PCOS Birth Stories
Stephanie’s Story (PCO, gallstones, unmedicated vaginal birth)
Name: “Stephanie” Age: 40
Pre-pregnancy Weight or Dress Size: 326 lbs., 5’2″
Baby Info: girl, 8 pounds 15 ounces, 20-7/8 inches
Wt. Gain in Pregnancy: none, postpartum last 40 lbs.
Infertility Problems? PCOS, conceived after taking metformin (glucophage) for ~1 month
Any Complications: developed gallstones at 29.5 weeks, managed through low fat diet; slight increase in blood pressure and fluid retention at 37 weeks, managed through increased protein intake and 4 hours bedrest/day
Type of Birth: unmedicated vaginal birth
Birthplace: hospital Provider: OB
Breastfeeding: Milk never came in despite use of hospital rental pump; baby does get the breastmilk she is able to pump
Special Notes on Pregnancy: Bradley childbirth education, first pregnancy
Kmom’s Notes: Although it does NOT occur with all PCO moms, there are some who develop problems with milk supply, even when being extremely proactive. Other PCO moms are able to breastfeed without problems; no one knows currently why some PCO moms are affected and others are not. More research is needed, but little is being done.
We had a very healthy pregnancy and uncomplicated vaginal delivery which I attribute primarily to two things. First, we were careful to find a size-friendly practitioner who didn’t treat me as if I were a train-wreck waiting to happen. Her exact words at our initial visit (8 weeks pregnant) were, “Yes, you have some additional risk factors, but right now you’re fine and we’ll assume everything is going to be fine. We’ll just keep a close watch on you.” We chose an OB rather than a mid-wife because of my risk factors, but she was as committed as we were to having as natural a pregnancy and delivery as possible.
Second, we did everything we could to have a healthy pregnancy, following the Bradley method of education, diet and exercise. I think this really made a difference and allowed me to have an easy pregnancy. In fact, I think the fluid retention/blood pressure problem I developed could have been avoided had I been able to continue the Bradley diet. (The low fat diet I had to follow for the gallstones didn’t have the amount of protein I think I needed.)
I went into labor 4 days after my due date. Latent first-stage labor was fairly straight forward and slow, as is typical in first-time mothers–about 15 hours to get to 6 cms. I didn’t do anything special for pain management other than using the techniques I had learned in class and through my reading. Mostly I tried to remain physically and mentally relaxed, used even abdominal breathing, and lots of visualizations. At 15.5 hours, I got the urge to push, but had only dilated to 7 cms. The next 20 minutes were especially difficult. I had to try NOT to help my body push, and the pain was very intense as my cervix finished dilating and the baby began her descent.
Fortunately, I went from 7 cms to 10 cms during those 20 minutes and was then told I could push. It took one or two contractions to get the hang of pushing, but I pushed my daughter out in only 15 minutes! The only intervention we had was an episiotomy (2nd degree with no tears or extensions), and our daughter was and is wonderfully healthy.
We had our first breastfeeding attempt in the delivery room, and kept our daughter with us for about an hour. Then my husband accompanied her to the nursery, where she was weighed, measured, and bathed (he dressed her for the first time, with a little help from the nursery staff). She roomed in with me during my hospital stay and we came home 2 days later.
Things I didn’t anticipate: how much delivery would hurt, how annoying hemorrhoids would be post-delivery, that my pelvis would hurt after delivery as my bones began to move back to their pre-pregnancy positions, and how much more I could love my husband and daughter as the days go by. P.S. We’re planning baby number 2 next year!
Paula’s Story (gd, severe pre-eclampsia, induced premature vaginal birth)
Name: “Paula” Age: #1: 27 #2: ?
Pre-pregnancy Weight or Dress Size: 420 lbs. for #1, 410 lbs. for #2
Baby Info: baby #1: Female, 7 lbs 1oz, 20.5″ baby #2: Female, 7 lbs. 1 oz. 19.5″
Wt. Gain in Pregnancy: 7 lbs. with #1
Infertility Problems? PCO, Luteal Phase Defect, conceived on injectables
Any Complications: #1: gd, primary hypertension, severe pre-eclampsia, induced at 36 weeks; #2: type II diabetes, primary hypertension but no pre-eclampsia this time, induced at 38+ weeks
Type of Birth: induced vaginal births with epidural
Birthplace: hospital Provider: OB
Breastfeeding: yes, for 2 years with #1; breastfeeding #2 (discontinued Metformin to do so)
Special Notes on Pregnancy: began pregnancy #1 with primary hypertension and slight anemia; pregnancy #2 with hypertension and diabetes
Kmom’s Notes: Paula’s first pregnancy was complicated by primary hypertension, which she was on medication for. Primary hypertension can often become worse in pregnancy, becoming pre-eclampsia despite medications. This is what happened to Paula. In addition, she developed gestational diabetes (diet-controlled) at about 18-20 weeks. Had her pre-eclampsia not worsened, she would have been induced at 38 weeks because of the gd and blood pressure concerns combined. As it was, when her pre-eclampsia worsened, they elected to induce at 36 weeks instead. Induction probably succeeded so early because she was already partially effaced and dilated before they began, although they did nothing to ripen the cervix ahead of time.
Between pregnancies she developed overt diabetes. Because her PCO is very significant, she and her doctor elected to have her take Metformin (Glucophage, 2000 mg per day) throughout her second pregnancy (but not for nursing). Although her blood pressure remained a concern (and she was “maxed out” on 3 blood pressure medications through the pregnancy to keep it under control), she did not redevelop pre-eclampsia in the second pregnancy, which she credits to the Metformin. They did add insulin during the pregnancy later on. Paula was induced at 38+ weeks because of the type II diabetes. She felt she had a terrific doctor for her pregnancies, very size-friendly. Not all of the doctors in the pregnancy were as size-friendly, but her primary doctor was “GREAT”.
Baby #1: I was induced 4 weeks early due to severe pre-eclampsia. I was given magnesium sulfate and pitocin at 6pm on Thursday. I was already 80% effaced, and 2cm dilated. By 6am Friday I was 100% effaced, and dilated to 3-4 cm. The broke my water and I began having contractions with in an hour. I dilated quickly to 10cm by 9:30am and delivered vaginally at 12:03 pm. Labor in all was about 6 hours. I only required one internal stitch for a small internal tear.
I did learn through this whole process to listen to my body. The labor nurse was trying to get me to push differently then what my body was telling me. She wanted 3 shorter pushes when my body wanted 2 long ones. When I finally listened to my body I delivered very quickly. After discussing this with my OB I did what my body told me and had much better pushes then what I had been having.
I did have some problems breastfeeding at first due to the fact that she was 4 weeks early and didn’t want to latch on very well. She had been tube fed, finger fed, and cup fed and like the ‘instant gratification’ that provided, versus having to ‘work’ for her food. [But nursing did work out in the long run, despite the slow start and the severe PCO.]
Baby #2: Our second child was conceived through an injectable cycle. I was 410 when I conceived this child. [I was on Metformin before the pregnancy and remained on it for pregnancy.] My OB had actually read up on the use of Metformin in pregnancy and was going to suggest it to me if I wasn’t already on it. I had approached him before my first appointment because both my RE (Reproductive Endocrinologist) and Endocrinologist wanted me to stop UNLESS my OB agreed to let me take it.
There are so many benefits to taking Metformin during pregnancy, and I really wanted to avoid the pre-eclampsia that I had with my first pregnancy. I also did not want to risk going off of Metformin because of the dramatic decrease in miscarriage rate while on it. The fact that there are no known deformities or problems while taking Metformin in pregnancy made me feel comfortable enough to take it. I know some doctors will not give Met in pregnancy because they are uncomfortable with the fact that no US studies have been done, but all of the information coming from other countries seems to indicate that it is safe.
[I was induced at 38+ weeks, due to the diabetes.] I arrived at the hospital at 1 p.m. and began the paperwork and all. The IV was started around 3 p.m. with Pit; I didn’t need any prostaglandin gel because I was already 2 cm and 50% effaced, baby at -1 station. The Pitocin was started; they increased it every 30 minutes.
Around 6 p.m. I began having contractions about every 2.5-3 minutes. They were tolerable and I could breathe through them easily enough. We were waiting for the doctor who was supposed to show up around 5 p.m. for AROM (breaking the waters). Finally around 7:30 p.m. he arrived and ruptured my membranes, the contractions slowly began to get worse, and the baby was doing okay. Around 8:40 p.m. we had a scary deceleration where her heart rate dropped from the 140s to 75 with internal monitoring so we knew it was an actual drop. The intern came rushing in to do ‘fetal scalp stimulation’ which brought her heart rate back up. I then was told I had to lay on my side and that seemed to keep her heart rate up.
The contractions while on my side were getting pretty uncomfortable and combined with the drop in heart rate I decided to get the epidural. The funny thing is that while sitting (for almost an hour) to get the epidural I couldn’t feel the contractions at all, and even had to look at the paper to see if I was still having them. Talk about positioning making all the difference.
Once back on my side I could feel the contractions again until the epidural took full effect. About 10:30 p.m. I felt like I had to urinate with every contraction, but that was all I was feeling. I figured it was just the pressure form the contraction. Finally at 1 a.m. I asked the doctor to check me. My bladder was so full he couldn’t feel the baby. I was straight cathed (catheter) and checked and was 7 cm. About 10 minutes later I felt like I had to push. [Kmom note: A full bladder can impede labor progress! It’s important to pee every hour or so in labor.]
I waited 2-3 more contractions and decided it was time to call the nurse. My nurse was gone to lunch and another nurse (who waited another 3-4 contractions before coming to the room) told me I was only 7 cm 20 minutes ago, and I really didn’t have to push; that the epidural should be working fine and I should be able to get through the contractions without any problem. I told her my last one went from 5 cm to 10 cm in 45 minutes and I felt like I had to push. The stupid woman still wasn’t going to check me. I insisted and she reluctantly checked me. I was at 10 cm and it was time to push.
The doctor got to the room and got the stirrups up. I began pushing and he was going to check to see where the baby was. He asked how long it took last time; I said 1.5 hours of pushing. He commented it wasn’t going to take as long this time. I could feel her head almost crowning at this point, then with the next push she was crowning and out. I pushed for a total of maybe 5 minutes, and out she came. So much for not having to push. Her apgars were 8/9 and we got to nurse her right away. It was such a different experience from my first.
Apparently I am ‘wired’ a little differently than most and with an epidural I am mostly numb except for the vaginal canal and perineal area (my epidural last time did not work completely properly either). I didn’t realize this was any different from ‘normal’ until they went to put in a stitch (I needed 2). I could feel the needle and began in with “OWIE OWIE”, and the doctor asked, “You can feel that?” I told him I couldn’t feel my toes but I could feel that. So with one stitch left, they just put it in without any numbing agent (with my permission). I figured I would get stuck once with a stitch or once that I would feel with the Novocain and either way I was going to feel it.
I know that one of my BIGGEST concerns [before my pregnancies about my size] was that the monitoring belts would not fit around me. Not only did they fit, but the contraction monitor actually worked! I know they used an internal monitor last time as soon as possible because they did have a hard time finding a heartbeat without my laying in a very uncomfortable position and then holding the monitor there. I just figured that if they didn’t get the heart rate all the time it was really no big deal, that the fading in and out (which includes the rate dropping sometimes because of the monitor) was just because I was moving or the baby was moving. With my second I just assumed the same thing until they got the internal monitor on.
My doctor is GREAT! [Very size-friendly.] I wish I could say that for all of the doctors in the practice. I had one who complained every time that she saw me because they told her to measure me. She didn’t understand why they even bothered to measure me because I was so “off the charts”. I may have been off the charts, but I did grow according to the curve they use, so it was useful in following the growth of the baby. I can’t think of anything differently my doctor did with me that he doesn’t do with every other woman. I did see him more frequently, but that was due to the type II diabetes and insulin monitoring than anything.
I am nursing; it’s the only way to go for me!! I always tell everyone I am too lazy to bottle-feed; there is too much work involved. [I stopped the Metformin for nursing.] I would LOVE to be back on the Metformin, but my doctors are not comfortable with women taking it while breastfeeding. I know there is the same issue in pregnancy, but I can actually find information on Met in pregnancy but I can’t find any on Met and nursing. I did realize the other day that I was on Met while I was breastfeeding #1, but she was almost 2 years old and I was in the process of weaning her. I think once this one is eating more solid foods, I will start the Metformin again even though I will still be breastfeeding.
Lisa Z’s Story (twins, diet-only gd, vaginal birth)
Name: “Lisa Z” Age: 36
Pre-pregnancy Weight or Dress Size: 308 lbs.
Baby Info: boy, 5 lbs. 12 oz; boy, 5 lbs. 13 oz.
Wt. Gain in Pregnancy: 15 lbs.
Infertility Problems? PCOS, used Fertinex and IUI
Any Complications: gd
Type of Birth: vaginal
Birthplace: hospital Provider: OB
Breastfeeding: had serious problems; “a lactation consultant actually told me to give up!”
Special Notes on Pregnancy:
My story, despite the fact that I gave birth to twin boys, is actually rather boring (thank God!). I did develop gestational diabetes very early on in my pregnancy, and I was expecting that to happen for many reasons (family history, my weight, the fact that I was carrying twins – all increase risk). However, I was able to control my GD through diet and it proved to be not much more than a minor inconvenience during my pregnancy.
I became pregnant with the help of Fertinex and IUI (Intra-Uterine Insemination). I suffer from PCOS, and do not ovulate without pharmacological assistance. I did conceive once before with the help of fertility drugs, but it was an ectopic pregnancy, which we were able to abort with drugs and managed to avoid any kind of surgery. At the beginning of my pregnancy I weighed 308 pounds. At the end, I weighed 323. After delivery, I was down somewhere in the 280’s, but alas, that was short-lived, and I am now back up to somewhere around my late pregnancy weight.
As for my labor – my water broke 2 days shy of 36 weeks. I went to the hospital and basically sat around a lot waiting for labor to start. About 12 hours after I checked into the hospital, the contractions started. A couple of hours later I had an epidural, which came out and had to be redone. Because of this, they gave me MEGA-doses of meds, which caused me to be completely paralyzed and numb from the waist down. My dh and I fell asleep until the doctor came in early in the morning to check me (which required both my OB and my dh hoisting my deadweight legs into the air so that he could examine me) and promptly announce that it was “showtime.” He had me start pushing in my labor room, but once the 1st head appeared, I was taken to the operating room, which is standard precautionary procedure in multiple births.
My delivery progressed very normally – Baby A arrived after not much more pushing, and Baby B, who had been breech until then, flipped his little self around to be delivered head first. It took 23 minutes and the help of forceps, but both boys were delivered vaginally and in perfect health – 5 lbs. 12 ounces and 5 lbs 13 ounces! I took them home with me 2 days later.
Carol C’s Story (PCO, Group B Strep, vaginal birth)
Name: “Carol C” Age: 32
Pre-pregnancy Weight or Dress Size: 260 lbs.
Baby Info: boy, 10 lbs. 6.5 oz, 21.75 inches
Wt. Gain in Pregnancy: 15 lbs.
Infertility Problems? PCOS; we did a round of Clomid earlier in the year, then decided to wait and got pregnant all by myself (well, DH helped!)
Any Complications: Group B Strep positive
Type of Birth: vaginal
Birthplace: hospital Provider: OB
Breastfeeding: yes, 6 months plus now. “I intend to let him wean when he wants to, but hope that’s another year or so away.”
Special Notes on Pregnancy:
Kmom’s Notes: Carol’s story of back labor, difficult pain, waters breaking before labor, and having difficulty dilating beyond 3 cm at first raises the question of malposition (posterior or asynclitic, etc.). However, either that was not really the problem or the position corrected itself because her labor proceeded on to a normal vaginal birth. Also note that this baby was almost 10 and a half pounds; according to many OBs, this is ‘too big’ to birth normally, but obviously Carol had little trouble.
The only time my doctor ever mentioned my weight was when I was losing too much from queasiness during the first trimester – and even that was just to make sure that I was TRYING to eat sensibly and not trying to diet during pregnancy.
My whole pregnancy was pretty uneventful. Morning sickness was limited to queasiness and disinterest in food – I hardly ever actually got sick. My blood pressure was always fine. All those other routine tests they do were always fine.
I was still feeling pretty good when we checked into the hospital, and determined to have a natural birth, in spite of back labor. We had taken a Bradley class, and were prepared with a bag full of massage toys. DH was getting me through the contractions okay. That is, until 8 hours had gone by since water breaking, and I hadn’t gotten past 3 cm. :)The doctor on call insisted that we start the pitocin, because of the Group B Strep.
I was still handling it okay, until the second time they increased the drip. There were a yucky couple of hours there, with lots of vomiting (MAN, was I glad that I wasn’t the one who had to clean up my messes!), sweating and moaning. And so I caved and asked for the epidural. The pit had done its job though, because when the anesthesiologist got there, I was at 6 cm, and by the time they finally got the epidural right (3rd try), I was at 9 +.
I’m disappointed that we didn’t have the birth of my dreams, but I’m happy with how things turned out. I really did feel great after the epidural, and pushing was a breeze. I got to have a mirror, and that was really neat! My nurse massaged and stretched me for an hour, and I give her some credit for me not having to get an episiotomy and only having minor tears with my big boy. Well, my wide hips might have had something to do with it. too!
My precious son is just the most wonderful little person in the whole wide world, and I’m thanking God several times a day for blessing us so greatly. Being a mommy is just so indescribably wonderful!
Suzanne’s Stories (PCO, unmedicated vaginal births, gd with #2)
Name: “Suzanne” Age: 34 with #1, 38 with #2
Pre-pregnancy Weight or Dress Size: #1: size 24-26; 5’9″ and 270 lbs.; #2: 284 lbs.
Baby Info: #1: 7 lb. 9 oz., girl #2: boy, 8 lb. 4 oz and 20.5 inches
Wt. Gain in Pregnancy: #1: lost 3 pounds total #2: lost 10 pounds
Infertility Problems? PCO. Took 4 months to conceive baby #1, 2 years to conceive baby #2 ( 50 mg Clomid, hcG shot, IUI [IntraUterine Insemination] and progesterone support. 4th Clomid cycle). RE ‘never mentioned wt. as part of fertility problem.’
Any Complications: none with #1, insulin-dependent gd with #2
Type of Birth: both vaginal
Birthplace: Hospital Provider: nurse-midwife primarily
Breastfeeding: #1: 2 years, including pumping at work for 8 months after going back to work when baby was 12 weeks old. #2: yes, despite some low blood sugar at first
Special Notes on Pregnancy: natural childbirth; no drugs either time. Used a doula.
Kmom’s Notes: Please note this PCO mom did not have trouble breastfeeding, nor did she get high blood pressure. PCO does not have to equal these problems! Also note that this mom went from 5 cm to complete (10 cm) within 15 minutes of getting into warm water in her first birth, and that it was also helpful in the second birth.
In her second birth, despite developing insulin-depending gd, Suzanne had several things going for her. Her first baby was born vaginally and naturally, making a vaginal birth this time more likely. She got good control of her blood sugars, plus a supportive set of providers (and when she found an unsupportive one she switched!). Her baby was average-sized, which makes them more willing to give a trial of labor. She had a midwife and doula for her birth, both of which tends to cut the c/s rate significantly, and she was able to use water for laboring as well as a standing position for pushing and birth. But SHE was the one who did it, and admirably too!
I am a plus size mom. I weighed 270 pounds at the beginning of my first pregnancy and gained and lost 3 pounds over the 9 months by eating healthily. I had no complications during my pregnancy or birth. Here is the birth story of my first child.
My due date was September 19, I went into labor at 4 AM Monday morning September 18th. I woke up to what felt like light menstrual cramps coming at about 20-minute intervals. I checked the time tried to go back to sleep. I dozed a little until 6 AM then decided to take our dog for a walk around the block (if it was false labor that should make it go away). The contractions didn’t go away, this was the day! After the walk my partner and I went to a friend’s house to labor and I decided to take a bath in their very large tub. After that we took another walk, I started around the block and the contractions were getting more and more intense. I could walk and talk between, so we were not too concerned. We got back timed the contractions, they were one minute long and five minutes apart. We thought, “Wow, maybe we should go to the hospital.” It was about 10AM, I called our midwife and doula, getting pagers for each. The doula called back first. She said I was too jolly between contractions and she would be over in a few minutes.
She arrived and said she didn’t think that we should go to the hospital yet. She started to help me through the contractions. My favorite spot was in a big leather chair in the family room. I would lean back, the doula would stroke my hair and my partner would push on my knees in toward my pelvis. At first I could talk between contractions but after a while I didn’t want to talk much anymore. Periodically, my doula would tell me it was time to change positions and I would walk around the room. Standing contractions I did mostly hanging off of my partner’s neck, with one knee locked and the other relaxed. I also spent some time leaning on a hassock on my knees. The contractions were very painful in that position, so I thought; “these must be working well.” I was having double peaking contractions for a while. One would come and I would deal with it, be breathing a sigh of relief and be broadsided by another one. Once I got used to the pattern it was easier to deal with. I breathed through contractions until about 1 PM and then asked the doula, “When are we going to the hospital?” She said, “That’s up to you.”
I was on my way out the front door as everyone gathered stuff to bring to the hospital followed behind. My partner drove me and the others followed in their cars. The hospital was 10 minutes away and I had 3 or 4 contractions on the way. We left the car and headed for admitting. The doula was right behind us and was there as we headed for the room. It was a very long walk to the maternity wing from admitting, they offered me a wheelchair three times but I declined. I didn’t feel like sitting. So we walked down the different corridors stopping for contractions then moving on, up the elevator and finally to our room. The nurse monitored me for 20 minutes with the belts and did an internal and pronounced me 5 cm dilated. During the rest of the labor a hand held Doppler was used to monitor the baby’s heartbeat.
When the tub was ready we trotted off down the hall for a soak. My doula and partner stayed with me. I was trying to figure out whether the jets were helping or annoying the hell out of me when I was hit by a contraction that felt very different from the others. I made a sound that came from very deep inside me, a grunt. Lindsey recognized the sound as the one a laboring woman makes when she is completely dilated. She yanked the nurse call-cord and our nurse came running. I was completely dilated. I had been in the tub about 15 minutes, 2 or 3 contractions total. I got out of the tub. They wrapped me in a blanket and off we trotted back down the hall to my room.
The midwife hadn’t arrived yet. She had been eating lunch with a friend when we arrived at the hospital at 5 cm. She thought she would have time to finish lunch and then come over. The nurse called her back and told her to get over to the hospital ASAP. We had to wait for her to arrive. The nurse kept telling me that she could deliver the baby, she was studying to be a midwife…but don’t push unless you have to. So I huffed through the contractions only pushing a little at the end of each. Not pushing was the hardest part of the labor. The midwife finally arrived I could push. I held on to the edge of the bed and squatted to push. Between contractions they pushed a little stool under my bottom and I would sit and rest. Once the baby came down and stayed down I moved onto the bed with my doula at my head and my partner holding my leg up. I pushed for about 45 minutes total.
My daughter was born at 3:59PM. Her APGAR scores were 9 and 10. Total labor was 12 hours from the first contraction, 6 hours of active labor. I had 2 stitches for “skid marks” but my perineum was intact. I did not need nor want any anesthetic at any point in the labor.
Suzanne’s 2nd Story: My second pregnancy and birth were totally different from the first. It took 2 years and 16 cycles of trying to conceive #2. I ended up with a diagnosis of PCO and treatment using clomid to stimulate a follicle, Hcg shot to cause ovulation, then Intra-Uterine Insemination. I found out Dec 23 that I was pregnant. What a wonderful Christmas present!
I started getting morning sickness at about 6 weeks and continued with it until I was 25 weeks along. Then I was diagnosed at week 28 with gestational diabetes. I was shocked and found that my caregivers were all working from scraps of paper and seemed unsure of the acceptable glucose levels. I called around and finally got in touch with an endocrinologist and he assured me that they were following the standard of care. I ordered a book on GD and read up. That helped put my mind at ease. Then I had a goal to reach.
I started testing my blood 4x a day, fastings and 2 hours after each meal. I also would test extra times if I was curious or was feeling a low blood sugar reaction coming on. So I would test 4-8x a day. These are the numbers that we used:
Fasting: Under 100 (closer to 70 is better)
After Meals: 120 or lower (my dr. didn’t mind higher numbers once a day a few times a week)
They sent me to a nutritionist who was useless. The diet she put me on…contained too many carbs in each meal and too much food overall. When I cut out all but one carb exchange (~18g) per meal I could almost control the daytime glucose numbers. That turned out to be too little food for someone in later pregnancy. They also lump in the management of fat and salt along with management of carbs and I did not have a problem with fat and salt. The whole regimen seemed to be geared to the elderly and didn’t seem to apply much to me. I refused to limit my fat and salt intake (I was losing weight for-goodness-sake!); I did not have a problem with my blood pressure. I was sane about it, but did not limit non-carb foods. I consulted a friend of mine who is a nutritionist and she helped me to choose more whole foods and food combinations That was they key to keeping my numbers good. I began walking .8 mile per day, with a second walk if my numbers were off.
But I lost 12 lbs. in 3 weeks and my fasting glucose number first thing in the morning could not be changed by diet and exercise. So I had to take insulin. I started out with one shot in the evening but that didn’t work. Then they had me on a shot in the morning and one in the evening. They also combined regular insulin (fast-acting) and a slower-acting type (NPH). I would load the syringe and take a pinch of flesh near my belly button, poke the needle in at an angle then inject the insulin. It is not as bad as it sounds; the poke doesn’t really hurt, but the insulin makes the area of the shot sore for a little while. I had to watch out for low blood sugar reactions, which I had often (shaking, sweating, disorientation). Insulin-dependent diabetics have to eat frequently and keep in mind when the insulin will hit. The dr. warned me that my insulin needs would increase as the pregnancy progressed but they did the opposite. My dosage decreased 2 times near the end.
Getting gd felt like my dreams of another natural birth were going down the tubes. I was referred to an OB who told me, “If you have an 11 LB baby it is an automatic c-section; unless you want to sign a paper stating that a paralyzed left arm [the baby’s] is OK with you.” She was trying to scare me of my birth but only succeeded in scaring me of HER. I asked this OB about how she would deal with a large baby and it was clear from her answers that she delivers women in the lithotomy position and usually anesthetized When I asked about positioning she said it wasn’t quick enough. Translate that as: there is no way to get you onto hands and knees with an epidural. [Kmom’s note: These interventions are thought by many to increase the incidence of shoulder dystocia and birth trauma/paralyzed arm the OB is referring to. One of the hardest parts of gd is distinguishing the true risks of the condition from the doctor-caused problems that come from standard management like this.} My midwife on the other hand has delivered 11 lb babies vaginally (not that I wanted to :-)) I wanted that OB to be as far from my birth as possible. (It turns out that this OB gives that same speech to all overweight moms. My feeling is that she is a fatphobe.)
I switched to a different OB who was great and had no problem with standing by just in case the midwife needed her. She praised me on my management of the gd and was not concerned at all that the baby would be too large. From 34 weeks on I did 2 non-stress tests (NSTs) per week and had an ultrasound at 38 weeks. Everything looked fine so I was able to keep my midwife with the OB standing by just in case. The OB was fine with monitoring my insulin and NSTs and letting the midwife do the rest. That was just right for me because my nightmare was to lose my chance at another natural birth. [Kmom note: See, you can too have a midwife in a gd pregnancy! And some midwives will co-manage even an insulin-dependent pregnancy if all is well.] I delivered 6 days before the due date. [There was no pressure from my doctor], she was cool. The baby showed up as 8 lbs two weeks before his due date and they found that acceptable. Also, I was not measuring larger than expected. My gd was very well managed.
My labor started at 8 am. I had 3 contractions in a half an hour. I called my support people and they soon started arriving. I used the same doula I had with my first birth so we slipped easily into the pattern of her helping with my concentration and relaxation. We hung out at the house while my contractions got more intense and closer together. A short walk around the neighborhood was helpful in the beginning but things got going very quickly. I did some contractions on hands and knees or sitting but most were standing and leaning. I breathed normally through the whole labor. We tested my glucose level every hour during the labor. The last test before leaving for the hospital showed low blood sugar and I ate a couple of glucose tablets. This saved me from having to have IV glucose because they didn’t know what the dosage was on the tablets. No IV!
When we got to the hospital I was 6 cm and went directly to the tub. I felt the baby drop as I stood to go to the room with the tub down the hall, it felt so good! The contractions were hard but the time between them lengthened and the water made the labor seem like a breeze. I went through transition with a little shaking and burping, then I was ready to push. This is where may labor got really hard. I knew that it was too late for an epidural but I would have had one if it were possible. The rest of the labor was such a breeze that there was no way I would have asked for pain relief. There is no way that I would recommend having an epidural just in case it got bad later.
I got back to my room between contractions and couldn’t bring myself to get on the bed. Physically I could have climbed on, but it didn’t feel right. I had planned on helping Nicholas “out” and the midwife had agreed but when we got to the room I preferred to stand for the delivery so the midwife warned me that I wouldn’t get my wish. I told her I didn’t care. Consequently, I delivered Nicholas standing up with one foot on the floor and one knee on the bed. I yelled, “NICK! NICK! NICK! OUT! OUT! OUT!” One nurse, in her 50s or early 60s, was very concerned about me delivering standing up. The midwife told that that is how it was going to be. That nurse came in when she went off shift and hugged me and told me she thought I was “heroic”.
I pushed for a while and when I checked for the head I couldn’t feel it. I almost lost hope, but buckled down to business. Soon I could feel his head and knew it would be over soon. The midwife stood behind me and passed him between my legs within seconds of his birth. Nicholas was born “in the caul” meaning he had the amniotic sac over his head. The midwife had to break the sac and suction his airway. Nicholas was born at 4:28 PM after 8.5 hours of labor with about 2 hours of it spent at the hospital. I pushed for about 40 minutes. I had a small tear where an episiotomy would have gone, it took 2 stitches. Pushing caused a hemorrhoid that has healed completely. I retained a small bit of placenta which came out at 4 weeks postpartum with a gush of blood but no other problems.
Nicholas had to be fed formula every 3 hours for the first 72 hours because his pancreas was working overtime due to my gd and he had low blood sugar. I used a Supplemental Nursing System (SNS) with a thin tube going down to my nipple from the bottle of formula. I had requested this in my birth plan to avoid having problems with nipple confusion. [He nursed every 3 hours, and while he was nursing I slipped him the tube so he would also get the formula. They added some glucose water to the formula in the SNS because his numbers didn’t rise enough at first. After the first 3 days, he has been 100% breastfed.]
My partner’s sisters visited me later and I told them, “Get an epidural.” I regret that now that the memory of the pain has faded. I am happy and proud that I have had 2 natural births. If I had it to do over I would not choose to use pain meds. Nicholas is 4 months old now. Since he was born everyone has commented on how alert he is. I think that he is alert because he was not drugged at birth.
Pam’s Story (PCO, insulin-dep. gd, placenta previa, c/s)
Name: “Pam” Age: 29
Pre-pregnancy Weight or Dress Size: 232 lbs.
Baby Info: boy, 7 lbs 11oz, 21 inches (born at 39 weeks)
Wt. Gain in Pregnancy: lost 8 pounds
Infertility Problems? PCO. 100mg clomid and IUI (8th clomid cycle, 3rd IUI).
Any Complications: borderline high b/p at first, insulin-dep. gd, placenta previa, hemorrhage
Type of Birth: elective c/s
Birthplace: hospital Provider: family doctor, OB, endocrinologist
Breastfeeding: BFed successfully for 15 months when I *forced* weaning. I have an inverted nipple which posed no problems.
Special Notes on Pregnancy: GD diagnosed at 14weeks and on insulin by 18 weeks
After 2 years of trying to conceive due to PCO, we got pregnant. I had all day morning sickness for 14 weeks. At that point I was diagnosed with GD. Despite diet changes etc, I had to go on insulin at 18 weeks since my fasting sugar levels wouldn’t come down. I was also diagnosed with placenta previa (low-lying placenta) and told to take it easy for the pregnancy.
By 36 weeks I was told that my GD was controlled so well (baby was not big at all) and that the placenta had shifted enough, I was going to be able to have a vaginal birth. At exactly 39 weeks I started bleeding and since the baby hadn’t dropped and I wasn’t dilated or soft AT ALL, it was decided that an induction would be pointless. A c-section was scheduled for 3 hours later. I was comfortable with this choice.
I had an epidural, which the doctors had NO problems putting in. I was easily shifted from my bed to the OR table, even after the section when I was totally numb and couldn’t help. I was awake and conscious for the section and my DH was right next to me. Despite the fact my placenta had broken apart and was hemorrhaging, my boy was born totally healthy and fine. Apgars 8 and 10. My arms were restrained by a blood pressure cuff and the IV’s, so I couldn’t move much, but the nurse freed my one arm so I could touch and caress the baby while DH held him.
Baby never left my sight until DH took him across the hall where I was being taken minutes later. I tried to BF an hour after his birth (the soonest they’d let me) and he wasn’t interested. He didn’t nurse well at all that day and he finally got a great latch the next morning. From there on in, BFing was not a problem, even on the inverted nipple. I had trouble getting him to latch for a few days, but that was due more to my inexperience and FF breasts. Once we got the hang of it, there was no problem (as long as I used the football hold exclusively). My milk came in by gallons on day 3 and we kept it up until I weaned him at 15 months.
My pain level was easily controlled with Tylenol 3’s and I was walking around in less than 24 hours (in fact at 10 hours I walked (slowly and with help) to the bathroom). The staples were taken out on day 4 when I was discharged. I never had any problems with the incision. It healed over easily. By 4 weeks postpartum I was able to run and do pretty much everything. I stopped taking extra strength Tylenol after 10 days. My GD completely disappeared immediately upon delivery, and I’ve been healthy and happy ever since.
Elayne’s Story (PCOS, triplets!, preemies, c/s)
Name: “Elayne” Age: 23
Pre-pregnancy Weight or Dress Size: size 18, 204 lbs.
Baby Info: #1: boy, 2 lbs. #2: girl, 1 lb. 13 oz. #3: girl, 1 lb. 13 oz.
Wt. Gain in Pregnancy: 45 lbs.
Infertility Problems? PCOS, treated by Clomid
Any Complications: premature dilation and cerclage, preterm labor, premature delivery at 26 weeks
Type of Birth: c/s
Birthplace: hospital Provider: OB
Breastfeeding: pumped for 3 months, severe nipple confusion generated in hospital nursery
Special Notes on Pregnancy: my preterm contractions, although VERY noticeable to me, never registered on the hospital toco monitors
We knew going into trying to conceive that things would be difficult. I knew at 17 that I didn’t ovulate, and I’d been on the pill ever since. After nine months without a period off the pill, I started infertility treatments, namely Clomid. I was told there was a 5% increased risk of twins, and no mention was ever made of triplets or more. We thought twins we could handle.
On my successful cycle, we’d gotten up to 150mg of Clomid, and the doctor said that if it didn’t work this time we’d have to go up to the injectible drugs. But I did have a good follicle, and the doctors decided to give me an HCG injection to induce ovulation. Nobody bothered to tell me this could increase the risk of multiples.
I tested positive, and made my first appointment with the midwife I had selected for my homebirth. At 5 weeks, I had some cramping and bleeding on a business trip, so when I got back I scheduled an ultrasound with my OB to check on it. We saw four sacs and three heartbeats. Apparently, I conceived quadruplets and then miscarried one, which accounted for the bleeding.
Things were pretty uneventful for a while (if you can call triplets uneventful). I was forced out of my job and just took it easy, little to no physical activity, limited errands, etc. At 20 weeks, when I went for a Level II ultrasound, they discovered my cervix had dilated to 1.5cm. I wasn’t having contractions, just uterine irritability, so they decided to just do a cerclage. I was on and off bedrest after that. Every time they let me off bedrest, I started having contractions. I’d come in to the hospital, they’d give me IV fluids and sometimes keep me overnight, then send me home on bedrest again. Every time I went to the hospital, they put me on the toco monitors, but no contractions ever registered, regardless of what I was feeling.
At 24 weeks, I began developing gestational diabetes. With diabetes running rampant in my family tree, and being hypoglycemic myself, I am very familiar with blood sugars and testing. I already had my own monitor, more of a toy before but used seriously now. I checked my fasting sugars every day, and occasionally checked after meals. At 24 weeks, I began getting very high readings after meals, 160+. That week, I also had sugar in my urine. Despite all this, my OB insisted that it was impossible to detect or even develop diabetes before 28 weeks, and he refused to test me. Knowing better, I put myself on a strict diabetic diet, allowing for multiple gestation, and kept track of my sugars. This was very difficult in the hospital, though, because I couldn’t control my diet. More than that, nobody seemed to understand how much a triplet mom needs to eat to have big healthy babies, regardless of her size.
At 26 weeks, I went into full pre-term labor. At first I thought it was gas pains, because it was all in my back. A couple of hours later, I realized that gas pains don’t come every seven minutes on the dot, and the contractions also started to radiate across my belly. We went into the hospital, and they immediately put me on the toco monitor, and spent the usual hour trying to catch all three babies on the strip at once (never happened). As usual, no contractions registered on the monitor. They started to blow me off, and I protested that I was really feeling strong contractions. The nurses tried to feel them through my belly, but they said they couldn’t feel anything. I asked them to please check my cervix, like they had always done every time before. They refused. Instead, they sent me home on a sedative, Seconal, treating me like I was nuts. The sedative knocked me into a daze. I was still feeling contractions, and just barely aware enough to register the times (moving through 6 minutes into 5 minutes apart during the night), but I wasn’t coherent enough to think, “Gee, maybe I should call another doctor or go back to the hospital.”
By the time the Seconal wore off the next morning, my contractions were very strong, 5 minutes apart. I still waited a little while, out of pure sheepishness, because after being sent home the night before I believed them, I thought surely I was imagining it. That morning, though, I started suddenly bleeding heavily, and we did go back to the hospital. Sure enough, my cerclage had ripped out. Not only that, but I was dilated to 5 cm already. Even with all of this, though, my contractions, though painful, STILL never registered on the toco monitor. They admitted me and put me on bedrest, and gave me magnesium sulfate, terbutyline, and antibiotics and steroids for the babies. The tocolytics worked almost immediately, shutting my contractions down to nothing. Unfortunately, it was too late. I dilated to 6 cm before the drugs kicked in, and 24 hours later my water broke.
There was no hope for a vaginal birth of triplets, certainly not at 26 weeks. They were too small and fragile to really withstand the stress of a vaginal birth. So we went for an urgent c-section. The anesthesiologist came to talk with me beforehand, explaining how the spinal worked, all of which I knew after having a spinal for my cerclage. I told her about the spinal wearing off before I even left the operating room last time, and added that painkillers in general have little to no effect on me. She blew me off (like everybody else), telling me not to worry.
We went into surgery at about 11:00, and my babies were born at 12:09, 12:09, and 12:10, about 30 seconds apart. I got to touch the girls briefly as they went by. My boy needed resuscitation more urgently, so I only got to see him in the portable incubator before he was taken upstairs. By luck, my L&D nurse had a student nurse working with her that day. The student had to be there for the section, but couldn’t do anything. So we gave her a camera, and she took a ton of pictures of the births. Bloody, but they’re the only pictures I have of my babies not attached to anything for the next three months.
By the time my third baby was born, I was beginning to feel more than I should. By the time they were stitching me up, I felt every stitch and every twitch. They made my husband leave the room, but he saw them pump four or five drugs into my IV before he did. None of them really worked. They finally gave me Verced, so the end is a little hazy…yet Istill remember a good deal of it. On the upside, I did get a letter of apology and reference from that anesthesiologist, for me to show at any future surgeries.
Breastfeeding was a complete failure. Not on my part; I was a milch cow. I was putting out 50 ounces a day when I quit. I tried and tried and tried to have a “No Nipples” order put on the babies’ charts, because I was concerned about that interfering with breastfeeding. The hospital staff insisted on giving them bottles anyway. They breastfed exclusively for two weeks before getting their first bottle, and they were doing well, getting latched on and getting decent amounts of milk out. The hospital still insisted, and the very day they got their first bottle, they refused the breast. I continued to pump until they came home, but with no help I did not have enough time to pump and bottlefeed.
We now have one baby with cerebral palsy, and the other two have a tendency to wheeze and catch bronchitis from every little cold, which we understand is a result of their having been on ventilators for almost two weeks after birth. Other than that, fortunately, they are doing well. We’re working on getting pregnant again, hopefully with only one baby this time. I’m taking Glucophage to control my PCOS, and it seems to be working well.
My babies’ website, http://www.y2kbabies.net/littlebits, has even more information about the pregnancy and birth.
Anna’s Story (PCOS, PIH, induction, malposition, TOL c/s)
Name: Anna Age: 36
Size before pregnancy: 265 lbs.
Wt. Gain in Pregnancy: 10 pounds
Baby Information: baby girl; 7 pounds, 6 ounces; 18.5 inches long at 37 weeks
Fertility Problems? Conceived while on Metformin; had done three gonal-F/clomid cycles prior to the month of this conception
Complications, if any: I think PIH – long story
Birthplace: Hospital Provider: I had an ob/gyn and a perinatologist
Type of birth: attempted VBAC; delivered by C-section
Breastfeeding: Pumped breastmilk for the first four months
Special notes about birth:
Kmom’s Notes: Anna feels that her doctor wrongly attributed her blood pressure in pregnancy to “chronic hypertension” because of her size. In fact, her blood pressure was normal before pregnancy, was normal in the first several visits, and then started to rise. However, when she asked about pre-eclampsia, he told her she had chronic hypertension and she felt that this assumption was based on her size and not on the facts. After her pregnancy, her follow-up visits record very normal blood pressure readings. Obviously, she did not have chronic hypertension, and the higher BP was due to pregnancy.
This was Anna’s second child. Her first had been born by cesarean, and she was hoping for a Vaginal Birth After Cesarean this time. Because of her rising BP, Anna’s labor had to be induced, which strongly lowers the chance for VBAC in most cases. However, women *do* have VBACs with induction; unfortunately, her baby was slightly malpositioned, which made it difficult to be born vaginally. Because the doctor did not know how to help the baby re-position, a repeat cesarean became the wisest choice at that point.
Anna showed great strength of character by demanding that the anesthesiologist re-do her anesthesia for the cesarean! All along, they were not taking her seriously when she told them she was not getting good relief with the epidural. They also did not take her seriously because their monitors showed her contractions weren’t very strong. (Many large women report that contraction monitors do not accurately measure the strength of their contractions.) When the anesthesiologist tried to tell her that her epidural was sufficiently strong for a cesarean, she fought back and PROVED that she still had feeling and needed more. Reluctantly (because doing a spinal after an epidural does have risks), he did a spinal, and she was able to have a ‘good’ cesarean experience. If she had not been so assertive, she probably would have been one of the unfortunate few (like Kmom) to feel their cesarean surgery. Standing up for herself like this in the face of their disbelief was amazing.
Having experienced secondary infertility due to PCOS and three miscarriages, we were delighted and frightened to find we were expecting again. I had pre-eclampsia in my first pregnancy, so they monitored me closely as a result.
About 4 weeks prior to the due date, having seen my blood pressure increase slowly with each visit, my perinatologist wanted me admitted for possible delivery. My ob/gyn, who seemed convinced ( despite the fact that my first couple of BP readings with this pregnancy were normal) that I was chronically hypertensive, disagreed. He sent me for observation to the maternity floor of the hospital, but told the nurses that if my BP stabilized, I was to be sent home. After six hours on my left side, I did see a bit of a decrease in BP, so they sent me home to follow up the next Tuesday with the ob/gyn.
On Tuesday, I went to my appointment, and my BP was 175/110. That was the highest it had been, and I argued with my ob that I was ready to deliver. He begrudgingly sent me to the hospital, again for “observation”. After several hours without a change in my BP, he decided to go ahead and induce labor. Cervidil was inserted and a pitocin drip started, and just a couple of hours later, my labor began.
The nurses were wonderful. They monitored me closely, and tried very hard to encourage my plan of a natural, drug free labor and delivery. After twelve hours of no sleep, they finally convinced me to do something for the pain. My cervix had only dilated to 3, I was progressing very slowly, and I was already exhausted. I hadn’t eaten since 6 AM the day prior, since once I was admitted to the hospital, I wasn’t allowed anything but ice chips. I agreed to some narcotic relief, the doctor decided to break my water, and I finally slept fitfully for about two hours. The pain seemed to be getting worse, and upon inspection, I had progressed to 5 cm.
The nurse asked about an epidural, and even though I had strongly desired a natural birth, I felt totally wiped out and needed some relief. Finally, with the epidural, the pain subsided, and I was able to get some bit of sleep. It seemed to me that the epidural wore off quickly, and twice, the nurse called to bring someone in to give me a little more medication. The third time, with the pain seeming to me to be very intense, a new anesthesiologist came in and told me that based on my ‘strip’, the contractions weren’t that bad and I should be fine with what I had. He also noted that I hadn’t progressed past the 5 – 6 cm point in quite some time, and said that if the pain did continue, I could call back. After about 45 minutes, the nurse who was taking care of me stood up for me and demanded that someone come and give me more meds for the pain. The anesthesiologist came back, and another round of drugs was administered.
About 5 that evening, February 14th, after having been in labor about 21 hours, I felt like there was something passing – there was no pain, but I felt for sure something was coming out of me. Seconds later, the feeling passed, and the nurse checked under my gown. She became quite frantic, scooped up the waterproof pad that I was laying on, placed it on a table out of my view, and ran to get another nurse. I became extremely concerned, and my husband didn’t seem to know what was going on, and when the other nurse came in, they both agreed that my doctor needed to be called immediately. Apparently, I passed an extremely large blood clot, and after the doctor came, he deemed me okay to continue with the labor.
After several more bouts of trying to convince people that my epidural wasn’t working, and the pain was really bad, the nurse confirmed that my labor seemed to have stalled. I had been at the 6 – 7 cm point for a long time, so the doctor was called in. At 2 AM on February 15th, the decision was made by the doctor, myself and my husband to go ahead with the c-section. The baby’s head wasn’t in position, and I was so exhausted that I felt if the time to push came, I’d be in a terrible predicament. The anesthesiologist tried to convince me that my epidural was just fine, but I proved to him that my feet and legs were totally feeling, and the contractions were absolutely being felt. I refused to go into surgery until something else could be done, so he agreed to a spinal. I am certain that had I not demanded something else, I would have felt the scalpel make the cut.
At 2:34 AM, on Thursday, February 15th, after 31 hours of labor, our second daughter was born via c-section. She had APGARS of 9 and 9, and after a few minutes of introductions, she was taken to the nursery. She remained there for a few hours. I insisted on stitches instead of staples, so I didn’t have to have the staples removed, which I found uncomfortable after my first c-section. She and I went home four days after surgery, and except some minor drainage from the incision, I healed well.
I believe that the ob/gyn made a call regarding my increasing BP based on my weight. I kept close track of my BP, and I know it was normal up until about 4 months into my pregnancy. I learned during this labor and delivery that if you don’t speak up, you won’t get what you want. I hope I remember the lesson in other areas of my life!
Camila’s Story (PCOS, epidural, vaginal birth)
Name: “Camila” Age: 23
Pre-pregnancy Weight or Dress Size: 180lbs
Baby Info: girl, 7lbs 9oz, 20″long
Wt. Gain in Pregnancy: 20lbs
Infertility Problems? PCOS. Used Glucophage 1000mg for a month plus exercise and lots of water to conceive.
Any Complications: no
Type of Birth: vaginal
Birthplace: hospital Provider: midwife
Breastfeeding: yes, and it’s been 14 months now! Planning to wean by the end of this year.
Special Notes on Pregnancy: eliminate as much stress as one can during pregnancy and take long , slow walks!
I planned to deliver at the birthing center. I went with my husband to the classes and everything. At 40 weeks and 1 day my labor started and my husband drove me to the birthing center where I stayed for 12 hours with hard contractions. My midwife intentionally broke my water. (I won’t let this happen again-it’s not a good idea if you are looking to have a natural delivery-let your body do the work!)
Because it was taking too long, I was transferred to the hospital right after my midwife’s assistant came (boy, I hated that woman! She made me feel so uncomfortable!). At the hospital they gave me pitocin and also I asked for an epidural (I was exhausted by then!). And who knew—2 hrs later my beautiful daughter came out. She was quiet but then, right after she was taken away from me, she cried and cried! It was the best baby cry I have ever heard!
I am happy for having my baby so healthy, but I felt I was deprived of the natural and empowering birth I was planning for. I am grateful for my baby for I never thought I was going to conceive, but I hope I get another chance to have not only the perfect baby and a bigger family as I always dreamt about, but also the perfect birth! GIRLS, NEVER GIVE UP!!!
Dee’s Story (c/s due to size-phobia, insulin-dep. gd, vbac)
Name: “Dee” Age: 29 in first pregnancy, 35 in second pregnancy
Pre-pregnancy Weight or Dress Size: #1: 247 lbs., size 22-24; #2: 258 lbs., size 24-26
Baby Info: First Child: boy, 7 lbs. 5 oz. Second Child: boy, 7 lbs. 8 oz.
Wt. Gain in Pregnancy: -7 lbs. with #1, +7 lbs. with #2
Infertility Problems? Yes, needed Clomid to conceive; PCO
Any Complications: Severe GD in second pregnancy
Type of Birth: c/s in first birth; VBAC in second (induced)
Birthplace: hospital Provider: OB
Special Notes on Pregnancy: c/s in first pregnancy (fat-phobic doctor); VBAC in second pregnancy (with gd!)
Kmom’s Notes: Dee’s story reflects the importance of choosing your provider wisely! Her first doctor was a fat-phobic man who expected her to fail based on her weight, and created a self-fulfilling prophecy. Some of the doctors she saw after that for infertility treatments were also fat-phobic, but this time she stood up for herself and eventually found one that was not. Her VBAC was probably made possible by the great support she had from her OB, the flexible laboring protocols (including using water despite being on pitocin) she was able to negotiate, and the support of her doula and husband (research shows a doula cuts the c/s rate by nearly 50%). And of course, most importantly, it came about through her own determination and woman-power!
In retrospect, I realize there were many clues thrown out by my ob/gyn over the months of my pregnancy that forewarned of an unnecessary c-section. The biggest clue was his repeating the mantra, “Of course, at your weight, it’s likely to end up a c-section.” I weighed 247 at the beginning of the pregnancy. In spite of a very healthy and uneventful pregnancy, my labor was long and ineffective. My waters broke at 10 in the evening, 13 days post dates. I went into the hospital immediately because….well, I wanted to have that baby! While I had light contractions all night long, they were ineffective. In the morning, I was given prostaglandin gel. That got things rolling and within a half hour I was having strong and consistent contractions. I was through transition, fully dilated and effaced and felt the urge to push around 3 pm. Four hours later I was still pushing. All throughout the day, the doctor repeated his mantra omen. Neither he nor the nurse encouraged me to move about, change positions or try any alternative birthing techniques. So, it was no wonder, again in retrospect, that E was born via c-section, with dislocated hips and a huge hematoma on his scalp from the different types of vacuums the doctor tried to use.
Fast forward to 6 years later. I was 35 years old and finally expecting my second child after having battled secondary infertility for 4 years, and after having several miscarriages. Most of the battle regarding my infertility was dealing with fat phobic doctors who refused to treat me until I lost weight. Of the 5 doctors I saw regarding my infertility, one put me on 100 mg clomid the first cycle and didn’t monitor me at all. I was given no information regarding what to expect, charting my temps or anything. I had extreme pain during that cycle and was told, “Oh we expect those things”. So I went to another doctor. She found a huge cyst on my ovary, told me I needed to lose weight and put me on phen/fen. I lost 45 lbs or so. She referred me to an RE she worked with. He refused to put me on any more treatments until I lost another 45 lbs. I refused. He was the one who said, “If you really want a baby you’ll lose weight.” I had been on the phen/fen the maximum recommended and it wasn’t effective any more. So, the RE refused to treat me and I refused to diet. I went to another ob/gyn who basically had the same opinion as the RE. I made an appointment at the local university hospital. Lo and behold, the RE staff there immediately identified my problem. I was able to get pregnant, but I would lose the baby before it even implanted.
See, I had been having regular 30 day cycles with occasional 35-40 day cycles. I had been keeping record and I could have sworn I was pregnant on those 35-40 day cycles. I had all the symptoms…swollen breast, nausea. But then the period had come. The other doctors all insisted I wasn’t getting pregnant but because of my weight I had PCO. Well, this new RE, Dr. N., said, “Yeah you have PCO, but you are also getting pregnant and losing the baby.” With an attitude of “you have the right to have a baby and you can have a baby….I’m going to figure out how to help you”, he decided to simply try an assisted cycle with clomid, and after ovulation, progesterone.
On the first cycle we tried, I got pregnant!! I also carried that pregnancy to term. Dr. N recommended one of his recently graduated students for my ob/gyn. She was marvelous. Pro vaginal birth and size accepting, Dr. M saw my pregnancy as joyously as I did. I wanted a vaginal birth so badly. I had felt like such an idiot when I realized how duped I was by my first ob/gyn. His fat phobia and surgeon mentality had doomed me to a c-section right from the start and I was felt so ignorant for believing him and not seeing what was going on. I also felt the delivery and drugs after interfered with my bonding with the baby. I can honestly say, I felt like a zombie until we finally got home and I stopped taking the pain drugs. Then I fell in love with my son. But, I will always regret that he didn’t get those first few days of love that babies thrive on. I wanted my next child to have that opportunity and I strongly felt having a VBAC (Vaginal Birth After Cesarean) would lead up to that.
Everything went well, with the exception of severe nausea on my part, until the 28th week when we discovered I had gestational diabetes. You know, I never realized how important it was to me that my pregnancy be totally normal and without even the mildest of complications. I cried when I found out I had gd. My numbers were mildly high, but consistently high. So, I was put on insulin and a diabetic diet. Complicating everything was my reactive hypoglycemia. This insulin resistance left me feeling nauseous all the time. I again felt a sense of failure. I was so mad at my body. I was so certain that it was my diet that caused the problem, even though in reality I had actually been following the ADA diet all along.
Well, somehow, between the needles and lancets, I managed to make it to 37 weeks. I was very sick from the gd and hypoglycemia and I was under a lot of stress due to both my parents being criticallly ill, my husband having to move 3 states away, and my trying to sell our house. Between the stress and the illness, my body was breaking down. I was swollen, though my blood pressure was fine. I had several episodes of false labor, 2 of which took me to the hospital. The baby’s heart rate was running too high and I was dehydrating frequently from the vomiting. So, feeling I was doomed to a c-section even though my heart strongly desired a natural birth, I asked the doctor to induce me early and she agreed that the environment in my body was no long doing any good for the baby. Since we knew from the infertility treatments exactly when I had conceived the baby, we decided to deliver the baby on week 38.
I told my doctor I just wanted to plan a c-section as I was so certain the induction was going to end up in a c-section. However, she persuaded me to have a trial of labor and said, “I don’t see any reason why you can’t deliver this child naturally. It’s your decision, but I’d like to encourage you to give it a try. If you get into it and want a c-section I’ll go that route. But, I’d like you to try.” So, I agreed to try. I have to admit, I had planned the whole pregnancy for a vbac. I was so certain I could do it, but when it got down to the wire, I was scared of a repeat of what happened with my first child. I was scared…just plain scared. After testing the amniotic fluid for lung maturity, it was determined the baby was ready to be delivered. Everything was perfect for his lung scores; so my doctor and I decided to go ahead with the induction beginning on the 25th. I was dilated to 2 cm and 50% effaced. The baby was at -3.
So, my husband “Rosh”, my doula “Kathy” and I arrived at the hospital Sunday evening, and the doctor applied prostaglandin gel to my cervix. I started having irregular contractions right away. Since I had been having strong false labor for almost a month, it wasn’t really surprising that I’d have at least some response to the gel. We passed a relatively boring evening in the hospital. Kathy and I walked the hallway and I rocked to try to get the contractions to going at a stronger rate. I was still dilated to only 2 and at 50% and -3 when the nurse checked me before the second application of p. gel. I asked for a mild sedative to help me sleep, because I knew I wouldn’t be able to with all my excitement and agitation. I was given visterol.
So I slept all of 4 hours and was awakened to take my morning shower. My nurse was worried about my gd and my tendency to have insulin reactions, so she brought me a tray of food which included a muffin and scrambled fake eggs. I would later belch that egg throughout the active phase of labor. I didn’t even eat the whole thing and it still came back to haunt me. At the 8:00 check and pitocin start-up, the cervix was still at 2, 50% and -3. Things didn’t look too good for a successful vbac at that point. The -3 station was a repeat of my first delivery. But we plunged ahead anyhow.
I started having regular strong contractions almost immediately. They were strong and regular. I took a short walk with Kathy down the hallway. Then I took to sitting on the rocking chair and rocking. That rocking movement really seemed to help me deal with the discomfort. At around 9:00, my doctor’s partner arrived and checked me. I was 4, 80% and -1 to 0!!!! He decided to break my waters. I wasn’t so keen on it, but didn’t feel like arguing with him. I felt intimidated by him, so I let him do it. The gush of warm water was just an amazing feeling. I was surprise a how much there was. Anyhow, at this point we had committed ourselves to birthing this baby one way or the other. I had figured I had relinquished myself to a repeat c/s.
Off and on, the nurse would prick my finger and check my bg levels. It was fluctuating wildly. So, she and the doc monitored it closely adding insulin or dextrose to the iv depending on my bg. I hated that pin prick. It just seemed so unfair when I was having to deal with the pain of labor, but I knew it had to be done. It was frustrating, but necessary.
It wasn’t long before the contractions began to be long and hard. I was surprised it was going so fast, but boy was I hurting. The nurse then decided I should get in the bathtub for awhile. I don’t know how long I was there…maybe 45 minutes…when I started begging for an epidural. The contractions were soooooooo strong. The nurse was patient and encouraging and very competent in finding ways to delay me from getting the epidural–“oh try leaning this way” or “how about we kneel for awhile?” Then I started getting more insistent (ok I BEGGED) and she said ok. She drained the tub and started the shower. She had me stand up and lunge with one leg on the tub edge. Then she poured the cool water over me. At this time I was having a very strong burning sensation that originated near the c/s scar. I finally begged a bit more and she then took her time drying me off and getting me and all my iv tubes into the nightgown. Finally she got me into the bed and left the room to find my doctor.
I kept begging for the epidural. I don’t know how much time had passed, but it seemed like 74,568 years :^). Finally my doctor walked in the door. I think I exclaimed something like “Oh thank God you are here, can I have an epidural?” She held my hand and said yes. Phoebe disappeared to call the anesthesiologist. Dr. M. held my hand while I had contractions and she didn’t let go until I kind her pushed it away on one very big contraction. She is a very compassionate doctor who is VERY pro-vbac and has one of the lowest c/s rates in the are…as did her partners and the hospital I was birthing at. I had chosen her because of her reputation and my RE’s referral.
Anyhow the epidural guy finally got there and took his time getting the epi in. I was still 4, 80 and -1 to 0. I was really being a pain, too. I complained every single contraction. It hurt sooooo badly. I don’t remember my first hurting so much. I hadn’t had any pain intervention with him, but this time things seemed very bad. The contractions just didn’t let up and they were sooooooo intense. I also felt intense burning and pain at the site of the c/s incision on my skin. Looking back, I think the internal pain must have centered at the internal incision. It just seemed concentrated right across the front just above the pubic bone. The nurse felt it was due to scar tissue tearing away with the contractions.
While the anes. was fiddling around with my back, I sat on the edge of the bed and rocked with each contraction. In retrospect, I think that must have really helped get things going. Finally the guy told me to hold still (HA!~!~!~) while he inserted the needle. I think it took several contractions, and I really did my darndest to hold still. Finally, I felt like my bladder was being pushed and I had no control over it. I told Phoebe I had to pee. She said in a very nurturing voice, “Go right ahead and let it go. Just relax and let it go.” Well I did. There really wasn’t a thing I could do to stop the drenching anyhow. After the initial flood, with each contraction I felt this push on my bladder and a little voiding. I began to feel like I just wanted to push my whole bladder out.
The epidural was in and I felt my left leg get tingly and numb. But nothing else went numb. The epidural was ineffective and had been placed in the wrong position. I had a dead left leg and lots of pain. It was exasperating. So, they were getting ready to get me back onto my back (I was still sitting on the edge of the bed), when I told the nurse something was pushing on my bladder. She suddenly got excited and said, “Maybe you are ready to push. Do you feel like pushing?” It dawned on me that that was the case and I grunted in the positive. So, she checked me. I was 8 to 9 cm!!!!!! I had gone through transition while waiting for the epidural and no one had even known. Now I had a numb left leg and the rest of me never did get relief, but I think that was the best thing that could have happened. it was time to push and the epi might have screwed that up.
By this time, though, I wanted a c/s. This is where I have to say THE BIRTHING TEAM MAKES ALL THE DIFFERENCE!!! Had I not had the doula, my wonderful nurse, and Dr. M. there to encourage me, I would have grabbed the scalpel myself!!! I begged Dr. M. not to let me go through what I went through with my first delivery. She promised she wouldn’t. For each contraction, I bemoaned my inability to push the baby out with 2-3 pushes like some other women do. I whined and complained a lot, I think. I was being such a wuss, but it hurt sooooo much and the contractions were coming sooooooo quickly. Some other doctor was there and for some reason he actually did the delivery. I have to ask Dr. M. why that was, but anyhow she stood right there and told him what to do while she encouraged me and held my legs up along with Rosh, Kathy, and the nurse.
The nurse was marvelous…though I hated her at the time (contraction hatred). She insisted on my getting on to my knees and trying. It was in my birth plan and she was insistent that I give it a try. With my numbed left leg, balance was really hard and I got terrible muscle contractions in my back where I have an injury from 6 years ago. She had me turn from back to knees and knees to back. All the darned wires from the baby monitor and contraction monitor and IVs would get tangled up around me. It drove me nuts. That and the hair of my husband’s beard tickling my shoulder when he’d rest his chin on my shoulder and count during the contractions…UGH!!
At one point I asked to see the head as it begins to crown. It was soooo cool, but I couldn’t stand to look more than once because all I wanted to do was get that OUT!!! I couldn’t stand any distractions. Even the encouraging and gentle comments from the doctor, nurse, etc. got on my nerves. I just wanted to concentrate. I told them to be quiet. My husband did the counting for me while I pushed. It helped to give me something to focus on. I wanted to groan, but the nurse told me to focus it inward. I wanted to tell her I’d focus it at her, but I really could feel progress being made after I put all of the air into the push. So, I focused. Interesting how you can hate the very people who help you when you feel so much pain.
Finally, about an hour and half after I began pushing, the head crowned and I felt the “rim of fire”. Oh golly did that burn, but it was SUCH a relief to know the baby was THERE!!! I’m not sure how many contractions there were after that, but I think maybe 6. Finally the nurse said, “This next contraction and the head will be out.” I didn’t believe her, but I decided I was going to prove myself. So, with the next contraction, I pushed like you couldn’t believe. Then “WHOOSH” this thing popped out of me and there between my legs with a gush of warm waters was the head of the tiny fellow. Oh WOW! What a sight and what a feeling. It was beautiful. I wanted to hold him. But I had to wait for the darn shoulders. The doctor told me I had one more push. I think I whined, ” I still have to push”, but as I whined that, the uterus gave one strong contraction, I didn’t push at all, and the shoulders popped out!!! WOW! They did a quick check and handed the little guy to me. What a wonderful smell and touch and sound and and and….it was beautiful. He was beautiful.
Suddenly the nurse that I hated through each contraction (but who I realized was doing what I had wanted, btw) was the most loved creature in the world. I wanted to kiss DH, Kathy, the doctors and the floor!!! Fortunately for the others, only DH got the kisses. It felt so wonderful to be through the pain; it felt so marvelous to have my baby vaginally and to hold him and nurse him. I felt like I had won, liked I’d accomplished some grand and glorious feat. The doctors waited until the cord stopped pulsing to have DH cut the cord. The only thing I regretted was the long wait to get him to my face. I had to wait until the cord was cut. But, they honored my wishes that the cord be allowed to cease pulsing on its own.
They let me hold him quite awhile, then finally took him across the room to do the check and clean him up a bit. Oh, he smelled so nice with that amniotic fluid and vernix. Such a sweet and unusual smell. I regretted when they finally gave him a bath later. They bathed him right in the room. He never left my room. I labored, delivered and stayed in the same room the whole time. The nurses came in every hour for awhile to check his blood glucose levels due to my high blood sugar in the pregnancy and during delivery, but he stayed within normal range and was handling things well. So, no intervention was needed in that regard. He nursed and slept and watched the world around him. I fed him and watched him sleep and observe. It was blissful.
So, that is my version of the story. I’m sure some things are fuzzy in my memory, but for the most part everything was just as planned once the labor got going. My big recommendation to anyone planning on a vbac, CHOSE A GOOD SUPPORT TEAM and MEDICAL TEAM. I never thought I would wuss out like I did, but I would have given into a c-section RIGHT THEN. Had it not been for a pro-vbac doctor, hospital, nurse, and friend, I don’t think I would have had my vbac. Also, don’t be surprised at how much you will resent everyone helping you during the birth. I think it just hurts so much that it is beyond our capacity to keep focused on the outcome. So I let them do that for me. AND THEY DID!!! Bless them all.
Gretchen’s Stories (twins by c/s, then home waterbirth VBAC)
Name: Gretchen Age: 33 in first pregnancy, 35.5 in second pregnancy
Pre-pregnancy Weight or Dress Size: #1: 150 lbs. at 5’7″; #2: about 155?
Baby Info: First Preg.: fraternal twin boys, 7 lbs. 14.5 oz. and 6 lbs. Second Preg.: girl, 7 lbs.
Wt. Gain in Pregnancy: ~65 lbs. with twins, about 40 lbs. with second pregnancy
Infertility Problems? PCO, needed Clomid to conceive twins; no Clomid needed for 2nd pregnancy
Any Complications: c/s for double breech twins in first pregnancy
Type of Birth: scheduled c/s in first pregnancy; home waterbirth VBAC in second
Birthplace: twins: hospital 2nd preg: home Provider: twins: family practitioner and then OB; 2nd preg: Certified Professional Midwives (partners)
Special Notes on Pregnancy: Both pregnancies were complication free, despite the higher risk for gd and PIH. Had lots of ultrasounds and many of the ‘usual’ prenatal tests with the first pregnancy, had no prenatal testing other than an ultrasound at 7 weeks to confirm viability with second pregnancy.
Kmom’s Notes: Although most PCOS moms are plus-sized, not all are, and Gretchen is one of the ‘average-sized’ PCOS women. As noted above, birth stories from PCO moms of all sizes are welcome here.
Gretchen is also a veterinarian and so knows a lot about medical procedures and surgical issues (both in humans and animals!), but even so was persuaded into an elective c/s in her first pregnancy. With her second, she informed herself carefully and chose homebirth to help avoid unnecessary interventions and the ‘high-risk’ labels she felt she would get from an OB.
You can see pictures of the waterbirth at http://members.truepath.com/bgadland/birthpix.html. Gretchen also has an awesome page on PCOS, interesting discussions about obstetric care, and other valuable pages as well.
I was diagnosed with PCOS when I was 17 and was promptly put on birth control pills. I took them for 13 years. After finishing medical school (I’m a Veterinarian) and working for a couple of years, my husband and I decided to start a family. Somehow I managed to put out of my mind the fact that the physician who’d diagnosed my PCOS had told me I might have trouble getting pregnant. After 11months, I did conceive and promptly miscarried. This happened again a few months later, and at that point we decided to see a Reproductive Endocrinologist. At that time, the treatment for PCOS was pretty limited and I started Clomid. I conceived on the second cycle and shortly thereafter the twin pregnancy was confirmed.
I had a lot of anxiety about the birth—a little because of my history of miscarriage but more because I was absolutely terrified of having a cesarean section. Somehow, I’ve always known that surgery is not the way to have a baby. My own medical training meant that I wasn’t deceived in the slightest about what is involved with abdominal surgery. I knew that I was going to be considered ‘high risk’ because of the twins, and that it would take a real fight for me to avoid a lot of intervention. I selected a Family Practitioner for my prenatal care—he was a personal friend and I knew he was pretty laid back about protocol during labor and birth. My pregnancy went forward without a single problem, but I could feel the fear starting to grow in my physician. I wish I’d paid more attention to that but because he was a friend, I had a sense of loyalty to him and didn’t feel comfortable looking elsewhere for my care.
At about 28 weeks, baby A turned footling breech and that was that. He never turned again. His brother (baby B) was kind of breech/transverse but that’s not really as concerning because the second twin often turns around during labor, after the first baby is out. I was unable to find anyone in the mainstream medical community who’d even talk about attempting a vaginal birth with 2 breech twins, especially since I’d not had a vaginal birth yet. I didn’t know anything about more mother-friendly caregivers and didn’t know anything about how to encourage breech babies to turn. I was looking at my worst fear come to reality.
I really wanted to go into labor before surgery. My physicians (at this point I was getting dual care from an OB) were on the surface supportive of this until I approached 38 weeks. Then suddenly it seemed that if I waited any longer, something horrid would happen and I just had to schedule the section and get those babies out. No one could really tell me what horrid thing was going to happen, but I started being told that I was stubborn, that I was putting my babies at risk by waiting any longer. I left my prenatals in tears. I was told that having a cesarean was no big deal and that I should just be grateful that I had babies, since we’d had so much trouble conceiving them. I was still holding out hope that they might turn at the last minute, because sometimes that does happen. But at 39 weeks, 4 days I couldn’t take the pressure from everyone (including friends) any longer and I scheduled the surgery. I felt like I’d scheduled my own execution.
I had a “good” cesarean, if there really is such a thing. We were able to negotiate several changes in routine hospital procedure because we had a little time to prepare. Our boys stayed in the operating room with me and my husband and then went straight to recovery with me where we started breastfeeding. I was able to select the anesthetic regimen that I wanted (another advantage of being medically trained!) and was happy with how that worked. The boys roomed in with me and we got lucky and never had another mother in the room with us so my DH was able to sleep in the other bed and help with infant care. Other than being absolutely terrified when they were suddenly ripped out of me with no warning, both boys handled the surgery well and were strong and healthy at birth. They latched on well, and breastfeeding appeared to be off to a good start.
I had pretty good support from most of the hospital staff with regard to exclusive breastfeeding twins, although that did change before we left. My milk was very late in coming in (about 5 days) and the boys lost quite a bit of weight–by the time we were ready to leave, we almost had to sign them out Against Medical Advice because I was under a lot of pressure to supplement with formula. My recovery from surgery was physically unremarkable, other than a slight reaction to the suture at about 4 weeks postpartum. My emotional recovery took a lot longer–I had moderate postpartum depression and we had very little support, either practically or emotionally for what we went through in those first few months.
Because the “birth” was so distressing, breastfeeding was very important to me. It turns out that I’m one of the women with PCOS whose milk supply is affected by the condition. I was able to feed them exclusively but it was really quite marginal as I look back on it. I started solids right at 4 months and it was very obvious that from that point, they gained better than before. Nevertheless I did and still do take pride in the fact that I kept at it and we didn’t wean completely until they were past 2 years old and I was halfway through my next pregnancy.
It took me about 6 months to even consider that I might want to have more children. I knew I didn’t ever want to have another cesarean and what little trust I’d had in the obstetrical community had really been broken by the way I’d been treated at the end of my pregnancy. I knew that having had a cesarean, I’d automatically be ‘high risk’ again and as I started to explore my options, I realized that support for women having Vaginal Birth After Cesarean (VBAC) in the mainstream was rapidly diminishing.
I became intrigued with the idea of homebirth. I’d heard about it when I was pregnant with the boys, but it scared me. As I did more exploration of woman-friendly birth options, I came to the conclusion that homebirth is in fact as safe or even safer than hospital birth, and is probably the only way to stack the deck in your favor if you don’t want a lot of fear and stress around your pregnancy and labor. I found a midwife practice in our area and we arranged to have an interview with them. For the sake of completeness, I also interviewed an OB that had a reputation of being very VBAC-friendly and a Family Practitioner. After the interview with the midwives, I was convinced and so was my husband—homebirth was the way we would plan to go.
The real challenge was getting pregnant again, or so we feared. I didn’t want to take Clomid again because I really didn’t want another twin pregnant—only because I knew it would really reduce my chances at a normal birth. I knew that there were newer ways of treating PCOS so I made an appointment with a Reproductive Endocrinologist (RE) for a consult. It was 5 months before I could get in to see him, [and in the meantime my cycles restarted, I was showing signs of fertility and using a number of alternative/complementary therapies, and we stopped trying to ‘prevent’ pregnancy.] I discovered I was pregnant the weekend before my appointment. I had a routine ultrasound at 7 weeks with the RE because of my history of miscarriages [and the PCOS] and then transferred my care to the midwives.
Talk about night and day! Prenatals were a joy—45 to 60 minutes. They were concerned about how I was doing, not just about what my urine looked like and how much I weighed. I was so supported and they were so confident in my ability to birth my baby. They didn’t have a lot of experience with PCOS and asked me if there was anything in particular we needed to watch for. I explained there was a higher risk for GD and PIH but since I’d gone through a twin pregnancy without either of those problems, I wasn’t particularly concerned this time. They agreed—I kept my protein intake up, drank lots of water and herbal tea, and had a very pleasant pregnancy, this time without all the emotional turmoil.
I think the most stressful part of the whole thing was our decision to not tell my husband’s family about our plans—my family was quite supportive but we knew his family would be pretty freaked out by the very idea of homebirth and we did not need the grief. It was a tight line to walk not to reveal our plans but not actually lie to them either. I was ‘prepared’ to go ‘late’ and so refused to tell my due date—this is kind of fun to do, it really drives people nutty. It was great to know that I wouldn’t even hear the word ‘induction’, much less have to worry about fighting off an induction.
As I passed my ‘due date’, I’d been struggling with increasingly intense prodromal labor for several nights, plus the emotional issues of when my mother would be arriving. Late on Wednesday afternoon, my midwife called to let me know it was normal to be struggling with all of this, and she suggested I have a glass of wine before bed. If it was prodromal labor, that might relax things enough to let me sleep some, and if it was the ‘real thin’ then it wouldn’t stop anything. I was exactly 41 weeks pregnant.
[Kmom note: Although most of us cringe at the idea of a glass of wine in pregnancy, at this stage it actually probably isn’t any more dangerous than the “therapeutic rest” morphine that doctors use for the same purpose in the hospital, and many midwives prefer the wine.]
By bedtime I was contracting the usual 2-3x an hour. By 3 a.m. I realized that the contractions were coming about every 10 minutes. Laying in the bed was not a good thing at that point. Decided to get into the shower and see if that would relax me enough to sleep. Spent an hour in the shower without realizing it. Got out and hurt more—I was kneeling by the side of the bed, kinda breathing through them and DH woke up By then they were about 3 minutes apart! I didn’t want to call anyone yet because I was still convinced they’d stop with the dawn but did tell him to go back to sleep (which he did!). At about 5 things were still happening so we decided to call the midwife and tell her that things were a bit more intense. We decided to call her back in an hour.
At about 6 I called my friend and labor support, then the midwife, then the family that was watching our boys for the birth. So we just hung out and breathed and it wasn’t too bad. By 7:30 everything came to a screeching halt as the sun came up. I cannot tell you how freaked I was about this. But I did remember that for some women, especially in early labor, changes in the environment can really throw you off, so I hoped that was what happened. The boys left and I got back in the shower. By the time I got back out, the contractions were back to every 3 minutes—funny to feel so relieved about being in pain, but there it is! Somewhere in this I did lose the mucus plug, and that really excited me. (What a trip birth is!)
My labor support showed up about 9 while I was upstairs rocking in the rocking chair–it was this pretty surrealistic experience–we’d be talking about something trivial and then I’d stop and breathe and she’d time and remind me to relax and then we’d just pick up the conversation. My midwife called and I decided I’d like to have someone, mostly just to check on the baby every once in a while. She sent her senior apprentice (also a doula and a Home Birth After Cesarean mom) who checked on how I was doing. Then I wanted to be alone, so everyone left and I just kinda chilled out some more. My husband was cleaning and doing chores and finally blowing up the pool.
I really don’t remember when I first got in the pool but it was heaven. We had the fishy pool that many homebirths use and it was really great for us—I was able to assume any position I wanted. For me, water was HEAVEN, although I reacted differently to it than some women—it definitely helped me cope and relax but it kicked my labor into a higher gear (the shower did too). I turned down a vaginal exam and my midwives were SO cool about this. Actually, what they said was “OK, this baby will be born whether we check or not.” I was really afraid of the vaginal exam because I just couldn’t deal with the idea that I might be only 3 cm or something, plus lying on my back for checks on the baby was bad enough, even in the tub.
At some point, I’d been in the tub a while and everything clicked up a notch. I was having trouble all of a sudden, and that’s when my support made a difference. I was shaking uncontrollably and started to cry, and my labor support was great—kept reminding me that it was all normal and I was doing great. My husband was mostly puttering but came in for a while, and he wiped my face for a bit. Then came the first time I thought about being non-compliant—they asked me to get out of the tub. They said I was showing signs that I needed to get out and get upright, to hang onto DH and walk around, swivel my hips, that sort of stuff. On the one hand I knew it was a good idea to keep things moving, but on the other hand I knew it was going to hurt and I really liked the tub! But I did it, and I was right, it hurt like hell.
My midwife showed up shortly after that—the first thing she said to me was, “I hear that you officially don’t want to be doing this anymore!” (Yes, I’d already said that.) For most of the labor, I didn’t really want people around me much and I NEVER wanted anyone touching me anywhere other than to wipe my face. All the pain was up front, in my cervix and across my lower belly, never anything other than tightness across my back (THANK YOU GOD!!!). I had a little rest on the couch, then I went upstairs to be alone. I got in the shower, things got hairier pretty fast and I ended up in the bedroom by myself. By this point I was getting loud—okay, I’ll be honest, I was pretty stinkin’ loud the entire labor. That really surprised me, I’m not normally a loud person at all. I was kind of side-lying on the bed and the contractions were coming one after another and they just would not stop and I was definitely losing any semblance of control. I couldn’t keep my noises low and frankly I didn’t give a flying flip about control after too long. My labor support came in, sat down and just was ‘there’ with me. And then it happened, the moment that my DH will never let me live down (because it is just so darn ‘not me’)—-NO NO NO NO OH GOD MAKE IT STOP!!! I’d not had a vaginal exam, I had no idea ‘where’ I was in labor and was afraid to believe it might be transition.
My midwife came flying up the stairs and sat on the bed, saying something about it getting pretty intense, and she wanted to check me. I just started crying and saying, “I can’t, I’m so scared because if I’m at 3 cm then I’ll just die because I can’t keep doing this.” She says that she knows its scary but holds out the carrot—if I let her check and I’m at least 5 cm I can get back into the pool. Well, give me that pool, so she says, “In between contractions, roll over and we’ll be as quick as we can be.” (In between? There was NO in between!) Anyway, I was 9 and a half with just a little anterior lip. Music to my ears, let me tell you. So after crushing their hands through a couple of contractions (later, my labor support said I almost shoved her through the wall a couple of times–how do women ever do it in the hospital confined to a bed?), I finally got up and moving. A word of advice—don’t do transition on the stairs, it really sucks. But by the time I got to the pool, I was pushing.
I was waiting for this because it’s supposed to “feel good after the dilation.” Well, I guess I got to join the “pushing hurts like hell and really kinda sucks” club. It wasn’t fun. It was more like being demonically possessed! And it definitely hurt, even though I was supposedly ‘doing’ something (not consciously, really, it was being done TO me and through me). I found that kneeling but with my legs folded and spread really far apart felt the most effective. The apprentice told me later than the midwife was really concerned because it was so weird but the apprentice could tell it opened me even better than squatting. I tried leaning back on my tail bone for a bit but that wasn’t going anywhere, so I stuck with the squatting and kneeling thing. The apprentice was pretty much doing everything and she was supposed to catch the baby (which was totally cool with me), so she was trying to gently coach me through pushing. It ended up being kinda funny in the deep recesses of my brain (I couldn’t really talk); she’d tell me to push a little bit more towards my bottom and I’d just laugh inside because it assumed that I had any control at all—the only thing I could change was holding my breath a bit longer when I pushed. I could tell that made a difference because I actually felt the baby move down when I pushed that way (totally cool feeling, by the way—-there’s so much women lose when they are drugged!).
So I pushed. It was a very odd place I went to. I just lived each contraction, then caught my breath in between. I had no sense of time at all, it was just the contraction and then the next. It started to feel a bit burny and I gasped something about that and the apprentice felt down and said, “Bulging bag” (my membranes had not yet ruptured). So I kept pushing and she kept saying, “Even more bulging bag” (guess that vit. C worked for me—I heard her comment about how tough the bag felt). At his point, I was learning over the side of the tub, butt sticking out but still under water, and trying my best to break DH’s fingers (that’s what husbands are best for, physical abuse during labor!). I felt this ‘pop’ and heard her say, “There go her membranes,” so I decided it was time to really get serious about getting the baby out. On the next contraction cycle I felt the burn start, and I pushed as best I could.
My daughter crowned on the last push of the contraction. All these people were yelling, “Pant, pan, don’t push, just let her come easy!” and I’m thinking, “Shut up! I couldn’t push if I wanted to and if I could I would because this REALLY REALLY HURTS.” They’re going on about what a great job her head is doing stretching me and I’m thinking, “No **** Sherlock, get that head OUT OF ME!” Finally, about a hundred years later, a contraction starts up and ‘pop’ out her head comes. They said, “Pant, so we can check for a cord.” There was no cord so they said “Push,” so I started pushing—and nothing! Nothing. So there she is, head hanging out, under water and nothing. They ask me to push but that’s pretty useless without the contraction. I hear someone say, “Head’s been out 2 minutes” and I hear the midwife say, “Get pads on the floor in case we have to get her out of the tub”. I’m thinking in the tiny part of my brain that never stop, “Oh shoulder dystocia, I’d better get this baby out.” Contraction starts and I start shoving and the midwife jumps in and fiddles with something and WHOOSH, out she flies! (It wasn’t a real shoulder dystocia, she explained to me later, she basically just had to tip the baby’s head up a bit and wiggle her a little—not a big deal but not something the apprentice had had to deal with yet–so the midwife did end up catching in the end.) I flipped over and they passed her up to me and I held her on my chest and at that moment, none of the past hours mattered in the slightest. It was 4:32 p.m., just about 13.5 hours after I first thought ‘something might be happening’.
She was a bit floppy–initial Apgar of 5—turns out that while she didn’t have a nuchal cord around her neck, she did have an ‘occult’ cord—the cord was looped up over her chest and so was pinched there at the end. I think it was only a factor at the very end because her heart tones had been perfect throughout the labor, and the midwife wasn’t able to check right at the very end (mostly because I couldn’t get myself turned over to be checked). She had given me “2 more contractions and then I absolutely have to check again” and I got things done in 2 more contractions. The baby’s 5 minute Apgar was 9, so she did fine.
The water in the tub was getting pretty bloody so they really wanted me out of there because they were a bit concerned about hemorrhage (the midwife told me later she suspected I might bleed more than usual because of the uterine distension from my previous twin pregnancy, so she wasn’t surprised, although the apprentice was a bit freaked). Got out and sat on the couch and the placenta fell out—a 7 minute physiological third stage! [In other words, it went quickly even with no pitocin to force things along—-Kmom] They asked my DH if he wanted to cut the cord and he said, “Heck no, that’s what we pay you for,” so they cut it and got me laid down and within 30 minutes my daughter was nursing. But I was still bleeding so we had to deal with that. I ended up losing ~4 cups of blood, quite a bit for an otherwise uncomplicated birth. They gave me Shepherd’s Purse tincture and I drank and ate a lot and by the time they left, my uterus was actually involuted down almost to the size they’d expect 24 hours later. So I think some of it was just that I lost a lot of blood in a few hours that ‘should’ have come out over the next day. I only passed clots a couple more times and 4 days out had very little lochia at all. So, while it was a bit scary (I did get really faint and woozy and had to be carried up the stairs), it ended up not being all that serious.
10 minutes after the birth, the phone rings and its my mother—she’s in town, 15 minutes away. The timing could not have been more perfect. Guess God knows what He’s doing after all. DH calls his mom and tells her we aren’t at the hospital, we’re at home. Later she told him that she’s really glad we didn’t tell her about our plans, that she would have worried the entire time, so we played that one just exactly right too.
I didn’t tear (at least 2 minutes of the ‘ring of fire’ did do something positive!) and just a couple of minor ‘skid marks’ on my labia. I felt so good ‘down there’ that I forgot to use the peribottle. But no one told me how much it itches when those skid marks heal! The herbal bath that I used for perineal healing was wonderful and it dried up my daughter’s cord like gangbusters too. She had no molding—probably because she was almost born in the caul [still in the bag of waters—Kmom]—and only one little scrape by her right eye—she is just as ‘perfect-looking’ as her cesarean brothers were. I felt great within days and really had trouble remembering that I’d just had a baby, that’s how different the recovery was.
Random closing thoughts: Did I ever think about uterine rupture? 2 times—when I first started pushing because it hurt so damn much and all low and in the front (but since the pain stopped in between pushing I figured it was unlikely). And then when I was still in the pool but bleeding I again thought of it (but because it didn’t hurt at all, I figured again it was unlikely). Never crossed my mind at any other point.
What coping techniques did I use? In early labor, the more classic Bradley technique relaxation stuff was really helpful, although not in the side lying position. Later I drew a lot on the variety of stuff that Birthing From Within talks about—especially vocalization and ‘going into the pain’—as funny as it sounds, facing and embracing the pain was the only thing that made the slightest difference during what I now know was transition. If you don’t have that book, get it. Period.
Was it my dream birth? Well, actually, I didn’t have a dream birth and I did that on purpose. It was exactly the birth I needed, and I find it supremely ironic that I basically had a textbook ‘Friedman’ curve labor—12 hours of dilation, 1.5 hours of pushing. Who’d have thunk me of all people would do it ‘by the book’?!? Yes, I’d do it again, no doubt about it. I’m not on a screaming high but I’m happy. And having fun. That’s really all I want–the first 12 weeks after the boys were such a dismal, grey, unhappy time, with no positive thoughts to it at all—just to be having fun is enough for me.
Could I have done it in a hospital? Well, I hope never to know the answer to that question. I do know I would not have done it the way I did do it if I were in the hospital—I probably would have taken drugs if offered (I would have taken a bullet if offered there at the end although my labor support says I don’t give myself enough credit for how strong I am). In the hospital, I would not have had the freedom to be loud, to move around, and most importantly, to be absolutely by myself when I needed to be. I think that was the single most important thing my support people did for me—left me alone. I am so thankful that I had the support from my husband and the people that mattered when it came to planning a Home Birth After Cesarean (HBAC)—it was the best decision I could have made.