After birthing quite a large baby and experiencing shoulder dystocia, Jessica Bower went on a quest to figure out why she had grown a baby that size. She shares with Adriana how gaining control of her sugar levels really helped with her “Mission: Make a Small Baby” for her third birth. This nutritional connection with her body was key in her decision to have an induction for her fourth birth after developing gestational diabetes, leading to the waterbirth she so desired.
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- Why This Doula Needed a Doula, blog post written by Jessica about fourth birth
- Silas’ birth, a video of Jessica’s fourth labor and birth
- The Business of Being Born website
- Real Food for Gestational Diabetes: An Effective Alternative to the Conventional Nutrition Approach, by Lily Nichols
- Real Food for Pregnancy, by Lily Nichols
- 9 Gestational Diabetes Myths, blog post by Lily Nichols
- Sterile water injections for pain relief during labor, Evidence Based Birth
- Sterile water injections for relief of back pain in labour, Mater Mothers’ Hospital
- Do you need a waterproof mattress protector like Jessica did?
- Thrive With Your Newborn, Birthful’s signature postpartum prep course
Related Birthful episodes:
- Big Babies and Shoulder Dystocia
- Gestational Diabetes Explained
- Newborn Sugar Levels and Breastfeeding
- [Postpartum] Hormones After Birth
- How to Time Your Pain Relief Options
- What You Need to Know About Birth Positions
- Shaking and the Primal Nature of Birth
[Birth Stories] How Nutrition Was Key for Her “Mission: Make a Small Baby”
Adriana Lozada: Welcome to Birthful, Mighty Parent or Parent-to-Be. I’m Adriana Lozada and today we’re going to wrap up our Nutrition and Nourishment series with a set of birth stories from Jessica Bower.
I wanted to include this episode in our Nutrition and Nourishment series because Jessica’s journey is a great example of how what you eat and how you nourish your body now— during pregnancy— can impact your births.
And it’s not just about what you eat, but how your particular body processes that food.
So for example, during her second pregnancy, Jessica ended up birthing quite a large baby, and before getting pregnant again she really wanted to understand why she had grown a baby that size. So she dug into the research. She found that the chances of having a large baby correlate very strongly to blood sugar control during pregnancy, and so during her next pregnancy, she went on what she called “Mission: Make a Small Baby” and really worked on getting her sugar levels in check.
This proactivity also helped her be more in tune with her body and allowed her to make really informed and collaborative decisions with her care providers, especially when, for her fourth pregnancy, her body needed more help balancing her sugar levels.
Now sugar levels during pregnancy are definitely a vital piece of the puzzle, and I would say that another thing that’s incredibly important to keep in mind is that pregnancy is in many ways a depleting event. And this is something that I say so much you’ve probably heard me say it before, but once you are done with this pregnancy, please really focus on deeply nourishing your body to replete your stores. And your postpartum body will be primed for that nourishment, so make it part of your postpartum plan.
Also, if you are between pregnancies, try to give your body the time and resources it needs to get ready for another pregnancy and nourish the heck out of it while trying to conceive. I know that’s not always possible and this is not about guilt or trying to reach some elusive perfect state. We are all human and things like this can be trickier when you have little ones. Just don’t forget about you.
You’re listening to Birthful. Here to inform your intuition.
Welcome Jessica. It is lovely to have you on the show today.
Jessica Bower: Thanks. I’m excited to be here.
Adriana: You’ve got four kids, right?
Jessica: Yes, four. Life is busy!
Adriana: Life is so busy— I can’t even imagine four kids! So, four birth stories— and when you reached out, you said you wanted to focus on the last one, but I want to make sure we give context (and you did too, of shortly going through the first three, just so people have a bit of context of where your head was at for the last one). Before we do that, why don’t you share a little bit about yourself?
Jessica: Well, my name is Jessica and I live in Greensboro, North Carolina. I have four kids. I have a six-year-old boy, a four-year-old boy, a three-year-old girl and a one-year-old boy. And so life is really busy! If I’m not hanging out with my kids and my husband, then I’m also a doula and I am meeting with expectant moms and dads, and helping them in their births or their postpartum and working with them through that whole journey.
Adriana: So you just said that’s four under six you’ve got.
Adriana: That is and doula work. That’s a lot.
Jessica: Yeah. Yeah, it’s a lot. I really don’t have any dull moments, but I’m the kind of person that I just like to always be going. And I don’t really like a lot of downtime. So, I don’t know. It works out!
Adriana: That’s a good, like, figuring out how to balance your home. This is one of the things that I talk about in my postpartum preparation class, of that whole understanding of your personality, your needs, and when you have a child, like, their personality and their needs. And are you guys, like, a good fit? And if not, like, understanding each other and then if you’re not a good fit, trying to figure that out. ‘Cause you could have… I need downtime, so a super clingy kid is difficult for me, whereas I know people that worry a lot or need to check in, so a very calm and quiet kid is disconcerting because they’re constantly like, “Are you breathing? Are you okay? Are you…?” and it’s just about matching those personalities. How does that work in your household with four?
Jessica: Well, I have to say my husband is amazing, so he does do a lot to let myself have some downtime, but my second and my fourth kind of have personalities like my husband (which is more calm and relaxed). And then my first and my third kids are more like me, and we get excited about everything and, like, just what we eat for breakfast is fun and exciting! And so it’s fun to see their different personalities develop but I do… I feel like I became a doula because I did want something outside of the home. I did it right after my third was born and it was when she was a newborn. I was like, “I have to get out of here,” and I know that… Well, that’s just being honest. I don’t know how it sounds, but it’s being honest.
Jessica: And so I felt like I had the great balance of being able to be with my kids most of the time, and at the same time, like having this great creative outlet to be able to serve other people and then also make a living.
Adriana: Yeah! And to me, that sounds very sane.
Jessica: Yes, yes. Yeah, thank you.
Adriana: Yes. No judgments!
So then, alright, let’s take you back to… quickly go through the first three. Six years ago, what was going… What were your thoughts about birth and, like, where were you at with wishes and what happened?
Jessica: Right. Yeah. So way back when I was pregnant with my first baby, I had watched The Business of Being Born, y’know, a year before I even tried to get pregnant. And I just always had a desire to have an unmedicated birth. That was just something that I don’t know where it came from; it was just deep in my heart.
My mom died when I was a little girl, so no one ever talked to me about my birth or anything. So I really don’t know where it came from. And then I had back surgery when I was a teenager, so the idea— I’ve always been very protective of my back, so the thought of anything going in my back was really terrifying to me! So those were originally my two big motivators: just this weird intuition and then also not wanting to have an epidural were my big motivators in wanting to have an unmedicated birth. So I just started doing a lot of research and tried to figure out good options. And I found a practice with midwives that allowed water birth in the hospital, so I felt like that was a good fit. I took the Bradley method, which was great for me and my husband for a childbirth class. And then a lot of my friends had had unmedicated births, so I was just really confident and I was like, “Well, they did it! And I’m friends with them. So maybe I can do it too!”
My one big regret going into that birth was that I didn’t hire a doula. I thought about it, but my husband and I are both really frugal, and we waited probably until I was about 35 weeks and then reached out to our Bradley method instructor and asked if she would be our doula— she was already full for our due date. So we went into that one, and it was four days past my due date and in the middle of the night, my water broke. It was like 2:30 in the morning. And I’m so glad someone told me to get a waterproof mattress protector because I mean, it was totally saturated!
And it was no doubt that my water broke, and then I was hoping contractions would start, but they didn’t. So after about 12 hours and nothing happening, we went to the hospital and I was… my cervix was totally closed and we did a round of Cytotec that got things going.
And then four hours later, we did another round of Cytotec and I felt like it… I just could not get a break. And the contractions were back-to-back-to-back! And I just couldn’t seem to… we tried a lot of positions. We were on the ball and in the shower, and then I just ended up being on my side, in the bed.
And I felt like I just couldn’t get a break. And I looked at my husband; I was like, “I can’t do this anymore.” So I asked them to check me to see where I was and I was three centimeters. So I was like, “That was such a letdown!” I was like this… I was having signs of transition. I was shaking, like, and y’know, looking back… I don’t know.
But so I decided to get a dose of Fentanyl because I really did not want an epidural. I still wanted to try to avoid that. They started an IV and gave me the dose of Fentanyl. And so I went to sleep. It knocked me out. I went to sleep for about 45 minutes, and then I woke up and I, like, screamed at my husband and said, “I have to push!”
So they checked me and I was about eight centimeters and had a bulging bag of water. So at that point I got in the birth tub, labored there for about an hour, then I really started pushing. Ended up needing to get out of the tub to push, ’cause I just wasn’t making much progress in the water.
And then, after pushing about two and a half hours, he was born and it was beautiful and amazing. And he was nine pounds and five ounces. And so at the time I thought, “Oh, wow. That was a really big baby!” and so… and he was a big baby. I mean, a nine-pound baby is not small! But me and my husband looked at each other and thought, “Wow, that was awesome. But next time we’ll have a doula,” because it was crazy how things progressed from three centimeters to eight, y’know, in a matter of an hour, basically. That was kind of a whirlwind, and we felt like if we would’ve known a little bit more, that that could have happened that… I don’t know, that maybe I would have, like, gone without a narcotic.
And at the time— I mean, now I look at it different— but at the time I really beat myself up about taking that one dose of Fentanyl. And I wish I wouldn’t have done that, because everything turned out fine and everything was great. But at the time, I did beat myself up about that.
Adriana: And that Fentanyl, it sounds like it maybe gave you the space you needed to gather yourself, y’know, knock you out, get 45 minutes of sleep and really get out of your head and let your body relax…
Jessica: Right, really relax. Yes. I agree.
Adriana: …y’know, move along. Who knows?
Jessica: Exactly. Oh yeah. No, who knows? Exactly. Like, what if I wouldn’t have done the Fentanyl? Would I have still progressed like that knowing, y’know…? I don’t know, but now I feel good about it, y’know— but at the time I kinda beat myself up about it.
Yeah, so then that kind of brings me to the next baby. And all the kids, I wanted to make sure I, like, breastfed for a year, and then I was okay with getting pregnant again, after a year. And I still breastfed them through the pregnancy— not all the way through, but about halfway through. But I wanted to give myself, my body, a year after birth before I got pregnant again, which I definitely recommend more time, if you want.
Then that brings me into the second pregnancy. And so going into his birth, I was just really confident. I thought I had a nine-pound baby, I only had one dose of Fentanyl, like, I really want to have a water birth this time.
And I was just like, “I can do this.” And my whole mentality was just, “I really trust birth and I trust the birth process and this is going to be good.” So I had had some bloody show over the weekend and I went out on Monday, which was my due date. And they were, y’know, just doing the fundal height measurement on my belly, and I’ve always (with all my babies) measured, like, exactly on track. And when they measured that time, they were like, “Well, you’re measuring 43 weeks instead of 40 weeks.” And they’re like, “You know, 43 weeks is kind of… You know, that’s a little more than what we would expect,” but the midwife didn’t feel like she needed to do an ultrasound or anything.
She just said, “We know you’ve had a big baby in the past and we’re not worried about it.” And I was like, “Great! I’m not worried about it either.” And then later that day I went and got a pedicure— that’s kind of my due date ritual, go get a pedicure on my due date. I mean, if I make it that far, I want to have good toes for labor! And I told the person doing it, I was like, “Hit all those spots on my feet, please, to try to make contractions!”
Adriana: So as a pedicure-slash-acupressure?
Jessica: Right. Right. And they were… and the whole shop was talking about me, because my belly was huge. I mean, very huge. So they were all talking about me and my stepmom was with me and it was funny because she said, “Well, if you make her go into labor, I’ll come back and give you an extra, extra big tip, y’know, tomorrow.” So, anyway, she actually… She did get it back and give them an extra big tip.
Adriana: Oh, that’s fabulous.
Jessica: Yeah. So… so anyway, I… contractions started while out, while she was rubbing my feet. And then I went home and I was just a little nauseous and felt off. And this was about dinner time when I got home. And so, I was there and just decided to go to my bedroom and kind of lay there through some contractions.
And then my younger— well, I guess my only child at the time!— he kinda came in and I was done with him. Like, I was like, “No, you need to go away!” So that was a big sign in me that I knew that this was real labor, because I didn’t want him to be around. I was ready to have, like, my space, so my in-laws came and took him away and that was a big relief to have him taken care of and know he was fine somewhere else.
And then as it got evening, I contacted my doula and she said, “You need to sleep.” And I was having contractions, y’know, every five minutes. I was, like, thinking, “Oh, things are going to pick up.” But she said, “You need the rest.” And I was like, “Okay, well, she said, ‘Rest,’ I’m going to rest.” So, surprisingly, I slept pretty well— still went to the bathroom every hour or so from about 9:00 p.m. to 3:00 a.m. And I’m so glad that I did!
And I didn’t know what was… This is a totally different labor than my first, ’cause the first one was basically an induction. So this was, y’know, my spontaneous labor at home, which was really cool. I really, really liked laboring at home. That was really nice.
Yeah, so I woke up around 3:00 and my husband… I was like, “Yeah, I think I want your help now.” So I just did a few different positions, was in and out of the tub, ate some food, and then around 9:00 a.m., we decided to go to the hospital because contractions were about three minutes apart. So, got to the hospital and I was about five to six centimeters but the baby was still high, like minus two. And so that was exciting for me because the first time I went to the hospital, I was zero with my first baby.
So I just kept being really confident. And I was like, “This is great, because this is gonna happen.” So my doula joined us at the hospital and set up the birth tub for us. And I got in the tub and I was just doing my thing, super calm and all different positions. Everything was great. Around one in the afternoon— we’d been in there about four hours— I wanted to get checked. Like, I felt like something was different, but I wasn’t ready to push, but I wanted to get checked. They came in and checked my cervix and it was fully-dilated, like totally gone. But the baby was still minus two, which is still pretty high up in the pelvis, which is why I wasn’t having any kind of urge to push or anything. So they were fine just letting me keep laboring. So we got out of the tub, did squatting, did the toilet, like, did anything to try to get the baby to come lower. Oh, I… my water still hadn’t broken. So there’s that too!
So then after about two hours, the doctor came in, around 3:00, and he explained “There’s this thing called shoulder dystocia, and that is when the baby’s head is born, but the shoulders are still behind the pubic bone. And when that happens, we need to get the baby out as fast as possible. And there’s a few maneuvers we can do. But it is an urgent situation.” And he just wanted to let me know so that if a lot of people started doing a lot of things, y’know, I wouldn’t be worried or anything.
Adriana: Had anybody mentioned shoulder dystocia before that?
Jessica: So, no. I had no idea,
Adriana: Right. So all of that… So you hadn’t heard about shoulder dystocia before that moment and he’s here telling you this while you’re pretty much, like…
Jessica: …I’m in labor!
Adriana: Yeah, right?! You’re fully dilated, indeed. Like you’re waiting to push and this comes… What did that do to you?
Jessica: So I’m still contracting, y’know, every minute I’m sure, every two, three minutes. I mean, it was full-on active labor. My doula was there. She heard the whole conversation and she was like, I mean, y’know, she was like, “Do you have them?” She kind of explained a little bit further what shoulder dystocia is. So if people are like, “What’s shoulder dystocia?” you have an excellent episode on it…
Adriana: Yeah, I’ll link it on the show notes.
Jessica: Yes, for sure. So I had no idea and basically my doula was like, “Well, you know, it doesn’t happen that often.” And she was like, “You’ve had a bigger baby.” And we knew that […] was big! And obviously, the doctor was concerned enough to mention it, but the doctor didn’t recommend a C-section or anything. Y’know, like the whole atmosphere in the room still was very calm. It was just a matter-of-the-fact thing, but I really didn’t know the complications that could come with it. And honestly, in retrospect, I’m so glad I was totally unaware.
Again, I was just still blissfully unaware and did not know. And I remember him saying it, but it wasn’t… I don’t know, it didn’t do anything to me. So I was like, “Okay…” So I keep laboring, it gets to four o’clock and I’m just really struggling at this point. I was like, “I need something to change. I need something to happen.”
Asked the nurse to check me again, the baby was still minus two. I mean, still up there, just no change! Hasn’t moved. So, we decided to try— obviously I didn’t want Fentanyl or anything, but you can’t do a narcotic when you’re complete, y’know, typically, especially with the second baby— so we decided to try the sterile water injections. And so that’s where they put four injections in your back, of sterile water. It’s exactly what it sounds like! They had four nurses all do it at the same time. And so it’s… it hurts really bad when they put it in, but it’s supposed to. I don’t know… maybe you can explain a little better about what it’s supposed to do?
Adriana: Yeah! It’s very non-invasive in the sense that it’s just water in your skin. It’s very deep. It creates little papules, little bumps, on your back. And it’s like two on each side of your butt crack, I think, more and more towards the middle of the buttocks. And the reason they probably had four nurses doing one altogether is— because I’ve only seen it done once or twice—
Jessica: Right. Same here.
Adriana: Alright, and the reaction of the person getting it was so intense. So when you say it hurts, can you please tell a bit more what it felt like?
Jessica: I mean, it’s like… I want to jump all the way off the bed, like through the ceiling! I mean, it hurts so bad, but then you’re like, “I can’t jump because of having needles in my back.” So, I’m pretty sure I screamed and I mean it hurt.
Adriana: Yeah, that seems like the appropriate reaction. It is super insanely, intensely painful, but it’s… then it goes right away.
Jessica: Right. And then it’s supposed to help, kind of, relax or take the edge off.
Adriana: And it does. It works on the gate theory of pain where you’re kind of short-circuiting all signals to the brain, like good, so intense that it’s like, “I can’t deal with anything else.” And it is very helpful for intense back labor and it can take away the feeling of back labor for an hour or two.
Jessica: Oh, and I didn’t even mention that, but yes, it was all back labor with this baby. Like, I didn’t even, mentally feel anything in the front. I mean, I know it was happening obviously, but because the pain was so intense in my back, I didn’t feel anything in my friend, which was another sign that I was probably having a big baby.
Adriana: After you got the injections, then back labored, like, did it help the back labor calm down?
Jessica: So it did. It did what it was supposed to do. And I didn’t really think it did at the time, but my husband and my doula said, “Yeah, it worked,” because I was actually able to just rest on the bed for about an hour, like, and it hadn’t been… the only position that I could remotely tolerate anything was anything in the tub, and I was actually dozing between contractions. So it really did what it was supposed to do. I would say it worked for about an hour/hour and a half, basically did what it was supposed to do. Around six o’clock, it was wearing off. And, so the doctor had mentioned, doing… breaking my water to try to see if that would help drop this baby down.
And at six o’clock I had decided— I’d been complete for five hours— I decided, “Okay, I’m just… I’m done. I’m ready to do something.” So we had just told our nurse to call the doctor and to do that, and I had gotten back in the tub in the meantime, while we were waiting on them. And so while I was in the tub waiting on him, I actually started to get an urge to push and it was kind of mild at first, but then quickly intensified. and then my doula asked, “Can you reach down and feel your baby’s head?” And I reached down and I didn’t feel his head, but I felt my bag of waters! I felt this really slick thing, so I knew it was my bag of waters bulging— this is over a period of about five minutes. I mean, this is very… just a couple of contractions that I’m having this change.
And then my water broke. I felt a pop! And then immediately after that, huge urge to push and then about one contraction, his head was out. So his head was out, I’m in the tub and the nurse had just run in the room. I mean, this… ’cause this was all happening very quickly. The nurse had run in the room and then they, kind of, they went ahead and hit the whole “shoulder dystocia” alarm in the hospital because they were basically anticipating it. I didn’t know that at the time, but they were anticipating it to happen.
Adriana: And was that actually happening?
Jessica: Yeah, so his head was out in the tub and the poor nurse, she was new at the time and she was just… she was a little panicky. Everyone else in the room was really calm, but my main nurse was there, freaking out a little bit.
And so then the doctor came in right after everyone else. The doctor was really chill and also it’s really random, but why I had a doctor at this waterbirth— normally it’s midwives at a water birth, right?— but I had this doctor, a male doctor, and he had only done a few waterbirths in his life, but he was so chill about it and fine with it. And the practice at the time was short on midwives, so he happened to be covering that shift but he was fine with it and he was fine with me being in the tub. So that was just really awesome that he was all good with that! But anyway, he came in and he was really calm and I was sitting up in the tub, like sitting on my, like, on my bottom, kind of leaning back.
And he just said, “Okay, flip over please,” because he wanted to do the Gaskin maneuver, which is a good way to try to resolve shoulder dystocia, flipping on your hands and knees. So I flipped on my hands and knees and I pushed like that for one good contraction. And then even tried to push, y’know, in between contractions and his head is still just hanging out, but like not moving.
And I knew— I was like, “He is not moving,” and I was pushing as hard as I could. And at this point I knew things were really intense, and they needed to get the baby out quickly because someone was counting every 30 seconds. She was saying like, “30 seconds… one minute… one and a half minutes…” y’know, because they’re counting how long the baby’s head has been out before birth happens.
But the doctor was so calm. He was really patient. But then when he saw it wasn’t going to come out with me on my hands and knees for a contraction, he just said really calmly, he just said, “We need to get her out of the tub.” And he comes up behind me and reaches, like, he’s behind me and reaches under my armpits and just picks me up!
And two nurses grabbed my legs and they picked me up and put me on the bed. And then started doing the McRoberts maneuver, which is where people have your legs pulled really far back up to your ears, basically— I mean like your knees are pulled as far back as they can. Someone’s putting fundal pressure on your belly, so pushing down really hard on the top of your belly. And then the doctor is reaching in, to basically try to figure out which shoulder they can pull forward to keep it from being stuck.
And so all that’s going on at once and I had been really calm through the whole thing, and at this part I think I did, like, scream while I was pushing because, and you’re trying to push this whole time! And I heard them say “Three minutes…”
Y’know, it was… the head had been out for awhile, and then finally they were able to push over shoulder for it and he was born. And I think he was stuck for about three and a half minutes. And then they… Y’know, my first birth that he, like, went into my chest right away. This one, he was like blue and limp and they clamped and cut the cord right away. And he was over on the warmer with the neonatologists checking him out and he was fine. His Apgar was like a five at one minute, but then it was up to eight at five minutes. So he was fine. And he was back on my chest within five minutes. But it was a huge whirlwind that at the time, I had no idea what really went down.
But I… at the time I was just like, “Wow, that was a big baby.” Y’know, a little bit after that they weighed him and he was 11 pounds, eight ounces. So he was large. And I just realized that was a really serious thing. And I did not want to have a big baby again.
Adriana: Yeah, I mean, so it was great that he was so calm and that you’d been warned, even if it was just right before, like, “This might be a possibility.” But clearly it got serious in that first maneuver. And if people listened to the episode, right, with Rachel Reed, she says, “We have different maneuvers that we can do.” There’s this, and there’s this, and there’s this.
Adriana: And that I’m glad they did! That he went to the Gaskin maneuver first, ’cause that’s one that you don’t see so often— they kind of jump to the McRoberts. But knowing that that didn’t work and then getting you out of the tub and then time was of an essence at that moment.
Jessica: Right, right. Exactly.
Adriana: Yeah, and 11 pounds, eight ounces, that is quite the big baby!
Adriana: Yeah. So you were determined to not have a big baby again. What other things… What other feelings were you having from this? Or how did this change your perspective towards birth?
Jessica: Yeah. So, I suddenly, y’know, I had always, like, I was… birth is like… I just trusted birth. And I suddenly was like, “I don’t know that I trust that anymore.” You know? And there was a lot of… I mean, there’s just a lot of doubt and I mean, yes, fear, y’know, of “I don’t know just what could have happened,” y’know?
Yeah, it was just… and then when I went through and read, y’know, in worst-case scenario shoulder dystocia is a cesarean. That was kind of scary too. And then I thought, “Well, goodness, would I have blamed myself if something would have happened, y’know, to him.” And I mean, that’s just my honest what-I-was-feeling, y’know?
I’m not trying to scare anyone or anything, but I was just thinking all these things. And then I knew I wanted to have more children, but I was like, “I don’t want to do that again.” So the question is, “How do you get an 11 pound, eight ounce baby?” I mean, you know that’s a pretty large baby.
The doctor who did that— who did my birth, I mean— he was almost done with his career. He only had two more years and now he doesn’t do OB anymore. And he told me that was the second-largest baby he’s ever delivered vaginally, y’know, so they’re not that common to come out vaginally.
Adriana: Yeah, I had one doula client like that, and then she still takes the largest baby and she was close to that, she was more than that, but it was 12 pounds, three ounces. And it was vaginally, and that was like, she makes big babies already— this was her third, but that’s, like, almost a three month old!
Jessica: Right? Oh, it is. Yeah, yeah.
Yeah, I was also just very thankful and at the end of the day, I was like, “I’m just so glad that all the people were in place.” I mean, and I’m so glad that, y’know— not that a midwife couldn’t lift me out of the tub— but I think at the time of his birth, I weighed 185 pounds. So I’m glad that it was, like, a strong man who literally just lifted me out of the tub like it was no big deal… y’know, I don’t know. That was nice, to have that. And then the midwife came on call about 20 minutes after the birth. That was when the shift change was, and she… and I was like, “Oh, I’m so sad you weren’t here.” And she was like, “Yeah, I’m really glad it was the doctor.” So that was kind of funny!
So that kind of brings me to my third one. And I don’t want to talk about that pregnancy. I mean, it’s my one girl and it was a beautiful pregnancy and birth, but I want to kind of save time to talk about the fourth one. But my mission with her was “Mission: Make a Small Baby.” Like I told everyone, I was like, “This is ‘Mission: Make a Small Baby.” And when I say “small baby,” I said, “I want my perfect eight pound baby,” because having big babies, thinking about a six or seven pound newborn, I was like, “I’m going to break it!” y’know? But I didn’t want a large baby again. You know, some people just make big babies, but for me, I just thought, “Well, what can I control?”
I was like, “Well, what if I have some insulin resistance? What if there is some undiagnosed gestational diabetes?” So I kind of went down that track and what made me go down that track was a lot of people in my family have Type 2 diabetes, you know? So I decided “Why not try it?” Kind of… the tricky thing was, again, I wanted my waterbirth and, the practice said, “Well, if you have to be medicated for gestational diabetes, or we have to test you, or it’s on your file in any way that you have gestational diabetes, you can’t have a waterbirth.”
And I thought that was kind of, y’know… anyway, that’s another thing, but I decided they… so I just… I had always passed the glucose tolerance tests like normal and my second trimester with the first two children. but I thought, “Well, I don’t know if I trust the test.” I love your episode with— is her name “Lily Nichols”?
Adriana: Lily Nichols, yeah.
Jessica: Yeah, with the Real Food for Gestational Diabetes. I devoured her book Real Food for Gestational Diabetes. I loved it. And I just decided I’m going to treat myself like I have gestational diabetes. I mean, worst-case scenario, I have a better diet. And I never felt like I had a bad diet with the first two pregnancies, but I did… like, I would eat a lot of fruit and I would eat a lot of whole grains, which, if you are insulin resistant, you might want to lower those carbs, even though they’re healthy carbs. Y’know, kind of change what you’re doing as far as what you’re eating.
Adriana: And what I love about what you’re saying, and Lily’s book and her episode and all the work she does, is that she brings it back to you and you getting to know your body and realizing what your sugar levels do and how to control that, which is healthy for anybody, right? No matter, regardless of gestational diabetes, it’s providing the optimal health, basically, in terms of nutrition for your own individual needs. So just getting in touch with that for yourself, I think is huge.
Jessica: Right. And also the glucose tolerance, that drink makes me so sick. So I just decided with the third baby, I said, “I’m not going to do the glucose tolerance test. I don’t think it’s accurate for me,” I said, “but I know that you don’t want anything in my file showing that I had diabetes.” So I had to borrow my dad’s diabetic testing supplies, because if they prescribed it for me then I would… it would not look good for them for whatever reason. So I just was like, “I’ll do it on my own.”
So I tested my own sugar, and they were happy with it, but I did really change my diet. And so basically with diet and exercise, my numbers were really good and within range, and I felt good about things. And I just knew my baby was smaller.
So long story short, I wanted an eight pound baby. She was seven pounds, fifteen ounces. And it was all because I changed my diet! And I mean, it was a big diet change, so yeah. And so it was a really… it was a great birth, but it still wasn’t my waterbirth. So that brings me to baby four…
Adriana: So going into baby four, what were you thinking? Y’know, I’m guessing you wanted a small baby again… or not a big baby again.
Adriana: And then, my question to you, though, is what were you feeling in terms of your trust and your fears around birth? Because it seems like a lot of those developed along the way.
Jessica: Right. So I had always been passionate about birth. I always thought being a doula would be awesome. And so I became a doula when the third baby was about five weeks old— before my first postpartum visit, I went to my first birth. So that was really cool! I love (I love) being a doula. But also being a doula, you see all the great births and you see crazy stuff happen too— y’know? And so I used to say, “I just trust birth. I trust the process.” Now in the most part, most of the time, you can trust the process. But I say now that I personally have a very healthy respect of the birth process and I know that sometimes interventions are great and needed. And the most of the time, we can leave it alone. So that said, going into the fourth baby, I ended up being in my own head a lot through the pregnancy and then the birth.
And so you’ll hear more about that as I share this! So, I wanted to try to do a birth center birth, but this time around, I went to our local birth center and started my prenatal care there, but basically I risked out at 25 weeks because I started taking my own sugar. Just, I was like, “I know how to do this. Last time, I had my perfect 8 pound baby. I’m going to do it again this time. It’s going to be great.” And so at about 25 weeks, I’d been taking my sugar for a few weeks at that point, and my fasting numbers were just… they were just too high. They weren’t crazy, but they were high enough to where I needed to be medicated. And that was really discouraging because I knew when I was doing, I was doing all the right things, and I saw a really good nutritionist, who was in line with the, like, Lily Nichols-type method, lower carb and everything! And her only advice she could give me— I did an hour consultation with her— and she said, “You can try to eat your meals slower, so that you have… your body has more time to process the food.” And I just said, “I have three young kids at home!” Like, I eat when I can eat, y’know? I just thought that was funny. That was her only piece of advice. So, it was kind of discouraging to risk out of the birth center, but I got to go to… I have to give a shout out to Daniela at Wendover OB/GYN in Greensboro, in case anyone’s listening in the area, ’cause she was so good. I’d done a lot of births with her. And so I knew that I wanted to be under her care. If I was going to be in a hospital waterbirth setting, hopefully I wanted to be under her care. She was like, “This is okay; we can do this. You just have to be medicated, but we’re going to do this.” So I started out doing just Metformin to try and get the fasting number lower, and it didn’t really do a lot. The fasting number was still high. So then we had to move to insulin, which, y’know, that means giving yourself shots a couple of times a day and just the whole thought of like, “Why am I on insulin?”
Y’know? And a little frustrated at my body in the process of like, “Can’t you figure this out?! I’m feeding you the right things. I’m exercising. This is just really frustrating, y’know?” But things were… we got it pretty well under control by about 29-30 weeks. We were feeling good about the numbers, which is good ’cause y’know, that’s when your baby’s starting to really pack on the weight. Then the other issue that I was having in this pregnancy, if you’ve had an 11-and-a-half pound baby, and then you’re trying to grow a normal-sized baby, and you’ve had all these babies closely together, then basically in my abdominal area, I had lots of room for the baby to move. So as we’re in the third trimester, this baby is just all over the place. Like one week he would be head down, one week he’d be [breeched], one week he would be transverse, and his position was just all over the place. And that just really made me anxious because I was like, “Well, what if he’s breech and my water breaks? Then that means I’m going to have a c-section.” And I’m like, “I’ve had three unmedicated births. I just don’t want it! And he… this is my last baby.” And I’m like, “I just don’t want to end my last baby, y’know, having a c-section because of a breech baby.” So that was a big place of, kind of, fear and anxiety— so my biggest fears were the position. And then I was more concerned about this baby’s size because I was on insulin, y’know; I mean, I was having to be medicated to control the diabetes and everything.
So, there’s just a lot going on. And thankfully my doula and my midwife basically were my therapists through it, to just be like, “It’s okay, this is normal. You’re going to be fine.”
Adriana: Emotional support is so huge. People undervalue how much having great care providers and people on your birth team and in general, right, like, providing that support.
Jessica: Oh yeah!
Jessica: Right? And my midwife was so great because I had to… I would, I had to text her my numbers and she, y’know, she gave me her phone number to be like, “Here, text me!” because I had to text her my numbers every three days, so we could adjust the insulin accordingly. So that was just so nice to have one provider versus going in every week and seeing someone in a rotation— that would have been crazy, with what I was having to deal with with the medication.
So that was great. So basically we get around to it, and my biggest thing was… I’m not afraid of an induction, but I am afraid of going into labor with a breech baby and not being able to turn the baby, or just my water breaking and definitely not being able to turn the baby. And then I was also a little bit concerned about cord prolapse because the baby was transverse a large majority of the time so that’s, y’know, where he’s laying across sideways and if my water’s broken, nothing is over the cervix, y’know, there is a higher chance of cord prolapse. That’s something that’s really rare— but again, that was me getting in my own head because I know these things, So we decided… I wanted to be induced at 39 weeks, and that way I would know the baby was in the right position and I felt like it would give me my best shot at having a (hopefully!) straightforward vaginal birth.
Adriana: So this one started very different from the other ones, but completely on your own terms.
Jessica: Right, right. So I felt— and I, y’know, I’m not a control freak— but I mean, I wanted to be in control of this. So, as much as I possibly could be.
Adriana: And a way to try to minimize your fears
Jessica: Right, exactly. Like what were my biggest fears? And I’m thinking, y’know, my biggest fear was just having no control of my water breaking, which is a legitimate thing that happened to me, y’know, with my first baby.
Adriana: Well, and we know that fears and that whole brain mind-body connection is huge during birth. So that is absolutely valid, yeah.
Jessica: And I almost was confident enough— I had never gone into labor before 40 weeks. And so I was pretty sure my body was not going to go into labor before 39 weeks, just with my mind where it was and my history. I just wasn’t concerned about labor before the induction. So we decided to go in to be induced, and I was three centimeters, but my cervix was really thick and the baby was minus three, so really high up in like floating, basically up in there.
So we started with Cytotec, which I was a little nervous about with my first experience with Cytotec, but that’s what my midwife recommended. And I was like, “I chose this midwife for a reason, I’m going to go with it.” And so— oh! And the baby was actually head-down the morning of the induction, so that was a nice surprise, that we didn’t have to do an external version to get the baby in the right position. So it was just nice. But shortly into the induction— I think about an hour in— I was starting to have just crampy and everything, and the baby went off the monitor and the nurse came in and was like, trying to get the baby on the monitor. I feel the baby moving, so I’m not worried about him or anything, but he’s off the monitor because he’s flipped already transverse, y’know? So I’m like, “Well, how in the world are we going to do this if the baby can’t even keep his head on the cervix?!”
So my midwife comes in… A lot of times when you do an external version, that’s done by a doctor, but the midwife just moved him back, because she literally was just pushing gently on the side of my belly to get him to move back.
Adriana: Well, and it seems that from all you’re saying that his ability to move, so he had a lot of room, so it wasn’t like usually, you need a doctor in control and an ultrasound and have everything be very regulated because there’s a lot of force required, and because there’s no space, right? It’s a big effort, but it sounds like—
Jessica: I had the opposite problem!
Adriana: —more just adjusting that baby, yeah.
Jessica: And they did bring the ultrasound in to make sure that they had put his head back down, and then they put a big Velcro binder on my belly and basically I was wearing a corset. So it was uncomfortable and it was tight. But again, I was like, “I don’t care! I just need the baby to be head down.”
And then things kind of moved along… At lunchtime, they checked me, I was three to four, thinning some, the baby was a little bit lower. So we decided to do another dose of the Cytotec. A couple of hours after that, the baby went off the monitor again, and I had a freak out moment and the nurse was like, “No, he sat down. He’s fine.”
I was like, “I need my midwife to come in and make sure that the baby is still head down!” I don’t know, I just really needed that reassurance because of what had happened before. They came back. He was fine. He was still head down. At four o’clock, checked the cervix again, no change— the baby was still high.
So basically the Cytotec had done what it was going to do and decided we needed to start Pitocin because the goal was to be able to break my water, to get labor, to take off on its own, but we couldn’t do that because the baby was still so high and we didn’t want to have that cord prolapse happening.
So, started the Pitocin around five o’clock and my husband had gone to get dinner for us because I’m all about eating in labor. And again, it really wasn’t an intense labor at this point. I mean, it was… I was contracting about every… about every three minutes, but it was pretty mild. So he went to go to our favorite burger place, which is right across the street from the hospital.
And, anyway, and then the midwife came in and was like, “Well…” checked me again and said, “Well, I can break your water?” I was kind of… I was scared about it at that point, because I was like, “Are you sure? Are you sure you can break it? Because two hours ago, you said it was too high…” and I knew there had been some change, but it didn’t feel like a lot of change to me as far as intensity and all that. All I could see was like breaking the water and then we’re running down the hall to do a stat C-section because there’s cord prolapse.
And I was just really nervous about that. But finally, I was like, “Okay, well… What else can we do? I’m just going to trust her.” I’m just going to trust her that she knows what she’s doing. And finally, I said, “Have you ever had… have you ever broken someone’s water and had cord prolapse?” And she said, “No.”
And I was like, “Alright, well… I’m not going to be the first one,” and somehow that gave me the confidence to just be okay with it. So she broke the water. She had the nurse apply fundal pressure at the top of my belly to push the baby’s head down while she was in there. And she did a really slow leak, so… but basically it took about two minutes of the midwife just in there, making sure the baby’s head was coming down and getting nice and applied, and the nurse pushing on my belly, the bed was full of water (I mean, full of tons of clear fluid— and that’s common for if you have gestational diabetes, to have a little more fluid than normal— but it was a lot of fluid). And then the baby looked… it looked externally like two inches lower because of all the fluid going down and then the baby dropping down. That was kind of cool to see!
Adriana: Right?! How interesting to have that immediate— like, within minutes!— have that change. And I wanted to pause a second and give a little bit more information of what a slow leak is, because when people hear about breaking a water, especially if you had so much water, thinking, “Oh, it’s going to be an enormous gush and all this water going out,” but I’ve seen this more and more in the past few years, where instead of doing a big break of the amniotic sac, it will be more of like a little tiny prick, almost like a pinhole.
Jessica: Yeah, that’s what she did.
Adriana: Yeah, and let the water just slowly leak out so that the baby can descend, ’cause it’s the gush that can get that cord to come before the head and create the prolapse. But if you’re slowly, very controlled, letting that fluid out, then there’s less of a chance of that happening.
Jessica: Yeah. So I felt good about things. They changed the pad out from under me. And I just was like, “I know things!” That this was a doula insight— I was like, “I know once I stand up, things are going to get more intense and I need to eat that hamburger first. So I’m not getting out of bed yet.”
So they broke my water, y’know, we’re monitoring the baby and I’m just sitting up in bed. And I was like, “I have to eat my hamburger,” and, y’know, I didn’t get fries with it. And I normally would not have had a hamburger, because I wouldn’t have eaten a bun, but I decided, I mean, I’m only going to be pregnant for a few more hours, so I’m just going to do this.
So I had my hamburger… and then I had some carrots and celery with it, and it was great. And then I got out of bed and immediately when I got out of bed, I was like, “Alright, this is the real thing. This is labor. I got out of the bed about 7:15, and, by 7:40, y’know, I said, “Okay, it’s time for the birth tub.”
And I was still on Pitocin then, and the goal was to have labor going strong enough and intense enough to be able to turn off the Pitocin, to be able to get in the tub. Because at that hospital, we don’t have waterproof monitors. And if you’re on Pitocin, you have to be consistently monitored. So we want the labor to be really intense, so we could turn it off and my body would take over and just keep doing its thing.
So at 7:40 my midwife checked me, I was six centimeters and got in the tub and contractions were consistently two to three minutes apart— and it hurt! And it hurt more than I remembered, because when you’ve watched birth on the outside for so long and you see so many people go through it, that you’re not experiencing it… I mean, I have to feel for my clients, but it’s a different way than feeling it for yourself. And I knew that I would be surprised at the intensity of labor, even though I had done it three times before, I knew I knew it would hurt more than I thought it would.
And it did— that did not disappoint. It hurt, but… and then the things going through my head were hilarious. Like I was in the birth tub and I was staring at the hospital bed and I was like, this is why people get epidurals. This is why people get them because this hurts. And I had just done a doula meeting the day before, and I was telling the mom how empowering birth is! And in my head, I was like, “I lied to her! Birth is not empowering!” And I… it was just this hilarious, because I was thinking these things and birth is amazing and empowering, but this is what was going through my head.
Adriana: That sounds like transition thoughts…
Jessica: Yeah! Well, yeah. Yeah, it was just really funny. And I just… I said, “This hurts!”
And then they were like, “Do you want us to rub your back? Do you want counterpressure?” And I was like, “No!” And then my midwife just did anyway. She just put her hand on my back and it felt so good. And then I was like, “Ohh, you have to keep doing that,” y’know? But it was funny ’cause I was like, “No, I don’t need that.”
And then another funny thing— that actually got caught on video— was I said, “I need a life vest or something!” I don’t know what was making me think that. “I need a life vest or something.” And my midwife said, “Well, that’s your husband?” He said, “Yeah, I brought my swim trunks.”
And I said, “No, this is my tub!” like real strong, y’know, “Get out!” I didn’t want anyone in my birth space. So that was just really funny. And then after being in the tub about an hour, the midwife made me get out… I do that to moms— I want them to get out, change it up a little bit. So she’s like, “I just want you to get out and go to the bathroom and then come back in.”
So I went out, went to the bathroom, I thought I was going to die while I was sitting on the toilet. I’m not one of those people who likes to sit on the toilet. It’s magical for so many people; I think it’s torture. So I was there for one contraction and then I was like, “I need my tub again!” So that was at nine o’clock, went back in the tub. Soon after that, I started to feel kind of pushy and with the second baby, y’know, I barely had that sensation and then he was out— y’know, one push! And with the third baby, it was very similar. So I was thinking, “Oh, once I feel that sensation, like the baby’s just going to shoot out because that’s what my babies do.”
And, I started to feel that sensation, but it wasn’t overpowering yet. So I was like, “I’m gonna wait. I’m gonna wait until it’s overpowering.” But I had told the midwife, I was like, “Go ahead and check me.” So she checked me while I was in the tub. She said, “You’re complete! Push whenever you want.”
But I… anyways, so that sensation slowly started building and then it really was there. But then I pushed and I felt like I was… it wasn’t doing anything like I pushed, but it wasn’t like I was moving a baby, it was not like the two prior births. And I started getting in my head again and I was like, “What is wrong?”
And I said, “Is he too big?” Like, “What is happening here?” And we’re like, “He’s not too big. He’s fine. He’s not in a bad position. He’s fine.” But I was really worried about those things. So, and then the midwife said, “Well, do you want me to take the binder off of you, so that…?” because you know, I have this corset on me too. “I don’t know how much that impacts the intensity of labor pain, but I’m sure it doesn’t feel great to have a corset on you while you’re contracting.” And I was like, “No, don’t take my corset off.” I mean, she could feel the baby’s head— it wasn’t going to move— but I was still like, “No, that’s my safety net,” like, “You can’t take that off of me!”
So I pushed really hard for about 10 minutes. And I was sitting upright and all my babies I had sitting upright or kind of leaning back, but upright. And she had asked like, “Is that how you want to push the baby?” I was like, “Yeah, that’s how I pushed all my babies out. That’s what I’m going to do.”
And they… then they were trying to convince me to flip over on my hands and knees. They were like, “Just turn over and see what happens.” I was like, “No, I don’t want to do that. This is how much my baby’s out. Nope. I don’t want to do that.” She’s fighting with them. And then, finally, after I was realizing that what I was doing wasn’t working, I decided to listen.
And so I flipped over, and then the very next contraction I pushed and he just… I just felt him slide right out. And he kind of was behind me a little bit, and the midwife pushed him between my legs and then my husband helped pull them up, and me and my husband pulled him up together out of the water. So it was really, really special!
Adriana: Mhm. You got your waterbirth!
Jessica: I know, finally!
Adriana: And I think for that, like, every labor gives you different challenges. I always say— you hear me do this— that labor takes you to your edge, and everyone is so different. And it feels like, y’know, as you’ve been telling these stories, it’s that whole relationship with birth and fear and taking control.
And, in this one, it seems like what you had to fight or work through the most was that fear— like it was such a mental breath almost.
Jessica: Oh, it was. Yeah. I mean, and I felt like even though no one else— well, once we had the binder on, no one else— like no one else was concerned about a big baby. Y’know, I was the only one who was remotely thinking about that. No one else was concerned about cord prolapse, y’know, but I mean, those were all big things in my head that I had to work through, yeah.
Adriana: What did you feel you learned the most from this one?
Jessica: Having the right support team around you, y’know— like the right doula, going to the right care provider, because at the end of the day, I just had to trust them, y’know? And that was everything for me. I was really particular about who I wanted in the room. Like I… you know the nurses at the hospital? Do I want this nurse, y’know?
And also another thing was having to let go of other people’s expectations of what they thought I might do, because in the birth community, y’know, or at least around here, a lot of people… I didn’t tell anyone I was getting induced, because I really felt like I was gonna get a lot of judgment from people who didn’t understand my full story. Because y’know, a lot of people go, “Your baby will get in the right position. It’ll be fine. You know, you’re going to grow the right size baby.” And I was like, “For me, this is what I need to do.” But a lot of times I care about what other people think. So I really had to just shut everyone else down, and, like, only pay attention to what my doula and my midwife and my husband and myself were saying. And that was it. Y’know, I didn’t need anyone else’s opinions in it. So that was a big process of learning to let go of that, everything else.
Adriana: When people share their stories here, I hear a lot of them are saying it was the people around me sharing their horrible birth stories, I needed to tune those out. Or telling me “You wait, you’ll see. You won’t get what you want.” And you being at a birth community, presented a different set of challenges in a similar way of, the opposite— like, not horror stories, but oh, sort of, almost dismissive of, “It’ll be fine. It’ll be fine. You’re over-worrying!” And it really does not matter at all, except what the birthing person is feeling and believing.
Jessica: Right. Exactly.
Adriana: Oh, thank you so much for sharing all these stories and your big journey, your quick and big journey!
Jessica: Yeah! Thank you.
Adriana: That was Jessica Bower, who is an International Board Certified Lactation Consultant, birth doula, and mother of four. You can learn more about Jessica at growingfamiliesnc.com
And you know how Jessica mentioned that for her, having the right support team was hugely important? Well, that was the perfect segue for our next series, which will be all about care providers.
We’re going to be looking at the different types of providers and what to look for so you can choose the one that best fits your needs and wishes.
You can connect with us @birthfulpodcast on Instagram. In fact, if you are not driving, you know we’d love it if you would take a screenshot of this episode right now and post it to Instagram sharing your biggest takeaway from the episode. Like for example, did you know about shoulder dystocia? Make sure to tag @birthfulpodcast and @growingfamilieslactationdoula so we can see it and amplify it.
You can find the in-depth show notes and transcript of this episode at birthful.com, where you can also learn more about my birth and postpartum preparation classes and download your free postpartum preparation plan.
Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte.
Thank you so very much, as always, for sharing and listening to Birthful. Be sure to follow us on Goodpods, Spotify, Apple Podcasts, Amazon Music, and everywhere you listen.
Come back for more ways to inform your intuition.
Lozada, Adriana, host. “[Birth Stories] How Nutrition Was Key For Her ‘Mission: Make a Small Baby’” Birthful, Birthful. August 3, 2022. Birthful.com.
About Jessica Bower
Jessica lives in Greensboro, NC with her husband Ray and four children. There’s never a dull moment in the Bower house, as you can imagine— but there is a lot of love, excitement, and fun! When Jessica isn’t with her family, she’s spending time working as a lactation consultant and birth doula at Growing Families Lactation and Doula. Jessica thrives on meeting with expectant moms during pregnancy, preparing them for birth, and then helping them adjust to life with a new baby. Her other favorite pastimes include spending time with good friends and eating healthy food!
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