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Mom with Type 1 diabetes delivers healthy baby girl

Pregnant with her third child, Carly Gahler, RN, BSN, a diabetes educator at Welia Health, saw the pandemic preparation unfold in her weekly prenatal appointments.

One week, clinic staff were wearing face masks. The next week they were donning face shields. And the next, scrubs and gowns. Guidelines for personal protective equipment (PPE) were changing as rapidly as new information about the virus arose and availability shifted. Carly had been working from home, so her prenatal appointments gave her a window into Welia Health’s COVID-19 response as a patient.

“I have Type 1 diabetes, which requires a little extra care for mom and baby. Starting at 32 weeks, which for me was early on in March, I was in the clinic twice a week for various appointments, just as everything was starting with COVID. Even though everyone was in masks, and you could only see their eyes, I could feel the warmth and love from the Welia Health team.”

Carly Gahler, Welia Health Diabetes Educator and recent Birthing Center Patient

Diabetes and pregnancy

Although Welia Health was increasing the use of virtual visits, Carly had to physically go to the clinic for her appointments. When pregnant women have Type 1 diabetes, they must complete a weekly biophysical profile starting at 32 weeks. This assessment checks four main categories of the baby’s health – heart rate, fluid level, tone and movement.

While there is a list of complications that can arise with diabetes in pregnancy, the two main concerns are hypoglycemia, a condition where blood sugar can drop to be dangerously low, and larger than average birth weight. Another concern for expectant mothers with diabetes is that continued high blood sugars can cause an increase in amniotic fluid, much more than they need. So, every four weeks, providers recommend a growth ultrasound to make sure the baby doesn’t grow too large or too rapidly. Throughout the pregnancy, both Carly’s and her baby’s assessments came back fine.

A new way of working

In her role as a diabetes educator, Carly focuses on these biophysical assessments when working with expectant mothers with Type 1, 2 and gestational diabetes. She closely monitors her patients, doing everything possible to keep moms and babies safe.

Due to the COVID-19 pandemic, any high-risk employees were asked to work from home to reduce their exposure. “I worked up until the Friday before the Monday I had my baby. The ability to work from home when you’re pregnant is wonderful – you don’t have to worry about which clothes fit at nine months,” Carly chuckled. “I was fortunate that most of my job duties were able to be done from a home office.”

Scheduled C-section

Carly’s first two pregnancies resulted in emergency c-sections, so with a scheduled c-section she liked having the chance to prepare a little more for her baby’s birth. Plus, the Governor’s Stay-at-Home orders during the pandemic allowed her plenty of time to make sure all the preparations were made. She even made sure her husband Traver’s bag was packed because new hospital rules did not allow him to leave and reenter.

Delivery among friends

Baby Madelyn Gahler, born June 15, 2020

“A planned c-section was a completely different – and much improved – delivery experience than with my previous emergency c-sections,” commented Carly.

Dr. Matthew Schultz delivered Carly’s healthy baby girl, Madelyn, on June 15 at 8:05 am. She weighed 8 pounds and 9 ounces.

“Having my baby at Welia Health was just a wonderful experience,” said Carly. “Given COVID, we couldn’t have visitors, but knowing all of the staff, many quickly stopped by to say hello and wish us well. I could literally feel the compassion from the nurses because they just take such great care of their patients.”

Madelyn was born in the new birthing center. Carly remarked that the rooms are beautiful with large windows allowing in a ton of natural light. She loved having her husband and baby in the room with her.

“Other than a few hints of change and encouraged masking, there wasn’t anything major that made delivering during a pandemic too different,” said Carly. “The whole process was quite comforting. In fact, not having visitors was nice in a way because Traver and I had that time to focus on my recovery and just bond with Madelyn.”

Adjusting to a zone defense

Madelyn has two big adoring brothers, Mason who is six, and Milo who is three. When Carly, Traver and Madelyn were in the hospital, they FaceTimed with the boys, yet only talked for a bit because they were off running and playing. But now that everyone is home and adjusting, it is much different.

“Mason and Milo are just enamored with Madelyn and love her to pieces,” said Carly. “Milo is normally our wild one, always wrestling with his big brother. But now has been so gentle with his little sister, holding her and even singing to her. It’s like a switch flipped in him and he has become a protector and caregiver. Mason is just excited to be a big brother again.”

Carly also has enjoyed seeing Traver be a father to a daughter. Her husband loves to wrestle with the boys, but she is finding his tone with Madelyn so sweet. Carly feels a different vibe when she watches Traver cuddling with his daughter or when he’s simply holding her. She’s enjoying the nuance.

The new parents of three are a little intimidated by being outnumbered. With family close by, Carly is thankful for the help and support she can count on. Having three kids will be a big change, but it’s one Carly and Traver are ready for, particularly as they watch their boys with their baby sister.

Most details of a birthing experience are forgotten in a few years, but Carly will remember this experience as one in a lifetime – giving birth during a pandemic, now being outnumbered, and adjusting to a whole new normal.

patient stories

Maeva Miller, a Welia Health patient.

From the start, Amy Miller knew something wasn’t right with her newborn daughter. Although Amy is a certified speech pathologist at Welia Health, she gave birth to her two daughters at another healthcare facility, one that had cared for her throughout her life. Yet, it was one of her close colleagues, Dr. Donner, who saved her younger daughter’s life—by chance.

Amy’s daughter, Maeva, was born in July 2018. Hours after she was born, Maeva started experiencing reflux so badly it was coming out of her nose. The nurses advised Amy to just “put her on her side,” as she most likely had swallowed some fluids during birth.

Amy dutifully followed their instructions. But as the postpartum days passed, Maeva got progressively worse. She had significant stridor, a high-pitched wheezing sound caused by airflow being disrupted. Amy remembers watching Maeva’s chest retract as she struggled to breathe; when she would eat, Maeva would have blue spells and aspirate. Maeva struggled so much to eat and breathe that she would pass out and wake up 10 minutes later screaming. 

Amy, feeling terrified for her baby’s life, brought Maeva back to the birthing facility. There, Amy consulted with the baby’s doctor, listing all of the symptoms she and her husband were witnessing. At the end of the appointment, the doctor flagged only that Maeva wasn’t gaining weight. Again, Amy was told that Maeva was okay–that she just had small facial features and that her lungs were clear. 

Fast forward five weeks, when Amy brought Maeva in a second time, the providers made notice that Maeva had only gained three ounces. Typically, babies gain one-to-two pounds in the first five weeks.

Dr. Donner’s diagnosis

On August 16, 2018, Amy brought her three-year-old daughter, Harper, in for a pre-op appointment with Dr. Donner, a Welia Health family medicine physician. Harper was getting tubes in her ears. “I remember debating bringing Maeva at all, because of her issues,” recalled Amy. “She screamed a lot, and her breathing was so loud that people would turn and stare at us, often commenting.” 

Amy never had an answer for them because she was told multiple times by the birthing facility, “This is normal.” 

After Dr. Donner completed his exam with Harper, he turned to Amy as Maeva was experiencing her usual stridor. “Does she always sound like that?” he inquired.

Feeling shocked and then relieved, Amy realized that someone in the medical field had finally acknowledged her stridor. “Immediately, a flood of information and emotion came out,” said Amy. “I told Dr. Donner everything—symptoms, appointments, her lack of eating, her poor weight gain. Everything.”

The Welia Health doctor of 33 years took Maeva out of her car seat, and he listened carefully. He maneuvered Maeva in different positions, and he listened again. He listened to her lungs and stridor. After placing Maeva back in her car seat, Dr. Donner said, “I think she has laryngomalacia or tracheomalacia.” 

Amy said that she was quite certain at that point that she looked like a deer in the headlights. When Dr. Donner showed her a video, she kept thinking: “That’s my kid, that’s exactly what my child sounds like.” Dr. Donner printed information about laryngomalacia and trachealmalacia and told Miller to get an ears, nose and throat (ENT) referral right away.  

Surgery at six weeks old

Maeva Miller, at six weeks hold, following surgery
Maeva, at six weeks old, following surgery.

Within a week, Miller was back in Maeva’s primary office requesting an ENT referral. On August 26, Maeva had an appointment with an ENT in the Twin Cities. 

“Within three minutes of having a scope completed on her, Maeva was diagnosed with severe laryngomalacia and failure to thrive,” said Amy. “We were told that if she didn’t have surgery, she would be unable to attend daycare—a simple cold would mean her being admitted into the hospital within hours.” 

Due to the severity of her condition, Maeva was scheduled for a supraglottoplasty, a microscopic surgical procedure, at Children’s Hospital just three days later. At just six weeks old, Maeva was to have surgery on her larynx, arytenoids, and epiglottis.  

Following the procedure, the surgeon said Maeva had a Level 4 laryngomalacia, the most severe form. The infant’s airway was only three mm wide prior to surgery—about three pencil dots wide. 

“Everything went well,” said Amy. “Recovery was rough, to say the least, but we were able to go home less than 48 hours after the airway surgery. And when we did, we had a completely different baby on our hands—one who smiled, ate, and rarely cried.” 

A happy ending

For many babies who receive the laryngomalacia diagnosis, it’s simply noisy breathing. Then, there’s a small group of babies who are diagnosed with life-threatening laryngomalacia, like Maeva.  

“Our life was completely turned upside down all because of an airway disorder that was supposed to be common, normal, no big deal,” said Amy. “Today, Maeva is a pint-sized powerhouse who is healthy and happy. She still has laryngomalacia, but just a mild form. Dr. Donner truly saved her. I don’t know where we would be without his knowledge, patience and support. I am forever grateful.”

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