EBB 407 - Migraines and Insulin and Umbilical Vein Varix, Oh My! An Empowering Pregnancy and Hospital Birth Story with Heidi Gustad, Librarian and EBB Childbirth Class Graduate

0:00Heidi Gustad: Hi everyone. On today's podcast, we're going to talk with EBV childbirth class graduate, Heidi Gustad, about her birth story involving gestational diabetes, an umbilical cord abnormality, and an unmedicated hospital birth.

0:16Heidi Gustad: Welcome to the Evidence-Based Birth Podcast. My name is Rebecca Decker, 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 slash disclaimer for more details. Hi everyone, and welcome to today's episode of the Evidence-Based Birth Podcast. Today, I'm so excited to have a graduate of the EBB childbirth class here to share her birth story. Heidi Gustead is a first-time elder millennial mom, librarian, and published knitting pattern designer in Chicago.

1:00Heidi Gustad: Heidi is passionate about helping people make things, learn things, and connect them with resources to do the same. Access to information and informed consent are where Heidi's personal interests and experience in pregnancy and birth overlap. Heidi is a graduate of the EBB Childbirth class with EBB instructor Carly Ann Marshall-Brown, and she's here to share her birth story, including some information about how she navigated a diagnosis of gestational diabetes and an umbilical vein varics. Heidi, welcome to the Evidence-Based Birth Podcast. Hey, it's nice to meet you. Yeah. So nice to meet you.

1:37Heidi Gustad: I'm sure you heard my voice a lot and now we get to talk in kind of in person. So very cool. So Heidi, would you like talk with us and our listeners about, you know, what your pregnancy experience was like? So I decided at 36 that I was interested in pursuing parenthood for the first time. My husband and I have been together for 18 years now. So we were together like 13 years or something before we decided to try becoming parents. And I had gone into my marriage kind of like, oh, I don't know. I don't know. And I had a lot of friends who had adverse experiences during pregnancy. I also grew up with these, I mean, a lot as women, we have these stories that we hear growing up about pregnancy and childbirth.

2:25My mother's experience with me, I was born in two hours after she was administered way too much Pitocin in North Dakota in 1987. And then my father's mother had tuberculosis when he was born. And it was the 50s. There was a very early C-section done. My father was sent to one grandmother's house. His 20-month-old sister was sent to another. And my grandmother was sent to a TB ward. so I have these like two generations of really intense negative birth experiences that I grew up with and so I think that resulted in this like big fear of pregnancy and childbirth and then as I became a young married woman and I had other friends who were married in with the intention of having kids right away I heard time and again all these negative experiences with hospital birth and so I was like okay I've been on the fence I don't know if I want to do this years go on I go to therapy.

3:17I learn how to cope with these like little trauma stories that are just in the ether. And I realized that I want to have a kid. So that's like a little bit of the backdrop here. And so we decided to start trying to have a baby. But as we started trying to have a baby, I also wanted to tour different birthing spaces in Chicago where I live to see what was available and just what to start, what spaces to envision myself potentially laboring in. what is the difference between different hospitals and birthing options. And so even before I got pregnant, I toured the birth center of Chicago and they are on the North side.

3:55They're the only birth center in the city limits. There might be one on the South side that's open since I had my baby. So just a small asterisk there. But I toured that space and it was the first time I had ever seen a birthing center in person. And I realized that this was the first birthing space that felt like safe to me on like an animal lizard brain kind of level. And then it was actually not long after that tour that I ended up finding out that I was pregnant. So I think there was like this like deep in my psyche, like I feel safe enough that I could be pregnant and also give birth safely.

4:28And so I got pregnant and then started going to appointments at the birth center. And then I also wanted to establish care at the hospital that the birth center transfers you to in case of a transfer. And that hospital, my immediate provider was really kind, but scheduling was always very strange. They were very aggressive about me saying that I also was getting care at a birth center. And they said that I would have to choose at a certain point because they didn't offer fragmented care. I've never heard that phrase before or since. So I was starting to have these little red flags about the hospital that I was going to.

5:06It was Advocate Illinois Masonic in Chicago. And I go to them for a lot of other care, but for maternity care, it just wasn't quite feeling right. The thing that made me realize I needed to consider exploring another hospital was when, unfortunately, in addition to having gestational diabetes and the umbilical vein barracks, I also experienced four to five days a week of migraines for my first two trimesters. I ended up having a brain MRI. I got prescribed a whole bunch of different medications, but there's not a lot you can do for pain management when you're pregnant. And I ended up having to cut down my work hours to 20 hours a week because I was throwing up from pain and it wasn't HG, it wasn't nausea, it was just pain from the migraines.

5:50And my OB at Advocate Hospital prescribed a medication called Butalbital. And it was the first time somebody prescribed something and said, yeah, this has been prescribed, there's good research on it. And I was like, okay, I'll just trust this medical doctor. They went to a lot of school. They've been practicing. They're nice. And then I took it and I was like, wow, I'm not in pain for the first time this week. I had a little energy. So I was like, I'm going to research this some more though, because it does seem like there's a barbiturate in here. And there is, it's basically Excedrin migraine, but with a barbiturate as well.

6:21Heidi Gustad: Yeah. I was prescribed that in my pregnancy. And I remember the first few times I took it, I was like, wow, I feel really good. And then that kind of scared me because I was like, I don't think I'm supposed to feel this way. And I was like, wait a second, is this addictive? And I looked it up and it can be. So that was kind of scary for me as well. Exactly. So you get it. I was like fetal heart defects, addiction, withdrawal. I was like, oh no, I already have been managing my pain. Let's just tough it out some more. Yeah. And eventually I finally got in with a neurologist who gave me the two meds that worked for me were an occasional sumatriptan and then cyclobenzaprine.

7:02That one's been really good because it turns out it was like I have hypermobility in my neck and pregnancy was exaggerating it and the hormones weren't helping. And also that first trimester, they thought it was just normal like hormone headaches that a lot of people experience, but they just kept going. So it was a whole adventure. And that was even before I started insulin. So, but I will say the thing about getting that butalbital and then being like, okay, I need to really be doing my own research on all this stuff they're giving me. Was it underlined for me that like, I have to always double check my research because this is my body, my child.

7:37I want to figure out what's actually happening here. And it was my first like kind of wake up call that like, while we're all on the same team and bringing this child into the world, I have to advocate for myself, which obviously I learned a lot more about in the EBB class. So once I realized I did not want to be at that first hospital anymore, I went to the birth center and I got really good care there, but they were concerned because my blood sugar numbers were still not great. I'd started doing practice at home every day. I was seeing a nutritionist. I started tracking all my food. I started seeing an endocrinologist who gave me a specific like carb diet for, and like time for every meal and I was sticking to it like military level precision.

8:23I read Real Food for Gestational Diabetes. Although that book did, I will say if anybody has a history of eating disorder, I feel like some of the language can be a little triggery. That was one thing I had to get past when I read that, but it was good information for having gestational diabetes and advocating for yourself with traditional medicine with that diagnosis. Hopefully I'm not rambling too much. No.

8:46Heidi Gustad: So you did all the things trying to manage your gestational diabetes, but what ended up happening? Yeah. It became pretty clear that with diet and everything else, my fasting blood sugar was still going to be too high. And with my age and my pregnancy progressing, it was just clear I needed to do insulin for the safety of my baby as much as me. I was resistant to going on insulin because once you're on insulin, you are not eligible for a breast center birth in Chicago. Yeah, that's really tough. Yeah. And I was like, well, this is, you know, this is the healthy thing. This is evidence-based. I need to be in a hospital in case something goes wrong.

9:22And I didn't really have a choice at that point because the birth center was like... They risk you out of their care. Exactly. And luckily that happened before my third trimester. So I had time to be more educated, do my research. And I was already well into the research. Being a librarian, that also is just almost a compulsion. But yeah, so then the birth center also coincidentally that month, they lost their like office coordinator and like, I think two midwives in a short amount of time. And so they didn't have enough staff to stay open. And so around the time I risked out of care, they had to suspend care for several months.

10:00And that included when I would have given birth. So it all kind of worked out. I worked with a doula named Cassie Leachman. She's in the north suburbs of Chicago. And she recommended with my diabetes diagnosis to go to North Shore Hospital in Evanston, which is, I'm on the north side, so it's not a crazy drive. It was longer when I was in labor, but everything feels longer then. But it ended up being a really good fit because you could still have a midwife led delivery half. I think they have, I think it was six of their 14 labor and delivery rooms had tubs, not just showers. And the showers were really nice.

10:37And then they even had one delivery room that had like a birthing center size tub that you could be in with your partner and laboring. Spoiler alert, my birth was fast and they couldn't get the tub filled in time, but we can, we'll get back to that.

10:51Heidi Gustad: Yeah. So how long a drive is that like without terrible traffic without terrible traffic um like about 35 minutes okay but with traffic longer than that it can be longer yeah longer okay yeah I was just like don't go into labor during rush hour don't go to labor during rush hour right but yeah so then because of the diabetes and the insulin I then had to start getting growth scans and non-stress tests um starting at 32 weeks, which is actually today. 32 weeks was one year ago today for me, fun fact. And at the first growth scan, they were like, I think we need to get an OB in here to talk to you.

11:33And I was like, okay, what's up? And that's when they said, there's this thing called, there's something going on with your umbilical cord. And they said, it's this thing called an umbilical vein barracks. And Rebecca, did you want to explain?

11:44Heidi Gustad: So quick crash course for all of you. The umbilical cord contains two arteries in one vein. It's surrounded by this gelatinous tissue. It's called Wharton's jelly, and it's covered by a single layer of amnion. And the umbilical cord, the arteries, the two arteries carry deoxygenated blood from the fetus, from the baby to the placenta. And then the blood picks up oxygen and nutrients in the placenta, which is attached to the pregnant person. And then the vein carries the oxygenated blood from the placenta to the baby. So the baby is getting macronutrients and oxygen from the placenta via the umbilical vein and carries that oxygenated blood to the fetal heart.

12:31Heidi Gustad: It's a little bit opposite than what we usually think of in terms of how arteries and veins work. So I just wanted to kind of clear that up. And the physical dimensions of the cord kind of depend on the baby's size. Avarix, V-A-R-I-X, is when the umbilical cord vein has a dilation. If there was a dilation in the artery, it would be called an aneurysm. So this is what, it's similar to that, but it's in the vein. And typically, first of all, I want to say this is very rare. You know, I've seen numbers from anywhere from like one in 2000, one in 4000. But when it happens, it typically is happening kind of in the part of the vein that's in the baby's abdomen, but it can occur in the part that's like outside of the baby as well.

13:16Heidi Gustad: So there are two criteria to diagnose it. It's all about measuring it. So is the diameter greater than nine millimeters or is it one and a half times larger than the rest of the vein? So both aneurysms and varics have been associated with fetal demise. And I looked up the statistics on it. It really depends on if it's isolated or not. So an isolated umbilical vein varics means there's no other abnormalities. It's just kind of a fluke. Non-isolated means that it's happening in conjunction with other congenital abnormalities. There's something kind of a bigger picture going on with the baby. So the interesting thing is that both cases, whether it's isolated or non-isolated, there are higher risks of having a baby that's small for gestational age.

14:06Heidi Gustad: But really, they have found that it's much more dangerous if it's non-isolated. If there's like other congenital abnormalities, other things going wrong, then the risk of fetal demise is around 7%. Some researchers have found the risk of fetal demise is only 0.4 % if it's isolated, if there's nothing else going on. So it kind of really depends on, you know, what's the bigger picture. There is still a higher risk for fetal growth restriction, and there's not a lot of research on like the best way to manage it. It's kind of like, we know what it is. We know what the risks are, but because it's so rare, there's just not a lot of studies on this as you probably found.

14:47Heidi Gustad: And people don't typically follow this. So there's not research on this after 39 weeks. So you can't say, well, this is what the outcomes are at 37, 38, 39, 40, 41 weeks. Again, it would be a hard thing to study because it's so rare. Does that line up with what you were kind of taught when you were diagnosed? Absolutely. And I was also told like, because when I first found out about it, it was at the OB's office, not in the hospital that I was going to. It's an OB midwife practice. And I had to get a referral to maternal fetal medicine. So I was sitting there with like five days over a weekend before my MFM appointment.

15:27And it was the weekend of my baby shower. So I was just like, so out of it that weekend. But yeah, that was pretty much what they said. A lot of the doctors were like, especially once I reached maternal fetal medicine, they were like, oh, I've never even seen this before. Are you here for diabetes? What are you here for? And I even had a couple of nurses kind of look at me like they didn't know what I was talking about when I said I had a UVV. But luckily it ended up being like a non-issue. But in that like window of time, that baby shower weekend, when I didn't know anything other than that, I had this, the name of this issue.

16:04I did some of my own research, of course. And I found some older research that like, I guess it used to be that like, if you had this diagnosis, it was like, you need a C-section, you have a 35 % stillbirth rate, babies, you should be induced or C-section by 34 weeks. And I was like, oh God, that's like in two weeks. like what is all of this right I was already like getting used to injecting a needle into my baby bump every night like it just felt like one thing after another and it was like right when my headaches got better all this other stuff escalated and I just remember thinking like I thought I'd be reading parenting books right now and I'm still just trying to figure out how to feed myself every

16:43Heidi Gustad: day right you're having to relearn like how to eat for your gestational diabetes and then And just rare diagnosis, like what you said, is hard to find recent information on. And one tip I will give parents, umbilical cord problems are confusing. They're not as common. And so sometimes when you're diagnosed with one, you don't hear people talk about it. And so you don't know a lot to begin with. I will say that I think a quick and easy way that is somewhat affordable, you still have to pay for it to get information on a rare condition is to get a temporary one month subscription to up to date. It is a really great subscription based website where they, they host literature reviews on all kinds of conditions across, you know, not just obstetrics.

17:33Heidi Gustad: So that is a great place to go to find, and they don't always have, they'll admit like, this is all we have, but at least you can kind of get, you know, the definitions and some pictures and some basic statistics about what it is. Yeah. Yeah. And I'm also really lucky that I had a very like kind patient midwife team who understood like that I was coming from hoping for a birth center birth. Right. And I was also, I just like, I'm just gonna be honest with you. Like my entire adult life, my biggest fear was like getting pregnant, being pregnant, giving birth. And they were so kind about it. And I said, you know, I've done my own work in therapy that I just know I need to know what's happening and why it's happening.

18:11and like, that's just what I need you to know from me. And I made a point also of making sure I saw every midwife, which was easy because I had to be there like three times a week once I had all these ultrasounds and stress tests to get done. But I made a point of seeing everybody, making sure they knew my story. And I think it made me a lot more confident going into the birthing room.

18:36Heidi Gustad: Okay. So you had a doula, you had a team of midwives, you were going to have a midwife-led birth at the Evanston hospital. And even though you had these diagnoses, you felt like you were still going to be able to like have informed consent. Yeah. I mean, I busted my butt. I have a whole binder of all this, all of like everything from the workbook, from the EBB class to all of my handouts from like my lactation class, my parenting class, my plan. Cause I assumed I was going to end up in an induction with being 38, diabetes, varics, et cetera. So I've just had my whole binder and my plan was just to like review my notes and just read through maybe color a little during the induction.

19:19But I was like, I'm going to be informed. I made sure I had physical, multiple physical copies of my birth preferences. My doula had it. My midwife team had it. My med list included like a million things because I was on so much diabetes medicine at that time. And having all that documentation just gave me so much more confidence going into it. And I think I just knew I needed to build confidence because, I mean, I was mentally prepared for a long induction C-section. And I just said, I just surrendered. And that was when I stopped going from a place of fear to informed embracing of like the chaos, embracing what I'm not in charge of.

19:58Heidi Gustad: It's like you controlled what you could control and you did all the research and you educated yourself. but then you also had to let go and know that birth takes many different paths. Yeah. And I also think that like the EBB class, like what clinched signing up for it for me was when I knew I was going to be on insulin and that a birth center environment was not going to happen. And so I knew that there was a chance that there could be, you know, whoever's on shift. You can't control who walks in. Yeah. And I went from thinking I wanted to basically birth alone in the dark with like my doula in one corner and my husband in another.

20:33And just like they could wave to a nurse if they, if I needed something like that was what my initial envision was, but that was not going to be a reality for me.

20:42Heidi Gustad: Was there anything in particular from the EBB childbirth class that like sticks out at you that you felt would be helpful or ended up being helpful? Yeah. Especially with my like medical anxiety background, the section on understanding that the people who work at the hospital are someone to be on your team. Not everybody is an enemy here. Most people don't actually want to witness trauma. They don't want to witness somebody have a different outcome than they were hoping for. Like they are in this profession because they're passionate and some of them are traumatized. And I work in a profession where I've had, I've experienced trauma.

21:17It's very different in a library than a hospital, but I got stories. librarians with stories yeah go figure but all that to say like that realizing like oh we all want to see the baby and the happy moment and the health at the end they don't want to know that you know if I was a nurse I wouldn't want to know somebody's going home with trauma that they're going to have to hold while they're postpartum it's it's hard

21:43Heidi Gustad: Mm-hmm. Yeah. So kind of the parts about building the team atmosphere were helpful. I know you were anticipating there would be an induction, but you didn't end up having a medical induction. Can you tell us kind of what happened? Yeah. That was also a lot of information from evidence-based birth, especially in birth prep too. It was like at a certain point, there was so much information I was having to navigate with these diagnoses and migraines in life that I was like, I don't even know where to start researching for like vitamin K shots, how to avoid the epidural, when to go into the hospital, whatever.

22:21So with all this different information that I had to weed through, it helped me know what I needed to be informed about as I put my birth preferences together. And I still was really hoping that I'd be able to have a spontaneous labor unmedicated. Ideally, just let me just give birth. And so what I did to prepare for that was actually early on when I was having all those migraines, I started working with a pelvic floor PT because I thought like starting to work on some of those muscles might help with the migraines I was having. And it did help, but it also helped me a lot with labor and delivery prep.

22:58I got to go in having had a pelvic exam from my PT. And she said that I'm one of probably three patients she's ever had that did not have pelvic floor dysfunction going into childbirth. So that was also a confidence builder. And I had more muscles built because of working with her. And I knew more about how to organize my breathing and stay calm and things like that. So that was one big prep. I also started doing a lot of acupuncture. And that was initially to help with my migraines. But then I also learned about how it can be a natural induction option. And so the day that I, 37 weeks was when my acupuncturist would start doing labor induction.

23:41treatments. And the day I had my first acupuncture appointment, I was 37 weeks and three days. And 12 hours after that appointment, my water broke. And nine hours after that, I was holding my baby. Wow. So that was crazy. I was also drinking. I started raspberry leaf tea that week. I was also doing, expressing colostrum so that I had that because of the gestational diabetes so that I could have that for my son if he needed that when he was born. So the, I also used my breast pump the first, for the first time the same day I had that acupuncture and about three hours after I used my breast pump for the first time, my water broke.

24:29So we're going to have to link to in the

24:32Heidi Gustad: show notes to our podcast series on all of those techniques. So it sounds like that was the magical combination for you, acupuncture, colostrum expression, and everything else that you were doing to kind of prep your body and mind for birth. I even ended up taking the spinning babies class six days before I gave birth. I thought I had more time and that's when the workshop was, but yeah. So you're doing positioning as well. And like the hanging upside down thing and spending a lot of time on a ball. Yeah. Never underestimate what someone could do to try and get labor started. Yeah. Right. Yeah.

25:12Cause I also had the induction was scheduled for me for 41 and one.

25:16Heidi Gustad: Okay. So they were going to have you go up until 41 weeks in one day. Yep. They wanted me to cut, they had the induction scheduled for 41 and one and like three days before I gave birth, they were like calls and get your name on their like radar for the day before your 41 and one to get a fully balloon place. So they were going to try to do a balloon first for me the day before. But ended up, you know, almost a month before that you were, you were already in labor. So your water broke. What happened next? You know how in like all the classes they're like, Oh, when your water breaks, it's not like the movies.

25:54It's not cone heads. That's what Carly and my EBB class kept saying. It's not like cone heads. It's not like a waterfall. Well, in my experience, it wasn't cone heads, but it was close. Like I got up at 2am, I went to the bathroom. And when I like lifted my one leg to get back into bed, I was like, Oh, wow, like this is happening. Like I said to my husband who was dead asleep, there's water coming out of my body, honey. He's like, what? Like dead to the world to sleep, of course. And I was like, the baby I think is coming today, sweetie. And then he got up really fast. And like my water was like to my ankles immediately.

26:39And then I went to the bathroom and it was bloody show mucus plug. I mean, I was like, I took, and then I texted a picture to my doula and I was like, this seems like it's happening. And she was like, oh, yep. Yes, it is. and then I talked to a midwife who was on call at the hospital she was like oh you know this you're early try to stay at home as long as you can like we talked about I'll be I'm not on this was a Friday night she was like I'm not on duty tomorrow but I'll be there Sunday so I'm probably going to be the person who delivers your baby and I was like great that's awesome and then within 90 minutes of my water breaking.

27:16I was at five, one and one. So your contractions were? Five minutes apart for one minute for an hour.

27:25Heidi Gustad: Okay. So it was time. Yeah, pretty much. Did you meet your doula at the hospital then? Yeah. And I stayed home for a while because I was like, I don't want labor to stall out when I get there. That's what all the research says. I just, I'm going to stay home because that'll, I can keep moving. I'm in my house. I can pet my dog. And then also we had to get the dog to the kennel. All of our family lives out of state. So we waited until the kennel opened and it wasn't open until 9am on that Saturday. So I'd been in labor for seven hours. And oh my goodness. And then I was like, honey, you got to get that.

28:00Like we got to go. Like we can get the dog later. Like, yeah, just having enough time to like drop the dog off. I was at home alone and I was like, I think I'm at 312 right now. Like we got to buff it. And then my husband comes home. I waddle to the car and then we live in Chicago. Saturday morning traffic can be a thing. And it was that day. That's so weird to me, but go on. And we live right by an on-ramp to the highway and it was under construction. Oh no. And so we had to go to the next on-ramp and it was bumper to bumper standstill traffic in a residential neighborhood. I probably had seven contractions when we went like two blocks and it got to the point where I was hanging onto the door and I was like, are we going to need to knock on somebody's door and like call an ambulance?

28:52Cause this is now, now anyway. And we got to the hospital in time. Like once we got on the highway, we, my husband drove pretty fast. We got there, we got in. And since it was my first pregnancy, like they got me, I was just standing at the check-in desk and my labor tones were getting like deeper and my swing was like getting more like, I can't be still, I've got to keep my pelvis moving. Midwife on duty and the nurses on duty come out and they were like, oh, this woman is very, she's here. And this is happening. Like now my doula wasn't even there yet. Cause she was like, she did, we, I ended up progressing faster than she expected.

29:30Cause I just texted her at two. And then when we left for the hospital and she was like, you could have bothered me. Anyway, I'm getting kind of in the weeds here. No, you're fine.

29:38Heidi Gustad: This is like an edge of your seat kind of birth story. You made it just in time. Yeah. You were definitely advanced. Did you find out how far along you were? The one little anecdote about check-in is I found out after the fact that a bunch of the nurses thought I was coping poorly because they thought I wasn't as far along. Yeah. They were like, look at this first time mom. Yeah. I'm like moaning and my head's on the counter and they're like... Rolling their eyes. You know? And then two hours later, I'm holding my child. So I only ended up getting one total cervical check during this whole time.

30:14And it was after I'd gotten in the room. I was having contractions every probably two, three minutes. And then I had a little break and my doula was like, do you want to try to go to the bathroom? And I was like, yeah, that's on my... I need to do that. But I don't have a lot of time. So we got to the toilet, had another contraction, peed. And I was like, Cassie, that's my doula. I was like, Cassie, I'm pretty sure that this is not, this is not feel like I need to go number two. This feels like I need to go baby. And she was like, oh, okay. And like calmly like flags down the nurse with like, I'm sure a look on her face.

30:52The midwife rushes in, checks me. And she was like, you're at 10 and two. We need to get you in the bed. So I was like plus two station and 10 centimeters at my first check. Wow. So he came really fast. And then I ended up laboring on hands and knees, looking longingly at the birthing tub in the room that didn't have time to be filled. My husband also, once my doula got there, our plan was that he needed to be told to like sit down, drink water, eat something because he'll put himself last in a situation like that, which is sweet. But then he sits down and he crosses one leg over the other, produces an apple from our snack bag and starts chomping this apple loudly while I'm having contractions.

31:41And my doula sees me like look over at him and like pull a face. And she looked at me like, do you want me to kick him out? And I was like, I don't care.

31:53Heidi Gustad: We're casual here, I guess. But the etiquette of don't eat in front of someone who's about to put their baby out. Yeah. Yeah. There's not much time to do any like self-advocacy while it was in labor because it was so fast. I am not apparently a loud person when I'm in labor. I was silent like most of the time other than like natural, like deep moaning sounds because that's what I was practicing doing for months. It was what I know is supposed to work. And in my head, I wasn't visualizing anything. I've just counted. I've had PTSD with panic attacks before. And I actually really believe that learning how to cope with panic attacks, because it's this body overwhelming thing that you have to learn to like mentally cope with.

32:38And counting always helps me when I'm having panic attacks. And I found that when I would do that counting, every time a wave came up, I would just be like, okay, I only have to get through a minute. And I found if I counted up to 20 and then down to one very slowly and kept breathing. And that was what I needed to do. It was like the third to last push before my son was born when I'd said, come on. Cause I had like, I could feel him like coming back into my body a little bit. And that was the one time my doula was like, whatever you're doing, keep doing it. It's almost there. And then the midwife actually at that point said, I see a whole bunch of blonde hair and that snapped me out of that little moment of frustration because my husband has really dark hair and I grew up very very blonde and I was not anticipating having a blonde child and that like moment of oh this is what we're doing this is this is a real baby about to be born and then getting to touch his head after because I did have to push for a little while touching his head was another thing that got me through was just knowing that like this is productive this is what we're doing this is what we're here for like eyes on the prize

33:47Heidi Gustad: Mm-hmm. What was the actual moment of his birth like? I ended up having to go into a lunge from all fours. Okay. And that's what finally got him out. It was so fast because the whole thing only took nine hours and it was like almost a month before I was anticipating coping with all of it. I think I didn't have precipitous labor, but it was still so fast that it was this like. It was fast for you. happened. And I remember a lot of my thoughts were about my mother having given birth to me in two hours and thinking like, good Lord, that must've been crazy. But I was also making sure that I told my husband, remember, go over with the NICU team because my son had to get looked over because of, they were concerned about the barracks and things like that.

34:34They did a little bit of delayed cord clamping, but they needed to get him over to the NICU team where they wanted to. And at that point, like everything was dictated in our plan. And I just knew like, I'm not really capable of communicating right now. I've got to trust my doula knows my plan. My husband knows my plan and I need to focus on after birth.

34:57Heidi Gustad: And then what happened in those minutes after the birth? They checked out my son. He was small. He wasn't tiny. He was five pounds, 14 ounces. So on the small side, but his head was, I think it was like 85th percentile still. I'm kind of glad he ended up being small because he's already 25 pounds now. But yeah, I just remember wanting to know he was okay and then wanting to get to skin to skin as quickly as possible. And that was, we were able to do that. And what did that feel like? It felt pretty awesome. There was still part of my brain that was still kind of in shock that I was done being pregnant.

35:34Done being pregnant, done being diabetic, done with these migraines. It was so happy that he was there and healthy. I was still in shock that I was able to have a spontaneous birth. I didn't even get to use laughing gas. Laughing gas was like way on my list of like, I'll use this when I'm really feeling like I can't go on. There wasn't time for anything. Oh, yeah. I didn't even have an IV, even though I was diabetic. I had all sorts of plans for advocating for like managing my blood sugar during labor. and it went so fast and I was only at the hospital for a couple hours that they were trying to do my intake in between contractions.

36:13They were like, how tall are you? And I said five, had a contraction and then said five, cause I'm five, five. And she was like, five, what? I was like five, five. And then had another contraction.

36:27Heidi Gustad: Well, it's funny that you said you were just relieved to not be pregnant anymore? Because I can really identify with that. I know some people love pregnancy, enjoy it. But if you've had a rough pregnancy with chronic pain, migraines, et cetera, there is that relief that comes with knowing that part at least is over. Absolutely. And like, I'm 39 now and I don't know if I want a second kid or not. Like the labor and delivery part was actually kind of cool. When I look back on it, I'm very fortunate to be able to say that. But the biggest con for me is trying to figure out how to live through having all those migraines again, especially with a toddler.

37:09Heidi Gustad: That's something we're thinking about doing a podcast episode on is managing migraines in pregnancy. So apparently it's needed. Tell us about your postpartum experience. What was that like? My postpartum experience was good. I mean, he was a little early, so there was a few things left on my to-do list, but I'm also with my birth binder and being a librarian was very, like as prepared as I could be given that he was a little early. Like my, my breast pump was clean because I had just used that. The crib was together. The changing pad was together. Like we had what we needed. And I think I have a couple of friends who have had micro preemies.

37:45So I think my obsession with being over prepared and prepared early was definitely a result of seeing their experiences. But I did have some frozen meals prepped. That was a really good thing to have, to be able to just have some microwave meals ready to go, especially because I was breastfeeding and trying to get my son's weight up. Breastfeeding was tough at first because my son had a tongue tie that we ended up having to get clipped. He had jaundice. That wasn't that big a deal. We just had to go back once or twice to get that checked. But it was the feeding. That was the biggest issue. I had to nurse him.

38:19We would top him up with formula and I would have to pump.

38:22Heidi Gustad: And if you're doing that every two hours, as a lot of people know, like it takes an hour and a half to do this like three-step process. And then we do it every two hours. It was like, you know, that was just my life was like. It's crazy how much feeding a human can take out of you. Yeah, exactly. And then I was trying to keep up with my nutrition, which luckily I wasn't diabetic anymore. So I was like, yeah. So your blood sugar went back to normal after you gave birth? And my son was fine. They had to give him glucose once, but we found out later that was probably because the tongue tie wasn't held.

38:57He just wasn't taking in enough milk. He's since obviously caught up because he is two foot six and 10 and a half months right now. Yeah. He's a big kid now, but my dad's six, four and my brother's six, three and my husband's six feet. So I was kind of braced for it. But yeah, postpartum mentally was pretty good. My folks were able to drive out from North Dakota for a few days and that was invaluable, especially at the beginning. And especially as someone who had a child older and I have no sisters and my brother has kids, my mom was like, yes, she was just so excited that her daughter had kids to get to be the, you know, maternal grandma.

39:37And they were really helpful with food, with helping take care of the dog, cleaning up some of the stuff that I hadn't gotten to clean yet. Mainly it was helping us sleep. That was the biggest thing was sleep. And then I was able to get a really quick newborn photo session booked for what ended up being before his due date. So we have some really cute pictures up in our house of him being like teeny, teeny weenie.

40:02Heidi Gustad: Yeah. Yeah. And I don't look horrible in them. So I thought that was a bonus for being two weeks postpartum. Yeah. It's interesting when you've had a rough pregnancy house, sometimes you can have like your postpartum is, you know, looking back comparably pretty good. Yeah. You know? Yeah. Like I was like, oh man, I can eat like chips. I can eat cravings foods. This is great. Yeah. But it is interesting when you've had a hard pregnancy, like just that you give birth and then suddenly the switch flips and you suddenly don't have insulin-dependent diabetes. Like that's a big shift. Yeah, that's huge.

40:41Heidi Gustad: Yeah. Well, Heidi, you've taken us like on a big journey from like not sure if you wanted to have kids and the family history of trauma with child birth to navigating a pregnancy with insulin-dependent gestational diabetes and this umbilical cord abnormality and then going on to have a natural and basically a naturally induce labor and having the birth you, you know, ultimately wanted. What advice do you have for people who are listening, who are, you know, thinking about entering birth or parenthood soon? I would say, I always feel like I see on social media, these, a lot of comments that are like, my birth plan is not die and let the hospital take care of it, LOL.

41:25And I get that. Like that's growing up what I always thought we needed to do. But we live in a world where women's healthcare is not the biggest priority. We live in a world of insurance. We live in a world where there's a lot of stressful things going on and our birth workers and hospital workers are already stretched really thin. And I think the smartest thing is to be more informed and more educated. and it's, you're likely to prevent so much trauma by knowing what to expect. Everything from like, oh, I know I want an epidural and I have no interest in natural childbirth. But if you do a little prep to know how to cope with that a little bit, you might end up with a better outcome that might hurt you, like hurt your heart a little less, if that makes sense.

42:21Yeah.

42:22Heidi Gustad: It does strike me too. It's a good reminder, you know, with your birth story, how you don't have to know everything too, but when things come up, you can do your research and educate yourself about that thing in that moment and then just take the next steps. Yeah. And I also think, I really think that viewing the birth plan document as a birth preferences document, framing it as preferences, not plan also helps, helped me get in the mindset of this is a like malleable situation. You know, there's a lot of different potential outcomes and this is what I'm hoping for. But not having to make decisions in the moment was probably the biggest thing that I was grateful for because there wasn't time.

43:06Heidi Gustad: Yeah. I really loved your tip of counting up to 20 and then down. Were there any other like mantras or affirmations you said to yourself in pregnancy and birth that helped you cope with difficult things? Because of all having all the migraines, I was like, okay, I want to learn to make this pain productive. And that's when I started reading about pain management for labor and like how to endure pain for a longer amount of time. It sounds so horrible, but it's the reality of what I was dealing with. And so learning different ways of distracting myself, playing with like heat and cold, learning about gate control theory.

43:41Heidi Gustad: I would talk about in the class. Yeah. Even using like a labor comb or my own fingernails sometimes to just distract because I also had to work. My work denied my migraine accommodation. So I was sitting cooking under fluorescent light while having a migraine at work. That's a good point that, you know, when you have other challenges in your life, a lot of the coping techniques you can learn for those can be helpful in labor as well. Yeah. Yeah. And having coped with the panic attacks in the past, that was also really helpful. You were able to transfer those skills over to labor. And I'd like to, if somebody has always dealt with a lot of anxiety, you might be more prepared for birth than somebody who hasn't.

44:25If you know how to deal with that, because your body is panicking sometimes. And that's what you have to talk yourself out of.

44:32Heidi Gustad: Yeah. So the coping skills you learned for anxiety were helpful in labor as well. Yeah. Yeah. Yeah. And to be fair, I got lucky and I only have done this once. So this was just my experience. But we love learning from people's experiences. I think it's really important. So thank you so much, Heidi, for coming on the podcast and sharing your pregnancy and birth story. And we really appreciate you sharing your lessons with us. Yeah. And thank you for helping educate me while I was pregnant, Rebecca. It was invaluable. You're very welcome. This podcast episode was brought to you by the book, Babies Are Not Pizzas.

45:06Heidi Gustad: They're Born Not Delivered. Babies Are Not Pizzas is a memoir that tells the story of how I navigated a broken healthcare system and uncovered how I could still receive evidence-based care. In this book, you'll learn about the history of childbirth and midwifery, the evidence on a variety of birth topics, and how we can prevent preventable trauma in childbirth. Babies Are Not Pizzas is available on Amazon as a Kindle, paperback, hardcover, and Audible book. Get your copy today and make sure to email me after you read it to let me know your thoughts.