by KMom
Copyright © 2000-2006 KMom@Vireday.Com. All rights reserved.
This FAQ last updated: January 2006
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
CONTENTS
Many women over the years have requested a section for birth stories of plus-sized moms. Large women come into pregnancy with so many fears and body issues that reassurance that other large women have indeed done this is important. Pregnancy books and most websites do not fulfill this need; mostly they are filled with warnings not to get pregnant until you lose weight, dire predictions of disastrous pregnancies filled with complications, or horror stories designed to scare you into compliance.
Although there are many birth stories online, most are of women of average-size. While these are also important to read, many large women have longed for a collection of stories of plus-sized pregnancy---normal births, complications, special births, just plain births---warts and all. It is important for us to see that many of our large sisters have traveled this journey before us. Therefore, Kmom has put together a collection of BBW birth stories over the years.
Because of her own experience with gd, she particularly started collecting GD birth stories as well, and these have been separated into a separate collection, found here. Not all involve BBWs; some are from average-sized women. It is hoped that these will offer information, cautionary tales, examples of the widely varying treatment given to gd women, but most of all encouragement to gd moms everywhere. Being diagnosed with gd can be emotionally devastating and cause great anxiety; these stories are proof that there may be more choices within this condition than you would think, that you CAN cope with gd, and that your baby CAN be born healthy. Hang in there!
More stories will be added over time, so keep checking back if you are interested. Unless specifically requested, all identifying information has been removed or changed to protect the privacy of the participants. In a few cases, Kmom has edited the stories for clarity, brevity, and format (significant changes are indicated by brackets), but most stories are told in the exact words of the mothers. All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
How To Submit Your Own Birth Story
Note: All GD moms, whether plus-sized or average-sized, are welcome to submit their stories. Please follow the following directions carefully, as follow-ups and clarifications take a great deal of time away from Kmom's family. Kmom's family will thank you!
If you would like to submit your birth story, you can email kmom at kmom@vireday.com with your birth story. You need to fill out the format in order to provide some basic information, then include your simplified birth story (please be fairly succinct in order to save space on Kmom's website!). If your story already appears elsewhere on the web, feel free to fill out the format and give a basic summary of the story, and then submit the link to your page. It is also vitally important that you explicitly state permission in your email for Kmom to use your birth story on this website and/or in any future publications (such as a book or magazine article on plus-sized pregnancy).
Kmom welcomes all types of stories, including wonderful empowering births, 'average' birth stories, so-so stories, and horror stories of disempowerment or assault. All types of birth stories have lessons to teach us. Kmom particularly wants to collect stories of beautiful, natural vaginal birth in order to contradict the popular medical viewpoint that large women cannot have a normal birth experience---too many books contain only the scare tactics of how 'high-risk' our births must be. Large women can and DO give birth normally all the time, and often without medication or other interventions! Being large does not have to mean lots of intervention or unusual care. If you have a wonderful birth experience, please take time to share it with other large moms so they can be inspired! (Notice that the largest section of stories in this FAQ is the collection of vaginal births!)
However, large women also experience horror stories in birth, just as average-sized women do. These experiences should also be heard. In addition, some large women definitely experience fat-phobic care, and these experiences need to be documented so that cautionary lessons can be learned from them. Therefore, Kmom strongly urges women with these types of experiences to share them as well. These are often difficult to write about, but many women find that the writing begins the healing process. This has been Kmom's experience as well. Starting the writing is the hardest part, but the more you write and speak of it, the more healing takes place. Unresolved grief stays in the body and often harms us further. Getting it out is the first step on the path towards healing.
Regardless of how wonderful or not-wonderful your birth was, the exact moment-by-moment details of labor are less important to portray than what kind of treatment you experienced, helpful hints for pregnancy, what helped you prepare for labor best, the emotional processing you went through for pregnancy and birth, lessons you learned, etc. Think about what you would most like to tell other women from your experience, what would have been most helpful to you to have heard when you were pregnant, what the main lessons from your experience were, what you learned as a large woman, etc.
If you wish to submit your birth story, please fill out the following format, explicitly give Kmom permission to use your story, type in your story (no attachments please), and edit it to see if you have filled everything in and corrected any errors (please do this, it saves time for Kmom!). Feel free to use a 'pen name' or initials in your story in order to protect your privacy. Unless specifically requested, most personal information is usually changed or deleted.
Birth Story
Type in your birth story here; no attachments please!
Then email your story to kmom@vireday.com and mark it 'birth story'. Kmom reserves the right to edit and add commentary to the stories. Check the website every few months; Kmom will periodically update and insert new stories in the FAQ as they accumulate and as her toddlers permit! At times this will be every few months, and at times this may be only once or twice a year, so please be patient.
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.
GD Birth Stories: Diet-Controlled GD
Karla B's Story (diet-only gd, vaginal birth)
Kmom's Notes: Note that Karla was 'allowed' to go to 41 weeks before facing a mandatory induction, although that was easier because her baby was of average size and she did not need insulin in the pregnancy. However, even so, it's unusual for gd moms to be 'allowed' to go to 41 weeks, but this story shows that there ARE providers out there who are open to this if this is important to you.
As far as losing weight after gd goes, proof is small and mostly speculative, not definitive. Certainly, Kmom strongly agrees that ALL women with gd should improve their diet and exercise levels; if this helps you lose weight, great! For some women, losing weight probably will help and does make sense. However, for some women who are chronic yo-yo dieters, yet another diet may make things worse. Losing weight should not be pursued regardless of the price (i.e., drugs or weight loss surgery often introduce more risk than they alleviate), but it certainly IS an option worth considering. However, individual circumstances and dieting history must also be taken into account. For some women, maintaining a stable weight while improving diet and exercise may be a more sensible option. For others, losing weight is probably most sensible. More on this debate will be found in the upcoming section on GD: Future Risk of Diabetes.
Birth Story
I'm happy to say I had an easy and uneventful pregnancy. At my first visit, my midwife said not to worry about weight too much, as most women seem to gain the amount that is right for them. She also explained that many women who are overweight before getting pregnant often don't gain a lot during pregnancy, and sometimes even lose a little weight. I never had any morning sickness, but during the first trimester my appetite wasn't great so I didn't gain a lot of weight. The only way that my weight really affected my pregnancy was that I sometimes had to remind them to use the larger cuff for an accurate blood pressure reading.
Around 24 weeks, I failed the one hour GTT and was referred for the three hour. I failed that too and was diagnosed with gestational diabetes. At this point I had only gained about 9 pounds, and later learned that low weight gain can be a symptom of gestational diabetes. While I was very upset to be diagnosed with GD, I decided that there were worse things that could happen in pregnancy, and that I was going to learn as much about it as I could so that I could be effective in managing the condition. The first thing my midwife said to me after I was diagnosed was, "You know you did nothing to cause this, right?" I was so relieved to hear her say this, as I had been having thoughts like, "I should have lost more weight before getting pregnant" and "Did I eat too much sugar?"
I was happy to find out that I could still work with a midwife (with occasional visits to an OB), and that I could have a healthy, enjoyable pregnancy and delivery despite GD. I learned how to test my own blood and was put on a special diet that was tailored specifically for me. I never felt deprived on the diet, and in fact sometimes had a hard time eating all the food that I was supposed to. I had very few food cravings after starting the diet too, which was a relief since I feared having to deny my cravings for sweets. During the first week of the diet, I lost a couple of pounds, but then gained them back and stabilized at a 9 pound weight gain. My dietitian expressed a little concern that I wasn't gaining weight, but my midwife wasn't worried since she knew I was getting adequate calories and nutrition. I also found out from my sister (a dietitian herself) that many GD moms don't gain any weight after starting the diet, but if they continue to lose weight, they should see their dietitian to add extra calories. I feel that as a result of the diet, drinking lots of water, and not gaining much weight, I managed to avoid some of the common complaints of pregnancy, such as swelling and constipation. I was even able to wear some of my regular clothes (mainly tops and knit pants) throughout my pregnancy. In fact, looking back, I felt better during the 2nd and 3rd trimesters than I did before getting pregnant and than I have since having my baby!
As my due date neared, I worried a little about having to be induced or have a c-section. My midwife assured me that my clinic did not routinely induce GD moms before their due dates, so that was a big relief to me. I enjoyed some of the extra attention I got (such as extra ultrasounds and hearing the heartbeat during non-stress tests). I told my midwife that I'd rather not be induced if possible, and she shared my opinion. She felt that many women are induced too early, and since their bodies aren't ready, they labor longer and harder and then often end up with a c-section. But, she said the fact was they wouldn't be able to let me go for too long because of the diabetes. She consulted with one of the OBs, and they decided that since my GD was in such great control, they'd give me a week past my due date before they would induce me. I've since learned this is pretty unusual for GD moms, so I was quite thankful for their willingness to work with me.
I also talked with my midwife about the possibility of my baby having low blood sugar and needing glucose water. I planned to breastfeed exclusively and wanted to avoid any artificial nipples. She said that if the baby did indeed have low blood sugar, I would be able to breastfeed to try to resolve the problem. Only if breastfeeding didn't resolve the problem would they consider giving glucose water. This news was also important in making me feel much more relaxed and confident about my birth plan. I'm glad my midwife and I talked about these issues, and even more glad that she and I agreed on all the things that were most important to me.
The day before I was supposed to be induced, I went into labor around 2:30am. I went to the hospital around 10:30am. The nurses and the midwife on call all seemed very impressed that I had only gained nine pounds, and they kept commenting on how great that was. I spent most of the day walking or in the tub, and the midwife spent several hours with me, helping me through contractions. Unfortunately, I had "screamers" in the rooms on both sides of me, and while I tried to ignore them, it did make me anxious about what was to come. Thankfully, I managed to deal with my contractions pretty well though, and had no medication for most of my labor. Sometime around 5pm, we decided she would break my water, at which point the contractions became much stronger and closer together. She offered intrathecal morphine (the "walking epidural"), and I decided that I would accept it (although I had been terrified at the thought of having a needle in my spine!). I went from 5cm to 10cm in less than an hour, and when I announced the intrathecal morphine wasn't helping anymore, they told me that's because it was time to push!
I pushed for 50 minutes (but it seemed like 5 minutes). Shortly before my baby was born, they asked me to turn onto my side and got out the oxygen mask because the baby's heartbeat was dropping. I never needed the oxygen since moving onto my side was enough to resolve the problem (but it turned out the baby had the cord wrapped twice around her neck). The midwife suggested an episiotomy because she feared I would tear into my urethra. I agreed and she made a small incision. Within a few more contractions, my baby girl was born at 6:45pm. She was just perfect, and was only 7 lbs 13 oz (not bad for a 41 week baby of a GD mom). (They had predicted 8.5 lbs at my 40 week appointment, so of course I had visions of a 9.5 lb baby!). She didn't have any blood sugar problems and took to breastfeeding like a pro.
So, I'm happy to say from firsthand experience that plus size women can have easy, healthy, and enjoyable pregnancies. Even though I did have a complication that labeled me high risk, it was something that was very manageable, and in the end it didn't have a negative effect on my pregnancy, labor, or delivery (and in fact I'd say it even had a positive effect in making me healthier than I would have been otherwise). Thanks for letting me share my story, and I hope it helps other plus size moms (especially those who develop GD) to feel better about their situation.
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."
Stacy's Story (3 pregnancies; gd + ketones with 3rd; 3 c/s)
Kmom's Notes: Stacy's extreme problems with ketones in gd are unusual. So was the level of calories she needed to have normal levels. Most gd moms are given around 2000-2200 calories; some docs restrict obese gd moms to 1500-1800 calories but this raises the danger of ketones and brings up whether the mother is adequately nourished at that level. However, Stacy ended up with the highest caloric totals I've ever seen for a gd mom---2800 calories! She also had to stop exercising to stop the ketones; this is very unusual. However, her ketones had probably become so out of whack previously in the pregnancy that such drastic measures were needed to stop them. Fortunately, her providers did measure them regularly (not all do) and experimented till they found what worked best for her. They didn't simply apply a uniform protocol, which helped a great deal.
Birth Story
I was diagnosed with GD at 28 weeks. With my other two pregnancies I had failed the 1 hour glucose test, but passed the 3 hour one. Not this time. My fear for the health of the baby and being absolutely terrified of blood tests, wreaked havoc on my emotions. I was determined to do everything possible to avoid insulin injections, even though I knew that it may be inevitable.
First, a little history. This was my 3rd pregnancy. My first baby was born when I was 29 years old. I was a dress size 20 when I became pregnant with him and gained less than 5 lbs during the pregnancy. (Not because I was trying to not gain weight, I ate very normally. My body simply didn't gain weight.) At 32 weeks gestation I noticed that he had become suddenly a lot less active. (Thank God for the doctor recommending counting kicks early on.) I went in to see my OB and was put on a fetal monitor immediately (non-stress test). The baby was having dips in his heart rate. They rushed me to a local hospital that had a more advanced neonatal ICU. As soon as we arrived there, his heart rate took a drastic plunge and he was born by emergency C-Sec. within minutes. He is now a perfect, simply amazing, brilliant little 6 yr. old.
Baby number 2 was born 14 months later. My dress size was still a 20 but I had gained about 10 lbs since the first pregnancy. Again, with this pregnancy I gained little weight. I was not diagnosed with G/D but once again I had failed the 1 hour blood glucose tolerance test and then passed the 3 hour test. On his due date, after 14 hours of labor, the baby went into fetal distress and was also born by an emergency C-Sec. His situation was totally unrelated to his brother's. He was born with a rare skull bone abnormality, that was corrected by surgery when he was 2 months old. But because of that problem, his head was simply unable to pass through the birth canal. He is now a perfect, hilarious, brilliant little 5 yr. old.
Ok, now back to baby number 3. With this pregnancy I was 35 years old and had again gained about 10 lbs since the last pregnancy I was now a size 22. At the beginning of the pregnancy, after much discussion with my OB, I decided to have a planned C-Sec. this time. Once I made that decision, I was completely relaxed about the rest of the pregnancy. We also decided at that time, that this third child would be our last, so I planned to have a tubal ligation at the same time. The decision was made long before the GD diagnosis.
After being diagnosed at 28 weeks, I began the diet and exercise program given to me by the doctor and registered dietitian. I stuck to it to the letter, but something wasn't working right. My ketone levels were registering "high" everyday. I had been very inactive due to an accident I had been in for a few months prior to and throughout my pregnancy. So, not only was I a plus size person to begin with, but my metabolism was certainly not normal either. Although, like many large women, I had gained almost no weight up to this point in my pregnancy.
Within 2 weeks of starting the diet/exercise program I had lost 8 lbs. At first the dietitian and doctor told me to not worry about it since many people lose weight when they begin the program. My blood sugars were all fine. But then when they saw my ketone levels they decided to take action. I figured that my body was just in so much shock from actually exercising, that it just couldn't help losing weight. I cut the exercising down to 5 minutes after meals.....and they raised my caloric intake to first 2500 calories.....then to 2800 calories.....and then finally to 3000 calories per day. Finally my ketone levels went down to "small" and "trace" readings, but I was still losing weight. With the agreement of the dietitian, I stopped exercising altogether. In my case, that worked. I stopped losing weight, had no ketones, and by just lowering my calories back down to 2800, my blood sugars stayed within normal range. I was able to control everything without insulin injections. Yippppeeeeee!!!
At 38 1/2 weeks my daughter was born by C-Sec., healthy, weighing 7lbs 5oz.and was 19 inches long. A planned cesarean is a LOT more relaxing than an emergency one. (Although, due to my fear of blood tests, as mentioned above, I was MUCH more fearful of getting an IV than the surgery itself. Go figure.) Everything went as planned to the letter. It was almost comical, shaking the doc's hand and saying "OK, now go get my baby." It was incredible, magical, wonderful. I was given a spinal block and had no ill side effects from it. For some unknown reason, the baby's blood sugar was low at birth. It registered 29 which was well below the hoped for reading of 40 or higher. My husband was handed a bottle of formula and he fed her about an ounce of it right away. Her blood sugars came up to normal and have remained that way ever since. I was a little concerned that she might not want to latch on to me after trying a bottle nipple first, but she latched on like a pro on the first try, a couple of hours later. The baby did not have any shoulder dystocia any other troubles associated with GD or anything else, for that matter.
It was a lot of work, but very much worth it, and I have a whole new understanding of my body and my metabolism. My emotions went through typical upheaval after her birth, but I think that was probably due to lack of sleep as much as due to hormonal fluctuations. I am now slowly adding exercise back into my daily routine and am amazed at the difference it is making in me both physically and emotionally. My boys like Richard Simmons better than Big Bird. Ha Ha ;)
Michaele's Story (gd, induced vaginal birth)
Kmom's Notes:
Birth Story
I was 36 and this was my first pregnancy; we conceived the first month of "trying". I had a pretty easy pregnancy, although I'm overweight I'm pretty active and the swimming and bicycling I did during pregnancy really helped I think.
I had morning sickness and fatigue for the first 16-17 weeks, and I was diagnosed with GD and mild anemia at 27 weeks which was controlled by high protein, low-carb diet for the remainder of my pregnancy. I ended up taking the HMO Lamaze birth classes. I didn't bother with a birth plan since the hospital where I delivered had most of the things I wanted (like pro-breastfeeding, immediate bonding, no episiotomy, etc) as standard procedures.
Now for the birth story! Because of the GD my OB wanted to induce labor, so I chose a date and hoped against hope that I'd go into labor before that. But the morning of the chosen date rolled around and off we went to the hospital. Although I was ready, I was absolutely BAWLING my eyes out in the car because I was so disappointed that I hadn't gone into natural labor, but excited because I knew I'd have my baby soon!
We go to the hospital around 8 AM and my OB broke my waters and hooked up the internal fetal monitor, then I was given an IV and they started the pitocin drip. I was about 2 cm dilated and my cervix was soft so they didn't use any gel. The next several hours were pretty boring, I couldn't go anywhere except the bathroom and I couldn't eat anything although I was allowed to have water, juice, and tea. DH and I read the newspapers, did some crosswords, watched TV, and listened to music (I had brought a CD boombox to the hospital with me). I spoke to the anesthesiologist about pain relief options and decided to go with an epidural later if I needed it.
By about 2 PM I was really feeling the contractions and did some breathing and moved around as much as I could to find a comfortable position, at around 5PM (about 9 hours after labor started) I had them insert the epidural. I had a "light" epidural which was GREAT!! I could still walk to the bathroom and I could pee on my own throughout. I didn't ever have them deaden the pain completely. Honestly the thing that hurt the most was the DAMN automatic blood pressure cuff--YIKES!! DH was absolutely wonderful throughout, keeping an eye on all the monitors that I was hooked up to, doing some breathing with me, etc.
Anyway I was about 5 cm dilated at this point and I knew I still had a ways to go. They had been upping the pitocin all along and I was lucky that my body was responding well. The one "problem" that occurred during the next five hours was that the external contraction monitoring belt just wasn't easy to position well on my stomach so they opted to use the internal contraction monitor. So I ended up with yet another tube, this one goes in between the baby and the uterine wall and it HURT LIKE HELL during contractions.
I'm not sure when exactly transition started but it was the most uncomfortable part of my labor. Although the contractions weren't very really painful, I had a hard time relaxing in between them and my whole body would tremble. But before I knew it, the OB came in and checked me and said "time to push!"
At this point I'd like to make a plug for the L&D nurses at the hospital--I was there for three shifts and every nurse I had was just GREAT. I started pushing right after a shift change and the last nurse I had was absolutely terrific! Anyway at this point they turned down the epidural and the pitocin and I started pushing away. DH was a huge help here, counting during my breathing, and providing resistance against my legs. The nurse let me use any position I could think of--I pushed on my back, on the toilet, on my side, standing up, squatting, with the bar--you name it!! It was one of the most difficult things I've ever done physically. After about 2.5 hours of this I finally figured out an effective position (which was lying on my back with my feet pushing against the bar--absolutely contrary to any recommended position) and at 1:20 AM out came my beautiful little girl!! I had a small 2nd degree tear and came through labor much more easily than I expected to.
I held her immediately and made my first few attempts at nursing while the OB stitched me up. There is really nothing more amazing than meeting your baby for the first time!
Joann's Story (contradictory gd testing, changed doctors, normal vaginal birth)
Kmom's Notes: This mom was not given the proper instructions for the gd test, which made her question the results when they came back just over the cutoffs for 'gd'. She retook the test at 30+ weeks, this time following the proper guidelines, and this time she passed the test. Her doctor did not want to believe the second test. Because of that and 'hospital policies', she had the guts to switch doctors at 36 weeks. She did still monitor her eating and her blood sugar levels, and gave birth to a normal-sized baby without any problems or any pain meds.
Birth Story
My only instructions for the 3 hour test were to not eat anything after dinner the night before. I happened to have an early dinner the night before and got to the clinic later than I'd planned---leaving me with a fast of over 17 hours. Nothing was ever mentioned about carbo-loading either. I barely failed according to the NDDG cutoff values (4 points too high on the 2 hour reading, 5 points too high on the 3 hour reading).
[Kmom note: A too-long fast can artificially elevate fasting results, create ketones, and throw the whole system out of whack. It is a big stress on a pregnant woman's system. Carbo-loading's value is controversial; some research seems to show it makes no difference but many midwives swear by it in order to prepare the pancreas to respond adequately to such an intense load of sugar. At this point, it's probably better to err on the side of caution and do carbo-loading ahead of time.]
I found the information and courage needed to ask for a retest (following the 'rules' this time). The new test showed I did not have GD even though this retest was taken 3 weeks further into my pregnancy than the previous test (I was over 30 weeks for the second 3 hour test). I still watched my diet for the rest of pregnancy but was very thankful to get the GD label off the pregnancy, especially because of all the interventions they wanted to do.
Unfortunately, my original doctor ended up not believing the retest (he was on vacation when the results of the second test came in), and still wanted to treat me as GD. He did agree to letting me go up to 41 or 42 weeks before inducing as long as the non-stress tests (starting at 37 weeks) were fine. However, because of other reasons (mainly hospital policies), we decided to switch hospitals and doctors at 36 weeks.
My new doctor knew about the test results but did not freak out about the first one. The baby did not appear to be too large---I had not gained an excessive amount of weight. He would induce at 42 weeks and wanted non-stress tests twice a week starting at 40 weeks. I was eating healthier, avoiding too many carbohydrates, eating more protein, etc. I did still monitor my sugar levels for a few more weeks (until the batteries in my glucose monitor died---it took me a week before I finally got to the store and found the right batteries and by then I was out of the habit and only tested a few more times).
While I was testing my fasting sugar levels never got over 95 and rarely got over 120 after meals (they were only high when I'd obviously overeaten on tortillas or rice). I noticed that after I quit testing my stress level went way down. It was so much easier for me to just focus on eating healthy rather than focusing on making sure I "passed a test" with every meal.
I ended up having a baby girl five days after my due date. She was 8 lbs. 7 oz., and I did not need any pain medication during labor. She was not a small baby but definitely not a huge baby either (my grandmother gave birth to my uncle who was an 11+ lb. baby---that's huge). The baby's blood sugar was just fine--I don't know if they ever checked mine. Her Apgars were 8 and 9 although she did spend some time in the nursery due to her breathing being a little irregular because one nostril was blocked. The nostril has corrected itself now and she's doing great.
I do understand that diabetes is a serious illness and I have a much greater appreciation for those who deal with this all the time. I plan on continuing to eat healthier, especially when the time comes for baby#2. Hopefully, we will avoid all of this the next time.
Kmom's 1st Story (diet-only gd, induction, c/s)
Kmom's Notes: It's difficult to be objective about one's own birth experiences, but with many years behind me, I can see that this pregnancy was a call to healing. I was very scared, had no information about plus-sized pregnancy, was treated as high-risk by nearly everyone due to my size (though they were deceptively nice about it), and was undergoing major life transitions at the time. Although I did some pregnancy reading, I didn't do enough, had few resources for questioning what I was told, and behaved like a compliant 'good little girl' ought to. It took a horrendous birth experience to shake me out of that pattern. Although I cannot be glad for that experience, it certainly did set me on a different life path, started a great deal of valuable soul-searching and healing, and I can honor the learning and change that has come from it. And of course, I got the most precious baby in the world from it!
Birth Story
My first child was conceived during a period of great stress. I was very unhappy with the changes in my job, was working very long hard unhealthy hours, had too many extra activities, was deep in grief for my father who had died the year before, and was not being as healthy as usual in eating and exercise habits. To top it all off, just as we found out I was pregnant, my husband was laid off.
Although the pregnancy was a surprise, we welcomed it and were excited, if a tad worried about insurance coverage and plans. Then I began spotting, which continued off and on throughout the whole first trimester. This forced me to re-organize my life, drop my extra commitments, stop working so hard and long, and take time to just rest. It also meant no exercise. After a while, the OB agreed to do a vaginal ultrasound. This eliminated ectopic pregnancy, a significant worry, but it wasn't clear whether there was one baby or two. A further scan two weeks later showed only one baby. Thus the bleeding might have been a 'vanishing twin', low progesterone levels, or simply the random spotting that occurs in many pregnancies at first. We'll never know.
The doctor did not treat me meanly but did nothing to alleviate my fears, telling me (incorrectly) that my chances of miscarriage were 50% (they drop down once a heartbeat is seen), and was not very encouraging about my chances. She did no testing on Hcg numbers or progesterone levels, which could have told us a lot more; I think she basically wrote me off as a miscarriage. But she came highly recommended and was one of the few accepting new patients in the area, so I didn't complain.
I experienced very significant nausea, but she told me "not to worry" if I couldn't eat because "the baby would take what it needed." The plan I was given was low on protein and very high in carbs. Between erratic eating due to nausea and the low protein/high carb food plan I was given, I developed a pattern of wildly swinging blood sugars and ketone levels that would take 7 months to straighten out, and quite possibly added into my own insulin resistance and stress levels to cause my gd. Ah, hindsight! She did send me for a one-hour gd test in the first trimester, which was borderline. I then passed the 3-hour GTT (which made me shaky and sick); no further nutritional guidance was given. I believe that had I only been given some instruction in gd food plans at that point, I probably could have avoided the gd, but nutrition is not a high priority for most OBs.
Once I reached the second trimester, the spotting stopped, we relaxed, and I began really bonding to the baby. We took the AFP test without really understanding it, and when it came back low, we were devastated. No counseling was provided by the OB; a cold phone call from a nurse was all we got. We were sent for genetic counseling, which was terrifying because I am adopted and have no family history to fill in. It turns out that the reason the test was low was either because my cycles are long (making the baby younger than they thought), or because heavy women tend to have lower levels due to a larger circulating blood volume and they did not correct enough for that. We had an amnio, which was very painful (story in prenatal testing section). The doctor was very cold and unkind and blamed all the problems on my size (probably untrue). I experienced bleeding and cramping afterwards, and spent a horrible Xmas waiting for the results and wondering if I'd miscarry. After bonding so strongly with the baby during the bleeding scare, this was really awful.
When the results came back fine (it was a girl and healthy!!), we rejoiced and thought we were home-free. Not so. My husband was transferred to another state, and we had to leave our jobs, get the house ready to sell, and find a new house VERY quickly. Talk about stress! And during all this, I had to take my next gd test. It too was borderline, so I took the 3 hour GTT again, but no one gave me any guidelines on it, so I took it while I was sick and TOTALLY stressed in my last week at work. Not surprisingly, I went over the cutoffs this time. I had to do treatment and try and adjust my diet as we moved, but after moving my numbers became normal with care.
I was devastated to have gd, felt like I was being put on a 'diet' again after years of freedom from dieting stupidity, and humiliated that I had a 'fat person's disease.' I was also scared about what having gd meant to the baby and the birth, and scared because I was not given a lot of information about gd. However, at least I managed to get my numbers under good control quickly.
I really wanted to find a midwife practice in my new town, but was told I needed an OB due to the gd (not true). I chose the OB that seemed extremely personable, would not automatically induce at 38 weeks, and had a great bedside manner. The ultrasound predicted an average-sized baby so I was 'permitted' to go to term, but he wouldn't allow me to go beyond 40 weeks. We induced on a long hard unripe cervix, and I spend the night before writing a good-bye letter to my daughter because I had a bad feeling about it all. Sure enough, Dr. "Right" turned out to be "Dr. Jekyll and Mr. Hyde" in labor, and the birth as a result was quite traumatic. Being "nice" is not enough.
We did two doses of prostaglandin gel, then started the pitocin the next morning. Labor was easy to handle at first, especially since I was allowed some walking and rocking until the doctor broke my waters at noon (I was 2 cm dilated and she was at a -2 station; breaking the waters when she was not engaged in the pelvis was contraindicated and potentially dangerous but he didn't tell us that). At that point I was not allowed out of bed, and once the cushioning bag of waters was gone, labor became excruciating.
The baby was quite probably in the wrong position, which is what probably caused all the pain, but Lamaze breathing was NOT capable of handling this kind of pain! We tried IV meds before finally resorting to an epidural. In this case, the epidural was a blessing and allowed me to finish dilating, even though it was not fully effective and had a 'window'. By about 17 hours into labor, I was fully dilated and ready to push. We pushed for 2 hours with no progress. She stayed high (-2 station) and unengaged. Even with epidural left, I felt tremendous pain on one side of my back, another indication of position problems. We used stirrups for pushing; I asked to try squatting. But this did not budge her either; she was stuck. I was exhausted by the 'purple pushing' by then, and requested the c/s.
The next part I will leave out, but basically the booster epidural for the c/s did not fully take either. I felt the surgery. A lot. It was a horrendous experience, deeply deeply traumatic. I'll leave out the details, but it greatly affected all of us and has taken many years to heal. The hospital staff ignored it as if it never happened.
My baby was taken to the NICU nursery, given formula even though her blood sugar was fine and they knew we were nursing, and she was given a pacifier. Although my husband tried to be with her, he wasn't sure what to do with a newborn and was concerned about me, so my baby was basically abandoned for hours, something I will always mourn. It was 8 hours before I was permitted to try nursing her, and she developed jaundice between the gd, the pitocin, and the lack of nursing (all risk factors for jaundice). However, the good news was that despite the difficult birth and terrible c/s and separation, the minute I saw her we bonded like insta-glue and were deeply connected.
That was good, because nursing was very difficult at first! Traditional positions made me very sore (only the football hold worked well), she had many bottles of formula and glucose water at the hospital, and the jaundice and drugs made her extremely sleepy and unresponsive. She narrowly avoided needing treatment with bili lights; the nurses and doctors told me to use glucose water to 'flush out the jaundice' but I have since found out that this actually tends to increase jaundice. Between the c/s, the bottles, the lack of frequent nursing, and the severe edema I had from the pitocin and IV fluids, my milk did not come in for many days, but increasing the nursing seemed to help somewhat. Eventually we were able to slowly eliminate more of the bottles. I was too proud to see a lactation consultant, but eventually we managed to work out nursing despite everything. After a month and a half or so, we were fully nursing. It was very healing to finally have something work the way it was supposed to!
We had a very difficult start, from her very stressful pregnancy to her difficult birth. She developed a roaring case of diaper rash, then had 4 solid months of colic as her body struggled to cope with all the stress, drugs, formula, etc. I have since been told also that many babies that are malpositioned frequently experience severe colic (craniosacral therapy is supposed to help). However, at 4 months, a switch magically flicked and she became the perfect baby! Nursing went well and was very healing for us both. Although I never really intended to nurse beyond 3-4 months, we mutually decided to continue for over 4 years, including through her baby brother's pregnancy. I think the nursing really went a long way to healing the difficulties of her pregnancy and birth. She eventually weaned of her own volition, and I am very glad I didn't force the issue, since she seemed to really need it. She is a very healthy, smart, and active little girl now, and I love her deeply.
The pregnancy was a tough one, but it ultimately lead to a lot of healing and changes. I lead a much less stressful life now, have worked hard on emotional healing, have taken up exercising again, and although I do not diet I am careful again about what I eat and how it's timed. By being much more proactive about diet and exercise, I have been able to avoid gd in subsequent pregnancies, despite my age. I also am MUCH more careful about the health providers I select now, and am assertive about researching health care decisions. In many ways, I am a new person now, born through the fire and difficulty of this pregnancy and birth, and although I would never have chosen these experiences, I can value the healing and growth that has come from them. But sometimes I do mourn the peaceful and joyful pregnancy and birth that was taken from me by circumstances and insensitive providers!
Postscript: Kmom subsequently had a baby boy 2 years later. She avoided gd in that pregnancy, although she very carefully measured her blood sugars every day anyhow, even after passing the test. Though her blood sugars were under much better control, her second baby was larger, 9 lbs. 11 oz. and 21.5 inches long. This is apparently just genetic for her, not related to blood sugar after all. She eventually found a good set of nurse-midwives in this pregnancy and labored mostly spontaneously and all-naturally---a non-induced labor is MUCH easier to deal with! However, the baby was posterior, which went undiagnosed and unfixed, so the baby got stuck. After 5 hours of pushing, she had a repeat c/s (this time with a spinal!); as c-sections go, this was a 'good' one.
Kmom had another baby 3 years later. She also avoided gd in that pregnancy, despite being near 40, though she was careful to measure her blood sugar throughout as a precaution. Although her blood sugar was normal in this pregnancy too, it was a bit more borderline than in the second pregnancy. Yet despite this, her third baby was only 7 lbs. 9 oz. Obviously blood sugar levels don't seem to influence her babies' sizes. This one was probably smaller because it was induced a little early and he took after her husband's side of the family (7 lb. babies) instead of her side of the family (9 lb. babies), though who knows for sure! She had a VBAC in this pregnancy, despite 2 previous cesareans. Most OBs would probably attribute this to the smaller size of the baby, but Kmom feels it was because THIS baby was positioned anterior instead of posterior. She feels she could probably birth a much bigger baby vaginally as long as it was positioned optimally. But she was happy to have a VBAC whatever the reason.
Finally, four years later, Kmom had another baby girl. This time she chose a home birth with certified midwives, after careful research into the pros and cons of birthing outside the hospital. Again she monitored her blood sugar to ensure it remained normal; it did, despite Kmom being well over 40 by now. In this pregnancy, Kmom chose carefully which tests and interventions she felt were justified, and avoided the automatic testing so common in pregnancies of older moms. Having a home birth with midwives helped her have a truly relaxed and less stressful pregnancy. This baby went "overdue" by quite a bit, so it was a good thing her midwives were relaxed and laid back! Kmom's fourth baby was eventually born in the water, at home, in a lovely and safe birth. Surprisingly, this baby was 10 and a half lbs.! Not because Kmom had "gd" but because she was finally allowed to labor truly spontaneously and went to her natural pregnancy length without being forced or encouraged to labor early. Note that Kmom's second VBAC baby was a pound bigger than her c/s babies, and 3 lbs. bigger than her first VBAC baby, so obviously baby position was much more important than baby size after all!!
Kathy F's Stories (diet-only gd, arthritis, premature vaginal birth)
Kmom's Notes: This was Kathy's 5th child; some of her other pregnancies were not plus-sized ones, while others were. She also had a 'glorious' homebirth with baby #3; this story can be found in BBW Birth Stories under "Vaginal Births Under Special Circumstances".
Birth Story
Baby #5: I am extremely fertile; had our first four children in 4.5 years in my early 20s. We conceived again years later while trying to prevent it; we were thrilled anyway because we wanted more children. I did not seek medical care until the 5th month. From my earlier pregnancies I knew to take a good quality supplement with folic acid and I knew the warning signs of problems and had none, so I wasn't concerned.
Finally chose an OB in my 5th month, saw her several times. At first she seemed great, but then I was diagnosed with gd. The fiasco of her care after that was unbelievable to me. She did not get the diagnosis to me in a timely manner, delayed getting me to the dietician and then sent me to one my insurance didn't cover, didn't call in the glucometer prescription in a timely manner, etc. At that point I was so disgusted with the lack of decent care I realized all my trust had been destroyed and I was NOT going to let this woman deliver my child.
The OB I switched to is wonderful! The best I've *ever* been to. Wish I'd been with him from the beginning. I switched at 34 weeks and they were hesitant at first to take me, but by the time I told my story they took me on. I saw my new OB twice, once in the middle of my 34th weeks at which he does an ultrasound himself in his office. Everything was good. My b.p. was relatively normal, 130 or so over 85-90, nothing to be concerned about. [Kmom note: Some doctors would be concerned at this b.p. but this doctor was not.] The gd stayed controlled well with diet alone. My weight had continued to gradually drop, especially after being put on the GD diet. I was given a 2300 calorie diet, which gave me more than enough to eat and plenty of energy. I ended up losing 30 lbs. I asked my new doctor if my weight loss was a concern and he said no. The baby had been growing fine, ws a good size, and the lost weight was only a sign that I was eating right. If the baby wasn't growing normally, then he would be concerned.
[Kmom note: It's not unusual for large gd moms to lose weight in pregnancy. Doctors vary in their concern over this; some view it as a sign of something wrong, some want you to be losing weight, and some simply judge it on whether or not the baby is developing well. HOWEVER, any gd mom should be checked for ketones in the urine on a regular basis---particularly a gd mom who is losing weight. Strong weight loss or lack of gain can be a sign of ketone problems, which can potentially damage the baby. It's very important for this to be checked on a regular basis in gd or whenever a mom is losing weight in pregnancy. This mom was not checked for ketones and she should have been.]
I have Psoriatic Arthritis (PA), which is a rheumatoid-like arthritis accompanied by psoriasis, a skin condition noted for its red scaly patches. During a large part of my pregnancy, my PA went into high gear. My abdomen was covered with one enormous psoriatic patch that gradually migrated to my back. There was nothing that could be done for it. The medications they use for severe PA are dangerous for the baby, and cortisone creams only took the edge off the burning and itch. I found that an extra-virgin cold-pressed olive oil worked better than the standard creams for relieving the P. It didn't go away until the temperature climbed past 80-85 degrees F, normal behavior for my P (mercifully, this comes early where I live). In my 3rd month, I strained or pulled a ligament in my groin which never completely healed and only continued to worsen throughout the pregnancy. I didn't know it at the time, but I know now that this was due to the PA. My hips have been arthritic for several years but it hadn't spread until this pregnancy. This kind of arthritis also affects ligaments as well as joints and the strain on my lower abdominal ligaments was excruciating for me. At the end of the fourth month, I went to the mall to pick up something and had constant contractions the entire time. It was so severe I had to stop walking and just stand there until my uterus relaxed. I stayed away from malls and extensive walking after that. Eventually I couldn't walk or stand or even sit for more than 5 minutes at a time. By the time I went into labor, I was in pain in every cell of my body, slept only fitfully, and was extremely uncomfortable to to say the least.
Also, in my 7th month, my hay fever kicked in as it always does at that time of year. I developed allergy-induced asthma, so my family doctor consulted with my OB and gave me an injection to clear up the asthma, with the happy side-effect of developing the baby's lungs a little early. This turned out to be beneficial because I went into labor at 36.4 weeks.
Labor began at 2:30 a.m. with the loss of my mucus plug during yet another middle-of-the-night visit to the bathroom, with contractions intermittent until about 6 a.m., when they steadied to 8-10 minutes apart or so. We called the OB around 8 a.m., then my MIL (whom I had also asked to attend the birth). We were at the hospital and admitted around 9 a.m. They were wonderful labor support. Contractions were not quite steady, fluctuating between 5-10 minutes apart until noon, when they settled into a 5 minute pattern. At around 11 a.m. I realized I'd gone too long without food and requested milk and crackers to bring my blood sugar levels up a bit. I knew that the baby could go into shock and die in utero if my blood sugar levels dropped too far, especially because I had had a stomach flu the week previously, messing up my diet and blood sugar levels. I had not gotten back on track with a good balance before labor began. I knew this was a cause for concern from my personal study about gd.
My water broke spontaneously at about 2 p.m. and contractions became stronger. Dilation progressed normally through all this. I was at 4 cm when I was admitted, at 5-6 at noon, and at 2:15-2:20 p.m. I was 8 cm. I've been able to handle the labor pains by thinking of riding them as waves (as before). My husband sits by me or stands with me during this. I hang onto his shoulders and lean into him, letting him support my weight while he reaches around and applies pressure on that one spot in my lower back/pelvis region where I feel all my labor. This works better than any pain killers. I have never had an epidural, although I was tempted this time. I'm not quite as resilient at 34 as I was at 24. :-)
By 2:45 p.m. I realized I was ready to push from past experience. I never have felt the "need" to push the the pregnancy books describe. Instead I have just one long contraction. The pain reaches a peak, subsides, but only to a half-way point compared to the previous contractions, then goes back up again. This continues for 10 minutes before subsiding for about 30 seconds then starts again. This was my "sign". I told the nurse what was happening and what it meant. She immediately went into action. She checked me and said, "Well, you sure know your body!" I was indeed ready to go. The doctor had come in about 15-30 minutes before to check me and see how I was doing. He was called back and was there in moments. I was impressed with the cheerful efficiency of the staff, as it was shift-change time. There must have been four or five nurses there due to the change-over. It was like watching a well-rehearsed ballet, the way they all worked together. My doctor was incredible, and the nurses behavior toward him showed me even more how well-liked and respected he was by the staff. Everyone received the same respect and kindness from him as I did. Truly a gentleman, as well as an outstanding OB.
I pushed for 3 minutes (I was watching the clock!) and my daughter was born at 3 p.m. straight up by the room clock, but 3:02 by the official time. She just whooshed right out with only 2 or 3 pushes. I did not have an episiotomy and there was no tearing. Apgar scores were 9,9. I asked the nurse to please check her blood sugar level early. Labor had been 12.5 hours long, and I was worried. My instincts were right on, because her glucose level was at 22. Below 40 for babies is dangerous. I asked if we could just give her a bottle and wouldn't that take care of it? The nurse said yes and handed me a bottle to feed her. While I intended to nurse, I knew that my milk wouldn't be in for a day or two. The only alternative was an IV for the poor mite. I preferred the bottle to a needle!
[Kmom note: Actually, there is another alternative. Formula can be given by non-bottle methods so nipple confusion becomes less of an issue. Finger-feeding, syringe feeding, cup feeding, etc. can all be used to give a baby that needs supplementation some help without risking breastfeeding. This baby needed extra supplementation or IV glucose, being so low and particularly from being a preemie and from a mother who had been ill and thus had unstable blood sugar. But babies that are more borderline can be nursed FIRST to see if that brings up their glucose enough. Before the milk comes in, colostrum is secreted, and that is high in protein, which helps stabilize baby's blood sugar more than sugar-water does. If baby still needs more help, supplementation can then be offered by finger-feeding, etc. This baby DID need to be supplemented, but most gd babies do not need it, especially if the mom's blood sugar remains stable beforehand.]
Recovery was completely normal. I will say this----my third birth was at home with a midwife and this hospital birth rivaled that one in excellent care, as well as respect toward me and my wishes. It stands side-by-side with my homebirth as a glorious birth experience.
This baby was definitely premature and nursing was a real struggle. My nipples were too big for her little mouth, and she was unable to draw down enough milk. By the time she was 2.5 weeks old, she hadn't gained back any of the weight she had lost in the hospital. Her doctor was willing to let her go another week but I wasn't. I made the decision to give up nursing and begin bottle-feeding. This ended up being a very good choice for us because by the time she was five weeks old I had gone into a full systemic flare-up of PA, with extreme pain in every joint in my body, and could not hold her for more than a minute or two. The joint pain gradually lessened until I was in complete remission 6 months later. She is now a thriving and healthy one year-old, and has had only one ear infection in that time. I have opted not to immunize at this time, due to the psoriasis she has already started (my only child with this) and her premature birth status. The psoriasis indicates a possible immune-system problem, and I'm taking no chances.
And I've recently learned through an ultrasound that I'm 13 weeks along with TWINS!! :-) These will be our last children, I think! I intend to attempt breastfeeding again. Hopefully with a nursing pillow we will succeed, even if the PA flares up again. (See Kathy F's Twin Story down below!)
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.
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.
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.
Eve B's Story (diet-only GD, all natural vaginal birth)
Kmom's Notes: With GD and a big mom, the doctors all worry about a giant baby. Some give very restrictive diets as a result. But it's important to note that sometimes being too restrictive is not good for the baby either. Most GD babies, even those of big moms, are still "average" in size. Overly strict control can restrict fetal growth in some women. Now, no one will ever know if this is true here.....perhaps this mom just naturally has small babies, no matter how she eats. But the baby's appearance at birth suggested that perhaps some growth restriction may have happened. A lesson in the importance of moderation, especially in the face of very borderline GD results.
Birth Story
From the beginning, I was determined to have my child naturally. My husband and I took early Bradley Method classes, and followed the daily guidelines for exercise and nutrition, swimming everyday and eating plenty of protein. At 31 weeks, I took the 1 hour GD test and failed with a 146. I wasn't too worried about it, and neither was my doctor as though I am overweight, I am otherwise healthy, eat right and exercise everyday.
Two weeks later, I took the 3 hour test. I failed the first test with a 96, and then failed the second test with a score in the 180s. (I passed the last two with very low scores.) My doctor diagnosed me with GD, and it was a huge set back to my positive frame of mind. I thought I had done everything right and really started beating myself up. Like it was my fault. Like already I was a horrible mother. She put me on a 1800 calorie diet and wanted me back in a week to check my monitoring results. In one week on the 1800 calorie diet, I lost 8 pounds. My doctor didn't like that at all and jacked my diet up to 2000.
I was religious with the glucose testing. Testing four times a day, sometimes more even when she said I could back off a bit. I followed the 2000 calorie diet, but if I still felt hungry, I would always have more as I was afraid of not eating enough protein for the baby. The GD was a huge emotional strain for me. I felt embarrassed and guilty about everything I ate. I swam laps every morning for 45 minutes, plus I would walk ever night after dinner for 30 minutes or more. I didn't touch one thing with sugar, and measured all of my portions. My numbers were consistently normal, I scored high in less than 10% of my daily testing. Even when my numbers were high, my morning numbers were never more than 98 and my 2 hour after meal numbers never more than 135.
I was terrified that I would have to be induced.... or have a c-section.. or have a a so-called "fat" baby... so I followed everything to the letter. I was hungry for information, but found no adequate resources on GD except for this website. It would be an understatement to say that I obsessed about it, and for a large part of the end of my pregnancy, the GD caused me to be stressed, worried and unhappy.
At around 37 weeks, my doctor guesstimated the baby would weigh in at full term at about 8 lbs 2 oz which I was thrilled about. The Bradley Method is clear about not restricting your diet so you can have a big health baby, so 8 pounds was exactly what I wanted.
I went into labor at 39 weeks. My labor and childbirth were text book and absolutely perfect. I was able to have a perfect natural childbirth that went amazingly fast. I had no drugs of any kind. No IV (or even a saline hep lock.) I had no fetal monitoring other than twice when the nurse put a hand held monitor on me for two minutes each time. I went into labor at 7pm, was at the hospital around 4am at 4cm. Was at 8cm by 6am and was pushing by 7am. I only pushed for 21 minutes and the baby was born with my waters intact.
The big surprise came when the baby came out. At 6 lbs, 1oz and 20 inches, he was far from small, but what you would call skinny. The first words out of my doctors mouth were, "Somebody looks like his Mommy has been on a diet." I was totally shocked.
In the days that followed, there were some complications with breast feeding because of his size. He lost the initial weight, but because he was so small, his doctor was worried about him and ended up having us supplement and at one point even return to the hospital for an overnight. In the days that followed, I have continued to struggle with breast feeding because of the initial supplement.
I have become somewhat bitter about the whole GD thing. We will never know if his low birth weight was due to my GD diet, but I can't help but feel like if I had eaten the whole milk yogurt and ice cream and other goodies as the Bradley diet suggests, he wouldn't have been born with such a low birth weight and thus the ensuing chow issues. Not that I would have used it as an excuse to eat with abandon, but I would have skipped the no carb yogurt and Wasa crackers. It makes he hesitant to trust another GD diagnosis if I get pregnant again.
In the end, I am just happy that he is healthy and that I can throw out that damn glucose monitor!
GD Birth Stories: Insulin-Dependent GD
Laura's Story (insulin-dependent gd, induction, vaginal birth)
Kmom's Notes:
Many gd moms find that their blood sugar starts to drop near the end of pregnancy; if they are insulin-dependent, their insulin needs may drop as well (it's important to watch for hypoglycemia if that happens). Traditionally, doctors have taken this as a sign of placental calcification and degradation in 'regular' diabetic pregnancies, and therefore view it as a sign for immediate delivery by induction or c/s. However, it is unclear whether this is truly a sign of a placenta in trouble or not, and especially if the same concerns for 'regular' diabetic pregnancies apply so strongly to gd pregnancies.
One alternative explanation for a drop in blood sugar at the very end of pregnancy is the alteration in hormones that occurs as the body readies for labor. GD is caused by insulin resistance from 5 different hormones produced by the placenta in pregnancy. One of these is progesterone, which tends to peak at week 32 or so and has a very strong effect on blood sugar. However, at the end of pregnancy, the relative balance between estrogen and progesterone changes dramatically; progesterone levels drop significantly in order for the cervix to start ripening and softening for delivery. It seems logical therefore that a gd mom's blood sugar might experience a significant dip as this very strong hormone begins to decrease in the last week or so of pregnancy.
However, few doctors seem to know of or consider this change in hormone balance, and since sudden placental failure is a significant danger of regular diabetic pregnancies, most OBs understandably tend to err on the side of caution. At this time, it is unclear what a drop in blood sugar/decrease in insulin needs means at the end of a gd pregnancy; unfortunately, few doctors seem to be even asking the question or trying to find out.
Also note that Laura had a doula for her induction; although research on doulas during inductions is limited, we know that they help cut the c/s rate by about 50% in non-induced labors, and one small study seems to indicate that they also cut the c/s rate in inductions very significantly as well. Although Laura had to be induced, she was as proactive as possible about it, which probably helped increase her chances at a normal vaginal birth.
Birth Story
Birth story (with photos) can be found at www.deleons.com/birthstory.htm. Below is a brief summary.
Laura developed severe gestational diabetes during the pregnancy and needed insulin to help control her blood sugar levels. Her OB wanted to induce no later than the beginning of week 39, but they were able to negotiate going a few days beyond that so as to be closer to her due date. They did a great deal of research, including a trip to the local health library, in order to be sure that the induction was necessary. They concluded it was because of the severity of her gd and because they were worried about the potential degradation of the placenta (her insulin needs went down at the end of pregnancy and one possible explanation is the placenta degrading, a real risk with regular diabetic pregnancies).
She wanted to go into labor on her own. In order to help things along, she had lots of sex and also took Evening Primrose Oil (EPO), both by mouth and vaginally [both of which tend to help production of prostaglandins]. She did not go into labor ahead of time but these things may have helped prepare her better, since she was already 3 cm dilated when arriving for her induction. She also chose to discuss her preferences on induction with her doctor, and adjusted her expectations of labor to include monitoring and potentially more intense contractions, and possibly needing medication (although she still wanted to avoid an epidural).
They chose to break her waters first, then start the pit later. They found some meconium present. She also needed antibiotics after having tested positive for Group B Strep. They called in their doula after about 4 hours or so. She helped Laura get a bit more mobility and various comfort measures going, and as contractions got extremely intense, they opted for some Fentanyl. Eventually they decided they needed an epidural, but as they were putting it in, discovered she was at 9 cm. Shortly afterwards, she pushed out her baby!
Breastfeeding was difficult at first (see the related story on her website) but eventually they were able to overcome the obstacles and breastfeed long-term.
Suzanne's 2nd Story (insulin-dependent gd, natural vaginal birth)
Kmom's Notes: In her second birth, despite developing insulin-depending gd, Suzanne had several things going for her. Her first baby was born vaginally and naturally, making a vaginal birth this time more likely. She got good control of her blood sugars, plus a supportive set of providers (and when she found an unsupportive one she switched!). Her baby was average-sized, which makes them more willing to give a trial of labor. She had a midwife and doula for her birth, both of which tends to cut the c/s rate significantly, and she was able to use water for laboring as well as a standing position for pushing and birth. But SHE was the one who did it, and admirably too!
Birth Story
(Suzanne's first birth story can be found in the BBW: Normal Vaginal Births section. Essentially it is a wonderful natural birth.)
My second pregnancy and birth were totally different from the first. It took 2 years and 16 cycles of trying to conceive #2. I ended up with a diagnosis of PCO and treatment using clomid to stimulate a follicle, Hcg shot to cause ovulation, then Intra-Uterine Insemination. I found out Dec 23 that I was pregnant. What a wonderful Christmas present!
I started getting morning sickness at about 6 weeks and continued with it until I was 25 weeks along. Then I was diagnosed at week 28 with gestational diabetes. I was shocked and found that my caregivers were all working from scraps of paper and seemed unsure of the acceptable glucose levels. I called around and finally got in touch with an endocrinologist and he assured me that they were following the standard of care. I ordered a book on GD and read up. That helped put my mind at ease. Then I had a goal to reach.
I started testing my blood 4x a day, fastings and 2 hours after each meal. I also would test extra times if I was curious or was feeling a low blood sugar reaction coming on. So I would test 4-8x a day. These are the numbers that we used:
They sent me to a nutritionist who was useless. The diet she put me on...contained too many carbs in each meal and too much food overall. When I cut out all but one carb exchange (~18g) per meal I could almost control the daytime glucose numbers. That turned out to be too little food for someone in later pregnancy. They also lump in the management of fat and salt along with management of carbs and I did not have a problem with fat and salt. The whole regimen seemed to be geared to the elderly and didn't seem to apply much to me. I refused to limit my fat and salt intake (I was losing weight for-goodness-sake!); I did not have a problem with my blood pressure. I was sane about it, but did not limit non-carb foods. I consulted a friend of mine who is a nutritionist and she helped me to choose more whole foods and food combinations That was they key to keeping my numbers good. I began walking .8 mile per day, with a second walk if my numbers were off.
But I lost 12 lbs. in 3 weeks and my fasting glucose number first thing in the morning could not be changed by diet and exercise. So I had to take insulin. I started out with one shot in the evening but that didn't work. Then they had me on a shot in the morning and one in the evening. They also combined regular insulin (fast-acting) and a slower-acting type (NPH). I would load the syringe and take a pinch of flesh near my belly button, poke the needle in at an angle then inject the insulin. It is not as bad as it sounds; the poke doesn't really hurt, but the insulin makes the area of the shot sore for a little while. I had to watch out for low blood sugar reactions, which I had often (shaking, sweating, disorientation). Insulin-dependent diabetics have to eat frequently and keep in mind when the insulin will hit. The dr. warned me that my insulin needs would increase as the pregnancy progressed but they did the opposite. My dosage decreased 2 times near the end.
Getting gd felt like my dreams of another natural birth were going down the tubes. I was referred to an OB who told me, "If you have an 11 LB baby it is an automatic c-section; unless you want to sign a paper stating that a paralyzed left arm [the baby's] is OK with you." She was trying to scare me of my birth but only succeeded in scaring me of HER. I asked this OB about how she would deal with a large baby and it was clear from her answers that she delivers women in the lithotomy position and usually anesthetized When I asked about positioning she said it wasn't quick enough. Translate that as: there is no way to get you onto hands and knees with an epidural. [Kmom's note: These interventions are thought by many to increase the incidence of shoulder dystocia and birth trauma/paralyzed arm the OB is referring to. One of the hardest parts of gd is distinguishing the true risks of the condition from the doctor-caused problems that come from standard management like this.} My midwife on the other hand has delivered 11 lb babies vaginally (not that I wanted to :-)) I wanted that OB to be as far from my birth as possible. (It turns out that this OB gives that same speech to all overweight moms. My feeling is that she is a fatphobe.)
I switched to a different OB who was great and had no problem with standing by just in case the midwife needed her. She praised me on my management of the gd and was not concerned at all that the baby would be too large. From 34 weeks on I did 2 non-stress tests (NSTs) per week and had an ultrasound at 38 weeks. Everything looked fine so I was able to keep my midwife with the OB standing by just in case. The OB was fine with monitoring my insulin and NSTs and letting the midwife do the rest. That was just right for me because my nightmare was to lose my chance at another natural birth. [Kmom note: See, you can too have a midwife in a gd pregnancy! And some midwives will co-manage even an insulin-dependent pregnancy if all is well.] I delivered 6 days before the due date. [There was no pressure from my doctor], she was cool. The baby showed up as 8 lbs two weeks before his due date and they found that acceptable. Also, I was not measuring larger than expected. My gd was very well managed.
My labor started at 8 am. I had 3 contractions in a half an hour. I called my support people and they soon started arriving. I used the same doula I had with my first birth so we slipped easily into the pattern of her helping with my concentration and relaxation. We hung out at the house while my contractions got more intense and closer together. A short walk around the neighborhood was helpful in the beginning but things got going very quickly. I did some contractions on hands and knees or sitting but most were standing and leaning. I breathed normally through the whole labor. We tested my glucose level every hour during the labor. The last test before leaving for the hospital showed low blood sugar and I ate a couple of glucose tablets. This saved me from having to have IV glucose because they didn't know what the dosage was on the tablets. No IV!
When we got to the hospital I was 6 cm and went directly to the tub. I felt the baby drop as I stood to go to the room with the tub down the hall, it felt so good! The contractions were hard but the time between them lengthened and the water made the labor seem like a breeze. I went through transition with a little shaking and burping, then I was ready to push. This is where may labor got really hard. I knew that it was too late for an epidural but I would have had one if it were possible. The rest of the labor was such a breeze that there was no way I would have asked for pain relief. There is no way that I would recommend having an epidural just in case it got bad later.
I got back to my room between contractions and couldn't bring myself to get on the bed. Physically I could have climbed on, but it didn't feel right. I had planned on helping Nicholas "out" and the midwife had agreed but when we got to the room I preferred to stand for the delivery so the midwife warned me that I wouldn't get my wish. I told her I didn't care. Consequently, I delivered Nicholas standing up with one foot on the floor and one knee on the bed. I yelled, "NICK! NICK! NICK! OUT! OUT! OUT!" One nurse, in her 50s or early 60s, was very concerned about me delivering standing up. The midwife told that that is how it was going to be. That nurse came in when she went off shift and hugged me and told me she thought I was "heroic".
I pushed for a while and when I checked for the head I couldn't feel it. I almost lost hope, but buckled down to business. Soon I could feel his head and knew it would be over soon. The midwife stood behind me and passed him between my legs within seconds of his birth. Nicholas was born "in the caul" meaning he had the amniotic sac over his head. The midwife had to break the sac and suction his airway. Nicholas was born at 4:28 PM after 8.5 hours of labor with about 2 hours of it spent at the hospital. I pushed for about 40 minutes. I had a small tear where an episiotomy would have gone, it took 2 stitches. Pushing caused a hemorrhoid that has healed completely. I retained a small bit of placenta which came out at 4 weeks postpartum with a gush of blood but no other problems.
Nicholas had to be fed formula every 3 hours for the first 72 hours because his pancreas was working overtime due to my gd and he had low blood sugar. I used a Supplemental Nursing System (SNS) with a thin tube going down to my nipple from the bottle of formula. I had requested this in my birth plan to avoid having problems with nipple confusion. [He nursed every 3 hours, and while he was nursing I slipped him the tube so he would also get the formula. They added some glucose water to the formula in the SNS because his numbers didn't rise enough at first. After the first 3 days, he has been 100% breastfed.]
My partner's sisters visited me later and I told them, "Get an epidural." I regret that now that the memory of the pain has faded. I am happy and proud that I have had 2 natural births. If I had it to do over I would not choose to use pain meds. Nicholas is 4 months old now. Since he was born everyone has commented on how alert he is. I think that he is alert because he was not drugged at birth.
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.
Bec's Story (insulin-dependent gd, induction, c/s)
Kmom's Notes:
Birth Story
My story starts with the fact that I was trying to get pregnant for about 3.5 years. I was able to get pregnant a few times, but miscarried. After one run-in with a fat-phobic doctor, I found a doctor who was willing to help me (350+ pounds at the time) get to the root of the problem. We never got a definitive answer, but worked on the premise that I have weak ovulation leading to a luteal phase defect (the time after ovulation and before next menses was too short). With the use of 100 mgs of Clomid on days 3-9, 150 IU of Fertinex on days 10-11, hCG injection on day 14, intrauterine insemination and sex on days 15 and 16, another hCG injection for progesterone support on day 21, and finally 50 mg of progesterone twice a day through the end of 14 weeks LMP.
I had some early scares because of bleeding, but was allowed frequent ultrasounds to check the baby. I was watched carefully throughout the first trimester, having many more appointments than the average patient, because of my recurrent miscarriages. At 16 weeks I was told I was officially an average patient and no longer considered high risk. I chose to do the triple screen at 16 weeks which came back fine and a level II ultrasound at 20 weeks revealed all was well.
I was diagnosed with gestational diabetes at 27 weeks. It wasn't a big shock since I was 33 and have a family history of diabetes, but what did surprise me is that my one hour glucose test came back at 217. I opted against taking the 3-hour GTT since my one-hour test was high enough to prove glucose intolerance, but my doctor did insist on a fasting level for confirmation.
I was given the choice of trying to control my GD by diet or with insulin. My doctor felt that insulin was the best control, and I did some research and found studies indicating a lower incidence of macrosomial infants when GD was treated with insulin. I had already been pretty much following a diabetic diet, so I didn't feel there was much adjustment that would help. I saw a nutritionist who only increased my calorie intake to about 2000 and frequency of meals, not the balance of what I was eating. A diabetic counselor taught me to monitor glucose levels at home, give myself insulin injections, and discussed walking and arm exercises to help reduce blood glucose levels. Between all of these things, I had the GD in good control within a week, and perfect control (levels under 100) for the rest of my pregnancy. My insulin levels were adjusted periodically, including adding a second smaller injection when my dinner levels were a bit higher than I wanted.
I think my main issue with GD is that I felt that I was on a very rigid schedule since I was supposed to test my fasting level and 2-hour postprandials (four pin-pricks per day) and eat every 3- 4 hours. I even had to wake up at 2 a.m. to eat a small snack so I wouldn't have ketones in my urine in the morning. I exercised after breakfast and after lunch everyday, and tried to do after dinner but was often too tired by then. I figured at least I would be in good shape for labor. Even with GD, I feel I had a pretty easy pregnancy and that I felt very healthy throughout.
I switched doctors at 35 weeks to a doctor/midwife team. While my previous OB might not have induced me for another week, the new one didn't want me going past 40 weeks with GD. We knew my exact dates and I felt more comfortable not going past my due date myself; I actually would have pushed the other OB to induce me at 40 weeks! My son didn't show signs of distress, but my insulin need was dropping, something that can indicate the placenta is beginning to fail. It was hard to find good information on insulin-dependant GD . . . most of what I could find was for insulin-dependant diabetics and being extrapolated to women with GD. My original OB didn't feel that it should be, and I agree.
At 39 weeks I had a vaginal exam with the intent of stripping my membranes. I was only fingertip dilated and 30% effaced, so that didn't happen. At 39w5d I was admitted to the hospital for prostaglandin gel applications to the cervix. I had some gel in the morning, did a lot of walking trying to get things going, and then had more gel in the afternoon. I went from fingertip to a bit more than one and 70% effaced. I also started to lose my mucus plug, but had few contractions. I was sent home at 7 p.m. and told to return the next morning for pitocin.
I'm not sure why I was being optimistic about the pitocin since I know it doesn't tend to work well before someone is dilated to 3 cm, but I guess I just figured I needed to labor, needed to get the baby out soon, and somehow it would work. Even the pitocin didn't do that much for me immediately, and it was restricting my movement since I was on a monitor and it wasn't cooperating; if I moved, we would lose the heartbeat. I really didn't want to be stuck in bed and it was very uncomfortable. It was pretty clear mid-morning that my perfectly positioned baby decided to move and give me back labor. Every time I had a contraction, I would get a sharp pain in my butt and down my leg. In the early afternoon I was thinking I would be unhooked and sent home, but all of a sudden I felt something akin to a balloon expanding and then popping followed by a gush of fluid; my water broke, and there was meconium in it. I was on the clock . . . baby within 24 hours.
I was at 3 cm and the OB put an internal monitor on me, something I hadn't intended, but appreciated since it allowed me some more mobility. The pitocin and IV insulin were turned up since my blood sugar was rising. The midwife was wonderful trying to help me find more comfortable positions and massaging my back. The best position for me seemed to be sitting up in a rocking chair. In the evening, I was so exhausted I decided that the pain might be discouraging progress, so I had a small dose of narcotics to take the edge off. It worked and allowed me to sleep between contractions which were 1+ minutes on, one minute off for hours. I was rechecked late in the evening after my son showed a few decelerations. I had not made any progress and was still at 3 cm. The OB said I might just be too small (based on my tiny feet and short stature) to birth the baby and I should consider a c-section. She would let me go another hour or so and check if I wanted, or we could make the decision immediately. Since a friend of mine had recently lost a healthy full-term baby, I chose to do the c-section. My son was born at 12:44 a.m. on his due date. He weighed 7 pounds 11.5 ounces, 20.5 inches long, and apgars were 9 and 9.
My biggest regret about the c-section was that I ended up so exhausted that I didn't really get to hold my son and nurse him until he was 9-10 hours old. I know the pro-breastfeeding nurses were upset with the anesthesiologist about it, but I didn't really understand why I wasn't woken. Maybe it was the meds. I also missed my son's first bath, but I have seen most of the firsts since then and that has helped diminish the pain I had from that (which did cause some post-partum depression). My surgical wound healed easily and my blood sugars returned to normal within 48 hours. I was released 3.5 days after having the baby and my staples were removed 5 days post-partum. After a rocky start, my son is still nursing at 20 months.
Pam's Story (PCO, insulin-dep. gd, placenta previa, c/s)
Kmom's Notes:
Birth Story
After 2 years of trying to conceive due to PCO, we got pregnant. I had all day morning sickness for 14 weeks. At that point I was diagnosed with GD. Despite diet changes etc, I had to go on insulin at 18 weeks since my fasting sugar levels wouldn't come down. I was also diagnosed with placenta previa (low-lying placenta) and told to take it easy for the pregnancy.
By 36 weeks I was told that my GD was controlled so well (baby was not big at all) and that the placenta had shifted enough, I was going to be able to have a vaginal birth. At exactly 39 weeks I started bleeding and since the baby hadn't dropped and I wasn't dilated or soft AT ALL, it was decided that an induction would be pointless. A c-section was scheduled for 3 hours later. I was comfortable with this choice.
I had an epidural, which the dr's had NO problems putting in. I was easily shifted from my bed to the OR table, even after the section when I was totally numb and couldn't help. I was awake and conscious for the section and my DH was right next to me. Despite the fact my placenta had broken apart and was hemorrhaging, my boy was born totally healthy and fine. Apgars 8 and 10. My arms were restrained by a blood pressure cuff and the IV's, so I couldn't move much, but the nurse freed my one arm so I could touch and caress the baby while DH held him.
Baby never left my sight until DH took him across the hall where I was being taken minutes later. I tried to BF an hour after his birth (the soonest they'd let me) and he wasn't interested. He didn't nurse well at all that day and he finally got a great latch the next morning. From there on in, BFing was not a problem, even on the inverted nipple. I had trouble getting him to latch for a few days, but that was due more to my inexperience and FF breasts. Once we got the hang of it, there was no problem (as long as I used the football hold exclusively) My milk came in by gallons on day 3 and we kept it up until I weaned him at 15 months.
My pain level was easily controlled with Tylenol 3's and I was walking around in less than 24 hours (in fact at 10 hours I walked (slowly and with help) to the bathroom). The staples were taken out on day 4 when I was discharged. I never had any problems with the incision. It healed over easily. By 4 weeks postpartum I was able to run and do pretty much everything. I stopped taking extra strength Tylenol after 10 days. My GD completely disappeared immediately upon delivery, and I've been healthy and happy ever since.
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.
Penny's Story (insulin-dependent gd, induced vaginal birth)
Kmom's Notes: Penny was not plus-sized until her first pregnancy. She states that she was anorexic in college and 'probably messed up my metabolism for life'. She had a difficult first pregnancy with pre-eclampsia and a lousy OB. However, this time she had a "beautiful delivery. I felt fulfilled and joyful instead of empty and victimized like I did when my first daughter was born."
There are several items of interest in this pregnancy. First, note the disagreement her endocrinologist and her OB had about her treatment, illustrating the point that consensus on treatment protocols is limited, even among those who regularly treat gd. Find a different provider and you may well hear different answers to your questions, or different treatment goals.
Second, note that her OB insisted on inducing labor at around 38 weeks "to avoid delivering a 9 lb baby". Her baby was born at nearly 39 weeks and was barely over 7 lbs. Had she gone to term as she desired, it is unlikely she would have had a 9 lb. baby anyhow. This shows the problem of predicting size, even in gd pregnancies. Predictions of size are off significantly nearly 40-50% of the time, according to research, yet strong interventions are often done on the basis of these shaky predictions all the time anyhow. It is questionable whether this induction was really necessary, but since she was insulin-dependent, standard procedure among many OBs is to induce at 38 weeks.
Fortunately for Penny, she had previously had a vaginal birth, making an induction more likely to work. Inductions are much less likely to work (and to end in cesarean) in women with no previous vaginal births (i.e., first-time moms or moms who have had only previous cesarean births) and in women whose cervices are not ripe and ready for labor.
Birth Story
I was anorexic in college long ago. It was a symptom of poor self-image (I was pear-shaped but not overweight) and a bad and controlling relationship (NOT my husband). Dropping 30 lbs. in 3 months didn't make the relationship better--but it did give me a slight heart murmur.
This may have caused a problem with my first pregnancy when I had pre-eclampsia. I was worried about it but too ashamed to tell my OB. I did go through a short spell in my first pregnancy around my 7th month where I obsessed about how much weight I was gaining (a lot). I cried a lot but never purged or did anything to lose the weight I was putting on during my first pregnancy. The first 4.5 months I was so nauseous I lost 10 lbs. But afterwards I was so hunger all the time that I ate for the rest of pregnancy like I was starved. I supposed that I remembered how much it HURT to starve myself in college and I didn't want to feel that pain again.
Anorexia is a difficult thing to put yourself through. To reach a level of control (or lower metabolism) where you are not hungry for long periods--you have to withstand WEEKS of not eating anything which is very painful to your whole body, not just your stomach. When you can no longer stand the pain (or you're forced to eat), anorexics will binge and then purge when alone. All totaled, I went through this cycle of anorexic (at school), normal eating (at home) for about a year. I went through it again (another bad relationship) for about 6 months eight years ago. Several months after I recovered, I married my DH who was my high school sweetheart. 3 months after we were married, I was pregnant with our first daughter. I never put myself through this ordeal again. Add to it that I never exercised and I was doomed to add on weight. [She put on a lot of weight between pregnancies.]
My first daughter weighed 5 lbs., 9 oz--she seemed very small. I was induced at 37.5 weeks due to my high BP and protein in my urine. I nursed her for 8 months. She's 6 now--and very healthy. I had problems with my first OB--the problem was not with fat phobia but with insensitivity towards my emotions. Fortunately, the OB for my second pregnancy was different, although he was in the same practice (the first OB had left the practice).
I don't THINK my anorexia has had any bearing on my second pregnancy or my GD. I tried to diet sensibly before I became pregnant for the second time but bad eating habits die hard. [With my second I knew I would eat better and exercise after I got pregnant---more incentive I guess. I did have problems with nausea and lost about 8 lbs the first 4 months. Afterwards, I slowly regained that and ultimately gained a total of about 9 lbs. I never kept track since I didn't want to obsess like I did the first time...Now my appearance is not my main concern, my family is.]
We tried diligently (ovulation predictors, temp-taking) to get pregnant for 6 months. Just as I was about to give up, we were blessed! My GP called (on his day off) to give me the results of the blood test. His wife/nurse gave me the name (and a glowing recommendation) of her OB. After reading Kmom's website and the info on finding a fat-friendly doctor, I went to interview my new OB. I went with a list of questions in hand. I was pleasantly surprised when he and his staff treated me like a normal patient. There were no groans from the nurses about having to get a larger BP cuff. There was no mention about my weight. When I asked he said we'd see if any problems came up and then talk about it. He was very open and ready to go along with any type of delivery I wanted.
During the 29th weeks, I took the 1-hour glucose test. I failed it and took the 3-hour glucose test 4 days later. I also failed this test and was scheduled to meet the dietician the next week. Until then I was restricted to no sugars or fruit. (Grapefruit was the only food I craved so I felt very deprived.) The nurse/dietician was very nice but admitted to restricting the patients' calories to the point of ketosis. I was placed on a 2000 calorie diet with no sugar or fruit, especially juice. Needless to say I was worried. Ketosis is not good for the baby. She did suggest I try the ADA-approved Brand Name Diabetic Meals in Minutes Cookbook. On my next visit, I asked my doctor if I could have a few more calories--I was starving. He gave me another 400 which seemed to help.
I had been sending copies of my test results to my endocrinologist (I have hypothyroidism). The nurse called a few days later in panic; they wanted to see me asap. They had received my glucose results and wanted to manage my gd. I was given a meter and told to test 2x day---one fasting and another reading 2 hours after dinner. I was to try to keep my fasting numbers at 90 or below (my OB said 105 was okay) and non-fasting number at 120 or below. There was a big difference of opinion between the two doctors. I was grateful when my OB deferred to the Endo. I felt uncomfortable being in the middle of this heated debate.
I found out that keeping to my diet was not easy--pizza and spaghetti were big trigger foods for me and I could not eat them at all. So I began taking aerobic classes (land and water) for moms-to-be. This helped me numbers and my energy level.
Around 34 weeks, my numbers were too high. I asked my endo for another week to get them down but it didn't work. So at 35 weeks (my OB did not think insulin was necessary), I began taking insulin. It was a very easy system to learn. It was all in a "lily" pen. All I had to do was add the needle. The insulin was in a cartridge in the pen that held about 200 units. I gave myself 10 units in my thigh each evening before dinner. Everyone told me that sticking your finger hurt more and it was true. I barely felt the injection. My levels after that were great. I went to see the OB and the endo every week.
Despite this and the fact that I had practically stopped gaining weight, the OB wanted to induce me two weeks early--to avoid delivering a 9 lb. baby. I wanted to wait until my due date to induce. I felt he was trying to scare me into it. I finally conceded and asked if I could choose the day and he agreed.
My first delivery was induced and a horrible 13 hour nightmare. I was unable to receive an epidural due to a clotting problem. Narcotics only made me groggy and sick.
At 38 weeks and 5 days, we went to the hospital at 7:30 a.m. My water was broken and I was given pitocin. My labor nurse was great! I was trying to tough it out for a while, thinking I had to wait for my epidural. "Oh no," she said, "We're controlling your labor. If the epidural slows it down, then we just increase your pitocin." I asked her to please call the anesthesiologist. Then I found out, I need to have a whole bag of IV fluid first, at least an hour wait. UGH! That next hour was hard. But my nurse was wonderful. She brought in a birthing ball to help pass the time. It gave me something to do and provided lots of laughs for my DH and support people.
After I got my epidural--I think I got it just in time--things started progressing quickly. I don't think I could've survived the last two hours without it. During the hardest contractions I only felt a mild pressure. I was able to talk and laugh with DH and my family.
At 10 cm, I asked for warm compresses to avoid an episiotomy and to have the bed/chair set up (before the dr. arrived). When he got there, everything was ready, including a mirror since I was unable to see our first daughter's birth. 10 minutes later, we watched our beautiful girl arrive.
4 weeks postpartum, I went to see my endo, who asked me to check my glucose 1x every day, alternating fasting and nonfasting readings. My gd was gone! I still keep tabs on it 3x/week.
I've been nursing her for 3 months and the only problem has been that I produce about twice as much milk as I need. (Check out www.breastfeeding.com for info on breastmilk banking.) I have also lost about 25 lbs.
Lori's Story (insulin-dep. gd, rising b/p, induction, vaginal birth)
Kmom's Notes: This is an interesting story of a mom who had to have some interventions but fought off others, and with the support of her midwife (acting as a doula), was able to have a vaginal birth because of her hard work and careful choices. Because of her rising blood pressure, she needed to induce, but they essentially used 'serial induction' (where you delay breaking the waters and if the pitocin etc. does not have much effect at first, you stop and try again another day). They induced over 3 days, and she fended off many OBs who wanted to break her waters earlier. Amazingly, she did the induction without an epidural.
Although it's impossible to be sure, it sounds quite likely that her baby was malpositioned somehow. Intense pain without progress, back labor, labor stalling at 4 cm---these are common with malpositions. Her midwife put her on her side, and it looks like this might have turned the baby somehow into a more favorable position, for labor progressed after that. There is research that shows that side-lying (or all-fours) can help turn most malpositioned babies; it seems to have worked here. However, if they had broken her waters earlier, this may have put the baby into 'deep transverse arrest'---where the baby is gets so stuck in its malposition it cannot turn fully.
The baby's small size (just over 5 lbs. at 38 weeks!) could be from simple genetics, or a side effect of poor placental function due to high blood pressure. It could also be from too-aggressive insulin treatment. Some research has questioned extremely aggressive insulin treatment, noting an increase in small-for-gestational-age babies in this group. However, there's no way to tell for sure why this baby was smaller.
The midwife acting as doula probably also strongly increased her chances at vaginal birth too. Although small, one doula study found that women who had medically-necessary inductions with the support of a doula had a MUCH lower chance for a cesarean compared to those induced without the support of a doula. Moms who must be induced might want to strongly consider hiring professional labor support like a doula.
Birth Story
When I was thinking about getting pregnant, I considered dieting, but much of what I had read (including on this website) convinced me that crash dieting before being pregnant would not be good. Instead I concentrated on keeping my weight stable and eating well. I got pregnant the second month of trying, and the first part of the pregnancy was uneventful.
My husband and I took a Bradley class which scared me about drugs and some hospital practices, and I developed a desire for a natural birth although I did want it to happen in a hospital. I was concerned about unnecessary c-sections, because I am the kind of person who questions everything. If I had to have a c-section, I wanted to come away from it feeling that it had to happen. Because of all this, I was in the process of switching from my OB practice to a midwife I liked. However, that is when I got diagnosed with GD, and it did not respond to diet. The fasting numbers stayed high, so I started insulin.
I was very depressed---I was not going to be able to have my midwife in charge of the birth, and I was probably going to have to be induced, have an IV, the whole nine yards! The people at the high risk clinic I now had to go to said I had greater than a 50% chance of having a c-section, so I tried to mentally prepare myself.
[Kmom note: The c/s rate in insulin-dependent gd moms IS higher (unacceptably and probably unnecessarily so), but this rate of 50% they quoted her is excessively high. Most studies don't show c/s rates this high for GD moms, even those on insulin--it's usually between 25-40% or thereabouts, with a few studies on either side of these ranges. True diabetics (type I or II) do tend to have a c/s rate of about 50%, but it's not usually quite so high in gd moms. However, perhaps it was true that in THAT clinic, the rate was 50%---which says a lot about that clinic's practice!---but readers should not infer that the c/s rate is 50% for all insulin-dependent gd moms.
This is also an ironic comment on the purported benefits of insulin treatment, one of which is supposed to be a lower c/s rate due to a smaller baby. Although some studies have found a lower c/s rate in the insulin-treated group, most have found that the c/s rate is actually much HIGHER in this group, often even when macrosomia is reduced. This is probably due to the 'high-risk' mentality and interventions applied when insulin is used.]
In fairness, I have to say that I didn't get a lot of comments on my weight from the doctors and such. I mostly heard about it in the context of my risk of Type II diabetes later; that I should diet and exercise. When I was in the hospital it was never mentioned except that they were looking for the large gowns, but it was all matter-of-fact.
My midwife offered to be with me anyway---run interference with the hospital staff, etc., like a consultant. I gratefully accepted. During the last ten weeks I had two non-stress tests weekly, went to the clinic once a week, and had acupuncture to try to control my BP which had started to rise. The midwife and I were planning to try to get my cervix ready for labor with Evening Primrose Oil (EPO) and try to induce labor with acupuncture/castor oil just before my scheduled medical induction.
But we didn't get the chance---when I went in for my routine 38 week visit, my b/p had shot up and they wanted to induce starting that night. After some discussion we agreed. My midwife was a realist; she didn't try to hide the fact that we were going into a situation with the odds stacked against us. My cervix was not dilated or ripe at all, and with my high b/p the medical staff would be very eager to section me at the first sign of distress. We'd just do our best.
We checked into the hospital Friday evening and I got the Cervidil (a prostaglandin insert). Saturday morning they started the Pitocin and ran it all day---nothing happened. Saturday night I got Cervidil again and fended off an OB who wanted to break my water. Sunday morning I got the Pitocin again and fended off another OB who wanted to break my water. (The general OBs on call were trying to do things contrary to the perinatologist's ideas.) Early Sunday afternoon I finally began to have contractions and my water broke! I now had 5 bags on my IV: saline, glucose, insulin, Pitocin, and Magnesium Sulfate (for the b/p).
The contractions got intense and I started to vocalize through them--I had my husband in front of me and a doula behind me applying counterpressure (back labor, ick). At some point during all of this I had an internal monitor placed. I hadn't wanted it, but those belts just did not work on me once I was having contractions.
I was at about 4 cm, and a couple of hours later I was still at 4 cm. I was very discouraged---for some time it had taken all of my skill to get through it, and I was losing confidence. I said to the midwife, "Oh God, if I am going to have to get an epidural I'd just as soon get it over with..." She helped me stay in the present and reminded me how fast things can change. She suggested a small shot of Fentanyl to help my back and wanted me to change positions. I agreed to try her plan. The Fentanyl didn't seem to do anything for the contractions, and the position change (she suggested I lie on my side) seemed to intensify things. I think the baby may have been turning. I went from vocalizing to downright screaming during the contractions---forget Lamaze and Bradley and all those other MEN! This went on for about half an hour (kudos to my husband who was a rock---love but no pity) and she checked me again---I was ready to push! "Well, no wonder!" everyone said, and we got ready to push.
Pushing was hell for me; some people said it feels better at that point but not for me. I screamed during every push (what a sore throat I had the next day!). [Kmom note: Perhaps there was some malposition left, as this can make pushing slow and extra painful.] I pushed her out in about an hour. At the very end she started to show a little distress, and the midwife urged me to push harder and harder. She later told me that the distress wasn't bad yet, but she didn't want the baby to be born with depressed breathing because they would take her away.
So at last she came out---what a feeling! The midwife actually ended up delivering my baby because the perinatologist was called away to a c-section. She was much smaller than we thought at 5 lbs. 4 oz. The ultrasounds were wrong; they said she was average. She had to have lots of glucose tests but she was very healthy. She and I were both a little spacey from the magnesium sulfate but other than that I felt pretty good. I got up in half an hour and went to the bathroom. I had one small tear, smaller than the episiotomy, from having to push her out fast at the end.
Despite the days in the hospital and the stress, the birth is a very positive memory for me. I feel lucky to have the outcome as good as it was given the circumstances. I believe that the midwife and not letting them break my water too early were instrumental in saving me from a c-section. The other factor was just luck. I'm also glad I didn't get the epidural because I would never have been able to push her out so well, and they would have needed to use vacuum or forceps when she was distressed. I hope to have another baby in a few years, and I know I might not get so lucky the second time, but I'll never forget the experience of feeling the baby come out. I'm glad I got to do it at least once.
Jamie's Story (insulin-dependent GD, footling breech, c/s)
Kmom's Notes: A good reminder that just because a provider has the title of "midwife" doesn't mean that she's guaranteed to be size-friendly. It's too bad Jamie's OB and midwives didn't know that a chiropractic technique called "The Webster In-Utero Constraint Technique" often enables breech babies (even footling breech babies) to turn on their own, with an even greater success rate than external versions. There's no guarantee that seeing a good chiropractor would have enabled this baby to turn, but it's a shame it was not tried and a cesarean became inevitable.
Birth Story
When I was 35 I gave birth to Emma. It was my second pregnancy; my first was when I was 18. My first pregnancy was emotionally very hard on me. My parents hated my boyfriend and in retrospect he was a complete loser who couldn't really give me the emotional support I needed. Although I love my son dearly, I never had a moment of happiness about that pregnancy or birth. But there were no physical complications at all.
My second pregnancy was so much better emotionally. I was married to a wonderful man, my family loved him and his family loved me. I looked so forward to having this baby, I thought this pregnancy would be emotionally healing after the trauma of my first one. I was a little nervous about being pregnant and being plus-sized and that's what led me to this website. It was very comforting to hear that all kinds and sizes of women have happy, healthy pregnancies.
I found a midwife here in town and started seeing hr. I always felt like she thought I was a disaster waiting to happen. It wasn't anything overt she said that made me feel that way. Just little things. I have white coat hypertension [Kmom note: A common phenomenon where blood pressure appears higher in the presence of a doctor or other health professional but is normal otherwise.] I told her that but every appointment she got so nervous about my BP. And it was usually right around 140/90. That's my usual BP in a doctor's office and I repeated that at every appointment. Finally she talked me into buying a home monitor (at the cost of $99) and had me take a reading every day. My BP was fine. I think the highest home reading I had was something like 128/84.
She also seemed convinced I would develop GD and almost made me a nervous wreck over it. And when I was diagnosed with GD at 26 weeks, I felt like she had jinxed me (irrational, I know). I was sent to a perinatal center to see a doctor and nutritionist and learned how to check my blood sugars. (The perinatal center wanted me to check my BP TWICE a day even though I hadn't had any high readings at home and no longer even had them in the midwife's office now that I was used to her.)
I tried controlling the GD through diet but after a week or so of my numbers not being where they should, I was put on insulin. I freaked out when I got this news. I have a lifelong fear of needles and couldn't believe I had to give myself shots. This was one of my biggest fears going into pregnancy (the other being a c-section) and it was coming true. It turns out that giving myself the shots wasn't so bad. After a couple of days I was used to it and it really didn't bother me at all. Because of the insulin, I had to start seeing the OB who my midwife practiced under and he was in a different city. So now travel was added to every appointment (in the winter, in the northeast). Then I hardly ever actually saw the OB, just one of the other midwives in the group, unless they had a question for him.
Of course, the GD diagnosis led to more interventions than I liked. I had 3 long, drawn out ultrasounds that took over an hour each to measure the size of the baby. Big babies run in my husband's family and I told this to everyone I saw but always felt like no one listened. I don't think I ever got any more response than a nod from one of the midwives in the group. The last ultrasound I had was at 35 weeks and they estimated the baby's weight to be 8 lbs. 5 oz. The OB and midwives were convinced that I was going to end up with a huge baby. We also found out she was footling breech. We had known she was frank breech and the midwife gave us some exercises to try and turn her but they didn't work. I was scheduled for an external version but when she turned footling breech the OB said it was very unlikely to work and I should have a c-section (my second big fear come true). I was scheduled for an amnio on April 4 with a section to follow on April 6 as long as her lungs were mature enough. With my fear of needles, the thought of an amnio was almost enough to make me faint. I had no idea how I was ever going to make it through that.
Early in the morning on March 31, my water broke spontaneously. I was scared but also grateful I avoided the amnio. Emma was born at 8:20 a.m. by c-section. She was 20" long and weighed in at 8 lbs. 1.7 oz. Obviously the ultrasound estimates were wrong. I was 37.5 weeks along when I had her, two and a half weeks after the 8 lbs. 5 oz. estimate.
Although this pregnancy did not turn out to be the emotionally healing experience I had hoped for, I have a beautiful, healthy baby girl whom I couldn't love more. And I really hope to have one more someday.
Michelle G's Story (insulin-dependent GD, induction, provider problems, vaginal birth)
Kmom's Notes:
Birth Story
In order for my birth story and the emotions I have related to it to make sense, I'd like to give a little background. I have PTSD - post traumatic stress disorder. It's a result of an extended period of abuse during childhood. I am rarely affected by it anymore but childbirth is an area of my life that I need to be careful with. I do best when I feel in control and understand what is happening and why. I wanted a birth where the nurses didn't do internal exams, I didn't want an IV, and I wanted to use my own BG monitor and to be in charge of administering my own insulin.
First off, the outcome, a healthy, sweet baby was realized. Matthew is our sixth baby and he is a treasured addition to our family. The way he came into the world was not as I hoped. The interventions and loss of control have triggered another PTSD episode and I believe many of the problems I experienced could have been avoided if I had been treated like an adult instead of a patient.
I was diagnosed with GD at 29 weeks. I had never had problems in my previous five pregnancies but I did have some risk factors namely being overweight and 38. The diagnosis was especially difficult to accept because my midwife who had delivered my previous three children had become seriously ill and was out of the office from my 28th week until I was 36 weeks. She worked solo in the practice so I had never seen any of the doctors in the practice. The office in general was stressed in trying to pick up her patients and deal with their unique perspective on childbirth (the majority were highly committed to natural child birth). So I basically felt like I had no one to turn to for information.
I met with one of the doctors twice for about five minutes each time. He spent the time addressing my concerns about the interventions that GD could possibly cause by going over all the reasons I might need a c-section. He seemed to not realize that I had had five previous vaginal births - the last four with no pain medication and no problems.
So I turned to the internet for information especially regarding testing and how labor and delivery was managed. In the meantime, I was finally put on insulin - this was after two weeks of extremely high blood glucose readings. It was very difficult for me to get "plugged into the system"; I believe it was due to being the midwife's patient and high risk. I don't think the office knew exactly how to handle me. My insulin and diet teaching and daily insulin management was turned over to a home health care agency that specialized in maternal home health needs. I found their care to be extremely professional and the only complaint I had was that they were a bit too cautious in adjusting my insulin requirements. I was very insulin resistant and even after 20 days on insulin (4 times a day), they still were not able to get my fasting numbers under control.
After 20 days, I was discharged back to my midwife's practice. I was told to call when my levels were over the limits and that the doctor was to adjust my insulin. The next day, I turned in my charts (BG and insulin levels) with my questions but no one ever called me. So, I took charge and began to adjust my own insulin (I was still adjusting every day). I got my fasting numbers under control and had very tight control of the postprandial numbers without ever experiencing a low. I needed 48 units of NPH at night to get my fasting numbers down to the 90's and just for breakfast - one carb. And one protein, I needed 20 units of regular insulin.
This is important to demonstrate that I did have a very good handle on how my body dealt with insulin. I found that I was extremely sensitive to stress - after yelling at my children, I had a 20 - 30 point surge in my BG levels AND they would not come down until I took an additional insulin injection.
My midwife came back to work when I was 36 weeks. I had to go in twice a week for non stress tests and ultrasounds. She basically was hands off in managing the GD and consulted with one of the doctors if I had a question.
In addition to being extremely insulin resistant, I also had great difficulty in doing the blood tests. I was testing at least 7 times a day. I used three different monitors until I finally found one that I could use successfully. The problem was that my hands would sweat profusely when I had to do a finger stick. Two of the monitors needed a large drop of blood and I was unable to get one due to this problem, so then I had to stick again - several times. A number of times, I would mess up a strip because it took too long to get the blood on the strip and the whole process became a huge stress to me (and yes it affected my BG). I finally switched to a Freestyle and had no more problems.
Well, armed with both the knowledge of my difficulties in testing and my personal experience with my insulin needs, I asked my midwife to allow me to test myself during labor and administer my own insulin (even after 9 weeks of insulin injections, I was still needle phobic and did not want to be on an IV for insulin). My midwife conveyed this to the doctor and when I went to the hospital at 37 weeks he wrote the orders allowing me to do both of these things.
I agreed to be induced because I had asthma that was uncontrolled, the GD and finally low amniotic fluid. The doctor and my midwife both felt that I had had enough and it would be better for me and the baby to proceed with the induction. I had been induced several times using Cervadil and needing to be augmented with Pitocin. Even though they were long labors, I was able to get through them fairly easily with no pain medications so I didn't expect any problems this time.
I trusted my midwife and her judgment. I had known her for almost 7 years - she had been delivering children for nearly 30 years and I respected her experience. I didn't need to fight her or convince her of my desire to have a low-key birth. Even with the interventions we were taking, I was in control of what was happening to my body. She ran "interference" for me and kept the nurses from performing unnecessary exams; she kept them from placing an IV (needle phobic and found it very intrusive) and basically asked them to let me labor in quiet and peace with minimal interruptions. I found this environment to be safe and was able to labor in peace.
The Cervadil was fairly effective this time - after 12 hours, I was 50% effaced and 2 -3 cm. I made it through 24 hours at the hospital with my labor picking up. The one snag was that after she broke my water, the baby tried to float back up, so I was restricted to an upright position in bed until I had progressed more and got the baby to be firmly engaged (I had planned to move to a tub for the rest of the labor but had to wait).
I had a fantastic nurse during this period. She was one semester away from being a midwife, but circumstances necessitated her going back to nursing. She had worked as a labor and delivery nurse for 20 years and had the same philosophy as my midwife. They were an awesome team.
It was coming up on the evening shift change and my midwife asked me to consider starting Pitocin. My contractions were slowing a bit and I was still only 80% effaced. She was sure that just a short period on it would enable me to progress enough to get off the Pitocin and into the water to labor.
During this entire period, I did eat my regular GD diet and administer regular insulin. My BG remained low and I felt very good.
The new nurse came on duty and everything I had organized fell apart. I found out through other people that she had argued with the nurse who had cared for me for the previous 12 hours and with the doctor who wrote the orders letting me test my own BG levels and administer insulin as needed. She asked me a few questions about my GD but never let me know that it was because she believed I was going against hospital protocol. This was after 24 hours of having things the way I wanted and experiencing no problems.
She basically went behind my back and got the doctor to rescind his orders. He was so bothered by the whole thing that he came in and yelled at me - "What is this I hear that you won't use the hospital's meter and you won't be hooked up to an insulin drip?"
Well, that was the end of my low-key, safe, peaceful labor. I immediately broke into a huge, hysterical crying fit. My contractions stopped for the next 6 hours or so (even with the Pitocin that should have only been necessary for a little while). My BG levels went up - of course because I was stressed but again the nurse didn't want to hear what I knew about MY GD. My blood pressure went up and she continued to nit-pick every detail of my labor.
I felt like each thing she did was a power struggle and she was determined to come out on top. The IV she inserted was the most painful one and in a very awkward place making me unable to push off with that hand. Each time I needed to use the bedpan (I can't urinate in front of others) necessitated me telling her to leave - she didn't get that after the first, second or sixth time and I found it to be so disrespectful to me. She hooked me up to an insulin drip and said "How about you don't have to do anymore insulin injections?" with a smug tone of voice, again treating me like a child.
I had to use the hospital's glucose monitor because in a side by side test, mine was 13 points lower than hers. I tried to explain how the readings varied even with the same monitor, but again I was just a patient - she was the expert (side note - the baby was checked three times in a row by the same monitor and had levels of 38, 25 and 35 - see how consistently accurate their machine was?). The test strips she used were Accucheck curved strips - the exact same one that I had no luck in using. Thankfully, my hands didn't sweat.
I decided to receive an epidural because basically my midwife had given up trying to manage my labor and there was no way I felt like I could get through transition with the nurse's support. It was an extremely painful procedure, unlike the one I had received with my first labor. I needed a second dose of lidocaine to get through it.
As soon as I sat up, I nearly passed out - my blood pressure crashed to 60 over 40 and possibly lower but I am foggy about most of the next hour. I remember someone saying "Did you hydrate her - that's the same bag of pitocin she started with" (the Pitocin was started at 9:00pm and I had the epidural around 3:00 AM - so about 6 hours with no additional fluid and another side note is that I had received no nutrition for 17 hours not even a glucose drip). I received several doses of medication - ephedrine. I remember thinking that I was going to die and I worried about the effect on the baby.
An hour later, I could finally set up and I immediately felt pressure but the nurse didn't register it. An hour later, I said that I really felt pressure and she decided to check me (she wasn't suppose to, my midwife was in the next room) and I was 9 cm but she said the baby was high. She walked out of the room to get the anesthesiologist because the epidural hadn't worked on one side when I screamed that the baby was coming. I had my hands between my legs trying to hold his head in. With the next contraction, he spilled out on the bed as the nurse arrived followed closely by my midwife.
I could tell my midwife was livid with anger - she said "well at least I'm here in time to deliver the placenta". In my spaced out frame of mind, I thought she was angry at me. The nurse said smugly that she guessed she would have to write up the delivery because she was the attendant and I thought I would throw up.
My midwife quickly stitched me up without talking to me and left the room. I later learned that she wasn't mad at me but it doesn't change how I experienced the last bit of my labor. She told me that she tore into the nurse because she had clearly stated to her that I go very fast at the end but again, the nurse thought she knew better.
In retrospect, it seems like the nurse was in charge of my labor and delivery. A person I had never met somehow had more authority than a doctor and my midwife. If I were to give any advice, it would be to contact the head of the maternal medicine unit and find out what the protocols are in handling gestational diabetes - especially insulin dependent. It's vital to know what you are up against if you have any wish to have a say in how your labor is managed.
I would also strongly encourage hiring a doula or having a very strong-willed friend along to keep pushy nurses in line and to offer support. I dearly love my husband and he would do anything for me but just couldn't deal with the medical community. I think if I had had an experienced doula, she could have asked that the nurse be changed and helped me to get my focus back on having the baby.
I also should have met face to face with the doctor so that he understood my GD. As it was, I don't believe any of the doctors reviewed my charts. I don't think any of them understood how insulin resistant I was or what factors affected it or how competently I managed it. I think if I could have done that, he would have been more likely to support me in the face of this nurse.
Unless I don't turn up with GD next time or any other high risk problem (other than age), I will definitely not step foot in the hospital again without the biggest, meanest doula I can find. :-) I seriously want someone who is not intimidated by the medical profession because I will not be treated like this again. I don't really need support to get through labor (just the last 20 minutes) but I definitely need someone to stand up for me.
Anonymous1's Story (3 vaginal births, the last with insulin-dep. gd)
Kmom's Notes: This mom's water broke before labor with baby #1. She was told that if she had no signs of labor yet, she probably wouldn't and therefore should come in for induction the next morning. Actually, research shows that even if labor doesn't start right away, most women go into labor within 12-24 hours after their water breaks, as it did for this mom. There is usually no need to induce.
Doctors feared that going too long after the water breaks was a risk for infection, but the actual infection risk turned out to be vaginal exams and procedures, which would be increased during an induction. The main factor was not so much how long the water had been broken, but how many germs had been introduced via vaginal exams, internal monitors, and other procedures. Most midwives (and many doctors) today believe that most women whose water breaks before labor should not induce but simply wait to go into labor, which will happen for most within a day or so (as it did for this mom). However, there are occasional exceptions where a different protocol might be necessary (such as possibly with group B strep), so always consult your provider.
Birth Story
Birth #1: I was 29 during my first pregnancy. I was about 270 lbs. and had to take serophene to conceive. My cycles have always been sporadic, whether overweight or not. I conceived my 3rd month on serophene. The only problem I had during the pregnancy was some first trimester bleeding. GTT (Glucose Tolerance Test) was negative, blood pressure was fine, weight gain of 17 lbs.
At 5 p.m. on a Sunday, 14 days before my due date, my water broke. I called the doctor at 8 p.m. (when I got home) and she said I would probably not go into labor as I wasn't feeling anything, and I should come in the next morning at 7 a.m. for an induction. By 12:30 a.m. I was on the way to the hospital, arriving at 1 a.m. My first was born at 4:13 a.m. with about 17 minutes of pushing. She was 8 lbs. 15 oz. I had no drugs but did have an episiotomy.
Miscarriage: The next time I conceived was on the first month of serophene. I miscarried that pregnancy with low progesterone. It was discovered I had a 7 cm ovarian cyst.
Birth #2: The next time I conceived was on the second month of serophene and I was 32 years old, 250 lbs. I had low progesterone and took progesterone, which caused first trimester bleeding. I do not remember what my weight gain was, but my GTT was negative, blood pressure was good. Only complication was after a bad sunburn, my blood pressure went up as I was dehydrated. [Kmom note: Dehydration can elevate blood pressure or start labor prematurely----it's VERY important to stay well-hydrated in pregnancy!]
Didn't go into labor till 3 days after due date. I was at the hospital for 45 minutes before my second baby was born. Had an epidural, just in time for pushing. Only numbed me for the stitch up (episiotomy again). I pushed out that 8 lbs. 12 oz. baby in about 7 minutes.
Birth #3: I had a 6 cm cyst removed in between pregnancies. The cyst was on a fallopian tube, not ovary.
I also conceived the third time on the second month on serophene. I was 34 years old and 300 lbs. This time my GTT was positive and the gd was very tightly controlled with diet and insulin. My blood pressure was good; in fact it was often quite low. I was also dehydrated with a bad sunburn with this pregnancy. Had elevated b/p and swollen feet with dehydration. One week on bedrest and everything was back to normal.
I went into labor 2 weeks early, after losing a total of 2 lbs. over the pregnancy. I woke up at 1 a.m. in labor. Left to the hospital at 2 a.m., arrived at 2:30, and baby was born at 3:15 a.m. At 7 lbs, 12 oz., she was my lightest. She came out with my very first push. no drugs, no episiotomy, but substantial ripping. [Kmom note: The ripping may have had to do with the 2 previous episiotomies. Once cut, the area often remains weaker.]
Sharon's Story (insulin-dependent gd, group B strep, vaginal birth)
Kmom's Notes: Sharon's stories show that having insulin-dependent gd doesn't have to mean a ton of interventions, an induction, or a difficult birth. Note how much easier she found labor when standing, and how she used hot water to help her when labor started getting more challenging. Also note that sometimes, just when you feel that you've got to have that epidural, just lasting a little bit longer is enough to make it through without.
Birth Story
I'd switched providers in my 35th week. I'd started out in the Alternative Birthing Center with midwives. Lost that when diagnosed with gd. Lost the midwives when I became insulin-dependent. I didn't want to give birth with OBs on the regular maternity ward of a big teaching hospital. So I switched to a less-conservative OB with a community hospital. And I'm glad I did.
My new OB, while initially talking induction at 40 weeks, allowed me to go to 41 weeks because my numbers had been good, and I was measuring on target. (OK, I admit, my adamant desire to avoid induction had something to do with this decision.) Fortunately, I went into labor naturally two days past my due date.
I sort of knew something was up. All day Saturday, I'd been feeling what can only be described as 'pre-menstrual'. Vaguely crampy. Nothing definitive, but a sensation that'd I hadn't had in quite a while. Decided to get some things done just in case. Went grocery shopping, got a massage, made DH take my belly pictures in front of the house with the new tulips waving behind me. The thought occurred to me to make dinner something special, just in case it was my last as a non-parent. Ultimately, we went to a local restaurant for some average veal parmesan. During dinner, I threw a couple of contractions. Just like the braxton hicks tightenings I'd been having for quite a while, but this time they sort of wrapped around to my back.
At home, I counted and realized that I'd had quite a few of these tightenings, and we might want to time them. DH started timing them as I noticed they were definitely getting stronger. I was handling them OK. I discovered that being upright and/or leaning forward on something made all the difference in my pain.
When they were about 5 minutes apart, we called the doctor. The doctor on call asked if it was my first and didn't seem too concerned. Then he asked what my status was at my last appointment. We told him 3 cm and 80% effaced---his tone changed and he told us to go to the hospital immediately. I was astonished to find out it was already midnight at this point! Time definitely suspends during active labor.
Contractions in the car are no fun. I was heartily annoyed when they made me ride in the wheelchair to maternity. After weathering contractions sitting down in the car, the last thing I wanted to do was sit down again. The doctor introduced himself and checked me. I was disappointed to find out that I was still only 3 cm and slightly more effaced, but the contractions were strong and regular so they admitted me. We were committed now!
At this point, the contractions were completely radiating in my lower back. All I wanted to do was get settled into my room and into the hot shower. The hot water on my back was the perfect thing for my back contractions. DH kept me company trying to figure out the right things to say and not say. Truthfully, during contractions, I couldn't have cared less what he said. But just his presence was incredibly comforting. I don't remember how long I was in the shower, but they made me get out for my IV (antibiotics for Group B Strep, as I'd tested positive), and to run a fetal monitor strip. My (male) maternity nurse had a good touch for the IV.
It was probably about 2 a.m. at this point, and I admit it, I was hurting now. Being made to lie in bed for the monitoring was almost enough to put me over the edge. One good contraction and I felt my water break with a small gush. The contractions definitely changed at that point, and not for the better. They were sharper and hurt in the front and back now. DH was good with the counter-pressure on my back, but this was helping a lot less than before. The word, 'epidural', started creeping across my consciousness. How easy it would be. I was having trouble remembering why going natural was a good thing. DH wanted to be supportive of my decision to go natural, but he was conflicted seeing me in so much pain. At this point, I remembered some advice---always ask to be checked before making any decisions. The nurse checked me and I was 5-6. Everyone in the room was very impressed with my progress---except me. All I could think was "5 more cm of this!" I cried uncle and asked for the epidural.
And if the anesthesiologist had been standing there with a needle, I'd have done it. However, the nurse told me that I could have something in the IV while they called the doctor on call. What? No doctor available in the house right now? I declined the IV meds and neglected to answer them about paging the epidural guy while handling a few more contractions. I was feeling a little 'grunty' during contractions, and pooped a little while standing up. (I was never worried about pooping during labor. I totally didn't care. I just pointed it out to the nurse to clean up.) I asked if I could poop some more and had a couple of pushy contractions on the toilet while the nurse told me that I shouldn't try to push the poop out, just let it come out.
At this point I asked to get back in the shower, as the contractions were almost literally running me over. In the shower, I had one contraction and felt the overwhelming urge to push. I squatted down and felt the pressure move down. Uh oh. I got out of the shower and asked to be checked again. Thankfully, he didn't question me. His fingers didn't even enter my vagina when he exclaimed, "Oh!"
He called for the other nurse to get the doctor. "She's complete and almost crowning!" The contractions were different now. They didn't hurt as much, or at least I don't remember them hurting. I just had the overwhelming urge to push. Urge isn't the word. It just happened, I was along for the ride. Dh asked what that was at my vagina. He was a little astonished to be told, "That's the baby's head."
Pushing didn't hurt like I expected it to. Pressure, some stinging, more pressure. The doctor came in and gloved up and told me I could push when I felt like it. A good solid push and the doctor told me, "Hang on, the head is out." What? I really expected it to get a lot worse before the head came out. Another gentle push and I felt that amazing feeling of the body sliding out of me into the doctor's hands. It was purely happenstance that the CD player, queued up with music, came on with Stevie Wonder's "Isn't She Lovely" at just the moment our doctor announced, "It's a girl!" It was 3:05 a.m., and she was 7 lbs., 4.2 oz., 20 inches long.
I was in complete shock. We'd done it. The baby gargled a little and started crying lustily as soon as they suctioned her out. They put her slippery little body on my stomach and let her cord stop pulsing before coaxing a reluctant hubby to cut the cord. Both DH and I were fascinated by the placenta and sac as the doctor examined it and explained it to us. The next few hours passed with a couple of small stitches, a decent first pass at breastfeeding, and a terrible attempt at some sleep while they took the baby to the nursery for her initial work-up.
The baby is beautiful (of course) and seems to be taking to breastfeeding pretty well. We'll work out the parental sleep logistics soon enough. After going through it without even a Tylenol, I understand how it can be a life-changing event. I faced my greatest fear, pain, and came out on the other side. Good luck!
Sharon's Second Birth Story
I woke up Wednesday feeling kind of punky. I'd been having some pains in
my sleep and they continued that morning. Drinking a lot of fluids and a hot shower helped some, but they were never really far away. I
considered letting DH in on the secret, but with all the Braxton Hicks I'd been having, I figured I'd wait until they were serious. I was going
to the hospital later for an NST anyway.
So I puttered about and went in to the hospital for the NST. My mother comes to watch DD while I'm hooked up. I had one contraction while on
the monitors...which the darn machine didn't even pick up. Oh well. We had lunch with grandma and Isabella and I went home for a nap. I joined
her, which I ordinarily wouldn't do. I'm glad I did. Isabella woke up early and because DH was working late, I decided to run a couple of easy
errands at the mall. I wasn't really having discrete contractions at this point, but my uterus was feeling sort of
irritable.
Walked around the mall and had a nasty fast food supper. I felt momentarily guilty for feeding Isabella chicken fingers for the second
time in one day, but I just wasn't up to cooking. At this point, I was definitely getting some more discrete contractions, but they really
weren't more than surges of pressure and not in a definable pattern. Still, I sort of knew something was going on because they felt more
productive than the tightenings I'd been having for weeks.
By the time I got home, DH was waiting. He got Isabella ready for bed while I puttered around the house a bit. After she was in bed, I finally
told him that I thought something might be up. I decided to try a bath to see if it made a difference. Sure enough, contractions stopped
completely while I was in the bath, but came back when I got out. We didn't do the timing thing, but I was mentally keeping track. Around
2:00 AM, they were semi-regular at about 10 minutes apart. I also had the loose stools which were the harbinger of labor last time. But it
wasn't until I decided to check myself and felt not my cervix, but something hard and foreign that I decided to "ring the bell". I also
forgot to mention that I was 3cm dilated at my last appointment the day before and my first labor was quite
quick.
Doctor actually wasn't eager to get me to the hospital, but I asked to just be checked. I didn't mention checking myself. So we called in my
mother to watch DD and off we went. Got to the hospital around 2:30 and entered the ER to the smiles of the
reception people. I'm thinking laboring women are about as pleasant as it gets down there. Interestingly, this time they didn't insist on the
wheelchair, just a nurse to walk with us, which was fine.
The L&D nurse was very nice, but it was quite apparent that she didn't think I'd be staying. Contractions were very sporadic on the monitor and
I probably didn't have that "in labor" look about me. Her manner changed completely when she checked me and found that I was 5cm with head "well
applied." She also noted that my Group B strep came back negative, which was wonderful news as it meant no mandatory
IV.
I have to make a note about my emotional state at this point. I wasn't ready. I *love* late pregnancy, even in August. I like wearing maternity
clothes and having the old ladies smile at my belly. Even with all the hassles of managing my gestational diabetes, I just didn't feel like
giving in. However, I was eager to meet this new person.
We get settled into the room and I commenced laboring. I made the comment more than once that this slower labor thing was great. Every few
minutes, I'd have a contraction which I swayed and breathed through. At this point, they weren't painful except for a peak which got my
attention, but passed quickly. In between I paced the room and joked with DH and the nurses. The first monitor strip they did, I asked if I
could have it done in the rocking chair instead of the bed. My contractions slowed down but felt stronger. Even so, they didn't
register more than 25 on the monitor. Stupid machines. The nurse wasn't really worried, having been reassured by my 5cm status earlier. At one
point another nurse came in and joked with me. "Has anyone mentioned you're pregnant?"
"Gosh, really? You know, that would explain a few things." Off the monitor, my nurse took me on a walking tour of the unit. I had
only one minor contraction and for all observers looked like nothing was going
on.
But for the most part, they left DH and I alone, which suited me fine. I have to comment about my Dear Husband. He has the knack for knowing when
to joke with me and when to just shut up and do what he's told. He is *my* ideal labor support person. During this time, I discovered that
just pacing brought the contractions on most regularly and spent most of the early morning doing that. Contractions were still anywhere from 2-10
minutes apart, but feeling very productive. When the contractions got stronger I asked DH for counter-pressure on my back, which is where I
felt most of the pain. Ultimately, doing my own counterpoises with my thumbs and sort of wagging my hips worked best.
Because labor seemed to be going so slow, I was hesitant to get into the shower and slow it down
further.
Finally, I started getting tired and asked to do the next monitor strip on the birth ball. Again, the contractions spaced out, but felt
stronger. It was also nice just to rest a bit before "bringing them on" again by walking. At this point I was actually wondering if I was going
too slow. After a bit, I asked to get into the shower just to see what would happen. Contractions felt *great* in the shower and came on even
more regularly. I decided to get serious. I started chanting "OK, it's time" and "open" during the contractions and sort of mentally letting
go. That's when I felt my water break with a small "pop" and a little gush. It was probably about 6:30 at this
point.
Of course, they never just take your word for these things and wanted to test with the strips. It was inconclusive, but they noted it anyway. The
nurse checked me for the second time that night and discovered I was a 7-8. At this point contractions stopped and I took advantage of the
breather. I made a comment about getting back into the shower when I got a case of the grunts. This is my term for it. You get a whopper
contraction and all of a sudden the only thing you can do is push and grunt. Nurse wryly commented that the shower probably wasn't going to be
a good idea and called the doctor.
While waiting for the doctor, contractions slowed a bit I got a good breather. Doctor came, checked me and said I was 8 with a lip and to
breathe through a couple of contractions. Um, OK. It was about 10 minutes to shift change and they mentioned the name of another doctor on
the way in. Meanwhile, my doctor left the room while I struggled through one contraction before feeling the overwhelming urge to push again. I
mumbled something about the lip being gone while they paged the doctor again
stat.
Another aside. Just once I'd like to give birth without the words "don't push" being uttered. Yeah, tell that to my
body.
Doctor comes in and pushes my legs *way* back and insists I hold them. I don't like this and I refuse to hold my leg, so he's pushing it back
with his shoulder. He insists this will reduce tearing, but I'm not convinced, but in no position to argue. This time, I really didn't get a
strong crowning sensation. Some pain, yes, but no clear sense of burning like last time. Two good pushes and the head was out. Another good push
and I felt that amazing sensation of his little slippery body leaving me. In that instant, I had a son and all pain disappeared. 6:56 AM. He
was fussing a bit while they wiped him. They put him on my stomach and he immediately looked up at me and stopped crying. An action which cost
him an APGAR point.
The placenta delivered quickly and easily with a small feeling of pressure and some minor cramping. The doctor said that I tore and I'd
need a couple of stitches. I was annoyed at that because I felt that the pushing position was the reason, but agreed to the local. Thankfully, I
was mostly still numb and the local and stitching was only a minor annoyance. I looked over to where DH was watching them examine the baby
and saw his face. My husband had a son.
We had our first nursing and he was a pro. Having a tiny newborn nursing felt so weird after so long, but so
right.
The nurse checked Domenic's blood sugar several times and had trouble getting a reading. Finally she got a reading of 45 and they mentioned
supplementing with formula. Now, I'm a major breastfeeding advocate. I'm a confident person who deals with medical professionals as consultants,
not gods. I *know* that colostrum is the right thing for low blood sugar. I also know that even one feeding of anything but breastmilk can
potentially change the flora in the gut. I was even half-aware that 45 wasn't that low, but the nurses were insisting and I did what most
immediate post-partum mothers do when pushed about the health of their long awaited baby. I gave
in.
Thankfully the IBCLC came into the room at this time. Whether somebody summoned her, or she was just there because of shift change, I don't
know. But she gave me the option of pumping some colostrum for a supplemental feeding. I did this and was thankful that I'd continued to
nurse through pregnancy because I actually got some more colostrum (5-6cc's) to give him with a syringe. Another blood test showed him
still at 45, but people seemed content with that reading this time. After his next nursing he was 65 and
fine.
All in all, my labor was what I wish on every mother. Some might say that I have natural births because I birth easily. Others might say I
have easy births because I avoid interventions. I'd say it's a bit of both. Being able to move around and choose different laboring positions
makes all the difference for me. Not being "tethered" to an IV leaves me free to move as I choose. Contractions I had in bed, or sitting down
felt more painful than the ones I had in the shower which seemed more productive. And I'd also like to say that the emotional labor can be as
trying as the physical. But every twinge and angst-ridden moment is wiped clean in the end.
To see pictures, go to http://members.aol.com/sharondio/birthpix.htm
Erika's Story (insulin-dependent GD, premature labor, vaginal birth)
Kmom's Notes: Although it is impossible to know for sure, it is quite possible that the reduced calorie diet Erika was placed on did indeed contribute to the premature birth of her baby. Many midwives believe this happens frequently with twins; when the babies are not receiving adequate nutrition within, it becomes safer and healthier for the babies to come out early, even as preemies. Unfortunately, many doctors and nutritionists do not recognize this and continue to dictate reduced calorie diets to plus-sized women. Even the most rigid GD guidelines do not suggest such strong caloric reductions as 1300 calories, however.
Birth Story
This is a rather embittered story about over-managed GD. I'm currently in my second pregnancy and what I learned in my first has served me well so far. At 31 weeks I'm diet-controlled and with a midwife who is committed to not allowing my first pregnancy experience to be repeated. So far so good.
I had a completely normal first pregnancy until week 28 when I screened positive on the one-hour glucose test. When I went back for the three-hour, the nurse who drew my vials commented very 'cutely' to my belly, "Mama's been hitting the ice cream too hard so we have to do this test." I failed the three-hour. It wasn't until over two years later that I found out about carb-loading and how it can affect your results. I remember not eating anything past 3:00 p.m. the day before. The test was drawn late in the morning.
My OB, the only person my insurance would cover at the time, was truly unavailable for support. She rushed through all our appointments, not leaving time for questions. At week 30 she referred me to the hospital's 'gestational diabetes care clinic' comprised of three rotating endocrinologists, a nutritionist (dare I call her that?) and a nurse-educator, all of whom I saw every Tuesday. At our first meeting the nutritionist very patronizingly recommended we all eat as much aspartame as possible before introducing us to our new diet, one that I would later calculate to add up to roughly 1300 calories per day, avoiding most fruit, dairy, and carbs.
I was sent home with all of this overwhelming information, and after attempting diet control for one week I lost three pounds. The following Tuesday I was chastised by the nutritionist, "You're not eating any fruit! Your baby needs fruit!" then, accusingly, "Why aren't you gaining any weight?" Instead of working with me to up my calories in a constructive way, she recommended I be put on insulin injections immediately.
At my next OB appointment my doctor declared that because of the diabetes she wouldn't let me go past my due date and we would probably be looking at induction or scheduled c-section at 38 weeks. She then hurried from the room as usual to check on her next patient. This is when I lost my mind.
I phoned a doula immediately. We had a long talk, and she confirmed my OB's reputation for pre-emptive cesareans. I had resolved to hire her, except the next evening I went into spontaneous premature labour and had a baby four hours later. I'm convinced that the absolute panic of the 'inevitable' c-section, combined with the sudden third-trimester starvation diet caused it. My current OB, midwife, and nutritionist agree.
When I went into the hospital in labour the nurse team had no idea I was insulin dependent until I told them. They were all strangers. I have to say my labour and delivery did go off without a hitch though - no epi, no tearing, 20 minutes of pushing. My only issue was a consistent battle between myself and the nurse team over not wanting any needles in my body. They actually wanted to break my water to "speed things along!" I mean, come on, 4 cm to fully dilated in 90 minutes at 35 weeks? I don't think speediness was a problem.
My son was in the NICU briefly with jaundice and some minor complications of prematurity. He's healthy as a little horse today - 90th percentile in size for his calendar age - off the charts for his gestational age.
I learned several things from my first pregnancy. The blood lab nurse's comment combined with the horrible nutritionist caused me some serious and unexpected food issues later on. I was in therapy for anorexia at the start of my second pregnancy because I was so terrified of repeating my first pregnancy experience. I've mostly recovered now, though eating enough and testing blood sugars every day is a still a serious psychological struggle. I ended up quitting my work completely this time in order to concentrate all my effort on diet, exercise and my young son. Stress is a huge factor with my blood sugars.
My advice to a newly diagnosed GD patient would be to call a doula, educate yourself fully about the GD testing and treatment process (if you're here you're doing a great job already,) then sit your doctor down and grill them on how they see this changing your labour and delivery plans. If you're overweight do NOT let people assume you have GD because you're fat or you "eat too much ice cream." Even though obesity is one risk factor, your weight is not something that's going to change significantly prior to week 40, and no one is doing you any favors by making you worry about it during your third trimester. After being chastised repeatedly by medical personnel about my weight during my first pregnancy, it turns out my mother's birth father was type 1 diabetic - most likely the genetic reason for my impaired glucose tolerance in pregnancy.
I have a much more relaxed and non-judgmental care team this time around, so hopefully I'll be submitting a happier story in a few months!
GD Birth Stories: Special Situations (Twins, Preemies, etc.)
N.M.'s Story (ID twins, gd, vaginal birth)
Kmom's Notes: 37 weeks is basically full-term for twins; her OB did not pressure her to induce early simply because she had gd. Usually, gd is more common with fraternal twins than identical twins because a double placenta tends to double the insulin resistance from hormones, but sometimes moms with identical twins get gd too.
NM also found that the gd food plan she was given as a twin mom was inadequate, a complaint Kmom has heard from more than one twinmom. Although you'd think that gd food recommendations would be fairly straightforward across the board, there are more variations than you would think. In the past, many gd food plans had too little protein and too many carbs; the most recent thinking seems to be that you get better control and fewer problems by increasing the protein amounts somewhat and decreasing the corresponding carb content as well. Significant caloric restriction for heavy gd moms is another area of controversy, and several large twin moms with gd have complained of totally inadequate caloric intake for a multiple pregnancy.
Birth Story
I was diagnosed with gd after the [glucose challenge] with a level at 140. So, they sent me to the 3 hr GTT and my fasting level was normal, my 1 hr was 202 (cutoff was 190), my 2 hr was 165 (the cutoff number) and my 3 hr was normal. I was officially diagnosed as having GD.
They gave a GD diet which was completely ill-suited for a pregnant woman weighing 270 lbs or so and expecting twins! It was lacking enough protein and had way too many carbohydrates and definitely not enough calories. I told my doctor that I was going to eat more protein and a little less carbohydrates and he said okay. Also, my doctor wasn't too worried because one of the side effects of GD is having too large of a baby, but since I was expecting twins, he said it would at the most make them weigh a normal baby's weight (my boys were 4.5 and 5.3).
I had to test my blood 4x per day (fasting and one hour after each of my meals). My numbers were fine as long as I didn't overdo the carbohydrates in one sitting. I saw that my body could not handle carbohydrates for breakfast, so I ended up eating only protein and a few hours later having a carb and protein snack. I was able to keep my numbers within the recommended range by cutting out all sugars and making sure that I ate protein along with my carbs.
I went into labor at 7:15 pm., [37 weeks into the pregnancy]. Since I didn't have any real contractions by 9:15 pm, my OB had me take 3 ounces of castor oil. His reasoning is that a twin uterus is usually so stretched out that many times it has trouble really contracting. The consistency was disgusting and I ended throwing up the first bit. I forced the rest down my throat, though. At 10:45 pm my contractions picked up and I was constantly going to the bathroom as my bowels were emptying out.
At 3:30 am we arrived at the hospital. I was immediately hooked up to a pitocin drip and two monitors, one external and one internal. I was not allowed to get out of bed. I did not take any pain medications because I had the attitude that although it was painful, I could handle it. I just breathed through each contraction. As I approached transition, I threw up. It was mostly stomach acid as my stomach was already empty. The best part is that I knew I was almost to pushing.
I started pushing at 5:10 am. No one properly prepared me for pushing, it is really hard work. I think of it as equivalent of doing 3,000 sit-ups in a row (okay, okay, not THAT bad, but definitely hard work). At 5:56 am, Baby A was born. At 6:00 am, Baby B was born. It was an incredible feeling to push the babies out! Of course, since they were tiny, I really only had to push their heads out as they had such tiny shoulders. From what I understand, the shoulders on a 7 lb baby are the hardest part to push out. But, in my case, once their heads came out the rest of the body came flying out. I only had a tiny tear which my OB stitched up. Both babies had apgars of 9/9. Don't let anyone tell you that you cannot give birth. Your body is prepared and ready to do what it needs, just have a positive attitude and believe in yourself.
Leslie A's Story (fraternal twins, gd, vaginal birth)
Kmom's Notes: Note that this mom used 'serial induction' successfully (try inducing with pitocin but do not break bag of waters; if no labor after x hours, go home and try again later--often labor is jumpstarted in between labor tries, or the 2nd induction 'takes'.)
Birth Story
Conceived one cycle after a miscarriage (single baby). Midwife suggested that fertility is enhanced after miscarriage; thus the twins. Twins do not run in my family! Spent much of the pregnancy terrified that I'd lose one or both of the babies.
Difficult pregnancy with bleeding in first and third trimesters and pre-term labor starting at 22 weeks. On bedrest for last half of first trimester and for third trimester. Anti-contraction medication in third trimester which made sleeping and concentration difficult.
Nurse Midwife was great, no size bias, mild GD was "no big deal." Had many (10 or so) ultrasounds to check position of twins, growth rates etc. Did not have many other common tests (e.g., no amnio, etc.). I was a very proactive patient and did a lot of reading and Internet research on twin pregnancy. In addition, we took a childbirth preparation course for parents of twins as well as a Bradley course.
Midwife talked me into an induction in week 38 (considered full term for twins). Spent twelve hours on pitocin drip--no significant contractions so midwife said I could go home. Went into labor on my own four days later (38 weeks, 6 days gestation).
I called my doula after labor seemed to have started. She came over to our home and stayed with me until my labor seemed productive. We went to the hospital after I'd been laboring at home for about six hours. At hospital I walked a lot and used the whirlpool tub. Labor did not progress very fast. At about hour fourteen, my blood pressure suddenly started to shoot up (no high blood pressure before labor). Midwife strongly suggested an epidural since they bring down blood pressure. I agreed. Pitocin was also started and she broke the water of the first twin. Meconium was present so things became more urgent (pitocin turned up, etc.) Scalp monitor attached to first twin. After this point my midwife stayed by me the entire time and was very comforting and reassuring.
Was fully dilated at hour twenty-two and was wheeled into C-section room (standard procedure at the hospital for multiples) for the birth. The backup OB came into the C-section room (still carrying her purse!) and told my midwife she could handle it on her own. Pushed for three and a half hours for first baby. I was very tired so I "let" midwife use vacuum extraction for first baby who had already crowned. Midwife broke water of second twin (also had Meconium) and attached scalp monitor. After about fifteen minutes I started pushing out the second twin. After about three pushes she was born. I did not have an episiotomy, but I did have some very minor tearing which required three stitches. The placentas were fused and I had trouble birthing them so midwife had to "dig around" a bit to get them out. Our doula took video of some of the labor and the final stages of pushing and birth so I have an accurate record! I was a bit "out of it" at the time!. I did watch a bit of the actual births in a mirror, although I had to close my eyes much of the time to concentrate on pushing.
Our babies were healthy, although M. had a bit of fluid in her lungs which was suctioned out. She nursed well from the beginning. H. had a bit of trouble with latching but learned within three weeks or so.
Overall, I am pretty satisfied with the handling of my pregnancy and birth. I'm very glad that I went with a midwife (recommended by Kmom, BTW) and that we used a doula. The midwife was much more liberal in her approach that I think an OB would have been and the doula was invaluable during labor, since she allowed my husband to focus more on me and less on being my coach.
Lisa Z's Story (twins, diet-only gd, vaginal birth)
Kmom's Notes:
Birth Story
My story, despite the fact that I gave birth to twin boys, is actually rather boring (thank God!). I did develop gestational diabetes very early on in my pregnancy, and I was expecting that to happen for many reasons (family history, my weight, the fact that I was carrying twins - all increase risk). However, I was able to control my GD through diet and it proved to be not much more than a minor inconvenience during my pregnancy.
I became pregnant with the help of Fertinex and IUI (Intra-Uterine Insemination). I suffer from PCOS, and do not ovulate without pharmacological assistance. I did conceive once before with the help of fertility drugs, but it was an ectopic pregnancy, which we were able to abort with drugs and managed to avoid any kind of surgery. At the beginning of my pregnancy I weighed 308 pounds. At the end, I weighed 323. After delivery, I was down somewhere in the 280's, but alas, that was short-lived, and I am now back up to somewhere around my late pregnancy weight.
As for my labor - my water broke 2 days shy of 36 weeks. I went to the hospital and basically sat around a lot waiting for labor to start. About 12 hours after I checked into the hospital, the contractions started. A couple of hours later I had an epidural, which came out and had to be redone. Because of this, they gave me MEGA-doses of meds, which caused me to be completely paralyzed and numb from the waist down. My dh and I fell asleep until the doctor came in early in the morning to check me (which required both my OB and my dh hoisting my deadweight legs into the air so that he could examine me) and promptly announce that it was "showtime." He had me start pushing in my labor room, but once the 1st head appeared, I was taken to the operating room, which is standard precautionary procedure in multiple births.
My delivery progressed very normally - Baby A arrived after not much more pushing, and Baby B, who had been breech until then, flipped his little self around to be delivered head first. It took 23 minutes and the help of forceps, but both boys were delivered vaginally and in perfect health - 5 lbs. 12 ounces and 5 lbs 13 ounces! I took them home with me 2 days later.
Dana B's Story (fraternal twins, diet-only gd, c/s)
Kmom's Notes: This mom was given an 1800 calories a day food plan, despite having twins, and told to drink Slimfast to keep down her weight gain. She had a borderline gd reading; her doctor elected to treat it as gd just in case despite it not meeting the full standard diagnostic criteria. Because her twins were not positioned well, she had a c/s. She had a lot of blood loss afterwards, which may also have affected her milk supply (see above). (Many times undiscovered or undertreated anemia after blood loss in childbirth can impact milk supply.)
Birth Story
After a year or more of trying to conceive and a couple of months considering fertility treatment options, we decided to try Serophene (which is the same or a similar chemical to Clomid). With this decision we knew we were taking a chance of having multiples, twin primarily, but we felt that it was worth the 9% risk stated in the materials. (Of course, I found out later I have *four* sets of twins in my family history so that fact certainly increased our odds.)
At my 11 week appt., my first one after getting pregnant, the OB could feel my uterus quite high---when he shouldn't be able to feel it at all yet. He sent me for my first ultrasound, where we saw two tiny sacs with beating hearts! (DH was sick that he missed this appointment!) After all the trying, waiting, and consideration, I thought I was ready for this possibility, but I was not. The nurses teased me about the look on my face for the rest of the pregnancy! I was in shock---all I could think of was double the daycare, double the clothing, braces, college---double *everything*! Dh, on the other hand, was ecstatic! "Hnnng! *I* did that!" said my caveman.
My OB works with infertility patients frequently, so has delivered many sets of twin--which has taught him to be very cautious. He leans toward intervention, which didn't bother me. I'm not much of an "au natural" kind of person; with doctors in my family, I trust them. However this OB *did* have a thing about weight, and Kmom and others were shocked when I mentioned that he recommended that I use SlimFast to avoid weight gain. I cried, and Kmom recommended that I find a new, more balanced OB, but I really trusted him when it came to the babies. I decided to ignore any weight-related comments and focus on the healthy-baby ones.
I loved being pregnant, despite the bedrest and preterm labor. I know that I crave attention, so I ate it up with a spoon during this time! I also enjoyed having a big belly that I could be proud of. I didn't have morning sickness, but "ligament stretching" is a bear! My bones and ligaments had a lot of adjusting to do to fit those two babies into my 5'3 frame!
At my 33 week appointment, I mentioned that it felt like A (on bottom) was sticking one little finger out my cervix and wiggling it, like he was trying to get out. (Yes it felt kind of weird, kind of tickly-itchy.) It was my cervix changing--I had dilated to a 2 and was 50% effaced. My OB sent us directly across the street to the hospital to check in. I had not noticed any contractions, even "false labor" ones, so this was a surprise.
Sure enough, the monitor showed some contractions, but I couldn't feel them. We were able to control the contractions with Brethene and Procardia (asthma and heart medications that soothe smooth muscle groups, like those around your uterus). A couple of time, the contractions got a little feisty, so we used injectible Brethene instead of pills, but that always worked. We never had to go to the 'hard' stuff like mag sulfate. If I had lived closer to the hospital instead of 45 minutes away, they would have sent me home. Instead, I moved in for the long haul. I was on pretty strict bedrest. I wasn't to sit up except to eat, but I could go to the restroom and take a 5-minute shower every other day. I looked forward to shower days! My parents stayed at our house during this time and visited me during the day. DH visited in the evening after work and on his days off. I didn't have much time for boredom between nurses, family, and other visitors!
At 35 1/2 weeks, my OB told me I could get out of bed! He was satisfied with the twins' development. He still wanted me to stay at the hospital, though, because A was frank breech andB was transverse---which meant I'd have a c/s (this OB doesn't like to put the second baby at risk by trying to turn one or both when they aren't in head-down position). He told us to go out to lunch and to the store to buy the babies something, then come back to the hospital like it was an apartment. (Odd arrangement, but woohoo! Sunshine! Real Food!)
I never made it--and am glad (my water would have broken in a restaurant, ugh!). While we waited for the hospital to figure out his "treat us like an apartment" order, my water broke! Once we convinced the nurse that I hadn't just wet myself, thing got exciting. I got an IV, DH got scrubs on (thank goodness he was even there!), and we wheeled down the hall to the OR, where I got scared for the very first time during the whole pregnancy. Something about that room was suddenly very intimidating. And the contractions got quite strong by that time, too. DH held me while I got an epidural (that hadn't seemed scary until that very moment--but it went fine).
Ahh...then there was no pain and not nearly so much stress. The doctor came in, a nurse turned on some rock and roll music for hi, and DH watched the whole surgery from beside my head. (But he wouldn't videotape it for me....sigh). The surgery must have happened really fast, because the twins were only a minute apart, but that was a really looonnng minute, it seems! I just remember an awful lot happening between babies, and nothing seemed to occur at a frantic pace--but then, I was pretty loopy. DH took the babies to the nursery for their baths while the doctor put me back together. I decided to take a nap at this point. I woke up to go to the recovery room.
Then things got exciting again. My uterus didn't clamp down like it should, so I continued to bleed profusely where the placenta had been. My blood pressure dropped to 64/40 or something and the nurses began working quickly. They shut my parents out of the room and paged a doctor. He ordered a shot of something and the nurses pushed on my stomach to help pressure-stop the bleeding. It worked and I was stable by the time DH brought the babies back from the nursery to see me. I got to try nursing them there in recovery, but we were all pretty tired, so mostly we snuggled.
My recovery from the c/s wasn't anything to write home about, but it was okay. I didn't realize that I should have continued taking iron pills to compensate from the lost blood, so I was even more tired than I would have been already. Between that, lack of sleep, and the extra energy it takes to make milk, I was a very tired camper for the first several weeks! But we had *two* precious babies! Nope, it wasn't the birth story I expected, but it has worked out beautifully. I made it and even went back to work part-time at 5 weeks (I burned 3 weeks of leave in the hospital). And I'd say our family is now flourishing in an "all-time best" period of fun and communication...although the twins do take a toll on our ability to manage romantic encounters!
My best advice for delivering moms? Request prunes with every meal. Don't ask---just eat the prunes! :-)
Kathy F's Twin Story (insulin-dep. gd, premature labor, vaginal birth)
Kmom's Notes: These are Kathy F's 6th and 7th children. Several of her other birth stories are in the BBW Birth Stories: Vaginal Birth Under Special Circumstances FAQ. They include homebirth as well as hospital birth.
This story was very long; it has been summarized. The major summarizations were placed into [brackets], although there were minor abridgments throughout.
For those facing a complicated pregnancy or long-term bedrest, there is a terrific organization called Sidelines that can help with information and support. www.sidelines.org is the website for further info.
Birth Story
We found out we were having twins at 10 weeks during a routine ultrasound at my first OB appointment. We were ecstatic! We had wanted 7 children, but knew that my 6th pregnancy would have to be my last due to the physical problems I was having. My husband was with me, so we learned of our double blessing together! We were getting our seven after all!
At 12 weeks I started bleeding. A gush one morning frightened me very badly. I was put on partial bedrest and the bleeding changed to constant brown spotting within 24 hours. This continued until the 18th week, when all spotting finally stopped completely.
I had been thrilled with my OB's care of my last baby (#5) but this pregnancy was different. My OB was a naturally quiet person, and wasn't as communicative as I felt I needed with this unusual multiple pregnancy. I also couldn't shake the feeling that things were going to be complicated. I wanted a specialist, so at the end of my fourth month, I changed to a perinatologist. It was a very smart and important decision, and I believe it was instrumental in bringing my girls strong and healthy into the world. My new docs had me come in each week and were very proactive in their care, looking to catch problems before they arose.
Starting around the end of the 4th month (as I changed doctors), I began having constant contractions, i.e., 'irritable uterus'. Until Oct. 4, they weren't doing anything to my cervix. 3 weeks before then, I'd had a fairly new test called a "fetal fibronectin" test, where the fluid around the cervix is tested for a certain protein that apparently is always present when a woman goes into labor. If none of this protein is found, it's almost a guarantee that the woman will NOT go into labor in the next 2 weeks, but if the protein is present, there's a 17-40% chances (depending on what study is used) that the woman is going into labor in the next week or two. This protein was present for me both 3 weeks previously and in another test 1 week before the Oct. 4th date. This test, plus everything else, caused my doctors to put me on home-monitoring and complete bedrest for the duration of pregnancy. I was able to use the bathroom but that was all.
With home monitoring I had to strap on a contraction monitor for an hour and just lie there while it recorded any contractions. Then I would place the monitor into the base and 'fax' the recording to the monitoring center at the hospital where it would be checked. I never had more than 2 contractions in any given hour. In fact, I never did get to 6 an hour, which was the benchmark for labor my doctors had set. A couple of times that last week I had 3 in half an hour but then it would stop. My contact nurse agreed that I didn't fit the criteria for labor. I know it didn't FEEL like labor, and I'd had 5 children before this and had a pretty good idea of what that feels like! But this pregnancy ended as differently as everything else about it.
On Oct. 4, I got dressed and went to my regular weekly appt. I had contractions, but they didn't feel any different than usual. The week before I was barely dilated to 1 cm and not effaced at all. We did a vaginal ultrasound to see how my cervix was going. I knew there must've been big changes when the tech's expression changed from a smile to a carefully guarded one. The doctor was called in immediately and my cervix checked the usual way. Turned out I was dilated to 3 cm and 50% effaced. "Well, you're sure not going home," the doctor informed me. "We don't know where you're going, but you're not going home."
We were having an electrical storm that morning, so they couldn't air-evac me to my insurance's choice of hospital 30 minutes away, and they weren't going to risk an ambulance ride so I got to go to the hospital of MY choice right next door to the doctor's office. Once admitted I was put on monitors, and was definitely in active labor, having contractions anywhere from 5-12 minutes apart. Standard for me for the first 5 cm of dilation. I was put on Magnesium Sulfate to stop the labor, and since the Mag was somewhat slower acting, was also given a shot of another tocolytic (not terbutaline). It did the trick. Wed. night I went into labor again, had 7 contractions in an hour. They again gave me the tocolytic, raised the Mag to the maximum, which again arrested the labor even though I was not dilated to 4+. [I asked for and got a catheter because getting up brought on the contractions.]
I have a strong belief in a personal loving God, so after they did all this and left me alone in the darkened room I laid as still as I could and prayed, tears running down my cheeks. My prayer (and fear) was so intense I felt as if I was standing before the throne of God, and beseeching Heavenly Father with all my heart to please stop the labor. Please give me and the babies time. [I felt his love, but that I was praying for too much time that He couldn't give because of other complex, long-term factors.] I prayed for just a few days, just enough to let the steroids work on the girls' lungs and help them develop more completely. I felt a great peace, a great sense of surrender, and commitment to accept His will and not fight it. In a very real sense, I felt Him stop the labor. The medication I had been given was his tool. The labor stopped because Heavenly Father heard my petition and granted it. I know this with all my heart.
About 3x a day the doctor wanted a monitored reading of the babies' heartbeats. This was an extremely difficult thing to do because I had to try and stay completely still--not even scratch an itch---or the whole thing would be thrown off and I'd have to do it all again. [The sessions could last an hour or more.] My arthritis in my hips was aggravated by the pregnancy and with the Mag relaxing my muscles it made the arthritis even more painful. The pain during these days was excruciating, perhaps the worst pain I've ever experienced in my entire life. Through prayer and contemplation I was strengthened and found this time to be one of great joy and communion with the Spirit in spite of the pain. I also made a game of being as friendly and kind to the nurses as I could. Since I had to be there, I figured I might as well see if I could make their work as pleasant as possible.
While in the hospital on bedrest, my Gestational Diabetes (developed at 28 weeks) was uncontrollable by diet alone. {Kmom note: Some tocolytic drugs, while a necessary evil for some, do tend to increase blood sugar, as do the steroid shots she was given to mature her babies' lungs. No wonder she needed insulin, but it was a small price to pay for the necessary meds in this case.} I was put on insulin, just two shots a day, long-acting, and the lowest dose. That took care of the problem.
[By the following weekend, my Mag dose was lowered, I got bathroom privileges, and needed less monitoring. But the next week they increased. I told the nurse. Things were feeling different. I didn't want to admit it to myself, but I had a gut feeling my time was nearly up. Early Tuesday morning, about 6:45 a.m., I got up to use the bathroom and before I was even standing I felt my water break. I called my husband first before even calling the nurse so he could arrange for care for the other kids and get to the hospital. After I went to the bathroom, I pushed the button.] It was a funny tableau--me standing there with fluid running down my legs and 3 nurses standing in the doorway looking at me. "I think my water broke," I said. "Yes, I can see that!" said one of the nurses. Then controlled chaos ensued. We were all cheerful and joking a bit, no point in being fearful. I had been receiving the absolute best care from the doctors and nurses, the NICU was a level 3, and advances in neonatal care made the chances of everything being fine as high as they could be.
The nurse wanted to get a monitoring strip on the babies but we couldn't find them. We could find echoes of their heartbeats but couldn't pin them both down at the same time. Pretty soon the u/s tech was called in to find them. Turned out Baby B was lying transverse on top of Baby A, who was vertex. But both were fine. Because of their position and their borderline weights--barely 1500 grams---the doctor said a c-section would be best. That was fine with me! I'd already decided that whatever the doctor wanted to do, I would agree to. I knew I had the best perinatologists in the state and wasn't about to second-guess them! That was why I switched to them in the first place.
The doctor did want to give me a couple of hours without the Mag to see if the labor was going to continue. [It didn't stop, but it never got regular either. I had some HARD contractions after my water broke, but they were never regular. I was very controlled during labor, never making a peep, and that plus the irregular contractions confused the heck out of everyone. I did tell them after about an hour that labor wasn't going to stop and she'd better get the doctor and get things ready, but then I let them give me some Demerol and it became difficult to communicate. Those hard but irregular contractions (never more than 3 or 4 in any hour) had been doing a LOT, then I had a really hard one down in labor and delivery. The nurse there KNEW, especially since for once *I* didn't know, but she was right---I was not only at 10 cm but baby A wasn't interested in waiting for the doctor or the c/s! (I've always known and told the nurses when I was at ten---my contractions followed a set pattern in all my other labors, but the Mag really threw that pattern off this time.) The nurse called for the doctor, stat, and things really got moving.]
I was wheeled in the O.R. and prepped. The doctor told me that after baby A was delivered vaginally, we could still do a c/s for baby B. The risk to her was still there. But then the doctor did a quick ultrasound to determine the position, and another miracle was discovered. Baby A had come so far down the birth canal on her own, she'd given baby B enough room to maneuver from transverse to vertex (head-down)! My husband and I were thrilled; it took me a few seconds before I realized I wasn't going to have a c/s after all.
Baby A was born with one tiny push from me, and my goodness, she was protesting!! What a cry! She was LOUD!!!! The doctor told me to wait for another contraction, but they'd been so intermittent that after waiting 5 minutes or so, I just decided to push anyway. It took a few minutes, but baby B was born 9 minutes after baby A and was as LOUD as her sister!! They both had Apgar scores of 9, 9!! I'm still amazed at that. They were 3 and a half and 4 pounds, respectively, and 16.5 and 17.25 inches respectively.
They were in the NICU for a week, then in a level 2 nursery for 2 more weeks, then discharged from the hospital on apnea monitors. They were on IVs for just a couple of days while the Mag was flushed from their systems. Then when we started bottle-feeding them and they did so great the IVs were removed. They also had prongs for extra oxygen in their noses for a few days, and received small amounts of caffeine for a week or so to help them because of Apnea Bradycardia (breathing lapses and slow heartbeat) episodes. They never had to be intubated or have gavage feedings, which is amazing for 31 weekers. The girls are now 3.5 months old and are 11 and 12 lbs. They are both remarkably healthy.
There was one major complication with the twins, and I'd like to encourage EVERY parent of a preemie, no matter how big, to get their eyes checked for Retinopathy of Prematurity (ROP) both within the first weeks of birth and absolutely by the 37th week. That 37th week is critical. You may end up saving your baby's eyesight by taking the time. In my hospital, they routinely check preemies born 32 weeks or sooner. One of my babies had ROP, stage 3 (stage 4 means blindness). Laser surgery corrected the problem. Her 6-week checkup after surgery was last week and her eyes were declared perfect! It is obvious to us that she is seeing very well, is tracking, etc. ROP doesn't happen to all preemies, and happens less the older and bigger they are. But you never know, so get their eyes checked to be on the safe side! The American Pediatric Association only recommends routine screening of preemies 28 weeks or less, and 1500 grams or less. My daughter was older and bigger and would be irrevocably blind if it weren't for the more liberal policies of my hospital's NICU.
The afternoon of the delivery I had a tubal ligation, since my body is just not managing pregnancy well anymore. My last child before the twins was born at 36 weeks, and with the insulin-dependent GD and the arthritis, it just would be really pushing it to risk getting pregnant again, both for me and any future children. I've also developed a hernia, either umbilical (bellybutton) or incisional (from the tubal ligation), and will need surgery soon to correct it. [This may be from the multiple pregnancy or not but I probably won't ever know for sure.]
Both girls are very cheerful and full of smiles. We are enjoying them immensely. One is sleeping through the night consistently but the other is still waking up at least once or twice a night. Ugh. But soon they will be out of our room and in separate cribs. I'm looking forward to it! :-) Although I forgot to ask how the placentas looked because I was too drugged, they were completely separate and it is obvious by looking that my girls are definitely fraternal twins.
Sal's Story (PCOS, GD, PIH, fall down stairs, induction, vaginal birth)
Kmom's Notes:
Birth Story
I have PCOS and took Glucophage in order to ovulate. All was well during the first trimester. At 16 weeks of pregnancy I had an extremely abnormal AFP level. Then at 20 weeks I developed pregnancy induced hypertension. After 16 weeks of bedrest my OB recommended that we induce at 36 weeks if an amniocentesis showed mature lungs. The night before the amnio we were preparing for the baby and I fell down the stairs (14 steps), fracturing my spine in 3 places, breaking my tailbone, and injuring my shoulder. The injuries were evaluated and found to be stable and not in need of surgery (thank goodness!). The amnio was performed and my doctor missed on the first attempt, had success on the second attempt, and the lungs were immature. However, the amnio triggered contractions so I had to spend a day in L&D. My blood pressure skyrocketed even on complete bedrest after my fall and my OB decided it was necessary to admit me to the hospital and begin an induction at 37 weeks.
I went into the induction dilated at 1.5 cm and effaced 75%. Now that I was in the hospital they no longer allowed me anything by mouth and insisted I take only IV pain meds. I was given 2 mg of Stadol and a dose of Phenergan---it made me intensely disoriented and miserable and the baby had a couple of significant decelerations. Once it wore off I decided pain medicine was not a good friend of mine!!!! After a full day of pitocin and contractions I had no progression! The pit was discontinued for the night and begun again first thing the next morning. My OB then broke my amniotic sac to try and get things moving and cranked up the pitocin (even on the max dose the day before I never went into labor).
After several hours of contractions I had only dilated to 3 cm! Two hours later I was only at 3.5 cm; however now I was really uncomfortable so they let me get an epidural. I was terrified of the epi due to my recent spinal fractures, however, I had wonderful relief with it. A catheter was placed in my bladder and internal monitors were placed on the baby's head and in my uterus to have better monitoring. The pitocin was then increased above the normal maximum level and I was very closely monitored.
Once settled I took a good nap with my only discomfort being rectal pressure with each contraction. Two hours later I awoke to increased pressure and I was 7 cms! The pressure continued to increase (but no pain) and another 1.5 hours later I was complete and +1 station, ready to push! When I began pushing the epidural was turned off and I became intensely nauseous and the pain was intense from both the labor pain and my back injury. Due to breaking my tailbone [in the fall], my birth canal was very swollen, so every time I pushed the baby down he popped back up! It didn't take long for me to become miserably overwhelmed with pain and I began vomiting. At this point I begged for help!
The nurse called the OB and he immediately performed an episiotomy and used the vacuum to assist in the delivery. The vacuum fell off and the OB had to cut even further with the episiotomy. However, the baby came out after a few more pushes along with the OB's help (and vacuum!). The baby was born healthy as can be and fully mature. He was 7 lbs. 14 oz., 19.5 inches with Apgars of 8, 9, and 9!
Just after delivery I began bleeding and they had to give me lots of pitocin and massage my abdomen to get my uterus to cramp down properly, however it responded well to treatment. I developed hyperlactation [too much milk---kmom], most likely due to my PCOS, and with help from the lactation consultant we are doing WONDERFULLY and the baby is now gaining weight appropriately! My blood pressure and severe edema went down quickly a few days after delivery and within a week I had lost over 20 pounds!
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.
Dawn2's Story (diet-only GD, herpes, PROM, preemie, vaginal birth)
Kmom's Notes: Dawn was able to ask a lot of informed questions of her providers, and was able to advocate for the kind of birth that she wanted. Having a doula can be especially helpful if you are facing complications and a more medically managed pregnancy, like GD pregnancies often are. Being co-managed and attended by a midwife at her birth probably also helped her avoid an unnecessary c-section.
Dawn's baby was probably malpositioned; she had strong back labor and a long pushing stage in which she seemed to make little progress for a long while. Then she felt the baby rotate internally and suddenly pushing became more effective, and the baby was born not too long after that. Once again, fetal position makes all the difference in the world for this mother.
Birth Story
I failed the 1-hour glucose screening test, but not by much as I recall. After the 4-hour test, I was diagnosed with gd because my fasting was high and my 2-hour level was high. I was placed on a 2100 calorie food plan, which I followed but had real emotional issues with because I hadn't dieted for many years (with a stable weight), and I really felt deprived not being able to eat the sweet things that I hadn't denied myself for years. I fell right into the emotional landmines that dieting brings, and it was really hard for me.
I tested 4 times a day--in the morning and 1 hour after each meal. I had done a ton of research on gd and so was in the position of asking questions of my provider (midwife) that she couldn't answer. I was co-managed by an OB, but he used Matria, a diabetes management provider, to which I was supposed to call in my numbers and talk with a counselor each day. I really felt like no one could give me a straight answer to my questions--it was a big deal because I asked whether the cutoffs they were telling me to have were supposed to be measured in blood or plasma, and what they told me didn't match the numbers I had seen -- I felt like they were asking me to have blood glucose numbers much lower than necessary, and the stress was causing my numbers to be higher. I was really concerned about insulin and the effects of altering my baby's metabolism before birth. If the OB had insisted on insulin, I was thinking that I would consider switching providers.
As far as the GD, I did get into something of a groove, but I found that fruit affected the numbers more than anything--I couldn't have an apple without my numbers jumping up, and that just seemed so counter-intuitive that fruit could be bad for me. But I was careful to be really active, maybe even more so than when I wasn't pregnant, and my after breakfast and after dinner walks really seemed to help.
One morning just after I was 34 weeks pregnant, I woke to a little moisture, kind of like when you've had a lot of discharge the night before. After my morning walk, I noticed a little bit of brownish discharge on my underwear. I didn't think anything of it, but later, as I was getting dressed, I felt some leakage. I thought it was just urine, as my sister had had a lot of urine leakage as she got to the last couple of months. But, combined with the discharge, I thought I'd call the midwife's office. They told me to come in, which I did later in the day. I wore a pad, because all day, as I walked around, I would occasionally feel some leakage, just a little here and there like I couldn't hold urine. I had been having occasionally tightening contractions, Braxton-Hicks, for the previous few weeks, and the frequency of those did not change.
When I got to the midwife's office, she started to do an internal exam, and as luck would have it, there was a little gush at the same time. She said, "That's not urine. It's coming from your cervix. I think you're going to have to go up to the hospital for a bit." I was really surprised, because I did not expect her to tell me that my water had broken. When the OB came in, the first thing I said was "I guess we don't have to worry about her getting too big!" and he was a total jerk, telling me that gd babies may be big, but they're not mature, etc, etc, etc. Just what a woman who has just been told she's going to have a premature baby wants to hear. I also thought I might have a herpes outbreak at the time, although I hadn't had any through my pregnancy, and was planning to go on suppressive therapy for the last 4 weeks of the pregnancy. (Vaginal births are now ok for moms with genital herpes if there is no outbreak at the time of birth.) The OB gave me these options: If I was having an outbreak, or if the baby was breech, I would be scheduled for a C-section right away. If the baby's lungs measured mature after they sampled the amniotic fluid, they would induce if I didn't go into labor soon, because I had estimated that my water had broken sometime in the morning, and they wanted the baby born within 24 hours. If her lungs didn't show maturity, they would let me hang out, and give me antibiotics to prevent infection, but they wouldn't stop labor if it started.
It turned out I wasn't having a herpes outbreak, so I was sent to the hospital with instructions that I would be admitted. Baby was head down, which was good, and I was put on a monitor, and I guess I was having occasional contractions, but I didn't really feel them. My doula and I waited for a while for the results of the amniotic fluid sample, and her lungs weren't as mature as they wanted, so they started me on IV antibiotics and I waited for a room in the high-risk antenatal unit.
The next morning I wore the monitor something like twice a shift. I was supposed to be on bedrest, but was able to go to the bathroom. As the day went on, the contractions got stronger and stronger and more and more frequent, and I seemed to be passing my mucus plug in the afternoon. I called my doula around 5 pm, because I wasn't able to handle the contractions on my own any more. I didn't really feel like eating, but managed to nibble a little. I think the contractions were about every 7 or 8 minutes at that time, but I could definitely breathe through them, and though I was supposed to be on bedrest, I would stand up and kind of rock my hips during contractions, to try and help gravity move her down. The nurses "caught" me, though, and I did have to wear a monitor part of the time.
By 8 pm or so, I was in "active labor" and was wearing the monitor. I could absolutely not lie flat--it was too painful, so I generally laid on my side. My back was also beginning to hurt constantly, so my doula rubbed it with an ice pack through contractions, which had gotten steadily closer and closer together. I had a couple of internal exams, and I guess I went from 3 cm dilated at 9 pm, to something like 8 cm at 10 or 11 pm. Fairly early on, I started asking for an epidural because I was having a hard time managing the contractions, but they didn't want to give me one because I was only at 3 cm, so they gave me some Nubain instead. That helped a lot, and I was able to relax. The next time they checked me, I got a second dose, which helped but not as much as the first one. When that wore off, I started to feel like I wanted to push. The decision had been made that the midwife could manage my labor since the baby was good-sized and looked good on all of the monitoring, so I was really thrilled because I had wanted a midwife, not an OB, all along.
The moved me from my antenatal room to an operating room because there were no labor and delivery rooms available--it was a full moon and the hospital was packed. My doula and my mom came in as my support persons, and I started pushing around 1 am. I tried several positions, on my back, on all fours, I stood and tried to squat, but it really took a long time to feel like the baby was getting anywhere. It was really, really discouraging to feel like I was doing this incredibly strenuous work and the baby wasn't coming down at all. We talked about an epidural, especially after I had pushed for something like an hour and nothing was happening. I wanted one, because the back pain and contractions were very difficult. But in all of the movement, my IV had come out, and they wouldn't give me an epidural without an IV in. The nurse tried to get another one started, but was not successful after poking me I don't know how many times. They had to call in an anesthesiologist to get an IV going, and he tried several times as well--I will say it was difficult for him, too, because I couldn't stay still for very long--it seemed like the contractions came every couple of minutes, and then I had to push, so he couldn't really search well for a vein. This took another hour or two, and I pushed all while they were trying to get an IV started again. Finally, they got one started, but the baby had finally made some progress downward, so I didn't get an epidural.
At one point in between contractions, I was resting with my doula and the nurse holding my legs up (because the pressure was so intense), and I felt the baby unmistakably rotate. At that point pushing seemed to have a point, and soon I started to be able to see her head in the mirror up in front and above me, and that really motivated me. It was still somewhat slow and agonizing, and right as she was crowning was really intense, but the moment her head came out (5:12 am--after 4 hours total of pushing) all of the pain and pressure was gone--almost instantaneously. It was really amazing how quickly the pain was just . ..gone.
She didn't cry immediately, and she was taken to the warming table, and she started mewing within a few minutes. Her apgars were something like 7 and 8, which I thought was great for a preemie, and she was 6 lbs 5 ounces! The midwife saw that there had been a knot in the cord, which could have been fatal if she had gotten bigger. I got to hold her after a couple of minutes, and my mom carried her up to the NICU for observation.
There was no episiotomy, no tears and I didn't require any stitching--the midwife said that was probably because I hung out with her crowning for a couple of contractions--she didn't come out in one push. In recovery, the most thrilling thing was that I got to drink some orange juice--which I hadn't been able to have for a while! I made sure that the nursing staff knew I wanted to breastfeed and got the information as to the baby's first feeding, which was scheduled a couple of hours after I got to my room. I went to the NICU, and was able to try to nurse with a lactation consultant's help right away. She didn't latch on for long, but she did latch for a bit, and then I followed with a bottle. She was on IV antibiotics (because she was born more than 24 hours after membrane rupture) but didn't need extra heat or oxygen.
I went down for almost all of her feedings, and attempted to get her to nurse first, before giving a bottle. I was quickly given a pump and instructed on how to do that, and I think I started getting little drops of milk on Friday night (she was born early Thursday morning) which I took down for the NICU to give her in a bottle. At one point, the NICU nurse called me about a half an hour before her scheduled feeding because she was crying and the nurse thought she was hungry--so I was able to continue to try to get her to nurse first when it would be most useful. I was released Saturday afternoon, but the NICU doctors wanted to keep the baby for another day, as she had started to get somewhat jaundiced. Sunday I checked on her right away, and because she hadn't really lost any weight and the bilirubin levels had peaked I was able to take her home then.
When we got home, our routine was every 3 hours to attempt to nurse, feed pumped milk, then feed formula if she was still hungry, and then pump if she hadn't latched on for at least 15 minutes. At her one week appointment, she was above her birth weight, and because the schedule was making me crazy, her pediatrician told me I could feed her on demand. After about 3 weeks, she was nursing much more consistently, and I dropped the pumping, and about once a day gave her some supplemental formula. By the time I went back to work when she was 12 weeks old, we only supplemented on occasion, but that changed as I didn't let down well to the pump and couldn't keep up with her demands by pumping. (Tried oatmeal, fenugreek/blessed thistle, breast compression while pumping, but my supply just got lower and lower as each month went by.)
At 11 months, she's 20 lbs, we're still nursing, although I've stopped pumping, and I hope to continue nursing as long as she wants to. She gets 2-3 bottles of formula daily at daycare, and 1-2 daily on the weekends when she nurses to sleep for her naps. I was thrilled that I got the kind of birth that I wanted, although there were so many things that almost derailed us in the process! What was important to me was that I had a healthy baby, born vaginally, and that I avoided an epidural and episiotomy, and I got all of that, although it was not easy! And breastfeeding was not easy at the beginning, but I feel that we have been successful at it and am not ashamed we had to supplement--I wish we didn't have to, but the circumstances were such that we have, and she's thrived.
I hope this story is useful for someone .. .the best advice that I can give you is to research, research, research--and don't be afraid to question your caregiver. Ask for their rationale for the decisions they are advising you to make and if it doesn't make sense, see if you can get another opinion and talk about it. Get as much support as you can--I had a wonderful experience with my doula and would highly recommend getting one, even if you have a partner because they offer a neutral perspective and are there to help you get the kind of birth you want.
GD Birth Stories: Vaginal Birth After Cesarean
Note: There are more gd vbac stories coming; Kmom is awaiting several story submissions and final permission before putting them up. Keep checking back!
Dee's Story (c/s due to size-phobia, insulin-dep. gd, vbac)
Kmom's Notes: Dee's story reflects the importance of choosing your provider wisely! Her first doctor was a fat-phobic man who expected her to fail based on her weight, and created a self-fulfilling prophecy. Some of the doctors she saw after that for infertility treatments were also fat-phobic, but this time she stood up for herself and eventually found one that was not. Her VBAC was probably made possible by the great support she had from her OB, the flexible laboring protocols (including using water despite being on pitocin) she was able to negotiate, and the support of her doula and husband (research shows a doula cuts the c/s rate by nearly 50%). And of course, most importantly, it came about through her own determination and woman-power!
Birth Story
In retrospect, I realize there were many clues thrown out by my ob/gyn over the months of my pregnancy that forewarned of an unnecessary c-section. The biggest clue was his repeating the mantra, "Of course, at your weight, it's likely to end up a c-section." I weighed 247 at the beginning of the pregnancy. In spite of a very healthy and uneventful pregnancy, my labor was long and ineffective. My waters broke at 10 in the evening, 13 days post dates. I went into the hospital immediately because....well, I wanted to have that baby! While I had light contractions all night long, they were ineffective. In the morning, I was given prostaglandin gel. That got things rolling and within a half hour I was having strong and consistent contractions. I was through transition, fully dilated and effaced and felt the urge to push around 3 pm. Four hours later I was still pushing. All throughout the day, the doctor repeated his mantra omen. Neither he nor the nurse encouraged me to move about, change positions or try any alternative birthing techniques. So, it was no wonder, again in retrospect, that E was born via c-section, with dislocated hips and a huge hematoma on his scalp from the different types of vacuums the doctor tried to use.
Fast forward to 6 years later. I was 35 years old and finally expecting my second child after having battled secondary infertility for 4 years, and after having several miscarriages. Most of the battle regarding my infertility was dealing with fat phobic doctors who refused to treat me until I lost weight. Of the 5 doctors I saw regarding my infertility, one put me on 100 mg clomid the first cycle and didn't monitor me at all. I was given no information regarding what to expect, charting my temps or anything. I had extreme pain during that cycle and was told, "Oh we expect those things". So I went to another doctor. She found a huge cyst on my ovary, told me I needed to lose weight and put me on phen/fen. I lost 45 lbs or so. She referred me to an RE she worked with. He refused to put me on any more treatments until I lost another 45 lbs. I refused. He was the one who said, "If you really want a baby you'll lose weight." I had been on the phen/fen the maximum recommended and it wasn't effective any more. So, the RE refused to treat me and I refused to diet. I went to another ob/gyn who basically had the same opinion as the RE. I made an appointment at the local university hospital. Lo and behold, the RE staff there immediately identified my problem. I was able to get pregnant, but I would lose the baby before it even implanted.
See, I had been having regular 30 day cycles with occasional 35-40 day cycles. I had been keeping record and I could have sworn I was pregnant on those 35-40 day cycles. I had all the symptoms...swollen breast, nausea. But then the period had come. The other doctors all insisted I wasn't getting pregnant but because of my weight I had PCO. Well, this new RE, Dr. N., said, "Yeah you have PCO, but you are also getting pregnant and losing the baby." With an attitude of "you have the right to have a baby and you can have a baby....I'm going to figure out how to help you", he decided to simply try an assisted cycle with clomid, and after ovulation, progesterone.
On the first cycle we tried, I got pregnant!! I also carried that pregnancy to term. Dr. N recommended one of his recently graduated students for my ob/gyn. She was marvelous. Pro vaginal birth and size accepting, Dr. M saw my pregnancy as joyously as I did. I wanted a vaginal birth so badly. I had felt like such an idiot when I realized how duped I was by my first ob/gyn. His fat phobia and surgeon mentality had doomed me to a c-section right from the start and I was felt so ignorant for believing him and not seeing what was going on. I also felt the delivery and drugs after interfered with my bonding with the baby. I can honestly say, I felt like a zombie until we finally got home and I stopped taking the pain drugs. Then I fell in love with my son. But, I will always regret that he didn't get those first few days of love that babies thrive on. I wanted my next child to have that opportunity and I strongly felt having a VBAC (Vaginal Birth After Cesarean) would lead up to that.
Everything went well, with the exception of severe nausea on my part, until the 28th week when we discovered I had gestational diabetes. You know, I never realized how important it was to me that my pregnancy be totally normal and without even the mildest of complications. I cried when I found out I had gd. My numbers were mildly high, but consistently high. So, I was put on insulin and a diabetic diet. Complicating everything was my reactive hypoglycemia. This insulin resistance left me feeling nauseous all the time. I again felt a sense of failure. I was so mad at my body. I was so certain that it was my diet that caused the problem, even though in reality I had actually been following the ADA diet all along.
Well, somehow, between the needles and lancets, I managed to make it to 37 weeks. I was very sick from the gd and hypoglycemia and I was under a lot of stress due to both my parents being criticallly ill, my husband having to move 3 states away, and my trying to sell our house. Between the stress and the illness, my body was breaking down. I was swollen, though my blood pressure was fine. I had several episodes of false labor, 2 of which took me to the hospital. The baby's heart rate was running too high and I was dehydrating frequently from the vomiting. So, feeling I was doomed to a c-section even though my heart strongly desired a natural birth, I asked the doctor to induce me early and she agreed that the environment in my body was no long doing any good for the baby. Since we knew from the infertility treatments exactly when I had conceived the baby, we decided to deliver the baby on week 38.
I told my doctor I just wanted to plan a c-section as I was so certain the induction was going to end up in a c-section. However, she persuaded me to have a trial of labor and said, "I don't see any reason why you can't deliver this child naturally. It's your decision, but I'd like to encourage you to give it a try. If you get into it and want a c-section I'll go that route. But, I'd like you to try." So, I agreed to try. I have to admit, I had planned the whole pregnancy for a vbac. I was so certain I could do it, but when it got down to the wire, I was scared of a repeat of what happened with my first child. I was scared...just plain scared. After testing the amniotic fluid for lung maturity, it was determined the baby was ready to be delivered. Everything was perfect for his lung scores; so my doctor and I decided to go ahead with the induction beginning on the 25th. I was dilated to 2 cm and 50% effaced. The baby was at -3.
So, my husband "Rosh", my doula "Kathy" and I arrived at the hospital Sunday evening, and the doctor applied prostaglandin gel to my cervix. I started having irregular contractions right away. Since I had been having strong false labor for almost a month, it wasn't really surprising that I'd have at least some response to the gel. We passed a relatively boring evening in the hospital. Kathy and I walked the hallway and I rocked to try to get the contractions to going at a stronger rate. I was still dilated to only 2 and at 50% and -3 when the nurse checked me before the second application of p. gel. I asked for a mild sedative to help me sleep, because I knew I wouldn't be able to with all my excitement and agitation. I was given visterol.
So I slept all of 4 hours and was awakened to take my morning shower. My nurse was worried about my gd and my tendency to have insulin reactions, so she brought me a tray of food which included a muffin and scrambled fake eggs. I would later belch that egg throughout the active phase of labor. I didn't even eat the whole thing and it still came back to haunt me. At the 8:00 check and pitocin start-up, the cervix was still at 2, 50% and -3. Things didn't look too good for a successful vbac at that point. The -3 station was a repeat of my first delivery. But we plunged ahead anyhow.
I started having regular strong contractions almost immediately. They were strong and regular. I took a short walk with Kathy down the hallway. Then I took to sitting on the rocking chair and rocking. That rocking movement really seemed to help me deal with the discomfort. At around 9:00, my doctor's partner arrived and checked me. I was 4, 80% and -1 to 0!!!! He decided to break my waters. I wasn't so keen on it, but didn't feel like arguing with him. I felt intimidated by him, so I let him do it. The gush of warm water was just an amazing feeling. I was surprise a how much there was. Anyhow, at this point we had committed ourselves to birthing this baby one way or the other. I had figured I had relinquished myself to a repeat c/s.
Off and on, the nurse would prick my finger and check my bg levels. It was fluctuating wildly. So, she and the doc monitored it closely adding insulin or dextrose to the iv depending on my bg. I hated that pin prick. It just seemed so unfair when I was having to deal with the pain of labor, but I knew it had to be done. It was frustrating, but necessary.
It wasn't long before the contractions began to be long and hard. I was surprised it was going so fast, but boy was I hurting. The nurse then decided I should get in the bathtub for awhile. I don't know how long I was there...maybe 45 minutes...when I started begging for an epidural. The contractions were soooooooo strong. The nurse was patient and encouraging and very competent in finding ways to delay me from getting the epidural--"oh try leaning this way" or "how about we kneel for awhile?" Then I started getting more insistent (ok I BEGGED) and she said ok. She drained the tub and started the shower. She had me stand up and lunge with one leg on the tub edge. Then she poured the cool water over me. At this time I was having a very strong burning sensation that originated near the c/s scar. I finally begged a bit more and she then took her time drying me off and getting me and all my iv tubes into the nightgown. Finally she got me into the bed and left the room to find my doctor.
I kept begging for the epidural. I don't know how much time had passed, but it seemed like 74,568 years :^). Finally my doctor walked in the door. I think I exclaimed something like "Oh thank God you are here, can I have an epidural?" She held my hand and said yes. Phoebe disappeared to call the anesthesiologist. Dr. M. held my hand while I had contractions and she didn't let go until I kind her pushed it away on one very big contraction. She is a very compassionate doctor who is VERY pro-vbac and has one of the lowest c/s rates in the are...as did her partners and the hospital I was birthing at. I had chosen her because of her reputation and my RE's referral.
Anyhow the epidural guy finally got there and took his time getting the epi in. I was still 4, 80 and -1 to 0. I was really being a pain, too. I complained every single contraction. It hurt sooooo badly. I don't remember my first hurting so much. I hadn't had any pain intervention with him, but this time things seemed very bad. The contractions just didn't let up and they were sooooooo intense. I also felt intense burning and pain at the site of the c/s incision on my skin. Looking back, I think the internal pain must have centered at the internal incision. It just seemed concentrated right across the front just above the pubic bone. The nurse felt it was due to scar tissue tearing away with the contractions.
While the anes. was fiddling around with my back, I sat on the edge of the bed and rocked with each contraction. In retrospect, I think that must have really helped get things going. Finally the guy told me to hold still (HA!~!~!~) while he inserted the needle. I think it took several contractions, and I really did my darndest to hold still. Finally, I felt like my bladder was being pushed and I had no control over it. I told Phoebe I had to pee. She said in a very nurturing voice, "Go right ahead and let it go. Just relax and let it go." Well I did. There really wasn't a thing I could do to stop the drenching anyhow. After the initial flood, with each contraction I felt this push on my bladder and a little voiding. I began to feel like I just wanted to push my whole bladder out.
The epidural was in and I felt my left leg get tingly and numb. But nothing else went numb. The epidural was ineffective and had been placed in the wrong position. I had a dead left leg and lots of pain. It was exasperating. So, they were getting ready to get me back onto my back (I was still sitting on the edge of the bed), when I told the nurse something was pushing on my bladder. She suddenly got excited and said, "Maybe you are ready to push. Do you feel like pushing?" It dawned on me that that was the case and I grunted in the positive. So, she checked me. I was 8 to 9 cm!!!!!! I had gone through transition while waiting for the epidural and no one had even known. Now I had a numb left leg and the rest of me never did get relief, but I think that was the best thing that could have happened. it was time to push and the epi might have screwed that up.
By this time, though, I wanted a c/s. This is where I have to say THE BIRTHING TEAM MAKES ALL THE DIFFERENCE!!! Had I not had the doula, my wonderful nurse, and Dr. M. there to encourage me, I would have grabbed the scalpel myself!!! I begged Dr. M. not to let me go through what I went through with my first delivery. She promised she wouldn't. For each contraction, I bemoaned my inability to push the baby out with 2-3 pushes like some other women do. I whined and complained a lot, I think. I was being such a wuss, but it hurt sooooo much and the contractions were coming sooooooo quickly. Some other doctor was there and for some reason he actually did the delivery. I have to ask Dr. M. why that was, but anyhow she stood right there and told him what to do while she encouraged me and held my legs up along with Rosh, Kathy, and the nurse.
The nurse was marvelous...though I hated her at the time (contraction hatred). She insisted on my getting on to my knees and trying. It was in my birth plan and she was insistant that I give it a try. With my numbed left leg, balance was really hard and I got terrible muscle contractions in my back where I have an injury from 6 years ago. She had me turn from back to knees and knees to back. All the darned wires from the baby monitor and contraction monitor and IVs would get tangled up around me. It drove me nuts. That and the hair of my husband's beard tickling my shoulder when he'd rest his chin on my shoulder and count during the contractions...UGH!!
At one point I asked to see the head as it begins to crown. It was soooo cool, but I couldn't stand to look more than once because all I wanted to do was get that OUT!!! I couldn't stand any distractions. Even the encouraging and gentle comments from the doctor, nurse, etc. got on my nerves. I just wanted to concentrate. I told them to be quiet. My husband did the counting for me while I pushed. It helped to give me something to focus on. I wanted to groan, but the nurse told me to focus it inward. I wanted to tell her I'd focus it at her, but I really could feel progress being made after I put all of the air into the push. So, I focused. Interesting how you can hate the very people who help you when you feel so much pain.
Finally, about an hour and half after I began pushing, the head crowned and I felt the "rim of fire". Oh golly did that burn, but it was SUCH a relief to know the baby was THERE!!! I'm not sure how many contractions there were after that, but I think maybe 6. Finally the nurse said, "This next contraction and the head will be out." I didn't believe her, but I decided I was going to prove myself. So, with the next contraction, I pushed like you couldn't believe. Then "WHOOSH" this thing popped out of me and there between my legs with a gush of warm waters was the head of the tiny fellow. Oh WOW! What a sight and what a feeling. It was beautiful. I wanted to hold him. But I had to wait for the darn shoulders. The doctor told me I had one more push. I think I whined, " I still have to push", but as I whined that, the uterus gave one strong contraction, I didn't push at all, and the shoulders popped out!!! WOW! They did a quick check and handed the little guy to me. What a wonderful smell and touch and sound and and and....it was beautiful. He was beautiful.
Suddenly the nurse that I hated through each contraction (but who I realized was doing what I had wanted, btw) was the most loved creature in the world. I wanted to kiss DH, Kathy, the doctors and the floor!!! Fortunately for the others, only DH got the kisses. It felt so wonderful to be through the pain; it felt so marvelous to have my baby vaginally and to hold him and nurse him. I felt like I had won, liked I'd accomplished some grand and glorious feat. The doctors waited until the cord stopped pulsing to have DH cut the cord. The only thing I regretted was the long wait to get him to my face. I had to wait until the cord was cut. But, they honored my wishes that the cord be allowed to cease pulsing on its own.
They let me hold him quite awhile, then finally took him across the room to do the check and clean him up a bit. Oh he smelled so nice with that amniotic fluid and vernix. Such a sweet and unusual smell. I regretted when they finally gave him a bath later. They bathed him right in the room. He never left my room. I labored, delivered and stayed in the same room the whole time. The nurses came in every hour for awhile to check his blood glucose levels due to my high blood sugar in the pregancy and during delivery, but he stayed within normal range and was handling things well. So, no intervention was needed in that regard. He nursed and slept and watched the world around him. I fed him and watched him sleep and observe. It was blissful.
So, that is my version of the story. I'm sure some things are fuzzy in my memory, but for the most part everything was just as planned once the labor got going. My big recommendation to anyone planning on a vbac, CHOSE A GOOD SUPPORT TEAM and MEDICAL TEAM. I never thought I would wuss out like I did, but I would have given into a c-section RIGHT THEN. Had it not been for a pro-vbac doctor, hospital, nurse, and friend, I don't think I would have had my vbac. Also, don't be surprised at how much you will resent everyone helping you during the birth. I think it just hurts so much that it is beyond our capacity to keep focused on the outcome. So I let them do that for me. AND THEY DID!!! Bless them all.
Margie's Story (5 children; #4: c/s, insulin-dep. gd; #5: VBAC, insulin-dep. gd)
Kmom's Notes: Margie has 5 children; this is mostly the story of #5, her gd vbac. The fact that she'd had 3 vaginal births before her c/s increased her chances for a VBAC, as did her supportive staff and taking good care of herself. Her birth stories (all of them) can be found at:
http://pregnancy.miningco.com/health/pregnancy/library/stories/b13797.htm (1st 3 births)
http://pregnancy.miningco.com/health/pregnancy/library/stories/blcameron.htm (4th birth)
http://pregnancy.miningco.com/health/pregnancy/library/stories/bl9907196.htm?pid=2839&cob=hom
Birth Stories
Baby #5: This story begins with pre-pregnancy. This was a much planned for baby for a few years before she was even a sparkle in her Mother and Father's eye. I have four children, one of which I had Insulin Dependent Gestational Diabetes with. I wanted to have more children and knew that I would have to deal with this again. We got pregnant on our first try with In Vitro. Our previous son was conceived through In Vitro also. I found out I was pregnant and was very overjoyed. I was prepared for the pregnancy and hoped to make it better than my last. Even with Insulin-Dep. GD.
Only thing I wasn't prepared for was the onset was much earlier than my previous pregnancy. I began insulin at 12 weeks. My previous baby was born via C-Section due to Macrosomia. He weighed 11 lbs and 3 oz. I knew that if I kept with the diet and insulin that I would not have a huge baby. So on with the diet and insulin. My goal was to keep the baby's size down and hopefully go into labor on my own. I wanted to know what it was like to go into labor and not have pitocin. My three previous babies were either induced or augmented with Pitocin. As we were approaching the due date, all tests were showing that she was fine and not at all huge. I had twice weekly NST's (Non Stress Tests) and AFI's (Amniotic Fluid Index) tests. All were great. One nurse did however say that I had a decrease of fluid and was concerned. More on that later.
My due date approached and I asked if I could go another week in hopes that I would go into labor on my own. OB agreed. I thought for sure that I would have contractions and so forth, but by the next week nothing was going on. I had JUST gotten to 1 cm. Insulin-Dependent GDM has many risks. One is the function of the placenta could stop, resulting in placenta failure and stillbirth. That was why all the NST's. When it came time to decide if I would consent to an induction I reluctantly agreed, feeling that this was what was best for my baby. So Induction Day rolls around. I'm instructed to report to L&D with my orders in my hand at 7:30am Monday morning. I'm really apprehensive since my last induction was during a span of four days and I had a c/s anyway.
We get settled into my room. We meaning my husband, my Doula, and myself. They are very nice and sensitive to my needs with the monitors. The L&D nurse made sure I wasn't on them any longer than I had to be. She found out that I'm a clock watcher!!! I had my first application of P-Gel and asked her about my status. I'm 1 cm, 0% effaced, my cervix isn't too soft, baby is head down, and cervix is almost in an Anterior position. At the 2nd application I continued to have contractions on my own for several hours. This brought me to 1+ cm, -2 station, 30% effaced. An hour later the 2nd dose of P-Gel is given. With this exam I am 2cm, -2 station, 30% effaced. We are encouraged to walk the halls. We do so leisurely and this results in some contractions. So after all that walking I progress another centimeter. Monday night at 10:20pm I get another dose of P-Gel and we all get some much needed sleep for the next day. The contractions just about stop.
I am impressed with my nurse's sensitivity to my needs. I had drawn up a birth plan, but did not give it to them. They seem to be just as committed to me having a VBAC as I am. They all have studied my previous birth and remind me often that this is so much more different. After she got past -2 station, I relax. Cameron never made it past -5. Things certainly do seem different. At 4:15am it's rise and shine. I get back on the monitors for a test strip and the endocrinologist orders hourly Blood Glucose Tests. I think this was the most annoying part. He also orders an IV push of insulin as needed. At 5:00am the IV is started and pitocin is started at the lowest dose.
5:35am my water breaks. Remember, one of the nurses said I had such low levels of fluid. I change positions and noticed my water had broken. There is water coming out that is clear. I soak 2 chux pads. The L&D nurse has to rush to get more, I soak 2 more pads. She puts a towel between my legs as the water keeps coming. Every time I laugh, there is more water!!! I soak through another set of chux pads and another towel. Seems like enough water to me. We all cheer that my water broke on its own. Something's happening. Pitocin is steadily increased and contractions are going nicely in a pattern.
At 7:30am the new crew comes in. Our nurse ended up being the same nurse I had the day I had my c/section with Cameron. At first this worried me, but she reminds me that we have gotten further than we ever did with him and this is all together different. This relaxes me and we get ready for the hard work ahead. It's 8am and she checks me. I'm at 3cm 50% effaced, -2 station and my cervix is soft. The monitors around me are really irritating me. We discuss internal fetal monitors. One thing that I was most afraid of was the internal catheter to measure contractions. The nurse shows me that they are much different than they used to be. I had one nearly 15 years ago and the memory was terrible. I realize that they cannot effectively monitor the strength of my contractions with the straps. I'm a big woman and the baby is small. So I agree to the internal monitor for contractions so I will not be over stimulated on pitocin. That alone makes me fear for a rupture. In the 20 minutes that we discuss this and they place the monitors, I progress to 4 cm, 70% effaced and still -2 station. Contractions are 2 1/2 minutes apart and bearable. I can't believe how much the effacing is happening since this usually is the slowest part for me. I also had went from 4cm and 70 to 90 percent effaced to delivery in a matter of minutes with my previous pregnancy. I warn them. The contractions are really bearable and not at all painful. Just a force, but not really painful. They peak quickly and resolve quickly. The atmosphere is still very upbeat and we are playing Hymns on the boom box. This creates a very peaceful and serene atmosphere in the room.
I get my next exam at 10:00am. I have already progressed to 5cm, 80% effaced and still at a negative -2 station. I'm amazed at how easily everything is going. It just seems to roll along. In 30 minutes I progress to 6 cm, 90% effaced and she drops down to -1 station. Still the contractions have not changed or even seem to be that hard. In the next 30 minutes I again progress even further to 8 cm, 90% effaced and 0 station. They tell me I'm in transition. I'm amazed at how easily everything is going and even being in transition, I'm not in that much pain. While I was at 4, I was getting a bit apprehensive that the contractions would get harder to deal with and was asking about an epidural. My previous births were horrendous with the over-stimulation of pitocin. Sue talks me out of it and I agree to forge on through. So I'm at 8 cm and it doesn't' seem to be that bad. It's 11:45am and the OB is called. I am 9 cm, 100% effaced and zero station. The OB gets there and things start to halt. The contractions are getting harder and she isn't coming. I'm getting really concerned that I am some how unconsciously holding her back. They tell me she is posterior and is pounding on my cervix causing it to swell from 9cm back down to 6cm. At this point I am standing trying to get her to come down. I tried going to the bathroom and she still isn't coming down. Her heart rate drops severely and the OB nurses rush into the room. We are really scared at this point because it isn't coming back up. I'm laying on my side with oxygen mask on praying that she is OK. All sorts of things rush in my mind. I ask my husband who is an Elder in our church to give me an emergency blessing. He does and her heart rate normalizes.
I then get an epidural. The epidural doesn't take on a strip going along my belly and I can feel the contractions in a localized area. The Anes. tells me that this is called a window caused by the position of her head. They turn off the pit drip and I lay on another side to get the medicine to hit that awful nagging spot. Things settle down and I snooze. During this time DH gives baby a blessing by laying his hands on my belly. I didn't find this out til later. It's 3:00 and I'm at 10cm, 100%, and +1 station. They ask me to push. I have to say that I would make fun of the ladies on "A Baby Story" pushing through their epidurals. I now know that it is so hard to push. I haven't pushed in 15 years. I didn't practice this part!!! It was difficult to coordinate the pushing. No one counted in my face and I was really glad about that.
It's 3:15 and we have put the Hymns back on. She is slowly moving up and her head is crowning. I'm not sure at which point they called the OB. Her head is slowly pushing it's way out. The entire time her head is exposed the OB nurse is gently stroking her head. She is treated gently from the beginning and the tone in the room is quiet and not tense. She decides that she has had enough of the womb and her head pops out. No pushing from me. Then the body just slips on out. She is born and my first look at her is in amazement at her size. All of my babies are over 8 lbs including my 11lbs 3oz boy. She is really long and skinny. The OB walks in fully expecting to deliver a baby. He missed it and gets to catch the placenta. She cries and is cleaned off and placed on my stomach. I get to cut the cord. I couldn't see it and Bill took pictures. They ask me if it is OK to take her to clean her off. They are very quiet and gentle with her care. She is cleaned off and they assess her. She is measured and weighed. 7lbs 9oz. 19 3/4 inches long. Her Apgars are 8 and 9.
One nurse said I was bleeding pretty bad. They call the OB back in and he finds clots in my uterus causing it not to contract. They take care of this and the bleeding slows down. I am sat up so I can nurse, but when I am moved up I nearly pass out. My BP is extremely low. 99/34. They call the Anes. back in and she puts some medicine in my IV to get my BP up. I continue to have low BP the remainder of my visit. I am able to nurse her and the colostrum is able to maintain her blood sugar. She looks great. As soon as my epidural wore off we were back in our room getting to know each other.
Despite these little mishaps and having to get the epidural, the birth was very positive. I was able to have a VBAC. I did not submit a birth plan to the floor. I wonder if my doula did since everything I asked for was honored. I nearly got everyone I asked for. It almost seem too good to be true. During the entire time of my labor, a friend of mine is calling and being called to update my lists on my progress. I have an enormous amount of support and prayers during this time. This birth is a triumph. Not only that I got the most beautiful baby in the world, but that being diabetic I was able to make it post dates, I had a small baby, and she had no side effects of my diabetes. Most important that she was born a VBAC. She was at one point a twin. Her brother or sister was 10.2 weeks before he/she died in utero. We will always hold that precious baby in our hearts. But we say Welcome to the World to this baby.
Postscript: Breastfeeding does not go well, due to the anemia from all the blood loss after the birth. Additional factors may also include low thyroid levels and abnormal nipple shape. This was very disappointing but the baby did get the benefits of colostrum and some early milk.
Tabitha's Stories (borderline high BP, induction, c/s; borderline GD and BP, hospital VBAC)
Birth Story
Baby #1
My blood pressure had been a little high, off and on, throughout my last trimester. When I reached 39 weeks the doctor suggested an induction at 41 weeks and I agreed. I was given pitocin at 7:30 AM, doctor broke my water sometime in the late morning. I spent the entire time in bed---sometimes rolling from one side to the other, most of the time reclined. About 3:00PM I was at 7 cm. At 5:00 I was still at 7 cm and the doctor mentioned that we might need to do a c-section. At 6:30 the doctor said that the baby was fine and not in any distress and I was fine as well (had the epidural a few hours earlier) but since I hadn't made any more progress he doubted I would, and if I continued to labor into the night the baby might go into distress, so it would be best to go ahead and do the c-section while nobody was in distress. He told the nurses we were doing the c-section for CPD, and mentioned to one of them (as we were waiting in the hallway for the OR to be prepared) that I was his last patient for the day and he was ready to go home. The baby was "born" at 7:31 PM.
Baby #2
After I failed the 1-hr glucose challenge in my second pregnancy, my doctor immediately diagnosed me with GD and refused to do the 3-hr test to confirm it. I already had been sensing that he was looking for reasons to pressure me into another c-section, and this seemed to be the perfect reason for him, so at that point I decided to find a new provider who would do the 3-hr test to confirm the diagnosis (and would guarantee me a trial of labor). I passed the test, although my blood sugar levels were still a bit high on one of the readings, so I still had a borderline diagnosis.
On Sunday, I woke up to contractions about 10-15 minutes apart. They were painless, just as they had been for the past 2-3 weeks. I had been checked on Friday and told I was at almost 4 cm, 40% effaced, but the baby's head was still high. So I sent my family to church but I stayed home. And everything stopped. I tried a few things to keep contractions going, but nothing worked.
By the afternoon I was feeling anxious, and ready for things to get going again, but I was not having any contractions at all. I consulted with my doula, and told her I was staring at a bottle of castor oil. She laughed, and said if I really felt ready, to go ahead. I took a couple of tablespoons of CO mixed with orange juice and a few hours later I took a few more tablespoons of CO. Around 7:30 I started having a few more contractions--still painless, for the most part, although I had a couple of really strong ones. My doula and the midwife who agreed to help out came over to check me out and see if I had made any progress. Lo and behold, I was at 5 cm, almost completely effaced, and the baby's head was engaged! The midwife tried to sweep my membranes, and she said there was nothing to sweep--we were definitely making real progress. I was thrilled to be so far along, when most of the contractions I had felt to that point were painless--it was going beautifully so far! We all went to bed.
At 3:00 Monday morning I woke up with some mild contractions. They were about 3-4 minutes apart, but still painless. After an hour, I talked to my doula, and told her I'd call her back when the contractions felt stronger or were getting closer together. At that point the contractions were stopping whenever I moved around, but would start again when I stayed still. I decided to take a shower, and while I was in the shower the contractions didn't stop, even though I was standing up. The water felt good though.
About 5:30 things started to get a little more intense for me, so I called my doula and told her I was ready for more support. I woke my husband up so he could take a shower, and called my mom upstairs so she could the doula and midwife in when they came. My call also woke up my sister, who was upstairs with her children, and she came down to help get the apartment ready. Mom came down and fixed me some oatmeal. The whole time I was just sitting on the couch having contractions, but doing ok. I wasn't able to talk through the contractions, but I could still eat in between them. By 7:00 I put my unfinished bowl of oatmeal down and didn't eat anything else--it was time for business. My sister and the midwife started working on getting the pool full of warm water (heating canning pots of water on the stove) while my husband and doula focused on me. I was having intense back labor, which confused me because the baby was definitely anterior and in a perfect position.
At some point I started feeling nauseated, and threw up, but it didn't bother me too much--not nearly the way the nausea took me out when I was in labor with baby #1 (it turns out I threw up twice when moving from early labor to active labor, and twice more when entering transition). My water broke at 7:45, while I was standing in the bathroom. We checked the baby's heartrate and it was beautiful. By then the pool was ready, so I climbed in--the water felt so good! I threw up a couple more times in the pool, and they sent Dad out to get me some Coke to sip on. I have no idea how long I was in the water, but eventually they had me get out so we could check the baby's heartrate again (still beautiful). I asked Dad to come down and help my husband give me a blessing. The midwife checked me and said the baby's head was in front of my pubic bone and not putting enough pressure on my cervix, so I needed to be in a more upright position--no more leaning forward. It hurt a lot more to stand up straight, and I relied completely on my husband and doula to hold me up. I was getting tired, and thinking I just needed to get some sleep.
Someone suggested that I lie on my side for a couple of contractions. It was so nice to lie down, but the contractions were getting a lot more intense. In between each contraction I actually fell asleep, but during each contraction I was almost in tears. I kept thinking maybe this wasn't such a good idea after all--and I wanted to either take a break (maybe finish things up the next day) or run to the hospital and get an epidural. I did realize at some point that just when the contraction felt unbearable and I couldn't take it anymore, it would subside--that helped me keep going, although I kept thinking that if it got any worse I just wouldn't be able to do it. They checked me again and asked if I felt like pushing--I didn't. But they said that the sounds I was making sounded like pushing sounds, and all of a sudden it was time to go to the hospital!
The midwife called the hospital to let them know we were coming, and asked them to call the doctor (they didn't). As we drove, I was able to completely relax between contractions, and then they had me blowing through the contractions. By the time we got there, 5 minutes later, I was feeling the need to push.
We arrived at the hospital at 10:53 AM. At the hospital we rushed into triage and I was put in a wheelchair. Although I had been blowing through contractions in the car, once we entered the hospital I started moaning again--mostly to let the hospital staff know things were getting urgent. We got into a room--the floor was still wet from just being cleaned. They got me into the bed and I started blowing again. The nurse checked me and said I was at 6 or 7 cm--but I had been almost complete at home. We think it was just some cervical swelling, caused by the drive to the hospital, or that she was trying to convince me that I wasn't ready to push yet. The doctor came in, irritated that he hadn't been called earlier. The nurse was a little irritated that she hadn't been able to do all her pre-birth stuff too. There was a brief discussion about the IV, EFM, and episiotomoy--I was refusing all of them, and we just kept telling the doctor that I knew the risks and was refusing them. I was supposed to sign something, but we never got around to it!
Finally the nurse said she could tell I was complete without even having to check, and then they had to get the bed ready so I could push. There was a brief discussion about stirrups and my pushing position-I refused the stirrups but finally agreed to push in a reclined position although that worried me. I decided if that position didn't work I would insist on trying other positions, but the doctor was very emphatic that I needed to be reclined so he could do his job. It was even harder not to push at that point, but my doula and midwife kept saying that the baby would take care of the pushing, and I didn't have to do much work, if I could just let him do it. Once it was officially time to push, the contractions slowed down, and someone said something about how maybe they had jumped the gun a bit and I wasn't really ready. But I did feel the need to push, and I could feel the baby moving. I was getting some mixed messages, with the doula trying to tell me to slow down and the doctor telling me to push more-the midwife could see the baby crowning and wanted me to slow down so I wouldn't tear, but she couldn't say much there at the hospital because of her status as a midwife. The doula couldn't see what was happening, but she did tell me to slow down--but that was really hard to do at that point! The head started to come out and they suggested that I feel it--I reached down and felt, but couldn't tell what I was feeling--it felt more like brains than a head. My husband was on one side of me and Mom was on the other--they were helping hold my legs because I just couldn't do it myself. My husband did some counting to help me focus my pushing, which helped (I'm a math person, and numbers really can help me focus). As soon as the head was out, his right hand popped out too! I was then able to relax and the rest was more controlled. We figure all my back labor was caused by the hand being up by his face (and the hand did cause 2nd degree tearing). The cord was around his neck too, but it was very loose and not a problem at all. The doctor started sucking out his mouth, and then I pushed him out the rest of the way easily. He was born at 11:40 AM.
The whole experience was so amazing! When I was lying on the bed, thinking I wouldn't be able to do it if things got any worse--that was as bad as it got. It never got worse than that. I know I wouldn't have been able to do it without all the help I had, but with that help, I was able to stay in control and handle it. The baby is nursing well, although he slept too much for the nurses' comfort, and actually gained weight instead of losing weight in the hospital. I was able to walk right away, and although I was a little sore from the stitches, I feel a million times better than I did after the C-section. This baby weighed half a pound more than his c-sectioned brother, the one with the "CPD" diagnosis. I'm so thrilled with how things went. The only thing that would have made it better would have been not going to the hospital at all! I definitely feel empowered, stronger, because of this.
Lisa's Story (diet-controlled gd, anticardiolipin problems, premature labor, VBAC)
Kmom's Notes: The GD diet this mother reports being given is highly questionable. Although women with GD must carefully control the amount and type of carbs they eat, they should not be forbidden from consuming carbs completely. The pregnant body (and the baby) need carbs and the nutrition available from carbs for optimal development and health. Furthermore, if carbs are lowered too strongly, the mother is forced to burn her own stored fat for energy, resulting in ketones, a kind of acid by-product. Some studies have linked persistent levels of ketones to neurological damage to the baby. This is why it is important for women with GD to monitor their ketones, especially if their carb intake is low.
The other notable thing about this story is that it highlights the ABSOLUTE importance of the proper size of blood pressure cuff. This mother was almost forced into an unnecessary cesarean because her blood pressure was erroneously recorded as dangerously high. The nurses used the wrong-sized cuff; they should have known that a large cuff was required for a large person. Note how much of a difference the correct cuff made in her blood pressure----from 180/104 with the standard sized cuff, to 114/63 with the correct-sized cuff. From dangerously high to completely normal.
ALWAYS check to be sure that medical personnel are using the correct-sized cuff when taking your blood pressure.
Birth Story
In my second pregnancy, I was 37 years old and weighed 256 lbs. when I finally got pregnant. He was conceived through IVF and was a frozen embryo transfer. The pregnancy was considered "high risk" due to my "advanced maternal age" and the fact that I had an anticardiolipin problem and needed to be on 2 shots of heparin daily thru the entire pregnancy. I was also on progesterone shots up thru week 11.
In week 26, I was diagnosed with gestational diabetes. I did not have that problem with my first pregnancy, 7 years previous. The gestational diabetes was diet-controlled. I could not have milk, fruit, fruit juice, or bread in my diet. My diet consisted of protein, veggies, and 1 splurge of a balance fat/protein snack at bedtime.
During the whole pregnancy, I had a level 3 ultrasound done monthly. After I was diagnosed with GD, I still had a level 3 monthly, but I also had nonstress tests done 2x week from week 28 on. According to all the ultrasounds, he was growing at a decent rate, but was a large baby. I was scheduled for a planned repeat c-section (my choice) in beginning wk 38.
Due to a fall, I went into premature labor at 34 weeks and was put on magnesium sulphate for 5 days. My 3rd day in the hospital flat on my back, they told me my BP was dangerously high (180/104) and they had scheduled me for an emergency c-section. They were preparing me even to the point of having the anesthesiologist come in and talk with me.
When my dr. got there to talk to me pre-op, he saw the BP monitor and cuff they were using. He flipped! They had been taking my BP with a small cuff. He went right out to the nurse's station, came back with a larger cuff and took my BP. It was NORMAL---actually a little low for me (114/63)!!!!! Surgery canceled!
I was released on Wednesday afternoon, got to sleep in my own bed 2 nights and went into full-blown labor on Friday morning at 5:30. By 6:30 my water had broken, back in the hospital by 7:30, and had my 6 lb. 6 oz. baby boy by 9:30 a.m. Never made it to my planned scheduled c-section, didn't make it to my last "refresher" lamaze class, didn't have time to make it to labor and delivery room (gave birth in the prep/waiting area).
Due to the heparin, they had a problem stopping the bleeding, and the one stupid dr. tried to "help" the placenta out by pulling the umbilical cord. After my dr. got there, he whisked me right into the OR, transferred me from the gurney to the operating table himself, I finally got my epidural I wanted, and he removed the rest of the placenta by hand, and stitched my small tear. He said the baby came down the canal so fast, I tore up high in the vaginal wall---nowhere near any possible episiotomy site.
My little man ended up spending 5 days in the NICU due to breathing problems. They never found out the reason why he stopped breathing immediately after delivery. The speculation is that he was born sooooo fast that his system was shocked. Due to the "precipitous" birth, I had to sign papers to be tested for drugs. My dr. laughed about it but said it was required by the state in such a fast birth. He knew I wouldn't even take a Tylenol or Sudafed unless I cleared it with him first.
Jen's Stories (SROM, induction, c/s; VBAC; VBAC with GD)
Kmom's Notes: This birth story just goes to show what the research shows; that spontaneous labor is very important in improving success rates for VBAC trials of labor, and especially when the mom has GD. The hardest part is keeping the doctors from insisting on inducing early and/or doing an elective cesarean at term.
Birth Story
My Birth History:
This was my third pregnancy. My first ended in a C-section (water broke at 39 weeks, Pitocin induction, 20-hour labor, epidural, 3 hours of pushing, posterior baby – 8# 8oz.), and my second ended in a VBAC (spontaneous labor at 40 weeks 6 days, got to hospital at 6cm dilation, no meds, 8-hour labor, 90 minutes of pushing, posterior baby turned ROT just before complete, 2nd degree tear – 8# 10oz.). I did not have gestational diabetes in either of my previous pregnancies. I was tested at 24 weeks though, failed the 1-hour and had to take the 3-hour both times. They encouraged me to walk around between blood draws, as long as I showed up every hour, I could do whatever I wished. I think that made the difference in me passing it.
And now my 3rd pregnancy/birth story:
At 30 weeks of pregnancy, I took the 1-hour and 3-hour glucose tolerance tests and failed them, resulting in a diagnosis of gestational diabetes. I met with a diabetes “educator” (I use the term loosely, I think they were following out-of-date diabetes rules) and started checking my sugars. I was supposed to have a fasting number between 60-90, and one hour post-meal numbers at or below 130. As long as I was conscious of what I ate and exercise, my levels were all within acceptable range.
I would exercise briefly twice a day – a quick walk down the street and back with the kids after breakfast, and another short walk with the dog after dinner. I had a brief period of high fasting numbers (between 94-98), and my doctor wanted me on insulin. I refused. Then I figured out how to get the fasting number down by trying a few tricks on Kmom’s website. I found that if I ate two proteins and one carb for my bedtime snack, ate it at 10 pm, and tested in the morning at 7:30 AFTER my shower, my number was always at or below 90. One week, my belly measured 3 cm “too big” so Jan (my OB) sent me to ultrasound, baby measured 1 week “ahead”, the same as he had at my 20-week ultrasound. After that, my belly measured right on. My doctor wanted me to start non-stress tests at 36 weeks, but I delayed them until 39 weeks.
At about 34 weeks of pregnancy, my husband Dan and I interviewed a homebirth midwife. I had been so stressed out by how my doctor wanted to manage things (she had said that they induce all GD moms at 40 weeks, and since I was a VBAC, there would be no induction, but that they would need to do a C-section), that my husband suggested I call a midwife, and we would meet with her. It was wonderful, and we decided to have a homebirth with Paulette.
At 39 weeks, I had my first nonstress test. Baby passed it. At 40 weeks, I had a second NST, and baby was sleeping, so the doctor sent me in for a biophysical profile. Baby scored 8 out of 8 on the BPP, and measured 8# 1oz. My doctor mentioned that she didn’t want me going past 41 weeks (although she didn’t say why, but it didn’t matter to me – I assume it was because of the GD). I went home to my husband and we decided that would be my last appointment with her.
The nightly contractions started about a week before my due date (10/19/04 was the due date). I would contract most evenings, they would intensify if I laid down. I would try to sleep at about 10:30, at which point I would tell my body, “That’s enough now.” It seemed I was just not mentally ready to have the baby yet. My due date came and went, as expected, since I went past my EDD with Adam (my second baby, first VBAC).
The night before labor began (40 weeks, 4 days), we had dinner at my in-laws’ house. My sister in law rubbed my belly and said she thought something was going to happen very soon. I was contracting, and they were getting painful, but it was nothing new. That night, I felt contractions all night long – definitely unusual, since before, they would quit when I fell asleep. I could feel the contractions in my dreams, and occasionally one would wake me up. They were only about 20-30 minutes apart.
In the morning, I got up at 6:30, and went to the toilet several times with loose bowels. I kept expecting to see bloody show, but I didn’t. I woke Dan at 8 and said, “I think today’s the day.” He got the kids up, dressed, and fed while I was in and out of the bathroom some more. At 8:30, I called the midwife and told her what was going on. She asked if I thought she should start heading our way (a three-hour drive), and I said “I think so. I’m not entirely convinced it’s labor yet, it might just be poop.” She laughed and said she would leave very shortly. I told her “At this point with Adam, I had about six hours left until delivery.” She said she’d call when she reached Minot (halfway point, 90 minutes away).
Dan had me get in the shower right then. And in the shower, it hit me that it really WAS labor – I was needing to lean against the shower wall and “breathe” during contractions. I was handling them well. I could feel them in my back, but happily, it was NOT “back labor”! Throughout all this activity, baby was very active, assuring me that he was fine in there.
I tried to eat some toast and drink some low-carb orange juice but I couldn’t finish it. I wasn’t very hungry. I wanted to stay nourished and keep my blood sugar up though, and I hadn’t eaten since the night before. I was intent on getting the bed sheets washed, dried, and put back on the bed, so I did these things, and had Dan put the plastic sheeting over the top. I would walk around between contractions, and then slow-dance with Dan during the contractions. They quickly became more intense, and I got out my birth ball. I found so much relief in lying across the top of my birth ball, swaying during contractions.
My parents came and got the older boys at about 9:45. As soon as they left, I started making noise with contractions – long, low moans. Things were getting more intense, and I had Dan try to call Paulette. She must’ve been in a dead spot though, because there was no answer. From that point on, he tried calling her every few minutes, and never did reach her. I moved from the birth ball to kneeling in front of the couch, and making a LOT of noise with contractions. It was becoming more high-pitched, and I started to feel like it was getting out of control. I do NOT like that feeling. In hindsight, I believe this is when I would’ve been 7 cm or so, entering transition. I had Dan heat up my rice sock, but it never made it out of the microwave. I had him applying intense counter-pressure on my lower back, and then taught him how to do the double hip squeeze, which was exactly what I needed. He was excellent.
Around 10:30 I think (who looked at a clock?), I told him “I think my water is thinking about breaking.” I didn’t really know what to do, and a few contractions later, it broke. I went into the bathroom and stood in the tub. The pain was real intense, I removed my pants and underwear (I had put a pad in, since I wanted to remain dressed, and I knew my water would break at some point!), and saw a light green pad. I started to cry and hollered, “There’s mec! There’s mec!” [Kmom note: mec = meconium, baby's first bowel movement. It can sometimes indicate fetal distress.] It was only light mec, but it distressed me. And the midwife still hadn’t called to say she’d reached Minot. I was very upset, and cried. I told him we needed to go to the hospital. He really tried to convince me it was OK, but within a few contractions after my water broke, I knew things were going to happen fast. I said we needed to get to the hospital now. My husband really wanted us to stay home and have the baby on our own, but I just didn’t feel right about it. At this point I started to really want drugs, and I said so, several times. I knew in my head that meant transition, but I didn’t really care, I just wanted to feel better.
So between contractions, I walked to the Suburban, no bags or anything. As soon as I got in the truck, a contraction hit, and boy oh boy, I knew we needed to get there FAST. I told Dan I was feeling pushy, and that it was common for multip moms to get their babies out in just a few pushes. He drove like an ambulance all the way to the hospital: speeding like crazy, lights flashing, horn honking, while I SCREAMED with each contraction. I was pushing! I felt powerless to stop it. On the way, I started to feel the “Stage 2 Sleepies” – a feeling I felt while pushing out Adam – the desire to close my eyes and nap between contractions. A little over halfway there (it’s usually a 20-minute drive, but I think we made it in less than 10), I felt his head duck under the pubic bone and it scared me enough to figure out how to NOT push, and breathe instead of scream with the contractions. I did not want to have the baby in the car. I was hoping people would see my license plate (“DOULA”) and realize what was going on – they must have, because people moved out of our way!
Dan ran into Admitting, and they told him to go park in the ambulance bay. He did, and a doc and nurse came around with a wheelchair. I got in as soon as I could. Dan said, “She’s pushing.” The nurse said, “Well, she needs to stop.” LOL! He said, “She’ll push if she goddamn well wants to!”
We finally got up to a room. I took off my pants and underwear and climbed onto the bed. Dan took his “spot” – the same spot he had with Adam, kneeling on the floor next to me, on my left. His knees hurt, so he asked for a pillow (I have a gardening pad in my doula bag for that very reason – but we left it at home!). The nurse, Penny, who I knew and liked from doing births (I’m a doula, but you’ve probably figured that out by now), told me my doctor, Jan, was in surgery and couldn’t deliver, so I would have her husband. I was disappointed, but at that point, I didn’t care too much. She held the monitor to my tummy (with my permission) and took a quick listen to the baby, his HR was in the 130’s, holding strong. I asked for drugs again. My husband asked if I wanted a narcotic, and I said, “No, I don’t want an IV! I just want to be numb from the boobs down!” Pretty irrational, but if you’re familiar with women in transition, it’s completely normal! I made Penny chuckle.
I had gotten so good at holding back from pushing, that I felt like I didn’t have to push anymore. I had Penny check my cervix, and I was complete but with a rim. She said if I felt like pushing that I could go ahead, and the rim would probably move. I had a contraction and forced myself to push. I knew I didn’t have to, but I really wanted the pain to end! I pushed twice. Then I felt a gentle hand on my leg, and it was Jan! I was so thrilled she made it. If I couldn’t have Paulette, then Jan was almost as good.
I really got down to business with pushing after that. I pushed two or three times with the next contraction. I remained on my left side, gripping Dan’s shoulders and screaming in his ear (it took two days for the ringing to go away – I felt SO bad!) while I pushed. I couldn’t believe the head wasn’t out yet! I could feel it, and it really hurt – worse than Adam’s head. It really burned, but I pushed through it because I wanted it to END. Finally the head was out! I think they suctioned just a bit, and then I pushed the rest of his body out. It felt amazing! I forgot about how I wanted to deliver the baby myself, and how I’d wanted the big mirror to watch everything. Jan handed me my baby immediately, and my husband reminded everyone not to tell me the gender. As soon as the baby was in my arms, I looked–-another boy!! I called him by his name right away (Mason Everett), lifted my shirt over my head, and laid him against my skin. I was so thankful to not be in pain anymore, and I laid there with a silly grin on my face, relishing this, my very last baby. The last time I would ever feel a little, yet weighty body slither out of me, and hold a slimy, precious newborn in my arms. It was a moment I won’t ever forget!
I latched him on several minutes later, and he nursed like he’d been doing it for a week already. I pushed my placenta out, and Jan said I had just a little skidmark, and asked if I wanted a stitch or two. I left it up to her medical opinion, and she decided to put a couple in. Mason weighed 9# 1 oz. and was 21 ľ” long, with a 14” head.
They checked his blood sugar 1 hour after birth, 2 hours after birth, and 4 hours after birth, and all three times it was above 40 (their “cutoff” for low blood sugar in newborns), so he didn’t need his sugar checked anymore after that. I was nursing him every hour and a half, to help my milk supply come in quickly, and also to keep his blood sugar stable.
Lori C's Story (diet-only GD, induction, vaginal birth; fetal distress, c/s; HBAC)
Kmom's Notes: A good lesson in the risks of breaking the waters. It offers very little benefit in most circumstances, but does carry risks. In this situation, baby #2 went into fetal distress after the doctor broke her waters, and she ended up with a cesarean---under general anesthesia, no less.
Lori had a tough VBAC labor because she had a long, premature urge to push, which is very hard to resist. Fortunately, with good labor support, she got through it and went on to have a VBAC with her baby.
Birth Story
What an experience - laboring and birthing . . . something that I hadn't completely had the opportunity to experience until this day. Not the picture perfect HBAC that I had dreamed about, but I wouldn't have done it any other way! The third time's a charm, they say!
Baby #1: Induced vaginal birth
My first birth was a medically managed vaginal delivery after I was induced at 38+ weeks for fear of big baby (I had diet controlled gestational diabetes) - she was 7 pounds, 13 ounces.
Baby #2: Cesarean
The second birth I wanted to do things very differently, but kept the same hospital OBs because, after all, they would just catch my baby . . . Well they didn't even do that. After laboring for just 8 hours, the doctor broke my water and I progressed from 3-8 centimeters in 30 minutes, had a premature urge to push and my cervix was swelling. The doctor saw fetal distress, and took me back immediately for a c-section - I was out under general anesthesia, and within 7 minutes, the baby was cut out of me, and my life would be forever changed.
I answered a calling that I felt and became a doula to try to help women avoid the traumatic event I experienced on my son's birthday. I also found the International Cesarean Awareness Network at about 6 months post partum, whose unconditional support and understanding brought much healing to my heart. Both of those changes in my life forever changed me, and although we weren't planning any more children, I was glad to be helping other women. Well, God had other plans for us, and we found out in October 2004 that we were pregnant for the third time.
Baby #3: VBAC
The Birth Story of Kayla Anne, June 30, 2005, 6:20pm
This time, I felt as though I really did everything I could to plan the safest and healthiest birth for myself and my baby. I hired a midwife, 2 doulas, and decided that birthing at home was the safest place for me to be. And this is the story of my third child.
Around 12:30am on June 30th, I awoke to a contraction. Several minutes later, another contraction. Could this be it? Could this be the day that I've been waiting for for over nine months? The contractions were mild, coming about every 6-8 minutes probably, though I was hesitant to time them knowing it didn't mean much. The feelings: excitement, worry, peace, calm, joy . . . all mixed together in my being. Excitement that I would actually have a fair opportunity to birth my baby the way God intended, which I had never previously had. Worry as to what the road ahead of me would bring. Peace that I would trust my instincts, my body, my supporters, and birth my baby! Calm that I was remaining at home for this sacred day. Joy that I would soon birth my baby and meet this joy that I had nurtured and loved for over nine months.
I lay in bed, not wanting to awaken my husband, Mike, wondering if I should call C, my midwife. I gave myself some time to go back to sleep, and after about an hour, I called C, as she had requested prenatally, to give her a heads-up that I thought I was in labor. She asked that I call her again when anything changes. I also called my sister, T, to let her know, as she had gone to Pittsburgh the day before, but we wanted her to be with me for the birth, and to take care of my other two children, Hallie and Bennett. I couldn't sleep, as contractions were still coming, though still tolerable, so I decided to distract myself a bit, check e-mail, and get some final things prepared for the labor and birth.
At about 3am, I called C to let her know that this was definitely labor, and the contractions were getting a bit closer together, but I was managing well. She decided that she'd be on her way, and I was wondering if I'd called her too early. I don't think I was ready for support at that point. I hadn't even awoken Mike. I liked the time that I had alone, laboring with my baby, smiling as I thought of what was to come. I knew that was soon to change, so I woke Mike up and told him that today was the day. I labored a bit longer in bed, on my hands and knees, and then I decided to call my doulas and let them know that C was on her way. I decided to stagger when people were coming, so I called W first, and called M a bit after.
I labored for a while on the birth ball after Mike blew it up, which felt really good. Sometime between 4 and 5am, W came and immediately started rubbing my back, which felt very calming and relaxing. I mentioned to her that I had just called M, and so she should be here in a while. By about 6am, my entire birth team was there including my midwife, birth assistant and two doulas. Oh, and my sister was on her way, and I decided to wait to call my mom until I was further along in labor. When M came, she took over with the back rub, which felt so nice and relaxing during contractions. I also held Mike's hands during each contraction, as I needed to feel him close, and be with me throughout this journey.
I coped in various ways throughout the morning including on the toilet, on my hands and knees in bed, on the birth ball, standing up and leaning, and at one point (around 9am) I got into the Jacuzzi tub, and then later in the morning, I got back in again. The kids were in and out, and gave me kisses, and it was nice for them to see mommy working hard, getting ready to birth their baby brother or sister. My sister, T, had come at some point earlier, and she was also in and out (more in than out, from what I was told, but I felt so surrounded in support with my eyes closed, that I don't know exactly who was with me throughout labor). All of my support people gave me just what I needed even before I asked. I had plenty of water to drink, cool clothes with lavender on my forehead, hands to hold, voices to calm, and all was well.
I remember around 11am, I started to feel the urge to push, and I wanted to get out of the tub to use the bathroom, as I didn't feel as though it was time to birth, but just to go to the bathroom. Someone commented about not letting me push the baby out in the toilet, but I knew it wasn't time. I was feeling the urge, but the time wasn't right. I asked C to check me, and I was at 4 centimeters dilation. This was crushing news for me, and my first emotional setback. I felt as though I was working so hard, yet my body was progressing so slowly, and I didn't think I could do this all day. I remember someone saying that my body was going to labor just how it needed to, and with that, I tried to find my patience within. With everyone's help, I regained my strength to continue on, and so I did.
Throughout the day, I tried so hard to resist this increasingly overwhelming urge to push, which just got harder and harder to control. I needed to look in M's eyes, and count over and over again. I kept being told to "try not to push", and I was trying, but I couldn't help it, my body was doing it. That was a bit frustrating for me to hear this from everyone repeatedly, and I probably voice my frustration more than a few times. I'm not sure what I did for coping other than counting wherever I was (and I was definitely mobile - standing in the bathroom, being on the toilet, on the bed, next to the bed, in the tub . . . though I do have some moments that I remember.
I remember sitting on the birth ball, leaning on my bed, with the birth assistant on my left side rubbing my arm just breathing. She had such a calming presence, and I felt less of a need to vocalize with her next to me. I remember at one point being in the bathroom with just Mike and C and having a Popsicle while laboring on the toilet. That was around noon, when my mom got to the house. The one and only time I saw her was when she came into the bathroom gave me a kiss, and told me she was so proud of me. I remember being in the bathroom with M and W next to me, leaning on the countertops, looking into M's eyes desperately while trying to count to distract myself from this incredible urge that was overtaking my body. At that point, I thought to myself that I have got to get to the hospital to have an epidural to stop myself from pushing - at that point, and once more later, were the only times the thoughts of transfer entered my mind. We were counting over and over from one to four, and during one contraction I said FU@*!! M said, "Let's go with that", but repeating that word when I thought I'd never want to do that again wasn't appealing, so we went back to counting.
Resisting this urge was the hardest thing physically and emotionally for me. I knew probably too much about the birth process, and kept thinking that I was going to get nowhere by how I was having to deal. I felt like in order to not push, I had to squeeze my bottom, but I also knew that by squeezing my bottom, I wasn't going to dilate the way my body needed to. I felt very much stuck between a rock and a hard place, but luckily I never thought to myself that I wasn't going to birth my baby - I just thought that maybe it would be at the hospital instead of home.
I was checked again sometime between 3 and 4pm, and was found to be 6 centimeters dilated. Another breakdown moment . . . 14 hours into labor, resisting the urge to push for over 4 hours, and I was only 6 centimeters?? I couldn't believe it. Emotionally, I was done. Physically, I was done. That was a moment of another good cry, which my midwife encouraged as I lay in bed feeling so defeated. I don't know what I said, or if I said anything, but I really had a hard time moving forward from there. What choice did I have though? The labor wasn't stopping until this baby was out, so I continued on.
C suggested that she give me something to help me relax for an hour, and then they try to power the baby out. I agreed, but did feel a bit uncomfortable about the "powering the baby out" part, but we'd cross that bridge when we got to it. I got into the tub at about 4 or 4:30pm while they gave me some nasty tasting drink to help me relax (homeopathy, not alcohol, though I could have used a drink by that point!). Boy, that was good stuff. I could feel the contractions, I could feel the urge, but my body couldn't push with the feeling. C said a couple of very empowering affirmations that I just grasped and repeated for the next hour. Through each contraction, I said, either "I am strong" or "Release the baby" to help me relax, and this was probably the most bearable time that I had had since about 11am.
After about an hour, they started dosing me with some more homeopathics to try to get my contractions going stronger and closer together. That, along with some nipple stimulation immediately got my contractions harder and closer together. I was worried at this point about uterine rupture because I knew the chances were greater when my labor was messed with, but at this point, I was exhausted and knew I needed to get the baby out. The urge to push came back fiercely at about that time, and C checked me and found me to be about 8 centimeters dilated. She manually tried to dilate me to complete while I pushed with my contractions, and WOW - it hurt! She also suggested breaking my water, which at that point was fine with me. After a bit more time, she had her birth assistant (senior midwife too) check me just to confirm what C thought was a lip, and the birth assistant said I could push past it.
I'm not sure why or how I ended up getting out of the tub to birth my baby. M later told me I was restless and said I wanted to get back in bed. Anyway, I pushed a couple of times on my side, and then Mike got behind me and I pushed semi-reclining until my baby was born. The feelings were so much more intense than I thought they'd be, and I was much louder than I thought I'd be. At one point, I remember saying (multiple times), "Guys, I'm done." And they would say, "Yes, you are almost done." But that's not what I meant. I meant I was done trying, and I thought to myself, how can I get myself out of bed, down the stairs, into the car, and to the hospital to have my baby, but that wasn't necessary.
Really, I was almost done, and after about an hour of pushing, I did it! I pushed my baby out! I couldn't believe it. I was ecstatic, and so relieved that it was over. I just kept saying, "WE DID IT!!!" with great pride and joy! I am so grateful for the support that I received, and for the belief that everyone had in me. The belief and confidence that others had in me and my body carried me through the times in labor when I didn't have confidence in myself, and that's just what I needed to birth this baby. And this is the biggest accomplishment of my life - I birthed my baby the way that God intended safely and comfortably in my own home! I wouldn't have it any other way!
Annie Booth's Story (GD pregnancy, induction, c/s; diet-controlled GD, vbac)
Name
to be used in FAQ: “Annie Booth” Age:
27
Pre-pregnancy
weight:
123
Baby
info:
girl, 8.1 lbs, 22 inches
Complications:
gestational diabetes
Type
of birth:
vaginal, no epidural
Birthplace:
hospital Provider:
OB
Breastfeeding:
yes
Other
Notes on the Pregnancy: I had a miscarriage prior to this pregnancy. My first child was born via c/section due to a failed
induction--I had gestational diabetes with that pregnancy as well. I
was about 10 days over due this pregnancy.
My pregnancy went about as well as it
could go. I was extremely happy to
have passed the initial blood sugar test since I had gestational diabetes with
my first pregnancy, thus had to forgo any sugar and carbs, and I love carbs.
So I ate sweets whenever I had the craving and enjoyed myself.
We
moved to a new town when I was about 5 months pregnant.
It was kind of stressful finding a new provider. I had found a birth
center to go to where we used to live, and our new town is very rural, thus not
a lot of options. I really wanted to achieve a vaginal birth--the
c/section I had due to "failure to progress" after an induction [last
time] left me feeling like my body didn't work as
it was supposed to. My daughter's
pediatrician told me of her OB with whom she had a VBAC so I chose to go to him
Things
went well until the 8th month, when the doc. looked at my chart and realized I
had GD with my other pregnancy and despite the fact I had passed the urine test,
he wanted me to take the 3 hour glucose test--which I found to be stupid as I
had been indulging in sweets this whole time and if I had it, wouldn't baby be
"monster baby" by now??? But
he wouldn't be appeased--I tried "missing" appointments but he kept
pestering, so I went, and of course had GD.
So I had to do the annoying blood sugar monitoring and kill the chocolate
beast.
Move
ahead to my due date. I had an
appointment that day. My doc had
told me he was ok with me going past due, as I had a history of it.
He knew of my desire to VBAC so imagine my surprise when he asks me if I
would like to schedule a c/section the following day, seeing as I am
"officially" past due and since I have GD I have a risk of stillbirth!
I was floored. I said,
"No," hollowly, and scheduled a non-stress test in two days.
I went home and cried my eyes out. This
is when I found kmom's website as well!!!
Over
the next six days I went in for three more non-stress tests.
The doctor got more and more agitated as the week wore on; at one point
he had spittle in the corners of his mouth as warned me of my dead baby, despite
the fact that I had kept my blood sugars in check and the non stress tests were
all perfect. I hung tough, but it
was really hard.
I
finally agreed to have my membranes ruptured at the hospital nine days past due
if I didn't have the baby over the weekend.
Thank god, I started getting erratic, painless contractions Friday.
They continued thru Saturday, when I had a non-stress test done at the
hospital. They were getting
stronger--enough for the doc to come check me.
He gave me the option to stay or go--I flew outta that place like a bat
outta hell. I knew I would make no
progress sitting in bed! I said "See ya tomorrow," and went home to
take our 3 year-old roller-skating (no, I didn't skate!!!).
By
early evening, the contractions didn't seem to be getting any stronger, so I
tried that old wives’ tale and slurped down some castor oil.
Yuk!!! An hour later I
missed the end of the movie I was watching on TV since I was on the can.
I headed to bed shortly after, and awoke at 11 p.m. to my water breaking
and contractions five minutes apart!!! I
called my doula and she calmed me down. The
nurses told me to go to the hospital if they came five minutes apart, and I am
glad I didn't. I was able to walk
around, eat, and get in the shower.
By
three a.m. the contractions were getting the best of me.
I wanted to go to the hospital to get a shot of Nubain.
When we got to the hospital I was 6 cm dilated!!!
I was so happy to have made it past the 3cm I stalled at with my first
daughter! I got the Nubain in an
I.V., and it went straight to my head and stalled my labor for the next two
hours, but I got a nice rest. The
Nubain started to wear off and they wanted me to make more progress, so I sat on
the edge of the bed, eventually standing up in the bed because sitting of any
sort felt horrid. I got out of bed
because they were afraid I was going to fall off it.
They dusted off this big yellow peanut ball, and I labored leaning over
that thing until I was 9 1/2 cm. I
was checked and had a tiny lip of cervix.
Now,
the pain was very intense up to this point, but it got worse when I was made to
lay on my side with my top leg propped on the stirrup in hopes of the baby's
head smooshing the lip down. It
worked, but it was hell. This was
the only point at which my breathing and counting didn't work and I was
screaming "It hurts it hurts it hurts!!"
My poor mom didn't know what to do at that point; I can only imagine what
it is like to see your child in such pain. But it's all worth it.
Time
to push! Doctor makes his guest
appearance and asks, "How is your epidural?"
Uh, buddy, I didn't get one! I
ask for a squat bar, and am ignored. I
ask again and he says, "Well, it's too late now".
So I am sitting up best as I can and I PUSH.
It feels soooo good! I am
grunting, what a release! Then they
tell me to tuck my chin and not grunt. So
I do that. Two more rounds of
contractions I push, and the doc wanted to do an episiotomy.
I say no. He tries to
stretch me, but tells me, "The baby's head is this big (makes circle with
hands) and you are only this big". Tired,
suggestive woman in labor says, okay.
One
last push and she is out!!!! Beautiful,
big, pink baby girl! I can't
believe it! I keep saying "I
did it! I did it! Jeff, I did it! Mom,
I did it!" And look at her, so
big and long; 8.1 lbs and 22 inches and perfectly healthy- better apgars than my
c/section baby. And I can move!
So, that is the story of Georgia's birth and the story of my empowerment. I was able to have my baby vaginally because I had faith in my body to do it naturally. Listen to yourself, and don't believe every word that comes out of your doctor’s mouth. And do try to find a provider who is in tune with your wishes. I had to make due with what was at hand and it was hard standing up to the doctor for me, but it was so worth it to actually BIRTH my baby. Meeting my first daughter on her birth day was amazing; but there is no comparison between a natural birth and a c/section. It's like watching a movie of the beach and then actually being there.….
Bonnie's Story (2 c/s, insulin-dependent, VBAC)
Kmom's Notes:
Birth Story
I had the most powerful, beautiful, incredible experience of my life. And it only took 4.5 hours from start to finish. Not counting the nine months beforehand, of course.
My first contraction started at 4 p.m. and our 3rd daughter was born at 8:27 p.m. She weighed in at a bountiful 10 lbs., 2 oz. So I guess God said to me, "My child, you have worked hard enough at this pregnancy. You may have the blessing of a speedy labour." Not to say that it was terribly easy. In fact it hurt a whole heck of a lot. Kind of surprised me, actually---don't know why.
I seem to be starting at the end. Let me back up a bit. We all decided that because Dr. M was on call this weekend and I had hit my due date we were going to actively pursue having this baby. At 9 in the morning we went to the midwife's office where I had a quick internal exam and stretch & sweep. I was still four centimeters dilated and 80% effaced. We made a plan to try a castille soap enema, then a castor oil treatment. If that didn't work we would try rupturing my membranes. At any rate, the suitcase was in the car.
We went out and finally found the enema kit, and trooped back to the midwife's office. They had gone out to run errands and do a home visit for another client. The first try didn't work, so the midwife said to start the castor oil, and then to try the enema again. I took the first dose of castor oil at 2:40 p.m., the enema about a half hour later, and then the second dose of castor oil a half hour after that.
At 4 p.m. I started to feel some contractions along with a lot of cramping (uggghhh, not a pleasant experience, that!). We called my friend to come and get my daughters because I was feeling distracted and needed to be able to focus. At first I had wanted my children around me, but then I wanted them to go. A was really anxious about the pain I was experiencing. Good thing she left when she did. T wanted to stay. I made sure that she knew that things were probably going to get rough.
By 5 p.m. the contractions were getting painful, and still less than 30 seconds duration, but they were only a few minutes apart. I still wasn't totally sure that these weren't just more cramps. DH paged the midwives around 5:25 p.m., and one spoke to me on the phone during a contraction to hear how I was coping. I guess that what she heard reassured her, so she told me she would be right there. DH called my doula at around the same time. I was worried that we were doing all this too soon, but in retrospect I'm awfully glad we did. The midwife arrived at 6 p.m., and not a moment too soon! I was sitting in an office chair and she was kneeling beside me as I had a couple of contractions, and then, whoosh, my water broke at 6:10 p.m. What an incredible feeling! The first thing I said was "I did it myself!" (I guess I was really anxious about having AROM.) What a neat feeling, and it actually relieved a lot of pressure. Everyone commented on how clear the fluid was. (There is some controversy about meconium in the baby when a mom has a castor oil induction.)
At this point, things really started heating up (as if they weren't already!). The contraction felt like they were just ripping my pelvic bones apart, and there was barely time to catch a breath between them. I sat on the birthing ball, squeezing DH's fingers during every contraction---he tried to move his hand once and I almost freaked---I just *needed* his hand. I leaned on the doula, she was just so comfortable and comforting. She spoke to me so quietly, and she said everything I needed to hear. I felt so much trust in her. As I made noises that became high-pitched, she told me to "find my tone", and bring the noises down low. She encouraged everything I did. I felt like I was doing everything right. Between contractions she made sure to help me relax my shoulders (she knows that's where I 'carry' my tension). It was absolute perfection. Looking back, I remember how quiet it was in the room while I was 'working'. What an incredible amount of respect they showed for me.
My daughter sat there quietly the whole time with huge round eyes. She actually got a few minutes of contractions on video, for which I was later thankful.
At around 7:30 p.m., the midwife checked me and I was 6-7 cm. Shortly thereafter, someone suggested I try to get up and go pee. I think that was the turning point. Crashing pain jolted me along the short distance to and from the washroom. I returned to the birthing ball, where the contractions just double-ended one after the other. Around that point, I started asking for an epidural (sheepish grin). The doula got firm with me then, looking closely into my eyes and reminding me of my wishes. I kept saying that I was so tired, and just wanted to sleep for a few minutes, just take a little rest. After a few more minutes of that, something changed.
It didn't hurt as much, and then my body made me make a grunting noise. The midwife asked me if I felt like I needed to push. I said no---and then I grunted again. 8-) She decided to check me again. I remember clearly that she said, "I can't feel the cervix---she's fully!" That sunk in through the pain, and I felt renewed strength. C knelt down in front of me, looked me directly in the eyes and said, "That was transition." Everyone started scurrying around packing things to go in the various cars. It felt so surreal as I looked through the fog and watched all these preparations go on around me. All I was required to do was to stand there. DH was assigned the job of "helping" me get my shoes on. I'm afraid I didn't assist him much, and I stepped on his fingers heavily. Poor guy.
We headed down to the street, where, limelight-hogger that I am, I stood on the sidewalk in my pyjamas and had a very noisy contraction. It was 8 p.m. on a Saturday night in downtown---there were quite a few people to witness the spectacle. I made my way to where the van was, doors standing open. During the 10 minute trip to the hospital, I kept making those grunting, pushing noises, and my doula kept firmly telling me to open my eyes and blow. DH drove, white-knuckled, as quickly as possible, but I don't think he broke one traffic law!
We pulled up to the hospital and walked in at about 8:10 p.m. It was a short ride up to the 6th floor in the wheelchair. I made sure I made lots of noise all the way, so people would hear me coming! ;-) Dr. M popped his head in for a moment, but didn't interfere in any way. Nurses stepped in, too, to bring equipment, but left quickly. I think C spoke to them in the hall and told them their presence wasn't needed.
I still can't believe how undeniable the urge to push was. After the midwives helped me turn on to my side, it was clear sailing (well, almost). The doula moved my hand down as the baby's head crowned (will I ever forget that feeling?). I told them I didn't want to push anymore after the baby's head was half out because I was too tired, and almost in unison they said, "You HAVE to push!" It's a good thing I am so obedient (smirk). The shoulders were slightly stuck, and C moved in to rotate the baby while the backup midwife pushed on my pelvic bone---quite the bruise I have there too, I might add. It was the most amazing feeling as she slid the rest of the way out of me on to the bed.
I was totally surprised as I looked around and saw everyone crying. They put my baby on my chest and covered us with blankets. I was shouting---"I had a baby, I had a baby!" I don't think I have ever been more proud of myself---or more happy. It was the achievement of the biggest goal I had ever set for myself.
We had been at the hospital for 20 minutes. DH, in a choked voice, was the first to announce her sex, and he cut the umbilical cord. I had her at my breast within 5 minutes of her birth.
To my dismay, the midwives wanted me to push out the placenta---I didn't want anything to do with that because I was starting to feel pain after the adrenalin wore off. I thought that was bad, until they wanted to check me for tearing. Oy! I had a second degree tear, and needed 2 internal stitches, and 3 external---all in different places. It was incredibly painful as they discussed the optimal number and placement of stitches and then proceeded to stitch me.
The midwives took blood, and I figured this was a good time to check the baby's blood glucose. I used my own glucometer because it was more accurate than their strips. Her sugars were 3.3 (kmom note: 59 mg/dl), which isn't bad. The pediatrician had told me they would recommend supplementation if the sugars got below 2.2 (~40 mg/dl).
After about an hour and a half, it was over. We were left alone in the room, with only DH's parents (who had arrived while I was being stitched and waited patiently in the hall while they overhead me complain about the pain of the stitches) and my other friend.
The midwives asked us what we wanted to do next. They didn't particularly want us to go home because of the distance if anything should go wrong. Staying in the hospital, with a private room, would cost about $175 because we don't have private insurance. We decided to take a room at one of the nicest hotels in the city. Believe it or not, the rate was only $150! After a total of 5.5 hours, we rolled out of the hospital.
I was still euphoric as we walked (I rolled in a wheelchair) into the splendor of that hotel. We got a room for DH's parents, and by chance the rest of us ended up with a suite. It was incredible. I sat in the living room of our suite, eating pizza from room service and nursing my baby until 5 a.m. I didn't sleep much even after I went to bed, because I couldn't believe this was all real. The baby slept between us in the queen-size bed.
When I called down to the desk to arrange for a late check-out, I spoke to the assistant manager. i explained that I had just had a baby, and we had spent her first night there. The woman was suitably impressed and gave us permission to stay till 3 p.m., with her congratulations. A short while later, a knock came at the door. It was a waiter with a lovely tray of fruit and candies. There was also a card, addressed to the baby. It said, "Dear baby xxxx, Thank you for spending your very first night with us here at xxxxx. We hope you will come visit us again when you get older." It was signed by all the staff at the desk. I cried at the thoughtfulness of it.
Later in the morning, we ordered a room service breakfast for the family as we waited for the midwives to arrive for a pre-arranged 'home' visit. The waiter arranged the white linen cloth, crystal, and fresh flowers on the oak dining table in our suite and set out the covered plates. I sipped my fresh-squeezed orange juice and devoured the most delicious scrambled eggs, home fries, and sausage. How much better than the hospital is this?
The midwives check me and the baby. We had check her sugars two more times and they were holding stable at 3.6 and 3.3. (65 and 59 mg/dl) She had also been nursing almost constantly. All was well.
It is now a week later, and I think we have settled in nicely. The two older girls both seem to love their little sister. I could wish for more sleep, but in the end I am awed by the strength and alertness of a healthy, full-term baby, having never had one before.
I have had 2 previous cesareans. I also had insulin-dependent Type II diabetes. I am 5 ft. tall. I worked very hard at normalizing this last pregnancy and I trained as if I was going into a marathon: good food, lots of exercise, saw all my caregivers regularly. But do you know what I think the most important thing was? I educated myself, and made all my own decisions. It can be done.
Kmom's Story (2 c/s, then VBAC)
Kmom's Notes: This is a summary of my VBA2C story. Slightly different versions of it can be found in the various BBW Birth Stories FAQs, found elsewhere on this website. A really long and excruciatingly complete version of all of my birthstories can also be found on my website under "Kmom's Birth Stories".
Birth Story
As noted above, my first baby was born by a horrific c/s after a very medicalized pregnancy and a difficult induction. The anesthesia didn't work and I felt the surgery intensely. My baby and I were separated for quite a while, we had difficulties getting nursing started, and I had Post-Traumatic Stress Disorder, including flashbacks and nightmares about the surgery for quite a while afterwards.
This provided a very strong motivation (!) for me to pursue VBAC in my second pregnancy. However, I had limited resources for VBAC preparation and still had not fully grieved or processed the trauma of the first birth, which I feel definitely influenced my second birth. Despite laboring naturally and spontaneously with #2, we ended up with another c/s. The baby was in an undiagnosed posterior position and became 'stuck', so despite dilating easily, we pushed for almost 5 hours and still ended up with a 'failed' trial of labor. Fortunately, this time we used 'spinal' anesthesia, and this c/s was a good experience, if not my desired birth. In fact, I wonder if maybe I needed to have a 'good' c/s in order to start healing from the first awful experience.
Although we definitely wanted 3 children at least, I found it difficult to make the decision to start a 3rd pregnancy because I felt extremely limited by the provider/birthing choices that seemed to be available to me. I felt boxed in and without choices, so I delayed trying to conceive. In the meantime, I found out about Nancy Wainer's workshops on Healing and Grieving for birth experiences, and I went to one. That was the start of the breakthrough for me. Although I personally did not experience an epiphany of healing during that weekend, I began the difficult process of opening the wounds and processing the grief, and much of the groundwork for my later healing was laid during that weekend. Within a few months, I felt far enough along in the process that I was mentally ready to try to conceive again. I began interviewing caregivers, and entered the pregnancy with hope and optimism, although that optimism wavered at times during the pregnancy!
I continued the healing process by taking several workshops/classes with Birth Works (a childbirth preparation course), and these really furthered the healing process. In particular, they had me relive the horrific experience of feeling the surgery in my first c/s, and although that was very difficult, it helped reduce the emotional power that experience had over me. It also clarified for me the nature of that fear, how it related to my other issues, and why it resonated so strongly in my life. So while I was terribly afraid of re-experiencing that awful event, in the long run it was greatly freeing to do so, and allowed me to release the emotional bondage from the experience. I mention these things prominently because I'm convinced that for me, VBAC preparation was not simply a matter of physical preparation and education about birthing choices. For me, emotional preparation was also KEY to achieving a better birth experience.
There were two main differences between my second birth (my 'failed' VBAC) and my third birth (my 'successful' VBAC). First, I learned a great deal more about baby positions and their influence on labor and birth, something that had been a problem for me twice previously but had gone undiagnosed and discounted as a cause for problems. I actively sought out information about preventing or changing malpositions, carefully used a number of these techniques, and selected providers that were extremely familiar with the problem and ways to help fix it. Second, I actively sought to emotionally process my previous births and overall issues in my life. This meant taking several workshops, reading any VBAC book I could get my hands on, doing some hypnotherapy to help me deal with fears and visualize a better birth, journaling to help my emotional processing, and even doing some therapy sessions with a counselor to help continue to heal the abuse and body trust issues from my past. I don't think that my VBAC would have happened without the intense concentration I gave to this emotional preparation. For some women, VBAC is solely about physical issues, but for many of us it relates to the underlying issues basic to our lives, and represents a beautiful opportunity for healing in our lives. VBAC actually becomes the vehicle for emotional growth and healing.
As far as the actual pregnancy goes, it was fairly unremarkable. Although I had never seriously considered homebirth for me, I researched it to represent it fairly on my website, and wound up being impressed by the research stats on it! I ended up choosing it for me, which is a huge turnaround from the way I viewed birth in my first pregnancy. We chose carefully the tests and procedures that seemed reasonable to us while declining others, and were very proactive about diet, exercise, and stress. Because of my age and a history of mild gestational diabetes in my first pregnancy, we chose to monitor my blood sugar daily with a home glucometer and to take the gd screening test to be sure all was well. As in my second pregnancy, I once again tested negative for gd, but we still treated me as borderline gd and were very careful with diet, etc. In addition, I walked one or two miles almost every day, and also did water aerobics/swimming and pregnancy yoga several times a week.
Given my history, I also researched ways to prevent/treat malpositions. One of these included the "Webster In-Utero Constraint Technique", a chiropractic treatment that was reputed to be very effective in turning breech babies. A variation was also was rumored to be effective for posterior babies, so I searched for a chiropractor in my area familiar with the technique. I was unsuccessful in finding one until the pregnancy was almost done (almost 36 weeks). I had had a great deal of sacro-iliac pain, some sciatica, and lots of pelvic discomfort, but after one treatment with the Webster Technique, I felt like a new woman! The chiropractor said that my pelvis/sacrum was out of alignment and that sometimes this can cause the soft tissues (ligaments etc.) to twist or pull on the uterus, which then can cause the baby to assume unusual contortions in order to fit comfortably inside. My pain significantly lessened after the treatment, and several follow-up treatments also helped my body to re-align itself properly. This pain had been with me for nearly 5 years since my first pregnancy, and every doctor (and 3 other chiropractors) I had seen in the interim had failed to even take the problem seriously, yet this chiropractor had resolved the problem quickly, and I am convinced it also physically helped me towards a VBAC as well. I would encourage any woman who has had a problem with baby malposition in the past to look into this technique (see other parts of my website for further info).
As far as labor goes, my midwife decided to encourage the baby to come at 38 weeks. Although induction usually LESSENS your chances at VBAC (and this is clearly borne out by research), some midwives feel it can be helpful in a few select cases. She decided that this might be one of those unusual cases and opted for it; I went along with it, although I had strong misgivings about it. This was a difficult decision to make, but at the time I did convince myself it was the right one----for me, not for VBAC women in general. Now, after time to process and review this decision (and in view of new research on the increased risks of inducing labor in VBAC moms), I no longer feel it was the right decision. However, you decide what to do on the information that is available to you at the time and based on my midwife's recommendations, we induced labor at 38 weeks. I greatly regret this now.
The first part of labor was intense but not overly hard; it was nice to spend it at home and not rushing to the hospital. As labor intensified, we got into my tub (which had really speeded up my second labor). Between the tough contractions, though, we did manage to relax some, and we even sang through part of labor ("Come Unto Him All Ye That Labor" from The Messiah and "Dona Nobis Pacem"). I have great memories of this aspect of labor. However, I began to have misgivings about my midwife along the way and did not care for her cavalier attitude towards checking on the baby regularly and her attitude towards me.
Despite very intense contractions and having started the labor already dilated to 3+ cm, dilation stalled at around 5 cm, even after hours of contractions. This is often a sign of baby malposition, but the baby was clearly anterior! I began to get discouraged. The midwife decided to break the waters to bring the baby's head down more fully onto the cervix. Labor became EXTREMELY intense then, and was VERY difficult indeed to cope with. A recheck after a few hours showed little progress still being made despite the tremendous contractions. I began to question staying at home, since labor was SO painful and no progress was being made; I also had an inner feeling that something was 'wrong' somehow (my second labor had been relatively easy and quick despite the baby's posterior position---all the pain and lack of progress this time made me very uneasy).
I became very emotionally upset, started wondering about a repeat c/s, and at the very least wanted to transfer to a hospital for more constant monitoring and maybe an epidural. But when I mentioned this to one of my midwives, she became very dismissive of my pain levels and feelings, and derisive of the idea of transferring. I became extremely angry that she discounted my feelings and was derisive of my perceptions. I felt bullied and 'unlistened to.' She eventually crossed the line from being unsupportive into being downright emotionally abusive, and all I wanted to do was leave.
To be fair, she felt that I must have scar tissue on my cervix from having previous c/s at full dilation which was preventing dilation and wanted to manually stretch the cervix through the adhesions. However, because of her bullying attitude and derisiveness, I had lost all trust in her and refused to let her try this. It just didn't feel 'right' to let her do this, and in hindsight I'm glad I didn't let her do it. Manually dilating a cervix can be very damaging, and there was a lot of cervix left to dilate. She could have done some bad damage to me had I let her try this.
My other midwife was very supportive emotionally (despite feeling that I should try the manual dilation) and I greatly appreciated her support, so I tried to stick things out a little longer. As a compromise, I got back in the tub and labored another 2 hours, despite very intense pain levels and an increasing sense of disquiet. Finally, I told my first midwife I was transferring to the hospital no matter what she thought. It's not that I felt physically safer at the hospital, but that something told me I needed to go. By then I was also extremely upset with the first midwife and wanted to leave to get away from her. In essence, I "fired" my midwife and left in the middle of labor to find a safer and better provider, not only for my own sake but for my son's safety as well. This is not a condemnation of homebirth but of that particular midwife and the way she practiced.
I initially wanted to just have a c/s and get it over with, but after considering carefully, elected to go in and try an epidural first as a last-chance effort towards a VBAC. Even though the hospital was only 5 minutes from my house, that was a very loooooong trip to the maternity ward, let me tell you! Very painful. We left the midwife I was upset with at home and took the midwife we were happy with to the hospital for moral support.
At 4:30 a.m. or so, we arrived at the maternity ward and started setting up for the epidural. I had TREMENDOUS back labor by then and needed very intense counterpressure on my back. Although we will never know for sure, it is quite likely that the baby once again was malpositioned, although he was still officially anterior. My guess in retrospective is that he was in a compound presentation (with his hand or arm by his head, probably with his elbow over his face, which puts tremendous pressure on the sacrum and causes nasty back labor). The hospital bed had a section that drops for deliveries, and this was accidentally in an uneven (not level) position. As they had me scoot into position for the epidural, my hips shifted unevenly on this, and suddenly I had a tremendous urge to push. I could NOT sit still for the rest of the epidural, so they could not complete the process. The needle was in my back and everything (ick), but I never had the chance to get any drugs because suddenly I was pushing. What probably happened was that the particular hip movement I made on the uneven bed caused the baby's arm to drop away from his head, and with his position resolved, he moved quickly down into my pelvis.
At this point, we gave up on the epidural. (I was really bummed at the time, considering the pain! But in retrospective I am glad we didn't end up with one.) I was checked and found to be nearly dilated, but with a stubborn cervical lip all around. The OB on call had not arrived yet, so the nurse offered to manually move the lip over the baby's head. I felt this was different and less likely to be damaging than manually dilating a cervix several centimeters, so I agreed to it. It hurt like heck but was quick. After this we were fully dilated and pushing. The baby's head momentarily stopped descending well; my other midwife thinks his head hit my pubic bone and stopped progressing. They had me in a "C" position for pushing, sitting on my bottom with my chest curled forward, when what I really wanted to do was arch my back. Against the nurse's wishes, my other midwife lowered my bed so that I was more flat and could arch my back to help the baby move under my pubic bone. For me this seemed to have been the key to getting the baby through the pelvis and out. After she saw that it helped and that my midwife knew what she was doing, the nurse stopped fighting us, despite my midwife not having privileges at that hospital. If the nurse had continued insisting on a rounded back/neck-to-chest position, I don't know if the baby would have been able to get out.
I vividly remember the midwife telling me to touch my baby's head as he crowned (this was one of my greatest desires and I am so grateful she remembered), but I kept telling her I couldn't! My hands were supporting my hips and bottom off of the bed as I arched my back and I couldn't take them away during a contraction. As soon as we could, we found a way between contractions for me to move my hand briefly down there and feel the baby's head as it came out where it was supposed to! That was a GREAT feeling, very magical and so special. I didn't have long to enjoy it (since I needed to put my hand back to help get in the best position), but it was an amazing feeling I will always remember. I am so grateful my midwife helped me remember to do this!
The baby was born within 12 minutes or so of starting to push. Because he was born so quickly, it was not fun to get him out, and my bladder got pretty bruised along the way. Also, at the very end, the baby's heart tones began to drop a bit, so they had us push very forcefully and even between contractions in order to get him out quickly to be sure all was still well. His shoulders tried to stick a little bit coming out at first, probably because they had us pushing between contractions and before he finished turning (restituting) inside, but fortunately they did not end up getting stuck and resolved without any help. With a great scream from me (it was VERY intense!), out popped my baby, and I had a VBAC!
The baby was indeed just fine, and although I didn't get my fantasy birth of delivering him into my arms or underwater, I did get to hold him shortly after he came out, while still attached to me. That certainly never happened after my c/s; IT FELT WONDERFUL and was worth every minute of pain. My husband declined to cut the cord, so I got the great symbolic privilege of cutting the cord myself, which I loved. This was the first time in 3 births that I actually got to SEE my baby right after birth, to hold him while still naked and goopy from baby juices, to see the cord and the placenta etc., to nurse the baby right away there on the table, to be the first to hold my baby and bond with him, to look into his eyes right after birth and connect with him immediately. It was an AMAZING feeling. It's hard to describe just how much it meant to me. I'll never forget the feeling of looking into his eyes while he was still connected to me, to feel him all warm and goopy from my body, to feel our souls meet. It was a moment frozen in time that I will always treasure.
The doctor did not arrive in time for the birth; she was about 2 minutes too late! Although she was great about handling an unexpected homebirth transfer, I was just as glad she wasn't there for the actual birth. Because we pushed the baby out so fast, I did tear slightly, and needed 3 small stitches. That wasn't a lot of fun, but let me tell you, 3 small stitches (even 'down there'!) were a heck of a lot better than 6-7 layers of stitches from a c/s! I had significant bruising and swelling of my bladder area from the quickness of the birth, so I ended up having trouble peeing after the birth and needed a catheter for days afterwards. That was a major drag, but so many other things were better about the VBAC that I put up with it, and everything did end up returning to normal, with no lasting effects.
So although this VBAC birth was not a very easy one, I still absolutely feel that the VBAC was FAR better than a c/s. I had a lot of fun in the first couple of weeks, noticing all the ways in which recovering from a VBAC was easier and vastly superior to recovering from a c/s. ("Look, I can sleep on my stomach already!", "Look, I can cough and laugh without pain!", "Look, I can lift my other kids and snuggle them right away!", "Look, I can get out of bed easily!", etc.) My husband got a kick out of my delight in those minor but so-telling details. :-) In the end, even after all our care to avoid a baby malposition, we did end up with a compound presentation of some kind, but at least this was a type of position that was more easily resolved (compared to a posterior). Once the baby's hand/arm was moved down, he was born very quickly indeed, a great relief after pushing for 2 hours the first time and 5 hours the second time! And what a joy it was to know that my body had actually 'worked right' after all, and to have those intensely precious memories of holding my baby right away in my arms.
If I had had to have another c/s, I would have been very sad and disappointed, but I really would have been okay in the long run. I didn't see this birth as a "pass/fail" activity. For me, the baby and the JOURNEY towards his birth was the most important part. Getting a VBAC was the bonus----a really wonderful and enjoyable bonus, mind!---but not the main part. VBAC is not the right choice for every woman, but it can be a path of tremendous personal growth, even after a disappointment. I am so glad I didn't give up after my first 'failed' VBAC, and I would encourage other women who are so inclined to persevere also. I feel I am a much healthier person as a result of this journey, and I have taken many steps on the path of healing. And I have a sweet, precious little bundle to boot!
Postscript: Four years later, Kmom had another baby, a girl this time. Again she chose a home birth with certified midwives, but this time chose midwives who did not believe in much intervention in labor, who were much more emotionally supportive, and who believed that the final say in decisions belonged to the parents. Again Kmom monitored her blood sugar to ensure it remained normal; it did, despite Kmom being well over 40 by now. Choosing her midwives more wisely this time helped her have a truly relaxed and less stressful pregnancy. This baby went "overdue" by quite a bit, so it was a good thing her midwives were relaxed and laid back! Kmom's fourth baby was eventually born in the water, at home, in a lovely and safe birth. Surprisingly, this baby was 10 and a half pounds! Not because Kmom had "gd" but because she finally allowed to labor to begin truly spontaneously and went to her natural pregnancy length without being forced or encouraged to labor early.
Note that Kmom's second VBAC baby was a pound bigger than both her c/s babies, and 3 lbs. bigger than her first VBAC baby. Obviously baby position was much more important than baby size after all!!
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