Episode 16 SN: The Challenges of a Reluctant Cervix: Stefanie
Today’s guest experienced both extremes of the spectrum when it came to creating a family: uncomplicated pregnancies that led up to more challenging births. She enjoyed an easy step into her first pregnancy and wrestled with infertility leading to her second. Both pregnancies were straightforward while both births, strayed from the script, injecting unwelcome drama. While labor more or less spontaneously arrived, her cervix refused to heed the call, and that led to births she didn’t anticipate, one after another. Importantly, both deliveries ended with healthy babies. Listen to how she navigates this uncertain terrain.
Amniotic sac
https://prenatalyogacenter.com/blog/everything-you-want-to-know-about-your-water-breaking/#:~:text=Did%20you%20know%20there%20are,end%20of%20pregnancy%20fused%20together.
https://pubmed.ncbi.nlm.nih.gov/25279443/
PCOS
https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473601/
Low amniotic fluid
https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/oligohydramnios-912/#:~:text=About%208%25%20of%20pregnant%20women,common%20during%20the%20last%20trimester.
Cervical dilation
https://rep.bioscientifica.com/view/journals/rep/134/2/1340327.xml
https://academic.oup.com/molehr/article/6/4/375/1087032
Audio Transcript
Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette kamenecka Today’s guest experienced both extremes of the spectrum when it came to creating a family: uncomplicated pregnancies that led up to more challenging births. She enjoyed an easy step into her first pregnancy and wrestled with infertility leading to her second. Both pregnancies were straightforward while both births, strayed from the script, injecting unwelcome drama. While labor more or less spontaneously arrived, her cervix refused to heed the call, and that led to births she didn’t anticipate, one after another. Importantly, both deliveries ended with healthy babies. Listen to how she navigates this challenging terrain.
After conversation, I added medical information in certain places, and also include the insights of a wonderful OB and from an anesthesiologist.
Let’s get to the story.
P: Hi, thanks so much for coming on the show, can you introduce yourself and tell us where you’re from.
Stephanie: Yes, so I’m Stephanie Hussein Ramadi and I am based in the UK, on the outskirts of London.
P: Lovely I’m wildly jealous…
S: Really?
P: And Stephanie. How many kids do you have,
S: I’ve got two boys, Five years old and 11 months 11 months.
P: Wow, yeah, yeah you’re busy.
S: Sure am.
P: And before you had the kids, I’m imagining that you had some idea about what pregnancy was like, what, what did you imagine it would be before you got there,
S: I just imagine a you get pregnant when you’re ready to get pregnant, you get pregnant and you know you have a smooth journey, pregnant for nine months but in fact is 10 months. And, you know, you go to the hospital, you have your baby healthy baby and somehow you just become a mom isn’t it, so that is how I visioned it be like, I was pregnant I didn’t read up on any other watching videos or read up on stories because I didn’t want anything distorting my thoughts about pregnancy
P: yeah, that’s fair. So let’s go back to the, let’s go back to the beginning that wasn’t easy to get pregnant.
S: So my first one, yes I got pregnant pretty much straightaway. And my second one, it took longer.
P: So, let’s go through the first one first then so you get pregnant easily, and then you find out with like a home kit. Yeah, yeah.
S: So I found that with like yeah home kit, yeah, that’s, I think that’s what everyone uses anyway.
P: Yeah,
S: I found that because probably about six weeks or so already, when I found out I had to sell I had like the sore boobs and stuff, but obviously I didn’t know if it was pregnancy or not, my first one, isn’t it.
P: Yeah, yeah
S: so yes I just took the test and straight away like literally immediately came up positive. Yes. Okay. Good.
P: That’s Awesome. And how was that pregnancy.
S: that pregnancy was good to get the pregnancy was good, I had no complications during the pregnancy, I didn’t really put on much weight I only had baby weight. My baby balm I was healthy moved around fine. Like, I still felt like myself basically. Yeah, and I think it got complicated when it came to delivery.
P: So what what happened there, were you imagining like a natural birth or what did you want.
S: so I plan to have a water birth. I’ve always had an obsession water birth. And then about just over about a week before I was June I felt like my water had broken. It wasn’t a Gush, but there was just constantly can basically. And after I put down a sanitary towel just to be sure, and it was getting soaked so quickly, so obviously I called the hospital to say this is what is going on. They advised me to come in. And when they did examine me they were like, Are you sure your water is breaking any evidence I had was the sanitary towels and they could see it was so. Yeah, and then eventually they said oh, might be one of your bags apparently we have two bags of water on there by that, but maybe it’s just one of them, that has leaked basically.
P: apparently, there are two layers to the amniotic sac. The amnion, the intersect is the one that holds the baby, and the chorion is the outer membrane. These two bags are in contact with each other. By the end of the pregnancy have likely fused, but it’s possible to have a leak or tear of the chorion, which can repair itself and not be considered quote a ruptured membrane, I found an academic article from 2015, suggesting that there’s a new way to talk about this false rupture of membranes and true rupture of membranes. If the leaking fluid, bears no evidence of vernix that biofilm that protects the baby’s skin in utero or meconium. It’s just the corium that has broken,
S: which then meant that I had to deliver sooner than expected. So I had to come back, I’ve got sent home, and then have to come back in the next morning to be induced…so that basically meant my water birth was out the window because when your water breaks, and it can be risky for the baby. And not only that they found that there was meconium as well. So he had pooed inside me so yeah that was basically it. Yeah, we have to get this baby out, so induced me said I can give birth naturally. So when I say, naturally, and vaginal birth. I don’t want people to feel like C section is not natural. So, um yeah so that process started. Unfortunately, I wasn’t dilating quick enough. And it gave me,
P: were you’re having contractions or anything like Did you feel anything else.
S: I had slight contractions, to meet other names my pain thresholds, but there was contractions, but it wasn’t like oh my god I need to give birth, like it wasn’t like the pain wasn’t intense, to me, but according to the monitor. It was quite intense but I’m guessing it was my pain threshold.
P: My recollection of contractions is like I just that I took my breath away, so it wasn’t super painful but I couldn’t talk.
S: No, I could talk I was talking with nurses at the time, this was just, just beginning though but towards the end when they introduced me and it was now like every five seconds, every minute, every time, that’s when I was like, oh my god, I was so much pain right now. And but I was still bearing I still kept it I still kept going because they obviously wanted me to dilate, they couldn’t deliver. I was having like two minutes, one minute contractions for, probably, maybe about seven hours.
P: Oh my god, wow,
S: I still dilated to about four centimeters in that amount of time. Exactly. Go through this pain and I wanted to go in with no colors I didn’t want any of that I just wanted gas and air gas and air where the work was making me feel sick, to be honest. And after a while my mom was like, No, you have to take some painkillers. This Pain is excruciating. Get some what’s it called again,
P: the epidural
S: epidural Yeah. Get some epidural, but by the time I got the epidural over the brain for so much pain I was just I was the point but I still took it anyways. Then it got to a stage or I know what your baby is now and distressed because you’ve just been in like this for too long.
P: Yeah,
S: your baby’s distress, his heart rate is dropping, we need to get this baby out so unfortunately for you. We have to do a C section because sometimes I really really strongly did not want. And I remember when they told me that I was literally in tears. I felt like my world was ending, not because it’s because I’ve never even thought about C section or even read about it, I just wanted a completely natural birth no painkillers and now you’re going to give me a C section,
P: yeah pretty much the opposite, right
S: Yeah, pretty much the opposite basically but basically you know, gave birth by an emergency C section, he did have an I did have to stay in hospital for about seven days, because he had suspected sepsis.
P: Oh wow.
S: Yeah, so they had to monitor him, but after the seven days, it cleared up, infection was gone. And yeah, and to be honest I haven’t had any other issues with him. Thank God for that. Yeah, healthy way, very active so definitely not the birth experience that I envisioned for myself.
P: How was your recovery from the C section.
S: It was really good I think. I’ve been thinking about it, I was a little weak my stitches were healed. As I was still able to lift my baby breastfeed him. I didn’t have issues. I wasn’t moving as much, but I was still moving like people couldn’t tell that I even had a C section because I was still able to move around, do what I needed to do, and I was blessed that entire because my mom was around with me so I didn’t have to do as much on my own. But I had a blessed speedy C section recovery. Back to my feet in no time.
P: that’s awesome.
S: Yeah, I remember at the hospital as well. Oh, That was another thing, when they did the C section, I lost a lot of blood. I am quite, I have low iron as well. So, another blow was they were telling me I need to, I might have to have a blood transfusion…what on earth is going on, but because of how active I was in the hospital I was able to go take my shower walk up and down there like to really see don’t look like someone who has lost a lot of blood that is low on iron, and if you do that you can maintain it, by taking the tablets, then we’re happy to discharge without having the transfusions, I was like no, there’s no way I’m going to have a transfusion. Like you can’t add any more to my plate.
P: Yeah, yeah. So how is it taking care of the baby and how long does your mom stay like do you have help?
S: My mom was with me for about a month, ideally at least like 10 minutes away from me, but she stayed physically with me for two weeks. Right. And then she came every day. Mom home, and after she left my mother in law actually came so the way our culture works is you know when you give, have that help. That’s you know, if you’re lucky to have your parents alive or close by. Yeah, yeah.
P: So when you say your culture does this, what does that mean.
S: So, I am originally Nigerian so I’m born British but my parents and my husband’s family in Nigerian as well. So in the Nigerian culture when you give birth, your mother or your mother in law, usually stay with you, for… back in Nigeria, they still review for about three months. But, yeah, and you’re not supposed to do anything so it’s for you to get healthy, get back on your feet, and just support you raising your child if your parents are not alive and you have an older sister. Then she usually does it for you. They would come for maybe like four to six weeks, and stay with you in your home until you know you have recovered, and you know, babies well and so yeah, that’s, that’s what I meant by in our culture so as soon as you give birth, you have that support with you, like they already know that’s what they’re meant to do.
P: That’s amazing.
S: it’s a bit more difficult here in the UK because in the UK. Our parents are working as well. So yeah, it can’t stay with us as long as we would like, but they try to stay for at least the first two weeks, or first month even.
P: That’s amazing. Wow.
S: Yeah, I would say for about six months straight I had health, which was good, especially you know, after having a C section being your first child as well.
P: You just don’t know what’s going on right so useful to have someone who does… my husband and I were just saying how postpartum care in the US is really meager. It’s like your first appointment is at six weeks and if you’re not lucky enough to live with near your family or have family living with you like people like your mom and your mother in law who know what to do. Yeah, it’s a really hard road to travel by yourself, right or like as new parents.
S: Yeah, it’s something that mums over here, who are struggling, we get seen, I think, day after you go home, so we get help to come to your house and in 10 days after as well. But after that once you’re discharged from the Health Visiting team, it can be lonely a lot and a lot of moms struggle with their babies is really a big it’s something that really needs to be implemented. I’m sure in the US and UK as well aftercare for months. Yeah, it’s so important.
P: Agreed. So it sounds like you were, you had a pretty smooth fourth trimester because you have people to tell you oh yeah, you’re doing it right or you’re doing it wrong or whatever.
S:Yeah.
P: Yeah. That sounds lovely was nice. It was nice,
S: but I do remember the beginning I was like, I just want my baby like just give me my baby basically is like. They weren’t feeding him, I was I was basically just you know, the milk factory, when he’s hungry they’ll bring it over to me once it’s fed, they will take over. I remember the first time I had a conversation with my husband like, I just want my baby basically like, why, but now that I look here, I am so grateful I had that support.
P: Yeah, yeah, I can totally I can totally imagine that feeling where you’re like, don’t I get to hold them. Right. So what’s your five year old into now
S: he’s at school right now…he’s super active he’s very into video games, which he gets from his father. Yeah, he’s really into video games right now and today was like his birthday back at school actually since
P: oh wow, yeah. That’s exciting. So tell us about your second one, what was that like?
S: my second one. But he, yeah it was difficult getting pregnant with him. So before him, I was actually pregnant, but I had a miscarriage, about six weeks…before I even got pregnant. I actually had an appointment with my doctor, just to check, you know that everything is right, and I had a scan and they told me that I had PCOS
P: PCOS or polycystic ovarian syndrome is a hormone disorder The egg might not develop as it should, or it might not get released during the menstrual periods like it should. That’s the problems with fertility. How common is it in the US, the Department of Health and Human Services is five to 10% of women between ages 15 and 44. Many women notice it when they try to get pregnant and have trouble.
S: And they were like, how did you get pregnant with your first child I was like, I had no issues literally within three months of trying to get pregnant,
P: did you not realize you had PCOS, did you not have any symptoms
S: not at all, because they were like people that usually have PCOS they usually put on weight quite easily, and then put on weight at all. Yeah, come up with them, they’re usually quite hairy as well and I didn’t have any of the typical symptoms so it’s literally when I went into get checked to say, you know, why is it taking me so long to get pregnant this time that they advise I go and do the scan and they saw that basically, even when I was pregnant with my first child, I had, there was nothing mentioned to me about PCOS I had several scans was nothing mentioned to me about that.
P: Yeah, that’s interesting. I wonder what that’s about. Dr. Wilcox thanks so much for coming on the show, it’s great to have your medical insights.
Dr. Wilcox: Well, happy to be here.
P: So after the birth of her first child Stephanie and her husband had trouble getting pregnant again. After scanning her doctor’s office they diagnosed PCOS. Is it unusual to find this out after getting pregnant so easily the first time.
Dr. W: Yeah, I mean, so polycystic ovarian syndrome, you know, can affect up to eight or 10% of women in her case I would say there’s different criteria for diagnosing it, so it may have just gone undiagnosed one criteria one part of the criteria can be the appearance of your ovaries on ultrasound, if they’ve looked polycystic in appearance, but a certain percentage women will have polycystic appearing ultrasounds. Ovaries on ultrasound and not have polycystic ovarian syndrome. So you really have to meet the most criteria for it, there’s two or three different commonly used criteria, you generally have to have irregular periods or evidence that you’re not ovulating regularly. So if someone has regular cycles, monthly cycles, but their ovaries appear polycystic on on ultrasound, I would say that probably is not meets the definition that sort of depends on what her situation was. Certainly if she is not ovulating regularly that can make it challenging to get pregnant, and that’s something that, that would be explored. If someone was having a hard time getting pregnant,
S: exactly. So, I was like okay, so that gave me the option of, you know, I have a keep on trying to dollar been trying for over a year, or I can go through the fertility treatment, right, because they’re like because you’ve already had a first child, you can just keep on trying, or go through this route and I said you know I’ve tried long enough, so let’s go down, down, fertility route and then they gave me an appointment which was about six months, I think it took about six of the appointment for six months. And literally, a month before the appointment I fell pregnant.
P: Ah,
S: and I literally have to call them and say, Okay, I’m pregnant, I didn’t need this equipment anymore, so so grateful for that.
P: That’s the way to do it.
S: So, the pregnancy itself was fine, I obviously still battle, I still battle with my low iron, when I’m pregnant, so I had to be on Iron tabs which was, for me, I don’t think they were working because even though I still got tested Every time I still got my blood tested my iron levels were still low. Well, we still went through the pregnancy the pregnancy was fine. I had no complications. Once again, smooth pregnancy, and then complication came when it was time I’m trying to think when the turning point was what actually happened. This was all during lockdown as well COVID period,
P: I hadn’t thought of that you’re right, a lot of dances in COVID Wow. Was it hard to be pregnant and COVID
S: so it was just starting so I gave birth to my son in March and COVID was just starting in March, okay. And at that time, there was still not allowing partners go into the hospital, you only have to go to your appointments yourself. Yeah, so I had just a routine scan. And when I went into the scan they told me I don’t have enough water around the baby, and they needed to do some more checks and so that’s how I ended up from going for routine scans, Then in the hospital overnight, and them telling me, you know, we’re going to don’t have enough water around a baby, so we have to deliver this child. And I went in as well so you know I want to try natural again so it was called VBAC. I don’t know if it’s cool yeah yeah,
P: so how far along, were you,
S: three days off…Yes, yeah. So a week before I was supposed to go in . So, yeah, So they said to me, we have to deliver this child because you don’t have enough water around him basically,
P: about 8% of women experience low amniotic fluid, if it’s low enough, it’s called oligohydramnios, which is less common, how you manage the situation depends on a bunch of things like its severity what caused it. That gestational age of the fetus, a bunch of different things can cause it like issues with the fetal kidneys, an issue with the placenta or leaking or ruptured membranes.
S: And I said okay on hold my husband, let him know what’s going on because I was on my own. Yeah, and like the next morning we’re going to induce you once again to already knew what this induced process is because that’s what I had with my first son, is that
P: basically like Pitocin or like,
S: yes, yeah, that liquid to make him attract quicker. And so they did. And once again, I had the same issues that I had with my first son was delayed dilation, yeah I was contracting, but I wasn’t dilating and they said, You know what, after about quite a while maybe like nine hours, says, Hey, I think we’re gonna have to do a C section with a let’s wait for a little bit waited for a little bit. And then notice, heart rate was not was not steady, There wasn’t quite sure what it was but they just knew it wasn’t steady so they said okay we’re gonna take it to theater, and we’re going to deliver this baby by C section, this time I was okay with a they already told me the risk because I’ve had a C section before I might actually have to end up having another one.
P: Yeah,
S: I was already aware I was more aware this time. Yeah, so it got to the root the beauty now and they say you know what your scar is starting to open up and we can see his fist poking through so that explains why his heart has been fluctuate it hasn’t been steady and when that happens, they literally have to get this child out within four minutes, but I didn’t know when they put me on GM general general anaesthetic and I was knocked out, I woke up and had a baby,
P: we I need to take a minute here, is that shocking, did you feel him like did your scar hurt or anything.
S: Well I just have epidural, to be honest so maybe that might be why. I didn’t see it myself personally, it’s only when they, when I got into theater, they’re getting ready to do what they need to do. And straightaway, they’re like, your scar is open up. That was one of the risks they warned me about as well. Early days when I said I wanted to have a be back though like there’s a risk there is a low percentage, yeah, yeah, there is a risk that your scar can open up again.
P: Also, kind of surprising since your older one is five years ahead of the younger one, right.
S: So I think it’s probably because of the prolonged delivery so in terms of me dilates me to pressure, yeah, I forgot the name of the delfy was having on my body for such a long time. He was just an active baby he wanted to get out of that, how come I really. So I think that was what actually affected it, that’s what made it actually open up as my pregnancy my scar was fine. It’s never opened up there’s no literally was no issues,
P: so uterine rupture after a Previous section is rare, but it happens in 1% of cases. Let’s hear what Dr. Wilcox has to say about it.
Dr. W: the risk with a vaginal birth after cesarean or sometimes we call it a vaginal trial of labor so if someone’s had a prior cesarean section. The incision on the uterus, where, during the C section where the baby is delivered through is repaired with suture and then heals over time, the concern and we know about 1% One in a 100 women undergoing a national child labor that that scar can break open the forces of labor and that that part of the uterus is a thinner part of that, muscular wall of the uterus. So that’s the danger, and why, they are they’re monitored very carefully. And fortunately, most of the time, the scar is okay but if there has been a rupture, whatever presenting part is down there, whether it’s the head the hands, the placenta is going to be coming through that, that bar and it can be it can be obviously very dangerous there can be cases where babies have died or and or and also that the uterus can get quite damaged because that, that scar can extend into the sides, it can tear into the sides of the uterus where the blood vessels are, and there are cases where certainly where women need to emergency hysterectomy, Just to control the bleeding. So while it’s a rare event, one in a 100 and the risk of a significant damage to baby is about one in 1000 it can be quite dramatic when it happens. So that’s, that’s why, you know, we’re always very careful with monitoring labor.
P: wow
Dr. W: Yeah,
P: and there’s no way to, obviously, even with ultrasound determine like the strain
on the recovered area
Dr. W: Yeah, they’ve done studies looking at that trying to measure the thickness of that area hasn’t that hasn’t provided useful information. Unfortunately, there certainly are women, you know, to be a candidate to be a safe candidate you have to have what’s called a low transverse incision on the uterus which is the typical type for a C section, but But yeah, in terms of being able to predict who might rupture of that 1% is, is challenging, and our most sensitive measure that that might be happening, is how the baby looks and that’s why there’s, you know, you have to have a dedicated anesthesiologist on the unit you because you need if you think that’s happening you move extremely fast.
P: That’s kind of a testament to how powerful contractions are
Dr. W: absolutely, yeah.
S: Yeah, so that’s how in two minutes, they delivered him, he was fine, according to my notes he didn’t brave straightaway so they had to actually take him to a a special unit
P: Yeah, like the NICU, or something.
S: Yes. Yeah, and child intensive care unit, and it was fine. I was fine as well. And, literally the next day we were discharged from the hospital because he had no issues, and well so there was no issues then you can go home.
P: were you vying to go home, did you want to go
S: I wanted to go home. Yes, I do want to another week in the hospital like I did in my first, honestly,
P: I want you to stay but okay, I’m really nervous.
S: Yeah, I went home the next day, I was discharged. Oh yeah, I missed a part, so I woke up and I found that I just saw a baby next to me, that oh my gosh I’ve had their baby. I was knocked out, it was an I think they said I’ve been sleeping for probably about six hours before I woke up to find a baby literally next to me on the beds.
P: Wow.
S: Yeah, it was quite it was quite an emotional experience basically for him.
P: No kidding, what, how big was he,
S: he was about three kg.
P: For those of us, actively avoiding the metric system three kgs is in the neighborhood of six and a half pounds.
S: Now, they were just a little bit smaller than my….he was 2.87 kg. And my first was 3.02 kgs so he was just a little bit smaller. Yeah, he is fine and is growing well you know eats very well his health be haven’t had to touch with any complications or any reasons to go to the hospital or anything like that.
P: Was your partner in the room with you when he was born,
S: because they I had to go into theater he couldn’t come in, and no one was allowed in the theater so I was on my own, until he was born, and he was able to come into the wards, not the theater room.
P: this sounds scary. Were you scared that he didn’t have time for that or.
S: Initially I wasn’t scared because I just felt like it was just another C section procedure. Yeah, I think it’s only when I got in there and they said to me, baby needs to come out and literally like right now. Sweat It really hit home that oh my gosh I hope he’s okay like my emotions were running, running through my head but I didn’t have enough time to even raise emotions because they gave me this, the general anaesthetic and I was literally knocked out. It wasn’t any plan to have a general anaesthetic.
P: Yeah, yeah
S: it was just you know I’ve had a digital we’re just going to get the baby out done. When this happened, they said, Oh, we have to give you this. I didn’t ask any questions so I’m just I just want the baby to be okay.
P: Well also like what do you what are you gonna say no, like,
S: exactly.
P: You don’t really have much to stand on.
S: Yeah, exactly. I didn’t ask any questions. It was just we’re gonna give you this, and that was the that was the last conversation. I remember having I remember hearing in the theater room as well,
P: I brought this question about anesthesia to an anesthesiologist, Dr. Tammy Euliano who practices in Florida. Dr Euliano, if Stephanie already had an epidural Why did she also need general anesthesia for this surgery.
Dr. Euliano: So there’s two different things we do with epidurals one is what’s called analgesia, which is reducing your pain but not to a level where you could do surgery, and then anesthesia which is complete lack of sensation, and so usually we can convert an epidural for analgesia, which is just less drug really for anesthesia for surgery but it takes a few minutes, and in that case of a uterine rupture, you don’t have a few minutes at the time the baby’s going to be decelerating and there’s a risk that the rupture gets worse and possibly even includes a blood vessel of mom that could make her hemorrhage. So, when it’s a presumed uterine rupture the vast majority of them go to sleep.
S: yeah, It was, I was just grateful that you know he was healthy, he came out well, you know, he had no complications. But Just put me I just thought you know what am I ever gonna have like a normal pregnancy that people just get pregnant, their waters gush, you know, we have great give back. But, at this rate.
P: I mean, it sort of shows you that like for the, you know for every step of the way, there’s so many things that have to be coordinated to make the pregnancy work correctly and you know to get pregnant, a whole bunch of things have to happen at the same time and in the right order and in the right way. And that’s true during pregnancy and in the birth, because clearly you can have contractions, but like there’s some coordination issue with the cervix or whatever, like there’s so many things that have to be working in concert like I, every single person I talked to I think How is anybody born ever anywhere and walking around
S: exactly I’m like, when people told me their birth stories, you know, I just walked up the stairs next thing you know, baby was ready to come like, get my cervix to open up.
P: Yeah, yeah
S: my pregnancy was like so straightforward, all through the nine months so is that is the disconnect. Yeah, where does that come into it.
P: although The time for cervix to shine is often a birth. A lot is happening to the cervix over the length of the pregnancy as the lower part of the uterus, its function in pregnancy is to lend a mucousy helping hand to sperm wanting to enter the fallopian tubes. It acts as a barrier to pathogens between uterus and vagina during pregnancy and during most of those nine months, it must maintain a certain degree of firmness, but then has to soften at a hurry and open for birth. This opening part seems like it’s just happening during labor but preparations for that spotlight event, start early in the pregnancy. When certain hormones that help with softening or in rich supply that remodeling process move slowly until the birth, at which point rapid changes have to happen cervix has to dilate from the size of a blueberry to the size of a bagel, the chemical cascade at birth includes hormones and immune cells entering at the right times in the right frequency in conjunction with contractions, which have their own chemistry, it’s complicated when you dig into the details, feels a little like magic.
Yeah, that’s one of the bummer of it right is that everything else has been so kind of according to plan.
S: Exactly
P: that it’s hard at the end. So if you could give advice to your younger self, what do you think you would tell her
S: I would still stick with it, read the stories just you know, the process, because that alone can get you over thinking so I’m so glad I didn’t do that, my younger self is, I think everyone’s pregnancy is different. That’s why, all my friends actually everyone’s pregnancy is different, like, is actually okay if you don’t have a normal pregnancy I think that’s actually normal not to have a normal you know fairytale, ideal I do see that you know where envision believe that everyone’s process is different just because this person was able to give back within 10 minutes, doesn’t mean that you are also going to be able to get back within 10 minutes, you know
P: yeah, that’s really smart, it’s hard not to compare but your main point is don’t compare because it’s exactly right.
S: Exactly, everyone’s story is different. And I think that’s why I say don’t read up too much as well because when you beat up you set yourself such a high expectation, that when you don’t meet that expectation you start worrying you start panicking and that’s where sometimes postpartum depression can creep in as well, and prenatal depression, because you just have this expectation unless there’s something…. being your baby and kick today and all of a sudden you feel like we were just going through it and that’s what worked for me and think we read Google is not offering we think is offering specific things is no offering.
P: No, I agree the comparison doesn’t help. That’s totally well Stephanie thanks so much for coming on and sharing your story, it’s super interesting story and I’m glad for people to hear it.
S: Thank you for having me. My pleasure.
P: So much to Dr. Wilcox and Dr Euliano for walking us through some of the medical issues that came up here. Thanks also so much to Stephanie for sharing her story, and thank you for listening. If you liked this episode, feel free to like and subscribe. And if you want to share your story, go to war stories room.com and sign up. We’ll be back soon with another episode that examines the challenges and revels of the triumph that comes with this complicated process of becoming a parent.
Episode 15: Recipe for Happiness: Check Your Expectations at the Door of L&D: Tabitha
Episode 15 SN: Recipe for Happiness: Check your Expectations at the Door to L&D: Tabitha
Our ability to delay pregnancy through various forms of birth control may lead us all to have expectations about our ability to manage our own fertility. It’s one thing to stop pregnancy, and something altogether different to initiate it. Today’s guest, a fan of control like the rest of us, is a master planner. She planned to get pregnant quickly, have an enjoyable pregnancy, and a routine birth. But the birth refused to follow the birth plan. Pregnancy is, among other things, an educator, teaching hard and often valuable lessons. All the events of that first birth helped to broaden her expectations in her pursuit of a second child, and as a consequence, she and her partner were able to create amazing birth memories the second time around.
Acupuncture to regulate menstrual cycle
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962314/
Melasma
https://www.whattoexpect.com/pregnancy/symptoms-and-solutions/melasma-mask-of-pregnancy/
Water breaks before labor starts
https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142
https://www.ncbi.nlm.nih.gov/books/NBK532888/
Mode of delivery and microbiome
https://www.embopress.org/doi/full/10.15252/embr.201643483
Audio Transcipt
Paulette: Hi, welcome to war stories from the Womb. I’m your host Paulette Kamenecka. Our ability to delay pregnancy through various forms of birth control may lead us all to have expectations, our ability to manage our own fertility. It’s one thing to stop pregnancy and something altogether different to initiate it. Today’s guest, a fan of control like the rest of us is a master planner. She planned to get pregnant quickly she planned to have an enjoyable pregnancy and she planned a routine birth, but the birth refused to follow the plan. Pregnancy is, among other things, an educator teaching hard and often valuable lessons, all the events of that first birth, helped to broaden her expectations in her pursuit of a second child. As a consequence, she and her partner we will create amazing birth memories, the second time around. After our conversation, I went back into the interview to add some details about some of the issues we discussed. I also, for the first time ever, have the insights of an awesome anesthesiologist, who answered some questions, I’m guessing we all have.
Let’s get to the interview.
Hi, thanks so much for coming on. Can you tell us your name and where you’re from.
Tabitha: Hi yeah thank you so much for having me. I am Tabitha, and I live up here in Alaska, and I am born and raised. So I’m 100%, authentic.
P: wow, what is it like there right now is it, are you covered in snow or
T: definitely covered in snow, but I have to say it’s like a balmy 20 above today.
P: Yeah, only the locals would call that balmy is my guess,
T: well since you’re in California yesterday is still cold for you but that’s more than for us for sure because this time of year it’s actually not uncommon for it to be 40 below 0
P: Oh, my good lord. Wow. You just established yourself as someone who’s tough so we can go.
T: Well thank you yeah…I think you have to be to live here for
P: I’m sure, no kidding. So how many kids do you have,
T: I have two kids, a five year old son, and two, almost three year old daughter.
P: That’s a fun age,
T: so much fun. Yeah,
P: so before you had kids, maybe you were thinking about getting pregnant. What did you imagine pregnancy would be like,
T: Well, the first thing that I thought is that it would be easy, because from all of your high school sex ed lessons they pretty much say, if you have sex you will get pregnant.
P: Yeah,
T: so I had no idea that getting pregnant is a thing and that there’s only a small window of time during the entire month, when you have a chance. My husband and I originally didn’t want children, and I just always thought that I’d be a career woman.
P: Yeah,
T: and it’d be kind of dual income and we could travel the world and all of those things, but then when it was Christmas, and my parents came to visit. I was suddenly so sad because I was like Christmas isn’t the same without children.
P: Yeah
T: and then I got really bummed out because I was like not even my parents won’t even be here forever and I decided that day was like, I need to be pregnant now. My poor husband was like wait what? But then I just I was so excited to be pregnant, and then I was so frustrated that it wasn’t something that happened instantaneously and like the more I looked into it, the harder it seemed.
P: Yeah,
T: so that was, that was an interesting introduction that was totally unexpected.
P: So, it sounds like maybe you guys had some trouble or what was your experience getting pregnant.
T: Well I had been on birth control for a very very long time, and luckily I had gotten off of hormonal birth control, a year prior. And I hadn’t had my cycle for an entire year and like that would have been incredibly frustrating if we were trying to conceive.
P: Yeah
T: because I always assumed it was just like you get off the pill and then you can conceive, but I was still having long cycles, so my cycle is about 60 days, so we only had a shot, about every other month, and I, I’m kind of the Type A like I just wanted to get it done, I want it now and, I was trying to track ovulation and doing all of that but that was a little tricky because I didn’t have a typical cycle, we did you know quote unquote try for six months, but we only had three shots, and I was doing acupuncture to regulate my cycle which I think help.
P: So that’s pretty interesting acupuncture to regulate your cycle. When I went to look it up, I found a number of articles that suggest it can be helpful, but we don’t fully understand how it’s helping another thing to add is that most of the studies I saw focused on women with PCOS, which is not tariff issue. And I was tracking ovulation and
T: so it’s kind of funny because I went like zero to 60 I was like doing all the things that a lot of couples don’t do until they’ve been like, trying to conceive for a year. Let’s make this happen. I’m gonna control every factor that I can, which doesn’t really isn’t really much was my first introduction to pregnancy and motherhood really
P: yeah
T: so yeah we weren’t trying for long, but it definitely did give me a huge sense of empathy for these couples that I hear of who tried for years.
P: Yeah,
T: I had a small glimmer into that world and I do, it’s tough.
P: I think it is, I think you’re right, we’re all fed a steady diet of, it’s so easy to get pregnant, be careful. Which seems just silly like I think you should just give kids the, the real information. I don’t think it’s realistic to imagine that teenagers won’t ever have sex, but I think it would be good for them to know, you know when they’re at greatest risk. Anyway, so you guys get pregnant on that how is it after that
T: the beginning wasn’t too bad, and I loved being pregnant, I’m actually, I’m somebody who’s always carried my weight in the middle and I just always hated my belly, but then being pregnant I mean we’re talking like two weeks in and you know you’re just bloated you’re not actually showing I was like, All the maternity clothes like that little baby that was like my favorite thing. I was super lucky that I love being pregnant I had toward the end, I had some struggles with heartburn. That was probably my biggest issue but I was super fortunate and you know, this was, I mean almost six years ago now, so maybe I’m just remembering the good things to be totally transparent, but
P: yeah,
T: our son was due in September and so I really loved that I was able to get out and walk even toward the bitter end, which is a sharp contrast to our daughter who was born in February and here in Alaska, it’s very icy I didn’t feel like I was able to get out as much.
P: Yeah,
T: I just really loved getting out getting sun, though I did have the dark spots on my face.
P: Yeah, that was talking about melasma, aka the mask of pregnancy, and it’s caused by higher levels of estrogen and progesterone, which increased melanin production. I link to an article in the show notes about ways to handle it if it bothers you, but it sounds like it fades after delivery or sometimes after breastfeeding.
T: But that was worse because I was getting so much sun because I was outside walking, As much as I could.
P: Yeah,
T: you know I was a little queasy during the first trimester, but I mean I was like that classic obnoxious woman who takes a picture every single week and looks up all of the baby development and I did kind of this graphically designed photo of me with all the information about how I was feeling how my husband and I were doing how the baby was developing the first child, let me be clear that did not happen with the second, but I did love being pregnant.
P: That’s awesome. Honestly, it’s good to hear a story like that because it mostly sounds like a myth, so it’s nice to have a real person who actually enjoyed it and it was pretty So, why don’t you take us to the, the labor like how did all that started your water break or what happened, how did that work.
T: yeah, so I feel like in every story that I hear about you know trying to conceive pregnancy and then labor and delivery. I just always remind myself that nobody makes it through unscathed, you know if you hear about someone who has an amazing pregnancy, maybe it took them years to conceive or maybe they had a horrendous labor and delivery just nobody gets it easy the whole way through. So I feel like I was super lucky that I had a pretty easy pregnancy, but I didn’t get that labor and delivery that I wanted. I was also I was expecting to go into labor late I wanted that mindset and that expectation, because my mom was late with my brother and I and I just heard so many moms, expecting their baby to arrive on their due date and then being so frustrated at the bitter end just like every day lasts an eternity because they’re just waiting for their baby to come and so I just really put my mind two weeks after the due date. So of course, as my first introduction to motherhood, Our son arrived a week early.
P: oh wow
T: To me it felt like he was like three weeks early. So, it was literally the day of 39 weeks. My water broke at about two in the morning and it was a gush, and I was like, wow, what is this. Yeah, And my husband was sleeping and at the time, we lived only five minutes from the hospital, and I was having no contractions yet. And I originally had wanted to labor at home as long as possible, but I had tested positive for Group B strep.
P: Yeah,
T: so I had to go to the hospital, in order to get the intravenous antibiotics within, you know, I mean not like rushed to the hospital but you kind of have to get there. Once your water breaks, and I was really disappointed that my water broke. I mean before any contractions, it was the very first thing so I didn’t get to labor at home, at all. And my husband is a really heavy sleeper and also really irritable, shall we say when he gets waken up so we live five minutes from the hospital I was like, I woke him up and let him know but I was like I’m just gonna drive myself to the hospital, make sure that this is actually amniotic fluid make sure yeah I am in labor. And so I got to the hospital and checked in and everything, and they confirmed that it was amniotic fluid. I wasn’t dilated at all like, not effaced, least everything was thick, I mean, none of the other factors of labor had happened yet,
P: if your water breaks before labor or contraction start, it’s called pre labor rupture of membranes, or prom. It happens in roughly 8% of pregnancies. In most cases the cause of prom is unknown, the longer it takes for labor to start the greater your chance of infection.
T: and so the nurses kind of got me checked in and everything and they kept telling me, like from my doctor that I should start Pitocin to induce the contractions, and I kept putting them off, I was like oh, we’ll just wait for my husband to get here. I was just really hoping for a miracle and just hoping that my body would kick in and that naturally I could have the contractions and everything without having to do the Pitocin. I originally wanted all natural, labor and delivery and so I did not want to start the negative cascade of interventions by starting with Pitocin, which I had been, I read a ton and I had a very thorough birth plan. And while I think it’s wonderful to be very well informed and know what your decisions are I clung to that as things that I thought I could control, that I could not necessarily control and so I had set up a expectation that it really was highly unlikely that it would have been met. And so that really caused a lot of anxiety and stress for me throughout the entire thing, which ironically will cause problems or delay your labor.
P: You mean because you were stressed.
T: Yeah, yep, I felt like that was, that probably wasn’t helping and then that my mind was just kind of in a negative place and I was so frustrated and to be honest I was mad that I was being told to start Pitocin and then I felt like I didn’t have a choice.
P: were they doing that because of the GBS issue.
T: Yes, because they were saying that I had to deliver the baby within 24 hours I think it was,
P: yeah.
T: And, and so they wanted to do the Pitocin to give me a chance to have enough time to labor to have the baby to have the baby within that 24 hour window.
P: Okay,
T: so I was just hoping that my body would kick in and do everything in time on its own. And so my doctor I kept putting off the nurses and then the doctor came in and finally told me herself and then she, I was like okay we’ll start really slow. And then I all of a sudden was like really anxious because my husband wasn’t there and so I had texted him like okay, you need to be here now thinking, we just live five minutes away. And so he didn’t get my text because he was in the shower so he’d been trying to like arrange his work he was gonna hop through the shower and then he was gonna bring my bags with him later. Anyways, I was a little perturbed. When he arrived because I had wanted him to be there. So I would recommend probably going to the hospital with your husband and not trying to be quite as independent as I was. But he got there, and then I had also wanted my breast pump to be able to naturally induce labor and he’d forgotten that. And again, we’re only five minutes away so I made him go get it, but gosh I was just, I have to say I’m sure I was like that. Angry. Angry laboring woman and it also didn’t help that I felt really judged by the nurses because they were like, Is your husband coming and I’m like, okay, he’s not a deadbeat dad he just, I told him not to come yet, so leave me alone, kind of. So yes, I was really angry and then as the contractions got stronger and stronger. I was so angry and sad. And then they told me that, or baby wasn’t getting enough oxygen. And because I was on Pitocin I also had to have a any sort of I guess intervention. They put a blood pressure cuff on me, so I felt like, Oh and I wasn’t able to move around because I had the blood pressure cuff and because I had the oxygen mask and I couldn’t even really position myself comfortably. So I was laying on my side and I just felt like a pinned animal like just strapped to the bed, not able to move. And when a contraction wave would hit me I would rip off my mask whip off the blood pressure cuff and like that was, I couldn’t have the blood pressure cuff squeezing my arm, in addition to the contractions squeezing the rest of my body like it was, it really felt like pure torture, and then My poor husband like didn’t know what to do. And then of course he did the worst thing that even they told us in the birth class is not to do, like, kind of narrate the contractions like Oh that one wasn’t so bad.
P: oh good lord, oh man…
T: I will murder me.
P: I mean, for better or worse, it’s very hard to express accurately what the pain is like,
T: well I totally agree. I think he was just trying, he didn’t know what to say. And so he was like grasping at things like trying to comfort me. And it was even hard for me because I remember I was holding his hand, but I did not want to be touched, so I was like holding his hand out for my body.
P: Yeah
T: I wanted to hold on to him but I didn’t want my arm touching me and I didn’t want him touching me. And so, our son was our baby was in distress and so the next thing that they did was an internal, monitor, and again this is on the list of things that I didn’t want, but it appeared to not be optional, you know, there were the baby was having low oxygen and the an irregular heartbeat, and so the doctor has her like arm up trying to touch the baby’s head to put the monitor on my uterus and the nurse was struggling to open the package and it felt like an eternity that she was like, struggling to open the package to hand to the doctor.
P: Yeah.
T: Enter homicidal laboring woman again. And then, when the doctor went to put it in. It slipped back out so it didn’t take so then we had to do it again. And then, after we had that in for just a little bit. The doctor was like, we need to do a C section. And I was like, Is there any way you can give me any more time and she was like, 30 minutes. And so I labored for 30 more minutes. And then I was only five centimeters.
P: Yeah,
T: and I was wheeled to the C section, the O R.
P: Yeah,
T: the operating room, and, like, this is really where my negativity and anger. You know, started to reach its full potential. Then I was you know they’re trying to do the epidural and the anesthesiologist is like hold still and I’m like, I’m having contractions, You’ve got to be kidding me now.
P: this is a question I remember from my own C section. When I was asked to hold still while I was having contractions and iPhone is likely to hold still up here as I am to cook you breakfast, so like Tabitha I’m wondering why anesthesiologists are asking us to hold still. I found one who can give us a great answer. Hi, thanks so much for coming on the show Dr Euliano
Dr. Euliano: happy to be here
P: okay good. Will you tell us about your specialty.
Dr. E: I am an obstetric anesthesiologist at the University of Florida in Gainesville, Florida, so that means that I did. Medical School, four years of anesthesia residency and then an additional year of a fellowship, specifically in obstetric anesthesia.
P: So Tabitha is in the operating theatre and having contractions and the anesthesiologist tells her to hold still for the epidural. Why are you saying that to us when we can’t hold still and why are you trying to do that requires us to be still.
Dr. E: So we need to get this needle into what’s called the epidural space. So, without a picture, it’s a little hard to describe but so the first layer is skin. And then there’s some tissue between that and, And the ligaments and so then where your spine is there’s different tissue planes ligaments between the top of the spine, the part that you can touch on your back, and then we need to get between those. And then there’s a couple other layers that we have to go through and we’re going through it entirely by feel that by sensing the resistance of the tissues, and when we get to where we want to be, we’re within half a centimeter of where we don’t want to be. And so we’re touching the needle and you move and we don’t move with you, then we can go to a place we don’t want to be, which can result in you getting a really bad headache. The next day, so, so that’s why we asked you to hold still, or at least warn us if you’re not going to be able to so that we can adjust for that, but yeah it’s entirely a feel procedures so, so we need to be able to feel the resistance of the tissues in your back and if you are moving then that complicates that got I don’t know how you did it.
P: I don’t know how you do it at all…good lord that sounds impossible, and there’s no like press to like use ultrasound or something so you can see, so it’s not just feel.
Dr. E: Yeah, so there’s not really a way to do it under ultrasound, some people will use ultrasound so that they can figure out exactly where to start or figure out what depth to expect to hit the epidural space but those of us who’ve been doing it since long before ultrasound.
P: Yeah,
Dr. E: you get pretty used to what the different layers of tissue feel like, and, and you just know where you are but that’s why it’s good to have somebody with experience doing your epidural,
P: good lord that seems like a sixth sense. Oh, my God. Wow, that’s very cool. All right, well, now everyone should remain still critical.
T: So I held them still as they could and then just the whole time when they’re setting everything up tears just pouring out of my eyes just like, I didn’t want this, and then I had also read a bunch about how like babies who have C sections have more allergies very often, and I mean, as we all know it’s not ideal, obviously, for a lot of reasons. And so I was just so disappointed that I wasn’t gonna be able to give my baby, the best start. And I was just really negative in my head, and something that was interesting. I’ve never heard anyone else describe the side effect of the medication. The way that I experienced it, but I wasn’t able to really speak, it was like I had all these thoughts racing through my head, but I couldn’t really talk, and my husband was kind of watching the C section like he could see he works in, he’s familiar with medical so they let him watch I think a little more than maybe they would just someone off the street and so he was watching the C section so I felt like he wasn’t paying attention to me. Yes, had all of these negative thoughts in my mind I wasn’t able to tell him what I needed from him, and I was in kind of a negative point anyways, so maybe I wouldn’t have.
P: Another thing Tabitha mentions in her experience is that during the epidural she had thoughts racing in her head, but she couldn’t communicate is that a side effect that you’ve heard of before from an epidural,
Dr. E: that would be odd from an epidural, in order for us to be high enough that you can’t speak, it would be too high for you to breathe properly and we would have to put you to sleep so, could be an emotional reaction to the situation where you feel like you can’t speak but physically in order to knock out your ability to actually mouth words, we would be knocking at your ability to breathe and then we wouldn’t be able to keep you awake,
P: she did say that it was like a very emotional thing for her because she desperately didn’t want a C section and so I think there was sort of an inner struggle for her.
Dr. E: Yeah, and it sad the pressure we put on each other as women that somehow you failed if you end up with a C section it’s, it’s a yeah it’s not the way it ought to be, sometimes it’s just the right way. The safest thing for you and your baby and that’s okay,
T: but I just felt like I had ruined my baby. I wasn’t giving them the best start and again I’d had the group B strep so I know there was a somewhat at the time. A more recent procedure where they could swab some of the bacteria vaginal bacteria to put on the baby’s face so that even if the baby isn’t born vaginally.
P: Yeah,
T: they can still get that bacteria, but because we were literally the whole point was to avoid getting the bacteria on the baby. Now that wasn’t an option for me, so I just, oh my gosh I was so disappointed. And this is like, still makes me feel emotional but like when they pulled our son out and they’re taking him over to the little incubator, I couldn’t, couldn’t hear him breathing, and again I couldn’t ask it took me forever to get out. Is he breathing. I could just see the oxygen mask over his face. And my husband, and the pediatrician responded right away now. Yes, yes, he’s fine. He’s doing good. And I just like my first thought was, like, I want to do over like this is ruined, like I already haven’t given my baby. The one thing that I thought I was at least going to be able to give them the perfect start and I was so determined. And I just felt so cheated, that I didn’t get to have that amazing, miraculous experience.
P: When Tabitha talks about not being able to give her baby the best start. She’s talking about research that suggested that a vaginal delivery gives the baby a better microbiome than a C section delivery. A diverse microbiome is a community of bacteria that lives in our gut is now being connected to many different positive health outcomes. So that’s why you’d want it. I just stumbled on this research by Dr Keirsey a guard at Baylor apologies if I’m mispronouncing her name on this very issue. She has a 2016 paper that looks at the relationship between mode of delivery and microbiome and finds that there may not be a relationship between how your baby was delivered, and the microbiome they receive current thinking is that what leads to a poor microbiome is a diet high in fat during pregnancy. So it may not be C sections per se that lead to bad outcomes. Her article notes, and I quote, exposures and events during pregnancy, that may lead to a Cesarean section, but not the surgery itself, maybe the drivers of variation in the microbiome and risk of less ideal health outcomes. So importantly diet during pregnancy is key for this microbiome issue, not necessarily how the baby is delivered.
T: After some processing because it really was traumatic it took such a long time before I could even talk about it without crying. I had a healthy baby like I should have been so grateful…he didn’t have to go to the Nikki or anything, but at the time I was just in such a negative spiral, because I had these crazy specific expectations that were not met, and I felt like a horrible mother like, What kind of mother doesn’t give their kid the best start and I wasn’t able to do that and so I was kind of like maybe I’m not cut out for this,
P: I’m totally sympathetic and I think a lot of this on all fronts is chemistry right like you, I think we all expect that you’ll have contractions, then the water will break and kind of the order of operations which didn’t happen. And I think you imagined that you’ll have the time to have the contractions kind of progress in the way that everyone expects and that also is chemistry too. Right, I mean you can Pitocin them out but that too may take a long time right you just everybody’s different and you are also like, you know, a wash and hormones so yes you’re angry but you know that’s one of many things you probably felt that day.
T: And I feel like it was especially challenging for me because I am generally not a very emotional person. And so, feeling like I had no control over how emotional I felt was also kind of stressing me out in addition to everything else.
P: Yeah. How was your recovery from a C section and like how did you guys leave the hospital.
T: So I left the hospital I think after two days which they recommend for but I was like, get me out of here. And I regretted that a little bit later because we struggled with breastfeeding, which was something I thought would be the most natural thing in the world, but it wasn’t I did heal up really well from the C section. Overall, I would highly recommend making sure you drink enough water and those stool softeners. Don’t skip them because that is an important piece as well.
P: Yeah, I remember being afraid to go to the bathroom after the C section.
T: Yes, so funny, ish story about that so I was terrified as well. And then when I went to go, I couldn’t. So I again super hormonal I went, ended up going this is embarrassing but I ended up going to the emergency room because I, I, like, again, darn research I’d read a lot about how you can have impacted bowels and I was just like oh my gosh I need to get this taken care of, and you know in hindsight I could have just gone to the store to get an enema for me but basically paid a lot more money to do that in the ER, but it was it was terrifying and it was like confirming my worst fear, and I actually had I thought stayed on top of things like I was supposed to do, but perhaps I’m just a little more sensitive to that than other people.
P: Yeah, I remember that being hard I wouldn’t be too hard on yourself and it is a little bit scary if you’re, you know, I remember like trying not to go to the bathroom because you think the C section scar is gonna open or it seems pretty fragile so, so I’m sure you’re not alone. I bet they knew exactly what to do because you’re not the first one.
T: Yeah.
P: So how was it when you had your son home, like you figured out breastfeeding
T: we figured out breastfeeding eventually. Another thing, I ended up. It’s funny because I was also against having to use the shield. The nipple shield I had just heard about how the biggest you get kind of addicted to it and then you can’t breastfeed without it. And luckily one of the nurses who, years later, actually, she’s actually now one of my best friends but the first time we met, she was helping me and she just had like the sweetest gentlest loving way to convince me, you just need to feed your baby like who cares, you have to use shield, like it’s no big deal, it’s not about, you know, achieving perfection or, you know, some unrealistic ideal again or you’re probably noticing a theme here for me. And so we used the shield for a couple of months, and then we were able to get off of the shield and I think he you know you’re just so in gorged, and then my baby was only six pounds, nine ounces, so he was just a little tiny guy, and just physically it wasn’t as compatible and when he got a little bigger, a little stronger, it was no big deal. Oh, there was one night when I was trying really hard to breastfeed him. And I wasn’t able to and I had some formula on hand, again I was against it. I didn’t want to use it but I had to do that and I was all nervous about nipple confusion with using a bottle so quickly, But I mean, he was just screaming in the middle of the night and I literally had no way to feed him so I was really thankful that I had it on hand. And I was able to feed him but there were definitely a couple couple of times when it was just really stressful to try to get him to latch and to eat enough and in hindsight, the field actually worked out well because I did not have nearly the cracking and bleeding that a lot of my friends did. And I think that was because they had kind of a barrier, before I was able to like build up the calluses, if you will, so I, in some ways, it actually worked out really well.
P: Good…that sounds excellent. And so I assume you guys found your rhythm.
T: He did Yep, and then I nursed him until. Gosh, somewhere between 18 months and two years old, I can’t remember exactly but we had a good long run at it for sure.
P: yeah, That’s a long time that that I wonder if that doesn’t override the need to have the vaginal birth for that element of the microbiome.
T: That’s a good point, maybe,
P: you said you had two kids. So did you start, what, what were your plans for the second child, did you start immediately or what were your, what were you thinking
T: we had originally planned to start, I guess our son was born in 2015, I think the beginning of 2017, we had planned to start, and then I actually, we were going to start in January as you can tell, I’m like a planner and so I was still breastfeeding our son. And so that seemed like a good time, a good gap between between kids couple years. And so, we plan to start trying really trying, you know, getting out all the research and metrics and everything. In January, but we weren’t like preventing before that and kind of just, if it happens sooner, whatever. And so I actually I didn’t realize until February. I had actually gotten pregnant in December.
P: Oh wow.
T: Yes. And it was the reason it took me so long to figure it out, was because I had a really light bleed it was like a weird period I thought but I didn’t realize that I had had a period and then had even suspected it a little bit, and took a pregnancy test. But I had two different kinds of pregnancy tests I had the kind of that was two lines was the positive and I had the kind of that was a plus sign was a positive.
P: Yeah,
T: and I think I had like, you know, thrown out the instructions it was just the test and I think, I think I had probably tested positive that first time but was looking for the wrong thing, and I didn’t realize I found out about nine weeks that I was pregnant, and then actually we ended up miscarrying which at 11 weeks, which was devastating. Oh my gosh, it was so awful like so much worse than I ever could have expected and so we miscarried. On February 23 And then, yeah, so awful. I don’t want to go into that because I will cry.
P: yeah, that’s fine I’m sorry, yeah that’s fine.
T: Yeah, but just anyone should know they’re not alone. Um, and then of course I wanted to conceive right away as soon as possible like not that a baby can replace another baby, but I just felt like I needed that and felt like it would be healing, and so I did everything I could to like, prepare my body but also give myself time and so then I think we started trying to conceive again maybe in April, or maybe we did conceive almost right away maybe maybe there was just one or two months of weight, but pretty quickly. And then that pregnancy. I knew right away because I was, you know, paying attention and planning, and that pregnancy was a little more stressful just that I was always worried if everything was going correctly and especially since I miscarried at 11 weeks I had thought I was so close to being in the homestretch, you know, because your, your promised you’re guaranteed at 12 weeks your baby’s going to be fine. I mean, I say that sarcastically but it really feels like that way and you really look forward to that milestone as a pregnant mom. And so I was super nervous the first trimester. And then my second pregnancy was very much like my first pregnancy, the heartburn, again, was probably my biggest issue, and having being largely pregnant in January and February in Alaska was kind of stressful. I was just always worried about falling, and so I just had, I parked close and I had like the, the grips on my boots, and I just I didn’t walk outside, like I had but it was also harder to stay active, I did walk some but I didn’t enjoy walking indoors or on a treadmill nearly as much so I didn’t do it as often. Yeah, but overall, again, I had a really, really good pregnancy, though I did find out that she was breech, we found out that pretty early, I think at our 20 week ultrasound. I tried everything to get her to flip everything natural that I was comfortable with, I was not comfortable with full with a cephalic version because I felt that manually flipping the baby I mean there was probably a reason she was breech you know either she was tied up in the, the umbilical cord or the umbilical cord wasn’t long enough, there wasn’t enough amniotic fluid. I just I wasn’t comfortable physically forcing it.
P: Yeah, that makes sense
T: I did. I did hypnosis, and I also did a few acupuncture treatments. And one thing that was crazy is one of my acupuncture treatments, right after I hopped off the table I was putting my clothes on, and I could feel her try to flip it was the weirdest feeling like, like she was kind of in a hammock sort of with her head under my right rib, And I felt her head go up like between my ribs, and to the point where I had to like lean back in the chair that I was sitting on to like put my socks on. And she was like, I could just feel her like trying to kick over, and she never did, but that was kind of a crazy, a crazy experience
P: that sounds like you gave it the college try. That’s well done.
T: I totally did and I did a little bit of like the handstands and stuff but my goodness I was like okay well I’m trying to flip my baby around I might break my neck, I’m not sure that’s a good idea, but it was an interesting experience. And so I felt like I was, again, a little bit cheated out of my natural birth experience but I wanted, but I was a lot more realistic because I’ve been a mom for a couple years at this point, and knew to, for sure is that my intention and know what I desired, but not hang everything on that, and knew that I would just have to roll with the punches, because that flexibility. If you don’t have that motherhood, you’re gonna be so much more stressed and anxious, and you know when you’re trying to control things that you can’t control. No good can come of that.
P: Yeah, Yeah, also I feel like if the baby’s breech like some of the visions that are kind of out of your hands right like.
T: Absolutely, yes,
P: that is, that’s a definite C section, right?
T: It was yes and so I scheduled this feast actually which I had kind of chuckled to myself I’m like another thing I thought I would never do. And, of course you know had felt so judgmental of people before who did it but I’m like oh well now that I’m in it I see that that really is a necessary thing sometimes.
P: Yeah,
T: I scheduled it as late as I possibly could. I think it was like, 39 weeks and four days, which was a little bit late, considering it was my second child, and that my first child had arrived at 39 and one days.
P: Yeah,
T: and so I was really hoping to go into labor naturally I just thought that would be nice to at least know the baby was ready, but I did not, and a nice affirmation or confirmation was the morning of my daughter’s birthday. I, there was a huge snowstorm. And so I was just like.
It’s so nice that this is planned like what if there was a crazy snow storm we also we live on a super steep hill we’re just out of town and crazy Alaskan winters, I was like I can’t imagine being in labor, yeah stuck on the side of the road or in a ditch or something like that.
So that was just a really good confirmation that I made the right choice, given our circumstances, I also didn’t really have anyone. A lot of my girlfriends who just had a baby, we all have babies around the same time and so it was my mom was able to come up and watch her son and so I mean, I’ll be totally honest, the logistics were a lot smoother. So that was, I just had to take the wins where I could
P: totally. So, so it sounds like you didn’t your water didn’t break there’s no labor you, you went to the your appointment like it was an appointment.
T: Exactly. So, it was delayed quite a while but mentally I had prepared for that I’m like I know this is scheduled, but I actually worked at the hospital at the time so I was like, I know that it’s probably going to be delayed. So in my mind I was prepared for that. I also had a doula the second time, which was really helpful even though I had done it before. I really wished I would have had her the first time, but it was nice where you know just hanging out waiting joking with the nurses, laughing, I had prepared like through hypnosis, and then just affirmations. So anytime my mind would start to worry or wander, I would, I had all these affirmations at the ready and so they wheeled me into the OR, and I wanted to see my baby being born so they set up a mirror for me to watch.
P: Oh wow,
T: I have all of these affirmations in my mind, and then my doctor. Also, let us drop the curtain. So when they pulled her out and pulled her out of my belly, I got to see it, I got to watch her come out of my stomach.
P: That’s super cool.
T: Oh, it was amazing. I feel so grateful, and then my husband was able to watch the whole thing and the whole thing is on video which is like such a special treasure. I don’t know if a lot of places will let you do that, but, yeah, the experience was completely different. She was, she was able to be skin on skin on my chest which I wanted afterward, which I did not get with our son and I was really upset about our daughter was like snuggled in, and our pediatrician. I knew her also and she was amazing and she was like, Oh, let me take a picture and so we got a picture when she was first born and she made sure my boob wasn’t in it which I appreciate.
P: that’s well done, that’s well done
T: was like, well, you should add that to your list of like your resume. Yes, but she was amazing I just loved because I knew her and that was another pro of the scheduled C section I knew that she was going to be our pediatrician, most likely, so that was also really nice and I got to have our daughter’s skin to skin recipes, breast feeding was super easy. But another thing that we were able to do the second time, second time which I think was actually new technology, they’re able to do what I had researched this before so I knew going in was called a tap block. So they were able to do local anesthetic around my incision, so I didn’t have to have any pain medication for, I think it ended up being 48 hours they said up to 72 but around 48 I could feel it wearing off. But I think that probably helped with breastfeeding also because I didn’t have the pain meds in my bloodstream, it was just local.
P: Oh, that’s totally interesting I hadn’t heard of that, that’s cool.
T: Oh, it was amazing. Like, I highly recommend it was called a tap blocked that made a huge difference because I think the bonding felt so much more amazing to, I still had a little bit of the disconnect from the drugs from the actual epidural and surgery, but it was a lot better and those drugs were off faster, and it was so nice that you do have to be I’d had a C section before so I knew not to push it. That could be the one downside of having that local tap block is having no idea that I mean, you are really healing just because you feel great doesn’t mean you can just say, doesn’t mean you can just do whatever
P: Tabitha talks about a TAP block, can you tell us how that works.
Dr. E: So TAP stands for transversus abdominus plain which is just the name of the muscle that we put the drug, near, and basically all the nerves that supply your abdominal wall from skin down to right before you get inside your abdomen all come from your back around the sides. And there’s a place on your side where we can deposit up a large volume of numbing medicine that will stop those nerve impulses coming from basically the incision, getting up to your brain and causing pain so we can put medicine there that blocks those impulses and it actually works quite well, if, if the anatomy is good so usually we just do it under ultrasound it’s one needle stick on your side we inject a bunch of local and on each side and we’re done. There was a lot of enthusiasm for a while about maybe 10 years ago. But then it turned out that if we use Derma, which is a long acting morphine that we put in if you stay awake for your C section we almost always put it in the spinal or the epidural and adding the tablet didn’t turn out to add any pain relief because they both sort of wore off at the same time.
P:. That sounds like a totally different experience than the first one and quite nice, was amazing.
T: And I did still have some reservations about having a scheduled C section, but my girlfriend that I mentioned who had done, helped me with the nipple shield with our son. She’s a labor and delivery nurse, obviously. And so I talked to her about having a scheduled C section and she was like, honestly, it’s really great because you can have the team you want, they are prepared for you and stay on emergency, so it’s safer. Everything felt smoother and I know a lot of it was me because first of all I’d done it before I knew exactly what I didn’t want.
P: Yeah,
T: it was so nice to have her perspective and like her encouragement, just to be like the staff that needs to be there’s going to be there, you’re going to have the people that you want. And it’s actually kind of funny because our babies were doing our second babies were due a week apart and she actually had her son, that morning. In birthday.
P: That’s awesome. Wow, it was amazing. Yeah, what are your kids into now.
T: Gosh, everything. No, our son is just, oh my goodness, such a loving ball of energy, he is just the sweetest, kindest smartest kid he takes after his dad, and our daughters. She is such a spicy free spirit, but I love it so much because it’s just, she knows what she wants in life and I feel like so often people lose that and it’s such a fun reminder of like there is no question about what she was that girl knows exactly what she wants. And so I’ve definitely learned some from her about knowing what she wants and she is also just so happy and giggly.
P: That’s awesome That’s a very good. It’s a very good end to the story.
T: Yeah, and that is kind of my I think my biggest blessing was just not having these ridiculous expectations that can’t be met and controlling what you can, which is your attitude right, and so that was a big difference was that my attitude was completely different. The second time and everything went so much smoother.
P: Oh my god, that’s so cute oh my god she sounds adorable. Thank you.
T: Just a minute, sweetheart, made most of the way without interruption.
P: You know I couldn’t add better sound effects and that’s perfect.
T: Oh there you go,
Unknown Speaker 8:16
tell us, and thanks so much for coming on and sharing your story today I totally appreciate it.
Unknown Speaker 8:20
Thank you so much, I
Unknown Speaker 8:21
just it’s they’re two of my favorite stories so thank you for letting me share.
Unknown Speaker 8:25
Thanks again to Dr Uliano for sharing her insights with us. She cleared up some questions I’ve always had about the epidural, I appreciate it and thanks to Tabitha for sharing her story. If you like this episode, feel free to like and subscribe. Also reviews are how other people find the show so we so appreciate your views. If you’d like to share your story, go to war stories from the womb, calm and sign up. We’ll be back soon with another story, the crazy messy hard and beautiful things that can happen in this process, and the amazing things we can do to overcome the challenges.
Episode 14: Help! This Pregnancy Has Taken Over my Body: Alasen
Episode 14 SN: Help! This Pregnancy Has Taken Over my Body: Alasen
Today’s guest stepped into her first pregnancy relatively easily,getting pregnant within a few months of trying…… and that was the last easy thing she experienced. She describes herself as someone who is “not a pregnancy unicorn”. She had body image issues while pregnant, felt nauseous, swollen and was generally physically uncomfortable for most of the pregnancy. And then postpartum recovery was even more challenging. A hormonal imbalance caused a too dramatic weight loss, she was visited by postpartum depression and anxiety, and a baby who wasn’t particularly interested in sleeping through the night added to her ‘non-unicorn’ status. In an effort to dig herself out of a hole, she started researching nutrition and found a much better way forward for the second pregnancy, and ultimately for life. I learned a lot talking to my guest today and hopefully you will too. You can find her at https://thenutritiondoula.com/ and in Instagram @thenutritiondoula
Body dysmorphia
https://www.womenshealth.gov/mental-health/body-image-and-mental-health/pregnancy-and-body-image
Adrenaline in labor
https://link.springer.com/article/10.1207/S15327558IJBM0801_04
https://www.sciencedirect.com/science/article/pii/S152169342030033X
Diet and depression
https://www.health.harvard.edu/blog/diet-and-depression-2018022213309
https://www.medicalnewstoday.com/articles/318428#antioxidants
https://academic.oup.com/nutritionreviews/article/79/3/247/5843529?login=true
Audio Transcript
Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette kamenecka Today’s guest first steped into pregnancy, relatively easily getting pregnant within a few months of trial. And that was the last easy thing, she experienced. She describes herself as someone who is as I quote, not a pregnancy unicorn. She had body image issues while pregnant, felt nauseous for a large chunk of the pregnancy and physically uncomfortable, then postpartum recovery was even more challenging. In an effort to dig herself out of a hole, she started researching nutrition and found a much better way forward for the second pregnancy, and ultimately for her life. I learned a lot, talking to my guest today and hopefully you will too. I’ve paused our conversation in places to add medical details and to include the insights of a thoughtful OB.
Let’s get to the story.
Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette kamenecka Today’s guest first steped into pregnancy, relatively easily getting pregnant within a few months of trial. And that was the last easy thing, she experienced. She describes herself as someone who is as I quote, not a pregnancy unicorn. She had body image issues while pregnant, felt nauseous for a large chunk of the pregnancy and physically uncomfortable, then postpartum recovery was even more challenging. In an effort to dig herself out of a hole, she started researching nutrition and found a much better way forward for the second pregnancy, and ultimately for her life. I learned a lot, talking to my guest today and hopefully you will too. I’ve paused our conversation in places to add medical details and to include the insights of a thoughtful OB. Let’s get to the story.
Episode 13: Your Placenta, Best Friend or Frenemy: Brooke
cover art care of Francee Greer
Episode 13 SN: Placenta: Best Friend of Frenemy? Brooke’s Story
Today’s guest is no stranger to hard labor. As a strength and training coach she’s seen how disciplined effort produces results. But long runs and weight lifting sets didn’t prepare her for some of the consequences that the complicated chemistry of pregnancy can produce. Through the course of her different pregnancies she tangled with HELLP syndrome–a pregnancy complication that requires emergency attention, and a visit by gestational diabetes. Now, with three kids under 5, she can add a new exercise to her regimen: child wrangling.
Find out more about Brooke here: https://www.wreckingroutine.com/
HELLP syndrome
https://www.healthline.com/health/hellp-syndrome#risk-factors
https://emedicine.medscape.com/article/1394126-overview#a6
https://www.sciencedirect.com/science/article/pii/S0925443912001901
Difference between preeclampsia and HELLP
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692334/
Gestational Diabetes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515446/
https://www.sciencedirect.com/science/article/pii/S0925443919300237
GD by population group
Audio transcript
Paulette: Hi, welcome to war stories from the womb a podcast where women tell stories about getting pregnant, being pregnant and giving birth, with a focus on the difference between their expectation of the process and their experience. I’m your host Paulette Kamenecka. I’m the mother of two girls, and while I thought pregnancy would be challenging, I had no idea how challenging it would be for me. I had trouble with every part of the process—I definitely didn’t make it look easy, and I’m totally grateful to have made it through. Today’s guest is no stranger to hard labor, as a strength and training coach, she’s seen how disciplined effort produces results, but long runs and weightlifting sets, didn’t prepare her for some of the consequences that the complicated chemistry of pregnancy can produce through the course of her different pregnancies, she tackled with HELLP syndrome, a pregnancy complication that requires emergency attention, and was visited by gestational diabetes. Now with three kids under five. She can add a new exercise to her regime child wrangling. Let’s hear how she managed all the uncertainty of these trying situations.
P: Hi, tell us your name and where you live.
Brooke: Hi, I am Brooke and I live in Minnesota.
P: Oh wow.
B: Yeah.
P: How many kids do you have,
B: I have three.
P: Wow.
B: Yeah, three kids, we have three kids and under four years.
P: Nicely done.
B: Thank you. That was not what we thought would happen but that’s what we got.
P: So that’s usually the way it goes, before you got pregnant. What did you think pregnancy would be like?
B: oh man I you know honestly I don’t know if I thought that much about it, but I probably had this like vision that was going to be this like magical thing I was gonna be so in tune with my goddess body and like it was gonna be super easy and, you know, that whole thing, and I mean there’s definitely the magic, and all of that and then there’s all the other things that come with pregnancy, which I was much more adept at being aware of, rather than like this goddess SNESs that you tend to see around social media, yeah,
P: yeah, yeah, pregnancy has good marketing,
B: it really does. And there’s so many things that people don’t talk about.
P: Yeah,
B: like, even my sisters, you know, and it was like, come on guys like give me the down and dirty and they like, wouldn’t they wouldn’t, you know, so it’s a chat with your girlfriends.
P: Yeah, no kidding….Did you get pregnant easily the first time
B: we did, yes, we, so I’m a teacher, or I was a teacher, and at the time of my first pregnancy I was teaching so we were timing, or trying to time the birth of the baby with summer vacation because that I would get more time at home with the baby. I think we missed our goal, we wanted to like give birth in May, and ended up being June so it, it took us an extra month out of, maybe two or three months of trying, pretty close.
P: pretty close…did you find out what the home kit or how did you find out you were pregnant
B: yeah oh man I’m trying to remember. I think I found out really early, you know, they say wait till your periods late and all of that but I, I kind of knew that something was up. So I took a test around the three week mark, and it came out positive a home pregnancy test and I kept it a secret for a whole day my husband and I tell each other everything I kept it a secret the whole day. I was very proud of myself. And then I had bought, he’s from Minnesota, so I bought him a twins, their baseball team, like little onesy, and I like wrapped up and I gave it to him after work one day and that’s how I told him.
P: that’s good that’s a good reveal
B: yeah that’s like a first pregnancy standard.
P: well done
B: the subsequent one’s You’re like, Guess what,
P: and how was that pregnancy.
B: It was, it was good. It was great, everything was textbook baby was growing well she was breech. For a while I was nervous about that but around the 36 week check she had flipped. So that was good. Everything was fine.
P: Were you thinking natural birth.
B: I was very open, I wanted to go natural as long as I could stand it. Yeah, so I was preparing for all the like Hypno birthing I you know I was, I wasn’t in any one camp I’m gonna do this method but I definitely wanted to try and go natural you know I’m a runner so I run long distances, I run marathons and things so I was like well I can you know I can get through that so I could probably get through this. So, I was preparing for that.
P: Yeah, we should mention you’re like, you’re like a strength coach Aren’t you
B: yeah I’m a personal trainer and a health coach.
P: Okay, wow. Well, then I’m glad the first part for easy.
B: Yes.
P: So what happened at the end of the pregnancy.
B: So I went for my 36 week checkup. So I was teaching summer school, my first baby was born in June. So I was teaching summer school because in Colorado where I was teaching school ends, the end of May. So then there was summer school so teaching summer school so my 36 week check didn’t come till 36 weeks and like five days because I was busy teaching I couldn’t get in. The day before my appointment I was feeling kind of funny I woke up feeling funny, but you’re 36 weeks pregnant, you know you’re everything feels funny at 36 weeks pregnant. You know, I had this pain in my side a little bit under my rib cage I was really tired, like, just all those, all these things so the next day I went in, I had an early morning appointment went in, and she did a urine, I felt fine the next day, she did a urine sample. She did a blood draw. Went about the day she took the baby heartbeats good she had flipped she’s no longer breech, awesome. We’re good. Let’s schedule your next couple appointments we’ll schedule an induction day just in case, etc so I’m scheduled out for you know, five more weeks. So my husband I went ran some errands. And then, my doctor calls. So I was on the phone with my mother actually she was asking me how the appointment went I’m telling her, am I the Call Waiting kept keeps going and keeps going and keeps going, I’m like, Mom, this is my doctor I gotta go. So I call her back and she says, You are Man What does she say she said something along the lines of you need to go to the hospital immediately you are having a baby today. So basically there Oh, it was there’s protein in your urine. So that essentially means that you have preeclampsia, or what I had what she could tell from my blood work was I had hellp syndrome. your blood pressure is sky, like, very very high. So you could stroke out at any minute.
P: Well, that’s terrifying
B: Yes….we’ve not, you know it’s your first pregnancy your first baby, all of those that is not what you want to hear and the only things I’ve been preparing for are this like, I’m waiting for my water to break it’s gonna, I’m gonna feel the birth pains you know the labor pains and we’re gonna go to the hospital, it’s gonna be this like magical almost romantic thing, and suddenly it was like if you’re not at the hospital in an hour, you could die. And it was like, Oh, okay.
P: I talked to the maternal fetal medicine doctor I did get some insights about some of the medical issues, Brooke is facing. Hi Dr. Robertson thanks so much for coming on the show, can you introduce yourself and tell us about your specialty.
Dr. Robertson: I’m Patty Robertson, I’m a professor at the University of California San Francisco and I provide obstetric care to high risk women, specifically the subspecialty of maternal fetal medicine.
P: Okay great, we’re in the right place then. Do we know why hellp syndrome strikes people.
Dr. R: Well we know that some women are high risk for developing preeclampsia, and a subset of women who have preeclampsia, which is high blood pressure and protein in the urine, actually get help, h e l p stands for hemolysis where the blood, or hemolyzed is or breaks up elevated liver enzymes are part of it, and often low platelets, so any woman with Preeclampsia is at risk for help and help can be life
P: It Looks like the cause of health is unknown. There are a bunch of theories about the source of the problem, like a dysfunctional placenta, or immune system disagreement between the mother and the fetus. It’s a rare disorder affecting less than 1% of pregnancies. Risk factors include being over 34 Being Caucasian, having diabetes or kidney disease, having high blood pressure or a previous pregnancy.
B: And I, you know, I’m in disbelief talking to my doctor, so I said to her on the phone because I find humor in situations I shouldn’t. And I, I said, you know, the carseat is still in the box, can we do this tomorrow. You know because they’re supposed to have all the things right
P: yeah, yeah
B: and she was like, No, that’s not funny. Move it, and I was like, okay. So it took us like…
P: it sounds like I didn’t feel that badly.
B: I felt fine. I felt totally fine, my blood pressure was high when I had gone to my checkup so my blood pressure. I don’t know my bottom number but my top number is in the 90s, usually. So it was definitely above that. I can’t remember what it was but through the duration I was 140 or above by the hospital for the next, you know, week,
P: but it’s hard to feel a sense of urgency when you can actually feel anything. Right, right. I can feel it didn’t feel real.
B: Exactly like if she had told me this the day before when I wasn’t feeling good, I would have believed her.
P: Yeah,
B: I was tired I had pain, like I get that. But this next day I you know I went to a five mile walk that morning like I was good. So, yeah, that was hard,
P: so I’m imagining you, you put together the car seat quickly.
B: I think we threw the box in the trunk. So I took a shower and you know I’ve been listening to all these birthing podcasts, so I made sure I ate something I showered I cried, I called my family I packed the go bag because I hadn’t done that yet, you know 36 weeks. And then off we went. It took us, so she wanted me at the hospital in an hour and that hospital is a 45 minute drive from where we live, and it took me like two hours to pack shower, eat and stop crying.
P: Yeah,
B: So it was a three hour process,
P: so you get to the hospital and how are you received?
B: it was, it was really terrifying, like not very well done at all but so we we walk in and we had toured the hospital ahead of time we did all those first time, you know, pregnancy things we toured the hospital we knew where we were going. And so we go up to the pregnancy floor and they they’re expecting us like the doctors called ahead they’re on their way. So we walk in, they say, Are you Brooke Selb and I said yes, so they scooped me right into the room that’s like right off the entry doors like you don’t, I didn’t even go in the ward, you know, right there. They had me change into a robe, when, at that point I changed in the bathroom like no modesty was gonna continue but it’s like changing the bathroom whatever and they’re like all like kind of waiting like tapping their foot outside the door, So then they tell my husband, they say, Okay, you go down and move the car and go park the car and get her bag, and come back up within the 10-15 minutes that it took my husband to do that I was in a gown in a bed, hooked up to I think it was three different IVs.
P: Oh wow
B: And, yeah, like just hooked up strapped up all these things and I was like, What is going on, and my husband comes in after he took the car to the parking garage and he was like, he just looked at me like a deer in headlights, like, this is nothing what we talked about like we’re not we’re not prepared for what this, what is this,
P: yeah.
B: So we were there for a while so I got put on magnesium sulfate, which helps with the reduces your chance of having a stroke.
P: Okay
B: so, so I got put on that, and you have to be on that. I want to see it was 24 hours on that before they were going to induce me to get the baby out. So basically just watching me and making sure that I wasn’t going to have a stroke.
P: Right, so that sounds scary.
B: It was terrifying and it took to my, my health insurances such that whatever doctor is on staff is the doctor who will deliver you. So we saw, I think two or three doctors before one doctor came in and actually looked at us and saw we were so terrified and he said, has anyone explained to you what’s going on. And we said, No. And so he like pulled up a chair he sat down and he explained to us what my condition was what the care plan was, what the result could be good or bad.
P: Wait so go slowly here. What did he tell you.
B: So he, he told us that, you know, because this is HELLP syndrome. It means you’re an organ failure, your kidneys and liver are going down, it could result in stroke you could have a seizure. And if, if we do not get the baby out, it this could kill you and the baby.
P: Okay, a quick summary. Both preeclampsia and HELLP construct quickly without much warning, although doctors are working on finding biomarkers to identify women who are at higher risk for these conditions, and effort to alert them before everything goes south, some people think HELLP is a severe form of preeclampsia, but there’s also a camp of researchers who think HELLP is its own separate disorder because some women experienced help with symptoms that are different from those typical for preeclampsia, so maybe the jury’s out on the exact relationship between these two conditions. But in any case, both are serious, and both require immediate attention.
B: So then I was on the magnesium sulfate. And then they started Pitocin. And he said that if the Pitocin wasn’t going to work then I would have to have a C section which was the absolute last thing that I wanted to do.
P: Right.
B: so yeah and he actually has the same doctor that delivered my second as well.
P: Nice,
B: Yeah, yeah,
P: Could you feel the magnesium sulfate.
B: Yes, it makes you crazy, so it makes you super tired I couldn’t keep my eyes open for more than 20 minutes at a time so I kept like falling asleep. I’m need glasses for distance driving at night, and I had to wear them all the time because I couldn’t, everything was blurry or seen anything and I was like so hot, it makes them really hot and everyone in the room my poor husband, They were freezing because they turn the air down really low, and he was just freezing the whole time because you’re just like, sweating, so it makes you really out of it.
P: That seems like a hard state to be in to push out a baby.
B: Yes, and, and you can’t eat anything. And then they have me on Pitocin. So you’re just all whacked out right. And then the other issue with HELLP syndrome is your blood platelets drop. So, if my blood platelets dropped too low, they would not be able to give me a epidural, because they can’t get it in for risk of bleeding out.
P: Oh wow,
B: so my nurse who thankfully for us on thankfully for the woman before me, the week before she had had a patient who also had HELLP syndrome so she knew exactly what to do. They were testing my blood every like two hours so she rushed ordered a test, and said look if your blood platelets are at this specific level I want to say it was under 100,000 I’m not great at my medical but it was somewhere in there. She said if your blood platelets are still above this number, I’m going to have him put in the epidural port, essentially, like we don’t have to turn it on, but you have to get it in. Thank goodness because they got, they put in the epidural. And then my next blood draw my platelets were too low to have done it.
P: Oh wow.
B: Yeah, so if anyone has ever pushed in a bed or like gone through labor in a bed where you can’t get up and move around, it is so uncomfortable like you want to be moving and, you know, rocking and you can’t do that when you have HELLP syndrome. So that was really wonderful of her, and then I ended up using the epidural, so it was great, it was there,
P: and you just had a birth, just with the epidural.
B: I did so it took three and a half hours of pushing, I was on oxygen in between pushes because I kept passing out.
P: Oh my god,
B: yeah. They finally let me eat ice chips. During pushing, and I was like, downing them because I hadn’t eaten anything in quite some time. And they made me like stop at one point, they’re like you have to stop eating ice chips you need to focus on pushing and I’m like okay but I’m like really dehydrated, you know, whatever. So three and a half hours, and then the doctor who was a different doctor than the one who explained everything to us because rotation. She started pulling out the, the suction.
P: Yeah,
B: right. And I was, I was done, I still had some fight left in me, magically, and it was like I do not want another intervention. Like my friend just had a baby that had to get suction and the poor baby’s skull was all like bruised up, you know all of this, and so I just started. Forget pushing with contractions, I just started rage pushing, essentially. Everything I have is going into this right now and then out she came.
P: Oh nice.
B: Yeah it was great that Rob said the doctor almost missed her because she came out so fast she like barely caught her and
P: that’s a pretty good ending after the, after the birth, how do you feel,
B: I felt very tired but you know you’re euphoric, because all of a sudden the baby comes out and they popped her on my chest. And this doctor was so great, she, she knew that I was so upset my birth plan had completely gone out the window., you know my like mental birth plan I didn’t type it out or anything but my mental birth plan. And she said, What else was in your birth plan that you really want to have happen. So I had a couple things I wanted delayed cord clamping I wanted to push with contractions and I wanted immediate skin to skin, so she was able to give me all three of those until you know three and a half hours and where she’s like, Forget contractions, you know, So then you know I get this like baby on my chest and, you know, all of a sudden you’re like totally fine.
P: Yeah, that’s lovely.
B: It was and then it was hard because you still, if you have health syndrome, I still have to be on magnesium selfie. For a number of hours after birth, you know you deliver the placenta. Essentially that’s supposed to remedy help syndrome, you’re supposed to just like, almost snap back to normal.
P: If the placenta is the bad actor in HELLP syndrome causing all these problems. Why is it that once you deliver the placenta, all the problems don’t subside. Well, that is a great question, and nobody even really understands preeclampsia that well we’re study, trying to figure out why you get it, and we know how to cure it, which is to deliver the baby and the placenta, but for some women, it triggers a hypertensive response that persists. And in fact, even women who have a normal blood pressure normal delivery and then let’s say four weeks later they get a severe headache and they go to the emergency room, they can actually have preeclampsia, you can get it for whatever reason, up to 12 weeks. Now a lot of older moms have preeclampsia it’s one of the risk factors and they’re also at risk of high blood pressure, perhaps genetically in their family. So, pregnancy is kind of a stress test, it might bring things out that you’re determined genetically to have in 10 years or 30 years, like diabetes or high blood pressure, and we know that one of the leading causes of maternal death is cardiovascular disease which includes stroke. Now usually stroke occurs at a top blood pressure number of 160 or greater, but with HELLP, we’ve seen stroke occur at 140 over 90, which we use as the enrollment level for blood pressure, high blood pressure, diabetes, they both can persist and need to be acknowledged by the woman that it could be a chronic condition for her.
P: I want to just add here that numerous sources suggest that women who experience preeclampsia eclampsia or help are at a lifetime increased risk for cardiovascular disease, and so are the babies that were a part of the preeclamptic eclamptic Or HELLP pregnancies, so it’s important to follow up with your doctor to keep track of these risks, after the pregnancy is over,
B: but I couldn’t be left alone with the baby for a full 24 hours while this stuff got out of my system because I might drop her I still couldn’t get out of bed, you know, the whole thing, so that made it that made it feel, it was hard to bond with her because I couldn’t. If I was already holding her I was still stuck in the bed I couldn’t get up and like put her in the bassinet I had to have my husband or have a nurse.
P: Yeah,
B: take her and then put her down and then you’re you know you’re trying to establish a breastfeeding relationship and you know my body wasn’t ready to give birth so that was hard and
P: yeah,
B: it’s just a whole you, you enter into the next phase of tough, and that’s with any with any newborn.
P: Yeah, it’s hard. The fourth trimester is harder than also harder than marketing.
B: I, people need to talk about that more the fourth trimester is the worst. My third is eight months old right now and I feel like I’m just coming out of a fog. Yeah, so it’s a long process.
P: and babies are a lot of work,
B: they really are.
P: After this unbelievably like physically challenging thing right that’s like the next the next up, you’ll be up for many hours in a row, do they let you leave the hospital right away or not.
B: My blood pressure would not come down. So, I we were there, five days in total. Five days. We left when our baby was, she must have been four days old. Most people leave that when they’re babies a day, maybe, you know.
P: Yeah,
B: they kept waiting for my blood pressure to come down and it wouldn’t, to the point where, on day four, they’re like okay, you’re gonna be discharged a one more blood pressure tech and then we’re gonna, you know, most likely let you go when I was like, awesome. So I’m like, I’m dressed on packed like babies in her going home outfit you know all these things were ready, they come in, they do my blood tests and they check my blood pressure and they’re like, we can’t let you leave, I sobbed like ugly cry. My poor husband man like she hasn’t even been out so I was you know the whole thing like You’re so crazy emotional at that point and you’re just like nonsensical. So on day five, the doctor comes in and is the same one who explained a lot to us in the beginning and he was like, Okay, I hear you’re really upset. I don’t want you to leave but I will let you leave if you promise to test your blood sugar I’m sorry, different pregnancy test your blood pressure. Yeah, thank you. Every day, and you have to be blood pressure medications, I was like, Okay, I’ll do it, I’ll do it. Where do I sign let me out. So then we got to leave. Thank goodness and it took about another week or two, a blood pressure medication for it to finally come down, and then it hasn’t gone up since,
P: could they explain why it didn’t snap back after the placenta was birthed.
B: No, no, but there are some women who even develop preeclampsia, after birth.
P: Yeah. Right, right. Yeah. wow, but that baby was fine and then you were fine and
B: she’s great. She was born at 36 weeks and six days, so she was considering late term premiee you to write that on all your paperwork she missed the cutoff by three hours. This was really frustrating since she was little she was six pounds when she was born, you know, cuz she needed another three weeks to be good, Maybe a good nine pounder right. Oh,
P: six pounds is nothing to sneeze at…that’s like, you know that’s a legitimate weight.
B: Well, let’s get into my next one.
P: You bring her home and how long before you get pregnant again
B: Yeah, two years, they are exactly two years apart.
P: And how was the second experience.
B: So it took a year to get pregnant again. The second pregnancy was great textbook, I was taking a baby aspirin every day up to 36 weeks to prevent preeclampsia and HELLP syndrome again, so that was some new research that had come out every, everything was great, went into natural labor, did the whole like magical experience going to the hospital did get an epidural, thank goodness, and then pushed, he was out, it was it I think I pushed five times or something and he was out and he was nine pounds one ounce.
P: Wow,
B: that was a little different. Yes. He was a Big Boy
B: are you and your husband tall?
B: yes I’m six feet and my husband is 6’5”
P: Okay, well that makes sense then you’re gonna, have a big baby
B: yeah, my husband was 12 pounds when he was born. It was very large
P: Oh my…that feels very Guinness records kind of
B: yeah, right…his poor mom, she’s like really tiny.
P: But that one was that one went smoothly so
B: he was great he was like my little textbook baby.
P: That’s all. Yeah. So now you have to at home. Yes,
B: but then a year later you get pregnant for the third time oh my gosh, eight months later I don’t know what we were thinking. Yeah, so I got pregnant for the third time and it was one of those like I’m, it’s the middle of the night, it’s like two in the morning I’m feeding the eight month olds, you know, and I’m like thinking in my head, you know, because your head starts running at that time of night and you’re like, No, no, wait a minute. No, and then I go take a home pregnancy test I’m like digging in the back of the door, only got my husband you know, where’s this thing and I take it and I, I, I really cried. I was not ready.
P: Yeah,
B: it’s really close and people do it and they do it a lot closer than 19 months apart
so much respect, it is hard,
P: it is hard. Yeah, yeah. But also, like, you can’t, it’s hard to also time.
B: Exactly, exactly.
P: Yeah, so you kind of get what you get. And so how was the after you recovered, and, you know, got excited found some joy for the third one. How was that experience,
B: a mess. It was a mess. So I was diagnosed with gestational diabetes, so everything was fine. And then I got gestational diabetes. So that was,
P: is that like halfway through or,
B: yeah, so you do the, when do you do the sugar test,
P: it’s like 20 weeks
B: 20 weeks 24 weeks I want to say, and I failed it. But at this point we had moved to Minnesota. So my first two babies were born in Colorado and then we moved to Minnesota. So diagnosed with gestational diabetes with some new doctors, etc. And I was so upset about it I’m a health coach. I’m a personal trainer I run, I eat mostly healthy foods you know I’m not like a sugar monster, but I just, I couldn’t mentally wrap my head around the fact that I had this,
P: it’s emotional for Brooes to get this diagnosis because she thinks I take care of myself. I exercise regularly and I’m careful about diet. How did gestational diabetes fall on me,
Dr Robertson: but another way to look at it if she hadn’t been so big. The consequences of both of those diseases could have been much worse.
P: Yeah, yeah, just,
Dr. Robertson: you just don’t know. But no matter how hard you work at perfect health. It’s not totally under your control.
P: Yeah,
Dr. Robertson: so many of our patients are in their 20s and 30s and 40s, and they don’t feel that they deserve a diagnosis of diabetes, even if they had it during pregnancy, and then they don’t go back for follow up testing so they don’t know. And then they eat their regular diet, and then they end up with complications because they haven’t been followed, appropriately, like to check their eyes if they have diabetes once a year to make sure there aren’t extra blood vessels growing to be associated with blindness later on.
P: So it sounds like you were saying, if you have gestational diabetes, you’re potentially at risk of developing type two diabetes later.
Dr. Robertson: Yes, and sometimes actually women have type two diabetes in don’t know it. And then we don’t really know until she comes for the follow up test after her pregnancy is over whether she’s a type two or pre-diabetes are totally normal.
B: My sister had it with her third baby and my mom had it with her third baby which is actually me. So you know there’s that component. You’re also more likely to get it if you’ve had a nine pound baby. And my second was nine, one, yeah. And you have to be over 25 How old was I 34 Yeah, so, you know, I had some of the precursors to getting it but I eat healthy and I exercise and like this isn’t me, you know, whatever. So I would, I tried diet I tried exercise, I tried everything to not have my blood sugar numbers be above what they should be. So you know I got up at two thirty in the morning and I had a protein snack and then I, I went for walks before bed and I tried testing it before I even got out of bed in the morning and I tried testing it right before you know I tried all these variations and it just, it wasn’t happening so I ended up on insulin for nighttime insulin because it was my morning fasting number, that wouldn’t come down, right, for most of it towards the end, the last three or four weeks. It was mostly all day that my, I really had to be careful about what I was eating, to make sure my blood sugar was within range. I was so hungry the entire pregnancy. I was so hungry. Oh man, because you can eat a lot of fruits, wheat, a ton of fruit, you know, things like quinoa beans, you know, all those things would spike it, so no different for everybody, what spikes you. Yeah, so like something my sister recommended I try I couldn’t have, because it would spike me. So it was a lot of trial and error.
P: That sounds hard to manage just kind of in general but especially with two little kids.
B: Yeah, and I was, I was not pleasant to be around, like I was cranky, so
P: that sounds really hard and, and I think I just saw an article suggesting that doctors think there’s some genetic component to gestational diabetes.
B: My parents are not diabetic. So, I don’t know I mean,
P: I don’t think you need to be diabetic but I think the thing I read said that type two diabetics have some genetic component, so there’s some familial thing passed passed down, and diabetes you also have some kind of genetic component that affects how you process insulin, and pregnancy obviously is a big chemistry experiment, and so that also all which is to say that even if you’re running every day and eating perfectly well. You can still have it. Right, yeah.
B: Yeah, and I mean there is, you know it’s your plus the reason you would get it is your placenta is making hormones that are causing the glucose to build up in your blood. So it’s like your placenta the hormones in there is doing it. Same thing with, you know HELLP syndrome is you have to get the placenta out it’s like all these things were like my body and the placenta, are not communicating very well,
P: and that’s that is genetic right that is you and your husband’s DNA are, are kind of duking it out to figure out like how invasive the placenta will be and how it will operate
B: It’s crazy.
P: I remember with my second eyes. I must have failed that the sugar test, because I had to prick myself for, you know 10 days or something and that was, um, that’s not pleasant.
B: No, and you probably have to do it four times a day. Record your numbers and don’t lose the paper and, it’s a mess
P: that’s what is it, what does gestational diabetes do to the birth, anything.
B: So they just they not a ton, they had to induce me, which I was very upset about, because you know I had such a magical experience with my second of going into natural labor, but the fear is if you end up with a nine pound baby, you know, the longer your pregnancy goes the heavier the baby will be, if you’re a gestational diabetic you’re likelier to have a larger baby, and because I’d already had a nine pound baby. They were very fearful that I was going to have another
P: Yeah,
B: which creates a lot of complications, so I was induced at 39 weeks, which is good, they let me go that long which I was saying before, and then they test, you have to test your blood sugar regularly throughout the day, you’re limited in what you can eat during induction just so exhausting. I mean, let us eat Please Like we have to push you know there’s this whole like mission at the end. And then they test once the baby’s out, they continue to test both of you for the next 24 hours,
P: and how did that go.
B: It was the birth was the mess induction wasn’t, it was fine. It was a long day, you know they want you there at 7am to get started on all the things and I wanted to do it as naturally as possible so I had the balloon catheter first. I tried all the remedies and then still ended up on Pitocin.
P: Yeah,
B: so two babies through Pitocin right. It was a long day so we were there at seven in the morning, and the baby wasn’t born till I want to say nine at night.
P: Oh, that is a long day
B: it’s just exhausting and like contractions were would come if I was standing up, if I sat down, they stopped. So you know you’re just trying to you’re on your I was on my feet, the whole day.
They don’t let you eat, you know by the end of it I did get an epidural because I was just so exhausted, and they, you know, I was like, Oh, this hurts something hurts or you know I’m fine whatever maybe we should check or something and they were like, oh you’re having a baby right now. I was like, Oh great, like my epidural was working really well too well. So there was a race actually between me and the woman in the room next door who also got induced that morning of who was going to go first and the doctor was delivering both of us, she was suiting up for the woman in the other room she was going to push the nurse goes running to go get her and go stop. Come over here. It was like okay, so she got suited up baby was out in a push. I pushed the doctor made a joke, I laughed, made a half push and the baby was that
P: that’s how it’s was done ladies and gentlemen.
B: She’s a very happy girl.
P: Was she big?
B: she was eight pounds six ounces.
P: Oh, so that’s not so bad.
B: But if we went, you know, if we went to 40 weeks she would have been nine pounds.
P: yeah. For sure
B: So they were right.
P: And then does the gestational diabetes goes away after the baby’s born.
B: Yes, so we will both were instantly fine, but you do. For me, I have a higher risk of developing type two diabetes. Now, you know, later in life. So, even more important to eat. Not all the Halloween candy.
P: Yeah, yeah that’s tricky. I agree. Okay, so you brought her home and the other kids are excited how did that all go, oh
B: yeah, our, so we had them come to the hospital to meet her are then three year olds, our oldest girl she was very excited to meet her. They hit it off right away our son he was 19 months at the time, so it took him a little longer, as it does, you know, it took him about, I’d say a month, a month to six weeks to kind of be like alright, she’s not leaving, I better, you know, get on this train, and now he is her biggest supporter. He keeps an eye on her. He picks up her toys when she drops them like he’s just in love with her.
P: So that’s super cute. So how old are they now.
B: Oh gosh, so four. So everyone’s almost a half so four and a half, two and a half, and nine months.
P: Wow. It’s a busy house
B:, we’re tired. There’s a lot of joy, but there is a lot of teaching them how to be a little humans who are kind and respectful. So, yeah, yeah. And I, you know, when we moved to Minnesota a year and a half ago I left my teaching job to be home with the kids. So it’s, it’s a learning experience so I’ve been home now for almost a year and a half. And I don’t think I’ve ever done so much self reflection and like self checking than than I did in 11 years as an educator, so
P: yeah it’s it’s a totally different process, right
B: it really is, it’s a different beast,
P: but it makes you think about how you were raised right like,
B: oh yeah, there’s a lot of that to think about,
P: oh, this is how my mom did it. What does that mean,
B: right, or what should I do differently or, You know, all those things.
P: Yeah, that’s awesome. So, what is the oldest one into
B: anything make believe. So, any like pretending we don’t know each other and we knock on each other’s doors and we know she likes to play house, but like pretend that we don’t know each other to play house it’s not like she’ll play house with dolls, we have to play in person she’s super social, which is weird because my husband and I are introverted, so she’s like our little butterfly,
P: that’s fun to watch.
B: Yeah it is, it’s good for us to she like just chats up like she’s very little stranger danger which is not great she’ll just chat people I’m like okay, like they don’t need to know.
P: Yeah. Is your son Similar.
B: No, he’s our little introvert so even if we’re just hanging out as, you know, our family of five, you know, after a little while he kind of wanders off by himself to a different room to play by himself for 10 minutes and then he wanders back super into trucks and animals, like,
very boy, you know,
P: yeah, yeah. And do you have a line on the little one yet.
B: She’s She’s feisty. She’s redheaded, You know, so there’s that. The other two are blonde. She’s our little redhead, anything her big siblings do. That’s what she wants to do she wants to be in the mix, she doesn’t want to know she doesn’t want to eat. She wants to be with them.
P: Can she walk yet or is she still crawling?
B: No…She’s almost crawling she’s doing the rocking she’s almost figuring out the weight distribution on one side to the other can be any minute I’m terrified.
P: That’s a very cute. Well, it sounds like, people look after her.
B: Right, yes that and we have to like bolt everything down.
P: That’s very funny, so are you, are you still training, are you still doing the training.
B: Yes. So I personal train online and run coach online, which is really great.
P: and who are your clientele?
B: so I predominantly work with women with young kids who want to lose weight or cross the finish line, so anywhere from a 5k to a full marathon.
P: Wow that’s cool.
B: Yeah, its so much fun. I love it and it gives me something during the day, you know, in those like downtimes, to think about.
P: Yeah,
B: which is really, it’s very sanity, keeping
P: yeah, it’s nice to have something something adult
B: yes then to have something else on my brain,
P: so and that sounds like a useful thing for like a postpartum period right when everyone wants their body back
B: oh my gosh yes it takes so long, I mean I’m nine months out and I’m still getting there, so it takes a long time but yes I work with women who are postpartum. I work with beginners, the whole nine.
P:That sounds awesome.
B: Yeah,
P: I think I have your, your website is it called wrecking routine is that what it’s called
B: wrecking routine because I am not a fan of routines, except when it comes to my kids and their time for bed.
P: Yeah,
B: so it’s about doing something different, and seeing what happens.
P: That sounds awesome, I will I’ll put a link to that in the notes so people can find you.
B: Great, thank you,
P: thank you so much for sharing your story, you have a lot of adventure in that in that in those experiences I’m glad that your son was super easy, but you have like a contrast right you experienced at all. It’s not so easy to make another person.
B: No, it isn’t. Takes a lot,
P: but luckily you paid off with the joy in the end.
B: Yes. Yeah, and I get to be home with them and so
P: yeah that’s lovely.
B: It’s really nice.
P: Awesome. Thank you so much again for sharing your story.
B: Thank you, I appreciate it.
Episode 12: A Double Sided View: pregnancy through the eyes of an OB: Dr. Nicole Rankins
Cover Art from David Janelle https://www.etsy.com/search?q=pregnancy+OB+david+janelle
Episode 12SN: A Double Sided View: Pregnancy through the eyes of an OB: Dr. Rankins
It seems self evident that most doctors would agree that being the doctor and being the patient are two entirely different experiences. And being the patient as a doctor is a third, different path. Today’s guest is an OB, and got pregnant with her first daughter when she was still in residency. Unlike many guests, she probably knew too much about the world she was stepping into–which led her to have an anxious first pregnancy. As it turned out, that anxiety was well placed, as she did run into some complications in that pregnancy, and a delivery at 32 weeks. But what she learned from that first experience informed her next one, which was a much smoother ride. Dr. Rankins and I discuss advice she gives to mother’s to be, and the crisis in maternal health facing women of color. We are joined by a senior policy analyst at the Center for American Progress who offers her insights on racial inequality in maternal health. Listen to this inspiring story.
Cover Art care of David Janelle at https://www.etsy.com/search?q=pregnancy+OB+david+janelle
Dr. Rankin’s website:
Dr. Rankin’s podcast: All about Pregnancy & Birth
Racial inequality in maternal healthcare
https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/
Maternal mortality report
The Measured Effect of Doula Services on Birth Outcomes
Black Mama’s Matter Alliance
https://blackmamasmatter.org/bmhw/toolkit/
Changes in postpartum coverage for women on Medicaid
Get involved with the Momnibus Act of 2021
https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus
Audio Transcript
P: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka Today’s guest is an OB, talking to her feels a little like peeking behind the curtain to see how a magic trick is done. As someone who’s been on both sides of this interaction, her perspective and her story are totally interesting. She entered into pregnancy with much more real knowledge about the world she was stepping into the most of us do. Despite this information, or maybe because of it. She did have an anxious first pregnancy, and did run into some complications. But what she learned from that first experience informed her next one, which was a much smoother ride. After we talked about her experience in her own pregnancies, Dr Rankin’s and I discuss advice she gives to mothers to be, and the crisis in maternal health facing women of color. I also include the insights of an amazing researcher at the Center for American Progress, let’s get to this inspiring story.
P: Hi, welcome to the show. Can you introduce yourself and tell us where you’re from?
Dr. Rankins: Yes, I am Dr. Nicole Callaway Rankin’s I’m an OB GYN, and I live in Richmond, Virginia.
P: Dr. Rankin, thanks so much for coming on the show it’s very fun to have an OB, because your story will be super interesting for people listening.
Dr. R: Yeah,
P: the first question I usually ask people is what did you think pregnancy to be like. And for you, did you have your children after you were already a doctor?
Dr. R: That’s a good question… so I had my first daughter, when I was just out of my residency training so I had gone to medical school had done my four years of residency I was in the middle of a fellowship, when I got pregnant with my first daughter, and I was terrified.
P: That’s not what I was expecting to hear; but maybe you know too much. Maybe that’s what it is…
Dr. R: Yes, so, I as you might imagine, is that I’m a little bit of a type A ish person. And, number one, it took us longer to get pregnant than I thought it would. So, in this, please don’t, you know, crucify me for those who really seriously struggle with infertility, but at six months, I was like, this is, this is crazy like what’s going on what’s happening. And then I discovered I had been on birth control pills before then for a really long time. And once I came off birth control pills, like I had terrible ovulation pain like I would be like curled up in the corner on the floor like this hurts. So I just thought that there was wrong I thought I had endometriosis, I didn’t know what was going on. So when I found out that I was pregnant. It was like it was just as I was about to say, I need somebody to look inside my belly and see what’s going on because this isn’t right, and the pregnancy test popped up positive and I was like what am i Wait, what am I really pregnant. And then I immediately went to the dollar store because dollar store pregnancy tests work just as well. And I got like four more. I told my husband that we had to go get like a bunch more, and we did get a bunch more and they all confirmed that I was indeed pregnant.
P: That’s totally exciting I think most of us go through life with the myth that the minute you start trying you’ll be pregnant. We ultimately absolutely needed fertility help but I know that every month, up to the point at which that was discovered. You know I assumed I’d be pregnant because that’s the story that you’re told
Dr. R: exactly and it can feel like and you feel like there’s people around you who get pregnant like they sneeze and they get pregnant and you’re like, like why is this and then you look around and you see other people and you’re like why is it that me, it can be a lot.
P: Yeah, yeah, and you hear a lot of people who got pregnant by accident right anything
Dr. Rankins: Yes.
P: and you think, how’s that possible?
Dr. R: Yeah.
P: What was your pregnancy like?
Dr. R: So I was like I said I was a little bit anxious from the start, and things were fine until like the summer we’re not, maybe like nine or 10 weeks I had an episode of bleeding, where I bled, like all the way through my clothes.
P: Oh wow
Dr. R: So, which of course terrified me. So I went in to the office, caught you know call my husband, he was out of town, it was like a lot everything ended up being fine, but that episode certainly made me nervous. And even before that I would like, you know, check to try and ultrasound myself here and there. But definitely like ultrasounded myself a couple of times to try to look and see what was going on so I was a little bit like just nervous and anxious about what was what was going on but, you know, physically I felt, I felt fine I didn’t have like nausea or vomiting or anything and other than that bleeding episode. Things were very reasonable and I had finally like, calmed down, but it was like, okay this is good, around about 24 weeks I had to have a follow up ultrasound because at my 20 week ultrasound. The doctor noticed that there was a little bit of extra fluid like not not a ton, but a little more than she would have liked to see so I went back for a follow up ultrasound. And that was the first ultrasound where I really felt like relaxed about everything. And it turns out that that was the ultrasound where our daughter was diagnosed with having a problem during the pregnancy so an intestinal malformation. So, ended up being something called duodenal atresia. So at that ultrasound. And you would think that I knew what I was looking at but I was trying to stay like fairly neutral and not. I was do a better job like not trying to be my own OB, so she was doing the picture that she took lots of pictures and she came in, and, you know, she said, the baby had a ton of I had a lot of extra fluid at that point because the problem that she had, it happens in about one in 10,000 pregnancies in, where the first part of the intestines is not connected together. Well, and though she can’t couldn’t swallow the amniotic fluid so it was like backing up so I had a lot of fluid they saw the issues and then, you know, we had to go from there. This is sometimes associated with chromosome problems particularly Down syndrome so then I had the next hurdle of what were we going to do about that. My husband and I decided that we wanted to know more information so I ended up getting an amniocentesis, and the chromosomes ended up being fine that she does not have Down syndrome but that was certainly a stressful time, waiting for that.
P: A lot of people say they’re worried about the amnio Were you worried that it would have some kind of effect,
Dr. R: no, not really. Well for one thing I knew I had enough fluid, I think anybody could have reached like shot a needle from across the room and like flew it was the easiest aim, like, I probably will let a student do it because it was I had so much extra fluid that it was so easy to do. So the procedure itself I wasn’t worried about it was just more the anxiety of getting the result back.
P: So that sounds a little stressful. I assume there’s nothing during the pregnancy for that.
Dr. R: No, no, it’s all like you have to figure out, you have to wait until until after the baby’s born so then what happened is, then I got calmed down again because we met with a pediatric surgeon who said and I delivered at the same place where I did residency so at Duke, and we met with a pediatric surgeon and he was like, you know, this, this typically doesn’t end up being a huge problem. The most of these babies are born full term, they have surgery three or four days after after birth, and then we fix it, they stay in the hospital for a week or so go home and like things end up being fine. So I felt reassured that Okay like I know I have this issue but you know we have a plan and most of the time things end up being fine and I felt just a lot better and then having the amnio back the chromosomes and I just felt a lot more reassured that the things didn’t end up going the way that we thought,
P: well, so what happened then did you make it to 40 weeks?
Dr. R: No, I did not. So on a Friday, I had been having contractions, on and off, because I had the extra fluid can make you have contractions so I’ve been having contractions and then
P: wait let me ask you one kind of silly question, did you know that it was contractions. Did you know what was going on?
Dr. R: I did, yeah, I did and I knew that they were not like they weren’t painful, they just, I could just, they would happen, cramping and then it would go away, so it wasn’t like anything major. And when I got put on the monitor for like testing and things like that, it, I could see that they were happening but I actually did know that they were, they were contractions. And I also knew that, on that Friday morning that they were different, so they started getting regular before they were like, here and there and then that they started getting regular and I was 32 weeks and zero days exactly, they started getting regular. They were painful and just consistent and I told my husband I was like you know something isn’t isn’t right, this is different, I need to go to, you know, I think we need to go to the hospital, and my husband is lovely. We’ve been married for 15 years, but he knew I was like, tending towards anxiety and he’s like, Are you sure do we really need to go, I was like no, I really think this is different. And he said that he knew that something was wrong because on the car ride he could see me clutching the door handle of the car. Yeah, yeah, yeah.
P:So what happens when you get to the hospital.
Dr. R: Yeah, so I got to the hospital and, again, I felt comforted, because I knew I knew the staff and this was so that helped a lot, but the where I work, they had midwives, they still do have no bias and she checked me in and she’s like, Oh yeah, you’re a centimeter dilated and your cervix is effaced, and I was contracting every two or three minutes, so I was definitely like going into labor so then I had an ultrasound, because the length of the cervix can help predict, like whether or not you’re going to go into preterm labor and my cervix was like, longer than two centimeters is good. Mine was like, millimeters like,
P: oh wow,
Dr. R: yeah so I was definitely like going in to labor…
P: so there’s nothing they can do to stop it at that point you can’t take medication or…
Dr. R: well they thought, well, they said like, Okay, let’s try. Let’s try taking off some of the fluid, like some of the amniotic fluid because I have a lot so they thought maybe if it decompressed the size of the uterus a bit that things will quiet down so then I had another. It’s like an amniocentesis except they connect the needle to a drain, and they drained off like a liter of fluid.
P: Wow.
Dr. R: Yeah, it doesn’t hurt you just kind of sit there and the fluid comes out, but it did nothing I just continued to keep having contractions and then they said, well that’s maybe, you know, then I got admitted, of course, and I don’t recall getting any medicine like I didn’t get magnesium or anything to try and stop the contract like I didn’t get a whole lot to try and stop
P: once your cervix is effaced that’s not game over?
Dr. R: No, not necessarily, no. Sometimes you can still, still try and stop it yeah I don’t remember getting a lot to try and stop the contractions but I don’t think anything would have worked like I just rapidly progressed to like six centimeters. So, I did get ended up getting an epidural, and that’ll kind of play into the story later. Not because I was in a terrible amount of pain, but they just kind of thought like, just in case and maybe it might help like slow things down because epidurals will slow down labor a little bit but not, not a lot but I think we were all just kind of like pulling it whatever we could to try and see if we could slow this slow this down. So I just progressed, my water broke and I got to eight centimeters, and then she started having these big drops in her heart rate, and of course I know what that, that means you know big drops in the heart rate so the doctor.
P: Wait, what does that mean?
Dr. R: It’s a sign of distress. So when babies, yes on the heart rate monitor it was, it should normally stay in the range of like 110 to 150 and hers would drop down to like 80 or 90 beats per minute, you know, so it was dropping low and coming back up dropping low coming back up. So the doctor on call was like well maybe you can go ahead and just try and push, because I was like eight or nine centimeters and at 32 weeks we knew she was going to be smaller. So maybe just try and push through not a completely dilated cervix, but that just made the heart rate changes worse. So then, decision was made to go to C section, and at the C section so normally in a C section we do something where we, we, we test where we do a little clamp test to see if the patient is numb and making sure they can’t feel well I shouldn’t say… that makes sure they can’t feel pain like you’ll feel pressure and you’ll feel touching, but you shouldn’t feel like pain and they did the clamp and I was like no, I feel that like it felt like a distinct, it was pinching, but because her heart rate had been low, they went with the C section anyway and I, and I completely felt it,
P: Yikes!
Dr. R: yeah. Yeah, it was it to this day I will never…. It makes me stop whenever someone says they can feel it because it’s a, it’s not, it’s obviously a terrible feeling. And my husband just said I was just clutching, you know his hand saying like, you know, wait wait wait wait wait wait wait, but they just, you know, kind of went, and it doesn’t take long to get a baby delivered.
P: Yeah,
Dr. R: especially you know, for first time C section, It can be easily, a minute or two. That’s it. But it’s during that time it was very painful and then I remember they gave me something through the IV to help, to help with the pain medic, you know, help with the pain, and it was like, made me all like woosey. I remember I said, You just gave me some happy drugs that. And then the next thing I remember distinctly is like the surgery being over, and being transferred to the bed and I should take that back, I do remember before that because they don’t give you the medicine until after the baby’s born, so I do remember the moment when she was born. And I said I have to see her, I have to see her and they held her up over like the surgical drape. She looked like a monster. She had like her hands like up and claws and she just like she was like ready and she was like fighting and ready she was a little skinny squirrely big headed thing, but she looked pretty vigorous so that made me feel better and then I got the medicine and then like I said, next thing I remember it was, it was over.
P: So as a doctor. Do you think he would have proceeded with a patient like you in the same way.
Dr. R: You know that’s that’s a great question and I don’t think anybody’s ever asked me that. Probably yes, honestly because you feel like the anesthesia is telling you like we can get it under control. You know the baby’s heart rate is low, you want to get the baby dellivered so you’re trying to find the right balance so Yeah, honestly I probably probably would probably have, you know, before. So, yeah, but if I can at any moment like pause and say hey we need to work on this if there’s time then yes for sure. I pause and like we need to do something different
P: for your daughter’s condition does she produce a normal apgar or does
Dr. R: she, you know, do so yeah so she came out fine she came out bigger she never needed to be intubated. So she had she, she was fine, I should say I had had steroids betamethazone which is a steroid medication that you get that can help mature the baby’s lungs I had that the week before, only on a hunch, from my doctor that well, you’re at this point in pregnancy you are starting to have some contractions, let’s do it just in case, and it ended up being needed. So she came out, she was fine and she went to the NICU, she had surgery. Three days after she was born. When she came out of it and I first saw the pictures that were added as far as immediately. She went to the NICU my husband went and saw her and got pictures. I was like, is she okay, because like her ears don’t look like they’re in the right spot and like her aid so like, what is going on with that is that look to me. I don’t know if I was just anxious just again she ended up being fine she’s a beautiful girl but those first moments when I looked at that preterm baby I was like, Okay. And I should also say that in the recovery room. After the C section, I was so hungry I had not eaten all day, and I had Chick fil A like one chicken tender and like five french fries that was the best meal, I have ever had in my life
P: How much did she weighed.
Dr. R :Okay, so she weighed. Three pounds seven ounces or, I remember the grams because it was 1555 grams, because a very low birth weight baby is 1500 grams and I was excited that she was over 1500 grams at 1555 grams.
P: Well Well done for her the first hurdle is 32 weeks like I know that for preterm babies. They’re there kinds of markers of like early preterm and late preterm like where’s 32 weeks is that …
Dr. R: it’s, it’s kind of in the middle, like late preterm for sure is after like 34 weeks so it’s not like super duper early survival is great at 32 weeks but they’re gonna spend a little bit of time in the hospital
P: and she because she had the beta metazoan like her lungs were fine or…
Dr. R: she never needed any additional like oxygen she was fine breathing on her own.
P: So she’s in the hospital just to grow them and like gain body fat and
Dr. R: grow gain body fat and to have certain have the surgery to fix her intestines.
P: So we had surgery on our daughter to for the heart problem. The day after she was born and that’s kind of a terrifying thing, but our daughter was a whopping six pounds.
Dr. R: Okay,
P: I’m imagining three pounds is a little stressful.
Dr. R: It was, it was, it was an, she, it definitely was she had born on Friday had surgery on Monday, And at the surgery went great. But then after the surgery, they extibated her or took the tube out a little too quickly, and I happened to be we happened to be visiting and at the bedside when that happened, so that was another stressful moment, you know, watching as I could, You know hear her oxygen level, dropping and see that she’s not breathing and they tried to usher me out of the room and I like refused to move like I couldn’t move I just like, No, I need to stand here, so they re-intubated her, and then kept her on the ventilator a little bit longer just took a little bit longer to recover from the the anesthesia than they had anticipated. Um, so that was a scary moment but thankfully that was the last of the scary moments.
P: That’s great. I’m assuming that the surgery is required for her to like metabolize food,
Dr. R: so she could nothing can pass through her intestines I mean babies back in the day before they knew about this with, I mean if you can’t, if your intestines aren’t connected and they, you can’t eat you can’t absorb any nutrients while she’s inside of me she’s getting all the nutrients through the placenta so she doesn’t really, you know, babies don’t need their intestines but on the outside they need their intestine so literally they just made a little incision cut her open and connected the intestines back together.
P: That’s amazing.
Dr. R: It is it. The surgeon, the surgeon, he was, he was, we remember he was German, because my husband’s mother is German, and he was very like, you know, like, he comes out and he says, the child did very well in the surgery. Okay. You clearly you call them all the child, so you don’t have to remember, who’s the boy who’s a girl but it was, like, the child did very well.
P: that is was very funny. The German version of like Captain.
Dr. R: Yeah.
P: Very funny. Yeah, also to call her the child since she’s like a teeny baby whose five minutes old
Dr. R: Yes, but exactly he said the child.
P: It’s very funny but, you know, thank God he did a good job. So, yeah, so how long do they have to keep her in the NICU.
Dr. R: So she was in the NICU for a month, just feeding growing getting bigger and I will say, NICU nurses are some of the most remarkable people on the planet, period. Like, don’t get me wrong, my colleagues, the doctors, the nurse practitioners people who round we saw them like maybe once it you know they come through, they check and do things but it’s the NICU nurse who is like, they are with you know come visit when you call they talk to you. They’re the ones who were like come on you’re going, bathe This baby because you need to take care of this child. You’re gonna change these diapers. Come on, we can do this here we go, and they are just, they just, they’re remarkable.
P: In our experience, they were the most competent people I’ve ever met and my when we were kicked out of the hospital which is the way we see it, we were willing to stay… that you know we were like trying to get someone to adopt us, we were like, what, how can we just go home with you.
Dr. R: They are amazing. They are amazing, and it was a similar sort of like one day the NICU doctor was like, if you guys want to have any more time alone and you should go out this weekend because she’s going home next week, and we were like, What, wait What,
wait a minute, like wait a minute.
P: You’re like didn’t this baby just have surgery?
Dr. R: like didn’t like what happened, like what, and people would always say, like, Yes, I’m a doctor and, but I’m an OB GYN, I don’t know what to do with a little person like. Please stop, like, just forget I’m a doctor like I’m just so scared mothered figure out what’s what, but she went home exactly a month after she was born she weighed a little over five pounds when, when she went. When she went home and home, you know since then she’s been she’s been she’s 13 Now, 13, and five and a half inches taller than me and the year ahead and school. So very very very smart yes yes but in the beginning it was a little bit like you were and I’m sure you had the same thing when you go home you worry like every little thing like one time she threw up, and it was just like, oh my god, something’s happened where the connection is, it’s bad. We’re going in. We went it was almost like a snowstorm a snowstorm was about to start and I was like no, no, no, we’re going to the pediatrician. When you look when I look back at it, it was like, you know, it was like a little like terrible, but you just until you, they get a little bit bigger, It just, you have that like anxiety for a while, I think,
P: Oh, for sure, for sure, and I remember my daughter had a heart condition and I would call the nurses and say, she seems really tired and they’d say, put her to asleep. Like, there’s no magic like
Dr.R: Right. Right. Right. Right, yeah, you know, And we had to feed her every three hours.
P: Oh wow.
Dr. R: For a long time, like the doctor was like you have to scout, you have to feed her every three hours social growth, so we had to do that whole schedule and pumping and supplementing and all of those things. So yeah, I mean, ultimately you figure it out if you get you get past it, I’ll tell I’ll tell everyone. When I share my experience because occasionally I’ll share it with patients when they have preterm babies, I don’t like to push my whole story but like you never ever, ever forget. Having a child who’s in the NICU just never forget it. But you do get past it.
P: I think that’s totally true. Totally true. Yeah, yeah. So what she into now?
Dr. R: she is into reading, so she is a very avid reader, she is into smart comments back to her parents.
P: that sounds like 13
Dr. R: She is, she is she really is smart, she’s interested to get interested in like social justice issues, she’s not quite into athletics yet. I think she’ll run track once things have like settled down with, you know, COVID times she’ll probably run track she’s, bless her heart, she’s not the most coordinated of people always asked if she played basketball, I was like no, she’s I don’t think she’s like
P: do they say that because she’s tall?
Dr. R: yeah, because she’s tall, but I think that track she can run fast in a straight line so she’ll probably run track but she loves to read. She loves to read, we have another daughter, and their younger daughter and they’re their best friends so that’s all healthy happy.
P: That’s awesome.
Dr. R: Yeah.
P: So what was the second pregnancy and getting pregnant and being pregnant, and the birth easier?
Dr. R: Funny story, the second time. I’m grateful that the second time around I was like okay, if I can go through all that, like, I can, this, this is going to be okay, like we’re, we can handle whatever kind of comes our way so I was much, much, much more relaxed about the whole process, and then I felt like I had done some like personal work like meditation and things to try to like to calm myself down so I posted a totally different way so the way that I found out we were like, Okay, our first daughter’s a year old like okay let’s start trying, you know I was 32 to 33 when the first one was born so I wasn’t getting any younger. So we started trying and then I was at work one day and I was like, I don’t think I’ve had my period in a while, like, I don’t think it happened and my husband was like, he literally texted him I was like, I haven’t seen my period in a while and he’s like, genius, this is genius. You’re an OB GYN go take a pregnancy test.
Like, oh yeah, I should probably do that. And lo and behold, yes. I was indeed pregnant.
P: Oh good, that’s a nice, it’s a nice way to slide into it the second time, right?
Dr. R: yes yes and that pregnancy was fine except I did have nausea and vomiting, a bit with that pregnancy and like weird food intolerances, I don’t know why we can tolerate some food to something, some things like Cheerios would make me vomit like profusely, it was just weird. Once at work in the bathroom. I’m not lying. I threw up. And it went on three walls like, I don’t know what it was, it was awful. I felt so bad I told the cleaner I’m so sorry I’m so sorry I just said, is terrible and she’s like it’s fine I’ll fix it so that only lasted the first trimester, but otherwise the pregnancy was completely fine, I didn’t have any issues at all ultimately ended up having a scheduled repeat C section, which to some degree, I regret because I did it more so because it was convenient for work, you know, and looking back like when you make those decisions for work like it’s never worth any more than a job anymore, you know,
P: yeah, yeah,
Dr. R: it wasn’t worth it I think I would maybe try for for the back but otherwise the pregnancy itself and the repeat C section was, was marvelous like it was, there was no pain or, or anything and it’s how I knew that I wasn’t crazy because honestly thought for a second like was that just exaggerating like was I crazy to think that I felt this way at my first C section, you know, it was definitely what I had this second one, that it’s solidified that no this is a completely different experience than what I had the first time,
P: I’m impressed that you went for this C section the second time after the first experience.
Dr. R: Yeah, yeah, I don’t, I don’t know what just so I think the, the type eight is still up like I can schedule it on a certain day was just. And then I pick, I’m not gonna lie hand picked like everybody who I wanted to be there so that’s I see so for the anesthesiologist was like can you be there, you know, so that the nurse everybody so that made me feel better.
P: Well, that totally makes sense that actually in that context if you can control that element then that seems just wise, yeah. And so if you have an early birth, you’re not at risk to have it again or?
Dr. R: you are actually you are that’s one of the biggest risk factors to have another preterm birth, but for me it didn’t, didn’t, the second one was full term,
P: and is there anything they do to monitor you for the second time around.
Dr. R: So they do have links at measure the length of your cervix, during the pregnancy, that’s the most the strongest predictor, sometimes we do progesterone in order to help reduce the risk the second time around, I did not do progesterone, the second time around it wasn’t as in favor, then I mean my younger one is 11, so that was a while ago
P: that birth what sounds like a day at the office because it’s. scheduled I’m assuming there’s no contractions and
Dr. R: yeah I had just started like literally that that morning starting to have a few contractions but nothing terrible but that but that was like. Easy peasy lemon squeezy. Like the C section itself was straightforward. I stayed in the hospital two days. Today I hate hospitals that Yeah,
I hate being a patient. So I went home two days afterwards, and I felt fine.
P: Wow. That’s amazing.
Dr. R: Yeah, yeah, yeah,
P: and what’s the 11 year old into.
Dr. R: She is also into reading as well, she is into drawing, so actually painting like she likes to paint. Sometimes she’s into pushing back against her older sister can smell her oldest is was a little bit bossing sometimes, but they’re actually in many ways very similar and the things that they like she also likes racecar driving. So,
oh wow, that’s cool.
Dr. R: Yeah, yeah,
P: hopefully that will mellow by the time she gets her license.
Dr. R: Yes,
P: a little runway
Dr. R: Yes, yes, yes.
P: So, that’s an amazing story I’m glad the second time it was totally smooth. Yeah, it is, um, the bar is set so kind of low after the first one right, like anything less than that kind of high pitched excitement seems very easy.
Dr. R: Yes it does, it does
P: so that’s nice.
It’s lucky to get the opportunity to interview and OB about her pregnancy experiences. I also want to ask her about her work in educating women about pregnancy, and about her perceptions of the way the field of obstetrics manages issues like racial inequality when it comes to maternal mortality. Obviously you have a podcast called all about pregnancy and birth, which I listen to religiously.
Dr. R: Oh thank you,
P: It’s fabulous. on your web page, you have stuff about a birth course and a birth plan, and the birth plan is particularly interesting to me because most people I’ve spoken to have said like, oh, I had a birth plan but then X happened. I’m interested in your birth plan, what the theory is behind that and do people get to use it and like how does that work.
Dr. R: Yeah, so I say birth plan this because what people commonly use but like one of the first things I say in that free class is that we have to change it to birth wishes, because birth is a completely unpredictable process, and none of us can control birth, even if physicians tell you like, oh, we can just induce you and it’s, we don’t actually have control over what ultimately happens it’s, it’s unpredictable. So it’s really about wishes and things that you want, want for your birth experience and how to get that and then also just understanding, like the two biggest factors that will influence your birth and that’s the hospital where you give birth, and whoever is caring for you during your pregnancy and birth. so it is really asking questions so you’re informed about the way that they practice and that it’s in line with what you want for yourself so one of the biggest things I say and stress is that birth is unpredictable, this is really about riding the waves of that unpredictability, because when people aren’t satisfied with their birth experience it’s most often because they were not prepared for the fact that it could then it may not go as they, they saw that they wanted it to go or as they thought it was gonna go. So when you’re prepared for the unpredictability then you, you feel good about the experience, either way and you don’t blame yourself or feel guilty if things don’t go exactly like you anticipate
P: that sounds super smart That’s good advice. And the other thing I’m wondering about is, you know, if you read the statistics about black women and maternity. It’s like, it’s like criminal, like I don’t know what word would better describe that situation. do want to talk about that a
little bit.
Dr. R: Sure, so yeah I mean, black women are three to four more times likely to die in relation to childbirth compared to white women and that is completely due to racism, there’s, you know like, full, full stop.
P: To get a broader view of this issue, I talked with a senior policy analyst, at a think tank in Washington DC. Hi, thanks so much for coming on the show, can you introduce yourself and tell us about your professional background.
OA: Sure. Well thanks for having me so much Paulette, so my name is Osub Ahmed, I’m a Senior Policy Analyst for women’s health and rights on the women’s initiative team at the Center for American Progress, I work on all issues around women’s health and rights including birth control, abortion, and of course maternal health,
P: good Lord You must be busy.
OA: We’re very busy team. Yeah.
P: So first I wanted to have you lay out the statistics for us
OA: in terms of looking at the US versus other developed countries, there was a recent study from the Commonwealth Fund, that looked at the US is rate compared to attend other developed countries and in 2018 The US is rate with 17 maternal deaths per 100,000 live births, and that is about double what other high income countries, rates are that distinction is not a good one, we’ve been having this conversation around our maternal mortality crisis for years, but this rate hasn’t gotten better, and I think it’s something that we really really need to develop policy solutions around in order to ensure that women don’t have to be scared when they get pregnant and face you know the childbirth or it should be a joyous experience,
P: and I’m guessing that that number hides this racial disparity issue where the 17 doesn’t really reflect the rate for everyone.
OA: Absolutely yeah there is a racial disparity embedded in that larger rates, women of color and black men specifically are three to four times more likely to die from pregnancy related complications compared to white woman. And so, there, there are many reasons for that of course first and foremost is that racism is embedded in our healthcare system, and it affects the quality of care that black women receive their ability to access coverage and the resources they need to have healthy pregnancies, and even in the postpartum period, there are many issues that prevent women from having healthy perinatal experience
P: when I have looked at the numbers before it looked like white women in the US have almost the same number as white women in other countries that are doing well so literally, black women and people of color are really the ones who are mostly impacted by this terrible maternal mortality rate.
OA: Yeah, absolutely. There’s so many issues I mean it’s a very complicated issue. And I think that, you know, of course, like I said, racism and sexism is at the core, but when you break it down, you know you’d look at for instance issues around health coverage, you know, that is very important especially, you know, childbirth and pregnancy is very expensive.
P: Yeah,
OA: out of pocket, and so having insurance is critical to make sure that you can go for your prenatal visits that when you go to the hospital and come out with, you know, come back with your baby that you’re not gonna be saddled with these incredible bills, and that in the postpartum period that you can still go and seek out that health care. I think that that is, that is one very very important area, of course, other things related to weathering and impacting literally a person’s physical health and their body, their mental and physical health, they’re all things that cause black woman to ultimately experience these higher rates of mortality, when they’re pregnant and after they give birth,
P: and we’re talking about insurance, which to some degree, is a reflection of income, but black women across the spectrum face this higher mortality rate it’s not just income right so there’s many other things going on right it’s not like, If only everyone was insured this wouldn’t happen.
OA: Absolutely. So that’s a really important point to make, and there’s a lot of research that suggests that, whether it’s your income, your class where you live in the country. These things are not protective factors I think that there are some statistics that show that black woman who are more highly educated tend to have higher rates of preterm birth compared to white women that are not as well educated, so it just again shows that it doesn’t matter if you’ve been able to, you know, achieve all the things that you think would make sure you’re in a safe position, it ultimately your interactions with the healthcare system are going to put you at a disadvantage literally because of the color of your skin.
Dr. R: And it’s hard for people to wrap their heads around that because they think of racism and they think of like slavery or the KKK or things like that or maybe what we saw at the capitol for God’s sakes, but it’s but it’s actually more tends to be more more subtle, where people have implicit bias, they’re, they’re treating people differently and they don’t realize it.
P: Let’s talk about the insidious ways that race plays a role in these cases.
OA: If you look at this from a sort of, at different levels at the individual level, you can look at people’s interactions with the healthcare system, and with providers for instance, it can be very very subtle interactions that indicate to you that you aren’t valued, that you won’t be heard or listened to, there is the story which, you know, I think is a very important story but you also have to remember there’s many other stories around Serena Williams and her where she knew that there was something wrong, and she, she insisted to her doctor and they didn’t listen and she had to insist again and again. That is just an example of so many other black woman’s experiences that they have higher pain tolerance, and so they’re just, you know, or they’re being aggressive or, or just dramatic or just that what they are telling you is not true. And that is not only dangerous in terms of health consequences but it is, it impacts you on a deep emotional level as well. Looking more on a structural level, everything from access to doulas and midwives, it is difficult to pay out of pocket for a doula.
P: Yeah,
OA: and oftentimes doulas will lower their rates to make sure that women can afford their services but you know that hurts ends up hurting both the woman and the doula access to doulas is critical because they help to navigate the healthcare system and be an advocate, but if you aren’t able to afford a doula, because your state has decided not to allow for Medicaid reimbursement for example, that puts a woman at a disadvantage, and I fully believe that if black women had more doula support, that there would be better outcomes around maternal mortality, there’s a lot of issues around the health care system where we don’t ensure that women can access the things that they need, particularly women who are on some public insurance programs like Medicaid, there are a lot of things that can be done to reform Medicaid. And these are very clear things and yet, policymakers and legislators haven’t made those moves yet. And I think that that its clear that black woman in particular will need some of those reforms.
Dr. R: One of the biggest things is that our concerns aren’t often taken seriously enough. There’s story after story of concerns not being addressed not taken seriously enough pain not being addressed. And when you look at the factors and this is even for educated, black women, then that leads to sad outcomes related to bleeding after birth related to high blood pressure issues after birth so it’s really related to just not listening. So this is why I say especially honestly the way our maternity system in the US in particular is the patriarchal is based on, you know patriarchy and taking away power and control and choices from women about what to do in their own bodies and we’ve gotten better. We’ve definitely gotten better, we’re not like where we were in the 50s or 60s or whatever you know where everyone was like knocked out you couldn’t have anybody in the delivery room, but we still have some room to go and I say all that to say like, everyone actually needs to have someone who can advocate for them on their behalf during pregnancy and birth, and the idea is hopefully you don’t need it because you end up being in the supportive system, but sometimes you don’t know until you get there, but it’s really important for black women and people of color to have advocates for you to be educated and empowered with information so you can both advocate for yourself or if you’re not in a position to do so you have someone there who can advocate for you on your behalf, that’s really key.
P: So like a doula would be a good thing to bring to the
Dr. R: 100% Yeah 100% A doula would be a great thing to have.
P: Oh, you know, I was gonna ask about if there’s any data about doulas and our measured impact.
OA: So yeah, there actually is, is data out there about doulas and their impact on birth outcomes. So there are studies that have found that when birthing people have doula support, they have better maternal infant health outcomes so that includes lower rates of preterm birth, lower rates of C sections again having an advocate in the room to, you know, if it does fall into an emergency C section conversation they can be there to push back if necessary. Also, higher rates of breastfeeding initiation. So there’s a lot of really great things that come out of doula support during the birthing and postpartum, as well as really prenatal experience, it’s all part of the woman’s sort of journey and when a doula is present, the woman does better, and her baby does better too.
Dr. R: And I tell people its hard because you don’t want to be seen as like the difficult person or like make a scene or those kinds of things but ultimately it ends up being like, your, your life, potentially, you know, you start from a place of kindness and human connection and saying hey I’m scared I’m worried, help me, those things that if that doesn’t work, then you may need to elevate it to a level of like I am demanding that you come see me and you can do something about this. You have to actually like involve people in their care, you can’t make those, those choices for them in that case of consent in, in particular, this comes up with things like breaking people’s water without consent or stripping membranes without consent, those are things that just, that just shouldn’t happen and it all comes down to whether it’s listening to the patient or explaining things it’s like really just putting that birthing person at the center of the experience and if you work from that, then you’ll be fine.
P: It’s probably most acute in OB work because it’s so intimate and so, you know everyone remembers their birth forever like, as opposed to like a gallstone, exactly.
Dr. R: Yeah, exactly, exactly. Yeah,
P: so it is super important. So, is there any other suggestion you have other than getting a doula is there anything else we can do.
Dr. R: Yeah childbirth education, I think is really important, we’ve gotten away from childbirth education and people routinely doing time with education, I think that’s key. It’s not, obviously not going to give you the same level of knowledge and expertise that I have it, you know 15 years of experience, but you will be able to communicate intelligently about things when you go through a good childbirth education class and there’s lots of options you have to find something that works for you, you know, as you said I have an option for online classes geared particularly for women who plan to give birth in the hospital, but do something like that’s my plea to please do some childbirth education because that really makes a difference, and your partner should do it too.
P: Oh that’s a good suggestion. So you can definitely, either you can be your own advocate or he or she can, because
Dr. R: yeah, yeah, yeah. Yep.
P: I think that’s another thing you don’t know before your first pregnancy is how compromised you’ll feel in the moment right you’re, you were in extreme pain right so how can you possibly kind of steer the ship.
Dr. R: Right, exactly, yeah,yeah, for sure.
P: Well, I totally appreciate your amazing story and your podcast and your, your website with the birth course and the birth plan that seems super helpful. And hopefully it will do, do people good to have more kind of knowledge to get the pregnancy and birth they want.
Dr. R: Yeah, thank you thank you I certainly appreciate that and if you to anybody who’s interested in my website is it okay if I mentioned it, absolutely. So the website is Dr. Nicole Rankin’s comm so that’s pretty easy to remember and you can find all the stuff there for the podcast and free downloadable resources like the warning signs to look out for after birth the free birth plan class and then as far as social media Instagram is my favorite place to be. So I’m there at Dr. Nicole Rankin’s also.
P: Okay, great. Well, I will put that in the show notes also so people can find you.
Dr. R: Yeah. Well thank you so much for having me on. I appreciate it.
P: Thanks so much for coming on. I really appreciate this conversation. Thanks again to Dr Rankin’s for coming on the show and sharing her experiences, both as a new mother and as an OP. Thanks also to also, for giving us an insight into the scope of the maternal mortality problem facing women of color and black woman in particular, and for giving us a sense of what’s being done and what needs to be done to resolve these long standing issues. Our conversation was longer than the clips included here. We talked about some of the progress that’s been made in particular, Miss Hoffman, talked about the federal package of legislation that was introduced by Congresswoman Lauren Underwood, Congresswoman Alma Adams, Congresswoman, all the Adams and former senator Kamala Harris and the members of the Black maternal health politics. It’s called the Black maternal health omnibus of 2021. It’s a package of wonderful bills they tackle a number of different issues around maternal health, including the 12 month postpartum Medicaid coverage investments in rural maternal health, the promotion of a diverse perinatal workforce and the implementation of implicit bias training. If you want to get involved in this issue, see the show notes for episode 12 on the war stories from webpage. In the shirts I also included links to Dr Rankin’s work, and to some of the studies that this aspect talks about. If you liked the show, we could really use your reviews, because these help other people to find the show. If you’d like to share your story, go to war stories from the womb. COMM And sign up. Thanks so much for listening. We’ll be back soon with another story of overcoming.