by KMom
Copyright © 2000-2006 KMom@Vireday.Com. All rights reserved.
This FAQ last updated: January 2006
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
CONTENTS
Many women over the years have requested a section for birth stories of plus-sized moms. Large women come into pregnancy with so many fears and body issues that reassurance that other large women have indeed done this is important. Pregnancy books and most websites do not fulfill this need; mostly they are filled with warnings not to get pregnant until you lose weight, dire predictions of disastrous pregnancies filled with complications, or horror stories designed to scare you into compliance.
Although there are many birth stories online, most are of women of average-size. While these are also important to read, many large women have longed for a collection of stories of plus-sized pregnancy---normal births, complications, special births, just plain births---warts and all. It is important for us to see that many of our large sisters have traveled this journey before us. Therefore, Kmom has put together a collection of BBW birth stories over the years.
Because of her own experience with gd, she particularly started collecting GD birth stories as well, and these have been separated into a separate collection, found here. Not all involve BBWs; some are from average-sized women. It is hoped that these will offer information, cautionary tales, examples of the widely varying treatment given to gd women, but most of all encouragement to gd moms everywhere. Being diagnosed with gd can be emotionally devastating and cause great anxiety; these stories are proof that there may be more choices within this condition than you would think, that you CAN cope with gd, and that your baby CAN be born healthy. Hang in there!
More stories will be added over time, so keep checking back if you are interested. Unless specifically requested, all identifying information has been removed or changed to protect the privacy of the participants. In a few cases, Kmom has edited the stories for clarity, brevity, and format (significant changes are indicated by brackets), but most stories are told in the exact words of the mothers. All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
How To Submit Your Own Birth Story
Note: All GD moms, whether plus-sized or average-sized, are welcome to submit their stories. Please follow the following directions carefully, as follow-ups and clarifications take a great deal of time away from Kmom's family. Kmom's family will thank you!
If you would like to submit your birth story, you can email kmom at kmom@vireday.com with your birth story. You need to fill out the format in order to provide some basic information, then include your simplified birth story (please be fairly succinct in order to save space on Kmom's website!). If your story already appears elsewhere on the web, feel free to fill out the format and give a basic summary of the story, and then submit the link to your page. It is also vitally important that you explicitly state permission in your email for Kmom to use your birth story on this website and/or in any future publications (such as a book or magazine article on plus-sized pregnancy).
Kmom welcomes all types of stories, including wonderful empowering births, 'average' birth stories, so-so stories, and horror stories of disempowerment or assault. All types of birth stories have lessons to teach us. Kmom particularly wants to collect stories of beautiful, natural vaginal birth in order to contradict the popular medical viewpoint that large women cannot have a normal birth experience---too many books contain only the scare tactics of how 'high-risk' our births must be. Large women can and DO give birth normally all the time, and often without medication or other interventions! Being large does not have to mean lots of intervention or unusual care. If you have a wonderful birth experience, please take time to share it with other large moms so they can be inspired! (Notice that the largest section of stories in this FAQ is the collection of vaginal births!)
However, large women also experience horror stories in birth, just as average-sized women do. These experiences should also be heard. In addition, some large women definitely experience fat-phobic care, and these experiences need to be documented so that cautionary lessons can be learned from them. Therefore, Kmom strongly urges women with these types of experiences to share them as well. These are often difficult to write about, but many women find that the writing begins the healing process. This has been Kmom's experience as well. Starting the writing is the hardest part, but the more you write and speak of it, the more healing takes place. Unresolved grief stays in the body and often harms us further. Getting it out is the first step on the path towards healing.
Regardless of how wonderful or not-wonderful your birth was, the exact moment-by-moment details of labor are less important to portray than what kind of treatment you experienced, helpful hints for pregnancy, what helped you prepare for labor best, the emotional processing you went through for pregnancy and birth, lessons you learned, etc. Think about what you would most like to tell other women from your experience, what would have been most helpful to you to have heard when you were pregnant, what the main lessons from your experience were, what you learned as a large woman, etc.
If you wish to submit your birth story, please fill out the following format, explicitly give Kmom permission to use your story, type in your story (no attachments please), and edit it to see if you have filled everything in and corrected any errors (please do this, it saves time for Kmom!). Feel free to use a 'pen name' or initials in your story in order to protect your privacy. Unless specifically requested, most personal information is usually changed or deleted.
Birth Story
Type in your birth story here; no attachments please!
Then email your story to kmom@vireday.com and mark it 'birth story'. Kmom reserves the right to edit and add commentary to the stories. Check the website every few months; Kmom will periodically update and insert new stories in the FAQ as they accumulate and as her toddlers permit! At times this will be every few months, and at times this may be only once or twice a year, so please be patient.
Most moms will recognize most of these terms, but women new to reading about childbirth may be puzzled by some of the terms and abbreviations used in these stories. This section briefly defines some of these in order to help women understand the stories better.
GD Birth Stories: Diet-Controlled GD
Karla B's Story (diet-only gd, vaginal birth)
Kmom's Notes: Note that Karla was 'allowed' to go to 41 weeks before facing a mandatory induction, although that was easier because her baby was of average size and she did not need insulin in the pregnancy. However, even so, it's unusual for gd moms to be 'allowed' to go to 41 weeks, but this story shows that there ARE providers out there who are open to this if this is important to you.
As far as losing weight after gd goes, proof is small and mostly speculative, not definitive. Certainly, Kmom strongly agrees that ALL women with gd should improve their diet and exercise levels; if this helps you lose weight, great! For some women, losing weight probably will help and does make sense. However, for some women who are chronic yo-yo dieters, yet another diet may make things worse. Losing weight should not be pursued regardless of the price (i.e., drugs or weight loss surgery often introduce more risk than they alleviate), but it certainly IS an option worth considering. However, individual circumstances and dieting history must also be taken into account. For some women, maintaining a stable weight while improving diet and exercise may be a more sensible option. For others, losing weight is probably most sensible. More on this debate will be found in the upcoming section on GD: Future Risk of Diabetes.
Birth Story
I'm happy to say I had an easy and uneventful pregnancy. At my first visit, my midwife said not to worry about weight too much, as most women seem to gain the amount that is right for them. She also explained that many women who are overweight before getting pregnant often don't gain a lot during pregnancy, and sometimes even lose a little weight. I never had any morning sickness, but during the first trimester my appetite wasn't great so I didn't gain a lot of weight. The only way that my weight really affected my pregnancy was that I sometimes had to remind them to use the larger cuff for an accurate blood pressure reading.
Around 24 weeks, I failed the one hour GTT and was referred for the three hour. I failed that too and was diagnosed with gestational diabetes. At this point I had only gained about 9 pounds, and later learned that low weight gain can be a symptom of gestational diabetes. While I was very upset to be diagnosed with GD, I decided that there were worse things that could happen in pregnancy, and that I was going to learn as much about it as I could so that I could be effective in managing the condition. The first thing my midwife said to me after I was diagnosed was, "You know you did nothing to cause this, right?" I was so relieved to hear her say this, as I had been having thoughts like, "I should have lost more weight before getting pregnant" and "Did I eat too much sugar?"
I was happy to find out that I could still work with a midwife (with occasional visits to an OB), and that I could have a healthy, enjoyable pregnancy and delivery despite GD. I learned how to test my own blood and was put on a special diet that was tailored specifically for me. I never felt deprived on the diet, and in fact sometimes had a hard time eating all the food that I was supposed to. I had very few food cravings after starting the diet too, which was a relief since I feared having to deny my cravings for sweets. During the first week of the diet, I lost a couple of pounds, but then gained them back and stabilized at a 9 pound weight gain. My dietitian expressed a little concern that I wasn't gaining weight, but my midwife wasn't worried since she knew I was getting adequate calories and nutrition. I also found out from my sister (a dietitian herself) that many GD moms don't gain any weight after starting the diet, but if they continue to lose weight, they should see their dietitian to add extra calories. I feel that as a result of the diet, drinking lots of water, and not gaining much weight, I managed to avoid some of the common complaints of pregnancy, such as swelling and constipation. I was even able to wear some of my regular clothes (mainly tops and knit pants) throughout my pregnancy. In fact, looking back, I felt better during the 2nd and 3rd trimesters than I did before getting pregnant and than I have since having my baby!
As my due date neared, I worried a little about having to be induced or have a c-section. My midwife assured me that my clinic did not routinely induce GD moms before their due dates, so that was a big relief to me. I enjoyed some of the extra attention I got (such as extra ultrasounds and hearing the heartbeat during non-stress tests). I told my midwife that I'd rather not be induced if possible, and she shared my opinion. She felt that many women are induced too early, and since their bodies aren't ready, they labor longer and harder and then often end up with a c-section. But, she said the fact was they wouldn't be able to let me go for too long because of the diabetes. She consulted with one of the OBs, and they decided that since my GD was in such great control, they'd give me a week past my due date before they would induce me. I've since learned this is pretty unusual for GD moms, so I was quite thankful for their willingness to work with me.
I also talked with my midwife about the possibility of my baby having low blood sugar and needing glucose water. I planned to breastfeed exclusively and wanted to avoid any artificial nipples. She said that if the baby did indeed have low blood sugar, I would be able to breastfeed to try to resolve the problem. Only if breastfeeding didn't resolve the problem would they consider giving glucose water. This news was also important in making me feel much more relaxed and confident about my birth plan. I'm glad my midwife and I talked about these issues, and even more glad that she and I agreed on all the things that were most important to me.
The day before I was supposed to be induced, I went into labor around 2:30am. I went to the hospital around 10:30am. The nurses and the midwife on call all seemed very impressed that I had only gained nine pounds, and they kept commenting on how great that was. I spent most of the day walking or in the tub, and the midwife spent several hours with me, helping me through contractions. Unfortunately, I had "screamers" in the rooms on both sides of me, and while I tried to ignore them, it did make me anxious about what was to come. Thankfully, I managed to deal with my contractions pretty well though, and had no medication for most of my labor. Sometime around 5pm, we decided she would break my water, at which point the contractions became much stronger and closer together. She offered intrathecal morphine (the "walking epidural"), and I decided that I would accept it (although I had been terrified at the thought of having a needle in my spine!). I went from 5cm to 10cm in less than an hour, and when I announced the intrathecal morphine wasn't helping anymore, they told me that's because it was time to push!
I pushed for 50 minutes (but it seemed like 5 minutes). Shortly before my baby was born, they asked me to turn onto my side and got out the oxygen mask because the baby's heartbeat was dropping. I never needed the oxygen since moving onto my side was enough to resolve the problem (but it turned out the baby had the cord wrapped twice around her neck). The midwife suggested an episiotomy because she feared I would tear into my urethra. I agreed and she made a small incision. Within a few more contractions, my baby girl was born at 6:45pm. She was just perfect, and was only 7 lbs 13 oz (not bad for a 41 week baby of a GD mom). (They had predicted 8.5 lbs at my 40 week appointment, so of course I had visions of a 9.5 lb baby!). She didn't have any blood sugar problems and took to breastfeeding like a pro.
So, I'm happy to say from firsthand experience that plus size women can have easy, healthy, and enjoyable pregnancies. Even though I did have a complication that labeled me high risk, it was something that was very manageable, and in the end it didn't have a negative effect on my pregnancy, labor, or delivery (and in fact I'd say it even had a positive effect in making me healthier than I would have been otherwise). Thanks for letting me share my story, and I hope it helps other plus size moms (especially those who develop GD) to feel better about their situation.
Kathy1's Story (GD, baby's head tilted, vaginal birth)
Kmom's Notes: Kathy's long days of pre-labor ('false labor') and then stalling at 4 cm for a while was a good clue that something was wrong with the baby's position. Unfortunately, most doctors pay very little attention to this, and breaking her waters may have forced her baby into instead of through her pelvic bones. Adding pitocin on top of that poor position to strengthen contractions pushing baby down may well have caused the damage and bruising she saw in her baby after birth, although of course it's difficult to know for sure. Getting up and shifting position probably corrected her baby's position and may well have saved her a c/s.
Birth Story
Kathy1's first child was delivered vaginally at about 40 weeks after being induced on a mostly unripe cervix. She found labor tolerable until the doctor broke her waters at about 3 cm, and then contractions became very intense and nearly continuous (very common occurrence). Eventually she opted for the epidural as a result, and did get some sleep. During transition, she desperately wanted to get up and move around, but was trapped in the bed by wires etc. and began to feel panicky. She began to feel the urge to push but was not allowed to until dilation finished, and had trouble keeping from hyperventilating. Eventually she began pushing, although it was not very effective due to the epidural. After an hour and 40 minutes of pushing, her son was born, weighing 8 lbs, 14 oz. However, the amniotic sac was not delivered with the placenta as it should have been and the doctor had to go get it, which was difficult, caused a lot of bleeding, and caused her to need a lot of pitocin afterwards.
With Kathy's second child, her father was diagnosed with type II diabetes during her pregnancy, and so she opted to be tested early for gd at 20 weeks. She did indeed have it, but was able to control it through diet only. Because of the gd and the fact that her previous baby had been almost 9 lbs. without any gd, her doctor wanted to induce her at 39 weeks. Fearing a pit induction again, she tried a castor oil induction at 38 weeks instead. The following is her story.
"After having mild, non-productive contractions for 3 days, I decided to try some castor oil in hopes of starting real labor. I drank 4 oz of castor oil with equal parts orange juice about 7 pm. After about 3 hours, I began having diarrhea, which lasted for maybe 2 hours. And then about an hour after it ended, the contractions began. By 1:00 am they were VERY strong and about 2-3 minutes apart, and by 2:00 am I was settling into my labor room at the hospital. I was at 2 cm and 50% effaced.
A friend joined us at the hospital and she and I giggled and talked through the early labor while my husband snoozed. I walked the halls, taking breaks to be monitored for about 15 minutes every hour. The contractions weren't bad at all, and I was having no problem dealing with them. About 9 am I was 75% effaced and 3 cm, so the doctor broke my water to speed things up. The contractions got much harder and faster, and I was really breathing through them, but we were all still in a good mood and laughing and talking between contractions. By about 1 pm I was totally effaced and 4 cm, but my labor had stopped. I was getting very tired by then and discouraged. So I tried to rest and see if things would pick back up. They didn't. After walking and trying various things, we started some pitocin about 4 pm. The contractions got much harder, and after about an hour I started to feel panicky, as it was getting more difficult to handle the contractions.. So they gave me a bit of Stadol to try to help me relax, but it wore off quickly.
Just when I thought I couldn't take anymore, my friend Amy arrived. Amy has been an OB nurse for many years, and is now a lactation consultant and childbirth educator. Needless to say, she knows how to handle a woman in labor! I was crying when she walked in, and I started begging her saying "Please...I want an epidural!!" She said "You don't need one. You need to calm down." She got very stern with me and made me breathe with her through a few contractions. When I got panicky, she'd just get stern again and tell me to look at her. Then a strange thing happened. I relaxed and I began to feel empowered. If I paid attention, my body was trying to tell me what positions helped the contractions along. It felt better to be standing and swaying, and pacing around. I did that for a while, and Amy was keeping me focused and helping me breathe through each contraction. I was handling it!! But I was also awfully tired.
Soon they checked me and announced I was at 7 cm, but my nurse and Amy also had begun to suspect that the baby's head was in my pelvis a little funny. Amy had me squat on the edge of the bed through several contraction to open my pelvis, and I felt his head shift down into the birth canal, and the pressure was incredible! I started to panic a little again. I kept saying "He wants to come out NOW!" And Amy would calm me and say, "not yet--breathe." I was breathing and having to focus so hard during contractions, but was dozing off in between. (My husband said I was even snoring!!) Resisting the urge to push was so hard! But thankfully I went from 7 to 10 in about 20 minutes, but when I pushed, he still wasn't moving down. Amy told me to lie on my side and draw one leg up to push. The doctor didn't argue with her although his preference was to use the stirrups! So I got on my left side and drew up my leg and I pushed through 3 contractions, and with every one they were saying they could see more...they could see hair, etc.
On the third I pushed with all I had, and I remember making some kind of growling sound. His head was partly out and Amy said, "If the contraction's over, rest." And I thought "Forget that!" His head was partway out and I had some kind of fear that if I stopped and rested then, he'd be hurt in some way, so I took a deep breath and PUSHED!! I felt something pop and he came flying out onto the bed all at once (not the usual "head then body" delivery). It sure was a good thing that I didn't have stirrups because I don't think the doctor would have been able to catch him!
David's head was very bruised and the bridge of his nose and left eye were extremely swollen--further evidence that his head had not originally gone into my pelvis correctly. I am SO GLAD that I made it through without the epidural. It was hard, and a lot of work, but if I hadn't been able to squat and roll on my side and such, I just might have had an emergency c-section. And I am SO thankful that Amy was there, because she helped me fight the urge to withdraw into myself during the pain of the contractions, which was the only time when the pain would overwhelm me. As long as I could remain focused on something outside of my own body, I was able to stay on top of the contraction and handle it. David nursed right away in the recovery room, and I was amazed that he latched on immediately. He was 7 lbs, 11 oz., 20 1/4 inches long, with apgars of 9 and 10."
Update: Kathy writes that "My son has recently seen a surgeon...and the surgeon was [able] to provide an explanation for his postpartum nasal swelling that kept him in the hospital until he was 5 days old. He suffered a broken nose due to the positioning of his head in my pelvis. This also explains the extreme swelling across the bridge of his nose and one of his eyes."
Stacy's Story (3 pregnancies; gd + ketones with 3rd; 3 c/s)
Kmom's Notes: Stacy's extreme problems with ketones in gd are unusual. So was the level of calories she needed to have normal levels. Most gd moms are given around 2000-2200 calories; some docs restrict obese gd moms to 1500-1800 calories but this raises the danger of ketones and brings up whether the mother is adequately nourished at that level. However, Stacy ended up with the highest caloric totals I've ever seen for a gd mom---2800 calories! She also had to stop exercising to stop the ketones; this is very unusual. However, her ketones had probably become so out of whack previously in the pregnancy that such drastic measures were needed to stop them. Fortunately, her providers did measure them regularly (not all do) and experimented till they found what worked best for her. They didn't simply apply a uniform protocol, which helped a great deal.
Birth Story
I was diagnosed with GD at 28 weeks. With my other two pregnancies I had failed the 1 hour glucose test, but passed the 3 hour one. Not this time. My fear for the health of the baby and being absolutely terrified of blood tests, wreaked havoc on my emotions. I was determined to do everything possible to avoid insulin injections, even though I knew that it may be inevitable.
First, a little history. This was my 3rd pregnancy. My first baby was born when I was 29 years old. I was a dress size 20 when I became pregnant with him and gained less than 5 lbs during the pregnancy. (Not because I was trying to not gain weight, I ate very normally. My body simply didn't gain weight.) At 32 weeks gestation I noticed that he had become suddenly a lot less active. (Thank God for the doctor recommending counting kicks early on.) I went in to see my OB and was put on a fetal monitor immediately (non-stress test). The baby was having dips in his heart rate. They rushed me to a local hospital that had a more advanced neonatal ICU. As soon as we arrived there, his heart rate took a drastic plunge and he was born by emergency C-Sec. within minutes. He is now a perfect, simply amazing, brilliant little 6 yr. old.
Baby number 2 was born 14 months later. My dress size was still a 20 but I had gained about 10 lbs since the first pregnancy. Again, with this pregnancy I gained little weight. I was not diagnosed with G/D but once again I had failed the 1 hour blood glucose tolerance test and then passed the 3 hour test. On his due date, after 14 hours of labor, the baby went into fetal distress and was also born by an emergency C-Sec. His situation was totally unrelated to his brother's. He was born with a rare skull bone abnormality, that was corrected by surgery when he was 2 months old. But because of that problem, his head was simply unable to pass through the birth canal. He is now a perfect, hilarious, brilliant little 5 yr. old.
Ok, now back to baby number 3. With this pregnancy I was 35 years old and had again gained about 10 lbs since the last pregnancy I was now a size 22. At the beginning of the pregnancy, after much discussion with my OB, I decided to have a planned C-Sec. this time. Once I made that decision, I was completely relaxed about the rest of the pregnancy. We also decided at that time, that this third child would be our last, so I planned to have a tubal ligation at the same time. The decision was made long before the GD diagnosis.
After being diagnosed at 28 weeks, I began the diet and exercise program given to me by the doctor and registered dietitian. I stuck to it to the letter, but something wasn't working right. My ketone levels were registering "high" everyday. I had been very inactive due to an accident I had been in for a few months prior to and throughout my pregnancy. So, not only was I a plus size person to begin with, but my metabolism was certainly not normal either. Although, like many large women, I had gained almost no weight up to this point in my pregnancy.
Within 2 weeks of starting the diet/exercise program I had lost 8 lbs. At first the dietitian and doctor told me to not worry about it since many people lose weight when they begin the program. My blood sugars were all fine. But then when they saw my ketone levels they decided to take action. I figured that my body was just in so much shock from actually exercising, that it just couldn't help losing weight. I cut the exercising down to 5 minutes after meals.....and they raised my caloric intake to first 2500 calories.....then to 2800 calories.....and then finally to 3000 calories per day. Finally my ketone levels went down to "small" and "trace" readings, but I was still losing weight. With the agreement of the dietitian, I stopped exercising altogether. In my case, that worked. I stopped losing weight, had no ketones, and by just lowering my calories back down to 2800, my blood sugars stayed within normal range. I was able to control everything without insulin injections. Yippppeeeeee!!!
At 38 1/2 weeks my daughter was born by C-Sec., healthy, weighing 7lbs 5oz.and was 19 inches long. A planned cesarean is a LOT more relaxing than an emergency one. (Although, due to my fear of blood tests, as mentioned above, I was MUCH more fearful of getting an IV than the surgery itself. Go figure.) Everything went as planned to the letter. It was almost comical, shaking the doc's hand and saying "OK, now go get my baby." It was incredible, magical, wonderful. I was given a spinal block and had no ill side effects from it. For some unknown reason, the baby's blood sugar was low at birth. It registered 29 which was well below the hoped for reading of 40 or higher. My husband was handed a bottle of formula and he fed her about an ounce of it right away. Her blood sugars came up to normal and have remained that way ever since. I was a little concerned that she might not want to latch on to me after trying a bottle nipple first, but she latched on like a pro on the first try, a couple of hours later. The baby did not have any shoulder dystocia any other troubles associated with GD or anything else, for that matter.
It was a lot of work, but very much worth it, and I have a whole new understanding of my body and my metabolism. My emotions went through typical upheaval after her birth, but I think that was probably due to lack of sleep as much as due to hormonal fluctuations. I am now slowly adding exercise back into my daily routine and am amazed at the difference it is making in me both physically and emotionally. My boys like Richard Simmons better than Big Bird. Ha Ha ;)
Michaele's Story (gd, induced vaginal birth)
Kmom's Notes:
Birth Story
I was 36 and this was my first pregnancy; we conceived the first month of "trying". I had a pretty easy pregnancy, although I'm overweight I'm pretty active and the swimming and bicycling I did during pregnancy really helped I think.
I had morning sickness and fatigue for the first 16-17 weeks, and I was diagnosed with GD and mild anemia at 27 weeks which was controlled by high protein, low-carb diet for the remainder of my pregnancy. I ended up taking the HMO Lamaze birth classes. I didn't bother with a birth plan since the hospital where I delivered had most of the things I wanted (like pro-breastfeeding, immediate bonding, no episiotomy, etc) as standard procedures.
Now for the birth story! Because of the GD my OB wanted to induce labor, so I chose a date and hoped against hope that I'd go into labor before that. But the morning of the chosen date rolled around and off we went to the hospital. Although I was ready, I was absolutely BAWLING my eyes out in the car because I was so disappointed that I hadn't gone into natural labor, but excited because I knew I'd have my baby soon!
We go to the hospital around 8 AM and my OB broke my waters and hooked up the internal fetal monitor, then I was given an IV and they started the pitocin drip. I was about 2 cm dilated and my cervix was soft so they didn't use any gel. The next several hours were pretty boring, I couldn't go anywhere except the bathroom and I couldn't eat anything although I was allowed to have water, juice, and tea. DH and I read the newspapers, did some crosswords, watched TV, and listened to music (I had brought a CD boombox to the hospital with me). I spoke to the anesthesiologist about pain relief options and decided to go with an epidural later if I needed it.
By about 2 PM I was really feeling the contractions and did some breathing and moved around as much as I could to find a comfortable position, at around 5PM (about 9 hours after labor started) I had them insert the epidural. I had a "light" epidural which was GREAT!! I could still walk to the bathroom and I could pee on my own throughout. I didn't ever have them deaden the pain completely. Honestly the thing that hurt the most was the DAMN automatic blood pressure cuff--YIKES!! DH was absolutely wonderful throughout, keeping an eye on all the monitors that I was hooked up to, doing some breathing with me, etc.
Anyway I was about 5 cm dilated at this point and I knew I still had a ways to go. They had been upping the pitocin all along and I was lucky that my body was responding well. The one "problem" that occurred during the next five hours was that the external contraction monitoring belt just wasn't easy to position well on my stomach so they opted to use the internal contraction monitor. So I ended up with yet another tube, this one goes in between the baby and the uterine wall and it HURT LIKE HELL during contractions.
I'm not sure when exactly transition started but it was the most uncomfortable part of my labor. Although the contractions weren't very really painful, I had a hard time relaxing in between them and my whole body would tremble. But before I knew it, the OB came in and checked me and said "time to push!"
At this point I'd like to make a plug for the L&D nurses at the hospital--I was there for three shifts and every nurse I had was just GREAT. I started pushing right after a shift change and the last nurse I had was absolutely terrific! Anyway at this point they turned down the epidural and the pitocin and I started pushing away. DH was a huge help here, counting during my breathing, and providing resistance against my legs. The nurse let me use any position I could think of--I pushed on my back, on the toilet, on my side, standing up, squatting, with the bar--you name it!! It was one of the most difficult things I've ever done physically. After about 2.5 hours of this I finally figured out an effective position (which was lying on my back with my feet pushing against the bar--absolutely contrary to any recommended position) and at 1:20 AM out came my beautiful little girl!! I had a small 2nd degree tear and came through labor much more easily than I expected to.
I held her immediately and made my first few attempts at nursing while the OB stitched me up. There is really nothing more amazing than meeting your baby for the first time!
Joann's Story (contradictory gd testing, changed doctors, normal vaginal birth)
Kmom's Notes: This mom was not given the proper instructions for the gd test, which made her question the results when they came back just over the cutoffs for 'gd'. She retook the test at 30+ weeks, this time following the proper guidelines, and this time she passed the test. Her doctor did not want to believe the second test. Because of that and 'hospital policies', she had the guts to switch doctors at 36 weeks. She did still monitor her eating and her blood sugar levels, and gave birth to a normal-sized baby without any problems or any pain meds.
Birth Story
My only instructions for the 3 hour test were to not eat anything after dinner the night before. I happened to have an early dinner the night before and got to the clinic later than I'd planned---leaving me with a fast of over 17 hours. Nothing was ever mentioned about carbo-loading either. I barely failed according to the NDDG cutoff values (4 points too high on the 2 hour reading, 5 points too high on the 3 hour reading).
[Kmom note: A too-long fast can artificially elevate fasting results, create ketones, and throw the whole system out of whack. It is a big stress on a pregnant woman's system. Carbo-loading's value is controversial; some research seems to show it makes no difference but many midwives swear by it in order to prepare the pancreas to respond adequately to such an intense load of sugar. At this point, it's probably better to err on the side of caution and do carbo-loading ahead of time.]
I found the information and courage needed to ask for a retest (following the 'rules' this time). The new test showed I did not have GD even though this retest was taken 3 weeks further into my pregnancy than the previous test (I was over 30 weeks for the second 3 hour test). I still watched my diet for the rest of pregnancy but was very thankful to get the GD label off the pregnancy, especially because of all the interventions they wanted to do.
Unfortunately, my original doctor ended up not believing the retest (he was on vacation when the results of the second test came in), and still wanted to treat me as GD. He did agree to letting me go up to 41 or 42 weeks before inducing as long as the non-stress tests (starting at 37 weeks) were fine. However, because of other reasons (mainly hospital policies), we decided to switch hospitals and doctors at 36 weeks.
My new doctor knew about the test results but did not freak out about the first one. The baby did not appear to be too large---I had not gained an excessive amount of weight. He would induce at 42 weeks and wanted non-stress tests twice a week starting at 40 weeks. I was eating healthier, avoiding too many carbohydrates, eating more protein, etc. I did still monitor my sugar levels for a few more weeks (until the batteries in my glucose monitor died---it took me a week before I finally got to the store and found the right batteries and by then I was out of the habit and only tested a few more times).
While I was testing my fasting sugar levels never got over 95 and rarely got over 120 after meals (they were only high when I'd obviously overeaten on tortillas or rice). I noticed that after I quit testing my stress level went way down. It was so much easier for me to just focus on eating healthy rather than focusing on making sure I "passed a test" with every meal.
I ended up having a baby girl five days after my due date. She was 8 lbs. 7 oz., and I did not need any pain medication during labor. She was not a small baby but definitely not a huge baby either (my grandmother gave birth to my uncle who was an 11+ lb. baby---that's huge). The baby's blood sugar was just fine--I don't know if they ever checked mine. Her Apgars were 8 and 9 although she did spend some time in the nursery due to her breathing being a little irregular because one nostril was blocked. The nostril has corrected itself now and she's doing great.
I do understand that diabetes is a serious illness and I have a much greater appreciation for those who deal with this all the time. I plan on continuing to eat healthier, especially when the time comes for baby#2. Hopefully, we will avoid all of this the next time.
Kmom's 1st Story (diet-only gd, induction, c/s)
Kmom's Notes: It's difficult to be objective about one's own birth experiences, but with many years behind me, I can see that this pregnancy was a call to healing. I was very scared, had no information about plus-sized pregnancy, was treated as high-risk by nearly everyone due to my size (though they were deceptively nice about it), and was undergoing major life transitions at the time. Although I did some pregnancy reading, I didn't do enough, had few resources for questioning what I was told, and behaved like a compliant 'good little girl' ought to. It took a horrendous birth experience to shake me out of that pattern. Although I cannot be glad for that experience, it certainly did set me on a different life path, started a great deal of valuable soul-searching and healing, and I can honor the learning and change that has come from it. And of course, I got the most precious baby in the world from it!
Birth Story
My first child was conceived during a period of great stress. I was very unhappy with the changes in my job, was working very long hard unhealthy hours, had too many extra activities, was deep in grief for my father who had died the year before, and was not being as healthy as usual in eating and exercise habits. To top it all off, just as we found out I was pregnant, my husband was laid off.
Although the pregnancy was a surprise, we welcomed it and were excited, if a tad worried about insurance coverage and plans. Then I began spotting, which continued off and on throughout the whole first trimester. This forced me to re-organize my life, drop my extra commitments, stop working so hard and long, and take time to just rest. It also meant no exercise. After a while, the OB agreed to do a vaginal ultrasound. This eliminated ectopic pregnancy, a significant worry, but it wasn't clear whether there was one baby or two. A further scan two weeks later showed only one baby. Thus the bleeding might have been a 'vanishing twin', low progesterone levels, or simply the random spotting that occurs in many pregnancies at first. We'll never know.
The doctor did not treat me meanly but did nothing to alleviate my fears, telling me (incorrectly) that my chances of miscarriage were 50% (they drop down once a heartbeat is seen), and was not very encouraging about my chances. She did no testing on Hcg numbers or progesterone levels, which could have told us a lot more; I think she basically wrote me off as a miscarriage. But she came highly recommended and was one of the few accepting new patients in the area, so I didn't complain.
I experienced very significant nausea, but she told me "not to worry" if I couldn't eat because "the baby would take what it needed." The plan I was given was low on protein and very high in carbs. Between erratic eating due to nausea and the low protein/high carb food plan I was given, I developed a pattern of wildly swinging blood sugars and ketone levels that would take 7 months to straighten out, and quite possibly added into my own insulin resistance and stress levels to cause my gd. Ah, hindsight! She did send me for a one-hour gd test in the first trimester, which was borderline. I then passed the 3-hour GTT (which made me shaky and sick); no further nutritional guidance was given. I believe that had I only been given some instruction in gd food plans at that point, I probably could have avoided the gd, but nutrition is not a high priority for most OBs.
Once I reached the second trimester, the spotting stopped, we relaxed, and I began really bonding to the baby. We took the AFP test without really understanding it, and when it came back low, we were devastated. No counseling was provided by the OB; a cold phone call from a nurse was all we got. We were sent for genetic counseling, which was terrifying because I am adopted and have no family history to fill in. It turns out that the reason the test was low was either because my cycles are long (making the baby younger than they thought), or because heavy women tend to have lower levels due to a larger circulating blood volume and they did not correct enough for that. We had an amnio, which was very painful (story in prenatal testing section). The doctor was very cold and unkind and blamed all the problems on my size (probably untrue). I experienced bleeding and cramping afterwards, and spent a horrible Xmas waiting for the results and wondering if I'd miscarry. After bonding so strongly with the baby during the bleeding scare, this was really awful.
When the results came back fine (it was a girl and healthy!!), we rejoiced and thought we were home-free. Not so. My husband was transferred to another state, and we had to leave our jobs, get the house ready to sell, and find a new house VERY quickly. Talk about stress! And during all this, I had to take my next gd test. It too was borderline, so I took the 3 hour GTT again, but no one gave me any guidelines on it, so I took it while I was sick and TOTALLY stressed in my last week at work. Not surprisingly, I went over the cutoffs this time. I had to do treatment and try and adjust my diet as we moved, but after moving my numbers became normal with care.
I was devastated to have gd, felt like I was being put on a 'diet' again after years of freedom from dieting stupidity, and humiliated that I had a 'fat person's disease.' I was also scared about what having gd meant to the baby and the birth, and scared because I was not given a lot of information about gd. However, at least I managed to get my numbers under good control quickly.
I really wanted to find a midwife practice in my new town, but was told I needed an OB due to the gd (not true). I chose the OB that seemed extremely personable, would not automatically induce at 38 weeks, and had a great bedside manner. The ultrasound predicted an average-sized baby so I was 'permitted' to go to term, but he wouldn't allow me to go beyond 40 weeks. We induced on a long hard unripe cervix, and I spend the night before writing a good-bye letter to my daughter because I had a bad feeling about it all. Sure enough, Dr. "Right" turned out to be "Dr. Jekyll and Mr. Hyde" in labor, and the birth as a result was quite traumatic. Being "nice" is not enough.
We did two doses of prostaglandin gel, then started the pitocin the next morning. Labor was easy to handle at first, especially since I was allowed some walking and rocking until the doctor broke my waters at noon (I was 2 cm dilated and she was at a -2 station; breaking the waters when she was not engaged in the pelvis was contraindicated and potentially dangerous but he didn't tell us that). At that point I was not allowed out of bed, and once the cushioning bag of waters was gone, labor became excruciating.
The baby was quite probably in the wrong position, which is what probably caused all the pain, but Lamaze breathing was NOT capable of handling this kind of pain! We tried IV meds before finally resorting to an epidural. In this case, the epidural was a blessing and allowed me to finish dilating, even though it was not fully effective and had a 'window'. By about 17 hours into labor, I was fully dilated and ready to push. We pushed for 2 hours with no progress. She stayed high (-2 station) and unengaged. Even with epidural left, I felt tremendous pain on one side of my back, another indication of position problems. We used stirrups for pushing; I asked to try squatting. But this did not budge her either; she was stuck. I was exhausted by the 'purple pushing' by then, and requested the c/s.
The next part I will leave out, but basically the booster epidural for the c/s did not fully take either. I felt the surgery. A lot. It was a horrendous experience, deeply deeply traumatic. I'll leave out the details, but it greatly affected all of us and has taken many years to heal. The hospital staff ignored it as if it never happened.
My baby was taken to the NICU nursery, given formula even though her blood sugar was fine and they knew we were nursing, and she was given a pacifier. Although my husband tried to be with her, he wasn't sure what to do with a newborn and was concerned about me, so my baby was basically abandoned for hours, something I will always mourn. It was 8 hours before I was permitted to try nursing her, and she developed jaundice between the gd, the pitocin, and the lack of nursing (all risk factors for jaundice). However, the good news was that despite the difficult birth and terrible c/s and separation, the minute I saw her we bonded like insta-glue and were deeply connected.
That was good, because nursing was very difficult at first! Traditional positions made me very sore (only the football hold worked well), she had many bottles of formula and glucose water at the hospital, and the jaundice and drugs made her extremely sleepy and unresponsive. She narrowly avoided needing treatment with bili lights; the nurses and doctors told me to use glucose water to 'flush out the jaundice' but I have since found out that this actually tends to increase jaundice. Between the c/s, the bottles, the lack of frequent nursing, and the severe edema I had from the pitocin and IV fluids, my milk did not come in for many days, but increasing the nursing seemed to help somewhat. Eventually we were able to slowly eliminate more of the bottles. I was too proud to see a lactation consultant, but eventually we managed to work out nursing despite everything. After a month and a half or so, we were fully nursing. It was very healing to finally have something work the way it was supposed to!
We had a very difficult start, from her very stressful pregnancy to her difficult birth. She developed a roaring case of diaper rash, then had 4 solid months of colic as her body struggled to cope with all the stress, drugs, formula, etc. I have since been told also that many babies that are malpositioned frequently experience severe colic (craniosacral therapy is supposed to help). However, at 4 months, a switch magically flicked and she became the perfect baby! Nursing went well and was very healing for us both. Although I never really intended to nurse beyond 3-4 months, we mutually decided to continue for over 4 years, including through her baby brother's pregnancy. I think the nursing really went a long way to healing the difficulties of her pregnancy and birth. She eventually weaned of her own volition, and I am very glad I didn't force the issue, since she seemed to really need it. She is a very healthy, smart, and active little girl now, and I love her deeply.
The pregnancy was a tough one, but it ultimately lead to a lot of healing and changes. I lead a much less stressful life now, have worked hard on emotional healing, have taken up exercising again, and although I do not diet I am careful again about what I eat and how it's timed. By being much more proactive about diet and exercise, I have been able to avoid gd in subsequent pregnancies, despite my age. I also am MUCH more careful about the health providers I select now, and am assertive about researching health care decisions. In many ways, I am a new person now, born through the fire and difficulty of this pregnancy and birth, and although I would never have chosen these experiences, I can value the healing and growth that has come from them. But sometimes I do mourn the peaceful and joyful pregnancy and birth that was taken from me by circumstances and insensitive providers!
Postscript: Kmom subsequently had a baby boy 2 years later. She avoided gd in that pregnancy, although she very carefully measured her blood sugars every day anyhow, even after passing the test. Though her blood sugars were under much better control, her second baby was larger, 9 lbs. 11 oz. and 21.5 inches long. This is apparently just genetic for her, not related to blood sugar after all. She eventually found a good set of nurse-midwives in this pregnancy and labored mostly spontaneously and all-naturally---a non-induced labor is MUCH easier to deal with! However, the baby was posterior, which went undiagnosed and unfixed, so the baby got stuck. After 5 hours of pushing, she had a repeat c/s (this time with a spinal!); as c-sections go, this was a 'good' one.
Kmom had another baby 3 years later. She also avoided gd in that pregnancy, despite being near 40, though she was careful to measure her blood sugar throughout as a precaution. Although her blood sugar was normal in this pregnancy too, it was a bit more borderline than in the second pregnancy. Yet despite this, her third baby was only 7 lbs. 9 oz. Obviously blood sugar levels don't seem to influence her babies' sizes. This one was probably smaller because it was induced a little early and he took after her husband's side of the family (7 lb. babies) instead of her side of the family (9 lb. babies), though who knows for sure! She had a VBAC in this pregnancy, despite 2 previous cesareans. Most OBs would probably attribute this to the smaller size of the baby, but Kmom feels it was because THIS baby was positioned anterior instead of posterior. She feels she could probably birth a much bigger baby vaginally as long as it was positioned optimally. But she was happy to have a VBAC whatever the reason.
Finally, four years later, Kmom had another baby girl. This time she chose a home birth with certified midwives, after careful research into the pros and cons of birthing outside the hospital. Again she monitored her blood sugar to ensure it remained normal; it did, despite Kmom being well over 40 by now. In this pregnancy, Kmom chose carefully which tests and interventions she felt were justified, and avoided the automatic testing so common in pregnancies of older moms. Having a home birth with midwives helped her have a truly relaxed and less stressful pregnancy. This baby went "overdue" by quite a bit, so it was a good thing her midwives were relaxed and laid back! Kmom's fourth baby was eventually born in the water, at home, in a lovely and safe birth. Surprisingly, this baby was 10 and a half lbs.! Not because Kmom had "gd" but because she was finally allowed to labor truly spontaneously and went to her natural pregnancy length without being forced or encouraged to labor early. Note that Kmom's second VBAC baby was a pound bigger than her c/s babies, and 3 lbs. bigger than her first VBAC baby, so obviously baby position was much more important than baby size after all!!
Kathy F's Stories (diet-only gd, arthritis, premature vaginal birth)
Kmom's Notes: This was Kathy's 5th child; some of her other pregnancies were not plus-sized ones, while others were. She also had a 'glorious' homebirth with baby #3; this story can be found in BBW Birth Stories under "Vaginal Births Under Special Circumstances".
Birth Story
Baby #5: I am extremely fertile; had our first four children in 4.5 years in my early 20s. We conceived again years later while trying to prevent it; we were thrilled anyway because we wanted more children. I did not seek medical care until the 5th month. From my earlier pregnancies I knew to take a good quality supplement with folic acid and I knew the warning signs of problems and had none, so I wasn't concerned.
Finally chose an OB in my 5th month, saw her several times. At first she seemed great, but then I was diagnosed with gd. The fiasco of her care after that was unbelievable to me. She did not get the diagnosis to me in a timely manner, delayed getting me to the dietician and then sent me to one my insurance didn't cover, didn't call in the glucometer prescription in a timely manner, etc. At that point I was so disgusted with the lack of decent care I realized all my trust had been destroyed and I was NOT going to let this woman deliver my child.
The OB I switched to is wonderful! The best I've *ever* been to. Wish I'd been with him from the beginning. I switched at 34 weeks and they were hesitant at first to take me, but by the time I told my story they took me on. I saw my new OB twice, once in the middle of my 34th weeks at which he does an ultrasound himself in his office. Everything was good. My b.p. was relatively normal, 130 or so over 85-90, nothing to be concerned about. [Kmom note: Some doctors would be concerned at this b.p. but this doctor was not.] The gd stayed controlled well with diet alone. My weight had continued to gradually drop, especially after being put on the GD diet. I was given a 2300 calorie diet, which gave me more than enough to eat and plenty of energy. I ended up losing 30 lbs. I asked my new doctor if my weight loss was a concern and he said no. The baby had been growing fine, ws a good size, and the lost weight was only a sign that I was eating right. If the baby wasn't growing normally, then he would be concerned.
[Kmom note: It's not unusual for large gd moms to lose weight in pregnancy. Doctors vary in their concern over this; some view it as a sign of something wrong, some want you to be losing weight, and some simply judge it on whether or not the baby is developing well. HOWEVER, any gd mom should be checked for ketones in the urine on a regular basis---particularly a gd mom who is losing weight. Strong weight loss or lack of gain can be a sign of ketone problems, which can potentially damage the baby. It's very important for this to be checked on a regular basis in gd or whenever a mom is losing weight in pregnancy. This mom was not checked for ketones and she should have been.]
I have Psoriatic Arthritis (PA), which is a rheumatoid-like arthritis accompanied by psoriasis, a skin condition noted for its red scaly patches. During a large part of my pregnancy, my PA went into high gear. My abdomen was covered with one enormous psoriatic patch that gradually migrated to my back. There was nothing that could be done for it. The medications they use for severe PA are dangerous for the baby, and cortisone creams only took the edge off the burning and itch. I found that an extra-virgin cold-pressed olive oil worked better than the standard creams for relieving the P. It didn't go away until the temperature climbed past 80-85 degrees F, normal behavior for my P (mercifully, this comes early where I live). In my 3rd month, I strained or pulled a ligament in my groin which never completely healed and only continued to worsen throughout the pregnancy. I didn't know it at the time, but I know now that this was due to the PA. My hips have been arthritic for several years but it hadn't spread until this pregnancy. This kind of arthritis also affects ligaments as well as joints and the strain on my lower abdominal ligaments was excruciating for me. At the end of the fourth month, I went to the mall to pick up something and had constant contractions the entire time. It was so severe I had to stop walking and just stand there until my uterus relaxed. I stayed away from malls and extensive walking after that. Eventually I couldn't walk or stand or even sit for more than 5 minutes at a time. By the time I went into labor, I was in pain in every cell of my body, slept only fitfully, and was extremely uncomfortable to to say the least.
Also, in my 7th month, my hay fever kicked in as it always does at that time of year. I developed allergy-induced asthma, so my family doctor consulted with my OB and gave me an injection to clear up the asthma, with the happy side-effect of developing the baby's lungs a little early. This turned out to be beneficial because I went into labor at 36.4 weeks.
Labor began at 2:30 a.m. with the loss of my mucus plug during yet another middle-of-the-night visit to the bathroom, with contractions intermittent until about 6 a.m., when they steadied to 8-10 minutes apart or so. We called the OB around 8 a.m., then my MIL (whom I had also asked to attend the birth). We were at the hospital and admitted around 9 a.m. They were wonderful labor support. Contractions were not quite steady, fluctuating between 5-10 minutes apart until noon, when they settled into a 5 minute pattern. At around 11 a.m. I realized I'd gone too long without food and requested milk and crackers to bring my blood sugar levels up a bit. I knew that the baby could go into shock and die in utero if my blood sugar levels dropped too far, especially because I had had a stomach flu the week previously, messing up my diet and blood sugar levels. I had not gotten back on track with a good balance before labor began. I knew this was a cause for concern from my personal study about gd.
My water broke spontaneously at about 2 p.m. and contractions became stronger. Dilation progressed normally through all this. I was at 4 cm when I was admitted, at 5-6 at noon, and at 2:15-2:20 p.m. I was 8 cm. I've been able to handle the labor pains by thinking of riding them as waves (as before). My husband sits by me or stands with me during this. I hang onto his shoulders and lean into him, letting him support my weight while he reaches around and applies pressure on that one spot in my lower back/pelvis region where I feel all my labor. This works better than any pain killers. I have never had an epidural, although I was tempted this time. I'm not quite as resilient at 34 as I was at 24. :-)
By 2:45 p.m. I realized I was ready to push from past experience. I never have felt the "need" to push the the pregnancy books describe. Instead I have just one long contraction. The pain reaches a peak, subsides, but only to a half-way point compared to the previous contractions, then goes back up again. This continues for 10 minutes before subsiding for about 30 seconds then starts again. This was my "sign". I told the nurse what was happening and what it meant. She immediately went into action. She checked me and said, "Well, you sure know your body!" I was indeed ready to go. The doctor had come in about 15-30 minutes before to check me and see how I was doing. He was called back and was there in moments. I was impressed with the cheerful efficiency of the staff, as it was shift-change time. There must have been four or five nurses there due to the change-over. It was like watching a well-rehearsed ballet, the way they all worked together. My doctor was incredible, and the nurses behavior toward him showed me even more how well-liked and respected he was by the staff. Everyone received the same respect and kindness from him as I did. Truly a gentleman, as well as an outstanding OB.
I pushed for 3 minutes (I was watching the clock!) and my daughter was born at 3 p.m. straight up by the room clock, but 3:02 by the official time. She just whooshed right out with only 2 or 3 pushes. I did not have an episiotomy and there was no tearing. Apgar scores were 9,9. I asked the nurse to please check her blood sugar level early. Labor had been 12.5 hours long, and I was worried. My instincts were right on, because her glucose level was at 22. Below 40 for babies is dangerous. I asked if we could just give her a bottle and wouldn't that take care of it? The nurse said yes and handed me a bottle to feed her. While I intended to nurse, I knew that my milk wouldn't be in for a day or two. The only alternative was an IV for the poor mite. I preferred the bottle to a needle!
[Kmom note: Actually, there is another alternative. Formula can be given by non-bottle methods so nipple confusion becomes less of an issue. Finger-feeding, syringe feeding, cup feeding, etc. can all be used to give a baby that needs supplementation some help without risking breastfeeding. This baby needed extra supplementation or IV glucose, being so low and particularly from being a preemie and from a mother who had been ill and thus had unstable blood sugar. But babies that are more borderline can be nursed FIRST to see if that brings up their glucose enough. Before the milk comes in, colostrum is secreted, and that is high in protein, which helps stabilize baby's blood sugar more than sugar-water does. If baby still needs more help, supplementation can then be offered by finger-feeding, etc. This baby DID need to be supplemented, but most gd babies do not need it, especially if the mom's blood sugar remains stable beforehand.]
Recovery was completely normal. I will say this----my third birth was at home with a midwife and this hospital birth rivaled that one in excellent care, as well as respect toward me and my wishes. It stands side-by-side with my homebirth as a glorious birth experience.
This baby was definitely premature and nursing was a real struggle. My nipples were too big for her little mouth, and she was unable to draw down enough milk. By the time she was 2.5 weeks old, she hadn't gained back any of the weight she had lost in the hospital. Her doctor was willing to let her go another week but I wasn't. I made the decision to give up nursing and begin bottle-feeding. This ended up being a very good choice for us because by the time she was five weeks old I had gone into a full systemic flare-up of PA, with extreme pain in every joint in my body, and could not hold her for more than a minute or two. The joint pain gradually lessened until I was in complete remission 6 months later. She is now a thriving and healthy one year-old, and has had only one ear infection in that time. I have opted not to immunize at this time, due to the psoriasis she has already started (my only child with this) and her premature birth status. The psoriasis indicates a possible immune-system problem, and I'm taking no chances.
And I've recently learned through an ultrasound that I'm 13 weeks along with TWINS!! :-) These will be our last children, I think! I intend to attempt breastfeeding again. Hopefully with a nursing pillow we will succeed, even if the PA flares up again. (See Kathy F's Twin Story down below!)
Amy S's Story (diet-only gd, vaginal birth)
Kmom's Notes: Amy worked very hard to keep her blood sugars normal and to educate herself about her care options. Knowing the odds of being induced, she worked very hard to ripen and efface her cervix ahead of time, using Evening Primrose Oil, nipple stimulation, etc. In her case, it seems to have paid off. She was able to avoid induction after all, and was able to have pretty much a natural birth.
Birth Story
A little background first---we had some trouble conceiving and also had a previous miscarriage. We were finally successful when I added low-carbing to the charting etc. We did a routine pregnancy test at the R.E.'s office the day we were to start treatment, and discovered I was pregnant.
Up to about 16-18 weeks was often very scary, as I had a couple of bad bleeding episodes---placental separation, low-lying placenta, etc. So I spend a great deal of time on bedrest or restricted movement, and all problems eventually resolved. At 22 weeks was diagnosed with GD which was successfully managed with diet alone. By the third trimester I was finally feeling pretty good, everything under control---except then started the worry of induction, as my docs would not let me go late due to the GD.
So at 36 weeks I started taking Evening Primrose Oil (EPO) daily to help ripen the cervix. I also started drinking red raspberry leaf tea regularly, as it is supposed to help tone and strengthen the uterus. My cervix was great--by 37-38 weeks it was fully effaced and I was dilated 1-2 cm.
The induction was scheduled for Tuesday---exactly 40 weeks and I started getting pretty itchy the week before wanting to avoid induction. I really wanted a natural birth and hated all of the extra interventions that are necessary with pitocin inductions. I had tried some nipple stimulation on and off, but had never gotten very regular contractions, and tried it again on Saturday evening at about 9:15. Well I got one little contraction and then about 15 minutes later it felt like the baby was pounding on my cervix. I stood up and my water broke and the contractions started in earnest---2 mins. apart.
We called the doctor and the doula immediately. I knew this was major labor and wanted to get to the hospital. I probably didn't have to, but I told the doctor that I had been in labor longer than 15 minutes when she called back---I didn't want her to say that I should wait at home for an hour or two---couldn't do it.
We got right to the hospital and into our room. I was really blown away by how intense labor was and luckily we got a great nurse who really tried to help handling the pain--she had read my whole birth plan while we were headed over! They finally checked me and I was only at 2 cm and that was really disappointing cause I really felt as if I was in very active labor. The next two hours were tough; they were having a really hard time getting a tracing of the baby's heartbeat with the monitor. They kept wanting me to be laying down, which was excruciating. I was fighting going to the scalp monitor--that really scared me. By just after midnight I was begging for pain relief and was given an IV and Stadol, which helped for exactly 4 contractions. :-( Our doula arrived at about the same time and I know I relaxed a bit knowing she was there, so I can hardly credit the Stadol with anything.
At this point, labor got even stronger--my contractions were double-peaking regularly, which meant that they were 3 minutes long with just about 40 seconds in between. At about 1:30 a.m. they checked me again. I was really in need of assistance with the pain and was asking for an epidural, so they wanted to know how far along I was. I had gone from 2 cm to 6 cm in an hour. At this point my doula advised me I probably wouldn't get any relief from the epidural because the labor was going so fast. I didn't believe her and requested one sooner. The doctor insisted at that point that we use the scalp monitor to get a good tracing of the baby's heartbeat and I gave in and let her do it.
Well, I never got the epidural (I went from 6 cm to 10 cm in that hour). I was sitting up and the anesthesiologist had gotten the local in but my contractions were so long and strong (transition) that there was hardly any time for the doctor to work in between. All of a sudden I found myself pushing---it was absolutely automatic--couldn't have stopped if I had tried. After two pushes we paused and talked a moment---the doula was saying, "You are having the baby now, no epidural." It took me a moment or two to get it, but finally agreed that I was really pushing out the baby now. The nurse wanted me to lay back on the bed and rushed to put on gloves to check me. I had 3 more contractions as I lay back with lots of pushing, and apparently the anesthesiologist ran to get the OB and the nurse was holding the baby's head in, because with one final push the baby popped out completely as soon as the OB was there to catch her. (Note: catch her, not deliver her.)
She was born at 2:33 a.m., and she was placed on my chest immediately and her daddy cut the cord when it stopped pulsing. Her Apgars were 9 and 9 and she was calm and alert. We spent the first hour or two cuddling, deciding her name, and letting her try to latch onto my breast. She weighed in at 7 lbs. 13 oz and was 20 inches long. Even with that incredibly fast birth, I had no tears--just one skid mark--and was given time to deliver the placenta naturally also.
This has been the most amazing time of my life. I knew becoming a mother would be wonderful, but this is far beyond all expectations. We have had just a few bumps in the road so far. I got hit pretty immediately with a very bad postpartum depression--and needed to start medication right away. But it's a medication that is hardly measurable in breastmilk so is considered very safe for the baby. Luckily I knew I was at risk for it and knew what to do when it happened. It was a very scary time, though.
She had some trouble latching on at the hospital and they got us started with a breast shield unfortunately. My milk came in strong and she is nursing really well. She gained back her birth wt. plus 6 oz. before two weeks, but we are still using the shield much of the time. I decided it was better to keep things low stress and use the shield while I was getting the depression stuff handled, so am just beginning to try to wean her off of it now at 3 weeks.
All in all a great birth; only one hassle from anyone about my size (a comment from anesthesiologist). Had lots of support from caregivers, thanks to my being very upfront about my desires and expectations all through the pregnancy.
Paula's Story (gd, severe pre-eclampsia, induced premature vaginal birth)
Kmom's Notes: Paula's first pregnancy was complicated by primary hypertension, which she was on medication for. Primary hypertension can often become worse in pregnancy, becoming pre-eclampsia despite medications. This is what happened to Paula. In addition, she developed gestational diabetes (diet-controlled) at about 18-20 weeks. Had her pre-eclampsia not worsened, she would have been induced at 38 weeks because of the gd and blood pressure concerns combined. As it was, when her pre-eclampsia worsened, they elected to induce at 36 weeks instead. Induction probably succeeded so early because she was already partially effaced and dilated before they began, although they did nothing to ripen the cervix ahead of time.
Between pregnancies she developed overt diabetes. Because her PCO is very significant, she and her doctor elected to have her take Metformin (Glucophage, 2000 mg per day) throughout her second pregnancy (but not for nursing). Although her blood pressure remained a concern (and she was "maxed out" on 3 blood pressure medications through the pregnancy to keep it under control), she did not redevelop pre-eclampsia in the second pregnancy, which she credits to the Metformin. They did add insulin during the pregnancy later on. Paula was induced at 38+ weeks because of the type II diabetes. She felt she had a terrific doctor for her pregnancies, very size-friendly. Not all of the doctors in the pregnancy were as size-friendly, but her primary doctor was "GREAT".
Birth Story
Baby #1: I was induced 4 weeks early due to severe pre-eclampsia. I was given magnesium sulfate and pitocin at 6pm on Thursday. I was already 80% effaced, and 2cm dilated. By 6am Friday I was 100% effaced, and dilated to 3-4 cm. The broke my water and I began having contractions with in an hour. I dilated quickly to 10cm by 9:30am and delivered vaginally at 12:03 pm. Labor in all was about 6 hours. I only required one internal stitch for a small internal tear.
I did learn through this whole process to listen to my body. The labor nurse was trying to get me to push differently then what my body was telling me. She wanted 3 shorter pushes when my body wanted 2 long ones. When I finally listened to my body I delivered very quickly. After discussing this with my OB I did what my body told me and had much better pushes then what I had been having.
I did have some problems breastfeeding at first due to the fact that she was 4 weeks early and didn't want to latch on very well. She had been tube fed, finger fed, and cup fed and like the 'instant gratification' that provided, versus having to 'work' for her food. [But nursing did work out in the long run, despite the slow start and the severe PCO.]
Baby #2: Our second child was conceived through an injectable cycle. I was 410 when I conceived this child. [I was on Metformin before the pregnancy and remained on it for pregnancy.] My OB had actually read up on the use of Metformin in pregnancy and was going to suggest it to me if I wasn't already on it. I had approached him before my first appointment because both my RE (Reproductive Endocrinologist) and Endocrinologist wanted me to stop UNLESS my OB agreed to let me take it.
There are so many benefits to taking Metformin during pregnancy, and I really wanted to avoid the pre-eclampsia that I had with my first pregnancy. I also did not want to risk going off of Metformin because of the dramatic decrease in miscarriage rate while on it. The fact that there are no known deformities or problems while taking Metformin in pregnancy made me feel comfortable enough to take it. I know some doctors will not give Met in pregnancy because they are uncomfortable with the fact that no US studies have been done, but all of the information coming from other countries seems to indicate that it is safe.
[I was induced at 38+ weeks, due to the diabetes.] I arrived at the hospital at 1 p.m. and began the paperwork and all. The IV was started around 3 p.m. with Pit; I didn't need any prostaglandin gel because I was already 2 cm and 50% effaced, baby at -1 station. The Pitocin was started; they increased it every 30 minutes.
Around 6 p.m. I began having contractions about every 2.5-3 minutes. They were tolerable and I could breathe through them easily enough. We were waiting for the doctor who was supposed to show up around 5 p.m. for AROM (breaking the waters). Finally around 7:30 p.m. he arrived and ruptured my membranes, the contractions slowly began to get worse, and the baby was doing okay. Around 8:40 p.m. we had a scary deceleration where her heart rate dropped from the 140s to 75 with internal monitoring so we knew it was an actual drop. The intern came rushing in to do 'fetal scalp stimulation' which brought her heart rate back up. I then was told I had to lay on my side and that seemed to keep her heart rate up.
The contractions while on my side were getting pretty uncomfortable and combined with the drop in heart rate I decided to get the epidural. The funny thing is that while sitting (for almost an hour) to get the epidural I couldn't feel the contractions at all, and even had to look at the paper to see if I was still having them. Talk about positioning making all the difference.
Once back on my side I could feel the contractions again until the epidural took full effect. About 10:30 p.m. I felt like I had to urinate with every contraction, but that was all I was feeling. I figured it was just the pressure form the contraction. Finally at 1 a.m. I asked the doctor to check me. My bladder was so full he couldn't feel the baby. I was straight cathed (catheter) and checked and was 7 cm. About 10 minutes later I felt like I had to push. [Kmom note: A full bladder can impede labor progress! It's important to pee every hour or so in labor.]
I waited 2-3 more contractions and decided it was time to call the nurse. My nurse was gone to lunch and another nurse (who waited another 3-4 contractions before coming to the room) told me I was only 7 cm 20 minutes ago, and I really didn't have to push; that the epidural should be working fine and I should be able to get through the contractions without any problem. I told her my last one went from 5 cm to 10 cm in 45 minutes and I felt like I had to push. The stupid woman still wasn't going to check me. I insisted and she reluctantly checked me. I was at 10 cm and it was time to push.
The doctor got to the room and got the stirrups up. I began pushing and he was going to check to see where the baby was. He asked how long it took last time; I said 1.5 hours of pushing. He commented it wasn't going to take as long this time. I could feel her head almost crowning at this point, then with the next push she was crowning and out. I pushed for a total of maybe 5 minutes, and out she came. So much for not having to push. Her apgars were 8/9 and we got to nurse her right away. It was such a different experience from my first.
Apparently I am 'wired' a little differently than most and with an epidural I am mostly numb except for the vaginal canal and perineal area (my epidural last time did not work completely properly either). I didn't realize this was any different from 'normal' until they went to put in a stitch (I needed 2). I could feel the needle and began in with "OWIE OWIE", and the doctor asked, "You can feel that?" I told him I couldn't feel my toes but I could feel that. So with one stitch left, they just put it in without any numbing agent (with my permission). I figured I would get stuck once with a stitch or once that I would feel with the Novocain and either way I was going to feel it.
I know that one of my BIGGEST concerns [before my pregnancies about my size] was that the monitoring belts would not fit around me. Not only did they fit, but the contraction monitor actually worked! I know they used an internal monitor last time as soon as possible because they did have a hard time finding a heartbeat without my laying in a very uncomfortable position and then holding the monitor there. I just figured that if they didn't get the heart rate all the time it was really no big deal, that the fading in and out (which includes the rate dropping sometimes because of the monitor) was just because I was moving or the baby was moving. With my second I just assumed the same thing until they got the internal monitor on.
My doctor is GREAT! [Very size-friendly.] I wish I could say that for all of the doctors in the practice. I had one who complained every time that she saw me because they told her to measure me. She didn't understand why they even bothered to measure me because I was so "off the charts". I may have been off the charts, but I did grow according to the curve they use, so it was useful in following the growth of the baby. I can't think of anything differently my doctor did with me that he doesn't do with every other woman. I did see him more frequently, but that was due to the type II diabetes and insulin monitoring than anything.
I am nursing; it's the only way to go for me!! I always tell everyone I am too lazy to bottle-feed; there is too much work involved. [I stopped the Metformin for nursing.] I would LOVE to be back on the Metformin, but my doctors are not comfortable with women taking it while breastfeeding. I know there is the same issue in pregnancy, but I can actually find information on Met in pregnancy but I can't find any on Met and nursing. I did realize the other day that I was on Met while I was breastfeeding #1, but she was almost 2 years old and I was in the process of weaning her. I think once this one is eating more solid foods, I will start the Metformin again even though I will still be breastfeeding.
Tammy's Story (gd, PIH, induction, vaginal birth)
Birth Story
I conceived easily the first month I was off birth control pills. We had some concerns about my health in the beginning because I have had high blood pressure my entire adult life, however, it has been under control with medication for several years. I also have been glucose intolerant for a couple of years. I was not as responsible as I probably should have been in that I did not consult my doctor before I got pregnant. I simply stopped taking the birth control pills and things happened naturally. My blood pressure medication had to be changed after I conceived in November 2003.
In March a new obstetrician joined the group who was treating me. My primary care was changed to her. I really liked her and she had a lot of experience treating gestational diabetes. She gave me guidelines to follow in checking blood sugar and my diet that the other doctors had not. I was checking blood sugar five times daily with the goal of keeping fasting sugars under 105 and two hours after meals under 120. As long as I followed the diet, 75% of my results were within these goals with 95% being within 10 points.
Actually, the obstetrician and my primary care physician disagreed on my diabetic status. My regular doctor did not think I was diabetic and felt that starting insulin would cause me to have low sugar numbers and actually make it worse. She did agree to prescribe insulin if I wanted it. The obstetrician thought I needed it. I decided to follow the diet closely and monitor my blood sugars. As I stated earlier, the numbers were never terribly high and actually improved as the pregnancy continued.
After 36 weeks, the obstetrician had me coming in on Mondays and Thursdays for fetal monitoring and ultrasounds every Thursday. She was concerned about the possibility of fetal death even though the baby was doing great every time.
When I was in the office on Monday, 7/19, I was doing great 96 great fetal monitoring results and blood pressure 123/78. We decided to deliver the baby the following week. I had an appointment with my regular doctor on Wednesday, 7/21. My blood pressure was 170/107. She called the OB and they sent me to the hospital. I was hospitalized until Friday for a pre-eclampsia work up.
I was having no swelling (wore rings and pre-pregnancy shoes until delivery), no headaches, no protein in urine, etc. My blood pressure was high but everything else was normal. The baby appeared fine on the monitor and ultrasound. This was a special ultrasound because the technician was more thorough than others that I had. We were finally able to tell that I was having a girl. I was discharged Friday, 7/23, with orders for bed rest.
I did fine over the weekend and my husband stayed busy working on the nursery. I saw the OB again in her office Monday, 7/26. I am now at 39 weeks. My blood pressure was stable and we decided to continue with our plan to induce labor the next day. I had dilated 1.5 cm and the monitor showed some mild contractions.
I was at the hospital at 6:00 AM July 27. The doctor explained that I was to be induced with cytotec. This is supposed to be a kinder and gentler way to induce than pitocin. I was given the first dose about 8:00 AM. When the doctor came back about noon, nothing had happened so she gave me double the dose I had earlier. After a few hours I was having some cramps 96 like with my period- and my back was hurting. I was not having anything that seemed like labor pains. It was hard to judge from the fetal monitor whether anything was happening or not. I guess because of my size, the external monitor did not work very well.
When the doctor came back about 5:00 PM, I had dilated to 3 cm. The doctor explained that I needed to dilate 7 more cm which could take 3 hours per cm and 3 hours for pushing. Meaning the birth could be another 24 hours away. I told myself it won 't take that long. I was determined to have my baby soon.
The doctor decided to break my water and insert an internal monitor about 5:30. That did it. Fast and hard contractions started immediately. They were coming less than two minutes apart and the monitor showed them peaking at 110.
My epidural was ordered a little after 6:00 PM and was in and giving me relief by 7:00. While turning around to get the epidural, I pulled the monitor out. When the doctor came back to reinsert it about 7:00 PM, I had dilated to 6 cm. She said she usually had the nurses page her when a patient got to 6 so she would not be leaving the hospital.
I got so comfortable with the epidural that had trouble staying awake. The nurse checked me again about 8:00 PM. When she pulled the sheet back she said I had a lot of bloody show. The next thing she said was, "You're ready." I had gone from 3 to 10 cm in about 2 hours.
Pushing was hard work but went well. After a little over an hour of pushing, my beautiful daughter was born at 9:29 PM. I wanted to touch her but I was afraid to at the same time. The nurses moved her to a warmer beside my bed while the doctor was sewing up my episiotomy I could see some of what they were doing but I couldn't see her very well.
Finally the doctor brought her back to me and I saw that her right leg was crooked below the knee, the foot is sideways, and she only has three toes. Everything else was normal. At that point I was not capable of reacting to a problem. I had my baby and she was beautiful.
Sometime the next day an orthopedic surgeon saw her and reviewed her X-Rays with us. Several bones in her lower leg and foot are missing. He talked to us about referring her to a Shriner 's Hospital. He assured us that this was not caused by anything that my husband or I did.
I look back on the pregnancy as the most wonderful thing that ever happened to me.
Eve B's Story (diet-only GD, all natural vaginal birth)
Kmom's Notes: With GD and a big mom, the doctors all worry about a giant baby. Some give very restrictive diets as a result. But it's important to note that sometimes being too restrictive is not good for the baby either. Most GD babies, even those of big moms, are still "average" in size. Overly strict control can restrict fetal growth in some women. Now, no one will ever know if this is true here.....perhaps this mom just naturally has small babies, no matter how she eats. But the baby's appearance at birth suggested that perhaps some growth restriction may have happened. A lesson in the importance of moderation, especially in the face of very borderline GD results.
Birth Story
From the beginning, I was determined to have my child naturally. My husband and I took early Bradley Method classes, and followed the daily guidelines for exercise and nutrition, swimming everyday and eating plenty of protein. At 31 weeks, I took the 1 hour GD test and failed with a 146. I wasn't too worried about it, and neither was my doctor as though I am overweight, I am otherwise healthy, eat right and exercise everyday.
Two weeks later, I took the 3 hour test. I failed the first test with a 96, and then failed the second test with a score in the 180s. (I passed the last two with very low scores.) My doctor diagnosed me with GD, and it was a huge set back to my positive frame of mind. I thought I had done everything right and really started beating myself up. Like it was my fault. Like already I was a horrible mother. She put me on a 1