Author: paulette_kamenecka

Hi, thanks so much for coming on the show; So excited to have a midwife on the show, to share her experience. It’s very cool to hear from the people who know too much. So, 

Anne: Thanks for having me, 

P: Can you introduce yourself and tell us where you’re from.

A: Yes, my name is the Anne Richards. I am a midwife in the Bay area of California. I started my career in Oregon, and have been at my current practice which is a hospital practice for just over five years. 

P: That’s very cool. So we’re gonna hear your birth story and then you have a super interesting story because you’re also a surrogate but, but before we get there, I just want to talk a little bit about the midwife career. Are you a midwife before you have your first baby.

A: Yes, yes I had been a midwife for five years before I had my son of being practicing as a midwife,

P: so I’m guessing in five years you saw a lot of stuff.

A: Oh yes, all not probably too much that, yeah, definitely.

P: So, How did you walk into birth, did you think, Oh, this will be super easy or what was your feeling about it.

A: I started in a birth center up in Oregon, you know we’re, it was just the midwife and the patient until the very end and the nurse would come in, I think knowing what I know now, and I love out of hospital birth, don’t get me wrong, I don’t know if I could go back to a birth center because I was just sort of blissfully naive coming out of, out of midwifery school and hadn’t seen enough births to really see the full spectrum of what can happen. By the time I had my son I’d been in a hospital based practice and a much busier practice for two full years. what I tell my patients is Expect the unexpected was willing and ready to just meet that birth that labor and birth where it was.

P: So let’s start from the beginning, yes you start you walk into pregnancy, kind of with open eyes.

A: Yes, and kind of low expectations. 

P: Ok…Good. And then do you get pregnant easily. 

A: Yes…Very we were very lucky. Yes, I just like I tell my patients who are under the age of 35 which I was at the time, be prepared to get pregnant on the first try and be prepared to potentially you know, it takes it takes a year before you’re even eligible in most practices to see a fertility specialist, and we got pregnant on the second try, so I was on the one end of the spectrum like, oh crap, this happened, like I’m there yeah I’m so thankful. But, okay, I was expecting a little bit longer.

P: Yeah It takes a minute to sink in, right. So, definitely. I think we all imagine if we’re not educated like you are is the minute you try you’ll get pregnant because that’s kind of the line you’re fed in high school. Yes, and you just kind of travel with that even though it’s not necessarily salutely, and then how was the first trimester. 

A: You know I am so lucky with pregnancy and I almost feel guilty saying that now to an audience but again though I had low expectations I knew I could be really nauseous I could be really tired I think the life of the midwife affords you a different perspective on fatigue, you know, working nights, days weekends you know my sleep schedule is already erratic so I was pleasantly surprised. But again, I think that was my, my expectation going into it was like, oh this is gonna be really really hard and it wasn’t easy but it was less hard than I anticipated. 

P: Oh good, 

A: it was really lucky.

P: If only we could transport that set of expectations to everyone. I think it would be a much nicer ride.

A: It’s what I tell everyone, all of my patients, it’s the, you know, the best preparation for parenthood, like set your expectations low going into pregnancy and into parenthood and maybe you’ll be very pleasantly surprised, because, you know, I that’s really what I think has served me so well as both a pregnant mom, a pregnant surrogate and as an in motherhood is just keep those expectations low with you,

P:  I’m with you. And the second trimester is fine. You’re, you’re seeing a midwife for your care is that, how you are doing it?

A: yes,I just saw my colleagues so I knew I was going to give birth, where I practice, because I adore where I work and feel very comfortable and confident and care. I would just be on labor and delivery and pop over for a prenatal visit and, you know, the beauty of being a midwife is, you know, you kind of know what to expect in terms of prenatal care and I could really do the bare minimum. Still, be safely monitored, and same thing I just knew that I was lucky it was a healthy pregnancy and you know I didn’t need too much and to monitor it safely. 

P: That sounds awesome, so it sounds like a smooth ride into birth. 

A: Very, very, very, very, um, I again I feel guilty saying this out loud and I feel guilty with patients who are struggling with pregnancy because I am not one of those people.

P: I know, but you’re the you’re the ideal it’s fine to be the ideal right.

A: I know we’re fair enough and that’s right and when people come in and kind of give me, give me this guilty, you know grin at their prenatal visits and say, I feel really good. I’m like, that’s great, like I own it, that’s okay. It doesn’t mean something horrible is coming, you know you might you might just be someone who is really lucky and also works hard at it, I will say, I do believe that staying very active in pregnancy serves you well for a healthy pregnancy and a more comfortable pregnancy. And so I was very, very active and I think that that really helped get me through it, more comfortably.

A: So, let’s be specific about this, what kind of exercise, did you do and what were you comfortable with and how did it change

P: when I was in midwifery school, they knew research was coming out saying, you know, we’ve probably been putting far too many physical restrictions on pregnant women, as it comes to exercise and in this country we see way more gestational weight gain than is really recommended, and that has, you know, negative outcomes like your risk of gestational diabetes and hypertension and bigger babies. And so knowing that that we’ve been putting too many restrictions, the new norm kind of is if you safely did it pre pregnancy you can continue it in pregnancy, you know, with some modifications, listen to your body and so that’s what I went with so I was doing, you know, high intensity interval training, like I was doing like orange theory and my water broke out orange theory, 

P: oh my god like 

A: I yeah I felt great. I mean some definitely pubic bone discomfort towards the end and pelvic discomfort and I would have friends say they didn’t feel sorry for me because I was making it worse, Doing these workouts but I felt really good so I kept doing it and you know I would slow down but I ran the whole way through. I felt really really good. I attribute that to not really changing that routine all that much.

P: That’s super interesting to me because I went into it a runner, and I ran until like the third trimester and then it just felt uncomfortable.

A: Yeah, that’s what he told me about that I was expecting that, and I didn’t I think I found out later on that he was so low in my pelvis that there was probably nowhere else for him to go so I’ve been carrying him so low that I feel much different in the third trimester, but that’s what I tell people just, you know, one day running might feel great and the next might not for the rest of your pregnancy or maybe it’s just that day, but really just listen to your body, we don’t tell women anymore that you need to wear a heart rate monitor that you need to be able to talk while you’re exercising. The one thing that we really know now is you don’t want women overheating so I do tell people if hot yoga was your jam, it’s not going to be any more, but really I tell people just do what you’ve been doing don’t pick up high intensity interval training in pregnancy if you’ve never done it before, you know, but if you do CrossFit pre pregnancy with, with few modifications you can safely do it in pregnancy if you’re really just paying attention to how you feel,

P: that is super interesting and I feel like that story is changing right or has 

A:yes oh hugely, hugely enough. That’s again probably in the last within the last 10 years there’s been huge changes in what we can safely advise women regarding pregnancy and exercise

P: wait so I want to hear about the water breaking, I was going to take us to the birth like how do you know, today’s the day, This sounds like a dramatic how you found out.

A:  Well, so my son was, he was head down, and then we were doing this voting vaginal birth training within the organization for which I work and nurses and doctors and midwives were coming from all these different hospitals within the network to do you know this this training on promoting vaginal birth. And one of the trainings was focused on teaching nurses how to really feel a baby in the abdomen and how to safely monitor with limited intervention, so that we could promote mobility and labor and so I 30 or 31 Weeks was the belly model. So nurses can really put their hands on my belly and try to feel my son’s position. And at the beginning of the day the midwife who first assessed me said oh he’s head down, we didn’t know he was a he, but oh the baby’s head down. Great. And by the end of the day I think so many people have been poking and prodding because it was hard to feel his position at 30 weeks he wasn’t all that big yet. By the end of the day I remember the midwife put her hands on my belly and her eyes got wide, and I looked at her and I said, Who’s breeches me or the baby is breech, she said yeah and I thought well, not a big deal. We know 30% of babies are breech at 30 weeks so we don’t really worry about it. So I was doing, you know, spinning babies exercises every day to try to get him to turn, and he never did. So, we did everything I did all the things I went to acupuncture and moxibustion I did chiropractic care all the things I tell my patients, 

P: wait, what’s, what’s moxibustion? 

A: moxibustion is through an acupuncturist and it’s I can’t even explain it very well but it’s literally you light this thing you put this thing between the mom’s big toe and her second toe, and you light it and it’s supposed to help turn babies,

P: although I could barely pronounce it moments ago, I looked it up and moxibustion is a technique used in traditional Chinese medicine that uses heat generated from a burning herbal preparation to stimulate acupuncture points. It’s supposed to regulate meridian points and visceral organs, and it does this by increasing chi circulation and reducing chi stagnation–chi being the energy that circulates through the body at all times. It looks like this is a procedure that’s been around for 2500 years, has been used to cure all kinds of things, one of which is breech presentation. I found an article on PubMed from 2010 That looked at systematic reviews of moxibustion, and it gave a generally favorable nod to the ability of moxibustion to affect breech presentation, check out the show notes for details. 

A: And then we even tried to turn him in the hospital, via a procedure called an external cephalic version, literally, you know, putting an IV in giving a medication to relax the uterus and a physician tries to turn him manually, 

P: that doesn’t sound comfortable

A: as he wasn’t having it was horrible, it’s the worst of all anything through my labor versus, it’s the most discomfort I’ve ever felt. Because it’s so sudden, there’s no build like in labor, it’s just all of a sudden it’s this massive massive massive discomfort. I really train to be sort of mentally disconnected and be ready for that. And I, I did really well with the relaxation, but he wasn’t having a lot of, you know pressure on the placenta and on their cord, and so we watch to their heart rates very closely during those procedures and he did not like it. And so we had to abandon ship, we almost met him that day, via emergency cesarean because it was, it was 

A: Good Lord!

A: yeah it was that it was that intense…there is a different level of anxiety I think when you’re caring for a colleague and birth colleague. And I’ll never forget the two physicians were there and one was trying to turn him and the other was monitoring his heart rate and she is a New York provider, former New York provider, calm, cool and collected nothing browses her and I’ve never seen her that frazzle, she was just watching his heart rate and hollering out that that his heart rate had been very low and wasn’t coming back up so I thought we were going to meet him that day. Thankfully we didn’t. We decided then to schedule cesarean at 39 weeks which is, which is the procedure in our hospital and most hospitals when you have a known breech baby as you’re trying to find that sweet spot of scheduling a C section when they’re well beyond 37 weeks and nice and fully cooked, but prior to labor that’s the goal.

P: Why can’t we deliver a breech baby vaginally, they get stuck or what 

A: yeah so you know some places you can, our practice doesn’t do it, the risk is that the butt is usually smaller than the head. So if the butt comes out of the butt can potentially come out of a cervix that’s not fully dilated say seven or eight centimeters, depending on the size of that baby’s booty. And then the risk is what we call head entrapment, is that the head, the cervix is not dilated enough to let the head come through and the head literally gets stuck in the lower part of the uterus, it’s a true emergency, it’s something that if I’d had a baby before I would have been willing to maybe find a provider somewhere that does vaginal breech births because there are providers who do them, but usually women have to have had a baby before, and there’s lots of criteria like the baby has to be in a specific type of breech position not just butt down but in a position where like the legs are are up and crossed you know they can’t have one leg hanging down, they’ve got to be in a very specific position. So vaginal breech births do happen, but knowing the risk of it, especially as a first time laboring mom I just I was not comfortable with it and we don’t do them at my hospital and I knew I wanted to deliver it my practice,

P: if the baby isn’t yet breathing oxygen, what is, what’s the problem with the head being stuck for a minute while the cervix is still opening.

A: Good question. The risk is that it sort of like if, if anyone has ever come on and talked about a shoulder dystochia, you know the the head coming out with the shoulders getting stuck. Same thing with eventual breech birth is that, then the cord is getting buried we know the cord gets more compressed as the baby comes down the birth canal. And so you’ve got half of the baby out and so yes the baby is still getting oxygen through the umbilical cord, but it’s usually very limited, and the baby can only handle that for a certain amount of time. 

P: Yeah, I’m not sure I would be up for that sport either. Good lord

A: Yeah it was I’ve never seen a head entrapment I hope I never do, knock on wood, wherever I, You know where I’m sitting. It was just something where I think of the quotes I use with my patients a lot is like, I respect birth but I don’t trust it. I know that might sound really negative but I just was thinking, there’s a reason that the American College of Obstetricians and Gynecologists recommends cesarean for breech babies I trust the research I trust the evidence and I knew, you know, this was just the way my kiddo was supposed to enter the world and that was okay. I’ve tried everything and he wanted it this way.

P: So we’re headed to a C section, but I don’t usually associate C section with water breaking so I how does that work?

A:  Yeah. So again we scheduled the C section in my case was scheduled right around 39 weeks. And this, this shows what a bad patient’s medical providers can be at my very first appointment. When you’re sort of trying to estimate what the due date is oftentimes we go with the due date by the woman class period menstrual period, but if that very first ultrasound in early pregnancy gives a different due date. If the duty difference is greater than a certain number of days, we’re supposed to switch it to the, to the ultrasound, because these all fetuses regardless of genetics, and to measure the exact same from head to booty what we call a crown rump length measurement.

P: So am I. Okay, they’re all the same size of 20 weeks.

A: No at like six weeks, seven weeks at 20 weeks then genetics comes into play and babies have hugely vastly different measurements, but in very, very early pregnancy. That’s why we a lot of practices do a very early ultrasound is like let’s make sure this fetus is measuring, quote unquote, what we expect you know especially based if a woman has a very accurate last menstrual period, so that we can kind of just give them the most accurate and today possible. Okay, so the first appointment, I lied about my period because the, the, he was measuring, not as far along based as far along as I should have been on my period. Now it was still concordance, we should have started with my period due date, but the due date that I was that I could have if I went with my ultrasound was further and I didn’t want to be induced so at six weeks I was already considering I don’t want to be induced which is hilarious now in hindsight, the way everything went. So, my, my due date was like six days later than it really should have been on paper because I lied said oh my periods aren’t regular don’t go with that due date my periods were beautifully regular so I’m the worst patient, so my C section was scheduled at 39 weeks but in reality I was almost 40 weeks.

P: Yeah, 

A: so I’m went to Orangetheory and at the very end of the workout I did this big squat and my water broke and I knew it. It wasn’t like the movies, it wasn’t the big water balloon popping but I felt it and I was like, oh Gosh. Okay, and again it’s, it was so humbling and such a good lesson for me because I tell my patients like you just got to meet your labor and birth where it is and in my mind, all I’ve had to really forfeit was this optimal birth and I, you know, now it was okay I’m going to have a baby on this day and then lo and behold right things change again. So, I dragged my feet did not want to go in because I thought no no I’m not ready. I’m not ready today. Today’s not the day, any of our patients call, and our breach and their waters broken we tell them to come in right away. Because, again, sort of the risk with the head getting stuck in a cervix that isn’t fully dilated. Bottom sitting in the pelvis there’s more room, pelvis, for a bottom. And so what can happen is the umbilical cord, very rarely, but when there’s so much space that the water breaks the umbilical cord can slip out of the cervix in front of the body in front of the butt, and it’s called an umbilical cord prolapse, and it’s, again, a true emergency because that, that baby’s oxygen supply is getting significantly squeezed. Well, all of that knowledge went out of my head. In that moment, as a soon to be mom and I just thought, no, no, I’m not ready. I’m not ready. So I went home and I showered I called my, my kiddos father and he was at work and I said this happened. Don’t come home yet. I mean, all of the things that I would be mortified if one of my patients did, but I knew it was happening. And very quickly I started to have pretty uncomfortable cramping and still didn’t go in. So the worst patient.

P: And you know the cramping is his contractions. 

A: Oh yeah, I knew exactly what it was, I knew exactly what it was and I, I just couldn’t wrap my mind around it, I could not wrap my mind around like today’s the day, so I have so much more empathy for patients who have like true preterm births, you know, and thinking, I have another month as another two months, I can’t imagine what that must be like because I was full term, I was 40 weeks about and still it felt like, no, no, this can’t happen. It was, yeah, it was, it was, I was ridiculous. And then finally I get my husband got off the phone at work and told his co workers what was going on and he thought, well, she’s a midwife I’ll trust her and all his co workers asked, you know what’s up. And he told them, and they all said, oh my gosh get home right now, like Don’t listen to her get home, and he came and he could see I was uncomfortable with contractions, and he was like we gotta go. This is crazy. We got to go. 

So we went in and I think we got there around noon and my son was born via cesarean and it’s 2:38pm that day. Yeah, so, and But same thing when I got there, they put me on the monitor, you know, to watch his heart rate and watch contractions and the contractions always read differently on people doesn’t mean people feel them I was so people don’t look at the contraction monitor look at your patient Look at mom, you know, what is she, how does she look during contractions because you can see a lot of contractions via the external monitoring mom might not feel them at all or you can have a woman writhing in discomfort and the contractions aren’t picking up well, but the, the physician and the midwife who were on came in to see me and looked at the monitor and said Are you feeling these and I, again, I didn’t want them to rush. I don’t want them to feel panicked. Just like gritting my teeth and I was like no, not really. And they walked out of the room and I was like, Oh, this is terrible. I just…they’d had a busy day I didn’t want to be. I just don’t want them to feel rushed, I want them to have lunch, I wanted them to take their time So, anyways, it was, it was all very humbling, but we met him a couple hours after getting there. 

A: So now that he’s How old is he now. He is three, three and a quarter, he was 2018, so he turned three in June of this year. 

P: Now when you look back, do you think it was just, you weren’t in the mind space or like you were committed to the date in your head or like what do you think was going on there.

A: Yeah, I think I just thought, you know, my ever since I became a midwife I’ve envisioned my, my, perfect, you know, haha, vaginal delivery. My perfect vaginal birth. And so I thought all I had to give up. Is that vaginal birth like okay, I’m dealing well with the scheduled Syrian, that’s my first hiccup, right, that’s, that’s where I have to give up control. And so when this happened when a water broke well before the the scheduled cesarean and I thought, no, no, no, no, I’ve already given something up, I, you know, that date was it I wanted a little bit more maternity leave. You know I just stopped working, I’m not ready, you know, I didn’t have dog care arranged for my dog, you know, my husband was supposed to go up to Oregon to sell a house, he owned up there like the next couple days it was just the timing wasn’t right, which is so ridiculous, but I tell people all the time, you know, sort of, sort of like with when you’re trying to achieve pregnancy, it could take months, it could take up to 12 if you’re under 35 Well, it could, you know your water can break your labor could start anytime, ideally after 37 weeks and until 42 weeks like that’s all full time it’s a huge window and I know that, and yet ready

P: I mean it is it is a lot to give up right, there’s a yes, while you’re pregnant, there is kind of a daily push and pull in that you’re feeling new things you don’t feel well is this something, is it nothing… You’re in this kind of constant Flexi space for nine months. It almost seems like too much to ask to say. And guess what,

A: absolutely It’s so wild and I think I I still had no idea what it was like to take a baby home but I had an idea I knew my life was going to change in an instant. That day, forever, and I just didn’t feel ready for it now that you’re ever ready but I, you know, the curtains weren’t hung and, you know, like all these silly things that I was like no I was supposed to get that all done. I just didn’t feel ready, I thought, you know, six more days would make me more ready which is hilarious but I just wasn’t ready that day.

P: So what was postpartum likes instead arrived early at your doorstep. 

A: Yeah, again, I think my expectations for the C section are really low, thinking I’m going to be in a lot of discomfort so again I was really pleasantly surprised. Was it uncomfortable Yes. Was it awful No, I was lucky that I, you know, didn’t labor, I have a lot of empathy for women who do go through, like all of labor and then push for a long time and then have a cesarean, I feel like that is. I can’t imagine that would be like the recovery of both essentially or like women who have twins and one is born vaginally one’s born via cesarean I really can’t imagine. But it was fairly easy, I was really lucky with breastfeeding my son latched in the operating room, which was really great. We do skin to skin in the operating room at my hospital, we got to watch him come out like they dropped to this, you know, dropped a solid drape, there’s a clear drape so I could watch him come out, we didn’t know if he was a boy or girls, his dad could announce what we had, it was great. Again my expectations were really low so I thought, the newborn phase..it’s gonna be terrible and I kind of loved it but I think, again, I can’t preach this enough that my expectations were low and was it hard did. Are you sleep deprived, do your nipples feel like they’re gonna fall off, you know, yes, yes and yes but it was so much better than I expected.

P: That’s awesome. That was a smooth story and I kind of, since I know that you were a surrogate. I kind of imagined that it would be pretty smooth because you don’t go into that unless you had a relatively easy experience so yeah, why don’t you tell us about that. How did you walk into the surrogacy and, you know what had that always been your plan or

A: Yeah. You know I’m not a religious person, but I do think there are people up there, looking down on us and intervening in, in, in ways and at times that they need to. So, I actually had wanted to be a surrogate in my early 20s Before I met my son’s father before I ever considered children of my own and and quickly found out as you just mentioned that really no agency will take on a surrogate who hasn’t been through birth herself you know you need to prove that you can have a healthy full term pregnancy without major complications and a healthy birth. So I kind of gave it up and thought, Okay, well, I won’t be a surrogate probably, so I actually did egg donation in my early 20s, and there are at least two girls out there now that are have biologically mine that are, you know 10 Plus, it’s anonymous on my end, so I can’t ever ask details about them but I know that at least two baby girls were born, I’ve just always been really fascinated in infertility and, you know, if people really want to have a baby and I can help them do that. I would like to. 

So, anyways, I thought well, surrogacy won’t happen you know I met my son’s father had him, and then actually my husband and I decided to separate at the beginning of the pandemic, and it was very amicable we just, we have two jobs that lead us in totally opposite directions timewise, and we always joke that we would be to single parents in reality we were, because we’re ships passing in the night and it just got to be too much and we just weren’t good at being married so literally one day we decided or I mentally decided like okay I think we need to call it like on a Friday, I still remember it was a Friday and in May of 2020, and I have a colleague who I didn’t know that well but I knew that she was she and her husband were looking for a surrogate, and she couldn’t carry for a variety of reasons, and we thought she’d found one through an agency in Southern California, we live in Northern California. And, you know hadn’t heard anything in several months but I knew it could take a long time so I decided on Friday that I thought my husband I should probably, you know, decide to officially separate and divorce, and the next day at work, she and I worked together and midwives we rarely work together, you know, we’re usually passing off to each other so it was even rare that we were on the floor together at the hospital and she asked me how I was doing and I said you know I think I’ve decided to end my marriage and she looked at me eyes wide and I said no, no, it feels good to say it out loud, we’ve been working really hard, it’s just, it’s not working for us and so I think we need to change something up and I said how are you and she burst into tears and said, our surrogate fell through the one in Southern California. I just don’t think this is ever going to happen. And I looked at her and that moment they said, I’ll be your surrogate, and she, you know, rightfully so, looks at me and said you’re crazy. You just told me you’re ending your marriage. 

And I said no no I know, but I’ve actually wanted to be a surrogate for 15 years, you know this is not something, this is not me offering to pick up a shift for you right like I do know that, that this is a lot, and I know that I don’t know just how much it is, but this has been on my radar for a big portion of my life before I became a midwife and I could see that she kind of thought, okay, maybe, but still didn’t believe me, rightfully so. So I just said, Well, tell me what I gotta do you know what medical records do I need where do I need to send them so we got the ball rolling and funnily enough and bless my child’s father the following, when we finally decided like got together in person and decided that week that yes you know divorce was the best option for us. I looked at him, I said okay now I need you to pretend like we’re happily married so that I can we can pass psychological screening so I can be a surrogate and he just sort of shook his head and laughed and was like, yep sounds about right. like, didn’t skip a beat, because he also knew this is something I’ve always wanted to do and I’m so grateful to him because we do psychologists would never sign off on someone actively going through divorce to be a surrogate, and that’s one of the first steps is psychological screening, and he and I sat together on a zoom call you know happy couple so that was May of 2020 and then went through it takes a long time just to get all the screenings done, you know, pass the psychological screening the health screening, And so the transfer was not for another five months was in October of 2020 it just takes that long to get everything done, to lead up to that point,

P: and then you’re not donating an egg or anything, you’re just surrogate.

A: Correct, they already had embryos they had three healthy embryos and so there was not the discussion, you know, their plan was just to just implant one which I was very happy about to put in a singleton, but they still had two healthy embryos if needed. So yeah, none of it, none of this baby was is genetically mine it is their embryo

P: and how did that process go, How did the implantation go and how did the pregnancy go 

A: Yeah, the worst part about all that was actually just the injecting hormones, I had to give myself you know intramuscular shots every night, when you’re doing a frozen embryo, you have to do those shots for much longer. A lot of people they’re doing IVF themselves so they’re implanting their own embryo it’s usually what they call it fresh transfers, they don’t have to do the hormones as long but I had to do them for like through I think 12 weeks of pregnancy and so your, your sides and your, your butt gets so sore, but you know that’s really all I have to complain about the transfer was easier than like cervical cancer screening or what we used to call a pap smear it was so easy you know they put a speculum in they look at your cervix, they put a little tube through your cervix and it’s done it’s almost comically fast, and the, the intended. Mom, my colleague got to be there for that which we weren’t expecting with the pandemic so it was really awesome that she got to be there for more of it than we anticipated.

P: So it’s interesting to me that they give you all those shots, because I feel like the IVF protocol is usually for people who have infertility problems, which you clearly don’t have. So it seems like you have the chemistry to carry out a pregnancy, Why would you need. Why would you need all this other stuff

A: Yeah, that’s a great question. It’s because you know there’s so much as you are in the early phases of pregnancy so when they implant. The implant the embryo I forget how far you know, how many days old, that that embryo is, but my body, You know if you were going through a natural pregnancy, there’s so many hormonal shifts that your body’s already doing once it knows the sperm has met the egg that my body had not done so you’re really and they want to increase the odds of a successful viable pregnancy. So they’re basically boosting your uterine lining making it really nice and fluffy for an embryo to implant so lots of things that would have already happened in my body naturally had it known I was a few days pregnant, plus some, you know, to just really increase the odds that, that it was going to be a successful pregnancy because, you know, with, with say an early miscarriage which so many women suffer. It can be that their, their uterine lining wasn’t fluffy enough for their hormones were a little bit off, they didn’t have high enough progesterone, which is a pro pregnancy hormone. So that’s really what you’re taking so that your body is the the best and most ready vessel, it can be for this embryo,

P: that makes perfect sense that’s true that yeah, you’re a little bit skipping the line by by implanting an embryo.

A: That’s a perfect way to put it exactly so you’re trying to sort of compensate for that skipping the line. 

P: So how was that pregnancy

A: It was great. Again, you know, it was a little bit more uncomfortable I again I was really dedicated to staying really active because I was hoping for a VBAC or a vaginal birth after cesarean and that was something my, my colleague and her husband were totally on board with thankfully I mean if they’d felt more comfortable with the scheduled cesarean and I still would have done it, but I thought well you know let’s see if my body can do this, if I can do this because, since I had labored fairly quickly after my water broke with my son, I thought, I think I’m a really good candidate for a VBAC pending this baby is not breech and pending you know other other factors that can lead to a scheduled cesarean so I, even more so was super dedicated to staying really active, you know your uterus is a muscle and though there’s no research I kind of think if you have a healthy toned body and toned other muscles I always think maybe your uterus will be more toned, you know, and that’ll it’ll operate, you know, more efficiently in labor so I stayed really active and was really lucky again and felt great. I really, you know, I’m one of those annoying women that that really does enjoy being pregnant.

P: That’s awesome, that’s well and like, you’re the perfect person for surrogacy, so that’s awesome too. Yes. So take us through the day of the birth how the battle happened. 

A: Yeah, so, again, all of these things that I discourage my patients from doing in both birth stories but

P: this part got momentarily crunched up by a bad internet connection, but basically what Anne said was that she and her partner both have jobs with unforgiving hours without much flexibility you

A: our childcare setup is kind of piecemeal, you know, and we just, it’s, it’s build care needs outside of myself, my husband and mother who gets very kind of lays her out laser up and is very time specific, we actually decided to schedule an elective induction which I am so against an induction just to be induced but it sounds so silly but it, the timing was kind of perfect if we did it during this very specific window, and there are actually calculators that you can do to show what your odds of a successful VBAC are based on how far along you are in the pregnancy how old you are, how much you weigh for your height. And so we knew that if I gave birth before 40 weeks my odds of a VBAC were a little bit higher, so we kind of put it all together and we knew we were like we’re being the worst midwives that were thinking that you can control this but lets try it, and, but we both agreed that if the early phase of the induction if I, my body wasn’t doing anything we were both on board that we would stop it and wait for spontaneous labor, Just because she really wanted to support me with having a vaginal birth both both for having it and also knowing that as a single mom to, you know, the recovery of a cesarean was a little bit daunting, and so I was really hoping to have a vaginal birth, we were in agreement that if things were not progressing, that we wouldn’t do it. But they did. we got really lucky.

P: So you went in front of induction, and you had a vaginal birth.

A: Yeah so, with a cesearan, there are certain medications you can’t use with an induction so you’re really the early baseman induction if anyone’s had one or looking at one, in terms of knowing they’re going to have one coming up or considering one or being told they might need to undergo one, the cervical ripening phase is what takes the longest you know it’s not actually the painful contractions that are causing dilation that takes a while it’s getting your cervix ready to open, getting it nice and soft and thin, so that it can dilate later on. And when you haven’t had a previous uterine surgery, whether it’s cesarean or another type of uterine surgery, you can take an oral medication that helps your body kind of cramp and do that. That’s how most women experience early spontaneous labor, but when you have had a uterine surgery you’re limited to a mechanical method called a cook balloon or Pitocin through the IV if your body’s ready for Pitocin. And my body was not my cervix was definitely not ready for this induction, but you can put in this mechanical tube catheter called a cook balloon and you inflate one little balloon by the baby’s head and one balloon on the other side of the cervix and for 12 hours that stays in place to put constant pressure on the cervix to help it thin out soften and do early dilation. 

And so, again with timing this induction we chose the midwife who is supremely skilled at placing these cook balloons, and God bless her, it was the hardest cook balloon she’s ever done my body was so not ready she was sweating, we were putting her hair off, you know, like she was in a ponytail. It was the end of a busy shift she just she stuck with it and capacity me and I stick with it was very uncomfortable and I used nitric oxide which was awesome we have that at our hospital which is laughing gas they use it  very prominently in Europe but not as much here in the States, and usually could balloon placement I don’t know, three to five minutes and mine took like 45 to 50 minutes. 

P: Wow. 

A: It was, it was intense, and that was really because my cervix was really tucked way behind the baby’s head, because my body wasn’t ready and we just had to get me in all these different positions to make it work and I cannot sing the praises of my sister midwife my midwife colleague enough who stuck with it and put it in. So she got it in and the plan that can stand for up to 12 hours, and because it was so difficult again the intended. Mom and I agreed. Okay, if this comes out in the morning, and the next step was Pitocin there’s really nothing else to do after the balloon, because I don’t have the option of that oral medication to keep the early phase going, so that if my cervix isn’t ready for Pitocin we’re, we’re going to take the balloon out we’re going to go home, but when they put that in I started cramping a lot overnight and so I was hoping to get some sleep overnight but I was cramping really uncomfortably throughout the night, and I was excited by that but okay, this is triggering something, you know, this is, this is a good sign, and the intended moms was in the room with me she slept with me in case anything happened overnight we needed to meet him, you know urgently via Syrian or something. And I was so nervous about her getting sleep knowing that she was the one heading into the sleepless newborn days that I would just like bury my face in the pillow and like try to moan as quietly as possible so that she could sleep. I really didn’t want to know how uncomfortable I was, and I would like to occasionally get up and walk the halls, I just tried to be so quiet to let her sleep. So the balloon came out in the morning, and it had done perfect work, and you know the cramping and combination my body was totally ready and we were so excited that okay let’s, You know, let’s do this. 

So the balloon came out at seven or 730 in the morning on the 14, and they started me on Pitocin and the next step, knowing my birth history with my son how quickly I started you know strongly laboring after my Waterbrook was to break my water at some point. So the balloon came out I was actually pretty comfortable they started me on Pitocin I, you know we had some breakfast and then. It’s so funny I tell people write down their birth stories and I’ve already forgotten the details I’ll have to go back and love. Think they broke my water around 10:30am And the next contraction was a doozy. And then when my eyes just getting wide and like, oh, okay, I remember this, You know it got it got really intense really quickly. And I was thinking I was head on into it thinking I would probably get an epidural because I really wanted to be present for the birth, you know, and not to say if you don’t have an epidural, you can’t be present but having attended many, many births by now, there’s this look of a, if you look at birth photos you know on any blog, or social media, there’s this most unmedicated women who have their, their heads are back in the pillow, there’s a baby and they’re just kind of you can tell they’re just so relieved that it’s done physically so focused that it’s, I think the, the, a lot of women report they don’t really remember the baby necessarily coming out because they were you know so immersed in in the labor, so I knew I really wanted to be very present for that and I also didn’t want my, my friend to be worried about me like focused I don’t want her to be worried, focused on my discomfort I want her to midwife me I wanted her to just be a mom in the room, and focused on that baby coming out and if I was in the throes of unmedicated labor, you know, I knew that she would be more focused on me I didn’t want that for her or her husband, 

All of that being said now that I’ve experienced it. Regardless of wanting to be present for that moment when contractions started pretty early. I was like, Oh yeah, I’m going to get that epidural. So I did use laughing gas for quite a while, but it was so interesting that contractions felt so much different than I thought they would. So all of that now I talked to women a lot more like what did contractions feel like for you, because everyone I think feels them differently. My whole rim of my pelvis felt like it was going to explode, you know, It was just it was so filled in my abdomen, I felt like in my bones, it was just wild i i was just so thrown by it, and one of my best friends whose a labor delivery nurse, our sons are three weeks apart, she was my primary labor support and, you know, Just put her hands exactly where I needed them and the intended mom just said all the right things like we just have this seamless birth team it was, it was beautiful. 

And so my water broke I think around 1030 I’m so I’m so appalled. I don’t remember the time but I labor for a few hours and then I think I got the epidural around the 2pm, and it didn’t work for about an hour and so now to another level of empathy for patients when you’re just kind of can’t really move in the way that was working for you, but you’re still feeling pain it was so intense. And, and I remember the look on the intended mom’s face– she just felt so horrible, you know, like it was her fault or something and of course it wasn’t I just, I was trying to sort of grin and bear it like, I’m fine, but of course you can tell I was in a lot of discomfort, and I think for a lot of people, they might say the same thing that once you decide to get the epidural you probably actually wanted it like an hour before, so it feels so long until you’ve got that relief. It was finally got the relief. I did have the midwife who was on was busy and so I had my nurse. See how far dilated I was and I was nine and a half, like as soon as, so I had, I had labored quite quickly. And so our plan was I was going to get a nap because I had, you know unexpectedly been up all night, and I was going to send the parents out to get a breather, you know, and, you know, knowing they were going to meet their baby soon. And my friend said, oh, you know, you can start pushing even more not here and I texted her and I said, No, no, we’re not pushing for long. We’re not going to do this forever, We’re getting this baby out. So we started pushing at five o’clock and he was born into his mom’s hands at 545

P: Oh my god, that’s awesome….they don’t really know, muscular uterus.

A: Oh yes, yes, exactly. Yeah, that’s right I want to say that I was like, Do you remember how hard I’ve been training for this. We’re not doing this for a long, and again, so much empathy for women who do push for hours and hours and hours because I knew it would require everything in my body but again, until you’re in it you just have no idea how much effort it is to push the baby out, and I use the mirror because I was unfortunately very very numb with the epidural so I didn’t have that that rectal pressure that a lot of women experience, which I know is uncomfortable but I was kind of looking forward to that to help guide me. So without that I used, I used a mirror and that was a game changer so I know if women are offered that it can be, you know, it can be unnerving to see your reproductive system for lack of a better phrase or and your vagina, totally on display, but it’s so different when you’re focused you’re focused on that head right you’re not just looking at, oh how swollen are my labia or how bad are my hemorrhoids, it’s, it’s so motivating so something to consider if women are offered that by their nurse or their provider, a mirror really I think helped motivate you in guiding your forces, especially if you don’t have a lot of sensation of where to push.

P: So if you’re using the mirror because you can see the muscles tense and then you know the contraction,

A: I can see the head. No, I could see the head, like I could see where I was, I was pushing, when I was pushing quote unquote correctly, and when I wasn’t so I could just see his hair and I was like oh okay that’s the spot that’s the spot. And would tell myself like do that again do that again, because without that sensation it is so hard and I knew that for women who do have very dense epidurals, which is sometimes will try to turn them down or get them into other positions so that they can have more spontaneous sensation to push, but without that, you know, I saw I use the mirror and didn’t really need to feel that pressure because I could see him move and I would just remember like okay that’s your spot pushing that spot again.

P: So if you see him move then you know you’re doing it effectively. 

A: correct. And luckily he was nice and low before we started pushing apparently when I carry babies they hang out my pelvis super super low which is why my breech son would never turn because he was wedged in my pelvis and, and luckily he’s this baby started at a low stations ri My body had really helped to get down to where I can quickly see his head,

P: that’s super cool, I’ve never heard of the mirror before and I had awesome, I had two C sections and so I have no kind of experience 

A: Oh interesting, yeah, yeah, it’s something that a lot of patients are, they’re either totally for or totally not for, and I never push it on people but like if a woman’s been pushing for, you know, quite a while, the baby isn’t descending I’m like let’s just try it, and it’s crazy how often it can work really really well, because they just get that instantaneous feedback.

P: I would think for everyone who here feel very well have gardens, right, this is totally,

A: totally. And I, you know, I think people are just like, oh I don’t want to see all of that, staring right at my own vagina

P: a brief sidenote not here, I’m ending this conversation after I talked to him and listening to it again. I am a little bit surprised that women have a problem with the just comfort looking at your own anatomy seems like a learned behavior that is not serving us, so kudos to him for helping people with this.

A: tell them like it’s different, like you’re going to be focused on your baby, not, not your vagina, and, and it can work really well most women even if they didn’t think they want it, I find it very helpful

P: is super cool and so yes Warren and then does he do skin to skin with his mother.

A: Yeah so that was one of the first things that we talked about in the psychological screening was, you know, in the the psychologist that we talked with knew that we were both midwives and so she said you know this baby will not be my skin to skin with you, you won’t touch the baby, I said oh I absolutely I know that. And so there’s actually one of the nurses who’s in the room filmed the birth without us knowing, and she filmed it from like right behind my shoulder so you can really just see the intended parents which, you know, I watch it daily for a good cry, Because the Dad’s tearing up oh it’s so beautiful, until I’m getting, you know goosebumps just thinking about it, like knew the baby was not going to go to me, and I knew it was, I had such a different perspective on this pregnancy, you know I really sort of mentally trained like this is not your embryo, this is not your fetus. This is not your baby, and so I didn’t have that connection that I had with my son, you know, I, I knew I wouldn’t be inclined to reach down for him I didn’t feel like my baby ever, but he actually had the umbilical cord wrapped around his neck twice, which we didn’t expect because he didn’t show signs in his heart rate during labor which is usually how we kind of know an umbilical cord might be getting pinched somewhere. And so because of that, his mom needed to put him on my belly to unwrap the cord. You see my hands like fly up towards my head because I didn’t want her to think I was like no, no, no, he’s not supposed to be on me I was like kind of panicked, and she says like we’re just using you as a landing pad like don’t worry I knew that I wasn’t having this like, give me my baby you know I did. I just wanted to make it very clear that I was aware of where he was supposed to be but he went skinless he had a nice long umbilical cord so we could do delayed umbilical cord clamping but he could go skin to skin with his mom and oh it was magic. It was totally magic.

P: that sounds Awesome. That’s amazing. Well, I can’t even. I’m like the opposite of you and so in terms of birth and delivery and all that, literally, everything was hard or didn’t go right or whatever. And so I look at, but, but I look at people who are willing to be serious and I think like, I don’t even think you can imagine what you’re giving to someone else.

A: Yeah, and it was so enormous. And I think because it’s always been on my radar, I felt selfish like I get to do this you know I really, if anyone else did it, I would be you know is crazy and ever looks at me, the looks I’ve gotten. Okay, but, you know, one of the things when my husband I decided to separate I’m an age right. Don’t think I’ll probably have more children of my own, and I was sad not to be pregnant again I was sad not to try for a VBAC and experience labor and so, you know, selfishly, I was like, I need to do this like yes I know I do know I’m giving this family, this this couple, a huge gift but I felt like I really don’t. I went out to, because I got to experience and then I thought I would not get to again.

P: And the whole thing is amazing, I just, you know, in our case we had doctors who saved our child’s life, and I think, yeah, I think daily for sure. No idea how you change their lives, right. Yeah, absolutely. And the same is true for you though because it’s not only have you changed your sister midwives live and her husband, and that baby but everyone a baby touches, right, like,

A: yeah grandparent Yeah,

P: right. It’s just a million people.

A: Now that’s a good point that’s probably where I’ve been the most touched is, is there, the parents, families or friends reaching out to me and saying like you have no idea, it’s like, oh yeah you do forget that ripple effect like this little boy is in so many people’s lives. It’s not just them but that’s a great point because that is that is probably where I was most overwhelmed by my love is, is the love I received not from them but from other people around them who, who were so excited as well. 

P: That’s amazing. That’s so awesome, thank you so much for sharing both your story with your son and the surrogate story because they’re both amazing.

A: Thank you. It was, I feel so lucky and it is um, as a provider to now having been, you know, I say we just the introduction was good for me as a midwife to that I’ve experienced, you know spontaneously when then an injection into a vaginal birth and so it’s really, really ramped up on the view of the provider, just have this perspective that I would never give up and I’m so grateful for and talking to patients. That’s awesome. Yeah,

P: thanks so much for coming on and sharing your story