Ep 79: Plus Size Does Not Equal High Risk

Is weight alone a pregnancy risk factor requiring intervention?     Brylee is a mom to 3 precious babes, and she’s experienced both negative and positive birthing experiences.  Today we’ll jump into the reasons behind both.   Show Notes Brylee had been told for many years that pregnancy would be very difficult, as she was diagnosed with PCOS as a teenager.  She and her husband became pregnant as soon as she stopped taking birth control. Her OB was so convinced that she wouldn’t be able to become pregnant, that she said she’d give her 6 months to try for a baby before exploring other options. Little did her OB know, she was already pregnant at that appointment!   Brylee had terrible implantation cramps with her first daughter.  They were so bad that she was scared it was a miscarriage (the day after her positive pregnancy test).    Her interest in birth began early, as her mother had Brylee’s brother in a birth center unmedicated.   After watching The Business of Being Born, Brylee let her OB know that she wanted a natural birth.  The OB always dodged the questions and said “we’ll see”.   Brylee woke up with (what she now knows was typical bloody show) and called the on-call doctor.  The doctor acted as if the bleeding was an emergency, and had her come in.  The OB did everything she could to pin pre-eclampsia on Brylee, which she feels was because Brylee is a plus-size mother.   She had one high blood pressure reading, which she feels confident was related to the stress of the situation… she had had zero high readings throughout the pregnancy.  Brylee refused induction, finally was released the next morning, and went home for the weekend.    On the following Monday, Brylee saw the same OB again, and had another high reading.  She told her mom, “I am TERRIFIED of that woman.”  She felt it was a case of White Coat Syndrome, just as her dad has.   The OB sent her straight to the hospital to be induced:   Cytotec 4 times   Ina May’s Guide to Childbirth gives an informative review of why Cytotec can be dangerous   They then started Pitocin.  After laboring for a long time, Brylee received an epidural.     After 30 minutes of pushing, Brylee had her baby.   There was absolutely no continuity of care for Brylee: Her Doctor was on vacation, another OB sent her in for the induction, another started the induction, and another delivered her baby.   With her second birth, Brylee knew she wanted to have a different experience.  Her friend had a birth with them that was wonderful, so Brylee was excited to use the practice of 8.     Brylee had one high blood pressure reading, and so her midwives sent her Maternal Fetal Medicine.  They put her on medication, and the medication constantly made her pass out, as it was bottoming out. At her 3rd midwife’s appointment, the midwives used a blood pressure cuff for a plus-size woman, and low and behold… she had a normal reading.   Because of Maternal Fetal Medicine’s diagnosis (Chronic Hypertension— which she knew was not the case), the recommendation was for Brylee to be induced at 38weeks.   She failed the first Gestational Diabetes test, so she was required to take it again, which she passed.   One doctor at MFM told her that if she’d been in any other state, her blood pressure would not be an issue.  For whatever, in the south, particularly in Tennessee, this doctor said that other doctors hold very strongly to very specific numbers.   Brylee convinced her doctors to let her wait to be induced until 39 weeks.  After a long day of waiting for a room, and laboring, Brylee’s doctor told her they needed to break her bag of waters.  The baby was high, and they did not tell Brylee the risks associated with this.   Fortunately, the baby was fine, and once she began pushing, the baby was out in two pushes.   Unfortunately… soon after she gave birth, a nurse came into her room and switched her blood pressure cuff from the larger size to the standard size.  Brylee’s blood pressure numbers then spiked with the new cuff.   Because of her terrible experience, Brylee decided she was NOT going back to the hospital.  Her third baby was a huge surprise!     Brylee began searching for a homebirth midwife in her area that would take her.  In a local birthing center, her BMI was too high to deliver.      She found a midwife who serviced her area, and set up a meeting.  After deciding to work with her, several appointments in, Brylee had a high blood pressure reading.  Her midwife mentioned that she thought this was likely due to the blood pressure cuff being the wrong size, not her actual blood pressure.  Her midwife ordered a new cuff, and Brylee never had a high reading again.   Brylee’s midwife referred her to a CNM just to have check her out as a backup, and the CNM was incredibly encouraging.  She said Brylee was a perfect candidate for homebirth.   During her anatomy scan, the tech that saw her ended up ripping her skin.  It was a horribly painful experience for Brylee.   As she entered labor… Brylee’s water broke at her parents’ house on their couch.  She tried to get contractions going by walking, dancing, and using a breast pump.   Her midwife had come over in the morning to see what her dilation was (she was a 2).   Brylee decided to try the Miles Circuit    When Brylee called her midwife to let her know it was time for her to come, her midwife responded that she had a fever, so she was going to have to send her partner.   Brylee went from 4cm to pushing in a matter of minutes.       Episode Roundup Wow, what a difference in care.  As we head into the episode roundup, that’s the topic I want to discuss.  What I love about midwifery, particularly the homebirth variety, is the level of individual care.  The midwifery model of care lends itself to truly learning about the mother, gaining a full understanding of her health, and then proceeding with the intention of keeping her risk factors low and in check. Conditions were never pushed on Brylee based off of the fact that there “just must be something,” and she was given the opportunity to absolutely rock her birth, which she did.     Individualized care, my friends.  That’s what it’s all about.  Okay, that’s all I’ve got for you this week.  I look forward to seeing you back here next week.   Links From today's Show:   Miles Circuit Ina May’s Guide to Childbirth The Business of Being Born     Join the Facebook Group!