Long before she was ready to start a family, Mary Farah knew exactly how she wanted her pregnancy and delivery to go.
A devotee of natural remedies and holistic medicine, she envisioned a home birth, with her husband and a midwife and doula by her side.
But Farah hadn’t anticipated expecting her first child during a pandemic. And being she has type 1 diabetes, her pregnancy already was considered high risk.
Still, she found a midwife willing to work with her, as long as they partnered with a doctor. During an ultrasound, she was diagnosed with a life-threatening umbilical cord complication known as vasa previa – when fetal blood vessels cross the entrance to the birth canal, potentially resulting in a hemorrhage and stillbirth – that would require prolonged hospitalization and premature cesarean delivery.
The news triggered “depression and anxiety,” Farah says, and drove her to seek a second opinion.
The 32-year-old first-time mom ended up in the care of Christina Han, MD, director of Maternal Fetal Medicine at UCLA Health.
“I loved everything about Dr. Han and UCLA immediately,” Farah says. “My husband and I felt so much more comfortable even prior to finding out about the possible vasa previa.”
Dr. Han mapped the umbilical cord with advanced ultrasound technologies, and downgraded Farah’s diagnosis. She determined Farah wouldn’t have to be hospitalized for any extended time and that with close surveillance, vaginal delivery would be possible. Dr. Han also connected with Farah’s previous medical team to ensure that her transfer of care was the right decision for everyone.
Farah and her husband, Michael, exhaled. They were still starting a family during a once-in-a-century pandemic, but they finally felt they could enjoy the excitement of expecting.
Women with diabetes of any type are at greater risk of complications from COVID-19, and type 1 diabetes presents inherent risks to the mother and fetus, too, Dr. Han says.
“There could be an increased risk of miscarriage, congenital anomalies, growth problems, placental problems, amniotic fluid issues, preterm delivery, stillbirth and the potential need for the baby to end up in the neonatal ICU and for the baby to have glucose issues after delivery,” Dr. Han says. “The pregnancy itself can also make the management of the type 1 diabetes more difficult because the placenta makes the woman resistant to insulin, so their insulin requirements go up and they’re at higher risk of going into the condition called diabetic ketoacidosis,” which can be fatal.
Farah had managed her diabetes well since being diagnosed at age 8. It was her experience with the condition — and with hospitals as a child — that inspired her interest in natural and alternative medicine.
“This was the first time in my life I ever resented being diabetic, just because of having to stay on top of my sugars nonstop,” she says. “If it went over a certain number, I’d have a meltdown just wanting to be sure (baby) Mabel was OK.”
Still, Farah didn’t rely on a glucose monitor or insulin pump during her pregnancy. “She had tried some of those technologies in the past, prior to pregnancy, and decided together with her endocrinologist that these devices weren’t right for her,” Dr. Han says. Instead, Farah manually tracked her levels.
Though she had dreamed of a home birth, such an approach carries “significant risk” for mothers with type 1 diabetes and their babies, Dr. Han says. The umbilical cord diagnosis, known as velamentous cord insertion – in which the umbilical cord inserts in an abnormal manner – further complicated Farah’s circumstances.
That didn’t stop her, however, from laying out a detailed birth plan filled with her holistic intentions, including a desire to avoid unnecessary interventions and C-section delivery, if possible.
“We were able to comply with a lot of the birth-plan requests that she had made, so she could still get her birth experience the way she wanted it, despite having these diagnoses,” Dr. Han says. “She and I went through every line on the birth plan to figure out what made sense, explain what didn't make sense and what was going to apply to her. The entire team knew about her birth plan and followed it as much as we could, letting Mary guide us in the process.”
Baby Mabel Josephine arrived in perfect health on Jan. 21 with a thicket of dark brown hair.
“She’s the absolute best,” Farah says. “We are so in love.”
“What’s really crazy, I found out having Mabel, is so much of what I thought I wanted turned out to not be so much what I wanted,” the new mom says of her pregnancy and delivery experience. “I had so much in my mind of how I wanted the pregnancy to go: I’m going to have a midwife, I’m going to have a doula. But then I just found I really trusted myself and my doctors, and I didn’t quite need the support that I thought I would need.”
Farah says she’s filled with gratitude as she marks her first Mother’s Day as a mom.
“It’s so cool to think about a holiday I’ve never celebrated,” she says. “I’ll just be happy to be home with my family and that we’re all healthy and happy.”
