All of Us

All of Us

Wednesday, June 29, 2005

K's Birth Story

K. was our first child born in Michigan. I wanted to see a nurse midwife as I had with the previous 3 children. There are 2 nurse midwife practices in my area. One is a group of 9 and the other is a group of 2. I called the larger practice and was told that the clinic nearest me had 2 of the 9 midwives practicing there, and that they did their own deliveries. I was concerned that with such a large group, I would not get to know them all and have a relative stranger at delivery. At my first appointment, however, I found out that the information I was given was incorrect, and that all 9 midwives rotate being on call. She assured me that they have common practice guidelines and that they go over their cases biweekly so that any of them would be aware of any situation pertaining to me. They hadn't wanted to see me until I was 10-12 weeks, so by 18 weeks I'd had 3 visits, 2 with one midwife and one with the other. I just didn't get a warm feeling from them. The one I liked better had a very flat affect, as though she was depressed, and the other one was perkier, but brusque. My Arizona midwife was so wonderful, warm and loving, and we had grown very close over the years.

At that point I called the other midwifery practice in town and switched to them. I had seen one of their midwives before for an annual checkup and really liked her, and really wanted fewer people in the practice. Unfortunately they were a 30 minute drive away, while the other midwives had been only 10 minutes away.

I really like the new midwives and things went along fine until it came time for the GTT. They gave me the bottle of glucola and told me to drink it before I went to the lab for the blood draw. I forgot to make the appointment and promptly lost the glucola. (We got a new car and it was discarded when we sold the old one, I believe). At my next midwife appointment they gave me another bottle and told me to do it ASAP. I did, and it came back at 145. Anything above 140 is considered too high and you have to take the 3 hour GTT. I didn't want to take the 3 hour, so I convinced them to let me redo the 1 hour, arguing that I'd had a large lemonade about an hour before the test. This time I was very careful to not eat anything sugary, and it came back in the low 150s.

They told me it was important to eat at least 10 carb servings per day for the 3 days prior to the 3 hour GTT. I proceeded to binge on carbs, not realizing that this might have an impact on the test. In fact, the last thing I ate before the 12 hour fast began the night before was a Dove bar! My scores on the 3 hour were 105 fasting, 185 at one hour and well below the cutoff on at 2 and 3 hours. That was 5 above the cutoff for fasting and right on the cutoff at one hour. If you have any 2 scores above the cutoff you are considered to have gestational diabetes. I was so borderline that I didn't really believe that diagnosis, and there are actually 2 sets of criteria, the National Diagnostic Group and the Carpenter Coustan. The latter is more conservative and that is what the OBs that supervised the midwives I was seeing used. If they used the former criteria I wouldn't even have been diagnosed. The American College of OB/GYN endorses both sets of criteria.

So off I went to the dietician. I followed the diet religiously and tested my blood glucose. After only 5 days there wasn't enough improvement in my fasting blood glucose (the after meals numbers were fine) so they sent me to the endocrinologists to begin insulin. I had done enough reading to know that this treatment was definitely in the gray area of effectiveness. Basically, people with mild GD don't see many benefits from aggressive treatment--mortality and morbidity are unchanged but they do have smaller babies, less shoulder dystocia, and MANY more inductions, c-sections and interventions performed on them. I cried over this for days, and argued with the midwives, who told me that if I didn't follow the treatment, dictated by "standard of care", which was dicatated by their OB supervisors, they might not be able to continue my care as I would be high risk.

I began taking the insulin, which wasn't as bad as I imagined it would be. The endocrinologists, however, were awful. They were rude and condescending, often refusing to explain things to me and treating me like a child. They only saw patients on Tuesdays and were often running an hour behind. You have to pay to park at the hospital clinic and I had 2 small children with me. After the first time I was kept waiting that long, I informed the nurses on each visit that I had another appointment in an hour and would have to leave if I hadn't been seen. Although my blood glucose numbers were almost always the same, they kept insisting they were "creeping up" and raising my insulin dose, which was very small anyway. Initially they saw me every two weeks, doing basically everything the midwives did: urine test, blood pressure, weight check, etc. except the actual belly exam. Then they said they wanted me to come once a week, which I objected to, since I was seeing the midwives that often by now as well and their examination of me was redundant. I had to call in my blood glucose numbers to a nurse once a week anyway, so I made up excuses why I was unable to make the appointment every other week. (By now I was really angry with them and being really passive aggressive). At 38 weeks they said, "Well, this is your last appointment. What is your plan for giving birth?" "Going into labor and having the baby." "You mean you don't have a plan to be induced? You must call your provider TODAY and discuss this with him." People with gestational diabetes often have their placenta begin to deteriorate sooner than normal, and induction is the rule. I had been going for nonstress tests twice a week at the midwives' office and they were all perfect, so I wasn't very concerned. I usually go to 41 weeks, and we'd agreed to go at least to my due date as long as the baby and I seemed fine.

I began a regimen of walking, sex and herbs which exhausted me and gave me nonstop Braxton Hicks contractions. By 39.5 weeks I was 4 cm dilated and very stretchy! My due date came and went, and I agreed to be induced at 40 weeks and 4 days, mostly because that was a Thursday and this hospital didn't do elective inductions on the weekend and there was only one midwife available on Fridays, who would be dividing her time between people in labor and office appointments.

I called at 7am Thursday, per instructions, and the hospital said they were too busy. The midwife called later and arranged for me to go in at 1pm. I had only slept for about 4 hours due to tremendous anxiety about the induction.

Got there and got in a room, with a total nazi by-the-book, threatening nurse. The midwife asked the charge nurse to switch nurses for me, but it turned out that the Nazi was off in a half hour. My initial finger prick blood glucose was 5 points over the cutoff for needing pitocin, although that wasn't taking into consideration that I'd just eaten before I left for the hospital, but Nazi nurse said it didn't matter. It turned out that when they got the lab blood glucose back which was drawn at the same time, it was 25 points lower! I knew the finger prick machines had a margin of error of +/-15, but not 25! So I was well within the correct range.

We'd agreed that if the baby was low enough to not risk cord prolapse, they would break my water instead of using Pitocin, and see if that got labor going. Unfortunately he was very high, and breech as well! This hospital will not do breech births, but will do external versions. I spent the hour waiting for the doctor to arrive with my rear propped up high and my head low, praying a lot, hoping he would turn over. When the doctor turned on the ultrasound, he had! I was so happy. They wrapped a large belt called a binder around me to try and prevent him from flipping back over. Interestingly, I hadn't felt a movement that seemed like a 180 degree turn. Unfortunately they'd already given me a shot to relax my uterine muscles for the version, which also makes you feel really jittery, so we had to wait for that to wear off before beginning pitocin.

They finally began Pitocin around 6pm. I had to be constantly monitored (due to my previous c-section 5 births previously!) and have IV fluids so I now was tethered to the machine and dragging a heavy IV pole around. The bathroom doorway had a raised threshold which made it hard to get the pole over and really irritated me. My favorite midwife was off at 10pm and I was sad when she left. I'd hoped she'd be there for the birth. By 11pm I was very tired, so I laid in bed for a while, dozing. There were constant contractions, but not really hard. By 2am, the midwife suggested we stop. I was on the maximum allowable dose of pitocin, and still no action. Both the midwife and I were astonished that the pit hadn't worked on me, considering I was 5cm and very stretchy by this time. She said I could go home and come back, or stay overnight at the hospital. I was worried that I wouldn't be able to sleep in the hospital but she said she'd give me a sleeping pill and tell the nurses not to bother me. This sounded preferable to driving all the way home (30 minutes) and being awakened early by very excited chilren who would be so disappointed that I was STILL pregnant. First the nurses scavenged up a frozen dinner for me. The sleeping medication worked well, and I slept till about 10am, got up, showered and had breakfast.

They resumed the pit around 12pm Friday. The afternoon was very boring. Around 5:30 pm, in the absence of any real contractions, the midwife suggested we have the doctor perform a procedure called "needling the membrane" where they put tiny holes in the amniotic sack with a needle and slowly push the baby down, the fluid leaking out the holes allowing this to happen. When the baby is low enough, they go ahead and break the sack. This must be peformed in the OR due to risk of cord prolapse. While waiting for the doctor to arrive, I noticed that the contractions picked up some. When she arrived and examined me, she felt that the baby was now low enough to break my water without needling the membranes. Once again, my prayers were answered and I was relieved.

Unfortunately, the amniotic fluid had a lot of meconium in it. They told me that meant that they wouldn't put the baby right on my chest, but would examine and suction him first, and that there would be a pediatrician and pediatric nurse in the room in addition to the midwife and labor and delivery nurse. At this point, we decided not to call our parents, who were at home with the kids and supposed to bring them to attend the birth. I was worried that if the baby had trouble breathing or other problems from the meconium it would be too intense or frightening.

The contractions had really picked up after the water was broken. I was still on pitocin, which the nurse kept turning down. The labor was very intense and I was tired and afraid. I requested an epidural, which the midwife, nurse and D. tried to talk me out of, saying it was going so fast that it would soon be over. I said that I wanted to be able to request it and if the anesthesiologist got there too late, so be it. Daryl began reading me the consent form, and once I heard all of the conditions, I changed my mind.

I walked/paced as much as I could tethered to the monitor until it was time to push. I pushed for 2 contractions and he came out easily, no tears. He was born at 6:45pm on Friday, June 20. I got a brief look at him and then the pediatrician examined him. The midwife had suctioned his mouth when only his head was out (she made me pause in pushing) and not gotten anything, and he was biting the tube! The pediatrician didn't get anything either, so he was fine. I didn't know whether he was a boy or girl, so I called over to D., who was grinning ear to ear when he told me it was a boy. He weighed 9lbs. 14 oz, my second smallest baby at that time. His blood sugar was fine, so no signs of gestational diabetes. Our parents and children arrived within an hour of his birth. After they went home, D. went to an Italian restaurant we both like and got a really nice dinner, pasta and bread and salad and even a split of wine which the owner gave him for free when told him what the occasion was. I was excited to eat all the carbs I wanted!

We named him Ian initially, which both of us liked but neither of us was crazy about, so we changed it the next day. I stayed 2 days in the hospital after his birth.

He is so happy and full of life, a real joy to be around. We treasure him.

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SE Michigan, United States
Mother to 10 fabulous kids, ages 4 to 21 years! Married for 26 years to my best friend.

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