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Entries in Large for Gestational Age (3)

Tuesday
Jul312012

Cesarean Scar: Emina's Story

My due date was April 26, 2012 but on the morning of April 20th, I woke up with contractions. What seemed like "fake" (braxton hicks) contractions, I was going to find out soon that they weren't fake. I waited an hour and they seemed to get worse. Finally I went to the restroom and saw that my mucus plug came out. When I saw that, I called my doctor and she advised me to come into her office right away and she would check me out. 

When I arrived to her office, she took me in right away. She checked me down there to see if I was dilating. She told me I was 2cm dilating and should go to the hospital now and register. I will never forget this day because not only was this my first child coming into the world but I was also terrified of giving birth. I was so out of it, that I ended up driving myself to the hospital, registering myself and walking myself upstairs to the maternity floor. I had already called my husband, my mother and father, my in-laws, my brother, my brother in law and sister in law... EVERYONE. They all yelled at me asking why I would drive myself to the hospital ( at the time I did not know why I did either ). 

I checked into my room at about 12:30pm, which was next door to a young women who I work with, that had given birth the day before (such a coincidence). She had given birth vaginally and explained how she was so sore down there. But she told me that she had gone 8cm without an epidural until she finally needed it. Also explained to me how the birth was not bad at all (her baby was 6lbs-ish). She calmed my nerves a bit but I was still so, so scared. 

Finally, after being in my room for 15 minutes, my mother arrived and she was in tears. She was excited and scared for me. She said she didn't like to see me in pain. My contractions were bad. They were 3-5 mins and they were painful. Within the next few hours I had my whole family in the room with me, while I was going through experiencing these painful contractions. I was walking around a lot, because I wanted the labour to go quickly. I was doing stretches and anything possible to get the birth going. 

After about 4-5 hours in my room, my doctor came in to check my status of the dilation. I was 4cm dilated and I was 60% effaced. I was still feeling these bad contractions but did not want an epidural until I was closer to about 8cm. Everyone was watching me in pain. Although I was in so much pain, I had a smile on my face the whole time. My family was making me laugh, walk, talk a lot, stretch out. It was a soothing experience to have everyone there. After another couple hours passed by, my doctor came to check on me and I was at 5cm dilated but still not effaced 100%. 

After an hour of being 5cm dilated, I couldn't take the pain anymore and my doctor suggested an epidural to try to get the birth process moving. I agreed to the epidural, even though I was also terrified of the epidural. I was shaking a lot when the anesthesiologist came in to give me the epidural. My husband was in the room with me and kept comforting me that I would be fine. They did a great job that I didn't feel anything when they stuck the needle in. It was like a tiny pinch and that was it. After the epidural, I felt GREAT! I felt so confident in giving birth. But, after a couple of hours on the epidural, the doctor had checked me again and said I didn't move from the 5cm and also my baby's heart rate was really high. She said she would give it another 30 mins and if nothing changed then we would have to take about other options. 

I felt my baby move A LOT, she was kicking like crazy. Everyone could see my stomach shifting a lot. I saw her foot prints a couple of times on my tummy, that’s how hard she was kicking. After 30-30 mins of waiting, the doctor checked again and of course I did not shift away from 5cm and at this point the head was basically stuck at my pelvic bone. The doctor said that the baby’s heart rate was getting really high, and my BP was getting really high, also the baby was basically stuck at my pelvic bone and if I gave birth vaginally, the baby would probably break my pelvic bone. So, she said I had no other choice but to have a C-section. When she told me I would have to have a c-section, tears poured down my eyes like a waterfall. Throughout the whole pregnancy, the thing I was most afraid of was having a C-section. My husband took my hand and told me everything was going to be fine, and that they wanted the baby to come out safely that's why I have to have a c-section. 

It felt like a knife went through my chest when they told me I had to have a c-section. My husband was so kind and loving. He encouraged me to go into the OR with a lot of confidence. When I got to the OR room, my hands were shaking uncontrollably. I was terrified. They prepped me up, cut me up and in came my husband. They said I would feel a lot of pressure but no pain. The process lasted pretty quickly and I felt EXTREME pressure, it was actually very painful for me. All of a sudden the doctor got the baby out and I didn't hear a cry, all I heard was,"OMG." When I screamed out," WHAT??? WHAT OMG??" The doctor said," Omg, the baby is HUGE."  Then I heard her cry. Everyone was cheering, my husband was in tears. I was crying and overwhelmed and didn't feel anything at that moment because I wanted to see my little ( or not so little ) baby. My husband came over with the baby and she was BEAUTIFUL. He said, "Babe, she is 10 pounds and 1 ounce." And I was shocked. I thought to myself OMG, no wonder she got stuck at the pelvic bone, she is a BIG, BIG baby. My whole family could not believe how huge she was. 

After staying in the recovery room, I finally got to hold my baby and kiss her. It was a surreal moment but honestly, I wouldn't change it for the world. Although I was disappointed that I hadn't given birth vaginally, I was extremely grateful that my baby came out safely and perfect. All I wanted was for my baby to be ok, whether it was vaginally or c-section, at the end of the day I was glad and never bitter about my c-section. 

When I touch my scar, I feel powerful. C-section is a major surgery and a birth at the same time. Although I am not fond of having a scar, it represents my baby and me. I was a strong women to be able to go through this birth, any way it happened. I am never bitter about it. I am more than thankful that my baby came into this world safely. Although I ended up going into Congestive Heart Failure 2-3 days after the c-section and ended up getting Post-partum cardiomyopathy, the experience was still great. I am thankful for life every day, especially my baby’s. My life is precious and every moment is a blessing to me. The fact that I can hold my baby and see her beautiful face every day is a gift of God. I thank God every day for my daughter and for my own life (since my own life hung on a very thin string). No matter how you give birth, be thankful for your baby and yourself. I love my scar, it’s a sign of strength. I love my baby, my life, my family and I love the fact that I can sit here and share this story with everyone. Never look down upon yourself, instead be grateful that your baby came into this world, which a lot of people take for granted. 

Hope you enjoyed my story and the birth of my beautiful little Ariana. God Bless!

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.

Friday
Oct142011

Glass Shards of Diabetes

When I heard Dr. Oz talk about what diabetes does to the body (synopsis below), it finally sank in what was happening (diabetes-wise) to my body as I ate and ate and ate some more, giving me my ponderous belly (“Buddha belly”) and I could visualize the internal damage I was surely causing myself when I ignored the disease that has killed several members of my family.

Gestational and regular Diabetes Mellitus (GDM/DM) have been an on-going discussion on my Navelgazing Midwife Facebook Page for the last few days. The conversation began with the vaginal, pain-med-free birth of this 13 pound, 11 ounce baby boy in England. When there are babies this huge in the news, I typically comment about undiagnosed GDM and then the rebuttals ensue. “I had an 11 pound baby and I didn’t have GDM!” or “Not everyone with a big baby has GDM.” And I end up explaining diabetes, over and over again, so I thought it was darn tootin’ time to explain myself here, offering a place to refer to because the discussion will continue coming up as our privileged cultures get fatter and fatter, and more and more women will be diagnosed with GDM/DM and our families, with DM, too.

Also, when this topic comes up, I get comments like this one:

“I have a huge family history of Type II DM, and I've had two 9+ babies. I'm a healthy weight, active, and eat a decent diet... but I feel like I'm just a ticking time bomb for DM!”

The last thing I want to do is scare the bejeezus out of anyone! What I do want to do is 1. Make my Self grasp the gravity of my own situation and 2. Encourage women (people) at risk to pay attention, not freak out.

So, as I said, Dr. Oz explained why diabetes is so devastating in a way, for the first time, that made so much sense. He had an animation that (in its most simplistic form) showed how a carbohydrate changes into a glucose molecule after we eat it and how the glucose (sugars) flow through our bodies, literally feeding our brains and muscles so they are able to function. He also showed how the pancreas sends out insulin receptors, scattering them throughout the body so they can metabolize the glucose for the brain and muscles to absorb, explaining they act almost like vacuums, the glucose zooming towards the insulin. However, when we eat more carbs/sugars than our bodies need, the pancreas can’t keep up with sending out enough insulin receptors and the glucose then zips around the body, causing damage and the extra calories make fat, especially fat around the middle of the body. This inability to keep up is the Insulin Resistance (IR) we’re hearing more and more about. The newest term is Impaired Glucose Tolerance (IGT), a description often called Prediabetes. Other forms of IR are Polycystic Ovary Syndrome (PCOS) and Metabolic Syndrome (MS). All of these are often used interchangeably, but do have nuances of differences that are better explained by the experts, not in this basic piece.

What is a part of this piece is that when I say “GDM,” I am lumping in all the different IR, PCOS, MS, etc. issues because they all go hand in hand, merely located on different parts of the same spectrum of pancreatic metabolic pregnancy disorders.

I know this part is boring as crap, but bear with me, the good stuff’s coming.

So, when we left the glucose, it was floating around looking for some insulin to metabolize it. Dr. Oz brilliantly describes the glucose (crystals) as glass shards that course through the body, slicing things as it wanders hither and yon. In our arteries, the shards make cuts and the artery then “bleeds”, forming a clot and then a scar when it heals. Over and over again, the shards cut, “bleed,” then scar, building up on each other. Sometimes the shard slices off a section of the scar tissue, making an even bigger spot that eventually scars and the part sliced off “floats” downstream, mashing up against another group of scars. Eventually, over time, the scar tissue... and other cholesterol thingies... have built up so much, it completely closes off the artery; arteriosclerosis, one of the major risks of diabetes.

This shard analogy explains a lot of the damage diabetes causes, from slicing the kidneys into eventual failure to causing eye damage, blinding the diabetic. However, I cannot, for the life of me, find why GDM causes stillbirths. As a midwife and as someone who discusses this topic so often, it frustrates me terribly not to know the exact biochemical/physical mechanisms between diabetes and babies being born still. All over everywhere, we can find that stillbirth is a potential complication of GDM, but I’ve scoured .org and medical journals looking for the specific piece of information I’m looking for. If someone out there can help, I would very much appreciate it –and I know others would, too.

This brings me to a point, actually, that we hear such and such is a risk of <fill in the blank> (stillbirth from diabetes, as an example), yet it isn’t explained why. I believe if we knew why complications happened, women would be more compliant; I know I would be.

Audit on Stillbirths in Women with Pregestational Type 1 Diabetes, found in Diabetes Care, written in 2003, is one of very few articles/studies I found that explains what happens to the fetus in utero and why he or she eventually dies:

Early as well as late suboptimal glycemic control may predispose to fetal distress, due to fetal hyperinsulinemia, acidosis, and hyperlacticemia, as maternal hyperglycemia and elevated HbA1c are risk factors for fetal asphyxia, possibly leading to intrauterine death.

And while this speaks about Type 1 diabetes, it does, absolutely, have a great deal to say about Type 2 during pregnancy; mainly, the better the glycemic control, the safer the baby.

(As an aside, I learned a new term: “neglectors.” In the same study, explaining the stillbirths goes this way:

The lack of fetal surveillance together with the lacking improvement in glycemic control during pregnancy, the high rate of smokers, and the low social status indicate that this group has limited compliance, corresponding to the term “neglectors” introduced by Mølsted-Pedersen and Pedersen in 1967.

I suspect today’s term is closer to “non-compliant.”)

Onward.

Large-for-Gestational-Age vs. Macrosomic

During these endless Net conversations (which I thoroughly enjoy, by the way), big-babies-as-a-genetic-factor butts up against the big-baby-because-of-undiagnosed-GDM. What is the difference and who gets to say which is which (or who is who)?

In the olden days, a large for gestational age (LGA) baby was different than a macrosomic baby, but in the literature now, I see the terms being used interchangeably; odd. This makes the distinction between the genetically large and macrosomic babies nearly impossible. But, I did find these two definitions, what I have been familiar with for many years.

Large for Gestational Age:

“Gestational age is a measure of the growth and development of the fetus in the uterus and the infant after birth. LGA refers to a fetus or infant who is larger than expected for the age and gender or with a birth weight above the 90th percentile. The measurement is based on the estimated gestational age of the fetus or infant, compared with what is considered normal height, weight, head size, and developmental level for a fetus or infant of the same age and gender.”

Macrosomic:

“One of the most important factors about macrosomia is the differential rate of growth of the fetal head, chest, and trunk as gestation proceeds, both in the babies of diabetic and of nondiabetic mothers. Until 36-38 weeks, the fetal head generally remains larger than the trunk. Between 36 and 40 weeks, however, the relative growth of the abdomen, chest, and shoulders begins to exceed that of the fetal head. This is especially the case in babies of diabetic mothers where glucose substrate levels are higher in both the mother and fetus. Thus both in prolonged gestation and in babies of diabetic mothers the size of a baby's trunk is likely to increase, increasing its chances of shoulder dystocia.”

I do agree there can be ten pound babies of six feet tall moms and that is likely enough to not be a macrosomic baby, but ten pound babies of  5’4” 200+ pound moms are a different story.

The basic point of this whole post is to say that just because a woman tests negative for GDM does not mean there aren’t other insulin-related issues at play… issues that can make for abnormally-sized babies and include the complications that come along with such babes. For those with IGT/Prediabetes, most will develop Type 2 Diabetes within ten years. I’ve also read there are ten to fifteen years before the Type 2 Diabetes diagnosis where pre-diabetes is taking a toll; one that, too often, includes pregnancy.

I met a woman just today whose first baby weighed eleven pounds and she’s post-dates with her second. When I mentioned glucose issues, she defensively told me she didn’t have GDM, but how can someone not be convinced there is some glucose/insulin issue at play? What are doctors and midwives not saying that lead moms to believe nothing is wrong? Do these women have to finally develop diabetes in order to retrospectively acknowledge their child’s size was, indeed, a giant wake-up call about their future health? That is exactly what I had to do after bragging about not being diabetic with a 10 pound 6 ounce baby; I might not have tested positive, but I positively had something glucose-related going on.

Why are there so few of us talking about this in the midwifery/natural birth community? I believe this is something we all need to work with. Don’t we want our mamas and babies to stay safe? Sweeping this issue under the rug is going to do nothing but cause more stillbirths, more shoulder dystocias and more diabetes for everyone. Let me tell you, first hand… diabetes SUCKS.