by KMom
Copyright © 2000-2006 KMom@Vireday.Com. All rights reserved.
This FAQ last updated: August 2006
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
BBW Birth Story Pages
BBW Birth Stories: Pre-Eclampsia Birth Stories
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.
This is a collection of BBW birth stories collected by Kmom over the years. Stories have been separated into various categories (vaginal birth, c-sections, twins, gd stories, etc.). Because some stories fit more than one category, many will repeat on different pages. Some stories are already up on the web in a more complete form elsewhere; with the mother's permission, Kmom has linked to these sites and urges readers to click on the link and read the more complete story.
Unless specifically requested, all identifying information has been removed or changed to protect the privacy of the participants. All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
This particular FAQ presents the stories of moms who have had blood pressure concerns. Some of these simply had borderline b/p in pregnancy, some had pre-existing hypertension before pregnancy, and others had b/p problems accompanied by other symptoms that indicated pre-eclampsia or other problems. Although the FAQ is titled "Pre-Eclampsia Birth Stories," it really covers any story where blood pressure was a significant concern.
More stories will be added over time, so keep checking back if you are interested in reading further stories. If you are interested in sharing your birth story, click here for more information, birth story format, and submission guidelines. New birth stories are always welcome; Kmom updates the birth stories FAQs about once or twice a year so be patient for your story to show up. If you do submit your story, please carefully follow the format and directions given in order to shorten the amount of work involved for Kmom. Kmom's family will thank you!
Most moms will recognize most of these terms, but women new to reading about childbirth may be puzzled by some of the terms and abbreviations used in these stories. This section briefly defines some of these in order to help women understand the stories better.
Pre-Eclampsia/Elevated Blood Pressure Birth Stories
DocMoms's Story (mild pre-eclampsia, induction, vaginal birth)
Kmom's Notes: This mom had quite a large pregnancy weight gain, but this sometimes happens when women lose a lot of weight before pregnancy; their bodies go into the 'regain' and 'storage' mode common after diets, plus gain for the pregnancy as well. Pre-eclampsia can also predispose to high weight gain from fluid retention as well. However, some women also just gain more than others, so it's hard to say for sure what the cause was here.
Although it's very difficult, here's proof that some women can do an induction without an epidural. A lot depends on the type of labor, the position of the baby, and the coping techniques/support of the mom (studies show doulas really help!), but it's quite an accomplishment to do a pitocin induction without an epidural! (And Kmom should know!)
Birth Story
My pregnancy was pretty uneventful until 23 wks when I had a Urinary Tract Infection (UTI) and few contractions with it. I kept working and things went well until about 33 wks when I started feeling pressure down low in the pelvis. It felt like the baby was pressing down. I mentioned this to my doctor and she said decided to check my cervix and said that I was 50% effaced and 1cm dilated so I was placed on bedrest for 2 wks prior to returning to work. Someone directed me toward Sidelines, the support group for high-risk pregnancies. I must say that this was a very positive experience for me. I also received valuable information concerning birth from the book called "Birthing From Within".
I did well for another week at work, then my b/p started rising. I had baseline b/p of 120s/70s, but then it rose to 130-140s/80-90s. I had a lot of swelling in my hands, feet, and face. On the Wednesday before Thanksgiving at 38wks, they sent me for lab to check for pre-eclampsia since I had gained 10 lbs. in one week. The labs were ok, so I went home with instructions to take it easy. I went back to the doctor on Nov. 29th and had gained another 7lb.--all fluid, but b/p was ok, so back to work for a few days. We had 2 Non-Stress Tests and biophysical profiles as well. At 39 4/7 weeks my b/p shot up to 160/108, so to the hospital for monitoring and induction on Dec. 7th. I had planned for a natural, doula-assisted delivery, so I was initially disappointed.
My induction started at 0630 with a Pitocin-drip, but the contractions weren't too bad. At 0920, I had my bag of waters artificially ruptured and labor began to progress. It is really a weird feeling having all of that amniotic fluid rush and then trickle out. I labored without medication and it was very difficult, but my husband and doula were wonderful. She had a way of talking me through the contractions as my husband massaged my back, feet and legs. I also had back labor which was relieved by a heat pack made of rice stuffed into a sock and microwaved. This made the back labor thing much better. I received Stadol to take the edge off of contractions, but I could still feel them. I was just too afraid to get an epidural.
I began to push at about 1530 and my beautiful daughter was born at 1749 hrs. Labor lasted about 11.5 hours and I pushed for about an hour. I had a 3rd degree tear secondary to mild shoulder dystocia (stuck shoulders), but my daughter did well throughout all of this and maintained her heartrate. She never had decels or any fetal distress.
She weighed 7lb. 15 oz. She had a head full of black hair with brown eyes. She was placed on my chest and immediately went to the breast to suckle. I held her for approx. 20 minutes prior to them taking her over to get her ID tags and Vit K, eyedrops, etc. Her Dad was able to go with her for this. I had some complications after the birth including loss of my IV, so not Pitocin was available to help the uterus to contract. This caused a significant amount of hemorrhaging. Also, I had a Magnesium drip because of my high bp that caused my bp to plummet after the bleeding. My doctor and her staff did a great job at correcting these issues quickly. I know that God and his Angels were in the delivery room that day. So, despite all of the complications, I am wonderfully blessed to have a cherished little one in my arms.
Erica's Story (high b/p, induced, vaginal birth)
Kmom's Notes:
Birth Story
I fell pregnant accidentally when I was at University when I was 20 years old at 270 pounds. I was very nervous and worried about having a baby, which I think contributed to the high blood pressure. I didn't have any problems with the pregnancy except when I worked. I worked part time on my feet and could only stand for 5 hours at a time. I got terrible back pains, so bad I couldn't get out of bed at night to use the bathroom. I would crawl on the floor. I didn't have back problems prior (even when I worked) so I think it was just the pregnancy or pregnancy plus being overweight.
A week before my due date my OB was concerned about my blood pressure and sent me to the hospital. I was kept overnight and my blood pressure was okay. I think my b/p went up when I would visit the OB. I was also afraid of being examined, which I still have a problem with today because I am embarrassed about being overweight. My OB never said anything negative about being overweight, it was never an issue.
2 weeks overdue the OB decided to induce because he was afraid of pre-eclampsia. We used the gel first then the next morning they put in a drip which *worked*. Labor was terrible, I think it was the induction. I was planning to go "natural" but opted for pain relief once I couldn't mange the pain. I was also in labor alone; having a support person --I've heard-- can help with pain management. I was also worried about being "modest". The hospital had a sheet like thing draped over me and only my legs were really showing, even in the stirrups.
She was born 25 hours after the first gel induction. She was healthy and fine and so was I. She's now 6 years old and I'm due with my second child in a few months. I'm now 27, over 330+ pounds, and my blood pressure is fine. There is no reason this pregnancy won't be "normal". Although I'm still worried about the modesty thing again, I'll be at a different hospital.
Franny's Stories (PCOS, induced vaginal birth, posterior, forceps; cesarean for breech baby; home VBAC)
Kmom's Notes: Another case where the baby's position makes the birth difficult until it is fixed. In this mom's first birth, it was probably the combination of the hands-knees maternal position and the doctor using forceps that helped the baby to turn and be born vaginally.
Franny's second baby was breech. This may reflect a tendency among women who have had prior malpositions to have future malpositions as well. This may reflect a pelvic misalignment more than anything else, and we speculated that regular chiropractic care could help prevent position problems in the future.
She got that chiropractic care in her 3rd pregnancy. Did that help her to a vbac? Hard to prove. It's notable that this was the only pregnancy of the three without a malposition, so the chiro care may well have helped. However, she might have had a VBAC even without that care. It's more like an extra step to take, just in case.
Another notable thing about Franny's story is that she was told that she had to sign up for an elective repeat cesarean because her hospital didn't offer VBAC anymore. Fortunately, there were other choices in her community, and rather than being forced into unnecessary surgery against her will, Franny gave birth at home with a good midwife. And then she had the strength of will to write about it for her local paper!! She put those local doctors on notice that women will NOT be forced into unnecessary surgery!
Birth Story
Baby #1: I gave birth at the hospital where I worked at the time. I am an RN; I was working OB at the time and delivered with my 2 best friends as my nurses.
My B/P was elevated at my 38 week appt. and being the beginning of July and very hot and busy on the hospital floor where I worked, my MD sent me home with bedrest. I was swelling, but not spilling any protein and my labs were ok. I got a Non-Stress Test (NST) and baby looked fine. The next week we scheduled my induction because B/P and swelling continued and my cervix was favorable (ripe).
I entered the hospital at 6 a.m., my IV was inserted and pitocin began. I was having contractions, but they weren't anything. I was 4 cm when I started out. I walked the halls and rocked in the rocking chair. My husband and his parents were there. I worked on OB at the time and a Radiant Warmer Representative was there to in-service the staff on a new Warmer. I stood in the hallway with my IV pump and listened to his in-service at 9 a.m. By 9:30, he was done and I was tired, feeling contractions, but they weren't uncomfortable. I thought, if this is going to last all day I'm going to try to get some rest.
I went back to bed, got hooked back up to the monitor and my contractions were every 2 minutes, palpating moderate, but not uncomfortable. I had been laying down for 15 minutes and just got my eyes closed when I had 3 strong contractions that I had to use my breathing techniques through (I had coached so many other labor patients that I felt like I could do it). Then my water broke. Talk about warm soup down your leg! The contractions got really strong then. I was 5 cm. Got up to the bathroom to get cleaned up and got some pain medicine, Nubain 10 mg. I got back in bed, turning side to side and in 2 hours I was 8 cm. The contractions hurt, but they ended and knowing there was an end to every pain was a relief in itself. Back rubs, ice chips, and a cool washcloth over my eyes helped tremendously.
At 1 o'clock in the afternoon I started pushing. I pushed sitting up, lying on each side, on the toilet, standing up, squatting, and regular old lithotomy. I just couldn't get him to budge and I had pretty bad back pain. He was posterior. After 2.5 hours of pushing, I got on my hands and knees and pushed every other contraction because his heart rate was dropping. Finally, my doctor came in and I got a spinal in case I would have to go for an emergency c-section. They got me all set up for delivery and the doctor used forceps. After 3-5 contractions with pushing and pulling, we got him turned face down and delivered at 4:35 p.m. He was a bit exhausted and got a little oxygen, but cried well and after an hour of stitching, mom got to feed him. He nursed for 20 minutes like a trooper.
Baby #2: I was due 4/7. We knew dates for sure because we got pregnant with the assistance of Clomid and Glucophage for PCOS. My pregnancy really went quickly and pretty smoothly. From about 28-34 weeks baby was breech except for one brief period. Around 34 weeks I started doing the routine to turn her---lying on the ironing board, used a moxibustion stick at home, homeopathic pulsatilla, prayer, relaxation, imagery, talking to the baby, flashlight, music, the whole nine yards. I was on the verge of a breakdown about 35 weeks...called my midwife crying, "What am I going to do?"
We had talked about delivering breech and they weren't really sure. I had an appointment on Friday 3/14 for a consult with the OB (he's probably in his mid-50s and still does some vaginal breech deliveries) who backs up my CNM and possible External Version. We had planned to deliver at a birth center. That was all I was planning. I was thinking positively, I was relaxing and working on the imagery I was planning to use for labor...this baby was going to have a peaceful delivery and I was going to have a healing, positive birth.
I am a RN and work as a prenatal care coordinator for a community health clinic. I do home visits, education and referral for pregnant moms on the Medicaid program. I have worked as a doula in the past, but don't have time for it at present. I teach childbirth classes and had a class on Tuesday 3/11 from 5-7. Talked with a couple for about 30 minutes after class, then drove home, picked up my son at church (my husband is a pastor). We came home, I [ate] and read my email. I had just got Ina May's new book via Fed Ex that day and while my son was winding down...I started reading in the recliner. I had been sitting there about 15 minutes when I felt warm and wet---I jumped up so I wouldn't get the recliner wet and freaked out, "OH NO, that can't be my water!" When I pulled down my pants in the bathroom there was a lot of blood. Now of course, I'd just worked about a 12 hour day, moving constantly, and not really noticing much movement from the baby. In class that night we talked about Cesareans and abruption was going through my mind. I'm absolutely losing it, my heart was pounding, I was shaking all over, I'm shaking now just remembering how I felt. I read Prenatal Parenting early in my pregnancy and I had worked really hard on remaining calm and talking to the baby, taking fetal love breaks, especially when I'd had a rough day---now when she decides to come, I'm a mess.
I called DH on his cell phone. "Come home now, I'm bleeding." It was about 10 p.m. My son could tell I was worried because he was right there. "Mommy, are you ok?" (Side note: The next evening at Bible Study he asked for prayer for Mommy because she "Pooped blood in the toilet and it looked like Koolaid." He's still talking about that night!) DH got home, helped me find my midwife's phone number and we called her. She was a voice of complete calm, "I'll meet you on OB. It's probably just your water." DH has never driven so fast in his life! Now I was nearly a month early, I had just gotten finished saying that night at class that I would probably go close to my due date, I was too busy to have the baby early, I had home visits scheduled through the end of March, blah blah blah. I had no bag packed, had no comfort items gathered, had only 2 outfits for baby clean...I didn't have the crib pained, had no mattress, didn't have a pediatrician picked out, had not pre-registered at the hospital, I was going to deliver at the birthing center for heaven's sake!!----I WAS NOT READY!!!!
We got to the hospital and up to OB. They wanted me to change my clothes, I wanted heart tones. 130s, but very little variability...My midwife cam in and did a quick ultrasound, the baby's head was under my right rib cage, her bottom was inside my right pelvis, and her feet were over my cervix. My midwife sat on the bed with me, held my hand, and said, "We are not comfortable with delivering her vaginally this way, you need to make some decisions." DH went down to sign me in. When he came back I bawled in his arms for a few minutes then collected myself. My midwife and I talked about VBAC and she said that the doctor still did VBACs and was very pro-VBAC and had a good rate....I think she said ~80% success rate for VBACs. I made it clear that if the baby was OK, she was to be with me at all times. If she was not with me, DH would be with her. My midwife said that the pedi on call was a stickler about the baby going to the nursery, but she would do what she could.
DH's parents arrived to stay with my son during the birth. IV started (after 3 tries), into a gown, consent signed, we went to O.R. After the anesthesiologist got my fluids in (she about froze my arm off pushing about 700 cc in 10 minutes), she sat me up for my spinal (again, third time was the charm). The doctor was at my feet, my midwife at my side, and nurse on the other side. They were all awesome!---kept trying to recruit me, though. I laid back down and felt everything go to sleep, boy that is a funny sensation. With [my first child], the spinal took the pain away, so it didn't feel so weird. With no pain, it just feels like they put lead in and made it all go to sleep, kinda pins and needles sensation. They put my catheter in (gave me the option not to have it at all, but I figured I'd probably not want to get out of bed for a little bit once the spinal wore off and I knee it was also in place to make sure my bladder wasn't nicked during the surgery, so I got it).
I informed everyone that if my baby was ok, I wanted to keep her with me. I got this weird sense of humor and was defensive by joking about things, I was kinda strange. My BP bottomed out at 60/40 and my heartrate was going nuts in the 120s. She gave me something for my BP and I felt a little better. DH at my side, they started my baby's birth; tears rolling down my face, I asked him to pray with me. DH prayed from the moment he placed his hand on my face until we heard them say, "Here's baby." My heartrate came down to the 90s while he was praying and the anesthesiologist said, "Wish we could bottle that."
During prenatal ultrasounds, we had a brief peek to see girl parts, but never saw them again (breech), so I was not getting my hopes up. I knew that they would see sex before she was even out, but they weren't saying anything! After her birth, the doctor made the comment that he went in and felt limbs, he grabbed two and started to pull them out, but had an arm and a leg, had to go back and find a matching set. She cried quickly and after a peek at her, to the warmer. The pedi checked her over and I kept talking to her, "Keep crying," "Hello Amy," etc. I had tears streaming down my face and into my ears. They wrapped her up and handed her to DH; I got to touch her. The anesthesiologist held her face right next to mine so I could talk to and kiss her.
The doctor held a section of cord up for me to see. "See why she wouldn't turn around?" She had a true knot in the cord that was really pretty snug. He felt that she was lucky to be here and that she would have probably not tolerated the version we had planned for 2 days down the road. Now, I have seen true knots before, even after vaginal deliveries, and everything was okay, but I also assisted a twin delivery where one twin had a knot and was stillborn, the other was ok.
The anesthesiologist offered Demerol to help with cramping and I refused because I didn't really want to see my supper again. I asked to have my placenta and the anesthesiologist said, "Well, what on earth for?" I said, "Because it's mine!" I got my placenta in the freezer, going to plant it with a Magnolia tree outside Amy's bedroom window. (I had a Magnolia tree outside my window growing up.)
The pedi took her to the nursery. DH followed and picked up our son and my in-laws so they could see her and 10 minutes later when my surgery was over, the nurses and doctors took me to recovery, and my midwife went to get Amy. I got her to the breast within about 45 minutes after delivery. She was cuddled up with her head on my breast...My son came in and asked me, "Did you get your miracle, Mommy?" More tears. He got to see her, my in-laws were in the hallway looking in, and DH was walking around with my placenta in a bucket under his arm. Back up to the OB floor at 2 a.m., got my morphine [Patient-Controlled Analgesia] pump and slept off and on through the rest of the morning with Amy on my chest. [We] ended up skin to skin for quite a bit of that time. They checked me often, but basically left me alone, never asking to take her to the nursery for her admission bath, etc. I got out of bed for the first time around 10:30 a.m. the next day, got to oral pain meds and my IV out around noon. Kept Amy with me around the clock and nursing went well. Went home Thursday afternoon around 3:30 p.m. I refused her Newborn Screen on discharge and brought her back that Saturday.
OK, the last thing I wanted was a cesarean. But what I was praying for was an empowering, positive, healing birth and even though I didn't have the natural birthing center birth, that wasn't what I was praying for. Next time I will be more specific, but I did get control in my birth experience, I was hyperaware of what I was feeling emotionally, physically, and mentally, and I feel I was so prepared for coping with pain that it has made my recovery super rapid. As far as healing, in that I feel like I can delivery vaginally without the medical need for management. I have not had that yet, but our daughter is named for 3 very special women, 2 very dear to me. Amy's birth was healing to me in that way, a healing I didn't even know I needed, but God took care of nevertheless. Positive, a resounding yes, I have a beautiful baby girl with a perfect round head, she has dimples just like mommy and lots of dark hair.
Did I get what I wanted---no, but I did have control over what I did get. Did I get what I needed---definitely. I will no longer feel sorry inside for women who had to have a cesarean, but instead I will ask how they felt about their birth. That is so much more important. A cesarean is not fun, it's not natural, it can be unnecessary, but it does sometimes save lives, and it is a birth of a precious little one, and an event that is no less memorable or special...Sometimes we just need to be reminded of it.
Amy was 6 lbs., 14 oz., 20.5 inches. She is a good baby, nursing well. At three weeks of age she is 8 lbs. 5 oz., solely breastfed, and I have an additional feeding built in for pumping. I love the Lansinoh Ziplock bags for breastmilk storage, and the Avent pump is great. It's like "I can't believe it's not electric!"
Update: Franny went on to have a home VBAC too. This is her VBAC story.
10 days past my due date I was miserable and called my midwife for help (this pregnancy lasted more than 2 weeks longer than my first and 6 weeks longer than my second...I felt like I was pregnant forever, add to this that I took off work for maternity leave at 38 weeks and I felt a little like an elephant, in more ways that one). My midwife recommended that I see the Chiropractor and get a massage. I chose the latter and by evening (Wednesday) my contractions had started.
I went about my normal activities, fixed supper, went to church, bathed the kids, put kids to bed, went for a walk. Contractions were regular, but not very strong, more like annoying. Thursday AM we were to drive an hour away to see the midwife...I didn't think I could handle being in the car that long, so I told her to head our way. (She has 7 kids of her own, the youngest just turned 1 in November). I napped and felt like they were fading away and she said she'd just drop in to see how I was. I had gone into work for a bridal shower on Tuesday and one of my co-workers, an OBGYN Nurse Practitioner said I should just go to the hospital and have another cesarean since I was so far over my due date...had a lot of mental work to do to get over that.
Midwife arrived at 3 and I told her what I was thinking/feeling and she helped me get rid of it and by 3:30 my water broke. By 5, my doula and our friends that were going to watch our kids were present and I was starting to get uncomfortable. Around 7pm, I was 4cm (the first time my midwife ever had her hand in me). I got in the tub ( borrowed a spa in a box from a friend) and got hot, then had to get out to cool off. I had just attended a Michel Odent conference and had his words in my head. If a woman gets in the tub at 4 and makes no rapid progress after 2 hours, he recommended a cesarean. I kept thinking that I didn't have the urge to push, so had I made progress? After dark (9ish?) I got back in the tub and was very cold, my husband found a space heater and was holding it on me next to the tub and jokingly went "oops" faking dropping it into the tub and it took me over an hour to get back into a regular pattern. Had to get into the shower to get warmed back up and they encouraged me to drink some really salty hot broth.
By 11 I was loud and hurting, they also tried to cram a peanut butter and jelly sandwich and juice down my throat...PB is NOT easy to get down with 'labor mouth'. I was all over the place position-wise, remember enjoying a forward leaning position. I starting pushing around midnight, although my midwife said I wasn't *really pushing* until about 1 or so. Was in the tub when I started to push, but kept a rim of cervix and got out to the birth stool so the midwife could help hold it while I pushed. While on the birth stool I remember saying, "I give up. Take me to the hospital, Help me" and they gave me some homeopathy. When she was crowning I got back in the tub.
The midwife said I have 'a large perineum' and so it felt like crowning took FOREVER. I remembered what It was like with Daniel and I realized that I ever got to the point where I could push past the pain and make progress...I finally figured out the pushing thing this time...but the pushing into the pain to make progress, then the contraction ending and feeling the baby slide back up and knowing I'd have to push back through that pain again with the next contraction was nearly overwhelming. I was on my knees in the tub, resting my head on the side of the tub, Aryn put his arm along the back of the tub so I could rest my head and I accidentally bit him...didn't even realize I was doing it until he flinched.
I got to the point where I felt like my urethra was going to explode and I reached down to support my labia and felt her head...It didn't take long from that point...it was so empowering to realize how close I really was. Once her head was out, her body followed quickly, the midwife just allowed the water to catch her. Once she was out, I flipped over and reached for her. Within seconds, I was pulling her up so I could see her, unlooped 2 nuchal cords and brought her out of the water to my chest. She opened her eyes and looked at me and started to whimper. No lusty painful scream, but more like..."Wait a second, what just happened?"
I felt between her legs and discovered she was a girl, but waited until our son came into the room to lift her out of the water for him to see and announce. I was convinced I was having a boy because my pregnancy was so much like it was with Daniel...Instead I have a little girl that looks just like her big brother. I was out of the tub about 30 minutes after her birth and we left the cord attached for about 2 hours, at that point we were able to cut without clamping and it fell off when she was 4 days old. I had a small 'scuff', but nothing worth messing with suture-wise. My midwife had a herbal bath to soak in with Abby and it felt wonderful...had to learn the hard way to strain out the herbs though :-0 clogged the tub.
Abby nursed very well and my milk was in by 24 hours. She never lost weight. Was 8-5 at birth, 2:04am Friday, October 14th and was 8-9 on Monday evening. Abigail has been a joy, a wonderful baby. Sleeps through the night (started at about 1 month) and was smiling by 6 weeks. She does have some gassy spells, but they are brief. Will definitely do it again!!! But will wait until Abby is in preschool or Kindergarten...a newborn and a strong willed 2 1/2 year old is just way too much for me!
This was an editorial I sent to our local newspaper after my daughter's birth explaining my decision and outcome in relation to the release of 2004 C/S rates. Several of the OBs in our area were really ticked and found out that I was the Childbirth Educator at the local Medicaid clinic and were not happy. Our Medical director wanted me to assure him that I was not teaching or encouraging homebirth in my class. I replied that I simply told my story and that I did not believe that homebirth was an option for our clients for 2 reasons...they can't afford the out of pocket expense of homebirth and local docs refuse to provide back up.
The results are in and 2004 saw another increase in surgical birth rates -- 29.1 percent of women delivered their babies by cesarean last year, according to a National Center for Health Statistics report released last week.I chose not to become a statistic
Some doctors cited the reason for the increase was that more women are having elective cesareans, but keep in mind that "elective" does not mean that it was the woman's choice.
Earlier this year when we discovered we were expecting our third baby, I visited my OB/GYN to begin prenatal care. I was informed that we would be forced to have a cesarean if our baby was born at their hospital simply because I had a cesarean with my second child.
The cesarean rate has increased astronomically in the past 30 years: 5.5 percent in 1970, 16.5 percent in 1980, and 22.7 percent in 2000. The World Health Organization states that the cesarean rate should be 10 percent to 15 percent. Our bodies have not changed in 30 years, but medical management has. Although some babies have been saved by surgical delivery, a look at maternal and infant mortality rates show that nearly 30 countries lose fewer moms and babies than the United States and most of those countries have lower cesarean rates.
Having a vaginal birth after cesarean (VBAC) carries nearly half the potential complications than repeat surgery. Due to a 0.5 percent to 1 percent risk of uterine rupture, The American College of Obstetricians and Gynecologists has put very strict guidelines on VBAC, stating that the doctor and operating team need to be immediately available.
American Academy of Family Physicians guidelines noted that there are other problems that occur more often, and they found no evidence suggesting better VBAC outcomes based on the availability of resources. American Academy of Family Physicians went on to state that policies for VBAC "appear to be based on malpractice concerns rather than on available statistical and scientific evidence."
So, how'd I do it? I hired a midwife and kept my OB/GYN as backup. I found a doula -- someone trained to provide emotional and physical support during labor... and obtained a portable hot tub for pain relief. I ate well and read to educate myself. When labor started, my midwife came to me, and my daughter was safely born at home in water.
I'll do it again with my next baby. As long as doctors and hospitals do not allow alternatives, such as midwives, birthing centers and natural options for pain relief, more informed women who want to be able to make their own decisions will join me.
Linda O's Story (pre-eclampsia, induced vaginal birth)
Kmom's Notes: "Linda" was induced for rising b/p at the end of her pregnancy. After her waters were broken, like many women she found the pitocin contractions very difficult to deal with. In this situation, epidurals can indeed be a blessing! Although possible, it is very difficult to do a pitocin induction without pain meds or an epidural. Also, in these circumstances, an epidural may have benefited her high blood pressure (one of the possible side-effects is lowering of b/p, which can be problematic but in this case probably helped). Finally, the jaundice the baby had is also a possible side effect of pitocin, one that needs to be watched for after a pitocin induction.
Birth Story
Never felt discriminated against due to weight, I should mention. We discussed it at the first meeting, but she just said she'd watch my weight gain, which was well within normal range. In the opinion of my OB, just being a large woman was not an indication of a high-risk pregnancy.
Thursday: Went to OB, who checked my BP (it had been rising slowly), and found it to be 160/90 (norm for me 120/70) and immediately was admitted to the antenatal unit of the maternity floor to try and get some rest to lower the BP. BP didn't go down during the day, so OB decided to induce me slowly with Pitocin. Took Pitocin all night, with increasing contractions, but still not very bad. I had been about 2-3 cm dilated and 50% effaced already, so things were already moving along!
Friday: OB is disappointed I didn't react more to the drug--I'm still 3 cm, but now 100% effaced--she breaks my waters, contractions really kick in. I hold out 2 hours, doing Lamaze breathing with DH, but the pain gets to be too much--I got an epidural around 8 a.m. or so. Felt SOOOOO much better. What a godsend! Now I totally understand why so many women get them. I still had many hours of labor ahead and the pain was just awful. I couldn't even focus. But afterward I could relax and get ready for the pushing ahead--we (DH, Mom and I) all took naps and waited.
By 1 p.m. I was about 8 cm dilated--ready to start pushing around 4 p.m. The epidural wore off a bit and I was given just a bit more to get me through--turns out it was a bit too much, since I couldn't feel my muscles as much as I needed. But the pushing went well anyway--pushed for about 20 minutes and almost got her out. OB decided to give me a rest and let the epidural wear off a bit--waited about 30-45 mins., then pushed again and E arrived! Just before she came out, she had a quick dip in heart rate, so the OB really jumped in and helped me with getting her out.
I couldn't believe how beautiful she was when they laid her on my tummy to hold. She had some meconium in her lungs and had a bit of trouble breathing well--she did cry, but not lustily enough, so she was suctioned, given some chest PT, and then showed her to me briefly to hold and try to nurse (she latched right on, the smart girl!). Then they whisked her off to the nursery for the routine checks--DH went with her while I was sutured, etc. It turns out she needed more suction, got some oxygen, some more chest PT, and was then fine. Her Apgars were 8 and 9 in the delivery room, so I wasn't really worried. DH tried to be the daddy and not the doctor, but he did worry, although he managed to stay out of things and let the other pediatricians do their work!
Saturday and Sunday: I had to stay in bed for 24 hours, getting magnesium sulfate via IV as a precaution to treat the mild pre-eclampsia I suffered and prevent seizures. They brought E to us (private room, DH could stay) every few hours for feedings. She knew just what to do with the breastfeeding--amazing. Was moved on Saturday evening to a regular room and had DH and E with me most of the time.
Monday: I was checked out on Monday morning (got an extra day due to the mild pre-eclampsia), but E had to stay. She's a bit yellow and was getting more and more yellow, so they decided to put her in the neonatal ICU and have her get double phototherapy. I start pumping to get my milk to come in.
Tuesday: We spend whole day with E in the NICU, breastfeeding every few hours, and supplementing her with formula (she was very dehydrated).
Wednesday: E comes home! We have a very wonderful and tiring first day with her, feeding her every 2 hours (we had to wake her up each time with wet washcloths and feet tickling!). She is still yellow, but improving. What a beautiful little girl!
All in all, it was a good experience. I never felt my weight was a big factor for any of the hospital personnel and I felt I was treated appropriately and professionally. Would I do it again? Not sure--I love my daughter, but 4 months of colic and an acute lack of sleep is perhaps enough!
Monika's Story (pre-eclampsia, postdue, 2 homebirths, posterior/compound position)
Kmom's Notes: Be sure to visit this site. Very interesting story, great photos!
Birth Story
This is the story of two homebirths despite some high blood pressure and postdue concerns. The story (with graphic photos) can be found at http://members.home.net/mcmahan/. Below, Kmom summarizes the gist of the stories.
"This mom is a mid-sized BBW. She is not self-conscious at all about being in the very graphic photos, and the photos of baby #2 coming out are just AWESOME. Not bad considering the photographer is the teenage babysitter! Details about the births:
-First baby: high b/p concerns at end of pregnancy; used herbs (their site contains details for those interested). Mom was also almost 3 weeks past her due date when she finally goes into labor. Despite all this, they had a homebirth, though the labor was not easy (the baby was posterior) and the baby passed meconium. After the birth, the midwife was concerned about possible meconium aspiration, so they transferred to a hospital and had a hard time negotiating the bureaucracy and hassle there, but in the end all turned out well.
-Second baby: similar concerns with high b/p but all lab tests are reassuring and the herbs again seem to help. Baby similarly overdue, posterior at first, but this time mom's hands/knees position flipped the baby to anterior shortly thereafter and back labor ceased. Baby was large (10 lbs. 6 oz, considered 'macrosomic' by OB standards; most OBs would have called for an early induction or elective c/s), and did birth in a compound position (hand by head), yet despite baby's size and position, baby was born without any damage or trauma to mom or baby because of the careful handling from the midwife. The baby's older sister (not quite 2 years old) is present for the birth; shortly after the birth she demands that the baby be nursed immediately and that socks be put on his cold feet. ;-) The sweetest photo is of the 2 children, tandem nursing (nursing one on each side) after the birth.
Please note that even very big babies can usually be born without problems *IF THE PROVIDER IS WELL-VERSED IN BIRTHING BIG BABIES*, if mom has full freedom of position for laboring and pushing, and if the provider is patient and doesn't force the issue. Baby size does NOT have to mean a ton of intervention.
The photos are very graphic but beautiful; if you are not sure how birth happens or if you have a hard time visualizing that happening with you, I'd recommend going to the site and checking it out. You may not be choosing homebirth, which is also fine, but reading a variety of birth stories while you're pregnant is very important. And the very graphic photos really help show what happens in birth."
Jen S's Story (PIH, induction, c/s)
Kmom's Notes: Some women love their c/s, some are indifferent to them, and for some women, they are a total violation. For some women, it is almost akin to a rape. Jen feels this way about her c/s, and she certainly didn't get much support or help from the staff. Her wishes were often disregarded and it's a testament to her dedication that she was able to keep breastfeeding despite all the intervention from the hospital.
Jen took a Bradley childbirth education class, which is often helpful. However, there are a few doctors and hospitals where this is viewed with great hostility and the staff may hold it against you. The doctor she had was supportive, but she did not get that doctor for the birth. Kmom also wonders about the position the baby was in and if that affected the labor. Like many women who experienced a traumatic hospital or c/s experience, Jen plans a totally different birth next time.
Birth Story
Dh and I studied very hard. We read everything we could get our hands on and even some more. We were taking articles to class to share with the teacher. The classes were terrific. I really enjoyed hearing other birth stories. I couldn't wait to see what mine would turn out to be like. I was committed to a natural, drug free birth. Most of my friends thought I was insane. But I kept insisting that I was going to do it. I felt like it was best for the baby and for me. DH and I felt we had fully prepared for the birth of our first child. We took the responsibility of being parents very seriously as we learned everything we could. Our ultimate goal was to have a safe and satisfying birth, a healthy child, and a healthy nursing relationship fostered by immediate contact with mother and baby.
But I wasn't as smart as I would have liked to believe. Looking back now, I can see some major problems in my plan for a natural Bradley birth. My first problem was that I thought that because I had read and studied and knew so much that I would be in control, no matter what. My next problem was the doctor I chose. I really wanted to have a female doctor. The only one in my area had just gotten out of school. (Maybe she would have been the best choice?) And the other practice in town that all my friends went to were not only men but they belonged to my church. I couldn't go to them! So I decided to drive an hour away to see a woman doctor that I knew personally. My friend, who now lives in Oregon, was her nanny for two years. I felt like I trusted her. Besides the hospital was supposed to be one of the best. The problem with her was not really her at all, but it was the practice she was in. There were eight or nine other physicians in practice with her. So anyone could deliver my baby. How it turned out, the one doctor I never met was the one who delivered B!
DH and I wrote our birth plan and presented it to our doctor. We worked very hard on our plan and made sure that we hit all the major basics we wanted covered, being careful not to overwhelm our doctor. (This was a stupid idea we had. I now believe that a birth plan ought to be what you want it to, and if it is "too long" for your care giver to read, then you should find another care giver). I made a special appointment for DH and I to sit down with my doctor to look over our carefully designed birth plan. After presenting this to our doctor and complete discussion on every point, we felt satisfied that we were prepared for our Bradley Birth. I can remember her saying to me though, "I just hope that I am there." That should have been a clue to me that not everyone else would be so willing to let us participate in the birth of our child.
My next problem was that I was overdue. Despite every trick in the book, that baby was not ready to come out. I was eight days past my due date when my doctor decided that I should undergo several tests to see how the baby was doing. I should have canceled that appointment. My doctor decided that induction of labor was necessary due to several factors; an ultrasound found I had low amniotic fluid, my blood pressure was elevated and traces of protein were found in my urine and I had enormous swelling ankles and feet. DH and I talked it over. I had an idea that she would want to induce me and I couldn't see a way out of it at the time. I trusted her decision and besides, I really was anxious for that baby to come. It was kind of exciting. Needless to say, my birth plan was practically thrown out the window right at the start, but I was still optimistic.
The plan was for me to come in that night and start with prostaglandin on my cervix. Twelve hours later, they would start pitocin. But DH and I wanted to go home first (one hour away). We went home, ordered pizza, picked up some movies and I called some friends and my Bradley teacher to tell them what was going on. D's advice was to stay home for the night and get some sleep. There wasn't any real reason to go that night. I was tired from staying up the night before playing computer games and I should have listened to her. But . . . I was too excited. My plan was to go to the hospital and sleep there that night, get up early and walk the next day until the baby came. Boy, was I in a dream world! I should have listened to her and stayed home. But I really didn't want to call my doctor and explain, DH was hurrying me to get off the phone and I kind of wanted to go. So we went. By the time we got to the hospital, the doctor on call was irritated we had taken so long to get there. She wasn't interested in talking to us about the birth plan we were so proud of and determined to use. Her exact quote was, "You can stand on your damn head for all I care."
When we arrived in our room, the nurse had the bed, fetal monitor and IV all laid out for us. We refused the IV and allowed the E.F.M. for a little while. Then I was started with prostaglandins put on my cervix. Although I didn't realize it immediately, my contractions started within an hour or two. The nurse had explained to me that I might have some cramps. That's what I assumed they were. But they were my contractions. I didn't realize that they wouldn't feel like typical contractions. Right from the beginning the contractions started coming everyone to two minutes, sometimes right on top of each other. I felt them as pains in my lower back. I couldn't sleep and I couldn't rest. The nurse kept coming in the room to adjust the E.F.M. (which she said I HAD to have on if I was in bed). Within an hour of these contractions, I was lying in the bed and totally overwhelmed. They were taking my entire concentration to try and relax. When I was hooked up to the E.F.M., nothing was being picked up to suggest that I was having any contractions. I was starting to worry about what would happen when my "real" contractions were going to start. There was never the tightness in my abdomen, only severe back pain.
And since it was next in my doctor's plan and my labor did not seem to be progressing, the pitocin was started by seven the next morning. After awhile, I started asking for pain medications. An epidural was suggested but I said, "Oh no! I'm not having an epidural!" So I went on some more. The contractions kept coming but not registering on the monitor so my pitocin was turned up on a regular basis. I asked for pain meds again. I still refused the epidural but settled on stadol. This drug knocked me out. DH said I fell asleep immediately. I cannot remember much of anything, because I was in and out of consciousness. I couldn't tell what was real or what was a dream. It felt horrible! It was like a nightmare. The pitocin was still turned up again and again and when I couldn't sleep anymore, I tried to deal with the contractions (I'm not sure I even realized I was in labor yet).
After 16 hours of this, I was begging my husband for an epidural. I had changed my mind about the epidural when they told me I couldn't have any more stadol. DH tried hard to get me to relax and not have the epidural but I was tired and out of my mind and determined! So in came Dr. D and gave me the epidural I swore I'd never have. I can remember asking the nurse about how I compared to other women who requested epidurals. I wanted her to tell me that most women need one much sooner than I did and that I was really strong for waiting for so long. But she said, "Oh, other women usually get an epidural about the same time you did, at a three or four." I really felt bad after that. I was felt like a failure then and I feel like one now. After all my classes and education and relaxation exercises, I couldn't get any further with a natural birth than a woman who had planned on a medicated birth her entire pregnancy! Well, after I had the epidural, I dilated from three to nine. I wonder now if I was in transition or if the epidural had just helped me to relax? I wish I had a doula or my Bradley teacher there because maybe things would have gone differently.
My real doctor (not the one on call) had come by to check on me. She asked me if I minded if they could use an internal monitor. I didn't care. I was stuck in the bed, I had an IV, blood pressure cuff, oxygen mask, E.F.M. and I can't remember what else! I figured at least I'd get some equipment off of me. This was also the time when an internal pressure catheter was put in place. My husband describes the scene as very quiet as the nurses quickly stopped the pitocin when they finally saw my contractions show on the monitor (which were still in my back every one to two minutes and still had never shown up on the E.F.M.) My contractions were out of control. My husband still worries about the pitocin being turned up and up and up. He was relieved that the pitocin was stopped because he was worried about my uterus rupturing.
Once my epidural was in place, I fell asleep again. I was told to push an hour later although I had no urge. My nice nurse was finished with her shift and I then had a not so nice nurse assigned to me. DH and I were left to push the baby out by ourselves. I pushed and pushed and slept in between contractions. I wasn't working very hard. DH would watch the monitor and tell me when the contraction would start, then I would take two breaths, and push as hard as I could. DH watched the monitor and would tell me what number I reached. The next contraction, I would try to beat my previous record. About two hours later, the doctor on call came in and checked the baby's position. He was at a zero, maybe. The doctor told me that I would probably not be able to push the baby out and that I would need a cesarean. He gave us a long lecture on how he wouldn't be making any extra money and he wasn't trying to go home early. He said that he would be there all night anyway and so I could push for ten more hours if I wanted to but in his opinion, the baby was too big and would never come out. My choice was to try some more or hurry up and have the c/s because there was another lady who was going to have one and if I didn't go right away, I'd have to wait for them to finish up on her first.
Now this is where we NEEDED another support person there for us! I was in no condition to make any discussion. I didn't know what to do. DH wasn't in any better of a position. He didn't know what to do or say. He was looking to me for the answer. So, we agreed to the c/s. The biggest mistake of my life! I remember them giving me papers to sign before they prepped me and thinking that I wanted to say "Never mind, I don't want to do this," but feeling like it was already too late. The reason for the c/s was "failure to progress." One question I had before I was signing the papers was if I would be able to hold my baby right away. The nurses promised me that I would and told me that they try really hard for moms to have extra time with their babies when they are born via c/s. I felt satisfied with that answer and was feeling relieved that all of this would soon be over! Little did I know that the nightmare was just getting started!
My long awaited natural Bradley birth was not going to happen. Instead, my child was to be surgically removed from my body. I have heard women describe a c/s as an experience that is comparable to rape. I know that is a strong, intense and even insulting word of comparison but I have to agree. At least for me it seems to be comparable in the definition of the word. Maybe it is not for some women who truly need a c/s or for those women who really didn't care one way or the other. But for me, or for someone who expected a natural birth, it felt like a complete violation of my body that has left scars inside and outside of my body. I can never get rid of these scars, only learn to live with them. They will be with me for my entire life.
When someone has a c/s who did not want it, there are similarities to that of a rape in the feelings of violation, abuse and powerlessness. Just think, you are whisked away from your loved ones, drugged and paralyzed, forced to lie on a table with your gown pulled up over your breasts, exposing your naked body for everyone to see, your sexual organs are threatened and literally cut in a climate of total fear. You are afraid and helpless, left vulnerable and at the mercy of the total strangers around you, all the time wishing that it wasn't happening. Or in my case, just struggling to survive! I really hope that this is not taken offensively. I know it is an extreme analogy.
The c/s was the worst part of my labor. I was wheeled into the operation room (I remember it was very cold and there was music blasting, De Peche Mode, I think) and then I was made to scoot myself onto the table. The table was skinny and flat and hard! It was painful for me to lie on my back. I wanted them to hurry up so I could lay on my side again. Then I was so worried that they would not give me another epidural. I kept asking to make sure they knew that my previous one was wearing off. They hooked me up and my lower body went completely numb. My legs felt heavy and hot. My arms were not strapped down like a lot of hospitals routinely do. They were laid on little platforms and I had my IV and blood pressure cuffs in place. DH finally came in with his sterile scrubs on. Now I just laid there and waited.
When the anesthesiologist told my husband to announce the sex of our baby, I was so happy because I thought it was almost over. DH told me the baby was a boy. I was trying to see the baby but they didn't hold him up for me. I must have been losing blood or something because I felt like I was going to pass out. I felt horrible! I had to keep my eyes closed and concentrate on staying awake. I kept saying that I was going to pass out but nobody said anything to reassure me. I didn't hear the baby cry but I didn't worry. I guess I couldn't because I was busy concentrating on staying awake. Finally he cried and DH brought him over to me. I could only open one eye and peak at him. I said "Hi B.." I knew that DH was taking pictures and I could see them later. Then DH and the baby left. I was alone or at least without any one person I felt like I could really trust.
There must have been a nurse with my name because when the other doctors were giving her instructions, I couldn't understand what they were saying, I only heard my name. I kept saying "What? I don't know what you are saying to me. Huh?" It was awful to feel that way. What makes me mad now is that nobody in that room tried to treat me with any respect or dignity! They completely ignored my comments and failed to help relieve me of distress and confusion! I was still very uncomfortable and just wishing that they would hurry. Then I started to shake. I had no control over it. I was also freezing. But all my complaints and worries went unanswered. It was as if I was not there or like I was just a piece of meat lying the table and nobody cared or even wanted to listen to me. Then as they were finishing up, I felt horrible cramping. I don't know what it was exactly or how to explain it but with everything else, I couldn't handle it anymore. I started to cry and yell at them to leave me alone! I told them I was finished and to let me go! They said that they were almost finished and that I could get on the gurney and go to recovery soon. I thought that I was going to be made to lift myself off the operating table myself. This made me more hysterical. "I can't get off the table. I can't!" But they told me, "You have to, there is no choice" It was terrible! I was so upset! The anesthesiologist at my head wiped some of my tears away and finally told the nurses "That is enough." I think they were pushing on my very tender and sore, newly stapled stomach. I also believe that they might have been pushing a little bit more than necessary because they didn't like me, but that could all be in my head.
As I was being wheeled into recovery (they did lift me onto the gurney) I was finally given a blanket to help me get warm. In recovery, I was still hysterical. I think my blood pressure was extremely high and my pulse was like 200! (That was a number I saw anyway). I was still on my back but I was paralyzed and couldn't roll over no matter how much I wanted to. I cried and cried and finally asked for my husband. The nurse told me to stop my crying and that she was not going to get him unless I stopped. She said that he had been crying too and that she couldn't have both of us crying in there. This made me feel better as you could have guessed! Thankfully, DH came on his own to see me. He had tried earlier but they wouldn't let him in the OR again. Once he was with me, the nurse changed her attitude and was nice to us.
I must have had been in the recovery room for over an hour. I remember begging to leave. I feel so guilty for not asking for my baby but honestly, I can't remember even thinking about asking for him then. I guess I had all of my energy concentrated on myself right then. But now that I know what my baby was going through, I am kicking myself for not remembering to have the nurses bring him to me. We went to my own room and I had to scoot myself onto my bed. That was HARD. But once I was in my own bed, it was the most comfortable bed I had ever been in! The nurses were getting me settled and DH went to get B. When they brought him to me, it was like, "Oh yeah, I had a baby!" I felt so relieved then. I held B and I just wanted to take off all of his clothes and look at him! DH said, "Why don't you nurse him?". And I was like "Oh yeah, I wanted to do that." So I tried. It was a little awkward at first but B did beautifully. Our first time nursing went well considering that it seemed to be filled with interruptions. I had nurses coming in and out, DH was trying to gather our things from the labor room, and our family was calling us like crazy!
Then one particular nurse came in (she was specifically assigned to B, I think). She was upset that I was trying to nurse him. She was trying to tell me that he had very low blood sugar levels (due to stress during delivery) and that my nursing him would mess up the test levels. I was very confused and I didn't know what she was talking about. She said that B had a very stressful beginning because he wasn't breathing on his own for the first two minutes after delivery. I didn't know that! I looked at DH but he was quiet. We hadn't even been together long enough to catch up on what had happened. So I asked the nurse to explain to me more of what happened.
When B, he was not breathing. They bagged him for about two minutes and were about to put him on a respirator when he finally started breathing on his own. This must have had been why they took him to the nursery instead of leaving him with me as they had promised. And then he had low blood sugar, and to add disappointment on top of disappointment, he had been given a bottle of formula while I was in recovery to bring up his sugar levels. DH hadn't had a chance to tell me any of this yet but while I was in recovery, he saw all of this happening and he was banging on the glass, begging them to bring the baby to me. They obviously didn't listen. They were so intent on him having that formula that he was fitted with a NG tube to force the formula because he was throwing it up.
So when I finally was able to see B, he was on their schedule of formula feedings in an attempt to bring his blood levels back to normal. I didn't know anything about it so I agreed to let him have a bottle. I was allowed to nurse for 15 more minutes and then it would be time for a bottle. I tried to feed him the formula, but he kept spitting it up. The nurse came back and took him away to the nursery, promising to bring him back when he needed to eat next.
I woke up the next morning without ever seeing my baby. And when they brought him to me, he had another NG tube in place (due to throwing up the formula). They told me that if his blood sugar didn't go up within so many hours that he would have an IV. I asked if I would be able to try and nurse and the answer I got was, only if the baby REALLY wanted to. I nursed anyway.
All of this made me so mad! Especially after the lactation consultant visited me later that day. She seemed confused as to why they didn't let me try to bring his levels up with my colostrum. I wasn't allowed to try; I was actually discouraged from nursing at all! The next time I have a baby (and if I can help it, it will not be in a hospital) things will be different!
Update: Jen S. had a VBAC with her next baby, and a much more empowering birth. This story is in the BBW VBAC Stories section.
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.
Denice's Story (mildly elevated b/p, vaginal birth)
Kmom's Notes: Just being large should not qualify you for a 'high-risk' label. Although large women have somewhat increased rates of pre-eclampsia (high b/p) and gestational diabetes, the vast majority still do not develop these problems and no doctor should assume that you will have problems with them simply because of your size. It's smart to be aware of the possibility and be proactive about it, but be careful about doctors creating self-fulfilling prophecies.
Birth Story
My story is pretty simple. After one year of trying, my husband and I conceived our daughter. I weighed 300 lbs. and was a little concerned. My doctor was great and really never mentioned my weight. She did list me as high-risk and was sure that I would have blood pressure and gd problems.
Everything went smoothly until the last week when my blood pressure was elevated a little and she sent me home from work to rest. One week later my water broke in the morning and 14 hours later my daughter was born. The staff at the hospital treated me well and I never heard anyone mention my weight. The only thing at the hospital that didn't fit well was the gown and the "one size fits all" panties they give you after birth.
I had an epidural after 8 hours of labor and that went pretty smoothly. The doctor had some trouble getting the needle positioned correctly, but it didn't have anything to do with my size. I had to push for almost two hours but that is not unusual for a first-time mother. It probably would have gone faster if the nurse had asked about my flexibility earlier. (Even at my size my knees can go back to my ears!) Once I changed positions she came out in under 30 minutes. She was born perfectly healthy and scored 9s on her apgars. We did have to admit her back to the hospital two days after she was released for jaundice and dehydration because my milk took some time to come in.
GAMom's Story (high blood pressure, PROM, transverse malposition, c/s)
Kmom's Notes: This mom has not been evaluated for either PCOS or thrombophilia but may have some autoimmune problems affecting her fertility; test results have been contradictory. Progesterone supplements in the beginning of pregnancy seem to have helped this pregnancy continue. She also took low-dose aspirin for part of the pregnancy.
In a follow-up question, she noted that the hospital did not tell her to have her staples out at 3-4 days; she waited until her 2 week postpartum checkup to have them out! Ouch.
Birth Story
My husband and I had 3 miscarriages (all between 8-10 weeks). We really
wanted a baby. My OB-GYN was great. He immediately put me on progesterone suppositories due to prior miscarriages. We had our first ultrasound at 7
weeks. You could see the sac and heart forming. Our next ultrasound was at 15 weeks and you could see the babies heart beat. I was SOOO relieved. My
husband was great. I still didn't want to get all my hopes up. We got pregnant when we weren't supposed to. It had only been 2.5 months since our
last miscarriage and the doc wanted to run some tests. Oops! :-) We had our first round of tests and it came back with levels increased. Our doctor
informed us that it was probably just a false positive but sent us to a perinatologist anyway. We saw him once a month for quite a few months. Boy,
do we have great ultrasound pictures. Our baby girl developed quite
rapidly
over the time. All measurements were great and on target. Two amnios were attempted but the needle wasn't long enough. And
MAN, did they hurt!!!! They monitored closely and took precise measurements to ensure the baby was
okay.
We were finally released from him and seeing our doc every two weeks.
Everything was fine. Our baby had been head down since January at every visit. My blood pressure starting to rise a little to about 140/80 and
150/90 toward the 33 week. My doc put me on bed rest and then it soared higher. He released me back to work and it was fine. At the next visit it
was a little higher ( I was seeing him every week now) and it put me on home rest, not bed rest. It did much better. I went out to dinner with my
husband on Friday night and that night my water broke. It was just leaking and I really couldn't tell much difference between that and going to the
bathroom a good bit. By morning around 8,, we called the doctor and he sent us to the hospital. My water had definitely broke.
Because it had been broken for a while they wanted me on bed rest there. They hooked me up to all
the monitors and the baby was fine, but I was not in labor. they did and ultrasound and she had turned transverse. All things considered, we opted
for the c-section. The epidural was easy and I was awake for the entire thing. My beautiful baby girl was born that night at 8 thirty. She was
healthy w/ apgars of 8/9. She roomed in w/ us for Sunday and Monday. Monday night I put her in the nursery because we were going home on Tuesday. She
choked on them (they fed her a bottle!) and turned blue. As upset as I was, it ended up being good because she needed oxygen. Her O2 levels were in
the mid 80's. They put her in NICU and gave her antibiotics, oxygen, and
lots of tests. She also had to go under the bili lights after that test came back. I was in there as much as they would allow. She nursed well, but I
never did have milk that came in. She got a lot of colostrum though.
Within three days she went to the intermediate nursery on an apnea monitor and
oxygen. they couldn't wean her off the oxygen and she had a few apnea episodes. After it was finalized that her lungs just weren't completely
developed because of her prematurity and high birth weight for her prematurity, we PITCHED a big fit. To make a long story short, she came home on oxygen
and has been great ever since. She is now 8.5 months old and still on the
monitor, but no oxygen since 1 1/2 months. She now weights 20 pounds, 29 inches tall and
is a very HEALTHY baby girl.
I wish all the supersize moms had as great a doctor and experience as we did.
Michele's Story (triplets!, classical c/s)
Kmom's Notes: These triplets were not conceived with fertility drugs. With higher-order multiples, a classical (up-down) incision is often used.
Birth Story
My husband and I had just gotten married when I found out I was pregnant a month later. Around Christmas time I started bleeding and called my OB's office. I hadn't seen the OB yet because he likes for his patients to be at least 10 weeks at the first office visit. When I called the OB's office he had me come in for an ultrasound. I was given a vaginal ultrasound since I was only about 8 weeks pregnant. I thought I was having a miscarriage so imagine my surprise when the u/s tech asked me if I was taking fertility drugs! I told her no, I was not, why do you ask? To which she answered, well, you are having triplets!
My first reaction was to cry (from relief that I wasn't having a miscarriage and from shock). The tech went and got my husband who came in and saw me crying and assumed the worst. After he was told our "baby" was in fact 3 babies, he screamed, "WHAT!!!!", loud enough for everyone in the waiting area to hear! The tech informed the doctor what she had seen on the u/s and we were ushered into his office for the standard speech on what could happen, such as we could lose one or all of the babies, complications, etc. I was sent home on 2 weeks bedrest with bathroom privileges only. By the end of the 2 weeks the bleeding had stopped (it was caused by me helping my husband lift the 100 lb. headboard onto our waterbed which caused a small tear in the lining of my uterus).
I worked until 20 weeks of pregnancy. I wasn't ever put on bedrest again, but my OB did advise me to take it very easy. Basically, all I did for the rest of the pregnancy was take my husband to work each morning, come home, eat, go to bed for more sleep, eat lunch, rest again, pick my husband up, eat again, and go back to bed! On weekends I went to garage sales with my mom to stock up for our soon to be larger family. I had about 15 u/s/ during my pregnancy, non-stress tests done 3x a week during the last month (during all of these I have 1 contraction), and developed pre-eclampsia. I was so swollen I couldn't wear any shoes except for velcro strap flip-flops. They would varely fasten and 2 weeks after the girls were born you could still see strap marks on my ankles!
At 34 weeks I developed a cold and couldn't sleep laying down. I tried to sleep reclining on the couch for 3 days, but that didn't work so I finally went in to the hospital ER on Saturday. I was admitted to L/D because of the protein in my urine, where they did a 24 hour urine catch. After the urine was analyzed the doctors decided to deliver my girls. My OB, the Pediatrician, and the neonatologists who were going to be there were all out of town for the 4th of July. My OB's partner, plus another OB who offered to assist, the Ped's partner, and the neonatologist's partner all were there for my delivery.
I was given an epidural and then I was taken into the OR at about 9:30 and the girls were born at 10:03, 10:04, and 10:05 a.m. I experienced a window from the epidural where I could feel it when they clamped back my bladder so as soon as all the girls were born I was given Demerol by IV. Within 2 hours of their birth the nurses got me up and took me to see my babies. I did have a spinal headache caused by the epidural, which the nurses diagnosed. I was given a blood patch to clear that up (a blood patch is when they draw blood from your arm and inject it into the back to clot the hole that was punctured in the spinal column from the epidural, which causes spinal fluid to leak, causing a spinal headache).
I was in the hospital for a total of 6 days. Two of my babies came home after 2 weeks and the third came home after 3 weeks. All three were very healthy and only needed to learn to suck and gain weight. That's my story and I'm currently pregnant with child #4 (just one this time!).
Gina Marie's Story (pre-eclampsia, induction, fat-phobic doctor, classical c/s)
Kmom's Notes: Gina Marie was induced at 37 weeks because they suspected a 'big baby'; between 8.5 and 9.5 lbs. at 37 weeks by ultrasound. Because her baby was in the wrong position her labor stalled and she had a c/s. Her consulting OB chose to use a classical incision for the operation and was very insulting about her size; her c/s and recovery were a horror story.
In most cases, ultrasounds are very inaccurate for measuring 'large' babies near term, although in this case it was accurate. Inducing early for macrosomia (big baby) is clearly shown in research to INCREASE the rate of c/s without improving outcome at all, and anecdotally, many large women's c-sections are probably caused by this common practice of inducing early. However, Gina Marie's case is complicated by her blood pressure and edema at the end of pregnancy, and the size of her baby at 37 weeks made the decision more complicated. In most cases, inducing early for 'big baby' is clearly shown to worsen outcomes, but occasionally in selected cases can be helpful.
However, her midwives did little to prepare her cervix for induction, making an induction less likely to succeed, and the induction at 37 weeks resulted in fetal distress for her baby after it was born. Also, her baby was malpositioned, which is probably why labor did not progress. It is a difficult question whether the decision to induce helped or hurt her chances at a normal birth experience. Waiting even one more week might have helped her body and her baby to be more ready, yet the concern over blood pressure and edema was a real one.
Regardless, insult was added to injury when she encountered a very fat-phobic surgeon who was very unkind and discriminatory, and did a 'classical' up-down incision unnecessarily on her. Most very large women can still have a low-transverse (side-to-side or 'bikini') incision with careful management, or they can have an up-down or slightly higher side-to-side skin incision and a low side-to-side uterine incision. The reason given for a classical incision on very large women is to prevent infection in the moisture-prone area underneath the fat fold ("apron"), yet it should be noted that this classical incision infected badly---using a different incision didn't help! It is Kmom's anecdotal observation that the large women she has seen with classical "up-down" incisions have tended to have more problems than those with the "bikini" incisions. Regardless, nursing techniques (using a cool blowdryer on the incision, plus extremely strong antibiotics for very large women) can often help avoid many cases of infection in transverse incisions, making these practical even for large women. The decision to do a classical incision on Gina Marie was dubious at best.
Furthermore, the OB pressured her strongly while in labor (which is improper) to have her tubes tied in order to prevent her from having any more children. This is unethical and unprofessional, and much of her poor treatment after that may have been from the OBs attempting to punish her when she refused to have her tubes tied. She was later told that the classical incision would make it too dangerous to attempt to have another pregnancy at all, so one wonders if the doctor tried to prevent her from having more children by using this incision and accompanying scare tactics. [By the way, it's not true that a classical incision precludes subsequent pregnancy at all. It does raise the risk of rupture somewhat and most doctors will not permit the woman to try for vaginal birth subsequently, but it does not prevent you from having more kids. Many women (including some large women--see other stories) have had subsequent kids after a classical incision. This was pure scare tactics to frighten her out of having more kids.]
Gina Marie wanted to share her difficult story so that other large women can be aware of some common pitfalls to watch out for. She