Natural Birth: Conquered with Type 1 Diabetes, Polyhydramnios, Macrosomia, and Shoulder Dystocia

The night before Kate’s birthday, I left work early. I’d been having contractions for weeks, but something was different that night. I couldn’t put my finger on it, but knew I needed to get home and get to bed.

A little background: I was getting so many contractions due to having severe polyhydramnios. I had almost double the amount of amniotic fluid than a normal pregnancy would have. The doctor had placed me on Nifedipine to slow the contractions in the hopes of getting me to 37 weeks, which I was still 5 days away from.

That night, I couldn’t sleep. I literally did not sleep one wink. I was beyond uncomfortable – so full, so tight, so restless. I tried every possible position, on every piece of furniture. I tried walking, reading, relaxation tapes, and solitaire. Nothing worked. This was a whole new level of discomfort; I had crossed into “the miserable.”

As the morning sunlight filtered through my living room windows, and I was faced with another day of tortuous, preggo anguish, I broke down. I cried that cry of frustration, of discouragement. That cry when you realize there is nothing you can do to change your situation. All you can do is wait and endure.

And pray. So I prayed, out loud – a desperate plea through my tears:

“God please. Please help me. Give me a leak. Something. Anything. Relieve this pressure in my belly. I can’t do this much longer.”

I shuffled into my bedroom, plopped into bed and, amazingly, I fell asleep. About an hour later I awoke and found myself lying in a puddle.

Ummm. What. Is. This. My water?! Oh my gosh. Oh my gosh…Don’t panic.

I totally panicked.

I slowly got out of bed to use the bathroom and fluid gushed out of me and proceeded to gush with every step I took.

Holy smokes, this is the real deal.

I hurriedly walked across the house to the hubs office and, through my shaking voice and trembling body, informed him of the news. I called Laura, my doula, and then called Dr. B, who had graciously given me his cell number. He was excited and said it would be best to get to the hospital soon as this was my second baby and things could progress pretty quickly. Hard contractions hadn’t really kicked into gear yet, but I didn’t want to take any chances. So off we went.

The ride there was a mixed bag of emotions. One moment I was crying and saying, “I’m not ready! I’m not ready!” The next moment I was relieved, knowing we’d get to meet our baby girl soon and this discomfort would finally come to an end. I prayed for good nurses and that I could progress through labor naturally. Since I was still almost four weeks from my due date, there was a chance my body wouldn’t progress and would need some form of induction, which I was hoping to avoid. I kept reading my affirmation list, trying to stay positive and focused.

We got checked into triage, the nurse checked me and I was only 1cm. Dang it! She made the comment that they would “let” me try to progress on my own for “about four hours,” before inducing labor. I knew that had to be bogus, four hours is nothing and my water hadn’t been broken for too long! I couldn’t wait for her to call my Dr. He knew the plan, he knew my wishes, my fears, my anxieties, my concerns. Then Laura arrived and my anxiety instantly lowered.  I knew I needed her to help keep me focused and calm and get me through another med-free birth. (If you’re on the fence about getting a doula, HIRE THE DOULA. They are worth every penny.) They admitted me to a labor room, started an IV for antibiotics, due to being GBS positive, and also hooked me up to the monitors.

(A note about monitoring: Protocol usually states, as a diabetic, I need to be continuously monitored – meaning I’m practically tied to the bed. The. Entire. Time. This is the worst thing for someone trying to go without pain meds. I needed to be able to pace the room, walk the halls, get in the shower. My Dr. knew this and was fine with intermittent monitoring. My by-the-book nurse, however, was not a fan. Thankfully the hospital had wireless monitors, so I could still roam the halls while they kept an eye on baby’s heart rate and my contractions. Once my Dr. showed up, he allowed me to get off the monitors for an hour at a time.)

Then I made the appalling request for food. Slight panic flashed across my nurse’s eyes. (Typically it’s fluids only, in case you need a C-section.) She said no, then called Dr. B at my behest, and sure enough, he allowed me to eat. I’m sorry, but if having a baby is like running a marathon, as one OB told me once, you kind-of need to eat for energy, right?

As far as blood sugar management, the goal was to keep my insulin pump on. I did NOT want an insulin drip.  The worst thing you can do to a diabetic, in my opinion, is take away their control over their own sugars. We checked my blood sugar every hour and I titrated my insulin via my pump as needed. The whole labor I stayed between 70-125! I ate some oatmeal, eggs, crackers, and a fruit leather. I never took any boluses; I just let my basal do the work.

Early in labor I got a text from Dr. B that read: How you doing mama? Keep those blood sugars perfect so we can keep the pump. You are a super mama!

Seriously? Best. OB. Ever.

Contractions were starting to kick in – very mild, but at least they were present. Hubs and I walked the halls, chilled in the room with Sting and Simon and Garfunkel playing in the background as our labor soundtrack.

Eventually Dr. B showed up, smiling from ear to ear, so excited and energized. Contractions were coming about every three minutes, but I told him they weren’t very intense. He said step it up! Don’t just walk the halls. JOG the halls, lunge the halls, squat, power walk, take a shower – do everything possible to get labor going. NOW.

So we did lots of this:

https://youtu.be/jRyc146pVF8

(At one point during our run, my pants actually, without warning, fell straight to the ground….right in front of the nurse’s station….in front of Dr. B.  We laughed so hard, but unfortunately it’s not on tape.)

I hate jogging, but I have to say, I was having a blast. We snuck outside, got some fresh air, walked some stairs, and checked out the gift shop. Then we headed back for more jogging around the labor ward, pausing during the stronger contractions to breathe through them and really focus on relaxing my body. The hubs and Laura were at my side the whole time. Laura reminded me to relax my shoulders, hubs held my belly up during contractions to ease the pressure. Mind you, I’m also continuing to gush fluid THE WHOLE TIME, especially during contractions. It was a little ridiculous, running down my legs, onto the floor…it wasn’t slowing down at all.

I remember telling hubs and Laura, “This can’t be labor. I’m having too much fun.” Of course, I knew that would change. At some point Dr. B offered to check me, Laura suggested I decline, as there weren’t really enough signs yet that things had changed significantly. I agreed. Plus, since my water had already broken, the more “checks” I had, the higher the risk for infection. Dr. B went home, instructing us to call if needed.

Hubs and I jumped in the shower and that’s when things took a turn. Everything intensified dramatically. I had to focus more during contractions and started to turn inward. It was getting real now.

At this point we stayed in the labor room. I paced the room, back and forth and back again, over and over, leaning on my IV pole for support, moaning through the contractions to focus my breath to move the baby downward. At times I said aloud, “I can do this, I am doing this, my body is made for this, I can do this.” Hubs and Laura were encouraging me the whole way, cheering me on.

I was feeling A LOT of pressure down below; I could feel her moving down. The contractions became more and more intense. I kept pacing, pacing, pacing. I would pause at times, during the peak of the contraction, and focus on the leaf pattern on the tile floor, tracing the leaves over and over with my eyes, trying to keep myself distracted from the pain. I was so ready for the nurse to check me, and by this time, miss by-the-book nurse had gone home. I so hoped and prayed that I was getting close. She checked me out and, praise God, I was at 8cm!

“And…,” the nurse said. “You have a forebag.”

Dr. B had mentioned this earlier in the day. The way I understood it at the time, there are actually two layers of the amniotic sac. The one the baby is in and then the forebag, like an outer layer. Apparently what had ruptured for me was the forebag. So there was another inner bag that had not ruptured yet, the bag that had the baby directly in it. I couldn’t believe it. All this fluid gushing out and the actual sac the baby was in had not even ruptured. Ugggg!

Doc showed up shortly after that and I was faced with a decision. I could continue what I was doing and wait however many hours until the other water bag broke and baby fully engaged, OR I could allow Dr. B to break the bag. He assured me I would go from an 8 to 10cm in almost no time at all, once the bag was ruptured. I knew this meant a significant increase in the intensity of the contractions and…time to push. The whole pregnancy I had been dreading, D-R-E-A-D-I-N-G pushing. Pushing is my arch nemesis. Pushing is my Moriarty, my Kryptonite. I pushed an exhausting two hours with my first baby. It was not enjoyable. I was always out of breath and felt overwhelmed. I was not ready to push. Just writing this brings back all those anxious feelings.

But I decided to go for it. Pop the dang bag and let’s get this baby OUT.

I got in position, contracting, and uncomfortable the whole time. I felt and heard the “pop” and felt, again, the warm gush of fluid. Instantly I was fully effaced and 10cm and could push whenever ready.

Let me just say, the “urge to push” cannot be ignored or suppressed. It’s a full-on, involuntary convulsion. Kind-of like when you vomit – that heaving, retching sensation – except it’s in your vagina, and it hurts.

I tried various positions – leaning on the back of the bed, hands and knees, squatting, side-lying and slightly reclined. Dr. B suggested reclined to get better leverage and I’d have less chance of tearing.

I don’t know how to best describe how I felt during this phase of labor, so I’m just going to be honest:

I totally lost it. I freaked. I panicked. I lost all composure, all focus. I broke down and kept saying, “I can’t do it, I can’t.” What if she’s too big? What if I can’t get her out? What if I’m not strong enough? What if I run out of air?

Everyone around me kept telling me to stay positive and that I was pushing, I was doing it. But I pushed and pushed and wasn’t getting anywhere. Dr. B kept telling me to stop pushing with my face. He showed me where to focus my pushing. So I tried and tried….and got nowhere. I can’t tell you how frustrating and discouraging it all was. I panicked again thinking maybe my sugar was low. Dr. B assured me it wasn’t and he was right. With every contraction the nurse, my doula, the doctor, and my hubs would psych me up hardcore. They would count out loud, “1-2-3-4-5-6, keep pushing, push hard, don’t let it go, 7-8-9-10, take a deep breath, push again. Go! Go! 1-2-3-4….,” and on and on with each contraction. “Push her to the ceiling! 1-2-3-4! Chin to chest!! 5-6-7! Act like you’re pooping, 8-9-10! You got this! You can do this!”  I could never make it all the way to ten; I was losing my breath too quickly and couldn’t focus the energy downward to get her out. I was done for. Dr. B kept telling me I was close, but I didn’t believe him.

I have no idea how much time had passed, but it felt like hours that I was pushing. I was so exhausted, so weak from pushing yet full of adrenaline, my whole body was shaking. It was all at once terrifying and exhilarating. Eventually, by some miracle, I got it right. I started listening to just one voice, the nurse who said, “Push her to the ceiling,” and that worked. She was crowning! Dr. B told me to listen carefully to his voice, because there would come a point where I needed to stop pushing or to push very lightly. I knew if she was indeed a chunky babe, there was a chance of shoulder dystocia (shoulder getting caught on my pubic bone). Her abdomen always measured so massive, I figured the doctor just wanted to go slow for those reasons. Next thing I know the nurse is putting, what seemed like all her weight, onto my pelvic bone and was pushing – freaking HARD. It was like in CPR, when you do chest compressions, except this was on my pelvis. Not pleasant. I continued to focus on Dr. B’s directions as he slowly worked baby out of me.  Hubs and Laura continued their supportive words, “Almost there….She’s got a full head of hair!….You got this….She’s almost out!”  And finally at 9:18pm, nearly 14 hours after my initial water break, baby was officially BORN. Easily the biggest relief of my life.

Dr. placed her directly on my chest as we all gasped at how huge she was. I knew she’d be big….but she was a tank. I just kept saying, “Oh my gosh! Oh my gosh! She’s huge! Oh my gosh!” We couldn’t wait to see how much she actually weighed. Unfortunately, we couldn’t wait for the cord to stop pulsing before cutting it, because babe needed her shoulder checked ASAP. The nurse took her to the warmer to get vitals and check her shoulder. Her right shoulder was stuck for a full 40 seconds so they needed to make sure she had good tone on that side and there was no nerve damage. She did fine.

Next, the weight: 9lbs 9oz.

Holy smokes chub.

I attempted to breastfeed her, but she was somewhat lethargic. She scored great on her APGARs (8/9) but her blood sugar was 37. Baby’s blood sugars can run lower than adults, but 37 was pushing it. Also, due to her being almost four weeks early, she had trouble with the whole suck/swallow/breathe routine. Because of all of this, they suggested trying some formula to get something in her to bring up her sugars and then maybe she would be more interested in breastfeeding. She managed to get some of that down. All the while, Dr. B tended to my wounds.

As soon as baby and that lovely placenta were out, Dr. gave me Cytotec and started Pitocin in my IV, as Laura gently massaged my uterus to minimize the risk of hemorrhage. Because my uterus had been so stretched, both from a larger baby AND all that extra amniotic fluid, it would then be harder for it to contract down properly, putting me at risk for excess bleeding.

Then the stitching – I managed to sustain only a mild 2nd degree tear, but acquired a decent size hematoma that needed to be drained and stitched back together. Good times. He worked on me for a really, really long time. I gladly accepted some Ibuprofen and Percocet, some water and snacks. I held my sweet baby, Kate, smiled at hubs, and said, “We did it.” I thanked God over and over for getting us through it all. This was no easy pregnancy, but she was here. We both survived, all my fears had been conquered.  Diabetes can’t hold us down! And I had the most amazing support team on the planet.

Photographs by Laura C., Birth Doula. You can visit her website or Facebook for more information.