# Does a hospital have to follow my birth plan?



## Think of Winter (Jun 10, 2004)

Hello,

I am 29 wks and hoping for a natural birth in a hospital. I am high-risk, so a birthing ctr (even if there were one around here) or home birth is not an option for me. After a tour of the fabulous new birthing unit, I was disappointed and scared by the number of routine interventions they use (IV, no eating during labor, pitocin for delivering placenta, rooming-in discouraged, NO vbacs at all, etc.)

So I've written a birth plan, and am trying to figure out if we can afford a doula and bradley classes. I really want this birth to be as natural as possible (my previous birth experience was not good.)

My question is, how much of my birth plan can I insist on? Are there certain things that the hospital or my OB will say absolutely no to? Can they legally do that? W/ my first baby, born in another state, my perinatologist flat out said no when I asked for a few things, like to hold my baby immediately, or postpone an induction. I guess my fear is that my ob or the hospital will say "if that's how you want it, find somewhere else to have your baby."

Can anyone help me with this?

Oh, I wanted to add that so far my pg is uncomplicated (even if high-risk), and my birth plan says right at the beginning that I understand interventions may be necessary, but I don't want any routine interventions.


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## Satori (Jan 30, 2003)

I was flat out told my plan for a natural birth would not be respected with dd and not a single thing was respected. I'm considered high risk as well and am still planning on a home birth and will only go if I feel I need another c/s because dd's birth was so tramatic and there was no labor involved with her birth, i'd hate to think if I'd had to have a vag birth under those conditions. I'm not playing nice this time and making it clear, its my way or no way if I end up in the hospital again.


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## MerelyGod (Apr 5, 2005)

I sorry, I don't really know whether they have to follow a birth plan or not. I don't THINK they do, but I do think that you have the right to refuse any "treatments" they try to give you. Definitely, definitely try to get a doula if you can, and bring a bunch of copies of your birth plan to the hospital. Put one on the door of any room you are in, and give one to each nurse and doctor who sees you.

I also recommend bringing a copy of your birth plan to your next appointment to see what your OB says about it. If you get a negative response, you might want to look for a new OB, if at all possible. You can ask them to put a copy of your birth plan in with your chart (makes it seem more "official"). Another thing you can do is call the hospital and discuss your birth plan with someone who works in that department. They might be able to tell you how they would handle it. Even send a copy of your birth plan in with your pre-registration.

I also wanted to say, that I left my hospital tour horrified. The woman who gave the tour was administrative though, and didn't even work in OB, so I think she just didn't know how things were actually done (we were told they'd have to take the baby to do a bath and tests, and she seemed disappointed that there were no babies in the nursery when we walked by). I had a fabulous birth experience though. They totally respected my wishes and followed my birth plan exactly.

If you don't get positive reactions from your OB and hospital, I'd definitely recommend waiting as long as possible (as long as everything is going well) before going into the hospital. Actually, I'd recommend that anyway.


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## christifav (Nov 10, 2005)

Like pp, I was also flat out told that "you can write a birth plan, but I wouldn't show it to anyone". Meaning that the staff actually resents patients who want a say in their care and it will end up making you a "hated" patient who gets worse treatment (if that's possible).

I also toured a different hospital that was VERY respectful of a woman's right to choose her birthing options and on my way out of the hospital, the head OB nurse said, "I've been doing this for 30 years and I INSIST on doing your birth YOUR way".

So....Check out your nearby hospitals and hopefully one of them will sound more like the second hospital I toured.

Good Luck!


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## alegna (Jan 14, 2003)

There's not an easy answer. You don't HAVE to agree to anything. You CAN refuse EVERYTHING. BUT they will basically be on auto-pilot doing everything the way they always do. AND there is nothing you can do if they don't follow your plan, and they know that. Depending on the reason for being high risk, I would probably homebirth anyway. IMO and research there are very very few situations where you are actually safer birthing in a hospita.

-Angela


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## aileen (Jan 23, 2006)

when i was pregnant with my dd i was planning a hospital birth until, like you, the tour freaked me out (intermittent monitoring means 1/4 of every hour!?). it seemed that my ob was really at the mercy of the hospital. it sent me reeling, but once i got my feet on the ground i was able to get some good information.
#1. get a doula. if you can't afford it ask for peaolpe to chip in instead of presents?








#2. call and talk to nurses in delivery. i spoke with some women who were so understanding and helpful. they encouraged me to ask for a "high touch" nurse who likes doing natural births. also see #1.








#3. i have heard as well that having too long of a birth plan is sometimes viewed as a negative thing. another reason to have a doula. then you have an advocate instead of a list.








#4. do some kind of birthing from within type meditation to release your fears and frustrations form your last birth and about childbirth in general. also see #1.








i ended up falling head over heals for my doula (can you tell?) so much so that at 30 weeks i decided to plan a homebirth with her (she is a mw and naturopath, as well) but i truly believe that i would've had a lovely hospital birth with her by my side (well, lovely, but maybe with an episiotomy - not so lovely - at home sara just said, "this is when they'd be trying to give you the episiotomy".) be where you feel comfortable, and interview doulas until you meet the one who inspires confidence and makes you giddy to birth. you _can_ have a fabulous hospital birth.


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## yequanamama (Aug 30, 2002)

Your main issue is your caregiver. If your OB (I'm guessing?) is supportive of your plan, the nurses will have to honor it. If your OB is not supportive, find a new one NOW while you can. I know of women who have switched care providers in labor!

Certain things may be routine in a hospital, but that doesn't mean you can't arrange otherwise for your own birth. I WOULD check out another hospital, if that's an option for you, and run a birth plan by your OB, ASAP, to determine where they stand.


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## Think of Winter (Jun 10, 2004)

Thank you very much for your replies. I have an OB appt in a couple of weeks, so I'll run it by her then. I'm not optimistic. When I asked if she knew any natural childbirth classes, she gave me a number for Bradley (the only one around here) and said "I wouldn't recommend it though. The Bradley patients come in here with birth plans and things like that."

I spent quite a bit of time looking for an OB, and have already switched once. There are just very few options where I live, and natural family living is treated as an anomaly ("you mean like those people out in Colorado?" is what my OB said when I mentioned that I've been discouraged by how few resources there are around here for NFL.)

I really wouldn't mind driving an hour to get a better practitioner, but how do I find one? I called everyone I knew early on, and asked every pregnant woman I met.

I'll be out of town for a few days, but if anyone has more suggestions, I'd appreciate it. Thank you so much.


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## bobandjess99 (Aug 1, 2005)

Stay at home. UC if you have to. Otherwise, they can and will do anything at all they want to you. PERIOD. It is SOOO DANGEROUS to birth in a hospital...I just don't see why so many people don't understand that.......


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## MovingMomma (Apr 28, 2004)

Go to http://www.ican-online.org. Download the PDF file under "breaking news" near the top of the page ( "Enforcing and Promoting the Rights of Women Seeking Vaginal Birth After Cesarean (VBAC): A Primer"). READ it, especially the section starting on page 6, titled "Customizing Your Consent Forms: The New Birth Plan."

They do NOT have the right to perform a procedure that you refuse. BUT you must know how to enforce your rights.








Good luck!


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## Peony (Nov 27, 2003)

The nurses do play a huge role in a birthing plan. I am an RN, while I never was an OB nurse, I did assist when they were busy and worked on the other side of the floor so I knew most of what was going on in OB. Sometimes you can request certain nurses, if it's busy then sometimes it's whoever they can get to take another patient. While they are supposed to read birthing plans, it doesn't always happen no matter how many copies you give them. And I hate to say this, but there are some nurses who feel birthing plans are absolute BS, I got to listen to them pick apart and laugh at the birthing plans when things were slow.







They may know your wishes and still choose to ignore them. When dd was born, a RN I worked with frequently was my nurse, she knew exactly what I wanted, and still tried to get me to go along with things that I kept refusing, even though my CNM told her it was not neccesary. Remember the OB is only there is short periods of time, the majority of time will be spent with a nurse. Yes, you can refuse things, but that doesn't mean that they will take that easily and leave you alone. I highly suggest a doula, you need someone that you know and trust to be your advocate. You may get a wonderful OB nurse, or you may not, I wouldn't risk it without the help of a doula. Contact your local LLL leader and see if she knows a better OB, it sounds like you need one.


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## yequanamama (Aug 30, 2002)

The description of your doctor is definitely discouraging! It sounds very much like you'll have to find yet another doctor if you want a birth free of dangerous interventions. (What a pain!







: Why can't more doctors realize they serve US instead of vice versa?!)

I would contact that Bradley teacher right away. Even if you don't take her class, she'll be happy to give you the names of the doctors in your area who are the most supportive of natural childbirth.

The other people to check with would be doulas. You can find a list of doulas in your area on the DONA website (http://www.dona.org/mothers/find_a_doula.php) and ALACE website (www.alace.org) Make a few phone calls, and you should end up with a least a couple of better OB options. They'll also tell you if there are other hospitals in the area that are more supportive of natural childbirth.

Taking the time and effort for all this SO worth it. I'm one of those that searched for several weeks to find a situation I'm comfortable with. And it means I'll be driving nearly an hour to get to a hospital with supportive policies and midwives I can trust. (Homebirth not legal, and no birth centers here







) And I've got a hospital 7 minutes away! (And 20, and 25, and 30.)

Out of curiosity - and only if it's not too personal - why are you considered high-risk?


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## Quagmire (Sep 27, 2005)

Quote:


Originally Posted by *colleen95*
Thank you very much for your replies. I have an OB appt in a couple of weeks, so I'll run it by her then. I'm not optimistic. When I asked if she knew any natural childbirth classes, she gave me a number for Bradley (the only one around here) and said "I wouldn't recommend it though. The Bradley patients come in here with birth plans and things like that."

Oh dear. That does not sound good at all.

My hospital wasn't overly progressive, but they did accept my birth plan, put a copy in my file, and honor most of my wishes *during the birth* I had several OBs in my practice but the one I went over my plan with was the one I ended up delivering with too, and she didn't seem to think anything was weird about my bringing one in. All of my baby wishes were ignored







: A lot of the nurses in the nursery were real formula pushers and didn't pay any attention to the birth plan or the signs I taped to the bassinette ("I'm breastfeeding, don't give me pacifiers or formula" etc)

Anyway, is there another hospital in your area? Another OB practice you can look into? I believe you can switch up until 36 weeks in most places (don't know if that's state law or insurance law or what have you... that's what I was told by my midwife) If you are so high risk that you feel unsafe delivering outside a hospital or you can't find a midwife who will take you, then at least you might find an OB who is more open to caring for well-informed patients!


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## saritabeth (Jun 25, 2004)

Okay...I am a big supporter of birth plans. Its really good to know what you want and have your partner and caregiver on the same page.

This birth I am taking a different route. My MW knows me really well. My dh knows just what we want. I am not bringing a birth plan to the hospital because of the nursing eyerolling etc. I am also having a VBAC so they are already going to have all kinds of ideas about me.

Basically, I am going to give in to some stuff that I normally do not want...heplock, continuous monitoring....But because I am a VBAC I know that if I argue on these smaller points it is going to make the nursing staff obsessed with me. Im going to decline IV fluids, epidural etc...Im just going to be somewhat passive agressive as far as my treatment is concerned. I don't want to be a challenge to some nurse who just wants me to comply.

I don't know how great of a plan this is, but Im really wanting a VBAC and a hospital birth is pretty much my only option at this point (I looked into home birth and other options).

If your OB won't be with you and doesn't respect your wishes you may need to make a switch. The main reason I feel comfortable with what I am doing is that there is nothing I want that my MW is not 100% supportive of helping me with.

Good luck!!!


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## MovingMomma (Apr 28, 2004)

Quote:


Originally Posted by *saritabeth*
This birth I am taking a different route.

Please go the ICAN website and read the document I talked about above. The section on customizing your consent forms sounds like exactly what you need, and all the other info will be especially pertinent since you are a having a VBAC.


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## s_kristina (Aug 9, 2004)

Although it is a long shot I would check out this website http://www.babyfriendlyusa.org/eng/index.html It is the US website for the WHO and UNICEF's baby friendly plan. They have a list of hospitals and birth centers that are certified, but there are only 52 in the US. I just had my ds in November at a Baby Friendly hospital with a midwife and things went almost exactly how I wanted them to. I hadn't planned on such massive blood loss pp so ds spent some time in the nursery which is usually empty. The other thing I suggest is LLL. They have always pointed me in the direction of great doctors/midwives. The Bradley teacher I talked with did not know of any midwives working in hospitals near where I lived at the time, but the LLL ladies did know of one a half hour away. That Bradley teacher only knew of homebirth midwives and homebirth just isn't a safe option with my medical conditions. Good luck with your information gathering and birth.

eta: check to see if there is anyone local in the finding your tribe forum. I have gotten some great local advice when I moved to FL from them.


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## sapphire_chan (May 2, 2005)

Colleen, in your area are there any CNMs? If you need to be in the hospital, that might be a good compromise.

Something that's confusing me and I hope others will clarify: I thought most high-risk pregnancies had a chance of premature labor so you needed to be *ready* to use a hospital, but at term a homebirth was fine.


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## MovingMomma (Apr 28, 2004)

Quote:


Originally Posted by *sapphire_chan*
Something that's confusing me and I hope others will clarify: I thought most high-risk pregnancies had a chance of premature labor so you needed to be *ready* to use a hospital, but at term a homebirth was fine.

Totally depends on _why_ you are high risk.


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## sapphire_chan (May 2, 2005)

Right, but what other possibilities are there? I'd think spinal bifida and things like that would be more likely found towards the end of pregnancy, it wouldn't be something that would make the pregnancy high-risk to start with. I know there are things that can risk out a homebirth, but I thought they were mostly things discovered later on, the mom was low-risk right up until the problem was found.


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## rebeccalizzie (Apr 1, 2005)

I second asking in the Finding your Tribe forum. It's how I found my incredible wonderful super natural birth friendly ob/midwife team...in the midwest, of all places. I don't know *anyone* IRL who has had or even wanted a natural birth, I would have had no idea where to even start looking if it weren't for this place.

The idea of asking the Bradley teacher is a good one as well. Or asking your doula when you find one (and yes, a doula would probably be a good idea for you).

Good luck...I think between your hospital tour and your (s)ob's attitude, you should at least try to find someone else. From the little I know, I don't *think* you *have* to consent to anything, they can only take over and force interventions in a life threatening situation. But are you really going to want to fight with nurses and doctors while you are in labor???


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## Emilie (Dec 23, 2003)

i just came across ds's birth plan- no it was not followed- it was laughed at and the nurses were very rude to me. i did not want an epiesiotomy- and they Never attempted to get the baby out without one. I also put in there that I wanted him with me at all times- they took him from me for 3 hours- while I BEGGED- literally BEGGED- short of knocking down a door to get him- and they did not bring him to me.
They told me at the tour it would be followed. It was not. I did not have anything out of the ordinary on there to begin with( I had and wanted at that time) to have an epidural.
Here is the thing- do you want to feel in labor like you are having to STRUGGLE and ASK permission to do what you want- or do you want your birth to be about you- with no permission- no asking involoved? If so- get yourself a midwife- have a backup OB to watch for trouble- and have the baby at home.
Go read the birth stories on here. HOmebirth is not as crazy as it sounds. Really. I do not know what makes you high risk- but I would talk to a HB midwife about your issues. They are mostly HIGHLY skilled with natural labor- something doctors and nurses really know VERY little about. 30% of the births they see end of in sections. That alone in itself says they are not even good at VAGINAL delivery let alone NATURAL delivery. I have a friend who is an OB nurse- she thinks women who don't want drugs are STUPID and UNSAFE. PERIOD. NOw not all OB nurses are that way- but MANY are. Find out what the % of non medicate births are at your hospital.
Good luck to you.
Emilie


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## Emilie (Dec 23, 2003)

I secod- if you do choose to go the HOSPITAL birth route- a doula seems to be a neccesity- if only to advocate strongly for you wishes and KNOW about natural birth.


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## UnskulinMama (Nov 1, 2005)

Wow, I just have to say... I just read the ICAN paper on patient rights that someone mentioned and it *really* opened up my eyes. I sooo recommend everyone go read it! It's a straightforward read, and is certainly not just for women with previous c-sections! Very very good stuff there... I think hospital staff will be alot more willing to do (or not do) what you say when you show them that you *KNOW* your rights and will not be bullied!


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## Satori (Jan 30, 2003)

Quote:


Originally Posted by *UnskulinMama*
Wow, I just have to say... I just read the ICAN paper on patient rights that someone mentioned and it *really* opened up my eyes. I sooo recommend everyone go read it! It's a straightforward read, and is certainly not just for women with previous c-sections! Very very good stuff there... I think hospital staff will be alot more willing to do (or not do) what you say when you show them that you *KNOW* your rights and will not be bullied!

Rights or not they can and will make your life hell if you don't go along with the system, do you really wanna deal with that while in labor and pp? The only way i'm getting near the hospital for birth is if i'm seriously sick and need a c/s NOW because I know both my baby and I will be put through the wringer.


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## Think of Winter (Jun 10, 2004)

Well I am back from our trip and have caught up on the thread. Thank you all so much for your input. How depressing that hospitals are under no obligation to respect our birthplans.

To answer a few questions, I have type 1 (aka juvenile) diabetes. But my blood sugars have been excellent, the level II US showed no defects, and baby's growth is on target (big babies and birth defects are the main risks). Preterm labor is not a concern. I'm going to ask my perinatologist tomorrow what the specific risks are during labor and birth.
I'm pretty sure that I will not be able to find a midwife who would deliver me at home, as appealing as that is. I've looked around. Thanks for the links to baby-friendly hospitals (not one w/in 90 miles) and doulas (I have an appt. with the only one around.) I am seeing her next Monday, and have high hopes that she'll be able to either give me suggestions for a better OB practice, or that with her as my advocate, I can be reasonably assured that my wishes will be followed. I have tried the finding your tribe forum before, and haven't found anyone in my area (S. Jersey), but I did send out another message.

I too looked at ican online. But it's not clear to me how it would work to customize the hospitals consent form. How do I know before the birth what I will be willing to consent to? It's going to depend on what happens, right? Wouldn't it be dangerous to refuse all interventions before I know if I might actually need them? Anyone have any ideas about this?

Thanks so much, ladies.


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## mamanurse (Jan 22, 2006)

Ok, so I see you got a lot of very helpful replies, but I thought I would just throw in my two cents. I wanted a homebirth very badly when I found out I was pg. However, it was $1800 cheaper (for us, not our insurance) to have a hospital birth. We went with a hospital birth with an OB and managed to have a natural almost 100% non-interventional childbirth.
We had a birthplan, too, but our OB wasn't exactly onboard. As a nurse, I realized that they had to have my permission for any intervention (even routine) and had my husband be an assertive advocate.
The first piece of advice I can give is to stay at home AS LONG AS POSSIBLE, provided your water (if it broke) is clear and you are not having excessive bleeding. We were only at the hospital 37 minutes before dd took that first sweet breath.
However, in that 37 minutes, the RN managed to insert an internal fetal monitor and I received an episiotomy. Even though I said no to these procedures, my dh was too excited and distracted to assertively advocate for me. They justified the IFM because "everyone needs to be monitored the first 20 minutes" and the OB gave me an episiotomy because I had already torn.
There are also some compromises that can be made. Perhaps if your OB is insistant on an IV, they could just insert the catheter and not hook it up to fluids/medication unless "needed."
Remember, it is your wonderful body and only you can decide on what they do to it. Take care and good luck with a fabulous birth and healthy babe.


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## MovingMomma (Apr 28, 2004)

Quote:


Originally Posted by *colleen95*
I too looked at ican online. But it's not clear to me how it would work to customize the hospitals consent form. How do I know before the birth what I will be willing to consent to? It's going to depend on what happens, right? Wouldn't it be dangerous to refuse all interventions before I know if I might actually need them? Anyone have any ideas about this?

On pg. 6 of the ICAN white paper, in the 2nd to last paragraph, Prown writes:
"such a document will require staff to obtain direct, verbal consent from you each time they want to do a procedure you've already declined in writing. Then you can decide at that time if a treatment is needed and if you should accept it or not."

In other words, customizing your consent forms creates the default of "NO" and requires the staff to obtain your explicit consent for each procedure. Something I assumed was the default, but during DD's birth learned otherwise. I verbally told them no w/some procedures, which they performed anyway, and they administered Pitocin without asking or even _informing_ us. We found out about that later in my records.

FTR, we did have a birth plan. We are planning a homebirth with #2, and we will be customizing consent forms w/our backup hospital.


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## Think of Winter (Jun 10, 2004)

Thank you, Shannon. I should have read it more carefully. That sounds like a very good approach, to have NO interventions be the default.

Has anyone tried this, customizing their consent form? I'm curious what the hospital's response was. I guess I'm paranoid, but could they refuse to preregister me if I modify the form? I got my preregistration package today, and the consent form is very generalized.


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## Satori (Jan 30, 2003)

Quote:


Originally Posted by *colleen95*
Thank you, Shannon. I should have read it more carefully. That sounds like a very good approach, to have NO interventions be the default.

Has anyone tried this? I'm curious what the hospital's response is. I guess I'm paranoid, but could they refuse to admit me if I modify the form? I got my preregistration package today, and the consent form is very generalized.

Thats one thing I was wondering and how much will they badger you until you consent? Or will they pull a we can't/won't do xzy treatment until you do abc treatment when your refusing abc treatment.


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## MovingMomma (Apr 28, 2004)

Quote:


Originally Posted by *colleen95*
Thank you, Shannon. I should have read it more carefully. That sounds like a very good approach, to have NO interventions be the default.

Has anyone tried this, customizing their consent form? I'm curious what the hospital's response was. I guess I'm paranoid, but could they refuse to preregister me if I modify the form? I got my preregistration package today, and the consent form is very generalized.









Your welcome! I've read through it a few times, and keep going back and using the search function to reference specific things.

I don't know about refusing to preregister you, but pg. 7 talks about EMTALA, which says that a hospital has to admit you if you are in active labor & can't transfer you to another hospital until after you've delivered both the baby and the placenta.

And Satori, I think it's pretty much the luck of the draw (what the nurses on duty are like) as far as how much they will harass you during labor. I figure that since I was harassed and manipulated so much when we did things the "nice" way and I still ended up with a handful of unwanted interventions that it's worthwhile for me to put up with more harassment in order to stand firm on my rights and come away without unwanted interventions (if, God forbid, we do have to go to the hospital).


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## MovingMomma (Apr 28, 2004)

Quote:


Originally Posted by *mamanurse*
There are also some compromises that can be made. Perhaps if your OB is insistant on an IV, they could just insert the catheter and not hook it up to fluids/medication unless "needed."

I'm going to caution against making compromises. I thought that sounded like a good idea w/DD, but each compromise we made ended up in the full fledged intervention.

We agreed to intermittent external fetal monitoring: The medwife declared DD's heartrate "unreassuring" during the first "intermittent" monitoring & said we'd have to leave the monitor on.

We agreed to a heplock so an IV could easily be administered if necessary. They said I was looking dehydrated, but when I requested to drink in order to hydrate myself before putting the IV in, they laughed and said, "sure, try it!" while getting the IV ready. They had it in before I finished one glass of water. Later they administered Pitocin through the IV w/out our consent or knowledge.


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## kaylee18 (Dec 25, 2005)

Compleat Mother had an article by a mom with Type I diabetes who had (IIRC) two midwife-attended homebirths and then a hands-off hosp birth after midwife attendance was made illegal in her state for diabetic mothers.

I can dig it up and scan it in for you if you like.


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## littlest birds (Jul 18, 2004)

I have had two homebirths and one hospital birth with twins.

I customized my consent form. It said that I refused all procedures without direct consent. I also told them they could not do an episiotomy during labor (I'd already had a 10-lb baby at home) and they did not. I never asked them what I could do, but I did make compromises about what was less important to me. I do not think I could have fought for my rights very well if I had not already had a homebirth and tons of confidence in my body and in birth. I had a doula there who was really supportive and helped me decide when to compromise and when not to worry.

My first birth was a homebirth because I had a really condescending doctor for prenatals who obviously had no intention of using my birth plan. I found a midwife within about two weeks of my due date, and had a wonderful homebirth.

Ignoring or barely acknowledging birth plans when the going gets tough is the norm, even when a doctor agrees to "try" to stick with one... and when they don't even intend to try there is no chance. A birth plan gives you no rights if the doctors have your signed consent at admission, because that consent consents to pretty much whatever they see fit to do. And I think your rights are shaky no matter what in the hospital, unfortunately. I really hope things go well for you. Hospital birth is very frightening to me, and I hate the feeling that womankind (and "childkind") is full of its victims. I felt very fortunate that mine went okay--most don't. I don't want to reassure you, because trusting the professionals is simply not safe. Please do everything you can to make yourself safe!


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## Think of Winter (Jun 10, 2004)

Quote:


Originally Posted by *kaylee18*
Compleat Mother had an article by a mom with Type I diabetes who had (IIRC) two midwife-attended homebirths and then a hands-off hosp birth after midwife attendance was made illegal in her state for diabetic mothers.

I can dig it up and scan it in for you if you like.

I'd really appreciate that. Thank you. I found out today from my perinatologist that the reason it's so difficult to find a doctor here to support a natural birth is that my state is second in the country in malpractice suits. Things are so backward


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## yequanamama (Aug 30, 2002)

I think someone mentioned this earlier, but do you have CNMs in the area? They can usually care for diabetic patients.

As for the compromise route, that actually DID work for me with my first birth, as I agreed to and received only a saline lock, and intermittent monitoring. But you've got to go with your gut on that one. Do you think they'd really honor your wishes? Are you willing to really stand up for yourself in the face of the system if the badger you about it? Or would it be better to go the customized birth plan route and wait until you find an OB or CNM willing to care for you?

It really bites that we have to go to SO MUCH TROUBLE just to have a normal birth, doesn't it?


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## 3daughters (Aug 11, 2004)

My good friend is an OB resident. She says that woman that come into the hospitals with birth plans inevitably end up with a c/s. Its a staff room joke...

Also, I think it was Naomi Wolf in her book Misconceptions that backed up my friend's statement. In short, she believes that birth plans are not even worth the paper they are written on since they are so disregarded.

I wish you the best of luck finding a caregiver and hospital that will respect your wishes. My co-secretary has Type I Diabetes and I feel bad talking about natural birth and breastfeeding her since I know the cards are stacked against her in terms of finding caregivers that won't demand a c/s and formula right after birth







.


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## Think of Winter (Jun 10, 2004)

Quote:


Originally Posted by *3daughters*
My co-secretary has Type I Diabetes and I feel bad talking about natural birth and breastfeeding her since I know the cards are stacked against her in terms of finding caregivers that won't demand a c/s and formula right after birth







.

Yikes! I had many interventions with my son's birth, but was never told I'd have to have a c/s, only that my chances were 40%. Luckily I didn't need one. Is her baby really big? And formula? Why? If newborn's blood sugar is low, breastmilk does the trick. My ds did have slightly low blood sugar at birth (in the 40's, I think) but after a feeding it climbed quickly. BM is more digestible, as we know, so it's the best thing for them. If she is interested in corresponding, send me a pm and I'll send you my email.


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## MCatLvrMom2A&X (Nov 18, 2004)

When I had my dd in the hospital I only saw my ob 2 times total during 12 hours of labor. The first time he came in i was 7cm and he broke my water (without my permission) the second time was 20 min later when he came in to delever my dd. I didnt have a birth plan because when i mentioned it at one of my prenatal appt's the ob looked at me like i was stupid. I did tho tell both my dh and my mom who would be with me during labor what I did and didnt want. Well I ended up basicly getting everything I had said I didnt want. The first thing I told the ob that I didnt want was a episiotomy just as soon as he got into position to catch the baby and he looked at me smiled condesendingly and said OK. not even 2 min later he said gotta cut a epis. so snip snip. He did ask me if it was ok but when u are in the middle of pushing out a baby u cant think all u are thinking is I want it over.

So I learned that they will smile and say ok but when it comes down to it they will do it there way no matter what u really want. They are not worried about complaints after really cause most patients dont bother to follow up on poor treatment they just want to hurry up and get home.

The bottom line is when u walk thru those doors they can and will do whatever they want to do either by bullying u into it or just doing it before u can say no. U are at there mercy.

Even tho u may know better ur mind will play tricks on u when they suggest things. I found myself doubting my previous convictions when the ob suggested things I know were not needed.

I was also given pit without my permission.


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## kaylee18 (Dec 25, 2005)

Here's the article! Sorry it took a couple of days; I ended up typing it in.

_Compleat Mother_ terms of use:

"For the purpose of promoting natural, enjoyable birth and extended breastfeeding we welcome wise women and men to reproduce our stories, artwork and news without obtaining permission."

*Homebirth AND Diabetes*
_by Meg Scherbatskoy, Vermont_

_*Type 1 (Juvenile or Insulin Dependent) Diabetes is a form of diabetes that tends to develop before the age of 30, but can occur at any age. It's caused by an immune system attack on the insulin-producing beta cells of the pancreas. When the cells are destroyed, the pancreas can no longer produce insulin. People with Type I Diabetes must take insulin to survive. Insulin is the hormone produced by the pancreas that helps the body use glucose. It is the "key" that opens the "door" to cells and allows glucose to enter. The glucose then fuels the cells.*_

I developed Insulin Dependent Diabetes just before my 13th birthday in 1976. Diabetes and hypoglycemia run in my family, so it was not a complete surprise, but devastating nonetheless. It meant many changes for me and for my family; new responsibilities and new concerns around the clock, seven days a week. I did not handle it well during my teen years - not an uncommon story. I went into the hospital at least once a year for extremely high blood sugars.

In 1978, my mother came to visit me in the hospital before going to work; she ended up staying when she went into labor with her fourth child. As I stood in the hall of the delivery unit in my nightgown, I learned I had a sister to go with my two little brothers. A doctor came out to tell us that Mom and the baby were fine. He and I were talking and somehow the conversation turned to me having children. I was "too small and my diabetes too brittle (unpredictable)." He said I should plan to adopt. I was 15 years old.

I don't really remember my reaction to this news, but I do remember soon after deciding that I would never have children because I did not want to inflict them with diabetes. At that time, complications for insulin dependent mothers and their babies were very high. Mothers had a much higher rate of miscarriage, pre-eclampsia, kidney failure, heart problems, and high blood pressure. The baby might be overweight at ten or more pounds, or may have delayed lung development, heart complications, or multiple handicaps. The baby could have severe low blood sugar immediately after birth and if taken past 'term,' a risk of being stillborn. The mother's blood glucose staying consistently above 120 mg/dl can cause these complications. Today, with the advent of new technologies, new medicine, and research, these complications can often be completely avoided - though many doctors still do not believe this.

By 1988, I was married and had long since decided I _did_ want to have children. My husband, Jon, and I wanted to have at least three. The doctors were now telling me that I would probably be able to go to term and have a vaginal birth, but I would have to be in the hospital with the high-risk team. This was not what I wanted to hear.

I had been introduced to the 'alternative' lifestyle since Jon and I had made our home in Vermont. While still seeing my endocrinologist (diabetes specialist), diabetes educator, dietician, and ophthalmologist regularly, I now used homeopathics, herbals, chiropractors, bought our food at a natural food store, only wore natural fibers, etc. My chiropractor became my primary care provider while I saw an MD once a year for insurance. I also had the honor of being at a friend's homebirth. That experience made it quite clear; I wanted to have a "natural birth" - a _homebirth_.

Over the next five years, I read a lot about natural childbirth, improved my health, and prepared to start a family. I tried to read about diabetes and pregnancy, but there was almost nothing out there. I went to the library on the campus of the University of Vermont to research, only to find books on diabetes that were 10 to 30 years out of date.

In 1993, I got a clean bill of health with no diabetic complications, and a nod from my endocrinologist that it would be safe to conceive. I talked to my friends' midwives and they agreed to take me on. This was a new experience for them - scary even - but something they were willing to try. Jon and I got to work and in a few months, I was pregnant. As soon as I found out, I knew she was healthy and that everything was going to be fine.

My endocrinologist strongly advised me to turn my care over to the high-risk team at her hospital. Jon and I went for a visit (even though I had been warned not to go by several friends, based on their own experiences), to see if I wanted to receive care at the hospital. We were met at the door by a resident with the attitude that 'of course' I was going to get my care there, because no one else in the state would work with me. I should have run screaming from the place, but the doctor we spoke to reassured us that most of their mothers had "normal" births, and that they would work with me and my wishes. He did not think homebirth was even an option.

For the first six months of my pregnancy, I was with the high-risk team. For a multitude of reasons, this turned out to be the wrong place for me. There were six doctors on staff, any of which would be on call for my delivery. They wanted me to take a litany of tests, which I refused. I had to go for an office visit every two weeks, and every time, they would rehash all the things that could go wrong (like I didn't get it the first, second, and third time they told me). I was unhappy, depressed, and sometimes made to feel irrational. Whenever I went for an office visit, my blood pressure would be borderline; anywhere else it was well within the normal range. My husbands and midwives kept me sane. It finally came down to a disagreement about IVs. The doctors said they could not give me adequate care without an IV during labor and delivery. I had read that IVs can significantly slow labor, leading to induction and Cesarean. I would refuse an IV unless it was truly needed for erratic blood sugars or dehydration. They told me I should look for a doctor willing to work with me on those terms. I think they fully expected I would be unable to find anyone willing to work with me and come back with my tail between my legs. They were wrong.

I had already talked to my midwives about finding a new obstetrician to work with before the IV dispute; I also found a new endocrinologist. I was referred to a husband and wife team that is often back-up for our midwives. As it turned out, these OBs had 15 years' experience working with insulin dependent mothers, happily worked with midwives, and are advocates for homebirth. After reading my medical records, they were enthusiastic to work with us. I had very tight control with my A1C running 5.5 to 6.1% and had been very healthy throughout my pregnancy.

_Hemoglobin A1C is the substance to the red blood cells that carries oxygen to the cells and sometimes joins with glucose (sugar). Because the glucose stays attached for the life of the cell, about 4 months, a test of hemoglobin A1C shows the average blood glucose level for that period of time. Today, 4.3 to 6.1% is considered normal. Anything below 7% is considered excellent for an insulin dependent person._

The only problem I had had during my pregnancy was insulin reactions; they were often severe. Usually, insulin dependent mothers have trouble keeping their blood sugars low enough (between 80 and 120 mg/dl). I had difficulty keeping them above 70 mg/dl. Insulin reactions do not seem to affect the health of the baby.

_Insulin Reaction (Low Blood Sugar or Hypoglycemia) is a condition in which blood glucose levels drop too low (generally, below 70 mg/dl). Symptoms include moodiness; numbness in the arms, hands, and face; confusion; and shakiness or dizziness. When left untreated, this condition can become severe and lead to unconsciousness, convulsions, and, eventually, coma._

We discussed homebirth at length. My OB felt it would be better for me to deliver at the birth center. Because this was my first child, we had no way of knowing how I would labor and deliver. Would it be three days or three hours of labor? What would my blood sugars do?

The doctors and our midwives would not agree to a homebirth. This was a disappointment, but it made good sense. At the birth center, there would be no IVs unless truly warranted and no invasive monitoring of the baby. There would be a shower to stand in, freedom to move, and welcoming midwives. We started to prepare.

April 6, 1994, I went into labor: five weeks early. We hadn't gotten very far with our birth preparations. We took our time getting to the birth center, assuming we had at least 12 hours of hard work ahead of us. I walked in and my doctor examined me to see how far along we were. She gave me this big grin and said, "Well, you're fully dilated and there's a hairy little head down here." Forty-five minutes later, our daughter Genoa was born at 5.9 pounds, 18 inches; obviously a few weeks early, but strong as a horse. There was no intervention of any kind. By drinking juice as needed, I had kept my blood sugar between 75 and 85 mg/dl. The whole process had taken four hours. Our midwife missed the birth: fast, simple, and sweet. We went home ten hours later. I became a stay-at-home Mom who attachment parented by nursing, using cloth diapers, co-sleeping, etc. After Genoa turned two, we started to think about having another baby. I wanted to get an insulin pump before conceiving. A pump would give me better control of my diabetes, make the pregnancy much simpler, and reduce insulin reactions. About the time I started negotiations with the insurance company for the pump, I found out I was pregnant. As soon as I knew, I panicked. Something wasn't right. I didn't know what was wrong or what the ultimate outcome would be, I just knew this wasn't going to work. I went to my endocrinologist, my OB and my midwives. Everyone said I was healthy and in good control. There was no reason to be worried. So I got to work.

With Genoa's birth under our belt, our midwives and our OB were more confident that a homebirth was a possibility. We had long discussions with our midwives about everything related to diabetes that could happen and how to handle it. We wrote a detailed letter describing all the levels of insulin reaction and how to treat them. They also had many discussions with our OB, other doctors and other midwives. We compiled as much information as we could. Our midwives were nervous and cautious.

After a few months, they seemed to feel more confident, and we made plans for a birth at home. My OB and our midwives agreed that as long as my good health continued, my blood sugars stayed stable, and there were no other complications, we could probably have a homebirth. The final decision would be made when I went into labor, and was subject to change at any time, depending on what happened during the labor. Now, not everyone agreed with us. Neither my endocrinologist nor my MD thought it was a good idea, and my sister was frightened. My mother just wanted me to be sure I knew what I was doing. But other than having long discussions with us, no one did anything to try to stop us.

In my fifth month, I received my insulin pump. It took a little getting used to, but it made my life so much easier. My control was much better, and my insulin reactions were cut to a quarter of what they had been. Even with a pump, this pregnancy was harder then the last. I was sick the whole time and had little energy. At seven months, my midwife said the baby was not growing. I went in for an ultrasound. The baby was small, but there was nothing obviously wrong. I was scheduled for another ultrasound in two weeks. The day before my appointment I went into labor, four weeks early - March 30, 1997. I called my midwife. She said we were just over 37 weeks so she would be willing to try a homebirth if that was what I wanted. There was a pause as we both thought about it for a moment. Then in unison we both said we should go to the birth center.

We had been advised by my diabetes educator to cut my insulin dosage by half as soon as I went into labor. I thought this was too much of a cutback, but my OB had no experience with pumps so we cut it. A half-hour later my blood sugar went from 85 to 200 mg/dl. This is too high for a delivery. It should be between 80 and 120 mg/dl. I was not happy.

While in labor with intense shaking, I calculated an insulin dosage in hopes of getting my blood sugar back in the normal range. It didn't work. With Jon, Genoa, my mother, and our friend Carol present, our midwife helped to deliver our son Banning after three and a half hours of labor. He was four pounds and not breathing. Our OB whisked him up and took him to a treatment area where they helped start his breathing. He was very sick.

We spent the next three weeks with him in intensive care, until his death on April 20. Eight months later, we received a diagnosis. Banning had an extremely rare form of Glycogen Storage Disease, which affects the heart tissue [transcriber note: from the description, this sounds like Type IIa]. There is no prenatal test and no treatment. The specialists believe it is caused by the parents having a matching recessive gene. They assured us it had nothing to do with my diabetes. That means that any children we have will have a one in four chance of having GSD. The specialist suggested that we have no more children (personally, I think he is a bit of a spineless wonder). I asked if homebirth would be too risky. He said if we should have another child with GSD, where the baby was born would make no difference. If the baby was born in the hospital, they would simply send us home to wait for the child to die. He stressed that if we should have another baby that showed signs of distress, we should get a professional diagnosis prior to assuming it is GSD.

The year after Banning's death was difficult. There was a lot of pain, loss, anger, grief, sad memories and fears for the future. Jon and I did a lot of crying and talking. We had had Banning because we wanted to have another child to hold, love nurture, and watch grow. Banning had been with us for three weeks, but we did not have the patter of another set of little feet in the house. In January, we decided to try again.

By March 1999, I was pregnant: still wearing my insulin pump, no diabetic complications, and we had the same team of doctors and midwives as before. When I realized I was pregnant, I knew everything was going to be fine. However, I always ended that thought with "But anything can happen." I felt great, was healthy and in good control, and had even fewer insulin reactions. Actually, this was the healthiest pregnancy yet. Homebirth was once again on the agenda. We again compiled all the information we would for our midwives, hosted long discussions and worked hard to make everyone feel confident.

The only other concern for our midwives was they wanted this baby to go to 40 weeks - no more early births. So I ate extra protein and got more rest during the third trimester. Controlling my stress level was another matter. Everyone - our friends, family, doctors and midwives - was nervous and concerned. They tried not to show it, but it was there, nonetheless. Jon and I were nervous, too, but I think we all did an admirable job of dealing with our stresses and fears.

I made it to 36 weeks, 37, and then, 38. Our midwives told me I should expect this labor and delivery to take longer, because this child was going to be larger than my last two. I might even be late. We tried getting prepared again. At 38 weeks, our midwives wanted to know if we had everything ready. Yes, we had our birthing kit.


> They asked, "Don't you have the


_preparation sheet_ from last time?"
"No. We have never gotten this far into the process before."
"Well, then you probably don't have the _fast birth, slow birth_ sheets either."
We got all the sheets of instructions we needed, got everything ready, and then&#8230; waited.

On December 6, at 39 weeks, Jon got up a little early to play racquetball in town. I told him I thought he was being a little ambitious. He said we had a whole week; nothing was going to happen. About an hour after he left, Genoa got up and we settled down to eat a meal and then watch a video together. At 11:30, I started to have real discomfort. The baby's head had dropped down onto my cervix. At first it wasn't that bad, but the pressure only got stronger.

I called one of our midwives. Her daughter answered and told me her mom was swimming, so she wouldn't have her beeper on. I called the other midwife. She was just about to go out the door. She told me to try getting down on the floor on my hands and knees, with my head down, to try to relieve some of the pressure. She said some women can have the baby drop down with its head against the cervix for the entire final week (not really what I wanted to hear). I was to give the position a try and call her back in about ten minutes. Down I went on the living room floor.

Genoa watched her movie. I didn't realize it at the time, but I started having regular intervals of discomfort - labor. I called out midwife back and told her it helped a bit, but I was still very uncomfortable. She asked what I wanted to do. Since my last two had come so quickly, I thought she should come. She agreed and said she would leave right away. It's an hour drive to our house.

I called the club where Jon was, and they said they would pull him off the court. I started moaning, trying to keep the sound low and deep. Genoa, now 4 ½ years old, looked deeply concerned. I told her the baby was coming, so I was working really hard. Part of working hard was making all the right noises&#8230; I was all right, just working hard. I wasn't sure she felt any more secure, but she kept watching her movie. A little while later, she put her hand down on the floor in front of my face, and with a truly pitiful voice, told me she had a boo-boo that really hurt and needed a band aid. I tried to comfort her and told her I couldn't get a band aid for her right now, but we would take care of it later. She went back to her movie. The phone rang, and it was Jon calling from the car phone he had installed in case I went onto labor in the car. He was halfway home.

Jon arrived about 1:00. He helped me upstairs. I stayed on my elbows and knees on the bed to try to relive the pressure. Our swimming midwife called to see if I thought I was really in labor. This labor was unlike the first two when the babies had come so early, but I was in labor. We told her she should come.

My OB and I had already decided not to cut my insulin dosage this time. I seem to labor so fast that it just is not necessary. Jon checked my blood sugar; it was in the 50's. He got me juice, crackers, and cheese. He wanted me to eat something because this could take a long time. All I could do was drink juice. He timed my contractions at four minutes apart, two minutes each. Fifteen minutes later they were three minutes apart. Jon called my mother only to find she had left the house ten minutes earlier to go to a meeting down south. We are an hour north of my mother. Someone at her house left to get her.

Jon checked my blood sugar again; it was in the 70's. More juice. The contractions were becoming intense and coming very quickly. Jon was on the floor next to the bed holding my hands. Shortly before 2:00, I announced I had to push. Jon said, "What? Wait, no, no, wait. You can't push! I need to get behind you."

I pushed and the baby's head crowned. Jon was trying to open up the birthing kit and remember what to do first (You'd think having been an EMT for 15 years he could remember how to catch a baby). Another push. I told Jon I was going too fast; I needed to slow down. He reminded me to pant.

Just then, our midwife arrived. I felt relieved. Jon yelled down that he needed some help. I was concentrating on the baby, and Genoa followed the midwife up the stairs. She was so calm, telling us what a great job we were doing. She encouraged us to just keep doing what we were doing. Jon talked to Genoa, showing her the baby's head. When the baby had delivered to the bridge of its nose, it opened its eyes and looked around. A few more pushes and the baby was out, along with all the waters that had backed up behind her.

Ekaterina was born at 2:02 PM: seven pounds, 20 inches. She nursed immediately, and then started searching for her thumb. Much to my midwife's surprise, I delivered the placenta with one push. Ekaterina and I were both healthy and happy. I could feel all the tension and worries just drop away. A half-hour later, our swimming midwife was there to share in the joy.

I had adjusted my insulin pump dosage by cutting it in half. Insulin needs of the mother more than double during pregnancy, but drop back to normal immediately after birth. Because my blood sugar stayed below 120 mg/dl during the labor and birth, Ekaterina - just like Genoa - showed no signs of having low blood sugar.

After more than six years of hard work, I had finally had a successful homebirth. I wanted to birth at home because I believe it is the best possible birthing environment for a mother and her baby. No trips to and from the hospital, no poking and prodding, no unnecessary procedures, no nurses or pediatricians to argue with, no trying to meet everyone's needs but our own and our baby's.

I can hear all those doctors saying, "Boy was she lucky&#8230; again."

Let me tell you, "luck" had little to do with it. My family and I have worked our butts off for this "luck." Our hard work, recent medical advancements, and our team of doctors and midwives are what made this happen. I feel vindicated in my belief that many women with insulin dependent diabetes have the means and ability to have the birthing experiences of their choice. It is no longer necessary or effective for doctors to assume all insulin dependent women must follow the same pre-prescribed prenatal, labor, and delivery routine. Each woman's care can and should be evaluated individually based on her medical history, diabetes education and personal abilities.

This does not mean every woman, whether insulin dependent or not, will be able to have a homebirth. I can tell you the prerequisites that I had to meet:


> (1)No diabetic complication;
> (2) Good overall health;
> (3) Good diabetes education;
> (4) Ability to maintain tight control of blood glucose through the use of sliding scales, diet, exercise, new technologies, etc.;
> ...


These are prerequisites for an insulin dependent mother during any pregnancy, but for a homebirth they are even more critical.

And this is just for starters. There is also dealing with doctors who say you are taking unnecessary risks; doing eight to twelve blood sugar tests a day; writing down everything that goes into your body; appointments with your endocrinologist, obstetrician, and midwife; regularly getting up at 3am to test your blood sugar; negotiating with insurance companies; sliding scales; convincing your family and friends you are not reckless or crazy - and much more.
One more suggestion for any insulin dependent mother - _get an insulin pump_ before you conceive. I have done it both ways and using the pump is far superior. You'll never want to take it off.

I originally finished this story in February 2000; a lot has changed since then. In October 2001, Vermont state laws changed to specify that midwives are no longer allowed to be primary care givers or assist at a homebirth for an insulin dependent mother. I joined with mothers and midwives from all over our state to lobby for a waiver system for some 27 conditions for which the State believes midwives cannot adequately provide care. It was denied. At the time, I was preparing for the birth of our fourth child around December 29. We already had our birthing kit, were working with the same team of midwives and doctors, and planned to do everything just as we had with Ekaterina. In October, we felt forced to make plans to go back to the birthing center for the birth. On December 27, it took me about 30 minutes to realize that I was not having another night of Braxton Hicks, but was in labor. Thirty minutes later, I was holding our daughter Emelin at 8.2 pounds, 21 ½ inches. _Fast, simple, and sweet. No time to go anywhere, no time for anyone to get to us, and no problems of any kind._ We now have three healthy, beautiful girls and the memories of a beautiful boy. Genoa is 8 years, Ekaterina is three years, and Emelin is 9 months. Holding those three, I can assure you it was all well worth it.

Property of _Compleat Mother Magazine_ ISSN 08298564

[I found this note on breastfeeding from the same mom and decided to include it as well]

Dear Mother Dear,
Can a Type I Diabetic mother on an insulin pump breastfeed her baby?
Elizabeth Manuel email: [email protected]

Dear Elizabeth;

Yes, mothers with Type One Diabetes using an insulin pump can breastfeed.
The insulin pump gives regular increments of insulin 24 hours a day; this
is called the basal rate. You also calculate and then manually give
insulin when you are about to eat any food. (This is a bolus.) The bolus
and the basal rates disburse insulin in a way that mimics
functioning islet cells. This means you have fewer spikes, highs and lows.
The blood sugars stay closer to normal. I have had A1C's of 7.5 or less
ever since I started wearing the pump.

The more normal the blood sugars, the easier it is for moms to produce
milk. With spikes or high sugars you get dehydrated and I think there can
be leaching of ketones into the milk. With lows there isn't enough energy
to put towards the production of milk. The more stable your blood sugars
the better your milk production. There is no reason an insulin pump would
keep a mother from nursing and should make it easier to nurse. However, I
did not have the pump when I nursed my first child and I had no problems
at all, even though my blood sugars were not as stable as they are now.
If you have any more questions feel free to email me.
~Meg Scherbatskoy
[email protected]

Property of _Compleat Mother Magazine_ ISSN 08298564


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## Think of Winter (Jun 10, 2004)

Kaylee,

Thank you so much. That was a lot of typing! I often feel very alone in being a type 1 mom aiming for a natural birth, so reading her story was great.

I also really appreciate all the input from the other posters. I feel like I have a much better grasp of what I need to do to maximize my chances for a natural birth. The fact that so many of you have no faith at all in birth plans was a real eye opener. I have an OB appt next week, so wish me luck in communicating with her. She is, according to the maternal-fetal medicine group at the hospital, the most "liberal" OB available. And no midwives will deliver me. So I'm just going to have to make the best of what I've got here.

Thanks again.


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## orangebird (Jun 30, 2002)

Quote:


Originally Posted by *yequanamama*
Your main issue is your caregiver. If your OB (I'm guessing?) is supportive of your plan, the nurses will have to honor it. If your OB is not supportive, find a new one NOW while you can. I know of women who have switched care providers in labor!


Not necessarily. The nurses might call your dr and let them know you're admitted and then you won't see or hear from him again until you are pushing.

I had a very on board with my natural birth plans OB with my first pregnancy but as soon as I got to the hospital the nurses took over and went against everything he had said I could do/ not do during labor. It didn't matter what my doc had OK'd, the nurses ran the show. I was crying and begging to just get up and walk and they were so awful and mean. Once I sat down in the bed they never let me up again, not even to pee, and nothing for a minute was ever wrong with the health of me or my baby. I think if I had to birth in the hospital again I'd either go straight for a c-section or get an epi (I've had two wonderful homebirths BTW) just because thinking of re-doing all the fighting while in so much pain again makes me sick. I would never wish my first birthing experience on anyone, but I think I had a fairly routine birth for the hospital. And it was a vaginal birth even, lucky me. There has to be a midwife who can handle your iddm at home, no? Sorry, I'm just so anti hospital I can't even stand myself when the topic comes up.

Also, working in this area I will say, most L&D nurses I know laugh at your birth plan. They don't take it half as serious as the birthing mom sees it.

If you have to deliver there research the heck out of what you are getting into and bring a good doula.


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## ~pi (May 4, 2005)

Colleen,

I'm T1 (23 years, pumping for 2) and am expecting my first in late June/early July. I'm a grad student in a medically-oriented field so have institutional access to a bunch of resources and have done a lot of poking into journals and clinical texts.

Assuming all continues to go well with your pregnancy, the main risks during and just after birthing for you and your babe are:

(1) Shoulder dystocia. For some reason, the incidence is much higher for mamas with T1, independent of most other usual factors (I am blanking on the actual stat, but it's surprisingly high.) It is still confounded by macrosomia, though, and if you're measuring right on target that's a good sign.
(2) Stillbirth. Incidence is about 5 times normal (so about 2%). May be related to glycemic control during pg, but cannot be fully explained that way. Longer T1 (20+ years) may increase the risk.
(3) Hypos for you during labour. (Personally, I don't consider this any more of a risk during birth than during any athletic event, and it's easily treatable, so I don't take this one too seriously, but it's one of the things that came up in discussions with my MW, endos and peri.)
(4) Neonatal hypos.
(5) Breathing issues for the babe. (However, it is reasonable to suspect that this may have to do with the standard practice of inducing at 38 weeks.)

Personally, I am more than a little freaked out by the ~50% rate of C-sections for T1 moms, but I also think that that may be largely due to the standard 38 week induction and/or women's willingness to schedule a C. (Many of the T1 women I know online have had scheduled C-sections.)

Things I am doing to increase my odds of a successful NCB:

- Working with a midwife.

I am not eligible for a homebirth under my MW's provincial guidelines so she helped me put together a concurrent care arrangment.

My peri is technically in charge in the hospital and my MW doesn't even have clinical privileges at that hospital, so she will be essentially in the role of a doula, but she will be there as a familiar, trusted face, as a professional to make sure the other professionals (nurses, etc.) are on my side, and as someone who has experience with NCBs.

- Working with a supportive peri.

He's really great, has been very open and straightforward with me, and very respectful my choices. He's been very happy to discuss birth plans with me, and seems to be very much on the evidence-based train with me. We've had some great discussions about risk assessment, etc.

- Working with a supportive endo.

My endo is also a big NCB fan and is supportive of, for example, me wearing my pump and managing my own BGs (with DH's help) so long as they stay reasonable rather than automatically having an IV insulin/dextrose drip.

- Discussing my concerns in advance.

Maybe it's the culture here, but birth plans seem to be very well-accepted. I've been discussing elements of them since the beginning with all of my HCPs and all of them are supportive of that.

Since my endo won't be at the birth, and there is a chance my peri won't either, I am having them physically sign off on some of the potentially controversial issues. (E.g. no IV, no heplock, keeping my pump on, etc.)

I'm also arranging for a neonatal consult ahead of time to discuss post-birth care of the babe and plan to stop in at the hospital someday soonish (my lab is right nearby) to chat with the nurses and confirm that they're on board as well. I think I'm pretty lucky in that my hospital is quite NCB-friendly and hopefully there won't be any major problems, even if some of my requests might be a little unusual.









- Waiting as long as possible to head over to the hospital.

My MW will come to our house and we'll all head over together when it's time.

- The other usual NCB things like classes, reading, physical preparation, etc.

Hope this helps! PM me if you want more detail on any of the research I have.

*Kaylee*, thanks for typing that in! That was wonderful to read!!


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## 3daughters (Aug 11, 2004)

Kaylee, awesome story! Thanks for sharing it with us!


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## Think of Winter (Jun 10, 2004)

Maria,
Thanks so much for such an informative post! I'd love to continue to correspond with you as our pgs progress. I'll pm you when I get a chance.
Take care,
Colleen


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