Episode 293 Heidi's VBAC + Gestational Diabetes, GBS & Advanced Maternal Age

It can be difficult to find VBAC support with gestational diabetes and most who are supportive of VBAC highly recommend a 39-week induction. Heidi’s first pregnancy/birth included gestational diabetes with daily insulin injections, a 39-week induction, Penicillin during labor for GBS, pushing for five hours, and a C-section for arrest of descent due to OP presentation. Heidi wasn’t sure if she wanted to go through another birth after her first traumatic experience, but she found a very supportive practice that made her feel safe to go for it again. Though many practices would have risked her out of going for a VBAC due to her age and subsequent gestational diabetes diagnosis, her new practice was so reassuring, calm, and supportive of how Heidi wanted to birth. Heidi knew she wanted to go into spontaneous labor and try for an unmedicated VBAC. With the safety and support of her team, she was able to do just that. At just over 40 weeks, Heidi went into labor spontaneously and labored beautifully. Instead of pushing for over five hours, Heidi only pushed for 30 minutes! It was exactly the dreamy birth she hoped it would be. Thrombocytopenia Real Food for Gestational Diabetes by Lily Nichols Informed Pregnancy Plus Needed Website How to VBAC: The Ultimate Prep Course for Parents Full Transcript under Episode Details 05:50 Review of the Week 08:04 Heidi’s first pregnancy with gestational diabetes 12:05 Taking insulin 18:08 39-week induction 20:59 Pushing 24:29 Arrest of descent and opting for a C-section 27:06 Researching providers before second pregnancy 38:04 Discussions around induction 41:45 NSTs twice a week 47:10 Testing for preeclampsia 54:53 Spontaneous labor 57:43 Going to the hospital 1:02:03 Laboring in the tub 1:06:22 Pushing for 30 minutes Meagan: Hello, Women of Strength. It is Meagan and we have a friend from New Hampshire. Her name is Heidi. Hello, how are you? Heidi: I’m doing great. How are you? Meagan: I am so great. I’m excited to record this story today because there are so many times in The VBAC Link Community on Facebook where we see people commenting about gestational diabetes and for a really long time on the podcast, we didn’t have any stories about gestational diabetes. Just recently, this year really, we’ve had some gestational diabetes stories. I just love it because I think a lot of the time in the system, there is doubt placed with the ability to give birth with gestational diabetes or there is the whole will induce or won’t induce type thing, and with gestational diabetes, you have to have a baby by 39 weeks if they won’t induce you and it just goes. So I love hearing these stories and Heidi’s story today– she actually had gestational diabetes with both so with her C-section and with her VBAC. It was controlled. It was amazing. That’s another thing that I love hearing is that it is possible to control. We love Lily Nichols and the book about gestational diabetes and pregnancy. We will make sure to have it in the link, but it is so good to know that it doesn’t have to be a big, overwhelming thing. It can be controlled and it doesn’t have to be too crazy. Right? Did you find that along the way? Heidi: Yes. Yes, definitely. The first one was pretty scary, but then the second one, you know what you are doing and you can control it and you can keep advocating for yourself. Meagan: Absolutely. And then in addition to gestational diabetes, she had advanced maternal age barely with her second, but that is something that also gets thrown out. A lot of the time, we have providers saying, “We shouldn’t have a vaginal birth. We should have a C-section by this time,” so that’s another thing. If you are an advanced-maternal-age mama, listen up because here is another story for you as well. We don’t have a lot of those on the podcast. We are so excited to welcome Heidi to the show. 05:50 Review of the Week Meagan: Of course, we are going to do a Review of the Week and then we will dive right in. This was from stephaniet and it says, “Inspiring and Educational.” It says, “As a mother currently in her third trimester preparing for a VBAC, I was so happy to find this podcast. The stories shared are so encouraging and it is so comforting to know that I am not alone in feeling that once a Cesarean, always a Cesarean.” 100%. That is 100% true. You are not alone here. And once a Cesarean is not always a Cesarean. It says, “This does not have to be my story. Thanks, Meagan and Julie, for providing the support and education to women who are fighting for a chance to have a natural childbirth. I would love to encourage anyone wanting to learn more about VBAC to listen to this podcast.” Thank you, stephaniet . This was quite a few years ago, actually. This was in 2019. We still have some reviews in 2019 that weren’t read. It’s 2024, so that’s really awesome and as usual, if you have a moment, we would love your reviews. Your reviews truly are what help more Women of Strength find these stories. We want these stories to be heard so leave us a review if you can on Apple Podcasts and Google. You can email us a review or whatever, but definitely if you listen to the podcast on a platform, leave a review and that would help. 08:04 Heidi’s first pregnancy with gestational diabetes Meagan: All right, Ms. Heidi. Welcome to the show and thank you for being with us. Heidi: Thanks for having me. This is awesome. Meagan: Well, let’s talk about it. Share your story with us with your C-section. Heidi: Yeah. We were planning for a child and we just decided. We were like, “Okay. Let’s shoot for an April birthdate.” We just thought that we could just have a child, but we got lucky and we did on the first try. Meagan: Amazing. Heidi: We went to our local hospital that was about five minutes away for care and it just seemed good enough. At the time, I thought you just go to the hospital. You get care. You can trust the provider and you don’t really need to do anything other than a hospital birth class for prepping. We just went along that journey. They assured me, “This will be a normal pregnancy. Everything is great.” The pregnancy was uneventful until about 20 weeks when I found out my baby was missing a kidney during a routine ultrasound. That sent us down Google rabbit holes and all kinds of fun things. Meagan: I’m sure, yeah. Heidi: Yeah. So at that point, we were assigned a Maternal-fetal medicine OB. I was offered an amniocentesis if we wanted to check and see what else was wrong and things like that. That was a major curveball. Meagan: Did you end up participating in the amnio? Heidi: No, we didn’t. We had a couple of detailed ultrasounds after that. At first, they didn’t actually tell me what they were looking for. I had three ultrasounds in a row that were not the more detailed ones. Meagan: Oh, okay. Heidi: I was like, “Why am I having all of these ultrasounds? Nobody is saying anything.” I finally got a phone call telling me that my daughter was missing a kidney so that’s what they were looking for. I was like, “Okay. Good to know.” Meagan: Yeah. You would have thought some communication before then would have happened though. Heidi: Yeah. It was pretty scary. So what seemed pretty uneventful– Meagan: Got eventful. Heidi: Yeah, it did. So right around 28-30 weeks when they do the gestational diabetes check, I went in for my check and found that I would need to start tracking my blood sugar and diabetes does tend to kind of run in my family even though everybody is very healthy. I was wondering if it would come up and also being older, sometimes they say there is a link but it still took me by surprise because I’m a very active person and I eat really healthy. I felt like a failure basically. Meagan: I’m so sorry Heidi: Yeah. All of a sudden, I’m meeting with a nutritionist. They give me this whole package of a finger pricker. Yeah, exactly. All of a sudden, I’m submitting logs four times a day checking blood sugar, and the fasting numbers for me just weren’t coming down so it was about one week of that, and then all of a sudden, they were saying, “Okay. You probably need insulin.” 12:05 Taking insulin Heidi: It came on so fast, so strong. Meagan: Wow. Heidi: It was really scary so then I found myself going to the pharmacy. I am a very healthy person so it was just all really weird going to the pharmacy buying insulin and learning all about insulin and learning almost how little the medical field understands about gestational diabetes. That was something bouncing in my head bouncing off the wall trying to understand the plan there. Meagan: Yeah. Heidi: Yeah, so after that, then I got phone calls from the nurses. They said, “You know, now you are on insulin. Now, you are going to have twice weekly NSTs required at 35 weeks.” I’m thinking, “Well, I’m working full time. How am I going to do all of this?” There is just so much sick time and it was really, really difficult to hear all of that. Meagan: Yeah. How do I have time for all of that? Plus just being pregnant. Heidi: Yeah. Yeah. Insulin and just for anyone that doesn’t know, basically you inject yourself. I was injecting myself every night with an insulin pen and it was all just very weird because you’re also thinking, “Well, I’m pregnant. I’ve never been on this medication. What is it going to do to me? What is it doing to my baby?” Very nervewracking. It’s all normal to feel that way. Meagan: Yeah. I think sometimes when we get these diagnoses, we want to either recluse because it’s so overwhelming, and sometimes then, our numbers can get a little wonky, or we dive in so much that it consumes us and we forget that we are still human and we don’t have to do that. Heidi: Yeah. Now that you say that, I definitely did a little bit of both. Meagan: Did you? Heidi: I did a little bit of denial and then I did a little bit of obsessive researching. Meagan: Yeah, because you want to know. You want to be informed and that’s super good, but sometimes it can control us. Heidi: Yes. Absolutely. You’re watching every single thing that goes into your body. I probably didn’t look at food normally until my second pregnancy to be honest with you. Meagan: Really? Heidi: Yeah. Meagan: Yeah. Yeah. So it was working. Things were being managed. Heidi: Yes. I was honestly very grateful for the insulin. Obviously, it took a little while to feel that way, but it was very well-managed. My numbers were right in range. My blood sugars were always normal throughout the day. I never had to do anything during the day. I just checked my blood sugars. Then the other thing that came as an alarm, they told me about the NSTs which are non-stress tests. They also mentioned that I would need an induction in the 39th week because– Meagan: 39 to be suggested, I should say. Heidi: Yeah. It wasn’t explained to me that with that provider, it was a choice. It wasn’t a suggestion. It was like, “You have to do this or you might have a stillbirth.” It was really scary. Meagan: Oh. Heidi: I didn’t know I had a choice. Being a first-time mom and not knowing about evidence-based birth, this podcast, or all of it. I had no idea. So I was told I could schedule it anytime after my 36th week and for every appointment that I had as I started getting closer, I felt a lot of pressure from the providers to schedule the induction. They cited the ARRIVE trial. Meagan: Yes. Another thing I roll my eyes at. I don’t hate all things. I just don’t like when people call people old and when they tell people they have to do something because of a trial that really wasn’t that great. But, okay. Heidi: Yep. Yeah. I mean, they didn’t explain the details of it either. They just said, “Oh, it’s the ARRIVE trial,” so I go and Google and try to make sense of it. They just say, “Stillbirth risk increases.” They say, “If you are induced at the 39th week, there is no increase and chance of a C-section,” so I thought, “Oh, okay. Sure.” Meagan: Right. Right, yeah. Heidi: I finally gave in near the end and I scheduled my induction for the 39th week and 6th day. Meagan: Okay, so almost 41. Heidi: Yep. So then I worked right up to the night before my induction. I was admitted to the hospital at 7:00 AM. I was planning for an unmedicated, uncomplicated delivery and an induction using a Cook balloon because my provider had checked me in the office the day before and they found that I was 1 centimeter dilated so they said they could probably get the balloon. I’m thinking, “Oh, it’s going to be a mechanical induction. There’s going to be no IV. It’s going to be really as natural as possible.” 18:08 39-week induction Heidi: I get into triage and immediately, they start putting an IV in my right arm. I am right-handed. Meagan: Why do they do that? If you are listening and you are getting an IV, don’t hesitate to say, “Hey, that’s my dominant hand. Can we put it in the other one?” Also, don’t hesitate to say, “Don’t put it in my wrist where I’m going to try and be bending and breastfeeding a baby in the end. Put it in the hand or put it up in the arm.” Heidi: That’s really good advice. I didn’t know that the first time. Meagan: I didn’t either. Heidi: I knew enough to say, “Whoa, whoa, whoa. Put it in my left hand.” They ended up putting it in my forearm. So here I am. I was hooked up to Penicillin. I was GBS positive. I feel like I had all of the things. Meagan: Yes. We’ve got gestational diabetes, GBS, maternal age, and now we’ve got an induction. Heidi: Yeah. Oh yeah. So yeah. They put in Penicillin, Pitocin, and saline, and then they showed me how to move around while wheeling an IV pole. Meagan: Mmm, yeah. Fun. Heidi: Yeah. We felt a little gutted at that point. We are in the hospital and sorry, when I say we, it’s my husband and I. Yeah. The midwife had trouble getting the Cook balloon in. We just sat around on Pitocin that first day. The OB finally got it in around 10:00 PM that night. It was her first visit to see us actually. She probably could have gotten it in earlier had she come earlier. It sped up the labor overnight as soon as the Cook balloon went in. It was a bit painful. They stopped the Pitocin the next morning. My water broke on its own. They were talking about coming in to break my water and I think my body probably heard them, so it broke on its own. Yeah. I was just laying in the bed and it happened. Then labor began to pick up, but the contractions were still not regular. Pitocin was increased and then the contractions got really intense, but still irregular until around 4:00 PM that day at which point, I just couldn’t take it. I asked for the epidural. Meagan: That’s a lot. That’s a lot. Heidi: Yeah. It was intense. 20:59 Pushing Heidi: The shift changed and a new nurse had a student with her. So I consented to the student being there thinking, “Oh yeah. Come on. Come observe my awesome labor. This is going to be amazing. It’s going to be a vaginal delivery and everything,” so I’m like, “Yeah, sure. Let them learn.” I achieved 10 centimeters dilation and full effacement around 9:00 PM that night so it was really exciting. Meagan: That’s actually pretty fast. 10:00 is when the Cook was planned the night before. 9:00 PM, so hey, that’s pretty good. Heidi: Yeah. I was happy about that. I was so excited to push. I couldn’t feel a lot because I was on the epidural, but it really took the pain away and it helped a lot in the moment. So let’s see, I was mostly on my back. I was tired. I was just really tired at this point. There was, the nurse that I had was pretty new. She had been there for I think 6 months and then she was also trying to juggle the student nurse. She didn’t have a lot of knowledge of positioning. I thought going into it that all nurses were trained in Spinning Babies and all nurses had the knowledge of baby positioning and things like that, but I was wrong. Meagan: Yeah, unfortunately, they are not all. I don’t think a lot of them have it actually. Most of them don’t. Heidi: Yeah. I pushed mostly on my back and when the OB came in around 11:00, she noticed my pushing was not effective at 11:00 PM. Meagan: So two hours in. Heidi: Yes. My position needed to be changed. She got me up on the squat bar and then she left again, but she showed me how to push and everything in the meantime. When she came back in, she explained to me that I would probably need a C-section soon. I don’t exactly remember that sequence of events because it is so intense. I felt really defeated. I was like, “I just started. What do you mean I will probably need a C-section?” Meagan: So you were still wanting to keep going? Heidi: Oh yeah. Oh yeah. She also explained that meconium started to show in the amniotic fluid. The OB explained to me that the baby was probably in distress because of that. That was all that was said. Heidi: I spiked a fever. They gave me Tylenol and then the baby’s heart rate began to slow a little bit, just for a little bit. The OB inserted a monitor on the top of her head. At this point, I felt like I was pushing for my life. I was like, “Oh my gosh. I need to get this baby out. How do I do this?” But I still felt like, “I can do this. I can do this. I know I can do this.” Meagan: Yeah. Heidi: But there were definitely questions at this point. 24:29 Arrest of descent and opting for a C-section Heidi: Yeah, so then around 2:30 in the morning, I was told by the OB to get on all fours and try one last position and I could opt for a C-section at that point or I could push until the OB came back in. I was like, “You know what? I’m going to give it all I have. I’m going to work so hard and the baby is going to come out in the next 45 minutes. She’s got to.” So I did. Honestly, I was so grateful that I had that last 45 minutes. I feel like if I didn’t, it would have been stolen from me. I feel I was defeated when she came back in because she was still not out and I was exhausted, but I was ready. The baby was not going to come out any other way at this point for whatever reason. That was going to be dissected months later, years later by me, but in the moment, yeah. She was at station 0. I was told she wasn’t far enough down to do an assisted delivery, so they wheeled me into the OR for the C-section. I requested that the baby have skin-to-skin as well as delayed cord clamping. Unfortunately, none of this happened and I guess I should also note that once they put the monitor on her head, she did great. She still was not in distress. I was doing great too. The C-section was just really for arrest of descent. They just thought it was taking too long because I had been pushing for a little over 5 hours at that point. Meagan: Yeah. Heidi: Yeah. She was born via C-section at 3:20 in the morning. She weighed 7 pounds, 1 ounce and she was in the OP position. Meagan: I was just going to say, was there a positional issue here? I always wonder when there’s patterns like yours where I’m like, “That sounds like a positional thing.” Okay, so OP. Occiput posterior for anyone who is listening or sunny-side up. Baby just needed rotation. Heidi: Yeah. Yeah. Yeah. That was that. Meagan: Yeah. So then did you end up when you got pregnant, did you end up staying with this provider? How did that journey begin? 27:06 Researching providers before second pregnancy Heidi: I went back– let’s see. I’m trying to think. I went back for routine care almost a year later. I had care in between, but I had wanted to see that provider just to have closure. I asked her. At the time, I wasn’t really sure that I wanted another child. My husband and I were just really thinking, “Is that what recovery is always like?” After the C-section, it was really hard. I asked her, “If I were to have another child, what would be my odds of delivering vaginally? Could I have another child that way instead of the C-section?” She said, “You probably would end up with another C-section if you even tried so you probably have about a 40% chance.” It was not based on anything. Meagan: Hmm. So she didn’t even do the calculator, just gave you a percentage. Heidi: No. Just gave me a percentage. Meagan: Oh dear, okay. Heidi: So at the end of that appointment, again, I still had not really educated myself and knew that there were amazing resources out there, so I just said, “Okay. If I have another child, I’ll have to have another C-section.” I went home and told my husband. I said, “If we have another child, we’re going to have to have a C-section.” We were both like, “Okay, maybe we won’t have another child.” Yeah, so then another year passed. We were beginning to get ready and slowly started to research other providers just for routine gynecological care. We ended up finding a hospital that was just about 25 minutes away just thinking, “Well, what if?” I had heard this hospital was well-known for VBACs and I had also started seeing a pelvic floor therapist prior to going to this hospital for care who was working at this hospital. It was kind of on my radar. Heidi: From there, I met the OB. I met the OB and then I was just really shocked at how supportive she was. In the past, you just go into the OB or gynecologist and they will put you in a gown and they do whatever they need to do, a pap smear or whatever. But this one, the nurse had said, “Don’t get undressed. They want to meet you. They want to talk to you first.” Meagan: I love that so much. I love that. That’s awesome. Heidi: It was so different. It was in a hospital, but it didn’t feel like a medical office. The rooms were painted blues and greens. You could tell there was a lot of effort being made to make it feel like home. I began my journey. I had just met with her. This OB had talked to me about birth story processing. I had no idea what any of this was. I had no idea that I even had trauma from my last pregnancy at this point until I had just met with her and was talking with her. She said, “There is no pressure if you don’t want to have another child.” I was just there to meet with her and have a check-up. I think I want to say a couple of months passed and actually, that night, I went home to see my husband. I was like, “You know if we do have another child, it’s going to be here.” Yeah, so a couple of months went by and we did decide to have another child. Again, the baby was conceived right away. No complications. This time, we started working with a doula. I began birth story medicine at the same time. I did that for a couple of months in addition to my therapist to process the birth trauma and just everything. I was tested for gestational diabetes early during this pregnancy. I started insulin at 11 weeks and I was just kind of ready this time. It wasn’t as scary honestly the second time. It’s a lot of work. I would say that it was annoying, but it wasn’t scary. Meagan: Well, and you’re like, “I’ve done this before. I did a really good job last time. I learned a lot,” because you did go pretty deep into it, so you’re like, “I can do this. I’ve got this.” Duh, this kind of sucks, but you know. You got it. No problem. Heidi: Right. My first baby was born at a really great weight and there were no complications at all. Meagan: Good. Did they already start talking about induction and things like that from the get-go? Did they talk about extra testing? Because at this point, you for sure have it. Earlier or later, did they talk about that stuff? Heidi: With this provider, I went in and they told me I was old last time, the other provider. I’m really old. They looked at me and were like, “No, you’re not.” Meagan: No, you’re not. Heidi: Yeah. They’re like, “You’re 37. That’s not old.” Meagan: Yeah. Heidi: I’m like, “What?” Meagan: The other clinic, would they have wanted to do NSTs because of age and gestational diabetes? Heidi: I don’t know. Meagan: Okay. But these guys were like, “No, we’re good. We don’t need to do any extra testing because of an early diagnosis of gestational diabetes and now you’re 37.” Heidi: Yeah. They said what they do consider older but it’s still not impossible was, I believe, over 40. Meagan: So you didn’t even have that pressure from the get-go? Heidi: No, no. Meagan: What an amazing way to start. Heidi: Yeah. It was amazing. They also weren’t concerned with the fact that I was on insulin. We did talk about NSTs because I asked because I knew it would come up and they had said, “You can have once a week as long as your sugars are in control, we are comfortable with that.” I felt so relieved. Yeah. It was such a holistic, relaxed approach. They trusted me to manage my body and to know what I needed and that was so empowering, the whole journey whereas before, I felt like I had a really short leash and they were basically managing everything for me as if they knew what was right for me and my body. Meagan: I was just looking. I’m just looking because I’m sure people are like where is this person? Where is this provider? Was it at the CMC? Is that where it was? Heidi: Yes. Yeah, Catholic Medical Center in Manchester. Meagan: Awesome. This is good. These are good vibes here with this provider. Heidi: Totally, yeah. Oh my gosh, yeah. 38:04 Discussions around induction Heidi: So let’s see. Once I’m diagnosed with gestational diabetes, I have maternal-fetal medicine ultrasounds, but that also was true because my first daughter was born missing a kidney. Again, she’s totally healthy and totally great, but they wanted to make sure that nothing weird was going on, yeah. That was at about 32 weeks. They were also checking the baby’s growth and baby’s size at that point. Baby was measuring very average. She had two kidneys. Little things that we take for granted, we were so grateful for. Yeah. That went really well. The pregnancy was just progressing really well. In my third trimester, I was struggling with all of the extra appointments and the trauma that I was processing though from my last birth because I knew and my gut told me, “You need to work through this because if you don’t, you have to be really strong to have a VBAC. You have to really work through a lot of mental blocks and things that come your way.” So I just started getting really stressed between work and the appointments will all the different therapies so I decided to take a couple of months away from work prior to the delivery in order to process everything and prepare myself. That was a really hard decision but it was probably one of the best decisions that I could make. Meagan: Good for you. Heidi: Yeah. At around 36 weeks, it was suggested to me by my provider that I could consider a 39-week induction, but it was delivered so differently. Meagan: Good. Heidi: Reasoning basically says that ACOG has a suggestion for insulin-controlled gestational diabetes. They basically told me the data. They told me why they are suggesting this, but ultimately it is my choice. It was a discussion that I just found to be so incredible and weird in a really good way. Meagan: Which in my opinion is so sad that these things happen that are good conversations have to feel weird to us because that should just be normal, but it’s not a lot of the time, right? Heidi: Yeah. I was working with my doula at the time and she was a really big proponent of expectant management and letting everything happen naturally and honestly, that’s all I ever wanted. I think that’s what most people want. So I just explained, “I am not interested in induction. I want to do expectant management as long as everything progresses the way that it’s going and it goes well. That’s what I want to do.” They said, “Okay. We can do that.” Meagan: I love that. That’s great. Heidi: It was amazing. It was really empowering. 41:45 NSTs twice a week Heidi: So let’s see. They suggested that I have a 36-week ultrasound to check my baby’s size again. Actually, no sorry. They suggested it. I was actually able to negotiate my way out of it. I said, “You know, I just had one at 32 weeks. Is it really necessary to have another in 4 weeks?” I talked to the OB and she was like, “You know what? No. You don’t have to do that.” Yeah. Meagan: Things are just getting better and better. Heidi: Oh, so good. Yeah. So right around then, the NSTs began. I’ll just say also, I walk into– so NSTs were really awkward during my first pregnancy. I sat on the hospital bed so uncomfortable and sitting up with all of these things attached to me. At this provider, I go in. There is an NST room and it’s painted blue and it’s really common. There is a reclining chair and for me, it just really felt like they were normalizing the fact that NSTs do happen and it’s okay and it’s normal. Here’s a special space for it. Meagan: Well, and almost like they are setting you up for success in those NSTs because in NSTs, when we are really uncomfortable and tense, overall, that’s not going to be good for us or our babies. That’s going to potentially give us readings that we don’t want but when we are comfortable and we are feeling welcomed and we are like, “Yeah, we’re not happy that we are here taking this test,” or sometimes we are, but when we are comfortable and we are feeling the beautiful colors and the nice, soft recliner, it’s a very different situation to set you up for very different results. Heidi: Yes. Absolutely. Yeah, so then my journey just kept going. My NSTs were beautiful every week. It was really interesting how they set them up because they had the NSTs after the doctor’s appointments because they weren’t expecting. If they can get a good reading, I think the minimum is 20 minutes whereas I had the NSTs before so it was like they were looking for a problem then I had the doctor’s appointment so I ended up being there for 2 hours during my first pregnancy. But these ones, I never sat more than 20 minutes. The nurses usually saw what they needed within 5 minutes and they said, “Your baby is doing great. You’re out of here as soon as the time is up.” Meagan: That is amazing. Oh my gosh, 2 hours. That is a long time. Heidi: Yes. Yes. This pregnancy was really odd, but I’ll take it. I stopped needing insulin during the last two weeks. Usually, there is a peak near the end of pregnancy, and then the need for insulin goes down in the last two weeks I want to say. For me, it actually just kept going down, down, down, and then all of a sudden, it was gone. That didn’t happen last time. They were a little nervous about that because it didn’t really happen. I explained to them, “I think it’s honestly probably lack of stress,” because I wasn’t working at my job at the time and I was moving a lot more too, so who knows? Meagan: Really interesting. Heidi: It did make them a little nervous because they said there is very limited data, but sometimes it can indicate an issue with the baby. Meagan: Oh, the placenta. Heidi: Sorry, I’m nervous so I’m forgetting. Meagan: There are times when it can be the placenta being affected. Is that what they were saying? Heidi: Yes, thank you. They said, “We could offer an induction at this point,” because I was at 39 weeks when they brought that up. I said, “I don’t think so. I really want to stay the course. I want to do expectant management.” They said, “Okay, would you be open to twice-weekly NSTs?” I said, “Yes. If that lets me keep doing what I’m doing, we can do that and it’s probably not a bad idea, because you never know.” 47:10 Testing for preeclampsia Heidi: I woke up one morning at week 40 and thought my water was trickling out. I texted my doula and she was getting home from another birth and was going to rest, so I worked with my backup doula for that day which was a little scary. I didn’t know what was going to happen from there. Around 6:00 PM that night, my husband and I arranged for my mom to watch our daughter because we needed to get to the hospital to get the amniotic fluid checked. We probably should have gone a little earlier, but the backup doula had suggested it might not be amniotic fluid. It might just be discharge. Meagan: Is there much going on labor-wise? Heidi: Not really. It was pretty quiet. Then I actually had an NST the day before that and there really wasn’t much going on. I felt little Braxton Hicks-type things, but nothing much. We packed our bags, got ready, and got my mom. We arrived in triage. I had slightly elevated blood pressure which was just a routine check, but that basically led to them testing me for preeclampsia and then a urine test. Meagan: Hmm, a slight increase? Oh, man. Heidi: Yeah. It was slightly increased. You know, like a lot of people, hospitals make me nervous. Meagan: Yep. Yeah. They jumped right in and started going the moment you got there. Heidi: Yes. Yeah. It’s different. It’s still in the hospital, but it’s separate. Labor and delivery is separate. They just had a very different mindset at the moment. I was sure that I didn’t have preeclampsia. They asked me all of the questions and I’m like, “I really don’t think that’s what this is.” They were saying, “You’re also post-date with gestational diabetes.” Meagan: Post-date by one? Heidi: Yes. Meagan: Or by 40 weeks. Heidi: Yeah. Yeah, so I would need an induction if I get preeclampsia and all of this. Who let this girl go this long? What the heck kind of thing? Meagan: Not helping your blood pressure, that’s for sure. Heidi: I definitely started feeling PTSD. I was just like, “This again? Oh no. I feel like I’m in prison.” That’s the way it felt last time. I knew I needed to get out of there fast. It wasn’t good. The OB came in and lectured me. This was a different OB. She lectured me about preeclampsia and how I should really stay in the hospital. They were going to send for bloodwork even if it came back okay, I should stay the night. They drew the blood and I’m just beside myself at this point. I was like, “Well, when are they going to get the results back?” They said, “Probably about an hour or so.” You know how backed up the lab is. They were like, “Are you really going to drive home and come back?” I was like, “If I have to come back, which I really don’t think I will, then yes, I will.” The blood was taken. The nurse ran back within– I want to say it was 10 minutes. It was really fast. She said, “You guys should really consider staying. Your platelets are low.” I said, “Okay.” Meagan: The labs came back that fast? Heidi: They came back really fast. Meagan: Because you were saying that you were maybe going to go back home? That’s interesting. Heidi: Yeah. I said, “Okay. That’s thrombocytopenia.” My provider had said I had that. We talked about it and I also had it during my last pregnancy. Meagan: Wait, what did you just call that? Heidi: Thrombocytopenia. Meagan: Thrombocytopenia. I’ve heard low platelets. I’ve never heard it called that. Heidi: Thrombocytopenia. I actually listened to a podcast oddly enough with Nr. Nathan Fox. Meagan: We love him. Heidi: Yeah, he’s awesome. He was basically saying that it’s common and it’s generally not a big deal. Meagan: I just Googled it. Yeah, it says it’s a condition where the platelets are low. It can result in bleeding problems. Yeah. Okay, all right. Keep going. Heidi: Yeah. It was interesting because he had said, “Within range,” and I was within that range, but I also talked to my provider about it months before and she said, “Oh yeah. This is common. We are not concerned with your levels.” Luckily, I was like, “Oh my gosh. I know enough.” I was like, “Nope. I know what that is. We are okay and we are going home. They can call us with the results.” So we went home. Meagan: That is amazing. Did they make you sign an AMA or anything like that? Were they just like, “Fine. We were going to have you stay, but you are good to go.” Heidi: Yeah. There was no paperwork. Meagan: Okay. Good. Heidi: I was free. Yeah. I was actually amazed at how– I mean, I was very firm with them. I was just like, “We are going home now.” Meagan: That is hard. That is really, really hard to do, like really, really hard so good for you for following your gut. Heidi: Yeah. It felt really good. Yeah. We got home. I started to feel some mild, irregular contractions and the same thing I had been feeling. We sent my mom home because she was still at my house. Like, “Go ahead. We’ve probably got another day.” I was like, “I know something is going to be happening soon. I feel it.” So around 10:30 that night, I got the call from the OB– Meagan: Yours? Heidi: Sorry, the one in the hospital that was treating me. She had said, “All right. You don’t have preeclampsia. You don’t have to come back.” I said, “Okay. We did it.” Meagan: Yep. Yep. Yep. Can you imagine having to be there that whole time? Heidi: No. Yeah. I’m sure they would have found something else. Who knows? Meagan: You never know. 54:53 Spontaneous labor Heidi: Yeah, so when we were home, we unpacked our bags, ate some food and sent my mom home. I bounced on my birth ball. I was pumped. I was so excited. We were like, “Okay. Back on the normal track.” Then around midnight, some contractions started that I figured would stop once I laid down for bed. I didn’t really know. I never really had normal, non-Pitocin-induced contractions before, so I didn’t really know what they would feel like. I was in denial, to be honest. I was like, “There’s no way. I’m not going into labor right now. What are these? These are nothing. It’s just cause I’m nervous or something.” I laid down. My husband was already asleep at this point and they didn’t stop. They just kept getting stronger. I was lying there thinking, “No. I can’t go into labor right now. I don’t want to see that OB. I can’t. I can’t. This is not happening.” I was just willing my body, wishing and willing my body to wait until 6:00 AM or 7:00 AM until the shift change. So then I was like, “Okay. I should probably start timing these because this is no joke.” I found a timer and started timing them. They were spaced at 5 minutes apart lasting a minute each. I was like, “This is early labor. This is it.” I finally woke my husband up and I was like, “Hey. I think we’re going.” Meagan: This is going to happen. Heidi: Yeah. I called my doula. I had been texting her meanwhile the whole time and she was super supportive throughout, then I finally was like, “I need to call her.” She talked me through what I was experiencing because I had no idea. She was like, “You guys should probably leave soon because this is your second baby and it could happen really fast.” I noticed there was pink discharge. Meagan: And you had made it to 10 before. Heidi: Yes, exactly. She was like, “This could happen really fast.” I noticed some discharge and it was pink. Contractions started to be really regular and really painful. She was like, “That’s probably your cervix dilating.” I was like, “Why am I dragging my feet? We need to go. We need to go now.” 57:43 Going to the hospital Heidi: We called my mom to have her come back to our house. I think it was 1:00 in the morning at this point. She didn’t answer immediately probably because she was exhausted. Meagan: Probably asleep, yeah. Heidi: When she did, it was finally 2:00 AM and there was a bit of an ice storm outside, just a little one but just enough to make the roads slippery because she had texted me when she was going back home and she was like, “It’s kind of icy. I just want to let you know.” So then I was like, “Oh no. My mom’s on her way, but it’s going to take her a while to get back to the house.” Then it’s going to take us a while to get to the hospital. It was really getting pretty scary, but we were just like, “Okay. Let’s just pack our bags again,” because we had started unpacking them. My provider had actually said that they were comfortable with me going until at least 41 weeks so I was like, “I could go until 41 weeks and then who knows?” Meagan: Right. Heidi: Anyway, so we put everything back. It was a really good distraction and then every single contraction, we would stop and brace ourselves. My mom got to our house at 3:15. We got to the hospital around 4:00 AM. It was the longest car ride of my life. My doula was like, “The contractions might slow down in the car.” I was secretly praying that they didn’t because so many people that I knew had prodromal labor and I was like, “I want this to come like a freight train. I don’t want it to stop.” It is so painful, then a lot of people say you get nervous when you get in the hospital. Things will slow down. I was just so nervous about all of that. I got to the hospital. My doula arrived soon after. We spent almost two hours in triage even though we were already there filling out paperwork. The contractions didn’t stop or slow down during this. I was beside myself. I was like, “Oh my gosh. My body is ready. We are doing this.” The nurse in triage, at the time, was a different nurse. I think she worked a half shift or something, but she was really skeptical of VBAC. I was not comfortable with her. She said I couldn’t eat. She had obviously outdated info. I asked her, “Why can’t I eat?” She said, “Well, the odds of you needing another C-section are higher.” I’m like, “Well, how do you know that?” It was just really frustrating. I requested a midwife to deliver my midwife because the same OBs were on staff. I was going to a midwife for my care, a midwife, and an OB team. I actually ended up seeing the midwife even more than the OB so I really was comfortable with requesting a midwife to deliver, but the nurse really pushed back. She said, “You’re a VBAC. I don’t think you can have a midwife.” Yeah. She went into the hall, made a phone call with the midwife and the midwife on staff actually said no supposedly because I was a VBAC. Meagan: What? They had never said anything like this in your prenatals. Heidi: No. No. I think again, it’s a little different. They also use other hospital staff at this hospital so you never know who you’re going to get, but my doula is there and that’s what matters. That’s why I had a doula because you don’t know. Meagan: You don’t always know, yeah. 1:02:03 Laboring in the tub Heidi: They asked to do a cervical check. I was hesitant, but they said, “We have to do this to admit you.” I was like, “I’m not leaving at this point. I’m clearly in labor.” I consented to it and they found I was 4 centimeters dilated so I stayed. I got to my room around 6:30 and actually, I think I was about 80% effaced at this point. I got to my room around 6:30 and I just began setting it up to distract myself. My doula started setting up the bath for me. I was like, “I want to go to the bath.” I got to the tub around 7:00 AM to deal with the contractions because I really wanted a natural birth this time. My water broke 5 minutes after that. Shift changed at 7:00 AM. I feel like my body was like, “Okay, hey. Shift change at 7:00,” and then my water broke. Meagan: You said we were in triage for two hours and I was like, “Your body was waiting for shift change intuitively.” There you go. Heidi: I got in the tub. My water broke. A new nurse came in around 7:15. She had a trainee, but this was a nurse who had a lot of experience and she was just training to be in labor and delivery so it was basically like an extra set of experienced hands. She was also a nurse who had run a training for us a couple of months before and I was like, “I hope I get this nurse. I really, really hope I get this nurse.” In she walked, and I couldn’t believe it. She came down to me at the tub. She started asking me questions right away about my birth plan. It’s like she studied it. It was the most amazing thing. I can’t exactly remember what she was asking, but just clarification and she was like, “Yes. We can do this. We can do this and we will do that.” I was like, “Wow.” The first time, I had a birth plan, but I’m pretty sure they burned it. Meagan: Aww. Heidi: Then she just started talking about how the birth process would go and how I would be feeling mentally more than likely and she also said that she is well-versed in Spinning Babies. Meagan: What you wanted! Heidi: Yeah. Yeah. I was like, “This is heaven.” I also took a short course in it to prep for this labor and I really was trying to do all of the things. I couldn’t do all of the things, but I think there is a lot of science to Spinning Babies, especially having an OP baby the first time. Initially, I was experiencing back labor. She asked me, “Where do you feel your pain?” I said, “In my back.” She said, “Get on all fours. The baby could be OP.” I was just like, “Oh my gosh. I will do anything to not have another OP baby.” She said, “We’re going to spin her.” I stayed on all fours. I just did this. I started using the nitrous. This hospital provided nitrous. Meagan: Nitrous oxide? Heidi: Yeah. The other hospital did not have that, but I was so excited for that. It helped me just breathe through my contractions, really get in tune with my body, and gave me a focus. I was able to move around really freely. When I was in the tub, I started to feel the urge to push so we moved out into the bed. I still stayed on all fours. But I was also just, I don’t remember this, but my doula was saying that I really was kind of dancing. I was moving in the ways that my body told me to do. It felt so incredible and obviously painful. 1:06:22 Pushing for 30 minutes Heidi: Then it was about 9:15 and I was really, really wanting to push at this point. I was told to wait for a cervical check though and I was like, “Why do I need a cervical check? I’m ready.” Meagan: My body is saying I’m ready, yeah. Heidi: Yeah. A midwife came in. She introduced herself and she was like, “I’m going to be delivering your baby.” I was like, “Okay.” I couldn’t believe it. It was a different midwife and she was like, “I want to check you because you could have a lip if you’re not fully effaced. Your pushing will be ineffective.” She found that I was 10 centimeters dilated, fully effaced so then we went on and pushed. My daughter came out at 9:46 AM so we pushed for a half hour. Meagan: Oh my gosh! So you got baby in a good position and isn’t there such a difference between pushing? Heidi: Yes. Not having the epidural, I could feel everything. It was so real. She was 7 pounds, 3 ounces. She did have a compound presentation. She was head down, but yeah. She came out with her hand pressed against her head. Meagan: Yes, come out thinking. Heidi: Yeah. I had really no tearing, very, very minimal. I achieved the delayed cord clamping. My husband got to cut the cord. We didn’t have to remind them of our wishes. They just knew. We had a golden hour which I never had before, but I was told I could take as long as I wanted, and yeah. It was just the most beautiful thing I have ever experienced in my life and I just couldn’t believe I did it. Meagan: Yeah, what a journey. I am so happy for you. Heidi: Thank you. Meagan: Congratulations. And now, at this time of recording, how old is your baby? Heidi: She is 8 weeks. Meagan: 8 weeks. Brand new! How has the postpartum been? Heidi: Oh my gosh. It’s been amazing. I mean, as amazing as it can be. Let’s be real, but compared to what it was. Meagan: Good. I’m so happy for you. You know, when you finished your first, you were like, “My husband and I didn’t even know if we would ever want another kid.” I can just see this joy on your face right now. Where are you at in that stage now? Are you two and done or are you like, “I could do this again”? Heidi: We are two and done. Meagan: Hey. Heidi: Yeah, I mean it’s funny because the nurse and my OB were like, “You really should have another one.” Meagan: This is what I did. I went out with a bang. You went out with a bang. Heidi: You can’t top this. Meagan: You got the birth you wanted and all the things. You know, you advocated for yourself in the birth room. You left and then still advocated for yourself in the birth room. I mean, how amazing. How amazing. Heidi: Yeah. I ended up with the most supportive team. You do never know what you’re going to get, but the team that came in at 7:00 AM, oh my goodness. They treated me like I was just a normal, vaginal birth. There was no VBAC. There was no jargon. It was beautiful. Meagan: I love hearing that. That is truly how it is supposed to be and it’s so often not. Then yeah, then we learned more about the correct diagnosis or term of low platelets. I totally Googled it really quickly and it just said that gestational thrombocytopenia, how do you say it? Heidi: Thrombocytopenia. Meagan: Thrombocytopenia is a diagnosis of exclusion. The condition is asymptomatic. It usually occurs in the second half of pregnancy in the absence of a history of thrombocytopenia. Heidi: You got it. Meagan: It said, “The pregnancy and the platelet counts spontaneously return to normal within the first two months of postpartum.” We will make sure to have a little bit more reading. It will go back into some things, but one of the things it does say is that it is not necessarily an indication for a Cesarean delivery which is also important to know because I mean, there can be low platelet levels that are more intense like HELLP syndrome and things like that, but this is a really good things to know because that would have easily been something if it hadn’t been for Dr. Nathan Fox and if it hadn’t been for them talking to you about this. It could have scared you like, “Oh, okay. Okay. Let’s stay.” But you were fully educated in the situation and were able to make a good choice for you and advocate for yourself and say, “I feel good about this. You can call me when the preeclampsia levels come back, but I feel good about this decision. We’re moving on.” Then the amazing, miraculous, no insulin need, that’s another really cool thing about your story, but I also wanted to share Lily Nichols. I don’t know if you’ve ever heard of her. Heidi: Yes. For my first pregnancy, I read both of her books. She’s amazing. Meagan: She’s amazing. We’ll be sure to link her books and stuff in the show notes as well so you can make sure to check it out. If you were given a diagnosis of gestational diabetes or even actually just in general, her books are amazing. You can read and be really, really well educated. Okay, well thank you so much for sharing your beautiful stories. Heidi: Yeah. Thank you for having me. Closing Would you like to be a guest on the podcast? 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