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Thursday, July 24, 2014

Breaking the Silence

I have been asked to write about my birth experiences so here goes.

I became pregnant with my first child at 24.  As a type 1 diabetic, I had always been warned of the risks of having children.  When I was a child,  I was told I would never had kids, and that if I did, it would kill me or they would be hideously deformed.  I was told I would be hospitalized for months and that pregnancy could cause permanent damage to my kidneys and eyes.  "Steel Magnolias" always resonated in my mind.

 Medicine and technology have advanced greatly though and I was assured as an adult that I could have children, but there were still risks involved.  The risk of stillbirth was always looming.  I was told that even with near perfect control, this was always a possibility.  Risk of miscarriage was higher.  My baby would likely be big due to high blood sugars and it's lungs would develop more slowly.  Baby would be at higher risk for hypoglycemia at birth.  Heart defects were a possibility.  The list went on.  I had always wanted to be a mom though and was willing to take those risks.  "

Prior to pregnancy, my blood sugar control was not great but upon becoming pregnant, I lowered my a1c quickly.  To 6.3 by six weeks and to the low 5's for the remainder of my pregnancy.  I was told I was a poster child and that my a1c was likely lower than my OB's.  I was closely followed by an OB, an Endocrinologist, a Perinatologist (high-risk OB), a pediatric cardiologist (in case of heart defects) and an Opthalmologist (in case of diabetic retinopathy).  I had frequent monitoring and everything was going well.

As I neared the end of my pregnancy, my monitoring was more frequent, with Non-stress tests and Bio-physical profiles twice a week.  Around 35 weeks I was told my baby was breech.  The first thing out of the doctor's mouth was, "when do you want to schedule your c-section?"  I told him I wanted to wait to see if the baby would turn.  I didn't want a c-section, I wanted the childbirth experience I had always dreamed about.  He told me I was insane.  What women wants to be in pain?  From a very young age I had always envisioned giving birth.  I wanted to do it drug-free, I wanted the whole she-bang, the birthing bar, or maybe a water birth, I wanted to be yelling and cursing at my husband as I pushed my baby out.  I wanted to lift her to my chest and to immediately nurse her and bond with her.

Because of diabetes protocol I was told that I would be induced at 37 or 38 weeks due to the risk of stillbirth and/or a big baby.  My baby was measuring right on schedule and did not appear to be big at all but I blindly trusted my doctor, who had treated many diabetics.  At 37 weeks, the baby had still not turned despite all my efforts, standing on my head, doing flips in the swimming pool, playing music between my legs, even lying upside down on an ironing board.  I begged the doctor to turn the baby and he hesitantly agreed.

On September 8, 2004 at 37weeks 6days I would go in to the Peri and have an amniocentesis to determine Diana's lung maturity,  and if her lungs were developed, we would do the external version under an epidural (which I did not want) in case of emergency c-section and they would induce me from there.  When the doctor inserted the needle, he had a hard time getting fluid.  Apparently my amniotic fluid was low at a 6 and it would be dangerous to turn the baby.  I asked couldn't I drink water to bring it up?  I was told that wouldn't work and I should report to the hospital for my c-section.




A birth should be full of excitement and joy but mine wasn't.  After multiple attempts to get my spinal in (which were exceedingly painful), they finally got it in and I was draped and laid on the operating table.  I remember the doctor chatting away, talking about sitting in his deer stand.  I felt lots of pressure and then I heard a cry!  My beautiful Diana was out, but I couldn't hold her, I couldn't lift her to my chest or nurse her.  She was perfectly healthy, 7lb 1oz and no hypoglycemia.  She was immediately whisked away to be checked and cleaned up.  Daddy got to take her out and show her to our family, who was anxiously waiting.  During this period, I started feeling everything.  I started saying, "hey I feel that",  but the doctor ignored me.  I got more panicked and yelled, "I AM FEELING THIS" and totally freaked out.  They started injecting into my IV and the next thing I knew I was in recovery.  "When can I see my baby?"  "Oh, it is hospital protocol that the baby be observed for 6 hours.  You can see her after that."  I cried for my baby.

I stayed in the hospital for 3 days after my surgery.  I was swollen, weak and sore.  It hurt to stand up straight and I was terrified of popping my incision.  It hurt to cough or even move and I kept a pillow over my incision.  I had no milk, and my baby screamed with hunger (I later found out the milk not coming in for days was due to not giving birth naturally).  I finally gave in and let her have sugar water and later a bottle of formula.  "Your baby is hungry".  "She needs formula".  This was the beginning of the end of my breast-feeding journey, despite months of struggling with pumping, supplements and tears.  I was sent home with a goody-bag full of formula samples and bottles.







Two years later I became pregnant with my second baby.  Again, my blood sugars were well-controlled (despite many low blood sugars and a very scary low at 32 weeks) and I was followed exclusively by a perinatologist rather than an OB.  He was the top of his field I felt honored that he took me as a patient.  I told him from the start I wanted a VBAC (vaginal birth after Cesarean) and he said that should be no problem.  Things progressed normally, but as I got closer to my due date, the doctor hemmed and hawed about the VBAC.  He eventually told me, "I can tell by looking at you that you cannot deliver vaginally" and scheduled my repeat c-section at 38 weeks.  

I wanted a natural birth so badly.  I tried every self induction method I could come up with including castor oil, but nothing worked.  My baby was healthy and head down, ready to be born.   On October 31, 2006 I checked into the hospital to be monitored through the night and to have my c-section the following morning.  The nurse brought in the consent forms.  "You are agreeing to an elective repeat Cesarean", "Actually, no, it is not elective, he's making me have it".  No response.  "Your alternative is a vaginal delivery"  "No, it isn't.  He won't let me deliver vaginally".  Again no response.  I looked around the room at the birthing ball, the birthing bar, the birthing tub, and broke down sobbing.  The nurse just looked at me like I was insane. 

Again they struggled getting the painful spinal in and I was readied for my surgery.  I was instructed to remove my insulin pump which I removed begrudgingly.  The surgery progressed normally and my little boy was lifted up for me to see.  8lb even and perfect APGARS.  I was taken to recovery where I begged to see Aidan.  "Oh, there are no infant CPR certified nurses in here so you can't see your baby".  "What about my insulin pump?"  No drip had ever been started and I was up to 140.  "Your doctor is in surgery, you can talk to him when he finishes his c-sections in a few hours".  Hours pass, and no drip is started.  My doctor says, "oh I'm leaving it off, I don't want you going hypo!"  When I hit 200 I put the pump back on AMA and blood sugars were normal after that.  Aidan suffered from hypoglycemia and I was told he got formula or an IV so I gave in to the bottle which again was the beginning of the end.  I was again sent home with a goody-bag.  By 7 months old, Aidan was losing weight due to my low milk supply and I was told I was starving my baby.  "Feed him formula or else".  






Swollen and exhausted.

Weak and in pain.


     I went home very sore and had immense pain which continued for 6 weeks.  I couldn't even stand I was in so much pain.  The Army hospital ruled out appendicitis and gave me Tylenol and Motrin, which did nothing.  I was in so much agony, at my 6 weeks check up, I begged the doctor to do something.  He did an ultrasound and said my body was reacting to an internal stitch and was fighting it off like a foreign invader, thus the swelling and pain.  He gave me Percocet, which allowed me to function while I single-handedly cleaned and packed up our apartment to move to Fort Stewart where Matt had been stationed and had already been sent.  All while taking care of an infant and a two-year old.  Aidan's birth traumatized me and I mourned my lost births.  I tell people I was depressed for 5 years afterward.  

At 30, after two deployments, we had a big surprise.  I was pregnant again!  I did my research this time.  I spent hours upon hours reading about VBA2C and finding a VBAC friendly provider.  I found out ACOG's new policies. 


July 21, 2010

Washington, DC -- Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists."
I also came to the conclusion that inducing at 38 weeks was outdated and unnecessary if I kept tight control.  I was eating low-carb this time around which made things much more smooth with much fewer hypos than my previous pregnancies.  Matt was nervous, but supportive.  I found a wonderful perinatologist who also had a midwife who followed me.  He agreed that I could go to 40 or 41 weeks if things were going well and that if I wanted to attempt a VBA2C.  He also agreed to let me keep my pump and cgms on and ordered a normal diet for me so I could pick what I wanted and eat low-carb.  Adrian Christopher was born on August 27, 2011 after 20 hours of labor.  You can read his birth story here:  http://allisonprimalpregnancy.blogspot.com/2011/08/birth-of-adrian-christopher-vba2c.html


Adrian's birth was so healing and empowering.  It was the most amazing experience of my life.  My baby was immediately placed on my chest where he nursed and snuggled with me for over an hour. Within an hour or two I was in my pajamas, walking around, eating and felt wonderful.  He nursed like a champ and my milk flowed freely.  I ended up nursing him for 15 months.   I wish I could give birth again just for the experience.

Pushing!

Snuggling on my chest.

Going home!

I also wish that no other woman would have to go through what I did.  I later found out that the hospital where I gave birth to Diana had a 57% c-section rate and I also found out Aidan's doctor only worked one day a week.  It was really convenient to schedule me in his little book.  Educate yourself!  Empower yourself!  Don't be bullied!

A fellow Type 1 also had a successful vbac and I'd like to share some tips she shared with me.


How I beat the odds to have a successful T1D VBAC:
1.  Researched hospital stats to learn which of the six hospitals in my area had the highest statistics of VBAC success.  One hospital was clearly superior to the others in this regard, with 18% of all births occurring there being VBAC, and an 85% VBAC success rate.  (This hospital actually has the highest VBAC stats in the entire state.)
2.  Hired the most liberal Perinatologist in the region -- who happens to also work at the previously determined VBAC-friendly hospital of choice.  (For example, he is known as being the only doctor in this region willing to attend vaginal births of breech babies.)
3.  Fortunately, my current Endo also works at this same VBAC-friendly hospital.  
4.  Hired Integrated Diabetes Services (IDS) to help me manage my blood sugars throughout pregnancy.  (The CDE at my Endo's doesn't do pregnant T1Ds very often.)  My CDE at IDS helps pregnant T1Ds all the time; for example, she had 4 clients give birth within 2 weeks of me.  For anyone who is looking for more accessible support, I can't say enough good things about IDS's services to T1Ds across the nation and around the world!: http://integrateddiabetes.com/pregnancy-and-type-1-diabetes/
5.  Hired a doula who specializes in supporting moms attempting a VBAC.
6.  Went to a chiropractor regularly throughout the pregnancy.
7.  Aimed to eat 80 grams of protein per day.  
8.  Took a great childbirth education course (Hypnobabies).
9.  Politely declined almost all 3rd trimester testing, including weekly amniotic fluid level checks, twice a week non-stress tests (I only did it once a week), and all growth scans.  
10.  Labored at home until pushing began, arriving at the hospital ready to deliver.  (Afterwards, my doctor said, "That's the way to do it!  Show up without giving anyone at the hospital time to interfere!")

If any of you are wanting to VBAC, I encourage you to go for it!  #BREAKTHESILENCE

Thursday, January 9, 2014

Cholesterol and My VAP test results.

     So I am way behind on posting this but I wanted to put it out there for anyone who might be doubting this way of eating.  Some of the things you might hear from family or friends, "won't all that fat clog your arteries?" or "surely eating butter, bacon and coconut oil will raise your cholesterol!"  The simple answer is, "NO!".  Well, not like you think anyway.

     If you are a follower of this way of eating ie low-carb high-fat, Paleo, Primal or ketogenic you probably know this already,  but here is a refresher.  Half a century ago, this guy named Ancel Keyes proposed a theory.  It is commonly known as "The Lipid Hypothesis".  He published this study of 22 countries that associated saturated fat with heart disease.  The problem with his study is that it was completely bogus.  It was cherry picked.  He started with 22 countries but many didn't jive with his theory so he just threw out that data.  He only ended up with 7 countries that fit his criteria.  This became known as "The Seven Countries Study" which seemingly showed that there was a strong correlation between serum cholesterol and coronary heart disease mortality.  When this study was repeated by other scientists, including all the countries, the correlation disappeared.

     In 1960, Ancel Keyes was sitting in the American Heart Disease Committee that advised a low-fat diet for those at risk for heart disease.  As we know, things just went down-hill from there.  The public was blasted with advice that has since led to obesity, diabetes, stroke and yes-heart disease!  "Eat a diet low in saturated fat and eat these healthy vegetable oils instead!  Eat plenty of whole grains,  starches, fruit and vegetables!"  We can see how that turned out.   Obesity rates have skyrocketed.  As of 2011, 25.8 million people are diabetic-8.3% of the population!  79 million people are considered, "pre-diabetic". (http://www.diabetes.org/diabetes-basics/diabetes-statistics/) Two-thirds of the US adults are overweight or obese.  Heart disease is the NUMBER ONE cause of death for both men and women in the U.S.  today. (http://www.theheartfoundation.org/heart-disease-facts/heart-disease-statistics/)  Yeah, this plan worked out great.

        The tide is turning however albeit slowly and painfully.  In the past ten years a myriad of studies have come out showing NO correlation between saturated fat and heart disease.  http://www.ncbi.nlm.nih.gov/pubmed/20071648  "Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclusion in this study. A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD

CONCLUSIONS:

A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat."  Has this changed the recommendations?  Not so much.  It would be kind of difficult for the experts to just admit, "oh wow, we've been wrong for the last 50 years and gosh we must have killed a lot of people.  Whoops."  


     So back to cholesterol.  When asked about their cholesterol, most people just think about total cholesterol, but this is just a teeny tiny part of the picture.  Did you know that 50% of people who were hospitalized with coronary artery disease had "normal" cholesterol and that 75% of patients who had heart attacks fell within the current guidelines set for LDL?(http://www.atherotech.com/content/thevaptest/pdfs/vapbrochure.pdf)  Sounds like we're missing something huh?  

     We have "good cholesterol",  "bad cholesterol", triglycerides, VLDL and that's just on a basic lipid profile which is almost certainly all your doctor is testing.  This still is only a small portion of the total picture.  Yes, we want high HDL, "good cholesterol" lower LDL (bad cholesterol) low triglycerides and VLDL but an important factor that most doctors are overlooking is the LDL particle size pattern.  A diet that is low-fat and grain based results in small, hard dense LDL particles or "pattern B" which is harmful-a heart disease risk factor, high triglycerides and VLDL whereas a grain-free, low-carb diet high in saturated fat (think animal fats, butter, coconut oil and dairy fat) results in large buoyant benign LDL particles known as "Pattern A".  Most likely your doctor will say, "your cholesterol is high, lets put you on a statin" or "your LDL is higher than I'd like, lets start a statin" no matter what your LDL pattern is, completely ignoring the fact that if your LDL is pattern A, your LDL is benign, even beneficial.  
 Going beyond LDL particle size patterns we have lipoprotein classes and subclasses.

     A VAP test covers all these.  So why isn't this test routinely done?  I begged and pleaded for my doctor to run one for over 3 years and was always given the same explanation, "it won't change the outcome, there is no point".  There absolutely is a point!  I'm not taking a pill if I don't need to.  Finally, I convinced him to run it.  


     So enough of the explanations.  Here are my results:

     As you can see they are awesome!!!  My HDL (good cholesterol) is 93.  They want it above 40.  I'd like to see a grain eater with an HDL that high!  My LDL is 119.  Some would consider this on the high side but if you look down to Real-LDL size pattern, my LDL is Pattern A!!!  Large, buoyant fluffy LDL, the good kind.  My triglycerides are nice and low at 44, my VLDL is 13, my APO B 100 is 82, 11 and my real LDL C is 101.  LPA is 11, HDL-2 is 35, HDL-3 is 58, VLDL-3 is 7.  My total cholesterol to HDL ratio (preferably under 5) is 2.42- VERY LOW CARDIOVASCULAR RISK!!!  My triglycerides/HDL ratio is 0.69 (preferably under 4, ideally under 2).  

     These numbers are terrific!  If I had only had a basic cholesterol test however, a doctor would say, "oh my, your total cholesterol is 225!  That is high and you need to be put on a statin immediately!  This is why the VAP test is so important.   So many people are needlessly taking cholesterol medication.  The other major point here is that I obtained these awesome cholesterol numbers by following a very high fat (80% mainly saturated) low carb meal plan!  I am not clogging my arteries!  Here is the proof.