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
PolyCystic Ovarian Syndrome Birth Stories
Many women over the years have requested a section for birth stories of plus-sized women. 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.
After several years of collecting these stories, Kmom published a collection of BBW birth stories. Stories were 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. Many women have written and shared how valuable it was for them to read these stories, hear the variety of experiences, and know that they were not alone.
Eventually, Kmom began hearing from women with PolyCystic Ovarian Syndrome (PCOS), who wanted a Birth Stories FAQ of their own! Since many women with PCOS are BBWs, it makes sense to house these stories here. However, it should be noted that not all women with PCOS are large women (just as not all large women have PCOS). So while most of these PCOS birth stories will be those of larger women, average-sized women with PCOS are welcome to also submit their stories here too.
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. All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
Links for Information on PolyCystic Ovarian Syndrome
Special Note: For those who do not know what PCOS is, it is thought to be a disease/syndrome of insulin resistance. Women with PCOS tend to have several (but usually not all) of the following group of symptoms: irregular periods, excessive facial or body hair (hirsutism), thinning scalp hair, cystic acne, fertility problems, obesity that does not resolve easily with diet and exercise, insulin resistance (and therefore a tendency towards diabetes), Syndrome X (high blood pressure, high cholesterol/blood lipids, tendency towards diabetes), etc.
There are many resources available for more information on PCOS. If you think you might have PCOS or simply wish to find out more about it, Kmom strongly recommends visiting the sites listed below. They will have links to many more sites on PCOS.
How To Submit Your Own Birth Story
Note: The rules for submitting a PCOS Birth Story are basically the same as for a BBW Birth Story; women who have PCOS but are average-sized are welcome to submit their stories too. Please follow them carefully, as follow-ups and clarifications take a great deal of time away from Kmom's family.
If you would like to submit your birth story, you can email kmom at firstname.lastname@example.org 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 order to protect your privacy. Unless specifically requested, personal information is usually omitted.
Type in your birth story here; no attachments please!
Then email your story to email@example.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.
Terms and Abbreviations
Most moms will recognize most of these terms, but women new to reading about childbirth may be puzzled by some of the terms and abbreviations used in these stories. This section briefly defines some of these in order to help women understand the stories better.
PCOS Birth Stories
Stephanie's Story (PCO, gallstones, unmedicated vaginal birth)
Kmom's Notes: Although it does NOT occur with all PCO moms, there are some who develop problems with milk supply, even when being extremely proactive. Other PCO moms are able to breastfeed without problems; no one knows currently why some PCO moms are affected and others are not. More research is needed, but little is being done.
We had a very healthy pregnancy and uncomplicated vaginal delivery which I attribute primarily to two things. First, we were careful to find a size-friendly practitioner who didn't treat me as if I were a train-wreck waiting to happen. Her exact words at our initial visit (8 weeks pregnant) were, "Yes, you have some additional risk factors, but right now you're fine and we'll assume everything is going to be fine. We'll just keep a close watch on you." We chose an OB rather than a mid-wife because of my risk factors, but she was as committed as we were to having as natural a pregnancy and delivery as possible.
Second, we did everything we could to have a healthy pregnancy, following the Bradley method of education, diet and exercise. I think this really made a difference and allowed me to have an easy pregnancy. In fact, I think the fluid retention/blood pressure problem I developed could have been avoided had I been able to continue the Bradley diet. (The low fat diet I had to follow for the gallstones didn't have the amount of protein I think I needed.)
I went into labor 4 days after my due date. Latent first-stage labor was fairly straight forward and slow, as is typical in first-time mothers--about 15 hours to get to 6 cms. I didn't do anything special for pain management other than using the techniques I had learned in class and through my reading. Mostly I tried to remain physically and mentally relaxed, used even abdominal breathing, and lots of visualizations. At 15.5 hours, I got the urge to push, but had only dilated to 7 cms. The next 20 minutes were especially difficult. I had to try NOT to help my body push, and the pain was very intense as my cervix finished dilating and the baby began her descent.
Fortunately, I went from 7 cms to 10 cms during those 20 minutes and was then told I could push. It took one or two contractions to get the hang of pushing, but I pushed my daughter out in only 15 minutes! The only intervention we had was an episiotomy (2nd degree with no tears or extensions), and our daughter was and is wonderfully healthy.
We had our first breastfeeding attempt in the delivery room, and kept our daughter with us for about an hour. Then my husband accompanied her to the nursery, where she was weighed, measured, and bathed (he dressed her for the first time, with a little help from the nursery staff). She roomed in with me during my hospital stay and we came home 2 days later.
Things I didn't anticipate: how much delivery would hurt, how annoying hemorrhoids would be post-delivery, that my pelvis would hurt after delivery as my bones began to move back to their pre-pregnancy positions, and how much more I could love my husband and daughter as the days go by. P.S. We're planning baby number 2 next year!
Paula's Story (gd, severe pre-eclampsia, induced premature vaginal birth)
Kmom's Notes: Paula's first pregnancy was complicated by primary hypertension, which she was on medication for. Primary hypertension can often become worse in pregnancy, becoming pre-eclampsia despite medications. This is what happened to Paula. In addition, she developed gestational diabetes (diet-controlled) at about 18-20 weeks. Had her pre-eclampsia not worsened, she would have been induced at 38 weeks because of the gd and blood pressure concerns combined. As it was, when her pre-eclampsia worsened, they elected to induce at 36 weeks instead. Induction probably succeeded so early because she was already partially effaced and dilated before they began, although they did nothing to ripen the cervix ahead of time.
Between pregnancies she developed overt diabetes. Because her PCO is very significant, she and her doctor elected to have her take Metformin (Glucophage, 2000 mg per day) throughout her second pregnancy (but not for nursing). Although her blood pressure remained a concern (and she was "maxed out" on 3 blood pressure medications through the pregnancy to keep it under control), she did not redevelop pre-eclampsia in the second pregnancy, which she credits to the Metformin. They did add insulin during the pregnancy later on. Paula was induced at 38+ weeks because of the type II diabetes. She felt she had a terrific doctor for her pregnancies, very size-friendly. Not all of the doctors in the pregnancy were as size-friendly, but her primary doctor was "GREAT".
Baby #1: I was induced 4 weeks early due to severe pre-eclampsia. I was given magnesium sulfate and pitocin at 6pm on Thursday. I was already 80% effaced, and 2cm dilated. By 6am Friday I was 100% effaced, and dilated to 3-4 cm. The broke my water and I began having contractions with in an hour. I dilated quickly to 10cm by 9:30am and delivered vaginally at 12:03 pm. Labor in all was about 6 hours. I only required one internal stitch for a small internal tear.
I did learn through this whole process to listen to my body. The labor nurse was trying to get me to push differently then what my body was telling me. She wanted 3 shorter pushes when my body wanted 2 long ones. When I finally listened to my body I delivered very quickly. After discussing this with my OB I did what my body told me and had much better pushes then what I had been having.
I did have some problems breastfeeding at first due to the fact that she was 4 weeks early and didn't want to latch on very well. She had been tube fed, finger fed, and cup fed and like the 'instant gratification' that provided, versus having to 'work' for her food. [But nursing did work out in the long run, despite the slow start and the severe PCO.]
Baby #2: Our second child was conceived through an injectable cycle. I was 410 when I conceived this child. [I was on Metformin before the pregnancy and remained on it for pregnancy.] My OB had actually read up on the use of Metformin in pregnancy and was going to suggest it to me if I wasn't already on it. I had approached him before my first appointment because both my RE (Reproductive Endocrinologist) and Endocrinologist wanted me to stop UNLESS my OB agreed to let me take it.
There are so many benefits to taking Metformin during pregnancy, and I really wanted to avoid the pre-eclampsia that I had with my first pregnancy. I also did not want to risk going off of Metformin because of the dramatic decrease in miscarriage rate while on it. The fact that there are no known deformities or problems while taking Metformin in pregnancy made me feel comfortable enough to take it. I know some doctors will not give Met in pregnancy because they are uncomfortable with the fact that no US studies have been done, but all of the information coming from other countries seems to indicate that it is safe.
[I was induced at 38+ weeks, due to the diabetes.] I arrived at the hospital at 1 p.m. and began the paperwork and all. The IV was started around 3 p.m. with Pit; I didn't need any prostaglandin gel because I was already 2 cm and 50% effaced, baby at -1 station. The Pitocin was started; they increased it every 30 minutes.
Around 6 p.m. I began having contractions about every 2.5-3 minutes. They were tolerable and I could breathe through them easily enough. We were waiting for the doctor who was supposed to show up around 5 p.m. for AROM (breaking the waters). Finally around 7:30 p.m. he arrived and ruptured my membranes, the contractions slowly began to get worse, and the baby was doing okay. Around 8:40 p.m. we had a scary deceleration where her heart rate dropped from the 140s to 75 with internal monitoring so we knew it was an actual drop. The intern came rushing in to do 'fetal scalp stimulation' which brought her heart rate back up. I then was told I had to lay on my side and that seemed to keep her heart rate up.
The contractions while on my side were getting pretty uncomfortable and combined with the drop in heart rate I decided to get the epidural. The funny thing is that while sitting (for almost an hour) to get the epidural I couldn't feel the contractions at all, and even had to look at the paper to see if I was still having them. Talk about positioning making all the difference.
Once back on my side I could feel the contractions again until the epidural took full effect. About 10:30 p.m. I felt like I had to urinate with every contraction, but that was all I was feeling. I figured it was just the pressure form the contraction. Finally at 1 a.m. I asked the doctor to check me. My bladder was so full he couldn't feel the baby. I was straight cathed (catheter) and checked and was 7 cm. About 10 minutes later I felt like I had to push. [Kmom note: A full bladder can impede labor progress! It's important to pee every hour or so in labor.]
I waited 2-3 more contractions and decided it was time to call the nurse. My nurse was gone to lunch and another nurse (who waited another 3-4 contractions before coming to the room) told me I was only 7 cm 20 minutes ago, and I really didn't have to push; that the epidural should be working fine and I should be able to get through the contractions without any problem. I told her my last one went from 5 cm to 10 cm in 45 minutes and I felt like I had to push. The stupid woman still wasn't going to check me. I insisted and she reluctantly checked me. I was at 10 cm and it was time to push.
The doctor got to the room and got the stirrups up. I began pushing and he was going to check to see where the baby was. He asked how long it took last time; I said 1.5 hours of pushing. He commented it wasn't going to take as long this time. I could feel her head almost crowning at this point, then with the next push she was crowning and out. I pushed for a total of maybe 5 minutes, and out she came. So much for not having to push. Her apgars were 8/9 and we got to nurse her right away. It was such a different experience from my first.
Apparently I am 'wired' a little differently than most and with an epidural I am mostly numb except for the vaginal canal and perineal area (my epidural last time did not work completely properly either). I didn't realize this was any different from 'normal' until they went to put in a stitch (I needed 2). I could feel the needle and began in with "OWIE OWIE", and the doctor asked, "You can feel that?" I told him I couldn't feel my toes but I could feel that. So with one stitch left, they just put it in without any numbing agent (with my permission). I figured I would get stuck once with a stitch or once that I would feel with the Novocain and either way I was going to feel it.
I know that one of my BIGGEST concerns [before my pregnancies about my size] was that the monitoring belts would not fit around me. Not only did they fit, but the contraction monitor actually worked! I know they used an internal monitor last time as soon as possible because they did have a hard time finding a heartbeat without my laying in a very uncomfortable position and then holding the monitor there. I just figured that if they didn't get the heart rate all the time it was really no big deal, that the fading in and out (which includes the rate dropping sometimes because of the monitor) was just because I was moving or the baby was moving. With my second I just assumed the same thing until they got the internal monitor on.
My doctor is GREAT! [Very size-friendly.] I wish I could say that for all of the doctors in the practice. I had one who complained every time that she saw me because they told her to measure me. She didn't understand why they even bothered to measure me because I was so "off the charts". I may have been off the charts, but I did grow according to the curve they use, so it was useful in following the growth of the baby. I can't think of anything differently my doctor did with me that he doesn't do with every other woman. I did see him more frequently, but that was due to the type II diabetes and insulin monitoring than anything.
I am nursing; it's the only way to go for me!! I always tell everyone I am too lazy to bottle-feed; there is too much work involved. [I stopped the Metformin for nursing.] I would LOVE to be back on the Metformin, but my doctors are not comfortable with women taking it while breastfeeding. I know there is the same issue in pregnancy, but I can actually find information on Met in pregnancy but I can't find any on Met and nursing. I did realize the other day that I was on Met while I was breastfeeding #1, but she was almost 2 years old and I was in the process of weaning her. I think once this one is eating more solid foods, I will start the Metformin again even though I will still be breastfeeding.
Lisa Z's Story (twins, diet-only gd, vaginal birth)
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.
Carol C's Story (PCO, Group B Strep, vaginal birth)
Kmom's Notes: Carol's story of back labor, difficult pain, waters breaking before labor, and having difficulty dilating beyond 3 cm at first raises the question of malposition (posterior or asynclitic, etc.). However, either that was not really the problem or the position corrected itself because her labor proceeded on to a normal vaginal birth. Also note that this baby was almost 10 and a half pounds; according to many OBs, this is 'too big' to birth normally, but obviously Carol had little trouble.
The only time my doctor ever mentioned my weight was when I was losing too much from queasiness during the first trimester - and even that was just to make sure that I was TRYING to eat sensibly and not trying to diet during pregnancy.
My whole pregnancy was pretty uneventful. Morning sickness was limited to queasiness and disinterest in food - I hardly ever actually got sick. My blood pressure was always fine. All those other routine tests they do were always fine.
I was still feeling pretty good when we checked into the hospital, and determined to have a natural birth, in spite of back labor. We had taken a Bradley class, and were prepared with a bag full of massage toys. DH was getting me through the contractions okay. That is, until 8 hours had gone by since water breaking, and I hadn't gotten past 3 cm. :( The doctor on call insisted that we start the pitocin, because of the Group B Strep.
I was still handling it okay, until the second time they increased the drip. There were a yucky couple of hours there, with lots of vomiting (MAN, was I glad that I wasn't the one who had to clean up my messes!), sweating and moaning. And so I caved and asked for the epidural. The pit had done its job though, because when the anesthesiologist got there, I was at 6 cm, and by the time they finally got the epidural right (3rd try), I was at 9 +.
I'm disappointed that we didn't have the birth of my dreams, but I'm happy with how things turned out. I really did feel great after the epidural, and pushing was a breeze. I got to have a mirror, and that was really neat! My nurse massaged and stretched me for an hour, and I give her some credit for me not having to get an episiotomy and only having minor tears with my big boy. :) Well, my wide hips might have had something to do with it. too!
My precious son is just the most wonderful little person in the whole wide world, and I'm thanking God several times a day for blessing us so greatly. Being a mommy is just so indescribably wonderful!
Suzanne's Stories (PCO, unmedicated vaginal births, gd with #2)
Kmom's Notes: Please note this PCO mom did not have trouble breastfeeding, nor did she get high blood pressure. PCO does not have to equal these problems! Also note that this mom went from 5 cm to complete (10 cm) within 15 minutes of getting into warm water in her first birth, and that it was also helpful in the second birth.
In her second birth, despite developing insulin-depending gd, Suzanne had several things going for her. Her first baby was born vaginally and naturally, making a vaginal birth this time more likely. She got good control of her blood sugars, plus a supportive set of providers (and when she found an unsupportive one she switched!). Her baby was average-sized, which makes them more willing to give a trial of labor. She had a midwife and doula for her birth, both of which tends to cut the c/s rate significantly, and she was able to use water for laboring as well as a standing position for pushing and birth. But SHE was the one who did it, and admirably too!
I am a plus size mom. I weighed 270 pounds at the beginning of my first pregnancy and gained and lost 3 pounds over the 9 months by eating healthily. I had no complications during my pregnancy or birth. Here is the birth story of my first child.
My due date was September 19, I went into labor at 4 AM Monday morning September 18th. I woke up to what felt like light menstrual cramps coming at about 20-minute intervals. I checked the time tried to go back to sleep. I dozed a little until 6 AM then decided to take our dog for a walk around the block (if it was false labor that should make it go away). The contractions didn't go away, this was the day! After the walk my partner and I went to a friend's house to labor and I decided to take a bath in their very large tub. After that we took another walk, I started around the block and the contractions were getting more and more intense. I could walk and talk between, so we were not too concerned. We got back timed the contractions, they were one minute long and five minutes apart. We thought, "Wow, maybe we should go to the hospital." It was about 10AM, I called our midwife and doula, getting pagers for each. The doula called back first. She said I was too jolly between contractions and she would be over in a few minutes.
She arrived and said she didn't think that we should go to the hospital yet. She started to help me through the contractions. My favorite spot was in a big leather chair in the family room. I would lean back, the doula would stroke my hair and my partner would push on my knees in toward my pelvis. At first I could talk between contractions but after a while I didn't want to talk much anymore. Periodically, my doula would tell me it was time to change positions and I would walk around the room. Standing contractions I did mostly hanging off of my partner's neck, with one knee locked and the other relaxed. I also spent some time leaning on a hassock on my knees. The contractions were very painful in that position, so I thought; "these must be working well." I was having double peaking contractions for a while. One would come and I would deal with it, be breathing a sigh of relief and be broadsided by another one. Once I got used to the pattern it was easier to deal with. I breathed through contractions until about 1 PM and then asked the doula, "When are we going to the hospital?" She said, "That's up to you."
I was on my way out the front door as everyone gathered stuff to bring to the hospital followed behind. My partner drove me and the others followed in their cars. The hospital was 10 minutes away and I had 3 or 4 contractions on the way. We left the car and headed for admitting. The doula was right behind us and was there as we headed for the room. It was a very long walk to the maternity wing from admitting, they offered me a wheelchair three times but I declined. I didn't feel like sitting. So we walked down the different corridors stopping for contractions then moving on, up the elevator and finally to our room. The nurse monitored me for 20 minutes with the belts and did an internal and pronounced me 5 cm dilated. During the rest of the labor a hand held Doppler was used to monitor the baby's heartbeat.
When the tub was ready we trotted off down the hall for a soak. My doula and partner stayed with me. I was trying to figure out whether the jets were helping or annoying the hell out of me when I was hit by a contraction that felt very different from the others. I made a sound that came from very deep inside me, a grunt. Lindsey recognized the sound as the one a laboring woman makes when she is completely dilated. She yanked the nurse call-cord and our nurse came running. I was completely dilated. I had been in the tub about 15 minutes, 2 or 3 contractions total. I got out of the tub. They wrapped me in a blanket and off we trotted back down the hall to my room.
The midwife hadn't arrived yet. She had been eating lunch with a friend when we arrived at the hospital at 5 cm. She thought she would have time to finish lunch and then come over. The nurse called her back and told her to get over to the hospital ASAP. We had to wait for her to arrive. The nurse kept telling me that she could deliver the baby, she was studying to be a midwife...but don't push unless you have to. So I huffed through the contractions only pushing a little at the end of each. Not pushing was the hardest part of the labor. The midwife finally arrived I could push. I held on to the edge of the bed and squatted to push. Between contractions they pushed a little stool under my bottom and I would sit and rest. Once the baby came down and stayed down I moved onto the bed with my doula at my head and my partner holding my leg up. I pushed for about 45 minutes total.
My daughter was born at 3:59PM. Her APGAR scores were 9 and 10. Total labor was 12 hours from the first contraction, 6 hours of active labor. I had 2 stitches for "skid marks" but my perineum was intact. I did not need nor want any anesthetic at any point in the labor.
Suzanne's 2nd Story: My second pregnancy and birth were totally different from the first. It took 2 years and 16 cycles of trying to conceive #2. I ended up with a diagnosis of PCO and treatment using clomid to stimulate a follicle, Hcg shot to cause ovulation, then Intra-Uterine Insemination. I found out Dec 23 that I was pregnant. What a wonderful Christmas present!
I started getting morning sickness at about 6 weeks and continued with it until I was 25 weeks along. Then I was diagnosed at week 28 with gestational diabetes. I was shocked and found that my caregivers were all working from scraps of paper and seemed unsure of the acceptable glucose levels. I called around and finally got in touch with an endocrinologist and he assured me that they were following the standard of care. I ordered a book on GD and read up. That helped put my mind at ease. Then I had a goal to reach.
I started testing my blood 4x a day, fastings and 2 hours after each meal. I also would test extra times if I was curious or was feeling a low blood sugar reaction coming on. So I would test 4-8x a day. These are the numbers that we used:
They sent me to a nutritionist who was useless. The diet she put me on...contained too many carbs in each meal and too much food overall. When I cut out all but one carb exchange (~18g) per meal I could almost control the daytime glucose numbers. That turned out to be too little food for someone in later pregnancy. They also lump in the management of fat and salt along with management of carbs and I did not have a problem with fat and salt. The whole regimen seemed to be geared to the elderly and didn't seem to apply much to me. I refused to limit my fat and salt intake (I was losing weight for-goodness-sake!); I did not have a problem with my blood pressure. I was sane about it, but did not limit non-carb foods. I consulted a friend of mine who is a nutritionist and she helped me to choose more whole foods and food combinations That was they key to keeping my numbers good. I began walking .8 mile per day, with a second walk if my numbers were off.
But I lost 12 lbs. in 3 weeks and my fasting glucose number first thing in the morning could not be changed by diet and exercise. So I had to take insulin. I started out with one shot in the evening but that didn't work. Then they had me on a shot in the morning and one in the evening. They also combined regular insulin (fast-acting) and a slower-acting type (NPH). I would load the syringe and take a pinch of flesh near my belly button, poke the needle in at an angle then inject the insulin. It is not as bad as it sounds; the poke doesn't really hurt, but the insulin makes the area of the shot sore for a little while. I had to watch out for low blood sugar reactions, which I had often (shaking, sweating, disorientation). Insulin-dependent diabetics have to eat frequently and keep in mind when the insulin will hit. The dr. warned me that my insulin needs would increase as the pregnancy progressed but they did the opposite. My dosage decreased 2 times near the end.
Getting gd felt like my dreams of another natural birth were going down the tubes. I was referred to an OB who told me, "If you have an 11 LB baby it is an automatic c-section; unless you want to sign a paper stating that a paralyzed left arm [the baby's] is OK with you." She was trying to scare me of my birth but only succeeded in scaring me of HER. I asked this OB about how she would deal with a large baby and it was clear from her answers that she delivers women in the lithotomy position and usually anesthetized When I asked about positioning she said it wasn't quick enough. Translate that as: there is no way to get you onto hands and knees with an epidural. [Kmom's note: These interventions are thought by many to increase the incidence of shoulder dystocia and birth trauma/paralyzed arm the OB is referring to. One of the hardest parts of gd is distinguishing the true risks of the condition from the doctor-caused problems that come from standard management like this.} My midwife on the other hand has delivered 11 lb babies vaginally (not that I wanted to :-)) I wanted that OB to be as far from my birth as possible. (It turns out that this OB gives that same speech to all overweight moms. My feeling is that she is a fatphobe.)
I switched to a different OB who was great and had no problem with standing by just in case the midwife needed her. She praised me on my management of the gd and was not concerned at all that the baby would be too large. From 34 weeks on I did 2 non-stress tests (NSTs) per week and had an ultrasound at 38 weeks. Everything looked fine so I was able to keep my midwife with the OB standing by just in case. The OB was fine with monitoring my insulin and NSTs and letting the midwife do the rest. That was just right for me because my nightmare was to lose my chance at another natural birth. [Kmom note: See, you can too have a midwife in a gd pregnancy! And some midwives will co-manage even an insulin-dependent pregnancy if all is well.] I delivered 6 days before the due date. [There was no pressure from my doctor], she was cool. The baby showed up as 8 lbs two weeks before his due date and they found that acceptable. Also, I was not measuring larger than expected. My gd was very well managed.
My labor started at 8 am. I had 3 contractions in a half an hour. I called my support people and they soon started arriving. I used the same doula I had with my first birth so we slipped easily into the pattern of her helping with my concentration and relaxation. We hung out at the house while my contractions got more intense and closer together. A short walk around the neighborhood was helpful in the beginning but things got going very quickly. I did some contractions on hands and knees or sitting but most were standing and leaning. I breathed normally through the whole labor. We tested my glucose level every hour during the labor. The last test before leaving for the hospital showed low blood sugar and I ate a couple of glucose tablets. This saved me from having to have IV glucose because they didn't know what the dosage was on the tablets. No IV!
When we got to the hospital I was 6 cm and went directly to the tub. I felt the baby drop as I stood to go to the room with the tub down the hall, it felt so good! The contractions were hard but the time between them lengthened and the water made the labor seem like a breeze. I went through transition with a little shaking and burping, then I was ready to push. This is where may labor got really hard. I knew that it was too late for an epidural but I would have had one if it were possible. The rest of the labor was such a breeze that there was no way I would have asked for pain relief. There is no way that I would recommend having an epidural just in case it got bad later.
I got back to my room between contractions and couldn't bring myself to get on the bed. Physically I could have climbed on, but it didn't feel right. I had planned on helping Nicholas "out" and the midwife had agreed but when we got to the room I preferred to stand for the delivery so the midwife warned me that I wouldn't get my wish. I told her I didn't care. Consequently, I delivered Nicholas standing up with one foot on the floor and one knee on the bed. I yelled, "NICK! NICK! NICK! OUT! OUT! OUT!" One nurse, in her 50s or early 60s, was very concerned about me delivering standing up. The midwife told that that is how it was going to be. That nurse came in when she went off shift and hugged me and told me she thought I was "heroic".
I pushed for a while and when I checked for the head I couldn't feel it. I almost lost hope, but buckled down to business. Soon I could feel his head and knew it would be over soon. The midwife stood behind me and passed him between my legs within seconds of his birth. Nicholas was born "in the caul" meaning he had the amniotic sac over his head. The midwife had to break the sac and suction his airway. Nicholas was born at 4:28 PM after 8.5 hours of labor with about 2 hours of it spent at the hospital. I pushed for about 40 minutes. I had a small tear where an episiotomy would have gone, it took 2 stitches. Pushing caused a hemorrhoid that has healed completely. I retained a small bit of placenta which came out at 4 weeks postpartum with a gush of blood but no other problems.
Nicholas had to be fed formula every 3 hours for the first 72 hours because his pancreas was working overtime due to my gd and he had low blood sugar. I used a Supplemental Nursing System (SNS) with a thin tube going down to my nipple from the bottle of formula. I had requested this in my birth plan to avoid having problems with nipple confusion. [He nursed every 3 hours, and while he was nursing I slipped him the tube so he would also get the formula. They added some glucose water to the formula in the SNS because his numbers didn't rise enough at first. After the first 3 days, he has been 100% breastfed.]
My partner's sisters visited me later and I told them, "Get an epidural." I regret that now that the memory of the pain has faded. I am happy and proud that I have had 2 natural births. If I had it to do over I would not choose to use pain meds. Nicholas is 4 months old now. Since he was born everyone has commented on how alert he is. I think that he is alert because he was not drugged at birth.
Pam's Story (PCO, insulin-dep. gd, placenta previa, c/s)
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 doctors 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.
Sherie's Story (PCOS, hypertension, PROM, induction, compound presentation, c/s)
Kmom's Notes: A short cord and baby's hand by the head
could definitely cause a long hard labor.
At about 3 in the afternoon, at 37 weeks along in my first pregnancy, I started spotting. I had never had spotting or had any kind of bleeding at all during the whole pregnancy. I knew that this was most likely the mucous plug and some blood caused by the cervix beginning to dilate. I had no contractions and thought it would most likely be awhile before labor started. I went to take a shower during the shower my water broke! I called my husband to come home from work, we ate a light dinner and about 5:30 we went to the hospital.
My contractions were 2-3 minutes apart and I was dilated to a 3cm when I was checked shortly after I arrived. They put external monitors on me to track the contractions and the baby's heartbeat. The baby was moving around so much that we couldn't keep track of the heartbeat and they inserted a internal scalp electrode. They told me that I needed to be dilated to 6cm before they would give me an epidural. They said if given to early it could slow down labor. About 9 pm I was checked and had dilated to 4cm. I was having extreme pain and the nurse gave me Stadol. After that wore off I was checked again at about 12am and was still a 4cm. The nurse had me go get into a warm water bath to try to relax. I got ice chips and more Stadol. At 4am I was checked and was 5cm. I had nausea and threw up twice. I sat and rocked, I couldn't walk because of the extreme pain of the contractions and the nausea. My doctor came to check me at 7am and I was still 5 cm. At 9am my doctor said I could get the epidural, I was 5cm.
I had contractions all day and threw up 3 more times. I was given pitocin about 2pm because my contractions had slowed way down. At 6pm I had dilated to 7 cm and was exhausted. My doctor wanted to do a c-section because the water had been broken for more than 24 hours, I was exhausted and wasn't progressing despite the pitocin and my epidural wasn't working any longer also the baby's heartbeat showed he was stressed and needed to come out. I was so tired that I snored during the c-section, I could hardly keep my eyes open and when they showed me my baby I was so out of it I could hardly even look at him. He didn't cry much and he was so small, he didn't look like I thought he would. My husband wasn't allowed in the surgery because it was an emergency. They let my husband hold him a few minutes after he was born.
Later I found out that I had 4 large fibroids and the cord was unusually short. Also my baby had his hand up by his head and had a bruise under his eye were his hand had been. I was just glad it was over and that my baby was healthy and doing well. He had apgar scores of 7 and 9.
It was disappointing to have the c-section. It took some time to accept and come to terms with those feelings.
Franny's Stories (PCOS, induced vaginal birth, posterior, forceps; cesarean for breech baby; home VBAC)
Kmom's Notes: Another case where the baby's position makes the birth difficult until it is fixed. In this mom's first birth, it was probably the combination of the hands-knees maternal position and the doctor using forceps that helped the baby to turn and be born vaginally.
Franny's second baby was breech. This may reflect a tendency among women who have had prior malpositions to have future malpositions as well. This may reflect a pelvic misalignment more than anything else, and we speculated that regular chiropractic care could help prevent position problems in the future.
She got that chiropractic care in her 3rd pregnancy. Did that help her to a vbac? Hard to prove. It's notable that this was the only pregnancy of the three without a malposition, so the chiro care may well have helped. However, she might have had a VBAC even without that care. It's more like an extra step to take, just in case.
Another notable thing about Franny's story is that she was told that she had to sign up for an elective repeat cesarean because her hospital didn't offer VBAC anymore. Fortunately, there were other choices in her community, and rather than being forced into unnecessary surgery against her will, Franny gave birth at home with a good midwife. And then she had the strength of will to write about it for her local paper!! She put those local doctors on notice that women will NOT be forced into unnecessary surgery!
Baby #1: I gave birth at the hospital where I worked at the time. I am an RN; I was working OB at the time and delivered with my 2 best friends as my nurses.
My B/P was elevated at my 38 week appt. and being the beginning of July and very hot and busy on the hospital floor where I worked, my MD sent me home with bedrest. I was swelling, but not spilling any protein and my labs were ok. I got a Non-Stress Test (NST) and baby looked fine. The next week we scheduled my induction because B/P and swelling continued and my cervix was favorable (ripe).
I entered the hospital at 6 a.m., my IV was inserted and pitocin began. I was having contractions, but they weren't anything. I was 4 cm when I started out. I walked the halls and rocked in the rocking chair. My husband and his parents were there. I worked on OB at the time and a Radiant Warmer Representative was there to in-service the staff on a new Warmer. I stood in the hallway with my IV pump and listened to his in-service at 9 a.m. By 9:30, he was done and I was tired, feeling contractions, but they weren't uncomfortable. I thought, if this is going to last all day I'm going to try to get some rest.
I went back to bed, got hooked back up to the monitor and my contractions were every 2 minutes, palpating moderate, but not uncomfortable. I had been laying down for 15 minutes and just got my eyes closed when I had 3 strong contractions that I had to use my breathing techniques through (I had coached so many other labor patients that I felt like I could do it). Then my water broke. Talk about warm soup down your leg! The contractions got really strong then. I was 5 cm. Got up to the bathroom to get cleaned up and got some pain medicine, Nubain 10 mg. I got back in bed, turning side to side and in 2 hours I was 8 cm. The contractions hurt, but they ended and knowing there was an end to every pain was a relief in itself. Back rubs, ice chips, and a cool washcloth over my eyes helped tremendously.
At 1 o'clock in the afternoon I started pushing. I pushed sitting up, lying on each side, on the toilet, standing up, squatting, and regular old lithotomy. I just couldn't get him to budge and I had pretty bad back pain. He was posterior. After 2.5 hours of pushing, I got on my hands and knees and pushed every other contraction because his heart rate was dropping. Finally, my doctor came in and I got a spinal in case I would have to go for an emergency c-section. They got me all set up for delivery and the doctor used forceps. After 3-5 contractions with pushing and pulling, we got him turned face down and delivered at 4:35 p.m. He was a bit exhausted and got a little oxygen, but cried well and after an hour of stitching, mom got to feed him. He nursed for 20 minutes like a trooper.
Baby #2: I was due 4/7. We knew dates for sure because we got pregnant with the assistance of Clomid and Glucophage for PCOS. My pregnancy really went quickly and pretty smoothly. From about 28-34 weeks baby was breech except for one brief period. Around 34 weeks I started doing the routine to turn her---lying on the ironing board, used a moxibustion stick at home, homeopathic pulsatilla, prayer, relaxation, imagery, talking to the baby, flashlight, music, the whole nine yards. I was on the verge of a breakdown about 35 weeks...called my midwife crying, "What am I going to do?"
We had talked about delivering breech and they weren't really sure. I had an appointment on Friday 3/14 for a consult with the OB (he's probably in his mid-50s and still does some vaginal breech deliveries) who backs up my CNM and possible External Version. We had planned to deliver at a birth center. That was all I was planning. I was thinking positively, I was relaxing and working on the imagery I was planning to use for labor...this baby was going to have a peaceful delivery and I was going to have a healing, positive birth.
I am a RN and work as a prenatal care coordinator for a community health clinic. I do home visits, education and referral for pregnant moms on the Medicaid program. I have worked as a doula in the past, but don't have time for it at present. I teach childbirth classes and had a class on Tuesday 3/11 from 5-7. Talked with a couple for about 30 minutes after class, then drove home, picked up my son at church (my husband is a pastor). We came home, I [ate] and read my email. I had just got Ina May's new book via Fed Ex that day and while my son was winding down...I started reading in the recliner. I had been sitting there about 15 minutes when I felt warm and wet---I jumped up so I wouldn't get the recliner wet and freaked out, "OH NO, that can't be my water!" When I pulled down my pants in the bathroom there was a lot of blood. Now of course, I'd just worked about a 12 hour day, moving constantly, and not really noticing much movement from the baby. In class that night we talked about Cesareans and abruption was going through my mind. I'm absolutely losing it, my heart was pounding, I was shaking all over, I'm shaking now just remembering how I felt. I read Prenatal Parenting early in my pregnancy and I had worked really hard on remaining calm and talking to the baby, taking fetal love breaks, especially when I'd had a rough day---now when she decides to come, I'm a mess.
I called DH on his cell phone. "Come home now, I'm bleeding." It was about 10 p.m. My son could tell I was worried because he was right there. "Mommy, are you ok?" (Side note: The next evening at Bible Study he asked for prayer for Mommy because she "Pooped blood in the toilet and it looked like Koolaid." He's still talking about that night!) DH got home, helped me find my midwife's phone number and we called her. She was a voice of complete calm, "I'll meet you on OB. It's probably just your water." DH has never driven so fast in his life! Now I was nearly a month early, I had just gotten finished saying that night at class that I would probably go close to my due date, I was too busy to have the baby early, I had home visits scheduled through the end of March, blah blah blah. I had no bag packed, had no comfort items gathered, had only 2 outfits for baby clean...I didn't have the crib pained, had no mattress, didn't have a pediatrician picked out, had not pre-registered at the hospital, I was going to deliver at the birthing center for heaven's sake!!----I WAS NOT READY!!!!
We got to the hospital and up to OB. They wanted me to change my clothes, I wanted heart tones. 130s, but very little variability...My midwife cam in and did a quick ultrasound, the baby's head was under my right rib cage, her bottom was inside my right pelvis, and her feet were over my cervix. My midwife sat on the bed with me, held my hand, and said, "We are not comfortable with delivering her vaginally this way, you need to make some decisions." DH went down to sign me in. When he came back I bawled in his arms for a few minutes then collected myself. My midwife and I talked about VBAC and she said that the doctor still did VBACs and was very pro-VBAC and had a good rate....I think she said ~80% success rate for VBACs. I made it clear that if the baby was OK, she was to be with me at all times. If she was not with me, DH would be with her. My midwife said that the pedi on call was a stickler about the baby going to the nursery, but she would do what she could.
DH's parents arrived to stay with my son during the birth. IV started (after 3 tries), into a gown, consent signed, we went to O.R. After the anesthesiologist got my fluids in (she about froze my arm off pushing about 700 cc in 10 minutes), she sat me up for my spinal (again, third time was the charm). The doctor was at my feet, my midwife at my side, and nurse on the other side. They were all awesome!---kept trying to recruit me, though. I laid back down and felt everything go to sleep, boy that is a funny sensation. With [my first child], the spinal took the pain away, so it didn't feel so weird. With no pain, it just feels like they put lead in and made it all go to sleep, kinda pins and needles sensation. They put my catheter in (gave me the option not to have it at all, but I figured I'd probably not want to get out of bed for a little bit once the spinal wore off and I knee it was also in place to make sure my bladder wasn't nicked during the surgery, so I got it).
I informed everyone that if my baby was ok, I wanted to keep her with me. I got this weird sense of humor and was defensive by joking about things, I was kinda strange. My BP bottomed out at 60/40 and my heartrate was going nuts in the 120s. She gave me something for my BP and I felt a little better. DH at my side, they started my baby's birth; tears rolling down my face, I asked him to pray with me. DH prayed from the moment he placed his hand on my face until we heard them say, "Here's baby." My heartrate came down to the 90s while he was praying and the anesthesiologist said, "Wish we could bottle that."
During prenatal ultrasounds, we had a brief peek to see girl parts, but never saw them again (breech), so I was not getting my hopes up. I knew that they would see sex before she was even out, but they weren't saying anything! After her birth, the doctor made the comment that he went in and felt limbs, he grabbed two and started to pull them out, but had an arm and a leg, had to go back and find a matching set. She cried quickly and after a peek at her, to the warmer. The pedi checked her over and I kept talking to her, "Keep crying," "Hello Amy," etc. I had tears streaming down my face and into my ears. They wrapped her up and handed her to DH; I got to touch her. The anesthesiologist held her face right next to mine so I could talk to and kiss her.
The doctor held a section of cord up for me to see. "See why she wouldn't turn around?" She had a true knot in the cord that was really pretty snug. He felt that she was lucky to be here and that she would have probably not tolerated the version we had planned for 2 days down the road. Now, I have seen true knots before, even after vaginal deliveries, and everything was okay, but I also assisted a twin delivery where one twin had a knot and was stillborn, the other was ok.
The anesthesiologist offered Demerol to help with cramping and I refused because I didn't really want to see my supper again. I asked to have my placenta and the anesthesiologist said, "Well, what on earth for?" I said, "Because it's mine!" I got my placenta in the freezer, going to plant it with a Magnolia tree outside Amy's bedroom window. (I had a Magnolia tree outside my window growing up.)
The pedi took her to the nursery. DH followed and picked up our son and my in-laws so they could see her and 10 minutes later when my surgery was over, the nurses and doctors took me to recovery, and my midwife went to get Amy. I got her to the breast within about 45 minutes after delivery. She was cuddled up with her head on my breast...My son came in and asked me, "Did you get your miracle, Mommy?" More tears. He got to see her, my in-laws were in the hallway looking in, and DH was walking around with my placenta in a bucket under his arm. Back up to the OB floor at 2 a.m., got my morphine [Patient-Controlled Analgesia] pump and slept off and on through the rest of the morning with Amy on my chest. [We] ended up skin to skin for quite a bit of that time. They checked me often, but basically left me alone, never asking to take her to the nursery for her admission bath, etc. I got out of bed for the first time around 10:30 a.m. the next day, got to oral pain meds and my IV out around noon. Kept Amy with me around the clock and nursing went well. Went home Thursday afternoon around 3:30 p.m. I refused her Newborn Screen on discharge and brought her back that Saturday.
OK, the last thing I wanted was a cesarean. But what I was praying for was an empowering, positive, healing birth and even though I didn't have the natural birthing center birth, that wasn't what I was praying for. Next time I will be more specific, but I did get control in my birth experience, I was hyperaware of what I was feeling emotionally, physically, and mentally, and I feel I was so prepared for coping with pain that it has made my recovery super rapid. As far as healing, in that I feel like I can delivery vaginally without the medical need for management. I have not had that yet, but our daughter is named for 3 very special women, 2 very dear to me. Amy's birth was healing to me in that way, a healing I didn't even know I needed, but God took care of nevertheless. Positive, a resounding yes, I have a beautiful baby girl with a perfect round head, she has dimples just like mommy and lots of dark hair.
Did I get what I wanted---no, but I did have control over what I did get. Did I get what I needed---definitely. I will no longer feel sorry inside for women who had to have a cesarean, but instead I will ask how they felt about their birth. That is so much more important. A cesarean is not fun, it's not natural, it can be unnecessary, but it does sometimes save lives, and it is a birth of a precious little one, and an event that is no less memorable or special...Sometimes we just need to be reminded of it.
Amy was 6 lbs., 14 oz., 20.5 inches. She is a good baby, nursing well. At three weeks of age she is 8 lbs. 5 oz., solely breastfed, and I have an additional feeding built in for pumping. I love the Lansinoh Ziplock bags for breastmilk storage, and the Avent pump is great. It's like "I can't believe it's not electric!"
Update: Franny went on to have a home VBAC too. This is her VBAC story.
10 days past my due date I was miserable and called my midwife for help (this pregnancy lasted more than 2 weeks longer than my first and 6 weeks longer than my second...I felt like I was pregnant forever, add to this that I took off work for maternity leave at 38 weeks and I felt a little like an elephant, in more ways that one). My midwife recommended that I see the Chiropractor and get a massage. I chose the latter and by evening (Wednesday) my contractions had started.
I went about my normal activities, fixed supper, went to church, bathed the kids, put kids to bed, went for a walk. Contractions were regular, but not very strong, more like annoying. Thursday AM we were to drive an hour away to see the midwife...I didn't think I could handle being in the car that long, so I told her to head our way. (She has 7 kids of her own, the youngest just turned 1 in November). I napped and felt like they were fading away and she said she'd just drop in to see how I was. I had gone into work for a bridal shower on Tuesday and one of my co-workers, an OBGYN Nurse Practitioner said I should just go to the hospital and have another cesarean since I was so far over my due date...had a lot of mental work to do to get over that.
Midwife arrived at 3 and I told her what I was thinking/feeling and she helped me get rid of it and by 3:30 my water broke. By 5, my doula and our friends that were going to watch our kids were present and I was starting to get uncomfortable. Around 7pm, I was 4cm (the first time my midwife ever had her hand in me). I got in the tub ( borrowed a spa in a box from a friend) and got hot, then had to get out to cool off. I had just attended a Michel Odent conference and had his words in my head. If a woman gets in the tub at 4 and makes no rapid progress after 2 hours, he recommended a cesarean. I kept thinking that I didn't have the urge to push, so had I made progress? After dark (9ish?) I got back in the tub and was very cold, my husband found a space heater and was holding it on me next to the tub and jokingly went "oops" faking dropping it into the tub and it took me over an hour to get back into a regular pattern. Had to get into the shower to get warmed back up and they encouraged me to drink some really salty hot broth.
By 11 I was loud and hurting, they also tried to cram a peanut butter and jelly sandwich and juice down my throat...PB is NOT easy to get down with 'labor mouth'. I was all over the place position-wise, remember enjoying a forward leaning position. I starting pushing around midnight, although my midwife said I wasn't *really pushing* until about 1 or so. Was in the tub when I started to push, but kept a rim of cervix and got out to the birth stool so the midwife could help hold it while I pushed. While on the birth stool I remember saying, "I give up. Take me to the hospital, Help me" and they gave me some homeopathy. When she was crowning I got back in the tub.
The midwife said I have 'a large perineum' and so it felt like crowning took FOREVER. I remembered what It was like with Daniel and I realized that I ever got to the point where I could push past the pain and make progress...I finally figured out the pushing thing this time...but the pushing into the pain to make progress, then the contraction ending and feeling the baby slide back up and knowing I'd have to push back through that pain again with the next contraction was nearly overwhelming. I was on my knees in the tub, resting my head on the side of the tub, Aryn put his arm along the back of the tub so I could rest my head and I accidentally bit him...didn't even realize I was doing it until he flinched.
I got to the point where I felt like my urethra was going to explode and I reached down to support my labia and felt her head...It didn't take long from that point...it was so empowering to realize how close I really was. Once her head was out, her body followed quickly, the midwife just allowed the water to catch her. Once she was out, I flipped over and reached for her. Within seconds, I was pulling her up so I could see her, unlooped 2 nuchal cords and brought her out of the water to my chest. She opened her eyes and looked at me and started to whimper. No lusty painful scream, but more like..."Wait a second, what just happened?"
I felt between her legs and discovered she was a girl, but waited until our son came into the room to lift her out of the water for him to see and announce. I was convinced I was having a boy because my pregnancy was so much like it was with Daniel...Instead I have a little girl that looks just like her big brother. I was out of the tub about 30 minutes after her birth and we left the cord attached for about 2 hours, at that point we were able to cut without clamping and it fell off when she was 4 days old. I had a small 'scuff', but nothing worth messing with suture-wise. My midwife had a herbal bath to soak in with Abby and it felt wonderful...had to learn the hard way to strain out the herbs though :-0 clogged the tub.
Abby nursed very well and my milk was in by 24 hours. She never lost weight. Was 8-5 at birth, 2:04am Friday, October 14th and was 8-9 on Monday evening. Abigail has been a joy, a wonderful baby. Sleeps through the night (started at about 1 month) and was smiling by 6 weeks. She does have some gassy spells, but they are brief. Will definitely do it again!!! But will wait until Abby is in preschool or Kindergarten...a newborn and a strong willed 2 1/2 year old is just way too much for me!
This was an editorial I sent to our local newspaper after my daughter's birth explaining my decision and outcome in relation to the release of 2004 C/S rates. Several of the OBs in our area were really ticked and found out that I was the Childbirth Educator at the local Medicaid clinic and were not happy. Our Medical director wanted me to assure him that I was not teaching or encouraging homebirth in my class. I replied that I simply told my story and that I did not believe that homebirth was an option for our clients for 2 reasons...they can't afford the out of pocket expense of homebirth and local docs refuse to provide back up.
The results are in and 2004 saw another increase in surgical birth rates -- 29.1 percent of women delivered their babies by cesarean last year, according to a National Center for Health Statistics report released last week.
I chose not to become a statistic
Some doctors cited the reason for the increase was that more women are having elective cesareans, but keep in mind that "elective" does not mean that it was the woman's choice.
Earlier this year when we discovered we were expecting our third baby, I visited my OB/GYN to begin prenatal care. I was informed that we would be forced to have a cesarean if our baby was born at their hospital simply because I had a cesarean with my second child.
The cesarean rate has increased astronomically in the past 30 years: 5.5 percent in 1970, 16.5 percent in 1980, and 22.7 percent in 2000. The World Health Organization states that the cesarean rate should be 10 percent to 15 percent. Our bodies have not changed in 30 years, but medical management has. Although some babies have been saved by surgical delivery, a look at maternal and infant mortality rates show that nearly 30 countries lose fewer moms and babies than the United States and most of those countries have lower cesarean rates.
Having a vaginal birth after cesarean (VBAC) carries nearly half the potential complications than repeat surgery. Due to a 0.5 percent to 1 percent risk of uterine rupture, The American College of Obstetricians and Gynecologists has put very strict guidelines on VBAC, stating that the doctor and operating team need to be immediately available.
American Academy of Family Physicians guidelines noted that there are other problems that occur more often, and they found no evidence suggesting better VBAC outcomes based on the availability of resources. American Academy of Family Physicians went on to state that policies for VBAC "appear to be based on malpractice concerns rather than on available statistical and scientific evidence."
So, how'd I do it? I hired a midwife and kept my OB/GYN as backup. I found a doula -- someone trained to provide emotional and physical support during labor... and obtained a portable hot tub for pain relief. I ate well and read to educate myself. When labor started, my midwife came to me, and my daughter was safely born at home in water.
I'll do it again with my next baby. As long as doctors and hospitals do not allow alternatives, such as midwives, birthing centers and natural options for pain relief, more informed women who want to be able to make their own decisions will join me.
Elayne's Story (PCOS, triplets!, preemies, c/s)
We knew going into trying to conceive that things would be
difficult. I knew at 17 that I didn't ovulate, and I'd been on the pill ever
since. After nine months without a period off the pill, I started infertility
treatments, namely Clomid. I was told there was a 5% increased risk of twins,
and no mention was ever made of triplets or more. We thought twins we could
On my successful cycle, we'd gotten up to 150mg of Clomid, and the doctor said that if it didn't work this time we'd have to go up to the injectible drugs. But I did have a good follicle, and the doctors decided to give me an HCG injection to induce ovulation. Nobody bothered to tell me this could increase the risk of multiples.
I tested positive, and made my first appointment with the midwife I had selected for my homebirth. At 5 weeks, I had some cramping and bleeding on a business trip, so when I got back I scheduled an ultrasound with my OB to check on it. We saw four sacs and three heartbeats. Apparently, I conceived quadruplets and then miscarried one, which accounted for the bleeding.
Things were pretty uneventful for a while (if you can call triplets uneventful). I was forced out of my job and just took it easy, little to no physical activity, limited errands, etc. At 20 weeks, when I went for a Level II ultrasound, they discovered my cervix had dilated to 1.5cm. I wasn't having contractions, just uterine irritability, so they decided to just do a cerclage. I was on and off bedrest after that. Every time they let me off bedrest, I started having contractions. I'd come in to the hospital, they'd give me IV fluids and sometimes keep me overnight, then send me home on bedrest again. Every time I went to the hospital, they put me on the toco monitors, but no contractions ever registered, regardless of what I was feeling.
At 24 weeks, I began developing gestational diabetes. With diabetes running rampant in my family tree, and being hypoglycemic myself, I am very familiar with blood sugars and testing. I already had my own monitor, more of a toy before but used seriously now. I checked my fasting sugars every day, and occasionally checked after meals. At 24 weeks, I began getting very high readings after meals, 160+. That week, I also had sugar in my urine. Despite all this, my OB insisted that it was impossible to detect or even develop diabetes before 28 weeks, and he refused to test me. Knowing better, I put myself on a strict diabetic diet, allowing for multiple gestation, and kept track of my sugars. This was very difficult in the hospital, though, because I couldn't control my diet. More than that, nobody seemed to understand how much a triplet mom needs to eat to have big healthy babies, regardless of her size.
At 26 weeks, I went into full pre-term labor. At first I thought it was gas pains, because it was all in my back. A couple of hours later, I realized that gas pains don't come every seven minutes on the dot, and the contractions also started to radiate across my belly. We went into the hospital, and they immediately put me on the toco monitor, and spent the usual hour trying to catch all three babies on the strip at once (never happened). As usual, no contractions registered on the monitor. They started to blow me off, and I protested that I was really feeling strong contractions. The nurses tried to feel them through my belly, but they said they couldn't feel anything. I asked them to please check my cervix, like they had always done every time before. They refused. Instead, they sent me home on a sedative, Seconal, treating me like I was nuts. The sedative knocked me into a daze. I was still feeling contractions, and just barely aware enough to register the times (moving through 6 minutes into 5 minutes apart during the night), but I wasn't coherent enough to think, "Gee, maybe I should call another doctor or go back to the hospital."
By the time the Seconal wore off the next morning, my contractions were very strong, 5 minutes apart. I still waited a little while, out of pure sheepishness, because after being sent home the night before I believed them, I thought surely I was imagining it. That morning, though, I started suddenly bleeding heavily, and we did go back to the hospital. Sure enough, my cerclage had ripped out. Not only that, but I was dilated to 5 cm already. Even with all of this, though, my contractions, though painful, STILL never registered on the toco monitor. They admitted me and put me on bedrest, and gave me magnesium sulfate, terbutyline, and antibiotics and steroids for the babies. The tocolytics worked almost immediately, shutting my contractions down to nothing. Unfortunately, it was too late. I dilated to 6 cm before the drugs kicked in, and 24 hours later my water broke.
There was no hope for a vaginal birth of triplets, certainly not at 26 weeks. They were too small and fragile to really withstand the stress of a vaginal birth. So we went for an urgent c-section. The anesthesiologist came to talk with me beforehand, explaining how the spinal worked, all of which I knew after having a spinal for my cerclage. I told her about the spinal wearing off before I even left the operating room last time, and added that painkillers in general have little to no effect on me. She blew me off (like everybody else), telling me not to worry.
We went into surgery at about 11:00, and my babies were born at 12:09, 12:09, and 12:10, about 30 seconds apart. I got to touch the girls briefly as they went by. My boy needed resuscitation more urgently, so I only got to see him in the portable incubator before he was taken upstairs. By luck, my L&D nurse had a student nurse working with her that day. The student had to be there for the section, but couldn't do anything. So we gave her a camera, and she took a ton of pictures of the births. Bloody, but they're the only pictures I have of my babies not attached to anything for the next three months.
By the time my third baby was born, I was beginning to feel more than I should. By the time they were stitching me up, I felt every stitch and every twitch. They made my husband leave the room, but he saw them pump four or five drugs into my IV before he did. None of them really worked. They finally gave me Verced, so the end is a little hazy...yet Istill remember a good deal of it. On the upside, I did get a letter of apology and reference from that anesthesiologist, for me to show at any future surgeries.
Breastfeeding was a complete failure. Not on my part; I was a milch cow. I was putting out 50 ounces a day when I quit. I tried and tried and tried to have a "No Nipples" order put on the babies' charts, because I was concerned about that interfering with breastfeeding. The hospital staff insisted on giving them bottles anyway. They breastfed exclusively for two weeks before getting their first bottle, and they were doing well, getting latched on and getting decent amounts of milk out. The hospital still insisted, and the very day they got their first bottle, they refused the breast. I continued to pump until they came home, but with no help I did not have enough time to pump and bottlefeed.
We now have one baby with cerebral palsy, and the other two have a tendency to wheeze and catch bronchitis from every little cold, which we understand is a result of their having been on ventilators for almost two weeks after birth. Other than that, fortunately, they are doing well. We're working on getting pregnant again, hopefully with only one baby this time. I'm taking Glucophage to control my PCOS, and it seems to be working well.
My babies' website, www.y2kbabies.net/littlebits, has even more information about the pregnancy and birth.
ShortandBubbly's Story (low amniotic fluid, planned c/s, respiratory distress in baby, NICU at another hospital, breastfeeding problems)
Kmom's Notes: This mom did a great job under less-than-ideal circumstances. At 37 weeks they found that her amniotic fluid levels were quite low. Instead of trying to aggressively hydrate her to see if that would improve things (research shows this can significantly improve amniotic fluid levels, often enough to prevent the need for immediate delivery), they chose to do a cesarean the next day. Because the cesarean was done without the benefit of labor and because baby was 37 weeks, baby had respiratory distress (difficulty breathing, common in elective cesarean babies). His breathing problems led to him being transferred to another hospital's NICU.
The separation, plus the delay in getting a good pump, plus the nipple confusion from having bottles, plus possible oral aversion problems all led to great difficulty in breastfeeding. Supply was also an issue, which might be due to the circumstances and/or the PCOS. Hopefully, next time, she will be able to avoid this cascade of problems, get to hold her baby right away, and have an easier time with breastfeeding. She did an admirable job under very difficult conditions, though, and that's all any of us can do.
Even as I look at my son as his first birthday is less than two weeks away, I still cannot believe that my body was able to create something so beautiful. I had been experiencing symptoms of pregnancy such as fatigue, slight morning sickness, and not being able to eat things that I used to be able to eat. I was also late for my period, which wasn't unusual. But what alarmed me was that I did spot for a day and it stopped. My husband (who was my boyfriend at the time) and I were living together, but having a hard time with our relationship. I bought a test at the drug store and right before I went into the bathroom, I said, "It will probably be negative." Imagine my shock and surprise when that second line appeared in seconds. I remember shaking and tearing up from happiness. We went out that night with my best friend to celebrate.
It was a pretty uneventful pregnancy. No major complications. The only thing that was bothersome at all was the unbelievable swelling that I had in my legs, knees, ankles and feet. I never experienced any real morning sickness or heartburn. There was only one time where I remember waking up with heartburn. Teaches me for drinking orange juice right before going to bed.
We found out I would be having a boy when I was 28 weeks along. It got real fun when I could start to feel him move around. I will never forget the first time I saw him kick. I was laying down on my bed and all of a sudden, I saw my belly move! It was the most amazing thing I have ever felt before. Towards the end of the pregnancy, about a month before a delivered, it was impossible for me to go to bed before 4 a.m. I would lay in bed, and I would feel very energetic and restless. I spend lots of nights cleaning or playing online.
I was 37w4d along when we went to my appointment at the ob/gyn office. Little did we know, it would be my last visit. We were in the ultrasound room and the ultrasound technician asked if I had felt any fluid come out. I had told her I hadn't. She seemed concerned and called the front desk to have the midwife come in and look at it. The midwife came in and looked at the ultrasound picture, and then told me to move into the next room where they would hook me up to an external fetal monitor. The heartbeat sounded good and strong, and they were asking me questions about the baby's movement. Finally I asked, "What's the matter? Do I not have any fluid left?" I was informed that I had very little fluid in me and that baby needed to come out. They checked for dilation, and I was not dilated at all. Nor was his head in the birth canal. He was-head down, but not in the canal, and his body was slanted off to the right. We were instructed to the across-the-street to the hospital. We would have having a baby that day or the next day.
We arrived at the hospital and they brought us to our room where I was told to get undressed and get into the hospital gown. They brought in a portable ultrasound machine where they looked again. Apparently, I had more fluid than the other machine showed, but still very little. I was then told I would be having a cesarean the next day. They prepared me for it by having me take a bath and scrubbing my belly clean and hooked up an IV into my neck because we couldn't find a good enough vein in the arm. I have deep veins. I was then instructed not to eat after 10 p.m.
The big day was here and I hadn't slept a wink! My boyfriend put scrubs and a mask on and they wheeled me into the room. In there they put the epidural in my back, and it didn't take long before I wasn't feeling a thing! When I felt a little pulling, I knew that it was almost there! I know I heard a cry, although I don't remember it. He was born at 12:13 p.m. I was told that I cried a little bit as they stitched me back up. Once I was stitched back up, I was wheeled back into the room and hooked up to a pitocin drip so my uterus could contract back to normal. Thank god for the epidural is all I can say.
I hadn't gotten a chance to see my baby yet for he was having problems with breathing. Unfortunately for all of us, he had to be shipped to a different hospital's Neonatal Intensive Care Unit. It was a very hard few days on me mentally as well as physically. I had to wait four days until I could see my boy. And he was so beautiful! Full head of hair and I could hardly see his eyes for he hadn't really opened them up for me.
I had planned on breastfeeding my boy. I wanted that bonding experience, along with giving him the best I could. Unfortunately, since he was at a different hospital, I didn't have a real chance at that. About 36 hours after my operation, a nurse brought in an electric breast pump. The first night, I didn't even get an ounce. But my other half still brought it back to the hospital where our baby was staying. I would try pumping a few times every day until I was out of the hospital. Once I was out and was able to visit, we tried to get him to latch on. He tried but once he latched on, no milk came out. I tried to keep going, but he was getting real fussy because he was hungry and didn't want to wait for his food. So he got a bottle.
The next day he came home and we tried again. For a while, I used a manual pump, and I still got hardly any milk to come out. After a week of using manual pumps, we went to the hospital to rent an electric one. I was able to give him about 6-10 oz. per day using breastmilk.
I think the other problem was that my nipples are a little on the flat side, which made it hard for him to latch on all the way. Plus, about a month after I had him, I caught a real bad cold. So I didn't pump for 3 days because I didn't want him to catch it and I was so tired. As soon as I felt better again, I tried to pump and nothing came out. I pumped for an hour and only about 1/4 of an ounce came out. I was devastated. I wanted nothing more than to be able to give my baby my milk. But I just had to tell myself that I did the best I could and that is what counts.
[Looking back on the birth,] I wish that they had waited it out [to see if I could improve my amniotic fluid level via aggressive hydration], especially once they saw that I did have some fluids left. I often wonder, if they had waited, if he would have still had breathing problems.
It's almost a year later, and I can't believe how fast the time flew by. The recovery from the cesarean was very painful. But would I do it all over again? Definitely! Next pregnancy, whenever that may be, I am going to do my best to eat right and keep active and try and have a VBAC. I want to experience the feeling of holding your baby afterwards and bonding with it.
Sal's Story (PCOS, GD, PIH, fall down stairs, induction, vaginal birth)
I have PCOS and took Glucophage in order to ovulate. All was well during the first trimester. At 16 weeks of pregnancy I had an extremely abnormal AFP level. Then at 20 weeks I developed pregnancy induced hypertension. After 16 weeks of bedrest my OB recommended that we induce at 36 weeks if an amniocentesis showed mature lungs. The night before the amnio we were preparing for the baby and I fell down the stairs (14 steps), fracturing my spine in 3 places, breaking my tailbone, and injuring my shoulder. The injuries were evaluated and found to be stable and not in need of surgery (thank goodness!). The amnio was performed and my doctor missed on the first attempt, had success on the second attempt, and the lungs were immature. However, the amnio triggered contractions so I had to spend a day in L&D. My blood pressure skyrocketed even on complete bedrest after my fall and my OB decided it was necessary to admit me to the hospital and begin an induction at 37 weeks.
I went into the induction dilated at 1.5 cm and effaced 75%. Now that I was in the hospital they no longer allowed me anything by mouth and insisted I take only IV pain meds. I was given 2 mg of Stadol and a dose of phenergan---it made me intensely disoriented and miserable and the baby had a couple of significant decelerations. Once it wore off I decided pain medicine was not a good friend of mine!!!! After a full day of pitocin and contractions I had no progression! The pit was discontinued for the night and begun again first thing the next morning. My OB then broke my amniotic sac to try and get things moving and cranked up the pitocin (even on the max dose the day before I never went into labor).
After several hours of contractions I had only dilated to 3 cm! Two hours later I was only at 3.5 cm; however now I was really uncomfortable so they let me get an epidural. I was terrified of the epi due to my recent spinal fractures, however, I had wonderful relief with it. A catheter was placed in my bladder and internal monitors were placed on the baby's head and in my uterus to have better monitoring. The pitocin was then increased above the normal maximum level and I was very closely monitored.
Once settled I took a good nap with my only discomfort being rectal pressure with each contraction. Two hours later I awoke to increased pressure and I was 7 cms! The pressure continued to increase (but no pain) and another 1.5 hours later I was complete and +1 station, ready to push! When I began pushing the epidural was turned off and I became intensely nauseous and the pain was intense from both the labor pain and my back injury. Due to breaking my tailbone [in the fall], my birth canal was very swollen, so every time I pushed the baby down he popped back up! It didn't take long for me to become miserably overwhelmed with pain and I began vomiting. At this point I begged for help!
The nurse called the OB and he immediately performed an episiotomy and used the vacuum to assist in the delivery. The vacuum fell off and the OB had to cut even further with the episiotomy. However, the baby came out after a few more pushes along with the OB's help (and vacuum!). The baby was born healthy as can be and fully mature. He was 7 lbs. 14 oz., 19.5 inches with Apgars of 8, 9, and 9!
Just after delivery I began bleeding and they had to give me lots of pitocin and massage my abdomen to get my uterus to cramp down properly, however it responded well to treatment. I developed hyperlactation [too much milk---kmom], most likely due to my PCOS, and with help from the lactation consultant we are doing WONDERFULLY and the baby is now gaining weight appropriately! My blood pressure and severe edema went down quickly a few days after delivery and within a week I had lost over 20 pounds!
Anna's Story (PCOS, PIH, induction, malposition, TOL c/s)
Kmom's Notes: Anna feels that her doctor wrongly attributed her blood pressure in pregnancy to "chronic hypertension" because of her size. In fact, her blood pressure was normal before pregnancy, was normal in the first several visits, and then started to rise. However, when she asked about pre-eclampsia, he told her she had chronic hypertension and she felt that this assumption was based on her size and not on the facts. After her pregnancy, her follow-up visits record very normal blood pressure readings. Obviously, she did not have chronic hypertension, and the higher BP was due to pregnancy.
This was Anna's second child. Her first had been born by cesarean, and she was hoping for a Vaginal Birth After Cesarean this time. Because of her rising BP, Anna's labor had to be induced, which strongly lowers the chance for VBAC in most cases. However, women *do* have VBACs with induction; unfortunately, her baby was slightly malpositioned, which made it difficult to be born vaginally. Because the doctor did not know how to help the baby re-position, a repeat cesarean became the wisest choice at that point.
Anna showed great strength of character by demanding that the anesthesiologist re-do her anesthesia for the cesarean! All along, they were not taking her seriously when she told them she was not getting good relief with the epidural. They also did not take her seriously because their monitors showed her contractions weren't very strong. (Many large women report that contraction monitors do not accurately measure the strength of their contractions.) When the anesthesiologist tried to tell her that her epidural was sufficiently strong for a cesarean, she fought back and PROVED that she still had feeling and needed more. Reluctantly (because doing a spinal after an epidural does have risks), he did a spinal, and she was able to have a 'good' cesarean experience. If she had not been so assertive, she probably would have been one of the unfortunate few (like Kmom) to feel their cesarean surgery. Standing up for herself like this in the face of their disbelief was amazing.
Having experienced secondary infertility due to PCOS and three miscarriages, we were delighted and frightened to find we were expecting again. I had pre-eclampsia in my first pregnancy, so they monitored me closely as a result.
About 4 weeks prior to the due date, having seen my blood pressure increase slowly with each visit, my
perinatologist wanted me admitted for possible delivery. My ob/gyn, who seemed
convinced ( despite the fact that my first couple of BP readings with this pregnancy were
normal) that I was chronically hypertensive, disagreed. He sent me for observation to the maternity floor of the hospital, but
told the nurses that if my BP stabilized, I was to be sent home. After six
hours on my left side, I did see a bit of a decrease in BP, so they sent me home to follow up the next Tuesday with the ob/gyn.
On Tuesday, I went to my appointment, and my BP was 175/110. That was the highest it had been, and I argued with my ob that I was ready to deliver. He begrudgingly sent me to the hospital, again for "observation". After several hours without a change in my BP, he decided to go ahead and induce labor. Cervidil was inserted and a pitocin drip started, and just a couple of hours later, my labor began.
The nurses were wonderful. They monitored me closely, and tried very hard to encourage my plan of a natural, drug free labor and delivery. After twelve hours of no sleep, they finally convinced me to do something for the pain. My cervix had only dilated to 3, I was progressing very slowly, and I was already exhausted. I hadn't eaten since 6 AM the day prior, since once I was admitted to the hospital, I wasn't allowed anything but ice chips. I agreed to some narcotic relief, the doctor decided to break my water, and I finally slept fitfully for about two hours. The pain seemed to be getting worse, and upon inspection, I had progressed to 5 cm.
The nurse asked about an epidural, and even though I had strongly desired a natural birth, I felt
totally wiped out and needed some relief. Finally, with the epidural, the pain subsided, and I was able to get some bit of sleep. It seemed to me
that the epidural wore off quickly, and twice, the nurse called to bring someone in to give me a little more medication. The third time, with the
pain seeming to me to be very intense, a new anesthesiologist came in and told me that based on my 'strip', the contractions weren't that bad and I
should be fine with what I had. He also noted that I hadn't progressed past the 5 - 6 cm point in quite some time, and said that if the pain did
continue, I could call back. After about 45 minutes, the nurse who was taking care of me stood up for me and demanded that someone come and give me
more meds for the pain. The anesthesiologist came back, and another round of drugs was administered.
About 5 that evening, February 14th, after having been in labor about 21 hours, I felt like there was something passing - there was no pain, but I felt for sure something was coming out of me. Seconds later, the feeling passed, and the nurse checked under my gown. She became quite frantic, scooped up the waterproof pad that I was laying on, placed it on a table out of my view, and ran to get another nurse. I became extremely concerned, and my husband didn't seem to know what was going on, and when the other nurse came in, they both agreed that my doctor needed to be called immediately. Apparently, I passed an extremely large blood clot, and after the doctor came, he deemed me okay to continue with the labor.
After several more bouts of trying to convince people that my epidural wasn't working, and the pain was really bad, the nurse confirmed that my labor seemed to have stalled. I had been at the 6 - 7 cm point for a long time, so the doctor was called in. At 2 AM on February 15th, the decision was made by the doctor, myself and my husband to go ahead with the c-section. The baby's head wasn't in position, and I was so exhausted that I felt if the time to push came, I'd be in a terrible predicament. The anesthesiologist tried to convince me that my epidural was just fine, but I proved to him that my feet and legs were totally feeling, and the contractions were absolutely being felt. I refused to go into surgery until something else could be done, so he agreed to a spinal. I am certain that had I not demanded something else, I would have felt the scalpel make the cut.
At 2:34 AM, on Thursday, February 15th, after 31 hours of labor, our second daughter was born via c-section. She had APGARS of 9 and 9, and after a few minutes of introductions, she was taken to the nursery. She remained there for a few hours. I insisted on stitches instead of staples, so I didn't have to have the staples removed, which I found uncomfortable after my first c-section. She and I went home four days after surgery, and except some minor drainage from the incision, I healed well.
I believe that the ob/gyn made a call regarding my increasing BP based on my weight. I kept close track of my BP, and I know it was normal up until about 4 months into my pregnancy. I learned during this labor and delivery that if you don't speak up, you won't get what you want. I hope I remember the lesson in other areas of my life!
Maria's Stories (SROM, induction, c/s; dumped by midwife at 35 weeks, hospital VBAC)
Kmom's Notes on Pregnancy: This mom has PCOS, which sometimes can create an excess level of fear and vigilance in the providers about blood sugar problems and big babies. Women with PCOS do have more of a tendency towards blood sugar issues, but to worry about this at 35 weeks when all previous tests have been negative and there is no history of a big baby is ludicrous.
Because this mom questioned the validity of a test like this so late in pregnancy, the midwife released her from her care, leaving the mom virtually without options. However, Maria took lemons and made them into lemonade; against all odds she found an OB who was supportive of VBAC and supported her in labor despite never having met her before labor.
And that big baby the midwife feared? He didn't even weigh 7 lbs at birth. So much for the heavy mom with PCOS must equal heavy baby theory!
October 17th, 2004; 7:30 am- My water broke. I got up to pee and suddenly thought I was peeing on myself. I peed and then it just kept coming down and I knew this was it. I called my grandmother to let her know that my water had broken. I then tried to call my Obstetrician, Dr. D, but no one ever got back to me after I paged the On-call doctor twice. I didn't know what was going on. I called my mom. She came and picked up me and Chris. We walked out of my mother in laws apartment with a suitcase, a birthing ball that was fully blown and some other things. By now it was 9:30am.
We got to the hospital and we were there by 10:00am. I was triaged pretty much right away since I was leaking everywhere. I was put on a monitor for 30 minutes and was told that I was having sporadic contractions by the resident. Well duh, I knew that. I can feel them! The resident then checked me and I was 3 centimeters dilated, 80% effaced and she said my water had definitely broken. I was going to be admitted and I thought YAY! We're going to have a baby today!
I was given a room in Labor and Delivery and Dr. P came in and introduced herself. She came in and checked me once I was settled in and confirmed that I was at 3 centimeters, but she was not happy that my contractions were not regular and said to me "We have to put you on Pitocin now". I began to argue with her, "There's nothing else that can be done? Cervadil? Nipple Stimulation? Nothing?" I thought she was insane. I asked her to call Dr. D. I didn't want this. She came back saying that she was not answering her phone. I was sure something else can be done before Pitocin. I refused the pitocin at first and she said to me that either I went on Pitocin or I am risking the lives of both me and my baby, since there is a risk of infection with ruptured membranes. So after talking with my mom and grandmother, I opted for the Pitocin.
Here I was, 6 hours into having been put on Pitocin and Dr. P comes back. She decided to check me again and I was at 6 centimeters and completely effaced. She then said to me, "I don't like your progress on the pitocin and I think we might have to do a cesarean if this continues." Then Dr. Psaid " I believe you should get an epidural. You will feel more comfortable and if a cesarean becomes necessary, you will be able to see the birth of your baby. I also feel that the epidural will help you tolerate these contractions better so that you can be able to dilate quicker." So I asked Dr. P, "What are my other choices?" And she said, well, if you don't dilate, then we will have to do a cesarean under general anesthesia." I tried to argue with her even more and she said to me, "I'm the doctor, you're the patient, so we are going to do what I want to do". So at the time, I thought, Wow, I don't want that! So I got the epidural.
I made sure that the Attending Anesthesiologist was the one who did my epidural. I have back problems as it is, and didn't want any residents screwing with my spine. After the epidural, Dr. P comes back in, and says to me, "Look how happy you look now!" and then says to the nurse and my family, "Isn't she so happy?". I just rolled my eyes at her and made a fake smile. I could still feel the pressure of the contractions, but not the pain at this point. She also insisted that since we were not getting a good reading on the fetal monitor and now I'm in bed anyway, we should put it in Internal Fetal Monitor on my baby's head.
A couple of hours went by, and it was now like 8 pm. Dr. P came in and checked me again and I was 7 centimeters. She said "We might have to do a cesarean if this continues, we will increase the pitocin now." I was starting to get mad. I didn't want this. Dr. P instructed the nurse to increase the pitocin every 30 minutes and that she will be back to check me in an hour. She came back an hour later and said I was at 7-8 centimeters. Dr. P then said to me, "It looks like we are going to have to do a cesarean because you're not progressing fast enough and it's been too many hours since your water broke." I said to her "NO, I am NOT having a c-section! It hasn't even been 24 hours since my water broke! I want more time!" So after arguing with her for about 10 minutes, she finally said, "Ok, as long as the baby looks ok, we will let you continue to labor." She then told the nurse to increase the pitocin again.
About 10 pm, my daughter's heart rate began to fluctuate during a contraction, so then they lowered the pitocin. A bunch of doctors and nurses came running in and Dr. P told the nurse to decrease the pitocin and see if that works, of course this was after having another argument with me. This happened two more times after the pitocin was decreased once. Dr. P then said to me that my baby was under distress, and since I'm "Failing to Progress" and due to "Fetal Distress" we were now going to do a cesarean. I said to her, I do not want a cesarean, I am scared. I started crying. She kept insisting that this would be the best thing for and my baby. I didn't trust her at this point.
I did not believe her. I went into the Operating Room in tears. Here I was shaking, cold in this unfamiliar place. Krystina was born at 11:06pm on October 17th, 2004. She weighed 5lbs 12 oz and was 18.5 inches long! It was less than 24 hours since my water broke, and to this day I feel that I was butchered. I am pregnant with my second child and I'm now seeing midwife and strongly considering to have a homebirth after a c-section. I cannot see myself giving birth in a hospital and having everything go downhill. I strongly feel that Dr. P has taken something away from me. I can't seem to completely explain it. To me, Dr. P, is Dr. Knife.
Since this has happened to me, I now tell women to make sure they are fully informed before going into labor and to look at their choices in childbirth. Ask around about your Obstetrician and the doctors that go on call for your obstetrician. That was a mistake I made. I didn't know that Dr. P went on call for Dr. D. I know that Dr. D would have let me have my natural birth and let labor go on its own without forcing the knife on me. No one should have to be forced into a cesarean unless it's absolutely necessary, not cause you have been in labor for X amount of hours and now the doctor wants to go home. Birth is a natural process.
My story really goes back to October of 2004. My daughter was born by c-section and it was one of the worst experiences in my life. The hospital staff was very mean to me. They did not consider any of my wishes after I was told my birth plan would be followed I was given pitocin and practically forced into an epidural. I had a very horrible experience overall and dealt with Post Partum Depression. I was c-sectioned for failure to progress and fetal distress. My daughter was born with an apgar of 9/9 after I was told that her heart rate was going too low for it to be "safe". I later found out that a lot of what I was told during labor was false information. After giving birth, my ultimate goal was to have a VBAC and prove the OB who cut me wrong.
Two weeks before I gave birth, my midwife told me that she won't be able to be my care provider anymore due to some of my health issues [PCOS and hypothyroidism]. I was disappointed, upset and had no idea where to turn. I failed the One Hour Glucose test the 2nd time I took it, and was refusing the 3 hour glucose test so she told me that I needed to see an OB.
On November 7th, I began to have contractions that were lasting on and off. At this point, I was still sorta seeing the midwife till I could get to the OB's office the next day when she would be in. As the night progressed, the contractions began to get closer together and were somewhat stronger. Around midnight, I took a warm shower and they came to a halt. I woke up at 4am to some strong contractions on November 8th, but didn't think too much of them. I tried to get some more sleep, but I just couldn't, so I stayed up for a couple of hours. Around 8am, contractions started to pick up a little, and soon after, the midwife called me to check up on me. She instructed me to go the OB's office to get checked out. I called the OB's office and they told me to come in around 12:30. I called my grandmother and she picked me and and DH up and we headed into the city. I also called M (one of my Doulas) to have her meet us at the OB's office. We got to the OB's office and the office manager told us to go straight to Labor and Delivery.
We got to the hospital but didn't go upstairs right away. I stayed downstairs and dealt with the contractions in the lobby until M got there. In the meantime, I called my other Doula, E. We headed upstairs and I was admitted to triage upon arrival. I wasn't checked till we had been there a couple of hours and they picked up contractions for a couple of hours. Upon arrival, the nurse wanted me to change into a gown, but I refused the gown and said, "No, I want to stay in my ICAN t-shirt." So then the whole "What if there's an emergency" argument started and I said, "So cut it off." M said "There won't be an emergency". I had to laugh at that.
The one resident was so pessimistic and must have told us the risks of a VBAC so many times, I wanted to kick him. When I was checked, it was about 2pm. I was 3 centimeters dilated. I was admitted. We got a room in Labor and Delivery and Dr. D2 (the OB) came in to check on me about an hour later. I was 3-4 centimeters and so she decided to break my water. I was slightly hesitant about having my water broken however, she did say that my bag was bulging and it would break at any moment so I agreed.
After my water was broken, contractions began to pick up and got a lot stronger. I think I was handling them very well. At 10pm, I was checked again and was only 4-5 centimeters, so Dr. D2 said that as much as she knows I wanted to avoid pitocin, she just wants to give me the minimum and see if that will help me progress, cause I am taking a long time to progress. M and E were a great support in all of my labor. I remember the most helpful thing that they did was the Rice Tube Sock. I was dealing with a lot of back labor and it helped a lot. I found that swaying, the rocking chair, and standing helped through a lot of my labor as well.
Around 3 am, it had felt like I had been in labor for days, and I felt like I needed some sleep, so I requested an epidural, not so much for the pain, but to make the pain disapear so I can get some rest. The Anesthesiologist came in and I signed all the paperwork, and he did the epidural. It lasted an hour. I was right back to feeling the pain again, the epidural did not go in right. I was begging at this point for another epidural or something cause I needed some more sleep. Around 8am, I got another epidural and Dr. D2 came in and checked me again, I was 5-6 centimeters.
There were a few times I had doubt in my mind that I would get my VBAC, and I know I said at one point "My grandmother did this 8 times, I CAN do this!" At this point, I didn't know what would happen since I had so little progress. She said I would be checked again around noon. I don't know how the time flew between 8 am and noon. I did take a nice long nap though. I also had to fight with the nurses about not getting a catheter. I allowed them to put one in the first time, and it hurt so I begged to have it taken out. The nurse said she will only take it out if I can pee on the bedpan every so often, or it has to go back in. They increased the pitocin slightly after the epidural began to work. I must have really shocked the nurse, cause she said to me at one point that not many people can go on a bedpan with an epidural in place. I told her that I wasn't many people. I just don't like the feeling of the catheter.
At noonish I started to feel a lot of pressure so they got the resident in and he checked me. I was 8 centimeters with a lip! WOO HOO!!! That's where I "got stuck" last time. So instead of laying on my left side, I switched to my right for a little while to even out that "lip", and the baby's heart rate dropped a couple of times, so they asked me to move back on my left. It was like 12:30 or so when he checked me.
At about 1:15 or so, I began to feel a ton of pressure, like I had to poop, so I told them to get a doctor in there now cause this kid is coming out. I don't think anyone believed me, but I felt my baby trying to push his way out. The resident checked me and said I was complete so they would call Dr. D2. I had everyone yelling at me telling me not to push, but I couldn't hold back, I was giving little pushes because it hurt if I didn't push. Dr. D2 came and was very encouraging. YAY! Now I can push! I don't know exactly how long I pushed for, but I got see my baby's head crown!
Matthew Alexander arrived into the world on November 9th, 2005 weighing 6lbs 10.4 ounces and was 19.5 inches! His Daddy got to cut the cord and his birth was witnessed by my mom, my doulas and my husband. Ended up with a healthy baby boy; my sugars were checked during labor, and only elevated once which was cause I had a popsicle.
I was very glad that I ended up with Dr. D2. She pulled a lot of strings to help me get my VBAC, whereas another OB would have given up on me. She had the belief that my body could do it and it did and I am very thankful to her. I did not get to meet Dr. D2 until I was in actual Labor, but she turned out to be the best thing for me.
Camila's Story (PCOS, epidural, vaginal birth)
I planned to deliver at the birthing center. I went with my husband to the classes and everything. At 40 weeks and 1 day my labor started and my husband drove me to the birthing center where I stayed for 12 hours with hard contractions. My midwife intentionally broke my water. (I won't let this happen again-it's not a good idea if you are looking to have a natural delivery-let your body do the work!)
Because it was taking too long, I was transferred to the hospital right after my midwife's assistant came (boy, I hated that woman! She made me feel so uncomfortable!). At the hospital they gave me pitocin and also I asked for an epidural (I was exhausted by then!). And who knew---2 hrs later my beautiful daughter came out. She was quiet but then, right after she was taken away from me, she cried and cried! It was the best baby cry I have ever heard!
I am happy for having my baby so healthy, but I felt I was deprived of the natural and empowering birth I was planning for. I am grateful for my baby for I never thought I was going to conceive, but I hope I get another chance to have not only the perfect baby and a bigger family as I always dreamt about, but also the perfect birth! GIRLS, NEVER GIVE UP!!!
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.
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.
Stella's Story (PCOS, pre-eclampsia, precipitous labor, vaginal birth; weight loss surgery, bedrest, induction, vaginal birth)
Kmom's Notes: This mom had her first pregnancy at age 19. She had weight loss surgery (WLS), then a second pregnancy at age 32. Unfortunately, she was given no real instructions about nutrition in the second pregnancy, nor was she given extra vitamins or minerals (beyond the usual prenatal vitamin), despite the known tendency for women with weight loss surgery to have nutritional deficiencies.
Despite her difficulty with eating meat, no one monitored whether she was getting enough protein. In addition, she was not given extra folic acid (despite having taken Glucophage, which is known to impede folic acid absorption) or extra iron (despite a strong tendency for women after weight loss surgery to be anemic). At one point, there was some discussion about adding supplements like Ensure because she was steadily losing weight, but she finally started gaining weight so it was dropped.
Fortunately, the baby seems to be doing well anyhow. But this points to how little guidance is given to some women experiencing pregnancy after weight loss surgery, despite research recommendations to carefully counsel and monitor nutrition in women who are pregnant after WLS.
My first birth was almost 14 years ago and I remember very little now, except that I had no problem conceiving (was only off birth control pills for 3 weeks), gained 93 pounds, went into labor 7 weeks early, and still had an almost 7 lb. baby in 2.5 hours. Nobody believed me (that I was in labor in the first place---it was April fool's day, after all) and that I had to push so quickly.
13 years later, having been married to a new DH for a few years, and having wanted another baby for many years (can't figure out why I never got pregnant in all that time?), we started to try to conceive. I had been having messed up periods for about 2 years, and went to an OB about it. He pronounced me PCOS, started glucophage and provera (to induce a "real" period, in order to know when to start clomid), and prescribed clomid, even though the blood tests showed (somehow) that I did ovulate.
On October 14, he did a vaginal ultrasound, showing a small cyst on my left ovary. I took the provera, waited about 2 weeks for a period to show up (after all, I had about $200 worth of clomid just waiting to be used!), and it never happened. Now I was mad----thought for sure that the provera had messed something up! I took a home pregnancy test, just to rule that out before yelling at someone, and surprise, surprise, it was positive! According to my (new) OB, I had conceived on or around October 12, so perhaps the "cyst" the previous OB saw on ultrasound was not a cyst after all.
By this time, we had moved back to my hometown, so I visited my previous (and favorite) OB. I was concerned about having taken Provera and Glucophage, but there were no worries. My pregnancy was relatively uneventful. Baby was breech from week 32-35, and we were talking c-section. I was on bedrest for a while---low amniotic fluid. One ultrasound indicated a possible fetal kidney problem, was dilated to 3 cm and 80% effaced for about 5 weeks prior to birth, so was again on bedrest, but in the end all was well.
I have a history of precipitous labor and lived an hour away from the hospital/OB (and was tired of being pregnant anyway!), so I was induced at 38 weeks. At 7 a.m., artificial rupture of membranes by OB, 7:10 a.m. pitocin started, 8:40 a.m. first contraction. 11 a.m. (still at 3 cm), epidural administered (was a waste of time, never helped, still felt everything), 11:40 a.m. started pushing (at 8 cm dilated). 11:51 a.m. She was born!
This was such an easy birth (of course, I thought I was dying in the middle of it, but...). I wanted to leave about 4 hours later, but had to stay until the next day. Nothing hurt, except my back from the epidural. We left at noon the next day, and spent the whole weekend (she was born on Friday) at a pow-wow with my husband, my 13 year-old, and my 1/2 day old baby. It was great. I was 10 lbs. below prepregnancy weight when baby was 3 week old, but gained that and then some back, and am now about the same weight I was when I delivered, 6.5 months ago.
Now we're in the process of trying to conceive #3, our last, and being told that we'll "never get pregnant without help," which is really discouraging. We did it before, despite being told I was PCOS. My periods are back to crazy---two or three per month. The last one was so heavy I had to start norethindrone to stop it. OB wants me on that for a few months to try and regulate my cycle, and then we'll start on clomid. He says that my last baby was basically a "fluke," that I ovulate intermittently, if at all. He restarted my glucophage and upped the dosage, and just recently started me on aldactone, which really confuses me---how does a high blood pressure/heart condition medication help ME? I haven't had any tests (that I'm aware of) besides an insulin test (diagnosed insulin-resistant in October 2002), so get really upset and ask a lot of "how do you know" questions. I get discouraged, when they always want to do birth control pills to regulate---makes it hard to get pregnant that way! I wonder about aldactone (a class D drug)---what if another "fluke" happens?
Have been told to "drop some weight," which I agree wouldn't be a bad idea, but all the PCOS stuff recommends a low-carb diet, which involves mostly meat. I had my stomach stapled in 1996 and can tolerate hardly any meat, so am looking for other good ideas---there is very little information for the stomach staple-pregnancy connection, or diets following that type of surgery. I'm getting to the point where I feel my time is running out baby-wise, and would really like one more. I've done it before, both pre and post diagnosis, without help, and am lost as to why I need help this time......
As for pregnancy/nutrition guidance during pregnancy/WLS---I had no special guidance...From what I can tell, there is little to no information about pregnancy after WLS, and when you throw in PCOS/infertility into the mix, it's just an uncommon combination that not many (in the medical field) have experience with.
akp's Story (failed induction, botched c/s, complications; fat-phobic doctor, HBAC)
Kmom's Notes: Her c/s story is a good lesson in all the things that can go wrong during a c/s and afterwards, and why inducing for a "big baby" is usually a bad idea. Things were bad; fortunately, they didn't turn out even worse.
Her VBAC story is a good lesson in the importance of finding a provider who really believes that your body can give birth normally whatever your size, and the importance of perseverance in the face of opposition and obstacles. As the old saying goes, when a door closes, somewhere another one opens.
I have to start with my first birth because it leads into the struggles with my HBAC. My daughter was born via cesarean for many reasons, but mostly due to my being 306 lbs. at 40 weeks pg. I was told my baby was over 10 lbs. and that I did not have the hip structure to birth a baby larger than 7 lbs. I trusted my OB explicitly and believed that I couldn't do it. I also knew my only chance at help (mom) was flying in at 40 wks, 2 days pg and was only staying for two weeks. I asked many women and they ALL said cesareans were great and no big deal. The closest to a "don't do it" I got was the receptionist saying hers was tolerable. So, knowing I couldn't birth my HUGE baby (who was 9 lb, 12 oz--not huge) and that cesareans were no big deal, I went in for my failed induction, cascading interventions and finally was the last cesarean of the night for my OB.
My daughter was torn out of me, put through tests, given formula and spent time with my husband, with my mother and with my sister and her husband before I even got to see her. There is so much more to the trauma of the cesarean, but let's skip ahead. At my 8 week PP checkup, I told my OB that I was still in a lot of pain, was still taking Vicodin and didn't feel well. She felt something strange in my abdomen and sent me for an ultrasound, but that didn't find anything, so she told me that because I wasn't recovering from the surgery well because I was overweight. That if I had been in good health (not that there was anything wrong with me beyond being overweight and having PCOS/Hypothyroid--those 2 are out of my control and contribute to the weight) that I wouldn't feel like that and so on.
Skip forward again to 17 months PP. I was told that I had cancer and would die soon because I had a huge growth (the size of a 20 week fetus) that had gotten so large so fast, there is no other explanation. Tests after tests finally revealed that there was actually a lap sponge and surgical tape left within my abdomen from the cesarean. That was the cause of the "tumor" and 2 surgeries later, I was told that there "was hope" that everything would be fine, beyond the scarring and adhesions. 6 weeks later, I conceived E.
I called around 10 OBs and interviewed 3 in person before deciding on a VBAC-friendly OB. Things were going well and he provided forms reflecting VBAC as safer than a repeat cesarean. At 30 weeks, things started to change. I had decided to have a home birth by that point, so after finding the right midwife, my OB became shadow care (he never knew that was the case) and thank goodness for that wise decision! I started hearing "unproven pelvis" and "dead baby" from the "VBAC-friendly" OB.
By 34 weeks he was telling me that I was high risk because overweight women rarely have the stamina and endurance needed to have a vaginal birth. I started bringing witnesses to every appointment because being in his office was a nightmare. He was painfully aware of my trauma surrounding my last cesarean and STILL never relented on the dead baby theories. The only reason I continued to see him was because he was in my medical plan and could authorize any lab work my midwife asked me to get (i.e. thyroid checks). By my 39 week appointment, the doctor would get red-faced angry and tell me that I was killing my over 11lb baby and that I required an immediate cesarean.
At 40 weeks, we compromised and I agreed to a NST. The OB refused to do it in office, saying they didn't have the equipment. That I had to go to the hospital. I found out later that it was a blatant lie and an attempt to force a cesarean. The OB had called in advance, "explaining" to the hospital what he needed done. I told him and I told them that I refuse ultrasound. They told me that they HAD to measure the babies heart and would not do anything else via ultrasound. AFTER they had already measured the fluid levels, they informed me that I had a dangerously low AFI (later found out it was 6.9, which is within the published ACOG guidelines at 40 weeks pg) and that I needed to stay and have a cesarean. They wanted to escort me straight to L&D after the NST. I refused. The NST was perfect, not a blip, textbook perfect. I stood up, told them I would not sign any consent forms and that I was going home. There was more, but lets say everyone was giving me "dead baby" and "the OB will not tolerate this" language even while I was walking out of the building.
At 41 weeks pregnant and after no less than 6 harassing dead
baby phone calls per day since the NST (including weekends), my OB dropped me
from his care for "non-compliance." Whew, I could finally gestate in
Around 9:00 a.m., July 14th, I felt the first small pangs of labor, only I didn't know it was labor. At 41+4 days gestation, I was beginning to think that E had made his home in utero and wasn't coming out. I'd had several episodes of B-H contractions that made me wonder if I was in labor, only to be disappointed, so I wasn't going to get excited again. Plus, I had an appointment that morning with my wonderful midwife, V, at 10:00 and she'd be able to tell if anything was going on. Unfortunately, I let the OB's badgering get to me mentally and spent half the visit with the midwife that morning crying about how the baby was never going to get here and that maybe we should consider labor-inducing herbs. After a long discussion of the pluses/minuses, we decided to have V try to scrape my membranes. Unfortunately, I was only 80% effaced and 0 dilated. It wasn't worth the possible tissue damage and we left things alone. Happy to be further along than I was when labeled FTP and c-sectioned 2 years ago, I left thinking another week or so to go. I stopped by the grocery store and bought some homeopathics that V has had some reasonable success starting labor with and was contemplating starting them in the next couple days. At that point, I started feeling some stronger abdominal pains, but they were far apart and again, I chalked it up to Braxton-Hicks.
At noon, I was feeling contractions around 10 minutes apart, but still believed they were B-H and would go away. They weren't regular or overly painful, so I pulled out the breast pump I bought when #1 was born and pumped for a half hour (V had mentioned this might also start labor). Not only did it get labor going strongly, I think it over stimulated and caused the contractions to become close together too early. By the time I had pumped for a half hour, about 12:45 at that point, the contractions were 4 minutes apart and getting stronger. I put the pump away and finished watching a movie I had rented. About 2:30, I called V to let her know that the contractions were getting stronger and were finally regular. I didn't need her to come over, but wanted to let her know she'd probably get "the call" that night. I started cleaning up the house because I finally realized labor was happening and that E was going to be here in the next day or two.
I called hubby at work and let him know he'd have to leave work early to go and get #1 from preschool as the contractions were strong enough that driving was out of the question. I told him I didn't want anyone around me at this point, so don't leave work yet, just let them know you're leaving early. Lots of luck with that, he was so excited, he left right away and drove around a bit. I called him about 3:30 and said he could come home because it was getting hard to get housework done and there was a lot to do before the midwives showed up. He felt he needed to call the midwife once the contractions were 3 minutes apart, so he called V and I got in the bathtub. I told the midwife it would still be hours and she agreed, but thought it would be best to send out the assistant midwife (J) who was already in the area. J got to our house around 7:00 p.m. and checked to see how the baby and I were doing. She couldn't tell how dilated I was, but she could tell the head was coming down far with every contraction so she asked V to head over to the house.
Our Doula got to the house around 8:30 and V arrived around 9:30. I moved from the bath tub to the birth tub (kiddy pool we had bought for the birth) and stayed in the tub until about 10:00. I kept feeling the head move down during contractions, but then it would just move right back up, so I told V nothing was happening with the pushing. Having been at hundreds of births, V's intuition kicked in and she thought checking me for dilation was a wise idea--that way I didn't expend energy pushing when it wasn't time. I was only 3 to 4 cm when she checked shortly after her arrival and I was severely disappointed. E was also posterior at the time, so I was having some tough back labor. Fortunately, he didn't stay posterior for long (changing my positions also changed his).
Around 10:00 I moved from the tub to the bed-definitely not a favorite. It was horrible changing positions, but I knew the ladies (V, J and my doula) were right and changing positions was the best thing to do. After some contractions on the bed, I had to go to the bathroom and went to sit on the toilet. That is when things really got moving. I sat on the toilet from around 10:30 until almost midnight, trying to urinate and not wanting to change positions again (the first 2 to 3 contractions when I moved were hard to get through).
When I started grunting and pushing hard to urinate, V realized it sounded like I was actually pushing the head down and got the group to remind me of changing positions again. I really didn't want to at that point as contractions were one on top of the other and it was all I could do to catch my breath in between. Our Doula got me up and half carried me over to the bed as I could hardly walk with the strength of the contractions. As we left the bathroom, my doula brought up that finally had some bloody show. I was almost crushed as I assumed that meant I was probably only about 6 at that point. I figured most women have bloody show well before 3-4 cm, but I knew I had to be further than that since it had been 3 hours since I was checked. Ugh, prayer time-at that point; I thought about transporting to the hospital to get an epidural, but I had had one previously and back then, it stopped my labor all together. I was not going to have another cesarean!
So, I lay on the bed, it was midnight, the contractions were difficult and my doula kept reminding me to breath and stay on top of the contractions. I couldn't breathe through the contractions anymore and just held my breath grunting through them. I felt like my body was pulling into one huge 6 foot contraction and I shouted that my body was cramping up. V and my doula both tried to help with the cramping immediately, I grabbed my leg (I was on my side) and just lifted it up. Obviously, it was just the natural urge to push and not cramping, but I didn't know it at the time.
V had thought I was in pushing stage, but didn't want to say anything as nothing in labor is for sure. V let the others know and my doula got the camera ready, got DH and so on. I was still clueless and kept having these contractions that forced me to grab my leg and contract my whole body. I told everyone that it felt like he was moving down then going right back up and V reassured me that it what was supposed to happen. Finally around 12:15 I understood what was happening and could feel the head moving down-actually he was almost out. V saw there was meconium and knew I had low amniotic fluid, so she instructed my doula to make sure I didn't push after the head was out. I heard everyone talking about it, but could only concentrate on getting E out. I knew I would tear if I pushed too hard, but honestly, I didn't care any more. I pushed with all I had and then kept pushing some more. A few contractions later, E's head was out and V/my doula were telling me to take short breaths and not to push any more. V quickly suctioned E's mouth and nose and he was born at 12:35 a.m. on Friday, July 15th.
The extreme hormones and euphoria of what we had accomplished removed any remembrance of the pain a few minutes earlier. It was incredible. Nothing ever felt like that before. E was so beautiful and things were awesome. I bled a bit more than I should have, so after a while, V started pushing for the placenta to come out. V tugged a little on the cord, to encourage the placenta to release and I pushed with all I had at every contraction. Finally around 1:15 the placenta came out and more bleeding occurred. V continued with the herbs and started telling me that I was going to have to get a shot of pitocin if I didn't stop bleeding soon. I really didn't want pitocin as I'd had it with Elizabeth and I knew what it felt like. No thanks! We all prayed and really concentrated on stopping the bleeding, which happened fairly soon after that. After reviewing the placenta, it looked as though I had a partial separation of the placenta from the uterine wall-causing the extra bleeding. Fortunately, all ended well and it was just clean up from there.
I did have a short 1st-degree tear right at the very end from pushing too hard and fast, but I knew that would happen at the time. Within a few hours, I was eating and showering, thanks to my wonderful birth team. It was an amazing experience and I wish that all women could know the joy of birthing in a comfortable environment with an experienced team of women. There was such a sense of calm and peace through the entire experience that I would never birth unnecessarily outside of my home again.
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!
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 insistent 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 pregnancy 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.
Stephanie2's Story (c/s due to placenta previa; hospital VBAC with 12 lb. baby!)
Kmom's Notes: This mom had a VBAC with a 12+ lb. baby!! They were ready to do another c/s, but her OB showed up and put a stop to that. She was able to have great mobility during labor and pushing, which seems to be important with a big baby. Giving birth on hands and knees in particular may help get a larger baby out more easily, and some believe it may help prevent shoulder dystocia. So, being fully mobile when a big baby is suspected may be especially helpful and should be pursued whenever possible.
This mom also has PKU. I asked her to summarize what that means for those who don't know, and this is what she wrote:
PKU is a genetic disease where your body cannot process phenylalanine. This protein can crystallize on the brain if there is too much in the body and cause permanent brain damage. Early detection is SO important because if gone undetected for as much as 4 months it can cause PERMANENT mental retardation. (There has not been a case left untreated for a year where the child reached an IQ of 50 or higher.) When pregnant, breastfeeding, and as a small child you pretty much get NO protein of any kind (think vegetarian, no milk, rice, potatoes or meat), and you take a protein supplement with the amino acids minus the phenylalanine.
PKU can also cause a higher rate of birth defects, so PKU moms often have numerous, extensive ultrasounds. But with modern PKU food supplement formula, many women with PKU have healthy pregnancies and healthy babies.
First Birth: Cesarean due to Placenta Previa
In my first birth, I had placenta previa (where the placenta covers some or all [in my case only some] of the cervix). C-sections are pretty much mandatory for this complication, which I am ok with, as my son was healthy and I was able to keep my uterus. He was also macrosomic (10 lbs 13 oz). He doesn't have PKU, but is a carrier.
Second Birth: VBAC
My gynecologic care was non-existent because I have never been treated fairly by doctors because of my size, in my opinion. So when I started having problems (no periods, excessive body hair, and killer cramps when I did have a period), I finally saw a doctor who was "fat friendly." He almost immediately diagnosed PCOS and ran some tests to confirm it. He referred me to an Reproductive Endocrinologist and I worked with him as well as my OB-GYN to achieve pregnancy. Before even talking about fertility treatments I was adamant about considering VBAC, and came in with tons of research about it.
I was started on Metformin immediately and given the morning-after pill to induce a period. Then I did a 3 month follow-up of Yasmin. After another 2 months of normal periods he gave me 2 cycles of clomid which failed, and on the third go-around the stick turned pink.
All of this time I was on a Low Phenylalanine diet. As an adult this protein poses little problems to people with PKU but when pregnant or breastfeeding it is extremely important to keep these levels low, because even though your own brain is formed and generally unaffected by the protein crystallization, your unborn baby's brain is still susceptible.
Pregnancy itself was fairly uncomplicated, and because I was very careful with my diet, I was able to avoid diabetes or pre-eclampsia. [At one point they did think he might have hydrocephalus (water on the brain).] I was devastated, I had been taking pre-natal vitamins and drinking plenty of OJ to prevent this. (I have a sister w/ moderate Spina Bifida.) Come to find out it was either a mistake on the ultrasound or it healed itself.
I went into labour and arrived at the hospital. Check-in was great (we have swipe cards here), but my labour room was horrible. The bed was too high, the stirrups too narrow, and the gowns AND pressure cuffs were too small. They were ready to put me under general and wheel me into the OR when my OB showed up. He was pissed and stopped everything. My labor was progressing normally. I hit 10 cm within 8 hours.
I went into hard labor and had horrible throbbing stabbing pains in my lower back (back labour?). I rolled onto my side and this was alleviated. After 6 more contractions I got into the hands and knees position and delivered after only two more contractions. I did have some tearing, but required no stitches. Yes, he weighed 12 lbs 4 oz and was 23½ inches in length.
As far as being open to VBAC they did have an O.R. on stand-by just in case. I would not let them do internal monitoring but they did do the external belt monitoring. There was one instance where we thought we were heading [towards a cesarean] but my son must be scared of knives too because he tucked his head just in time. Through all of labor they were also doing ultrasounds.
I received EXCELLENT care from my doctors, but the hospital staff lacked some common manners. After my Dr and my husband tore into them, they changed rapidly. I would have like to have my baby at a different hospital but due to being high-risk, (PKU, VBAC, and previously macrosomic baby) I had to be at a level III. After delivery I was sent home in 2 days; I received decent care for those 2 days.
As far as PKU goes, the baby and I both have PKU. [Because of that we did not breastfeed.] There is some research as to breastfeeding being ok, as levels of phenylalanine are MUCH lower in breast milk than in formula, but being as how I have it too, there isn't enough research to be able to justify breastfeeding, in my opinion. Since formula is good enough and known not to harm him, I couldn't justify that risk. I am hoping before my next child there is more definite research to this as I would like to breast-feed, but I need more info.
My baby boy is wonderfully healthy, despite a nurse trainee feeding him standard formula TWICE. I am not happy with the hospital BUT my doctors gave EXCELLENT care. And despite having a caesarian, being obese, and other medical issues I was able to have a relatively normal healthy vaginal delivery.
Gretchen's Stories (twins by c/s, then home waterbirth VBAC)
Kmom's Notes: Although most PCOS moms are plus-sized, not all are, and Gretchen is one of the 'average-sized' PCOS women. As noted above, birth stories from PCO moms of all sizes are welcome here.
Gretchen is also a veterinarian and so knows a lot about medical procedures and surgical issues (both in humans and animals!), but even so was persuaded into an elective c/s in her first pregnancy. With her second, she informed herself carefully and chose homebirth to help avoid unnecessary interventions and the 'high-risk' labels she felt she would get from an OB.
You can see pictures of the waterbirth at http://members.truepath.com/bgadland/birthpix.html. Gretchen also has an awesome page on PCOS, interesting discussions about obstetric care, and other valuable pages as well.
I was diagnosed with PCOS when I was 17 and was promptly put on birth control pills. I took them for 13 years. After finishing medical school (I'm a Veterinarian) and working for a couple of years, my husband and I decided to start a family. Somehow I managed to put out of my mind the fact that the physician who'd diagnosed my PCOS had told me I might have trouble getting pregnant. After 11months, I did conceive and promptly miscarried. This happened again a few months later, and at that point we decided to see a Reproductive Endocrinologist. At that time, the treatment for PCOS was pretty limited and I started Clomid. I conceived on the second cycle and shortly thereafter the twin pregnancy was confirmed.
I had a lot of anxiety about the birth---a little because of my history of miscarriage but more because I was absolutely terrified of having a cesarean section. Somehow, I've always known that surgery is not the way to have a baby. My own medical training meant that I wasn't deceived in the slightest about what is involved with abdominal surgery. I knew that I was going to be considered 'high risk' because of the twins, and that it would take a real fight for me to avoid a lot of intervention. I selected a Family Practitioner for my prenatal care---he was a personal friend and I knew he was pretty laid back about protocol during labor and birth. My pregnancy went forward without a single problem, but I could feel the fear starting to grow in my physician. I wish I'd paid more attention to that but because he was a friend, I had a sense of loyalty to him and didn't feel comfortable looking elsewhere for my care.
At about 28 weeks, baby A turned footling breech and that was that. He never turned again. His brother (baby B) was kind of breech/transverse but that's not really as concerning because the second twin often turns around during labor, after the first baby is out. I was unable to find anyone in the mainstream medical community who'd even talk about attempting a vaginal birth with 2 breech twins, especially since I'd not had a vaginal birth yet. I didn't know anything about more mother-friendly caregivers and didn't know anything about how to encourage breech babies to turn. I was looking at my worst fear come to reality.
I really wanted to go into labor before surgery. My physicians (at this point I was getting dual care from an OB) were on the surface supportive of this until I approached 38 weeks. Then suddenly it seemed that if I waited any longer, something horrid would happen and I just had to schedule the section and get those babies out. No one could really tell me what horrid thing was going to happen, but I started being told that I was stubborn, that I was putting my babies at risk by waiting any longer. I left my prenatals in tears. I was told that having a cesarean was no big deal and that I should just be grateful that I had babies, since we'd had so much trouble conceiving them. I was still holding out hope that they might turn at the last minute, because sometimes that does happen. But at 39 weeks, 4 days I couldn't take the pressure from everyone (including friends) any longer and I scheduled the surgery. I felt like I'd scheduled my own execution.
I had a "good" cesarean, if there really is such a thing. We were able to negotiate several changes in routine hospital procedure because we had a little time to prepare. Our boys stayed in the operating room with me and my husband and then went straight to recovery with me where we started breastfeeding. I was able to select the anesthetic regimen that I wanted (another advantage of being medically trained!) and was happy with how that worked. The boys roomed in with me and we got lucky and never had another mother in the room with us so my DH was able to sleep in the other bed and help with infant care. Other than being absolutely terrified when they were suddenly ripped out of me with no warning, both boys handled the surgery well and were strong and healthy at birth. They latched on well, and breastfeeding appeared to be off to a good start.
I had pretty good support from most of the hospital staff with regard to exclusive breastfeeding twins, although that did change before we left. My milk was very late in coming in (about 5 days) and the boys lost quite a bit of weight--by the time we were ready to leave, we almost had to sign them out Against Medical Advice because I was under a lot of pressure to supplement with formula. My recovery from surgery was physically unremarkable, other than a slight reaction to the suture at about 4 weeks postpartum. My emotional recovery took a lot longer--I had moderate postpartum depression and we had very little support, either practically or emotionally for what we went through in those first few months.
Because the "birth" was so distressing, breastfeeding was very important to me. It turns out that I'm one of the women with PCOS whose milk supply is affected by the condition. I was able to feed them exclusively but it was really quite marginal as I look back on it. I started solids right at 4 months and it was very obvious that from that point, they gained better than before. Nevertheless I did and still do take pride in the fact that I kept at it and we didn't wean completely until they were past 2 years old and I was halfway through my next pregnancy.
It took me about 6 months to even consider that I might want to have more children. I knew I didn't ever want to have another cesarean and what little trust I'd had in the obstetrical community had really been broken by the way I'd been treated at the end of my pregnancy. I knew that having had a cesarean, I'd automatically be 'high risk' again and as I started to explore my options, I realized that support for women having Vaginal Birth After Cesarean (VBAC) in the mainstream was rapidly diminishing.
I became intrigued with the idea of homebirth. I'd heard about it when I was pregnant with the boys, but it scared me. As I did more exploration of woman-friendly birth options, I came to the conclusion that homebirth is in fact as safe or even safer than hospital birth, and is probably the only way to stack the deck in your favor if you don't want a lot of fear and stress around your pregnancy and labor. I found a midwife practice in our area and we arranged to have an interview with them. For the sake of completeness, I also interviewed an OB that had a reputation of being very VBAC-friendly and a Family Practitioner. After the interview with the midwives, I was convinced and so was my husband---homebirth was the way we would plan to go.
The real challenge was getting pregnant again, or so we feared. I didn't want to take Clomid again because I really didn't want another twin pregnant---only because I knew it would really reduce my chances at a normal birth. I knew that there were newer ways of treating PCOS so I made an appointment with a Reproductive Endocrinologist (RE) for a consult. It was 5 months before I could get in to see him, [and in the meantime my cycles restarted, I was showing signs of fertility and using a number of alternative/complementary therapies, and we stopped trying to 'prevent' pregnancy.] I discovered I was pregnant the weekend before my appointment. I had a routine ultrasound at 7 weeks with the RE because of my history of miscarriages [and the PCOS] and then transferred my care to the midwives.
Talk about night and day! Prenatals were a joy---45 to 60 minutes. They were concerned about how I was doing, not just about what my urine looked like and how much I weighed. I was so supported and they were so confident in my ability to birth my baby. They didn't have a lot of experience with PCOS and asked me if there was anything in particular we needed to watch for. I explained there was a higher risk for GD and PIH but since I'd gone through a twin pregnancy without either of those problems, I wasn't particularly concerned this time. They agreed---I kept my protein intake up, drank lots of water and herbal tea, and had a very pleasant pregnancy, this time without all the emotional turmoil.
I think the most stressful part of the whole thing was our decision to not tell my husband's family about our plans---my family was quite supportive but we knew his family would be pretty freaked out by the very idea of homebirth and we did not need the grief. It was a tight line to walk not to reveal our plans but not actually lie to them either. I was 'prepared' to go 'late' and so refused to tell my due date---this is kind of fun to do, it really drives people nutty. It was great to know that I wouldn't even hear the word 'induction', much less have to worry about fighting off an induction.
As I passed my 'due date', I'd been struggling with increasingly intense prodromal labor for several nights, plus the emotional issues of when my mother would be arriving. Late on Wednesday afternoon, my midwife called to let me know it was normal to be struggling with all of this, and she suggested I have a glass of wine before bed. If it was prodromal labor, that might relax things enough to let me sleep some, and if it was the 'real thin' then it wouldn't stop anything. I was exactly 41 weeks pregnant.
[Kmom note: Although most of us cringe at the idea of a glass of wine in pregnancy, at this stage it actually probably isn't any more dangerous than the "therapeutic rest" morphine that doctors use for the same purpose in the hospital, and many midwives prefer the wine.]
By bedtime I was contracting the usual 2-3x an hour. By 3 a.m. I realized that the contractions were coming about every 10 minutes. Laying in the bed was not a good thing at that point. Decided to get into the shower and see if that would relax me enough to sleep. Spent an hour in the shower without realizing it. Got out and hurt more---I was kneeling by the side of the bed, kinda breathing through them and DH woke up By then they were about 3 minutes apart! I didn't want to call anyone yet because I was still convinced they'd stop with the dawn but did tell him to go back to sleep (which he did!). At about 5 things were still happening so we decided to call the midwife and tell her that things were a bit more intense. We decided to call her back in an hour.
At about 6 I called my friend and labor support, then the midwife, then the family that was watching our boys for the birth. So we just hung out and breathed and it wasn't too bad. By 7:30 everything came to a screeching halt as the sun came up. I cannot tell you how freaked I was about this. But I did remember that for some women, especially in early labor, changes in the environment can really throw you off, so I hoped that was what happened. The boys left and I got back in the shower. By the time I got back out, the contractions were back to every 3 minutes---funny to feel so relieved about being in pain, but there it is! Somewhere in this I did lose the mucus plug, and that really excited me. (What a trip birth is!)
My labor support showed up about 9 while I was upstairs rocking in the rocking chair--it was this pretty surrealistic experience--we'd be talking about something trivial and then I'd stop and breathe and she'd time and remind me to relax and then we'd just pick up the conversation. My midwife called and I decided I'd like to have someone, mostly just to check on the baby every once in a while. She sent her senior apprentice (also a doula and a Home Birth After Cesarean mom) who checked on how I was doing. Then I wanted to be alone, so everyone left and I just kinda chilled out some more. My husband was cleaning and doing chores and finally blowing up the pool.
I really don't remember when I first got in the pool but it was heaven. We had the fishy pool that many homebirths use and it was really great for us---I was able to assume any position I wanted. For me, water was HEAVEN, although I reacted differently to it than some women---it definitely helped me cope and relax but it kicked my labor into a higher gear (the shower did too). I turned down a vaginal exam and my midwives were SO cool about this. Actually, what they said was "OK, this baby will be born whether we check or not." I was really afraid of the vaginal exam because I just couldn't deal with the idea that I might be only 3 cm or something, plus lying on my back for checks on the baby was bad enough, even in the tub.
At some point, I'd been in the tub a while and everything clicked up a notch. I was having trouble all of a sudden, and that's when my support made a difference. I was shaking uncontrollably and started to cry, and my labor support was great---kept reminding me that it was all normal and I was doing great. My husband was mostly puttering but came in for a while, and he wiped my face for a bit. Then came the first time I thought about being non-compliant---they asked me to get out of the tub. They said I was showing signs that I needed to get out and get upright, to hang onto DH and walk around, swivel my hips, that sort of stuff. On the one hand I knew it was a good idea to keep things moving, but on the other hand I knew it was going to hurt and I really liked the tub! But I did it, and I was right, it hurt like hell.
My midwife showed up shortly after that---the first thing she said to me was, "I hear that you officially don't want to be doing this anymore!" (Yes, I'd already said that.) For most of the labor, I didn't really want people around me much and I NEVER wanted anyone touching me anywhere other than to wipe my face. All the pain was up front, in my cervix and across my lower belly, never anything other than tightness across my back (THANK YOU GOD!!!). I had a little rest on the couch, then I went upstairs to be alone. I got in the shower, things got hairier pretty fast and I ended up in the bedroom by myself. By this point I was getting loud---okay, I'll be honest, I was pretty stinkin' loud the entire labor. That really surprised me, I'm not normally a loud person at all. I was kind of side-lying on the bed and the contractions were coming one after another and they just would not stop and I was definitely losing any semblance of control. I couldn't keep my noises low and frankly I didn't give a flying flip about control after too long. My labor support came in, sat down and just was 'there' with me. And then it happened, the moment that my DH will never let me live down (because it is just so darn 'not me')----NO NO NO NO OH GOD MAKE IT STOP!!! I'd not had a vaginal exam, I had no idea 'where' I was in labor and was afraid to believe it might be transition.
My midwife came flying up the stairs and sat on the bed, saying something about it getting pretty intense, and she wanted to check me. I just started crying and saying, "I can't, I'm so scared because if I'm at 3 cm then I'll just die because I can't keep doing this." She says that she knows its scary but holds out the carrot---if I let her check and I'm at least 5 cm I can get back into the pool. Well, give me that pool, so she says, "In between contractions, roll over and we'll be as quick as we can be." (In between? There was NO in between!) Anyway, I was 9 and a half with just a little anterior lip. Music to my ears, let me tell you. So after crushing their hands through a couple of contractions (later, my labor support said I almost shoved her through the wall a couple of times--how do women ever do it in the hospital confined to a bed?), I finally got up and moving. A word of advice---don't do transition on the stairs, it really sucks. But by the time I got to the pool, I was pushing.
I was waiting for this because it's supposed to "feel good after the dilation." Well, I guess I got to join the "pushing hurts like hell and really kinda sucks" club. It wasn't fun. It was more like being demonically possessed! And it definitely hurt, even though I was supposedly 'doing' something (not consciously, really, it was being done TO me and through me). I found that kneeling but with my legs folded and spread really far apart felt the most effective. The apprentice told me later than the midwife was really concerned because it was so weird but the apprentice could tell it opened me even better than squatting. I tried leaning back on my tail bone for a bit but that wasn't going anywhere, so I stuck with the squatting and kneeling thing. The apprentice was pretty much doing everything and she was supposed to catch the baby (which was totally cool with me), so she was trying to gently coach me through pushing. It ended up being kinda funny in the deep recesses of my brain (I couldn't really talk); she'd tell me to push a little bit more towards my bottom and I'd just laugh inside because it assumed that I had any control at all---the only thing I could change was holding my breath a bit longer when I pushed. I could tell that made a difference because I actually felt the baby move down when I pushed that way (totally cool feeling, by the way----there's so much women lose when they are drugged!).
So I pushed. It was a very odd place I went to. I just lived each contraction, then caught my breath in between. I had no sense of time at all, it was just the contraction and then the next. It started to feel a bit burny and I gasped something about that and the apprentice felt down and said, "Bulging bag" (my membranes had not yet ruptured). So I kept pushing and she kept saying, "Even more bulging bag" (guess that vit. C worked for me---I heard her comment about how tough the bag felt). At his point, I was learning over the side of the tub, butt sticking out but still under water, and trying my best to break DH's fingers (that's what husbands are best for, physical abuse during labor!). I felt this 'pop' and heard her say, "There go her membranes," so I decided it was time to really get serious about getting the baby out. On the next contraction cycle I felt the burn start, and I pushed as best I could.
My daughter crowned on the last push of the contraction. All these people were yelling, "Pant, pan, don't push, just let her come easy!" and I'm thinking, "Shut up! I couldn't push if I wanted to and if I could I would because this REALLY REALLY HURTS." They're going on about what a great job her head is doing stretching me and I'm thinking, "No **** Sherlock, get that head OUT OF ME!" Finally, about a hundred years later, a contraction starts up and 'pop' out her head comes. They said, "Pant, so we can check for a cord." There was no cord so they said "Push," so I started pushing---and nothing! Nothing. So there she is, head hanging out, under water and nothing. They ask me to push but that's pretty useless without the contraction. I hear someone say, "Head's been out 2 minutes" and I hear the midwife say, "Get pads on the floor in case we have to get her out of the tub". I'm thinking in the tiny part of my brain that never stop, "Oh shoulder dystocia, I'd better get this baby out." Contraction starts and I start shoving and the midwife jumps in and fiddles with something and WHOOSH, out she flies! (It wasn't a real shoulder dystocia, she explained to me later, she basically just had to tip the baby's head up a bit and wiggle her a little---not a big deal but not something the apprentice had had to deal with yet--so the midwife did end up catching in the end.) I flipped over and they passed her up to me and I held her on my chest and at that moment, none of the past hours mattered in the slightest. It was 4:32 p.m., just about 13.5 hours after I first thought 'something might be happening'.
She was a bit floppy--initial Apgar of 5---turns out that while she didn't have a nuchal cord around her neck, she did have an 'occult' cord---the cord was looped up over her chest and so was pinched there at the end. I think it was only a factor at the very end because her heart tones had been perfect throughout the labor, and the midwife wasn't able to check right at the very end (mostly because I couldn't get myself turned over to be checked). She had given me "2 more contractions and then I absolutely have to check again" and I got things done in 2 more contractions. The baby's 5 minute Apgar was 9, so she did fine.
The water in the tub was getting pretty bloody so they really wanted me out of there because they were a bit concerned about hemorrhage (the midwife told me later she suspected I might bleed more than usual because of the uterine distension from my previous twin pregnancy, so she wasn't surprised, although the apprentice was a bit freaked). Got out and sat on the couch and the placenta fell out---a 7 minute physiological third stage! [In other words, it went quickly even with no pitocin to force things along----Kmom]
They asked my DH if he wanted to cut the cord and he said, "Heck no, that's what we pay you for," so they cut it and got me laid down and within 30 minutes my daughter was nursing. But I was still bleeding so we had to deal with that. I ended up losing ~4 cups of blood, quite a bit for an otherwise uncomplicated birth. They gave me Shepherd's Purse tincture and I drank and ate a lot and by the time they left, my uterus was actually involuted down almost to the size they'd expect 24 hours later. So I think some of it was just that I lost a lot of blood in a few hours that 'should' have come out over the next day. I only passed clots a couple more times and 4 days out had very little lochia at all. So, while it was a bit scary (I did get really faint and woozy and had to be carried up the stairs), it ended up not being all that serious.
10 minutes after the birth, the phone rings and its my mother---she's in town, 15 minutes away. The timing could not have been more perfect. Guess God knows what He's doing after all. DH calls his mom and tells her we aren't at the hospital, we're at home. Later she told him that she's really glad we didn't tell her about our plans, that she would have worried the entire time, so we played that one just exactly right too.
I didn't tear (at least 2 minutes of the 'ring of fire' did do something positive!) and just a couple of minor 'skid marks' on my labia. I felt so good 'down there' that I forgot to use the peribottle. But no one told me how much it itches when those skid marks heal! The herbal bath that I used for perineal healing was wonderful and it dried up my daughter's cord like gangbusters too. She had no molding---probably because she was almost born in the caul [still in the bag of waters---Kmom]---and only one little scrape by her right eye---she is just as 'perfect-looking' as her cesarean brothers were. I felt great within days and really had trouble remembering that I'd just had a baby, that's how different the recovery was.
Random closing thoughts: Did I ever think about uterine rupture? 2 times---when I first started pushing because it hurt so damn much and all low and in the front (but since the pain stopped in between pushing I figured it was unlikely). And then when I was still in the pool but bleeding I again thought of it (but because it didn't hurt at all, I figured again it was unlikely). Never crossed my mind at any other point.
What coping techniques did I use? In early labor, the more classic Bradley technique relaxation stuff was really helpful, although not in the side lying position. Later I drew a lot on the variety of stuff that Birthing From Within talks about---especially vocalization and 'going into the pain'---as funny as it sounds, facing and embracing the pain was the only thing that made the slightest difference during what I now know was transition. If you don't have that book, get it. Period.
Was it my dream birth? Well, actually, I didn't have a dream birth and I did that on purpose. It was exactly the birth I needed, and I find it supremely ironic that I basically had a textbook 'Friedman' curve labor---12 hours of dilation, 1.5 hours of pushing. Who'd have thunk me of all people would do it 'by the book'?!? Yes, I'd do it again, no doubt about it. I'm not on a screaming high but I'm happy. And having fun. That's really all I want--the first 12 weeks after the boys were such a dismal, grey, unhappy time, with no positive thoughts to it at all---just to be having fun is enough for me.
Could I have done it in a hospital? Well, I hope never to know the answer to that question. I do know I would not have done it the way I did do it if I were in the hospital---I probably would have taken drugs if offered (I would have taken a bullet if offered there at the end although my labor support says I don't give myself enough credit for how strong I am). In the hospital, I would not have had the freedom to be loud, to move around, and most importantly, to be absolutely by myself when I needed to be. I think that was the single most important thing my support people did for me---left me alone. I am so thankful that I had the support from my husband and the people that mattered when it came to planning a Home Birth After Cesarean (HBAC)---it was the best decision I could have made.
Update: Gretchen went on to have another VBAC, also at home but not in the water this time.
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