Wednesday, March 20, 2013

'You can still wind up with an emergency C-section that is a GOOD EXPERIENCE'

Rachael shares her son's birth story:

I found out I had gestational diabetes at my first OB appointment. It was so early it wasn't even the OB I saw, but a nurse educator. I failed the glucose drink test and was sent for a 3-hour fasting to confirm. I also have PCOS, so insulin resistance from that coupled with a ridiculously strong family history (both parents, an uncle with Type 1, aunt with GD, all grandparents …) and the fact that I was not in optimal physical condition when I finally got pregnant (depression due to the difficulty conceiving from my PCOS led me to gain weight, and I was obese at the time) all combined to make me a perfect GD storm. It was definitely GD though as my A1C was fine; I had a hard time convincing some not-exactly-well-informed nurses that I wasn't a Type 2, but that's another story.

I started out on oral meds within a couple of weeks of my diagnosis, in addition to receiving nutritional counseling, upping my exercise intake, and put on a minimum 4 times daily blood glucose monitoring regimen.

Throughout all this, I knew I wanted a vaginal birth and blindly believed I would be a good candidate for it. I studied child development and early childhood education in college, which focused heavily on attachment parenting and all the choices that tend to go along with that, and was pretty upset the option of even TRYING a midwifery was stolen from me (GD is considered high risk, and midwives don't work with high risk patients).

My pregnancy was not a healthy one. I blessedly avoided severe morning sickness, but had a whole domino effect of complications and illnesses. I had repeated UTIs and yeast infections. I had thrush on my skin for most of the entire pregnancy. I had bad acid reflux (a preexisting condition due to my obesity but was managed with Nexium) that continued to require treatment. I developed respiratory problems and had "pregnancy induced asthma" — I had asthma as a child of two smokers, but hadn't needed treatment or been symptomatic since I was 10 - which required 3 different inhaled, oral steroids that I had to be on for the duration of my pregnancy (steroids raise blood sugar, you can see how this is a vicious cycle.) I came down with the regular seasonal flu (after getting both the flu shot and H1N1 shot — my OB said to be thankful I got the vaccine before I contracted the illness, since the way it reduces the severity of the symptoms is probably the only thing that kept me out of the hospital!) and then required oral steroids and Tamiflu and Ciproflaxin. While I managed to avoid hospitalization for the flu, I was pretty seriously ill and took multiple courses of the steroids to get well - all of which aggravated my diabetes.

Basically, I was getting sicker and sicker the further my pregnancy progressed. I saw a regular OB and a maternal fetal health specialist for high risk pregnancies. I had to send in my blood sugars once a week for the entire time I was pregnant. I had about 80 appointments for the whole 9 months or so. I had so many ultrasounds I lost count. Throughout ALL of this, I still planned on having a natural, unmedicated birth. I don't know WHAT I was thinking - clearly it was wishful thinking, not reality-based thinking!

My son was thriving and doing very well despite the medical hell and overall lifestyle of a senior citizen that I was living. He didn't start to measure big until the very end of my pregnancy. All of a sudden, my fluids were measuring very low, he shot up to an estimated 8 pounds, and I was having severe edema and borderline low blood pressure. At 37 weeks, I asked my doctor about induction. At that point, I had been on four-times-daily injectable insulin (which I had to inject myself right into my baby bump!) and was just so ready to be done.

She reviewed my current numbers and agreed that I was a good candidate for induction. 3 days later, after a nice dinner out together the night before, my husband and I showed up at the hospital at about 7 at night. I should have eaten before I got there! I just sort of assumed they'd feed me, but I had missed dinner time and all they had was a vending machine sandwich. I spent my entire labor asking everyone who came in the room what they had eaten most recently and then salivating over what they told me!

That night I got a pill to dilate my cervix inserted vaginally and an Ambien to sleep. I didn't sleep at all as I was woken up a lot for monitoring — at least my husband slept that night. In the morning I had progressed well, so I got to start pitocin (no breakfast though — sob!). After a few hours of that, I was still progressing well but they wanted me to walk around to help things along. I had not one but TWO IV trees hooked up to me (six different medications/fluids being needed at once! The nurses told me that it was the most they had ever seen for an induction. I was a very sick woman.), so my husband had to push one and I pushed the other as we walked around. His best friend came by to visit while we were walking and I remember distinctly telling him to LEAVE, NOW because the walking had kickstarted active labor with a bang.

The contractions started out at a manageable level. The labor nurses I had were great and very supportive. At first I wanted to just curl up in bed through them. They suggested I try the labor ball, the tub, etc. The tub was heavenly — but they made me get out after 30 minutes or so I think for monitoring. They were concerned about my son's heart rate and I had been hooked up to an external fetal monitor since they had started the pitocin earlier in the morning. Once I got out of the tub, all of a sudden, the intensity ratcheted up to an 11, at least. The contractions were UNBEARABLE. I think I stuck it out for something like four hours from the start of labor, and then I asked for an epidural. I have never been so happy to see a man in scrubs in my life.

There was one issue with administering the epidural — they had to do something with my multiple IV sites — I seem to remember I had one in each hand. At some point one of them just got removed and I looked down as I felt wet — blood was GUSHING out of the port on my hand. All while the anesthesiologist was in the middle of doing the epidural. I just closed my eyes and sort of turned my head away while the nurses apologized, stopped it, and got me cleaned up. It was all over in a few seconds, thankfully!

After the epidural I felt MUCH better. I was able to get some rest (I hadn't slept the whole night before) with the only really annoyance being the blood pressure cuff I had to wear constantly. Some of our family showed up to visit, and I could chat with them (chat = ask them about what they had for breakfast). I got to have some crushed ice. It was overall a pleasant, dreamy time of waiting and resting.

About 14 hours after labor had started, I was at a 10, 100 percent effaced, and ready for pushing. The first few pushes were thrilling. I was so excited — my son would finally be here soon! Pushing soon got exhausting, though. I started vomiting with every contraction and push. Two hours of pushing later, I was screaming in exhaustion and pain. Even though I had had two epidural bolsters, I was still able to feel about half of my body — not as intensely as I would have otherwise, but enough to feel pain. The vomiting had really taken a lot out of me. I started screaming that I was done and that I wanted a C-section. The OB on call (my regular one had to leave in the middle of labor!) was so sweet and gentle — she told me 10 more minutes of GOOD trying and then she could call it. I did my pushes dutifully, while watching the clock. When it hit 10 minutes I screamed, "I'M DONE!!!!" — haha. My husband thought I was "giving up" because we both knew how much we wanted a natural birth experience, having read about how much more beneficial it is with breast feeding, health, bonding, etc.

The anesthesiologist came in again I think, gave me much more medicine, thank God. They gave me IV anti-nausea medication that I was SO RELIEVED to get — but later on we realized I had a bad reaction to it. It was Zofran and it basically knocked me out completely. The rest of what happened is a blur — I had to fight to stay conscious and only remember glimpses here and there. I remember how cold the OR was, one of the medical personal by my head singing along with the music that was playing in the room (it was the radio or something, and an '80s song). I remember them saying something like "Why is she so sleepy?" I remember the sensation of being pushed and pulled on when they removed my son. I remember the way my husband's face changed as if he'd been slapped — he went from being tense and disappointed to utterly shocked — my son was about 2 full pounds bigger than they had estimated. He was just HUGE and we were totally unprepared for him to be that bi g… and, also, no wonder he had not fit through the birth canal! After that, it's a blur.

I woke up in the recovery room and was shaking badly. I felt awful but it was quickly fading. I nursed my son, sleepily, and mostly just sat there while the nurse and my husband held him to my breast. I asked if he was latching on (something I was very concerned about due to the C-section) and the nurse said he was a champ, then I passed out again. I later found out that he had some blood sugar issues and that my husband had given him some of the colostrum we had brought with us via a syringe while I was in recovery sleeping.

We got sent to a regular mother-baby room at that point, which was about 4 a.m. the next morning. I had checked in at 7 p.m. on a Tuesday and had my son at 1 a.m. on Thursday — we were all EXHAUSTED! Of course family started coming a few short hours later. My husband and I were both on cloud nine, though — other than being tired, we were elated. The lack of oxytocin I was so worried about with a C-section was not a problem. I was soooo happy I had had a C-section, and that my son was now in my arms, healthy, safe, and sound. I was so thrilled to EAT!

My son nursed great from the beginning, other than being a little sleepy due to being a late-term preemie. Also because he was so large, he tended to stay asleep longer than normal. He lost a bit more weight than they wanted (but, honestly, he was HUGE …) so I had to supplement him for about two days with formula — which at the time was upsetting and I cried, but in hindsight no biggie and I was obviously hormonal!

The nurses and CNA's I had were all SO WONDERFUL and nice and sweet and caring. They helped me have the best shower of my life. They helped us with everything, really, and were just such kind, nurturing presences that we were very grateful to have. I was doing well and so was my son (other than the weight thing). I had one bad lactation consultant — but that seems to be par for the course with them, there are bad ones and good ones and most mothers experience a little both of both. The majority of staff we had were just lovely though.

The hospital was a brand-new one and the rooms were gorgeous and hotel like. The food was good. There was cable TV. We had round-the-clock assistance with anything we might need and free snacks. I was in the hospital for three days after giving birth (the maximum stay covered by our insurance) before we went home. The whole experience was calming and relaxing and I would recommend it to anyone — who wouldn't want room service and a maid while you are dealing with the biggest transformation of your life!?

My incision healed wonderfully. Honestly, the stretch marks are much worse than worrying about some tiny scar! The worst part about the surgery was the itching from the leftover adhesive from the bandages. My son started gaining weight again within a few days after my milk came in (which took five days). I was able to start exercising after 6 weeks and eventually worked my butt off and ran my first ever half marathon last summer (when my son was 17 months old).

Now I am pregnant again with our second and last child. Despite being in much better physical condition, I have contracted early-onset GD once more. It seems to be going better this time though — I'm 15.5 weeks and no meds yet! I'm hopeful that I will be a bit healthier, but my husband and I both have MUCH more realistic expectations for pregnancy and birth. We are going to be scheduling a C-section this time and couldn't be happier about it. I am actually LOOKING FORWARD TO IT! I am hoping for a much calmer, more aware experience. I know now to stay away from Zofran … I can't wait to just be conscious and present for birth!

I hope you can use my story. I think it's great for women to know that even in a high risk complication-ridden birth, you can still wind up with an emergency C-section that is a GOOD EXPERIENCE.


gynecologist phoenix az said...
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Anonymous said...

So sorry you were conned by the hospital into formula-feeding your son. Don't get me wrong: I'm not against women choosing to formula feed, and I oppose measures like locking up formula tins from new mothers as I hear is happening in New York City. However, I think women who CHOOSE to breastfeed should have that choice respected. I too was conned into giving formula to my daughter at the hospital. She lost weight after birth - but DUH, I was pumped full of fluid, and my legs looked like the Elephant Man's after I gave birth, so naturally she weighed more than she usually would and so she lost more weight. If I ever have other children, I'll be sure to go to a baby-friendly hospital.

Alexis C. said...

Anonymous, you don't know her situation or her child's. Nowhere does she say she was "conned." Sometimes formula is genuinely needed.

Anonymous said...

In my case, it wasn't. I'm not really in favour of home birth (again, free choice, but I would never choose it for myself), but after the treatment I received at the hospital where I gave birth, I can see why some women are attracted to home birth.

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