by KMom
Copyright © 2000-2006 KMom@Vireday.Com. All rights reserved.
This FAQ last updated: August 2006
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
BBW Birth Story Pages
BBW Birth Stories: Vaginal Birth After Cesarean Stories
CONTENTS
Many women over the years have requested a section for birth stories of plus-sized moms. Large women come into pregnancy with so many fears and body issues that reassurance that other large women have indeed done this is important. Pregnancy books and most websites do not fulfill this need; mostly they are filled with warnings not to get pregnant until you lose weight, dire predictions of disastrous pregnancies filled with complications, or horror stories designed to scare you into compliance.
Although there are many birth stories online, most are of women of average-size. While these are also important to read, many large women have longed for a collection of stories of plus-sized pregnancy---normal births, complications, special births, just plain births---warts and all. It is important for us to see that many of our large sisters have traveled this journey before us.
This is a collection of BBW birth stories collected by Kmom over the years. Stories have been separated into various categories (vaginal birth, c-sections, twins, gd stories, etc.). Because some stories fit more than one category, many will repeat on different pages. Some stories are already up on the web in a more complete form elsewhere; with the mother's permission, Kmom has linked to these sites and urges readers to click on the link and read the more complete story.
Unless specifically requested, all identifying information has been removed or changed to protect the privacy of the participants. All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
This particular FAQ presents the stories of big moms who have gone on to vaginal birth despite previous cesarean births. The cesarean rate in obese women is very high, in most cases unnecessarily so. (Click here for a brief discussion of the factors that lead to a high cesarean rate in large women.) But having given birth previously by cesarean does not mean you must always do so.
Research does show that large women are given fewer opportunities for a VBAC 'trial of labor', and therefore have a much higher rate of repeat elective cesareans, despite the greater risks that cesareans pose for large women. Many big moms who have sought a VBAC have reported strong resistance and discouragement from health personnel they have consulted, or have faced strongly restrictive VBAC 'protocols' that have essentially prevented them from having a fair chance at VBAC. There is a lot of room for improvement in the health community's attitude towards VBACs, and particularly in their attitudes towards big moms and VBACs!
Yet for those large moms who carefully prepare both physically and emotionally, who research birthing issues thoroughly, and who choose their care providers and birth support judiciously, the journey towards a better birth can be extraordinarily rewarding and therapeutic, whatever the outcome. Many VBAC moms (particularly those who have struggled with weight and body image issues) report that they have found their VBAC journeys very empowering and ultimately, very healing. The VBAC journey can be a very special one.
This special section of Vaginal Birth After Cesarean (VBAC) stories is particularly dear to Kmom's heart. After having 2 cesareans herself and then a VBAC, she is personally familiar with the journey towards normal birth, and the struggles that can happen in that journey along the way. In addition, in her work with plus-sized women and in her reading of research on obesity and pregnancy, she has seen over and over again how often large women are pushed into interventions that lead to unnecessary cesareans. This FAQ is healing in that it shows that many of these interventions are NOT necessary, and that normal birth is possible for the vast majority of us, no matter our history or size.
Kmom has recently started a completely new area on her website devoted to Cesareans and VBACs. You will find a great deal of information and research about VBACs there. If you are contemplating a VBAC, you may especially wish to visit the FAQ on Great VBAC Resources, or any of the other VBAC FAQs in that section. Keep checking back, as many new FAQs will be added over time.
The purpose of this special BBW VBAC Stories web section is to show that fat women CAN and HAVE had VBACs, that many VBACs occur despite all kinds of negative attitudes and interference from family and medical personnel, and to show that the VBAC journey can be a powerful passage to healing and empowerment for fat women. There are many other BBW VBAC stories out there as well; Kmom strongly encourages big moms everywhere to share their VBAC stories here.
More VBAC 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!
Note: Women with a history of cesareans may find the ICAN (International Cesarean Awareness Network) organization helpful. This group provides support and information for women who have had cesareans in the past, those who may be facing cesareans in the future (first-time or repeat), those who have had any kind of difficult birth, and those seeking a VBAC. Although the group is definitely pro-VBAC, women who simply need support after a cesarean or require information about ways to make a necessary cesarean more birth-friendly are also welcome. Information on joining ICAN's email support group can be found at www.ican-online.org.
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.
Kmom's Notes:
Birth Story
My experience with delivering my second child as a VBAC was as follows: I was 13 days past my due date and getting desperate. I had taken 2 bottles of castor oil a couple of ounces at a time with no effect other than totally cleaning me out intestinally. My OB, who was very supportive of me throughout this pregnancy (never a mention of my weight, very supportive of my desire to VBAC), was ready to induce when I finally went into spontaneous labor after a couple of nights of prodromal labor. I labored at home for about 3 hours, waiting for my husband to come home from work. When my contractions were coming about 5 minutes apart, we left our 3 year old son with my brother-in-law and his 2 year old boy.
My sister (a labor and delivery nurse), my husband and I headed for the hospital. I was 3 cm. dilated and partially effaced when I arrived at approximately 5 p.m. I was installed in a birthing suite. I was asked if an enema would be OK and I said yes, but turned down the option of being shaved. I felt good that my opinion was sought in these matters. When I was at about a 5 cm. dilation I asked for an epidural. I had had an epidural with my older son, who turned out to be a c-section following 26 hours of very dysfunctional labor. That epidural was fully effective, no problems getting it in, no nasty comments from the anesthesiologist, etc. This time the epidural went in fine but was only fully effective on my left side. The right side would be numb for a period of time, then would "wake up" prematurely. I kept the anesthesiologist busy trying to keep my right side numb, too. I was pretty comfortable from about 5 cm. to 7.5-8 cm. when they allowed the epidural to begin to wear off in anticipation of pushing. I was using Lamaze breathing and my husband and sister were taking turns coaching me (this was early morning hours by now, so they were both tired and standing in for each other).
Just a few minutes after I had been checked at 8 cm. I was having some pretty incredible urges to push, so my husband asked that I be checked again. To the nurse's surprise, I had gone from an 8 to a 10 in less than 10 minutes and was ready to push. I don't know why, but it never occurred to me that once ready to push I wouldn't just push that baby right out, which was what I did. After only 20 minutes of pushing, my 8 lb. 5 oz. son Christopher was born. My total labor time was about 14 hours, which is average for a first vaginal delivery. I did have an episiotomy, but my OB didn't just cut me as a matter of course. He watched carefully and when it was apparent that an episiotomy would really facilitate things, he did give me one after telling me he thought it would be a good idea and getting my permission. Again, I appreciated being consulted. I felt that this was a very good experience, the level of care was excellent. As soon as Christopher's vital signs had stabilized he was given to me to nurse and he roomed in my room most of the remainder of the time we were in the hospital.
Update: Susan's 3rd child, a boy, was born by elective c/s. He was transverse and had a true knot in his umbilical cord. He weighed 7 lbs., 1 oz. and was 19.75 inches long, with a lot of dark hair. "Even though I had a c-section, I am feeling really good and had no complications at all--epidural went great, postpartum care and recovery have been really fine...I have given birth 3 times as a BBW, both vaginal and c-section, and have gotten along fine each time. You all can, too."
Dee's Story (c/s due to size-phobia, insulin-dep. gd, vbac)
Kmom's Notes: Dee's story reflects the importance of choosing your provider wisely! Her first doctor was a fat-phobic man who expected her to fail based on her weight, and created a self-fulfilling prophecy. Some of the doctors she saw after that for infertility treatments were also fat-phobic, but this time she stood up for herself and eventually found one that was not. Her VBAC was probably made possible by the great support she had from her OB, the flexible laboring protocols (including using water despite being on pitocin) she was able to negotiate, and the support of her doula and husband (research shows a doula cuts the c/s rate by nearly 50%). And of course, most importantly, it came about through her own determination and woman-power!
Birth Story
In retrospect, I realize there were many clues thrown out by my ob/gyn over the months of my pregnancy that forewarned of an unnecessary c-section. The biggest clue was his repeating the mantra, "Of course, at your weight, it's likely to end up a c-section." I weighed 247 at the beginning of the pregnancy. In spite of a very healthy and uneventful pregnancy, my labor was long and ineffective. My waters broke at 10 in the evening, 13 days post dates. I went into the hospital immediately because....well, I wanted to have that baby! While I had light contractions all night long, they were ineffective. In the morning, I was given prostaglandin gel. That got things rolling and within a half hour I was having strong and consistent contractions. I was through transition, fully dilated and effaced and felt the urge to push around 3 pm. Four hours later I was still pushing. All throughout the day, the doctor repeated his mantra omen. Neither he nor the nurse encouraged me to move about, change positions or try any alternative birthing techniques. So, it was no wonder, again in retrospect, that E was born via c-section, with dislocated hips and a huge hematoma on his scalp from the different types of vacuums the doctor tried to use.
Fast forward to 6 years later. I was 35 years old and finally expecting my second child after having battled secondary infertility for 4 years, and after having several miscarriages. Most of the battle regarding my infertility was dealing with fat phobic doctors who refused to treat me until I lost weight. Of the 5 doctors I saw regarding my infertility, one put me on 100 mg clomid the first cycle and didn't monitor me at all. I was given no information regarding what to expect, charting my temps or anything. I had extreme pain during that cycle and was told, "Oh we expect those things". So I went to another doctor. She found a huge cyst on my ovary, told me I needed to lose weight and put me on phen/fen. I lost 45 lbs or so. She referred me to an RE she worked with. He refused to put me on any more treatments until I lost another 45 lbs. I refused. He was the one who said, "If you really want a baby you'll lose weight." I had been on the phen/fen the maximum recommended and it wasn't effective any more. So, the RE refused to treat me and I refused to diet. I went to another ob/gyn who basically had the same opinion as the RE. I made an appointment at the local university hospital. Lo and behold, the RE staff there immediately identified my problem. I was able to get pregnant, but I would lose the baby before it even implanted.
See, I had been having regular 30 day cycles with occasional 35-40 day cycles. I had been keeping record and I could have sworn I was pregnant on those 35-40 day cycles. I had all the symptoms...swollen breast, nausea. But then the period had come. The other doctors all insisted I wasn't getting pregnant but because of my weight I had PCO. Well, this new RE, Dr. N., said, "Yeah you have PCO, but you are also getting pregnant and losing the baby." With an attitude of "you have the right to have a baby and you can have a baby....I'm going to figure out how to help you", he decided to simply try an assisted cycle with clomid, and after ovulation, progesterone.
On the first cycle we tried, I got pregnant!! I also carried that pregnancy to term. Dr. N recommended one of his recently graduated students for my ob/gyn. She was marvelous. Pro vaginal birth and size accepting, Dr. M saw my pregnancy as joyously as I did. I wanted a vaginal birth so badly. I had felt like such an idiot when I realized how duped I was by my first ob/gyn. His fat phobia and surgeon mentality had doomed me to a c-section right from the start and I was felt so ignorant for believing him and not seeing what was going on. I also felt the delivery and drugs after interfered with my bonding with the baby. I can honestly say, I felt like a zombie until we finally got home and I stopped taking the pain drugs. Then I fell in love with my son. But, I will always regret that he didn't get those first few days of love that babies thrive on. I wanted my next child to have that opportunity and I strongly felt having a VBAC (Vaginal Birth After Cesarean) would lead up to that.
Everything went well, with the exception of severe nausea on my part, until the 28th week when we discovered I had gestational diabetes. You know, I never realized how important it was to me that my pregnancy be totally normal and without even the mildest of complications. I cried when I found out I had gd. My numbers were mildly high, but consistently high. So, I was put on insulin and a diabetic diet. Complicating everything was my reactive hypoglycemia. This insulin resistance left me feeling nauseous all the time. I again felt a sense of failure. I was so mad at my body. I was so certain that it was my diet that caused the problem, even though in reality I had actually been following the ADA diet all along.
Well, somehow, between the needles and lancets, I managed to make it to 37 weeks. I was very sick from the gd and hypoglycemia and I was under a lot of stress due to both my parents being criticallly ill, my husband having to move 3 states away, and my trying to sell our house. Between the stress and the illness, my body was breaking down. I was swollen, though my blood pressure was fine. I had several episodes of false labor, 2 of which took me to the hospital. The baby's heart rate was running too high and I was dehydrating frequently from the vomiting. So, feeling I was doomed to a c-section even though my heart strongly desired a natural birth, I asked the doctor to induce me early and she agreed that the environment in my body was no long doing any good for the baby. Since we knew from the infertility treatments exactly when I had conceived the baby, we decided to deliver the baby on week 38.
I told my doctor I just wanted to plan a c-section as I was so certain the induction was going to end up in a c-section. However, she persuaded me to have a trial of labor and said, "I don't see any reason why you can't deliver this child naturally. It's your decision, but I'd like to encourage you to give it a try. If you get into it and want a c-section I'll go that route. But, I'd like you to try." So, I agreed to try. I have to admit, I had planned the whole pregnancy for a vbac. I was so certain I could do it, but when it got down to the wire, I was scared of a repeat of what happened with my first child. I was scared...just plain scared. After testing the amniotic fluid for lung maturity, it was determined the baby was ready to be delivered. Everything was perfect for his lung scores; so my doctor and I decided to go ahead with the induction beginning on the 25th. I was dilated to 2 cm and 50% effaced. The baby was at -3.
So, my husband "Rosh", my doula "Kathy" and I arrived at the hospital Sunday evening, and the doctor applied prostaglandin gel to my cervix. I started having irregular contractions right away. Since I had been having strong false labor for almost a month, it wasn't really surprising that I'd have at least some response to the gel. We passed a relatively boring evening in the hospital. Kathy and I walked the hallway and I rocked to try to get the contractions to going at a stronger rate. I was still dilated to only 2 and at 50% and -3 when the nurse checked me before the second application of p. gel. I asked for a mild sedative to help me sleep, because I knew I wouldn't be able to with all my excitement and agitation. I was given visterol.
So I slept all of 4 hours and was awakened to take my morning shower. My nurse was worried about my gd and my tendency to have insulin reactions, so she brought me a tray of food which included a muffin and scrambled fake eggs. I would later belch that egg throughout the active phase of labor. I didn't even eat the whole thing and it still came back to haunt me. At the 8:00 check and pitocin start-up, the cervix was still at 2, 50% and -3. Things didn't look too good for a successful vbac at that point. The -3 station was a repeat of my first delivery. But we plunged ahead anyhow.
I started having regular strong contractions almost immediately. They were strong and regular. I took a short walk with Kathy down the hallway. Then I took to sitting on the rocking chair and rocking. That rocking movement really seemed to help me deal with the discomfort. At around 9:00, my doctor's partner arrived and checked me. I was 4, 80% and -1 to 0!!!! He decided to break my waters. I wasn't so keen on it, but didn't feel like arguing with him. I felt intimidated by him, so I let him do it. The gush of warm water was just an amazing feeling. I was surprise a how much there was. Anyhow, at this point we had committed ourselves to birthing this baby one way or the other. I had figured I had relinquished myself to a repeat c/s.
Off and on, the nurse would prick my finger and check my bg levels. It was fluctuating wildly. So, she and the doc monitored it closely adding insulin or dextrose to the iv depending on my bg. I hated that pin prick. It just seemed so unfair when I was having to deal with the pain of labor, but I knew it had to be done. It was frustrating, but necessary.
It wasn't long before the contractions began to be long and hard. I was surprised it was going so fast, but boy was I hurting. The nurse then decided I should get in the bathtub for awhile. I don't know how long I was there...maybe 45 minutes...when I started begging for an epidural. The contractions were soooooooo strong. The nurse was patient and encouraging and very competent in finding ways to delay me from getting the epidural--"oh try leaning this way" or "how about we kneel for awhile?" Then I started getting more insistent (ok I BEGGED) and she said ok. She drained the tub and started the shower. She had me stand up and lunge with one leg on the tub edge. Then she poured the cool water over me. At this time I was having a very strong burning sensation that originated near the c/s scar. I finally begged a bit more and she then took her time drying me off and getting me and all my iv tubes into the nightgown. Finally she got me into the bed and left the room to find my doctor.
I kept begging for the epidural. I don't know how much time had passed, but it seemed like 74,568 years :^). Finally my doctor walked in the door. I think I exclaimed something like "Oh thank God you are here, can I have an epidural?" She held my hand and said yes. Phoebe disappeared to call the anesthesiologist. Dr. M. held my hand while I had contractions and she didn't let go until I kind her pushed it away on one very big contraction. She is a very compassionate doctor who is VERY pro-vbac and has one of the lowest c/s rates in the are...as did her partners and the hospital I was birthing at. I had chosen her because of her reputation and my RE's referral.
Anyhow the epidural guy finally got there and took his time getting the epi in. I was still 4, 80 and -1 to 0. I was really being a pain, too. I complained every single contraction. It hurt sooooo badly. I don't remember my first hurting so much. I hadn't had any pain intervention with him, but this time things seemed very bad. The contractions just didn't let up and they were sooooooo intense. I also felt intense burning and pain at the site of the c/s incision on my skin. Looking back, I think the internal pain must have centered at the internal incision. It just seemed concentrated right across the front just above the pubic bone. The nurse felt it was due to scar tissue tearing away with the contractions.
While the anes. was fiddling around with my back, I sat on the edge of the bed and rocked with each contraction. In retrospect, I think that must have really helped get things going. Finally the guy told me to hold still (HA!~!~!~) while he inserted the needle. I think it took several contractions, and I really did my darndest to hold still. Finally, I felt like my bladder was being pushed and I had no control over it. I told Phoebe I had to pee. She said in a very nurturing voice, "Go right ahead and let it go. Just relax and let it go." Well I did. There really wasn't a thing I could do to stop the drenching anyhow. After the initial flood, with each contraction I felt this push on my bladder and a little voiding. I began to feel like I just wanted to push my whole bladder out.
The epidural was in and I felt my left leg get tingly and numb. But nothing else went numb. The epidural was ineffective and had been placed in the wrong position. I had a dead left leg and lots of pain. It was exasperating. So, they were getting ready to get me back onto my back (I was still sitting on the edge of the bed), when I told the nurse something was pushing on my bladder. She suddenly got excited and said, "Maybe you are ready to push. Do you feel like pushing?" It dawned on me that that was the case and I grunted in the positive. So, she checked me. I was 8 to 9 cm!!!!!! I had gone through transition while waiting for the epidural and no one had even known. Now I had a numb left leg and the rest of me never did get relief, but I think that was the best thing that could have happened. it was time to push and the epi might have screwed that up.
By this time, though, I wanted a c/s. This is where I have to say THE BIRTHING TEAM MAKES ALL THE DIFFERENCE!!! Had I not had the doula, my wonderful nurse, and Dr. M. there to encourage me, I would have grabbed the scalpel myself!!! I begged Dr. M. not to let me go through what I went through with my first delivery. She promised she wouldn't. For each contraction, I bemoaned my inability to push the baby out with 2-3 pushes like some other women do. I whined and complained a lot, I think. I was being such a wuss, but it hurt sooooo much and the contractions were coming sooooooo quickly. Some other doctor was there and for some reason he actually did the delivery. I have to ask Dr. M. why that was, but anyhow she stood right there and told him what to do while she encouraged me and held my legs up along with Rosh, Kathy, and the nurse.
The nurse was marvelous...though I hated her at the time (contraction hatred). She insisted on my getting on to my knees and trying. It was in my birth plan and she was 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 pregancy and during delivery, but he stayed within normal range and was handling things well. So, no intervention was needed in that regard. He nursed and slept and watched the world around him. I fed him and watched him sleep and observe. It was blissful.
So, that is my version of the story. I'm sure some things are fuzzy in my memory, but for the most part everything was just as planned once the labor got going. My big recommendation to anyone planning on a vbac, CHOSE A GOOD SUPPORT TEAM and MEDICAL TEAM. I never thought I would wuss out like I did, but I would have given into a c-section RIGHT THEN. Had it not been for a pro-vbac doctor, hospital, nurse, and friend, I don't think I would have had my vbac. Also, don't be surprised at how much you will resent everyone helping you during the birth. I think it just hurts so much that it is beyond our capacity to keep focused on the outcome. So I let them do that for me. AND THEY DID!!! Bless them all.
Maggie's Story (3 babies: size-phobic dr.+ c/s, 2 VBACs)
Kmom's Notes: Maggie's first 2 babies were both about the same size despite a much bigger weight gain the second pregnancy. She also had a VBAC with a baby that was 9 lbs., something some doctors tell you that you probably can't do. Her third baby was smaller, for whatever reason, and again she had a very fast VBAC. In both of her VBACs, she had pitocin aumentation without any drugs, a very impressive accomplishment!
Birth Story
Baby #1: My first pregnancy I had a fat-phobic doctor who complained about every pound I gained and kept telling me about a patient who lost 50 lbs while pregnant. Because of insurance, he was the only doctor I could choose. Even though I knew it was unhealthy I would diet before my appointments to try to get a lower weight and then semi-binge after the appointment. My blood pressure also measured high during office visits because I was so anxious about my appointments. My normal blood pressure is 110/70, even when pregnant.
I ended up gaining 24 lbs and had a 9 lb daughter by c-section because the doctor thought she wouldn't fit. I never went into labor -- had a biophysical profile that measured the baby at 10 1/2 lbs +/- 1 lbs -- this is what the doctor based the c-section decision on. Despite all this I had a very easy c-section and recovery -- was able to have an epidural and be awake during the surgery. I considered the c-section a breeze and had no fear about another -- in fact was so comfortable with the known, was more nervous about going into labor.
Baby #2: My second pregnancy I had a wonderful new doctor to whom weight was not an issue. I gained 42!! lbs. This doctor looked at my previous records and stated that he believed in a trial of labor and that was our plan. I was very nervous and made him promise that if I stalled during labor I could have a c-section. I was a week past my date when my water broke. My doctor has the 24-hour rule -- if not in active labor 24 hours after water breaking, then start inducing with pitocin. I went into the hospital in the middle of the night since I was having contractions. I wasn't even dilated yet so they gave me pain and sleeping meds to get some rest until they started the pitocin at 8:30 am.
They increased the dose every 15 minutes once they started. It was a very boring morning and I kept thinking when is anything going to happen. I was on a strapped-on monitor and didn't move around much -- however, I had no desire to do so, so this wasn't a problem for me. I think I could have had them remove it and only monitor me once an hour or so if I wanted to move around more. At 12:30ish they checked me, only 3 cms dilated but they put an internal monitor that they attach to the baby's head. Told me I had hours to go yet.
Between 1-2 pm I had a really tough time with contractions coming fast -- did my breathing etc. Had hubby get the doctor at 2 pm because I wanted my epidural and I was feeling a lot of pressure. Doctor came to check at 2ish and told me I was ready to push. (Note: I didn't feel so much an urge to push as a sense of tremendous pressure in the vaginal region). After three pushes, my second daughter was born at 2:19 pm. She weighed 9 lbs 1 oz , 1 oz more than the baby that wasn't supposed to fit!
I tore when head came out but didn't feel it. I also screamed when she came out, which really surprised me -- never would have considered myself a screamer!! I was stitched up after delivery. Never did get my epidural -- everything happened very fast at the end. So in retrospect, I had a really bad 1- 1 1/2 hours of labor. I felt really empowered after this birth -- I remember being in my hospital room thinking, "I want to do this again!" As BBWs we are told by most of the medical community that something is wrong with us, but my VBAC told me that my body is fine the way it is and can get the job done, thank you very much.
Other things I remember... I did have monitors that made it hard to move around but I had no desire to walk around. I wanted to sit up and would change my legs from tailor-sitting to lowering the foot of the bed so I could hang my legs down. I have heard that the pitocin makes the labor very intense and it seemed that way to me but then again I have nothing to compare it to. I am very grateful that I only had a difficult 2 hours as opposed to much longer. Also #1 was 9 lbs and #2 was 9 lbs 1 oz -- so much for not fitting through my pelvis!
Also in retrospect I had a much, much easier recovery from a VBAC than c-section and I had told everyone that my c-section was a breeze and I truly felt that way. I cannot emphasize this enough -- the stitches were manageable and being able to get around just about normally was great. Especially since I had daughter #1 to worry about. I was concerned about how she was adjusting and it was great to be able to get out of the hospital more quickly and be able to help her adjust (a lot of my anxiety pre-VBAC was about child #1 and how she would handle mom in the hospital , new sibling etc.). Given the choice I want a vaginal birth next time too.
Most of all, I trusted my doctor -- he was instrumental in helping me believe I could do this. He wasn't even the doctor who delivered my baby, but it was the nine+ months leading up to the birth when I felt his confidence and support -- I went to a group with 7 doctors and had met several others but in fact the nurses are more important during labor than the doctor who just pops in and out. I didn't want a doula or other person beside me and my husband -- we wanted to do this on our own as a team. I am very comfortable with a hospital environment because I like knowing that medical backup is available if necessary.
To prepare for VBAC, I took refresher lamaze class, did some reading, asked a bunch of questions. I'm a bit of a control freak and a lot of my fear was of the unknown -- labor, potential pain etc. I would have been happy repeating the c-section only because I knew what to expect. Despite having a c-section the first time around and having a very easy recovery, a vaginal birth is much, much easier to recover from.
Baby #3: I fully anticipated a repeat VBAC but if medical emergencies arose I would have been OK with that. I did have an earlier complication with a severe bleed at 14 weeks and a residual blood clot. Was on restrictions for 3 months but blood clot eventually disappeared and I went back to normal activity. This was in no way related to be a BBW, but rather just one of those things...and we'll probably never know why it happened.
This baby arrived 5 days early, which was a surprise because I was at least a week late with my two daughters. The evening before he was born I started to feel really lousy---hips hurt, had to pee all the time, back hurt, etc. My walk really became a waddle so I think he had dropped that night. The next morning about 11:30 I lost the mucus plug. I also began to suspect that my water had broken--not in a big gush but just a more or less constant dribble. I was also having contractions but wasn't at all sure if they were for real or Braxton-Hicks. So the doctor told me to come to the hospital to be checked.
We got to the hospital about 2:30 p.m. I knew as soon as we got there that my water had indeed broken as I was much more gushy. The water had meconium in it. They were very calm about that which surprised me since I thought that meant the baby was under stress. I moved to a L&D room and wandered around until 4:30 or so. The contractions got a bit closer together but weren't bad at all. I was 4 cm dilated, not completely effaced, so they decided to start me on pitocin to speed things up because of the meconium. We also had an internal monitor because we kept losing the contractions or the baby's heartbeat on the external monitor.
Contractions started getting bad about 5:30 or 6:00 and I requested a doula to come help since I had gone through all the breathing techniques I remembered. I also asked about pain relief and was given the option of stadol which is supposed to take the edge off the pain but not eliminate it and can make you dopey. They said no to an epidural because last time I went really fast from 3 cm to 10 cm so they didn't think there was time for it before I had to push. So I chose nothing and just kept with the breathing. The doula arrived at 6:30 and was great---got a hot rice bag for my back, rubbed my shoulders, helped my husband help me, and helped me focus my breathing. Also brought a birth ball, but I was beyond using it at that point.
I was feeling a lot of pressure and the doctor checked me again at 7ish and I was at 9 cm. They had me blow through a few more contractions and then I told them I wanted to push. I pushed through 2 contractions and then his head was out and they told me to stop pushing because they needed to suction his airway due to the meconium. That was about the hardest thing of all, but after what seemed like forever they gave me the go ahead and he was born at 7:20 p.m.! He was crying and crying, the best possible thing, and I was so relieved it was over. His apgars were 9 and 9. This was my second VBAC and I feel really lucky that it went quickly again.
A word about the doula--I had only decided the day before to use one after running into one when I was getting my hair cut. She asked me if I was considering it and I said no, in fact I thought it might seem intrusive and I didn't want my husband to feel pushed aside. She gently gave me some things to consider and I called the program at the hospital to see if it was too late to use one. It wasn't but I would have to use whoever was on call and not be able to meet her head of time. So that's what I did and it worked really well--we hadn't done a lamaze refresher this time and I was anxious and my husband wasn't sure what to do to reassure me and she helped both of us through it.
Another point for BBW's -- I got pg first month with babies #1 and #3. So what was different with baby #2? Not sure and no confirmation from doctor but I had been on phen/fen for a year prior to trying to conceive and it is my belief that my hormone levels were out of whack from the dieting etc. Also about weight gain in pregnancy, I've had a wide range between baby #1 and baby #2 but found that all the baby weight was gone by 6 weeks postpartum. I did breastfeed and that helps for a while and then my weight would stabilize.
Franny's Story (induction, posterior, forceps vaginal birth; c/s for breech; home waterbirth VBAC)
Kmom's Notes: Franny had a posterior baby with her first birth that she did manage to have vaginally by flipping to hands and knees and the doctor using forceps. Still, not a peaceful birth. Her second baby was breech and came by c/s. These birth stories can be found on Cesarean, Supersize, and PCOS birth story FAQs.
In her 3rd pregnancy, Franny was told she would have to have a repeat c/s because her hospital no longer did VBACs. Instead she hired a good homebirth midwife and had her baby at home. She also had chiropractic care in this pregnancy, which may have helped prevent a recurrence of the fetal malpositioning the plagued the other births.
Birth 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.
Margie's Story (5 children; #4: c/s, insulin-dep. gd; #5: VBAC, insulin-dep. gd)
Kmom's Notes: Margie has 5 children; this is mostly the story of #5, her gd vbac. The fact that she'd had 3 vaginal births before her c/s increased her chances for a VBAC, as did her supportive staff and taking good care of herself. Her birth stories (all of them) can be found at:
http://pregnancy.miningco.com/health/pregnancy/library/stories/b13797.htm (1st 3 births)
http://pregnancy.miningco.com/health/pregnancy/library/stories/blcameron.htm (4th birth)
http://pregnancy.miningco.com/health/pregnancy/library/stories/bl9907196.htm?pid=2839&cob=hom
Birth Stories
Baby #5: This story begins with pre-pregnancy. This was a much planned for baby for a few years before she was even a sparkle in her Mother and Father's eye. I have four children, one of which I had Insulin Dependent Gestational Diabetes with. I wanted to have more children and knew that I would have to deal with this again. We got pregnant on our first try with In Vitro. Our previous son was conceived through In Vitro also. I found out I was pregnant and was very overjoyed. I was prepared for the pregnancy and hoped to make it better than my last. Even with Insulin-Dep. GD.
Only thing I wasn't prepared for was the onset was much earlier than my previous pregnancy. I began insulin at 12 weeks. My previous baby was born via C-Section due to Macrosomia. He weighed 11 lbs and 3 oz. I knew that if I kept with the diet and insulin that I would not have a huge baby. So on with the diet and insulin. My goal was to keep the baby's size down and hopefully go into labor on my own. I wanted to know what it was like to go into labor and not have pitocin. My three previous babies were either induced or augmented with Pitocin. As we were approaching the due date, all tests were showing that she was fine and not at all huge. I had twice weekly NST's (Non Stress Tests) and AFI's (Amniotic Fluid Index) tests. All were great. One nurse did however say that I had a decrease of fluid and was concerned. More on that later.
My due date approached and I asked if I could go another week in hopes that I would go into labor on my own. OB agreed. I thought for sure that I would have contractions and so forth, but by the next week nothing was going on. I had JUST gotten to 1 cm. Insulin-Dependent GDM has many risks. One is the function of the placenta could stop, resulting in placenta failure and stillbirth. That was why all the NST's. When it came time to decide if I would consent to an induction I reluctantly agreed, feeling that this was what was best for my baby. So Induction Day rolls around. I'm instructed to report to L&D with my orders in my hand at 7:30am Monday morning. I'm really apprehensive since my last induction was during a span of four days and I had a c/s anyway.
We get settled into my room. We meaning my husband, my Doula, and myself. They are very nice and sensitive to my needs with the monitors. The L&D nurse made sure I wasn't on them any longer than I had to be. She found out that I'm a clock watcher!!! I had my first application of P-Gel and asked her about my status. I'm 1 cm, 0% effaced, my cervix isn't too soft, baby is head down, and cervix is almost in an Anterior position. At the 2nd application I continued to have contractions on my own for several hours. This brought me to 1+ cm, -2 station, 30% effaced. An hour later the 2nd dose of P-Gel is given. With this exam I am 2cm, -2 station, 30% effaced. We are encouraged to walk the halls. We do so leisurely and this results in some contractions. So after all that walking I progress another centimeter. Monday night at 10:20pm I get another dose of P-Gel and we all get some much needed sleep for the next day. The contractions just about stop.
I am impressed with my nurse's sensitivity to my needs. I had drawn up a birth plan, but did not give it to them. They seem to be just as committed to me having a VBAC as I am. They all have studied my previous birth and remind me often that this is so much more different. After she got past -2 station, I relax. Cameron never made it past -5. Things certainly do seem different. At 4:15am it's rise and shine. I get back on the monitors for a test strip and the endocrinologist orders hourly Blood Glucose Tests. I think this was the most annoying part. He also orders an IV push of insulin as needed. At 5:00am the IV is started and pitocin is started at the lowest dose.
5:35am my water breaks. Remember, one of the nurses said I had such low levels of fluid. I change positions and noticed my water had broken. There is water coming out that is clear. I soak 2 chux pads. The L&D nurse has to rush to get more, I soak 2 more pads. She puts a towel between my legs as the water keeps coming. Every time I laugh, there is more water!!! I soak through another set of chux pads and another towel. Seems like enough water to me. We all cheer that my water broke on its own. Something's happening. Pitocin is steadily increased and contractions are going nicely in a pattern.
At 7:30am the new crew comes in. Our nurse ended up being the same nurse I had the day I had my c/section with Cameron. At first this worried me, but she reminds me that we have gotten further than we ever did with him and this is all together different. This relaxes me and we get ready for the hard work ahead. It's 8am and she checks me. I'm at 3cm 50% effaced, -2 station and my cervix is soft. The monitors around me are really irritating me. We discuss internal fetal monitors. One thing that I was most afraid of was the internal catheter to measure contractions. The nurse shows me that they are much different than they used to be. I had one nearly 15 years ago and the memory was terrible. I realize that they cannot effectively monitor the strength of my contractions with the straps. I'm a big woman and the baby is small. So I agree to the internal monitor for contractions so I will not be over stimulated on pitocin. That alone makes me fear for a rupture. In the 20 minutes that we discuss this and they place the monitors, I progress to 4 cm, 70% effaced and still -2 station. Contractions are 2 1/2 minutes apart and bearable. I can't believe how much the effacing is happening since this usually is the slowest part for me. I also had went from 4cm and 70 to 90 percent effaced to delivery in a matter of minutes with my previous pregnancy. I warn them. The contractions are really bearable and not at all painful. Just a force, but not really painful. They peak quickly and resolve quickly. The atmosphere is still very upbeat and we are playing Hymns on the boom box. This creates a very peaceful and serene atmosphere in the room.
I get my next exam at 10:00am. I have already progressed to 5cm, 80% effaced and still at a negative -2 station. I'm amazed at how easily everything is going. It just seems to roll along. In 30 minutes I progress to 6 cm, 90% effaced and she drops down to -1 station. Still the contractions have not changed or even seem to be that hard. In the next 30 minutes I again progress even further to 8 cm, 90% effaced and 0 station. They tell me I'm in transition. I'm amazed at how easily everything is going and even being in transition, I'm not in that much pain. While I was at 4, I was getting a bit apprehensive that the contractions would get harder to deal with and was asking about an epidural. My previous births were horrendous with the over-stimulation of pitocin. Sue talks me out of it and I agree to forge on through. So I'm at 8 cm and it doesn't' seem to be that bad. It's 11:45am and the OB is called. I am 9 cm, 100% effaced and zero station. The OB gets there and things start to halt. The contractions are getting harder and she isn't coming. I'm getting really concerned that I am some how unconsciously holding her back. They tell me she is posterior and is pounding on my cervix causing it to swell from 9cm back down to 6cm. At this point I am standing trying to get her to come down. I tried going to the bathroom and she still isn't coming down. Her heart rate drops severely and the OB nurses rush into the room. We are really scared at this point because it isn't coming back up. I'm laying on my side with oxygen mask on praying that she is OK. All sorts of things rush in my mind. I ask my husband who is an Elder in our church to give me an emergency blessing. He does and her heart rate normalizes.
I then get an epidural. The epidural doesn't take on a strip going along my belly and I can feel the contractions in a localized area. The Anes. tells me that this is called a window caused by the position of her head. They turn off the pit drip and I lay on another side to get the medicine to hit that awful nagging spot. Things settle down and I snooze. During this time DH gives baby a blessing by laying his hands on my belly. I didn't find this out til later. It's 3:00 and I'm at 10cm, 100%, and +1 station. They ask me to push. I have to say that I would make fun of the ladies on "A Baby Story" pushing through their epidurals. I now know that it is so hard to push. I haven't pushed in 15 years. I didn't practice this part!!! It was difficult to coordinate the pushing. No one counted in my face and I was really glad about that.
It's 3:15 and we have put the Hymns back on. She is slowly moving up and her head is crowning. I'm not sure at which point they called the OB. Her head is slowly pushing it's way out. The entire time her head is exposed the OB nurse is gently stroking her head. She is treated gently from the beginning and the tone in the room is quiet and not tense. She decides that she has had enough of the womb and her head pops out. No pushing from me. Then the body just slips on out. She is born and my first look at her is in amazement at her size. All of my babies are over 8 lbs including my 11lbs 3oz boy. She is really long and skinny. The OB walks in fully expecting to deliver a baby. He missed it and gets to catch the placenta. She cries and is cleaned off and placed on my stomach. I get to cut the cord. I couldn't see it and Bill took pictures. They ask me if it is OK to take her to clean her off. They are very quiet and gentle with her care. She is cleaned off and they assess her. She is measured and weighed. 7lbs 9oz. 19 3/4 inches long. Her Apgars are 8 and 9.
One nurse said I was bleeding pretty bad. They call the OB back in and he finds clots in my uterus causing it not to contract. They take care of this and the bleeding slows down. I am sat up so I can nurse, but when I am moved up I nearly pass out. My BP is extremely low. 99/34. They call the Anes. back in and she puts some medicine in my IV to get my BP up. I continue to have low BP the remainder of my visit. I am able to nurse her and the colostrum is able to maintain her blood sugar. She looks great. As soon as my epidural wore off we were back in our room getting to know each other.
Despite these little mishaps and having to get the epidural, the birth was very positive. I was able to have a VBAC. I did not submit a birth plan to the floor. I wonder if my doula did since everything I asked for was honored. I nearly got everyone I asked for. It almost seem too good to be true. During the entire time of my labor, a friend of mine is calling and being called to update my lists on my progress. I have an enormous amount of support and prayers during this time. This birth is a triumph. Not only that I got the most beautiful baby in the world, but that being diabetic I was able to make it post dates, I had a small baby, and she had no side effects of my diabetes. Most important that she was born a VBAC. She was at one point a twin. Her brother or sister was 10.2 weeks before he/she died in utero. We will always hold that precious baby in our hearts. But we say Welcome to the World to this baby.
Postscript: Breastfeeding does not go well, due to the anemia from all the blood loss after the birth. Additional factors may also include low thyroid levels and abnormal nipple shape. This was very disappointing but the baby did get the benefits of colostrum and some early milk.
Lisa's Story (diet-controlled gd, anticardiolipin problems, premature labor, VBAC)
Kmom's Notes: The GD diet this mother reports being given is highly questionable. Although women with GD must carefully control the amount and type of carbs they eat, they should not be forbidden from consuming carbs completely. The pregnant body (and the baby) need carbs and the nutrition available from carbs for optimal development and health. Furthermore, if carbs are lowered too strongly, the mother is forced to burn her own stored fat for energy, resulting in ketones, a kind of acid by-product. Some studies have linked persistent levels of ketones to neurological damage to the baby. This is why it is important for women with GD to monitor their ketones, especially if their carb intake is low.
The other notable thing about this story is that it highlights the ABSOLUTE importance of the proper size of blood pressure cuff. This mother was almost forced into an unnecessary cesarean because her blood pressure was erroneously recorded as dangerously high. The nurses used the wrong-sized cuff; they should have known that a large cuff was required for a large person. Note how much of a difference the correct cuff made in her blood pressure----from 180/104 with the standard sized cuff, to 114/63 with the correct-sized cuff. From dangerously high to completely normal.
ALWAYS check to be sure that medical personnel are using the correct-sized cuff when taking your blood pressure.
Birth Story
In my second pregnancy, I was 37 years old and weighed 256 lbs. when I finally got pregnant. He was conceived through IVF and was a frozen embryo transfer. The pregnancy was considered "high risk" due to my "advanced maternal age" and the fact that I had an anticardiolipin problem and needed to be on 2 shots of heparin daily thru the entire pregnancy. I was also on progesterone shots up thru week 11.
In week 26, I was diagnosed with gestational diabetes. I did not have that problem with my first pregnancy, 7 years previous. The gestational diabetes was diet-controlled. I could not have milk, fruit, fruit juice, or bread in my diet. My diet consisted of protein, veggies, and 1 splurge of a balance fat/protein snack at bedtime.
During the whole pregnancy, I had a level 3 ultrasound done monthly. After I was diagnosed with GD, I still had a level 3 monthly, but I also had nonstress tests done 2x week from week 28 on. According to all the ultrasounds, he was growing at a decent rate, but was a large baby. I was scheduled for a planned repeat c-section (my choice) in beginning wk 38.
Due to a fall, I went into premature labor at 34 weeks and was put on magnesium sulphate for 5 days. My 3rd day in the hospital flat on my back, they told me my BP was dangerously high (180/104) and they had scheduled me for an emergency c-section. They were preparing me even to the point of having the anesthesiologist come in and talk with me.
When my dr. got there to talk to me pre-op, he saw the BP monitor and cuff they were using. He flipped! They had been taking my BP with a small cuff. He went right out to the nurse's station, came back with a larger cuff and took my BP. It was NORMAL---actually a little low for me (114/63)!!!!! Surgery canceled!
I was released on Wednesday afternoon, got to sleep in my own bed 2 nights and went into full-blown labor on Friday morning at 5:30. By 6:30 my water had broken, back in the hospital by 7:30, and had my 6 lb. 6 oz. baby boy by 9:30 a.m. Never made it to my planned scheduled c-section, didn't make it to my last "refresher" lamaze class, didn't have time to make it to labor and delivery room (gave birth in the prep/waiting area).
Due to the heparin, they had a problem stopping the bleeding, and the one stupid dr. tried to "help" the placenta out by pulling the umbilical cord. After my dr. got there, he whisked me right into the OR, transferred me from the gurney to the operating table himself, I finally got my epidural I wanted, and he removed the rest of the placenta by hand, and stitched my small tear. He said the baby came down the canal so fast, I tore up high in the vaginal wall---nowhere near any possible episiotomy site.
My little man ended up spending 5 days in the NICU due to breathing problems. They never found out the reason why he stopped breathing immediately after delivery. The speculation is that he was born sooooo fast that his system was shocked. Due to the "precipitous" birth, I had to sign papers to be tested for drugs. My dr. laughed about it but said it was required by the state in such a fast birth. He knew I wouldn't even take a Tylenol or Sudafed unless I cleared it with him first.
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.
Birth Story
Birth #1: [Kmom note: A more complete version of her
c/s story is available on the CS story FAQ]
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.
Birth #2
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 peace.
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.
Maddy's Story (2 c/s, 1 hospital VBAC, 1 home VBAC)
Kmom's Notes: Another posterior baby story. She used a combination of patience, homeopathic remedies, rocking the hips, and the 'all-fours' position to turn the baby, plus a tub to help cope with the pain in the meantime. Labor stalled at 6 cm, common with posteriors. But because they were willing to wait things out and not force the issue with pitocin, their proactive measures did turn the baby and resulted in a VBAC; in most hospitals this would have turned into another c/s.
Birth Story
Baby #1 was a 42-week planned c-section for breech. The doctor wasn't comfortable trying to deliver her, and couldn't turn her (the cord looked like it might be around her neck). No labor or cervical changes at all.
Baby #2 was also a 42-week baby, an attempted VBAC with "midwives." (Hah! I trusted in the "midwife" label, but they really knew next to nothing that could have helped me. Spontaneous labor began the day before I was to be induced, but I was "only" progressing 1 cm every few hours, which wasn't fast enough. By the time 30 hours had passed, I was "stuck" at 6.5 cm, and had a beta-strep infection, so I consented to a c-section.
The hospital was horrid, and I vowed never to go back there, no matter how far I had to travel. Later, I learned that not eating, and being tied to the bed to "get a good reading on the monitor" had probably significantly contributed to my "failed" VBAC effort.
With Baby #3, I searched everywhere for a caregiver that would give me the benefit of trusting my body to do its job. I needed to move, I needed to eat, I needed to progress at my own pace. I called everywhere, and visited two local practices. One doctor took a look at my chart and told me, "You're overweight, you're out of shape, you failed at labor twice before, you don't progress, and you're going to end up being sectioned anyway. This is a waste of your time and mine." I picked up my jaw from the floor, and moved on...
I was ready to drive almost two hours to a midwifery practice, but one more doc was recommended to me, just across the state line (about 15 miles away). He was wonderful! He calls himself "a midwife in a doc suit," and it's *so* true. He truly believed I could do a VBAC, and was willing to work with me.
Because the first two babies were 9 pounders at 42 weeks, I consented to using a prostaglandin gel to see if we could coax a smaller baby to come at 40 weeks. For three days, I had three gel treatments a day, doses of castor oil, herbal tinctures, homeopathic remedies (pulsatilla and Kali Carb 30) to turn a posterior baby... I had decent labor during the day, went home at night--not too bad, except that by the third day, I was still only about 6 cm dilated--the same place I got stuck last time.
I consented to having my water broke, even though it was a bit earlier than I would have liked. My contractions completely stopped for almost six hours! They suddenly returned though, hard and heavy, at which point, I used a tub (what a lifesaver, especially in getting my own weight off of my back!), and a lot of hot compresses on my back. After three hours of hard back labor, the baby rotated around from her posterior position. Another two hours, and I had dilated the final 3 cm, and she was born!
It was the most wonderful, exhilarating experience of my life. I did it! I actually conquered the beast within, and my body worked as it should, to birth my baby. Funny thing was, even at 40 weeks, she was right at nine pounds anyway! But I did it, with no pain medication, no pit drip, no c-section!
My doc said, "You had the most functional dysfunctional labor I've seen... way to go!" I know I would have been sectioned eight times over anywhere else. The staff was so supportive, and no one made any of those horrible comments like the one nasty doctor had made. (I did want to take my baby and hold her in his face and say, "How's THAT for a waste of time?!?!")
Here I am, almost three years later, with a midwife (new to my area, and absolutely terrific!) who "doesn't see any reason whatsoever why I can't have a home birth." I'm still the same size, but I'm a different woman... I'm confident, I know my body can do it, and I'm looking forward to a great home birth!
Update: Maddy had her home VBA2C just recently! She had another girl, and this baby was 9 lbs. 11 oz. Below is her short version of the birth story.
I had labor off and on all week, so my midwife came Wednesday afternoon to see what we could do to get long and strong and steady labor. I agreed for her to strip my membranes, and things kicked in quickly then. From 7 p.m. to 1 a.m., I dilated from 5 cm to 9-10 cm. I would contract well for an hour or more, then they would slow down and I'd sleep for 45 minutes of so, with contractions spreading out to 5-10 minutes apart. Then my friends would get me up and get me back to work again.
I started pushing about 2 a.m., in the bathroom on all fours, then with one leg half on the toilet seat and me sort of crouching over, then standing....you name it, I tried it!! She was moving down but would NOT crown! My perineum is like vinyl, they said. ;-) She was "right there" for over an hour, and in spite of hot compresses and massage, she just wouldn't crown completely. So my midwife snipped (her second episiotomy EVER!!!), a tiny, tiny little snip, and let me tear from there.
I pushed her out slowly---her head stopped AFTER crowning, but before it was out, and I got a great look in the mirror, and FELT her head finish delivering!!! It was SOOOO cool!!! Then the rest of her came out, again with me feeling her descent and move out---one shoulder at a time...and then it was DONE!!!.....She nurses like a pro, and we're doing well.
Jenanne's Story (c/s, then VBAC)
Kmom's Notes:
Birth Story
First, I must offer a plug for my midwives -- they were *gold*! I love 'em and wish to God they were doing VBAC when I had my second child; as it was I ended up with an obstetrician then... but I digress.
My labour began lightly about two weeks after my due date. The midwives had, in fact, told me that if I didn't start before Monday (this was on Friday), I'd be sent to the hospital for the birth instead of being allowed to give birth at the center. This seemed a fate worse than death, so my labour began. :)
Contractions stayed erratic but no more than 10 minutes apart for two days. Finally, things began to speed up -- consistent 5 minute apart contractions -- but at the same time, my daughter's heart rate began to flux from 40 bpm to 200 bpm during contractions. I was taken at that point to the hospital where a mere thirty extremely invasive minutes later, the doctors decided to perform a c-section on me. I had an epidural for this; my midwife and my godmother were both allowed in the OR with me. Some small tugging and tense minutes later, E was born! She was utterly healthy, cried like a baby, and was beautiful beyond what my 19 years could imagine...
Latch on was a nightmare; blisters, bleeding, pain. The lactation consultants, La Leche League, and more were unable to make this better and six months later I stopped breastfeeding as a birthday gift to myself (my nipples took six more weeks to heal after that!).
Baby #2: M was born vaginally after a short (relatively!) labour of 4 hours or so. Contractions started, we went to the hospital, they said I wasn't dilated enough, we went home, we went back, my water broke, they let us stay. :) At that point I was dilated a mere 2 cm... the OB said, "She's gonna be a while, I'll be at home." M was born 30 minutes later. I was convinced that I wouldn't be able to give birth vaginally; that I was "defective" -- so no one was more surprised than me when her head crowned and *whoosh* she was born!
I was declared "untorn" and sent to my room; hours later when I was still bleeding I was declared "torn" and sent back down stairs to be stitched. Small tear; healing was a breeze compared to the c-section! No breastfeeding -- no milk; breast reduction surgery healed such that it wasn't possible.
Dee Bitner's VBAC Story (c/s; hospital transfer VBAC)
Kmom's Notes: Dee had a prior baby by c/s because of a malposition.
Birth Story
At 41 weeks, 5 days I'd been taking cohosh off and on for a couple of days. I was planning a home birth with midwives. Nothing was happening. I agreed to an ultrasound to check baby size. I was delighted to hear that Pounce (gender still unknown, since she was LOA - remember that position!) was between eight and eight and a half pounds. My husband and I both knew I could birth a baby of that size. This US was at 8am on Friday morning, by the way. I had slept for about four hours that night... Turner Classic Movies was showing Hiyao Miyazaki films and I really wanted to watch them. (Yes, I'm a geek. Thanks!)
While on the table, I had three surges (contractions, for those not familiar with HypnoBirthing [HB] language). My husband is currently working grave shift, so we ate breakfast and went home. He went to bed. I should have, but being stupid I stayed up and got on the computer. Surges were light and far apart. I'd had stronger and more regular for weeks, so I didn't think anything about it. I took a brief nap at around one, but people kept calling the house and waking me up.
At around five, I realized surges were closer and they were getting stronger. My husband had to go pick up our older daughter, but I had a distinct feeling that things were different. By the time he got back, I knew they were. A good friend (a guy friend, actually) who was more or less serving as my doula came over and the three of them worked together to fill the Aquadoula. Once it was filled, I got in. It felt fantastic. By this time it was approaching midnight.
Saturday morning, 42 weeks, I posted my last to the ICAN list and got off the computer. I should have slept. Instead, I used my HB techniques and listened to music. Things became a bit more intense. Around 4am I called the midw