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Friday
May112012

The Miracle of Peanut Balls

So my dear friend Coza, an L&D RN as well as a previous client of mine, has become a fan of the peanut ball. When she initially told me about them, I was baffled, not having a clue what she was talking about. Boy, did I get an education!

A peanut ball (PB) is like a birth ball, but shaped like a peanut. It comes in a variety of sizes, just like birth balls and can be used like one… in fact, several doulas use it instead of birth balls since they are more stable with a woman sitting on them.

But sitting on the ball isn’t what Coza was raving about. It was that, in the hospital she works in, they have lowered the cesarean rate considerably. Apparently, the news is leaking out about PBs and I’m learning creative doulas have manufactured their own “peanut” for women to utilize during their labors, using pillows and even the bedside table!

So what do you do with this fantastic peanut and how does it lower cesarean rates?

When women have an epidural, they are confined to bed and are pretty immobile. As we know, the baby’s head likes to be jiggled around in order to get into the pelvis in the correct position to be born. When a woman is mobile, she and the baby “dance” to facilitate the optimal fetal positioning. In bed, not possible. The peanut, while not wiggling mom around or anything, can be placed between her legs in a way to open the pelvis so dramatically as to allow the baby to get into his or her best position to be born.

Coza said this yesterday:

“So a bit ago I posted a thingy about peanut balls for the epidural crowd. Let me just say that we at Holy Family (in WA State) are firm believers in the power if the peanut! We are seeing labors shortened right and left. Women who stall flying to complete when that ball is shoved between their legs! Babies not coming down that are suddenly 'oh please don't sneeze or your nurse is catching your baby.' We peanut balls!”

Last year, Jill, of Unnecesarean, wrote about PBs in “Peanut Balls and VBAC Bans,” highlighting Banner Health’s new commitment to the peanut in all of their Arizona hospitals. The article Jill quoted from the Arizona Republic (“’Peanut Ball’ reducing C-section rate” said:

“The results were compelling. Those who used the ball decreased the first stage of labor by nearly 90 minutes and the second stage by 23 minutes compared with a control group that did not use the ball.

“The real payoff came through lower C-section rates. The C-section rate for the group of women who used the ball was 13 percentage points less than for the group that did not use the peanut ball.”

I was sent to a study that was done on PBs – “Use of a Labor Ball to Decrease the Length of Labor in Patients Who Receive an Epidural” and the Conclusion was:

“The use of the PB during labor for patients with an epidural significantly reduced the length of labor without adverse neonatal outcomes.”

What birth junkie wouldn’t be thrilled with such a low-tech way to help women have shorter labors and avoid a cesarean?

But how do you work with this thing? Where is it placed? And how can someone without a peanut mimic the position?

I was sent to this video on YouTube, but still don’t find as much about positioning as I’d like. My nurse-friend Coza gave me a graphic example of how to utilize the PB. Let me summarize here:

If the woman is on her side (and of course the bed will be somewhat elevated since you don’t want her flat), you bend both knees and push the PB as deep into her crotch as possible. Each woman will be able to have it at different depths depending on her thighs, but as far as you can is where the PB goes. Then, so the PB does tilt or fall out, roll up a towel and prop the end that pokes out of the back side of the woman; you want the ball parallel to the floor.

If mom is sitting more upright on her back (semi-Fowler’s position), alternate each leg and put the PB under one knee, the middle part right under the knee. Coza says this mimics lunges. She doesn’t say how often to change legs, but I can see every 20-30 minutes being a good time frame to have each leg open. (It’s what we do when we flip a mom side to side with her leg lunging on the bed, so makes sense it would be similar.)

Coza also says if she has a mom that can move to the position, she has them on all fours, leaning over the ball and rocking back and forth. She said this is so much easier for moms than doing it with a ball.

As you all use them, please let me know how they work for you.

Peanut Balls for everyone!

Saturday
May052012

Midwives I Have Loved

On this International Day of the Midwife, I thought I’d spend a few minutes reflecting on the midwives who’ve made an impact on my life, both as a woman and as a birth worker.

First would have to be Mary Carol Akers, a Certified Nurse Midwife I’ve written about before. Over the years, I’ve heard from Mary Carol a couple of times and recently had a NetFriend attend a birth with her. I’ve heard she’s actively working on opening a birth center. How wonderful she’s still making an impact all these years later.

Mary Carol with Aimee, 2 days after her car birth. 

Mary Carol was my midwife as well as my partner Zack’s (when he was Sarah) back in 1985-1986. She was so loving towards us, non-judgmental and treated us as intelligent women when so many did not. Mary Carol was a midwife I could bring my natural birth questions to and she never rolled her eyes or was condescending towards me, but would answer honestly and truthfully, giving me more information instead of creating a wall of disdain.

I remember specifically telling her I didn’t want to be a CNM because I didn’t want to waste my time with nursing school, that I didn’t want to sit with geriatric patients, taking their vitals and listening to a hundred hearts that had nothing to do with listening to newborn hearts. She, in her calm and gentle style, said to me that in listening to a hundred geriatric hearts, I would learn what normal sounded like, that I would learn the variety of normal and that was extremely relevant to listening to newborns. She said when you’ve listened to a thousand hearts, when you hear The One that is out of synch, you know it immediately. Over the years, I’ve applied that piece of wisdom, acknowledging that if I’d have felt thousands of clavicles, it would have, indeed, helped me as a midwife to know what a normal clavicle felt like. While I didn’t miss any broken collar bones, I still understand that feeling more could only have added to my knowledge base. The skills learned in nursing school are not for naught; they augment a midwife’s education, both with book learning and skills training. Until Mary Carol, I thought nursing school was a waste for any midwife.

Another midwife whom I adore is Suzanne Paszkowski, CNM. Suzanne and I worked together at the now-closed Special Beginnings Birth Center in Orlando, Florida. She’s still there, no longer doing births, but is a women’s nurse practitioner for an OB/GYN office. When I knew her, she was active in midwifery and I loved when I was on-call with her.

Suzanne was one of the calmest midwives I ever met. Her gentle style was amazing, even in the face of dire emergencies. She’d gone to the University of Florida for her degree (and was a die-hard Gators fan!) and then to Grady Memorial in Atlanta for her hands-on training. She told amazing tales of her time at Grady, the women the midwives attended to that no CNM would ever be expected to take care of: women with HIV/AIDS, women with multiples, women beaten by their partners… the list went on and on. I remember sitting with rapt attention as she described midwifery in the trenches, a lesson I would never get as a Licensed Midwife (which wasn’t legal then anyway in Florida). I remember thinking that if she was able to do all that, she most certainly was fine with easy-going pregnancies and births. Wasn’t she ever bored after all that excitement? Not at all, she said. Watching Suzanne at births, her quiet demeanor settling everyone’s nerves and concerns, was a joy and a privilege. I could never than her enough for teaching me how to BE STILL at births. She was/is a wonderful teacher.

The third midwife who’s made a distinct impact on me is Jennie Joseph, also in Orlando. Jennie is the most famous of the midwives who’ve touched my life and rightly so. Jennie is the creator of the JJ Way® Model of Maternity Care and owns The Birth Place. In Jennie’s words, “The goal of The JJ Way® is to eliminate racial and class disparities in perinatal health and improve birth outcomes for all. Key objectives of The JJ Way® are for pregnancies to reach a gestation of 37 weeks or greater and for newborns to have a birth weight of 5 lbs. 8 oz or greater, for women (and their families) to bond well to their babies and to start and succeed at breastfeeding.” She works and speaks tirelessly to eliminate pre-term and low birth weight babies. Amazing work.

Jennie came from England with her midwifery knowledge learned there. When she arrived in Florida, licensing had been abolished decades earlier. But, Jennie joined the others in fighting to reinstate Licensed Midwifery in Florida and she became the first modern Licensed Midwife in the state. It was a thrilling day when she finally received that piece of paper!

These three women have forever changed me as a midwife and on this auspicious day, I publicly thank them all.

Thursday
May032012

The Ethics of Facebooking a Birth

I was directed to a CPM’s Midwifery Facebook Page where she was sharing an enormous amount of information about clients… that one was miscarrying, then she found the baby’s heartbeat… that one woman was having a long labor, how far she was dilated and then when she delivered, including the sex and weight of the baby. I discreetly (believe it or not) mentioned that she might not want to share that information without a Media Release and I offered the Release I use with my clients. 

A tiny bit of my own back story. I revealed some unflattering information in this blog about a client that I thought I’d hidden enough details about several years ago. She recognized herself and I hurt her and her family very much. I apologized profusely and still feel horrible about hurting her. After that, I created a Release and use it with clients. I was given verbal permission with some of the women you see and read about here in my blog and that is written in their charts. I know now that isn’t enough and have clients sign the Release instead. So, you see this is a major hot button issue for me. 

The midwife in question on Facebook first told me she didn’t say anything other midwives shared and I encouraged her to lead, not follow… and that they were also wrong. I then got this (verbatim): 

“Hmm. Maybe someone needs to clarify for us poor ignorant midwives what is and isn't acceptable to post. Because we are under the impression that as long as we are not posting identifying information, such as they're names, addresses, phone numbers, social security numbers that it is ok to tell some information. Like mentioning that someone with insulin resistant PCOS actually got pregnant and carried to full term without complications. No one has any clue who I am talking about other than my apprentice. This also serves as encouragement to other women with the condition that they do can do it." 

For the record, I did not call her ignorant, nor even imply it. 

When this topic comes up, as it does from time to time, always when a midwife or doula shares information about a client on Facebook or in her blog, the subject of a HIPAA violation invariably follows. So, here I discuss what my understanding of what HIPAA says and how it relates to midwives and their Internet disclosures of clients’ pregnancies, labors, births and postpartum periods. 

HIPAA stands for the Health Insurance Portability and Accountability Act (HIPAA) and it: 

“It establishes appropriate safeguards that health care providers and others must achieve to protect the privacy of health information.” 

“It holds violators accountable, with civil and criminal penalties that can be imposed if they violate patients’ privacy rights.” 

It empowers individuals to control certain uses and disclosures of their health information.” 

Below, I discuss the relevant definitions for care providers, including midwives. Doulas, not being Healthcare Providers, are exempt; more on this later. I know this can be boring as crap, but bear with me. This is important for all of us to know and understand as the Internet consumes more and more of our lives. Note that the emphasis is mine. 

There is one definition that causes pause and that’s for what a Healthcare Provider is: 

“Every health care provider, regardless of size, who electronically transmits health information in connection with certain transactions, is a covered entity. These transactions include claims, benefit eligibility inquiries, referral authorization requests, or other transactions for which HHS has established standards under the HIPAA Transactions Rule. Using electronic technology, such as email, does not mean a health care provider is a covered entity; the transmission must be in connection with a standard transaction. The Privacy Rule covers a health care provider whether it electronically transmits these transactions directly or uses a billing service or other third party to do so on its behalf. Health care providers include all “providers of services” (e.g., institutional providers such as hospitals) and “providers of medical or health services” (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for health care.” 

I’ve read this as Internet discussions of clients do not qualify as HIPAA non-compliance. I wish I could find something that specifically addresses Internet conversations, but haven’t found that yet. 

However, I am not a HIPAA expert so perhaps we should assume HIPAA rules our transmissions and use them as our ethical responsibility. 

That’s a huge ASSUME, though, isn’t it. 

Let me continue for a second, with the assumption that we are, indeed, covered by HIPAA regulations. 

Protected Health Information. The Privacy Rule protects all ‘individually identifiable health information’ held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information ‘protected health information (PHI).’ 

“’Individually identifiable health information’ is information, including demographic data, that relates to: 

the individual’s past, present or future physical or mental health or condition,

the provision of health care to the individual, or

•the past, present, or future payment for the provision of health care to the individual,

and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.  Individually identifiable health information includes (my addition: but NOT limited to) many common identifiers (e.g., name, address, birth date, Social Security Number). 

I say “NOT limited to” because the midwifery community, especially the homebirth community, is so small that almost any information given out will be easily known by others, doulas and midwives. Probably even other mothers. 

“De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information. De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.” 

The homebirth midwifery community is too small to be able to share even the most basic information about clients online. If the mom has shared even one part of her unique story with someone else, that someone else can identify the woman in question. 

Example: 

Pregnant woman’s membranes ruptured with no contractions and was given Pitocin at 20 hours post-rupture.

Even that small amount of information might identify more than one woman, but in a homebirth community, it’s unlikely to lead to more than one person. And, the person that matters the most about who recognizes the woman is the woman herself. If she reads the midwife’s Facebook Page or blog, she will, undoubtedly, recognize herself. How fair is that? 

For those that have followed births on my Facebook Page who are now wondering if I broke these rules myself, the answer is not at all. Some women love the updates of their labors and births, being able to see the timeline when they have a minute to read postpartum. Even following my daughter’s labor and birth on Facebook was done with permission. Blessedly, my kids are comfortable with their mother’s outgoing writing. 

So what if HIPAA doesn’t cover the privacy of clients on the Internet, should there be an ethical responsibility to them? Absolutely. And this is where the doulas come in, too. I believe there should be peer pressure to keep our clients’ private lives private. If we can’t have legal rules about the issue, there should at least be moral rules. I hope others will join me in helping to protect women’s pregnancies, labors, births and postpartum times. I really hope midwives and doulas can get permission to tell the great birth stories! I love watching birth unfold as much as the next gal. Below is my Media Release for anyone to use if you want. Try and get both parents to sign. I believe more communication with clients is always a good thing.

Media Release 

I hereby give my permission for Barbara E. Herrera, LM, CPM to:

(please circle acceptable choices) 

______ Take photos of my pregnancy, birth and postpartum period. 

______ Photos may/may not show nudity – breasts – the actual birth with vulva pictures. 

______ May/May not use my name when using my photos or speaking/writing about my pregnancy, birth, postpartum, breastfeeding or family experience. (She has explained she typically does not use names.) 

______ May/May not use the photos on the following social networking sites: www.NavelgazingMidwife.com (Midwifery website), www.NavelgazingMidwife.squarespace.com (Blog), Facebook, www.YouTube.com, etc. If new technology is created, she will ask specific requests regarding using the photos there. 

______ May/May not submit photos of me, my baby or my family to magazines and media. No photo of the baby will include genitals (inclusive of entire Media Release). I will receive no compensation if the photos are published, but Barb will give our family a copy of the periodical in which the photo appears. Magazines might be hard copy or on the Internet. 

______ May/May not use photos of me, my birth, my baby or my family during conference presentations, midwifery texts and books. 

______ If any opportunity to use the photos arise that are not covered here, Barb will ask specific permission and add it to this Release. 

______ To speak about/Not speak about my pregnancy, labor, birth, postpartum, breastfeeding, parenting on any social networking site, periodical, public speaking engagements, book or midwifery text. If future technology is created, she agrees to ask additional permission to include it. She agrees to use professional discretion and we understand her primary reason for sharing is educational and not voyeuristic. She agrees, if I ask, to disclose where she has discussed me, my pregnancy, labor, birth, postpartum, breastfeeding, parenting and marital situations. 

______ To write about/Not write about my pregnancy, labor, birth, postpartum, breastfeeding, parenting on any social networking site, periodical, public speaking engagements, book or midwifery text. If future technology is created, she agrees to ask additional permission to include it. She agrees to use professional discretion and we understand her primary reason for sharing is educational and not voyeuristic. She agrees, if I ask, to disclose where she has discussed me, my pregnancy, labor, birth, postpartum, breastfeeding, parenting and marital situations. 

While I may make changes in the future to this Media Release, the changes will not be retroactive, but will be from the date of changes forward. 

Barb will keep a copy of this Release in my midwifery chart or, if I am not a midwifery client, in a separate chart specifically for Releases. She will scan the Release and email me the copy. 

I have considered these options and have discussed them with my partner/another important person in my life and understand the importance of full informed consent – and give it here.

Thursday
May032012

Labor Taking Longer Today

It’s been all over the news, “Babies Take Longer to Come Out Than They Did in Grandma’s Day,” the National Institute of Health’s study (“NIH study finds women spend longer in labor now than 50 years ago”) that looked at birth practices in the early 1960’s and compared it to those in the early 2000’s… a 50 year spread. Among the findings are that labor in the (1960’s) historical group was 2.6 hours shorter in first-time moms than the (2000’s) contemporary group. Subsequent labors were 2 hours shorter in the 1960’s group.

The quick run-down is women are older when they’re having their babies, episiotomies are done far less frequently, forceps are also done less frequently and that cesareans are utilized 4 times as often as the historical group… from 3% to 12%.

Wait a minute. A 12% cesarean rate in the early 2000’s? Where in the world would that have been? I cannot fathom that is here in the United States. Jill from Unnecesarean will know for sure, but wasn’t it about 30% back then? What does that make it… 10 times the number of cesareans as in the 1960’s? And today… we’re at 40% - 50% in plenty of places, making the percentage between the two cohorts even larger.

The study minimally looked at why the labors would be longer, including epidurals, but oxytocin was used much more in the contemporary group, one would think making up for the lost time with the epidural, but that didn’t happen.

So why have labors slowed down? I have my own theories.

Women go to the hospital a lot sooner than they used to. If women presented under 4cm in the olden days, they were sent back home and told to come back later. Now, if a woman’s having even prodromal (not changing the cervix) contractions, it’s more likely she will be kept than sent home. I’m sure liability is the major reason why this happens. If something happened to the baby in the interim between presenting at L&D and then finally being admitted many hours later, the hospital would be in serious trouble for sending the mom home. In fact, that happened in the UK with a mom (looking for the link).

When I first started attending births in 1983, women who went to the hospital and were found to be 3-4 centimeters, were sent out walking for two to three hours before they were checked again. If there were changes, then they were admitted. If there weren’t changes, they were sent home. That pattern was followed until the early 90’s (in my experience). That was when women started being admitted sooner and sooner, even if it was obvious their labors had barely begun. Now, if a woman is sent out walking, she wants to know why she isn’t admitted, somehow thinking if she’s in the hospital, things will move faster.

Is that why Pitocin is used so often, too? Maternal expectations? I wouldn’t doubt if it had a hand in the escalating use of the artificial hormone.

It can be frustrating for doulas who know their clients aren’t in active labor, yet the client wants them by their sides. That can make for an enormously long time with a woman, tiring her (the doula) out long before she would really be needed in labor. I’ve seen this time and time again. I’ve taken to saying, “Once you’re in active labor I will remain with you continually” and that has virtually eliminated the marathon labor sitting and giving the mom room to be self-soothing. Of course, I am always available to chat/text/talk and even visit, but being with a mom from prodromal labor on is ridiculous.

So, what isn’t explained in all the articles is the definition of what “labor” includes… what’s the dilation at admittance? Has there been spontaneous rupture of membranes? Was there artificial rupture of membranes on admission? And probably the largest question: What is the dilation that’s considered active? 3? 4? 6 (which is the newest definition… one that I adore!)? For many years, 1-3cm was early labor, 4-6, active and 7-10 transition. If that was standardized between the comparison groups, it would make the gathered information more relevant.

I’d love to hear from long-time L&D nurses, why they felt labors are longer now. Just like the study, I don’t know the exact reasons, but I think those of us in birth have a pretty good idea why. Women haven’t changed, but maternity care sure has.

Thursday
May032012

Cesarean Scar: Mandy's Story

Reading these stories has helped me. And so I share mine, in hopes that good will come from something that has hurt me deeply.
 
I always wanted to be a mother. I pictured myself loving every minute of pregnancy, and the joy and memories that bringing my children into the world would create. I didn't expect infertility. But I am glad God allowed it, because it taught me patience, and it taught me the priceless blessing of a life. I didn't expect pregnancy to be so hard on me. My body is not the same as it was 4 babies ago. But I am glad God allowed it, because I have learned to appreciate the value of working hard to take care of myself and eat right, and to do what's right for my body whether it responds or not.
 
I didn't expect for each one of my birth experiences to be so troublesome and uncertain. Preeclampsia with my two girls, two boys that were bigger than my body seems to tolerate, a uterus that somehow ensured each one of them would be posterior and cock-eyed, and a body that can't seem to get itself in labor for anything. I managed to push the first three out after an entire day of laboring. My third and fourth epidurals worked only for a short time, then they gave out. I am still glad God allowed it, because I learned that even when the worst happens to me, He is there to get me through.
 
I didn't expect to have to have my fourth baby cut from me. But he was over 10 pounds, and his head was turned wrong, and without the epidural my strength eventually gave out and his heartrate became erratic. I cried all the way to the operating room. I had a doctor I didn't trust who was abrasive and pushy, and now his mark is on my abdomen for life.
 
From such a big baby, I have a huge fold of skin that drapes over my scar. Some here have said that they are glad it hides the scar. To me, it draws attention to it. And it peeks out from every piece of clothing I have tried. My scar taunts me. It says I failed to bring my son into the world correctly. It says that he is healthy and beautiful and precious. The trade off was this horrible, ugly, sagging skin covered in stretch marks. This off centered, numb scar that hurts or itches from time to time even now when it has been almost a year. The knowledge that inside I have a cervical tear that I'm told means I can never even try to give birth naturally again.
 
This is the hardest one to be thankful for. But I'm glad God allowed it. If for no other reason than for the reminder that His love is sure even when I become less than I was.
 
When I look at my scar it says "I will always be with you, so you might as well accept me and learn from me, and comfort others who have me too."
 
When I touch my scar it says "Don't touch, I'm too unnatural and sensitive. Don't bother to shave here, it's going to be ugly either way. And don't let anyone see me. Not even your loving husband. Be ashamed of me."
 
But it can never make me be ashamed of the four beautiful children that have become my world. No regrets.
 

front view of c section scar, over 11 months postpartum

 side view of the large flap of skin covering the scar 
 

other side of the flap

the actual scar itself when the skin is lifted
Thursday
May032012

Cesarean Scar: Ashley E.

I had a Caesarean birth in May of 2009. . . since that day all I do is hope and pray that one day I will get give birth the way I always want to. Intervention free. (HOMEBIRTH!)

Every time I look in the mirror at myself and can see the scar I am reminded of that day I "gave birth" to my son. I love him no less, but I will never feel the closure needed to get over it. I recognize that it is a nice scar. It isn't all evil and scary looking. It healed nicely and is fairly straight. It does not completely disrupt my flow, but the mental notes attached to it are overwhelming. I remember the feeling of not having any control while in labor and now I have a scar to prove it. It makes me angry. I wish it weren't there. It's my battle wound.

I barely stand the thought of being touched on or around the scar. It is terribly uncomfortable. Some parts around the scar are completely numb. Severed nerves. Makes me sick.

It's unfortunate that I feel so badly about the way I "gave birth". . . it is what it is, I guess.

Thursday
May032012

Cesarean Scar: Jamie

My birth story is a story is not the way I had planned. I was asleep in bed when my water broke, Jan. 26, 2009. While cupping myself, I ran to the bathroom and sat on the toilet. I called my mom shaking like a leaf. I woke up my Don, my husband and he flew out of bed (just went to sleep like an hour before). I called the doc and they returned my call and told me to stay at home till the contractions got closer together. She asked me if I was feeling the baby move around and I was not. She said to eat something and try to get the baby moving. I didn't feel her move so I called back and they told me to go to the hospital.

I got to the hospital and they wanted to actually make sure my water broke because I had no pain. I had to wear a thick pad and walk the halls. My husband had me laughing and water was just gushing out. About an hour later, I had to show the pad, which was drenched and bloody. Then a resident wanted to check me. She took a sample of the fluid and came back and told me that my water didn't break. I told her yeah cause of the gushes I was having. She wanted to check me again, she was between my legs and told me to push. I pushed so hard and sprayed all over her! HA. THEN, she comes back and tells me that my water STILL hasn't broken!! WTCrap! They admitted me anyway. I didn't even have all my stuff cause I figured they would send me home. 

I walked the halls…..walk….walk….walk & walk and NOTHING!! I sat on a ball, nothing! Was having very mild contractions but no biggie. I even said "if this is what contractions are, I can do this NO PROBLEM", then I said "I know I will eat my words later"!

They gave me a Cervidil. Contractions were coming more frequently still, the pain wasn't that bad. I was told the next morning that I would be induced. The rest of the night, I had little to no sleep. The contractions kept me awake. 

Jan. 27th, they gave me the evil drug pitocin and was on my way! Boy, did I eat my words! I was dilating SOOOOO SLOOOW and was in SO MUCH PAIN!! I was given Stadol. Just took the edge off, still felt the contractions. They kept checking me and wasn't really dilating!! GRRRR!!! I was doing good with the contractions, THANKS to my mom!! She and I had eye contact and she was breathing with me. She was my focal point and what we were doing was definately working!! My midwife told me when I get to 4 cm, I can get a epidural (YEY) hours passed and I was checked, I was 4!! YEY well, so I thought, she wouldn't let me have one. WHAT?????

I begged for a c-section! She was like "no, you can do this". I begged for anything! I got NOTHING! One nurse was horribly rude to say the least. I looked at her and said "it just hurts so bad", her reply "what did you think was going to happen???", WHAT???? GRRRRR!!!

Hours and hours passed, I was checked, I was 5 (YES, only 5) FINALLY, they gave me my epidural! The BEST invention EVER!! Hours and hours passed again, they checked, I was FINALLY ready to push. I pushed, pushed, pushed for 2 and 1/2 hours, no baby. They told me I was going for a c-section, BUT they never turned off the pitocin. My mom freaked out, my sister called the hospital and screamed at the nurses. It was shut off then I was off to the OR for a c-section. 

While laying there, I was cold and SOOOOOO scared! I was shaking uncontrollably. They were ready to start. My arms were not belted down like I'd seen on TV and they kept shaking off the table. I kept asking for my husband and finally he was there by me. I felt them cut me. I told them, they said "we didn't tell you that you wouldn't feel anything", WHAT?????

So, Leah was born Jan. 28th. First word out of the doc's mouth was, "WOW, she is a big girl!". They showed her face over the drape and went to clean her up. I told Don to go take pics. On the way back he said he saw all my innards! (ha-ha) They weighed her right in front of us as I was being sewed and stapled shut. 9lbs, 13.5ozs, WOW she was way bigger than I thought! Was bigger than what all the docs thought also. I just couldn't get her out! TOO BIG!! BUT I had a BEAUTIFUL baby girl. 

The rest of my visit was horrible. I didn't get to shower till the next day. Don actually washed my body while I stood there in horrible, awful pain! I ended up staying at the hospital for 4 days after giving birth. My aunt worked at he hospital as a lactation consultant, which was great. She tried to get Leah to latch, wasn't having it. I had to pump then bottle feed her. I told my aunt my birth story and told them that I had a horrible experience and that I will never give birth in the hospital (thanks to the nurses) and never have the same docs again! She brought in the head of the hospital to talk to me. She wanted the names of the nurses (I had other rude nurses, and I couldn't remember their names!) and to write a letter to the hospital. I never did. But I will never have a baby there again!! Horrible hospital! 

A week later (yes, a week later) they wanted to take my staples out. Few days later, was at the ER. I had an infection that luckily, I caught early. The staples were taken out to early, but I didn't know. Horrible doc!! 

So, even though I had a horrible hospital issue, what my scar says when I look at it is "even though you didn't have a vaginal birth, its amazing that your body carried a baby for 9 months and still gave birth to a healthy happy baby. It doesn't matter how she was brought into this world, she is here." 

What my scar says when I touch it is "we brought Leah into this world together. You didn't give up, I am here cause you needed other assistance bringing her into the world".

I have no bitter feelings toward the scar. I rarely touch it though. It is hard, bumped out and numb. Sometimes it burns or feels like it's being ripped open. I am ok with it. It's a part of me. I think it as a gift from my daughter that I will have forever. I would do everything all over again… well, almost everything.

 

21 months post-cesarean

Thursday
May032012

Cesarean Scar: 3 Babies; 3 Scars

My first cs is the lower of the scars. Pit induction at 37 weeks for one bp of 160/90 or so, labs were fine though. First baby, didn't know any better, just wanted to be a good patient. I'm sure she was catywhompus anyway.

Ah, scar number two, hbac attempt to icky not fun cs. Of my scars this is the one that makes me saddest. Always thinking if I had done this or that different maybe I wouldn't have said scar, I was thiiiiiiis close....

Because of my muscles being cut into twice before and ultra loose hip joints I was in constant pain with preg number three. I was told that I risked perm hip damage if I tried to pass a kid through there, so cs there was planned, I still have days where I think I should have tried though.

I have no feeling in my lower left quadrant from my cs, I have def probs with my hips in the winter and have pt I do to try to strengthen the damaged muscles to help hold them together.

Thursday
May032012

Cesarean Scar: My Scars Are Loved

My scars are loved. It's where my beautiful children entered this world.
Love.

I had a sketchy troublesome first pregnancy, almost lost my Baby at 24 weeks. Bed rest. Lost what little confidence I had in my body/birth. I had an elective c section. My Doctor did try to talk me out of it, he was against the idea. Ultimately it is my body, my choice.

With my Second I had another elective c section. I feel if I knew that I could have successful natural births, I would have. But I had no faith in my body or birthing, and I wanted control.

I was glad that my water broke the morning of my first C section. I knew Baby was ready. I do wonder how it would have gone if I birthed naturally that morning.
Thursday
May032012

Cesarean Scar: Joy

What do my scars say?

Scar 1

Heartbreak.  Disconnect.  Confusion.  Anger.  Pain.
Bumpy.  Red.  Sore.  Knotted.  Angry.
Out of place.
Unsupported.
Groggy.
Distanced from my baby.  Ignored.  Left out.

VBAC

Determined.  Focused.  Natural.  My terms.  Unafraid.
Intense.  Overwhelming.  An experience.
Attempted.
I carried to the operating room the benefits of the labor experience.
I carried to the operating room the peace that I had tried and that this time it was MY decision.
Old scar cut away from me, in so many ways.

Scar 2

Less bumpy.  Less raw.  Calmer.  Less Angry.
Disappointed.
More connected.
Joyful.
Supported.  United with my child.  Skin to skin, nursing.
My child never leaving my side.
Respected.

The difference?  Education.  Preparation.  Prayer.  Support.  Advocacy.  Bravery.
 

Thursday
May032012

Cesarean Scar: Heather A.

My son's birth (extraction) story is too long, and probably too graphic to have on the site, so I'll give you links to it and let you decide if you want to link it there (I wouldn't post it outright... WAY too long!).
 
My first son, Jericho, died of a fatal abnormality called Classic Potter's Syndrome. There is no cure or treatment, he was born without kidneys and the cells which make them never developed. He died peacefully, without tubes and wires, in his father's arms. 50% of babies affected with it are stillborn, and the rest pass within hours of birth, mothers carrying babies afflicted do not carry beyond 35 weeks. While my son lived about an hour... I never got to see him alive due to medical mismanagement of my unnecessary cesarean. I fought, but not hard enough, and he was taken from me while I lay unconscious on a cold slab. I was so disconnected from the experience that it took over a year for the grief to truly hit. He was 34 weeks to the day when he arrived. A little early, but chubby and a head full of long black hair.
 
The doctor and nurses that tended to me that night were very unkind, and when I received his handprints the following day it was clear they hadn't even tried to give me something clear. They didn't even bother to unfold his fingers, even inking the top of his knuckles instead. It was pathetic. What I got was partial, smudged and barely classifies as a set of prints. It was devastating.
 
When I was pregnant with him he favoured one side; he always sat there, bum down, pushing against this one spot on my inner hip. I know now that it was his hand that I was feeling. None of my other babies have favoured a spot quite like he did.
When he was taken from my body the only mark that was left behind was an ugly scar. Every time I looked at it I felt angry and depressed: I didn't remember my surgery, I didn't remember his last kicks, his last breath, or see his face while he was still alive. I was angry that it was all I had, and I hated to see it. I still hate it. I wished he'd left something real, like stretch marks, or even padding from the extra weight... instead the surgeons carved me bare and replaced his memory with their disgusting sense of vanity. I desperately wanted something of his to be left on my body; something other than a scar from a surgery that I didn't have any part of, didn't want, and didn't need.
I decided I wanted a tattoo of his handprint in his favourite place. Unfortunately, because the prints were so mangled it took me years of canvasing tattoo artists to find one talented enough to say they would attempt to reconstruct it. Everyone I asked said they couldn't draw the details of a print and at best it would look like a "paint blob" with no definition or individuality... just a generic baby hand.
I finally made the appointment a few weeks ago when I found someone special. The artist I chose took his partial set of prints, and a template that my best friend had provided from her newborn daughter (she was one of the only people present at his birth and death, so having her involved is special to me) and reconstructed his hand using tracings, one little curve at a time. She painstakingly kept all his palm lines in tact (the only part of his prints that was preserved!) and made such a perfect reproduction that it really does look like he pressed his hand into ink and touched me.
 
Now when I look at my stomach, the scar doesn't look quite as bad... It's still horrible to see, and hard to imagine it's really there, but at least now there is a part of my son there too. This is his place, and he has finally made his mark.
 
The first photo, the smaller and uncensored black and white, is one I took less than a month following the surgery: I was trying to show how the scar made me feel.
The second is from the day after I received my tattoo. The scar looks exactly the same as it did almost 5 years ago... but it feels different today.

 

Thursday
May032012

Cesarean Scar: Faye

I've been pregnant now three times, I have an 18 year old, a 17 month old and one on the way in December.

My first Csection was horrible, after being in labor for ten hours the doctor decided that I could not have my son vaginally and being as young as I was I didn't fight it. So I was whisked away to the OR to have my son.

Sixteen years eight months later I delivered my second son via C section, I couldn't find a doctor in my area that would do a VBAC or at least let me try. So there I was again with yet another major surgery. Today I'm with the same doctor because again there are no doctors in my area that will even consider a VBAC for me.

C sections are painful, scarring, humiliating, and sometimes unnecessary. My stomach now has the "Mother's Apron" that fold at the bottom, which will never ever go away.

Good thing is I have two beautiful healthy boys and a daughter on the way.

Thursday
May032012

Cesarean Scar: Kate

My scar is a source of physical pain and emotional torment, it is lumpy and the skin is all in the wrong place.  The rest of my tummy is flat and taught, but the scar has a saggy bit of fat which does not go.
 
I hate my scar, every time I see it it reminds me of the day I was stripped of my rights as a human and physically forced into surgery I didn't want and didn't need...  Worse than that, it reminds me every 
day that in a following pregnancy I had placenta percreta, nearly lost my uterus, nearly lost my baby and nearly lost my life, all because I had a previous section for failure to let nature do its work and the placenta stuck to that scar inside me.  Before that I had three miscarriages, at 6, 10 and 17 weeks.

Even my blissful home birth between the sections does not dull the fear and pain.  My body and my mind are scarred, my children deprived of their mother for the hours they were cared for by a system which does not much care, deprived of that human touch, taught that the world is cruel and they can be abandoned when they need the most support. 

This is my scar, which is considered 'healed well' according to my notes ...  The first is lying down, the second standing. At 8 months old it is probably as healed as it will get, but it is a source of constant pain and irritation, never mind the aesthetic issues.  The two scars are evident and there is considerable tethering of the scar to the underlying tissue and a gap in the fat layer.  The scar is also about 3cm above my pubic bone, and actually was much higher than that when the skin was stretched during pregnancy...  The first section was unplanned but not emergency, so it is not as though there was no time for preparation or to be careful about the position. This is apparently a 'good scar' according to the obstetrician who did it, although I'm not sure how much experience he has of scars well after the event.  I am waiting for a second appointment with a reconstructive surgeon to repair the tethering which is causing pain now I've seen the obs. team to rule out any internal damage.

Wednesday
May022012

Cesarean Scar: VBA3C

Danielle Arnold McKenny would love to share her Victory: VBA3C story. Read and cheer with her!

Wednesday
May022012

Cesarean Scar: Amelia

Wednesday
May022012

Cesarean Scar: Kay

My first cesarean scar would have a different story- a sad, traumatizing tale resulting in months of awful postpartum depression and over a year of blaming myself for my first sons “unnecesarean”.  But this is a  story of my second scar! 

When I look at this scar, it says to me “Hey mama, you ROCK!”  After a horrible birth experience with my first son, resulting in a c-section, I had no doubt when I found out baby number two was on his way that I wanted a VBAC!  I had my midwives and a Doula, and my awesome husband for support.  When labour arrived, I was so excited and so ready!  I was not expecting a repeat of my first sons birth- so when the same things started happening the second time around- I was determined to do everything I could to make sure this baby had a chance to come out vaginally!  I got to 10 centimeters...I pushed for hours but my baby kept pulling out of my pelvis.  I danced, squatted, did lunges…pleaded with my unborn son, please come out baby, please!   Watching my belly…seeing his little butt snuggle his way into my ribs…just like his brother had done 22 months prior…I felt peaceful.  My baby wasn’t going to come out the way nature had intended.  He just didn’t fit.  My first son just didn’t fit- IT WASN’T MY FAULT.  My first sons entire life, I blamed myself for  his traumatic birth thinking things like “I didn’t try hard enough”, “It’s because I got the epidural” “I didn’t give him the best chance to position himself correctly” and now…my second baby who definitely had the “best chance to position himself correctly” wasn’t coming out either!  I leaned back in my bed and told my midwives “I’d like to have a c-section please!”  Peace washed over me.   My son was born shortly after…it truly was a very empowering experience!!    

When I touch my scar, it reminds me that I *am* a strong woman.   I grow beautiful babies!  Baby #3 is due in 5 months and I am so excited to meet him!  Even if our first meeting is in the Operating Room! 

Wednesday
May022012

Cesarean Scar: UK Reader

Dear Barbara, 

Thank you for your site, it gives me the power to share my story, and it even made me cry; the sad stories of the mother who werent as lucky as me and lost their babies. My heart goes out to them. 

I will try and be as articulate/concise as possible... 

MY Scar 

It is almost five years to the day that my scar decided to become part of me. I refer to it like a stranger, as i can still remember the time of navel gazing youth when i would look down to see smooth milky skin, and a flat tummy. 

I did not expect to have a C-section, and i wasted an inordinate amount of time planning how to deal with natural birth; the breathing, the positions, the gadgets, every possibility covered except one... 

I think i read all but two paragraphs on the way i actually gave birth, before having that slightly scary chat with my lovely surgeon a little after midnight. The surgery was i guess as good as it gets ( i don't really have a comparison)  the way i describe the feeling is; you (i.e. the patient) is like a handbag, and the surgeon is like the person trying to find their keys inside that bag. 

Anyway, I got through it with the help of partner and family, and low and behold there was a little baby boy hiding inside me! He is now a fully formed personality worth every single millimetre of my rather dramaticly red scar. 

I went for a check up the other day, and the doctor i saw was rather surprised at the redness/angriness of my 5 yr old scar. My feelings are mixed; partly worried it will make me less attractive to those i wish to seduce, but also partly proud, like a war wound, I suffered but i overcame it; a winner in the end. 

Looking at other peoples' scars they are all different, but they are definately not signs of failure. They are signs of how strong women can be, and what lengths of love & battle they will go to for their children. Thank you all for sharing.

Wednesday
May022012

Cesarean Scar: Peggy

My son was born November 21, 2009. After 12 hours of labor and progressing to 6 1/2 centimeters, my OB told me the baby had not budged an inch! She'd checked me numerous times over the course of the labor and he was still as high up in my belly as he had been a month prior to my water breaking. I like to think he was just 'comfy'. She told me if it were up to her, she'd do a C-section. She said she'd done lots of natural deliveries that she regretted, but never a C-section that she'd regretted. That sealed the deal for me. The only things holding me back from being completely on board the Cesarean train were my own fears of having surgery.  I was being selfish. After thinking about it for an hour or so, I told the doc to go ahead. If it was best for the baby, then who was I to complain. Before I knew it, I was in the OR... and then the recovery room... and I was holding my 8 pound little pumpkin. He was perfect. My recovery from the C-section was smooth but painful, as to be expected. I made midnight calls to the "on-call" emergency OB twice in the couple weeks following the delivery and both times, I was pretty certain that I was dying.- And of course I was told that the symptoms I was having were in fact normal. They were right. When I went to the OB for my 6 week post partum check up, my body had healed nicely and my son is almost 2 years old now and my scar has all but vanished. I'm currently pregnant with my second little boy and will be having a repeat C in 3 1/2 weeks. I'm nervous but excited. I have faith in my doctor and I know that she will take the absolute best care of me. My second incision may leave a scar more permanent than the first, but I don't mind. I'll wear it with pride. Bring it on!

Wednesday
May022012

Cesarean Scar: Payton's Mom

When I touch my scar I hate it. I wish I could have had a "normal" delivery. You see I didn't conceptualize a delivery other than a normal one. Like many others, my sister, and mother had normal deliveries, so I thought I would too. I did not know 1 in 3 have C-sections, and I did not know my baby was big. My OB never mentioned it.

I labored for many hours. She wouldn’t drop into the canal. The nurses said I would have to go by cesarean, I was horrified. I cried. I didn’t agree to it. For many hours maybe three or four I continued to push. The nurses tried to tell me it was ok. One even showed me her scar and said see it’s not that bad. She was skinny and not built like me. I am 5’1” and 145lbs regular. Not bad, but never skinny. I knew I would never be that lucky. It hurt so badly I finally agreed. She was 10lbs 3oz.

I like most moms of C-sections have the dreaded flap. I feel as if I was robbed of my normal body. I never get to go back to how I was before being a mom. I am embarrassed when my husband sees me nude, and I try to hide the misshapenness of my midsection with any number of clothing articles. I still get emotional over it. It was almost 5 years ago. I think the shock of having a C-section is the emotion that doesn’t fade.

The scar has begun to fade, and it’s easier to explain to my four year old little girl how she was born because I can just show her the scar, but I still long for the feeling of a natural birth. I still wish I had been emotionally prepared for the possibility of a C-section. I can list a hundred things I wish I could change about my L&D process. I still don’t now fully how I feel about it. I think it will be a process, much like a living organism, that is always in a dynamic state.

I want another child, and don’t know which method I will try to have him or her. I guess that’s between me and GOD.

Tuesday
May012012

"Big, Healthy Babies"

The headline read: “Record Breaking Baby Born at Paoli Hospital” and then the abbreviated story of one mom’s birth of her extra-large child unfolded.

“Six-day-old Blake Alexander Ciarlone is the new biggest baby born at Paoli Hospital, according to available records dating back to 2002.

“Born to Allison and Daniel Ciarlone, he was 12 pounds nine ounces, beating the previous record, set last year, by two ounces.

“Blake is Allison and Daniel’s second child and follows the trend set by his 2-year-old brother, Landon James Matthew Ciarlone, who was born at 10 pounds 13 ounces. Both births were planned Cesarean sections because Allison was getting too big. Blake was born four days early, and his brother Landon was born two weeks early.”

I posted the story on my Navelgazing Midwife Facebook Page and surely made some comment or another about the mom having Gestational Diabetes. Often when these articles come out, there is a disclaimer inside the piece stating, “Gestational Diabetes can cause babies to be this large, but <mom’s last name> did not.” Or, “Baby Ciarlone was born healthy.” In this article, we get a hint about mom’s diet during the pregnancy, unusual in these stories.

Both were pretty normal pregnancies, said Allison. She ate what she wanted, but it wasn’t anything excessive…. ‘I guess I just carry big babies,’ she said.”

Does she?

Here unfolds the discussion and I’ll answer the questions directed at me as we go along even though it becomes clear I didn’t answer during the discussion. These interjections will be in italics.

JT: Is it just me or are these stories getting more and more common?

KBH: They are! I have seen so many news articles and stories of babies 10lb+ lately who are obviously macrosomic, etc. and it's driving me nuts! Every single one, mom is "I guess I just make them big." Really, really wish people would wake up and realize that this is an issue!

CG: "big healthy baby" /sigh. Big doesn't mean healthy.

TWJ: But big doesn't necessarily mean unhealthy either. Just a thought.

SS-R: There's a difference between a "big, healthy baby" and a "macrosomic baby". Unfortunately, most news stories don't differentiate. I've seen a 10lb+ baby that was lean, stocky and long. Both parents were tall and stocky, with mom hovering around six feet tall and dad towering over her. Baby had great APGARS and perfect blood sugar. THAT is NOT the typical "biggest baby born" you see cropping up in the news.

HH: "Since she was measuring about 40 inches around (t)he waist at 36 weeks, her doctor “didn’t want to take any chances,” said Allison."

I am confused… I was almost 60 inches with my last. What's the big deal. (This was referring to: “Since she was measuring about 40 inches around he waist at 36 weeks, her doctor ‘didn’t want to take any chances,’ said Allison. They planned the cesarean section and were expecting another 10 pound baby, but were surprised by the extra two pounds.”)

Also, not to be rude, but she is a plus size momma. 40 inches isn't that big of a waist. Was she a size 5 before the pregnancy or something?

I can testify... I make big babies. My last was 9'13. I only gained 35 lbs and NO GD. Big can be healthy.

I wonder how much weight she gained.

NgM: It’s important to know that diet is not the only way to control GDM or IR. Sometimes it takes medications as well. I’ve known women to be meticulous with their diets and still have 10+ pound macrosomic babies because their pancreas needed more help than just the dietary changes. The diet certainly helps in these cases… imagine how large the babies would be without that help from mom… but the baby sometimes needs more help than even mom can offer.

KL-D: Is there any indication that this baby wasn't healthy?

NgM: A baby that big is, most assuredly, not healthy. ‎HH: There can be Insulin Resistance long before GDM and IR affects the size of babies, too. The GTT is an archaic screen/test, the best we have at the moment, but it doesn't catch all cases of IR (the lower limits catch some, however). ‎HH: They meant fundal height, not waist measurement.

TS: So, stupid question maybe for NGM-- if a mom is diagnosed with GDM or insulin resistance and is untreated aside from changing one's diet, is it possible to have a normal-sized baby?

NgM: No question is stupid! However, I’m not sure I understand this one totally. Let me try, though. If mom IS diagnosed with IR or GDM and changes her diet, is it possible to have a normal-weighted baby? Absolutely. If mom is diagnosed with IR or GDM and changes her diet, is it possible she might still have an LGA or macrosomic baby? Absolutely, because of the possibility of the pancreas needing more help than diet can offer… mom needing medications to help as well. Did I answer that right?

We don’t talk about it enough, but it isn’t just diet… there is also a huge part of the puzzle with exercise. Exercise helps the pancreas metabolize the food in many different ways. Simplistically, it gives the pancreas more power to shoot out the insulin as well as burning some of the food through energy expenditure instead of it needing to be metabolized with insulin. If pregnant women walked for 15-20 minutes after each appropriately sized meal (and appropriate carbs!), it can make or break an IR/GDM experience.

AKS: TS, I believe the answer has to do with tight control of blood sugars, which is sometimes possible via diet and sometimes not.

Also, I have a friend who just had a 9 lb. 2 oz. 23 inch baby. Definitely no GD--she tested her blood sugar 4 times/day before the GTT, which she passed. Baby had heel sticks after birth, zero blood sugar problems. Maybe some women really do grow big healthy babies? They just don't make the news?

NgM: Depending on who you ask, 4000 grams (8lbs 13oz) or 4500 grams (9lbs 15oz) = LGA or macrosomic (two different definitions, by the way, but often used interchangeably), so 9lbs 2oz would barely fit one description and not the other one at all. I hardly waggle my eyebrows unless the baby is over 4500 grams. Unless mom is under about 5’5”.
Also, I’ve read in diabetic literature that testing four times a day is hardly adequate to determine how a person’s blood glucoses are doing in any 24 hour period. Even four times a day and the HgbA1c together won’t track the ups and downs that happen throughout the day. 10-12 times a day is a more accurate number of finger sticks needed.
This is why I’ve wished the three day
continuous monitor might replace the Glucose Screen and GTT. The continuous monitor measures glucoses every 3-5 minutes for three days. Now that’s accurate! Here’s a great explanation about why the four times a day and the HgbA1c aren’t the most accurate ways to gauge BGs.

CS: This is the topic that had me hooked to NgM :) I ended up on her blog a few months ago for something entirely unrelated, and went to bed that night with a sigh of relief. I knew I had big babies and I always knew there was something not right. Hearing that IR can cause macrosomic babies was the light bulb I needed in this pregnancy. It makes sense. I'm 5'2, and both dads are 5'11 and under. So I always questioned where 9lb 2.5oz 23" and 9lb 5oz 24" babies came from. I hated hearing that I just made big babies, but it was a mantra I began to accept. My second son is huge. He's the size of his 4 year old brother. If I was going on just him, I'd agree I made big babies. But his brother normaled out quite quickly after birth. My first had a perfect APGAR, my second had a 7 and they took him to the nursery and his sugars were off. Add that with my dad's diabetes diagnosis at the beginning of this pregnancy, and the pouch around my middle that I can't get rid of, and I believe that I fit the category of IR macrosomic baby maker. Up until getting sick over a month ago, my diet was great. But I've gone off the diabetes lifestyle change as it was harder to maintain while battling chest infections with little sleep and raising my boys. I'm 24 weeks now, so I'm hoping to be healthy enough soon to regain my energy levels so I can change my lifestyle again and hopefully better my pregnancy, delivery, and my daughter's future. Thank you NgM for your logical and informative information on this subject. I wish you were able to reach more women on the subject.

Also, what was the test you recommended again? The one that tests 3 months worth opposed to the blood glucose level test? I'm going for the routine one next week and I don't suspect anything will come of it, but whether during pregnancy or after, I want to take that test just to see.

(Ps. I thought it was funny when my midwife asked if I wanted the glucose testing, I told her yes, but that I already changed my lifestyle based on the information I read on your blog. She smiled at me and nodded. She totally knew who you were and was supportive of the same information you speak of! Just thought it was cool that you are that well known up here in Canada too!)

NgM: Hilarious! And I’m flattered.

KDK: A1c is the more accurate test.

NgM: Yes, the Hemoglobin A1c is another measure of how a woman’s glucoses are doing, but it can only see from the point of the test backwards three months. Therefore, testing in pregnancy is good for observation, but not for diagnosing GDM. The reason the GD screen and GTT are done about 28 weeks is because that’s when the mechanism for pancreatic stress takes effect. While it seems gradual, it wouldn’t be surprising if it was a light switch reaction to the pancreas hitting its stress limit. Not diabetic one day and diabetic the next. Doubtful, but sometimes it’s easier to visualize what happens if you think of it that way.

But we know that Diabetes is a spectrum, it’s a ramping up of glucose in the blood because the pancreas gets more and more exhausted trying to keep up with metabolizing food intake. That’s why there can be tight control over food and exercise, but the pancreas still needing more help with medications because mom can only do so much. Diet and exercise are crucial… taking meds instead of changing the diet and exercising is inappropriate and probably pretty ineffective… but together, it can be awesome for the mom and baby.

SS-R: At 60, my mother has no signs of IR or Diabetes, she had four babies ranging from 9lbs even to 9lbs 15.5ozs. Diabetes in all its forms is virtually unheard of in our family at all, in fact. MOST babies born on my mother's side of the family are between 9 & 10 pounds (big, but generally not considered macrosomic). I think we need to be careful to distinguish between the two. There is such a thing as big and healthy, and I think we are going to be seeing more and more of it as people are eating better during pregnancy, as humans get taller with each generation, as smoking decreases- both during pregnancy and prior to it. There are a lot of things known to contribute to SGA babies, even in a good-sized baby, those things- or the lack of them- can cause a variation of a few ounces one way or the other, and when you are talking about people with a family or genetic disposition to babies that are on the upper end of that size bell curve, a few ounces can make a big difference.

That said, I am not one of the people who believe that all big babies are healthy, or that GD doesn't exist. I simply think we need to be cautious not to be diagnosing mothers and babies with medical conditions based on a single factor and without access to their medical information.

S: as I pointed out in my previous comment (and if someone could link the blog post where NgM discusses this in full) I kind of have a triple threat against me. I may have self-diagnosed, but it's not affecting my life. It's a lifestyle change that really is a billion times better for me. Diabetes can hit anyone at any time, regardless of genetics (although usually they do play a part). I would rather change my lifestyle now and possibly have a smaller baby (less traumatic birth) and possibly avoid becoming full-fledged diabetic later in life. Some women obviously make big babies. Genetics is great like that. But, the 3 strikes were that I had one child who was born large but who normalized after birth (i.e. he wasn't that high in the percentiles, but rather quite normal), diabetes runs in my family with my dad being diagnosed quite recently, and I've had recent weight gain (mainly in waist area). One thing on that list doesn't necessarily mean IR. It doesn't mean that it's not IR either, but I firmly believe that with each checkmark on the list, the chances are increased immensely. I think more needs to be studied on this to help more women. Diabetes is awful on its own, but to know what it does to your heart and the rest of your systems is enough to want to avoid it at all costs. I don't ever think that NgM is throwing everyone under the big babies = undiagnosed IR or worse bus. But I do think that her way of thinking could change the face of pregnancy and even diabetes as we know it for the world over.

LA: Seems to me that generalizations do one thing: hurt mom and babies (yeah, generalizing about generalizations).

There are big healthy babies. There are big unhealthy babies. There are small healthy babies. There are small unhealthy babies. ...There are many in between.

Lumping Mommas and babies into predetermined risk categories based on generalizations and assumptions is killing maternity care in the US. It ties everyone's hands. I don't understand why providers perpetuate one size fits all care. Who benefits? Not me. Not my kids. Lazy, CYA based medicine. Hmmm. There ya go.

I have 10-11 lb babies. In nearly 15 years of having babies I have never shows signs of or tested remotely positive for diabetes or IR (not GD bullshit, real diabetes). I have no family history of diabetes. I have children who have remained in the 90th + percentile to off the charts into their teens.

I grow big, healthy, strong babies and they grow into big, healthy, strong kids. My family has lots of big, healthy long lived adults.

Maybe those providing maternity care need some diversity training and lessons on genetics.

NgM: The size of your babies alone puts you at risk for future diabetes and unless you stay active and normal-weighted, you could very well end up with diabetes, too. It’s great you’ve avoided it so far, but I find it incredibly difficult to believe your babies were that big without any IR issues going on. But, that’s part of your argument, right? That I (and other providers) lump you in with the others… so ‘round and ‘round we go.

SS-R: C- I was in no way directing my comment at you. I was speaking about how quick some people are to call every large baby unhealthy when ALL they know is birth weight. In fact, I would be MORE inclined to give credence to your strong sense that something was off than to the medical professionals that told you everything was fine. If you were my friend and you were telling me this, I would PUSH you to fight for answers and to trust your gut.

I also think that IR does need to be taken into account, especially given the rise we are seeing in PCOS and related issues being diagnosed, and more attention needs to be paid to nutritional counseling prior to and during pregnancy than simply the 'weigh and shame' routine that many moms encounter.

CS: I think the problem is simply the testing for GD doesn't screen for IR which can cause problems much the same. To know that and to see big babies being born and to hear statements like "She ate everything she wanted" (which usually equates to salt and sugars... not many people make that statement when referring to copious amounts of fruits and vegetables and steak), you can't help but wonder. I don't think she is throwing this mom or anyone else under the bus, but raising an important topic of concern. How many babies are born that big where it is genetics? Are they still truly healthy or is there lower APGARS, messed up blood sugars, or even outside of just birth, what are the risks in the future? And if it's genetics, can diet and exercise (assuming there is no true GD that requires insulin) bring the size of the baby into normal parameters to minimize the risks? Or does genetics truly determine that the baby will be large no matter what (and presumably healthy)? In which case how can screening be done accurately to risk out women who do have undiagnosed IR? Can studies be done to prove the risks associated with living a lifestyle that creates a larger baby in that case?

So many questions, so many theories, and I think everyone just wants happy, healthy babies in the end. But I'm happy that someone is asking these questions and getting people talking about it. I'm kind of ill right now and heading to bed, but I'll try to find the link to NgM's blog entry on this. She does mention the 3 strikes rule instead of just focusing solely on the big baby aspect. Like I said, I have 3 strikes against me. It doesn't mean I have IR or will most certainly develop GD or DM, but it does light a fire under my bum to make some needed changes in my life. Do I need pop? Nope. Do I need 4+ teas with 2tsp of sugar every day? Nope. Do I need more exercise? Certainly. Living the lifestyle like I have diabetes isn't limiting at all. In fact I never felt better and I'm sure I was increasing my quality of life as well as my life expectancy. Even if the testing comes back that I'm not even IR and even if I just do make big babies, I'll still be thankful for the motivation to change my life and my habits as it can only be making my life better:)

MM: I had diet-controlled GD with my first pregnancy - my sugar control was spot on and I delivered a healthy 9lb 7oz boy. I figured he was big due the GD but my second, with absolutely no GD was 9lb exactly. My last, again with absolutely no GD, was born at 37 weeks, perfectly healthy weighing 7lb. By his due date he was 9lb. I've come to the conclusion that I do just make big healthy babies. They stay big til about 6 months, and then they even out to average size.

NgM:This was a great conversation, ladies… thanks for exploring it more in-depth. It certainly is one of my favorite topics.

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