We planned to try for a baby about a year after we got married. I expected to have some trouble getting pregnant given my age but I was able to fall pregnant straight away. I was initially traveling quite well with the pregnancy and had no real problems.
I had some bleeding at 10.5 weeks and went to the emergency department of my local public hospital fearing a miscarriage. I was very happy with the way I was cared for and treated, which cemented my plan to give birth at this hospital.
Initially I was only seen by midwives for my antenatal appointments. Even though I was seeing different midwives for every appointment, I was happy with the care that they provided.
Diagnosis of Gestational Diabetes
At 28 weeks things changed. I was diagnosed with gestational diabetes after failing the diabetes test and from there on was only seen by doctors for my antenatal checks. I was checking my blood sugar level 4 times per day and was commenced on a low amount of Insulin. I was doing really well with watching my diet and my blood sugar levels.
Towards the end of my pregnancy I was seen by the same doctor for every appointment, who was the head of the gestational diabetes unit at my local public hospital. I felt reassured that I was in really good hands. She informed me that an induction will be scheduled for 38 weeks and at that time I had no real plans for labour and birth. I was just trusting that the hospital was doing the ‘right thing’.
A friend from work offered me a gift, which was an appointment to see a doula. During our appointment she talked to me about my journey of pregnancy, labour, birth and motherhood and birthing in the hospital system. She strongly encouraged me to hire a doula or independent midwife for extra support.
This gift was a catalyst for me! The more I started enquiring and looking at things I started to realise that it really did matter how I gave birth and brought our child into this world.
Exploring my options…
I started exploring my options outside the main stream public system. I looked at private obstetricians, midwives and doulas. I did like the sound of a Doula. When discussing this with my family, my dad felt that it was better to go ahead with a midwife. With the main reason for his advise being the medical training that midwives have, in comparison to a doula. And I really saw the benefits of having an independent midwife, in particular towards the end of my pregnancy when negotiating safe care became a challenge for us.
We watched Microbirth and the effects of antibiotics and caesarean section on the baby’s future health. I went from someone who didn’t really care much about my hospital journey to someone who cared a lot about how things panned out.
My husband went to ‘Beer n Bubs’, an independent childbirth education program for partners. My husband got a lot out of that session and came back completely fresh and new. He said that we will have this baby the safest way possible but at the same time, not let anybody bully us with scare tactics into having unnecessary medical interventions.
At 35 weeks I started seeing Karen, an acupuncturist and practitioner of Chinese medicine weekly for prebirth acupuncture treatments because I knew that acupuncture can be used to induce labour in a more gentle and natural way, which I preferred. As part of the consultation I started discussing my wishes for this birth with Karen. Karen was fantastic and encouraged me to talk to an independent midwife.
A few days after my appointment with Karen I met with the independent midwife and we had a 3 hour conversation. I pretty much decided that day that this was going to be the midwife caring for me. I felt she really listened to me and was fully prepared to safely support my wishes for a natural labour and birth. My midwife introduced me to the concept of informed choice and decision-making, which helped me understand how to safely negotiate my personal wishes in the hospital system. She encouraged me to write a birthplan.
Around 36 weeks I had a routine pregnancy appointment at the hospital with the doctor and started discussing my plans for labour and birth, which included declining routine induction at 38 weeks, providing my blood sugar levels are well controlled and my baby is doing well.
The doctor explained to me that despite stable blood sugar levels and the current health of my baby, there is a higher risk of stillbirth in women with pregnancy diabetes, hence the induction at 38 weeks. I ask the doctor for the statistics on the stillbirth rate in order to understand whether declining induction was a risk that I was prepared to take. But she was unable to provide those statistics and recommended that I proceed with the hospital protocol of having an induction at 38 weeks anyway.
We already knew from the regular ultrasounds and monitoring that I have been having that my baby was healthy and on the 35th percentile with an estimated weight of 2.7kg. My diet and blood sugar levels were well controlled with only 18 units of insulin per day and I had only put on 5kg during pregnancy. With all of that in mind, I again informed her of my decision that I am declining routine induction at 38 weeks.
My voice was not heard!
I expressed to the doctor that I was really dissatisfied with her inflexibility around negotiating my personal birthplan. As a result, the doctor felt she was no longer able to provide care for me and proceeded to refer me to another doctor who might be better understanding of my personal wishes for labour and birth.
I left in tears questioning the decisions that I had made. Declining recommended treatment was very hard for me as I was made to feel like an irresponsible mother. I felt that rather then receiving individual care that focuses on my circumstances and personal wishes, I received hospital protocol centered care that was not evidence based. The head obstetrician of the gestational diabetes unit was unable to tell me the solid evidence for an induction of labour in women with pregnancy diabetes and was unable to give me the statistics on the stillbirth rate. But wanted me to have an induction!?
I felt really bad the entire week but my husband, Karen and my midwife fully supported me. My midwife was able to answer all my questions about test results, scans and medical procedures. She was able to translate the medical jargon for me into a simple language that I understood and discussed at length with me what I had discussed with the doctor in the hospital.
My heart was saying that I am doing the right thing and I started looking at the stillbirth rate statistics myself. I found an American study that found that the stillbirth rate is 0.017% versus 0.014%, which was a risk that I was prepared to take. I felt that my baby was not ready to be born at 38 weeks. I wanted my baby to decide when it feels ready to be born and things to take their natural course. I believe in life things happen for a reason and I wanted her to have what I believed was the best start in life.
Expression of colostrum
My midwife also prepared me for the possibility that my baby’s blood sugar levels might drop after birth, which could mean admission to the special care nursery or supplementation with formula. I was keen to avoid both and my midwife recommended that I start expressing my colostrum, which I did. By the time I went into labour I had collected 60 mls.
At 37 weeks I started seeing the new doctor and he was able to provide individual care and support. I was interested if he knew the statistics on stillbirth and too asked him about it. Again, to my surprise, he did not seem to be having any of these data.
After reviewing my case, in particular my baby’s health and my stable blood sugar levels, he was happy to support my birthplan and we decided to review the clinical situation again at 40 or 41 weeks or earlier if there is a valid medical reason. I saw this doctor for every appointment from here on. Over the next couple of weeks all scans and tests were coming back perfectly normal.
When I was 39 weeks pregnant my sugar levels suddenly started to climb and the doctor said that it was time to review the need for induction. I agreed for the induction at 40 weeks and attended for some additional monitoring appointments and tests to ensure that my baby is still doing well.
The diabetes educator from the hospital contacted me the day after my appointment with the doctor to review my diet, blood sugar levels and insulin regime in view of my blood sugar level climbing. It turned out the reason for my blood sugar levels climbing was me not administering the insulin at the correct times in correlation to my diet! With all of that in mind, I asked the doctor if we can keep on pushing the induction date out for a few days. He agreed.
40 weeks- labouring at home
At 40 weeks I was having an acupuncture treatment by Karen. With no signs of labour, I decided to organize a date night at a nearby hotel with my husband before we became 3. We had a lovely dinner, a walk in South Yarra and then went back to the hotel. I jumped in the jacuzzi around 10pm to have a bath when suddenly my waters broke! 10 minutes later I started to have strong and regular contractions. Another 10 minutes later we had to check out of the hotel to go back home because the contractions were really intense. I rang my midwife to let her know that I am in labour and she advised me to put on the TENS straight away.
The contractions were so strong. I could not handle the pain. I started asking for painkillers despite my desire to have a natural birth. The TENS machine was not really helping. We called my midwife again and asked her to come. She arrived 30 minutes later.
When my midwife arrived I wanted to know straight away how dilated I was and if these strong contractions were doing anything! But she thought it was too soon for a vaginal examination and encouraged me to keep going. We labored at home for as long as I could and I just let my body do its work. I prayed, visualised my healthy baby and was sending lots of love to my baby.
Then suddenly at 01.30am I felt like I needed to push. My midwife checked me and I was 9cm dilated! So we got in the car to transfer to the hospital for the birth. The car ride was fine. I really felt like I needed to push. I felt completely safe in case the baby was deciding to be born in the car because my midwife was with us.
When I arrived in the hospital’s emergency department at 02.10 the staff were taking their time. I knew there was another contraction coming and the urge to push was too strong now to suppress. I needed to push! They quickly put me in a wheel chair and transferred me up to birthing suite. Once I arrived there I took my underwear off and jumped on the bed on all fours. I asked my midwife what to do and she encouraged me to just follow the sensations of my body. 6 minutes later, at 02.35am Iman was born!
The hospital midwife put Iman on my chest immediately after birth and it was such a beautiful moment. Not long after, Iman was looking around trying to find my breast and my independent midwife helped Iman straight away to attach to my breast to prevent her blood sugar from dropping. The cord was still attached and the placenta was still in me at that time. I birthed my placenta naturally 30 minutes later and the cord was cut then. My blood loss was fine and I just had a small tear that I decided to get stitched.
Iman’s weight was 2.6kgs! I was so happy that I had followed my gut about declining induction at 38 weeks. If I had agreed to induction Iman would have been underweight!
Over the next couple of hours Iman was breastfeeding well but did have a few borderline low blood sugar readings. We just used my expressed milk to help her blood sugar level to come up. The 60mls of milk that we had expressed before Iman’s birth was enough to avoid formula or Iman going to the special care nursery. Iman stayed with me the entire time during our hospital stay and we were never separated. The expressing really helped. Iman also had hardly lost any weight when she got weighed 2 days after birth.
After 2 days at the hospital we came home. We were working hard with the breastfeeding and establishing a good milk supply. Iman was cluster feeding for many hours per day, was very unsettled and seemed to be very hungry. We hired a hospital grade breast pump and were trying to pump after every breastfeed trying to stimulate my milk supply. I was not keen to take any medications to increase my milk supply.
When she was weight at 3 weeks after birth she had only gained 111gr in 18 days. The use of donor milk was no option for us due to religious reasons. It was a really tough decision but finally introduced formula top ups for Iman at 3 weeks of age. She is still mixed fed- breast and formula and is a happy baby with lots of smiles.