even though they did when I was 9 months pregnant). My incision was gushing out tons of this clear pink fluid. My doctor told me what was going on [Kmom note: probably a seroma, which is a collection of fluid under the incision, which can be more common in heavy women]. He said my incision looked really good and was not infected. My sister had to express this fluid out of a tiny seep hole in my incision. There was tons of it. I asked if she was pouring warm water on me, but it was really this liquid coming from my body!
The main problems I had were after my pregnancy. Bfing, PPD, swelling, and the seepage from the incision. It took me about 4 weeks to get back to normal physically. Emotionally I still strengthen every day. She is almost two and we just started trying for another one! This time I hope to be more prepared about proper rest when you come home from the hospital; also to know more about option of bfing with inverted nipples. I will know that PPD is normal and talk more about it. I felt like a freak at the time, and that just made me feel worse! The problems I had due to my weight were minimal----having trouble telling if I was pregnant or not, having trouble deciding how far along I was, extra fluid under the incision---but all pregnancies have minor problems.
I wrote this because I want people to know that really big people have lives, they love and are loved in return, and they have babies just like everyone else. Just because you are "Supersized" does not mean you are doomed to have problems. If you keep a positive attitude and entertain a healthy lifestyle things usually are fine.
Syeda's Story (2 c/s for frank breech babies, VBA2C)
Kmom's Notes:
Birth Story
Monday night, my BH [contractions] changed character; I had 2 before bed that actually hurt a little, and I felt them in my back. I hopefully told my DH that we might be wakened by labor that night. I felt more contractions each time I woke for the bathroom, but woke in the morning still pregnant. Tuesday I was full of hope and energy. My kids were in preschool and daycare and I thought I could finish all those jobs that I needed to finish before going to the hospital. I was looking forward to the jihad (struggle) of real labor finally starting. My doula and I agreed that I would probably have the baby before Wednesday night. I accomplished a lot that day---3 loads of laundry, cleaned the kids' room, checked their bags...for their stay at Auntie's house, a big pile of yucky dishes cleaned....
Early...Wednesday morning, I [woke to finish folding the laundry]. I woke DH at dawn when it was time for the early-morning prayer, then I went back to sleep until the kids woke up. Sweet DH took the kids to work...all day as we were sure it couldn't be much longer. There was brownish goop on the t.p. all day and painful contractions in my back, but they never got regular or stronger. By late afternoon I was getting tired and discouraged. I tried nipple stimulation a couple of times. It really got the contractions going, and maybe 3 min. apart, as long as I kept it up. At that point I wasn't ready to do nipple stim until my labor became self-sustaining. I also wasn't ready to tolerate the moaning contractions nipple stim caused. I knew that if I had that kind of contractions without the nipple stim I could tolerate them, but the nipple stim was distracting to me. Also, I knew I had a NST the next morning and I really hoped to deliver before that.
Thursday morning a very, very tired me was still pregnant, still having painful irregular contractions, and feeling like time was running out. I considered myself officially 42 weeks. I wasn't really worried about the baby, I just wanted to pass my NST so I didn't have to think about the OB suggesting CS or induction, my greatest fears. DH and I want more children and I know it would be difficult, at least, to find a dr. who would attend VBA3C paid by Medicaid.
We 'passed' the NST but only after DH started talking to the baby. One of the reasons I picked this hospital was the newborn hearing test. Now the test was proved unnecessary because clearly baby could hear Baba just fine. How about that---not even born yet and Baba is already 'the sun and the moon' to this one too.
From curiosity I allowed an internal. She thought I was 2 cm and 90%, but admits she may have stretched me a little, without asking or explaining (1.5 to 2 cm). This must be why this was the MOST PAINFUL internal I have EVER had. I could kick myself for shouting OW instead of STOP, esp. after hearing, "I'm going to make sure you go into labor today." When the OB was finished I felt so violated and embarrassed to have let it happen. Thank God my DH had gone to the waiting room, no telling what he would have done. At home later, I wrote the ICAN support group online, thank you all very much for your support.
Later, Thursday afternoon I realized that I had been feeling pressure against the inside of my right hip. I assumed that it meant baby was malpresented, so I did some lunges hoping to knock baby loose. I waited until after Friday worship before I tried blue cohosh; guess what, no contractions. I quit the cohosh in the evening and the contractions stepped up to OOOOHHHH contractions. I suppose this change should have alerted me to impending birth, but it didn't occur to me at all. The contractions didn't feel any different. Early Saturday afternoon more cohosh, but no contractions. I took a nap late in the afternoon and slept through the next dose of cohosh. SURPRISE, the contractions returned. It never occurred to me that cohosh could stop my contractions. I must have had the dose wrong. DH called from work. Someone had given him tickets for the 7 p.m. Shriner's Circus. He and the boys would be home after. I told him to enjoy himself, knowing that if I needed him I could call his cell phone. I called my doula in the early evening and told her I was thinking of going to the hospital just to check and see if I had made any progress. She offered to give me a ride when she heard some of those contractions. I wanted to wait for DH and the boys to return. I still doubted that the baby was imminent. The boys returned around 9 p.m. I told DH I wanted to go get checked. I fully expected to return home later that night in spite of the contractions I was having, after all this had been going on for almost a week already.
We parked as close to the ER entrance as we could. OK, picture me, a 42 week/2 day Muslim woman, covered Saudi style. I wished I was more comfortable with Unassisted Childbirth, especially after 9/11. OK, prepare for the worst, but expect the best. At the desk I showed my tummy and was reminded which elevators to take to L&D. I looked at the wheel chairs as I walked past, thinking, "Oh, I don't need one of those." My labor seemed to be on hold at this point.
There were at least 4 nurses at the desk when we arrived at L&D. I told them I was in labor and I just wanted to check and see if I had made any progress. In triage, I answered "I don't know" to all the usual questions. "When did this start? How far apart are the contractions? Water broken yet?" After I had given my sample and changed to a hospital gown, the nurse checked me. "You seem to be about 6 or 7 cm." "YAAAAAH! This will be over soon." (Picture me dancing on the inside.) We settled into a nice room across from the OR. I didn't care, I knew I was going to deliver just fine. This was about 10 p.m.
I was hooked up to the monitor to give them their reassuring strip. I called my doula to let her know we were staying. Baby's [heart tones] were great but my contractions didn't show at all. I leaned back to relax...When my doula showed up I had been on the monitor for about 45 minutes and was ready for a bathroom trip. She got them to let me loose so we could try to speed up my contractions. Labor seemed to still be stalling. I think I wasn't quite settled in yet. She and I walked down the hall and back, hey, just in time to be monitored AGAaaaaaAIN. My bad luck, the only position they could get clear tones was laying down (protocol every 15 min). My good luck, the MW from my OB's office was on call. I really like her, she's very warm (guess whose b-day is the same as baby's).
We watched Saturday Night Live as I labored. My doula said she had never seen anyone as far along as I was and still laughing and joking. Whoever was closer (doula or DH) applied pressure to my back when a contraction started. I think I had been there 2 or 3 hours when I realized I was feeling pressure against my right hip again. I did lunges to swing the baby more to the left; it seemed the right thing to do. My OB, MW, and labor nurse were in and out, just watching.
Somewhere, I assume between 1 a.m. and 2 a.m., I was up trying to decide what I wanted to do next when I had a sudden urge to pee. When I wiped myself I saw lime green on the paper. I knew instantly my water had broken. I saw 'something' in the toilet when I stood up. "There's merconium," I told the collected crowd as I exited the bathroom. At 42 weeks 2 days I knew it was very possible, but I never really expected to see it and it scared me. The nurse did a test for amniotic fluid, of course it was positive. Nobody freaked out over the merconium, so I let it go.
My contractions picked up at this point. I became serious shortly thereafter. My memory of this part is very fractured. I am in the bathroom. "This is transition, right, it's almost over," my doula agrees with me. Walking from the bathroom I look at the TV as one of SNL's actors makes a joke; I laugh hysterically half-crying, thinking, "This is not THAT funny." I have to look away to stop laughing as I notice a contraction building. I try pushing in the bathroom without telling anyone, thinking, "Is it time to push yet?" I remember a contraction where I put my face to DH's chest and just scream until it is over.
"What do you want to do now?" the question comes through the air as I pace by the bed. I'm lost. "I don't know," I say. I walk, I squat, I search for what I need. I am back in bed, (monitoring?) I am on my left side having a contraction. Dh is pushing on my back and the doula is pushing down on my hip. DH's hand is in the wrong place. I reach to move it and my elbow connects with his head. "Sorry, move your hand HERE. Better." "Make du'aa (supplication), say "ya Allah," think of all the sins you're paying for, "ya Allah," "ya Allah," I breathe. I feel better.
MW says, "You're almost there but you're more dilated on the left than the right." A voice in my head says, "You heard her, roll over so you can dilate better on the other side," so I do. I hear her as if from far away, "You're 9.5 with a lip." I can see her hands 'down there' doing something. "Oh well, it doesn't hurt." I let it go.
3 a.m. Doula asks, "Why don't you try hands and knees?" It sounds good so I try. PAIN explodes in my rectum. I fall onto the bed on my side. "God it hurts," I think, then I'm pushing or trying to. A voice in my head is saying, "Don't take too long to push or you may run out of energy." I'm on my right side, someone lifts my leg. My legs are out straight, someone is holding the top one up. "This is not working, "I think, "What am I doing? There should be pressure on my feet." Between contractions I roll onto my back searching for somewhere to put my feet, something to push against. My feet are guided into the stirrups and one of the leg supports is in place. I'm trying to push; those #%$ stirrups are too far away. I try to escape over the head of the bed during the next contraction. I'm not really thinking, I'm just doing. MW's voice from so far away, "No, you have to come this way, towards the foot of the bed." My hands are pulled down to the handholds near the bottom of the bed; the other leg support is in place. This is what I was looking for. More disembodied words, "Curl in when you push. Yes, that's the way." Through a veil I hear how well I am doing. With the next contraction I move my feet to the near edge of the leg supports. I am 'squatting' on my back and PUSH, pulling with my hands. I feel it working. Doula takes my hand, "Here, feel the head." My hand is moved to this spongy, wet, hair covered thing coming out of me. "That's not what I thought it would feel like." Another contraction. I grab the handhold again and PUSH. I know I'm almost there.
3:17 a.m. PUSH, so slippery, oooohhh wow, the pressure is gone. I melt with relief. MW closely followed by DH announce, "It's a girl!" There's a baby on my tummy. "It's a girl?" I ask the air. I hadn't let myself think this one might be a girl, I've wanted one for so long.
My jihad complete, I want to move on to BF, but this new world is too interesting to Darling Daughter. The nurse takes her. MW suggests a push to deliver the placenta. I push; there is a big gush. "Well, that wasn't the placenta," I think. A few minutes later it plops out with a small push. I wait while the MW sews up my 2nd degree skid mark. The early hour catches up with me, I'm getting sleepy. DH asked, "What do you want to call her?" "Huda," I reply firmly. Huda, meaning guidance from Allah.
If you had asked me immediately after the birth if I wanted to do that again, I would have said NO! But by 2 weeks postpartum I was not only ready, but excited at the prospect, in spite of all the monitoring....
It was important to me to see how well my body could perform, given the chance. I've seen I'm not broken, and it's beautiful.
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.]
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.
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.
Jennifer T's Story (PROM, group B strep, induction, vaginal birth)
Kmom's Notes: This mom was empowered enough to seek out different care during her pregnancy. If she had stayed with her original OB, it's likely she would have had a MUCH different experience. Even after switching, she was "risked out" of a birth center birth because of her size. Not all birth centers do this, but some do because of the strict protocols they have to abide by through the hospitals they are associated with. It's a shame, because supersized moms may need the hands-off approach even more than most women do in birth.
Jennifer did interview a homebirth midwife during her pregnancy and ended up using her as a doula (labor support) during her hospital birth. This probably really helped a lot. Next time, though, she plans to just hire the homebirth midwife and stay at home!
Birth Story
I knew I was pregnant fairly early on since my periods are quite regular and I have ovulation pain. As soon as the test was positive, I called and made an appointment with my family doctor. He confirmed I was pregnant and sent me to an OB/GYN. I mentioned to him that I wanted to use a midwife and he told me the OB/GYN used midwives, so I decided to give him a try.
My experience with that doctor was absolutely horrendous. My blood
pressure registered pretty high, but I attributed that to the fact that a) just before the visit I had found out my mother-in-law was STILL smoking in
the house even though we had told her not to, b) I had to stand during the blood pressure measurement because they only had a college desk/chair
combo to sit in and my butt wasn't going to fit, and c) the nurse did it wrong. It was the most painful blood pressure measurement I've ever had. She
got the cuff inflated and then let a little air out, then inflated it more, let some out, etc. She did that about three or four times.
Then she had to stand on her tip-toes to see the numbers. So, my reading was quite high, but it probably read much higher than it should have. The doctor
freaked out and told me my blood pressure was high and I would have to see a perinatologist. I didn't even know what that was at the time, but I did know
that my blood pressure hadn't been a problem before. I told him this several times and said we should get
ahold of my records from my family doctor. He ignored me and started the scare tactics,
saying I was high-risk and I'd have to give birth at one of the high-risk hospitals and telling me that I didn't want a stillbirth or anything bad to
happen.
There were other problems with that office, such as the fact that they did not believe me when I told them I couldn't remember my last
menstrual period, but I did know when I ovulated. They were going to send me for an
ultrasound to check the dates. They also did not have a gown that fit (or at least they didn't bother to find one for me), which
didn't bother me that much except on principle. What did bother me was that the doctor did the exam (not very gently) and did not leave to let me get
dressed, but instead talked to me while I was just covered with a sheet. Oh, wait, he didn't really talk to ME, he talked to my husband mostly!
Needless to say, I did NOT go back to that doctor. I wrote a very nasty letter to them explaining why I would not come back to that office. I got a
call and an apology from the office manager. I thanked her for reading my letter, but told her I was going elsewhere. That is how I ended up with a
certified nurse-midwife at a practice with a birthing center.
The new practice was much, much better, though not without problems. I got on the scale once and it didn't register because I weigh more than 350. The
nurse asked me how much I weigh and I told her I honestly don't know. She seemed surprised and asked me if I was sure. I shrugged and said I just
didn't know. That was it for weighing me. The first visit went really well. My husband and I heard the heartbeat (I was about 11 weeks along at that
point) and talked about the birth center and how it is for low-risk women. We were pretty excited, assuming we would be giving birth there. However,
between visits I got a letter from my insurance company saying I was pre-approved (or whatever they call it) to go to the hospital for those two
days around my EDD. I thought that was suspicious since I was going to use the birth center. So at the next visit I was going to ask about this letter and
ask very specific questions about what low-risk meant. I started by asking what kind of things would mean someone couldn't give birth
at the birth center. Our CNM was quite uncomfortable at this point and indicated that I was at risk for PIH and GD due to my weight and family
history. I asked if I would use the birth center if I did NOT develop those complications. I kept asking questions and she finally said that I was not
going to be able to use the birth center because of my weight and those risk factors. I was very disappointed and depressed after that visit.
That week I called a homebirth midwife (an LM). I had been interested in homebirth
in the beginning, but somehow had let people talk me out of it. I did some
more research into it at this point and was very excited at the prospect. However, my husband was not willing to do a
homebirth with me. So for several months I was very angry about the decision about the birth
center and a bit angry with my husband regarding the homebirth. We kept seeing the CNM and planning on the hospital birth, though. My blood pressure
was fine. The only time it was high was the visit after we found out about the birth center decision. I planned to confront our CNM, but I wimped out.
They took my blood pressure and then made me lie on my side for 15 minutes so they could take it again. It was fine after that and every other
time after that. I did the test for GD twice, which I know they do not make everyone else do. I agreed to do it twice because of my family history. Each
time my blood sugar was just fine.
In other words, I had a very easy pregnancy. My worst problems were some pubic
symphysis pain around 5 months and some sciatica during the last couple of months, which went away after the baby
dropped. I also had heartburn a bit those last few months. I never had morning sickness or any of the usual complaints and my ankles only swelled
when I ate lots of salty foods during the day.
The decision about the birth center still bothered me because I knew that it was simply based on my weight and nothing else. This really hit home when we
started taking classes at the birth center. One of the instructors started the class by telling us how wonderful the birth center is and she'd never do
it any other way. Then she went around the room and I said we were going to the hospital. She was surprised and said something about how it sucks when
you HAVE to go to the hospital. When we left that class I was in tears and was very angry about the whole thing. We discussed the birth center decision
with one of the CNMs (our usual one was on vacation) and they claimed that I was at risk of having a big baby and of bleeding out more than normal. I
still wasn't really buying their reasoning, but talking about it did help with the anger. We also called the homebirth midwife back. My husband agreed
to meet with her because he saw how upset and mad I was about the whole birth center issue. So we met with her and we were all set to do a homebirth. By
then I was about 36 weeks along. The next week they did the test for Group B strep and I tested positive. We did some research and read a lot about it.
We talked to the homebirth midwife and eventually decided to do it at the hospital because it didn't seem to be worth the risk. If I could have found
a nurse or someone who would do an IV at home, then I would have done it that way.
The homebirth midwife offered to act as our doula, so we took her up on that offer and it worked out wonderfully! I ended up being induced because my
water broke and I had no contractions for 18 hours. I had planned to do a lot of the labor at home with our doula, but since my water broke and I had
the Group B, we went to the hospital. We got one dose of penicillin in and then left and got lunch and made some phone calls and all that. I would have
kept going to the hospital and back home, but apparently my veins are difficult to get an IV into, so I decided to just stay at the hospital. We
were there all day Monday with no contractions, just getting penicillin. At one point the CNM came and decided to make sure that it was amniotic fluid!
The test was positive, so we waited until the 18 hour mark. I was scared to death of the pitocin, partly because I knew it could make labor more
difficult and painful and partly because I didn't want that much intervention. No one explained to me that they were going to do the pitocin
the way they did. They started it around 1:00 AM at the lowest dose and increased it every half hour. My cervix was already around 2-3 centimeters
and about 85% effaced and the baby was dropping good, so the pitocin worked well. I didn't
start having decent contractions until around 5 or 6 in the morning. I didn't get any real sleep that night. The doula and CNM wanted to give me
some kind of pill to help me sleep, but they didn't explain to me that the pitocin wouldn't work right away so I decided not to take the pill. At some
point the next day (the exact timing is kind of a blur) our CNM came in and said that my bag of waters was a "high break" and she wanted to break the
bag of waters lower down. I agreed to that, thinking it sounded reasonable. That did seem
to help things along, although they discovered that there was meconium by that time.
Towards the end of labor the CNM wanted to put in the internal contraction monitor. I could tell that our doula thought this was a bad idea but she
didn't want to say anything out loud. She tried to keep me on the toilet for some contractions. I was almost ready to push at this point. I felt the urge
a little, but they said it was too early and that I was only about 7 cm dilated. I was in that foggy labor land, though, so I couldn't think of
arguments against the internal monitoring, so in it went. The CNM left, I think, but came back not too long after that it seems.
By the time they broke my waters, they discovered meconium. So a pediatrician was at the birth. Our CNM wasn't there when I started pushing,
so the nurse was telling me not to push. At first I was doing what they told me, but even through the fog I knew that the pediatrician was there, that a
nurse and a LM were there and that it was safe to push. I even argued my case and said it wasn't my fault that the CNM wasn't there. I am amazed that
I was able to think clearly enough to work through that because I was quite out of it from the endorphins and from being so tired. I was worried that I
would be too tired to actually push and do that part since I basically had not slept in two days.
So I started pushing before the CNM got there, but she did make it for most of the pushing and the delivery.
[I only pushed for a little more than an hour, and if I remember correctly, once
his head was out the rest of him came out with just one more push so shoulder
dystocia was definitely not a problem despite the fact that he was a good size
(I just don't think that 8 lbs. 10 oz is a BIG baby....just a nice size!)]
After the delivery, I did bleed out a bit. [Kmom
note: Bleeding excessively is one of the risks of induction. Also,
the midwife pulled on the cord to get the placenta out, another risk factor for
bleeding.] They gave me a shot of pitocin in my thigh and then a shot of something else
that starts with an M in my arm. I would guess that the pitocin didn't end up in my muscle in my thigh because of the amount of fat there. I was really
out of it because of the lack of sleep and the blood loss. I was on pitocin all night, but was released the next day. We were home less than 24 hours
after he was born.
I didn't get to nurse right away because of the meconium. Also, the baby was pretty jittery when he came out, so they tested his blood sugar. It was high
and they decided to give him some formula through the tube (he was intubated to check for aspiration) because they thought his blood sugar was going to
drop. I suspect that they were concerned about his blood sugar because he was over 8 pounds. They kept checking his blood sugar, but after the second
or third time (it was sometime after I felt better too) I asked if it was normal and the nurse said yes, so I told her not to test it anymore. We had
also asked to NOT do the vitamin K or the eye antibiotic, so I just had to sign the waiver for that.
So I didn't get to nurse right away, but I did get to nurse within the first hour thanks to my doula. She was awesome! The nurse had swaddled the baby,
but my doula took that off and put him to me skin to skin and showed me how to get him on the breast. I ended up having some breastfeeding problems
because my milk came in pretty late (day 5 or 6, but he seemed ready for it on day 3!) and then it wasn't quite enough. So I pumped and took some herbs
and worked him up to nursing 10-12 times a day. We also had to supplement a bit, but only for a few weeks. He didn't have any nipple confusion, luckily
enough. He was really good at his part! [Kmom note: One of the post-partum
effects of bleeding a lot after a birth is anemia, which can affect milk
supply. Fortunately, they seem to have resolved it without any permanent
damage to her supply or breastfeeding.]
I also had some problems with latching because of my breast size and my belly, but we worked those out with the help of a lactation consultant. The side-lying position works really really well, but with a modification----instead of tummy to tummy, his legs are up by my head. The tummy to tummy is working better now that his head is bigger, but it wasn't working when he was a newborn because there's just too much breast tissue above my nipple and he couldn't breathe. I think that is the most important thing I learned from the LC. I don't think I would have figured that out on my own. At this point Aidan is 5 months old and we still primarily use the side-lying position but other things are starting to work, too. None of the cradle positions seem to work, though.
[The birth center was a big disappointment, partly because I did expect midwives to be much more supportive. I think the issue is mostly an insurance liability one. They were worried about me having a big baby and having a shoulder dystocia. At one point they did mention that and said something about how there wouldn't be enough manpower at the birth center if dystocia was a problem. Of course, that's probably because they use the knees to chest maneuver instead of hands and knees to resolve the dystocia. One of the midwives did tell us that if the birth isn't textbook, people get transferred to the hospital. I'm not sure if she was saying that to make me feel better or if it's true, but I suspect that they risk people out at the drop of a hat, both during pregnancy and during a birth at the birth center.
Next time we are definitely working with the Licensed Midwife (homebirth midwife). She is awesome. I had more rapport with her after a 5 minute phone call than I had with the CNM the whole time.]
Jenni M's Story (PROM, spontaneous labor, easy vaginal birth)
Kmom's Notes: Jenni probably did so well in having a normal birth without complications because her doctor did not push her into induction, let her labor while walking and with mobility, did not push her into having an epidural "just in case," and because she had a special labor nurse who acted like a "doula" for her. Eating right, exercising, and taking care of herself also helped her be healthy going into labor.
At one point it certainly appears as if her baby might have had a minor malposition---she had a lot of labor pain, her labor stalled, she made very little progress for a while, but then suddenly she had contraction after contraction and baby was born shortly thereafter. This sudden change of progress often happens when the baby's position corrects itself (baby moves hand away from its face, baby straightens its head, or whatever). We may never know if she truly had a malposition, but the clues certainly suggest she might have had a minor one that resolved fairly easily. Because her nurse helped her be mobile, this probably also helped any possible malposition resolve.
Please note that Jenni is one of the bigger mothers on this FAQ, not quite 400 lbs. Her story shows that even very large moms can have normal pregnancies and births, especially when their doctors/midwives leave them alone and let them labor spontaneously, give them special support during labor, and encourage them to be mobile and to labor without drugs. Not all big moms have the opportunity for that because of complications, but whenever possible, outcomes do tend to be better in big moms when labor is spontaneous, mobile, and natural.
Birth Story
It was my due date. I had the usual discomfort of being that far along, including loose feeling hips and some swelling in my feet (it was July and HOT). It was a Sunday and I couldn't bear the thought of work again on Monday, as I had worked right up to then. So my hubby and I went walking around the local mall and grocery store.
Once we got home contractions were about 8 minutes apart. So I took a shower and cleaned up around the house. Lo and behold, my water broke! I called the doctor and he said to go to the hospital. It was around 7 p.m. when we got there and contractions were about 5 minutes apart. So after I was checked and it was determined that I was only about 1 cm dilated, we walked the halls of the hospital.
We walked intermittently until midnight, and then the contractions were becoming harder and more frequent. I had an open mind about the possibility of an epidural and wanted to talk with the anesthesiologist. This was the only time I got any negative vibe about my size. He told me that there might be some difficulty with placing an epidural because of my weight, but that he thought he could do it and was willing to try. I told him I would let him know when and if I was ready. I was only at 3 cm by this time.
I labored through the night and there were times when I felt like I was panicking, but we got through them by thinking back to the childbirth classes and practicing those breathing techniques. Just when I felt like I couldn't take it anymore and was ready for an epidural, in walked the nurse who was the instructor of those classes. We labored together and I seemed to stop progressing. So, the dream nurse took off the blood pressure cuff and we tried a variety of different positions to keep me feeling in control and somewhat comfortable. There was still no change in my cervix and they were talking about pitocin until about 6:45 a.m.
Then all of a sudden it was one contraction after another after another. When she checked me, I was at 9 cm, fully effaced and ready to go. I felt a tremendous urge to push and did so regardless of the advice not to, assuming we still had a long ride to go.
The doctor was taking his sweet time to get to the room, and a nurse literally had to grab him by the arm and pull him into the room. He gave me the okay to push, and it felt so good to finally be able to legally push that I sure gave it my all. After only 10 minutes or so, my daughter was born, completely healthy.
I did not have the opportunity for a midwife, but the dream nurse was a savior. By all means, if you can, get a midwife to coach you through the rough spots.
Do not believe them when they say that you will have complications because of your weight. If you eat right and exercise like everyone should, you have the same chances as anyone else for a normal, fulfilling birth experience.
Tami's Story (posterior baby born vaginally at home; postdates homebirth)
Kmom's Notes: Pregnancy #1: Tami worked up until her due date and had no complaints. They used a fetoscope only (no Dopplers). Did have a Glucose Tolerance Test, which was normal. No other testing.
Note that the first baby had difficult establishing bfing. Although many factors can be responsible, it is not unusual for many posterior babies to have more difficulty nursing at first, or to have long-term colic problems. Chiropractors theorize that this is due to cranial and neck trauma during the birth in a less-optimal position. Many women have found that Cranial Sacral Therapy or gentle chiropractic work (done by someone TRAINED in treating newborns) can often help in this situation.
In her second pregnancy, Tami had no testing at all during the pregnancy. Fetoscope only was used, except for using the Doppler while in the pool during active labor. Tami also notes that she nursed the first child through the second pregnancy.
Birth Story
Link to birth story #1: www.visi.com/~jlb/homebirth/micah.html
Link to birth story #2: www.visi.com/~jlb/homebirth/naomi.html
Kmom special note: Tami has great pregnancy/baby photos and even a short movie ("It's a girl!) on her website!
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