by KMom
Copyright © 2000-2006 KMom@Vireday.Com. All rights reserved.
This FAQ last updated: February 2006
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
BBW Birth Story Pages
BBW Birth Stories: Vaginal Birth Under Special Circumstances
CONTENTS
Many women over the years have requested a section for birth stories of plus-sized moms. Large women come into pregnancy with so many fears and body issues that reassurance that other large women have indeed done this is important. Pregnancy books and most websites do not fulfill this need; mostly they are filled with warnings not to get pregnant until you lose weight, dire predictions of disastrous pregnancies filled with complications, or horror stories designed to scare you into compliance.
Although there are many birth stories online, most are of women of average-size. While these are also important to read, many large women have longed for a collection of stories of plus-sized pregnancy---normal births, complications, special births, just plain births---warts and all. It is important for us to see that many of our large sisters have traveled this journey before us.
This is a collection of BBW birth stories collected by Kmom over the years. Stories have been separated into various categories (vaginal birth, c-sections, twins, gd stories, etc.). Because some stories fit more than one category, many will repeat on different pages. Some stories are already up on the web in a more complete form elsewhere; with the mother's permission, Kmom has linked to these sites and urges readers to click on the link and read the more complete story.
Unless specifically requested, all identifying information has been removed or changed to protect the privacy of the participants. All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
This particular FAQ presents the stories of moms who have had challenges in their pregnancies but yet have gone on to give birth vaginally anyhow. Sometimes, when problems occur in a pregnancy, doctors can make you feel like normal birth is not possible anymore and that you must have a c-section, yet many women can and DO give birth normally anyhow. Hopefully, these stories will help inspire moms to keep on working for as normal a birth as possible under their circumstances.
More stories will be added over time, so keep checking back if you are interested in reading further stories. If you are interested in sharing your birth story, click here for more information, birth story format, and submission guidelines. New birth stories are always welcome; Kmom updates the birth stories FAQs about once or twice a year so be patient for your story to show up. If you do submit your story, please carefully follow the format and directions given in order to shorten the amount of work involved for Kmom. Kmom's family will thank you!
Most moms will recognize most of these terms, but women new to reading about childbirth may be puzzled by some of the terms and abbreviations used in these stories. This section briefly defines some of these in order to help women understand the stories better.
Birth Stories: Vaginal Birth Under Special Circumstances
(also see VBAC stories)
N.M.'s Story (ID twins, gd, vaginal birth)
Kmom's Notes: 37 weeks is basically full-term for twins; her OB did not pressure her to induce early simply because she had gd. Usually, gd is more common with fraternal twins than identical twins because a double placenta tends to double the insulin resistance from hormones, but sometimes moms with identical twins get gd too.
NM also found that the gd food plan she was given as a twin mom was inadequate, a complaint Kmom has heard from more than one twinmom. Although you'd think that gd food recommendations would be fairly straightforward across the board, there are more variations than you would think. In the past, many gd food plans had too little protein and too many carbs; the most recent thinking seems to be that you get better control and fewer problems by increasing the protein amounts somewhat and decreasing the corresponding carb content as well. Significant caloric restriction for heavy gd moms is another area of controversy, and several large twin moms with gd have complained of totally inadequate caloric intake for a multiple pregnancy.
Birth Story
I was diagnosed with gd after the [glucose challenge] with a level at 140. So, they sent me to the 3 hr GTT and my fasting level was normal, my 1 hr was 202 (cutoff was 190), my 2 hr was 165 (the cutoff number) and my 3 hr was normal. I was officially diagnosed as having GD.
They gave a GD diet which was completely ill-suited for a pregnant woman weighing 270 lbs or so and expecting twins! It was lacking enough protein and had way too many carbohydrates and definitely not enough calories. I told my doctor that I was going to eat more protein and a little less carbohydrates and he said okay. Also, my doctor wasn't too worried because one of the side effects of GD is having too large of a baby, but since I was expecting twins, he said it would at the most make them weigh a normal baby's weight (my boys were 4.5 and 5.3).
I had to test my blood 4x per day (fasting and one hour after each of my meals). My numbers were fine as long as I didn't overdo the carbohydrates in one sitting. I saw that my body could not handle carbohydrates for breakfast, so I ended up eating only protein and a few hours later having a carb and protein snack. I was able to keep my numbers within the recommended range by cutting out all sugars and making sure that I ate protein along with my carbs.
I went into labor at 7:15 pm., [37 weeks into the pregnancy]. Since I didn't have any real contractions by 9:15 pm, my OB had me take 3 ounces of castor oil. His reasoning is that a twin uterus is usually so stretched out that many times it has trouble really contracting. The consistency was disgusting and I ended throwing up the first bit. I forced the rest down my throat, though. At 10:45 pm my contractions picked up and I was constantly going to the bathroom as my bowels were emptying out.
At 3:30 am we arrived at the hospital. I was immediately hooked up to a pitocin drip and two monitors, one external and one internal. I was not allowed to get out of bed. I did not take any pain medications because I had the attitude that although it was painful, I could handle it. I just breathed through each contraction. As I approached transition, I threw up. It was mostly stomach acid as my stomach was already empty. The best part is that I knew I was almost to pushing.
I started pushing at 5:10 am. No one properly prepared me for pushing, it is really hard work. I think of it as equivalent of doing 3,000 sit-ups in a row (okay, okay, not THAT bad, but definitely hard work). At 5:56 am, Baby A was born. At 6:00 am, Baby B was born. It was an incredible feeling to push the babies out! Of course, since they were tiny, I really only had to push their heads out as they had such tiny shoulders. From what I understand, the shoulders on a 7 lb baby are the hardest part to push out. But, in my case, once their heads came out the rest of the body came flying out. I only had a tiny tear which my OB stitched up. Both babies had apgars of 9/9. Don't let anyone tell you that you cannot give birth. Your body is prepared and ready to do what it needs, just have a positive attitude and believe in yourself.
Lori M's Story (fraternal twins, induced premature vaginal birth)
Kmom's Notes:
Birth Story
I had a wonderful OB. She was very sympathetic to my needs not only as a large woman, but as someone carrying twins. (With my other two children I wasn't a large sized woman so I left those experiences out.)
[As noted, I had premature labor at 31 weeks.] On Dec 10th, I went in for a routine NST (non-stress test) and fluid check on the babies. While I was hooked up to the monitor, a couple contractions showed up. The docs checked me and said I was at 3cm and 30% effaced. At 3pm they admitted me to the hospital and put me on Magnesium Sulfate. Not very fun. It burned going in and made me feel like my chest was on fire. By 7:30pm I was dilated to 7cm and 60% effaced. The stopped the Mag and gave me an epidural. We all thought I would deliver that night.
By about 9pm my contractions had stopped and I hadn't progressed anymore. They kept the epidural in for another 24hrs "just in case". On Dec 12th, I was moved to the High Risk ward and told I wasn't going anywhere until I delivered my babies. For the first 24 hours in HR, I was only allowed clear liquids and still had a catheter. After that, I was allowed to eat solids and had to use a porta-potty next to the bed. I complained for a week because I could barely fit on that to relieve myself. They finally allowed me to use the normal bathroom. Thankfully, the hospital had super-sized gowns so my bottom wasn't swinging in the wind.
There I stayed until Dec 29th. The docs did an amnio and told me my babies were mature enough to be born. They said I could wait, but they wouldn't advise it since the girl twin was taking up all the resources and it could become fatal for the boy twin. We decided to induce. I waited until 2am on the 30th for a bed to become available (all those millenium-planned babies were coming into the hospital in labor). At 8am they started a pitocin drip and gave me an epidural. I had made it VERY clear to everyone that walked into the room that I absolutely refused to have a C-section unless someone was in danger. Thankfully, this was an upwardly mobile hospital and they totally agreed with me.
So, with no further complications, no pain and minimal pushing, Baby A was born at 11:12am PST followed by her brother at 11:25am. I did not have any tearing or an episiotomy and have only had the usual cramping (like period cramping) for about 3 days afterwards.
I hope this gives some of the larger women encouragement that a natural birth is possible.
Leslie A's Story (fraternal twins, gd, vaginal birth)
Kmom's Notes: Note that this mom used 'serial induction' successfully (try inducing with pitocin but do not break bag of waters; if no labor after x hours, go home and try again later--often labor is jumpstarted in between labor tries, or the 2nd induction 'takes'.)
Birth Story
Conceived one cycle after a miscarriage (single baby). Midwife suggested that fertility is enhanced after miscarriage; thus the twins. Twins do not run in my family! Spent much of the pregnancy terrified that I'd lose one or both of the babies.
Difficult pregnancy with bleeding in first and third trimesters and pre-term labor starting at 22 weeks. On bedrest for last half of first trimester and for third trimester. Anti-contraction medication in third trimester which made sleeping and concentration difficult.
Nurse Midwife was great, no size bias, mild GD was "no big deal." Had many (10 or so) ultrasounds to check position of twins, growth rates etc. Did not have many other common tests (e.g., no amnio, etc.). I was a very proactive patient and did a lot of reading and Internet research on twin pregnancy. In addition, we took a childbirth preparation course for parents of twins as well as a Bradley course.
Midwife talked me into an induction in week 38 (considered full term for twins). Spent twelve hours on pitocin drip--no significant contractions so midwife said I could go home. Went into labor on my own four days later (38 weeks, 6 days gestation).
I called my doula after labor seemed to have started. She came over to our home and stayed with me until my labor seemed productive. We went to the hospital after I'd been laboring at home for about six hours. At hospital I walked a lot and used the whirlpool tub. Labor did not progress very fast. At about hour fourteen, my blood pressure suddenly started to shoot up (no high blood pressure before labor). Midwife strongly suggested an epidural since they bring down blood pressure. I agreed. Pitocin was also started and she broke the water of the first twin. Meconium was present so things became more urgent (pitocin turned up, etc.) Scalp monitor attached to first twin. After this point my midwife stayed by me the entire time and was very comforting and reassuring.
Was fully dilated at hour twenty-two and was wheeled into C-section room (standard procedure at the hospital for multiples) for the birth. The backup OB came into the C-section room (still carrying her purse!) and told my midwife she could handle it on her own. Pushed for three and a half hours for first baby. I was very tired so I "let" midwife use vacuum extraction for first baby who had already crowned. Midwife broke water of second twin (also had Meconium) and attached scalp monitor. After about fifteen minutes I started pushing out the second twin. After about three pushes she was born. I did not have an episiotomy, but I did have some very minor tearing which required three stitches. The placentas were fused and I had trouble birthing them so midwife had to "dig around" a bit to get them out. Our doula took video of some of the labor and the final stages of pushing and birth so I have an accurate record! I was a bit "out of it" at the time!. I did watch a bit of the actual births in a mirror, although I had to close my eyes much of the time to concentrate on pushing.
Our babies were healthy, although M. had a bit of fluid in her lungs which was suctioned out. She nursed well from the beginning. H. had a bit of trouble with latching but learned within three weeks or so.
Overall, I am pretty satisfied with the handling of my pregnancy and birth. I'm very glad that I went with a midwife (recommended by Kmom, BTW) and that we used a doula. The midwife was much more liberal in her approach that I think an OB would have been and the doula was invaluable during labor, since she allowed my husband to focus more on me and less on being my coach.
Lisa Z's Story (twins, diet-only gd, vaginal birth)
Kmom's Notes:
Birth Story
My story, despite the fact that I gave birth to twin boys, is actually rather boring (thank God!). I did develop gestational diabetes very early on in my pregnancy, and I was expecting that to happen for many reasons (family history, my weight, the fact that I was carrying twins - all increase risk). However, I was able to control my GD through diet and it proved to be not much more than a minor inconvenience during my pregnancy.
I became pregnant with the help of Fertinex and IUI (Intra-Uterine Insemination). I suffer from PCOS, and do not ovulate without pharmacological assistance. I did conceive once before with the help of fertility drugs, but it was an ectopic pregnancy, which we were able to abort with drugs and managed to avoid any kind of surgery. At the beginning of my pregnancy I weighed 308 pounds. At the end, I weighed 323. After delivery, I was down somewhere in the 280's, but alas, that was short-lived, and I am now back up to somewhere around my late pregnancy weight.
As for my labor - my water broke 2 days shy of 36 weeks. I went to the hospital and basically sat around a lot waiting for labor to start. About 12 hours after I checked into the hospital, the contractions started. A couple of hours later I had an epidural, which came out and had to be redone. Because of this, they gave me MEGA-doses of meds, which caused me to be completely paralyzed and numb from the waist down. My dh and I fell asleep until the doctor came in early in the morning to check me (which required both my OB and my dh hoisting my deadweight legs into the air so that he could examine me) and promptly announce that it was "showtime." He had me start pushing in my labor room, but once the 1st head appeared, I was taken to the operating room, which is standard precautionary procedure in multiple births.
My delivery progressed very normally - Baby A arrived after not much more pushing, and Baby B, who had been breech until then, flipped his little self around to be delivered head first. It took 23 minutes and the help of forceps, but both boys were delivered vaginally and in perfect health - 5 lbs. 12 ounces and 5 lbs 13 ounces! I took them home with me 2 days later.
Kathy F's Twin Story (insulin-dep. gd, premature labor, vaginal birth)
Kmom's Notes: These are Kathy F's 6th and 7th children. Several of her other birth stories are below. They include homebirth as well as hospital birth.
This story was very long; it has been summarized. The major summarizations were placed into [brackets], although there were minor abridgments throughout.
For those facing a complicated pregnancy or long-term bedrest, there is a terrific organization called Sidelines that can help with information and support. www.sidelines.org is the website for further info.
Birth Story
We found out we were having twins at 10 weeks during a routine ultrasound at my first OB appointment. We were ecstatic! We had wanted 7 children, but knew that my 6th pregnancy would have to be my last due to the physical problems I was having. My husband was with me, so we learned of our double blessing together! We were getting our seven after all!
At 12 weeks I started bleeding. A gush one morning frightened me very badly. I was put on partial bedrest and the bleeding changed to constant brown spotting within 24 hours. This continued until the 18th week, when all spotting finally stopped completely.
I had been thrilled with my OB's care of my last baby (#5) but this pregnancy was different. My OB was a naturally quiet person, and wasn't as communicative as I felt I needed with this unusual multiple pregnancy. I also couldn't shake the feeling that things were going to be complicated. I wanted a specialist, so at the end of my fourth month, I changed to a perinatologist. It was a very smart and important decision, and I believe it was instrumental in bringing my girls strong and healthy into the world. My new docs had me come in each week and were very proactive in their care, looking to catch problems before they arose.
Starting around the end of the 4th month (as I changed doctors), I began having constant contractions, i.e., 'irritable uterus'. Until Oct. 4, they weren't doing anything to my cervix. 3 weeks before then, I'd had a fairly new test called a "fetal fibronectin" test, where the fluid around the cervix is tested for a certain protein that apparently is always present when a woman goes into labor. If none of this protein is found, it's almost a guarantee that the woman will NOT go into labor in the next 2 weeks, but if the protein is present, there's a 17-40% chances (depending on what study is used) that the woman is going into labor in the next week or two. This protein was present for me both 3 weeks previously and in another test 1 week before the Oct. 4th date. This test, plus everything else, caused my doctors to put me on home-monitoring and complete bedrest for the duration of pregnancy. I was able to use the bathroom but that was all.
With home monitoring I had to strap on a contraction monitor for an hour and just lie there while it recorded any contractions. Then I would place the monitor into the base and 'fax' the recording to the monitoring center at the hospital where it would be checked. I never had more than 2 contractions in any given hour. In fact, I never did get to 6 an hour, which was the benchmark for labor my doctors had set. A couple of times that last week I had 3 in half an hour but then it would stop. My contact nurse agreed that I didn't fit the criteria for labor. I know it didn't FEEL like labor, and I'd had 5 children before this and had a pretty good idea of what that feels like! But this pregnancy ended as differently as everything else about it.
On Oct. 4, I got dressed and went to my regular weekly appt. I had contractions, but they didn't feel any different than usual. The week before I was barely dilated to 1 cm and not effaced at all. We did a vaginal ultrasound to see how my cervix was going. I knew there must've been big changes when the tech's expression changed from a smile to a carefully guarded one. The doctor was called in immediately and my cervix checked the usual way. Turned out I was dilated to 3 cm and 50% effaced. "Well, you're sure not going home," the doctor informed me. "We don't know where you're going, but you're not going home."
We were having an electrical storm that morning, so they couldn't air-evac me to my insurance's choice of hospital 30 minutes away, and they weren't going to risk an ambulance ride so I got to go to the hospital of MY choice right next door to the doctor's office. Once admitted I was put on monitors, and was definitely in active labor, having contractions anywhere from 5-12 minutes apart. Standard for me for the first 5 cm of dilation. I was put on Magnesium Sulfate to stop the labor, and since the Mag was somewhat slower acting, was also given a shot of another tocolytic (not terbutaline). It did the trick. Wed. night I went into labor again, had 7 contractions in an hour. They again gave me the tocolytic, raised the Mag to the maximum, which again arrested the labor even though I was not dilated to 4+. [I asked for and got a catheter because getting up brought on the contractions.]
I have a strong belief in a personal loving God, so after they did all this and left me alone in the darkened room I laid as still as I could and prayed, tears running down my cheeks. My prayer (and fear) was so intense I felt as if I was standing before the throne of God, and beseeching Heavenly Father with all my heart to please stop the labor. Please give me and the babies time. [I felt his love, but that I was praying for too much time that He couldn't give because of other complex, long-term factors.] I prayed for just a few days, just enough to let the steroids work on the girls' lungs and help them develop more completely. I felt a great peace, a great sense of surrender, and commitment to accept His will and not fight it. In a very real sense, I felt Him stop the labor. The medication I had been given was his tool. The labor stopped because Heavenly Father heard my petition and granted it. I know this with all my heart.
About 3x a day the doctor wanted a monitored reading of the babies' heartbeats. This was an extremely difficult thing to do because I had to try and stay completely still--not even scratch an itch---or the whole thing would be thrown off and I'd have to do it all again. [The sessions could last an hour or more.] My arthritis in my hips was aggravated by the pregnancy and with the Mag relaxing my muscles it made the arthritis even more painful. The pain during these days was excruciating, perhaps the worst pain I've ever experienced in my entire life. Through prayer and contemplation I was strengthened and found this time to be one of great joy and communion with the Spirit in spite of the pain. I also made a game of being as friendly and kind to the nurses as I could. Since I had to be there, I figured I might as well see if I could make their work as pleasant as possible.
While in the hospital on bedrest, my Gestational Diabetes (developed at 28 weeks) was uncontrollable by diet alone. {Kmom note: Some tocolytic drugs, while a necessary evil for some, do tend to increase blood sugar, as do the steroid shots she was given to mature her babies' lungs. No wonder she needed insulin, but it was a small price to pay for the necessary meds in this case.} I was put on insulin, just two shots a day, long-acting, and the lowest dose. That took care of the problem.
[By the following weekend, my Mag dose was lowered, I got bathroom privileges, and needed less monitoring. But the next week they increased. I told the nurse. Things were feeling different. I didn't want to admit it to myself, but I had a gut feeling my time was nearly up. Early Tuesday morning, about 6:45 a.m., I got up to use the bathroom and before I was even standing I felt my water break. I called my husband first before even calling the nurse so he could arrange for care for the other kids and get to the hospital. After I went to the bathroom, I pushed the button.] It was a funny tableau--me standing there with fluid running down my legs and 3 nurses standing in the doorway looking at me. "I think my water broke," I said. "Yes, I can see that!" said one of the nurses. Then controlled chaos ensued. We were all cheerful and joking a bit, no point in being fearful. I had been receiving the absolute best care from the doctors and nurses, the NICU was a level 3, and advances in neonatal care made the chances of everything being fine as high as they could be.
The nurse wanted to get a monitoring strip on the babies but we couldn't find them. We could find echoes of their heartbeats but couldn't pin them both down at the same time. Pretty soon the u/s tech was called in to find them. Turned out Baby B was lying transverse on top of Baby A, who was vertex. But both were fine. Because of their position and their borderline weights--barely 1500 grams---the doctor said a c-section would be best. That was fine with me! I'd already decided that whatever the doctor wanted to do, I would agree to. I knew I had the best perinatologists in the state and wasn't about to second-guess them! That was why I switched to them in the first place.
The doctor did want to give me a couple of hours without the Mag to see if the labor was going to continue. [It didn't stop, but it never got regular either. I had some HARD contractions after my water broke, but they were never regular. I was very controlled during labor, never making a peep, and that plus the irregular contractions confused the heck out of everyone. I did tell them after about an hour that labor wasn't going to stop and she'd better get the doctor and get things ready, but then I let them give me some Demerol and it became difficult to communicate. Those hard but irregular contractions (never more than 3 or 4 in any hour) had been doing a LOT, then I had a really hard one down in labor and delivery. The nurse there KNEW, especially since for once *I* didn't know, but she was right---I was not only at 10 cm but baby A wasn't interested in waiting for the doctor or the c/s! (I've always known and told the nurses when I was at ten---my contractions followed a set pattern in all my other labors, but the Mag really threw that pattern off this time.) The nurse called for the doctor, stat, and things really got moving.]
I was wheeled in the O.R. and prepped. The doctor told me that after baby A was delivered vaginally, we could still do a c/s for baby B. The risk to her was still there. But then the doctor did a quick ultrasound to determine the position, and another miracle was discovered. Baby A had come so far down the birth canal on her own, she'd given baby B enough room to maneuver from transverse to vertex (head-down)! My husband and I were thrilled; it took me a few seconds before I realized I wasn't going to have a c/s after all.
Baby A was born with one tiny push from me, and my goodness, she was protesting!! What a cry! She was LOUD!!!! The doctor told me to wait for another contraction, but they'd been so intermittent that after waiting 5 minutes or so, I just decided to push anyway. It took a few minutes, but baby B was born 9 minutes after baby A and was as LOUD as her sister!! They both had Apgar scores of 9, 9!! I'm still amazed at that. They were 3 and a half and 4 pounds, respectively, and 16.5 and 17.25 inches respectively.
They were in the NICU for a week, then in a level 2 nursery for 2 more weeks, then discharged from the hospital on apnea monitors. They were on IVs for just a couple of days while the Mag was flushed from their systems. Then when we started bottle-feeding them and they did so great the IVs were removed. They also had prongs for extra oxygen in their noses for a few days, and received small amounts of caffeine for a week or so to help them because of Apnea Bradycardia (breathing lapses and slow heartbeat) episodes. They never had to be intubated or have gavage feedings, which is amazing for 31 weekers. The girls are now 3.5 months old and are 11 and 12 lbs. They are both remarkably healthy.
There was one major complication with the twins, and I'd like to encourage EVERY parent of a preemie, no matter how big, to get their eyes checked for Retinopathy of Prematurity (ROP) both within the first weeks of birth and absolutely by the 37th week. That 37th week is critical. You may end up saving your baby's eyesight by taking the time. In my hospital, they routinely check preemies born 32 weeks or sooner. One of my babies had ROP, stage 3 (stage 4 means blindness). Laser surgery corrected the problem. Her 6-week checkup after surgery was last week and her eyes were declared perfect! It is obvious to us that she is seeing very well, is tracking, etc. ROP doesn't happen to all preemies, and happens less the older and bigger they are. But you never know, so get their eyes checked to be on the safe side! The American Pediatric Association only recommends routine screening of preemies 28 weeks or less, and 1500 grams or less. My daughter was older and bigger and would be irrevocably blind if it weren't for the more liberal policies of my hospital's NICU.
The afternoon of the delivery I had a tubal ligation, since my body is just not managing pregnancy well anymore. My last child before the twins was born at 36 weeks, and with the insulin-dependent GD and the arthritis, it just would be really pushing it to risk getting pregnant again, both for me and any future children. I've also developed a hernia, either umbilical (bellybutton) or incisional (from the tubal ligation), and will need surgery soon to correct it. [This may be from the multiple pregnancy or not but I probably won't ever know for sure.]
Both girls are very cheerful and full of smiles. We are enjoying them immensely. One is sleeping through the night consistently but the other is still waking up at least once or twice a night. Ugh. But soon they will be out of our room and in separate cribs. I'm looking forward to it! :-) Although I forgot to ask how the placentas looked because I was too drugged, they were completely separate and it is obvious by looking that my girls are definitely fraternal twins.
Mary S's Story (antiphospholipid antibody, twins, premature, vaginal birth)
Kmom's Notes:
Birth Story
I should begin by saying that I have a fairly rare condition called antiphospholipid antibody syndrome, also known as Lupus Anticoagulant (although I don't have lupus and this isn't an anticoagulant, so go figure). What this means is that my blood clots too easily while I'm pregnant. In order to keep blood clots from forming in the umbilical [cord] and killing the baby, I take two shots a day of blood thinner, Heparin, and a baby aspirin.
We found out we were having twins at our first ultrasound at 6 weeks. No twins run in our families so we were very very happily surprised to find out we were expecting two instead of one. My pregnancy was relatively uneventful until I was 25 and a half weeks and we had a scare with some BH contractions that didn't want to stop. They did a fetal fibronectin test which showed positive that the boys were more likely to be born in the next two weeks so the doctor on call thought that steroids to mature their lungs would be a good idea. Since the two shots are given 24 hours apart it's a darned good thing he did.
April 30, at 28 weeks to the day, I went in to work for the first time in two weeks after being on partial bed rest after the Easter incident. About 8 a.m. my tummy was a bit achy; I thought it was gas. I went to the restroom about 8:45 a.m. and realized I had lost my mucous plug. I called my DH to come get me, then I called the doctor's office, that was at 9 a.m. By 9:30 a.m. I was at the hospital and having fairly painful contractions every couple of minutes. They put in an IV and gave me a shot of Terbutaline to stop the contractions, then did an ultrasound. The boys were fine---baby A still vertex and baby B still breech.
Fifteen minutes later a resident comes in to check me and I was already complete. In the meantime the Terb had kicked in and the contractions had stopped. They put me on a gurney and rushed me up to an operating room (all twins are born there, and there was no point in stopping in Labor and Delivery). My DH disappeared off somewhere to be covered in paper products and they start trying to get a second IV into me.
Meanwhile my doctor shows up. I was a happy girl at this point. I love my doctor and didn't think she'd make it in time. She tells me that since I'd already had my morning shot of Heparin I couldn't have a spinal or an epidural so no pain meds for me---and if they couldn't get the breech baby out vaginally they'd have to knock me out and do a c-section after delivering baby A. Not what she, or I, wanted to do with me on high doses of blood thinner.
Sometime during all the hubbub DH was let into the room, thank goodness. So Dr says, "OK, with the next contraction go ahead and push." I'm like, "What contractions, they gave me Terb downstairs." Have you ever seen a doctor explode? It's kind of fun. "WHO GAVE HER THE TERB?!!!????" So, now we get pitocin to start things back up, it's right about 11:30 (I know this because there was a clock right over the doctor's head and I found myself watching it more than once) and about 5 minutes later I feel a cramp. She says go ahead and push, so I pushed 3 times and with a HUGE gush of water out squirms baby A at 11:30 a.m. Apparently the water shot about 8 feet out; I distinctly remember my DH standing up and looking and saying, "Oh my!" I think we soaked most of the staff. So, time to get baby B out and they tell me to push again, but he's breech so the resident doing the delivery has her hand in me up to about the elbow trying to grab him and pull him out. That was NOT pleasant, but one push later out came Will with an even BIGGER gush of water (Ha! Got the rest of them!) at 11:44 a.m.
So, less than 4 hours start to finish and two beautiful, if tiny, boys to show for it. Honestly, the worst part was them messing around and delivering the placentas and checking me for tears, all while I just wanted them to stop fooling with me so I could see my boys. Everything was fine, though, Jon was crying and breathing on his own and Will was flailing his little legs around. I didn't have any tears and didn't even get a single stitch.
I wasn't planning on natural childbirth, I was all about the epidural, but it was so quick it really wasn't bad at all pain-wise. I was too busy being worried and too rushed to have time to worry too much. Heck, the delivery wouldn't have hurt at all if everyone had kept their hands to themselves. I was up walking around less than an hour later and was able to go by the NICU to see them on the way to my room. They were little, but healthy. Both are now doing well.
You can see their web page and my full birth story at: http://pages.sbcglobal.net/atomicpossum/boys/boys.htm.
Stephanie's Story (PCO, gallstones, unmedicated vaginal birth)
Kmom's Notes: Although it does NOT occur with all PCO moms, there are some who develop problems with milk supply, even when being extremely proactive. Other PCO moms are able to breastfeed without problems; no one knows currently why some PCO moms are affected and others are not. More research is needed, but little is being done.
Birth Story
We had a very healthy pregnancy and uncomplicated vaginal delivery which I attribute primarily to two things. First, we were careful to find a size-friendly practitioner who didn't treat me as if I were a train-wreck waiting to happen. Her exact words at our initial visit (8 weeks pregnant) were, "Yes, you have some additional risk factors, but right now you're fine and we'll assume everything is going to be fine. We'll just keep a close watch on you." We chose an OB rather than a mid-wife because of my risk factors, but she was as committed as we were to having as natural a pregnancy and delivery as possible.
Second, we did everything we could to have a healthy pregnancy, following the Bradley method of education, diet and exercise. I think this really made a difference and allowed me to have an easy pregnancy. In fact, I think the fluid retention/blood pressure problem I developed could have been avoided had I been able to continue the Bradley diet. (The low fat diet I had to follow for the gallstones didn't have the amount of protein I think I needed.)
I went into labor 4 days after my due date. Latent first-stage labor was fairly straight forward and slow, as is typical in first-time mothers--about 15 hours to get to 6 cms. I didn't do anything special for pain management other than using the techniques I had learned in class and through my reading. Mostly I tried to remain physically and mentally relaxed, used even abdominal breathing, and lots of visualizations. At 15.5 hours, I got the urge to push, but had only dilated to 7 cms. The next 20 minutes were especially difficult. I had to try NOT to help my body push, and the pain was very intense as my cervix finished dilating and the baby began her descent.
Fortunately, I went from 7 cms to 10 cms during those 20 minutes and was then told I could push. It took one or two contractions to get the hang of pushing, but I pushed my daughter out in only 15 minutes! The only intervention we had was an episiotomy (2nd degree with no tears or extensions), and our daughter was and is wonderfully healthy.
We had our first breastfeeding attempt in the delivery room, and kept our daughter with us for about an hour. Then my husband accompanied her to the nursery, where she was weighed, measured, and bathed (he dressed her for the first time, with a little help from the nursery staff). She roomed in with me during my hospital stay and we came home 2 days later.
Things I didn't anticipate: how much delivery would hurt, how annoying hemorrhoids would be post-delivery, that my pelvis would hurt after delivery as my bones began to move back to their pre-pregnancy positions, and how much more I could love my husband and daughter as the days go by. P.S. We're planning baby number 2 next year!
Megan's Story (gallstones, pre-eclampsia, premature induced vaginal birth)
Kmom's Notes:
Birth Story
Summer of 2002 and it was HOT! [I] started swelling and showing signs of pre-eclampsia at about 32 weeks. Doctor told me to drink a gallon of water a day to make sure I stayed hydrated. Other than that, no bed rest or any special instructions.
Woke up [one] Wednesday morning...with terrible epigastric pain. I went to work feeling horrible and started to drink my gallon of water but couldn't keep it down. I left work early and called the doctor's office. They called back about 2 hours later and when I explained the situation to them, they said to go to the Labor and Delivery floor of the hospital for IV hydration. I received 1.5 liters of fluids before I passed a small amount of urine, my blood pressure was climbing, and they admitted me to the hospital. Thus began my nightmare!
I had an abdominal ultrasound and found that the pain I was having was from gallstones. Each day for the next four days, besides being poked, prodded, and drained of enough blood to float a battleship, the doctor on duty would come in and tell me that I was going to be induced that day. What an emotional rollercoaster!
After four days of Magnesium Sulfate and two betamethazone injections, I was induced on Saturday at around 5 p.m. The labor and delivery were actually the easiest part of my whole hospital stay. I was given medication for vomiting and it knocked me out for a while and then [was] given Stadol for my gallbladder pain, which also knocked me out. When I started having back labor, I was given my epidural and I slept for a while.
When the doctor checked me at around 5:15 a.m., I was only dilated 5 cm but I was having a lot of pressure. He checked me again and told me to push while he was checking me and I went to 8 cm. My son was delivered about 8 minutes later!
He was having a little trouble breathing so he was taken to the NICU after a quick peek and I didn't see him for more than 24 hours because I couldn't get out of bed. After that, my blood pressure kept going up and up and I was being given IV medication, couldn't have visitors except my husband, no TV, and couldn't open the shades for fear the sunlight would overstimulate me. I had these bumpers taped to the bed rails in case I went into seizures! My platelets were next to nothing from the pre-eclampsia and each blood pressure check (every 15 minutes) caused my arm to bruise terribly.
I was transferred to the postpartum unit and was put in a room with a girl who was taking her baby home. My primary doctor called me on the phone and told me that I was not allowed out of bed unless my blood pressure was under 160/90. Every time the nurse came to take my pressure, I'd be so anxious about it being high; it almost always was. Every cell in my body was aching for my baby and I couldn't see him.
My pressure started to stabilize over the next couple of days and on Thursday, my eight day ordeal was over! As happy as I was to leave, I didn't want to leave my son there. I was not supposed to drive for two weeks but starting the next morning I was at the hospital for about 6 hours a day until he came home 13 days after his birth.
He's [now] a happy, healthy baby with a very happy mommy!
Leah's Story (gallstones, posterior baby, vaginal birth, postpartum hemorrhage)
Name
to be used in FAQ: “Leah” Age:
21
Pre-pregnancy Weight or Dress Size: 275 lbs.
Baby Info: 7 lb., 14oz. 20 inches GIRL!
Wt. Gain in Pregnancy: initially lost 30 pounds, gained that back plus maybe 10.
Infertility Problems? I got pregnant on our first try
Any Complications: Post Partum Hemorrhage, Strep B, OP Baby (back labor)
Type of Birth: Vaginal
Birthplace: hospital Provider: OB
Breastfeeding: I breastfed for 6 months
Special Notes on Pregnancy: I had gallbladder attacks during my pregnancy
Kmom's Notes: An induction is an induction, whether it's by "natural" means or by the artificial drugs used in the hospital. When you rush labor or try to strengthen it artificially, contractions tend to be harder and you risk the baby not being in an optimal position for birth. This is what happened here.
This mom did an an amazing job of lasting through a long hard labor with an OP (occiput posterior, "sunny side up," i.e., baby facing towards mom's tummy) baby. This is not an optimal position for labor and birth, and it can be extra painful too. Fortunately, it all worked out; although many posterior babies end up being born by cesarean, some (like this one) do end up coming up just fine despite being posterior.
Birth Story
My birth story can be found online at http://www.ordinary-girl.nu/princess/birth.html
Summary:
After 3 months of marriage my husband and I decided to get pregnant. I ended up
getting pregnant on the first try. Everything was textbook except for the
gallbladder attacks that I was having (quite severe) which I had BEFORE I got
pregnant also.
I was 6 days overdue when I drank CASTOR OIL to go into labor. I ended up having
a very long labor (as my daughter was OP), and at 8cm a plateau for hours.
I
was threatened with either a c-section or an epidural. At that point I was so
exhausted and tired (it had been Sunday evening when I pushed myself into labor
and by then it was Tuesday Morning) I went ahead with the epidural and had my
daughter 2 hours later. I also had
a post partum hemorrhage.
In
a way I felt like I had failed at my attempt to go naturally, but my instructor
told me that I made the best choice with the options I was given. I left with a
good feeling, and look forward to my next pregnancy and birth. The second time I
hope I'll be wiser, more patient, and I'm definitely still going to go natural.
Karla B's Story (gd, non-induced 41 week vaginal birth)
Kmom's Notes: Note that Karla was 'allowed' to go to 41 weeks before facing a mandatory induction, although that was easier because her baby was of average size and she did not need insulin in the pregnancy. However, even so, it's unusual for gd moms to be 'allowed' to go to 41 weeks, but this story shows that there ARE providers out there who are open to this if this is important to you.
As far as losing weight after gd goes, proof is small and mostly speculative, not definitive. Certainly, Kmom strongly agrees that ALL women with gd should improve their diet and exercise levels; if this helps you lose weight, great! For some women, losing weight probably will help and does make sense. However, for some women who are chronic yo-yo dieters, yet another diet may make things worse. Losing weight should not be pursued regardless of the price (i.e., drugs or weight loss surgery often introduce more risk than they alleviate), but it certainly IS an option worth considering. However, individual circumstances and dieting history must also be taken into account. For some women, maintaining a stable weight while improving diet and exercise may be a more sensible option. For others, losing weight is probably most sensible. More on this debate will be found in the upcoming section on GD: Future Risk of Diabetes.
Birth Story
I'm happy to say I had an easy and uneventful pregnancy. At my first visit, my midwife said not to worry about weight too much, as most women seem to gain the amount that is right for them. She also explained that many women who are overweight before getting pregnant often don't gain a lot during pregnancy, and sometimes even lose a little weight. I never had any morning sickness, but during the first trimester my appetite wasn't great so I didn't gain a lot of weight. The only way that my weight really affected my pregnancy was that I sometimes had to remind them to use the larger cuff for an accurate blood pressure reading.
Around 24 weeks, I failed the one hour GTT and was referred for the three hour. I failed that too and was diagnosed with gestational diabetes. At this point I had only gained about 9 pounds, and later learned that low weight gain can be a symptom of gestational diabetes. While I was very upset to be diagnosed with GD, I decided that there were worse things that could happen in pregnancy, and that I was going to learn as much about it as I could so that I could be effective in managing the condition. The first thing my midwife said to me after I was diagnosed was, "You know you did nothing to cause this, right?" I was so relieved to hear her say this, as I had been having thoughts like, "I should have lost more weight before getting pregnant" and "Did I eat too much sugar?"
I was happy to find out that I could still work with a midwife (with occasional visits to an OB), and that I could have a healthy, enjoyable pregnancy and delivery despite GD. I learned how to test my own blood and was put on a special diet that was tailored specifically for me. I never felt deprived on the diet, and in fact sometimes had a hard time eating all the food that I was supposed to. I had very few food cravings after starting the diet too, which was a relief since I feared having to deny my cravings for sweets. During the first week of the diet, I lost a couple of pounds, but then gained them back and stabilized at a 9 pound weight gain. My dietitian expressed a little concern that I wasn't gaining weight, but my midwife wasn't worried since she knew I was getting adequate calories and nutrition. I also found out from my sister (a dietitian herself) that many GD moms don't gain any weight after starting the diet, but if they continue to lose weight, they should see their dietitian to add extra calories. I feel that as a result of the diet, drinking lots of water, and not gaining much weight, I managed to avoid some of the common complaints of pregnancy, such as swelling and constipation. I was even able to wear some of my regular clothes (mainly tops and knit pants) throughout my pregnancy. In fact, looking back, I felt better during the 2nd and 3rd trimesters than I did before getting pregnant and than I have since having my baby!
As my due date neared, I worried a little about having to be induced or have a c-section. My midwife assured me that my clinic did not routinely induce GD moms before their due dates, so that was a big relief to me. I enjoyed some of the extra attention I got (such as extra ultrasounds and hearing the heartbeat during non-stress tests). I told my midwife that I'd rather not be induced if possible, and she shared my opinion. She felt that many women are induced too early, and since their bodies aren't ready, they labor longer and harder and then often end up with a c-section. But, she said the fact was they wouldn't be able to let me go for too long because of the diabetes. She consulted with one of the OBs, and they decided that since my GD was in such great control, they'd give me a week past my due date before they would induce me. I've since learned this is pretty unusual for GD moms, so I was quite thankful for their willingness to work with me.
I also talked with my midwife about the possibility of my baby having low blood sugar and needing glucose water. I planned to breastfeed exclusively and wanted to avoid any artificial nipples. She said that if the baby did indeed have low blood sugar, I would be able to breastfeed to try to resolve the problem. Only if breastfeeding didn't resolve the problem would they consider giving glucose water. This news was also important in making me feel much more relaxed and confident about my birth plan. I'm glad my midwife and I talked about these issues, and even more glad that she and I agreed on all the things that were most important to me.
The day before I was supposed to be induced, I went into labor around 2:30am. I went to the hospital around 10:30am. The nurses and the midwife on call all seemed very impressed that I had only gained nine pounds, and they kept commenting on how great that was. I spent most of the day walking or in the tub, and the midwife spent several hours with me, helping me through contractions. Unfortunately, I had "screamers" in the rooms on both sides of me, and while I tried to ignore them, it did make me anxious about what was to come. Thankfully, I managed to deal with my contractions pretty well though, and had no medication for most of my labor. Sometime around 5pm, we decided she would break my water, at which point the contractions became much stronger and closer together. She offered intrathecal morphine (the "walking epidural"), and I decided that I would accept it (although I had been terrified at the thought of having a needle in my spine!). I went from 5cm to 10cm in less than an hour, and when I announced the intrathecal morphine wasn't helping anymore, they told me that's because it was time to push!
I pushed for 50 minutes (but it seemed like 5 minutes). Shortly before my baby was born, they asked me to turn onto my side and got out the oxygen mask because the baby's heartbeat was dropping. I never needed the oxygen since moving onto my side was enough to resolve the problem (but it turned out the baby had the cord wrapped twice around her neck). The midwife suggested an episiotomy because she feared I would tear into my urethra. I agreed and she made a small incision. Within a few more contractions, my baby girl was born at 6:45pm. She was just perfect, and was only 7 lbs 13 oz (not bad for a 41 week baby of a GD mom). (They had predicted 8.5 lbs at my 40 week appointment, so of course I had visions of a 9.5 lb baby!). She didn't have any blood sugar problems and took to breastfeeding like a pro.
So, I'm happy to say from firsthand experience that plus size women can have easy, healthy, and enjoyable pregnancies. Even though I did have a complication that labeled me high risk, it was something that was very manageable, and in the end it didn't have a negative effect on my pregnancy, labor, or delivery (and in fact I'd say it even had a positive effect in making me healthier than I would have been otherwise). Thanks for letting me share my story, and I hope it helps other plus size moms (especially those who develop GD) to feel better about their situation.
Suzanne's Stories (PCO, unmedicated vaginal births, gd with #2)
Kmom's Notes: Please note this PCO mom did not have trouble breastfeeding, nor did she get high blood pressure. PCO does not have to equal these problems! Also note that this mom went from 5 cm to complete (10 cm) within 15 minutes of getting into warm water in her first birth, and that it was also helpful in the second birth.
In her second birth, despite developing insulin-depending gd, Suzanne had several things going for her. Her first baby was born vaginally and naturally, making a vaginal birth this time more likely. She got good control of her blood sugars, plus a supportive set of providers (and when she found an unsupportive one she switched!). Her baby was average-sized, which makes them more willing to give a trial of labor. She had a midwife and doula for her birth, both of which tends to cut the c/s rate significantly, and she was able to use water for laboring as well as a standing position for pushing and birth. But SHE was the one who did it, and admirably too!
Birth Story
I am a plus size mom. I weighed 270 pounds at the beginning of my first pregnancy and gained and lost 3 pounds over the 9 months by eating healthily. I had no complications during my pregnancy or birth. Here is the birth story of my first child.
My due date was September 19, I went into labor at 4 AM Monday morning September 18th. I woke up to what felt like light menstrual cramps coming at about 20-minute intervals. I checked the time tried to go back to sleep. I dozed a little until 6 AM then decided to take our dog for a walk around the block (if it was false labor that should make it go away). The contractions didn't go away, this was the day! After the walk my partner and I went to a friend's house to labor and I decided to take a bath in their very large tub. After that we took another walk, I started around the block and the contractions were getting more and more intense. I could walk and talk between, so we were not too concerned. We got back timed the contractions, they were one minute long and five minutes apart. We thought, "Wow, maybe we should go to the hospital." It was about 10AM, I called our midwife and doula, getting pagers for each. The doula called back first. She said I was too jolly between contractions and she would be over in a few minutes.
She arrived and said she didn't think that we should go to the hospital yet. She started to help me through the contractions. My favorite spot was in a big leather chair in the family room. I would lean back, the doula would stroke my hair and my partner would push on my knees in toward my pelvis. At first I could talk between contractions but after a while I didn't want to talk much anymore. Periodically, my doula would tell me it was time to change positions and I would walk around the room. Standing contractions I did mostly hanging off of my partner's neck, with one knee locked and the other relaxed. I also spent some time leaning on a hassock on my knees. The contractions were very painful in that position, so I thought; "these must be working well." I was having double peaking contractions for a while. One would come and I would deal with it, be breathing a sigh of relief and be broadsided by another one. Once I got used to the pattern it was easier to deal with. I breathed through contractions until about 1 PM and then asked the doula, "When are we going to the hospital?" She said, "That's up to you."
I was on my way out the front door as everyone gathered stuff to bring to the hospital followed behind. My partner drove me and the others followed in their cars. The hospital was 10 minutes away and I had 3 or 4 contractions on the way. We left the car and headed for admitting. The doula was right behind us and was there as we headed for the room. It was a very long walk to the maternity wing from admitting, they offered me a wheelchair three times but I declined. I didn't feel like sitting. So we walked down the different corridors stopping for contractions then moving on, up the elevator and finally to our room. The nurse monitored me for 20 minutes with the belts and did an internal and pronounced me 5 cm dilated. During the rest of the labor a hand held Doppler was used to monitor the baby's heartbeat.
When the tub was ready we trotted off down the hall for a soak. My doula and partner stayed with me. I was trying to figure out whether the jets were helping or annoying the hell out of me when I was hit by a contraction that felt very different from the others. I made a sound that came from very deep inside me, a grunt. Lindsey recognized the sound as the one a laboring woman makes when she is completely dilated. She yanked the nurse call-cord and our nurse came running. I was completely dilated. I had been in the tub about 15 minutes, 2 or 3 contractions total. I got out of the tub. They wrapped me in a blanket and off we trotted back down the hall to my room.
The midwife hadn't arrived yet. She had been eating lunch with a friend when we arrived at the hospital at 5 cm. She thought she would have time to finish lunch and then come over. The nurse called her back and told her to get over to the hospital ASAP. We had to wait for her to arrive. The nurse kept telling me that she could deliver the baby, she was studying to be a midwife...but don't push unless you have to. So I huffed through the contractions only pushing a little at the end of each. Not pushing was the hardest part of the labor. The midwife finally arrived I could push. I held on to the edge of the bed and squatted to push. Between contractions they pushed a little stool under my bottom and I would sit and rest. Once the baby came down and stayed down I moved onto the bed with my doula at my head and my partner holding my leg up. I pushed for about 45 minutes total.
My daughter was born at 3:59PM. Her APGAR scores were 9 and 10. Total labor was 12 hours from the first contraction, 6 hours of active labor. I had 2 stitches for "skid marks" but my perineum was intact. I did not need nor want any anesthetic at any point in the labor.
Suzanne's 2nd Story: My second pregnancy and birth were totally different from the first. It took 2 years and 16 cycles of trying to conceive #2. I ended up with a diagnosis of PCO and treatment using clomid to stimulate a follicle, Hcg shot to cause ovulation, then Intra-Uterine Insemination. I found out Dec 23 that I was pregnant. What a wonderful Christmas present!
I started getting morning sickness at about 6 weeks and continued with it until I was 25 weeks along. Then I was diagnosed at week 28 with gestational diabetes. I was shocked and found that my caregivers were all working from scraps of paper and seemed unsure of the acceptable glucose levels. I called around and finally got in touch with an endocrinologist and he assured me that they were following the standard of care. I ordered a book on GD and read up. That helped put my mind at ease. Then I had a goal to reach.
I started testing my blood 4x a day, fastings and 2 hours after each meal. I also would test extra times if I was curious or was feeling a low blood sugar reaction coming on. So I would test 4-8x a day. These are the numbers that we used:
They sent me to a nutritionist who was useless. The diet she put me on...contained too many carbs in each meal and too much food overall. When I cut out all but one carb exchange (~18g) per meal I could almost control the daytime glucose numbers. That turned out to be too little food for someone in later pregnancy. They also lump in the management of fat and salt along with management of carbs and I did not have a problem with fat and salt. The whole regimen seemed to be geared to the elderly and didn't seem to apply much to me. I refused to limit my fat and salt intake (I was losing weight for-goodness-sake!); I did not have a problem with my blood pressure. I was sane about it, but did not limit non-carb foods. I consulted a friend of mine who is a nutritionist and she helped me to choose more whole foods and food combinations That was they key to keeping my numbers good. I began walking .8 mile per day, with a second walk if my numbers were off.
But I lost 12 lbs. in 3 weeks and my fasting glucose number first thing in the morning could not be changed by diet and exercise. So I had to take insulin. I started out with one shot in the evening but that didn't work. Then they had me on a shot in the morning and one in the evening. They also combined regular insulin (fast-acting) and a slower-acting type (NPH). I would load the syringe and take a pinch of flesh near my belly button, poke the needle in at an angle then inject the insulin. It is not as bad as it sounds; the poke doesn't really hurt, but the insulin makes the area of the shot sore for a little while. I had to watch out for low blood sugar reactions, which I had often (shaking, sweating, disorientation). Insulin-dependent diabetics have to eat frequently and keep in mind when the insulin will hit. The dr. warned me that my insulin needs would increase as the pregnancy progressed but they did the opposite. My dosage decreased 2 times near the end.
Getting gd felt like my dreams of another natural birth were going down the tubes. I was referred to an OB who told me, "If you have an 11 LB baby it is an automatic c-section; unless you want to sign a paper stating that a paralyzed left arm [the baby's] is OK with you." She was trying to scare me of my birth but only succeeded in scaring me of HER. I asked this OB about how she would deal with a large baby and it was clear from her answers that she delivers women in the lithotomy position and usually anesthetized When I asked about positioning she said it wasn't quick enough. Translate that as: there is no way to get you onto hands and knees with an epidural. [Kmom's note: These interventions are thought by many to increase the incidence of shoulder dystocia and birth trauma/paralyzed arm the OB is referring to. One of the hardest parts of gd is distinguishing the true risks of the condition from the doctor-caused problems that come from standard management like this.} My midwife on the other hand has delivered 11 lb babies vaginally (not that I wanted to :-)) I wanted that OB to be as far from my birth as possible. (It turns out that this OB gives that same speech to all overweight moms. My feeling is that she is a fatphobe.)
I switched to a different OB who was great and had no problem with standing by just in case the midwife needed her. She praised me on my management of the gd and was not concerned at all that the baby would be too large. From 34 weeks on I did 2 non-stress tests (NSTs) per week and had an ultrasound at 38 weeks. Everything looked fine so I was able to keep my midwife with the OB standing by just in case. The OB was fine with monitoring my insulin and NSTs and letting the midwife do the rest. That was just right for me because my nightmare was to lose my chance at another natural birth. [Kmom note: See, you can too have a midwife in a gd pregnancy! And some midwives will co-manage even an insulin-dependent pregnancy if all is well.] I delivered 6 days before the due date. [There was no pressure from my doctor], she was cool. The baby showed up as 8 lbs two weeks before his due date and they found that acceptable. Also, I was not measuring larger than expected. My gd was very well managed.
My labor started at 8 am. I had 3 contractions in a half an hour. I called my support people and they soon started arriving. I used the same doula I had with my first birth so we slipped easily into the pattern of her helping with my concentration and relaxation. We hung out at the house while my contractions got more intense and closer together. A short walk around the neighborhood was helpful in the beginning but things got going very quickly. I did some contractions on hands and knees or sitting but most were standing and leaning. I breathed normally through the whole labor. We tested my glucose level every hour during the labor. The last test before leaving for the hospital showed low blood sugar and I ate a couple of glucose tablets. This saved me from having to have IV glucose because they didn't know what the dosage was on the tablets. No IV!
When we got to the hospital I was 6 cm and went directly to the tub. I felt the baby drop as I stood to go to the room with the tub down the hall, it felt so good! The contractions were hard but the time between them lengthened and the water made the labor seem like a breeze. I went through transition with a little shaking and burping, then I was ready to push. This is where may labor got really hard. I knew that it was too late for an epidural but I would have had one if it were possible. The rest of the labor was such a breeze that there was no way I would have asked for pain relief. There is no way that I would recommend having an epidural just in case it got bad later.
I got back to my room between contractions and couldn't bring myself to get on the bed. Physically I could have climbed on, but it didn't feel right. I had planned on helping Nicholas "out" and the midwife had agreed but when we got to the room I preferred to stand for the delivery so the midwife warned me that I wouldn't get my wish. I told her I didn't care. Consequently, I delivered Nicholas standing up with one foot on the floor and one knee on the bed. I yelled, "NICK! NICK! NICK! OUT! OUT! OUT!" One nurse, in her 50s or early 60s, was very concerned about me delivering standing up. The midwife told that that is how it was going to be. That nurse came in when she went off shift and hugged me and told me she thought I was "heroic".
I pushed for a while and when I checked for the head I couldn't feel it. I almost lost hope, but buckled down to business. Soon I could feel his head and knew it would be over soon. The midwife stood behind me and passed him between my legs within seconds of his birth. Nicholas was born "in the caul" meaning he had the amniotic sac over his head. The midwife had to break the sac and suction his airway. Nicholas was born at 4:28 PM after 8.5 hours of labor with about 2 hours of it spent at the hospital. I pushed for about 40 minutes. I had a small tear where an episiotomy would have gone, it took 2 stitches. Pushing caused a hemorrhoid that has healed completely. I retained a small bit of placenta which came out at 4 weeks postpartum with a gush of blood but no other problems.
Nicholas had to be fed formula every 3 hours for the first 72 hours because his pancreas was working overtime due to my gd and he had low blood sugar. I used a Supplemental Nursing System (SNS) with a thin tube going down to my nipple from the bottle of formula. I had requested this in my birth plan to avoid having problems with nipple confusion. [He nursed every 3 hours, and while he was nursing I slipped him the tube so he would also get the formula. They added some glucose water to the formula in the SNS because his numbers didn't rise enough at first. After the first 3 days, he has been 100% breastfed.]
My partner's sisters visited me later and I told them, "Get an epidural." I regret that now that the memory of the pain has faded. I am happy and proud that I have had 2 natural births. If I had it to do over I would not choose to use pain meds. Nicholas is 4 months old now. Since he was born everyone has commented on how alert he is. I think that he is alert because he was not drugged at birth.
Laura's Story (insulin-dependent gd, induction, vaginal birth)
Kmom's Notes: Many gd moms find that their blood sugar starts to drop near the end of pregnancy; if they are insulin-dependent, their insulin needs may drop as well (it's important to watch for hypoglycemia if that happens). Traditionally, doctors have taken this as a sign of placental calcification and degradation in 'regular' diabetic pregnancies, and therefore view it as a sign for immediate delivery by induction or c/s. However, it is unclear whether this is truly a sign of a placenta in trouble or not, and especially if the same concerns for 'regular' diabetic pregnancies apply so strongly to gd pregnancies.
One alternative explanation for a drop in blood sugar at the very end of pregnancy is the alteration in hormones that occurs as the body readies for labor. GD is caused by insulin resistance from 5 different hormones produced by the placenta in pregnancy. One of these is progesterone, which tends to peak at week 32 or so and has a very strong effect on blood sugar. However, at the end of pregnancy, the relative balance between estrogen and progesterone changes dramatically; progesterone levels drop significantly in order for the cervix to start ripening and softening for delivery. It seems logical therefore that a gd mom's blood sugar might experience a significant dip as this very strong hormone begins to decrease in the last week or so of pregnancy.
However, few doctors seem to know of or consider this change in hormone balance, and since sudden placental failure is a significant danger of regular diabetic pregnancies, most OBs understandably tend to err on the side of caution. At this time, it is unclear what a drop in blood sugar/decrease in insulin needs means at the end of a gd pregnancy; unfortunately, few doctors seem to be even asking the question or trying to find out.
Also note that Laura had a doula for her induction; although research on doulas during inductions is limited, we know that they help cut the c/s rate by about 50% in non-induced labors, and one small study seems to indicate that they also cut the c/s rate in inductions very significantly as well. Although Laura had to be induced, she was as proactive as possible about it, which probably helped increase her chances at a normal vaginal birth.
Birth Story
Birth story (with photos) can be found at www.deleons.com/birthstory.htm. Below is a brief summary.
Laura developed severe gestational diabetes during the pregnancy and needed insulin to help control her blood sugar levels. Her OB wanted to induce no later than the beginning of week 39, but they were able to negotiate going a few days beyond that so as to be closer to her due date. They did a great deal of research, including a trip to the local health library, in order to be sure that the induction was necessary. They concluded it was because of the severity of her gd and because they were worried about the potential degradation of the placenta (her insulin needs went down at the end of pregnancy and one possible explanation is the placenta degrading, a real risk with regular diabetic pregnancies).
She wanted to go into labor on her own. In order to help things along, she had lots of sex and also took Evening Primrose Oil (EPO), both by mouth and vaginally [both of which tend to help production of prostaglandins]. She did not go into labor ahead of time but these things may have helped prepare her better, since she was already 3 cm dilated when arriving for her induction. She also chose to discuss her preferences on induction with her doctor, and adjusted her expectations of labor to include monitoring and potentially more intense contractions, and possibly needing medication (although she still wanted to avoid an epidural).
They chose to break her waters first, then start the pit later. They found some meconium present. She also needed antibiotics after having tested positive for Group B Strep. They called in their doula after about 4 hours or so. She helped Laura get a bit more mobility and various comfort measures going, and as contractions got extremely intense, they opted for some Fentanyl. Eventually they decided they needed an epidural, but as they were putting it in, discovered she was at 9 cm. Shortly afterwards, she pushed out her baby!
Breastfeeding was difficult at first (see the related story on her website) but eventually they were able to overcome the obstacles and breastfeed long-term.
Kathy1's Story (GD, baby's head tilted, vaginal birth)
Kmom's Notes: Kathy's long days of pre-labor ('false labor') and then stalling at 4 cm for a while was a good clue that something was wrong with the baby's position. Unfortunately, most doctors pay very little attention to this, and breaking her waters may have forced her baby into instead of through her pelvic bones. Adding pitocin on top of that poor position to strengthen contractions pushing baby down may well have caused the damage and bruising she saw in her baby after birth, although of course it's difficult to know for sure. Getting up and shifting position probably corrected her baby's position and may well have saved her a c/s.
Birth Story
Kathy1's first child was delivered vaginally at about 40 weeks after being induced on a mostly unripe cervix. She found labor tolerable until the doctor broke her waters at about 3 cm, and then contractions became very intense and nearly continuous (very common occurrence). Eventually she opted for the epidural as a result, and did get some sleep. During transition, she desperately wanted to get up and move around, but was trapped in the bed by wires etc. and began to feel panicky. She began to feel the urge to push but was not allowed to until dilation finished, and had trouble keeping from hyperventilating. Eventually she began pushing, although it was not very effective due to the epidural. After an hour and 40 minutes of pushing, her son was born, weighing 8 lbs, 14 oz. However, the amniotic sac was not delivered with the placenta as it should have been and the doctor had to go get it, which was difficult, caused a lot of bleeding, and caused her to need a lot of pitocin afterwards.
With Kathy's second child, her father was diagnosed with type II diabetes during her pregnancy, and so she opted to be tested early for gd at 20 weeks. She did indeed have it, but was able to control it through diet only. Because of the gd and the fact that her previous baby had been almost 9 lbs. without any gd, her doctor wanted to induce her at 39 weeks. Fearing a pit induction again, she tried a castor oil induction at 38 weeks instead. The following is her story.
"After having mild, non-productive contractions for 3 days, I decided to try some castor oil in hopes of starting real labor. I drank 4 oz of castor oil with equal parts orange juice about 7 pm. After about 3 hours, I began having diarrhea, which lasted for maybe 2 hours. And then about an hour after it ended, the contractions began. By 1:00 am they were VERY strong and about 2-3 minutes apart, and by 2:00 am I was settling into my labor room at the hospital. I was at 2 cm and 50% effaced.
A friend joined us at the hospital and she and I giggled and talked through the early labor while my husband snoozed. I walked the halls, taking breaks to be monitored for about 15 minutes every hour. The contractions weren't bad at all, and I was having no problem dealing with them. About 9 am I was 75% effaced and 3 cm, so the doctor broke my water to speed things up. The contractions got much harder and faster, and I was really breathing through them, but we were all still in a good mood and laughing and talking between contractions. By about 1 pm I was totally effaced and 4 cm, but my labor had stopped. I was getting very tired by then and discouraged. So I tried to rest and see if things would pick back up. They didn't. After walking and trying various things, we started some pitocin about 4 pm. The contractions got much harder, and after about an hour I started to feel panicky, as it was getting more difficult to handle the contractions.. So they gave me a bit of Stadol to try to help me relax, but it wore off quickly.
Just when I thought I couldn't take anymore, my friend Amy arrived. Amy has been an OB nurse for many years, and is now a lactation consultant and childbirth educator. Needless to say, she knows how to handle a woman in labor! I was crying when she walked in, and I started begging her saying "Please...I want an epidural!!" She said "You don't need one. You need to calm down." She got very stern with me and made me breathe with her through a few contractions. When I got panicky, she'd just get stern again and tell me to look at her. Then a strange thing happened. I relaxed and I began to feel empowered. If I paid attention, my body was trying to tell me what positions helped the contractions along. It felt better to be standing and swaying, and pacing around. I did that for a while, and Amy was keeping me focused and helping me breathe through each contraction. I was handling it!! But I was also awfully tired.
Soon they checked me and announced I was at 7 cm, but my nurse and Amy also had begun to suspect that the baby's head was in my pelvis a little funny. Amy had me squat on the edge of the bed through several contraction to open my pelvis, and I felt his head shift down into the birth canal, and the pressure was incredible! I started to panic a little again. I kept saying "He wants to come out NOW!" And Amy would calm me and say, "not yet--breathe." I was breathing and having to focus so hard during contractions, but was dozing off in between. (My husband said I was even snoring!!) Resisting the urge to push was so hard! But thankfully I went from 7 to 10 in about 20 minutes, but when I pushed, he still wasn't moving down. Amy told me to lie on my side and draw one leg up to push. The doctor didn't argue with her although his preference was to use the stirrups! So I got on my left side and drew up my leg and I pushed through 3 contractions, and with every one they were saying they could see more...they could see hair, etc.
On the third I pushed with all I had, and I remember making some kind of growling sound. His head was partly ou