Friday, June 12, 2009

Audrey's Birth Story - PG13 version

I'm not known for my patience when it comes to waiting on my babies to be born... I tried every "natural" remedy known with my son in my attempts to induce his labor before his scheduled medical induction. After two weeks of eating egg plant parmesan, jogging, jumping up and down outside during a thunderstorm, an enema, and sex, labor commenced just 18 hours before his induction was scheduled. And, I had thankfully figured out the combo that worked for inducing my labors... and although an enema is not a very pretty way to start labor; for me, as a diabetic hoping to have a drug free labor, it sure beat waiting around until the doctor's scheduled hospital induction date arrived with all hopes of a natural labor lost to pitocin and interventions. And so, now you know how the labor really began...here's the rest of the story...

The first contraction I felt and thought, "oh, this could be it" was in the bakery section of Sam's Club around 3:30pm on a Sunday afternoon. The contraction came on very strong, and I found myself doubled over the shopping cart with a surprised look on my face, begging my husband to stand in front of me as much as he could because I was so embarrassed. After the contraction was over my husband, Todd, asked the typical husband question: "are you in labor!?" I denied it and just recommended that we head home quickly. A second strong contraction hit in the parking lot, but I was still in denial that my first attempt to induce this labor would have worked! I was only 36 weeks and 6 days, the bare minimum of me feeling like the baby would be "ready" to come.



We arrived home around 4:15 and I set myself to getting dinner ready and staying busy so that if this was labor, it would continue and progress quickly. I knew from my first labor that if I worked hard and kept busy, the labor would get a good strong start. I felt so nauseous and couldn't eat the heavy broccoli alfredo I'd cooked for my son and husband so around 5:30, I called my best friend who made us both a strawberry smoothie. She, too, asked if I thought I was in labor and by that point, I was starting to entertain the idea that this could be it; admitting that to her and my husband. She laughed at me saying, "Jenn, you always think you're in labor, but call me if it keeps up", since she and her husband were to take care of our son if we went to the hospital. After she left, I went back to doing laundry which required going up and down the stairs and making up the beds for guests just in case. Around 7:30pm I realized this was definitely labor. I was putting laundry into the washer and a contraction hit that required every bit of my attention, I grabbed the washer, bent in half, and held on for the ride. Once it was over, I went upstairs, scared out of my mind, having finally admitted to myself that I was going to be having a baby soon.

The contractions were about 4 minutes apart and lasting 45 to 75 seconds. The most comfortable way for me to work with them was on my hands and knees while I rocked my hips back and forth or side to side. I called our doula and told her I'd let her know when we were going to go to the hospital, but in the back of my mind I had a lot of doubt about my ability to labor without drugs and wasn't sure I would follow through with that promise to call her back. My husband got our son to bed and checked on me periodically as he was trying to tie up loose ends with his grad school work in anticipation of missing a few days of school.

Finally, around 9:30pm, the contractions were so intense I knew we were going to have to go to the hospital soon and we called our friends back over and told them this was it, plan on staying the night here.

The ride to the hospital had been the hardest part for me during my first labor so I asked my friend to ride with me rather than the doula; thinking at this point that I would probably end up getting an epidural. The contractions were still 4 minutes apart however and I was pretty discouraged about my labor, thinking I was wimping out since they were not getting closer together. BUT, they were certainly getting stronger...

We finally made it to the car around 11:10pm, I sat in the back seat with Katie, my friend, and Todd drove. Todd turned around about 4 miles into the trip and said, "Are we really going to St Lukes? We've never even seen the place!?" St Lukes was the more natural-labor friendly hospital in our area and was about 20 miles from our home. St Johns was the "baby factory" in the area where our first child was born and only about 15 miles from the house. Well, with this being the second baby and us in the middle of graduation and a cross-country move, we'd put visiting the hospital off until tomorrow...turn's out we'd be there, but not for a hospital tour! "YES, we're going to St Lukes!" I yell at my dear husband from the back seat. "But I thought you wanted drugs and the food is better at St Johns!" Todd's response. "I don't know and take me to St Lukes!" Ok, sounds like an intense car ride to the hospital, but trust me, it was G-rated compared to the car ride with my first labor. Katie held my hand and rubbed my forehead through each contraction in the car and we talked about meeting Audrey in-between. I was so proud of how well I handled the ride since this is the point when I gave into the fear and doubt of natural child birth during my first labor. This was a turning point for me, I realized I'd made it through my biggest fear of the process...I started telling myself, I can do this.

We arrived at the ER at 11:40pm and I was contraction free on our entrance, I told the attendant I was here for labor and delivery... She had this look of "you must be a first timer, because you clearly aren't in labor and they are going to send you home" written all over her face... and cue the contraction... Jenn with water bottle in hand bent over wheel chair and spills water everywhere. Cue change on her face..."oh, well maybe she is in labor". Some 16 year old came and insisted I sit and ride the wheel chair up to labor and delivery despite me telling her I'd rather walk.

11:55pm - Arrive at labor and delivery floor and meet nurse Kristen...God is amazing...Our meeting with her started about the same way as with the ER attendant, since I was resting in between contractions, she was suspicious of my labor, but asked me to gown up anyhow so she could check me. I was so nervous at this point, here was the answer we'd been waiting for all night, were we going to have a baby...and internal exam says...7 cm!!!! Yay, I am in labor, I think to myself...how there was any doubt left in my mind I know not.

And here was the moment of truth...I said to Kristen, "We came here because I couldn't tolerate the pain at home anymore and I wanted drugs. But I had really wanted to have a natural birth, what do you think?" And our angel nurse Kristen replied to my and Todd's surprise: "Oh, you can do it, you are working with your contractions really well, you don't need any drugs"

Wow, now here's where having a hospital whose staff are comfortable with natural birth makes ALL of the difference, in my first labor I got to the hospital at the exact same point in my labor and their response to my fear was "honey, we need to get you an epidural so you can calm down".


Another interesting twist in the story occurs around this point, we realize that the doctor we'd "fired" at the recommendation of our perinatologist was the attending doctor this night...crazy, but great for us because he is on-board with type one's and natural birth as well and supported our nurse throughout the night in her decisions.

12:30am - Kristen comes back in, she's heard from the doctor, not my doctor ("my dr" being the OB recommended by the maternal fetal specialist to deliver us), but the one on call. So basically a doctor we'd never met. He ordered her to start an IV and break my water...however, awesome nurse Kristen says "I think breaking your water is the worst idea ever, you are managing fine now, so lets just ignore that for the moment, but I do have to start the IV." She has trouble getting the IV going... not a wonder since I didn't eat or drink all day because I felt awful; so she calls the anesthesiologist to start the IV. After the anesthesiologist gets the IV started she turns to me and says, "now I can start an epidural any time if you'd like"...Kristen jumps in from across the room "We wont be needing your services any more".

Inside my head there are a thousand alarms and flashing red lights and sirens going off in that moment... I must have looked like a deer in the head lights, I still do as I write this...I was screaming inside...WE WONT BE NEEDING YOUR SERVICES ANY MORE????????!!!!! what, NO, don't I get to decide THAT!?

Ok, well of course I get to decide that, but I knew Kristen was behind me and wanted me to have what I really wanted which was an intervention-free labor and delivery. I trusted her thoroughly at this point, so despite the look everyone could see on my face, I said nothing and changed my stunned look over my nurse telling the one person who could give me an epidural that I wouldn't be needing her (with a bit of attitude might I add - go nurse!) to a quiet smile.

Alright, now we're set, it's somewhere between midnight and 1am and I'm committed to having Audrey without drugs. Katie starts to leave...oh, no you don't Katie, I've realized at this point that I need all of the help I can get to do this. Over the last hour Katie has rubbed my back or head during every contraction as I rocked back and forth holding on to Todd. The rocking motion brought that baby into the world. So, there was no way I wanted her to leave. Now, this wonderful friend of mine deserves much credit in this story, she had a 9 week old, nursing baby at home herself! But she smiled and was gracious enough to entertain my request that she stay until the baby came. That moment, was the true turning point for us all, Todd, too, realized we were committed and got out his computer and found some relaxing music for me.

Around 1:15ish I think, the nurse checked me againg, 8 and 1/2cm she said. My thought... Are you Kidding me!? I still have a long way to go! ... Ok, I've prepared with the Bradley method for this birth, and so far the technique was serving me well, but again, I thought I need more help... I asked if I could get into the water. "Of course!" replied the nurse. (At this point, I feel like I'm on some alter universe where I don't have diabetes anymore... I think the most incredible thing about the whole labor and delivery process was that I didn't feel like I was treated differently than any other patient...for once I wasn't considered a huge liability or risk - one better off served with a c-section, I was any other women having a baby!) I've failed to mention that my blood sugar has been hanging in there this whole time around 100. I checked every 45 min to 1 hour just to make sure because the thing that causes low blood sugars in baby is when mom's sugar runs high in the hours to days before delivery.



1:30 - Into the tub I go...wow, it helped so much, even though it was a regular old bath tub, no fancy pants labor tubs for me :). (Here's where the idea of a combo labor/delivery/post-partum room was so great because the room had a regular bathroom in it with plenty of privacy. A lot of hospitals who advertise labor tubs have them in a room other than your room and when you are in intense labor, the last thing you want to do is get all gussied up and go for a stroll down the hospital hallway!) The freedom of being off of the monitor was half of the relaxation I think, those belts that hold the fetal monitor on are pretty uncomfortable after a few hours. Kristen said she was going to take her lunch while I labored in the tub because that would give me some down time... her relaxing, this-is-no-big-deal attitude helped me to stay calm and relaxed through the birth. It was also a much needed break for Todd and Katie who had been on their feet since we arrived at the hospital too. I worked through the contractions in the tub mostly on my own, Todd would encourage me through the tough ones. Although, I continued to need to rock and move through each one despite being in the water.

2:20am - Kristen returned and said they needed to check me again. My contractions were the worst when I had to lay on my back in the bed, the only time I spent in the bed was when they made me lie down for internal exams. Yay- 9.5 cm she said! She thought I could finish up quickly if we broke my water at this point, I was really scared, but also REALLY REALLY tired and agreed, let's go for it. The attending doctor broke my water about 10 minutes later and then labor changed!

2:45am - The nice 4 minute window I had between contractions was long gone, and they are much different now, I have a strong urge to push. Kristen encouraged me to just bear down and give myself a few more minutes to make it to 10cm and be fully dilated.

2:55am - My instincts took over at this point, the baby was coming, I could feel her moving down with each contraction, I'm making a lot of noise for the first time through the whole process. Kristen said I would work better if I kept the groans lower, but groaning definitely helped at this point. I was on my knees with my body laying over the head of the bed, it was up at a 90 degree angle. At some point I realized it was time to push and told everyone.

3:10am - I need to change positions! I'm feeling a lot of pain and pressure down there and praying that this wont last much longer because I know I cant keep going if it continues to feel like this. I get into typical pushing position on my back and try that for 2 contractions...NO way, that was awful. May I try the squat bar I asked? A contraction hits as they are putting the bar on the bed, I grabbed it and squatted, "OHHHHH, SHE'S COMING" I yelled! I instinctively stood up and pushed one last time...and...welcome Baby Girl at 3:21am! (Well...it was a little more complicated than that, the cord was around her neck and the only people in the room were nurses yelling.."sit down, you have to sit down now, we have to wait for the Dr to come and get the cord off!". He came running and then we had baby girl with one last push!)

I laid down and welcomed my baby girl in my arms, my husband and I were the first people she ever saw. It felt right this time, thankfully. My baby wasn't lying across the room on some table screaming as a doctor did procedures on me so he could move on the the next patient... thankfully, the doctor on call didn't arrive for another hour, by that point I was ready for baby to go get all cleaned up :) But there she lay in my or my husband's arms for the first part of her little life. Her blood sugar was 64...no need for supplemental formula and she latched right on for nursing.

What a night. That was a very detailed account of Audrey's birth story, hopefully it will be an encouragement and help to you as you plan for your own birth. Now, granted, putting the words plan and birth in the same sentence may be a silly idea, so maybe preparing for birth is a better way of saying it.

There were some key factors that made a huge difference for me in accomplishing this goal... 1-turned out Kristen was the natural childbirth educator at the hospital, 2- she was a true advocate for me as a doula or otherwise natural-birth-experienced individual would have been when it came to standing up to the doctor over routine interventions like breaking my water, 3- I had great blood sugar control this day and the days leading up to the delivery, by the grace of God, I do believe. I am thankful that I got to experience a natural birth because it finally gave me the confidence in myself I have always dreamed of, for whatever reason, I needed to prove to myself I could do this despite my diabetes, I wanted to be treated like a normal woman. The specialists may have thought me crazy, but by sticking to my guns and ensuring my blood sugars WERE as close to normal as I could, I had the best chance possible at this. Not to mention, the whole experience taught me how good of control I can achieve in managing my diabetes. In future posts I'll break more of that down, but here's to changing the way doctors look at type one birth!

Thursday, June 11, 2009

Welcome

Hello all, I'm creating this blog for women who have type one diabetes especially and for all women interested in natural childbirth. I hope it will be a place where we can compile their birth stories and that it will be an encouragement for the medical community to take a second look at us...maybe we aren't so different.

My name is Jenn and I have 2 children, 22 months old and 4 months old. I have type one diabetes, diagnosed at age 12. I am a registered dietitian and practiced in acute care for 3 years. I had my first child at 24 years old and my second at 25. During my first pregnancy I decided, after much research, that natural (drug-free) childbirth was the best thing for me and baby. I sought an OB for my care, however was repeatedly referred to a maternal-fetal specialist because of my diabetes. Not knowing much, as it was my first pregnancy, I found a specialist and began the months of stringent diabetes management to ensure I had a healthy baby. Thankfully, and by the grace of God, I had a healthy 8lb 9oz baby at 39 weeks. Glycemic control was very good thorough out the pregnancy, with A1C's ranging from 5.9 to 6.2. The baby did suffer from mild hypoglycemia at birth and for the next 36 hours, sugars from 28-40, however his sugars stabilized with supplemental formula feedings. Unfortunately though, the birth of this child was much more difficult than need be and complicated by epidural anaesthesia and a vacuum assisted delivery. Not to mention the emotional complications of weeks of bio-physical profiles and non-stress tests in the latter weeks of the pregnancy. I ultimately ceased trying to breastfeed baby at 2 weeks postpartum and had a 6 month battle with post-partum depression...But keep reading...the story has a happy ending...

Now, for baby number two... with a much more informed and confident mother. I decided to continue with the maternal fetal specialist for my diabetes management; however asked this doctor to partner with another OB who would deliver the baby and was experienced with natural childbirth. The specialist did not approve of the delivery doctor of my choosing and recommended another...ok, we compromised and went with the other doctor. I was stronger emotionally this time, I knew with good glycemic control I'd proven I could have a "normal" sized baby and deliver vaginally...I also knew I needed to do it naturally for me. I refused procedures I was not comfortable with after open and honest discussion with my physicians, like vibroacoustic stimulation of the baby for non stress testing. I worked very diligently with the physicians on managing my diabetes and let them know when I felt they were being over cautious and unreasonable (they documented thoroughly in the medical record as to avoid liability for my "decisions"). Glycemic control was even better this pregnancy, A1C's ranged from 5.4 to 5.9. And in the end, it all worked out, again, by the grace of God. Ironically, baby was delivered by the doctor we were asked to "fire" by the specialist. He casually and rarely assisted the nurse as needed, I was allowed off the fetal monitor to ease the pain of natural child birth in the water, and in the end... a healthy baby was born at 37 weeks weighing 7lb 10 oz through a completely drug free and awesome labor! Baby breastfed beautifully from the moment of birth and my recovery was a breeze. I felt like myself again in no time, without the emotional battle I'd experienced before.

I love both of my children dearly and share these bits of their birth stories to let you and your doctor know that in the end it DID make a difference for me when I had the baby the way I wanted. Having a healthy baby is a BIG part of the picture, but I think having a healthy Mama at the end of the day is important too.

There's the short of it. Over the coming months, I hope to give you details bit by bit, in as organized a fashion as someone as unorganized as myself can manage. I would love to respond to your questions about having diabetes and having babies or about having a baby naturally, so please feel free to ask. And one final note of encouragement to women with type one who hope for a natural child birth... I have a dear friend, Beth, who has type one as well and delivered her FIRST child naturally just last week. She will share her story soon too! That makes 2 of us. I was so frustrated as I searched and searched for stories of women with diabetes who'd had natural births and could never find any...so be encouraged, it is possible and this blog is committed to discussing the in's and out's of having a baby naturally even when you have type 1 diabetes!