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In this episode, I am joined by Katie Kane, a parent from Cherry Hill, New Jersey who took the Evidence Based Birth Childbirth Class when she was pregnant with her daughter. Katie worked with EBB Instructor Cat LaPlante. 

From the beginning of her pregnancy, Katie planned for an unmedicated hospital birth – leading her on a path to researching doulas and eventually finding the EBB Childbirth Class. She was intentional in choosing her birth team, and ended up switching providers when she knew her first was not the best fit for her. With the support of her husband and doula, Katie was able to navigate roadblocks that may have resulted in different outcomes for her birth if she had not been so well prepared.

Resources
  • Find an Evidence Based Birth Childbirth Class or Comfort Measures for Labor and Delivery Workshop here.
  • Find an Evidence Based Birth Instructor, and all EBB parent resources here.
  • Follow Jen McLellan at Plus Size Birth, the Plus Mommy podcast and Instagram. You can also hear Jen on the Evidence Based Birth Podcast here.
Transcript

Rebecca Dekker: Hi everyone. On today’s podcast, we’re going to talk with Katie Kane about her unmedicated hospital birth experience. Welcome to the Evidence Based Birth Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Rebecca Dekker: Hi everyone, and welcome to today’s podcast episode. Before we get started with today’s interview, I just have one quick announcement. Last week, we made available my book, Babies are Not Pizzas: They’re Born, Not Delivered. We made it available in the ebook or digital version for free on our shop through May 9 only. So, there’s just a few days left to download that book for free. Just go to ebbirth.com/shop, and you’ll see the instructions there on how you can download that ebook. We’ve been hearing from tons of people all over the world who are downloading it and reading it with their friends. Some people are even starting impromptu virtual book clubs to talk about it. So, we were excited to be able to provide that for everybody leading up to Mother’s Day, and again, just go to ebbirth.com/shop to get your digital copy of the book. Now, let’s go to our interview with Katie Kane.

Rebecca Dekker: Hi everyone. Today, I’m so excited to welcome Katie Kane to the Evidence Based Birth Podcast. Katie lives in Cherry Hill, New Jersey, right outside Philadelphia. She was married in 2017 and a year into her marriage, got pregnant. She and her spouse had Lucy in June 2019 right before their two-year anniversary. Katie is a school counselor in Pennsylvania, and they live together with a rescue dog named Roscoe. Welcome, Katie, to the Evidence Based Birth podcast.

Katie Kane: Thanks for having me, Rebecca.

Rebecca Dekker: So, tell us how did you find out about the Evidence Based Birth Childbirth Class and your instructor Cat LaPlante.

Katie Kane: Sure. So, actually, we found out about the Evidence Based Childbirth Class through our search for a doula. So, right when I was about 17 or 18 weeks pregnant, we decided that we wanted to pursue an unmedicated birth, and my reason for wanting to do an unmedicated birth I think is unique. I haven’t heard a lot of people with this reason. So, I wouldn’t consider us I guess like crunchy people. I always go to the doctor when I’m sick, take medicine when I need to, but the reason I wanted to do an unmedicated birth was because back in 2012, I had migraines, and I had to do a spinal tap to check the fluid levels. Through that, I actually had a… When they do a spinal tap, they make a little puncture, and that’s supposed to close and mine didn’t.

Katie Kane: So, what happened was for about a week, I was laid up in bed and every time I stood up, I would get sick and have a horrible headache because that hole wasn’t closing and the pressure was building up so quickly. So, I had to go back in and actually get a procedure where they took blood from my arm and had to put it in my back, so that it would close. So, because of that, I had such a fear of getting an epidural. It just terrified me, and when I got pregnant, I thought, “Okay, maybe I’ll get over this fear,” but as my pregnancy progressed, I was getting very, very anxious about the thought of having to get an epidural.

Katie Kane: So, I knew I wanted to do an unmedicated hospital birth, and I really had, like I said, I didn’t have a lot of people in my life that did unmedicated births or really supported that. So, really, the only person I knew in society was Audrey Roloff. She was on that show, Little People, Big World, and she did an unmedicated hospital birth. So, I read her birth story, and she talked about how essential it was to have a doula. So, I was like, “Oh, great. I need to make sure I get a doula.” So, I searched our area for how to find a doula, and Cat’s group popped up, and through messaging back and forth with Cat, she of course hooked me up with a doula, and she also told me about the evidence-based birth class.

Katie Kane: So, we signed up for that, and my due date was July 2nd. So, our classes started right at the end of March. So, that’s how we found the class.

Rebecca Dekker: What was your experience like taking the class?

Katie Kane: Our class… I think this is how your classes are all set up. Two in-person meetings. So, the first meeting was in person. The last meeting was in person. Then it’s Zoom calls in between. I think the biggest takeaway from your class… It was six sessions total, I believe, and of course, we went over everything that you would go over in a typical labor and delivery class. You go over the stages of labor. You go over what effacement, dilation, like all that nitty-gritty, but my big takeaway from the classes, that was definitely part of it, all that nitty-gritty details, but the ability to advocate for myself through this process and just feeling so confident.

Katie Kane: My husband and I just felt so confident advocating for the birth that we wanted, and there were definitely some roadblocks along the way where the class helped us have that confidence and had that ability to advocate and know what questions to ask of our providers in order to gather information, and the class isn’t really us against our provider. It is more how to work with your provider and how to be able to explain to your provider why you’re hoping for the birth that you’re hoping for and then also just making you comfortable navigating any roadblocks that might come along the way.

Katie Kane: So, that was definitely the biggest takeaway, and then our last class was all about comfort measures, and that was super, super helpful, and our doula also, when she came to meet with us, went over comfort measures as well, and that being the last class was really great because it was so fresh in your memory for delivery.

Rebecca Dekker: So, did your doula get to come with you to that last class?

Katie Kane: No, she actually… I think that we set it up where we did the last class, and then she came to our home because my plan was to labor at home as long as possible. So, she likes to show you areas in your home that you can also… how you can squat down in your kitchen and how to set yourself up to be able to do certain things with the birth ball in different areas of your house. So, she wanted to come to our home to be able to show us that.

Rebecca Dekker: Oh, cool, and for those of you who are listening, when Katie took the class, it was the two in-person classes and then the four Zoom meetings in between along with all the videos that you watched. But right now, we’re doing this interview in the midst of the COVID-19 pandemic, and we have moved the class completely online during the pandemic. So, it’s a little bit different but same content, just a little bit different content delivery during the pandemic. So, take us to that end of your pregnancy, and we know you were planning an unmedicated birth because of that complication you’d had with the earlier experience. What was your mindset like leading into the birth?

Katie Kane: I mentioned before how we had a couple of barriers that we needed to navigate with our care provider. So, the first thing was at my… I actually switched care providers at 20 weeks, and I’m happy I made that switch. That was with the support of our doula and also with the support and resources that we found within the Evidence Based Birth class.

Rebecca Dekker: Can you tell us a little bit more about that? What led you to switch providers and what was that process like?

Katie Kane: Sure. So, when I got pregnant, I originally went with who my GYN was. She was an OB. She was a GYN. So, I got pregnant. I just thought I would deliver at that hospital, which was in Pennsylvania. It’s not really a big deal to travel from Cherry Hill to Pennsylvania. We would be delivering in the city and delivering in Philadelphia. So, my husband was just a little bit nervous about having to navigate driving in the city when I was in labor. So, that’s one of the reasons that we ended up switching because we ended up switching to a hospital in South Jersey.

Katie Kane: I was struggling with my first care provider because when I went in for my first prenatal visit, at eight weeks, I had a high blood pressure reading at the beginning of the visit. I’m also overweight, and she immediately gave me the diagnosis of gestational hypertension, and she also had me doing a lot of just unnecessary tests, I felt like. She had me doing a glucose test at 12 weeks, and she wanted to do a 24-hour urine collection. I just felt like I was not showing any symptoms of having gestational diabetes. I was not showing any symptoms of having high blood pressure because at the end of that visit, they took my blood pressure, and it was normal and just every visit, we were going back and forth about this gestational hypertension to the point where I ended up… I see a cardiologist already because I have a history of heart condition. I have a heart disease in my family, so I see a cardiologist.

Katie Kane: I ended up visiting my cardiologist, and he felt I did not have hypertension at that point. He had me monitoring my blood pressures at home, sending them to him every month. So, I was really close and on top of this. I did not want to get the diagnosis of gestational hypertension if I didn’t have it. So, that was a really frustrating process and then through talking with Cat, she had shared that they… She’s actually encountered this with a lot of people at that hospital and practice specifically that they’ll have these hypertension diagnosis that you get it immediately if you have one high blood pressure.

Katie Kane: This was one of my questions I wanted to ask you about at the end, just the criteria for actually having that diagnosis, because I’ve read a lot of different things. So, that was a big reason that we switched as well. The process of switching was I was at 20 weeks, and it wasn’t as smooth as I hoped it would be. So, I had my anatomy scan with my previous provider, and then when I switched to my other provider, I actually didn’t see anybody for until I was about 28 weeks. So, I was a little nervous about that because I had missed my 24-week appointment with any provider during the process of switching, and of course, this gestational hypertension diagnosis came over on my paperwork. So, that was a continuous struggle throughout my pregnancy.

Katie Kane: My blood pressures were always… They were high. They were on the higher end of normal throughout the pregnancy. So, I was monitoring my blood pressures at home, and when I was monitoring that at home, they were creeping up in that 130 over 90 range. So, my cardiologist did end up putting me on a very small dose of Labetalol, but of course with having that gestational hypertension diagnosis, what came out of that is the conversations with my provider around 36 weeks for induction, and I did not want to have an induction. I was very fearful about the cascade of interventions and also with being overweight, I was very fearful about having a C-section because I had just read that sometimes women that are overweight have a higher chance of having a C-section. So, I was very concerned about that.

Katie Kane: And of course, my baby was big, and she was measuring big, and I’m big. Both my husband and I were over nine pounds at birth. We’re just bigger people. Of course, that was a constant conversation that, “Oh, you have a big baby. You have a big baby,” but through the evidence-based birth class, I knew that I didn’t have gestational diabetes. We didn’t use an egg donor, so I knew that my body was not going to make a baby that was too big for me to deliver vaginally. So, I felt confident about that but around 36 weeks, my provider started mentioning induction. At the 36-week and 37-week visit, they mentioned induction. I said, “No, I didn’t want to do an induction.” 38-week visit came around, and there was a bigger conversation around induction, and I hadn’t been checked at that point, and my office was great.

Katie Kane: You only got checked if you wanted to. So, at the end of the 38-week visit, we decided that we would revisit at 39 weeks, and my due date again was July 2nd, which was a Tuesday, so I scheduled my 39-week visit purposely on a Friday because I wanted to give myself as much time as possible to get as close as possible to my due date. So, at 39 weeks, we really had a big conversation around induction, and the way that this office works is that you see a different provider at every visit so that you can meet all the providers as they can’t guarantee who’s going to deliver the baby. So, I had met this new provider and he was able to really provide me a lot of information about what the concern is with gestational hypertension, and the concern being that the longer I stay pregnant, it’s not necessarily… The way that he explained it was, “It’s not necessarily a concern for at that moment, but it could impact me later in life,” is what he was saying.

Katie Kane: So, we had a long conversation, and he said that we would have a visit on Monday, which would have been July 1st, and that if I hadn’t gone into labor at that point, he really wanted to schedule me for an induction on my due date. So, that was a Friday, and I actually had… When I got to that appointment on that Friday, I had started losing my mucus plug. So, he checked me. I asked him to check me, and I was one and a half centimeters dilated and 80% effaced, so I asked him to do a membrane sweep at that point, and which he did, and then after that visit, I talked with my doula just about… You go over this in your class as well. Just how the scenario would work if I had to be induced in terms of her being there for me and then also just any recommendations that she had, and she recommended acupuncture, which is something that we go over in the Evidence Based Birth class. I think mentally I… So, we hadn’t done any of the acupuncture at home.

Rebecca Dekker: You mean the acupressure?

Katie Kane: Acupressure. Yeah, sorry.

Rebecca Dekker: So, was your doula recommending the acupressure or going to see an acupuncturist?

Katie Kane: She was recommending seeing an acupuncturist.

Rebecca Dekker: Okay, and you hadn’t been doing the acupressure practice?

Katie Kane: No, I hadn’t. I don’t think I was mentally ready to deliver yet, so I had-

Rebecca Dekker: You didn’t want to encourage anything.

Katie Kane: Yeah, I didn’t want to encourage anything at that point. I wasn’t there yet but after that appointment on Friday, I had been drinking the red raspberry leaf tea. I had been eating a lot of pineapples. We’ve been having sex. So, I’ve been doing those things, but I wasn’t up for doing the acupressure yet. I wasn’t up to for doing any nipple stimulation yet. So, she recommended I go to an acupuncturist and I did, so I scheduled an appointment for that Saturday, did the acupuncture, so that was Saturday morning, and then that day we just did all the things. We went for a walk. We had sex. I drank my tea, a pineapple… I ate a lot of pineapple cores, which I know is iffy, but one of the doctors had said that it was something that she thought might work. So, that night, so now we’re getting into the labor story.

Rebecca Dekker: Yeah, tell us what happened next.

Katie Kane: We knew that this was going to be our last weekend alone because either I was probably going to be getting induced the next week or hopefully, we would have the baby. So, my husband likes to smoke meat, so he has a smoker outside, so he was making a smoked pork. We were going to have a nice dinner. We were hanging out at home with our dog, and it was actually a really stormy day, but it was one of those nice summer storms. So, we were hanging out at home. We had had our dinner. I had been having what I would consider a lot of period cramps probably two or three weeks before, but then I started having contractions, and we call it waves in the Evidence Based Birth class.

Katie Kane: So, I started having my waves, and it’s true. They say, “When you have them, you know that you’re having them.” It’s just a very, very different feeling. So, I started having them, and I was like… I think I’m having waves. They were definitely very, very spaced apart, but I was having them. So, we cleaned up the house because I wanted the house to be cleaned up, and then we went out and got ice cream because I was craving so badly chocolate and banana ice cream. So, we went and got ice cream, and this was around nine o’clock at night I think that I had my first wave.

Katie Kane: We did that. We got home, and I knew that I needed to sleep, and I really wasn’t… I don’t know. It’s funny thinking back on this, but I know a lot of women described, like they’re just not able to sleep because they’re so excited, but I was so nervous about how much energy I was about to output the next day that I was like, “I definitely have to sleep.” So, we went to bed. That was around 10:30, and I was even bold enough because I had been taking Benadryl to help me sleep, and I was even bold enough to take Benadryl that night, which I would not recommend because it’s not really a good idea because if you wake up, you’re going to be drowsy. Luckily, that didn’t happen to me.

Katie Kane: So, I slept for about four or five hours, and I was definitely having contractions while I was sleeping, but they weren’t enough to wake me up. Woke up around 2:30, and I was having contractions I couldn’t sleep through. I didn’t wake up my husband, but I just spent a lot of time in the bathroom. True what they say about the early stages of labor, like you’re having some diarrhea. You’re having some nausea, and I just spent a lot of time in the bathroom. I was losing more of my mucus plug, and I was just alternating between the bathroom and between my birth ball back and forth, back and forth, and my husband woke up around 4:30 and started timing the contractions.

Katie Kane: When we had talked with my doula, I told her like, “I wanted to labor at home as long as possible. I wanted to be coming into the hospital hot ready to deliver this baby. I wanted to stay home as long as possible.” So, we were home. We contacted my doula around 6:00 AM, told her that labor had started, and the positions I was doing at home is we have some very big plush couches. So, I would be on my knees facing the back of the couch, hanging over the back of the couch, and my husband would be doing counter pressure on my hips in between. We also did positions where I was just hanging over the yoga ball with my knees on the floor and hanging over the yoga ball, and then we also… I would be sitting on the yoga ball and hanging over the end of the bed.

Katie Kane: So, we were all over our bedroom and living room. I was taking a shower and at some point, I started to feel like… I just started to feel more panicky. I wasn’t feeling as grounded as I wanted to feel. I didn’t like being at home anymore. I just really felt like I needed to know like, “Was I dilating?” I was very surprised that I wanted to know if I was dilating or not because we had, of course, looked at all the evidence about doing cervical checks, and I said, “I didn’t want cervical checks unless it was necessary,” but I equated it to when you’re on the treadmill and you cover up the screen because you don’t want to see how much time has passed, and you keep peeking to see how much time has passed. It was like that for me. I just needed to know that I was making progress.

Katie Kane: So, we ended up going to the hospital. We left for the hospital around nine o’clock, and my doula ended up calling me, and she was like, “I know this wasn’t part of your original plan. Just talk with me,” and I was at the point where I couldn’t really talk to the contractions. So, she heard me go through a contraction. I just said like, “I’m not handling them well. I just feel like I need to be at the hospital.” So, she said, “Okay, go to the hospital. Let me know what they say,” because at this point, I had really only been able to not sleep through contractions since about 2:30-3:00 AM. So, it was still presumably early-ish labor.

Katie Kane: We went to the hospital, and I had been to the hospital previously in triage, and I was very, very nervous about going through triage. I just found it to be an uncomfortable area. I hadn’t had great experiences with some of the nurses down there, so I was nervous about going through triage. So, we get there. We go through triage. I was very, very uncomfortable, like visibly uncomfortable, visibly going through contractions, and I had ordered gowns, like labor gowns off the internet, so that I didn’t have to wear one of the hospital gowns because like I said, I’m bigger, and I had had to wear one of the hospital gowns when I went in.

Katie Kane: Lucy hadn’t moved much one day, so I had to go in for a non-stress test, and it was just so uncomfortable. It barely fit me. So, I was wearing one of my gowns. I get in, and I get a nurse, and she was like, “Okay, put this on and go give me a urine sample,” and I said, “Oh, I’m already wearing… This is a gown. I’m just going to stay in this,” and I just felt like that immediately set the tone that she felt like I was a difficult patient, which was very unfortunate. So, I also was having an extremely difficult time sitting down. I couldn’t sit. It was extremely uncomfortable, and I think it’s because… I think my water bag was right there. It just was very, very uncomfortable. I couldn’t sit.

Katie Kane: So, she of course wanted me to sit in the bed so that I could be monitored. I couldn’t sit, so she’s standing there trying to hold the monitors on me, and she’s just getting visibly frustrated with me that the monitors weren’t staying on, that they weren’t picking up the baby, and this is interesting, and I don’t know if this is necessarily evidence-based or if this was just my experience. But throughout my entire labor, the monitors were not really picking up my contractions. I think it’s because I am overweight, and I don’t know if other people have this experience, but I hadn’t heard of it before.

Katie Kane: The monitors were not picking up my contractions and luckily, my nurse up in LMD was very aware of that. Didn’t make a big deal about it. The nurse down in triage was not as great about it. So, they end up coming in, and you have to do all these pre-labor blood draws. So, the whole time in triage, I was just like, “This is why people do home births. This is why people go to centers. This is just a very stressful experience being down in triage.” So, they check me, and while she… They have a doctor midwife come in and check you. So, while she was checking me, the nurse said to the doctor like, “Is she even dilated?” Because they weren’t picking up contractions on the monitor, and I guess she just thought I was being a wimp that I was not handling things well.

Katie Kane: So, I was dilated four centimeters at that point and 80% effaced. I was admitted, and then they end up taking me upstairs. I wanted to walk upstairs because like I said, it was so difficult to sit down. And again, while I was walking upstairs, of course, I’m having contractions consistently and had to stop. I couldn’t walk through the contractions. I had to stop, and the nurse at one point said to me, she was like, “This would just be a lot faster if you would let me wheel you upstairs.” So, my initial entry into the hospital was so frustrating. It was just so difficult and just completely deflated me.

Katie Kane: I got upstairs at L&D and immediately, my guard was up with my nurse. I just immediately was like, “I just really hope that is not how… ” I was fearful that my nurse from downstairs was going to be my nurse up at the labor and delivery floor. So, luckily, she wasn’t. She was amazing. I got in, and I don’t really know what my husband and I were thinking. This was a bad move, but basically I got to my room, and I was like, “You should just go to the car and get everything.” So, I was alone in my hospital room, and my nurse came in and very nice, and she said, “Are you planning an unmedicated birth or are you hoping to get an epidural?” I said, “I don’t know at this point. My plan was to do unmedicated, but this is so painful.”

Katie Kane: She said, “Okay. I just need to know that if you do want an epidural, I need to have two liters of fluid into you,” and that is all she said about an epidural the rest of the delivery, and I was so thankful for that. You have to get a hep-lock for emergencies, but you don’t have to be hooked up to IV fluids or anything. When I got there, my nurse suspected that I was dehydrated, which is probably why the contractions were so painful, and I definitely think she was correct. She offered to hook me up to a bag of IV fluid, but I didn’t want to. In the class, we had learned that IV fluid can puff up. It puffs you up. It can puff up the baby, and that the percent of weight loss could actually be greater in babies that had IV fluid.

Katie Kane: So, if your baby lost too much weight in the hospital, it could be because they were on the IV fluid. I’m not sure if I’m explaining that correctly. Is that correct, Rebecca?

Rebecca Dekker: Yeah, it is a risk of having too great a volume of IV fluids if they give you too much.

Katie Kane: Okay. So, I just started drinking water, which really, really helped and just helped calm me down. My nurse said… She started reading through my chart, and I just felt like she was the first person that finally read my chart because down labor delivery, they would ask you questions that were in my chart, and that can be frustrating. So, she was like, “Oh, wow. You had a horrible experience when you had to have a spinal tap in the past. I totally understand why you don’t want to do an epidural. That makes absolute sense.” So, I just felt like she actually cared about me and that she actually was encouraging me and understood my birth plan. I was able to drink some water and just able to calm down a bit.

Katie Kane: I ended up sitting on the toilet because that was a position I found comfortable, and my doula came in. I just am so, so thankful that we hired a doula, and it was obviously a big expense, and we just absolutely needed a doula. My husband is a… I don’t want to saying that we’re rule followers, but we’re just… We’re not going to ruffle feathers if we don’t have to, and especially in a hospital setting, like my husband’s not comfortable in a hospital setting, so we just need somebody there that was supporting us. I would just encourage anybody, like if you don’t have the resources for a doula, I know that sometimes there’s doulas in training that are looking for clients to build their portfolio. So, they’re not always as expensive as some of the more seasoned doulas, but she was a great, great resource.

Katie Kane: She got there, and she was just able to calm me down, got off the toilet because my hospital required you to do 20 minutes of monitoring every hour, which was… That I didn’t love because I know that you don’t need 20 minutes, but she was able to calm me down, and I got in the bed, and I was being monitored. So, this was probably around 11:30, so I got my first 20 minutes strip for being monitored. My nurse stood there and held monitor on for Lucy’s heartbeat because they were having a hard time. She was moving so much. So, did the monitoring, and then we went into the tub. I specifically asked for room with the tub, and it was so nice. We got into the tub, and the tub had jets, and we had my playlist going. We had the candles going, not the ones that with the wicks, but the ones that are LED candles going, and it was just quiet and peaceful.

Katie Kane: We had the lights dimmed. I was drinking water. I was going through the waves. My doula was encouraging me to keep my legs open, so that my pelvis was in a good position. It was just like that was just a beautiful experience, and I was in the tub for probably about an hour to an hour and a half, and then I had to get back out to do another strip of monitoring. So, I got out, and I was on the bed, and I asked to be checked again. When I had actually gotten into the room the first time, I did my first trip of monitoring, my doctor came in and checked me, and I was at a six at that point.

Katie Kane: I asked my doctor to check me again. So, this was probably around 1:30, and she checked me, and while she was checking me, Lucy’s bag of water broke, and that was a huge relief on my body, and I was at a seven at that point. What ended up happening, so I was in the bed getting monitored, and they put the peanut ball between my legs, and I was on my side, and my contractions slowed way down, and I’ve heard of this with other women that when your body is about to go into transition, your body can give you a little bit of a break. So, my contractions slowed way down to the point where they’re probably six to eight minutes apart, and I was dozing off between them.

Katie Kane: My doula was… She had said, “Do you mind if I just run downstairs and grab something to eat? I’ll be back,” and I was just laying there, and everything was very, very calm in the room. My husband was there. So, she went downstairs, and the whole time I was being checked, Lucy’s station… She was at a positive two. Positives are really high up, right, Rebecca?

Rebecca Dekker: Positive would mean lower.

Katie Kane: Okay, so she was-

Rebecca Dekker: She’s lower in the pelvis.

Katie Kane: She was higher in the pelvis. So-

Rebecca Dekker: She was a negative two, maybe?

Katie Kane: She was at a negative two, yeah. So, she was at a negative two the whole time. So, from your class, I knew, “Okay, great, I’m dilating. Great on my face, but the baby has to come down.” So, my doula had said… Before she left, she said, “We’ll try new positions when we get back because we want to be changing positions every half hour.” So, I was laying there, and all of the sudden, I don’t know if she just… It almost felt she just shot down, and my husband said I let out this blood-curdling scream and arched my body off of the bed. So, the nurse was there, and she was like, “Wow, that’s great. The baby probably just moved down. That’s probably what we’re feeling.”

Katie Kane: So, that was around 2:30 and 2:30 PM, and this is really when things started picking up. So, I definitely was going through transition at this point, and I don’t even really know how they were able to do this. I don’t know if it was because it was the Sunday and it was so slow. But from 2:30, from that point on, the doctor and nurse were in my room for the entire time. No one left. So, I guess there weren’t as many women on the floor. My doctor was there. She checked me, and she said that I… This was around 2:30-2:45. She said, “I was at a nine, nine and a half,” and my body was pushing. My body was pushing, and it’s so hard because they kept saying like, “Katie, it’s okay if your body pushes, but you cannot push,” and that’s just an impossible statement.

Katie Kane: If you’re a woman in labor, and they tell you not to push, it’s impossible not to push. So, we were basically waiting for the rest of my cervix to thin out and for me to fully dilate. My doctor tried, I think, manually pushing back to see if she could push the cervix back, just that little bit. That was extremely painful. Just basically everything down in my vaginal area, my pelvis area was extremely painful. So, being at the hospital, they had to continue to monitor Lucy, and every time they put the heart monitor on, it just was so, so painful.

Katie Kane: They had me sit, and they adjusted the bed in a way that I was sitting with my feet in the stirrups. I was sitting all the way up in a chair, but they had bottomed it out, so I wasn’t sitting on the bed. There was nothing below me, so that was a good position to stay. At that point, so my doula had me clenching onto a comb. She said I think it was the gates pain theory that if you try to reroute the pain in your body that it won’t be from one area to another. So, I was clenching on this comb, bringing pain to my hand. It would help distract me. That definitely worked a lot for me. I was clenching that comb the whole time.

Katie Kane: So, we are probably about around 3:00 o’clock, 3:15 at this point, and we’re just waiting for that last little bit, and it was excruciating. My doula’s helping me breathe through it. She has a fan on my face. I’m doing the horse flips as much as possible, but the transition time was really, really painful. I did ask my nurse at one point. I said, “Is it too late to get an epidural?” She just looked at me, and she said, “Whoa. I don’t think you’re going to be able to sit still for an epidural,” and I didn’t want an epidural. I just wanted her to tell me it was too late, so that I knew in my mind that the baby was coming soon.

Katie Kane: My doctor checked me around 3:25-ish, and I had completely dilated. Lucy was ready to come out, so they had me do a practice push while my doctor was gowning up, and my doctor said, “Wow. She’s really ready to come.” I guess my nurse said I was bulging at that point, and my nurse looked at me and said, “You’re going to have a baby in 10 minutes,” and that’s truly what I needed to hear because I was like, “I can give this 10 minutes. I can do this for 10 minutes.” I did panic a little bit when right before I started pushing because I said like, “She’s going to be huge. I don’t know how I’m going to push her out,” and then my husband… because we had talked about this in the class. My husband said, “Your body didn’t make a baby that you can’t push out. You can push her out.”

Katie Kane: So, with my husband’s support and with my doula, my doula had one leg, and my husband had another leg. This is one thing that I wasn’t… Everything was so quick and everything was so chaotic. Not chaotic, like there was nothing wrong, but I wasn’t in a position, and we hadn’t discussed it before of how I wanted to labor. So, I did end up pushing on my back. I think that’s just because a lot of women that maybe have epidurals do, and I hadn’t said I wanted to push in any other way. I honestly don’t know if I could have pushed on all fours. I really wanted to try pushing where the bed was all the way up, and I was on my knees and hanging over the edge of the bed, but at that point, I don’t know if I could have moved into that position.

Katie Kane: So, I was a little disappointed that I didn’t push in another position, but honestly, pushing on my back worked, and I pushed for about 10 minutes. At one point, I reached down, and I felt Lucy’s head, so I knew she was right there, and my nurse was putting olive oil on me, and she could tell at one point I was backing off from pushing, and she said, “What you’re experiencing is the ring of fire. It’s real. You can do it.” So, with that, I was able to push through that, and my doctor said… I don’t know why. I do know why she said this. I feel glad she didn’t say it before, but she said like, “Katie, I need you… ” because in my mind, I was like, “Once I get the head out, it’s good. The rest of the body just follows. The head’s the biggest part, so it’ll be fine.”

Katie Kane: So, she’s like, “Katie, once you get the head out, I need you to stay in control of pushing because she is bigger, so we need to make sure the rest of her body can get out,” and in my head, I was like, “Oh my God. I don’t know if I could do that.” But I pushed, and the doctor caught her, and she came out perfectly, and her cord was a little short, so she was only able to lay on my stomach. We did delay cord clamping, so I couldn’t bring her all the way up to my chest. Her cord was pretty short. So, she was on my stomach, and she was screaming her head off, and I was just so… This feeling after having her was just pure euphoria. I was so happy that it was over that I got her out.

Katie Kane: I was proud of myself. I was proud of my team. I was so ecstatic that she was here. It was just a really, really… It was a high, like it was a great, wonderful experience. My first doctor that I had did say like, “If you’re going to do an unmedicated birth,” and I thought this was good advice, “you need to be prepared to go unmedicated all the way through. So, not just delivering the baby, but also delivering the placenta and having any stitches if you need it.” So, with the placenta, I guess at my hospital, they just wait for it to come out, but since I was unmedicated, I could feel it, and I just ended up pushing it out. My doctor was like, “Oh, okay. There it is.”

Katie Kane: Then during the stitching, I didn’t have a degree terror. I just had lacerations. I had two of them. Of course, they numbed me with the Lidocaine, but still you feel it, and it’s painful, and I do remember at one point my doctor was like, “I just need to hold still while I’m stitching you. You have to stop moving.” I was like, “I cannot stop moving. This is so painful.” It was almost more painful than pushing her out because when you push the baby out, it’s completely different. You’re working with something. You’re working with your body when you’re laying there and being stitched. You’re not doing anything. So, that was painful, but yeah, then we had our golden hour, and recovery was amazing.

Rebecca Dekker: It sounds like you did overcome some roadblocks to make it. It sounds like even some sometimes some of the words they used weren’t the most encouraging. I can see how it could have created some doubt for you to hear, “Oh, your baby’s going to be really big,” or, “This is the ring of fire,” which we specifically don’t use that word in the EBP class because we don’t want people to anticipate something because sometimes it’s just like saying the words makes you get more tense and more afraid, and then it does feel that way.

Katie Kane: Yeah. I was happy we did it in a hospital. At the time, I was happy. The more I think about it, if we have another baby, I think that we will maybe consider doing a birth center birth because I did end up leaving the hospital. I asked to leave the next day, so we left the next day. We left within 24 hours. I know it’s shorter at a birth center, but my recovery was so easy. So, I think that hospital just provided comfort that I thought I needed at that point, but now going through the experience, like I don’t think I need it.

Rebecca Dekker: You could have gotten that and maybe even more comfort at a birth center where you could have gone in a tub or-

Katie Kane: Right, and stayed in a tub.

Rebecca Dekker: And stayed in a tub, yeah.

Katie Kane: Right, right. So, I am happy with… because I do fully believe that if I hadn’t done the Evidence Based Birth class and had a doula that I would have been induced and probably ended up with a C-section.

Rebecca Dekker: Because of your risk factors and how they were labeling you as higher risk?

Katie Kane: Exactly. Exactly.

Rebecca Dekker: Okay.

Katie Kane: I don’t think the evidence was really there for me to be labeled as high risk. I remember my first doctor. At one point, I was talking to her about maybe switching over to the midwives within her practice, and she was like, “Well, I don’t even know if they would take you,” and I just was like, “Why? I don’t even have any risk factors at this point except for being overweight.” So, it was frustrating in that sense, and I think that that’s probably part of the reason I decided to stay with the hospital because I just felt like I couldn’t go to a birth center, but I know now that I can.

Rebecca Dekker: Yeah, you’ve definitely shown, and you said you only pushed for a little more than 10 minutes, right?

Katie Kane: Yeah, so Lucy was born at 3:40, and I started pushing right around 3:30.

Rebecca Dekker: Wow.

Katie Kane: So, yeah, it was 10 minutes. I do feel like I had done chiropractic care my entire pregnancy. I think that that was a huge factor was the chiropractic care because once Lucy descended, she was ready to go. There was no issues with my hips being out of alignment or anything like that. She was right there and ready to be pushed out.

Rebecca Dekker: What were some of the comfort measures that meant the most to you? I mean, I know you used a doula, and you talked about positioning and sitting in the bathroom and that sort of thing, but do any of the other comfort measures in the class feel really good?

Katie Kane: Water was really important.

Rebecca Dekker: Shower or tub?

Katie Kane: The tub.

Rebecca Dekker: The tub.

Katie Kane: The counter pressure was good at the beginning, but once it got towards the end, I really didn’t want to be touched. Music was wonderful, so we made our own playlist, and I specifically picked songs that I could sing the lyrics to to distract myself. So, our playlist was so important to me. What else did we do? The peanut ball, not necessarily that was a comfort measure, but when we went over the peanut ball in the class, I was like, “Yeah, I don’t see how this thing is all going to be effective,” but I had peanut ball in between my legs when she descended. So, I think that that was a huge, huge help. Used the labor ball at the beginning. Dim lighting was good as well as having those candles. So, we talked a lot about lighting in the birth class.

Katie Kane: When you’re going through labor, you could easily get out of control, and with the lighting and with the music, it just creates a calm atmosphere that you’re not going to get out of control. It’d be very hard to get out of control. So, just creating that environment was super, super important. I had a little sanctuary going on in the bathroom.

Rebecca Dekker: Did you do the relaxation practice with your husband?

Katie Kane: We did. We focused more on the… We wrote down things on Post-it notes and have around the house affirmations.

Rebecca Dekker: Oh, okay.

Katie Kane: So, we did more affirmations. The relaxation I didn’t find as much comfort in it as I did with the mantras.

Rebecca Dekker: It sounds like you went through the toolkit of comfort measures, and you picked the ones that worked best for you, and then you used them during your birth.

Katie Kane: Yeah.

Rebecca Dekker: That’s awesome.

Katie Kane: Yeah, absolutely, and I felt like there was other things in my toolkit if I needed it. I’m fully aware that… So, I would say my active labor. When I got to the hospital, I was probably in active labor. I was probably out of six around 11 o’clock, and I had her at 3:40. So, I was very lucky in terms of my timeline I think, but if I had to stay, if I was in labor longer, I felt like there was more that I could do. I knew there was a lot more positions I could do if I needed to. I didn’t end up using my birth ball in the hospital, but I knew that I had it there with me, and I knew I could if I needed to. So, there was definitely more that I could have used if I needed to.

Rebecca Dekker: Katie, thank you so much for sharing your story. It’s so encouraging and inspirational to hear how you made a plan, and you gathered all the resources, and you got the right support team, and you were able to fulfill your birth plan, which a lot of people are really discouraging to people when they say, “Well, you can’t plan your birth, or you can’t plan to have this,” but you really had everything lined up so that you could get as close to the experiences what you wanted. Do you’ve any advice for people listening who are planning on entering birth or parenthood soon?

Katie Kane: So, this was my first pregnancy. We were trying to get pregnant. So, of course, we were excited when we got pregnant, but I definitely experienced, I would say, depression during my pregnancy. I had a hard time connecting with Lucy. So, I don’t have a great relationship with my mother, and I was honestly really hoping that Lucy was a boy because I was fearful of a mother-daughter relationship just because I hadn’t had a great model of that in my childhood. I’m very much over that now, but there was a lot that I went through in my pregnancy, and I definitely… Because I was heavier, I didn’t feel her kick till a little bit later. Her movements, like I know some women are able to see the baby moving outside their belly. I wasn’t super jazzed for all of that.

Katie Kane: But the experience of delivering her unmedicated, like I felt everything, and I think that that really helped with our bonding because I felt such a… Her and I went through that and had that experience together and did that together, like her and I worked together to make this happen, and I just felt so connected to her after that that I think it really helped with all the fears that I was having during pregnancy and all the depression that I was having during pregnancy.

Rebecca Dekker: So, it sounds like the birth was almost like a healing experience for you?

Katie Kane: Yeah, it definitely was a healing experience.

Rebecca Dekker: Did it increase the confidence in your body?

Katie Kane: Yeah, for sure, for sure. I was way more confident in my body and just proud of my body for being able to do that. I felt like it did something that… I mean, we have people in our lives that love us and support us, but I got a lot of like, “Don’t be a hero. Oh, you think that now, but just wait till it happens. You’re going to be begging for that epidural.” I think people… I don’t know. People mean well, of course, when-

Rebecca Dekker: But they’re not always that helpful.

Katie Kane: Yeah, they’re not helpful at all. So, I was just so proud that her and I did that together, and I will say… So, your class is very much, like you learn a lot and knowledge is power, and I learned so much in your class, and I completely view birth differently. But what happens with that is when you have other women that tell you their birth stories, you view it from this different lens, and when people talk about their birth stories, it’s obviously such a sensitive special moment for them that you don’t ever want to question or make them feel like you’re judging their birth story.

Katie Kane: But I’ve had situations where one of my friends may be telling me a story about themselves or about somebody else, and they’re like, “Yep. So, my induction date is set because I’m already at 40 weeks, and I’m not dilated at all.” So, my induction date is set for three days from now, and it can be really difficult to talk to people about these things because they’re listening to their doctors, and they’re trusting their doctors, but I don’t think that people necessarily realize that they can ask questions about induction or even refuse an induction if it’s not medically necessary. So, I don’t want to say caution, but I want to just let people know that this class gives you a lot of information. It gives you a lot just in a completely different perspective, and that can impact you a little bit when you’re talking to other moms about their birth stories.

Rebecca Dekker: Yeah, it’s hard to unsee it once you’ve seen what is actually going on, and you’re awakened to this whole system and how it’s set up. It’s hard not to hear that in other people’s stories. When you remember that at least one in three births is traumatic, and our country where we live, you really start to see it, and it can be hard. It’s hard especially when people are at the end of their pregnancy. I mean, not a lot is going to change for them, you know?

Katie Kane: Right.

Rebecca Dekker: You really have to talk with people. Educate people earlier in pregnancy before they get to the end.

Katie Kane: Yeah, it could be a little bit of a challenge, but I’m so glad I had it. Like I said before, I really truly believe I would have had an induction at 38 weeks and would have ended up with a C-section because my body wasn’t ready, because when my body was ready, it was so ready to give birth. It did such a great job at delivering Lucy.

Rebecca Dekker: So, this is Rebecca here. Before we wrap up the interview with Katie, I wanted to quickly share some information about gestational hypertension that she had asked about earlier in the interview. I wanted to make sure I had time to pull up the professional guidelines, so that I could summarize some of that info for our listeners. So, I’m going to briefly in enter our interview with Katie to share with you some of the guidelines about gestational hypertension. Katie was asking, “How is gestational hypertension diagnosed?” So, to help answer that question, I looked at the ACOG Practice Bulletin Number 203 called Chronic Hypertension in Pregnancy, and I also looked at the UpToDate article on gestational hypertension.

Rebecca Dekker: For those of you who are not familiar with UpToDate, it is a membership website where you can pay as a healthcare provider or as a patient to access all of their articles, and they have a great trial option. If you are a patient in the healthcare system and you want to look something up on UpToDate, you can do a free trial. Also, I wanted to let everyone know that the American Heart Association has guidelines for how to get an accurate blood pressure measurement. I hear of a lot of people who have their blood pressure measured at prenatal appointments, and the measurement is done improperly.

Rebecca Dekker: The American Heart Association says that you should be seated with your feet flat on the floor, and you should be relaxed and quiet for five minutes. So, you should not be speaking while you’re having your blood pressure taken. Your bladder should be empty, and you should not have had caffeine, exercise or smoked for 30 minutes before the reading. The clothing should be removed from your arm, and your arm should be supported while the reading is taken. So, your arm should not be dangling down on the side. It should be resting, for example, on the armchair.

Rebecca Dekker: The blood pressure cuff must be the correct size based on the circumference of your arm. So, you can get an inaccurate reading if you are plus-size and then use a regular cuff on you. They should record the blood pressure in both arms at your first visit using the arm with the higher reading and separate any repeated measurements by one to two minutes. You should always be told your blood pressure readings after the healthcare worker takes them. So, there’s two different concepts, so we can talk about gestational hypertension and chronic hypertension.

Rebecca Dekker: Gestational hypertension is defined by the new onset of hypertension. At 20 weeks of gestation or later, in the absence of any signs of end organ dysfunction, the new onset of hypertension would be defined as a new reading of a systolic blood pressure, that’s the higher number of 140 or greater, and/or a diastolic blood pressure. That’s the lower number of 90 or greater. These blood pressure readings should be documented on at least two occasions at least four hours apart.

Rebecca Dekker: The problem is that gestational hypertension can sometimes be confused with chronic hypertension. Chronic hypertension is hypertension that’s diagnosed or present before pregnancy or before 20 weeks of pregnancy. The traditional criteria are a systolic blood pressure of 140 or higher and/or a diastolic blood pressure of 90 or higher. The diagnosis should have at least two high readings at least four hours apart unless it’s a particularly severe case. Any blood pressure is considered severe if you’re pregnant and have blood pressures of 160 or greater for the higher number and 110 or greater for the lower number.

Rebecca Dekker: ACOG considers it to be preeclampsia with severe features when blood pressures are at this level or when there are other signs or symptoms of preeclampsia along with an elevated blood pressure reading. So, how do you know if you had chronic hypertension before you got pregnant? Well, the American Heart Association and the American College of Cardiology recently updated the criteria for diagnosing high blood pressure or hypertension in adults. They have four categories: normal, elevated, stage one, and stage two. Normal blood pressure is when you have a blood pressure of less than 120 over 80. An elevated blood pressure is when you have a systolic blood pressure reading between 120 and 129 and a diastolic blood pressure reading of less than 80.

Rebecca Dekker: Then there’s also stage one and stage two hypertension. Stage one is when you have a systolic blood pressure between 130 and 139 or a diastolic reading between 80 and 89, and stage two is when you have a systolic blood pressure of 140 or greater or a diastolic blood pressure of 90 or greater. American Heart Association guidelines now suggest beginning treatment in people who are not pregnant at stage one. So, that’s when your blood pressure is 130 to 139 for the higher number or 80 to 89 for the lower number. Because the diagnostic criteria have changed for non-pregnant adults, it’s more likely that people who are pregnant will enter pregnancy already having been diagnosed with stage one or stage two hypertension.

Rebecca Dekker: Interestingly, previously undiagnosed chronic hypertension might be hidden in the first and second trimesters of pregnancy. So, if you’ve never been officially diagnosed with chronic hypertension but perhaps you had it, it can be masked in the first and second trimester because there’s a normal physiologic change in pregnancy that drops your blood pressure, and blood pressure typically only returns to pre-pregnancy levels in the third trimester. Because of this, it can be really hard to figure out if you have chronic hypertension versus gestational hypertension and sometimes, they can even be confused with preeclampsia.

Rebecca Dekker: Clinicians aren’t sure if gestational hypertension is an independent disease, or if it’s an early stage of preeclampsia. Anywhere from 10 to 50% of people with gestational hypertension go on to develop preeclampsia within the next one to five weeks. You’re more likely to progress from gestational hypertension to preeclampsia if you’re less than 34 weeks at diagnosis, if your average systolic blood pressure is greater than 135 during a 24-hour blood pressure monitoring period, and if you have an elevated serum uric acid level.

Rebecca Dekker: It sounded like from what Katie was talking about, she was a little worried that at first prenatal visit when her doctor told her she had just gestational hypertension that maybe she had white coat syndrome. White coat syndrome is defined as elevated blood pressure primarily in the presence of healthcare providers. It’s thought that white coat syndrome may make up 15% of all high blood pressure readings in doctors’ offices, but researchers think that anywhere from eight to 40% of white coat cases during pregnancy will progress to either gestational hypertension or preeclampsia later in pregnancy.

Rebecca Dekker: So, white coat syndrome in itself, the fact that you might experience an elevated blood pressure while you’re in the clinic but not at home may indicate that you’re at higher risk for hypertension in general. We don’t have time to go into a lot of details about induction for hypertension during pregnancy, but the data regarding the best time to give birth with hypertension and pregnancy is mixed. ACOG says that if you have chronic hypertension that is well controlled with medication, waiting until 39 weeks and six days could be considered.

Rebecca Dekker: The main reason induction is sometimes recommended earlier than that is to lower the risk of the mother developing preeclampsia. The guidelines state, “Expectant management beyond 39 weeks and zero days should only be done after careful consideration of the risks and benefits and with appropriate surveillance.” The question about what your diagnosis is if you are told do you have high blood pressures during pregnancy is a hard one and can sometimes only be answered in retrospect after you’ve recovered from birth. Then you could look back with your healthcare provider and say, “Oh, you know what? It was probably chronic hypertension,” especially if it was noticed in the first or second trimester and especially if the blood pressures were still elevated more than three months after giving birth.

Rebecca Dekker: On the other hand, if your blood pressure was only elevated in the third trimester, and it went back down to normal levels within three months after giving birth, then that would be considered hypertension during pregnancy and not chronic hypertension. Regardless if you have any high blood pressure readings during pregnancy, it’s very important to have a follow-up visit three months after giving birth to determine if you had gestational hypertension or chronic hypertension.

Rebecca Dekker: The presence of any type of hypertension during pregnancy is thought to be a window into your future heart health and can be treated as motivation to get seen by a healthcare provider and get careful follow-up and healthcare so that you can monitor your blood pressure and take actions to improve your cardiovascular health to help prevent future cardiovascular disease. So, I just wanted to insert that info that Katie had asked about diagnosing hypertension during pregnancy and now, we’ll get back to the wrap-up of her interview.

Rebecca Dekker: Yeah, that’s an incredible story, and I wanted to point out some resources. A good friend of mine Jenn McClellan runs plussizebirth.com. I don’t know if you’ve heard of it.

Katie Kane: I think that she was on-

Rebecca Dekker: She was on the Evidence Base Birth Podcast. Yeah.

Katie Kane: Okay, and was she on another podcast, Birth Hour?

Rebecca Dekker: Yes, mm-hmm (affirmative).

Katie Kane: I think she might have been on Birth Hour as well. I heard her birth story when I was pregnant with Lucy, and she was very, very encouraging. I have heard through your podcast or through the Birth Hour podcast, but she just really gave me confidence, like she talked about finally finding a provider was able to touch her body in a way, or maybe that was Jennifer Hartley.

Rebecca Dekker: Yeah, no. That was her. She talks about it. Yeah, being touched with compassion for the first time.

Katie Kane: That’s so true because I had a nurse practitioner that acted like she was grossed out by touching me, which was frustrating.

Rebecca Dekker: Yeah, so for anybody listening, Plus Size Birth is a great resource, and Jen McClelland also has a really awesome Instagram page called Plus Mommy. So, shout out Jen for inspiring all of us and teaching us that just because you’re a plus size or bigger, that doesn’t mean that you’re automatically high risk and that your body is broken.

Katie Kane: Right, right, right, right.

Rebecca Dekker: Thank You, Katie, so much for coming on the podcast to talk with us and sharing your story.

Katie Kane: Thank you so much for having me.

Rebecca Dekker: All right.

Katie Kane: Bye, Rebecca.

Rebecca Dekker: Bye.

Rebecca Dekker: Today’s podcast was brought to you by the Comfort Measures for Labor and Delivery Nurses Workshop. Last year at Evidence Based Birth, we hosted focus groups and talked with nurses from across the U.S. who told us that they wished they had a way to learn or refresh their comfort measure skills to use with birthing clients. So, we created the Comfort Measures for Labor and Delivery Nurses Workshop. This is a three-hour in-person workshop with nursing contact hours. If you’re a nurse, midwife or doula who wants hands-on practice with massage, acupressure, upright birthing positions, rebozo techniques and more, visit evidencebasedbirth.com/events to find a workshop near you.

 

Listening to this podcast is an Australian College of Midwives CPD Recognised Activity.

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