Doulas? Natural Birth?

Diabetes and Pregnancy Trying to Get Pregnant
1

Hi Ladies,

I am just coming to terms with the fact that the birth of my child is going to be much more medicalized than I had always imagined whether I like it or not. I honestly feel that this is the first time in my 25 years of T1 that it is holding me back in some way. I have some time to work through these feelings as I’m only 16 weeks along right now, but it is still something weighing heavily on my mind.

I just wanted to ask all you other T1s out there if anyone was able to birth without being induced or the use of medication? And if anyone used a doula and any suggestions you may have for making sure the doula and the medical team are in harmony?

I am giving birth at Columbia Presbyterian in NYC.

Thank you!

Andrea

2

I’m having a csection this time around. I’ve always dreamed of a assisted water birth. But since were such high risk hospital is our route, my son was induced and he turned out great. Good luck!

3

Since you are early on, have a very in depth discussion with your OB. I wasn’t induced with Pitocin but did have my cervix ripened with cervidril (I was 40 wks 3 dys). My OB knew that I did not want to be induced or have a C-Section unless necessary but when I started developing symptoms of preeclampsia the cervidril was the best option.

I chose to have an epidural but could have opted out if I chose to, but with a 10lb 11oz baby on the way I knew I had a hard job ahead of me. The turned it off for me to push and I delivered my daughter vaginally. That was as close to natural as I chose to get. I’m 14 weeks and told my new OB I’m Ok with a C-section only if I’m full term, baby is over 10 lbs and my placenta is starting to age.

I wonder if your OB would be willing to work with a doula and only intervene if medically necessary. She’ll get paid either way I imagine. Write out what you want and talk to your OB about what is possible and what isn’t. You are your own advocate and you don’t get what you want unless you ask, ask and ask. Good luck!

4

You should check out this book: http://www.amazon.com/Balancing-Pregnancy-Pre-Existing-Diabetes-Healthy/dp/1932603328

I checked it out of the library. I greatly valued reading the varied experiences of women, including at least one who went 100% natural!

I haven’t had my baby yet (I’m at 28.5 weeks), but here are some thoughts that came to mind…

I think it’s smart to accept that our pregnancies and births might be more medicalized than we’d like, because there is a higher chance of it being necessary and we will have to have an OB. However, we don’t need to accept that it will be medicalized no matter what. It’s so totally wonderful that we have modern medicine to help us if medical intervention really is needed, but it’s not necessary if we don’t need it. Some OB’s have across-the-board policies about mothers with diabetes (many induce early at something like 38 weeks simply based on our diagnosis), but remember that the doctor can’t do anything against your will. The best thing would be to find a doctor who believes in interventions based on signs of need rather than policy. (Like, my OB simply does not induce early unless she sees signs that it’s necessary, and she said that I statistically have a higher chance of a C-section but that I shouldn’t assume that means I’ll have one.) Failing that insist on being a part of the decision making process. (My plan regarding C-section, by the way, is to get a clear explanation of why it’s necessary at that point in time. If it’s medically sound, I’ll say yes. If it’s something like, “This labor has gone on for X amount of hours, and that’s just too long,” I’ll say no.)

I’m planning on a doula, and this doula also happens to be a lay midwife. I really like that extra qualification because I think she can keep me better informed about what’s medically necessary and what’s just the doctor or staff trying to hurry things along. She also gave me a lot of tips about which hospital and which doctors in the area are most natural-friendly. I actually didn’t end up going with any of her recommendations because I already felt that my OB-gyn was going to be great about treating me and my baby, rather than my diagnosis. I’m afraid I can’t speak from experience on helping the doula and the staff work in harmony, but I do plan on telling my doc that I consider her my #1 authority, and that the doula is simply there to support me as I cope. I also plan on telling the doula that I want her to treat the doc the same way, and that if she suspects a problem then she needs to tell me when the doc isn’t there, or give me a signal to say, “May I discuss this alone with my husband for a minute?” Doulas don’t generally get in the doctor’s way (that’s not their role!), but I just think there may be a little increased risk of that happening since my doula has been a midwife for over a decade. :slight_smile:

5

Thank you!

6

I’ve already spoken to my OB about her experience working with doulas and it does seem positive (although I haven’t met the other doctors in the practice yet). A doula does not do any of the medical work-she would just be there to support me and my husband emotionally throughout the birthing process. So, the doctor would still have to be involved in some way.

Thanks!

7

I already have that book! But haven’t read the whole thing yet…thank you for reminding me about it!

Luckily, my doctor does not believe on strictly following certain policies and neither do the other doctors in the practice. It is a high risk practice, 5 female OBs, so it could be any of them that deliver my baby.

Thank you for your insight!

Good luck with the birth of your child!

8

Hi Andrea,

I am a few weeks away from the birth of our first child – so I can’t share actual experiences yet, but I can completely relate to the emotions that you are feeling.

I was afraid to read up on natural labor or take a natural labor course because I knew that there would be a chance that I can’t have the labor that I want because of diabetes. So I resisted at first, but eventually I read a book about Bradley labor and we took a class that focused on natural labor. I was convinced that this was the type of labor that I wanted and that would be best for our son.

I was pleased to find an OB-GYN who was open-minded. She lets diabetic women carry to full term if there are no complications and prefers vaginal birth to c-section (and her past patients show that). So I felt like I had the best chance of a natural birth that I could hope for!

Fast forward a few months and despite great blood sugars throughout the pregnancy, our son has grown too big and even my OB-GYN is pretty sure that we will need to do a c-section. She is still taking it week by week at this point. I am in my 36th week now and during week 38, she will decide based on his measurements whether we will attempt induced labor or I will have a c-section. The c-section will be no earlier than week 38 and she may decide to wait, if he and my placenta appear to be doing fine. So I don’t have a date set yet and I will hope that we can leave him there, as long as he shows that he is thriving.

A doula is a good option no matter what type of birth experience you will have (even c-section).

I know that disappointment about how the birth happened is not going to help anyone (the baby or me) after the birth. So I am working now on celebrating the fact that my pregnancy has been free of complications and looking forward to the goal: the birth of our son!! Of course, I do wish that the labor would be different and I hate that diabetes had anything to do with the outcome. But my mother’s words have reassured me: she had a natural labor, an induced labor, and a c-section with her three children and she said that each birth felt equally special because of the end result :slight_smile:

Given that our son has macrosomic measurements and his abdomen is measuring larger than his head, I accept that a vaginal birth could be risky for both him and me. So I’m going to trust my doctors opinion. But a large reason that I feel ready to trust her opinion is because I know that she is not just doing a c-section for ease or convenience, but because she has experience and reasons that tell her that it is the safest in our case.

I hope that you are able to find a team that is ready to try natural birth or the most gentle forms of induction first if there are no complications. I think that it is important that you find a team that you trust so that no matter what decisions you and your team face later in the pregnancy, you will have an easier time finding peace with them!

Even with a c-section, we will have our doula there as a lactation consultant.

9

I’m in the same boat here. I’m at 32 weeks now and have found a OB team that I trust (for the most part). I trust 2 of the 4 doctors. Likely the OB that I see on all my appointments will be the one to deliver my baby. She seems to really care for her patients and she remembers my wishes from week to week so I dont have to forever repeat myself.

My goal is to have a completely natural birth. But, being a brittle type 1 for 13 years, the odds of my placenta making it that far along is unlikely. I’ve come to terms with needing Pitocin to get labor started. They dont do it in one shot- it’s an IV of Pitocin that will begin my contractions and hopefully my body will be able to continue from there. I was adament in all of my visits that there is no discussion of c-section. I have such a hard time healing from even minor wounds (often get infected), that I can’t even imagine what it’ll be like to heal from something so invasive like a c-section. If it comes to that, I’m sure that I will have a mental breakdown. I mean, I want my baby to be safe and healthy… but if I’m recovering from a huge surgery like that, how will I be able to bond with her? I’m really afraid of this.

I’ve written out my birth plan and given it to my Endo, my OB team and the hospital. I will not be using a duola because my doctors all understand what I am wishing for during the birth process. My husband is very supportive. I’m the type of person who will shout if I feel the nurses / docs aren’t listening to my needs. I dont feel there is a need for me to use a duola. We have lactation consultants at the hospital.

I’m getting excited and nervous about delivery lately. I just want this part to be over with so I can hold her and forget all the worries that surrounded this pregnancy. Good luck to you!

10

Hi Andrea,

I’m also only 16 weeks along, but have been thinking about these issues for awhile now. It is hard to accept that diabetes might mean you have to have a different kind of birth experience than you might otherwise choose. At this point, I’m trying to think positively about it and know that a) who knows, I might get to have a natural or mostly natural experience and b) as long as the experience is overall a good one and I feel that I am well taken care of and well informed, and that I feel that my OB is doing what’s best for the baby and for me, then it will be great.

I am going to a high-risk OB practice at a very well-respected teaching hospital. There is a midwifery practice in the same office. I have the benefit of knowing one of the nurses who works on the Labor and Delivery unit there, and I had a long talk with her about what to expect. She told me that some of the high-risk OBs are willing to let their patients be “co-managed” by a midwife. She also told me that there was a high likelihood that I would be delivered by a resident, which is not something I’m okay with (I know that nurses and doctors have to learn somehow, but I’ve seen enough blunders by new doctors and nurses that that scares me!) She said that if I were co-managed by a midwife, the midwife on call would be the one to deliver me, unless there were complications, in which case it would most likely not be a resident.

So that is a long-winded way of saying that perhaps you could ask your OB if this is possible at your hospital. My OB said yes as long as things are going well and there are no complications. So we’ll see what actually happens. :slight_smile: But maybe that’s a possibility for you?

From what I’ve heard, doulas are great. I’ve never heard anyone regret having a doula. My brother and sister-in-law had one even with a c-section, and they loved her. Around here, you can get one for free–one of the nursing schools has trained volunteer doulas.

Good luck!!

11

omg that sounds like such a horrible birth experience! Did you write out a birth plan at all? If so, they just ignored it? I’m just trying to figure out how to avoid this very situation. I’m glad that everything turned out in the end (both of you are healthy), but I would def look into a diff hospital this time around.

12

In my opinion, you need a doula. Especially with type 1 pregnancies and the urging of labor staff for medical intervention. You don’t know what you don’t know, especially the first time around.

For the birth of my daughter just over 3 years ago, we stressed our desires for no c-section, as few meds as possible and alternative laboring positions. What we got was my water broke at 34.5 weeks, doctors induced right away with Pitocin, although I could have waited as much as 12 hours to see if labor would start naturally. The Pitocin, along with all the fetal monitoring, meant I labored on my back and the contractions were a lot stronger than I bargained for. I opted for a epidural based on the pain levels and ended up pushing for 3 hours, resulting in uterine/vaginal trauma since my daughter was turned sideways throughout labor.

After a brief photo op holding her, she was then whisked away for testing and to be put in an incubator and I wasn’t allowed to see her again or nurse her for 3 hours. That was probably the most awful part.

I feel that a lot of this could have been avoided if we had a doula, who had been through it all many time before and acted as an advocate for our desires. We really didn’t know some of the questions to ask or what to fight for during that time of stress.

I am now TTC while living in Argentina and have already contacted a doula organization to find hospitals more open to natural births (although all births are more natural here - epidurals are somewhat rare and have to be ordered ahead of time) and there is no way I am having another baby, especially in a new environment without a doula!!

Best of luck to you!.Every birth is different, but I don’t think you can go wrong with a doula. They are there to attend to your needs and desires, where the doctors just want to get the baby out. There is a huge difference in that.

13

Thank you so much for sharing this story with me! I wish you all the best on the birth of your next child (whenever that may be). I have a few different doulas right now that I am speaking with.

14

Thank you! That is my plan!