Episode 11: Wrestling with Preeclampsia: Audrey
Episode 11SN Wrestling with Preeclampsia: Audrey
Like many women, today’s guest imagined that having a child would be straightforward–that’s the way she’d always seen it portrayed in the culture around her. And at the start, her expectation and experience lined up well. Getting pregnant wasn’t a challenge and being pregnant, was an exercise in smooth sailing for many months. But then the swelling hit, followed by an episode of fainting, and she and her husband found themselves caught up in the whirlwind of preeclampsia, including some of the more disconcerting features of this condition. She is fortunate to have excellent medical care and now both she and her baby seem to be enjoying toddlerhood. Listen to her story of overcoming.
Cover Art provided by Stephanie Davern from Mamapaints on Etsy
Preeclampsia research
https://journals.physiology.org/doi/full/10.1152/physiolgenomics.00017.2018
Blood pressure and preeclampsia
Recurrence of preeclampsia
Umbilical cord and preeclampsia
Paternal determinants in preeclampsia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330890/
Sucking reflex
https://www.stanfordchildrens.org/en/topic/default?id=newborn-reflexes-90-P02630
Dr. Rana’s research
https://www.tandfonline.com/doi/full/10.3109/10641955.2013.784788?scroll=top&needAccess=true
https://pubmed.ncbi.nlm.nih.gov/26105375/
https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.111.054361
(for more of her research, you can search https://pubmed.ncbi.nlm.nih.gov/ with Dr. Rana’s name and ‘preeclampsia’ as the keyword)
Audio Transcript
Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka. Like many women, today’s guest imagined that having a child would be straightforward. That’s the way she’d always seen it portrayed the culture around her, and at the start, her expectation and experience lined up well. But into the third trimester, the swelling hit, followed by an episode of fainting, and she and her husband found themselves caught up in the whirlwind of preeclampsia, including some of the more disconcerting features of this condition. Fortunate to have excellent medical care, now both she and her daughter are immersed in the joy of toddlerhood.
After our conversation, I went back into the interview to add details about some of the medical issues that came up. I also spoke with a great maternal fetal medicine doctor who specializes in preeclampsia research. I’m including her insights, not to scare anyone, but to give a full picture of what pre-eclampsia involves.
Let’s get to the interview.
P:Can you tell us your name and where you’re from.
A: My name is Audrey tipper and I am from St John’s Michigan.
P: Oh wow, cool. Is it snowing there.
A: And we just finally got our first dusting of snow yesterday.
P: Do you have one child?
A: We have one we’re one and done actually.
P: Oh, great.
A: We were originally planning on two we thought but because of my experience, and also because of my own personal history, and we’re really happy as a triad and we’re just gonna stick with that I think
P: that’s awesome.
A: Yeah,
P: well good I’m glad that you’re, you know over this part of it right,
A: yes. Yeah,
P: so before you ever got pregnant, what did you think it would be like?
A: you know, I, looking back, I thought that everything was gonna go like this textbook right like, I think that I thought that it was just, you know you get pregnant because they constantly, like your whole life, like you gotta be careful to not do that right. And so I just thought that it would just be super easy and then there you go, and then you go through the process and then you have a baby. And that’s it, and that’s not that I mean, that’s not really what happened for me. Yeah, the getting pregnant was for us we were thankful it was easy, but I know that that can be a challenge for other people and so that part was not our challenging part.
P: Good, we’ll take what we can get right.
A: Yeah, exactly.
P: Did you find out you’re pregnant from a home kit.
A: Yep, yep, we just did it. Yeah, just a little over the counter first response or something.
P: Yeah, yeah. Well, that’s exciting. Yeah, and then take us through the story like what, what, how was the first part of your pregnancy, did you have morning sickness or
A: I had a bit of morning sickness and I was still working, I have a degree in Hospitality and Tourism Management and at that point I was managing a property that rented space to a variety of food vendors or. We also had a lot of events and that sort of thing. So some weeks my hours were decent other weeks were long so you know that was just part of what I was doing. And so yeah I definitely had some, some morning sickness, a little bit in the beginning but then the next like like I guess you’d say the second trimester was was just fine. I was just pregnant and it really didn’t affect too much going upstairs. I was a lot more winded, you know, that kind of thing. But other than that, it was what I thought was pretty normal really then past that I started having issues with swelling. Then as I have, I started swelling like a lot, and I mean it was, it was so much that it was, it was painful,
P: does that I mean like ankles or…what’s getting swollen?
A: My hands, my feet, my legs just really everything honestly my face, you know, looking at pictures you can see it in there too. I was just really swelling and my aunt had had some issues with with her blood pressure and that sort of thing. And so she asked me hey have you talked to your doctor about this, she’s also a nurse so she’s, you know, that’s very you know, the thing that she would notice right away.
P: Yeah,
A: and I said yeah I did actually and they that the doctor that I saw, because that that the practice that I had had several doctors, and at that point in the I was seeing a different doctor every week so that way I could get to know them, if in case they were the one on call whenever I went into labor. Oh yeah so I was seeing all the doctors and the doctors that I saw that day. She really didn’t make me feel at all comfortable about my worries, and my husband and I laughed and we were like, Oh man, that was, was terrible. I hope she’s not the one on call whenever we, you know, go in and.
P: Did she say it wasn’t an issue or like what did she say?
A: Yeah, she was like, I’m sorry, so she was like basically just that I had to suck it up, that it was just part of being pregnant with some people swell and that’s just the way that it is. And so I, so I laughed and I cried actually because I was so upset that that because I was in pain and it was difficult and frustrating. And…
P: I don’t know that I would anticipate that either Right?
A: no, no, I figured she was gonna do something to help me whatever it was I didn’t know but you know she has degree she’s got way more experienced than I do. So yeah, I really didn’t anticipate that at all. And so then at that point I guess we would have been. Let’s see, we would have still had eight weeks ago, so what’s that 32 weeks Iguess
P: Yeah, exactly.
A: So two weeks later, I had another appointment that afternoon, but that the night before, I had gotten up in the middle of the night, to use the restroom because that’s what we do when we’re pregnant.
P: Yeah.
A: And the way my, my bathroom is set up the toilet actually sits in a little alcove so I can, I can put my elbows, you know to wall to wall if I were to, you know, press them out a little bit so it’s just, it’s really just the toilets in this little piece I mean, there’s the bathroom is larger than that but that’s just where the toilet, and I’m really thankful that our house is set up that way because while I was using the restroom, just like what I felt like it was in the movies. I literally passed out on the toilet.
P: Wow.
A: Yeah. And so, I remember thinking, like the next day I’m like that’s just crazy who does that, that’s totally like in a script that’s not real life.
P: Yeah, yeah.
A: And so once I came to I was leaning to the left side of the wall. I had not fallen off, and it took me a few minutes to really come back, mentally to because I realized just lay there against the wall for a while because I didn’t feel like I could stand up or have been set up at first. And so then I went back upstairs to our bedroom and I you know told my husband that I had passed out. And he said, Well, do we need to go to the ER like are you okay and I said, Well no, it felt like a normal passing out.
P: Wait, I’ll have to stop you there for a second. How often are we passing out? What does that mean?
A: I don’t know. in hindsight that should have been a sign that things are not right. Yeah, to be fair, the reason that I thought that I have a vasovagal response to getting my blood drawn. There’s nothing wrong with me. Like I’ve had my heart looked at and everything, I’m totally fine, but and I’m not afraid of the needles so I don’t know what happens for whatever reason, my body’s like oh no that’s not supposed to be here and sometimes I’ll pass out when I get. And so, to be fair, I know, like that’s like I pass out enough from that maybe less than once a year, it’s not really that often, but it’s enough that I have done it, and you’re like, okay this is normal,
P: right, right, no, no, that’s, that’s the only story you can tell, and that makes total sense.
A: Right. It is I, but, but still, that should have been like okay that’s weird to even say a little bit and so my husband and I, we went back to sleep. We didn’t get up and do anything and the next morning when we’re both thinking more clearly. He said, You know, maybe we should call the OB, and just ask about this and yeah that’s probably a good idea. So we were, we went to work, we actually carpooled that day and we’re in the car and I called the OB and I said hey this is what happened last night you know i What do you think, and I don’t know why don’t you just go into OB triage and get monitored and just have the level, you know, a checkout done. So we call our bosses, we’re gonna be a couple hours late, you know, sorry, you know, this is what happened. Okay, no big deal. So we get to OB triage and they check us in and my blood pressure is 179 over 103.
P: Uh-oh
Just a quick aside here, we know this is going to be a story about preeclampsia, There are a collection of symptoms that define preeclampsia, but elevated blood pressure is one of them. And the cutoff for what’s considered high blood pressure is 140 over 90. So Audrey’s blood pressure is way too high already.
A: They were like, Yeah, you’re not going anywhere. So they gave me this, because at this point would have been six weeks early, and or about, I mean, give or take a day I forget what the exact days were at this point that the doctor that came in. Once they moved me on to the to the actual board of delivery board was the doctor that I saw two weeks previously that we didn’t like
P: rut ro…we meet too soon.
A: And I have to say that in hindsight, the day to day business just isn’t her thing. She was amazing. Maternity Ward and, And we were like, is this the same woman but I was really really really surprised and she was able to get things done that we needed to get done for tests and you know, she just really made us feel comfortable and like she was just going to take care of us and so we were really quite thankful actually that she was the one that was there because she just handled things in a way that we felt was not only comforting but just really professional. She just did the right things.
P: That’s awesome.
A: It turns out just the day to day stuff just isn’t her bag. Yeah, yeah. We all have different things.
P: Did they think the fainting was related to the swelling like had you had high blood before?.
A: So, I was diagnosed with preeclampsia, so they put me on a magnesium drip right away, you know, and then the goal was to induce labor at that point because there’s, there’s nothing else to solve the situation from where, from where I was. So yeah, that’s, that’s just the the next steps that we started to do, and, and we didn’t, we didn’t think really too much of it we said oh I didn’t know what preeclampsia was, I had never heard of that before I was told that I was in the hospital with it.
P: I talked to a maternal fetal medicine doctor on the cutting edge of preeclampsia research, to give us some context for what Audrey is experiencing. Hi, thanks so much for coming on the show, can you introduce yourself and tell us where you’re working.
Dr. Rana: Yeah, hi. Thank you for having me here. So my name is Dr. Sarah Rana, I’m a maternal fetal medicine specialist. That’s the high risk OB provider, and I work at the University of Chicago medicine.
P: Okay great, thanks. So let’s talk for a minute about preeclampsia. Do you know how common that is,
Dr. Rana: yeah, so it kind of depends. So if you’re looking in the United States is about, I would say anywhere between five to 7% worldwide and maybe a little bit higher prevalence, you know, overall, all kinds of high blood pressures in pregnancy is like close to 10% So it’s pretty, pretty common,
P: That is common
A: And the doctor did tell him he’s like, look, this is, this is bad, you’re really sick, and this is the solution the only solution is that we have to take the baby and. And this is just this is the next steps and so okay. My husband and I carpooled so we could have date night but I guess we’re having a baby instead
P: new plan,
A: New Plan….Yeah.
P: So are we are we feeling nervous in the hospital now or you feel like I’m where I need to be and so this is okay,
A: you know, the entire time that I spent in the hospital, there was only one time that I was nervous and but otherwise I really just felt like the our doctors and nursing staff and other hospital staff just really were great. You know we were at Sparrow and Lansing here in Michigan and they just did a phenomenal job of doing what needed to be done to keep both my myself and our baby safe as well as, you know, you know they made sure Nick had drinks or snacks if he needed some of that too. So, in hindsight I realize that for us that was it was a really quite serious situation, and in hindsight, I’m a lot more nervous about it, and that majorly played into a piece of why we’re one and done because I don’t want it, I mean if you’ve had preeclampsia are statistically more likely to get it again, you know,
P: yup, yup
according to the preeclampsia Foundation research suggests that the risk of having preeclampsia, again, is approximately 20%. That’s one in five. But experts say to range from 5% to 80%, depending on when you had it in a previous pregnancy, how severe it was an additional risk factors you may have risk factors include things like age, race, whether you’re having multiples in a pregnancy, and a few other things.
A: I want to be here to raise my daughter. You know, I don’t. It’s statistically one of the leading causes of death in pregnant women, and
P: it’s totally scary. I totally agree.
A: Yeah, it’s just, I, it wasn’t worth the risk for me.
P: Yeah, and I actually. Yesterday I talked to a maternal fetal medicine doctor. Yeah, and I was saying can you explain it to me like what do you think is going on and she said we don’t understand like how I preeclampsia, comes about.
A: It’s amazing. They think I’ve read that there’s some relationship between the umbilical cord and preeclampsia, but they don’t know how or why that is. And they also think it’s possible that there’s some relationship that the husband is actually can give it to the baby so to speak to the pregnancy. And so it can come from either line, which is really interesting from a pregnancy standpoint.
P: Yeah, well his genetics are affecting your placenta Right,
A: right.
P: So it makes sense.
A: I agree.
P: So take it so obviously you’re here, and so is your daughter, so take us through the process.
A: I wasn’t sure if I wanted to do an epidural or a natural birth at first. So when I was in, originally I didn’t have that we just didn’t do anything until I, I was ready to make the decision they give me, I forget what was the Pitocin maybe or something but they gave me something, they started trying to induce, and for whatever reason, it just wasn’t working for me at all in any way shape or form. So then they tried …
P: Does that mean like you had contractions but no, your cervix didn’t
A: I didn’t have anything: no contractions my cervix wasn’t dialating was like nothing was happening. And so at that point they tried to forcibly dilate me. Which,
P: that sounds comfortable.
A: It was awful. It was incredibly painful because they stick some balloon in your cervix and then they try to blow it up.
P: Is that the Foley bulb?
A: Yes, yeah, it was really painful. That was terrible, I’m sure, like, yeah, I didn’t like that at all. So they wound up doing that twice over the. Let’s see. I don’t know how many hours but from the time I checked in. So the time we had to make different decisions was like 36 hours was a long time.
P: That is a long time.
A: And so we, we were just waiting for me to start doing anything, and nothing was happening. And this whole time I’m still on this magnesium drip which is terrible.
P: Is the magnesium sulfate making you loopy?
A: it makes me….It made me incredibly weak. I couldn’t sit up on my own hardly I couldn’t move my muscles and from what I was told the goal with the magnesium drip is to is to keep you from having strokes and seizures.
P: Yeah.
A: but I mean I couldn’t even like turn over on my side in bed, it was incredibly difficult,
I hated that. My mother in law did drive out because I hadn’t even packed a go-bag, I thought I had six weeks.
P: Yeah,
A: I thought I had all this time, no time. And so, you know, we didn’t have anything that we would have, like we had this great list, you know of all this stuff that we were going to pack, but none of it was with us because we did not plan for six weeks early. So yeah, we’re, we’re just at that point we’re just waiting. We’re waiting for my body to do anything. And so I finally start to have contractions 36 hours later. And every time I have contractions. Her heart rate drops through the floor. It basically just is completely almost non existent like they don’t even know where, like, it doesn’t even register anymore.
P: Good Lord. That’s scary.
A: It’s really scary. Yeah. So, at that point, they decided I needed to have an emergency C section because they told me Look, something is wrong. We don’t know what it is, but we need to get her out of there, and we don’t think that natural birth is the way is the way to do it safely. And so we were, you know, at that point we’re like, Oh God, this is really scary, because, you know like, this is not part of our birth plan, this is not written down. And, and so they started to prep us for surgery and, you know, I met the anesthesiologist was was awesome, actually he, he and his partner there was two of them that that work together to do that part of the job. One of them was from one of them had spent time in the army and the other expense, I want to say, Navy, Marine Corps Navy I forget which I know they’re completely different but and I have some friends in my life that I consider family that have spent time in the Marine Corps, so I like this fun banter that was normal to me, you know, between the branches was, was what they were doing and I just it felt really comfortable, which was nice because I needed something to feel semi normal in this crazy situation that. Yeah, so they wound up doing the, not the epidural, the other one, put it in the same place but it works slightly differently. And, you know, my husband was able to be in the OR with me and he’s up by my head and they took took her out, and it’s such a strange feeling because you can’t feel any of the pain but you can still feel them moving things around and you can still feel their fingers and it’s very strange.
P: I thought it felt like being on a roller coaster. Yeah, like, move all your organs back to where they’re supposed to be, I thought that was weird, I had a C section, too.
A: Okay, yeah, just the feeling of, like, yeah, that’s just strange and my husband, he said I wanted to look, even though I know that sounds weird, but I didn’t want to be a liability in case I had a problem with it. I was like thanks honey I appreciate that because I really needed to be the priority right then . They had taken right away to the queue with being six weeks early, we didn’t know. You know what state she was going to be in and what type of care she was going to need. So he went right with her and then my mother in law came in to my like recovery room and she’s so she stayed with, with me for a little bit in there, and then I still spent like another week, not quite a week in the hospital recovering because I was just that we couldn’t get my blood pressure down. And we really, they they gave me all these different types of meds I was on like three different blood pressure meds at once to try to regulate it, and we couldn’t they just couldn’t get it to come down and I want to say, maybe for like the weird thing too, because I was so sick. And because of, I think partly because of the magnesium, like I had this one picture with Linnea and I got to hold her for like a half a second, and then they took her way to the NICU and I didn’t like I didn’t get to do you know like the chest thing that you that like
P: skin to skin
A:Yeah, like you have skin to skin and you get to do any of that. And I didn’t even register that I was missing it and I didn’t even miss her at first because I was just so sick that I wasn’t functioning.
P: Yeah,
A: and like looking back on that. It feels weird because I hear all these stories from other women whose, you know, who got to experience that skin to skin and who still got to be mentally present, you know, with, with, with their babies when it after birth and I can’t relate to that at all. I didn’t even register that I needed to go see her, because I was so sick.
P: Yeah I think that’s, I think that’s fair. I think it makes sense, right. Like, you don’t have all the oxytocin because you’re not supposed to be delivering and you’re not right, you’re like, not in that frame. So yeah, that’s perfect sense.
A: Yeah, yeah, it does, I get the logic side of it, the emotional side of it, it’s a little weird. Yeah and then then like three days later, I woke up in the middle of the night. My husband had been staying with me this whole time because they had like a cot thing that they were he was able to stay on in my room. And I couldn’t breathe, I had some my chest was like, like, painful, and I couldn’t figure out, I didn’t know what was wrong with me so I press the call button for my nurse, and she came in and, and she told me later that when she called the doctor she was like, You need to get down here now I’ve been taking hair care of her for three nights and she has never acted like this. So, my husband had just stepped out for a few minutes because I was sleeping and he had went up to the NICU checked on Linnea stayed with her for a little while to spend time with her, and then he went down to the cafeteria got himself a candy bar, so he’s walking down the hallway. And here all these like, people with, with supplies, you know the rolling supplies that they bring to the rooms, they’re like running past him like he’s like, Oh, I hope they don’t turn down my hallway, they turned out my hallway. Nick’s like I hope they’re not turning into her room, she was fine when I left her, so of course like he turns them and there they are like this room is full of like 15 people and my husband’s like, what’s going on. She was fine. A few minutes ago. And so they did, like they did all kinds of different things to try to figure out what was going on and basically what was happening is I was drowning my lungs were filling with water because I had been. So, I was still so swollen and still so many issues from the, from the preeclampsia that it, it was the water was starting to release a little bit and chose to settle in my lungs.
P: Good lord is that, is that a normal preeclampsia reaction.
A: I haven’t heard anyone else having that happen. I don’t know,
P: three days after the baby was delivered. Audrey had fluid in her lungs.
Dr. Rana: Uh huh, pulmonary adema
P: yeah and her description of it was, I had so much fluid in my body from all the swelling and everything that it was the fluid was looking for a place to go and it ended up in my lungs. Is that an unusual outcome from preeclampsia.
Dr. Rana: Oh, actually not a lot of people can tell up so what happens in preeclampsia and any kind of, you know, hypertension, is after delivery. So first of all around the time of delivery people get IV fluid, and then by about like day three, day four, they start to mobilize these fluides. So in a sense, She’s kind of right in a sense that she’s saying that I had all this fluid in my body like it had to go somewhere. Normally people kind of reabsorb it back into your circulation and just merely peed out. Yeah, so you just have like, so but now you can have not only edema postpartum, it can develop even during pregnancy and, and during labor but it’s actually quite common to develop with that, after delivery and a lot of people are saying it’s because of this combination of your pre eclampsia because your vessels are leaky, then you get all this extra fluid when you were in labor and then you re mobilize all this food like three to five days after delivery, and then some people say maybe even taking drugs such as motrin, you know NSAIDS, especially if you have renal dysfunction that can also cause you know some of this impaired renal function to diurese and get all the, all the fluid out so you can then accumulate food in your lungs.
A: That was the moment before I initially gave me some lasix and it thankfully cleared me up. But that was the moment where I started to wonder if I was going to go home or not.
P: That’s terrifying.
A: Like I I started to wonder if I was gonna die like if I didn’t get to be a mom if I didn’t. If my daughter didn’t get to have both parents.
P: I’m so sorry. That is terrifying.
A: Thank you.
P:, it must have been a terrifying, it’s like must be a terrifying feeling.
A: Yeah, yeah it’s it’s really scary like. Not sure. You’re going to keep living I. Yeah, it was tough. That was the hardest night for sure.
P: So what did they give you? and it worked immediately.
A: Pretty, pretty close to immediate, really fast at least it’s called Lasix, it’s basically just a dehydrator. And it basically makes all the water, P and they say P out like a ton. And so,
P: thank God for that.
A: Yeah, seriously. Yeah,
P: so they figured out that there was water in your lungs.
A: Yeah, they did a chest X ray right there in my room that was one of the machines that they had brought in and that was one of the things that, that, that showed but because I complained of chest pain. The next day they also did like a heart like a sonogram like yeah so I had to do that. The next day, and a couple other tests that they wanted to just make sure that I wasn’t having heart issues and thankfully, it didn’t show any heart issues at all, and I was on blood pressure meds another oh I don’t know, three or four months.
P: Wow.
A: For a few months and I’ve read that some women never get off the blood pressure meds after having preeclampsia and for some women it’s about like what I experienced a few months and I’ve also read that myself and my daughter are at a higher risk factor for heart issues the rest of our life because we had preeclampsia together. There’s a lot of research that still needs to be done in order to figure out why and what can be done to help and that sort of thing but, you know, I try to stay as updated as I can now that I’ve had it
P: What does preeclampsia mean long term for women who’ve had it
Dr. Rana: There’s really no cure to preeclampsia, so there’s lots of data that preeclampsia leads to long term physical cardiovascular damage. So patients who have preeclampsia, are at risk to have lots of outcomes that are happening related to all the insults that happened during pregnancy or intrapartum period, immediate postpartum so patients who have preeclampsia at high risk will have high blood pressures after delivery, their higher chance to get readmitted with heart failure. And then after that they have a higher chance to have developing chronic hypertension, they have higher chance to have cardiovascular disease such as they can have MI and heart failures and edit me as an cardiomyopathy, they in fact have a higher chance of dying Absolutely. When you adjust for all of the risk factors of preeclampsia is a massive risk factor for long term cardiovascular dysfunction which lots of studies have now come out is not so long term actually start soon after delivery. So a lot of specialists in the, in the field are trying to walk away from the fact that just like write it off and it gets cured , we don’t want to say that you say well, delivery of the placenta and the baby will resolve some of the signs and symptoms of preeclampsia so your hypertension resolves in the acute phase, and you upload your lab abnormalities it resolves your renal function recovers, you know your kidney, your liver function will recover, but it does lead to long term, short term and long term postpartum outcomes. So, we are not saying now that it’s a cure. It’s actually just, it was all some of the symptoms but you have to watch these women really really carefully postpartum to prevent some of these complications that are happening to them after delivery.
P: So I know there is this higher risk of cardiovascular disease, but the pool of women who run into preeclampsia, is pretty heterogeneous so you can have preeclampsia at 34 weeks so you can have it later than that, it can be mild, moderate, severe are all those people at risk of cardiovascular disease or do we know whether some are more at risk than others because those two things seem like different kind of syndromes.
Dr. Rana: So they’re like two types of people like you were saying, so not just when they develop the patrons, but also what risk factors they have so there are, there are people who have pre existing cardiovascular risk factors, so if you are obese if you have higher, you know, BMI you are African-American race you have diabetes, you have other kind of risk factors that you came into pregnancy, and then that predispose you to have preeclampsia, so you know pre patients who develop preeclampsia have some of them, a lot of them have underlying chronic conditions that predispose them to have preeclampsia and then after they have preeclampsia the same cardiovascular risk continues right so then there is inflammation. There is androgenic imbalance there is all these hypotheses oxidative stress that all happens during, During pregnancy, then it kind of makes your cardiovascular system even more under stress, and then it kind of continues postpartum and then you develop long term cardiovascular disease. So that’s one group, but there’s obviously this group of patients who have no underlying cardiovascular dysfunction so you know they are not obese, they’re not have any other risk factors and they develop preeclampsia, so this is a kind of debate in the literature, whether it’s the pre existing cardiovascular disease that predisposes you to preeclampsia than that confused or preeclampsia per se, creates an insult in your body that predisposes you to have the cardiovascular dysfunction, but in terms of epidemiological evidence so yeah you’re right, patients who have term preeclampsia to slightly lower risk to have cardiovascular dysfunction compared to patients who have early eclampsia. Similarly, if you have severe preeclampsia, those people are at higher risk. If your preeclampsia in multiple pregnancies. Those people are at higher risk. If you have preeclampsia with preterm delivery so preeclampsia was that bad that you ended up delivering less than 34 weeks lesson 37 days you are at higher risk to develop cardiovascular disease and of course postpartum. If you have other cardiovascular risk factors and you certainly are at higher risk to have, you know, such as if you develop hypertension, then that’s independently increasing your risk of cardiovascular disease, above and beyond your risk to have been a risk, just associated with PMS, yeah. So yeah,
P: this sounds like this also answers another question which is, which I asked every maternal fetal medicine doctor does pregnancy reveal underlying conditions or does it cause it, and it sounds like you’re saying, both
Dr. Rana: Oh yeah, yeah, it’s a little bit of both, because there are some people and you know that’s why people are saying that maybe there are women whose cardiovascular system just cannot take the burden of whatever the markers are or whatever the, you know proteins are being released from the placenta and they just, then they develop preeclampsia. A lot of people are saying that it is like very chicken and egg theory, And the only way to prove that would be to take a cohort of people before they get pregnant, and then follow them out, you know, and then none such good studies have been done, but animal there’s animal evidence that you know if you just create preeclampsia in an animal they are at risk to have cardiovascular dysfunction later, after they deliver.
P: this is a long list of trouble that can follow on the heels of a pregnancy visited by preeclampsia. When i listened to my conversation with Dr. Rana again, I emailed her to ask if there’s anything positive that women can take away from this information and she basically said that Knowing that these risks are present, and finding them at a relatively young age, women have the opportunity to make changes to their lifestyles to potentially change their risk profile. if you follow up with your internal medicine dr and cardiologist, tell them that you had preeclampsia so that they can help you with life style changes.
P: I mean I did I say, the woman from UCSF Why do people continue to have high blood pressure after the placenta has been delivered, if that is the mechanism causing the high blood pressure and she said she didn’t know and maybe it’s a good sign that yours has, has actually resolved.
A: Yes, I am, I definitely feel like I was really lucky, I know, I mean I know it can go either way you can go on to have preeclampsia again or you can go on to never have it again and have three more kids and never have the same issue. So, it is just, you just don’t know at this point but I’m very thankful that I haven’t had any other issues, You know, after we left the house after I left the hospital we were, we were able to stay at the Ronald McDonald House, we were just so thankful for that we, that really made a huge difference for us
P: that’s an amazing organization right?
A: Oh, amazing…
P: so that you can be close to the baby in the NICU.
A: Yes, yes. And we were literally our, this house is literally across the street from the hospital where we are and I couldn’t even walk at first, across the street to get to her. That’s how much I was in pain and from my C section and so you know my husband would drive us across the streets, so we could walk into the building. And now I have a friend whose son is a month younger than linea, we were two weeks apart for our due dates and so it’s pretty exciting that we were, you know pregnant together and so I went to visit her, she also wanted to having to have a C section because she’s so tiny, it just, yeah, that was probably the best for her, but she, she was a week postpartum. And at that point I would have been five weeks postpartum. And she’s like, up and walking around and picking stuff off the floor and I was, we laughed and I was like Nick and I told her this years later, but Nick I can’t go back and visit her right now. I still can’t reach the floor and I’m five weeks postpartum because I had had so many issues, and I was on so you know different drugs for everything else and I don’t know exactly what affected what I don’t know about that but like I was so sick that I literally cried in the car because i. So,
I guess, jealous, really, really that’s what it comes down to I was jealous that somebody else had this amazing experience with their birth as compared to mine, because it was so bad…
P: Yeah, that is a dramatic difference although given that you were on medication for months after the birth, like your body, obviously had a lot of things it was going through right.
A: It was, it had a lot more. Yeah.
P: And how was linea, what how was she like, how big was, she was three pounds 11 ounces, she was very little 16 inches long, she was quite long.
P: Although, That’s not bad for that time right?
A: No. she did, she was, it was okay. Yeah, she thankfully was on breathing, assistance for only, like 12 or 24 hours, It was I can’t remember which now, but it wasn’t that long.
P: That’s awesome.
A: Yeah, the main thing that we had to wait for her to figure out was how to eat, she could not figure that out, that took probably half of the time that we were in the NICU. The doctors were like yeah she can go home but she can’t eat. So, we can’t let her go because we had a lavage feed her for a long time.
P: Is that a. Is that like a dropper or ?
A: No they stick, a tube down her nose.
P: Because she didn’t have a sucking reflex?
A: she didn’t she wasn’t able to do it. Yeah, she’s too early, I guess they learn how to do that with the amniotic fluid later on in the pregnancy. She was born too early.
P: According to the Stanford Children’s Hospital, the sucking reflex starts to develop around the 32nd week of pregnancy and is not fully developed until about 36 weeks. And they say premature babies may have a weak or immature sucking ability because of this.
A: Yeah, so she was in for, like you said three weeks, and yeah and then we said we just had to wait for it to eat and truthfully. That’s been an issue that has continued throughout her three and a half years, because we started presenting you know baby food type things at six months or so like they suggest that’s the current suggestions, and we would present and present and present and present and present and she just had no desire to eat it. I mean, I would say the first time she actually had a meal of food. She was probably 13 months old. I mean well over, it was definitely over a year old, maybe 14 months I don’t remember now, I probably have it written down somewhere that she just had no desire to eat, and thankfully I mean I was able to breastfeed, and so we just I just kept feeding her, what else to do. My plan originally was to breastfeed for about a year, and then you know transition into normal food, but she, she had other ideas. So I breastfed till about 17 or 18 months for her so about a year and a half, because she just, she just was she wouldn’t eat normal food she just had no interest. He loves yogurt. And I would say for the next year, was difficult to get her to eat anything but yogurt. She just had no desire, just didn’t we just didn’t want it.
P: Do we think it’s a texture issue?
A: No, because she eats to eat she’ll try anything. She’s very good at frying something she just won’t eat a full meal of anything. Now she’s doing okay with it. I think she eats you know, normal foods now, and she still gets quite a bit of dairy so I don’t know maybe her body just needs dairy maybe she’s pretty big. I don’t know. Yeah, but
P: yeah
A: so it’s interesting watching that progress though because she’s definitely that’s, that’s certainly been a theme for her life.
P: What she into now?
A: she was she loves school actually she really loves going to preschool she loves being outside. That’s one of her favorite things to do, but my husband and I like to you know be outside too so that’s, you know, my husband and I, we both grew up on farms.
P: Wow.
A: Yeah. And so, you know, my husband’s still enjoys farming. I am thankful it’s part of my history. I have no desire to get up and milk cows in the morning. She loves being outside. She loves to build is really a feel like a knit like. I mean, who knows, we’ll see what she really gets into but she seems like she really likes to stem type of stuff. She likes to see science experiments you know with the baking soda in the vinegar or you know stuff like that. during the beginning of the pandemic, we have a husband does 3d printing for fun, and also volunteers for a robotics team here at a local high school and so we had like, want to say with six 3d printers and in our mudroom in our back room, and we were printing, ppe. In the beginning, back there like helping with the robots she calls, B bots, of course. And so yeah she really just as into that kind of stuff.
P: That’s cool. That sounds fun.
A: Yeah, yeah, it is a lot of fun.
P: So let me ask you, if you could go back and give advice to your younger self, what would you tell her?
A: You know, I’ve thought about that actually. And the one thing that I would do differently than what I did before, because there wasn’t any sign, other than my swollen this, I would have started taking my blood pressure at home.
P: Yep.
A: That’s and I would have taken it every day a couple times a day, once I realized that I was that swollen and, and, you know, I talked to the doctors about that later, like what, you know, then they had actually tested me for preeclampsia, while in the office, the two weeks before I went in, so they, There was nothing at that point showing up in any of their tests that I had preeclampsia. The only thing was just that I was swollen and they’re not wrong but some women do just well when they have pregnancy.
P: So I have read a bunch of your work, and it looked like some of the things we’re working on our biomarkers to try to identify preeclampsia early and it looked like you had one specific measure that was the ratio of two chemicals. Can you tell us a little bit about that.
Dr. Rana: So there are two proteins, one is called soluble fit one and the other one is plgf placental growth factor so there are studies, lots of them, animal as well as, you know placental studies that this protein specifically soluble fit one is high, and women who have a fancier, and then calculating levels we can measure them in your approach so it’s like some similar to measuring for example a blood count in your in your blood, so you take out the blood, and then you measure this protein. And then this other protein plgf which is placental growth factor so soluble fat is high in women who have preeclampsia and plgf is low. So when you combine that ratio. That actually is a very good test to predict who is going to develop adverse outcomes, or who’s going to develop a plan so a lot of papers that I have written and what we’re trying to figure out is if you see a woman who has a suspicion of preeclampsia, so for example your lady was complaining or swelling, and blood pressure was probably fine. So preeclampsia has a lot of nonspecific signs and symptoms so you can have a headache, but headache is a very serious symptom because a lot of them who have a cloud of seizure, can have a headache that precedes your Atlantic seizure, so we can’t ignore headache, the concept of like somebody who’s pregnant and even without the potential, then it has things such as swelling, it has like, you know you have some pain here in the right upper corner but your labs are fine in patients who present some silence of preeclampsia, so they have mild amount of hypertension, but they have no protein or their mind about a protein, they don’t fit the diagnostic criteria, and even fit the diagnostic criteria these biomarkers are really good to differentiate who are the women that are at risk for example, people who are the women who are going to develop help syndrome, who are the women who are going to develop like some of the similar features of the fancier so identifying patients who are at risk among patients who have some clinical suspicion of preeclampsia, so that’s one of the kind of the ways that we look at the use of biomarkers in women, and you know you can imagine if you can do an early identification that will potentially you know in the real world will potentially help patients by either triage in them out and saying hey you know your levels are really normal and no so you’re probably not at risk, even though you have hypertension, compared to somebody else who whose levels are very high, you can say hey you know what you are at risk to have some sort of a preeclampsia related adverse outcomes, not that I’m going to deliver you, but maybe I’ll follow you really carefully.
A: Yeah, that’s the one thing that I would do differently, I was immediately start taking my blood pressure.
P: Well, as you said like preeclampsia was not on your radar,
A: I didn’t even know what it, I’d never heard of that word before.
P: Yeah,
A: which is now like anytime I talk to pregnant women that are like what should I know and I’m like, Well, yeah, I’m not saying you’re going to get this but what I am telling you is just to be aware of it.
P: Yeah,
A: all kinds of other things that could be a potential thing with pregnancy that could be your thing that, or maybe not that you wind up dealing with, but I guess the fact that it’s one of the leading causes of death in pregnant women now terrifies me that we don’t know about it that it’s not something that, That is a common thing that we are aware of.
P:Well, I mean, as you suggest, and this is my kind of motivation for this podcast as well. You kind of go into it thinking it’s gonna be fine.
A: You find great babies for millennia.
P: Yes, and like it just it seems like it might be easy, right, like, it will get pregnant without trying and yeah so I agree that it’s that we need to kind of be a little bit more aware of like all the things that can come with pregnancy.
A: Yeah,
P: but that certainly isn’t the way the system is set up now. No. So yeah, so hopefully you know, as we as we learn more, there will be more available to people,
A: to, yes, yes, I mean, that’s true. Yeah, that’s very true.
P: Thank you so much for coming on and sharing your story today, I really appreciate it and I’m happy to. Thanks again to Dr Rana for sharing her insights about preeclampsia, and some of her amazing research. And thanks also to Audrey for sharing her story in the shownotes, a link to some of the research that Dr. Rana described. If you’d like this episode, feel free to like and subscribe if you’d like to be a guest on the show, go over to the war stories from the wound website and sign up. We’ll be back soon with another story of overcoming.
Episode 10: Just When you Thought You Crossed the Finish Line, Colic: Clarissa
Episode 10 SN: Just When You Thought You Crossed the Finish Line, Colic: Clarissa
Some women waltz easily into pregnancy and motherhood, at least in the Hollywood version of the story. This was not the version today’s guest experienced. Getting pregnant and being pregnant was not as straightforward as she was led to believe. Recovering from her first trimester loss was challenging, but my guest and her partner persevered and her subsequent pregnancy went swimmingly. The next challenge: birth–which was physically and emotionally daunting. And as she recovered from the birth, she was introduced to the relentless press of colic. Slowly, slowly the colic subsided and now the greatest challenge is planning weekend adventures with an entertaining and talkative toddler.
D&C
https://www.mayoclinic.org/tests-procedures/dilation-and-curettage/about/pac-20384910
Pessary
https://www.mtw.nhs.uk/service/maternity-old/your-labour-and-birth/induction-of-labour/#:~:text=The%20pessary%2C%20which%20is%20inserted,your%20baby%20during%20this%20time.
Pitocin and contractions
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406087/
Book mentioned by Dr. Chamberlain:
Audio transcript
Paulette: Hi Welcome to War Stories from the womb
I’m your host Paulette Kamenecka
Some women waltz easily into pregnancy and motherhood, at least in the Hollywood version of the story. This was not the way today’s guest experienced that transition. Getting pregnant and being pregnant was not as straightforward as she was led to believe.
Neither was the fourth trimester. She and her husband were forced to surrender to the absolute lack of control that new parents have with a baby, thanks to their reckoning with the dreaded colic.
After our conversation I went back into the interview and included some details about medical issues that came up. I also included a conversation with a fantastic pediatrician.
One other issue to note: the sound quality on this recording has more texture than usual…Clarissa’s cat has a walk on role–literally; you can periodically hear her cat walking on paper on her desk while we’re talking, and in other places the internet squashes Clarissa’s voice a little bit …I apologize for that…and we’ll do our best.
Let’s get to the interview.
P: Hi, welcome to the show. Can you introduce yourself and tell us where you are?
Clarissa: Yes, Thank you for inviting me. My name is Clarissa. I’m from the UK. But I live in Madrid in Spain. And I’ve lived here for almost seven years now.
P: Oh, wow.
C: Yeah, love it was supposed to be 18 months. My husband I love with it. And stayed.
P: So are you fluent in Spanish at this point?
C: No. embarrassingly awful at Spanish. When I first moved here I taught English I never, never practiced. And the more I didn’t practice, the more I get embarrassed about practicing. So it’s a vicious cycle of not practicing being by the Spanish. There’s a lot of Spanglish. So with my sort of Spanish and everyone else’s sort of English, yeah, I can get by again, another reason why I have not got fluent because I can survive with my intermediate level. Yes.
P: Excellent. How many kids you have?
C: just have one, one little boy who’s just turned one.
P: Oh, lovely.
C: Just a couple of months ago.
P: Before you got pregnant with him, you must have had some ideas about what pregnancy would be like, what did you imagine that experience would be like?
C: I thought it would be very easy to become pregnant. And turned out it wasn’t. And yes, what I just thought, you know, in a couple of months I’ll be the pregnant everything will be fine and I’ll have a baby at the end of it. Because that’s what happens in the films and most of my friends thank goodness for them. And, and my mother as well, whose a very powerful and strong influence in my life. So yeah, that’s what I thought it would be.
P: And so when you started trying to do it, Was it easy? or What was your experience?
C: Well, The trying, the trying was fun, but after many, many months of many, many negative tests or you know, starting my cycle and disappointment it did become a little bit of a chore I think, a bit not soul destroying that’s too strong but every every month when there was another negative another No, it was hard to continue hard to keep going and keep motivated. And I think this is quite a common experience. I think it was almost coming up to a year of trying and I went to the doctor here to have a few tests to start the initial process of what is what is the process of not being able to conceive and what’s the next steps and the month after that I fell pregnant actually
P: Oh, wow
C: I think a friend of mine told me it happened to her I think when he started like again it’s not in my hands anymore I’m seeing a specialist things are gonna happen and then maybe your body relaxes and things as naturally as it did for me. I know, not always but it happened for us, which was good.
P: Yeah, that is good. That’s nice to short circuit that trip down the fertility path which is you know, not not a not a fun
C: is not a fun I know that a couple of my friends have been through it and it’s not fun. It’s very testing and trying. So I’m very thankful that even though it took a year I’m thankful that it happened naturally in the end.
P: And what happened with the pregnancy?
C: and so that one very sadly, we lost that pregnancy as a as a as a missed miscarriage. I’d gone to my gynecologist, sort of just to meet her and start the process again, being British in in Spain. I wasn’t 100% Sure of how things worked here. And so I met my gynecologist quite early on in the pregnancy just to sort of find out the process. And she did a quick scan. And everything was fine. I mean, early, early early, but she said it look good. And booked me in for the next sort of proper, more official scan, in a few a few weeks time my husband came along to that was about nine weeks into the pregnancy, that scan. And that’s when she told me that there’s no heartbeat, nothing had grown, it was the same size as it had been previously. And we did to have her manage this carriage or something, I’ll come into how she described it, but had to go home and take some medication to remove the effects of pregnancy she phrased it as.. to it as remove the effects of pregnancy or something like that.
P: I feel like that strange wording is meant to be delicate, although it’s a little bit off putting right it’s weird not to kind of call it what it is.
C: I kind of I Yeah, probably it was supposed to be a way to help me disassociate from it? I don’t know. But I found it really harsh. Actually, I found this process very difficult and quite hard on me. I didn’t know whether again It was difficult, or this particular doctor, but I found her very cold and very strange Matter of fact, and I’m someone who would need a little bit more comfort and being told it was a baby and all these things things. But yes, I found that quite difficult.
P: Yeah, I’m sorry, that sounds hard. I think that absence of suggesting there’s grief involved here is a weird way to handle it. I guess it’s more like medical than emotional or something like that. And that’s it
C:. Yes, it was very medical. Now, with with the benefit of hindsight, the benefit of distance. You know, I can see from her point of view, she would probably early miscarriages, I as we know are very common. Now. She probably sees them weekly, if not daily, it was the end of the day for her. It was the end of her shift. I don’t know what she had been put in it. But it was the some of the reasons that she might have been a bit cold. Still, I do feel like I was a bit of a number and Yes,
P: yeah, so that sounds like also surprising when you and your husband are going to the office for this exciting thing to have to have it sort of develope in that way. Right.
C: Yeah. Yeah. And it was, you know, it was his his first time any experience of any of any kind of that kind of office. And yeah, as I will know, his face will always stay in my memory. The memory of that is this kind of complete shock of what’s going on what’s happening as well, but he was amazingly supportive to me and his focus was definitely on right. Let’s keep clarissa happy, make sure she’s safe. Make sure she’s okay. He was wonderful. And I have to say in the end, again, I went home and took the medication that she gave me that day. Unfortunately, it didn’t work. Two weeks later, I went back to get another scan. And still she still does the same words of materails of pregnancy or remains of pregnancy or something that essence that is still there, so I had to have a DNC operation.
P: Clarissa mentioned a DNC which stands for dilation and coverage. It’s a surgical procedure. Once the cervix is dilated, so the uterine lining can be scraped with a spoon shaped instrument called the caret to remove abnormal tissues. It’s used to diagnose and treat certain uterine conditions, or to clear the uterine lining after a miscarriage.
C: And I have to say, Actually, she did that. And she did it. Her after care with that was wonderful. She quite nervous I had to go into the hospital, my own, my husband had to go to work. We just come to me up that after the operation, she came in for the aftercare talk and it was very caring, and about the grief that I will experience and to allow myself to feel this grief. And don’t let anyone tell me that just because it’s an early loss. It’s not a loss. And so she redeemed herself a lot after that aftercare, actually. I ended up with quite a positive feeling.
P: Good, good
C: It Took a strange way to get there.
P: Yeah, yeah….Well, I’m sorry to hear all that. That does sound hard.and the DNC is not pleasant. No matter what So I assume you took time after that to….
C: Yeah. Well, she, as part of the aftercare, she said wait until you’ve had one cycle before trying again. You’re right. I kind of because she said, Oh, you know, you’ll be in and out operation. They, you know, about the same day I went and didn’t think ever take anything calm. I feel fine. Yes. All right. It was quite um, it took my body a long time to get back to feeling okay and everything. And because of that, even though my cycle came, okay, my husband, I said, Let the beginning of a new year, it was January. Let’s give it some time. We’re not in a rush anymore. A bit of a cliche, but we we know we can get pregnant. So let’s just relax. We’re given a holiday, a family holiday, and we went skiing in January and didn’t think about it. Then I missed my second cycle, my second period. Take a test. And it’s very, very positive. So surprise, we were a bit shocked and not sure we’re ready. My husband especially I think he was particularly that I’m not sure I’m ready. This thing, but nature has it’s own way of doing things
P: That’s what the nine ones are for…It’s an acclimation period, right?
C: We used those fully. Yeah.
P: So how was this pregnancy?
C: And this pregnancy was great. I felt really, really well, for the first few months, a little bit of sickness and a little bit of tiredness. But overall, I felt fantastic. I used to use them. Every time I went for a scan, every time I had an appointment, I changed doctors actually, in the end, just to be more local to my house, but also to not have the same feelings of being in that waiting room. And having sort of negative feelings about that negative feelings about that waiting room. So I changed doctor and she was fantastic. I still get walking towards her office, I’d still get Oh, gosh, what is going to happen again? What’s going to happen again? And even every time every time I went to the bathroom, and is there going to be blood on the tissue? Is there going to be any I think every time you’ve had a loss, even if you feel very confident and happy. it’s always in the back of your mind?
P: totally, I think one thing that’s kind of prominent about that experience is that it makes it clear that you have no control. Like this is a process going on in your body. And while it is internal to you, that’s about the limit of your control. So that you know you’re always nervous, right? Because it happened last time and you didn’t do anything to make it happen, right? You have no control either way.
C: Yes. Which is a great thing about living in Spain, actually, they they every pregnancy loss, they test, the test and to see maybe why, why it happened, which is actually really reassuring because it confirmed that nothing I did, that baby was never going to be viable. And there was my body’s way of telling me that So yeah, that’s a positive thing. But I wouldn’t have got that back at home in the UK. So that’s a positive thing about living in Spain. And again, a little bit more confidence with this one because there’s nothing I did and yeah, I didn’t let go and hope for the best. But yeah, this pregnancy was better I had that’s what I do. last few weeks of it. My husband and I went out a lot in the evenings take advantage of it just being us two the last few times. And yes, I sort of got that burst of energy towards the end, which is nice.
P: That sounds lovely and and how was the birth?
C: Long
P: So let’s walk slowly through this one. Tell us you know what happened that day that you started to have contractions or whatever it started for you?
C: Well, a few weeks before my doctor was a little bit worried about my blood pressure. It was a little I mean not extraordinarily high. It was a little bit high. So I had to go and check every day at the pharmacist pharmacy. Keep checking. So that was in the back of my mind a little bit of a worry. And she was talking about not letting me go over too much and things like that. I was due the 13th of October and it was my birthday on the eighth of October and I woke up on the eighth on my birthday with sort of a gentle water leaking I’m sure I think nothing dramatic like the films or like that, just all day until leaking of water and my I am a midwife. I have done a an antenatal course with my the speaking with her and she said you know don’t have any contractions or anything. Just keep the endorphins flowing, keep happy hormones going. I had planned to go out Milk with my birthday said yet keep doing that, you know no need to rush to hospital or anything like this. So we have a lovely evening celebrating my birthday on the way back from that we did pop in to the hospital just to check everything was okay. And they said they will it was the doctor duty on it was midnight, the doctor on call had said no, we don’t think this is waters breaking go home. I had a routine appointment the next day anyway, due to my blood pressure. Come back with that, which I did. I had a lovely night’s sleep and had my appointment in the morning. My weekly appointment to check my blood pressure. And it was it wasn’t quite a lot. And obviously I was to my doctor, I think my waters are going and I came in last night and they said no. And she did a quick scan. And then I think they are your there’s not much water around the a baby, your blood pressure’s high. I think it’s enough. I’d like you to stay in and start the induction. And one thing I have to say about my doctor here, I was told that is quite old fashioned compared to us, the US, UK and other doctors in charge and they don’t talk to you about things. And it’s never my natural birth and all this but my doctor was very considerate of me considerate of my opinions. We always talked about decision before we made it together. And so I felt very happy with her, and her decision to suggest staying in. And yes, so that was Wednesday, the ninth. I started the induction process that day. And nothing really got going. It was just an
P: Does induction process mean Pitocin? Is that what that means?
C: Not at this stage. I don’t think It was just a pessary just to see if my cervix would open a little bit more.
P: What’s a pessary. It’s something used to help thin and soften the cervix getting it ready for labor. The pessary looks like a very small tampon that’s inserted into the vagina. It contains prostaglandins, which are hormone like substances that are released slowly over 24 hours in an effort to ripen your cervix.
C: And sort of start things a little bit without drugs and drips to stay in. But nothing Nothing happened. we stayed in hospital all afternoon like playing games and facetiming people and bouncing on my Pilates ball. But nothing got going so they took the pessary out three hours at about 7pm and told us to get another good night’s sleep and they will start the drip drip in the morning 7am. So that’s what happened. Had another very good night’s sleep. quite excited about we knew it as a boy. We knew he was going to be called Charlie. Getting quite excited about meeting him. And yes, seven o’clock in the morning. tHey started me on the drip things. Again, that felt quite slow it was. I sort of lost track of time. This point I think, remember at about midday. A lot of breathing through the pain, the pain was just getting really intense. And the midwives are coming in saying you wanted to wait for an epidural until you seven centimeters or six centimeters that isn’t a natural birth.the medication is making your contractions much more intense than it would be without them.
P: oxytocin is the hormone that helps encourage contractions during labor. pitocin, which is synthetic oxytocin can have similar effects. But in your body, oxytocin is released impulses both into the bloodstream and simultaneously into the brain for labouring women and the brain it positively affects mood and bonding behavior. Pitocin however, doesn’t cross the blood brain barrier. So if it’s being given to a woman in labor through an IV, it’s not creating the same emotional effects. And in part because it’s not being released impulses in the body. It can lead to contractions that are stronger and more frequent than naturally occurring contractions.
C: please, please have an epidural and you know I thought Yes, yes, please. Yes. So the other day I was rolled off that it was absolute bliss, feeling I have ever had in my life. Having this epidural, I think I managed to get a quite a couple of hours sleep in the afternoon as well with that going on. And unfortunately, of course it it does slow down the process the contractions were getting slower. Charlie was taking longer to come down into position. I think it was about five or six o’clock in the afternoon evening. My doctor came and said right we need to try to turn you on to your front to try and encourage him into the into a better birthing position. He’s not coming down the birth canal. She’s a very traditional Spanish lovely lady trying to make me laugh. But she’d seen this on an episode of Call the Midwife, which is a very UK, BBC drama but I wasn’t really in the mood for Jokes at that point. So I couldn’t, I’d sort of clicking the epidural and it’s been getting stronger and stronger, I couldn’t feel my legs, I had to turn on my front into like a downward dog position was impossible, my husband would have between doctors and my husband trying to turn me over to the downward dog position. And that unfortunately, as well picked out half of the epidural. So I could start feeling the left hand side of my body,
P: oh, no,
C: for the pain, which was, which was intense, intense pain. I don’t know what it was hours or minutes. But it had me doing a few practice pushes. Once I was back on my back, I think now that was my transition. Because I I remember having a bit of a breakdown, screaming, I can’t do this, I just cannot do this. And I’m so thankful that I gave birth before the pandemic, because my husband was there with me. And there was loads of doctors telling me I can do this, but the only person I believed was him. You know, he took me in the eye and told me I could do it. And he just completely calmed me down. We got through it. Again, Charlie was still not coming down anywhere close to the birth canal. Again, the full discussion with me as much as she could in my in my state of my left side and agony of things going on. But she did say we’d agreed as well that we’ll do everything we can do a vaginal birth. And that things are looking good and closer to having to do a C section. The baby’s still absolutely fine. His heart rate is good but it’s getting I think this is coming into sort of 8pm 9pm at night. And so we’re going to take you to theater, maybe prep everything for a C section, but we will we will really try to get him out naturally. And that sort of sped me on as I’m having done all this work to then
P: yeah.
C: But we got into the theater just in case James is outside having to put all the scrubs on and everything. I remember at this stage I was completely naked, I lost all kind of sense of propriety, or any kind of sense of this is not normal, but it was a student hospital. So a few student doctors, they’ve got some pediatrics in as well just in case Johnny hadn’t wasn’t doing very well. I know the doctors there for me and my niece the test and I just have my legs up on the stirrups, the very sort of old fashioned traditional way of giving birth stirrups and something to hold. And my poor husband sort of walked into the scene. Again, I just always I do manage to remember his face look strange in his face. He said I don’t want to look at the business end. But he walked in straight directly looking at it bless him. The doctor said if you try and push and if you can push with all your might we can we can get him out and we did it definitely was a team effort. My anesthetist was helping me breathe and my doctor was again talking to me through everything she said, I’m going to have to cut you if you’re going down we can use the forceps to get him out and my dream had been natural birth no forceps, no episiotomy, but at this point I was like Yes, yes, everything just get him out, get him out. And yet and he came out beautifully, wonderfully. Lucky I luckily the epidural was had failed on my left side, but not I couldn’t feel her cut me or I couldn’t feel anything like that, which the anesthetist was telling me That’s the most important thing. So that’s good. He had the he had the cord wrapped around a few times around his neck, which was the reason struggling to come down. But he was fine. They took him away It felt like three seconds later, in a way to make sure he’s breathing. But then he was on my chest. And he had done it. So it was strange experience.
P: That sounds like a triumph.
C: Yeah, in the end, it feels like a triumph. Because even though it was nothing as I’d imagined, I didn’t want any intervention or to be cut or to have as many doctors in the room as there were. But because I think I had such a good dialogue with my main doctor. And such a good relationship with her. And she always asked me before she did anything she asked me my profession and explained everything. I felt like it was a time when I feel very positive about it.
P: Good.
C: Yes. Yeah, that’s good.
P: And so how long do you stay in the hospital after that?
C: It’s typical for Spain to stay three days. Yeah. So we stayed, there was a tiny bit of worry because I’d lost quite a lot of blood during that. But in the end, I got to the test. I didn’t need anything to do at home for a few days. I remember being my first shower getting really dizzy. And they said that’s normal with the blood loss. Have a cold shower. Not a hot shower. But yes, three days quite, although we did sneak out a bit early because he was born so late. I think he’s born at 10pm at night. So he stayed that night, the next night, and we went home about 9pm the next next evening. But yeah, it was, I was so glad to get home, although also nerve wracking, because at the hospital, everything’s done. You know, they come early. Oh, maybe you should feel the baby. Now. Maybe you should do that maybe should change my, you know, brain kind of suggestions. But all right. Okay. That’s what I need to take further home. It’s just you.
P: Yeah, yeah. It’s nice to have adult supervision in the beginning for sure.
C: Yeah. Yeah.
P: And how was it when you got home?
C: Yes, it was often the nerve racking, where were the adults were in charge. Now. It was another bit of a haze of just feeding and I had no expectations of myself to breastfeed or not, I hadn’t really thought about it. But he and I just happened to, to click and bond and that way, and he found it quite easy. And I found it quite easy as well, he did have a tongue tie, which made it a bit sore. But we got that sorted quite quickly with my midwife here. So I just it was a haze of breastfeeding and changing. And then my parents came to visit which was lovely to visit, which again, I found helpful more than hindering, especially because because we live abroad there back in the UK, they can only visit for a short amount of time. They’re not here all the time. So it was a lovely bit of help. And then back to being just a three again, it was sort of I think about four weeks old, he started with a colic, which I found extremely testing, extremely testing
P: that’s so hard, but it didn’t happen like every night at six or like, was it regular? Or
C: it was my regular, yes, he wasn’t, he was always quite a clingy baby. I remember, when my husband went back to work, he went back to work after six weeks. So pretty much at the start of the joy.
P: Yeah,
C: he would only be in the daytime, he’d only be happy in the carrier. So even in the house, I would do some housework or some gentle things, but he had been the carrier. Next to me my heart. Now I consider the time I find it extremely suffocating. But now learning more about the fourth trimester. And things I can understand a little bit more. He just wanted to be close to me. But at about 5:30-6pm that wouldn’t do it and nothing would do it. He would just be screaming, screaming screaming to about 10pm at night. So but and it was always a time my husband got back from work. So I’d had quite a nice day with him. Sleeping, feeding, watching TV and going for a little walk. And then just my husband most of the day after work, screaming would start.
P: I took some questions about colic to a pediatrician. Hi, welcome to the show. Can you introduce yourself and tell us about your training?
Dr. Chamberlain: Absolutely. Thanks so much for having me. I’m Lisa Chamberlin. I’m a professor of pediatrics at the Stanford Department of Pediatrics and the School of Medicine here. And I work at the Stanford Children’s Hospital.
P: How long have you been a pediatrician?
Dr. Chamberlain: Oh, let’s see, forever 20 years.
P: Clarissa said it was you know, idyllic, she brought her new baby home. And then as soon as her husband’s paternity leave ran out, the crying started, let’s talk a little bit about colic how does a doctor define colic?
Dr. Chamberlain: Yeah. Great question. And I really feel for Clarissa it’s, it’s a hard thing to have to go through. So call it a few different definitions. But the one that a lot of us think of is crying, that is three hours or more a day, more than three times a week for infants less than three months old. So kind of the rules of three. If it’s less than three hours or less than three days a week or a child that’s over, you know, more like four or five months old, we would think less of colic. But if it meets those kind of rule of three criteria, and we think of it as colic,
P: do we know what the source of colic is why why babies develop it?
Dr. Chamberlain: We don’t know. So one of the first is a short answer, long answer. We have to make sure it’s not other things. So I need to make sure that there’s not any kind of neurological problems, rare things around the brain. Rare things with the heart there are Some heart conditions, and then things that have to do with the stomach places where like one of the valves, the pyloric valve is maybe a little tight that can cause stomach pain or more problems with formula or breast milk. So is there some sort of milk allergy? Is there some sort of intolerance to food? Because that can cause stomach pain, that last category that that intolerance to the food is the most common of those other things that I talked about? Once I’ve thought, you know what, I don’t think it’s any of these medical things. I really think what we’re talking about is colic, then we kind of go down that pathway. So what causes that? We’re not totally sure some people think that it has to do with a developing nervous system. And babies, I don’t know if it’s common to think about it this way. But some people talk about the fourth trimester, that those babies really maybe should stay in the womb until 12 months, but you know, blessedly on some levels, they come out at nine. So for the last three months, there’s a lot of neurological development. So it’s really kind of a normal developmental stage that they have to go through. And colic is just a manifestation of kind of a subset of kids who experienced that with more difficulty. So a normal process that on the bell shaped curve, they get too much stimulation and cry as a result.
C: So I think he found it quite hard to bond with him for that time. I did as well, I had, I had I heard about these initial when the first time you see his face, you’ll love him. 100% and I didn’t get that. I got a sense of I’ve always known him and I’ve he’s part of me, but I didn’t get that love feeling. So again, I think that was quite a testing time, especially for my husband. Only getting home and seeing him when he was a screaming angry ball of red flesh. But for me as well. We did we found that time very difficult as family.
P: yeah I think that’s pretty universal. It’s really stressful to have a baby You can’t calm down.
C: Yeah,
P: And with colic, you just can’t
C: and, and actually, because I the mum guilt goes but the mum guilt got to me that why can’t I calm him ? He’s my baby, I should I be able to do this. Why can’t I do this? Don’t I love him enough and all these things. Plus the hormones. Yes, healing from quite a traumatic birth. So many things. I have to say my husband was amazing, just so he would just sit on the Pilates ball all evening with him. I could see in his face the frustration and the sort of shock of this thing happening to us on my husband’s face. But the calmness he would have while he was holding the baby was amazing to me to see because I just didn’t feel I’m sure he didn’t fit inside. But he looked so calm. And he definitely radiated calm to the baby. Every time is my turn to have a go holding the baby I just felt guilt and sadness and absolute sort of horror with what was going on? It was Yes, it was a difficult time
P: Yeah, that sounds I mean, it’s hard kind of no matter what, but also, if you have the expectation that you’ll you know, you’ll be the one with the magic touch that will soothe him that it’s even harder.
P: So Clarissa talks about feeling like a bad mother, because she can’t see her baby, which I’m sure is not unusual. What What would you say to a patient who brought that to you?
Dr. Chamberlain: Yeah. So that’s actually one of the main things I was I was thinking about, and it’s this feeling what I hear a lot of people say it’s a feeling of helplessness.
P: Yeah.
Dr. Chamberlain And we’re not used to. And so I think for a lot of mothers, new mothers, you know, we’ve come with a sense of efficacy, and we can solve problems, know what to do. And, and this is a really helpless thing, and that you feel like, you know, you’re worried I’m doing something wrong. I’m not bonding with my baby, things like this. And so one of the first things I do, when I when I hear the story of colic is I reassure the family, and the mom, usually the mums, a primary caretaker, you know, you’re not doing anything wrong. This is a normal process, and you’re doing great and, you know, just to reassure them about that, and then try to give them some tools that can give them some options and some places to go. When they are feeling this range of emotions. And for some people, it’s frustration, some people anger, experiencing frustration and anger is normal. You’re not a bad person. If you feel that caring a creature that you love, so much cry in this way for so long. is really hard. so just really wanting to reassure people, and then also the exhaustion. This is all happening at a time when people are physically exhausted, they’ve given birth they are nursing, and they’re not sleeping through the night. So it’s really kind of a perfect storm to feel bad about yourself and feel about about your parenting. So we just tried to reassure people that, you know, you take it day by day, they will outgrow this, this ends, I promise it will end. And so what are some tools we can convey to help them bridge to the other side of this? Which, which will happen? They will get through it?
P: And are the tools like walk around and try to shut down simulation? What can you do?
Dr. Chamberlain: That’s a great question. So there’s a book, it’s an older book, but it describes the five S’s and it’s the happiest baby on the block book. And, and I disclosure, no, no conflict of interest. I don’t know the author, I get nothing for this. But it’s a very simple book, and it conveys kind of the five S’s. So the five things you can do that basically recapitulate the environment of the womb, the first one is swaddling. swaddling is the way that you can have the burrito Baby, you wrap the baby super tight in a blanket. And so that, that hold that that puts the child in very tightly again, like womb, like, right, like it’s all tucked in. And, and, and really snuggled it in and the second one is a side or stomach position. So again, in the womb, that baby’s in these different positions, and they’re out and we just hold them up all the time. So it’s side position, stomach position, using some sounds, that shushing sounds. So that’s kind of mimicking the heart tones that they would hear in the womb, sh-sh-sh that this sort of thing. So that constant sound, and there are people talking about using hairdryers using these white noise machines. So other things that can create that noise, doing some small swinging or jiggling is something else that you can do that helps to soothe the baby and then suck. So the last S is a pacifier or a thumb, something that the baby can suck on. So with these five S’s, these are the different things parents can try. And it’s kind of a trial and error thing, find the one that works for your baby. But people describe it like a switch, like when they, you know, it’s a combination of a couple of them, or maybe three of the five for your baby. And that this this kind of combination seems to flip a switch and the child then calms down. So those are some things that have really no cost, no side effects, easy to try, and are have been found by many parents to be very helpful.
C: You don’t you don’t care. You will do you, you know, you throw money at you. Yeah. living through it. You will do anything. Anything? Yes.
P: So what happens when colic eventually goes away? And do you know, Is it some kind of physiologic? Do we know what that is?
C: every time that I had my moment I would spend on the internet googling. And I never found an answer. We did used to feel in the evenings when it got peak screaming like you could feel the gas bubble in his tummy. And I mean, I spent a lot of time learning to massage and the leg thing just
P: yeah,
C: ease and gases. But in reality, it’s just waiting, I think waiting for his digestive system to develop a bit better. And online is no three months, three months, the magic age and we got to three months. And it wasn’t the magic age. And my mother in law and so I said no, no, it’s four months, four months is really the time and I reached that and things did start to really improve after four months. Plus that three months then there’s a lady in Madrid is quite well known with all the expat mothers about she’s a sleep. Sleep consultancy, gentle sleep consultants and I went to one of her to open evenings. And Charlie was just about three months and it was and again, sleep cycles of up to three months. There’s nothing you can do with a baby’s sleep I don’t know when they just want to be next to you all the time. But for three months, you can start implementing a routine and I did I got him that night, implemented the routine for him in in our bedroom, we used to let him sleep on the sofa all night until we went to bed but know his bedtime. He’s going into his bed with the monitor on and that was also a game changer. For us. I think he was relieved to have a routine at bedtime. We were relieved. And then at four months, it all started slotting in together a little bit better. his tummy got better his colic was improving. We have the bedtime routine down. He was going on he was going on. Yeah things definitely.
P: That sounds awesome and what what uh what are his tricks at one? What is he into?
C: ah, he is. If he will eating. He will eat everything. Which means he’s become very good at. Like the fine details fine is is fine motor skills is fantastic. And he’s talking skills, also. Very good. He’s just started nursery, full time. Slowly he was part time status early but he’s now been at nursery full time. A couple of months. And he’s just started to, in the middle of life now isn’t such a good sleeper. I can’t criticize on the time but every single day we wake up about the morning just for chat. He didn’t need me, doesn’t want me to go in, he gets a bit annoyed if I go in, actually, but just have a little 20 minute chat. And then they go to sleep. And nursery they say the same. He wakes up from the siesta just to have a litte chat, and they like Charlie your friends and sleeping. Those chatty is not walking yet he’s focusing on the chatting in the eating.
P: You know, we have two kids and the first one walked at 17 months. And she like Charlie, like talks kind of early and so she could order us around. She could say, Go, Go get me that thing; why would I have to get over there I have you
C: Yes, absolutely. That is exactly what he does. And because he’s my current only my best I, I would do anything for him so of course, yeah he tells me what he wants. I do it. Is it the trick. Right.
P: I think if you have a personal assistant, you don’t need to get there.
C: No, of course. Yeah, so making sense now. Right.
P: I hope you’re taping some of these conversations.
C: Oh, oh no, I’m not as your mind I remember taping a few nights of breastfeeding actually to have that kind of little snuffly sound that they make when they breastfeed, which I’m so glad I did because he sort of stopped weaned himself, quite early on really so I’m glad I’ve got that but yes, that’s a good idea. I will do some taping, especially for the granparents.
P: Well I was gonna say need it for the wedding.
C: Yes. Definitely. Little cherub face with his chatting. Yeah,
P: if you could go back and give advice to your younger self. What do you think you would tell her?
C: I’ve been thinking about this recently. It’s come up on a radio station I listen to here, and without a doubt it would be let go of your expectations. I definitely had high not high expectations. I just thought that I would love every minute of it. I thought it would be natural and I, when my baby cried I know exactly what he wanted because I’m his mother. And, yes, and then, the most important thing is that you don’t have to love every minute of it it’s okay to say, this is boring or This is hard.
P: Yeah,
C: or it’s not enjoyable.
P: Yeah.
C: And I think that’s positive because it makes the fun and the enjoyable. The lovely bits, even more special because there are so many lovely bits and enjoyable it’s and love them so much. And that is even more special to you if you acknowledge that. Some days are hard. Some days are boring, and I do miss my pre-Charlie life and I think that’s okay as well. I wouldn’t change anything I love my life I love having Charlie in my life but I have to accept that I, I’m not 25 I can’t go out to the clubs till 6am. I don’t want to.
P: Yeah,
C: but I’m also allowed to miss that I used to, I think, yeah,
would tell my younger self. Enjoy. I did enjoy my late 20s, that enjoying the 20s, and don’t have such high expectations of motherhood. It’s wonderful. And it’s not everything that I am. I’m also I’m still meet. Yeah,
P: that sounds wise lucky Charlie.
C: Hopefully, lucky charlie.
P: Yeah. Well thank you so much for talking to us today and for sharing your story.
C: Thank you. Thank you for inviting me it’s, it’s very important. Again, Wish I had listened to more stories when I was pregnant or when I was trying to get pregnant and it might have helped me realize, and not to be so scared about my emotions and my guilt, and the first few months, if I had listened to my story that so thank you for doing it.
P: Sure, absolutely. Thanks again to dr Chamberlain for the great advice about colic. And thanks to Clarissa for sharing her story. A link to the book dr Chamberlain suggested in the notes. If you like this episode, feel free to like and subscribe if you’d like to be a guest on the show, go over to the war stories website and sign up. We’ll be back soon with another episode of overcoming.
Episode 9: The Last Hour: Ashley
Episode 9 SN: The Last Hour: Ashley
Like all great adventures, pregnancy rarely goes as planned, especially for first time mothers. For today’s guest, the journey had all the hallmarks of a grand adventure: pure joy when she found out she was pregnant, the excitement of an impending birth, the physical challenges of a natural labor, and a real dose of anxiety, pain and fear in the aftermath of that birth when a serious hemorrhage becomes life threatening. Listen to her tell her story of ultimate triumph. Read more about Ashley’s experience on her blog, or follow her at X
Mucus plug
https://www.healthline.com/health/pregnancy/losing-your-mucus-plug#labor-symptoms
https://www.medicalnewstoday.com/articles/325872#why-does-it-fall-out
Epidurals
https://www.sciencedaily.com/releases/2009/01/090113074445.htm
Epidural and the length of labor
https://www.sciencedaily.com/releases/2009/01/090113074445.htm
Risk of infection from blood transfusion, rates in Canada
https://www.blood.ca/sites/default/files/External_Surveillance_Report_2015.pdf
Ashley’s blog
http://thinkoutsidethecrib.com/
Audio Transcript
Paulette: Hi! Welcome to war stories from the Womb. I’m your host Paulette Kamenecka. Like all great adventures pregnancy rarely goes as planned, especially for first time mothers. For today’s guest, the journey had all the hallmarks of a grand Odyssey, pure joy when she found out she was pregnant, the excitement of an impending birth, the physical challenges of a natural labor, and the sudden fear and pain in the aftermath of that birth. When confronted with a life threatening issue. Listen to her, tell her story of ultimate triumph. After our interview, I went back into our discussion, I included information about medical issues that came up, and I also included the insights of a thoughtful OB, let’s get to the interview.
So why don’t you tell us your name and where you’re from.
Ashley: My name is Ashley Lewko, I’m from British Columbia, Canada I live in Langley, and I just moved here actually at the beginning of this month away from my hometown in Penticton, so it’s a bit of an adventure for me.
P: It’s Beautiful there, right?
A: yes it’s gorgeous it’s very green
P: sounds lovely.
A: Yeah.
P: And how many kids do you have
A: I just have one His name is Liam and he’s about 21 months.
P: Oh, nice.
A: Yeah.
P: And before you before you became pregnant, you probably had ideas about what pregnancy would be like, what do you imagine it would be like?
A: I honestly I thought it would be a lot harder than it was, but it was difficult in different areas than I expected it to be. Like I expected being big to be like the issue but it was really like the morning sickness and just being tired. That was the hard part for me. It was not what I expected at all.
P: Yeah, I think that’s most people’s experience, so you get pregnant easily,
A: I got my IUD taken out, and then I had one cycle and then I was pregnant. So it happened very easily for me and I know that’s not the case for a lot of people but it just happened we weren’t expecting expecting it to happen that quickly like we took the idea and we’re like okay well like we won’t be careful. And then we weren’t expecting it to happen like right away, but it was all good,
P: and then did you find out you were pregnant with like a home test.
A: I did, I’m like an obsessive tester. So I took like many tests and like I still have it. It’s, I kept it for some reason. And you could like barely see the line on there and I’m like I’m pregnant. He’s like, No you’re not, like, Yes, I am. And you made me go to the doctor and I was.
P: And you said the pregnancy was pretty easy.
A: Um, for the most part. Yeah, it was. I didn’t have any complications or anything just the normal symptoms like morning sickness I had all day sickness for 40 weeks. But that was about it.
P: That seems like a lot.
A: Yeah, it was. You kind of just get used to it in a way. you just adapt.
P: So why don’t you take us to the birth like start with, you know, feeling contractions or wherever the contractions come…
A: So I was, I think I was 39 weeks, and six days. And me and my mother in law, we went to Walmart to get some last minute things. I’m like, Oh, I’m not feeling, right, like I feel different. And then we were literally in the baby aisle. And my first contraction happened in the baby aisle of Walmart. I’m like, Okay, well, I think, labor might be happening because I manifested that I would deliver on my due date, the whole pregnancy. And I’m like, it’s happening I’m delivering on my due date because I’m not going over 40 weeks I’m done. And I kept walking around just trying to make it progress and we walked around Walmart and then we went to our little mall in Penticton, and just kept walking and they kept getting stronger and then like okay well I think maybe I should go back home and just rest because I feel like it’s gonna be a long night, and I got there and I just had the urge to just keep walking so me and my partner walked up and down our driveway like, I don’t know how many times. And they kept getting stronger and stronger and like this is it, it’s happening, gonna have a baby on my due date, I called it. And, yeah, basically I did that for hours like this, my first contraction was at 11am on the 26th of January. And I had, I was laboring at home until. Gosh, I don’t even remember exactly but I think I went to the hospital for the first time at around midnight.
P: Wow.
A: And then, or maybe like 10, I went around 10:10pm, so I was laboring at home that entire time and then things started to get pretty painful. So I went to the hospital. And they checked me out and they’re like, no, you’re not in active labor yet you have to go back. So we went back home, thank goodness it’s only like it was a two minute drive. Yeah, went back home and then my mucus plug so that was a whole nother story. I don’t know how in detail you want me to go.
P: Yeah, You can tell the story.
A:Okay, the whole thing? in depth?
P: Blood and guts are welcome.
A: Okay, so I got back from the hospital and I decided to have a bath, I’m like I’m in pain I need to like control this somehow I wanted to do a natural birth, I didn’t want medication that was just the choice that I made. I don’t know if I would have done better with medication, but it was what it was, I did it. And so I had a bath, and then I’m like something doesn’t feel right, and the only place I was comfortable was on the toilet in that position like squatting on the toilet. That was the only place I could like handle my contractions. So, I’m sitting on the toilet and my partner Travis is sleeping in bed because it’s like we’re gonna have a long night and like I’m fine just go sleep. Like, you need to come here right now because something is coming out, like somebody is coming out. I don’t know what it is, and he’s, and we think like, this is my first baby I’ve never done labor or anything before, and he sticks his hand underneath. And there’s massive mucus plug just falls out of me. And it’s like, in his hand. We’re like, what is that. So I like called my midwife I’m like something just came out of me. I don’t know what it is it’s like a huge. Well, a booger. Basically, it’s gross it’s bloody it’s like, it was like, I have a picture of it, because we were like, Whoa, what the heck is this.
P: You may not meet your mucus plug in as intimate a way as Ashley and Travis did some women don’t even notice they’ve lost their mucus plug the mucus plug is made up of a jelly like substance secreted by the cervix, it acts as a protective barrier that closes off the cervical canal shielding the uterus from bacteria and other sources of infection. If you do lose it. It also means that the cervix is softening, meaning it’s behind the thinner and wider in preparation for labor. Although losing the plug alone does not mean that labor’s imminent.
A: And then, yeah, as soon as that came out the contractions really picked up. And then my midwife ended up coming to my house and checking me there because things were getting pretty intense and I, I started having the urge to push. Basically right after that mucus plug came out, and it was not fun at all and it’s really scary because you’re not supposed to push on a cervix that’s not ready. So that was an issue so because that was happening and I think I was about five centimeters dilated. They took me to the hospital–worst driving my life—we’ve got two speed bumps, out of our driveway. I’ll never forget them. Like every speed bump you’re like, waiting for the next one as you’re contracting and like, yeah, it was, it was an episode. And then he insisted he stopped at the gas station to get some energy drinks. So I’m sitting in the gas station parking lot, screaming in pain, as he’s getting energy drinks at like, I think it was like, 1am No.
P: Oh wow.
A: Yeah. So, going to the hospital we get there, and immediately get checked and they started giving me the only medication or medication I took was laughing gas. And they started like.
P: Does that feel like anything like you feel better or nothing at all.
A: Um, It kind of, for me personally I know a lot of people don’t like it but I did it the whole time. It makes you basically like just mentally relaxed, like it doesn’t really like take away the pain, necessarily, but it just kind of like helps you calm down. The weird thing about laughing gas is when you inhale it you know how you inhale helium and your voice gets super high. So when you inhale, laughing gas your voice gets super deep, and I had no idea I thought it was in my head because it kind of makes you a little bit high, but not nothing crazy in the last like minute. So I’m inhaling this laughing gas and talking and I’m like laughing at myself because I think in my head that my voice is deep but everyone around me is also laughing I’m like can you guys hear that, like, yeah, it makes you laugh, it makes your voice like super deep and I’m like sitting there on a, on a birthing ball with my huge tummy out just like, yeah, making jokes and stuff it was fun. And, yeah, laughing gas is a hoot. And then basically just labor that the hospital, my mom ended up coming I’m like I just want it to be me and Travis and I don’t need my mom Yeah, as soon as I started feeling the contractions I called my mom and she was there
P: one thing I found kind of interesting about your story that you wrote about in your blog is that you talk about kind of the terror of it all, which I think it is really scary.
A: It’s terrifying,
P: no one really says scary everyone says painful, but you don’t really know what’s happening to your body and it’s so massive and powerful and out of your control. Yeah, like I think terror is kind of the right word.
A: Yeah. Birth is terrifying you don’t know what’s happening you don’t know when things are going, you don’t like you don’t know anything. You don’t know if your birth is gonna be successful, the way you want it. You don’t know if you’re gonna have complications like. And like the pain of contractions without anything. When you are in like transition which is like seven centimeters on is like massive ocean waves is the best way I can describe it like it just comes on and you just, you have to embrace it, you can’t fight it because if you fight it it’s gonna be worse but you want to fight it because you don’t want it to happen. And that’s pretty it is terrifying but it’s also like really exciting. And, you know, I just kept telling myself one bad day, and this is going to end. Like, it’s going to end the baby’s going to come out and it’s going to end. I can just like get to that point, it’s going to end and I’ll be done.
P: Yeah, that sounds like good self talk.
A: Yeah, I I honestly I don’t know, I did tolerate it like decently. But I was pretty loud. I could have for my next child when we decide to have another one I’ll definitely know what to do and what not to do. with Like, my voice, because they tell you to like make deep moaning voices and I was like screaming high pitch which doesn’t help anything. Yeah. Anyway, where was I.
P: So we are. We’re having the waves come and you just called your mother.
A: Right, so she shows up, and I got in the shower, just to get some like hot water and I calmed myself down cannot at this point hard to remember because you start to get into that like weird days where you’re just like half sleeping half contracting. And I remember going on the bed and my mom and Travis were like taking turns pushing my hips together. And I was having super painful contractions and I wasn’t dilated enough to push I think I was like a seven, which is like cutoff to start to get like really bad. And my midwife checked me. And she’s like, you’re not dilated enough and you keep pushing on your cervix it’s not ready and it can damage it and then you can have a C section I think you need to have an epidural like Okay. Fine, whatever. And in our like appointments prior to my birth, they made me come up with a safe word because I didn’t want to have an epidural, so I had to say the safe word. And for some reason I chose the word brussel sprout. So imagine me with laughing gas with my deep voice, and they’re like you have to say your safe word or we’re not doing it and like brussel sprout. And so I had to say that, and then everyone started laughing and so they call that anesthesiologist, and I’m so proud of myself for saying that word. And I’m still laboring and he takes like felt like an hour to get there probably was a bit less but I took his time, I’m pretty sure he was on call shows up I’m like starting to freak out at this point and like maybe just check me one more time to make sure I’m not like there. And so my midwife checks me she’s like you’re at a nine but I can stretch you to a 10 like sweet, screw the epidural let’s do this. I don’t want an epidural right now like what’s the point of that when I can push. And so the anesthesiologist, had a fit in the room, as I at 10 centimeters, with no pain medications screaming and labor gets his epidural cart slams it against the door slams the door and like slammed it out in the hallway. It was like the most ridiculous childish thing I’ve ever seen in my life,
P: Yeah, that seems bizarre.
A: Yeah, it was like really weird. And we had to actually make like a formal complaint to the hospital because it was like, yeah, it was totally uncalled for
P: you can’t be the first one.
A: No
P: right? to turn away an epidural because it’s too late
A: Like, aren’t you Glad I don’t need to get an epidural like I’m sorry that you had to leave you’re ….At this point, it was like 7am. Yeah, like, yeah, it was not like it was the middle of the night it was 7am. He had to come from his house because he was on call like. Either way you would have had to leave your house like I’m sorry you didn’t get to do the epidural but like I don’t want it.
P: Yeah, yeah
A: you don’t need to throw a fit, like just move on. Anyway, yeah, it wasn’t not a good experience. It’s like, it’s definitely one way to make your stress levels skyrocket when you’re about to push out a baby.
P: Yeah.
A: As I’m like laying there half naked screaming and pain and this guy’s like throwing a fit slamming stuff. I don’t think I’ll ever forget it.
P: Yeah, I’m impressed that you still said no because a lot of people have stories where once they’ve called the person they feel like they have to go through with it.
A: Yeah,
P: I’m glad that you didn’t, that you said like it. Now I don’t need it right it’s that’s like a.
A: Yeah, I, I just, I had it so deeply planted in me that I was not going to get an epidural I was more scared of the epidural that I was of naturally pushing out a baby was more terrified of that needle going into my spine than doing what my body was naturally meant to do. There’s nothing wrong with epidurals I was just mentally scared of that needle going into my spine.
P: More than 60% of women in labor use an epidural, which is an anesthesia, that blocks pain in a particular region of the body. In the case of labor, usually everything below the waist, it can have some negative side effects like itching, infection, bleeding or headache, these consequences are short lived and uncommon, less than 1%. According to the British Journal of anesthesia. The estimated risk of permanent harm from an epidural for a woman in labor is lower than one in 80,000, to try to put that in perspective, you’re much more likely to be struck by lightning in your lifetime. Regardless of the statistic. No one likes the idea of a needle in their back And I remember being worried about getting an epidural before getting both of mine, but the risk of unintended harm is low.
A: And also just like advocating for yourself and what you want is so important, like, I don’t care that he got upset that he didn’t get to do an epidural I’m sorry this is my labor my story. And I’m not gonna let you ruin it by causing a fit, like,
P: well, but that’s why I’m impressed by because you’re, you’re, you’ve got other things going on.
A: Oh yeah Oh,
P: so, so it’s kind of amazing that you were still able to like most people say, for their second one, they’re going to get a doula because they imagined that they would, you know, be self possessed and have control over everything and then when it actually happens there’s so much going on that it’s hard to maneuver so so good for you to make that happen your way.
A: Yeah, my midwife. She was also a huge part in that like she. As we get through the story, you’ll see but she is such an incredible woman and like my, my team wanted me to have a natural birth if possible so they were also on my side, which made it that much easier.
P: Yeah, that’s awesome.
A: And they dealt with him and they just told him to leave but, yeah, so I didn’t get the epidural. And then it was time to push that that was honestly most the most terrifying part. Well no, it wasn’t the most terrifying part but as far as
P: of the birth
A: yes, of the birth. Yes, that was the most terrifying part, just like feeling, everything and pushing and you have to do it like you have, you have to bear down and push no matter how bad it hurts. And like all you want to do is just not push.
P: Yeah,
A: because like, yeah, a baby is coming out, and it is excruciating. And you just have to stick through it and push and I pushed for. I think I pushed for 45 minutes, not very long, and my partner and that’s probably because I didn’t get an epidural and I could feel what I was doing.
P: Yeah,
A: because that I know that when you get an epidural you do you have, most people push for longer because you can’t feel your body.
P: So this is a good question. Does an epidural slow down labor studies in the 20 teens suggested Yes, an epidural does lengthen labor, but most of those studies are observational, meaning that they compared the length of labor between women who chose to have an epidural and those who didn’t. So if this is your sample, the issue becomes did these choices reflect other differences between the groups that could have led to longer labor’s. In 2017, there was a randomized control trial of women, who either received an epidural or saline solution and the lengths of labor were the same. So perhaps the jury’s still out on this one.
A: And my partner actually caught her son, so he he birthed her son.
P: Wow.
A: Yeah. And that’s something that like made him feel like so connected to that moment. So I the midwives birthed the head and made sure that he was good and then he did the rest.
P: That’s amazing.
A: Yeah, it was really cool. And then he put our son Liam on my stomach, and they got them all. Situated, and I will never forget birthing the placenta. It was such a weird feeling like after you birth a baby, and then they like toggle an umbilical cord and like you birth the placenta. And it’s like this, just feels like jello. And they like lifted it and showed me the placenta I have a picture of that too, such a weird thing you’re like I grew that.
P: Yeah, amazing.
A: Yeah, and it looks like it looks like the tree of life.
P: That’s cool, you mean all the veins going through yeah that’s cool.
A: Yeah, so they inspect your placenta to make sure that nothing was left inside of you. Yeah, and it looked fine, I was fine I was doing okay. And then, my mother in law went and got us food. Obviously I’ve just been laboring for 20 hours, and I ate everything so fast I was so hungry and like so weak and like dizzy and shaky. And I don’t know where Liam was at the time I think he might have been like on the warmer, like getting checked out. He was perfectly fine like he was born and he was good to go, like nothing happened with him he was perfect. And then the nurse wanted me, this is about an hour after I delivered. She wanted me to get up and go to the washroom because they like check your uterus and like your bladders too full you need to drain it and then come back and I stood up, walked to the washroom with helped because I was so dizzy. Yeah, and I sat down and literally like, I don’t know 12 Golf golf ball sized clots just fell out of me. And I looked at the nurse and you could just tell in her eyes that something was wrong and that it wasn’t normal she’s like, oh, okay well let’s get you back to the bed, like, okay, and as soon as I stand up, I start to feel extremely dizzy. I feel dizzy talking about this right now. And I lay on the bed and like immediately I just started like profusely bleeding everywhere. And, like,
P: okay, that’s scary.
A: Yeah, it was. I didn’t really understand what was happening at the time, because I didn’t know I didn’t even know that hemorrhaging was a thing. I didn’t really understand it, and nobody really talks about it because one that’s terrifying and I’ve gone through counseling to get over it. But, yeah, it is terrifying and so
P: is it like a, is it like a rip of the uterus or like what exactly is bleeding?
A: Um, there was left over amniotic sac stuck to my uterus.
P: I contacted an OB, Dr Nicole Wilcox, to get details about some of the medical issues Ashley encountered. Hi Dr. Wilcox thanks so much for coming on to talk to us again.
Dr. Wilcox: Thank you. Happy to be here.
P: Can you explain to us how the amniotic sac could still be stuck to the uterus after delivery, even if the placenta is examined.
Dr. Wilcox: So, after delivery, whether it’s vaginal or C section, but more commonly with vaginal, the placenta after the baby’s delivered the placenta needs to be delivered and usually there are signs that it’s starting to detach from the uterine wall, and at that point you know you sort of gently guide guide the delivery of the placenta out of the uterus but it, you know it has membranes that was in a was the sack that surrounded the baby that are attached to it and those either the sort of meaty part of the placenta which implants into the uterine wall or those membranes, sometimes that a piece can can remain in the uterus, as it’s being delivered. And so one cause of postpartum hemorrhage can be a little bit of retained retained placenta or retained membranes. And so if you, you know, notice that a woman is continuing to have bleeding after delivery of the placenta that’s one of the things you would evaluate for it is sometimes you can just gently feel even feel up inside the uterus to make sure everything has been delivered we always examine the placenta to look to make sure it looks intact although you know it’s not that’s not foolproof you can certainly have a piece left behind and not be able to detect that just visually inspecting
A: so your uterus is trying its contracting and trying to get that out so it’s trying to expel it which is causing it to bleed, and basically making me bleed to death. Yes, is what would have happened. So, I’m laying on the bed and I had pushed so hard when I was delivering that I pushed my IVs out.
P: Oh wow
A: So I didn’t have IVs and my veins are collapsing. So I had, because every nurse can try twice, I believe, so I had, I think five nurses tried to get IDs into me. So that’s ten times. I had an IV poked into my arm I had bruises everywhere. So they got the IVs in, and then my midwife started doing bi-manual compressions.
P: What’s that mean she’s like pressing on your uterus
A: so one hand is inside of me.
P: Oh wow,
A: like in a fist, pushing against my uterus. And then the other hand is folding my uterus overtop of her fist from the outside, on my stomach folding it trying to contract it and trying to make it stop bleeding. She did that for about an hour. I was literally screaming on the top of my lungs. And like, passing in and out of consciousness, and like my blood pressure, I don’t remember the numbers it’s on the blog.
P: It was super low, it was like yeah 75 over 45 or something
A: it was Yeah, it was super low and my, my heart rate skyrocketed. And that was scary and my Travis was sitting beside me holding my hand. Like I don’t know how he did it but he just just like you’re okay like it’s fine. And I’m pretty sure that his mom had Liam, I have no idea I don’t know where Liam was at the time
P: wait let’s pause for a second. kudos to Travis man, he is obviously lying, and doing a great job.
A: Yeah, he did incredible i don’t i don’t know how he did it I would have been terrified and crying. If I was in his shoes because like my mom said it looked like a murder scene. And then the bimanual compressions didn’t work. And I was still bleeding and they’re like, you have to have surgery. So, they call the OB, and she comes up to me she goes okay so we have to do the surgery, there’s a chance it might not work. Do you still want to do it I’m like, Okay, well, what options do I have either I do it. And it might not work and I die, or I don’t do it and I die. Let’s just do it like you’re talking to me. Let’s go.
P: Yeah, yeah…
A: I’m in pain here like let’s just do the thing, never had surgery in my life, and I ate so much food that I couldn’t have. I couldn’t go under anesthesia.
P: Yeah, yeah, you couldn’t have general because you had food
A: right, yeah, so they couldn’t knock me out, which I was like,are you kidding me. Now I have to get an epidural after all of that I have to get an epidural, are you? It was kind of defeating, in a way, but I’m also glad I had it, because it was like a nice like this take away the pain for a minute after all of that. So I get wheeled into the operating room never been in the operating room in my life. I get a new anesthesiologists they just switch shifts, I get this amazing, incredible gentle kind hearted man and he’s like okay like we’re gonna do this, it’s gonna be okay. I’m going to give you some medications so your anxiety goes away you can relax, and he gave me the dose and like,can I have more? This isn’t enough. I need to like, go by by.
P: Yeah.
A: And so he gave me another dose and I was like falling asleep. Oh my gosh, I totally forgot to mention this so my midwife. She came with me she got in her scrubs she came with me to my surgery. She held my hand at the entire time. And like comforted me like I’ve never experienced anything like that I didn’t even know that they could do that. And she came with me because I was so scared and like one point I’m like, Am I gonna die. She’s like, No, no, you’re fine You’re fine It’s okay, and everyone was just so like comforting and yeah so she came with me. I’ve got the medication so I was calm and then I got the spinal, which is the weirdest feeling of my life.
P: Yeah,
A: because I was one high on drugs, and I take really well to any medication so I was my whole body was. I couldn’t feel myself breathing. It was terrifying.
P: That’s scary.
A: Basically I could just blink. I couldn’t like move my arms like nothing. And it’s only supposed to be from like the waist down yeah and then like my whole body was numb. And it was like that for like hours,
P: yeah that’s that’s very scary.
A: And then they like move you from your bed to like the operating table and I just remember like being so lifeless and just like. Obviously I’m drained because I lost so much blood. I don’t like I actually didn’t faint at all. I don’t know how I stayed awake. Yeah, like I was like, kinda like passing out but like I didn’t. I was awake the entire time. And they like move you and you’re like this lifeless numb body and all you feel like your head like wobbling, and they move you to the operating table and they like strap your legs up and they did a DNC. Yep. So they basically cauterized my entire uterus.
P: Can you describe what a DNC is?
Dr. Wilcox: Yeah, that’s a pretty typical step in, in a hemorrhage, if it’s not being resolved with, you know, massage medications, it definitely if you suspect that there might be some retained retained placenta or retained tissue or membranes, and the uterus, a DNC is a dilation a dilation of the cervix which is actually at that point is is typically already dilated; a curettage is a is really a scraping or a cleaning up the lining of the uterus. So it’s actually done in the setting of of postpartum but it also is done in women who aren’t pregnant, who are having bleeding issues but in that setting postpartum hemorrhage if the hemorrhage is ongoing. It’s very common to take a woman back to the operating room and you know if they have an epidural that can be used for pain control but to really evaluate, you know, take an instrument to gently feel inside the uterus to make sure that there is not some placental fragment piece of placenta or membranes that is that is remaining inside and sometimes that tissue can be sticky it can be sort of stuck to the wall and you have to, you know, kind of gently remove it and that can resolve resolve the hemorrhage.
A: And it worked. Thank goodness. And then I was wheeled into the recovery room and I’m like, I don’t know where my baby is that I just birthed like, Where’s my baby I’m not pregnant anymore like freaking out. And my midwife was with me the entire time and we were just talking and, yeah, I if she wasn’t there I probably wouldn’t have done, as well as I did. She really like changed it for me and made me feel comfortable and like cracking jokes and just making me happy. And like reassuring me that my son was safe and that he’s good. Yeah, that was fun.
P: Well that sounds, that sounds amazing to have had her there. Like it made a real difference.
A: Yeah, it was. like you remember when you had your epidural when it was wearing off.
P: Yeah.
A: Were you shaking?
P: I shook a little bit but it sounds like that as much as you did.
A: Okay, so they wheeled me back up to my room, and I got to hold my son and I was like, pale as a ghost like I couldn’t, like, you know how you put your hands down you like scootch your butt up on the, on the bed. I couldn’t do that. So I could like barely hold him and like I’m trying to breastfeed him and all of that. And I was like, as soon as like the spinal block started to wear off like my body was like, like shaking it was so weird. So I could like barely hold him I’m like shaking and like you’re, it’s like you’re, you know when you get that really intense shiver.
P: Yeah
A: and you can’t stop, it was like that, and it. I don’t remember how long that lasted but quite a while.
P: Can you explain to us why some woman. Shake as the epidural wears off,
Dr. Wilcox: it’s very common to have shaking, particularly around the time of delivery, but a lot of women will get that, after delivery and generally a reflection of, you know, I always tell patients it’s you know your it’s like your body’s, you know, running a marathon it’s, it’s just been through a physically very grueling event, to some degree, it’s hormonal but it’s also just, you know, the endorphins and to some degree, you know, exhaustion. and it’s not necessarily triggered or related to the epidural, although that can play a small role but it is a very common thing to see and after the delivery, whether it’s a vaginal delivery or C section.
A: And I totally forgot to mention this, but right after I delivered I signed an early release form for the hospital. I had a midwife as doing it naturally I wanted to go home and just be home, and they’re like okay, like you can leave in an hour and then that hour when I was supposed to leave this all went down. It’s just crazy like what if I did go home.
P: Yeah, no kidding. No kidding.
A: Yeah, um, delayed postpartum hemorrhage doesn’t happen very often either. It’s usually like right after delivery. And I think my blood clots so fast that it was just pooling inside of me when nobody noticed.
P: Wow.
A: Yeah, so probably going to the washroom saved my life.
P: Yeah, that’s amazing.
A: Yeah.
P: How long are you in the hospital when did they release you. For real.
A: Um, I got to the hospital. The early early, early morning of the 27th, and we went home on the 29th.
P: Oh, so you weren’t there very long.
A: No. I kept asking you to leave. It was I hated being there. It was like this tiny little room, and it was hot, and I was not feeling well and the bed was uncomfortable and like I woke up from surgery and I had a catheter I had all these IVs everywhere and like bruises on my stomach from them pushing on it and doing the compressions. I had bruises on my arms because the IVs. And
now I have to take care of a newborn and I can’t even scootch my butt up to sit up yeah it was, it was really hard. And when you lose, I lost 2.65 liters of blood, which I didn’t even know was possible. Like that’s a lot,
P: Ashley lost more than two and a half liters of blood. Is that a lot?
Dr. Wilcox: It is a lot because she probably in her body has maybe five liters, so she couldn’t last five to six she probably lost half her blood volume so that’s a postpartum hemorrhage is defined as being more than 500. milliliters which is half a liter if it’s between 500 and 1000 if you identify that you’ve likely lost more than 500, and the hemorrhage is ongoing you start mobilizing a hemorrhage team. And, you know, making sure you have good IV access you’re doing IV fluids and then after 1000, you are, you know, likely considering blood products, two and a half liters is. Yeah, that’s a significant significant hemorrhage and she’d likely needed a transfusion.
A: And they said, you can get a transfusion you don’t need it but there’s a chance that you could get AIDS.
P: There are things you can get with a blood transfusion.
A: Yeah. And I didn’t know that I’m like
P: Yeah,
A: I had no idea and I’m like, if I’m alive and I’m okay like I will reproduce blood. Yeah, whatever. Let’s not do it because I just I don’t think I need to risk that right now if I was going to like literally die then give it to me but
P: obviously everyone gets to make their own decision about whether to get a blood transfusion. I respect Ashley’s decision. I include this to give a sense of the risks of infection from transfusion.
Dr. Wilcox: So if someone’s had blood loss to that degree, and they’re what we call symptomatic meaning, she’s, you know, maybe a high heart rate low blood pressure, dizzy, dizzy tries to sit up or get up, then we’re really encouraging a blood transfusion which are really they’re very safe the risk of getting HIV from a blood transfusion is about one in a million to one and 2 million hepatitis, hepatitis B is about one and half a million risk. We’re screening you know so the blood is screened very carefully.
P: Dr. Wilcox is quoting rates from the US and looking at the rates in Canada where Ashley is from in a 2015 report on the risk of infection from transfusion. It’s one in 21 million for HIV and one in 7 million for hepatitis B.
A: I’m okay so it didn’t get the transfusion so I was really really weak for about two or three weeks. And I remember being in the hospital and I couldn’t even like walk to the bathroom without help, let alone like sit up and get my son out of the little bassinet they put him in and then lay down and breastfeed him like my midwife had to come and teach me how to breastfeed laying down, because I couldn’t hold him. Yeah, I could barely sit up. And, yeah, it was really tough recovering from that but I’d do it again.
P: Yeah, yeah, yeah,
A: it’s crazy what you do for your children.
P: Yeah. So you’re home Three weeks later, you’re, you have the baby you’re starting to feel better…you are good to go
A: Yeah Basically, going through that definitely gave me. I didn’t really recognize it until about a year after he was born that I had postpartum depression and anxiety, but we’re dealing with that now and I’m getting better, but it was, yeah it was a journey.
P: I mean, given all that you’ve been through, I mean, pregnancy is like is a huge transformation. Right? And then yeah, kind of chemistry change. And you had this pretty traumatic post birth experience.
A: Yeah.
P: That sounds terrifying, despite all the support. So that kind of, you know, it sounds like a rational reaction to all that.
A: Yeah, yeah, I remember. It was the third day postpartum. So the day after we got home, we actually got home on Travis’s birthday. And the day after was my little sister’s birthday, I’m like, I’m going to my mom’s house to say happy birthday to my sister. And the day after we get home, I could barely walk to the truck. I go out to my mom’s and I sat down on the couch, I was there the whole time. I didn’t move, but up to the truck, could barely get in. I walked back to our house, sat down and just started crying. And that’s when the baby blues hit it kicked in. Because everybody kind of goes through that after that, like hormonal change. And like, you’re like, no, you’re not pregnant. And now my baby’s out. And I’m not sleeping, and I’m hurting and my parts are hurting.
P: Yeah, yeah
A: my nipples hurt. Like all of that. It was never forget that either. Just that it was like a wave of emotion literally just took over me. It was it was intense. And nobody like talks about that. And how hard that can be.
P: Yeah, it’s super hard. That’s the thing, right is that so many people have babies, that in some sense that those numbers make it seem like it’s easy, but but almost nothing about it is easy. And it is so physically trying and taking care of a baby is just a ton of work. And you had such you had to build up your blood stores and all that I have a lot to overcome when you’re waking up every three hours and you know, had been up for the previous 20 hours. It’s a lot.
A: Yeah, totally. It’s more than a lot. There’s so many things that happen. And then bleeding and pain with that like, yeah, thank goodness, I didn’t tear at all. Not a single tear. I didn’t need stitches or anything. So I’m grateful that that didn’t happen on top of what happened.
P: Yeah, Yeah, no kidding. So this is a little bit of a tricky question. But if you could go back and give advice to your younger self, before the pregnancy, what would you tell her?
A: I’d tell myself, just to try your best to go with the flow of things instead of making expectations for yourself. Like, just have grace with things because as soon as your mother, nothing goes the way you want it to.
P: Yeah, yeah, I think that’s totally true. Although it’s hard because Yeah, right. So everything’s new. It’s such a surprise that it’s hard to not imagine a plan for yourself to think this is how I’ll handle it. But then
A: even now, like, he’s 21 months, and we’re going through the toddler sleep regression, and he was an amazing sleeper. I just put him down and he would sleep. And now it’s all different. I don’t know what I’m doing. It’s like, you can’t, you can’t stick to anything. Because babies grow so fast and change so fast. You’re schedules always changing, like, just go with it. And give yourself grace. And if you need to sleep on the couch for two hours while your child sleeps, do it. And do the laundry later because laundry can wait.
P: Yeah, that’s good advice.
A: Yeah.
P: What what’s your son into Now? What’s the What are his tricks?
A: He is a talker. He constantly talks he like I don’t he can say every word I say. And he really loves trucks. He loves like heavy equipment, trucks and he really likes the minions right now.
P: That’s cute.
A: Yeah. He is such a cute little guy. He’s so affectionate and kind already. loving it. Thank you to random people.
P: That sounds very cute.
A: Yeah, he’s adorable.
P: Well, I was so glad that it all worked out.
A: Yeah, me too.
P: Yeah, no kidding. And I totally appreciate you sharing your story because it is a you know, another narrative of how things can go.
A: Yep. I that’s why I made the blog post. I just felt like no one’s ever really talked about postpartum hemorrhage before. Like, I’ve never heard anyone go through that. And then I went through it and my grandma’s like, Oh, yeah, that happened to me. And like, why didn’t you tell anyone like?
P: how common is postpartum hemorrhage.
Dr. Wilcox: It’s it’s quite common, and it’s a It’s a leading cause of maternal mortality in this country. Yeah, well, it’s a leading cause in the maternal mortality that happens usually within the first day of delivery, certainly very common in outside the US as well. But But we it’s a significant issue in our country. And and and many people in the field have have developed protocols to really try and address prevention and accurately quantifying or really knowing exactly what the blood loss is probably the most important, one of the most important things is to recognize that it’s happening, and to act quickly, because women can lose a significant amount of blood very quickly. You know, the uterus is a very vascular organ. And it can, it can, it can bleed very quickly. But prevention in terms of knowing what a woman’s you know, blood count is going, you know, when they first arrive at the hospital, having that information, having IV access, identifying which women are higher risk, and taking appropriate steps, having the appropriate medications ready having blood products available. Because you you really need to stay on top of it.
A: No One Yeah, no one talks about it.
P: Did they say that there was any genetic component?
A: No. And they said for my next delivery, that they’re going to treat me like, I’m going to have one. So yeah,
P: well, that may be smoother.
A: Yeah. Which is kind of comforting. Because, like they can, I’ll tell I’m in a different city now. So I don’t have the same team, but. And I’m not pregnant, so I don’t have to worry about it. But it’s just nice that I can like tell whoever’s taking care of me that I had a massive hemorrhage. And just to watch for that make me get up sooner to make sure that I’m not bleeding. But yeah, I just it was terrifying. And I remember thinking like, I’m gonna die, and I just birth my baby, and I don’t get to meet him.
P: Yeah, that is that is scary. Yeah. Have you reached the point yet? of appreciating your strength?
A: Yes.
P: Okay, good.
A: Yeah. Yeah, I definitely had to do some counseling. And like, that’s also why I’m talking about it. Because talking about things like this helped me get through them. And just like sharing everything, and then meeting other people that had a hemorrhage to like, talking to other people. Like it just opened so many doors, and like, being able to be on a podcast and share what I went through on here. It’s going to help so many other people, and it’s just nice to not feel so alone.
P: Yeah, yeah, I totally agree. I totally agree. Yeah. So thanks so much for talking to me today. I totally appreciate it.
A: Yeah. Thanks for having me.
P: Thanks again to Ashley and thanks to Dr. Wilcox for her insights about postpartum hemorrhage. I’ve included links to the medical issues we discussed in the show notes. I’ve also included a link to Ashley’s blog think outside of the crib.com Thanks for listening. And if you liked this episode, feel free to like and subscribe and to leave a review. We’ll be back soon with another inspiring story about women overcoming the many obstacles to motherhood.
Episode 8:Zen & the Art of the Peripartum Period: Maria
Episode 8SN: Zen & the Art of the Peripartum Period: Maria
Every pregnancy is awash in chemicals–that’s how the magic happens, how we turn an egg and a sperm into another human being. But this chemistry can have other consequences, notably, peripartum depression. Peripartum depression, the condition formerly known as postpartum depression, has been renamed to reflect the fact that this form of depression can strike during a pregnancy, as well as after it. It is believed to affect 1 in 9 mothers, a full 50 percent of these cases are thought to occur during the pregnancy. Today’s guest didn’t share her feelings with anyone, first imagining that it was normal to have unsettling thoughts during pregnancy. After birth she experienced guilt about her lack of interest in connection. Fast forward five years, today she’s trying to help other mothers who find themselves in this situation. For more about Maria, find her work at https://www.parentonboard.com
GBS
https://www.cdc.gov/groupbstrep/about/fast-facts.html
https://www.acog.org/womens-health/faqs/group-b-strep-and-pregnancy
https://www.marchofdimes.org/complications/group-b-strep-infection.aspx#
Delayed cord clamping
Full interview with Dr. Bennett (aka, Dr. Shosh)
Resources mentioned by Dr. Shosh
Beyond the Blues (see bibliography)
Audio transcript
Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka. Every pregnancy is awash in chemicals. That’s how the magic happens. How we turn an egg and a sperm into another human being. But this chemistry can have other consequences, notably Peri partum depression. peripartum depression, the condition formerly known as postpartum depression, has been renamed to reflect the fact that this form of depression can strike during a pregnancy as well as after it. Today’s guest didn’t share her feelings with anyone. First imagining that it was normal to have unsettling thoughts during pregnancy, after birth she experienced guilt about her lack of interest in connection. Fast forward five years. Today she’s trying to help other mothers who encounter these issues in their pregnancies. After I spoke with my guest. I went back into her interview to add in additional information about acronyms, and medical issues we discussed. I also included some insights from an excellent clinical psychologist. Let’s get to this story.
P: Hi. Can you introduce yourself.
M: Yeah, Hi, I’m Maria, and I have two kids. Currently, I have a four and a half year old boy, and an almost two year old boy.
P: Wow! That sounds like a busy house.
M: Oh, it’s a very busy and very loud house,
P: and fun is my guess. So, before you got pregnant with these kids. What are your ideas about pregnancy?
M: You know, I didn’t really have very many ideas about pregnancy, like I never actually wanted to be a mom, up until it hit me over the head at around 29 that I desperately need a child, and then just kind of went for it but I thought pregnancy would be, you know, difficult, maybe uncomfortable but that was never the part that I really concentrated on like everybody else I was super scared of the birth and pregnancy. I don’t know what’s gonna happen.
P: And Did you get pregnant easily?
M: We didn’t have any issues
P: And early on, how did the pregnancy go?
M: it started fine. It was perfectly fine early on I didn’t even have like a whole lot of morning sickness. Some, nausea, and I was really tired but that was about it there weren’t any concerns no issues, everything was great.
P: And so what how far along were you when things were less great
M: I think somewhere in the second trimester, even though I was feeling fine, physically, emotionally I somehow stopped being excited about being pregnant. I was really excited. In the beginning I was really looking forward to it and then just as the time went on, the excitement just disappeared. I was no longer into it, I was crying a lot and just being very sad about life and the whole pregnancy situation just not knowing. That’s even something that I want to do anymore but then feeling like I wasn’t going to obviously terminate it. It was just like I wasn’t sure what was gonna happen once the baby comes
P: that that sounds really hard because by the second trimester, you’re kind of showing already
M: yeah, yeah, I was showing and you know, like on the outside, everything was perfectly fine I was healthy pregnancy from the physical standpoint, was doing great. There were no issues at all so like there was technically no reason for me to feel the way that I was feeling but, you know, I was feeling that way.
P: Did you talk to your gynecologist?
M: Oh,No I didn’t I was one of those people who very skillfully hid all of this. I presented very happy and excited every appointment and didn’t really talk, I might have mentioned to my midwife here and there that I was just a little bit, unhappy, but I think I didn’t explain it and I didn’t explain how unhappy I was but they kind of brushed it off as like, you know it happens you know pregnancy hormones fluctuate so no one really paid any attention.
P: Did you think that this is what pregnancy is?
M: Yes, I thought, that maybe that’s just how it is people just stop getting excited like you know you get a little heavier life becomes more difficult because you’re just not as into it
P: well that sounds hard. So I’m guessing you can’t you carry that feeling to the birth.
M: I did you mean I was just not like I carried on with my life and get everything but yeah, that excited but then also like the baby came about two weeks earlier than expected so we were totally unprepared we were supposed to have another meeting with the doula and obviously have appointments scheduled and everything and then it’s like boom babies coming
P: So Let’s walk slowly through that part like, what are you doing during the day. Did you, did your water break, were there contractions?
M: So, we had this plan that I was gonna, you know, finish work, about two weeks before the due date. Week 38 that last Friday I was gonna, you know that would be my last day and we’d have two weeks to prep for the baby like make sure to do all the finishing touches relax a little bit, so kind of things you do and that’s why I went into work I was tired My back was hurting a little more than normal, but it wasn’t anything like that I wasn’t used to that point it was just maybe a tiny bit more. So I went to work, finished off with work I come home, go out to dinner. Like I’m uncomfortable like my back hurts but still liveable. Go to sleep. Everything’s fine I wake up in the morning. On Saturday, and I feel worse than I did the night before. And my first thought is like, oh my god I have two weeks to go Is this what the last two weeks of my life are gonna feel like this is gonna be horrible. And I’m like, we’re gonna make it through this, when we get out, we go to Costco to go shopping. And at that point, I’m still not realizing that even though my contractions are still pretty far spaced. They’re actually now coming in as contractions because while we’re shopping. I’m walking, very slowly and there are points where I literally have to stop and hold, like the metal poles that Costco has to take a breather. Okay, know what time, we’re gonna go
P: yeah so did you know that was a contraction.
M: You know, I didn’t think it was real contractions I thought they were just like really bad Braxton Hicks that was. That’s what I was thinking, because you know at 38 weeks I didn’t think it was going to be happening so. No, I didn’t think it was a real contraction. So we got home and we’re kind of like sitting around it was me, my husband, my mom and our friend and, like, 4pm ish. I’m like well let’s, let’s order dinner. You know I’m pretty hungry like why don’t we order dinner we go online, order some dinner, and between the time that we order, and my husband goes to pick up the dinner I all of a sudden start feeling way worse. My back starts hurting much much worse. And I’m like, I’m not hungry anymore. I don’t know what’s happening but I’m not hungry anymore so I start like bouncing on them on the medicine ball and like stretching and all of that and all of a sudden I just feel more and more in pain. I start throwing up and then like my mom was kind of like I think these are real like I think you’re actually having contractions. And so they like, got me upstairs to our bedroom I sat in our bathtub to like alleviate some of the pain, which was really helpful, and then that went on for like, let’s say two three hours before my water broke finally and that’s when we were like, okay, for sure it’s the real thing we got to do it so we had to call the birth center because I was GBS positive and needed to receive antibiotics.
P: I’m gonna pause the interview for a quick second to talk about GBS GBS or group B streptococcus is a common bacterium found various areas of the body in both men and women. According to the CDC about 25% of pregnant women carry GBS, although they usually don’t have any symptoms GBS doesn’t often cause health problems in adults, but can cause serious infections in newborns and it can be passed from mother to baby during birth. If you test positive for GBS, the doctor may order IV antibiotics during your labor. Okay, back to the interview.
M: So we at around 10pm, we drove to the birth center to go and get checked and see if. You know I’m far long enough for them to actually give me antibiotics and to be there so it was an interesting long Saturday.
P: Good Lord I’m glad your mom was there to say like I’ve seen this before and guess what this is, this is a real thing.
M: Yeah, cuz I kept thinking no no, no that can’t be.
P: So you’re at the birth center are you gonna, you know, are you gonna do like a water birth or what how’s it set up?
M: the birth center like it’s set up the rooms are like the most luxurious hotel room you’ve ever seen like a beautiful bed, there is a tub there. There’s a very big bathroom were like, four people can easily stand they have like a toilet with a heated seat they have a shower where you can stand or you can sit down there’s like there was like a little like bench like a stone bench, because it was nighttime there was only one midwife usually like when it’s during the day there’s two midwives at night, that’s just whoever’s on call. So it was me my husband. The midwife, and the doula but the funny part is, it was a backup doula because my doula caught a stomach bug and couldn’t show up so that was kinda kind of crazy and funny. It worked out well because she was the doula I originally really wanted
P: oh
M: but she was busy at the time when I was booking the doula. this it was not really well it was just kind of like, oh hi hello yeah I don’t know you, but hey, let’s do this.
P: Yeah.
M: So the deal was that yeah hopefully like it was gonna work out, you could do a water birth because that’s available they have some nitrous oxide to help with the pain but other than that it was just supposed to be super low intervention just it’s as if your in your own very comfortable own how with medical care at your side, that was kind of the idea of the birth.
P: And how was the birth?
M: It was a very long night of no progression, and a lot of throwing up a lot of pain. While everybody slept, I couldn’t sleep because I couldn’t lay down on my back anytime I lay down on my side or throw off. So I spent most of the night, kind of sitting on the medicine ball with like a tower of pillows in front of me and just straddling straddling the ball with my head on the pillow just like that. Obviously if I fell asleep for half an hour at some point that’s great. But I don’t think I really slept very much, and then morning comes. The midwife checks me and realizes that she feels something weird, because it’s a birth center they don’t have ultrasound so they can only go by feel, and she says that, you know, because I’m feeling something really strange. It’s not his head. We need to send you over to the hospital. And, you know, by that point I haven’t slept in well over 24 hours and I’m completely exhausted. And just emotionally on edge and so I start crying while we go into the car to go to the hospital. Luckily the hospital, right next door so the drive is a whole five minutes but we go there we get checked in, not really having that many contractions at that point, they are very sporadic to go into the room the OB shows up was very sweet lady, and you know she puts the sound one over my belly after she checks me and she’s like the baby’s breech. And we didn’t know that the baby was breech because, at least, all the appointments, and even going into the birth, everybody all the midwife that felt the baby thought he was head down and even my stomach looks very different. The night before then it did that morning so it appeared as if he actually turned mid labor but never descended, he just heads up so that was very stressful to
P: a professional gymnast on our hands here Wow.
M: Oh, he is yeah he’s very wily always have been still.
P: So, the breech position means C section right?
M: yeah it means c section I mean maybe there are hospitals that will do otherwise but not here. It was immediate c section I was. Luckily, nobody was in distress baby wasn’t in distress wasn’t having any issues. So it was sort of like, I like to call it a, an emergency non emergency c section.
P: Yeah.
M: So they started like while they were going to prep me but I sort of went to the bathroom, and basically just closed the door for half an hour. t wouldn’t come out. And then the, the nurse had to kindly come and knock on the door, and ask figure out why am I not coming out why am I not coming out and asking me to please come out because your scheduled time is coming up and we need to get on with it, and I was crying and just completely lost it because that was, we were not prepared for a C section out was not mentally prepared for a C section it was not something I wanted. That was my first major surgery in life so I was incredibly scared of what that would be like, and then
P: all that seems rational especially since you. I mean I think that would be rational no matter what. But on top of you know 24 hours no sleep and you were already in this beautiful, beautiful birthing center where everything was all set up. That’s really the rug being pulled out from under you at the last second.
M: yes, Absolutely. It was like the last hope was like just shattered because it was like well okay fine I’ll deliver in the hospital. But then, yeah, like, oh he’s breech and you’re not delivering.
P: Yeah. So my guess is they eventually got you out of the bathroom.
M: They did. They got me out of the bathroom, they start prepping me they brought in an anesthesiologist who was less than kind. He was not very nice talking to me was very condescending man, just a very unpleasant gentleman, he, he kind of wanted the attention on himself, and he didn’t get it he was very pissed. So when he when he was administrating the spinal block he clearly you know missed the spot a little bit right like I mean we’re talking about like millimeters, and he hit a nerve because I just had like just, it felt like there was liquid fire over my right side of the body and so I kind of started screaming and he wasn’t he started screaming at me as to like Why are you screaming Why are you screaming like and I could barely even get a word out because I like…
P: because you have a needle in my back in the wrong place?
M: yeah, you have a needle in my Back in the wrong place and you know I’m barely lucid because you know the 24 hours no sleep and pain the whole time like I can barely form a sentence here. Luckily the nurse was very nice she was holding my hand and everything since you’re not allowed to have anybody in the room with you while they’re administering the anesthesia, so it was nice to have the nurse who was very comforting and kind and then the C section itself was. It was just rough because I don’t think it’s an unusual response but not everybody has this type of response to the anesthesia, I was shaking really badly they had to strap my arms because I couldn’t keep them in one spot and. And the people around me like his whole team was about as arrogant as he was it was a very unpleasant kind of situation I just like kept talking throughout the whole time just to keep myself awake and engaged, but it was not the best, not the best people to have around.
P: Yeah, that sounds like a hard circumstance when you’re already, everything has been turned around, that’s a bummer. And did they let your husband in once the block was on.
M: He was allowed inside so he was sitting next to me and he was like trying to like talk to me and everything and trying to you know just sit with me and be there so that was, that was very, very comforting to help at least somebody,
P: and the C section went smoothly after that.
M: The C section was perfectly fine It’s just that when they pulled the baby out, we wanted to do like delayed cord clamping.
P: I’m gonna pause the interview for another second to say that I found an article from December of 2012 that says that the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30 to 60 seconds after birth. in term infants delayed umbilical cord clamping does things to hemoglobin and iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
M: And they pulled the baby out and my husband. We were doing the C section with the clear drape, you know, when we lift up now. Yeah, so he saw her pull the baby out and he sees that she’s reaching for the scissors or the clamp whenever she needs to cut the cord and he, and he was like, yelling at the OB, no no don’t cut the cord we want delayed cord cramping and she looks at me she’s like I can’t do that, like he’s not breathing
P: as Maria is reliving this part of her pregnancy, she’s gotten upset, and it sounds like silence in this interview but she’s gathering herself emotionally. I left it in here it is.
P: I’m sorry, that is stressful,
M: It’s fine. Just a couple of seconds…. Sorry I actually never had an emotional response to this before.
P: Well it is it is kind of shocking I remember when we had distress in my own pregnancy and literally the minute they pulled her out I said I don’t hear crying. Why isn’t there any crying? I don’t hear any crying…like it is something that you’re so kind of primed to listen for and very distressing when you don’t hear it immediately. So did they spank him or something or what did they do?
M: I’m not sure. She didn’t have to do anything; she pretty much just rubbed him and he started breathing just fine but yeah when they pulled him out I think he was pretty blue like, it took them like a second maybe two to take a breath, but then I think they took them under the lamp right away and they never told us what his Apgar score was but he concerns because after about like two or three minutes under the lamp they just let my husband hold him so while they were stitching me up he was holding him right next to my head. It was very sweet but it also was very funny because he was very hungry and trying to latch on to my husband the whole time and he was very disappointed. So we always held on to that as like a funny memory that he was his first disappointment.
Yeah, the reason why I’m so surprised in some ways that’s an emotional response is that when, when it was happening. I didn’t have a response, I didn’t actually care, that he got pulled out that he wasn’t breathing, it was like, Okay, cool. We’re done. I kept asking like Is he okay Is he okay but I don’t remember feeling anything, it just almost felt like an obligatory like, well, what’s going on with this human but it wasn’t like, oh yeah I’m really worried it was just like, well, what’s going on. And then when I saw he was okay like I was like okay I just want to sleep I don’t really care. But yeah, that initial Bond was just not there at all. It was very weird disappointing feeling just kind of like emptiness
P: And at the time did you think this is depression or, or.
M: No, I don’t think, I thought, you know like, as pretty much any mom I thought there was something wrong with me, like, you know, because I was already not excited about motherhood that, to have. Even though I had him nearby I was still not excited just felt somehow. Well there’s something wrong with me I’m that mom like missing the mom gene or something like that just the usual things that mom’s think about, and that’s what the fact that I’m a therapist, and I have plenty of knowledge of depression what depression looks like what postpartum depression looks like but when it came to being able to identify it in me, nope. I Didn’t I even remember filling out a depression inventory.
P: Yeah.
M: In the hospital and then they also gave me one, like, the first appointment of my son. And I remember showing out being like, No, I’m fine, I’m fine. You know I’m the same as with pregnancy was like, This is what my wife is like this is normal like everything sucks but hey, this is what motherhood is like so. No, I didn’t think that that’s what it was, even though I was. So I was crying I was so upset and then as I started recovering, I had a lot of rage. So I was very angry all the time. And at the time, four and a half years ago, no one really talks about rage being a symptom with postpartum depression, so I don’t think anybody would have even really paid attention to that even if I told them, and I didn’t think about that as a, as a symptom so we just we just felt like, well, I just hate motherhood and then I’m not cut out for this and this and this sucks.
P: I talk to a clinical psychologist to get some insights about peripartum depression. Hi Dr Shosh, thanks for coming on the show, why don’t you introduce yourself.
Dr. Shosh: Oh, certainly, and thank you for inviting me. I am Dr Shoshana Bennett commonly known as Dr Shosh, and my work in this field came from personal experience, I’d been a special education teacher and then I plummeted into a very severe postpartum partum illness. And this happened actually twice after the birth of each of my children and it launched me into a brand new career back in the eighties. I became educated and got varying degrees and I am now a clinical psychologist have been for, for many many years,
P: let’s start off with something basic How common is depression?
Dr. Shosh: The statistics vary depending on how the study was done. So anywhere from 10% you see to 20%. I say on the safe side we can say around 15%. So we’re talking about one in seven. This is a very high statistic. We’re not talking about the usual worries and concerns that face a pregnant. Mommy, you know that you know she might be worried about what kind of a mom she’s gonna be or she might be worried about her body changing and she might, you know, many of these things are quite normal. But when the feelings get in the way of her daily functioning, or her ability to sleep at night. That’s one of the biggest warning signs that this is out of the normal range. Same with postpartum if the symptoms of either sadness, grief, anger, rage, low self esteem, insomnia. These are some of the most common if they get in the way of mommy’s ability to mainly enjoy or to feel like herself, or to get in the way of her functioning. This is a big indicator that she needs to be checked out.
P: Okay. Let’s alk about how this issue is identified. How does the person experiencing what may be symptoms know there’s an issue, or how does the clinician know they’re dealing with postpartum depression.
Dr. Shosh: There are a number of things we can look for, for instance, as I mentioned during pregnancy there are normal feelings that can come up, normal worries that float in and out. But if it becomes for instance an obsession. If she is focused on. Oh my goodness. What if this, what if that the what ifs are big, you know, The perinatal anxiety is is huge. Anxiety is one of the most common symptoms of the perinatal depression. So, what you’re looking for is an inability or difficulty sleeping at nighttime. Yes, if the mommy is having heartburn or if she’s peeing more frequently. This is normal during pregnancy, postpartum, the difference between normal baby blues and what might be a disorder, two main ways. One is in the duration of the symptoms how long they’re lasting because the baby blues the normal baby blues should be gone after about two weeks postpartum. She should be feeling much more like herself. The other way you tell the difference is in the severity of the symptoms.
P: So My issue with this system was that it depends very heavily on self reporting. Maria said she was angry all the time but it would require her to tell someone that for her to get treated.
Dr. Shosh: Sometimes the person living with her, somebody very very close to her can tell you know that she’s you know facial expressions body language not wanting to be with a baby or not being able to relinquish the baby to anybody else. you know that it can look one way or the other. Sometimes they’re holding on and they will, they’re too afraid, just too anxious to even put the baby in their partner’s arms, but often it’s, I can’t do this, I am overwhelmed I can’t handle this, I should never been a mother, mommy putting herself down. These are the kinds of things you listen for these are signs of low self esteem. So yes, in answer to your question, the mom, often does feel that something isn’t right. Often, unfortunately, it’s normalized or she herself, you don’t know what she herself thinks is normal. She might say, Well, I’m sure all new mothers are feeling this way, or their motherhood is terrible. I was never cut out to be a mother.clearly, you know, rather than this as an illness. But if the right questions are asked, or the right observations are made these, you know this illness, and all of these illnesses are 100% treatable.
P: At what point did you figure out like oh this is, I’m not a bad mom This has nothing to do with me this is some other kind of force in my body.
M: Honestly? I think after I had my second son. I it finally clicked into me that it wasn’t anything I did, and I didn’t do anything to like, bring those feelings on that it wasn’t my fault that I didn’t bond with him. It wasn’t his fault that I didn’t bond with him it wasn’t anybody’s fault that that happened it was illness that that got missed I didn’t get any help for it and yes I suffered yes our relationship and a lot of ways suffered in the beginning because we didn’t really get the bond.
P: Next, I’d love to talk about the chemistry in this condition, Maria was talking about how she had a hard time bonding with her son, and wondering if he can explain how chemistry contributes to that circumstance.
Dr. Shosh: You know, I’ve got to see that’s not my forte and explaining exactly what’s going on with the brain chemistry and I will also add that I follow the research, very very carefully and belong to those organizations doing tremendous research, we still really don’t know precisely what is happening. We do know, generally speaking, that when the reproductive hormones are shifting. When the estrogen and the progesterone etc are are shifting it does affect the neurotransmitters in the brain and other brain chemicals. So, I can’t tell you precisely what is happening, you know, some women will report not feeling close to their infants or feeling like as you mentioned that they can’t bond, we’re thinking this might have to do with oxytocin changes. Again, there’s a tremendous….as we speak, all that there is a tremendous amount of research going on as to what precisely is happening. And sometimes it is chemical only that affects behavior. Sometimes it is the. A woman thinks she’s feeling something abnormal. And so she starts feeling horrible about herself. So that isn’t just strictly chemical they they bounce off each other. And so it’s very interrelated we call the bio psychosocial factors because one can definitely influence the other.
M: And I think after I had my second son, just by being a surprise pregnancy was not a pregnancy when I felt it wasn’t wanted a bike in fact with him was the opposite I was very not into it in the beginning and then as it progressed, I became super excited when he was born and I was bonded to him right away and I was kind of like, just clicked in my head but like, it just happens you can’t you can’t change whether you bond right away or if it takes you a little while and if you have postpartum depression or not like you are not in control, whether it happens.
P: Yeah, not at all. You can’t control it, you have no control as you said it and it requires treatment.
M: Yeah, Absolutely. And I think as moms we’re so programmed to blame everything on ourselves that it’s just too easy to be like well it’s my fault I’m not being good enough mother, or I’m not doing something well enough. And so you don’t actually even think that like maybe there’s something wrong on the outside. This is not me it’s like my body’s just not functioning the way it’s supposed to but it’s not through any of my own fault so. But it took it took a second pregnancy for me to actually truly get there, really see and understand like what happened.
P: Well I’m grateful that happened so you could, you know, think back to what happened the first time and maybe reevaluate and kind of change your narrative around what happened.
M: yeah, No, it was I mean we always talk about our second one was definitely a blessing in many different ways that even though we weren’t sure if you ever wanted a second one, just because the first time was so hard and it’s not unusual for people to not want a second child when they have severe postpartum depression, but I’m kind of so glad that that happened because it just puts so many perspective on.
P: That’s Awesome. What so there Did you say they are four and two?
M: four and a half and two –they’re two and a half years apart.
P: so what are they into now?
M: Oh gosh, Paw patrol is a big one, you know, like every boy at that age Paw Patrol is huge. The younger one really likes Daniel Tiger’, so that’s really cute and the older one will watch it with him, they love chasing each other, and also they have indoor scooters they love chasing each other and scooters and hide and seek is another one so they’re, they’re very active. They like to play they’re very loud like yelling a lot. It’s a very boisterous household because those are two dogs that are also not quiet and not calm so it’s just like chaos.
P: That sounds fun actually.
M: I mean it is fun, it just gets overwhelming…
P: yeah yeah yeah
M: they’re a lot like they’re cute and I kind of like the age difference the first year was very difficult having a toddler and the baby is no joke there
P: Yeah,
M: but right now that there can play a lot together and do a lot of things together, definitely really fun to watch.
P: That’s awesome. Now if you could give counsel to your younger self. Before you got pregnant or you can during the pregnancy. What would you say?
M: I think I would say is that a with pregnancy and birth you kind of need to prepare for the unexpected because it truly is, you have no control and thinking goes for pregnancy birth motherhood is, like, you have to relinquish control, you’re not going to be in control of a lot of situations and the best you can do is learn to be flexible and adapt to things and Do the best you can, and that other one is kinda is be giving of yourself, give yourself as much self compassion as possible because you will make mistakes, things won’t go right and it’s okay, we’re all human and like that happened.
P: That was beautifully said, and I’m going to end this here now, because I want that to be the last thought in everyone’s head. That’s a really nice message to your younger self and to everyone else.
M: Thank you.
P: Thanks again to Dr. Bennet, also known as Dr. Shosh
and thanks again to Maria for sharing her story
- shosh and I had a long conversation, much longer than I could reasonably include in Maria’s interview. If you want to hear more about peripartum depression, I’ve put a link to my whole conversation with Dr. Shosh in the show notes that you can check out wherever you got this podcast, or on the website, warstoriesfrom the womb. com. In this conversation Dr. Shosh mentions some resources that may be helpful for peripartum depression and I’ll include those links in the show notes as well.
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we’ll be back soon with another inspiring story of a woman who overcame the many challenges of bringing another person into the world
Episode 7: The Fates Have Their Own Birth Plan: Jules
Episode 7SN: The Fates Have their Own Birth Plan: Jules
Many women enter pregnancy, coming from a life that feels firmly under their control. That was the case for today’s guest, whose past experience in the world led her to make detailed plans for her home birth. But the stars did not align, and what started out as a home birth ended with a hospital birth attended by a life threatening case of eclampsia. Luckily, both she and her son survived. For her second birth, she planned to be in the hospital, and again the fates refused to abide–a fast moving labor forced a home birth. Although she and her children are healthy, the chaos of these births required some significant processing–an activity the pandemic made more accessible. She has come out on the other side of these challenging experiences with two beautiful children and a stronger sense of self. Listen to her inspiring story. To get more details on this story, look out for Jules’ book Born in the Beyond, available soon, and follow her on instagram www.instagram.com/thejoysofjules
Hypno birthing
https://www.cochrane.org/CD009356/PREG_hypnosis-pain-management-during-labour-and-childbirth
Water’s breaking
https://www.webmd.com/baby/fluid-leakage#1
Don’t push until cervix is fully dilated
Eclampsia
https://www.bmj.com/content/309/6966/1395
Eclampsia/Pre eclampsia & Cardiovascular Risk
https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.118.11191
Audio transcript
P: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka. Many women enter pregnancy coming from a life that feels firmly under their control. That was the case for today’s guest, whose past experience in the world led her to make very detailed plans for her home birth. But the stars did not align and what started out as a home birth, ended with a hospital birth, attended by a life threatening case of eclampsia. This was an intense experience and my guest and her son are lucky to have survived. She described her second delivery, as more dramatic than the first. And she’s not wrong. The chaos of these births required some significant processing. She has come out on the other side of these challenging experiences with two beautiful children, and a stronger sense of self. After we spoke, I went back into the interview, and more fully described some of the medical issues we touched on. I also have the insights of a fantastic maternal fetal medicine doctor to give us some context.
Let’s listen to this amazing story.
Hi, welcome to the show. Can you tell us your name and where you’re from.
J: Hi, my name is Jules Theis, I’m from Toronto Canada but I live in Cannes France right now.
P: Oh nice lovely. And how many kids do you have?
J: I have two little boys, Oslo is five and Louie is three
P: oh wow nice those are good names.
J: Thanks
P: so many people come to pregnancy with an idea of what it’s going to be like before they actually embark on it. What were your ideas about what it would be like?
J: yes so when I first became pregnant I think I was a bit of an idealist, and I just thought pregnancy was going to be amazing. The first couple months were wonderful I’d always wanted to be a mum so I just fully embraced the pregnancy. And then as it unfolded obviously symptoms come up which are normal, but it sort of changed my perception of how pregnancy can be, but I still kept going with this, believing that the pregnancy and the birth will be really beautiful. And so I started planning for a homebirth really down to like every detail, ensuring that the expectations I had of this pregnancy and birth would be the complete dream.
P: Wait, tell me about a home birth, what do you need for that? like what does that look like?
J: Yeah, so in France, it’s pretty different than what I thought it would be like in North America. So it’s not really supported by the medical system in France, as much as it is in Canada and the US. So, when I went to Google home births in the south of France. There was one registered midwife for the entire department. And so I immediately contacted her and at that time I didn’t actually speak hardly any French so I was like hey, this has to work like it’ll only work basically she speaks English.
P: Yeah.
J: And so I contacted her and luckily she did speak English. And basically, she is there to assist in the birth, but you have to kind of supply your home with all of the medical stuff she doesn’t do this. So, in France, you have to register with a medical supply company and they basically delivered to your front door, a level one. ER room.
P: Wow
J: so there’s oxygen there’s all the medications you might need if there’s an emergency, but, like I said I was planning my perfect birth so I literally just stuck it in the corner of our bedroom. And it just sort of collected dust over the months and I didn’t even really think about it, and then Apart from that, it’s just whatever you want to make comfortable so for me it meant like putting up birth affirmations all over the walls. I had like a mattress for the floor, the bathtub I had all this stuff prepared, just to make myself comfortable.
P: Yeah.
J: And then when it’s time to just basically called the midwife up and she comes to your
house.
P: Wow, I feel like that’s pretty brave, that’s feels like a spirit of adventure.
J: Yeah, sometimes I look back and think what was I thinking, because I wasn’t actually that prepared i mean i think i was just so excited to do it and to, to, kind of, you know, give birth and be a mom, I didn’t really think much about the process of laboring in terms of okay well what happens if I’m in uncontrollable pain or something goes wrong,
P: pain is a tricky one to plan for right because it’s impossible to have a sense of what it will be like so.
J: Exactly,
P: you know, your, your on fair ground there because like, how could you know, right?
J: yeah. Yeah, exactly.
P: So did you get pregnant easily?
J: yeah, so the first time, it took about five months, which I know for many of my friends and people stories is is quite short. But when you’re going through it, it felt really long. And for me, I never actually tracked my periods or ovulations so it was sort of the first time I was understanding my body and like the cycle and the timing. But yeah, I took pregnancy tests every month not really knowing but once you become pregnant you instantly know, so when I did that test I was like okay I definitely felt it that time. And then the second time I got pregnant with my second son. One year after I gave birth to my first. So really close together and I got pregnant. The first try. It was. It shocked me.
P: Yeah, I think our expectation is because you’re told you know as a teenager, you’re going to get pregnant instantly. And so I can see that in the five month span every month that you’re not pregnant you don’t know how long that’s going to go on right so it’s a stressful. It’s a stressful thing, and I totally relate to the idea of like well, now we’re not preventing pregnancy, obviously, I’ll be pregnant.
J: Yeah.
P: It will be Immediate. So I’m glad it was, you know, relatively quick even though it doesn’t feel that way.
J: Yeah,
P: and then with your first one, how was the pregnancy itself?
J: So the pregnancy was pretty easy going and think it was quite normal I just had some, like all day morning sickness which…there’s not much you can really do but I was really healthy my levels were great, but that’s how I was allowed to have the home birth, because you have to be stable. Everything has to be fine.
P: So did you have an OB somewhere that you were like going to check in with?
J: I did for the first couple of months and then after I strictly just went to the midwife, and then to get any ultrasounds, you have to go to a separate doctor to do that so they, they monitor the baby. But it was, it was pretty natural in terms of the care like there was no ob gyn monitoring me.
P: It sounds like it’s all pretty smooth sailing and then let’s talk about the birth. How did you know what happened you know where were you?
J: So, it was, we ended up September, and the week leading up to that everyone, everyone was talking about this like super red moon, there was like this lunar eclipse. So all these French people because they are always really big on the moon and full moons have seen Oh your baby’s going to be coming really soon, but it was like a week early. And so I thought no no like I planned this he’s not coming, a week early and the night of the full moon I started to feel the surges. And I kind of was in a little bit of denial that it was happening but by at about 5am.
I was like okay this is actually happening.
P: You mean contractions? , is that….
J: Yeah. So, the problem at first was that my midwife had told us a couple of weeks before that she was going to be doing a training, out of the country. And so if I went into early labor, she wouldn’t actually be there. And so she gave us the contact with another midwife, just in case. And this midwife we met her. She didn’t speak any English, and I just didn’t click with her. And so the whole time I was like it’s fine it’s fine I’m not going to like she’s not going to be there for my delivery. And so, the first early stages of labor were kind of coated in this disappointment because I was not only early and I didn’t feel prepared the midwife. Our midwife wasn’t actually available. So I labored at home for about 12 hours on my own with my husband James, the contractions were okay i mean they’re painful but I could breathe through them I did some hypno birthing
P: Hypno birthing is a birthing method that focuses on self hypnosis relaxation techniques to reduce the fear, anxiety and pain, often attended to childbirth. It involves breathing techniques, focus on positive words and thoughts, and guided visualization to help relax the body before and during labor and birth evidence on its effectiveness is mixed I’ll link to studies in the show notes
J: I kind of went in and out of the bath. And then at about 5pm, they started to get really bad, like I knew it was official like I definitely needed help at that point. So we called the second midwife the backup midwife and she came like maybe 30 minutes after. And she arrived and checked my cervix and I was like, Oh, for sure I’m gonna be at the end, like I’ve been in labor for so long, and she checked me and I was only five centimeters. And I was so upset because I just couldn’t believe that I had gone through that much and I was only halfway there. And then I continued laboring. And I had mostly back labor. So it was like a pain I never experienced so every time I had a contraction instead of being like in my uterus where I expected it was all through my back and my sacrum. And she started figuring out which obviously wasn’t monitored was that the baby was back to back with me. And so usually when you have contractions like that it’s, it’s all forced to your spine. And so,
P: that doesn’t sound comfortable.
J: No, and I learned after usually if that happens look into an epidural at the hospital because it’s it’s it’s just excruciating but I didn’t have that option because I was at home. So I just had to kind of like suck it up and try and power through. And yeah I labored at home for a total it was nearing 24 hours I labored at home.
P: That sounds exhausting…so no sleep I’m assuming…
J: no no sleep. No, they always say like, oh, try and take a nap if you can, but I think if you’re having a natural labor with just no assistance, you just feel every contraction, and you have no relief so I didn’t rest at all.
P: Yeah, I imagine, feeling like someone’s pushing a spike in your back is not, you know, conducive to a nap.
J: Yeah,
P: so we’re 24 hours in and what happens next.
J: So, we get to 24 hours she checked me again and I’m, I’m done like I’m at the end I’m just like get this baby out every like thing I learned about natural labor about the hypno birthing and moaning and connecting. I completely disconnected to that. And all the while she’s speaking French to me, and I’m speaking English and James is in the middle trying to like translate everything. So it was, it felt very lost in translation the whole experience. So, I’m at the 24 hours it’s like nearing midnight. And I tell her I’m like oh I have this urge to push and prior to that I was in the bathtub and my, my waters broke in the bathtub. And I was like, Okay, this is great, again like the movies you think if the waters break your baby’s gonna come right
P: through pregnancy your baby is surrounded by a fluid filled amniotic sac when the baby’s head puts pressure on the SAC your water breaks. It can happen too early, before labor. At the beginning of labor or during labor, or they might not break on their own and the doctor breaks them in the course of delivery. According to Web MD, and about 10% of cases, your water breaks and the TV sitcom way. At the end of full term, your water breaks suddenly and contractions begin.
J: And so she’s like okay I’ll check your cervix again because if you have the urge to push you’re probably at 10 centimeters so you’re probably just like at the end. and she checks me, and she tells me I’m at 10 centimeters, but really I’m at nine centimeters, and she tells James like she’s at nine centimeters I don’t want to tell her because she’s gonna feel really discouraged. But if she has the urge to push, I’ll just let her do it.
P: I thought it was not safe to push on a cervix that wasn’t ready.
J: That’s what I thought too, so I assume because she told me 10 centimeters I could.
P: Yeah.
J: And so I start pushing because it felt good and I had that urge to.
P: Yeah,
J: and I kind of start switching positions I’m on the floor, I’m on all fours and squatting, and the baby just like not coming obviously. And so she I do that for about, maybe 20 minutes. And she checks the heartbeat and she says oh the baby’s heartbeats actually like a little bit low. I’m not really comfortable with this, I’ll let you push for 10 more minutes. And if he doesn’t come out, we’ll probably have to go to the hospital. And it’s so interesting because I was so terrified of the idea of the hospital, I was so scared to give birth there that’s why I wanted to have a home birth initially,
P: because you like have not had surgery before like what about the hospital scared you?
J: I just think I associated the hospital with only like bad things
P: yeah that’s fair.
J: Yeah, I didn’t never had a bad experience in the hospital like I never I’ve never had surgery I’ve never really had to be there for anything negative, but I think because I had read all the statistics of births in France, and seeing the percentage of epidurals, especially when people didn’t want epidurals because when I checked it was higher than 80%.
P: Yeah,
J: so for me , that scared me. And then reading,
P: so you thought they’d force an epidural on you?
J: yeah, force and epidural and that can lead to complications, for cesarean, and that’s what really scared me. So I thought if I stay at home. If I stay natural, then I’m in control of whatever happens. But what I later learned is your, you can’t control your body especially where it does what it does, you know. So I push for 10 more minutes. And nothing’s happening. And so she calls it and she’s like, okay we got to go to the hospital. And we hadn’t packed a bag, we hadn’t prepared in any way so I’m just like screaming out at James to pack, you know whatever we can glasses and toothbrushes and,
P: yeah,
J: a change the clothes. And we rushed downstairs so I live in. I lived in an old 300 year old village house with four stories. And so I’m at the top.
P: No!
J: and I have to walk down this like winding staircase down the streets to get to our car, and doing that like nine centimeters, it’s not ideal. And I sort of just lose control walking down the street to the car I’m just screaming, I don’t care who I wake up at midnight, I just am like howling. And we drive the 10 minutes to the hospital. It feels like 30 seconds. And we arrive at the, ER, and I suddenly felt like quite calm about being at the hospital like it actually felt kind of nice to feel like this would be. I’ll feel safe here.
P: Yeah,
J: I’ll have a team of support. And we arrived we arrived to the emergency room and then they take us to the maternity ward. And we’re freaking out we’re like, the baby’s heartbeats really low like this is really scary. And in France, the there’s, instead of nurses and doctors running the maternity it’s typically midwives, and then the OB usually comes in just at the end to make sure everything’s okay so as a team of amazing midwives and they check the baby they check me and they’re like, What are you talking about like everything’s fine. Baby’s fine. You’re great. You’re actually at 10 centimeters now, so whenever you feel ready to push, go for it. And I was like, Okay, this, this was great, and the head midwife. I’ll always remember her she had her mask on, but she had this like platinum blonde spiky hair. She was a big presence, and she spoke English and she looked at me right in the eyes and she’s just like you’re gonna do this. You can do this. And it feels so good because it was like the first sort of clarity I had for the entire labor because before it was just running back and forth between a French midwife and James. And so, I feel the urge to push with the next contraction and the French midwife that I had at my house the home birth, midwife was holding my one leg, James was on my other side holding my other leg, and I had the midwife in between my legs, and she was like, go. And so I start pushing and it feels really good. Like I loved the urge to push. It’s almost like there was so much pain happening at the same time that you just focused me in on what I needed to do.
And I push I push for about 10 minutes it’s about three pushes and she looks at me and she’s like, okay the heads out. The next push. He’ll be here, and actually it was a surprise so I didn’t even know it was a boy or girl so I was just like yeah okay I’m gonna meet my baby this is amazing. And I push as hard as I can. And I start to just shake vigorously. And my teeth are chattering and my eyes are fluttering, and I look at James and I look at everyone around me and everybody’s like, looking at me kind of confused. And then, everything goes black and
P: goosebumps. Goosebumps….yikes! I’m nervous about you… keep talking.
J: And I wake up the next morning about eight hours later and I’m in the intensive care unit of the hospital. I wake up, and there’s machines all around me beeping. I have three IVs in my arm. And I’m like, okay, where am I, it feels like I have a really bad hangover so almost forget for a second, like, like why I was here in the first place. Why am I like did an accident happen. Did something go wrong. And then I kind of am triggered to remember that I was pregnant, and I feel the pain in between my legs from giving birth. I lift up the covers I check my belly there’s no belly there’s no baby. And so I’m completely confused. I just think of the worst like something really bad has happened to me baby. And I catch the eyes of a nurse, out of the ICU and she comes in and in her broken English she explains to me that the baby’s okay I had a baby boy. His name is Oslo. He’s fine he’s with my husband James in the maternity ward. And at that point she called the doctors to explain what had happened to me as well as James to come see me. And basically what happened was, while I was pushing, I was totally healthy my levels were fine. As I was pushing my blood pressure skyrocketed. And I started having a seizure. And it was basically having the symptoms of eclampsia with no preeclampsia.
P: So what so what does that mean?
J: they don’t know they don’t have the answers for why it happens, especially for someone so healthy during their pregnancy
P: I talked to a maternal fetal medicine doctor who specializes in preeclampsia research to make sense of Jule’s experience. Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re working.
Dr. Rana: Hi. So my name is Dr Sarosh Rana, I am a maternal fetal medicine specialist. So I take care of high risk pregnant women, and I work at the University of Chicago medicine.
P: So I’m wondering, what’s the definition of eclampsia? Can someone have eclampsia without preeclampsia or is there a linearity to that spectrum or No?
Dr. Rana: Yeah, so this is a common presentation that sometimes patients can present with an eclamptic seizure so this is seems like what happened to this woman without having all the symptoms or even any symptoms of pre eclampsia. So preeclampsia is “pre” means before, it’s something that would happen before eclampsia, though I can tell you that scientifically it’s not really true, because many times patients with eclampsia can actually develop eclampsia without hypertension, without any of those classical symptoms or signs of preeclampsia such as that happened in this woman. It is actually not uncommon to have the eclamptic seizures suddenly Out, out of the blue and the pregnancy or even during giving birth, and the prevalence of having the eclampsia is actually quite low it’s not, it’s not that high in developed countries it’s quite high and depending on where you’re looking so for example in Haiti in Sierra Leone and like African nations, because of the lack of prenatal care, the prevalence of eclampsia is a bit higher, but a large majority of eclamptic seizures actually happened during pregnancy so antepartum, but so about 60%, but 20% of them can happen intrapartum so during labor, and this happens obviously very dramatic that the baby was just being delivered but you can have it in your first day second stage of labor, and then about 20% of them can even happen after delivery and majority of them are happening in the first 24 hours of of giving birth. So yeah, it’s a very dramatic disease and it’s actually a major problem especially in developing countries.
P: And do we know like what chemistry underlies that that issue?
Dr. Rana: Well, so there’s lots of hypotheses about preeclampsia in terms of it’s a vascular dysfunction problems so in the brain people believe that it’s like because sometimes then you have elevated blood pressures and in this case she didn’t have it, but it can cause like laser genic edema, so they can be hemorrhages and they can be edema and they can be something called press, which is just reversible posterior brain edema so it’s mostly from edema and hemorrhage, that the women can have a seizure.
P: Okay, so it sounds like bleeding in the brain or swelling in the brain can be the issue here.
J: And so they monitored me I assumed the ICU for four days they checked my vitals they were really scared I had brain damage from lack of oxygen. After I everything went black and I passed out. I flatlined. And…
P: that’s terrifying.
J: Yeah, the most terrifying is just for James because he was just there witnessing all of this, not knowing what happened. Yeah, so the midwife saved Oslo’s life because she actually without knowing she cuts an episiotomy in me. And so she had enough room. As I was convulsing his body was being sucked back into mine.
P: Oh my god,
J: and she had enough time to just stick her fingers underneath his armpit, and yank him out. They cut the cord. They cleaned him up, gave him to James, and said, you go out in the hallway. And you, we’ll call you in, like, and then they rushed the emergency team in, and they for an hour and a half, they were reviving me. And then finally I stabilized and they had a ventilator helping me to breathe.
P: Wow.
J: Yeah, its intense
P: It sounds like these seizures can be quite dangerous and the danger is that you can have some sort of cerebral issue or what’s the danger.
Dr. Rana: So the danger is from the seizure, is so dangerous that you can aspirate so we’ve had patients and she had cardiac arrest seems like which obviously can lead to death.
P: Yeah.
Dr. Rana: Yeah, so she was lucky that she, I’m sure that they had very good services there that she was resuscitated and brought back. So you can have aspiration, you can have cardiac arrest you can have brain bleed. So you can bleed in your brain. Some people can also have stroke so that can lead to long term neurological damage. The majority of patients I would agree with that plan to actually recover because you can give them medications control their blood pressures. Magnesium is a common medication that is used to prevent recurrent seizures, you can delivery them and majority of the patients will recover but eclampsia is actually a major cause of maternal death.
P: Yeah,
Dr. Rana: So it’s a very serious problem so she was actually frankly really lucky, and also she didn’t have any others features of preeclampsia so you can have other things along with eclampsia so you can have HELLP syndrome, you can have other things so yeah I mean she, she escaped in cardiac arrest which is pretty phenomenal so she’s quite lucky.
P: Wow. Oh my god, I mean, my first thought is, Thank God you were at the hospital.
J: I know
P: what would have happened on the fourth floor of your old house right?
J: And these are all the questions that still play in my mind because you just wonder what would happen.
P: Yeah, well that’s amazing. Maybe because you’re so healthy you were able to recover from this kind of shocking thing that happened to your body.
J: Yeah, because the miracle that always, I had no like symptoms after I had no effects from it. There was nothing left or like my, my levels were fine Three days later, I could walk I could stand my brain activity was fine, they’re scared about the organs can sometimes be affected after like your kidneys and your liver. Those were all fine. So for me it was really jarring because something like really traumatic had happened but it had no like lasting effects.
P: Yeah,
J: so it was hard to accept that anything had happened really yeah.
P: Yeah. Wow. So you’re in the ICU for five days did you say four days?
J: Yeah, it was the four nights five days on the fifth day, I could go down to the maternity
P: and then when were you released from the hospital?
J: Eight days. I was in the hospital for eight days.
P: That seems both long and not long enough so on the eighth day you just walk out with Oslo?
J: Yeah, it’s. It felt very strange because it felt like they had checked all of my like physical and medical but they hadn’t checked my mental state so in my head I’m going. Are they seriously sending me home, because I felt like such a disconnect between myself and the baby. I was struggling to breastfeed I was just struggling to, to make sense of what had happened. And I just was like should I say something like I shouldn’t be going home yet. And it’s, it’s interesting James took a video of me leaving the hospital, and I look like kind of like a Bambi like I’m just like coming out for the first time and my I’m like squinting and all my senses are being like, you know attuned like the smell of the cigarettes, the sun, the ambulances everything was like too much for me it was such a strange experience to be outside of the hospital which felt so safe for me.
P: Yeah. And so did you just go home and carry on or how do you how do you transition from that very difficult thing.
J: So, the hardest part going home was because I knew, like home symbolized something so different for me now. It was always like a beautiful place for me to go to I always felt like a foreigner in the streets of France but home was felt like such a cozy nice place to retreat to. And now as soon as I came home, I was like, I don’t like this place anymore because it had the lasting feeling that I was meant to have a home birth and I didn’t. So sort of coated in this failure and shame. James did an amazing job of like cleaning everything up. So, there was no like remnants of the home birth left, but I still had this feeling. And yeah, we just went back to normal life, because I didn’t have any like lasting physical effects of the birth and like me dying and coming back and all of this, I could very easily just sort of like deny that that trauma, even happened, and I just sort of like buried it, and was like, okay, everything’s fine like my baby’s beautiful and healthy. I want our life to go back to how it was before, just like, you know, a happy young couple. So, yeah, I tried my best to sort of make it look like everything was okay.
P: Women who don’t undergo that kind of traumatic experience, but have their own sort of expectations dashed in different ways have a hard time going home. So I can’t even imagine how do you kind of come to grips with this thing that has happened.
J: So, when we came home my mum had flown in from Canada to help us, and everything that came to visit us like I think the hardest part was everybody just had known about what had happened but I always say like a new baby trump’s, whether you had a good birth or a bad birth.
P: Yeah,
J: if you’re doing okay or not. And it just felt very fake, all of it, you know, I’d hear another guest was coming over I’d put on some clothes. I’d really want to just stay in my pajamas, and I try and put some makeup on and brush my hair and I just didn’t feel like myself so I think that sort of helped me in a way to sort of have this facade for guests because I didn’t feel like myself I didn’t even look like myself, and so we just kind of pretended, we played house for a while like everything was fine and. And the good thing is the baby was totally healthy so I’m grateful for that because it just was lasting effect in James and I that we were the only ones that really knew about the trauma in detail, you know. And so, whenever a guest would come we’d just be like, here’s our baby like everything looks great. But it became a lot and I was struggling so much with breastfeeding because I didn’t breastfeed him for the first four days. And so we tried but it just felt so foreign to me because I didn’t get to do it from the beginning.
P: Well also I would think your milk comes in and then it goes away. Right?
J: Yeah, so I, I had colostrum for the first three days and then I felt my milk come in and the first day. And so, that day they like tried to bring the baby to me. The hardest part about being in the hospital though was, I was in the ICU and he was in maternity and babies aren’t allowed it in the ICU and ICU patients aren’t allowed maternity. So I’d wait hours and hours every day just to find a room, we could meet at that was neutral ground. And I really only got to see him like once a day. James spent the whole time with him in the maternity. He was like, the mom from the beginning.
P: Yeah, yeah. At what point do you like feel yourself like how do you kind of get back to yourself?
J: So it took years. So my son’s five. Now, I wouldn’t say I got back into my body until really this year. Because I like I made an intentional decision to feel it and get back into it because pregnancies are a really good way to sort of like bandage over any wounds and any pain. So, when also turned one year old. My husband and I decided to try for another baby. And for me it was almost like because I was in so much denial about the trauma. It’s like I never got to feel it fully. I kind of just like pushed it pushed it. And so when I got pregnant, the second time I kind of thought oh this is ideal because I never actually have to get out of my body I breastfed for a year, and your body is amazing when it’s going through their breastfeeding, like everything just feels great. At least it did for me once I had worked out sort of the issues with breastfeeding I really enjoyed the experience. And then we decided to get pregnant again. And I gave myself 10 days like between deciding to wean Oslo, and getting pregnant was 10 days, so I never really got back into my body before I became pregnant again.
J: Do you and James have a conversation about we’re worried, this will happen again or.?
J: He was terrified. I was, I think because I was in just such disassociation with the trauma I didn’t even think about it like I knew I wouldn’t I knew I wouldn’t have a home birth again, I didn’t even want one.
P: Yeah.
J: And also I was considered high risk, even though, again I had no symptoms or anything. They just had to keep an eye on me. But yeah, I didn’t really think about it, he was really scared he was extra precautious, with all of that and for me, I was like, Oh, it’s a fluke it won’t happen again. But the, the birth of my second son, almost trump’s Oslo’s in drama. I was just, I’m not made to have birth…
P: how can that be? that doesn’t seem possible but also, like, the thing that’s hard is the thing you described in the beginning of this which is because you don’t know what caused this, and like what the seed is, it’s hard to avoid, right?
J:Yeah. Yeah, exactly, but I think women are so good at just having their survival tactics going so far into that, and for me that’s also like the way I was raised, when anything big and emotional happens, you just sort of act like it doesn’t. And so for me it was really embedded in my.
P: Yeah,
J: in the way I am.
P: That is a coping mechanism.
J: It’s huge. Yeah. And so when you ask me if I like when did I feel back in my body, it was more this year because I told myself like I cannot disassociate from this anymore I have to feel it. Yeah. That’s why the healing process is so hard and I think it’s it’s why it’s so hard to be a mum because you do have to allow yourself to to heal from whatever trauma you’ve experienced.
P: Yeah, and there’s not that much space if you’re lucky enough to bring the child home and you’re instantly into up every three hours, feeding…
J: Yeah, motherhood
P: Yeah. So how was the second pregnancy?
J: So the second pregnancy was just like the first. I was so healthy, I had the normal symptoms of just nausea, acid reflux, Charley horses and things like that but really amazing. And I always felt just so good pregnant. it just made me feel. I was actually in my body. And it was really nice. The second time because I feel like I wasn’t in my body that entire year after I gave birth to Oslo. So to be back to growing life again, it did feel like it filled it, it felt like it filled a void. Again, which was really nice I loved it. And so during that process I knew I couldn’t have a home birth so we found this amazing doctor this OB who spoke English and French so it’s perfect for us, he worked at this amazing Hospital in Niece, called Lon Val it’s like a private hospital with a sea view so I was like if I can look at the Mediterranean Sea and give birth at a hospital I’m happy I was really excited actually to have a hospital birth, and I had to be monitored every single week to make sure my numbers were fine they didn’t want to repeat what had happened with Oslo. And so, I had to see this amazing midwife Nedege every week she came to my house, and we became quite close it was, it was really nice she did some home births but for my sake, it was just to, to make sure I was healthy, and my baby was due. The week after my birthday. My birthday is July 3 he was due like, I think July, 10 or something. And it was on my birthday I woke up and I had contractions and I was like, No, I don’t want my baby on my birthday, I kept thinking I was like mums never get a day so like I don’t I’m not giving them my birthday. But again I was in denial about the whole thing so. So I started having pretty intense contractions, I’m only like two hours in, we call my in laws to pick up my son Oslo who’s like, he’s like 20 months at this time so he was really little. And I call Nedege my midwife to say I think I’m in labor, can you come over and just like check, because I still had the fear at the hospital that I wasn’t in enough. Like if I wasn’t enough.
P: dialated enough?
J: Yeah, exactly. That that can always cause for intervention because again I didn’t want to have an epidural I just went to a natural birth. So she came over like 30 minutes later, and she checks me and she’s like, you’re at seven centimeters, you need to get to the hospital now, which is, if there’s no traffic it’s like a 30 minute drive. If there’s traffic, it can be like an hour. So, we’re panicking, and I’m like, oh my god okay this, we’re doing it James goes and gets the car. I’m screaming down the street. It’s in the middle of the day, people are passing by and French people they’re like yelling felicitations! they’re like screaming congratulations happy, just like, oh my god, so I get to the car. And I tell her I can’t get in the car, like I feel he’s, he’s here, I can’t get in the car, and I’m like I don’t know what to do I don’t know what to do. And she’s like, Okay, well, you have to decide I don’t know, and so I was like you have to check me again. And so she goes well we have to go back to the house, we walk all the way back to the street, she checks me. I…baby’s there, head is there.
P: Wow.
J: That wasn’t a course of like 10 minutes, I went from seven centimeters to fully dilated. So James goes back to park the car, and I go up a flight of stairs and I can’t decide where to have this baby, so it’s still going in my head okay where am I going to have this baby. And I decided to just make a little nest on the landing in between the stairs going up and going down. Outside of the guest room. I don’t know why I chose that spot. It’s like, 35 degrees Celsius. I’m sweating. And I just want to have this baby. And I lie on the floor, James arrives back at the house he stays by my head, and Nedege is like crouching in between stairwells. And she’s like, whenever you want to push you can push like he’s here. we are not going to the hospital. And I was like, really calm it was so strange like I wasn’t stressed about being at home I was just like, here we go, we’re doing it. And I didn’t know that James had called the ambulance, while he was in the car because he was terrified that something bad would happen. And so he’s like I’m just gonna call the ambulance just in case something happens they can take her. So in between pushing, I hear this massive bang on the door and I’m like, Who’s knocking on the door I’m giving birth! And open, they open the door, and eight people come
P: Wow,
J: there’s a doctor. There are two nurses, there’s firemen. They all come up, they want to take me away and my midwife was like, No, no, no, she’s giving birth like. Be quiet. Watch. And so I have all these people going up the stairs downstairs, watching me. Like, what is happening? just legs open, and I just
P: This doesn’t seem like part of the plan….
J: NO! This is not part of the….I was meant to be birthing to meditative music, watching, watching the sea with my husband and my OB. This was not a part of the plan. And so she’s like, she shuts everybody up. They’re all watching me and she’s like, she looks in my eyes and she goes, you get this baby out. And so I just push as hard as they can. And he comes out and I can see I’m looking everybody’s eyes are just like open, they’ve never witnessed like a normal birth. P: yes
J: obviously their emergency service workers so for them this is like so new. And I push him out, like, really, really fast. He comes out he goes on my chest. And the amazing part was the firefighter, she was recording the whole thing…
P: Oh, That’s awesome.
J: Yeah, so I have it on video and James and I are just like crying and I just got that moment because for me the hardest part with Oslo. It wasn’t waking up in the ICU, it wasn’t going through all the process of all the medical stuff. It was really not having that moment with him that I’d worked so hard to have him on my chest and to connect with him. And so, I call it my stolen moment. And so the fact that I could get that with Louie was incredible. It was all I wanted. And so, You know, we spent like 30 seconds holding him and firefighters and the doctors like okay, allez! like we got to get her to the hospital. And I was like, can’t I just stay here like Can’t I have my home birth and just go back in my bed with my baby. And they wouldn’t they wouldn’t allow it. And so they carried me down all the flights of stairs. Put me on a gurney and put me in the ambulance and took me with Louie to the hospital. So that was kind of the bummer of it all was I got my home birth, but I didn’t actually get to have the benefits of staying at home.
P: I’m ambivalent about them taking you away, on the one hand, like thank god
J: yeah
P: and on the other hand, it seems like you’ve passed the scary threshold.
J: Exactly. Yeah, I mean I get why they did it but yeah. And I think it just taught me a lot about expectations and things with birth, like it doesn’t matter how much we plan. What we want our bodies just really lose control and you just have to kind of go with the flow and be open to whatever happens because, you know, I had planned my both my births pretty much down to every detail and neither of them went to plan, which, you know, it taught me a lot.
P: Yeah, it’s a good lesson at the threshold of motherhood.
J: Yeah,
P: because you know the period in which you are in control of things is now officially over.
J: Yeah, it’s so true. You just have to ride the wave because seriously, that is that is motherhood, so I guess it prepared me That way,
P: what so you when you go to the hospital they release you like how long do you stay this time?
J: So typically in France it’s three or four days, but it was pretty crazy because I’m in the back of the ambulance and with the doctor and nurse, and they’re just like on their phones, watching videos…I’m going, are you kidding me?and I’m there like, bumping along I’m in so much pain because you’re just bumping on this road and all the streets are like ancient so it’s not like a smooth. Nice highway. And I have my baby. And I felt this urge to push again. And obviously with Oslo’s birth I didn’t know what it was like to birth, a placenta to have to come out. And I’m like, excusez moi I was like I think the placenta is like coming. And she kind of looks at like under the sheets and she goes, No, no, you have to wait until we get to the hospital to do that. And I go, No, no, I think it’s coming, and then it just honestly was the most bizarre sensation because it just comes out and then I was like I think it, I think it’s out, and she looks she’s like, yep. And I just like sat with a placenta in between my legs as we wrote to the hospital, it’s just so glamorous…
P: it’s so funny for her to say no, wait.
J:Yeah, it’s very French though, just like you’re no that’s not accommodating of you. So you’re just going to wait till it’s fine for us. Well no, it doesn’t my body doesn’t work that way.
P:Yeah, no kidding. Yeah. So, did they make you stay for three days when she got there?
J:Yeah, so I had to stay, I think it was three days, which actually was kind of nice because our house is an air conditioned and in the summer it’s so hot and the hospital is air conditioned It was nice to have my meals brought to me and. And we did plan to be at the hospital anyways so it was okay like I was prepared for that. Yeah, so we just kind of took it as like a mini holiday and at that point we’re already parents to a toddler so it’s actually kind of a nice little getaway for us with our new baby.
P: Yeah, so that’s nice. Wow, that is some, some entrance into parenthood for you. It sounds like you’re, you’re feeling more connected and you’re, you found ways to kind of overcome the trauma?
J: Yeah, this year. I mean, I think, for all of us 2020 and being in a pandemic was really difficult. I think it shone a light on all of the parts of us that we were trying to hide away from because we had so much more time on our hands like for me I had a small business that I ended up closing down this year, so I wasn’t working. I had this time to sort of just really sit with myself, and I no longer kind of felt the need to hide, and I basically spent the year just getting over it and and healing from it in different ways. We had visited a therapist, five months after Oslo was born. I didn’t want to be James kind of after a while I was like I think I need to speak to someone and I think you should as well. And so that sort of opened the door to the healing process, it started to give me a language for the trauma so the the stolen moment, the therapist, gave that to me, which was really helpful, because I think it’s really hard when you go through a trauma, whether it’s a birth trauma or any other just to find the words to explain how you feel, because it’s all new. Most of us have never experienced that kind of like event before where it leaves you really scarred. So this year for me has been telling my story more and finding the words to explain it but also just sitting with it and being okay with what happened.
P: Yeah, it’s definitely a process
J: for me I couldn’t say that I died, like I had buried that so much I didn’t even realize I had died, and then James told me a couple years ago and we were talking about it as we were discussing it as a couple because we hadn’t even talked about it to each other, really. And when he told me I was like, Oh my God, oh, like I was in such denial about it that that had even happened, which for me now is so strange because it’s not like I caused it to happen like it was nobody’s fault but I think when you have shame associated with it you just don’t want anything to do with with with the story. When I was in the early days at the hospital and there was telling me it just didn’t make any sense to me and then I kept saying to James that like I had died and they had brought me back to life, and, you know, it was hard for me to even understand what that meant I was like obsessed with googling like near death experiences and to just find like other people that have gone through that. Yeah, it’s a very strange thing to to experience,
P: if you could go back and give yourself, your younger self advice about any part of this process what would you tell her?
J: I think I’d probably go back to when I was pregnant with also. I know I can’t really. It’s strange and the healing I’ve accepted the bad and the trauma and I’ve learned so much and I in a lot of ways I’m grateful for it because it’s taught me so much about myself and it was a huge learning curve for me. But what I wish I had known during the pregnancy was that. It’s really a process to just like let go, and to give in and let nature take over and to just accept what’s happening because I was just so controlling of every aspect of it and clearly nothing went to plan so I was totally caught off guard and I think it would have been nicer for me to just really have given the experience a little bit more and just let everything unfold the way it needed to without controlling it.
P: Yeah, that’s, uh, I feel like that’s that lesson is only learned when you don’t do it.
J:Yes.
P: So think about like your life before kids. There aren’t that many things that feel out of your control, maybe really they are what but you know you’re planning you’re, you’re doing this and that to try to make things look a certain way and for the most part, we’re pretty successful at it. J:Yeah.
P:It’s hard to meet that moment kind of the right way. Yeah, until you don’t, which is I think like a fairly universal experience right?
J: yeah, definitely and it definitely helped me now as a parent to just know that like, I can’t control much like, you know, you just have to kind of allow your kids to show you and you just have to kind of go with it, because we’re all learning.
P:Yeah, totally. Well, Jules thanks so much for coming on, I know you’re working on a book about this. So yeah, I will link to the show notes about your Instagram and get kind of updates about when that’s available.
Unknown Speaker 11:14
Yes, hopefully in the near future
P: perfect
J:Thank you so much.
P:Thank you. Thanks so much, Dr Rana, I will put a link for her on the war stories from the womb.com website and you can check out the amazing things she’s doing for preeclampsia research. Thanks again to Jules for sharing her story. If you enjoy this episode, feel free to like and subscribe if you’d like to share your story, go to our website and sign up. We’ll be back soon with another incredible story of overcoming.