Rebecca's Birthstory
By Rebecca
Mother to Corinne, born April 20, 2003

Baby Corinne
(More pics below!)

FINDING OUT I WAS PREGNANT

When my husband and I found out that I was pregnant, I wanted to be pregnant, but not necessarily that month. I had been a type I diabetic for over 18 years and my blood sugars had not been as good as I wanted them to be. Although my most recent pre-pregnancy HbA1c was pretty good at 6.5, I'd had some high readings, as high as 376. I had found it hard to be perfect knowing that in any given month there was only a 15% chance that I actually was pregnant. But when I knew I was pregnant, I became highly motivated.

On a weekly basis, I began downloading my blood sugars to my computer and analyzing the trends. I would then adjust my insulin to carb ratios based on the trends. I began counting every single carb I ate. To make it easier, I bought a copy of Animas ezManager for my Palm. It allowed me to enter the food that I planned to eat and then it calculated how much insulin I should take based on the food and my insulin to carb ratios. I checked my blood sugar about 7 times a day and took my insulin 4-7 times a day.

I tried to find an OB that specialized in diabetes, but my endocrinologist told me that there weren't any in the area. Instead, he gave me a recommendation for two doctors in practice together that his friend's wife had gone to and liked, Dr. R and Dr. B.

LEARNING ABOUT MY PREGNANCY

My first appointment was with Dr. R and I liked him. He was both outgoing and positive. At the beginning of my appointment he calculated my due date to be April 17, based on my LMP. But after he did an ultrasound, he changed my due date to April 12, based on fetal measurements. He also said that because of my diabetes he'd induce me about a week or two before my due date. At the time, I was happy with the the earlier due date and the idea of early induction because it meant that I could quit my job sooner.

I began to read as much as I could about diabetic pregnancies. I scoured the Internet. I read the book Medical Management of Pregnancy Complicated by Diabetes by the ADA, which is aimed at medical professionals, but gave me much of the information that I so desperately wanted and couldn't find anywhere else. I joined a Yahoo group for pregnant type I diabetics. (It wasn't until later that I found diabeticmommy.com.)

I very much wanted to have the baby vaginally with no episiotomy and no pain medication. I didn't want to be cut and I wanted to fully experience childbirth the way that most women have all over the world, all throughout time. As I read, I began to realize that one intervention can lead down a slippery slope to more and more interventions. Also, a woman in the Yahoo group said that her doctor was not planning to induce her early unless it became necessary for some reason, so I realized that early induction wasn't necessarily a given.

At my next doctor appointment, I happened to be scheduled to see Dr. B. First he spent about 5 minutes flirting with the nurse. He even lifted up his shirt and beat on his abs. He then spent about 1 minute with me. He verified that the baby had a heartbeat, shook my hand, handed me my stuff, and escorted me to the door.

I stopped him and told him I wanted to discuss a few things. When I told him that I wanted to have the baby as naturally as I possibly could, I could see his body start to tense up. He said, “Oh no. With diabetic pregnancies, we go by the book.” I wanted to discuss the options and the associated risks, and then make my own decisions. But he would have none of that. He was much more interested in putting me through his no-hassle assembly-line baby factory than he was in advancing his knowledge of diabetic pregnancies or giving me the experience I wanted. He quickly ended the conversation with some scare tactic explanation that included the phrase “dead babies, dead babies.” I decided that it was time for me to find a new doctor, even though I was scheduled to give birth in less than 4 months.

A NEW DOCTOR ... AND A DOULA

On the Internet I ran across a non-profit organization devoted to helping women in the the area have a more positive childbirth experience. I called them and the woman I spoke with recommended Dr. F and another doctor or two who were further away. I recognized Dr. F's name. My neighbor had gone to him for her pregnancy and liked him. So scheduled an appointment with him.

I wouldn't be able to get into see Dr. F until I was into my third trimester. But that was okay. I knew I'd be miserable if I went back to Dr. B and Dr. R, and Dr. F seemed like the best choice. And my pregnancy was going pretty well. I felt fine. I had some blood sugar readings that were high, but my highest HbA1c was 5.7.

Meanwhile my husband and I started our childbirth class at the hospital. One of our instructors would later become our doula.

At my first appointment with Dr. F, he spent over an hour with me, discussing anything that I wanted to discuss. I liked him. He had a sense of humor and most importantly he was willing to try to give me the birth experience that I wanted. He told me that he was there just to keep me out of trouble. I finally felt like it was my pregnancy and not my doctor's pregnancy. He also changed my due date back to April 17, based on my LMP. I was happy about that because I've read that it is standard practice to base the due date on the LMP if it is known and because it gave my body just a little bit more time to give birth on its own before any interventions might be considered.

A BIG BABY?

I had had a level II ultrasound as well as two fetal echocardiograms and all indications were that my pregnancy was no different than any other pregnancy. That is, until Dr. F did a fetal weight estimate when I was 36.5 weeks pregnant. The baby measured 8 lbs 5 oz, in the 100th percentile. If the baby gained a half a pound each week, that would make the baby nearly 10 lbs at full term! I started to freak out a little bit. I asked Dr. F if early induction would improve my chances of a vaginal delivery. We discussed it, but in the end, I decided against it. I focused on the fact that fetal weight estimates are often inaccurate and that other women have given birth vaginally to babies weighing in the double digits.

Just a few days before my due date Dr. F said that he would start to get concerned about the health of my baby if I did not deliver soon. He was concerned mostly about the health of the aging placenta, but also about the size of the baby. He recommended induction. I trusted his judgment and did not want to risk the health of my baby, so I agreed. The induction was scheduled for Saturday, two days after my due date. Dr. F and my doula both agreed that since my cervix was favorable, breaking my water would be the best way to induce labor and achieve the outcomes that I wanted so badly.

I did not go into labor on my own that week, despite several attempts at natural induction. On Friday, I left work a little early and my husband and I skipped our usual workout in favor of one last relaxing dinner out as a couple.

INDUCTION

I showed up at the hospital for my induction the next morning at 7:30am. Unfortunately, Dr. F had some sort of emergency and did not show up until 1:30pm! At that time he broke my water and I began to walk. I began to feel my first contractions around 5pm. I did not know it, but I had back labor. Fortunately, my doula knew just where to press on my back in order to relieve my pain. But soon the intensity of the pain outmatched the amount of relief she and my husband could provide.

I also began to feel nauseous. I threw up 3 times. It was probably due to the food I had eaten. I had had a bagel and milk for breakfast and some grapes and a granola bar during the day. The hospital staff advised me not to eat, but I did anyway. I don't regret it.

I got on the birth ball for a few hours. I was in a lot of pain. But I just relaxed my whole body and listened to myself breathe slowly and deeply. Then I moved to the bed. I knew that the bed wasn't the best place to be in order to keep my labor progressing, but it got to be too much work to balance myself on the birth ball.

As I lay there I wondered if I was in transition. I didn't think I could make it without an epidural it if the pain got much worse. I was afraid to ask if I was in transition for fear of finding out that I was not. Then my doula told me that she thought that I only had an hour left. That was when I knew I could do it. I could do anything for an hour. It turned out that it was more like 2 hours, but I had absolutely no concept of time, so I didn't know the difference.

Before I knew it, the nurse told me that it was time to push. At that point all of my pain had completely gone away and I felt great. I didn't even feel any contractions, so the nurse had to tell me when to push. I took my time and pushed about 80% as hard as I possibly could so that I wouldn't force anything. I closed my eyes and pretended like I was an Olympic weightlifter doing the deadlift, complete with sound effects!

My blood sugar had been pretty good throughout the day. I had asked to be allowed to check my own blood sugar and take my own insulin while I was in the hospital. Dr. F was cool with that and so were the hospital nurses, much to my surprise. However, I hadn't considered the possibility that there might be times when I would barely have the mental and physical capacity to do so. So there I was, in the middle of transition and then pushing, teaching the nurses how to use my blood glucose meter, lancet device, and insulin pens and calculating in my head how many units of insulin they should give me! It seems funny now.

BIRTH

After about an hour of pushing, the nurse told me that she needed me to hold my breath and push. There seemed to be some urgency in her voice. So I held my breath and pushed as hard as I could possibly push. I still felt absolutely no pain during pushing, even during crowning. At 2:16am on Easter Sunday, April 20, 2003, Corinne was born.

Apparently, there was some mild shoulder dystocia, and that was the reason for the urgency. Her heart rate was elevated initially, but it soon normalized on its own. Her apgars were 6 and then 9. Her blood sugars were very good at 120 and then 60, so she never required treatment for low blood sugar. And when they put her on the scale and she weighed 10 pounds 14 ounces!

Dr. F stitched up my 3rd degree tears. I had asked not to have an episiotomy. The only pain I felt was some slight discomfort sitting on the stitches over the next day or two. If I had had an episiotomy I always would have wondered if it was an unnecessary one. Yes, I know that's a little crazy given the fact that she was a nearly 11 pound baby!

LOOKING BACK

It was an awesome birth experience. Aside from being induced, everything went exactly how I wanted it to. I was on a total emotional high after delivery. I was so happy that I had done it. Things would have turned out so differently if I had not thought for myself and fought for what I believed in. I couldn't have done it without Dr. F and my doula. They are my heroes. And I am incredibly thankful that Corinne is healthy. I can't wait to do it again!

STATISTICS

Pregnancy
Length: 40 weeks and 3 days
Complications: type I diabetic for 18-19 years
HbA1c's: 5.7, 4.9, 4.8, 5.2, 5.5
Average blood sugar: 114
Highest blood sugar: 376
High blood sugars: 79 readings > 200, 15 readings > 250, 4 readings > 300

Birth
Interventions: induction
Complications: back labor, mild shoulder dystocia, macrosomia
Pain medication: none
Blood sugars before/during labor: 79, 164, 51, 78, 149, 62, 69, 80, 98, 172, 178

Baby
Weight: 10 pounds 14 ounces
Length: 22 inches
Apgars: 6 and 9
Blood sugars: 120 and 60

Diabetes and
Pregnancy:
What to
Expect
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