[Birth Story] How She Advocated for Her Vaginal Births Despite Having Diabetes

Yana Katzap-Nackman shares with Adriana how taking control of her sugar levels and bringing together a supportive team of care providers led her to have the births she desired, despite living with Type 1 diabetes. She tells Adriana how she matter-of-factly took herself off the hospital induction schedule, and how she navigated a postpartum experience that included having a TV crew from TLC’s Bringing Home Baby in her house. 

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Transcript

[Birth Story] How She Advocated for Her Vaginal Births Despite Having Diabetes

Adriana Lozada: Welcome to Birthful, Mighty Parent or Parent-to-Be. I’m Adriana Lozada.

As part of our Nutrition and Nourishment series, today we have a couple of birth stories from Yana Katzap-Nackman, who has had Type 1 Diabetes since she was 5 years old.

Now, usually, when we hear about anyone having circumstances that place them in a “high risk” category for birth, it feels almost like the self-advocacy has to take a step back as we go into a space where medical expertise seems to play a bigger role.

And one of the reasons that I’m so excited for Yana to share her stories, is that in her case, the opposite is true. As Yana learned more about her health, she became increasingly proactive in making sure she had a team of professionals who were well aligned with her needs and interested in taking the time to talk with her about her birth preferences, so that they could all figure out how to work together toward that common goal. I mean she even talked to a back-up OB to get them on board and lined up in case her primary OB wasn’t available!

This self-advocacy was possible because Yana had spent a lot of time connecting with her body’s health needs and getting her sugar levels under control, and a whole lot of other time learning about the birthing process and understanding that her voice carried weight. Or as Yana says, “it’s really easy to advocate after you’ve done your homework.”

Today, Yana continues to be a passionate birth advocate. She’s a doula, a doula trainer, a lactation consultant, and she’s also in the process of getting her masters in social work with a focus on integrated health, with the hope of working in perinatal mental health after graduation.

In the context of our Nutrition and Nourishment series, I hope that Yana’s stories inspire you to connect with your body, whether it’s by learning more about your sugar levels early in pregnancy or figuring out if your diet may be decreasing or increasing your chances of being Group B Strep positive. And if you happen to develop Gestational Diabetes, that’s even more of a reason to dive deep into your learning and preparation. Truly, Yana’s advocacy mindset is applicable to everyone!

You’re listening to Birthful. Here to inform your intuition.

Adriana: Welcome, Yana! It is such a delight to have you here on this show today.

Yana Katzap-Nackman: Thank you. It’s exciting to be here.

Adriana: And before we get into your story, why don’t you tell us a little bit about yourself?

Yana: Okay. So I am a Russian Israeli Jew from New York who lives in L.A.— there’s a snap at the end of that! I am married to Robert and have two kids, Benjamin and Mikayla. I am also a certified birth and postpartum doula and a DONA-approved postpartum doula trainer and I’ve got one more thing— I’m an International Board Certified Lactation Consultant in private practice.

Adriana: All the things! So much fun. How long have you been involved in birth work?

Yana: Since 2003— my first baby was born in 2002. And something came over me that said, “I’m gonna be a doula,” and I didn’t know what it was. So then I looked it up and it turns out that that’s what I was supposed to be.

Adriana: And I kind of know that feeling, although it didn’t hit me over the head so strongly— there’s a spectrum there— but I was like, “Oh, yeah. Yeah.” The more I did it, the more I realized, “Wait a second. I really enjoy… yeah, I really like this.” But the listeners are here for the birth story. So, yourself… go ahead.

Yana: The reason why I thought this would be important is because I meet a lot of women in their twenties and thirties, and they’re fearful, they’re scared of giving birth, because they have diabetes. And they always, y’know, they hear about me from someone and they wanna know about my birth story. And I figured, y’know, if I can share that with more people, then maybe there’ll be less fear as they go into the birthing experience.

Adriana: Absolutely. And just to clarify, it wasn’t gestational diabetes. You had diabetes from before, and then became pregnant.

Yana: Yeah, so I’ve had diabetes since I was five. And at the time that I was pregnant, I’d had it for 25 years and yeah, I’ve earned my stripes. And there are three types of diabetes: there’s Type 1, which is insulin-dependent; Type 2 that you can handle with diet and exercise or pills; and there’s gestational diabetes, that is pregnancy induced. And I have Type 1.

Adriana: What does that mean, just for us to know— what does that mean with your day-to-day? It involves shots?

Yana: So I have an insulin pump, which I got on right before I was pregnant, because I wanted to get a better handle on my diabetes. And in terms of getting pregnant, there’s a lot of pre-planning that has to happen in order for us to have a sustainable pregnancy and a healthy baby at the end of the experience.

Adriana: So what are some of those considerations that you had to figure out?

Yana: So first I had to get my sugars under control. So, I don’t even remember how I handled diabetes before my insulin pump, ’cause I took shots and my numbers were all over the place and the control was hard! And y’know, I hear the statement that some doctors say, “Oh, she’s a non-compliant diabetic,” and it’s really insulting because there’s so much that you need to do on a day-to-day basis to handle your life.

You need to test your blood. You need to take your medicine. You need to drink your juice, if you’re low. Give yourself more medicine, if your sugar’s high. There’s a lot that’s going on in terms of just living on a daily basis— and then you put into it, you throw into it any hormonal changes, and that puts you your numbers out of whack. So, it’s a lot of work!

Adriana: Yeah, it sounds like your life kind of starts revolving around your sugar levels.

Yana: And that’s the biggest thing for me. Especially having a daughter with Type 1, and one day she’s gonna have babies. I definitely wanna make sure that people know that diabetes is something that we have, but it’s not who we are. And so yes, we do have to take care of it and we do have to handle it, but it’s not gonna stop us from doing anything we want, including having healthy vaginal deliveries.

Adriana: And so was that— the figuring out if a pump was the next step for you— the first step into getting you towards pregnancy?

Yana: Yeah. Well… that’s what I thought.

Adriana: Okay…

Yana: So, first, I wanna say that I did not have insurance until I met my husband, and he was saying, “What are you doing walking around without insurance?” And I said, “Well…” Did he wanna take me because I have a preexisting condition? So I’m just gonna be here with my shots and my tester and go with the flow.

And so with my husband’s help, we got a good insurance and we were able to see an endocrinologist and she said, “Oh yeah, diabetes is wonderful with a pump. You can handle life a lot better. Well, maybe this is not wonderful, but you can handle life better with an insulin pump. And you haven’t been seen in a while. So why don’t you go across the street and have him check your eyes? We’ll do a little assessment of where you are with your diabetes before we go into pregnancy.” So I went across the street and it turns out that I had retinopathy, which is a complication of diabetes.

Now, mind you, I’m only 30 years old at the time. So that’s a big deal! So retinopathy is when you have too much blood glucose and it can damage the vessels and the retina and it can cause blindness. And so we started with eye laser therapy, and they told me that I have to wait a year before I can start conception to make sure that my levels are in check and the retinopathy didn’t come back. So we did that.

I got on the insulin pump— which was hard initially to figure everything out, ’cause it’s like a 24/7 computer that’s on you.

Adriana: Giving you all this information.

Yana: Giving me all this information. But it’s also, y’know, it’s beeping and it’s sending me alerts and I have to stop everything I’m doing.

And at the time I was in the entertainment industry and I felt like, “Oh my G-d, I’m gonna sit in a meeting and everybody’s gonna think that something’s wrong with me.” It’s basically bringing the awareness to the disease in daily life. So I had to adjust to that.

Adriana: And did you find that, y’know, at the beginning, this constant awareness was maybe overwhelming, but as you did it in the end to help you understand more, what was going on with your sugars and then make it so that y’know, you and your pump could live happily or have a more agreeable relationship because you were more on top of what… how to control your sugars?

Yana: Oh, yes, this, this was a life-changing device! The more I got into it, the more my sugars were under control. And, I got to a seven A1C number, which is great. You need to be under seven. And A1C is basically a measurement of your blood glucose levels over three months. And you want to be under seven to conceive, so we were really excited! But then my eye doctor recommended I switch doctors, ’cause I asked him to, switch doctors to Dr. Anne Peters in Beverly Hills. And she and her team were unbelievable. They got me from an A1C of seven to 5.5— which, I don’t remember the last time I was 5.5!— which was perfect for helping conceive and helping maintain and control diabetes while pregnant.

Adriana: So you were asked to wait a year before getting your sugar levels under control, have a really beautiful A1C number, and then make sure your eyes were doing great? And you had a new doctor to supervise all this. Then what happened?

Yana: So then she hooked me up with a nurse educator, which made a big difference in my approach to diabetes, and a nutritionist. And even the office manager was all like, “You’ve got this!” in my corner. It was great. Like I had a full team supporting me. I had an OB, and I felt like everything was going great.

And then at some point… And y’know, when you’re pregnant, you kind of think to yourself, “Oh my G-d, I’m gonna get that nod from, I don’t know, a sign from somewhere that I’m in labor or my water will break and I’ll say, ‘Hey, babe, it’s time to go,'” and all of that stuff.

But because I have Type 1— and I wasn’t aware of this— it’s an immediate induction and my OB didn’t share that with me. My endocrinologist did. She’s like, “Okay, so when you go in to get induced, we’ll change your insulin levels, so you won’t have to use a lot of insulin while in labor.” And I was like, “What? Wait a minute.” I’m just enjoying my pregnancy here. And you’re telling me I’m gonna get induced? So that was a big surprise.

Adriana: When did you find out about this?

Yana: Probably in the beginning of the third trimester. And so I went and talked to my doctor (my OB) and he was like, “Yeah, y’know, babies with women with Type 1 tend to be bigger. We want to avoid a cesarean. We wanna make sure your baby is healthy and thriving,” so he suggested induction. And I didn’t know to ask for anything; I wasn’t as savvy as I am today. And so I said, “Okay,” but I was really upset about it. And then he wanted to make sure that the lungs were mature, so we did an amniocentesis and that was really uncomfortable. I did not appreciate it. I did not care for how it felt.

Adriana: And this was around 30-something…?

Yana: And this was around 38 weeks. No, this was 38 weeks. And he says, “Okay, we can get you induced this afternoon. Everything looks great.” I said, “Wait a minute. I’m not ready for this. I need to wait until my parents come from New York.” So it took them a day to fly out, y’know, the amniocentesis was on the 5th of November and they flew in on the 6th and we took our time. We hung out as a family. And then, on the 7th, they wanted me to get to the hospital at 4:00 a.m. And I said, “I’ll get there at like 4:30.” Even when I showed up at 4:30, nobody was ready for me.

Adriana: Hospital time is something special, isn’t it? I call it “hospital time” ’cause it’s like “hurry up and wait.”

Yana: Yeah, exactly. Exactly. So we got there, we waited. We got to 6:00 a.m. and that’s when they started the Pitocin. Now… I wish I knew so many things that I know now, because instead of being up and moving and doing my thing, I was in the bed, getting my IV started. Oh, and I was also GBS positive, so they gave me antibiotics as well. I have to say that the team was amazing. Everybody was really nice. My parents were there, my husband was there. I was two centimeters dilated at 38 weeks, which was great. So I was, y’know… my cervix was ready to get induced.

Adriana: Is that why they didn’t start with prostaglandins and then went to Pitocin? I was gonna ask you! I was like, “Huh, they went straight to Pitocin at 38,” but that makes sense.

Yana: Yeah, two centimeters dilated, 80% effaced.

Adriana: Wow.

Yana: I know! I had to get the show on the road. So at some point— I think around seven o’clock in the morning— the doctor came in and he says I’m doing great. And he proceeded to rupture my membranes, which, y’know, I wish I knew better. And I just, y’know, let him rupture my membranes and everything was going great. And I remember the nurse saying, “You don’t have to be a hero. You can just get the epidural.” And I was thinking to myself, “I’m not suffering. Why do I need an epidural?” In my head, I was saying that. And then I was saying to her, “Can I just wait until I’m five centimeters dilated?” ’cause I read it somewhere. I just read it— I didn’t know the background of anything. But I got attached to the number five. And she said, “Sure.” So I guess at some point I got to five centimeters, and I got the epidural.

I think it was around one o’clock or something like that. And then, y’know, the thing that comes to mind with this labor: I’m in bed, I didn’t care for the epidural because I felt like I was stuck to the bed. It wasn’t like I was suffering before. So feeling that I wasn’t able to move really affected me. But I had music on and well, if you know me, you know that music is everything to me and musicians are my best friends. And of course this nurse was a singer in a band on her off time from the hospital. So she started singing. And so these are beautiful moments in my labor where I had a great soundtrack and she added to it and we had fun.

And then at 4:30 p.m., I felt the urge to push and we started pushing and I remember pushing for a long time. And I remember at some point we used the squat bar and she said that I had great control of my legs, which tells me… And I think at some point she said that the epidural wore off, which helped me with the pushing. But I also remember having the oxygen mask on— which tells me that, y’know, like, in hindsight, right?— probably there were decels. And the doctor pushed on my fundus. And at some point I remember him looking at the nurse and going, “I don’t know,” like I think they kind of were about to give up on me. And at that moment in time, I just felt this whoosh of energy like “You are not gonna take me to the OR! This is not what I do.” And with this oomph, this force, I pushed my baby. I did get an episiotomy, which was really hard to deal with postpartum. But at the time, I remember the doctor looking at my husband and saying, “I’m sorry, we’re gonna have to cut her.” And I wish he was talking to me.

Adriana: And it’s those little things that are so hugely important, y’know! That… Does that feel to you like a microaggression?

Yana: It feels to me, in my body, it feels postpartum… it felt… actually, y’know what, I’ll go back a little bit. I thought that my birth was unbelievable and that my doctor was amazing. I sent him the biggest basket ever to thank him for his service. And only after I took the doula training, I had so many “Aha!” moments realizing, “Wait a minute? What just happened?”

Let me go back there, let me. Because I did have some anger and I didn’t know why. I also felt very triumphant because I pushed my baby out. I had a vaginal delivery and that’s, y’know, someone with Type 1 Diabetes. You don’t— at the time, at least— you didn’t hear much about that. Everybody had a cesarean for one reason or another.

And I had a healthy pregnancy. I felt the best at my pregnancy state. And here I am, I can tell a story about a vaginal delivery. But it’s only after that I realized, “Wait a minute…” I have a lot to say about my first birth and I want to say it to people, or I want to thank the doctor, but I also want ’em to know that this is how I felt, and I didn’t say anything to him at the time ’cause I did not have that awareness.

But after I became a doula, of course, I went to see him and I said to him, “Hey, I became a doula.” And he says, “Why would you do that?”

Adriana: “Why would you do that?”

Yana: And I was like, “Well, there goes my resource.” I was like, “Well, there goes my resource. There goes my networking.” Yeah, so that happened.

Adriana: When was your son born? What time?

Yana: My son was born at 6:40 p.m. on November 7th, 2002.

Adriana: So all in all, I mean, you said you felt triumphant because you had a vaginal birth and with Type 1 Diabetes. But not only that, it was even for any induction standards, the fact that at 38 weeks you went in and the process started at 6:00 a.m.. And by almost less than—

Yana: 12 hours, yeah.

Adriana: Oh, just over 12 hours you had your son, like— that is a remarkable induction story!

Yana: Right?

Adriana: To us, yeah.

Yana: Every day I say to myself, “Oh my G-d, I’m so lucky.” I’m so… I’m thankful. There’s so much gratitude around my body. Y’know, I remember after my wedding, a friend came over, and we told him that I had Type 1 Diabetes and he goes, “Oh, damaged goods, huh.” And I was like, “Huh?!” I never felt like that about me, about my body— damaged goods, what?! Y’know? And this is just another verification that just because I have it, doesn’t mean that my body’s not great.

Adriana: Right. And I’d like to even flip it around and say that— I don’t wanna say you should be more proud, because that’s for you to feel however you feel—

Yana: I am.

Adriana: —but, and I’m so glad you are proud, but it’s more like in spite of this, you still do that. And more like it’s not “damaged goods.” It’s how powerful are you, that you figured out how to triumph with the condition that as you said at the beginning, doesn’t define you.

Yana: Right. Exactly. And thank you for saying that. I appreciate it. My mother always said to me, “You’re like everybody else,” y’know, don’t worry about it. “You’re like everybody else, you can do anything.” And y’know, part of that allows me to be in denial about the whole thing, but part of it allows me to say, “Yeah, I’m like everybody else. I got this. Nothing’s gonna stop me.”

Adriana: And then you surprise everybody and do the things!

Yana: Exactly. Exactly.

Adriana: Before we move on, tell me a little bit also how that postpartum happened. I mean, you said you had these feelings of some anger, that you didn’t know where it was coming from. And you did have obviously a lot of triumphant feelings of having accomplished this, but how was the experience and how was discovering this new baby of yours?

Yana: My new baby was unbelievably amazing. I remember getting him to hold him skin-to-skin, to tell you the truth, I was shocked! I was like, “Oh my G-d, what just happened?” So, there was no crying involved; I was just shocked. And then they took him away to check on him. He did have jaundice later on. He developed jaundice and, of course, sleepy baby and breastfeeding and Type 1 Diabetes all together…

It could be challenging. There could be a delay of the milk coming in, with people with Type 1. Uh, so I probably had some of that, and the fact that they used supplementation for his jaundice. We came home with lots of formula and not knowing what to do. I went to a… I guess a boutique over here on the west side to get some help and I did not get the help that I needed with breastfeeding. So I ended up pumping for three months. And then after that, I got onto this medication that was not compatible with breastfeeding— at least that’s what they told me. I wish I would’ve known to check! And so I stopped pumping and that was the end of my breastfeeding experience with him. But I… after I became a doula, there’s so much more that I knew that really prepared me for my birth with my daughter.

Adriana: How big was he? Because yeah, there’s that correlation between Type 1 or, or any, diabetes and bigger babies.

Yana: Yes, so Benjamin was born at eight pounds, three ounces. And he could have been bigger if we waited till 40 weeks. But, y’know, women push babies out that are bigger!

Adriana: Yeah. Yeah. Yeah, and did you find… did he have, aside from the jaundice making him sleep and being more sleepy, did your milk delay? Like, did he have any issues with latching, or was it more just the circumstances of the jaundice?

Yana: So being, y’know, a lactation consultant, I can kinda look back and notice all the interventions that caused a drop in milk supply, including the diabetes, including the supplementation, not knowing how often to pump, and not getting the right support.

I went to the doctor and told them that I have issues with breastfeeding and he gave me formula, a can of formula. And he said, y’know, “You tried.” So the support system around me, the system, I feel like the system has failed me with that situation. For many, many, months and years, I felt like I failed at this. And the more I’m doing this work, the more I’m realizing that it could have been different if the right support was there for me.

Adriana: Definitely!

Yana: Definitely.

So with my second, well, the preparation for the second birth— y’know, to say with second babies, everything is a little bit laid back. So were my sugar levels. I was going to start paying attention more to my sugar levels as a prep for trying to conceive again. And then, I had this dream and in my dream, I gave birth to this baby girl and I changed her diaper.

And y’know, her labia looked like, y’know, two pieces of clementine. And I was thinking to myself, “Oh my G-d, I’m having a girl.” And I woke up and I was looking for my girl. I was looking for my baby. Where’s my baby?

And then I found out, like, maybe a month later I found out I’m pregnant and I was pregnant with an A1C of 7.8— which is a problem. But I just knew she’s okay. The dream was so vivid. The dream was so clear. She was communicating with me. I knew she was coming and I knew it’s a girl. And then I went to see the doctor. And of course the doctor was, y’know, a bit scared for me because the numbers were not what she expected.

She had to tell me that there could be all kinds of developmental issues because I did not have the A1C under control and I remember just looking at her and telling her, “I understand you have to tell me about the anomalies. I get it, but my baby’s okay. She’s okay. And thank you for telling me.” And I remember just touching her arm and kind of comforting her, to let her know that my baby’s okay.

Now, y’know, it could be silly of me. It could have been… y’know, all kinds of things could have happened, but sometimes your intuition just takes over and you just know just things that you can’t explain. So anyways, I was pregnant with her. I felt the best I’ve ever did. Y’know, being pregnant, I think, is the best state for me. I wish I could be pregnant all day long! The relaxin is just flowing through me and my joints feel better. Everything just feels good. Oh, big part of the story— I went to the doctor and told him that I was pregnant, y’know, we checked to see that my pregnancy is okay.

And then I really wanted to talk to him about my birth preferences, because I was like, y’know, “I wanna talk to you about this before we go into labor. There’s some things I wanna do differently this time.” And he’s like, in my head I was thinking to myself, “I’m showing what birth’s supposed to look like. I’m going to teach him.”

Adriana: Right. And you were a doula by then, right?

Yana: And I was a doula, yeah! So this doula is gonna show him what it’s supposed to look like. And then when I realized he didn’t have time to talk to me about my birth preferences and this was 20 weeks, and he was talking to my husband and I was like, “Hmm. Something’s missing for me here.” I think my direction and his direction are two different directions. And, at the time I was very active in the birthing community and I met this doctor who just wrote a book called Fearless Pregnancy. And I looked at him and I was like, “Yeah, I think I like you. I think I want you to be my doctor.” So, I sent my original doctor a letter saying, “It’s not you it’s me. I gotta go.” And then I went to— you probably heard of him, Dr. Fishbein— and I said to him, at 20 weeks, “Will you take me?” And he said, “It will be an honor to take you.”

Adriana: And I do have an episode with him, so I’ll link it in the show notes.

Yana: Yeah, he’s great. I said, can I come and talk to you about my birth preferences? And I walked into his office and he sat down and took notes and I was like, “Wow, that’s amazing.” So I changed to him, I decided to have a doula this time around. And I met this woman who happened to be the original director for DONA International. I was the SPAR [State/Provincial/Area Representative] at the time and I met her and I thought, “I would like for her to be my doula,” and she lived in Washington. I called her up. I told her I’m pregnant. She got all excited for me. I said, “Would you be my doula?” And she said, “Yes.” And I felt like it was a safer choice than… all, like my whole birthing community, wanted to be my doula, which I was very thankful for!

But I felt like that way, I will not hurt anyone’s feelings if I import someone in. But I really felt like I got the right doula for me, which is important. I also did a circle, to talk about, y’know, birthing experience, your past experience.

And, I sat in that circle and— I forgot her name, but she’s an amazing leader in the community— and she said to me, y’know, “What do you need to say?” And I started talking about the induction and I started crying and saying, “I need help. I don’t wanna have an induction again.” And she says to me, “Would you like a hug?”

And I got so upset because I wanted them to tell me how to fix it. But instead they just gave me the space to talk, which sometimes we don’t appreciate it, in the moment. But in hindsight it was the best thing that happened to me in prep, so I released some of my fears.

And then my doctor’s like, “Okay, we gotta put a date on the calendar for an induction.” And I was like “Ughhh.” So, I came to be checked, and he says, “You need to do an amniocentesis.” And I said, “No!” He said, “Why not?” I said, “‘Cause it hurt the last time. I didn’t care for it and I don’t wanna do it.” And he says, “Well, if you don’t wanna do it, we have to postpone the induction to 39 weeks.” And I said, “Wait a minute. I can do that? My baby won’t die if I don’t induce at 38 weeks? I will still be okay?” It was like an “Aha!” moment. And so we pushed the induction to 39 weeks.

Of course while all of that is happening, I am taking all kinds of things to make sure that my GBS status is negative— which it was. I made sure that I started taking evening primrose oil at 35 weeks. I went to see an acupuncturist. I read all the books. I had a friend do reflexology for me the night before. And my other friend made an induction cake for me, which means like, an “intent for me to go into labor on my own” type of thing.

Adriana: But it wasn’t that the cake had anything in it to help?

Yana: No, no, I was… no, it was like, it was just a… y’know, like an intention. So, y’know, everybody rallied and did things for me. And my doula was great for emotional support. Oh, and so I was also a midwife assistant, and I’ve seen their little tricks and every once in a while they recommended castor oil, some cocktail with castor oil.

So I decided I got nothing to lose. Let me take a teaspoon of castor oil. Let me have sex with my husband the night before, just to, y’know, kind of check all the boxes of “Done all I could.” And I forgot to mention that that morning, I also got my membranes sweeped.

So, after doing all of that the next morning, I think it was 4:00 a.m., I felt something… I was like, “Mm, I don’t know, it could be something.” And that’s the next morning that I’m supposed to get induced as well, so that’s 39 weeks.

Adriana: So you were supposed to wake up anyway and go to the hospital to get induced and you’re starting to feel something?

Yana: Mhm.

Adriana: Mhm!

Yana: And, so then, I’m thinking to myself, “I think I’m in labor.” So I call up L&D and I take myself off of the list for induction. That was the best call I made, ever! At eight o’clock I hear a pop, like a big pop and then I’m all wet and it felt like a Champagne cork coming out! Y’know, like a nice pop and I’m like, “Oh my G-d, I think my water just broke.”

And that’s the thing I always wanted to experience, so I got really excited! Told my husband, told him to tell his parents to come, and we hung out here. The doula was here. I was here. Turns out my doctor was not available, but I forgot to mention that when I transitioned to him, I asked another doctor from the practice across the way to be his backup doula— his backup doctor— for me.

I know, right? So it turns out that she… I heard about her and she took a doula workshop as part of her training. And I felt like she would get me, so she was lined up to back him up for this.

I have to tell you that I enjoyed being in labor. I felt like this is all me. This is all my body. This is… I got this. I was on the birth ball. I was swaying. I was listening to music; Sheryl Crow was on, “If it makes you happy, it can’t be that bad.” Oh my G-d. I loved every minute of it. Then I found myself seeing little, like, visions— my grandmothers as they were, birthing.

And I remember thinking, y’know, “There are 300,000 women with me right now,” and I was doing my thing and I was in the shower and my doula was just hanging around, which I so appreciated. Like she was in the space, but not in my flow. And it made all the difference. Like I felt safe to be who I am in the space, which, thank you, Hannah! And then I found myself in the shower and just bouncing, and it reminded me of a client. And then I found myself on the bed doing something and it reminded me of another client. And as I was on the ball, I… all my clients came to visit me at the birth, in my head. And then I was on my bed— and I’ll never forget this— and I heard myself moaning and I was saying to myself, like smiling and saying to myself, “Ah, I must be in transition.” Because I’m moaning and it was the best experience, like I was watching myself in the flow of labor and it was just flowing.

Adriana: You were so deep into Laborland!

Yana: I was, I was. I wish I could be there all day long! And then my doula said to me, “Why don’t you go into shower?” So I did. And at some point she probably heard me go, y’know, that sound. And she says, “Yana, you’re pushing?” And I said, “Do me a favor, call Luana.” Luana was a midwife I was assisting at the time.

And she went to do some work with Doctors without Borders— I didn’t even know if she was back. But she called her and apparently Luana just walked through the door. No cell phones at the time that, y’know, that were that handy, I guess. She walked through the door and picked up the phone and the doula was telling her what’s going on.

So Luana came over. She checks me and she’s like, “We gotta go to the hospital. Baby’s right there.” And my husband went to take my in-laws to see where my son goes for daycare so they could pick him up later. So nobody’s home, but me and the doula, and now the midwife who happens to be my friend. And I said to her, “Can’t we just stay here?” And she says, “No, it’s a planned hospital birth. We gotta go.”

A side note: because I have Type 1 Diabetes, no home birth midwife wanted to touch me, I’m considered high risk. So we go outside and Luana has to take some stuff out of her car. And the doula gets to sit in the front seat. And now I’m in the back seat with Luana and I’m between the front seats and the back seats on my hands and knees. And, my husband just comes back home and he’s like, “Hey, where are you going?”

Adriana: “Just out for coffee, want something?”

Yana: The midwife says, “Just grab the suitcase, see us at the hospital.” So, y’know, I don’t know what happens next. I’m in between the seats. My head is in the midwife’s lap. And I’m, y’know, I’m trying not to push, but I’m pushing… trying not to push, but I’m pushing.

And I loved it. I remember being, at some point I wanted to just commemorate the experience and I said, “Where are we? And what time is it?” And they said, “It’s 12:25. And we are on Robertson Boulevard,” which is, I don’t know, five minutes from the hospital where we were? So we get to the hospital, and they bring me a wheelchair and I’m like, “No, I can’t sit. Get me a stretcher!” So they run and get a stretcher. I get on top of the stretcher. I moon the whole parking lot, but I don’t care. We go upstairs and the doctor waits down the hall. And my husband waits down the hall. I don’t know how he got there. And, we run in to have this baby. I remember just screaming at the nurses, “I don’t need IV and I’m GBS negative and don’t give me this.” And, y’know, I was just, I don’t know, I was being like a… like an army captain, y’know, giving orders to everybody. And the next thing I know, I’m feeling the ring of fire. I’m like, “Ah, what is that?” And they said, “Oh, the baby’s crowning.”

And I said, “Ah, the ring of fire!” Like, everything was suddenly so clear and easy. And I pushed her out. She had a cord around her neck, so they, y’know, the doc moved the cord and apparently it was a short cord. So she cut it and she put Mikayla on my belly and Mikayla did crawl up to the breast and she suckled on the breast.

And y’know, that was the end of, of the birth story. A second degree tear, no episiotomy. The birth was four hours and 37 minutes. She was born at 12:37. Her weight was seven pounds, eight ounces at 39 weeks, and she was as healthy as can be. I forgot to mention that while I was pregnant, I was taking a lactation educator’s class, just so I’ll know what I’m doing when I breastfeed the second baby. So breastfeeding was much easier this time around, while we were at the hospital. I don’t know if it was— must have been that morning— we went to the postpartum room and I don’t remember if it was like that afternoon or maybe the morning after, but the nurse came in to check Mikayla’s blood sugar levels. And the machine said 40, she was very nervous. She wanted to take the baby and supplement the baby.

And I looked at my pink baby that is not jittery, that’s doing just fine. That just breastfed. And I said, “I understand that you’re worried, I understand this is what you need to do. I’m not ready to give you my baby. Can you please call my doctor?” And I switched pediatricians. And, this pediatrician was also a lactation consultant so his priority is lactation. And he asked if the next test will be sent to the lab and the test at the lab was 60, not 40, and she and I did not need to be separated. She was not jaundiced. And we came home 18 hours later.

Adriana: I have all the feels for this whole story! I mean, wow, Yana! And for people who are listening and thinking, what’s this 40, what’s this 60, go listen to that episode on sugar levels— newborn sugar levels— and breastfeeding, and one of the things that we discussed is how the bedside tests can be quicker, but they can also be way more inaccurate. And what you— if you wanna get as close to the actual numbers, as you can— to have a blood test then, which takes longer, but is more accurate. And good for you for advocating on not only that part of it, but all of it!

Yana: Y’know, it’s really easy to advocate after you’ve done your homework. I recommend that every person that thinks they’re gonna get pregnant at some point will go and take a doula workshop because this workshop changed my life. It really did. So that’s my two cents for that.

Adriana: Yeah. Well, and some people might be listening and thinking that’s overkill. And I wanna say that it’s not, because I actually wish that every nurse/doctor/midwife would first do a doula training.

Yana: That’s right!

Adriana: And here’s why: on my end, it’s because we have… I always say we have the luxury of not doing anything medical, which means that our resources, suggestions, and knowledge are pretty much in line with what the birthing person has, because the birthing person is not gonna go and learn about, y’know, how to do a forceps delivery. That’s not their realm. So in terms of tools and knowledge, we are all in with the birthing person in creative ways and intuitive ways that have nothing to do with the medical, which empower them more.

Yana: ‘Cause they can do something. They can do something. It’s all them. It’s not somebody managing them. It’s them fighting, their voice. It’s them fighting, their power, and trusting that no matter what’s going on with their body, if they just listen to their body, they can do the best that they can with the circumstances that they were dealt.

Adriana: And coming from the place of their own process, knowing their body and being in tune with their baby, that— in that sense, they might not be medical experts, but they’re the experts of their experience— and honoring that we honor that and let them lead us. But at the same time, in order to lead, they gotta know where they’re going. That brings it full circle with you, like, y’know, take a doula training or take some really awesome childbirth education classes or watch tons of like all of the things. Watch lots of good videos on birth, physiological birth.

Yana: Mhm, yes. Yes.

Adriana: What was the postpartum with your daughter like?

Yana: Well it was funny, because I don’t know if I ever shared with you, but we had TLC over here doing a show about us: Bringing Home Baby. So we had a camera crew for the next 48 hours!

Adriana: Oh my G-d. I had no idea. Hold up, hold up. Okay, so while you were pregnant, you reached out to them, they reached out to you, like, how did this happen?

Yana: So I, every once in a while, I get an email from someone saying, “Hey, we’re looking for pregnant people. Do y’know anybody? Are you working with anyone right now?” And I usually, y’know, share their information with my clients saying, “Hey, this is an opportunity. Do you want it?” This time, they sent me an email and I emailed them back that, “No, I don’t have any clients right now because I’m also pregnant. And so I’m not taking anyone on, my apologies.” And they said, “Oh, You’re pregnant? How about you?” And I said, “Well, let me talk to my husband. But the only thing that I am willing to do is, because I know you can spin this, so I wanna make sure that we talk about doulas.” So that was my deal with them, that if I’m doing this, that we can talk about doula care and what it means and all of that good stuff.

And at the time, it was 2005, y’know, doulas were not as known as they are today. So we did it and I had a doula and we talked about doulas and they filmed us prenatally and they filmed us right after, like, we had left the hospital, with a camera guy in the front seat and Mikayla and I in the back seat.

Adriana: Oh, that’s hilarious. How long did they stay with you?

Yana: 48 hours.

So it was crazy. Thank G-d. Everything worked out fine. And it, y’know, we showed on TV that it was like the best pregnancy and delivery. And we were home 18 hours later and breastfeeding was going okay. Like, her first poop was on TV ’cause she, y’know, we were waiting for that poop. And she had a massive one and everybody got all excited and—

Adriana: —celebrated her first poop.

Yana: Yeah. And we got my doula on TV and I felt like I serviced the doula community well.

Adriana: Hmm. So in terms of you as a new mom, though, how were you feeling about your choice of having a camera crew with you during those first 48 hours?

Yana: Y’know, they were a pain… but I also set some boundaries. They couldn’t get into the bedroom unless I said it’s okay. But I definitely felt like I wish they wouldn’t have been there. But it’s a good— in hindsight, you look back and you’re like, “Hey, I got her a video,” y’know, she has something to look at.

Adriana: It’s the next best thing next to the birth video, right?

Yana: Exactly. Exactly. So it was okay. But thank G-d I didn’t have to, y’know, recover from an episiotomy. I was able to walk fine. I was able to breastfeed, which was something that I talked about on the video as well, that, y’know, I was worried that it was not gonna happen for me. And I breastfed Mikayla for three and a half years! So obviously there was nothing wrong with me.

Adriana: Right! And it was more, with the circumstances, you had the support and the knowledge, and you didn’t have the added circumstances of jaundice and the induction and extra fluids, then it all flowed.

Yana: Exactly. No pun intended.

Adriana: See what I did there?

Yana: I did!

Adriana: I didn’t, which is the funniest thing.

Yana: Go with the flow.

Adriana: It’s all about flowing. So you had mentioned, during the first birth, that there were things that you wished you had done differently. Did you find that you’ve come to peace with those feelings?

Yana: I find that I’ve come to peace with those feelings at times, and other times— like when people say that, y’know, they have Type 1 diabetes and they’re worried and they’re nervous and maybe they decide not to even have kids because they have Type 1— it gets to me. So… but in terms of personal feelings, I love my kids.

I think I have a great family. They’re both, y’know, awesome people. And, the only thing I would’ve done differently is that I wish I would’ve been more educated about birth. the first time around.

I feel so excited every time I see someone and it’s the first baby and they read all the books and they hire me to be their doula and they’re doing everything. They can kind of, like, prep for a wedding, right? You do everything you can to have the best wedding. Well, some people do the same thing for birth, and I wish I knew that the first time around.

Adriana: Mhm. Yeah. We know what we know when we know it. And I feel I didn’t have a doula for my child either. And it is one of our regrets and, y’know, knowing that it would’ve been a lot different if we had… but at the same time, I don’t know necessarily that I would’ve gone on this path of being a doula if I had a doula then.

Yana: Mhm!

Adriana: You never know!

Yana: Well, that’s the gift that my son gave me. I feel he gave me the gift of becoming a doula, and she gave me the gift of becoming a lactation consultant.

Adriana: Is there anything that you wanted to make sure the listeners knew about before we close?

Yana: Yes. I wanna make sure that people with Type 1 diabetes, go and check their eyes prior to conception, and get on an insulin pump and get on a continuous glucose monitoring system, because that will make a difference in their way of being and controlling their diabetes. And when they’re in labor— I forgot to mention— I took on my pump seriously, and I took it to labor with me. I negotiated having it on me at all times. So take your diabetes and don’t let anyone take over the care of it, just you and the endocrinologist.

Adriana: Thank you so incredibly, so, so much for sharing your great stories with us today.

Yana: Thank you. Thank you.

That was mom, lactation consultant, doula and postpartum doula-trainer extraordinaire Yana Katzap-Nackman. You can connect with Yana at headfirstdoulas.net

And you can connect with us on Instagram @birthfulpodcast

In fact –y’know the drill– if you are not driving, it would be so lovely if you would take a screenshot of this episode right now and post it to Instagram sharing your biggest takeaway from this episode. Make sure to tag @BirthfulPodcast 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 much for listening to and sharing 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.

CITATION: 

Lozada, Adriana, host. “[Birth Story] How She Advocated for Her Vaginal Births Despite Having Diabetes.” Birthful, Birthful. July 6, 2022. Birthful.com.


 

Yana and her family— from left to right, her husband Robert, daughter McKayla, son Benjamin, and Yana herself.

Image description: Yana and her family— from left to right, her husband Robert, daughter Mikayla, son Benjamin, and Yana herself.

About Yana Katzap-Nackman

Yana Katzap-Nackman was 5 years old when she was diagnosed with Type 1 diabetes (T1D). She always strived to live a normal life and vowed that diabetes would not stop her.

Yana is a big advocate for people with T1D. She is passionate about reminding people that diabetes does not have to take over their pregnancy and cloud their delivery. Working together with the right OB and endocrinologist can make a big difference in the birth outcome and overall experience for people with T1D.

Yana is a certified birth and postpartum doula, a postpartum doula trainer through DONA International, and International Board Certified Lactation Consultant (IBCLC) in private practice. She is currently pursuing a Master of Social Work (MSW) degree with a focus on integrated health, in hopes of working in perinatal mental health after graduation (2023).

Yana contributed her first birth story to her doctor’s book “Conquering Diabetes: A Cutting Edge, Comprehensive Program for Prevention and Treatment” by Anne Peters, M.D. (find it on pages 285-87)!

You can learn more about Yana and contact her via her website headfirstdoulas.net

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