Monday, February 28, 2011

type 1 diabetic birth story~

I had a Pharmacology professor in college who described, quite perfectly I think, the difference between pain and suffering:

Pain and suffering are two very different things. A person suffers from cancer, scleroderma, chronic hepatitis. It brings up concerns of pain only for pain's sake. A woman labors with great pain, but little suffering, for the birth of her child. There's an anticipation there; a joy making it worth the pain.

I thought I understood that. I mean, I wrapped my head around it rationally, academically, logically. But I had no idea what it meant until I labored and delivered this amazing little person (I've so lovingly nicknamed here as "littlebird") that I now have the privilege of calling our son, on February 20th.

It all started that week honestly (week 39) when I had one of my (many) 'routine' ultrasounds and fetal monitoring sessions scheduled at the perinatology clinic. Everything was going just fine with littlebird and as they did the growth scan it showed that he was in the 90th percentile for size; ie, nearly 10lbs. Wow. That Even the ultrasound tech felt it was overestimated and admitted that ultrasound can be off when measuring weight in fetuses. She also reminded me that his past growth scans showed him to be quite lanky, not large (both his parents are lanky, and MAC, his dad, is especially tall at 6'4"). She comforted me and said to just show the info to my OB and CDE and let them decide if it was of concern. So that was the plan.
The next day, the perinatologist (a type A, not-so-nice woman throughout my entire pregnancy, I'll admit) called me and said:
Your baby is too big. He's past the max for vaginal birth and so I'm recommending c-section for tomorrow.
Wow. Just freak me out and drag me to the hospital and strap me down while you're at it, lady. I didn't even know I had a "max".
So I called my OB, pretty much in tears and told him what she relayed. He had worked with me to go to 40 weeks as long as all was well with the little one. He had supported me throughout the entire pregnancy to give my body the best chance to go into natural labor. So he understood completely why that conversation upset me so much and got pretty mad. He felt she was putting the patient in the middle of something without having a doctor-to-doctor discussion first. Besides, ultimately, it was his call when I got induced (since he'd be doing it, not her). He read the report and felt the weight was a "vast overestimation" and most likely the baby was merely long, not large. My CDE felt the same, stating also that my diabetes was not to even be a consideration in the matter, since my last A1c had been 6.1% with stable numbers at that, no major pendulum swings skewing the picture.
So my OB told me to relax, we'll stick with the plan unless something called for a change, and to just wait until my scheduled date of induction (my due date, February 24th---pretty much an entire week).
So that's what I did. I went to my appointments at the perinatologist's office the rest of the week where she wouldn't even look me in the eye as I went in for my ultrasound (wow, really mature---this isn't personal!) and baby still looked good on the scans and the fetal monitor. By Thursday, they just told me they'd see me at my usual Monday appointment.
I drove home that day, feeling something different. Was it hope? Something deep inside me told me not to worry. I really knew it was going to be alright. And not just because everything eventually is alright because it well, has to be...even when it's not how we want it, life always gets to its point, you know? There was a warmth, a freshness in the February air, an honesty, an openness. The Sandia Mountains where I live looked lovingly down at me during that drive home. I listened to the music of Beirut, one of my favorite bands, the sounds of their Balkan horns comforting me. The woman I worked with at the refugee resettlement center happened to call me out of the blue and said that she had to call because she gets these "feelings" about certain things and knows how they'll pan out. She said she "just knew" it was all going to be ok. Something in my gut knew to trust her. If you knew her, you'd know why.
My close friend Kalena (we're both massage therapists) called me that night (Thursday) and said she was thinking of me on this nearly-full-moon and that she had some time and thought we should do a session working on all of the acupressure points for labor induction. We met at her office, lit with lovely candles and opera playing in the background. Littlebird moved about happily and I felt contractions throughout the session. I believe with all my heart that her massage jump-started the entire process.
My water broke at 1:30 in the morning on Friday, February 18th---exactly when the moon became full. I'd been told recently there would be a full moon on the 18th and that babies often liked to come on the full moon. I didn't want to put all of my eggs in one basket, but being scheduled for induction on the 24th (exactly my 40 week mark), I laid in the tub at night that week before, talking to littlebird as usual, calling him by his real name, gently weeping and asking him to come on the full moon if he could.
He heard me.
I woke up to wet pajamas, the scent of the ocean strong. I knew it was amniotic fluid slowly leaking from me. I checked my BG; it was 70-something. I had a small juice box. I could feel the excitement in my chest; my BG always drops when my brain in really on, coupled with excitement.
I didn't yet have any contractions, which is not surprising, considering this is my first pregnancy. Things don't move very quickly. I couldn't fall back asleep. Matthew, my partner, was so excited and nervous and half asleep; he started to put all of his things together like we were leaving right then. I told him to relax. So I paid some bills and we both tried to lay back down but kept softly chatting in bed.
I called my doula in the morning, an incredible friend, and told her I had an acupuncture appointment already scheduled for that morning to get things moving along, so we decided I should keep it. Diane, the DOM pulled up just as I was getting out of my car. I told her my water was breaking. She embraced me and said, "This is perfect! This session will really get him moving since your body's opening up as we speak." (Acupuncture works best to 'induce' labor if you are at least starting to dilate, efface, leaking amniotic fluid, or lightly contracting).
We did the session and all of the labor induction points felt deep and painful and different than anything I'd felt in the past doing acupuncture. I imagine those points were really open to being activated!
Later on, I still had no contractions and my BG remained stable all day. My doula came over in the afternoon and we all took a long walk with our dog who could tell something was up, and did lunges in the park. We took our last pictures of me pregnant. All I felt was the amniotic fluid leak.
I know to some people it seems odd (or even dangerous) to wait like I did. But I knew I wasn't in danger of what is called PROM (prolonged rupture of membranes) until past the 24 hour mark (because it increases the risk of infection in the baby), and that we'd certainly be going into the hospital before then. I merely wanted to wait and relax and try to let things get moving on their own at home. I truly believe that the more relaxed you are, the more relaxed your cervix will be and you can birth that baby in the hospital more efficiently (think Ina May Gaskin's 'sphincter law').
MAC told me he'd get me anything I wanted to eat for dinner. So we ordered chicken satay from the lovely little Thai place up the street. By 11pm, nothing was really happening and my doula said we should go into the hospital for the baby's safety at this point.
When we checked in, as expected, my OB was not on call. So we were given the option of birthing with a Nurse-Midwife or the on-staff OB. I chose the midwife, since I was wary of docs other than my OB (sorry) :)
They were very excited about my birth-plan because it stated what was *most* important to me and yet was flexible enough in case things didn't go as planned for a totally natural birth. I want to point out here that they all actually read it; kept checking in as the labor progressed about my input and my options available. You can see the birthplan I used here. I personally think some gals really overdo it on their birthplans. You can't truly "plan" birth. Especially with something like a first birth and type 1 diabetes (in the hospital at that). It seems to become a point of contention for some people. So I simply wrote on it any additional details I needed to add---such as all of my type 1 diabetes issues (using my pump and controlling my diabetes myself during the L&D with MAC's assistance, bringing my own food and treating any lows myself) and also added things like my desire to not be hooked up to anything but my pump, to birth in a position comfortable to me, and for the little one's vernix not to be washed off, no antibiotic eye ointment, no vitamin K shot, no circumcision. At the heart of the matter was me staying in control of my own type 1 DM and not jumping into a medically intensive birth too quickly, and littlebird being cared for with as little intervention as possible, unless necessary, of course.
The night was long. I started in on the contractions and while painful, I was managing them by laboring in the tub and moving around a lot. None of us slept. I couldn't eat at all. I was thankful I had such a high-protein, high-fiber meal for dinner, as it was all that sustained me for the next 24 hours. I was really nauseous and could only suck on ice chips to stay hydrated, despite bringing coconut water and juice and lots of delicious snacks. Haha, that's Murphy's Law for ya: if I didn't pack anything, I would've needed it!
By 8 a.m little was happening and the midwife I was assigned was about to end her shift. She came in and said, "Guess what? Your OB's on-staff today!" I nearly cried with joy! When he walked in he kinda laughed and said, "Well, I guess we can cancel that induction for next Thursday, huh?" He was going to be there all day and all night. I knew he'd be delivering my baby and that made such a difference in my anxiety about anything that might come up.
At this point, they just left us alone. At one point we realized that they weren't even following the "every hour you need to be on the fetal monitor" rule, since I was literally just in the room, laboring naturally. They just kept checking in and asking us how we were doing. So MAC, my doula, and I basically stayed in the room all day and labored *together*. They were amazing. They kept filling and draining the tub with warm water for my laboring. They kept getting ice chips. They kept cleaning up the floor when I had accidents (TMI, I know, but hey--- birthing a baby ain't pretty, folks.)
MAC kept checking my BG and helping me to make corrections. Strangely enough, I struggled not with lows, but keeping it below 140. I was anxious about it because I knew I wasn't eating, but I just couldn't. I was feeling so sensitive that at one point MAC put on chapstick and I exclaimed, "I smell peppermint! What's that peppermint smell?! I think I'm gonna barf!" :) We focused on hydration and just constant monitoring, which the staff was happy to accommodate since they all said they preferred the better control of pumps and made it clear they didn't want to touch mine! :)
Saturday "day" is where everything truly becomes a blur. I entered a different world. A different time span. Time flew by and yet felt eternal. I've never been in so much pain in my life but with so much excitement. The wind was howling like a wolf. The room felt hot, cold, hot, cold. I couldn't be naked enough, but couldn't put on enough clothes. You are a different person when you give birth. You are your internal self turned outward and back again.
I didn't want them checking and rechecking my cervix too often for fear of the increase in chance of infection since my water had broken. I let my OB check once and I was at 9 1/2cm.
Finally, around 5, my body began to collapse. MAC tells me my eyes started rolling into the back of my head. I hadn't slept since those couple of hours Thursday night, basically. The only position I was comfortable in for the contractions was squats and my knees were giving out even though I kept trying. My OB finally asked me if he could check me. I was still at 9 1/2cm. What a blow that was. He said there was a small lip of cervix still there so he tried to lift it over for me. That nearly made me jump off the bed and plaster myself to the ceiling. I screamed Oh my god, I can't! Please stop, Dr. Teicher!" MAC told me he said, "Well, that's good because I'm done. And wow, you're always so polite, I've been called much worse!" :)
He let me labor for about an hour or so longer but when he checked me again, I was still at 9 1/2cm. I started to feel upset. Dr. Teicher gently asked me to consider some help for my pain. He told me he thought I was getting wound up after so long and that was why I couldn't dilate further. I got teary eyed. He said I'd gone on so long and that it was incredible; everyone on the floor was amazed. I don't know if he was just saying that, but I knew he was right in a lot of ways. He seems like he can read your mind sometimes because the next thing he said was, This doesn't mean you've failed, Emily.
When the Nurse-Anesthetist was putting in the epidural, I was at my lowest point. I felt so defeated. All that work and no baby coming. They could see his head a little, but that was it, no more progress. Dr. Teicher told me he thought if I could just sleep for a couple of hours pain free, I would fully dilate, relax and could push him out. So I slept. We all did.
By 8 or 9pm, I was fully dilated and effaced. I started pushing, but my contractions were now not strong or efficient enough and littlebird's heart rate started to decelerate a bit (thanks, epidural, argh!) so my OB turned the Pitocin on to the lowest amount possible. This seemed to do the trick because they guided me in pushing (since I could no longer feel the contractions but thank heaven could still feel "pressure" and certain sensations, unlike some gals I've heard about going completely numb in every way on Epi's).
The room started to feel very dim; almost candle-lit. Quiet and sacred. I was determined to push him out. Caesarean was not on my list of lifetime things to do; especially with my first child, and I knew if all of this failed, I'd be in the OR in just a little while. With just a few contractions, I could feel littlebird coming down the birth canal. Dr. Teicher asked me if I wanted to touch his head as he crowned. I did, and it motivated me knowing he was literally right there. When he got a bit stuck, the OB had some nurses there to help pull him out, although they did need the vacuum on him, which bummed me out. Also, his arm apparently got a bit stuck at the moment he slid out (pretty common, I'm told) and so this caused me to tear quite badly (which, by the way, is healing nicely with Arnica Montana 6x homeopathic and epsom salt baths...) :)
But let me tell you---when I felt littlebird slide out of my body and the collective sigh of relief and excitement, I cried. It just came washing over me that he was out and we were both ok. The entire time, MAC had been checking my BG and it was staying stable in the 120's and 130's. When they checked littlebird's BG, it was about 60. Perfect. So they put him to my breast almost immediately after the birth and he latched beautifully to get some of that wonderful-antibody-nutrient-dense colostrum. Because neonatal hypoglycemia can occur as a delay, IDMs ("infants of diabetic mothers", nice acronym, eh?) are required to have their BG checked for a few hours---at least 3 times. He passed every time and was never even close to needing assistance. This was because my BG stayed stable and also because he latched quickly enough to get that good colostrum.
My OB said, "Are the bets still going on his weight?" People chimed in with their final estimations. The final number: 8lbs, 10 oz.
And he was long and lanky---21 1/2"!
A good size, a normal size; within range of vaginal delivery. And certainly not "almost 10lbs". Yeesh, thank god I always question things. ;)
After the delivery, the sensations in my body changed immediately. First, I went from nauseas to famished. So I ate a granola bar and didn't bolus, fearing the post-birth lows I'd been warned about. Wrong move. I skyrocketed to about 200. All those hormones competing with my insulin, I'd imagine. I got stressed-out towards the end too, knowing I was kind of under a time crunch headed toward c-section, so we all know what stress does to BG---usually increases it. That, and the Epidural and Pitocin change a lot of things I didn't *exactly* plan for as far as how my type 1 would react.
The next day I ended up struggling to keep my BG under control---even as I began to breastfeed. Again, I think it had to do with all those competing hormones, my not eating for over 24 hours, and stress (hello cortisol!) I just drank a ton of water (necessary to counteract the swelling from the epidural anyway) and ate good meals. Things started to decrease and balance out nicely, with no lows, surprisingly. I just kept checking religiously and correcting anything. It's hard to figure out how to change basal and bolus patterns, but I just increased or decreased settings one day at a time. Don't change too much at once or else you'll crash.

All in all, I got what was most important out of my first-birth experience, in a hospital at that, since t1dm makes me ineligible for homebirth (sad face). I always reminded myself throughout the pregnancy that "I worked this hard for a baby, not a birth". That's an important thing to stay focused on, because those of us who value natural birth so highly can easily get sucked into what I call the 'natural-birth-nazi' focus: where the only healthy mamas and babies are born via homebirth with no interventions, and that's just not true. You can use the best of both worlds--western and naturopathic principles because you might very well need them and still have a healthy pregnancy and birth outcome. For some of us, that's the only choice we've got anyway, so one of the best things you can do is find a healthcare team that supports that philosophy with you. So, the most important thing is that both littlebird and I are healthy and happy, and he had no major interventions, like needing to be in the NICU for low BG. He was also only given colostrum and is now breastfeeding beautifully full-time...growing big and strong!

I'll post next on some of the things that I feel made this birth work out well enough and why. For now, I hope my birth story was informative and somewhat helpful to any women out there reading this trying to plan a pregnancy with diabetes. It is possible. Just take it one day at a time---and literally one moment at a time if you need to. Don't let this disease control your personal goals. It isn't an easy one to manage, but it is manageable and you can accomplish anything you want to do with it if you keep it close to you, rather than pushing it away or ignoring it.


shaquila said...

i cant say enough how happy i am for you! birth is always trying and exciting....but the outcome is the most awesome thing! thank you for sharing your story with us. i know it will give women with diabetes hope and educate them at the same time!

Sysy said...

This was so amazing to read. What a journey and what a beautiful story! Your son will really appreciate reading it one day :)

Mori said...

thank you so much for sharing this em. made me tear up. such a strong mama bird. xoxo.

AJ said...

Simply Beautiful Em! So proud of you!- Akendra

Anonymous said...

Congratulations! I am so happy for you guys!

Heather said...

I just stumbled upon your birth story and I have to say how wonderful it all sounds! I'm also a type 1, have been since age 7. My son is almost 1 now and looking back on the way he was born makes me feel like I missed something amazing. I was induced at 38 weeks and after 16 hours of labor (most of which was with an epidural) I ended up with a c-section. Then my son was quickly rushed away to the NICU where he stayed for 3 days, followed by 2 more days in pediatrics for blood sugar issues and jaundice. Your story gave me inspiration and hope to try for a more natural birth if we decide to have another child (provided I can find a VBAC friendly OB, that is). Congrats!

Anonymous said...

Your birth story is very beautiful and inspiring for me personally because I'm a type1 and currently pregnant with my first baby who is also a boy, with all the negative that gets talked about I'm so enthusiastic about things working out in my favor after reading such a wonderful birthing experience. I don't mean to be intrusive but I would hope that you could email me as I have many many questions, my email is