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Trigger Warning: shoulder dystocia, birth injury to a newborn, and obstetric violence
Resources
Follow Siri’s journey:

Find out more about Siri’s birth and childbirth education team here: Doula Aileen (https://www.doulaaileen.com/), Heather Christine Struwe (https://holisticcontinuum.com) and Rhonda Fellows (https://www.oilydoulamn.com/about.html).

Find out more about the EBB Childbirth Class here.

Learn about Brachial Plexus social support systems:

Learn more about the evidence and research on shoulder dystocia:

Related EBB Episodes and Signature Articles:

Transcript

Dr. Rebecca – 00:00:00:

Hi everyone, on today’s podcast, we’re going to talk with Siri Lachmansingh, an Evidence Based Birth® childbirth class graduate, about her pregnancy with type 1 diabetes and a difficult birth with shoulder dystocia and a birth injury. Hi everyone and welcome to today’s episode of the Evidence Based Birth® Podcast. My name is Rebecca Dekker, pronouns she/her, and I’ll be your host for today’s episode. Before we get started, I want to make you aware of a content warning on discussing birth interventions, birth trauma, obstetric violence, and a traumatic birth injury to a baby during a shoulder dystocia case. The traumatic part of Siri’s birth story starts at around 41 minutes into the podcast, and I will give you a heads up before you reach that part.

And now I’d like to introduce our honored guest, Siri Lachmansingh. Siri, pronouns she/her, lives and works in Minneapolis with her family. She was a teacher of young children for many years and changed careers due to the pandemic. Siri has had type 1 diabetes since 2001 and became passionate about birth education during her second pregnancy in 2022. Siri is a graduate of the Evidence Based Birth® childbirth class with Rhonda Fellows and Heather Christine Stewart, two of our most experienced instructors. And Siri has been a guest on the Birth Hour podcast talking about her first birth experience. And today she’s excited to share the story of her pregnancy and birth of her second child journey. Siri, welcome to the Evidence Based Birth® podcast.

Siri Lachmansingh – 00:01:39:

Hi, Rebecca. Thank you so much for having me.

Dr. Rebecca – 00:01:41:

So we were so excited when you reached out and said you were interested in being a guest on the podcast. I think you’ll be the first childbirth class graduate to talk about the experience of being pregnant with type 1 diabetes. And I was curious if you could start off by telling us, like, how did you find Evidence Based Birth® and Heather Christine and Rhonda?

Siri Lachmansingh – 00:02:01:

Yeah, I’m really excited to be on the podcast today. I listened to a lot of Evidence Based Birth® podcast episodes last summer when I was pregnant. So I’m really happy to be here today to share my story. So I found Evidence Based Birth® actually through my Hypnobabies® birth class that I took last summer at the beginning of the summer. And I remember in their literature, they said that they were kind of partnered with Evidence Based Birth®, and that that was also another good resource. So I started listening to podcast episodes and that they were free. And I had quite a bit of time to listen on my headphones last summer. And so that was the beginning of my journey. And then I started learning about the birth community in the city that I live in. I live in Minneapolis. And you have a lot of episodes where you interview people that work, that are birth workers, in Minneapolis. And that was so interesting to me. I actually live just a couple blocks away from the Roots Community Birth Center. And so I moved into that neighborhood about five years ago. And that was interesting to me. And unfortunately, because of my type 1 diabetes, I couldn’t get my pregnancy care from them. But I’m actually now able to go there and get my other reproductive health. Now that I’m done having babies, I’m able to go there. So that’s pretty amazing. And I use them for other resources. Like I think I went for breastfeeding class there when my first baby was born and also like a baby wearing class. So that was just really fun to learn about all that. And so I also learned that like the path that you guys have to become a birth instructor, to teach the Evidence Based Birth® class. And I was like, well, that would be really interesting. I was a teacher of young children for a really long time. And then I have a different career now. And it’s just a desk job where I do sales. And so it’s not as fulfilling as teaching young children was. So I was exploring becoming an Evidence Based Birth® instructor. And I thought, well, maybe I should take the class first before I, cause you have to have a year of experience at least before you’re able to apply. So that, okay, well, before I make a plan of getting that experience, then I should probably take the class first. So I ended up taking a fast-paced class at the very end of my pregnancy. I think I was like 35 or 36 weeks when I started it. And it was four weekends. It was a virtual class and they offered the last class in person. I wasn’t able to go, I think my daughter was six, I wasn’t able to go in person, but it was still very helpful to do the last class virtually. It was intense because that four-week class, there’s a lot of material to cover. There’s a lot of reading to do. If I didn’t have the kind of job that I have, where I had enough time to read while I was at work while my toddler was being taken care of by other people, I think that would have been really challenging. But Rhonda and Heather were great teachers. I still remember Rhonda’s example of hip circles on the ball. And I really used that a lot as a comfort measure, also during pushing. That was super helpful. So that’s how I found the EBB class.

Dr. Rebecca – 00:05:17:

Yeah, and it sounds like you found the episodes about Minnesota. So episodes 141, 142, and 143, we feature different birth workers and parents from the Minneapolis area. And of course, Ihotu Ali, one of our research editors is from the Minnesota Minneapolis area as well. And she’s been featured on different podcasts. So we do have, it feels like a good connection with that community. And Rhonda and Heather Christine, like I said, are some of our most experienced instructors. And I know they also mentor newer birth workers and train them as well. So it sounds like you really got plugged in. And I love that you combined the Hypnobabies® with the Evidence Based Birth®, because I’m a Hypnobabies® mom as well. So, you know, what was that experience like taking two separate childbirth classes in the same pregnancy? And let me go back. Why did you take a class because you already had a baby? So why did you go back and get two classes in your second pregnancy?

Siri Lachmansingh – 00:06:16:

Okay, so well, oh, in my first pregnancy, I took a parenting birthing class. And that was what was suggested by hospital where I gave birth the first time. And it felt like it was very lacking. And so once I started to, after I had my first child, I started to learn more about, hey, what happened during my birth? And how come there were some things I didn’t know about? And what can I do to make this birth any different or to just be more informed about my choices? I had a doula for my first birth, and I was looking for a doula with some different experience. So I found a doula. Her name is Aileen Larson, and she is a Hypnobabies® instructor. And so when I interviewed Aileen, right away, we had like a really good connection. She has personal experience with type 1 diabetes in her own life. Her father has type 1 diabetes, and then also her daughter has type 1 diabetes. So just that she had a level of comfort with type 1 diabetes that I was looking for in a doula. And she also has attended, I think she’s attended a home birth with somebody with type 1 diabetes. And so that was really amazing because I think that it does happen. It’s kind of far and few because not a lot of people feel that’s the right choice for them. When I got to know Aileen and she said, well, I teach this Hypnobabies® course, it’s not, if you’re gonna be my client, it’s not necessary that you take this class, but this is something that you could do. So I experienced a shoulder dystocia with my first daughter. When I started reading about how the risk factors and maybe how to prevent a shoulder dystocia with my second birth, I found that some risk factors are epidurals, Pitocin and pushing on your back. I had gotten all of those things during my first birth. And so I said, okay, what could I do to try to prevent using those tools, that’s what they are, they’re tools for birth in my second one. And so I thought the Hypnobabies® would be a good path to take to try to not use epidural. And so that’s how I took the Hypnobabies® course.

Dr. Rebecca – 00:08:26:

Did you find a lot of help from or benefit from the self-hypnosis? Were you one of those people who really felt like you got it or not so much?

Siri Lachmansingh – 00:08:34:

I think it was very helpful because I had a lot of anxiety. The fear clearing tracts, being able to put the headphones in at night and have the tracts help me sleep at night, was, it was worth it.

Dr. Rebecca – 00:08:50:

I always fell asleep listening to those audio tracks and they were so relaxing. It was just, my whole body would really, yeah, I can see that.

Siri Lachmansingh – 00:09:03:

I felt like the hypnosis really helped during my birthing time. Changing the words that you use, because that’s a big part of Hypnobabies® and changing your thought patterns around birth. I still have my safety relaxation peace circle up over here on the wall and that just, I think about that a lot. Just changing a lot of our thought patterns was really helpful. I’m gonna learn that from Hypnobabies®.

Dr. Rebecca – 00:09:27:

Yeah, it’s a skill you can continue to use. I know I use it at the dentist. Still. Yeah, that sort of those kind of more stressful situations, it can really come in handy. Switching gears, in the EBB childbirth class, we focus on like the research evidence and comfort measures, which you said you practice those with Rhonda and Heather Christine, but we also talk about advocacy. Did any of that come into play? Were there any advocacy techniques you felt like you were better prepared to use?

Siri Lachmansingh – 00:09:55:

The one thing that I learned about in the EBB class that I didn’t use was the golden ticket. I had looked and looked for a care provider who was okay with me having or attempting a vaginal birth after having a first shoulder dystocia. I saw an OB at 12 weeks that said to me, we suggest that you have a cesarean birth for this pregnancy because of your previous shoulder dystocia and your type 1 diabetes. And so I just couldn’t believe that. I was like, I had a vaginal birth. My first baby was born and I had a very mild shoulder dystocia. She was maybe stuck for 20 seconds and they did quick McRoberts move, which is where you pull your knees up to your chest because I was on my back for that time too. She came out and she was okay. So I just was really surprised that they would suggest major surgery even after I had had a successful vaginal birth. That’s when I really started to look in to see what causes the shoulder dystocia and what can I do to try to prevent it. I was hoping to see a midwife, but it’s really hard to find a midwife who will take on a case of a pregnant person with type 1 diabetes. So I met with the midwives at Abbott in the Mother Baby Center and they said, well, it’s not possible for us to see you. You’d have to be seen by an OB and midwife team. And the hospital where I gave birth, which was Methodist, they have an OB group and they have a midwife group. The midwife group that attends births at the hospital, they’re not allowed to work in tandem with the OB group. So OB group, there are midwives that work under the OBs there, but they do not deliver babies.

Dr. Rebecca – 00:11:40:

They only do clinic care.

Siri Lachmansingh – 00:11:41:

They don’t attend births at the hospital. So my first pregnancy I had an OB and then I saw a midwife who specialized in like high-risk pregnancies. And so I got a little bit of that midwife continuity of care during my first pregnancy, but then on-call, OBs. I think a resident actually caught my first baby. So it just seems kind of like. When did I agree to that? So the golden ticket, finding a doctor who practices the continuity of care, who agrees with you. About your birth plan. This is how I want my birth to look. You know, I had to have an induction 39 weeks. I could have said no to the induction. I did, sort of. We’ll get to that later, but.

Dr. Rebecca – 00:12:28:

So I wanted to let our listeners know if you’re not familiar with the golden ticket, it is a part of the advocacy technique we teach in the EBB childbirth class where we talk about the golden ticket is where you have. A provider in the birth setting that is in full alignment with your wishes and not only will tolerate you but fully support you in your decisions. If you have that, you very rarely need any other advocacy skills. But if you don’t have it, then we go on to teach the four different tools that we use for advocacy if you don’t have the golden ticket. So when I put this class together, I had a conversation actually with a bunch of college students I was teaching at the time. I was like, I’m really torn. I don’t know what to do because I want to teach people to get the golden ticket. But what about when they can’t? Like what if they have complications or what if they’re in a community or a part of the world where they can’t get this kind of care and they’re kind of going up against this system that is not necessarily designed to support their wishes. And so that’s where we came up with the other strategies of how you deal with when you don’t have the golden ticket. So you’re saying you really wanted the golden ticket, but you never found it truly.

Siri Lachmansingh – 00:13:40:

Right, so I did find an OB that was okay with me being induced at 39 weeks and well, instead of just planning a cesarean at 39 weeks, because that was the other OB’s idea.

Dr. Rebecca – 00:13:51:

They were basically all saying you need to have a cesarean. And I wanted to point out another podcast I went on recently is the Parenting Translator podcast I was a guest on, and their host also had a shoulder dystocia with one of their most recent birth. And so we went over all the evidence. So if any of our listeners want to go learn more about what if you have a shoulder dystocia in one birth, what do you do the next time? I would highly recommend that episode. But I wanted you to share a little bit before we get to your birth story about what it’s like being pregnant with type 1 diabetes. So clearly you’re being kind of labeled as high risk off the bat. Yes. What are the other concerns you’re dealing with during pregnancy? Like, do you have more difficulty managing your blood sugars? Do you have your diabetes doctor involved? Like, what’s going on in the pregnancy?

Siri Lachmansingh – 00:14:40:

So, I think, one of the most important things that you can do is to be prepared to get pregnant. So usually someone will go see their endocrinologist and say, I’m gonna start trying to get pregnant. And they say, okay, well, let’s look at your A1C, which is your average blood sugars over the last three months. Your endocrinologist typically will say an A1C under 6.5 is ideal for pregnancy. So if you can start out having that kind of control with your diabetes and have an A1C under 6.5, you will have hardly any risk of having complications from your diabetes during your pregnancy. Those first couple of weeks are really important. And so just having that established good control, I think is super important. There are some people who, get pregnant with a high A1c, lower their A1c as soon as they find out that they’re pregnant and they have a completely healthy pregnancy. My first daughter was born in 2019 and my A1c had been 6.5 or under in the three years, two and a half years in between when I got pregnant again. So I saw my endocrinologist, she said, yep, go ahead and start trying. I got pregnant right away. And I think the biggest challenge in the first trimester with Type 1 diabetes is that you’re nauseous, or you could be nauseous all of the time, and that makes it challenging to eat when you need to, or eat when you’re supposed to, or handle your low blood sugars, because in the first trimester, you also have a lot of low blood sugars. And I think having a endocrinologist or a nurse practitioner that you really like and that you trust and that has a lot of experience caring for. Pregnant people with type 1 diabetes, that is a great thing to have because you’re gonna be seeing them a lot. And if you don’t like your endocrinologist or if you have like that white coat syndrome where you just get really nervous because they’re gonna tell you, oh, you did a bad job. That’s not the kind of person you wanna be seeing every other week at the end of your pregnancy. So make sure that you have somebody that you trust and that has experience with adjusting insulin levels. And also trust yourself because I did a lot of adjusting of my insulin levels throughout my pregnancy because I knew what my body needed. So that means that I would change my carb ratios and I would change my basal insulin on my own when I started to see like a two or three day pattern of, hey, you know, my blood sugar’s a little high after breakfast, I must eat a little bit more insulin. Or I’m waking up in the morning and my blood sugar is over 90, which they want, like the goals for your levels in pregnancy are very tight. Fasting in the morning, they want it to be under 100. And then one hour most eating a meal, it’s supposed to be under 140. And then two hours, it’s supposed to be under 120. Everybody’s blood sugars has a spike where they go up and down after a meal. And so, trying to get your curve to be flatter is really important. Taking pre-bolesting for meals is really important when you’re pregnant. Or taking, if you’re on shots, taking a shot 15 to 20 minutes before you eat. But the fun thing about pregnancy and type 1 diabetes is that you do have a lot of low blood sugars. And the way you fix low blood sugars is you have a snack. Or you get to eat something. So I really took advantage of the low blood sugars and I would eat sweets and treats. And that’s very different from gestational diabetes because gestational diabetes is mostly controlled through diet and exercise. And then I think some people do eventually take insulin if they need it. But type 1 diabetes, your body is just really using up all of your sugars in the first and second trimesters. So you end up, you are having a lot more low blood sugars. The third trimester is really where you have, more insulin resistance. All of the hormones in your body are causing insulin resistance. A weight gain is causing insulin resistance. And so sometimes people take two or three times the amount of insulin at the end of their pregnancy than they would normally. It’s changing all of the time, the kind of medicine or the amount of medicine you’re taking and what you’re doing to help your blood sugar stay even. What worked one week might not work the next week. And so you just have to be really flexible and know when you need a change. Be okay with that change. Be very flexible.

Dr. Rebecca – 00:19:13:

I think one thing that’s always impressed me about my friends and family with type 1 diabetes is… How in-tune they are with their body. You have all this experience of interacting with the medical system, advocating for yourself, being aware of what’s going on in your body. I think that it could be. A benefit when you bring that to pregnancy and birth, but also at the same time you’re suddenly interacting with a healthcare system that wants to control you in your body. And dealing with obstetricians that don’t trust you and your body. Does that make sense?

Siri Lachmansingh – 00:19:52:

Oh yeah. Definitely.

Dr. Rebecca – 00:19:55:

So like, how do you feel about, you know, when you’re interacting with, with physicians who they want to try and control the situation. When you’re so used to controlling your own situation.

Siri Lachmansingh – 00:20:08:

So right away, I knew that my OB team is going to be very different from my endocrinology team. The OBs at the Methodist Women’s Center trusted the endocrinologist team, because that was also part of the same hospital system or something, Park Nicollet and Methodist Hospital. They very much trusted my endocrinologist team. A1Cs were coming back great, so they would say, oh, how is your blood sugar doing? And they knew very well that I was taking care of it with the endocrinology. I think there are some OBs that want to have their fingers in a little bit and say, hey, this is what we want your blood sugars to be. And if they’re not there, then they’re giving you a hard time about it or telling you that you need to go see maternal fetal medicine, which is, some people with type 1 diabetes, pregnancies are seen completely only by a maternal fetal medicine doctor. And then that doctor will provide care during the pregnancy and also provide care for the diabetes. But I think that having an endo team is better, because then they have more of that experience. And with the technology, too, because maternal fetal medicine doctor might not know how to change the basal rates on your insulin pump, but your endocrinologist or your nurse will know how to do that.

Dr. Rebecca – 00:21:31:

Right. So really important to have both and hopefully they can be a communication. With one another.

Siri Lachmansingh – 00:21:38:

Yes. Yep.

Dr. Rebecca – 00:21:40:

And then getting towards the end of pregnancy, you mentioned it gets a little bit harder because of the insulin resistance that naturally happens in addition to your type 1 diabetes. Were you told you needed to have additional monitoring or tests or what were the conversations around? I know they were trying to suggest this as area, but in terms of induction, were there a lot of interventions being proposed in the third trimester?

Siri Lachmansingh – 00:22:04:

Mostly they just said, hey, this is the kind of testing you need to have. I think starting at, so I had growth scans about every four weeks, I think, at the end of my pregnancy. And so maybe 32 weeks and then 36 weeks. Those were big things for them because they wanted to say, oh, hey, this is where baby is measuring at. Baby is not getting too big because I think a lot of doctors would say, oh, people with have bigger babies because they. Are taking insulin. I challenged a nurse one time and I said that, I said, well, my first baby was born at seven pounds, three ounces. I don’t think that this baby is gonna be much bigger than that.

Dr. Rebecca – 00:22:45:

It’s the high blood sugars that cause the increased growth of a baby, not controlling it with insulin.

Siri Lachmansingh – 00:22:52:

So, it was just, it was confusing and I had a nurse that said, oh well, the insulin makes them beefier at the shoulders. And that is why shoulder dystocia is more likely when you have type 1 diabetes. And I was like, okay, I haven’t seen the research on this yet, so. But it’s just funny the ideas that people get in their heads about what babies of people with type 1 diabetes are supposed to be like. So yeah, the growth scans were important. I did do non-stress tests and biophysical profiles. The non-stress test, I think, was twice a week near the end of my pregnancy for the last six or eight weeks. And then the biophysical profiles were once a week. I was okay with that amount of testing. Some people with type 1 diabetes say no to that. That’s a lot of appointments. Going in twice a week for that testing, and then you also have to see your OB once a week. And then you also have to see your endocrinologist once a week. So that’s a lot, a lot of appointments. And not everybody can get that much time off of work. That’s the reality of it. So I did do the non-stress test twice a week. I liked that just because it was quick and easy journey past them. Usually all the time she passed her BPPs very quickly. She was making these things easy and quick for me because she was just like, Oh, yep, now your BPP is done within five minutes and you can go on and I can sit and read my book in the waiting room while I waited for the next appointment. You know, it was like kind of a break because I did have a toddler at home and a job. So it’s just how you look at these opportunities or times that you have. It’s inconvenient. Then you have to go to the doctor and wait for so long, but then what are you going to do to make that time worth it or enjoyable? So yeah, there was a lot of extra testing at the end. Then I started to talk to my doctor about induction. She said, well, my last pregnancy, my OB, because of my good control, he let me go to 40 weeks, and then we scheduled my induction right at 40 weeks. This time she said, I prefer that you are induced by 39 weeks, because then the baby grows a lot at the end of the pregnancy and then the baby won’t be so big and you have less of a chance of a shoulder dystocia. So I was like, okay, well, I have, you know, like some conflicts with childcare. So I think I ended up scheduling my induction for 39 weeks and like four days.

Dr. Rebecca – 00:25:09:

Yeah, and I want to point out that here at EBB, we do have an article about big babies that cover shoulder dystocia and the statistics with diabetes as well. And that’s available at evidencebasedbirth.com slash big baby. I also wanted to point out you were talking about shoulder dystocia and insulin. And I think there was a little bit of misunderstanding with what the nurse was saying because it’s the high blood sugar levels in you that are then transferred, that sugar is transferred to the baby which causes the baby to release their own natural insulin at too high of levels to try and manage that high blood sugar. And the high levels of insulin that the baby then produces is what causes the increased growth. So it doesn’t have anything to do with the insulin that you’re taking to treat yourself. It has to do with the higher blood sugar levels present in diabetes that then lead the baby to produce more of its own insulin and that increases protein and fat storage. So you mentioned the head shoulder discrepancy and that is something that can happen sometimes in diabetes. Is that the shoulders grow a little bit more in proportion than they should. So you agreed to a 39 and a half week induction. So take us to that day and tell us about how your birth story started with Journey.

Siri Lachmansingh – 00:26:28:

Well, first of all, I canceled my induction.

Dr. Rebecca – 00:26:31:

Never mind.

Siri Lachmansingh – 00:26:33:

Well, I was having some regular contractions. And so I called my doula and I said, hey, I’m having these regular contractions. I’m supposed to go in for my induction. And she said, well, you could just not go in if you don’t want to and just see what happens overnight. So I was like, OK, I’m all for it. Like we had dropped our daughter off at Grandma’s house. So she was out of the house. I knew that sometimes some moms, once their other child is in care and out of their hands, that their bodies are more ready to go into labor. So my contractions picked up a little bit, but then stopped overnight. So then, and I, as I called them, I said, hey, this is what’s going on. Can I just not come in tonight? And the OBs that were on call were like, no, no, no, no. You better come in tonight because you’re already past 39 weeks. And this is just not what we recommend. And I said, well, I’m not going to do that, actually. I’m just going to kind of wait it out and see what happens. And I had already spoke with the charge nurse because sometimes the induction spots fill up because you have to wait based on how many actual people who come in who are having their babies without induction. So I talked to the charge nurse. I said, hey, is there an induction spot for tomorrow morning? Because I’d like to just wait until tomorrow. And she said, yeah, we do have a spot open. So when I talked to the OB on call, and they said, no, we would really like you to just come in tonight. And I said, no, I’m going to wait. There’s already a spot open tomorrow. That’s okay. And so, I waited until the next morning and my contractions had stopped, so I went in in the morning. I had my EBP pocket guide, my induction pocket guide. Oh good. And I had just poured over that, and I had talked to my OB about what I wanted to do for my induction. So my cervix was closed, and I had had a lot of pain. Not a membrane sweep because my cervix was closed, but like massage on my cervix. Cervical massage. Cervical massage, yeah. To try to get things going. I’d had acupuncture and chiropractic work for like weeks beforehand. So I had done all of these things to try to make my cervix more favorable for the induction. I went in and I had started with an oral cervical ripener. I had a vaginal one last time and I felt that that was, it got really intense really fast. And I didn’t really want that this time. So I started with the oral cervical ripener and then decided to have a Foley balloon. I wanted to try to avoid Pitocin as long as possible because Pitocin, last time had made my contractions so back-to-back that I’ve, after about 24 hours, I think I got an epidural because I just couldn’t handle it anymore, I wasn’t able to sleep. So I wanted to try to avoid the Pitocin. So, I had the, the Foley bulb inserted because my cervix with the oral cervical ripener had gotten to about one centimeter. A few hours later, the Foley bulb came out and the plan was to break my waters. And I agreed to this because last time I was on the vaginal cervical ripener and my water broke but just the first layer. And I learned, I didn’t know about this during my first pregnancy, but I learned about it in I think my Hypnobabies® class that there are two layers in your bag of water. So like the forebag and the hind bag. One of the bags had broken, but the second one hadn’t in my first pregnancy. And so then baby’s head was not able to descend onto my cervix to make the progress. And so I was like, okay, well, let’s just get that out of the way. I’ll have them break my waters. This is for second time moms, a good plan for induction. And I remember and I will always. I will always say this, my OB told me. On average, a second time mom, it takes, with an induction, it takes about 17 hours from the beginning of the induction to when baby is born.

Dr. Rebecca – 00:30:25:

17, one, seven, 

Siri Lachmansingh – 00:30:28:

17 hours, yes. And I was like, okay, that sounds great. My first labor was like 36 hours. I was hoping to not do that this time. So this one, we broke my waters. Everything got really intense after that. It was nighttime and I called my doula Aileen in, because we knew that once my waters are broken that things were going to get more intense. So they broke my waters. It was so much water and I was just laughing because I was like standing up in the bathroom and there’s water gushing down as I’m laughing and I’m laughing, there’s more water gushing down and just made it just like a silly little cycle of like I laugh and.

Dr. Rebecca – 00:31:06:

Waterfall.

Siri Lachmansingh – 00:31:07:

Yeah. And then I tried to get some sleep and then I woke up I think about 11 o’clock at night and was having like really strong, pressure waves, we started to use hypnosis and, the waves were like, some of them were really long, some of them were short, I had, you know, they weren’t very consistent. I was making progress, so by 6 o’clock in the morning, I was dead tired and, I was six centimeters. I had been checked, but I hadn’t been told what my progress was. And I was feeling really pushy. Like I felt a lot of pressure in my bottom. I was like vocalizing like I needed to, you know, that I was feeling like I wanted to push. And I was just a little bit confused because I was like, I feel like the baby should be right there. But yet I’m still only six centimeters. It ended up that my bladder was very full and that baby’s head was like squishing my urethra. And so not being able to empty my bladder was really uncomfortable. Baby’s head couldn’t progress any further because my bladder is sitting there really full. So at six o’clock in the morning, I asked for an epidural. And knowing, well, I asked how many centimeters I was, first of all, because I wanted to make that decision. An informed decision. Because if I was going to be like eight or nine centimeters, I was like, okay, but so I asked and I found out, okay, I still have four more centimeters to go. I haven’t even really got to transition yet. I’m going to need some help here. And so I decided, yes, go ahead and get the epidural. And with an epidural, you have to get a catheter. And the nurse suggested, because your bladder is so full, would you like to try placing the catheter before?

Dr. Rebecca – 00:32:56:

Just getting the urine out and emptying your bladder.

Siri Lachmansingh – 00:33:00:

So I agreed to that. And that was very uncomfortable and painful because the, the nurses just had a really hard time placing the catheter, so that was uncomfortable. And then, of course, seeing when the anesthesiologist came, I was like, oh my God, thank you, you’re my favorite person. So I was continuing to use hypnosis and movement. I did get nauseous and so I was using essential oils and peppermints to help with my nausea and vomiting. Once I got my epidural, felt very one-sided. And the nurse said, well, it’s probably because of baby’s position. And so I kept having to switch sides and I was using a peanut ball, but I could never really get comfort and sleep, which is what I hoped for was an effort to do. Yeah. And, the OB that was on call there, she had a great resident. And she came in and she, cause I had asked her, I said, you know, last time with my first baby, I’d ask if I could push in an alternate position. I didn’t wanna push on my back. And the nurses said, oh, we’ll ask the OB. But then they never really got back to me with an answer. And then when they called in the birthing party, which is what they said when, hey, your baby’s gonna come out, they just, yep, you’re on your back. Drop the table down. This was in my first birth. So I didn’t really get a chance to even advocate for myself. Journey was having this, this is this birth I’m talking about now. Journey was having some problems with her heart rate, and so the OB said, hey, let’s put some saline back into your uterus, to kind of cushion the cord. And that was not fun because I had to be, I was finding it to be more comfortable on my side or on all fours during my contractions, even though I had an epidural. And this was before pushing. But she said, let’s fill it back up so that baby’s heart rate will be happy. We did that and I had to be on my back and there’s this big bag of saline that they want.

Dr. Rebecca – 00:35:03:

Yeah, and for our list there, this is called intrauterine resuscitation or intrauterine fluids. So, yeah, we’re basically replacing the water that came out.

Siri Lachmansingh – 00:35:16:

Yeah.

Dr. Rebecca – 00:35:17:

It provides more cushion to the baby’s umbilical cord and makes it less stressful for them, is the thought.

Siri Lachmansingh – 00:35:23:

So that was uncomfortable. I had also, because they were having a hard time keeping her heart rate on the outside monitor, the puck on the outside of my belly. It also agreed to having the intrauterine device where they stick the little node onto the top of her head. I was happy to have that because I had a blood pressure cost, I had a catheter, I had… Oxygen monitor, I had the puck that keeps track of your contractions, and then I also had the puck that keeps track of the baby. I was hoping for less things attached to me. And I was getting more things attached to me during this birth.

Dr. Rebecca – 00:36:01:

Yeah, and I think this is good for our listeners here because a lot of times this is what an induction looks like. 

Siri – 00:36:06:

Yes,

Dr. Rebecca – 00:36:01

There is a lot of monitoring, there’s a lot of things you’re attached to, and there are ways to get more comfortable. And some of our graduates have chosen to have what we call the internal monitor because then you don’t have the belts around your abdomen, which can be very, uncomfortable. Yeah. Yeah. So did that help then?

Siri Lachmansingh – 00:36:27:

I think it did. I think it did a little bit because then not having it on my stomach, just it felt different. It felt less restrictive. Having the big elastic bands gone was, was good.

Dr. Rebecca – 00:36:37:

Those can be very uncomfortable. People don’t always realize. Yeah.

Siri Lachmansingh – 00:36:42:

Because my contractions had been so irregular, I did start on Pitocin. And the nurse had a great few point on it. She said, pitocin can be a good tool when your body needs a little bit of help. So, Thank you, Pitocin that my contractions got more regular. And so then I progressed to 10 centimeters. I remember the OB coming in and my husband was trying to sleep. And I think my doula was also taking a nap. And she came in and kind of talked to me about, hey, this is what it’s gonna look like. We’re gonna have a few extra people in here on the baby care team just to make sure you know that everything is okay. She did say previously that she wanted to be on my back because if a shoulder dystocia happens, that is how she knows how to handle a shoulder dystocia. And the nurse kind of backed her up on that and said, yes, we want the doctor as comfortable and as possible to know, you know, like how to handle an emergency if an emergency happens. Because I had been asking about, hey, can I push? I know that. Hands and knees opens up your pelvis more. And I had asked her also about what’s the difference between like doing a McRoberts where the knees go up into your chest versus like already starting on your hands and knees. Or like, if you’re on your back and the baby is stuck and McRoberts is not working, why would they not flip you or have you flip yourself onto your hands and knees? I didn’t really get answers for that. It was just that, oh, this is what’s easier for the doctor.

Dr. Rebecca – 00:38:13:

And that’s what we talk about in our article on birthing positions. So ebbirth.com/birthing positions, we talk about one of the main barriers to upright birthing positions is care providers not having any training or experience in them. So they feel like a fish out of water if there’s an emergency. They don’t know what to do because they think you’re upside down. Is what they think.

Siri Lachmansingh – 00:38:35:

And I think that was another big reason of why I was looking for midwife to attend the birth is because midwives are going to be more OK in catching babies in these different positions. And so she said, yep, you’re going to be on your back. And then what I want you to do is when your baby’s head comes, we’re going to just do one big push. And I want you to get your whole baby out in one push. And I was like, wait a minute. Are you sure? Because my understanding, I’m not a nurse, but my understanding of physiological birth is that the head comes out, the shoulders start to rotate, and then the rest of the body comes out with the next contraction. And so that seemed very contradicting to me, even though like. Oh, we want to try to prevent the shoulder dystocia and maybe out as fast as possible. That was like, oh, I felt that they were telling me to do this. And so, when it came time for me to push, I had been, because my legs were very loosey-goosey, I had been trying some different pushing positions with the squat bar, with the back of the bed fully up, supporting my back. But what I found most comfortable, I was laying flat on my back and I had like one leg propped up and I was doing Rhonda’s hip circles. And that was the position that I made the most progress in. And that was the position that I would have liked to just birthed in.

Dr. Rebecca & TRIGGER WARNING – 00:39:51:

I wanted to pause and acknowledge that from this moment on, Siri’s story takes a difficult and traumatic turn, and she is subjected to obstetric violence and a birth injury to her baby that, in my opinion, could have been prevented if her obstetrician had listened to Siri, and if the OB had followed the evidence-based practices of allowing someone to birth in the position of their choice and using the two-step delivery instead of trying to push out the baby in one push. Also, you will hear that the staff were yelling at Siri to keep pushing even though her baby had shoulder dystocia and bone was stuck on bone. Continuing to encourage her to push goes against all protocols for shoulder dystocia. You do not want to keep pushing if the shoulder is stuck and you do not want to pull on the baby’s head. These actions could damage the nerves of the neck, shoulder, and arm. Instead, the shoulders need to be dislodged first using a series of standard maneuvers.

If you are trying to protect your mental health today or if you are pregnant and only want to listen to positive birth stories, you may want to avoid the rest of this podcast as it is disturbing and graphic. All our listeners should know that there is evidence that shoulder dystocia can be safely treated and birth injuries can be avoided if you are attended by providers who are trained in evidence-based ways of treating shoulder dystocia, who practice good communication and perform regular team drills at their facility on how to handle shoulder dystocia. I want to reaffirm that if obstetric violence happens to you, it is not your fault. Siri did everything she could have to prevent this and she was not listened to. Her rights as a birthing person and a parent were violated and she was more educated on how to prevent and treat shoulder dystocia than her team was.

I admire Siri’s bravery in sharing her story and I share her hope that nurses, doulas, and providers who listen to the rest of this podcast may hear this story and become motivated to learn how they can help speak up and how they can work to prevent birth injuries and prevent birth trauma. And now I’m going to turn back to Siri sharing the rest of her birth story in her own words.

Siri Lachmansingh – 00:42:03:

But when her head started to show, they went and got the doctor and the newborn care team. And they pushed up the back of the bed and dropped the bottom and, you know, got me up there and said, okay, well, and I checked with the doctor again. I was like. Big push is that is that are you sure that that’s what you want me to do that that’s what’s gonna get this baby out?” And she said yes. One big push and her body didn’t come out immediately. So then they’re like, oh, she’s stuck. So they’re then pushing my legs back and we’ve got extra nurses and the resident and then she’s still not coming out. I’m pushing that, you know, they’re starting to yell at me which is something that I did not want. And I put that in my birth guide. I was like, I don’t want people to yell at me to push cause that doesn’t make it any easier for me to be able to push. And they really wanted me to be bending and bearing down to try to get her out. And again, I’m thinking about this is confusing to me because when bone is stuck on bone just pushing against the baby’s shoulder against my pelvis is not gonna dislodge it and not gonna get the baby out. You have to move. 

Dr. Rebecca – 00:43:33:

Yeah. 

Siri – 00:43:34:

The doctor and the resident inserted their hands into my vagina, and I don’t know exactly if it was the doctor’s hands or the resident’s hands, but to dislodge the shoulder. And then I heard them, as they were telling me to push, the OB called for another doctor. And she said, you know, where is this, where is Dr. So-and-so? And they said, okay, I’m going to go get them in this other room. And this other doctor came in also. And so this is going on a couple minutes now. And so. One shoulder gets dislodged, the other shoulder dislodged. She comes out. And. I can’t remember if they bring her to me right away, because this all is very foggy. I think they show me that, oh, it’s a girl, because she was a surprise. And so I’m like, oh, yay, she’s a girl. And they’re like, OK, we’re going to take her over to the table to check her out, because that was a long time to be stuck. It was almost three minutes. And she starts to cry pretty quickly. And so I’m like, OK, at least that part is, you know, I can hear her crying. And my husband is over there. And he was telling me, yeah, I was telling her it was going to be OK. It’s all going to be fine. And daddy’s here. And she’s like, OK, I’m going to go check on her. And I’m like, OK, I’m going to go check on her. And I’m like, OK, I’m going to go check on her. And she’s like, OK, I’m going to go check on her. Bring her over to me and they say okay well she’s doing okay now but we are gonna take her for some x-rays because, she has some bruising on her face and bruising on her left arm, and we think that her arm might be broken. I’m gonna get a little emotional here, but. That was, that was such a scary part. Just those three minutes and dramatic. One thing that I wanted, I wanted her to stay in the room with me. You know, for as much care as they could do in the room, I asked them that. I said, can you keep her in the room with me? Because my first daughter was taken to the NICU and I think she was gone for about two hours. They said, okay, well, we’re just gonna take her for her X-rays. Dad will come with and then, you know, we’ll bring her back as soon as we can. To be in the room. With your baby, going to go get x-rays. You know, they’re cleaning up and there’s, and there’s meconium all over the room. It just feels. I wanted things to go differently, and they did it. And I tried. I tried doing a lot, too. To change the outcome. And, you know, everything that happened to me, I feel like most of the interventions I agreed with because I knew that they were benefits.

Dr. Rebecca – 00:45:52:

And in the moment, each step made sense.

Siri Lachmansingh – 00:45:55:

Yeah, yeah. So. Thankfully she didn’t have a broken arm. She, they call it a brachial plexus birth injury, which is where the nerves. We’re connected anymore. And so, she’s been doing. Physical therapy. And had a couple of procedures done. Where they, you know, fit her. Arm was kind of coming out of the socket. That’s a whole nother. Part of story but so she’s she’s doing much better now she’s nine months old and she’s doing really great and can move her whole arm it’s just a little bit farther behind the other one but That was the birth of Journey and it was, it was, like I said, it was dramatic and it was intense and it was another 36-hour induction and I don’t think that. My shoulder dystocia were directly related to my diabetes because my diabetes was very well controlled. When Journey was born, she was seven pounds and 15 ounces. So she, again, like wasn’t a big, she was a very normal-sized baby. Again, I don’t know. And the what-ifs don’t help. Right, but I’ve been, I’ve been trying to work through this birth drama by thinking about it and acknowledging the guilt that I feel and knowing that it’s not my fault. And being okay to talk about it. Because a lot of people, if they have a traumatic birth, it’s scary to talk about. And you it’s uncomfortable. Maybe you don’t want to, but that’s. A way that you can become comfortable with the story and you know, accepted. The biggest thing that I try to remind myself when I tell this story, when I think of it, is that I am safe, my baby is safe, and this was in the past. It was how she was brought into life, but. Doesn’t define how the rest of her life is gonna go. It doesn’t define how much I love her, you know, just. That’s just the story of it.

Dr. Rebecca – 00:48:07:

And how did you cope with it in the first few weeks after?

Siri Lachmansingh – 00:48:10:

The first week especially was difficult because bringing a newborn baby home is a lot already. But bringing a newborn baby home with a birth injury is, again, it’s different. We took her into physical therapy when she was five days old and got these. They said, okay, you can start doing these exercises when she’s 14 days old because they wanted some more time for any inflammation. Got some healing to happen, so start these stretches. It was just a lot because we’re doing, you know. Two-week check-up. Physical therapy once a week. I was feeling very down the first week. And again, I was crying a lot. I felt a lot of guilt. I talked to my doula, Aileen, about it when she came and for my postpartum visit. And she made sure to tell me that none of it is your fault. And the doctors, you know, they did what they could to keep your baby safe in that. Time. Again, like it’s not your fault. I know you feel guilty right now, but. You did what you could and you made the best choices for you and your family. I remember specifically like, Journey was about a week old, and we were driving to my dad’s house feeling. Such like. Baby blues, like, oh, in the evenings, the baby blues are the worst for me. The next day I started taking my placenta in capsules and I feel like it made such a big difference going forward. I hadn’t planned to have my placenta encapsulated but after Journey was born and the nurse was like, oh, here, do you want to look at your placenta? And I was like, yeah, sure. She said, oh, it looks like a really healthy placenta, which that’s a concern with some people with type 1 diabetes is that the placenta will get old and that’s what might cause a stillbirth or it might cause, you know, that’s why they say, oh, people with type 1 diabetes need to be induced at 39 weeks because their placenta ages quicker than a regular placenta. So I looked at my placenta and I said, oh, that’s wonderful, it’s beautiful. You know, I was like, well, actually, I kind of want to have my placenta encapsulated because this, Birth was so long and so difficult and I’m so tired that I will take anything that I think might help. I did, I don’t know if it was just placebo or, or, placenta capsules really helped me, but after I started taking them, I felt like I had more energy than I did, even though I was also chasing around a toddler. I felt like I had the mental capacity to get Journey’s care taken care of, to get to her appointments, to get to my own appointments, and to advocate for her because we were referred to go to Gillette’s specialty over in St. Paul. And for some reason, the referral didn’t get there. And so I was making phone calls saying, hey, this is a really important time, says our physical therapist, to get her in one of these splints or braces that will help stretch out her ligaments and stretch out her muscles. So just to have the energy and the time to be able to advocate for my daughter, that was a challenge, but. I felt like I took care of it and was able to advocate for her. And she’s just doing so well now. So I’m just, I’m really happy that. She’s doing amazing and She’s got so much personality.

Dr. Rebecca – 00:51:31:

You did an amazing job, Siri. Like, this is not easy.

Siri Lachmansingh – 00:51:36:

Thank you, Rebecca.

Dr. Rebecca – 00:51:38:

To have a condition that you do, and then go through a whole pregnancy keeping your baby safe, and then do everything you can to protect her during the birth. Like you said, it’s not your fault. And she’s here, you know, and you advocated for her before, during, and after. It’s really incredible.

Siri Lachmansingh – 00:52:01:

Thank you, Rebecca.

Dr. Rebecca – 00:52:02:

I’m just awed by you.

Siri Lachmansingh – 00:52:04:

Well, I just, I hope that other people can listen to this and know that their story doesn’t have to be like mine. And it, just to know that like, as long as you’re making the choices that you’re okay with during your pregnancy and your birth and that you, I ask all of my pregnant friends, are you taking a birth education class? And then I suggest EBB to them. And I’m still hoping. I needed some time after Journey’s birth, kind of a break from the birthing world. So, I’m just, once I started to feel comfortable with telling my story, I’m hoping that my path will eventually lead into it. You know, birth education again someday, so.

Dr. Rebecca – 00:52:48:

I believe that it definitely could for you. And I think your instincts were spot on and you had so much information and education, you know, that you went to all these steps to educate yourself. Even your intuition about not doing the single push of the baby. You know, the research backs that up as well. And you were not listened to. 

Siri Lachmansingh – 00:53:15:

Yeah, yeah. I mean, it was hard at the time. To feel like that wasn’t the best advice and then to double check and ask again.

Dr. Rebecca – 00:53:24:

Yeah, yeah. But how many parents would know? I mean, you know, like nobody, I would not, I would say. 99.9999% of parents would have no idea that there’s actual research showing that they call it the two-step delivery where you have a pause and you let the shoulders rotate before they come out. But that’s works better. We talked about that in episode 168 with Dr. Wormsley. And at the time we did that interview, she is a highly accomplished OB-GYN and she didn’t even know that research evidence, you know. So I think getting the word out there about about ways to prevent shoulder dystocia with birthing positions with two step delivery instead of one step is important. And also knowing that shoulder dystocia is treatable and that you want to have a healthcare team that does drills and practices this and that they know how to communicate with their patient when this is happening because just yelling at the patient and all those things contributes to the birth trauma and it doesn’t help the situation.

Siri Lachmansingh – 00:54:28:

I do, I think about that three minutes, like, with how many people there were in the room. They could have flipped me over onto my hands and knees to see if that would help. And if that didn’t help, then they could have flipped me back onto my back with all that time that they had.

Dr. Rebecca – 00:54:39:

I know, there is. The three minutes when they were just like panicking.

Siri Lachmansingh – 00:54:44:

Yeah, there definitely could have been, I mean, I think there could have been some other strategies tried.

Dr. Rebecca – 00:54:50:

Yeah, and there’s actually research showing that there are evidence-based ways of practicing to release the shoulders and unfortunately, I don’t see that a lot still. And a lot of hospitals is something we need to advocate for. If you go to ebbirth.com/bigbaby, we link to all the research on it. There have been hospitals that have been able to completely eliminate birth injuries simply by practicing the evidence-based ways of releasing the shoulders. And drilling and having all the team involved so that they know what to do. Unfortunately, a lot of people still find themselves in your situation. You did the best that anybody could have done in that situation. It’s really amazing what you’ve done, Siri. So we’re proud of you. And I hope that you’re able to continue working through the trauma and just please reach out, let us know if you need anything.

Siri Lachmansingh – 00:55:47:

Thank you, Rebecca. I will.

Dr. Rebecca – 00:55:49:

All right, everyone. Thank you so much for listening to Siri’s birth story and pregnancy story. And again, you can check out her other birth story on the Birth Hour podcast and we’ll link to all the other episodes I mentioned in the show notes. Thanks everyone and I’ll see you next week.

This podcast episode was brought to you by the Evidence Based Birth® Childbirth Class. This is Rebecca speaking. When I walked into the hospital to have my first baby, I had no idea what I was getting myself into. Since then, I’ve met countless parents who felt that they too were unprepared for the birth process and navigating the healthcare system. The next time I had a baby, I learned that in order to have the most empowering birth possible, I needed to learn the evidence on childbirth practices. We are now offering the Evidence Based Birth® Childbirth Class totally online. In your class, you will work with an instructor who will skillfully mentor you and your partner in evidence-based care, comfort measures, and advocacy so that you can both embrace your birth and parenting experiences with courage and confidence. Get empowered with an interactive online childbirth class you and your partner will love. Visit evidencebasedbirth.com/childbirthclass to find your class now.

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

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