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

Dr. Rebecca Dekker – 00:00:00:

Hi everyone. On today’s podcast, we’re going to talk with EBB Childbirth Class graduate Heidi Gustad about her birth story involving gestational diabetes, an umbilical cord abnormality, and an unmedicated hospital birth. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. 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 Gustad is a first time elder millennial mom, librarian, and published knitting pattern designer in Chicago. 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 varix. Heidi, welcome to the Evidence Based Birth® Podcast.

Heidi Gustad – 00:01:34:

Hey, it’s nice to meet you.

Dr. Rebecca Dekker – 00:01:36:

Yeah. So nice to meet you. I’m sure you heard my voice a lot and now we get to talk kind of in person over the internet. So, very cool. So Heidi, would you talk with us and our listeners about what your pregnancy experience was like?

Heidi Gustad – 00:01:52:

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. My 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 two generations of really intense negative birth experiences that I grew up with. And so I think that resulted in this big fear of pregnancy and childbirth. And then as I became a young married woman and I had other friends who were married 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, I learn how to cope with these little trauma stories that are just in the ether. And I realized that I want to have a kid. So that’s 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 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. They’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 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 safe to me on 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 this, deep in my psyche, I feel safe enough that I could be pregnant and also give birth safely. And 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. It 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 varix, 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. And 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.”

Dr. Rebecca Dekker – 00:06:21:

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.

Heidi Gustad – 00:06:40:

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.”

And eventually I finally got in with a neurologist who gave me the two meds that worked for me. They were an occasional sumatriptan and then cyclobenzaprine. That 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 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. 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. It underlined for me that I have to always double check my research because this is my body, my child. I want to figure out what’s actually happening here. And it was my first kind of wakeup call that 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 had started doing prick tests 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 carb diet and time for every meal. And I was sticking to it like military level precision. I 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 triggering. 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 in this.

Dr. Rebecca Dekker – 00:08:46:

No. So you did all the things trying to manage your gestational diabetes, but what ended up happening?

Heidi Gustad – 00:08:52:

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 birth center birth in Chicago.

Dr. Rebecca Dekker – 00:09:13:

That’s really tough.

Heidi Gustad – 00:09:15:

Yeah. And I was like, “Well, this is the healthy thing. This is evidence-based. I need to be in a hospital in case something goes wrong.” And I didn’t really have a choice at that point because the birth center was like –

Dr. Rebecca Dekker – 00:09:25:

They risk you out of their care basically.

Heidi Gustad – 00:09:28:

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 office coordinator and 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 and that included when I would’ve 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 it was six of their 14 labor and delivery rooms had tubs, not just showers. And the showers were really nice.

And then they even had one delivery room that had a birthing center sized 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’ll get back to that.

Dr. Rebecca Dekker – 00:10:50:

Yeah. So how long a drive was that without terrible traffic?

Heidi Gustad – 00:10:54:

Without terrible traffic? About 35 minutes. Okay.

Dr. Rebecca Dekker – 00:10:59:

But with traffic longer than that?

Heidi Gustad – 00:11:01:

Could be longer. Okay. Yeah. I was just like, “Don’t go into labor during rush hour. Don’t go into labor during rush hour.” But yeah. So then because of the diabetes and the insulin, I then had to start getting growth scans and non-stress tests 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.” And I was like, “Okay, what’s up?” And that’s when they said, “There’s something going on with your umbilical cord.” And they said, “It’s this thing called an umbilical vein varix.” And Rebecca, did you want to explain?

Dr. Rebecca Dekker – 00:11:44:

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’s getting macronutrients and oxygen from the placenta via the umbilical vein and carries that oxygenated blood to the fetal heart. 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.

A varix, 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. I’ve seen numbers from anywhere from one in 2,000 to one in 4,000. 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 outside of the baby as well. 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 varix 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 varix 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, but really they have found that it’s much more dangerous if it’s non-isolated. If there’s 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 what’s the bigger picture. There is still a higher risk for fetal growth restriction. And there’s not a lot of research on 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. 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?

Heidi Gustad – 00:15:06:

Absolutely. And I was also told, 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 five days over a weekend before my MFM appointment, and it was the weekend of my baby shower.

SoI was just so out of it that weekend. But yeah, that was pretty much what they said. A lot of the doctors were like, and 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 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 a non-issue. But in that window of time, that baby shower weekend when I didn’t know anything other than that, I had the name of this issue. I did some of my own research, of course, and I found some older research that I guess it used to be that if you had this diagnosis, it was like you need a C-section, you have a 35% stillbirth rate, you should be induced or C-section by 34 weeks.

And I was like, “Oh God, that’s in two weeks. What is all of this?” And I was already getting used to injecting a needle into my baby bump every night. 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, I thought I’d be reading parenting books right now and I’m still just trying to figure out how to feed myself every day.

Dr. Rebecca Dekker – 00:16:44:

Right. You’re having to relearn how to eat for your gestational diabetes. And then this 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 UpToDate. It is a really great subscription-based website where they host literature reviews on all kinds of conditions across, not just obstetrics. So that is a great place to go to find. And they don’t always have, they’ll admit this is all we have, but at least you can kind of get the definitions and some pictures and some basic statistics about what it is. Yeah.

Heidi Gustad – 00:17:47:

Yeah. And I’m also really lucky that I had a very kind patient midwife team who understood that I was coming from hoping for a birth center birth. And I was on also, I’m just going to be honest with you, my entire adult life, my biggest fear was getting pregnant, being pregnant, giving birth. And they were so kind about it. And I said, “I’ve done my own work in therapy that I just know I need to know what’s happening and why it’s happening. And 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 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.

Dr. Rebecca Dekker – 00:18:37:

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 have informed consent?

Heidi Gustad – 00:18:50:

Yeah. I mean, I busted my butt. I have a whole binder of all of everything from the workbook, from the EBB class to all of my handouts from my lactation class, my parenting class. My plan, because I assumed I was going to end up in an induction with being 38, diabetes, varix, et cetera. So I just had my whole binder and my plan was just to review my notes and just read through, maybe color a little during the induction. But I was like, “I’m going to be informed.” I made sure I had multiple physical copies of my birth preferences. My doula had it. My midwife team had it. My med list included 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 surrendered. And that was when I stopped going from a place of fear to informed embracing of the chaos, embracing that I’m not in charge of it.

Dr. Rebecca Dekker – 00:19:58:

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.

Heidi Gustad – 00:20:08:

Yeah. And I also think that the EBB class, 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 whoever’s on shift.

Dr. Rebecca Dekker – 00:20:23:

You can’t control who walks in.

Heidi Gustad – 00:20:26:

Yeah. And I went from thinking I wanted to basically birth alone in the dark with my doula in one corner and my husband in another. And just like they could wave to a nurse if I needed something. That was what my initial vision was, but that was not going to be a reality for me.

Dr. Rebecca Dekker – 00:20:42:

Was there anything in particular from the EBB Childbirth Class that sticks out at you that you felt would be helpful or ended up being helpful?

Heidi Gustad – 00:20:49:

Yeah. Especially with my 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. They are in this profession because they’re passionate and some of them are traumatized. And I work in a profession where I’ve experienced trauma. It’s very different in a library than a hospital, but I got stories.

Dr. Rebecca Dekker – 00:21:23:

Librarians with stories.

Heidi Gustad – 00:21:25:

Yeah, go figure. But all that to say that realizing like, oh, we all want to see the baby in the happy moment and the health at the end. They don’t want to know that. 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 hard.

Dr. Rebecca Dekker – 00:21:44:

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 what happened?

Heidi Gustad – 00:21:59:

Yeah. That was also a lot of information from Evidence Based Birth®, especially in birth prep too. 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 vitamin K shots, how to avoid the epidural, when to go into the hospital, whatever.” So with all this different information that I had to read 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 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. I 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 treatments. And the day I had my first acupuncture appointment, I was 37 weeks and four days. Or no, 37 weeks and three days. And 12 hours after that appointment, my water broke and nine hours after that I was holding my baby.

Dr. Rebecca Dekker – 00:23:59:

Wow.

Heidi Gustad – 00:24:01:

So that was crazy. I was also drinking, I started raspberry leaf tea that week. I was also 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 I also used my breast pump 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.

Dr. Rebecca Dekker – 00:24:30:

Well, we’re going to have to link in the 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.

Heidi Gustad – 00:24:48:

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.

Dr. Rebecca Dekker – 00:24:57:

So you’re doing positioning as well?

Heidi Gustad – 00:24:59:

Yeah. And the hanging upside down thing and spending a lot of time on a ball.

Dr. Rebecca Dekker – 00:25:06:

Yeah. Never underestimate what someone could do to try and get labor started on their own, right?

Heidi Gustad – 00:25:12:

Yeah. Because I also gad the induction was scheduled for me for 41 and one.

Dr. Rebecca Dekker – 00:25:17:

Okay. So they were going to have you go up until 41 weeks in one day?

Heidi Gustad – 00:25:21:

Yep. They had the induction scheduled for 41 and one. And three days before I gave birth, they were like, “Call us and get your name on their radar for the day before your 41 and one to get a foley balloon placed.” So they were going to try to do a balloon first for me the day before.

Dr. Rebecca Dekker – 00:25:42:

Okay. But ended up almost a month before that you were already in labor. So your water broke. What happened next?

Heidi Gustad – 00:25:50:

You know how in all the classes they’re like, “Oh, when your water breaks, it’s not like the movies, it’s not coneheads.” That’s what Carly and my EBB class kept saying. It’s not like Coneheads. It’s not like a waterfall. Well, in my experience, it wasn’t Coneheads, but it was close. I got up at 2:00 AM. I went to the bathroom. And when I lifted my one leg to get back into bed, I was like, “Oh wow, this is happening.” I said to my husband who was dead asleep, “There’s water coming out of my body, honey.” He’s like, “What?” Dead to the world asleep, of course. And I was like, “The baby I think is coming today, sweetie.” And then he got up really fast. And my water was to my ankles immediately. And then I went to the bathroom and it was bloody show. Mucus plug. 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 the midwife who was on call at the hospital. She was like, “Oh, you’re early. Try to stay at home as long as you can. We talked about. 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, I was at five, one and one.

Dr. Rebecca Dekker – 00:27:19:

So your contractions were…

Heidi Gustad – 00:27:21:

Five minutes apart for one minute for an hour.

Dr. Rebecca Dekker – 00:27:25::

Okay. So it was time to get going.

Heidi Gustad – 00:27:27:

Yeah, pretty much.

Dr. Rebecca Dekker – 00:27:29:

Did you meet your doula at the hospital then?

Heidi Gustad – 00:27:32:

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’m going to stay home because 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 9:00 AM on that Saturday. So, I’ve been in labor for seven hours.

Dr. Rebecca Dekker – 00:27:57:

Oh, my goodness.

Heidi Gustad – 00:27:58:

And then I was like, “Honey, you got to get that. We got to go. We can get the dog later.”

We ended up just having enough time to drop the dog off. I was at home alone and I was like, “I think I’m at 3-1-2 right now. We got to book it.” And then my husband comes home. I waddled to the car. And then we live in Chicago. Saturday morning traffic can be a thing, and it was that day.

Dr. Rebecca Dekker – 00:28:25:

That’s so weird to me, but go on.

Heidi Gustad – 00:28:29:

We live right by an on-ramp to the highway and it was under construction.

Dr. Rebecca Dekker – 00:28:33

Oh no. Yeah. 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 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 call an ambulance? Because this is now.” Anyway, and we got to the hospital in time. Once we got on the highway, my husband drove pretty fast. We got there, we got in. And since it was my first pregnancy, I was just standing at the check-in desk and my labor tones were getting deeper and my swaying was 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 now.” My doula wasn’t even there yet because she was like. I ended up progressing faster than she expected because 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 as I remember.

Dr. Rebecca Dekker – 00:29:37:

No, you’re fine. And this is an edge of your seat kind of birth story. You made it just in time. You were definitely advanced. Did you find out how far along you were?

Heidi Gustad – 00:29:49:

The one little anecdote about check-in is I found out after the fact that a bunch of the nurses though I was coping poorly because they though I wasn’t as far along. Yeah. They were like, “Well, look at this first time mom.” And I’m moaning and my head’s on the counter and they’re like rolling their eyes.

And then two hours later, I’m holding my child. So I only ended up getting one total cervical check during this whole time. And 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, 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 does not feel like I need to go number two. This feels like I need to go baby.” And she was like, “Oh, okay.” And calmly flags down the nurse with, I’m sure, a look on her face. The 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.

Dr. Rebecca Dekker – 00:31:03:

Wow.

Heidi Gustad – 00:31:04:

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 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. And my doula sees me look over at him and 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.”

Dr. Rebecca Dekker – 00:31:53::

We’re casual here, I guess, but the etiquette of don’t eat in front of someone who’s about to push their baby out. Yeah.

Heidi Gustad – 00:32:03:

Yeah. There’s not much time to do any self-advocacy while I was in labor because it was so fast. I am not apparently a loud person when I’m in labor. I was silent most of the time other than natural 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 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 mentally cope with, and 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, 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, because I could feel him 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 moment of, oh, this is what we’re doing.

Dr. Rebecca Dekker – 00:33:32:

This is a real baby about to be born.

Heidi Gustad – 00:33:35:

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 this is productive, this is what we’re doing, this is what we’re here for. Eyes on the prize.

Dr. Rebecca Dekker – 00:33:49:

And what was the actual moment of his birth like?

Heidi Gustad – 00:33:52:

I ended up having to go into a lunge from all fours. And that’s what finally got him out. It was so fast because the whole thing only took nine hours and it was 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…

Dr. Rebecca Dekker – 00:34:12:

It was fast for you

Heidi Gustad – 00:34:13:

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 have 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 they were concerned about the barracks and things like that. They did 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, everything was dictated in our plan. And I just knew 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.

Dr. Rebecca Dekker – 00:34:58:

And then what happened in those minutes after the birth?

Heidi Gustad – 00:35:00:

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 we were able to do that.

Dr. Rebecca Dekker – 00:35:26:

And what did that feel like?

Heidi Gustad – 00:35:28:

It felt pretty awesome. There was still part of my brain that was still kind of in shock that I was done being pregnant. Done being pregnant, done being diabetic, done with these migraines. I 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 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 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. They were like, “How tall are you?” And I said, “Five.” Had a contraction and then said five, because I’m five-five. And she was like, “Five what?” I was like, “Five, five.” And then had another contraction.

Dr. Rebecca Dekker – 00:36:27:

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 and 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.

Heidi Gustad – 00:36:47:

Absolutely. And I’m 39 now and I don’t know if I want a second kid or not. 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.

Dr. Rebecca Dekker – 00:37:09:

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?

Heidi Gustad – 00:37:19:

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 as prepared as I could be given that he was a little early. My breast pump was clean because I had just used that. The crib was together. The changing pad was together. We had what we needed. And I think I have a couple friends who have had micro preemies. So 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. We would top him up with formula and I would have to pump. And if you’re doing that every two hours, as a lot of people know, it takes an hour and a half to do this three step process. And then when you do it every two hours, that was just my life was like –

Dr. Rebecca Dekker – 00:38:35:

It’s crazy how much feeding a human can take out of you.

Heidi Gustad – 00:38:39:

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, sure.

Dr. Rebecca Dekker – 00:38:46:

So your blood sugars went back to normal after you gave birth?

Heidi Gustad – 00:38:51:

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…

Dr. Rebecca Dekker – 00:38:57:

He just wasn’t taking in enough milk.

Heidi Gustad – 00:38:50:

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 this. 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 maternal grandma. And 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 teeny, teeny weeny. This peanut.

Dr. Rebecca Dekker – 00:40:02:

Yeah.

Heidi Gustad – 00:40:03:

Yeah. And I don’t look horrible in them, so I thought that was a bonus for being two weeks postpartum.

Dr. Rebecca Dekker – 00:40:09:

Yeah. It’s interesting when you’ve had a rough pregnancy house, sometimes you can have your postpartum is looking back comparably pretty good. Yeah.

Heidi Gustad – 00:40:19:

Yeah. I was like, “Oh man, I can eat chips. I can eat cravings foods. This is great.” Yeah. But it is interesting when you’ve had a hard pregnancy. You give birth and then suddenly the switch flips and you suddenly don’t have insulin dependent diabetes. That’s a big shift.

Dr. Rebecca Dekker – 00:40:39:

Yeah, that’s huge.

Heidi Gustad – 00:40:41:

Yeah.

Dr. Rebecca Dekker – 00:40:42:

Well, Heidi, you’ve taken us on a big journey from not sure if you wanted to have kids and the family history of trauma with childbirth 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 induced labor and having the birth you ultimately wanted. What advice do you have for people who are listening, who are thinking about entering birth or parenthood soon?

Heidi Gustad – 00:41:14:

I would say I always feel like I see on social media a lot of comments that are like, “My birth plan is not die and let the hospital take care of it, LOL.” And I get that. 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 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.

Dr. Rebecca Dekker – 00:42:21:

Yeah. It does strike me too. It’s a good reminder 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.

Heidi Gustad – 00:42:39:

Yeah. And I really think that viewing the birth plan document as a birth preferences document, framing it as preferences, not plan, also helped me get in the mindset of this is a malleable situation. 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.

Dr. Rebecca Dekker – 00:43:06:

Yeah. I really loved your tip of counting up to 20 and then down. Were there any other mantras or affirmations you said to yourself in pregnancy and birth that helped you cope with difficult things?

Heidi Gustad – 00:43:17:

Because of having all the migraines, it 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 how to endure pain for a longer amount of time. Sounds so horrible, but it’s the reality of what I was dealing with. And so learning different ways of distracting myself, playing with heat and cold, learning about gait control theory.

Dr. Rebecca Dekker – 00:43:42:

That we talk about in the class. Yeah.

Heidi Gustad – 00:43:44:

Even using 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.

Dr. Rebecca Dekker – 00:43:58:

That’s a good point that 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.

Heidi Gustad – 00:44:10:

Yeah. And having coped with the panic attacks in the past, that was also really helpful.

Dr. Rebecca Dekker – 00:44:13:

You were able to transfer those skills over to labor.

Heidi Gustad – 00:44:16:

And if somebody has always dealt with a lot of anxiety, you might be more prepared for birth than somebody who hasn’t. If you know how to deal with that because your body is panicking sometimes and that’s what you have to talk yourself out of.

Dr. Rebecca Dekker – 00:44:33:

Yeah. So the coping skills you learned for anxiety were helpful in labor as well.

Heidi Gustad – 00:44:36:

Yeah. And to be fair, I got lucky and I only have done this once, so this was just my experience.

Dr. Rebecca Dekker – 00:44:43:

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.

Heidi Gustad – 00:44:56:

Yeah. And thank you for helping educate me while I was pregnant, Rebecca. It was invaluable.

Dr. Rebecca Dekker – 00:45:00

You’re very welcome. This podcast episode was brought to you by the book, Babies Are Not Pizzas: 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.