Episode 31SN: The Learning Curve of Pregnancy & Birth: Ashley

Today’s guest used to be a bodybuilder and is now a trainer and the owner of a fitness center and the mother of two kids. I think she’d describe herself as a woman who likes a challenge, and that’s probably a good way to step into the role of becoming someone’s mother.. Different circumstances required her to overcome challenges presented at each step of this process–she originally had trouble getting pregnant, she had a traumatic experience with miscarriage which ramped up her anxiety during the pregnancy that followed, she wrangled with postpartum depression–and each experience taught her something valuable that she was able to use, and from which she grow and developed into a stronger, better version of herself.

Ways to Find Ashley & her Fitness Center and Videos

Facebook page for Heal & Seal https://www.facebook.com/HealandSeal

Facebook page for for mom+me strong https://www.facebook.com/mommestrongllc
To Follow Ashley, go to  https://www.facebook.com/ashley.heyl

Rh incompatibility and RhoGAM

https://www.healthline.com/health/pregnancy/rhogam-shot#cost

https://www.acog.org/womens-health/faqs/the-rh-factor-how-it-can-affect-your-pregnancy

https://www.verywellfamily.com/can-being-rh-negative-cause-a-miscarriage-2371474

http://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000003906/Rh_negative_blood_pregnancy.pdf

Low body fat and infertility

https://academic.oup.com/humrep/article-abstract/2/6/521/639220

https://www.mdpi.com/2227-9059/7/1/5/htm

Exercise during pregnancy

https://www.acog.org/womens-health/faqs/exercise-during-pregnancy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622376/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527310/

Autoimmune disease and pregnancy

https://www.frontiersin.org/articles/10.3389/fendo.2019.00265/full

Audio Transcript

Paulette: Hi Welcome to War Stories from the womb. I’m your host Paulette kamenecka. I’m an economist and a writer and the mother of two girls.  Becoming the mother of these two girls was no easy feat…my body was reluctant to cooperate with the grand plan in my head at many points in this process….

This is true also for Today’s guest. She used to be a bodybuilder and is now a trainer and the owner of a fitness center and the mother of two kids. I think she’d describe herself as a woman who likes a challenge, and that’s probably a good way to step into the role of becoming someone’s mother.. Different circumstances required her to overcome challenges presented at each step of this process–she originally had trouble getting pregnant, she had a traumatic experience with miscarriage which ramped up her anxiety during the pregnancy that followed, she wrangled with postpartum depression–and each experience taught her something valuable that she was able to use, and from which she grow and developed into a stronger, better version of herself.

After we spoke I went back into the conversation and added some details about medical issues that came up. I also had the opportunity to get the insights of a really well spoken therapist about postpartum depression and the heavy burden of expectation that is still a regrettably stubborn feature of pregnancy and motherhood.

Let’s get to this inspiring story.

Hi, thanks so much for coming on the show, can you introduce yourself and tell us where you’re from.

Ashley: Yes, thank you for having me, my name is Ashley Kates, I live in Lexington, South Carolina, I am a mother to two and I actually own a fitness studio called mommy strong specifically tailored towards women and postpartum women. 

P: Cool, so we’ll get into that, but before we get there, let’s talk about the kids. Before you got pregnant, you probably had some idea about what pregnancy would be like, what were you imagining.

A: I think it’s probably what everyone assumes and I think motherhood was the same way for me is you see what videos and movies and such tell you, pregnancy is going to be like it’s glorious. It’s beautiful. You see your friends get pregnant, you see their beautiful maternity pictures. You think it’s nothing but rainbows and butterflies, people don’t talk about the pain, they don’t talk about prenatal depression prenatal anxiety, and you know the physical discomfort the symptoms that I personally do help women with now like the pelvic pain, the vaginal pain the abdominal back pain, stuff like that, I thought it was just like rainbows and butterflies, and they’re just gonna be beautiful and joyful the entire time.

P: Yeah, that seems to be a universal theme right that’s, that’s basically the story we’re fed for sure. 

A: Yeah. 

P: So, before you got pregnant the first time was it easy.

A: No, my husband and I tried for over two years to get pregnant. We then got pregnant, lost the pregnancy, the baby had passed around seven weeks but I carried the baby until the baby was about 10 weeks, and then I miscarried it or bled the baby out I guess you would say which that is a whole nother thing to talk about is the little information regarding miscarriage and what that looks like for women.

P: Yeah,

A: I was very lucky and grateful that the very next period, I concede my now five and a half year old.

P: Wait, so listen for a second with the miscarriage if you don’t mind. Did you go see the doctor and that’s how you found out, how did that come to pass.

A: So this is a great story, I actually have my very first appointment and they do an ultrasound and I come from what I would consider the more crunchy community, and they’re very on one extreme and they can be in very anti medicine, even things like ultrasound and so it was already sort of like a conflict of emotional interest for me but we went in, and it’s transvaginall, so you’re half naked laying there and the woman was doing and she said I’m sorry, I’m not detecting a heartbeat. My husband and I were like okay well what does that mean, like maybe it’s too early, and I kind of sat there and I’m sobbing and she’s got the wand up me and takes it out eventually she leaves us in there for about a half an hour, they move us to another room, leading us through a back hallway. And the doctor comes in multiple people came in asking me the same question we were there for over an hour and a half,

P: wow

A: said your baby has passed, it’s pretty clear. We can do a DNC right now, and just get it over with for you and us. It’s our first pregnancy, it taken us two years to conceive, we wanted to give our baby a chance maybe I wasn’t as far along as they had a single bed and read stories of that so we gave it a few weeks, I had a horrible experience with the nurse she ended up calling me a few days later and telling me because I was RH negative, if I didn’t get the RhoGAM shot right then and there, I’d probably never have a successful pregnancy, I would have miscarriages for the rest of my life.

P: Okay, to give some context to this discussion, the issue is Rh incompatibility which is a complication of pregnancy that evolves if the mother and baby have different Rh factors in their blood. What’s Rh factor? There’s a marker on red blood cells called Rh factor, and it can be positive if the marker is present, or negative if it’s not, roughly 18% of the population is Rh negative. This issue only arises if the mother’s RH negative baby is Rh positive. That’s the situation Ashley has. If you have this mismatch between baby and mother, you only get a negative outcome if some of the baby’s Rh positive blood gets into the mother’s RH negative bloodstream which can happen for a whole bunch of reasons including a birth during abortion or miscarriage, if the baby’s blood does get into it’s mother’s circulation. The mother’s immune cells view Rh positive blood as foreign and develop antibodies to attack these blood cells, which can wreak all kinds of havoc for the baby, 

this mismatch won’t necessarily affect the first baby because it takes some time for the immune system to develop antibodies, but it could affect the health of later pregnancies, if those involve a baby who’s Rh positive. The good news is that there’s a fix for this, you can desensitize the mother’s blood, so there’s no immune system reaction by giving her a shot called rogram. 

A: It was terrible 

P: Good lord, oh my God,

A: it was terrible. The whole experience was devastating. It was I, you could say it was traumatizing.

P: Yes you could oh my god, I’m so sorry that you guys went through that

 I’ve spoken before with a fantastic therapist, Rebecca Sheree from family tree wellness, about the challenges of navigating a miscarriage. And here’s what she had to say well we talked about Ashley’s experience

Rebecca: when you get pregnant, everything kind of opens up, right, we call it the portal in our work here. Family tree wellness because it just cracks you wide open. This whole experience of getting pregnant, trying to get pregnant, grief and loss also really cracks you wide open, you get more raw right and that’s a biological component where mom has to be open in order to connect and attach with her baby. And the flip side of that is that it also lets everything else in too right it’s sort of like you’re kind of porous and we don’t want to cut that off, right, right, we need that openness and I’d even go as far as to say that we need that openness throughout our lives, just so happens that this is when it really comes to fruition. So, it seems like that portal kind of cracked open with her getting pregnant that first time, it’s, it’s a really hard situation and it deserves a lot of warmth and kindness, and the ability to talk about it with somebody who really can listen and be curious with you.

P: So after the nurse calls you do call a doctor and say is this true or what happened.

A: I mean, here’s the thing, anyone who tries to scare you into anything is lying to you.  I didn’t appreciate that. And in the back of my head, I didn’t really believe that was true but it did put fear in me that I was doing something to cause my body not to be fertile and this is coming off of two years of infertility, I gave it a little bit of breathing room, but I didn’t leave it for very long. I was more angry that she was that unemotionally intelligent,

P: yeah. Yeah, agreed. And let me ask you another question because we had a hard time getting pregnant too and after a year with no success. We went to the OB for health, he didn’t do that because you’re on the crunchy train. 

A: Ah, so. To put it bluntly, I think my husband’s ego was more in the way he didn’t get checked and just kind of believed that it was meant to happen, it was going to happen and I’m just goes by and then you just don’t know all of a sudden two years is gone and there we are,

P: That seems like to me from my experience like you guys are amazing for for going that long because it’s so frustrating every month when it doesn’t work out right so I mean I remember the pile of negative pregnancy tests. So you know I just, I’m impressed that you guys could

like be hopeful. 

A: Also I was a national level finger competitor, so I don’t know if you’re familiar with like bodybuilding and stuff. I had competed for about five years, and there when I was at my lowest body fat I was around 10% I stopped ovulating. So we just assumed that my body was trying to figure out how to have a cycle.

P: Just a quick note here, I looked up the relationship between body fat and fertility and a hard time finding papers to talk about body fat and infertility when body fat is too low, but I did find an article from 1987 That said that a person required 17% body fat to maintain a period, and 22% to have quote reproductive ability and the issue seems to be that body fat affects centers of the brain and the ovaries that produce all the hormones that you’ll need for fertility to happen.

A:  It was inconsistent that first year that we tried some days would be 30 days. Some days 26 Some days 35 And then that second year it was pretty consistent it was every 29 days almost to the day to the hour. I think we were just 

P: that make sense. Yeah,

A: like, take time. My body’s just recovering from five years of that.

P: Yeah, that makes sense. So, you keep trying, despite what this nurse says, and you do get pregnant. Mm hmm. That’s awesome. That’s a happy day in your house I’m guessing

A: it was scary actually I refused to take a test for a few days and my husband forced me to buy the test and to take it because I was afraid I wasn’t emotionally ready to go through. Same thing, but at the same time, I was so emotionally broken from losing our baby. I needed that to feel that life again. 

P: Yeah, yeah, that makes sense. So, was the first trimester is just scary or how did you manage that.

A: It was terrifying. Yeah, really excited, but I always had the clock, the qualifier like I’m excited but let’s wait and see. I feel good but, you know, and every time I would go away as you know symptoms come and go, I would you know have crying fits and just freak out I didn’t tell people like I told with my first pregnancy and then we went to the first ultrasound my parents actually drove up from Louisiana, it’s like a 13 hour drive and they just want to be here no matter what the outcome is you, and it was wonderful and there was a little paper just, you know, floating around in there,

P: that’s exciting and very nice, but super nice for your parents to be supportive and to be there, and probably exciting for them right 

A: it was their first leaving grandbaby 

P: Yeah, yeah.

So how was that pregnancy, once you hit 12 weeks were you more comfortable,

A: I would say for the most part, I sort of let go and just trusted that this was meant to be. I remember I’m a Christian, by the way I remember being in the shower right before my husband forced me to take the test like crying, calling out to God like, why did you do this to me, why is this happening to us, you know, and he said very clearly, Have faith in me, because I have faith in you, you’re going to be pregnant again and it’s going to work, and so I just was like repeated that to myself over and over and over and over again,

P: that sounds like a good way to manage your stress was the rest of your pregnancy look

like. 

A: It was really simple, I was very fortunate that I didn’t have any, I mean I had mild nausea here and there, but nothing like women experience. I was working at a chiropractic office I was getting adjusted so I didn’t really I didn’t have any physical pains whatsoever. I stopped exercising so that’s one thing that was very different is because of the, you know, the hormone history of the competition. I wanted to minimize anything in my body that could affect her health. My daughter’s health.

P: when Ashley says she avoided exercise during pregnancy, she’s reacting to her very specific experience with bodybuilding which led to very low body fat and messed with her hormones. I just want to note that the American College of Obstetricians and Gynecologists recommends moderate intensity aerobic exercise like brisk walking, because it may decrease the risk of gestational diabetes preeclampsia and cesarean delivery

A: it was really simple, really simple, really healthy I had no issues whatsoever I had wonderful cravings like everybody else, but, you know,

P: that sounds great and now take us to the birth, how do you know, today’s the day. How does that unfold.

A: Okay so this is where some of that, like crunchiness comes in so when I had the miscarriage, as I shared with you. You know, it’s, it’s not a it’s not a part of the lifestyle to get the ultrasound, but I needed that to feel confident that my baby was okay, I’d rather know than not know. So we got the regular ultrasounds and moving into birth, I was doing a hospital birth led by OB GYN and nurses, which again is sort of against the crunchy world. And it was, it was emotional conflict there, because in the crunchy world you know people say things like the body’s meant to birth you don’t need medication, it doesn’t on its own. It basically demonizes the medical community makes it seem like if you have a hospital birth, you’re going against your innate design as a woman, and you’re almost abnormal for being in a hospital. So I had fear that I was going to be treated like something that needs to be sterilized or just a robot vagina having a baby, not like a person, and you know, my OB was very friendly. It was very calm, very understanding. Of course they will arise when you say I want to do unmedicated so whatever, and that’s okay. I was a week post, due date, and waddled in they’re like, oh my gosh you’re still pregnant, I was like, yeah, here I am 41 weeks and they were like, Okay, so do you want to get induced today, I was actually asked as early as 37 weeks if I was gonna do so I’m like no, let’s let this baby do her thing. And then my doctor had a heart to heart, he’s like, we can’t, can’t let you go past 42 weeks. So we scheduled induction for week 42 My daughter is so stubborn, and she came two days before that. 

P: Oh good, okay good.

A: And so it’s the middle it’s like eight o’clock at night, my husband’s on the back porch with our dogs crack lightning goes, and my mother in law told him, there’s going to be storm and your wife’s going on flavor and I happened exactly that way. First contraction, you’re like, I don’t know if this is really what I’m feeling it’s uncomfortable and you’re like ooh this is actually happening. Ooh, this is weird. And so we kept track of it, we call, and the doctor on call was like well you don’t sound like you’re in pain and I replied, Because I’m saucy that’s because I’m talking in between contractions. So he told us if it’s still, you know, progressing in the next hour. Come on in, so right around 11 o’clock we drove in my contractions were four minutes apart. They checked us in, I was like, I think, five centimeters because they admitted us. And I labored through the night and my contractions slowed when we got there, and I think all in all, right around 6am You know the doctor kept coming in saying things like, you don’t get a trophy for not being medicated, we’re gonna need to give you Pitocin. If you don’t progress further, you know, you’re there’s no way you’re gonna make this not an epidural like a negative talk but I was ready for battle you know cuz you’re taught that in a crunchy community to like fight against them.

P: Yeah but you crunchy community aside, this does not seem appropriate, this is not a caring, you centered situation is what it sounds like.

A: No, and that particular doctor, he was really funny during all of my prenatal appointments. It was kind of a surprise that he was acting like that. All that aside so I had probably been in labor from, like, 830 at night till six in the morning. The nurse comes in, they’re switching shifts and she’s with me till about seven, eight in the morning, no rest. And I’m falling asleep between contractions waking up, contraction falling asleep, and asked her, so how much longer do you think that I’ll be here, based upon the way that I’m progressing your experience or assumed it like the way that my contractions rolling and she’s like probably another eight hours, maybe as many as 12 Well, I’ve had friends with 24,36, 48 hours, labor so I don’t think that’s far fetched at all, you know, look at my husband and I tell him I can’t keep going this way, I really think that it’s time to get an epidural and the nurse suggested getting Pitocin. Because she said it’s not enough pressure to keep get the cervix ripe,  dilated enough. My contractions aren’t effective as effective as they would like them to be she’s positive terms. Anyway, and I was like there’s no way in heck, I’m going to get Pitocin without an epidural because those things are a beast, so we’re doing it. She called in the epidural, got the Pitocin epidural around nine o’clock. I took a nap until about 1030 They woke me up, they’re like, Oh, you’re 10 centimeters, it’s time to push, wow, I started pushing, and I looked at the nurse and I was like, What time do you think she’ll be born and she goes, 1115 and she was born at 1114

P: Oh my god. Wow. Thank God you progress so fast.

A: Yeah, I think this shifted my mind a whole lot on epidurals. I noticed that when I was in labor, every time I had a contraction, every part of my body would tense up. 

P: Yeah, 

A: my like my pelvic floor, my rear my thighs my core, my hands everything. When I got the epidural on my body. Let go. Yeah. And I think that it gave my body permission to let my daughter bear down on my cervix and let it, let my body progress. I really shifted my mindset from thinking that epidurals were this demon to hey there’s a time and a place for them. Yeah, yeah, the time and place for them,

P: especially when you’ve been up all night laboring right you’re just exhausted, like, imagine you haven’t even put your body through the hardest part yet. Right, like, you’re going to need to draw reserves from somewhere so that totally makes sense. Exactly. Did you enjoy the birth? How did  that go

A: Yeah, I was like, pushing and I couldn’t feel anything so I’m just doing what I thought memory felt like what it feels like to have a bowel movement this is what it feels like to push out urine so I’m going to try and connect to these sensations and push. And when she came out it was like, Oh my gosh, like I just birthed a baby

P: amazing. And also, I imagine, given your history as like a training person. You’re very kind of connected in touch with your body in a way that you can, you know, move things in a way that you want to.

A: I will say that that experience, transformed my mindset around the, around muscles and led me to where I am today, to where I do work with women with their core pelvic floor, and her postpartum body because so much changes in pregnancy, there’s so much that changes in your body, just in labor, so much that changes just in birth. First year postpartum. I mean it is. I like to say, more women go through in the two years of getting pregnant, and the first year postpartum that a man goes through in his lifetime. 

P: Yeah, 

A: exponentially incomparable.

P: I bet so. So what was it like when you went home.

 

A: So, right away when she was put on my chest, something was wrong. Like I could feel that something was wrong 

P: wait, with you or with her. 

A: Me, I immediately was afraid. I had postpartum depression but I didn’t recognize it. And I didn’t and I didn’t want to admit it because again that’s like, you’re, you’re doing all the healthy things you’re eating right or exercising or getting adjusted you put the oils on or whatever. If you have depression or anxiety, there’s something you’re broken right like that’s not supposed to happen so I didn’t want to admit it. 

P: It took this issue to Rebecca know about the pathways to postpartum depression which is how does it develop,

Rebecca:  there could be a biological component right after you have a baby, there’s a massive hormonal crash, right, and even like as as far into 48 hours after you have the baby, your hormones are just fluctuating. And so, you know, that is a component and we don’t want to discount that from a psychological perspective, you know, this idea of, oh my gosh, I just completely changed my life, there is no going back. And all of the ideas and messages that I got about what it means to be a mother come rushing it and I mean even right now talking about I can even get chills thinking about that right, it’s powerful, and all of those messages come not just from our own moms and our own families, but from society from what we would call legacy burdens things that are passed down intergenerationally that we have no control over, but somehow they’re in the cells of our bodies, so you know all that comes flooding in when they put that baby on your chest, and it sounds to me like when she said I knew that there was something wrong, that maybe there was some lack of connection, maybe she had some really fearful anxious part of herself that came into to kind of defend her from bonding right because of her previous traumatic experiences because, oh my gosh, what if I lose this one too. That’s so scary.

A: now, she was a she was a good baby. She didn’t sleep till she was two so she was up every one to three hours so she was 18 months old, I bed shared with her because I thought that’s what women are supposed to do, you’re supposed to breastfeed all night nurse on demand, and you sacrifice your sleep and your sanity to be a good mother, Because this is what you’re supposed to do.

  

P: I talked to Rebecca a little bit about the expectations that are placed on new mothers

Rebecca: we are taught that we have to sacrifice our bodies minds and souls for our kids…sort of my bottom line philosophy about all of this is that if our moms, and our potential moms were held in warmth and kindness and compassion, and the expectations were dropped it all be a lot better off, and that it feels like a really big tall order to ask for that, and that’s like a societal change that needs to happen. You look at other cultures that really put the mom first. And really care for her. After a baby’s born, it is so different, and also after women lose babies, you know other cultures have rituals around that that you know we’re talking about American society Americans really don’t have those rituals unless they create them themselves. And I think that’s equally important, but I just think that, you know, we’re missing the mark. At the very outset of creating families, it’s, it’s like okay, You know we’re not just a vessel for life It’s a privilege and an honor to be able to do that, I mean it’s nothing short of a miracle. Right. But because of that miracle we have to really be held in a way that is just infinitely different from how we’re doing it now, because how we’re doing it now is just putting a bunch of expectations on you should be this certain weight, you shouldn’t gain more than, you know X number of pounds during a pregnancy, you, you know, you should you should you should, And that just creates so much angst and fear inside of moms and, you know, we know that fear inhibits labor, it inhibits bonding, it’s just, it’s not, not a great place to start.

 

A: I ended up having to quit my job because I couldn’t do it all. 

P: Yeah, 

A: don’t get me wrong, she was a wonderful baby she was very happy, she very much needed her mom, and what I’ve learned now is that she feeds off my energy so when I’m having emotional mental struggles she does too and so we kind of like tip tap off of each other but for the most part, I mean, it was, it was still wonderful having her, it was just a struggle until that postpartum depression subsided. 

P: Well, what I’ve seen is postpartum depression is one in seven women. And the most common side effect of pregnancy, so it can’t be that you’re broken, it must be that it’s hormonal resolution right or something like that.

A: I firmly, firmly believe and this is one of my many soap boxes is that we do not nourish the prenatal body the way that we should or the postpartum body,

P: Yup 

A: the prenatal vitamin is not enough, I mean, women that have autoimmune diseases that show up within one to five years having their baby on thyroid issues one to five years after having their baby inexplicably wait one to five years after having their baby adrenal fatigue. It’s not like our bodies are all of a sudden malfunctioning, it’s because we’ve given given given given we literally create in life. Of course our bodies need to be nourished higher than a prenatal vitamins.

P: That’s totally true, as someone with an autoimmune condition. I hear you

So this is a big topic. Hey, the causes for most autoimmune problems can’t be attributed to one thing or another. True that autoimmune disease is a lot more common in women than men. I mean like a lot more common. It’s estimated that 78% of the population with autoimmune disease is female. And in general, one of the drivers of this imbalance is believed to be dramatic changes in hormones, which in turn affect the immune system. So we tend to see more autoimmune conditions in women after puberty and after menopause, and sometimes also after pregnancy. It could be that hormone swings after pregnancy, in conjunction with the stress of a new baby, Lack of sleep and nutritional deficiencies, contribute to postpartum onset, but the world of immunology, is a giant bottomless hole, and we learn new things about immune activity all the time, so stay tuned for more definitive information on this stuff. 

So, ultimately, though this is a success story, you just kind of rode out the postpartum depression or did you get help or how was that

A: I did not. I didn’t even admit to it until my husband and I had a very horrible fights, and he asked me, one of the most simplest questions you can ask and it was are you happy, and I realized, oh my gosh, like, I’m not, but it’s not your fault. I have something’s wrong with me, and nothing happened. Like I didn’t take anything but all of a sudden I just felt lighter and then three months later I got pregnant again. 

P: Wow. Oh my god, I’m going to be happy all day thinking how easy it was the second time, so thank you for that. 

A: You’re welcome. 

P: And how was that pregnancy.

A: It was, it was really good. It was challenging because my, we have so much chaos that happened since my daughter was born, my husband got hit by a freight truck in on November, 8 of 2017

P: Oh my god, 

A: he had a concussion, they got he was fine but it put us in a really bad place, financially and emotionally, so he had residual effects from the concussion, and we had the two years have been my postpartum depression that kind of pulled us apart. We had like four or five months where we were good and then pulled us apart so I got pregnant, a month after his car accident. It was really good and I was already doing what I do now, so my heal & seal which is the diocese pelvic floor work. So my body physically was really good. I would say that I struggled a little bit with prenatal depression when I was pregnant, but most of that I could attribute to situational things we were going through, but I will say having gone through what I did with my daughter made me realize that I’m not broken. This is I am okay. This is the season of my life, I am worthy of getting help. It’s okay to take medication, it’s okay to break, it’s okay to eat some cookie dough, and not feel like I’m poisoning myself, you know, I can do all of these things, and be okay. And so I think mindset wise it was a lot better and I actually made the decision to hire a doula with that pregnancy.

 

P: That’s a good call. And so it sounds like the pregnancy was fairly straightforward.

A: I mean I was a little more nauseous with him but never threw up. 

P: And then what was the birth like

A: the birth was incredible. Again, I went into it, wanting to have an unmedicated birth but truthfully, like my birth plan at the very top, just said to have a healthy living mother and a living baby I don’t even want to quantify the term healthy I just did living in the time between having my daughter and my son was about three years my daughter was three years and three months when my son was born. I’ve heard at least 200 Different birth stories. And I, I know that a birth can go any way, single direction at any single time at no fault to anyone whatsoever. And I didn’t want to set myself up with the expectations that I did in my first birth I actually didn’t tell many people that I got an epidural cuz I was ashamed of it. And I feel like that clouded the beauty of her birth and I didn’t want to carry expectations into my son um so as long as we were both alive medicated, I’m medicated C section, put under C section I don’t care. We just need to be alive. 

P: yeah

A: So, same thing, exact same situation, I walked in at 41 weeks and they scheduled me for an induction and two days later or two days before the induction date my water broke, which didn’t happen with my daughter, and it terrified me a little bit because when you go into labor on your own, you’re not on the clock, but when you go when your water breaks or on a 24 hour clock now because of risk of infection, and I got my birth plan is everyone alive but I didn’t want to have to get a C section I didn’t have to. Mostly because I know what their cover is like for the scar, for any other purpose. Yeah, water rates, I call my doula. I was like I’m peeing myself and it’s not urine I’m pretty sure my water broke she’s asked me questions about color the smell and I was like, I don’t know, there’s just stuff coming out. My husband’s panicking. And he was like, first of all go to the store, buy me some pads because I just walk around like go buy me some pads so he goes and buys me some pads and comes back and I’m in denial that I’m going to have a baby anytime soon, so I’m just walking around the house, packing up my daughter’s bag with you know, snacks and coloring books and crayons and whatever. So, he here, we’re going outside lightning strikes it starts to rain just like the first one. Apparently my husband said he was watching the Miami Dolphins game and lightning struck as my Waterbrook 

P: Oh my, God 

A: I know. Go figure. So they’re outside the car he’s yelling. Are you coming or what and my first contraction had and it is world, different than an unwanted broken contraction, and I’m like gripping on to the banner or banister on our porch and he’s like, Well, what are you doing I screamed. I was like, don’t you think call me This is horrible. And it goes away like I’m so sorry. Oh, it’s probably gonna happen a lot, just forgive me and so I get the car sitting on like a stack of towels. Driving in. So this is three o’clock Waterbrook around 233 o’clock we’re heading there we get there, I’m having contractions upon each other, the doula met us there, I can’t get a foot walking without another contraction she’s squeezing my hips and waters falling out with me. They don’t even ask me questions, they just bring me a wheelchair and bring me right back and I’m so grateful. So we’re in there. And it’s interesting, my five year old daughter’s there I don’t mind her being there and my husband’s uncomfortable with it I think it’s beautiful for her to see, what birth is so that she doesn’t have fear, and yeah, 30 years when she has a baby, wherever she has a baby. And I was laboring unmedicated and I did great. My contractions were really intense. They lasted, I think over a minute and 

P: oh wow. 

A: When I got there I was at seven centimeters so I was pretty good. Oh, I mean I went from like two at my appointment to seven and I’m just, I’m gripping the handles and sitting there, I’m breathing through it, everything’s fine and then they come in and say, you know, we’re not getting a good heart rate on your son, can we do, whatever it’s called, I was like, what does that mean, and they’re like an internal monitor, I was like, does that mean you have to go up to my vagina. She said, Yeah, I was like, No, laying down was painful for me I wanted to sit up and

P: so I think what Ashley Kate is talking about here is called a fetal scalp electrode, it’s an internal monitor that you can use after your water’s broken. If your cervix is dilated enough, and it’s a small clip that’s placed on a baby’s scalp to directly monitor the fetal heart rate.

A:  The doctor comes in and says, Listen, your birth plan is everyone alive but we don’t have a heart rate on and we need to do this and I was like, okay, so I waited for the break lay down, it was horrible. They inserted it, I sat back up I was able to get back in the zone and I was fine, then they’re, they’re like tugging on the cord and they’re talking, and apparently it wasn’t working so to do to get to. They laid me down sat me up, and that one wasn’t working so now they’re half there’s like six people in there and it’s starting to break my concentration, and so they’ve done it twice now. 

P: Yeah, 

A: third time they tell me that they need to reposition it and I was like, no, no, no, like this is torture so they lay me back down, which is fine, I mean I was just rebutting to pray that the gods of the world would just not make me do it again but I had to. So I lay down at this point, they’re like, holding my leg up, trying to take the other one off, well then I start having the ejection reflex, and I’m pooping myself. 

P: Okay, this is what I think is going on here, the fetal ejection reflex is also called the Ferguson reflex and happens when your body expels the baby without pushing. There’s a hormone feedback loop that’s engaged during birth, oxytocin is released in bursts in the brain in the body, and it makes the uterus contract, the pressure of the baby, the birth canal stimulates the release of more oxytocin which causes your uterus to contract more and push the baby further down the birth canal, until finally the baby’s born, but the pressure on the cervix and the vagina releases the anal sphincter which can also make you poop. Keep in mind, this is a reflex. So Ashley does not have control over it, but a baby born without pushing does not mean a baby born without pain.

A: and the Doctors like you’re not completely you’re not gonna see I was like I can’t help it I’m screaming.

P: what’s your not complete mean?

A: my, I wasn’t completely dilated I was only enough. He’s like, if you keep tearing down you’re gonna tear your cervix and I’m I can’t like I’m not doing this.

P: Yeah.

A: Yeah. Don’t they clean up my doodle, still on my side, they’re still holding my leg up, husband and daughter have left the room at this point. My doulas with me, and they won’t let me sit back up because for whatever reason they can’t get a good whatever. So I started screaming okay this is it someone fucking helped me and like cutting someone effing helped me, give me an epidural, this is that I’m done, let’s do it so they’ve been gearing up for draw I’m 90 and a half centimeters, and the nurses are like, we can’t get it for you and the doctors like yes we can get like just to get it set me up within 20 minutes I have the epidural, I start to breathe and I feel good. And I look at them and I was like, I’m so sorry.

I’m sorry, and they’re like it’s okay, I was like no, I was crazy, like that’s crazy crazy they’re like it’s okay and I said okay, can the water really thirsty, so they bring me some water and the doctor is like you know what you relax for 20 minutes we’ll come back in and check you and we’ll have a baby and I was like, okay, great, sounds good. So he comes in, and Dude man is ready to go and he’s starting to come out and they lay me back or lay me back, And we get rolling right and I’m pushing. And I can feel pressure. It’s like when you have a really deep pimple and you try and pop it it’s like I could feel the pressure of him, loved it. I can feel him in my belly. So I felt like we were working together versus with my daughter was muscle memory so I knew what I was doing. 

And I was pushing, and I think we were like five or six pushes in and the doctor looks at me and says, Listen, if you don’t push this baby out in the next two pushes, we’re gonna have to use the vacuum, and I’m a challenge oriented person and the nurse looked at me, the one I was with the whole time she’s like, Listen, you got this. You’re down, grab your knees, let’s go and I was like, Okay, I was like oh that’s what they’re like yes keep going, I was like, there’s my baby and he came on out and doctor gave him to me it was a totally different experience and with my daughter. It was, I was, I was immediately happier. I was clearer than before. It was totally euphoric, whereas with her it was like, Oh my gosh, what is happening with my leg. Oh it’s a baby here’s my bed like here’s my daughter come in. I thought it was wonderful and then I started thinking like Doctor was kind of reading by telling me that. 

so we get three different perspectives on this birth right, I thought it was amazing. I thought he was rude, but I thought okay, like maybe that’s how he talks. It doesn’t matter, like it was one little comment, you know, my husband thought he was wonderful because he took control of chaotic situation and made up happen. My daughter said that he was disrespectful and rude and so now I’m sitting here. My baby, he’s, he’s like, I don’t know, three hours old, and I’m like, what is reality. Like maybe I was just so caught up in pushing that I didn’t realize that I was being mistreated or not, you know, we went, you know, wonderful postpartum the babies slept well I had no pain, no, no real issues to speak of waiting for my appointment and spoke with the doctor and I was like, are we going to talk about the birth at all and he’s like, Well, what do you need. Now I was like well, I have my perspective, my husband has his and my Doula has hers and I kind of want to marry that with what the doctor wrote in the notes to understand what happened, explain my side, and then the doctor said, Well, you know, apparently every time you had a contraction your son’s heart rate decelerated greatly, which is why he was so forceful about getting the monitor, once we got the monitor, we were able to track it yes that was in fact happening. That’s why He gave you the epidural and also why he was telling you so forcibly to push, because when he came out he had the cord wrapped around his neck twice. 

P: Wow, 

A: that changes perspective, right, Like, is the birthing mother, we sometimes want this gentle, loving experience, but maybe what I needed was to be firmly told because what if my baby had died because that’s right, 

P: yeah. 

A: Dying delivery, all the time. Yeah, it’s really changed my perspective like, that’s you could have said it softer but maybe not in a moment, you know.

P: Yeah, it’s hard to remember, even though they’re professional adopters are people too and he may have been panicked. Right and that’s his panic voice in the same way that you were yelling at your husband when your body was being squeezed that like an unbelievable force, and it wasn’t, obviously that’s not who you are, it wasn’t really in your control. Maybe he was just responding to the moment.

A: being urgent, Yeah, I have zero trauma from that birth, I know that people have trauma from birth, but I think having those two years of doing my healing seal or three years of doing that program, and hearing all those birth stories made me realize that all these different things happen. And it’s my reaction to it that controls how joyful, the outcome is, aside from medical neglect.

P: Yeah, agree, that sounds like an amazing learning curve, you had between the first and the second, which is not to say the things in the first weren’t difficult, and the experience before that wasn’t super difficult, but it seems like you took all the difficult things from that experience and used them to your advantage to understand like how you could have more of what you wanted in the next one.

A: I agree with you and I think the biggest thing that I realized is that none of it’s in my control. 

P: Yeah, 

A: I’ve heard of homebirths going awry. I’ve heard of MIS. None of it’s in my control. It’s going to happen the way that it’s going to happen and I think for me as a birthing mother and what I empower all of my pregnant clients is have your plan and have your preferences but make sure that you’re focused on your non negotiables and leave the rest of variables and I mean non negotiable. It’s not like I want to have an epidural or I don’t, but your non negotiables are things that you feel very passionately about like, I want my husband there, or I don’t want to do the vaccines, or I don’t want to do the eyewash or if I need it right then and there, or I want to breastfeed or I don’t want to breastfeed, those things are things that you can control 

P: yeah, 

A: everything else just happens, and we have to just roll with it, again, aside from medical neglect,

P: it is a it is a challenging experience because my guess is that for most of us before giving birth. There are very few experiences where you have so little control over your own body and sickness may be one example, but outside of like cancer or HIV or something it doesn’t. Yours like pregnancy does, and there aren’t so many people managing you right like it’s a different feeling to have someone else telling you, I’m getting the vacuum.

A: You can’t manage yourself which is why I had the doula. My goal is to try and connect with my baby and feel what my bodies and birth are do that if you can’t like birth a baby and manage people at the same time if anyone in the world could do it, I probably could because I’m a great multitasker but, no

P: yeah I agree, hopefully in the future it will be changed and doulas will be covered by insurance, but they seem like a necessary and necessary person to have on your team in that circumstance, I think, I think for the first birth women don’t understand how compromised, they’ll be right.

A: Yeah, and I love that it’s an on, not that they’re not emotional with you, because my Doula was one of my best friends, but she’s not as emotionally invested in the birth as my husband and I are he acts more on anxiety and fear, I’m acting out of pain and fear. She’s acting out of rational thought she can see it she’s in other words, she, she has perspective, she has a calm tone, you know, it’s someone that is more closely affiliated to me than the doctor or the nurse that I am just meeting, typically for the first time, you know, so I think it’s huge, it’s a huge comfort level I told her that she was wanting stability, like she was just a pole of stability for me full time.

P: That’s awesome. So what are your kids into now.

A: My five and a half year old is very girly. She’s very prissy but she’ll also get very dirty with you she loves digging in the dirt, and my two and a half year old is everything, boy. He likes cars and trucks and dinosaurs and dirt, and he is aggressive and he loves to climb and jump. Oh my gosh, he is just a knight,

P: that’s fun. That’s a fun age and then he probably sounds very busy. 

A: Oh yeah. 

P: Tell us about your business and how that is related your experience.

A: Yeah, so after, like I said I came from the crunchy community and I found that there was a lot of cattiness between women and motherhood. You know when you’re working as a professional, you kind of just pay attention to your job, you know, I didn’t have a ton of friends I didn’t socialize much how to when I became a mother and stop working. I socialize and I found women were competitive and negative with one another. I found that you’re either vaccination anti vaccination, mostly anti closely breastfeeding bottle feeding, Christian non Christian liberal, conservative, tall, short, fat, skinny, all this, it was stupid to me, because here I am struggling with postpartum depression. I just want to get through the day. 

P: yeah

A: bEating up in the little for who I am. So I have this vision of having a facility where women could come and take care of their bodies physically, but in an empowering way not like you’re that you need to lose weight but like let’s get stronger so that you can play with your kids, and the healing field was really the first step to that so healing field. One of my friends was walking through the zoo with me and told me that she her vagina felt like it was gonna fall out. And she’s like, I have a single diastasis recti you’re good with muscles figure it out, I was like okay, challenge accepted me about six to eight months but I created a program how to test group, and then launched it and I then me, I’ll say God, God gave me the information but lives have been changing for the past four and a half years from this program. Women who felt like their core would never feel strong again back pain goes away, and women avoiding surgery, pelvic pain going away prolapse is going away and continents going away.

 

P: Oh wow.

A: In, yeah, in Canada, it’s actually really easy to fix. By the way,

P: Please tell me that you have like an online presence so people who don’t live in South Carolina can reach you.

A: Yes, so I have a Facebook page and I also have an Instagram for both humans and the studio which is called mommy strong. And the healing seal I have, I can do zoom sessions with people in person sessions and then I have an online vault where you can purchase videos that teach you how to do the techniques. 

P: Super cool. And actually this is an amazing story and I’m so grateful to hear it. Thanks so much for sharing it. Thanks so much for coming on the show today. 

A: Well thank you really thank you for giving me the chance to help empower women. 

P: Thanks again to Ashley for sharing her story and to Rebecca for sharing her insights about the burden of expectations around pregnancy and motherhood, and about postpartum depression. One thing Rebecca mentioned was that the current estimate for the frequency of postpartum depression is now thought to be 1 in 5, and according to some counts, 1 in 3 women which is obviously ridiculously common and the fact that these numbers may be tricky to pin down because women aren’t directly reporting on their experience with it suggests that we need a new way to manage this….

I will put all the links to Ashley’s facebook page for her studio and her videos in the show notes which can be found at the War Stories from the Womb website.

Thanks for listening. 

We’ll be back soon with another inspiring story.

Episode 30 SN: This Midwives Tale, A Story of Birth & Surrogacy: Anne

Getting pregnant, being pregnant and giving birth can be challenging in a myriad of different ways. But for some people, this massive transformation is….fairly straightforward. I totally enjoy talking to people who had a relatively smooth experience because it proves that the ideas many of us come to pregnancy with are not mythic, they do in fact live in the world …And sometimes these lucky souls who tread the untroubled path are intent on sharing their superpower through surrogacy. Today’s guest had an interest in fertility as a young adult, and this interest led her into nursing and midwifery. After the birth of her own child, she gave one of the greatest gifts anyone can give: she helped a couple who, for various reasons, couldn’t carry their own pregnancy, by becoming their surrogate.  It’s a beautiful and totally inspiring story.

Moxibustion

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987875/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789413/

https://www.hindawi.com/journals/ecam/2019/8950924/

Relationship between fitness and delivery

https://www.ajog.org/article/S0002-9378(21)00604-9/fulltext

Audio Transcript

Paulette: Hi welcome to war stories from the womb

I’m your host Paulette Kamenecka. I’m an economist, a writer, and the mother of two girls. On route to creating this family, I tripped over every possible obstacle–no part of this process was easy for us…that makes sense to me in some ways because

Getting pregnant, being pregnant and giving birth can be challenging in a myriad of different ways. But for some people, this massive transformation is….fairly straightforward. I totally enjoy talking to people who had a relatively smooth experience because it proves that the ideas many of us come to pregnancy with are not mythic, they do in fact live in the world …And sometimes these lucky souls who tread the untroubled path are intent on sharing their superpower through surrogacy. Today’s guest had an interest in fertility as a young adult, and this interest led her into nursing and midwifery. After the birth of her own child, she gave one of the greatest gifts anyone can give: she helped a couple who, for various reasons, couldn’t carry their own pregnancy, by becoming their surrogate.  It’s a beautiful and totally inspiring story.

One thing I should note: this midwife shares a lot of insights about pregnancy and birth, and while you will likely learn something listening to her, as I did, I just want to point out that she’s not giving out medical advice, but speaking both generally and specifically about her own experience. 

Let’s get to the interview. 

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

 

Anne: Thanks for having me, 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

A: Yes, and kind of low expectations. 

 

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

 

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

 

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

 

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

 

P: Oh good, 

 

A: it was really lucky.



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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

P: oh my god like 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

P: wait, what’s, what’s moxibustion? 

 

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

 

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

 

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

 

P: that doesn’t sound comfortable

 

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

 

A: Good Lord!

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

P: Yeah, 

 

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

 

P: And you know the cramping is his contractions. 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

P: So how was that pregnancy

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

P: Wow. 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

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

 

A: yeah grandparent Yeah,

 

P: right. It’s just a million people.

 

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

 

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

 

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

 

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

 

 

 

Episode 29 SN: A Labor & Delivery in Two Acts, The Experience of an OB & a Midwife in one Birth: Janis

Everyone faces some kind of challenge in the process of becoming a parent. Today’s guest took an unanticipated tour of possible approaches to labor and delivery. Once contractions were confirmed she arrived at the hospital to find her midwife busy with another birthing mother. So in the first half of her birth she was attended to by an OB, and the second half was overseen by a midwife, with very different approaches to labor. And because she was a single parent, she braved postpartum without a partner, which turned out to be a real challenge when colic arrived.

Audio Transcript

Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette kamenecka. I’m an economist and a writer and a mother of two girls. Everyone faces some kind of challenge in the process of becoming a parent. Today’s guest took an unanticipated tour of possible approaches to labor and delivery. Once contractions were confirmed she arrived at the hospital to find her midwife busy with another birthing mother. So in the first half of her birth she was attended to by an OB, and the second half was overseen by a midwife, with very different approaches to labor. And because she was a single parent, she braved postpartum without a partner, which turned out to be a real challenge when colic arrived.

 I also had the chance to talk with a fantastic midwife who provides useful insights about the practice of midwifery

Let’s get to this inspiring story.

Paulette: Hi, thanks so much for coming on the show, can you tell us your name and where you’re from. 

Janis: Yes, I am Janice Iseman and I live in Canada. 

P: Oh nice, lovely. So let’s talk about pregnancy, before you got pregnant. What did you think pregnancy would be like, what were you imagining.

J: I laughed because I nothing like what it actually was like, so I think when I saw photos of baby bumps It didn’t occur to me that that would have such a weight to it, that it would actually literally tip you forward. It just looked like this sort of beautiful air-filled. 

P: Yeah, 

J: ball on the front of the body, and I think that pregnant body is actually really beautiful, but I really didn’t understand what physical changes were actually happening inside the body. So I think that when I heard pregnant women talking about their different pregnancy issues, I didn’t get it. It didn’t make sense to me, it seems like not a big deal, like why are you complaining about having heartburn. You have this beautiful body. 

P: Yeah, yeah….So a light filled ball of air that is unrelated to physics, and is, it’s gonna make you get on your feet. 

J: Yeah,yeah, that’s not exactly what it felt like, obviously, but you know that’s definitely what I what I observed so it was, it was very shocking to me when that’s not what it felt like at all. 

P: Yeah, so, So let’s get Was it easy to get pregnant?

J: Yes, my planned pregnancy was actually unplanned, so that’s how easy it was, it was not on purpose. So I actually have a very fortunate story and that that was not something that I actually had to struggle for and strive for it totally happened and it happened, not on purpose.

P: Yeah, that’s what we’ll take the easy parts where we can get them right, so that’s great. And then you I’m assuming you found out with like a home kit. 

J: I did, 

P: yeah.

 

J: I found out in the way that many unplanned pregnancies are discovered because our periods are late, and I did have some other weird physical symptomology I was kind of feeling dizzy I was feeling claustrophobic, I am. According to the, to the personality tests and 87% extrovert, so that’s a lot of extrovert and I, and I very much live that way. And so I was really taken aback because I was out at a party and I felt like I wanted to go home. So it’s like a moment of introversion had stricken me, and I didn’t really know what was going on. And I also was dizzy a lot so that’s what took me to the store to get the home pregnancy test. 

P: Wow. And then what was the first trimester, like?

J: Well, I actually had been super athletic prior to getting pregnant, so I was, I was running six miles a day. and I had quite a lean bodyweight. So my first trimester was one of gaining a heck of a lot of weight. So by the end of the first trimester my midwife actually told me I was on track to gain 80 pounds, which I didn’t, but it was because I really dropped my activity, it didn’t feel good to me to run six miles a day. In fact, towards the end of that period it was just a bizarre experience because it had that sensation that I had only ever had when I consume too much water and I can kind of feel that sloshing around. 

P: Yeah,

J: so I just and I was tired a lot, and so I changed my eating habits I took my exercise habits and slashed them, and that would make anybody gain weight, even on a non pregnant body. 

P: Yeah, 

J: so my first trimester, was one of being exhausted, and really just falling into that pregnancy state of taking care of baby instead of running six miles a day.

P: I remember it being a different kind of exhaustion than any other kind of exhaustion

J: Oh yeah, yeah. Yes, I used to describe it as feeling like there was bowling balls on your head so I remember sitting in business meetings, And just feeling this kind of almost like I wanted to tip over. I’ve never had that before or after it’s different than sick, tired. It’s different Evening tired it’s just, yes bowling balls in your head, tired,

P: I remember being at my desk working away one minute, and the next minute I wake up with the imprint of the keyboard on my face seems 

J: that seems right. 

P: Where am I? How did that happen? Once you get to like 13 weeks does the fatigue abate, or how do you feel

J: it did actually end it was fairly instant, and that was a huge relief because I was not too sure how I was going to get through it, months of that. Yeah, because it really is. I mean, it’s not the entire first trimester that I was exhausted like that I don’t even know for six weeks, but that still that was, that was a really hard period, to try to adjust to because it was, I went from living this super high energy 87% extraversion lifestyle to, I just, I can barely function. 

P: And so how was the rest of the pregnancy you you’ve sailed into the second trimester, which is easier and then is there is the whole thing, easy up until the end, 

J: it actually was. Yeah, yeah, I think I would actually credit, a little bit the healthy lifestyle had coming into it. I think that I probably never been as fit or active before or after that little window right before, so I really did feel great and the pregnancy part was actually the easy part. 

P: Oh, good I guess. we’ll take that. And then, now take us to the day that you’re, it’s your son right. 

J: Yes, 

P: that your son is born, how do you know, today’s the day and what are what are you picturing 

like a waterbirth what’s on your mind?

J: Yeah what I pictured and what I what I had were two different things. Again, it was, it was different from the water filled belly to the heavy to the heavy real one, or the air filled belly I should say, 

P: yeah. 

J: So, what I pictured, because I always, and still am a Holistic Health person. My profession is one of being a movement specialist and, and nutrition coach so I’ve kind of got health and fitness wrapped up, and in a very holistic way. I wanted to be a woman who had this beautiful Hypno birthing experience. I read and listened to the Hypno birthing DVDs and the book, and felt like I probably could definitely do this in a way that the book suggested because it’s all about taking breaths, it’s all about your mindset, it’s all about this sense of calm like you would get it yoga. I had practiced Pilates for two decades, like I got this.

 

P: And so, so for people who aren’t familiar with it, this is an alternative to like an epidural right.

J: Well, yeah, I guess, I mean it’s a drug free, methodology, or making verbs comfortable, and it’s based on sort of the idea of a lot of breathwork and a lot of visualizations and a lot of self affirmations, and I think that there’s nothing wrong with any of those things but in retrospect I would say, for those of us who maybe want to live in that bubble. It’s a little bit more complex than that and I, and I really struggled because actually in a lot of ways I did not feel prepared for the volume of pain and the situation that actually did unfold. So, my sister came to visit, and we were shopping, and we went to Whole Foods in New York City and I suddenly had another moment where I felt the same thing that I did in my early pregnancy, there’s too many people in here, I really want to get out of here. And I went and sat outside on the sidewalk, and she finished up the shopping. I didn’t even actually know I was in labor, what I experienced was back pain. 

P: Yep, 

J: so that wasn’t what I was expecting, and so I didn’t turn to my sister and say I’m in labor, because I actually didn’t know I was, I just can’t go away from the people. And I knew my back hurt. And so we walked home, and at some point, my sister has a child that’s two years older, and she realized that I probably was in labor. So then we started enacting the labor plan, but in the meantime we were out at whole foods because we hadn’t eaten for the day. So she was in my kitchen cooking food and I was in the bathtub trying to figure out how far apart my contractions were and they were a minute apart, so basically from the time we were in the store until we got home 15 minutes later I was at a minute apart. 

P: Wow, pause this right here for a second. This is something that you’re doing without a partner. 

J: I was doing this without a partner, yes, 

P: explain a little bit about that is that, does that make you feel empowered, does that make you feel nervous. What, how are you feeling about that.

J: It just was what it was I didn’t actually particularly have feelings, so my sister came to visit because I was doing this without a partner. And so she was helpful because we already had somebody in the room to this

P:  totally. 

J: And I had doulas. Well we’re incredible. Yeah. To this day I keep in touch with one of the doulas and she’s amazing, and I am sure that I knew this at the time but we were actually her first doula client, but I loved having a doula because she was basically a professional husband.

P: Yeah, yeah, Yeah, well, way better than a professional husband because she’s seen a bunch of births Right,

J: exactly, exactly. So she helped me prior to the day of labor and delivery, she helped me come up with a plan, we made sure we went through the checklist, and I remember her telling me those one of the most prepared people she’d ever seen because six weeks prior to my due date I had the hospital bag packed, and I was because I was just nervous that actually I was nervous that this was going to happen and I wasn’t going to notice it was happening or that I wasn’t going to know, and I didn’t want to be caught unaware. So because I didn’t have a partner I actually over planned I over prepared and I was really, really in a place where I knew that there wasn’t gonna be somebody to just run home and grab something or help me out in that way so my sister was one of my birth supports as my doula and then I had a couple of friends present as well.

 

P: Okay, this, this is sounding ideal more ideal by the moment right this is a good tribe to go to the hospital with right this

J:  is was a great tribe. Yeah, so that’s exactly what happened was my sister was cooking I called the midwife, we established I was a minute apart, and decided to go to the hospital and then I called my birth supports, and everybody sort of made a plan for whether they were meeting me at the hospital or meeting me at my house. So one of my friends came to my apartment we hailed the cab. I leaned against the tree and had contractions. And then the cab came and we sort of managed to get me into the cab where the cab driver was offering me advice on what was unfolding which was, we had the whole community involved in this, in this labor in the car.

P: Well you know it could go either way like once you said you got a cab, I was a little worried he’d be like no way you’re gonna have a baby in the backseat but it sounds like he’s like, Oh, let me tell you, let me tell you how to do it.

J: Absolutely, he was he was excited and I actually remember this, it was ridiculous. He’s like, you don’t look old enough to be a mother, I’m like dude, I’m not sure that this is the time.

P: That ship has sailed, my friend. Yes.

J: So, yeah, we, we had a great cab driver, and I remember him telling me to put my feet up on the on the seat so that I could actually feel more comfortable he was really, 

P: that’s awesome. 

J: Yeah, it was great.

P: And so, in New York City is there an issue of like I might get there and there might not be a room or, you know, that doesn’t happen. 

J: You know what,  I don’t know if it happens in other hospitals but I gave birth at the hospital where I had done all my prenatal care, and so their system, at least back in those days it might have changed subsequently but they had a couple of midwives, and that’s actually part of why I chose that particular hospital, they had doctors and midwives, and then when I would do my prenatal appointments, it would be this kind of cast of rotating midwives that would see me because whoever happened to be on shift when I checked in, I probably would have already met them and probably already would have done one of my prenatal appointments with them

P: and they are on board  for the Hypno birthing. 

J: Yes. 

P: Okay. good

J:  Yes, so they’re on board for all the hippy things that you want to do list of them so. And they knew that I was bringing the doula in and everything was sort of kosher, they were fully aware that that was all going to be happening. So when I checked into the hospital. This is actually one of my favorite things ever another client.. When I checked into the hospital, the midwife was busy, so she was attending to another client, and so they put me in a room to wait by myself, which was awful. That was definitely the worst part of the entire thing. And then because the midwife was busy I actually got paired with a doctor. So the first half of my birth experience was with a doctor, the second half was with midwife, so if anybody out there wants to know what the difference between a doctor and a midwife is, I can tell you because within the same birthing experience I had both and they were extremely different experiences in an American hospital, 

P: lay it out, I want to hear it out. 

J: Yeah, yeah. So, I had back labor, which is why my back hurt at the whole foods.

P: Today I’m lucky enough to interview a great nurse midwife. For those unfamiliar with this specialty certified nurse midwives are trained as registered nurses, and also earn a Master of Science in Nursing with a specialization in midwifery is particularly well suited for this episode, because she started her professional life in a setting in which physicians and midwives, had a strained relationship. And then she switched to a practice in which nurse midwives and OBs work collaboratively, which she felt will lead to the best outcomes for mothers and babies meaning Healthy Moms healthy babies and a very low C section rate. One thing to add, Anna sitting outside while we’re talking, I know hear the chatter and noise from people around her and cars, we’re just going to play through. 

Today we’re so lucky to talk to Ann Richards midwife in California, Anne  thanks so much for coming on the show.

Anne: I’m so excited to be here. I’m a huge birth podcast fan and I feel so honored to now be on one 

P: In Janis’ case she said, a baby is sitting in such a way that she has back labor.

Anne: Oh, and that’s a different beast. 

P: So, so let’s talk about a little bit about that. Back labor is reportedly exceedingly painful. 

Do we know why it’s more painful? 

Anne:  It used to be or even still sometimes now if a woman is reporting a lot of back labor, we kind of attribute it to the baby being in what we call an occipital posterior position, or you know a stargazing baby or quote unquote a sunny side up baby if people heard those phrases, not always, we know now that it can be a variety of things, but if we were to operate on that, that theory that it’s related to maybe fetal mal positioning where the baby not being perfectly aligned in the in the pelvis, not only head down but looking down at the ground so that when they come out of the birth canal, they’re, they’re looking at the floor as opposed to the ceiling. If it’s the other way around, or even if the baby’s just a little bit cockeyed in the pelvis, then you’re getting bone against bone, instead of squishy fetal face against maternal spine, and that bone against bone is just an incredibly intense, it’s just not how it’s supposed to be ideally in a perfectly a fetus perfectly aligned birth, and that bone against bone is just excruciating it’s just very intense. 

J: The closest thing that I have found to describing what that sensation feels like if you’ve ever been skating and you fall on your bum. Stand up fall on your bum stand up fall on your bum stand up. Stand up fall on your bum and do that another, you know however many hours you’re in labor. I did have really strong sensations in the front they hooked me up to a monitor and because I was a Pilates instructor, I had off the charts strong abdominal contractions, but the pain of that back labor was so intense, I can feel any of those contractions in the front, so the plus side  to back labor is that the labor itself hurt so much that when you actually give birth, I’ve heard other women talk about the Ring of Fire, let me tell you that felt great. If was such a relief. Whatever happens for other people on the back labor just just erased all the rest of anything that would normally be experienced as pain, so I was laying in a room all by myself in this incredible back pain, and 

P: wait the breathing is not helping. Are you are you like into the Hypno birthing right there or

J:  I tried. Yeah, I tried. So, I’ll jump forward to the end of the story I actually got through the entire labor without any epidural without any medication of any kind, without any pain relief. I’m glad I did it because I only have one child, but it would be a very difficult thing to convince me to do again and the Hypno birthing was only of some benefit because at the end of it with that level of excruciating pain. It takes all of your energy, everything in your soul just to breathe, basically.

P: Yeah 

J: so, and because the Hypno birthing process and program had, it was my take on it so I don’t blame them, but it made it sound like it was all about my mindset and I simply stayed calm and took in these breaths that my vagina would open and I would have this almost orgasmic experience that is not at all what it felt like. So, I felt really like I was not prepared because I, my body skill set. If it was yoga class. Yeah, I’m in. but we’re talking about really escalated levels of pain, to the point where after I gave birth the nurse said, it’s like not even 10% of women make it through back labor without, without some sort of pharmaceutical intervention so I had an extreme scenario so I don’t want to say all the hypnobirthing is bad. 

P: Yeah, 

J: but it just was something that I think some row halfway through I was like, forget that like, that’s not a thing. This is unrealistic, and I just need to kind of get through it without, without dying. I kind of felt like

P: yeah, I mean I can’t imagine you practicing in your, in your apartment, or you’re not feeling anything. And then it seems like obvious and intuitive and powerful, then. But when someone has a sledgehammer to your back, less easy to use those mechanisms right, 

P: So I took my questions about hypnobirthing to Anne. can you tell us a little bit about hypnobirthing? 

Anne: Sure so Hypno birthing is very, you know, mindfulness based and really trying to train yourself in the pregnancy, they really recommend women start quote unquote training for this five of 20 weeks. And so it’s all about being able to sort of disconnect your brain from your body during birth and really working on reframing how we think about pain and contractions and oftentimes using different words like surges, because contractions for a lot of women can have a negative connotation, you know, really listening to these mantras throughout pregnancy that allow you to train to disconnect and so that when you start having surges or contractions in labor, you’re able to listen to these mantras and come and go somewhere else, like you’re not as focused on the physical work that your body is doing… it doesn’t work for everyone, you know that that method of training for women for whom it works, it just be mind blowing to watch them go through birth using just that, when it doesn’t work as well as maybe women and families hope or based on all the training done. I think it’s because it’s such a specific set of tools for the birth that once it doesn’t work it can feel very overwhelming. 

J: And this isn’t an experience I’ve ever had in my life before so I think that that’s also. When we only have one practice it’s something anything it doesn’t even matter what it is, it’s not going to go according to the plan that you imagined in your head. 

P: Yeah, yeah. 

J: So, birth is a very natural process. We also don’t really know what to expect until we’ve gone through the process because I also think everybody’s body is different, likely if I had another baby, that experience would even be different but I didn’t really know what it would feel like. And I did try to avoid a lot of the material that explained what it was like But then that also led to a scenario where I didn’t I underestimated how much pain I was actually going to be in.

P: Well that’s kind of a tricky thing right I think language fails us in terms of getting you to really have any sense of what it will actually feel like because it’s not like anything else, so there’s no analogy that you could even the falling on your, on your ass for ice skating like right that’s probably like a fraction of the real pain right but it’s as close as you can get so even if someone had told you that you wouldn’t have been scared of that and you would have said oh I can breathe through that.

 

JYes, and I would have said, Okay, I’ve gone skating and I’ve gone away but yeah, it’ll be okay. 

P: Yeah, Yeah,

J:  I think that one of the interesting things for me about the experience of having an unmedicated birth. 

P: Yeah, 

J: was an awareness that my body was kicking off natural drugs. So when I checked into the hospital, the maternity ward was in the very back of the hospital so the cab dropped me off at the front, which is like, literally, a New York city block away. Yeah. During the hospital. And as I was walking down the hallway, I recognized, and remember being actively aware at that point that I actually was stoned. So, the body will kick off, natural pain medication.

P: Janis brings up another cool topic, what your body does to help you manage the pain and I brought this question to Anne: What chemistry accompanies labor to make it easier on the mother.

Anne: So, you know, I call it labor lands when women really enter the active phase of labor. So, when families come into the hospital and maybe they’re going to go home because it’s an early labor and partners will say to me how will I know that it’s time to come back and I’ll say you’ll know, just watch her in between contractions, because not only will she be working hard through contractions but in between the contractions they in the act of basically where they enter the zone where women just told most women don’t want to talk, they don’t want to move, they don’t want any extra stimulation, because they’re so focused not only on the work they’ve done, but the work that’s to come because of that natural cascade of hormones it allows her to have the most intense physical discomfort probably for life. And then it allows her to relax enough to maybe do it again and again and again and again, it’s it’s sort of this seamless production of oxytocin then has work benefits and its relaxation benefit, 

J: which is really cool. Yeah so that was one thing I thought that it was a really interesting process to go through and feel everything that was happening in my body. Do I recommend it. Yeah, I mean if you have an interest in feeling it absolutely but I’m not sure that today that I would hold quite as fast to experiencing all of that pain as I did, but I did, I was I was adamant that, particularly because I had gone through the pregnancy alone, I wasn’t sure if I was going to have more children, so I wanted to really experience the sensations in my body. And I did.

P: And how long you were saying the contractions were one minute apart and then you got to the hospital. How long is this whole period, how long do you labor.

J: Well from Whole Foods to baby in arms, it was somewhere between 10 and 12 hours. There is a really fun photo of me laying in the hallway of my apartment building. That’s time stamped and there’s another really fun photo, exactly 12 hours later, with my baby. 

P; Wow 

J:  and we would have taken those photos prior to her a little excursion shopping, so my sister looked at me and she said, I think we should take some photos today because your body’s never going to look this way again and your, your belly has dropped. So we went and we did this whole photo shoot, so I know that I would always say that my labor was 10 hours, but for sure, I have to timestamp photos 12 hours apart between laying in the hallway and so. So it wasn’t it wasn’t too bad. All in. But at the time, it’s a long 10 hours,

P:  it seems, unbelievably hard, And the only lucky thing there is that I’ve talked to a bunch of women who say, 36 hours in, I was not fully dilated right and there’s so many other things competing for your resources that it’s hard to, it’s hard to manage that so I’m glad that yours went relatively quickly,

J:  it was, yes, I was under the average time for first birth, because, you know, there’s a whole lot of stuff that has to happen on that first birth, and that’s what sort of slows it down. So my contractions were pumping along like I had given birth before. Yeah, but that dilation and efffacing had to happen

P: yeah so that’s awesome and I accidentally stepped on the line that you were trading about Doctor versus midwife. So why don’t you tell us about that.

J: So, checking in with the doctor meant that I was put in the more traditional medical system, and then halfway through the midwife, had completed her other birth and came into the room. And then the second half of my active labor experience was with the midwife. The difference between those two is that the doctor version takes the mother’s comfort, and the mother’s body into very minimal consideration. So the fact that I had back pain was a little bit of an inconvenience because we were looking at time contractions we were looking at measurements we were looking into baby’s heart rate. We were looking to speed the process up. Which–that part was good, but there was a lot of discomfort, because the baby’s umbilical cord was actually wrapped around his neck, so they had monitored me, and they were trying to get that sorted out. And I had back labor and the nurse wanted to put my bed down, and she wanted to have specific moments when she changed the bedsheets so that we could, you know, keep the area free of the fluid that leaks out. 

P: Yeah. 

J: And that was done on kind of a bit of a schedule it wasn’t really done around my body. So what I remember is that the second that that midwife walked in she said she’s already told you she doesn’t want the bed flat, she has back labor, we’re moving that bed up and that changed instantly. And I felt like I was then part of the process where my needs, my comfort and my desires were actually going to be heard. So, when the nurse was there with the doctor. We had some natural birthing techniques. I wanted to drink some water. And they told me no, I wanted to have some essential oils to sort of smell, they told me no, they were concerned about me consuming anything they were concerned about any other, you know, foreign substances being in the room. I was really really hot, I was getting hot flashes. This is my favorite. So, my sister said Take off your robe, and the nurse told me put it back on, and I remember asking why and she said well, because a man may walk in the room and see your breasts, and I literally I was middle of labor and it was so painful, but I was like, a man is gonna walk in here and see my vagina that’s hanging out. He sees my breasts. So my experience,

P: and who’s walking in, like what three doctors or something right now,

J:  I know 

P: Is there are tour coming through what, that’s weird.

J: There is multiple things there, and I also was like, I am pretty sure that even if a man walked in, he’s not gonna be like ooh breasts. You know, like that’s that’s not what’s happening at all. But, so there is, there were moments in the in the traditional medicalized birth that really jumped forward at me in that hospital in that particular experience that just felt…. They’re very memorable, and they jumped forward as it didn’t matter what I wanted it didn’t matter what my comfort was it didn’t matter. And it did feel like there was kind of a subtle push towards just get a damn epidural, and then that way you won’t be hot. That way you won’t be feeling like you need the bed down that way. I remember her, the nurse, asking me to lift my bum so that she could change the bedsheets. When I was literally in the middle of an active contraction and I turned to her and said, Just give me literally less than 60 seconds this and that. And also, more stuff is gonna come out of me and then we’re gonna have to do this again. 

P: Yeah, yeah, yeah, yeah. 

J: So then when the midwife came in, all of that change I was allowed to, you know, have some water I was allowed to do whatever I wanted with my robe I was allowed to have the bed in a more comfortable position.

P: I asked Anne to talk about the differences, she might just pay between a birth guided by OBs and birth guided by midwives, I have to paraphrase the first part of Anne’s answer, because the sounds of a garbage truck drown out her voice. She said the physicians have very little if any training and unmedicated labor and birth. They’re trained to look at all the factors around birth because their expertise is in high risk situations, and they’re trained to surgeons, and this is what else she said,

Anne: they’re focusing on usually everything. What’s the mom working through contractions you know are contractions efficient is the baby’s heart rate okay. And I think physicians, and a lot of nurses too who don’t have a lot of experience and unmedicated labor and birth pain is very uncomfortable to witness and so you know it’s oftentimes they want to make that pain go away, where as midwives we’re trained in this is not an broke my leg pain and emergency pain, This is a physiologic pain a physiologic discomfort, and so it makes us less uncomfortable because our training is so much in normal physiologic birth, but I think for a lot of birth workers, they just don’t have experience in it and so the idea of an epidural makes them feel more comfortable, it’s not to say that there aren’t obstetricians out there who are fabulous attending an unmedicated labor, reverse there and just watching birth and letting physiological happen, but it’s definitely not the norm because it’s just not their training, 

J: we took into account what was happening with the umbilical cord in fact the midwife came in and we got his cord unwrapped. 

P: Oh, Wow, 

J: let me turn in different ways and unwrap it. So we went from this scenario where they were saying, you might have to get a C section and I actually remember crying and saying that I couldn’t remove my, my robe and that I couldn’t have ice cubes or any water even if I was hot and you’re nauseous, we’ll here have a have a Pepto Bismol so that you don’t feel bad too. Okay, we’re going to regulate your body temperature, we’re going to do it with. In this calm way. If you want to take your robe off we’re not concerned about turning into a strip joint. And so I was put into the process in my body and my needs were respected along with keeping the baby in a in a safe, comfortable happy environment, and my labor actually sped up. At that point, because I went from being actually distressed to. Okay, I can actually relax a little bit, and it’s feels less scary.

P: That’s awesome. It’s awesome also that the midwives have those kind of tricks to help with the umbilical cord that’s super cool it does, and you can imagine has a long history and you feel like you’re capable hands and she knows what she’s doing.

J: Absolutely. So I’m not having had that experience I’m not against doctors and nurses, but I do feel quite strongly that if you are somebody like me that wants to have non medicated birth, that it is going to be strongly in your best interest to have a support team, that’s specific for an unmedicated birth, and that likely means a doula and a midwife. And even if you can’t have the doula. It’s probably almost definitely needs a midwife because that midwife is going to take your comfort into account

P:  So Janis brings up another good point here: go into labor and delivery with the right team. Anne and I had a longer conversation about the different incentives that shape the way hospitals, practices and providers manage labor and birth…she had some words of wisdom about important choices women are making for their labor and deliveries…this is what she said…

Anne: if you have, you know, private insurance and you can choose if you are  somewhere where you can choose between a variety of different practices, especially do your research, you know, what is that practices without providers C section rate what’s the hospital C section rate if you have settings to choose from. If you’re choosing an out of hospital setting, what’s their transfer rates you know how until until what gestation, can you be pregnant or when would encourage induction What’s your hospital providers induction rate. You know what, just need to leave, you know, most people do a lot of research on the Crib they’re going to buy or the carseat they’re going to buy, but I’m just like, oh this is who I was assigned to for prenatal care and just follow suit and the way your labor, pregnancy, labor end up being who’s there to help you along the way and who’s guiding you as your provider.

P: And then, what, how long do you stay in the hospital and what’s the fourth trimester, like,

J: I stayed in the hospital, I gave birth at around four in the morning, so I actually was lucky enough to get to stay. And I was lucky enough to actually get to stay, not just that quote unquote night, I mean that night was over because it was, it was six by the time I actually got to the room, but I got to stay the next night as well. And the baby actually was born with a huge bruise on his head because of his fun back labor experience. So he had jaundice, and he wasn’t discharged with me so unfortunately we did spend one of those early nights apart which I didn’t really love, but my stay was pretty short, I didn’t have any side effects, particularly from the birth.

Nothing ripped or tore so I was a pretty clean case of. Get in, get out. 

And the fourth trimester for me. It was kind of exhausting. I had a baby that had acid reflux and colic, and he cried. He cried and he cried and he cried and he cried, and breastfeeding was hard because he basically just wanted to breastfeed 24 hours a day. So, it was, it was a huge adjustment for me and because I was on my own. I really didn’t get enough sleep. and there wasn’t anybody to help me out. My parents came to visit each for two weeks so I did get some very early support, but then everything fell to me and to my community of friends and I did have some very helpful friends, but at the end of it, every diaper change was me every pickup the baby was me every meal was me and it was, it was a lot I mean I didn’t know anything different, To this day, when somebody I know has a baby. I sort of look at my proverbial watch and I’m like, Oh, I’m going to get that note in about three months and that note always has, I don’t know how you did this by yourself. 

P: Yeah, yeah. 

J: But it was just one of those things where, just like my birth, I didn’t have anything to compare it to. So, when I look back on that, that’s just what having a baby was, and you know I had a baby that was on the more difficult end because he didn’t sleep all day he cried all day, but it just was what happened, and so it wasn’t like he was my second child and suddenly I was thrust into something that I was unaware of really wasn’t like that first time. It just was what it was. Fortunately for me, I took a long maternity leave, and I also came into this situation. Really really healthy and vital with a lot of energy. So, I think that all things considered, I was lucky because I was able to take a lot of time off work, and I had come into it from a great pregnancy, super healthy lifestyle.

P: I am with you until you get to colic, because it you know, it’s hard enough to do the, the day to day tending to a very small baby and it sounds like you had a little bit of help around the edges but all those people who are gone wants to colic hit, I’m assuming, and that’s just a really challenging thing, it’s just a really challenging thing to live through, especially without someone else that you can give the baby to to say, I need to walk around the block. Right, I need to like do something.

J: Yeah, yeah, so I actually remember taking him in the baby carrier to the drugstore at four in the morning or three in the morning because he was just crying and crying, crying and literally taking him for a walk was the only thing that made it stop, and I mean, my dad was like oh that’s a great way to lose the baby weight and I’m like, Dad, I just want to sleep. Yeah, I mean he wasn’t wrong way to look at the positive dad but it was, it was exhausting. There were days when he literally cried 10 hours a day, and I do remember calling my sister, throwing the phone into the middle of the room, putting it on speakerphone and literally just shouting into the phone like she was, she was like, What are you yelling about I’m like I just can’t stand it anymore, it’s just, it’s crazy. Because a colicky baby is one that there’s no particular reason that they’re crying, they just spend their whole time crying, 

P: and, and there’s the feeling that there’s the feeling that you should be able to soothe them. Right. And you just there’s nothing you can do right it seems like it is just a, like a developmental thing right for them to go through art, you know the book The happiest baby on the block, you know, a book so maybe you studied that book, but I heard Harvey Karp say, I haven’t been able to verify this, but I’ve heard him say that in Navy SEAL training. They play the sounds of crying babies all the time because it breaks people down, like it is like a physiological response. So, congratulations your navy seal, I don’t know. 

J: Thank you. I did realize during that period, that when babies cry, it is meant to be annoying, because at a certain point, I was exhausted enough that I remembered dreaming, and in my dreams. The baby was crying but I realized it was real and it was right beside me. 

P: Yeah, 

J: or it wasn’t, but a lot of times, that level of exhaustion actually required him crying to wake me up and get my attention and that’s ultimately what it’s for, I mean, yeah, babies need attuned parenting, yeah need somebody to hold them and they need somebody to feed them and they need somebody to care for them or they die. 

P: Yeah, 

J: and the only way that they’re going to get a tired parent to do that is going to be through being annoying. So I really, I really learned that one. Because if that was a pleasant sound to the human ears, especially because babies are cute, we would just put them in the corner and it would be like a puppy, where we interact with them, we have a good time but we leave it, we leave them alone. Right. So I believe that that’s a really interesting story with the Navy SEALs,

P: yeah so once I bet it was like dreamlike once he got over the colic,

J:  it was, it was. I laugh because I never really knew what an old soul was until I had a baby, and then all of a sudden I’m like, I don’t even know what that is but I think he’s got an old soul so every time he went through a developmental phase, he would get happier and happier and he’s a, he’s a super happy smiley kid. But when he was three months old he was sitting in one of those little bumbo chairs right beside me and I was reading a baby book that said, Oh, your baby’s personality must be coming out by now and he sat there when he wasn’t crying, he would sit there and make this noise, like oh my god, I have given birth to a curmudgeon. 

P: Bad news, bad news Janis

J: Yes. This isn’t going very well. And so I actually feel like he was just a child that it was almost like some sort of locked in syndrome where every phase, where he got to eat it made him happier when he got to walk it made him happier when he got to stand it made him happier. So that was a huge relief was that he actually did turn into a very happy smiley little kid instead of this crying curmudgeon.

P: What’s he into now What’s it, what it was he like at ten?

J: he loves Lego, he loves books he actually is super into food. He loves cooking and fun trying new foods from around the world. He loves video games and YouTube videos, and anything that you can build or construct or create, he’s really into that. He recently started working with horses and loves horses. 

P: Oh wow, 

J: skating, and so he’s got a got a range of interests.

P: That sounds awesome, very exciting. Yeah, if you could go back and give advice to your younger self, what do you think you would tell her.

J: There is a certain naivete before you have a baby. And I think, I didn’t. I had no idea how much energy it all was going to take and how much of a marathon, it is. And so a lot of times in those early days I was trying to sprint through. 

P: Yeah, 

J: I would tell my earlier self to sleep as much as I could during pregnancy because afterwards you’re just not going to sleep again for like, I don’t know how many years but he’s 10 and he wasn’t feeling well last night so at midnight he came in, turn the light on and, yeah, yeah, I think it’s never the same ever again. Um, and I didn’t really recognize, I’m, I’m a bit of an energizer bunny. I am always high energy, I feel like I always have something that I’m ambitious about and wanting to do so even as a high energy person I did not realize it was going to drop me into my ass. So the demands of parenting are a lot higher than what I really had ever estimated what anybody talks about when anybody tells you, because when I see little kids. My brother has a four year old and in short spurts, it’s very manageable. 

P:Yeah, 

J: it’s the 24 seven this of it, that really wears you out because you don’t get a chance to really get those long breaks or the period of real recovery. So when you’re working on less sleep and constant activity, and you still have to maintain the rest of your life, your career, keeping the house clean doing all the adult things. It just is a huge drain, and that’s such a negative word but you know you’re adding this 20 to 60 hour responsibility to your to week and it didn’t really occur to me that something else was going to have to get pulled out of my schedule and out of my life. To the extent that it really did.

P: Yeah, yeah parenting is harder than it looks for sure. 

J: Yeah, way harder than it looks. 

P: Yeah, well you made it through though so far. It sounds like he’s ready to go, he can cook. What else does anybody know, right, laundry, we got to work on the laundry. I will ask you to close your very close. Janis thanks so much for coming on and sharing your story,

J: thanks for having me

P: Thanks again to Janis for sharing her story with us and thanks also to Anne for sharing her experience as a certified nurse midwife and for helping us to understand the different perspectives on labor and delivery between OBs and midwives. As always, thank you for listening. Feel free to like and subscribe to the podcast, and leave a review if you can. You can find shownotes and other information on our website, warstoriesfromthewomb.com. We’ll be back soon with another story of overcoming.

Episode 28 SN: Outrunning Ectopic Pregnancies is No Small Feat: Kristi’s story

Both of my pregnancies taught me that just because some process is going on in the confines of your body, location does not imply control.

This is also true for my guest today.  To some degree, I think that if her timeline didn’t unfold in the very specific way it did, she would not have ended up where she did–the mother of two healthy girls. On the way to this outcome, she experiences both the best and the worst pregnancy “luck”.  Overall this story is one of good luck, because she is alive to tell it. Today’s guest did not endure one, but two tubal ectopic pregnancies. Often these types of pregnancies can be handled with medication, but if that route fails, as it did in her case, they require immediate surgical intervention to prevent a rupture, which can lead to internal bleeding and other emergency circumstances. Today’s guest was forced onto the hardest route out of an ectopic; and it’s the way she handled these pregnancy complications that makes her story one of incredible perseverance and resilience that she likely didn’t realize she embodied.

pregnancy/miscarriage hormones

https://www.verywellfamily.com/how-doctors-diagnose-miscarriage-2371375

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936313/

IUI

https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments/what-iui

Audio Transcript:

Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka. I’m an economist, a writer, and the mother of two girls, I’ve had three pregnancies, and each one taught me that just because some process is going on in the confines of your body, location does not imply control. This was also true for my guest today.  To some degree, I think that if her timeline didn’t unfold in a very specific way it did, she would not have ended up where she did. The mother of two healthy girls.  On the way to this outcome, she experiences both the best and the worst pregnancy “luck”. Overall, this story is one of good luck, because she’s alive to tell it. Today’s guest did not have one, but two tubal ectopic pregnancies. Often these types of pregnancies can be handled with medication but if that route fails, as it did in her case, they require immediate surgical intervention to prevent a rupture, which can lead to internal bleeding and other complications. Today’s guest was forced onto the hardest route out of an ectopic. It’s the way she handled these pregnancy complications that makes her story one of incredible perseverance, and resilience that she didn’t like we realize she embodied.

 After we talk, I go back and include the insights of a wonderful OB, who’s authored papers on ectopic pregnancy. 

Let’s get to this inspiring story.

Today’s guest and I just fell into our conversation, so I’ll introduce her: Her name is Kristi and she’s from Oregon and here’s her story.

 

Kristi: so my first daughter, we were not planning for. And we were actually honestly not planning on having kids period. That was one of the things that kind of joined me and my husband, it was like we are both on the same page, We’re gonna get married and we’re just going to live our own life and not have children. And then I got pregnant. But it was like this …I’m the one who actually freaked out my husband did not. He was like, Alright, let’s go. And I sort of had to take a moment to realize that this was a new plan for us, and have the smoothest pregnancy, no morning sickness, the only side effect of my pregnancy was heartburn. It was awesome. I loved being pregnant, giving birth was a different story, and honestly even that first birth, even though it didn’t go as planned, like it wasn’t crazy she got stuck and 

 

P: let’s go slower, your water broke

 

K: my water never broke i Okay, so I guess she is a little bit of a story but I was actually four and a half hours out of town. My husband’s grandpa died, and we made the joint decision that we were going to go to the funeral, even though it was the weekend of my due date, I researched the hospital that it was close to, and I was fine with it like if it happened it was okay, we were just going to tackle it as it came and it was fine, managed to go the entire time in that town, and we were on our way out of town in at a gas station, getting gas to head home, and I had my first contraction. So, was in labor for four and a half hours in the car. And 

 

P: did you know what it was?

 

K:  I had had Braxton Hicks, but these were definitely different and I don’t know if I really registered it, but they became pretty constant. And I think they got to within like four or five minutes apart when we were approaching Portland. And we had to make the decision of either turning off and going to the hospital I was delivering at, or going home, we had moved so I lived a little bit far from our hospital. So we opted to go to the hospital, I already had my bag so it was like, yeah, why not, we’ll just, they’ll tell us what we need to do, I think we ended up checking into the hospital a lot about noon on Friday. And it’s weird how this birth is a little bit foggy, I forget little details but when I got in there they let me hang out for a little while the contractions were definitely regulars so they actually ended up breaking my water. And then, obviously, the clock starts ticking, I got an epidural, but it never worked. Fully, so I was having 

 

P: you didn’t feel numb?

 

K: No. 

 

P: Oh

 

K:  it’s funny because now I hear people tell the story about like yeah like I took a nap, and I’m like, what you took a nap. Are you kidding me, so I had to keep having the anesthesiologist had to keep coming in and give me me boosters. So they finally decided to pull it and redo it. So they tried it again, and it’s still never really took effect. So I was in pretty hard labor, until Sunday, so I went with no sleep because I never not felt a contraction so they were coming. And about six o’clock on Sunday we decided we’re far enough along i i dilated I dilated all the way to 10. To start pushing at least try to see if we can make something happen because she just wasn’t really very low but I mean I was dilated so we’re going to try and I pushed for three hours. And my doctor finally it was just like, This is ridiculous. You’re exhausted. Her heart rate never did anything super weird but it kind of did so we just called it and ended up doing a C section, as it turns out. Her head was tipped sideways. So she was pushing with the side of her head she came out with a huge bump on her head where that part of her head was being sucked into the birth canal, but not the rest of her was perfectly big, she weighed eight pounds six ounces, big puffy pink never looked like the old man she’d looked like a baby like fine just took a long time to come out. 

 

P: Yeah

 

K: I recovered from my C section really well, and it was fine. It wasn’t, obviously, my story is always a person ever go the way you plan them, but

 

P: had you imagine like a natural birth or you just didn’t want a C section,

 

K: I just hadn’t planned on a C section, I was C section and my brother was C section, it’s always, it was always there, it just wasn’t the plan. Yeah. When the doctor finally made the call and we were going to have a C section. All of my contractions completely stopped it just stopped and my body was like yeah, thank you. Let’s just get her out. Like, I didn’t have another contraction. So I went into the O R, and never had a single contraction, after they called it. So I was probably ready for that

 

P: Yeah, yeah

 

K:  and recovered just fine and she was totally healthy like that bump went away within like two days and

 

P:  yeah, good 

 

K:she was healthy and, perfect. So that’s my first daughter. I mean a little bit stressful but to me it was nothing serious. I had to have a C section, but whatever, they are super common… So my daughter was about 2 we actually decided we wanted to have another and We tried for probably about six months, I think, and I got, I got pregnant. And at six weeks had a miscarriage. And it was a slow miscarriage, so I found out from the doctor that I was going to miscarry before I actually had a miscarriage my numbers were just dropping.

 

Paulette: So when Christie talks about numbers, I think she’s talking about HCG human chorionic gonadotropin, which is a hormone produced by the embryonic cells that will become the placenta during pregnancy. This hormone generally makes the uterus a happy place for a growing embryo it Ward’s off the mother’s immune cells, it signals to the years that implantation is coming, and it tells the body to make the hormone progesterone, to protect the endometrial lining and avoid a period. Early on the level of HCG roughly doubles every two to three days, and tells you that you’re pregnant, but if the level of HCG doesn’t increase in this way it can signal that something’s wrong. Doctors can take blood tests a few days apart to verify a falling hCG.

 

K: I wasn’t feeling good, I don’t think, and so I literally just waited at home for it to happen because I knew it was coming. And then we just kept trying and we went, I think we went about a year of trying.

 

P: wait, let me back you up here for one second, upset about the miscarriage?

 

K: Yeah, I was, I definitely was but it’s crazy all these people started coming out of the woodwork who had had miscarriages, they’re very common. 

 

P: Yeah, yeah, yah

 

K:  And, but I hadn’t realized it so just having all those people around you, being like, Yeah, I had a miscarriage too but I have three great kids so

 

P: yeah March of Dimes says it’s 50%

 

K:  I wouldn’t be surprised if it’s way more than that, 

 

P: because so many people don’t report or don’t even know. Yeah, 50% is already a coin toss, right, so. 

 

K:  I called in sick as soon as I found out this was happening and I didn’t go to work until it was done so I missed like a week of work, of just basically sitting at home. 

 

P: Yeah, 

 

K: waiting to lose baby which is obviously devastating, and I think because the rest of my story is so dramatic that feels like nothing. 

 

P: Okay, 

 

K: So, after trying for about a year, my doctor referred us to the local fertility clinic, I guess, like first thing she had us do was had my husband go get checked. And so he got checked and his numbers came out good but not good had plenty, but their movement was off a little bit so that raised kind of a red flag, so she wrote, she recommended us to one of two places. I happen to be extremely lucky at the time and my employer covered fertility.

 

P:  Oh wow. 

 

K: Yeah, so they covered 80% I think, 

 

P: wow

 

K:  all fertility, they’re extremely like gay marriage and family, very. Yeah, yeah. So they covered that. So, the goal is to stay employed with them for sure until we figured everything out. So we started with them, and you go through lots of testing, did that if I had completely unexplained. There was no reason that we could tell why I couldn’t get pregnant. So we started with IU I.

 

P: So an IUIi is an intro uterine insemination. Basically the doctor takes sperm and shoots them directly into the uterus with a little thin tube. When you’re ovulating, it can increase your chances of getting pregnant, but in fertility, nothing’s guaranteed.

 

K: And did four rounds of that. So you like do that and then wait a month, you do it again, wait a month so we went through four of that, 

 

P: and you find that  okay?  I did that also…

 

K: I mean it makes sense why they think that would work to me, especially if there’s question on the guide side, we’re just going to help these little guys out and get them right in there to the right place so it makes sense to me why it would work. I don’t know anyone who that has been successful for I’m sure there are people, but the I did not work for me. So, we went through four rounds of it, and then it was decided that we were going to try IVF. So, I, I learned the hard way that I don’t like giving myself shots. I know other people who went through it, but the idea of everything that happens, and I’d say now I should have written all of it down but I didn’t…it didn’t feel necessary  for some reason. So, our first round of IVF was successful. 

 

P: Oh wow, 

 

K: I got pregnant. You go through the whole process of them gathering the eggs right so a horrible part of blowing up and filling yourself with as many eggs as you can get.

 

P: I talked to one woman who said she could feel her ovaries, they got so big that she felt like said like well walking around, you can kind of feel them.

 

K: It is crazy it is a weird feeling. I don’t know if I could feel them but I definitely just felt like bloated and uncomfortable and like this is not normal. 

 

P: Yeah, 

 

K: after they take them out and they, you know, get rid of the ones that are definite no’s. Yeah, we ended with nine. We opted to do the genetic testing. I didn’t feel like after all of this, why would you put in one that’s not 100% 

 

P: Yeah, 

 

K: so, and I had the health coverage so I get, like, not doing it because it’s expensive, but we had the health coverage so that left us with four. 

 

P: what do they test for? 

 

K: So, they test for any genetic anomalies, so if there’s anything that sort of looks like it’s, it could possibly be rejected by your body. Because of a genetic mutation.

 

P: Yeah, 

 

K: it’s pulled. 

 

P: Okay, so it’s broad is pretty broad,

 

K: it is broad… I think, Because like we ended up with four super healthy, these are the best of the best of your, of what you got. And so we had four and we knew those, those are your four chances, we knew we had three boys and one girl, because part of the genetic testing is knowing exactly what sex you have, so we go the first round, and they’re doing lots of tests up to the point before they put that egg in. And I had fluid in my uterus, and I took a specific type of medicine and to try and get rid of that fluid, and like the day before we were going to put the egg in the fluid disappeared so that medicine we’re assuming works, so put the, again, I get pregnant. Everything seems fine. I get to, I’m pretty sure it was week six, because that’s, that seemed to be my magic number, and I call it was at work, and I call my doctor because I’m having like weird pains in my left side and it’s kind of going down my lane, which also feels weird.

 

P: Today I’m bringing questions about Christy’s experience to Dr. Tanya Glen. She’s a published author who’s written and researched about ectopic pregnancies, and is currently a fellow at Yale’s reproductive endocrinology and fertility clinic. Hi Dr Glenn thanks so much for coming on the show. 

 

Dr. Glenn: My pleasure 

 

P: in Christy’s case, she gets pain of her leg. Why does an ectopic cause that kind of pain.

 

Dr. Glenn: It’s not necessarily that every ectopic would cause that specific type of pain. And so, could very well be that if it was a ruptured ectopic already, the blood in the abdomen could cause irritation down the leg, but the majority of time when people have a ruptured ectopic they’ll have abdominal pain. That’s not a symptom that I get often from my patients usually it’s abdominal pain.

 

K: So I call them, just because I didn’t actually know if there was anything wrong but I called them and they tell me to come in. So I go in, and he breaks the news to me that he’s pretty sure I’m having an ectopic pregnancy. The embryo has went up into the fallopian tube and I’m gonna lose the pregnancy. He calls my doctor and my doctor wants me to come and see her, so she’s taking space in her schedule and she has me drive to her office from the downtown office to come see her, so it’s confirmed Yes, this is an ectopic pregnancy

 

P: Did they do an ultrasound?

 

K: Yes, They did an outside and a vaginal ultrasound. So you’re going to lose this pregnancy, we can help you along with this so they schedule me an appointment at the cancer center, but I can’t get in until for this is like new. So like for, you’re going to drive to the cancer clinic, and you’re going to go in and you’re going to get this medicine that is basically like a chemo medicine it’s going to make your body reject the pregnancy and your system will just flush it out. So that’s the plan like.

 

P: So Christy’s ectopic is going to be resolved with medication. What do you think the doctors gave her and how does it work, 

 

Dr. Glenn: people that may be having a ectopic that was treated like she was with medication first which is called methotrexate and attacks rapidly dividing cells, it’s actually used also for chemotherapy but we use it for tech topics we use it as a much lower dose, But attacks rapidly dividing cells and we’re gonna think about that, that also can cause pain itself. So most of my patients who get methotrexate will feel uncomfortable, you know, they’ll have some cramping, they might have back pain and it is just all kind of response to maybe having some bleeding, and that ectopic pregnancy or that pregnancy that’s not inside the uterus is resolving and those cells are dying, and that causes pain,

 

K: I have nowhere to go because I live so far from work so I go back to work, and hang out until I’m supposed to go, and my husband’s at work and I’m reassuring him that like I can do this just meet me at home. There’s nothing you can do, take care of, you know, our oldest daughter, and just be there when I get home. So, I go to Portland, get two shots, one in each butt cheek. By this time, I’m in quite a significant amount of pain, I remember not being able to get comfortable in. On the bed that this clinic is having me sit on and like I’m finding weird positions to sit so it doesn’t hurt, and it takes a long time by the time I’m driving home it’s dark, so I’ve had to wait so long at that clinic, it’s all the way on the other side of Portland so I’m having to go through Portland and to the other side to get home. They’ve prescribed me Vicodin, and something else for nausea. So Vicodin for the pain and something else for the nausea, because I’m, I’m just not feeling good, it’s super super painful to medicines I’ve never taken before also. So, I don’t know if you’re familiar with Portland but to get from one side of Portland to the other you drive through a tunnel. I just remember that when I went through the tunnel. I was in so much pain that I was basically driving with one foot pushing on the dash and one foot on the gas pedal because I, the pain was so excruciating, but

 

P: Did they  tell you that would happened, 

 

K: yeah that’s that’s why they gave me the Vicodin, it would be really painful. Not that I have no frame of reference,

 

P: yeah. 

 

K: What is too much pain, what is normal. Yeah, they said it would be painful, so this must be right. 

 

P: Yeah. 

K: So I still have to get to Safeway actually to turn in my prescription so that I can get this prescription so I can go home, so I have a standing job that I probably looked like a drug addict, by the time I got to Safeway, but I go to Safeway, I’m in my work clothes but I am sweating. I constantly have this rolling sense of feeling like I’m gonna throw up, which I’m thinking is because it’s so painful. So I go into Safeway, I literally like lean on the counter and hand them this prescription for Vicodin

 

P: Yeah, 

 

K: I’m sure. They’re like, yeah, lady. You’re a complete drug addict. 

 

P: Yeah, we’ll definitely fill this. 

 

K: Yeah, we’ll get right on that. Yeah, they told me it’s gonna be a half hour. So, I just go out to my car, I sit in my car, I get out of my car twice, and go into the Safeway bathroom convinced I’m going to throw up. I don’t go back, sit in my car, I’m sweating. I’m in pain, finally go in, I get the prescription. I go home. I take one nausea medicine, two vicodin, and I tell my husband and going to bed. I’ve never taken Vicodin before. I don’t know I don’t know what’s gonna happen, I go to bed and I go to sleep. I kind of remember him coming in and going to bed. I mean he’s clearly worried, but we also have a two year old in the house. 

 

P: Yeah, 

 

K: so he’s, you know door, trying to keep it together and trying to keep her, you know, Kara, wake up at like 11 o’clock. And I think I’m gonna throw up. And I remember getting up grabbing the closet or cuz I feel like I’m gonna fall over. And that’s it. The next memory I have is laying on my bedroom floor and there’s a fireman above me, sitting, sitting on me. Apparently what has happened is…

P: Goose bumps! Yikes…

 

K: Yeah, literally, so my husband heard me, thank God, fall into the bathroom. It was a really, really small bathroom so I’m laying in the door and he kind of wakes up and he’s like Christie What are you doing, don’t answer. And he turns on his light, and gets up and I’m laying in the bathroom door, and I’m unconscious and not breathing. Thankfully, my husband used to be a paramedic, so he grabs my shoulder he yanks me up, he’s pretty sure he pops my shoulder out of socket, but he doesn’t get to me over and into our bedroom. And that movement. I did throw up, but I aspirated it… so gets me breathing is yelling to our two year old to wake up to go get him his phone. She never wakes up. 

 

P: Yeah, 

 

K: so he leaves me for a second, goes and get this phone comes back and he’s calling 911 calls 911 hangs up with them, they’re on their way, he calls her friend to come over because he needs somebody to stay with her. My friend comes in, goes directly into my daughter’s bedroom shuts the door and sits on the floor and just doesn’t leave her. So I, when I wake up, my blood pressure is like 30 over 60 

 

P: Oh my god, 

 

K: I’m in really, really bad shape. So because my husband was a paramedic, they give us the choice of them either him driving me or them driving me to the hospital, we don’t know what’s wrong with me but my husband decides, we decide, I don’t, I wake up at one, I don’t care. I remember being like, yeah. Hey, how’s it going, it’s firemen and looking at my hand and realizing there’s like throw up in my hair and just been like yeah that’s okay that’s been going back wanting to go back to sleep on my floor. I don’t care what’s happening, I don’t care I just want to go to sleep, so they carry me down in a, in a sheet, my husband and two firemen carry me down our stairs and put me in my husband’s car. And he drives me to the ER, I kind of remember the drive but i All I remember is laying on my side and putting my feet on the dash and pushing on it because, again, my stomach is hurting so bad. We get to the ER, and I remember, a doctor coming in, and I’m doing an ultrasound on my stomach. Leaving really quick. And another doctor coming in, and then doing another ultrasound. And then I don’t remember anything until I woke up, so all I know it was really bad, and my whole abdomen was for full of  blood basically fluid. So my fallopian tube had ruptured, probably on the drive. That’s why my pain, suddenly got so bad, and I bled it, I was bleeding internally that entire time.

 

P: Here’s what Dr. Glenn had to say about how a ruptured fallopian tube behaves….

 

Dr. Glenn: What I’m really concerned about is, let say it ruptures, and you start bleeding because a tube has a lot of blood supply to it..it’s delicate, and it bleeds if you look at it wrong, and so if people are bleeding from that, they are going to continue bleeding

 

K: So when I woke up. My husband had apparently had a breakdown at some point in time and was calling on my family and crying and they had given me, 2  liters of blood 

 

P: for context here. According to medical news today the average size woman has 4.3 liters of blood in her system 

 

K: and removed that fallopian tube….I survived and woke up with my doctor,

 

P: wait, let’s let’s pause for one second here. I can’t believe you have another child. 

 

K: I do, yeah. 

 

P: So I’m just gonna say it’s amazingly brave to go back into the breach, 

 

K: yeah.

 

P: to say like yeah let’s try it again. 

 

K; Yeah, 

 

P: that’s so scary, Oh my god.

 

K: Yeah. Yeah, that’s probably the scariest. 

 

P: Also, the cancer drugs methotrexate isn’t what it is I,

 

K:  you know what I couldn’t even tell you. But I, I know you were like,

 

P: did it not work?  do they know what went wrong, 

 

K: it was too late. So they gave me this medicine, But it was too I was, it was too late. I was too far along, and too far past that point, that’s the answer I’ve been given is that if I had caught it like a little bit earlier, even hours earlier, it might have worked but I was too far along, for it to actually be able to reject.

 

P: So you’ve identified a tubal ectopic, is there any way to know how close the tube is to bursting.

 

Dr. Glenn: No, that’s the hardest part I think about we call them pregnancy but unknown location. So in Christie’s case I’m not sure if they actually saw like a mass in the tube. A lot of times we don’t we have to kind of go empirically like our ultrasounds are only so good, now they’re so much better they keep getting better and keep being the detect things that are smaller and smaller. But sometimes if their hormone pregnancy hormone levels too low, like it’s rising up normally that’s too low, we’re not gonna see anything that to 

 

P: roughly how big is the embryo at this point 

 

Dr. Glenn: three to five millimeters. 

 

P: Okay. that’s tiny

 

Dr. Glenn: It’s very tiny. Yeah. Now, let’s say her pregnancy hormone level was very high. That was kind of a relative contraindication to getting methotrexate, we say if it’s over 5000 or we see a heartbeat, in the, like, called adnexa which is in the tube or outside the uterus, those are relative contraindications to getting methotrexate, but they’re not absolute because some people really want to avoid surgery. There’s risks and benefits to both, but there’s no way to know that tube could be rupturing, as I’m seeing her, and she might feel fine that point, we do know that ectopic pregnancies can resolve on their own, and one that happened in the tube, when their pregnancy hormone level is very low like less than 200, about 80% of those will actually resolve without any medication intervention, It kind of extrudes out the tube and gets absorbed by the abdomen.

 

P: so then you had the burst fallopian tube on top of chemotherapy Vicodin and nausea medicine. Yeah,

 

K: to say the least, I, I pretty much I’m petrified to take it again, and just don’t want it in my body

 

P: that seems fair. 

 

K: I’m sure it has nothing to do with any of it but all the medicine that was involved with that little window of time I never want in my body ever again. 

 

P: Yeah, I feel like that’s fair. 

 

K: Yeah, so there’s lots of checkups that happened after, obviously I now have chemo medicine in me so even the thought of trying to have a baby again isn’t going to happen three months I think took three months for that to be completely out of my body,

 

P:  I know there are risk factors for ectopic Did you meet any of those risk factors?

 

K:  no 

 

P: In the published literature I saw about risk factors, there are a wide variety of things linked to ectopics…so I took this question to Dr. Glenn: What are the risk factors for ectopic pregnancy?

 

K: Actually, infertility, just in general is a risk factor. You have tubal factor. What that means is, if we know your tubes are abnormal, you know, if you’ve had pelvic inflammatory disease that can actually affect the tubes cause the tubes to become dilated and fluid filled, and they have cilia and your tubes to help sweep along the eggs kind of  like brooms. And we know that if there’s fluid in there, those can disrupt the. Yeah. And so, tubal factor being that we know that the tubes are not normal, increased risk for a topic, even if we do IVF, and we’re actually avoiding the tubes in general, still an increased risk. Other things were kind of unsure about why infertility itself is causing it. Even people with unexplained infertility, maybe they have some underlying factor in their uterus that doesn’t make it a good environment for an embryo implant or there is something in the tubes that we just don’t know yet. One reason I love and it’s frustrating about my field is, it’s so much unknown still. And so, you know, other things people realize that our risk factors is smoking, endometriosis….And then we also know you know that there has been an association between doing IVF cycles your hormones get incredibly high. We know that actually increases risk for ectopic that has been shown to I should say, but we don’t really know why, but about at least a good 50% of people that topics have no risk factors.

 

K: The thing that we come up with is that this mystery fluid in my body was coming from my C section scar, from my first daughter, I never healed completely on the inside so weird fluid from this scar from years ago was seeping into my uterus and the embryo didn’t like that fluid, so it was running away from it.

 

P:  Okay. 

 

K: And the only way to go was up. So, ran out and into my fallopian tube. Nobody knew that. And on every, you know, scan that I had and everything we could hear a heartbeat and, but we didn’t know, I mean there was no way of knowing where it was sitting. 

 

P: Yeah,

 

P: So the theory about why this happens to Christy is that her previous cesarean scar led to fluid in her uterus and the embryo was making implantation decisions based on the fluid in the uterus, I mean, that brings up all kinds of questions like how we’re as the embryo figure out where to implant, 

 

Dr. Glenn: yeah 

 

P: I did a brief literature search for that and couldn’t find anything in humans, but in animals, there’s all these suggestions that the placement of embryo implantation is pretty consistent across animals suggesting that something is guiding the embryo to figure out where to implant.

 

Dr. Glenn: Yeah, and is it like a chemo some kind of chemo attractant, is it the receptors that are have on their endometrial receptivity, is a huge area in our field because we know that in IVF it’s like if we have a let’s say a tested embryo, which is, you know when the eggs and the sperm come together and fertilize that egg. It will grow and become an embryo and usually about five days after that so Lightstation is called a blastocyst and that’s when we will put it back into our patient usually the day three or day five, we can test those embryos to see if they’re completely normal. And we can have normal embryos not implant. So we know there’s a lot of underlying factors about the receptivity between an endometrium or the uterus which enemies from being the lining of the uterus and the embryo that we just don’t understand yet, is why even with IVF, you know, even in let’s say a young patient 30s or, you know, Overall, the success rate per cycle of placing that embryo back in. It’s only 50 to 60%. There’s so much we don’t know yet. The embryo that doesn’t know how to attract the uterus, or the uterus, that’s not having all the right factors or adhesion molecules to actually be receptive to the embryo.

 

K: So, there’s a surgery, you can have done where they go into your uterus and they burn each side of your scar to seal it up. So, after all of this happens, I have that surgery. So I go see a specialist for the basically cauterize around your the scar to make the skin fused together so now that it’s just like in a little pocket, and not releasing any fluid into the uterus

 

P: does that hurt, or No, 

 

K: that wasn’t too bad actually. There were the recovery was super minimal, they go, I’m trying to think, I think they go in through your cervix. 

 

P: Okay, so they don’t have to make an incision or anything. 

 

K: No, so recovery super easy. I don’t remember that being bad at all. 

 

P: Okay. 

 

K: We tried the idea of another idea first and instantly rejected wasn’t a, I didn’t get pregnant, or anything it just didn’t take. And then I had the surgery to take care of that, because that fluid kept showing up. So, this is the determining factor since I had nothing else. 

 

P: Yeah, 

 

K: so I do the surgery where we seal off my scar. And we have, I have two more embryos, I have a boy and a girl. So because we’ve tried boy boy, we’re obviously going for boy. So when we decide that since nothings working. We’re going to put the girl in. And it’s sort of like our, like if it’s not going to work. Let’s try it with the girl. Yeah, which is horrible thing to say because now I have a daughter, but it works. And so we’ve sealed off the, this, the scar, and I get pregnant. And I remember standing in my bedroom when they call you right to tell you your numbers, that’s how you find out if you’re pregnant or not, and my numbers being crazy high, and it was like, YOU’RE NOT PREGNANT like you are 100% pregnant. Even with the like first pregnancy my numbers weren’t this high so it was like, this was the best possible thing like you are, you’re definitely pregnant. Yeah. Like, I’m not pregnant until I passed six weeks, just so you know, but I do, and I totally have another perfect pregnancy, again no morning sickness, no, I make it all the way, I graduated from my fertility clinic you graduate after the first semester you get to leave your fertility clinic and go to the regular doctor and I remember that day happening and everyone in the clinic cried my doctor cried. The person who was taking my blood every freaking day was crying like the receptionist cried, everyone knew what I had been through the whole office knew that that was like my last appointment. And it was the most amazing craziest feeling I was like, you see ladies with real bad shit. And you’re crying because I’m leaving, so this is a big deal. So, I remembered like starting with my regular doctor and it was great, the birth was completely different but still ended in a C section, but I had a doula, this time for my second daughter, the entire birth situation was completely different and 100% Amazing, with my second daughter, It still ended in a C section because I got a fever and she, her heart rate started getting weird. But I went to the hospital at 4am and she was born at 8pm. 

 

P: Oh, that’s not so bad. 

 

K: Right. That was like my water broke naturally, I got to walk around and I was had her over the toilet because I my water broke and I went from like four centimeters to 10 centimeters and the time it took me to go to the bathroom and come back. 

 

P: Wow. 

 

K: Yeah, but it was like all fine. It was amazing. Completely different this, she still did ended up having to be a C section but she was, it was still fine, and

 

P: wait, how we feel about the C section after the fears about the scar.

 

K: Well, we were pretty sure we were not having any more children at this point. 

 

P: Okay, 

 

K: and my and my doctor was well aware of whole situation. We made sure she knew I apparently don’t heal very well, we need to be like extra clean and clear on what’s happening on the inside of my body, so I felt like I had a lot of confidence in my doctor, so I mean it’s obviously not ideal, but I can’t get pregnant naturally so that’s what how me and my husband were thinking is like, its gonna be fine because we’re pretty sure we’re at the time, we were pretty sure we didn’t want to go down this road again.

 

P:  Yeah, 

 

K: this is it, and this is going to be amazing and our family is complete, still have one more embryo, but we weren’t even completely sure that we wanted to use it, and we had talked about what we were going to do with it. So to me it was okay. Again not ideal, it wasn’t what I was going for. I was pretty damn determined to have her naturally, actually, all the way to the point of seeing her head, and my husband could see her head. The biggest difference was, by when we decided we were going to call it and do a C section. I kept having contractions this time. So, laying outside the ER, completely flat because I’m getting ready to go in and still having contractions and being on the bed with the sheet up and still having contractions like that part was weird this time. And because she was had really gotten all the way down there, they said they like had to go in and get her, and pull her out of the birth canal this time we’re just he was just like, right there ready to hold out I recovered from C sections pretty fine. I’d never, like, say that you can really tell, I don’t have this car like it’s fine. We Bring her home, but we have to make the decision, we paid for the storage for the second embryo for quite a while, and made the decision to donate it to science so we did that, and then, so my second daughter was born in April of 2018. So February of 2019. I start having really crazy stomach pains, and they last for like a week, but they’re weird and I tried, I tried every medicine you can name for every stomach ailment you could think of, we finally decided I’m going to go to zoom care, and just going to get checked out that we can a car but I figure that’s just for like checking for different things and the doctor comes in is like, I have good news and bad news. The good news is you’re pregnant. The bad news is, because you have a history of ectopic pregnancies, I think you need to go to the ER. So I leave there immediately and call my husband and start driving to the hospital, 

 

P: wait, let’s pause here for one second, I feel traumatized by this news, are you traumatized.

 

K; Oh yeah. Oh, and this is impossible because I can’t get pregnant. So, this never crossed my mind that this was what was wrong with me. 

 

P: Yeah. 

 

K: So I tell my husband in the exact same way. Great news. I’m pregnant. Bad news I’m on my way to the ER, because they’re pretty sure I’m having another ectopic, but the pain doesn’t feel the same, so I’m like, I’m confident that, like we’re catching it in time, like this is gonna be okay. So my husband meets me at the ER, and we are sitting in the ER at a table and I have a glass of water, and my husband watches me change color, and almost fall out of my chair which is the exact moment that my fallopian tube ruptured again. So he goes and gets the doctors, 

 

P: I hope you went and bought a lottery ticket after this. 

 

K: It’s my, my second daughter is the definition of a miracle pregnant. Yeah, because, literally every pregnancy before her, didn’t work, and the pregnancy after her. Didn’t work. 

 

P: Yeah, 

 

K: and they two on either side of her literally almost killed me. 

 

P: Yeah, 

 

K: yeah.

 

P: So you, you fold the ground I assume that helps you to skip the line of the ER,

 

K: you skip the line magically Yes, you instantly get a bed, which is pretty amazing. And they did a lot of scans, I feel like I was in the ER, a lot longer this time because it hasn’t had a timeframe so like it just ruptured. 

 

P: Yeah, 

 

K: so the process of bleeding internally and stuff is happening in hospital. I still get two more liters of blood. I still have all of that stuff happen. I know I have no fallopian tubes, so I really can’t get pregnant now, unless I were to do IVF again, which obviously I’m not doing the fact that it happened twice, I guess that never happens. Yeah. Never. And even the doctors at the hospital were like this doesn’t happen. You can’t have this happen two times. So I now have two beautiful daughters. And that’s it. 

 

P: Wow. 

 

K: Yeah.

 

P: So you this one the certain they did surgery immediately you recover more easily.

 

K: Yeah, I mean it’s the recovery is pretty the same surgery is done with it orthoscopic Lee Yeah. So, I already have the scars pre made for them they just have to go into the same place, and they take. Yeah, they take that one out. Also, though.

 

P: So, so no one can explain why this happens again,

 

K: I mean the only thought is that, you know I had a C section with my second daughter, so is it just that same thing, and I just really don’t feel very well. So, I mean that’s all we can think of.

 

P: Clearly Christie had a pretty unusual experience, and I’ll talk to Dr. Glenn a little bit about that in a second. But one of the other things that’s clear from this experience is that there are a lot of unknowns in this area of medicine, and we may never be sure about why these two ectopics happened. Having said that, it sounds like Dr Glenn may have a slightly different theory. One of the risk factors for ectopic is previous ectopic which suggests that people are having more than one. 

 

Dr. Glenn: Absolutely. 

 

P: So, is this unusual for you or what’s your experience

 

Dr. Glenn:  overall, you don’t see people with multiple ectopic pregnancies in a row, but since this is kind of my patient population is infertile. Then I see it at probably a higher rate than majority of providers, but yes definitely just like so many different things in medicine, the one of the biggest risk factors is prior history. And so prior history of an ectopic definitely increases your risk so if you have a history of ectopic, you have a 10% chance of being a second topic, so you have to make topics, you have a 25% chance. And that’s because an ectopic pregnancy is already telling you you have something abnormal with your tube, 

 

P: it’s crazy. That is totally crazy, and I would never have known that those are the only surgeries I’ve ever had and 

 

P: my experience with the infertility stuff is that they know a certain amount, but beyond that, they don’t really know what which is why would you say to me like I can’t get pregnant without IVF, I think, of course you can right they just, they didn’t find your problem so they don’t entirely know what it is and, 

 

K: yeah, 

 

P: my guess is that is most people right if you pass all those things right like I passed to and then it turns out I have an autoimmune problem, which we found in the pregnancy when I tried to kill my daughter right like but I was totally cleared, they said like, oh you’re sitting, you know, we check the five things we’re gonna check for everything’s in working order. Goodbye. Good luck, 

 

K; Right, it is no, even the conversation I remember sitting in the like seminar that they do for the fertility clinic where they talk about, you know, it’s like the little class you go to before you actually are a patient, it’s like to introduce you to this clinic and they go over how a baby, actually, is made craziness of how actual impossible. It is, 

 

P: yeah,

 

K: you don’t know that until you sit down and somebody tells you exactly what is happening in your body, to make this happen. Here there’s so many people.

 

P: Yeah, I totally agree. I’ve just seen response like how is any baby born, how does it work, 

 

K: how does anybody actually have a baby. Yeah, yeah, 

 

P: there are a million complicated steps so it is easy to imagine that like, you know, you will be able to pinpoint all of them unless you have some obvious problem. Yeah, you know you won’t know what’s going on, both of your daughters seem kind of miraculous. Yeah,

 

K: I mean, and I funny thing because we’re my daughter’s, you know she’s eight and we’re getting to the point where she’s asking some questions and I had this realization, laying in bed the other night that when she finally does want to hear the story and want to learn how babies are made. I have two amazing stories. Yes, they, she gets to hear how the story of her and she gets to hear the story of her sister. She doesn’t necessarily yet have to understand all the things that happened in the middle but they’re both two amazing stories, yeah, yeah,

 

P: that is amazing what was the eight year old into.

 

K; She wants to be a vet, 

 

P: that’s fun. 

 

K: Yeah, she’s super into animals, and she takes horse riding lessons and play softball, 

 

P: that sounds busy. 

 

K; Yeah. 

 

P: What about the two year old What are her latest tricks. 

 

K: so my two year old is our firecracker. She is 100%. And they’re, They’re very different personalities. So, my oldest name is Josie and my youngest is Cody, one is soft spoken and sweet and nurturing and loving and one is a terror of my house. Yeah. she earned it I guess,

 

P: yeah, she totally did 

 

K: oh my god she totally did. Yeah, 

 

P: that’s awesome. That’s a great, that’s a great and triumphant story.

 

K: Yeah, it’s pretty crazy. I feel like I should like be doing more things. I almost died twice, I should being doing something. 

 

P: Well you I mean you have had two amazing children that’s right yeah, but I think you should play the lottery. I think you really have like access to numbers that the rest of us don’t right 

 

K: something, there’s something, right, yeah. Oh, yes, 

 

P: your story is a huge story of triumph, right, it’s amazing that you guys are. Everyone, like your kids do not bear any of the marks of your experience, 

 

K: no, 

 

P: which is amazing, right.

 

K: Yeah, I have two very perfectly healthy children. 

 

P: Yeah, that’s awesome. 

 

K: Yeah, they I have scars and things and, you know, I have no fallopian tubes, but they are perfect. 

 

P: That’s awesome. Totally awesome. 

 

K: Yeah, it’s pretty crazy.

 

P: So let me ask you one other question if you could give advice to your younger self, what would you, what would you tell her

 

K; Don’t ignore stomach pain.. It’s funny because I so my, my thing now is always, I didn’t want kids. Oh, look at what I went through to make sure I had to. Yeah. Like, I clearly did want kids, and they’re definitely my proudest, most amazing thing I would never ever change. Yeah, super. Like it never goes as planned. Yeah, 

 

P: there’s no plan, there’s no, no,

 

K:  I had a birth plan with with my children, I wrote it all out.

 

P: Yeah, yeah. 

 

K: Nope. It would be having no plan, 

 

P: right, your body’s going through so much transformation there is the sense of a loss of control or all these things are happening inside you that you literally there’s nothing you can do. Yeah, so the birth plan sort of makes psychological sense at the very least to say, you know at the end of this long process. This is how it’s going to go.

K:  Yeah,

 

P:  at least in your mind, as long as you’re able to give it up in the last minute when it doesn’t happen.

 

K: Yeah, I think my biggest recommendation, this would probably because I know I know lots of people have different things but I was so sure that I understood the birthing process with my first daughter, that in the, in the room with me and my sister in law, and my husband, obviously. And after having her. I decided with my second daughter to have a doula. And the reason for having her was that, I then learned that I’m in the middle of a situation where I cannot be my own voice. 

 

P: Yeah, 

 

K: and I need somebody to be there to be my voice, who’s not my husband, who’s not my family member, but understands what’s happening, and can be a voice of reason and that’s 100% what she was,

 

P:  it makes sense to have an advocate, I think you don’t realize the first time that you will need one. Yeah, because you think I’ll be totally in control, which I know people do. Yeah, and it’s useful to have someone who’s seen 100, who can say like this is, this makes sense or this doesn’t make sense yeah that’s good advice.

 

K: Yeah, she was amazing, and I recommend her to everybody now, so having that person who will this person literally dropped on all fours in the waiting room so that I could lean on her to have a contraction. Like, that’s the person you want in your ballpark,



P: yeah, yeah, that sounds like good advice. Yeah. Awesome, well thank you for telling me your story. I’m so glad to see you looking very vital. And that’s all kind of behind you now. So I didn’t catch Kristi’s sign off on tape, but 



P: I’d like to thank her again for sharing her story and to Dr. Glenn for her medical insights, Christy describes her children as the miracle. And on some level that’s true to grow a child from seed is nothing short of miraculous, especially given some of her specific circumstances. But hearing this story I really think it’s Christy’s response to all these overwhelmingly challenging obstacles. That’s miraculous and I found it totally inspiring.  Thanks for listening. If you like this episode, feel free to like and subscribe to the podcast, you can find detailed show notes at war stories from the womb, calm, and if you’re interested in sharing your story there’s a place in the website to contact us. We’ll be back soon with another inspiring story.

Episode 27SN: How did We Get our Current Culture around Pregnancy & Birth: Ask the Historians of Science

Talking to my mother and other women from previous generations it sounds like they got pregnant and gave birth in a culture that’s different from the one we face today. Based on these talks, I have often wondered how we got to the specific point we are at: where pregnancy is a very medical experience, C sections are so common,  we seem to be just starting to talk more openly about miscarriages and the postpartum period, and women are trying to navigate the demands of breastfeeding and work. In today’s show I interview two historians of science to get a sense of how we arrived at this particular moment in which we find ourselves.

Dr. Judith Leavitt

Lamaze method

https://www.healthline.com/health/pregnancy/lamaze-method-pain-relief

Dr. Janet Golden

Audio Transcript

Paulette: Hi Welcome to War Stories from the Womb. I’m your host Paulette Kamenecka. I’m an economist and a writer, and a mother of two girls…I’m also a daughter…and from talking to my mother and other women from previous generations it sounds like they had a very different pregnancy and birth experience than I did. Talking to my mother I have often wondered how we got to the specific point we are at: where pregnancy is a very medical experience, C sections are so common,  we seem to be just starting to talk more openly about miscarriages and the postpartum period, and women are trying to navigate the demands of breastfeeding and work. In today’s show I interview two historians of science to get a sense of how we arrived at this particular moment we find ourselves in….

First I’ll talk to Dr. Judith Leavitt from University of Wisconsin and then I’ll talk to Dr. Janet Golden from Rutgers university about maternal mortality, and miscarriage and hospital births and breastfeeding, among other things

Paulette: Hi, today I’m excited to welcome my guest, Dr. Judith Leavitt, who was the Ruth Blier Professor of History of Medicine history of science and Women’s Studies and the Associate Dean of Faculty at the medical school, University of Wisconsin Madison. She’s the author and editor of many books about women’s intersection with public health and medicine in America, and 2010 authored a book about changes over time and a father’s experience of birth. I feel lucky to get to talk to her today about how we find ourselves in the current birthing environment. Welcome Dr Leavitt. 

Dr. Leavitt: Thank you very much. 

P: So I’ve been reading your book brought to bed childbearing in America 1750 to 1950, which focuses on the experience of women mostly white middle class but it includes some details about immigrant women and women of color. These questions will all come from reading that which kind of blew my mind, in part because it’s shockingly relevant. Regrettably, so the first thing I want to ask is that in our not so distant past maternal mortality rates were super high, (accurately counting maternal deaths remains a tricky thing to do, even today, but according to dr leavitt’s book, she writes, “the statistics show that deaths from maternity related causes at eh turn of the twentieth century were approximately 65 times greater than they (were) in the 1980s”) and I’m wondering if women looked forward at all to start doing families like they do today or was the threat of their health, Overwhelming Do you have any sense of that.

Dr. L: I think women were very aware of the fact that childbirth was dangerous, and they were aware of it, not necessarily because they knew about national rates or any numbers around that but they did know and had experience with women who had difficulty, and had come close to death with childbirth and they also knew women who had died in childbirth or whose babies had died in childbirth, so they were certainly very aware and I’m talking now 18th century and 19th century, very aware that child birth was dangerous, I saw that worry very much in their writing. And let me say that I read women’s diaries and letters, for the most part to get their own point of view at the moment that it happened not and sometimes in the, in their memoirs and memories of past events but a lot of it was very current in their minds and they were very eager to have babies. They were scared, because they knew it was dangerous, and I think some of the choices that they made about what they wanted for their childbirth, had to do with that danger fright, that they had. But they were just enormously eager to have children. Also, and it didn’t seem to lessen that eagerness, the fact that it was dangerous, dangerous I think it did influence their choices, a lot, and one of the points of my book, I should say is that I think women’s choices is largely what drew changes in childbirth history over time, used to be thought that doctors kind of forced women into the changes that happen, and doctors certainly played an important role, especially in the 20th century, but my contention in my book is that it was women who made the choices that they made and they made them as you started out this conversation by saying because they were fearful that they might die or might get into some serious physical difficulty in childbirth. And those changes, you know, I always thought, unfortunately tended to medicalize childbirth more than it might have happened, traditional childbirth was an event that happened in women’s homes, and women were surrounded by women, other women who had had children, their mothers, their relatives, their aunts, their cousins, and their friends. And it was around that female birthing bed that male physicians started to enter the 18th century,In those situations, most frequently they were invited in when women were having a long and very difficult labor, and they thought that maybe physicians could help. And it was forceps that physicians first brought to that helping effort, and many physicians said all they had to do is rattle the forceps in their pockets to get the women’s labor to progress more without them. 

P: A little adrenaline, sure…

Dr. L: And that’s right exactly, and that they were invited in for those difficult kinds of childbirth, normal obstetrics wasn’t called obstetrics The ticket was called childbirth was midwife assisted and friend assisted and it was a very female event, and the physicians that did come in the male physicians were those that could enter a female, environment, and survive many didn’t many got scared by all the women around the birthing bed and left. Really, not, not doing much, 

P:  that’s super interesting I guess I didn’t, it didn’t occur to me that there was selection in the types of births that doctors first attended. So I imagine their success rate was low in part because they’re at the most challenging births,

Dr. L: right, except that they did have some success, obviously, helping birth. But midwives had a lot of tools in their kits, walking women around keeping them, mobile and and vertical was very helpful to a lot of women as they tried to get thrugh labor so midwives, had a lot of things they could do did do successfully midwives, it was really among the most important medical practitioners in the colonial period in America, by far, and they did more than just deliver babies they did a lot of other things that, because they were the, often the nearest and the most familiar of the health people that a woman, or family could call, they did call midwives to do other things, midwives. There’s a wonderful book on a colonial midwife by Laurel. LAUREL Thatcher over, called the midwives tale, and in we get a lot of what we know about late 18th century, early 19th century. Midwives from that. One of the things that we learned that was, I think, something we didn’t necessarily expect to learn is that midwives kept very very full, gardens, a lot of herbs that they would use in their medical treatments and some, some having to do a childbirth with them having to do with other diseases as well. So they were, pharmacists, as well as healers, and they were really very important part of whole scene around health and disease in the 18th and 19th centuries,

P: as women moved to the hospital in the 20th century is that the death knell for midwives because I feel like midwives are not nearly as common today.

Dr. L: Well, midwives started to be replaced in the 19th century, so it was well still in the homebirth period that doctors wouldn’t be called increasingly for normal deliveries as opposed to difficult deliveries, and then it depended on who you were, how much money you had who you knew who you might call so doctors when they started coming to normal deliveries in the 19th century, they often came with midwives, that is midwives came and midwives might even call them and they’d be both of them around the birthing doctors are very kind of gradually taking over some normal births, especially urban ones in the 19th century, but it’s really in the 20th century when childbirth, moves to the hospital that midwives are most replaced by doctors and it’s really the midwives still in the south, well into the 20th century, in rural areas and in some rural areas in the north, especially immigrant rural areas but immigrants in the cities also might have tried to find an immigrant midwife who spoke their language and call her in before calling in a doctor before going to the hospital so midwives have been involved in childbirth. Always in American history, and are still. But as you know, a very small part but I think a slightly growing part of childbirth today, and it’s mostly, I think among some immigrant groups, Hispanic immigrant groups, for example in Texas are very user friendly to midwives and other rural groups. There’s a big Midwife center in Washington state, and is catching on around the country, again I think somewhat urban, as well as rural by a lot of middle class women who feel they have voice and who don’t choose to go to the hospital. So, midwives and birthing centers which are often run by midwives are increasingly used it’s still a small percentage of total births, but it is an increasing number. 

P: Yeah, on this podcast I’ve talked to a bunch of women, both from England and Australia, where it’s just a much more common practice to go to a midwife unless you have a complication and deliver birth there which I wonder if that contributes to their low C section or lower than ours. 

Dr. L: Probably. Yeah, wonderful book, new book on the history of homebirths that deals with 20th century home births and Midwifery, which you may want to look at by Wendy Klein. It’s really a good entry into that question. 

P: I’m wondering about all these journals that you read. If anybody talks about infertility, how that was handled.

Dr. L: If they did, I didn’t pay attention to it at the time I was looking at some I’m sorry, I think, I let me tell you that when I started this research, it was really very hard to find childbirth accounts everyone told me don’t even look, You’re not going to find anything people don’t write about it, it’s this kind of taboo subject even Well of course I knew that wasn’t true, but I, I had to find ways to find childbirth stories, and so what I did when I went to an archive for example is look at family papers, kind of scanning through family papers until it was a birth, and a child in the family. And then I would go back to the women of reproductive age in that family. Nine months or further to see their child birth experiences and when and how and when they got pregnant and so that’s when I found a lot of a lot of women writing about wanting to get pregnant about excitement about getting pregnant, and they wrote about, you know their excitement when they were getting married and their excitement that they would get pregnant and their excitement about getting pregnant. And those women I found because they had had babies so in terms of women who might have been infertile, I probably wouldn’t have found them in that way of searching, unless that same woman has some infertility issues in her, her own experience, Shannon Whitleycombhas written a wonderful book on the history of miscarriage and that is partly about insecurities

P: in brought to bed it says the women who did not lose any of her children either at birth, or in the early years of their lives was rare in 18th and 19th century, far more common to the woman’s experience was the necessity of accepting the deaths of numerous offspring. I was wondering if because that was such a reality if miscarriage didn’t get any attention. If it was you know relatively early like it does today because he was surrounded by the death of children.

Dr. L: No, absolutely, it did. In that sense it did but but the ones I was talking about were ones, women who had lost children they had live birth, yeah, yeah. So in that sense I was, I was not talking about those women and infant mortality was just spectacularly high. In those years, and women experienced that they sometimes didn’t name their babies until they were a year or  two old because they were worried that that would be kind of Jinx, their success and raising them, and very often they named babies, after baby who had already died,

P: that’s interesting

Dr. L: or a child who had already died so there was Elizabeth who was in the grave and Elizabeth who had just been born or had been born a few months before, when they were finally named so a lot of families, you know, made one of my it was one of my difficulties in searching out experiences because you might have had three Elisabeth’s in a family, and trying to figure out which one was the one that I might get a birth story from, 

P: yeah. Yeah

Dr. L: That’s hard.

P: Yeah, it’s hard to imagine that, I mean obviously we kind of know, we know that intellectually but it’s hard to imagine what life was like with those editions, and that threat.

Dr. L: Exactly. And there have been people have written about it as if women didn’t love their children until they were a certain age because they were afraid to emotionally commit. And I don’t think that was true at all. I think women committed. The incident of birth, most of them are certainly in the first year of life.

P: In my first pregnancy halfway through the pregnancy. Doctors found that I had an autoimmune condition that was attacking the fetal heart. And so for the last three months they kept saying she’s not going to survive, she’s not going to survive and I had this struggle, on the one hand, you might try not to get attached to the idea of this baby. Although you’re already very pregnant with her. On the other hand, I thought, That’s not realistic. I’m already attached, and there will be no way to dampen the pain by waiting to name her. I’m sympathetic to the idea that naming someone makes them more real and more embodied, not naming them doesn’t make them any less real For me, that idea I can connect to. I myself was not able to say, and she’s fine. By the way she’s so good 19 Freshman. Freshman in college. 

Dr. L: Good for you for sticking it out. That must have been very difficult. 

P: It was super stressful, but you know, not naming a child, you’re still in love with the child right there’s no, no getting around that. 

Dr. L: Right. 

P: so another thing you mentioned in your book is that, women moved to hospitals to deliver before the death rate in hospitals, actually dropped below the death rate in home births and you have that great graphic of urban versus rural death rates which will forever be emblazoned in my mind, and I’m wondering if that was an issue of failure to communicate information effectively, how was that gap created. 

Dr. L: No, it was the same thing I had talked about for the earlier period women were always seeking out something that was going to make their childbirth experience better. And they always thought that paying attention to what was the most advanced in medicine was going to help them the most. So that’s why they got doctors involved in the first place with with difficult births, it’s why they have kept doctors involved for normal births, so called normal verse in the 19th century. What was interesting, it wasn’t just give me everything you have, I’ll take it with the doctors, the women always remained very critical of what doctors would do they were, they wanted the forceps, but they didn’t want the forcepts. 

P: Yeah, 

Dr. L: they wanted something that anesthesia for example, women really really wanted anesthesia after the middle of the 19th century, and yet, they wanted to be the ones in control of it not necessarily give that control to doctors. So there’s constant push and pull between women and physicians, even though it’s women who wanted the physicians and what they had to offer. You can’t really think of this as something kind of straightforward, so the move to the hospital was part of that, that women thought that the hospitals would have something to offer and one of the things that hospitals had to offer was around the clock care, which women were having a harder and harder time finding at home, it used to be that relatives would come they’d move in for, you know, maybe months to help you around childbirth and early childhood for the babies and your sister would come and it would be easy, relatively easy to have somebody with you all the time for all the help that you needed. Well that became harder and harder as the 19th century wore on, as women were in the workforce more as families who are more mobile and moved away from their original family. So women had that real drive to look for some place that they could go and have care that they didn’t have to worry about. So that was a big part of it. Another part of it was the physicians once surgery was getting established in hospitals, physicians themselves were moving into hospitals, instead of doing office care and home care. So it was harder to get physicians to attend you if you wanted a physician. If you stay at home so that that was part of what women wanted and it was also that part of it was something physicians wanted it was a lot easier for them to have nurses on call and everybody ready and they just run in and hold out their hands and deliver the baby, where everyone else had done all the work so that was easier for them they didn’t have to worry about the horse and buggy, they didn’t have to worry about cranking up their early automobile they were set in the hospital and had a much easier time too, so it was really a push and pull from physicians and then from women’s  end wanting to move birth into the hospital, they didn’t, I think realize as you put it about that mortality might still have been high in the hospital that infection was still an issue in fact is a bigger issue in the hospital than it was home. If they knew about it, it wasn’t the predominant thing in their minds they were looking for what they hoped would be a safe experience with people who knew what they were doing around them. What they didn’t realize that first generation that went into the hospital and it wasn’t the whole generation obviously all at once. The first women who went into that school didn’t realize consciously, what they were leaving behind. They didn’t realize the female world that they had created at home, which had been such a comfort to them and had eased the birth transition so well. They didn’t realize they were losing that if they went to the hospital, hospitals, they labored, if you can imagine this we don’t do this anymore they labored alone delivery room obviously there are people around them, the physician and probably the anesthesiologists and nurses in the labor room they were mostly alone nurses would come in from time to time to check if they were dilating, how far dilated, they were to check that they were okay maybe offer them some ice cubes, maybe not even that. Otherwise they’d be alone. And that was really, really hard to make that transition from being in the comfort of your family and friends to being alone as they put it, alone among strangers that’s why I named my book brought to bear because in the early period women were brought to bed by their friends by their relatives by people they loved and who loved them. In the hospital, they were alone among strangers, women in labor rooms would talk about listening to doctors and nurses talking outside in the corridor. they might come to the door and look at you, but they wouldn’t really come in and hold your hand and give you the kind of comfort that you wanted and needed if you if  labor was going to progress. Well, so it was a very difficult transition in that sense, but as I say women didn’t know they missed it until they missed it, and then they missed it badly.

P: Yeah, no kidding that that sounds really dramatic I talked to a woman yesterday who was born in Britain but her family’s from Nigeria. And she was saying when she got home from the hospital, her mother was with her for living with her for a month and you know that her mother in law came and she was saying in Nigeria that is the common practice that exactly what you described, which is that someone moves in with you to take care of everything, and the mother’s feet are not to hit the ground and, which sounds kind of amazing and she herself was saying, it’s much harder to do you know that we live in England because everyone has a job. So, you know, my mom can’t live with me anymore because she has to go to work.

Dr. L: so I recreated that a little bit when I had my first child, I’ll tell you this experience, it was on the delivery table, literally the delivery table when I was pushing, I’m working so hard that I realized the birthing mother is the most important person in that room, and, of course, working the hardest of anybody in the room. And the story historically from her point of view had not been told we knew about the doctors we knew about the nurses we knew about the midwives, you know less about the nurses and midwives and we have since come to know but we knew about childbirth from the medical point of view and we did not know it from the birthing woman’s point of view. And that’s right there is where my book was conceived as my child was pushing her way into the world, I knew I had to tell, try to tell the story from my point of view my working hard point of view. And the other thing that happened which was totally inadvertent but quite wonderful. In my first birthing experience was that I was doing a Lamaze delivery which was in, in my day a little unusual, 

P: the lamaze method was developed in 1950 by a french obstetrician and it was a natural birthing technique that focused on regimented breathing for each stage of labor

Dr. L: and the nursing student class heard about it and wanted to come in and see it. And so I had about 10 nursing students around my bed, all female. So, other than my husband who was there, I had recreated without knowing it, the female part of the experience, and it did help they all saying happy birthday when Sarah came out and it was, you know, it was quite a party in that sense in the same way as it had been what we used to call social childbirth, it was a social childbirth and a female social childbirth. 

P: That seems fitting. 

Dr.L: Yeah, it was but I didn’t know it at the time.

P: Let’s talk a little bit about Twilight sleep if it seemed as though, women were edging away from that social circle that was so helpful. It sounds like Twilight sleep was just the end of that.

Dr. L: it was, but one of many things in the hospital that ended that Twilight sleep was seemed very very attractive to women women, as I found out who call themselves feminists who wanted to imbibe that they men, choosing the way they wanted to have birth. When I was a feminist writing this book, I was thinking of feminism as something that meant I controlled the birth itself and that was a slightly different use of the word feminist but they were feminist and they wanted to choose and they had heard about this method this we’re talking about the second decade of the 20th century, in the 19 teens, and they had heard about this childbirth technique in Germany and wanted to bring it to America, and basically it was giving the laboring woman, a combination of scopolamine and morphine which would morphine to dull the pain and scopolamine to help you forget it, and it would kind of put you into this totally relaxed state of sedation and not really knowing what’s happening to you, and you would deliver your baby and then you would wake up and some women who did that. I remember having had a baby they didn’t know they had had a baby, so he missed the whole thing, which for me was really terrible because I loved the whole thing, I loved it, not in the kind of romantic, fuzzy pink way. 

P: Yeah, 

Dr. L: but in a way that helped that I understood the power of my body in a way that I hadn’t understood it before I had a baby. And that was incredible to me that a body, a woman’s body can do that, and I wanted every minute of that experience I wanted to be awake and alert for it, which is why I didn’t want medications but in, in the twilight sleep. Example women wanted that medication wanting to forget it wanted to wake up with a baby and not knowing it and not having felt it, and they did that until they realized that the dosages in those early years of using scopolamine and morphine the doses weren’t well regulated were, weren’t well understood and some of the babies were very lethargic after being born and the women not necessarily in great shape themselves so it was something that fell by the wayside pretty quickly in that form, but was continued to you be used once they understood dose medication, well into the 1960s. You may be still being used in places, my sister in law had a scopolamine Birth in the 70s but it was a way to medicate women without them, understanding it as medication per se. I think anyway they liked it and they came to the hospital for it so yeah they ended up one of the things you did under the effects of it was thrash about a lot and so they would put women into these into bed, high Canvas sheets so they couldn’t see and they couldn’t fall out, which also, you know freaked me out because you’re really alone in that environment, and I didn’t like that but they loved it, so.

P: Yeah, it sounds like horse blinders I’m not for that. And do you have any insight on abortion was it handled by midwives, was it a political issue, or the 18th The 19th 

Dr. L: well, yes and no. I mean, in traditional societies and including our own life was not seen to exist before quickening between the 16th and 20th week of pregnancy. So until a woman felt movement, you didn’t worry about that and yes women tried to get abortions if they didn’t want to have their babies and they helped each other do that. Midwives sometimes helped some, some absolutely refused to help, and doctors got into the act and helped, and then some also absolutely refused to help, until the late 19th century was seen as perfectly fine for quickening because it wasn’t seen as you had life yet. Technically, so people did it and, and the problem was finding a way to do it successfully. And of course, there weren’t a lot of very successful remedies. Then, and the same with birth control, you know, they tried all sorts of things for birth control and weren’t necessarily successful, 

P: that is super interesting to see how many historical lines from the past are still totally relevant today.

Dr. L: I do think that we are re experiencing many of the things we as individual women are really experiencing many of the things that women in the past have and we have some of the same concerns they may be manifesting slightly differently today but they are. There’s a lot of a lot we can learn from women in the past.

P: Yeah, the issue of control is so, fundamental to every woman who talks about her story about control over her bodyand almost everyone universally says, when they feel a loss of that sense when things are being done to them, it feels terrible and not natural and, and that seems true forever and I can see why women fought so hard to have people with them.

 

Dr. L: People with them and to make birth plans, even though a lot of women know that the birth plans can get thrown out…maybe too easily. They make them and they, they put a lot of stake in them, because they really do think about what they want in a childbirth experience, and of course many doctors really try to give them that. And pay attention to their birth plans and help them with that. And others just say dear, dear, I know more about this than you do, don’t worry just put it in my hands. So, you know we have those experiences, right away first in the hospital in the early 20th century and we still have today. You know, it’s something that we can look back on and see how did women, those women who kept control how did they do it. Yeah, and we can learn from that.

P: Oh, thank you so much for taking us on this tour of where we’ve been and hopefully where we’re going.

Dr.L: Well thank you for asking me. I hope that was useful.

P: Yeah, it was great. Thank you

P: and now a little bit more on where breastfeeding fits into the current day picture:

A special welcome to Dr Janet golden, a professor at Rutgers who specializes in the history of medicine, history of childhood, women’s history, and the American social history. She’s the author of several books, including most recently, babies made us modern how infants brought America into the 20th century, which is a very intriguing title, thank you so much for coming on Dr. Rosen. 

Dr. Golden: Oh, thank you for inviting me. 

P: One thing I want to talk about today is breastfeeding and sort of how we got where we are now culturally, I think there was no push to get my mother to breastfeed, as opposed to my kids when I, when they were born, there was an enormous push to breastfeed. So I’m wondering if you could kind of walk us through how we got here.

 

Dr. G: All right, that’s it, that’s a great question and I think we can say that there’s a very long history of forces, promoting breastfeeding and forces opposing breastfeeding, it’s very different in the United States than in other places, of course, where, just as an example. The French were very concerned to promote breastfeeding and for reasons of health because they were being outnumbered by the Germans and they wanted to build a strong healthy population that can then it becomes out of fashion to breastfeed everybody wants to have a wet nurse or send a baby out to a wet nurse so there are constant changes in this history 

In the United States, you know for most women in the early centuries of what we will call United States history, you pretty much had a choice of breastfeeding or using animal milks which weren’t as well formulated as they might be today, and most people simply didn’t have the means to purchase them out to maintain it properly if they did purchase it, they didn’t have refrigeration so breastfeeding was really the way to go until these canned formulas developed and then the formula companies jumped in and said get rid of wet nurses. Feed your baby the scientific way and go with melons, baby food or go with Borden’s condensed milk in a formula. So there was pressure in the other direction 

P: is that like 1950s When is that?

Dr. G: that really gets going in the end the first formula is get going in the late 1860s 70s 80s 

P: Oh, Wow, 

Dr. G: so they start pushing that only a few people can afford it, of course, the breast, but breastfeeding begins to look unscientific and so there’s, you know, we start selling the, the sugar formulas that go into the milk formulas, and of course once you have running water clean water indoors, you have electricity or gas heat to boil things, it just becomes a lot safer to do that. Now obviously, there is some controversy when formula companies are promoting these powdered formulas in countries where people don’t have access to clean water, low income they have to dilute the formulas so they’re not healthy for babies but we’re not, we’re not going to talk about that so we’re really gonna say that by the post war period 1950s Breastfeeding is just out of fashion it seems primitive It seems something that poor women do. The modern scientific ways is to bottle feed, and then it’s very precise you can measure how many ounces did my baby, drink some baby books had you weigh the baby before you fed the baby and then feed the baby and see how many ounces, they took in, and then people began to push back against that and saying no. Why should this commercialized enterprise these be in charge, why should medical authority dictate over what’s natural for women, let’s go back to breastfeeding and of course there is good scientific literature that says it’s, it’s a better alternative, you know, cows make milk for calves women make milk for babies, you know it’s it’s a natural correctly designed product, but of course not everybody can do it and not everybody wants to do it so we live in a world now where two things are true. One is that I think we can stipulate that scientifically medically speaking babies are better off drinking milk, designed for babies, which is from human females, But we can also say that. Secondly, we live in a world where we get clean water, we can properly prepare our formulas the formulas are well designed, and not everybody can or wants to breastfeed their baby so both things are true, and we’ve gone in the direction of making it easier to promote breastfeeding in hospitals, maybe a little too pushy on that as you can explain, and we’ve also reformulated to use a bad pun there are our WIC program and other things to support breastfeeding and we’ve put in, in places that employ large numbers of people we put in stations where women can pump their milk store their milk etc so we’ve made it certainly made it easier to be a breast feeding person, but that that has, I think shaded over for some people to be almost a command, and making people very resentful and unhappy with that, you know, I guess we live in a world where everything is polarized nowadays even taking care of infants.

P: yeah, That seems to be the case and a lot of women describe how they expected breastfeeding to be easy, because it is natural, but I don’t know that those two things go hand in hand, and once it is difficult, then there, then they think it’s something that’s wrong with them and all of a sudden it’s a comment about their ability to be a mother…after you give birth, that is the first thing that you’re doing. So, it’s challenging to have the first thing be something that’s not necessarily super easy. Do you have any sense of how common it is to have trouble breastfeeding.

Dr. G: I really don’t know because I think I’m sure there are studies on that I’m sure it’s difficult in the beginning I believe it’s harder for women who’ve had cesarean sections and have had some anaesthesia in their system, I believe it gets easier with second and third and fourth. So on children. But certainly, initiating breastfeeding it’s often better done if you have a mom or a support person who can get you through it it’s, it can be, you know it can be painful. Problems do develop you need support breastfeeding may be natural, your body may be designed to do it but that doesn’t mean you necessarily know how to do it. Some infants have trouble sucking latching on, you know it’s not, it’s not a perfect and easy thing to do, but I think what makes it so hard for people is the, the weight of expectations and judgment, you know, we live in a culture, I think it’s fair to say that the easiest people in the world to pass judgment on are either people like us who we feel we can do better than other moms in the, in the hospital with us or in the birthing center with us, and then people who are different from us and who behave differently from us and we can say oh they’re different and there’s something wrong with them. And oftentimes that judgment is really about women and about mothers and about child rearing. And that I think makes it all the harder, all that judgment that goes on and, and political divisiveness,

P: Yeah, and what I find, talking to people is that it’s not always on the surface, sometimes it is a it is a buried expectation that you don’t realize until you don’t meet it. Many women have come on the show and talked about how breastfeeding is the super painful and difficult thing and the latch didn’t quite work and the baby wasn’t getting enough milk, but it was still hard to give up, Because her expectation was, you know, good moms breastfeed.

Dr. G: Right. Just like when other women wanting to breastfeed and the 50s and the expectation was you’re a bad mom. Because you’re not buying the most up to date formulas and the fancy bottles that go with it. So, if we took the judgment, out of it. I think it would be easier for people to breastfeed it would be easier for people who didn’t want to breastfeed to bottle feed, it will be easier for people who want to partially breastfeed and partially bottle feed to be comfortable with that, but there’s the idea that we, that we have to pass judgment on this and make people uncomfortable about their choices. It’s always been that way, but it doesn’t have to be that way.

P: Well that’s interesting to hear that that is always the case so even when the pendulum swung the other way and people were being discouraged from breastfeeding, you were made to feel bad if you breastfed.

Dr. G: You were made to feel bad and there are many many stories of women who said I want to breastfeed my babies and the nurses would would only would start the babies on bottles without telling you so it was hard for them to latch on and then they would only bring you the babies every four hours even if babies were hungry and they’d cry themselves to sleep, and then they start wiping down your breasts with alcohol and other antiseptics. Oh they made it, you know, because it seemed like you were doing it seemed dirty if I can put it that way to put your baby on a breast and when you could have a scientific bottle that was you know had been sterilized to the right degree and gotten out all the germs so. As difficult as women today have it who choose not to breastfeed and get judged by nurses or by their friends or their doctors, it was a different way, maybe 50 6070 years ago.

P: That’s sort of shocking and I guess I don’t know whether I would call that marketing exceedingly creative because suggests that the scientific way is to do something that’s made in a lab, as opposed to what your body has produced, that’s sort of amazing.

Dr. G: Well, that you know we were very into measurement. So, how much is your baby weigh how much did How big was your baby how fast is it growing so if you can measure how many ounces your baby drank and write that down, which a lot of moms had charts to do that that just seemed like a very scientific thing to do.

P: Yeah, that that’s fair and I’m sympathetic to that and actually I don’t know if you’ve heard of a company called hatch. No, they have a very special changing pad with really sensitive monitors in it so that you can weigh your Baby and breastfeed and weigh them again, and it’s there’s an app on your phone and you can check it out and and it is for that purpose explicitly because so many women who breastfeed say I have no idea how much they got or if they drink anything or you know what’s going on so it’s funny that science has come to meet that demand another way.

Dr. G: Right, well, you know, our medical world is always in part about marketing, They’re very much intertwined, because you can sell people on science, whether it’s the science of hygiene and cleanliness or it’s the science of measuring your baby for a time women, middle class, upper class women were encouraged to buy scales and weigh their baby every day and write it down you know because measuring is science. So, and then the marketers got very into this our department stores have infants departments, they used to have nurses who works there who would tell you the right things to buy and give you medical advice so you know that that the world of science which has brought us many, many wonderful advances is also about the world of marketing which has brought us many, many products and they do get tied up together and help to sell each other.

P: That’s shocking to hear that there were nurses at department stores, impossible to imagine, and I guess a great way to sell stuff. 

So let’s talk for a little bit about these baby friendly designated hospitals, the impetus for this came from the WHO World Health Organization, 

Dr. G: right, it’s a worldwide effort

P: in the 90s, and then I’m sure it looks different here than it does in other countries, in 2007, it says that less than 3% of United States births occurred in 60 Baby Friendly designated facilities, but by 2019 28% of births are in 600 Baby Friendly facilities and Baby Friendly is a designation you get if you follow this 10 step approach to encouraging breastfeeding, but it sounds like it’s almost aggressively to the exclusion of anything else. 

Dr. G: Well, I would, I would say two things about that one is it’s fascinating to see how much it’s grown and I’m sure that has a lot to do with the marketing of the hospitals, right, if you have health insurance and you pick that hospital, because it’s a Baby Friendly Hospital and you like it, you’ll continue to bring your insurance cards when and go back to that hospital so that’s that’s good for the hospital. It is probably good for hospitals to move away from promoting bottle feeding to supporting breastfeeding, that how aggressively they do that, I would assume is to some degree determined by the, the nurses on the obstetrics floors, and how seriously they promote breastfeeding over bottle feeding, and if you think about it from the nurses perspective, if you have rooming in and a mom can pick up her baby and breastfeed on demand, then that’s a lot less work for the nurse taking the baby back to the baby part of the hospital and feeding the baby, him or herself. So there are all sorts of incentives built in for the hospitals for the staffing of the hospitals for the baby, certainly, you know if you’re going to support breastfeeding, which is a good thing overall, But how you handle that I’m sure it’s very idiosyncratic, and it may depend on whether you have the night nurses or the day nurses and are they new hires are they the older hires how they feel about it.

P: Yeah, it’s interesting to see sort of what’s developing and just so interesting to me that there’s this cultural shift that happens you know almost on its own cycle, where it goes back and forth. So, can you imagine at some point in the future where breastfeeding will be out of fashion.

Dr. G: It may well change because now, you know, now we’re beginning to see what uh what environmental pollutants are in women’s bodies and in breast milk so maybe they’ll have formulas that don’t have those pollutants and we’ll move away from it. When we talk about breastfeeding we’re talking about the health of a woman and a baby and a family and workplace issues and social issues and environmental issues, and it all gets encapsulated in this tiny realm of Will you or won’t you breastfeed, but there really so many bigger surrounding issues is breastfeeding supported by do we have six months of paid family leave in this country. No we do not, you know, that might be a better support for breastfeeding or partial breastfeeding, then what happens in a Baby Friendly Hospital or a baby unfriendly hospital if we want to label the other ones

P: that oh that sounds much more expensive, potentially, potentially much more helpful but much more expensive. 

Dr. G: Right. 

P: The other thing that seems tricky about maternal health and newborn health is that I feel like it has not received as much medical attention. You know all the issues that come with pregnancy, many of which remain a black box preeclampsia we’ve known about for hundreds of years, we’ll still know kind of how that works. So it’s, it’s tricky to see what will be the lever that will encourage a shift in one way or the other to change.

Dr. G: Right, I mean we still have many many women who’s who are uninsured. 

P: Yeah, 

Dr. G: even with our expanded Medicaid and programs there. We have undocumented women, who I believe if they call up a center, they can get prenatal care, and they’re supposed to not wait more than six weeks but in fact I think there is not enough services for them, their children are going to be Americans. They’re here. And yet we’re denying them a kind of Healthy Start There are so many complicated issues around pregnancy and birth that are much more expensive as you say, not necessarily harder to solve because the rest of the world seems to solve them. But if we don’t have those conversations then we bring it back to this individual well that mom didn’t breastfeed or that mom should breastfeed or why is she fully breastfeeding and leaving the baby formula when she goes to work We’re talking about individual decisions, but we’re not talking about the structure in which they’re made. 

P: Well, so you bring up a good point other than vastly more generous medical supports that other countries give their women. Is there any do you have any sense a theory about, you know why culturally in America, you know postpartum care is one visit at six weeks, and I as far as I can tell, you know, after you’ve been through, almost 10 months of pregnancy and an exceedingly challenging delivery, you could, you could use care before then, but we, but we don’t do it that way. Do you have a sense of like, what else is driving those differences between US and other countries.

Dr. G: Well, you know we have a for profit healthcare system. So, I believe that if you’re an insurance company said, Is there any data to say you need continuing care that, you know, first year after giving birth. Well, no their baby will go to the pediatrician and you as the mom, you’ve had your one postpartum visit you’re done. Why do we have to pay for another visit for you. So we have that problem right there. Yeah. And, and I think that there’s just a sense of, you know you’re you’ve become. you go from being the vessel for the baby you deliver the baby then the baby is going to get that the S chips care the Medicaid care the private insurance care the clinic care, but you as the mom you’re kind of done to your next pregnancy I guess, Or your annual gynecological checkup. We don’t and so we have a very high maternal mortality rate in this country as a result of that, but we have a strong tradition, really, I would say from the post world war two period of saying, everything is a private matter, you know, It’s for you to go to your doctor. It’s for you to decide if you want to be pregnant or not pregnant, we don’t, we don’t have a system that says, we have some responsibility to our citizens and non citizens who are here and who should have good healthcare.

P: Dr golden thanks so much for coming on and talking to us today. I feel like I’ve learned a ton.

Dr. G: Okay, well it’s been wonderful to talk to you.

P: Thank you again to Dr. Judith Leavitt and Dr. Janet Golden for giving us a sense of the factors over time that have come together to contribute to the pregnancy and birth culture we have today. Thank you for listening, and if you liked this episode, please consider sharing the podcast with your friends.  The next episode is a return to a birth story…and this story is really, in some sense, a loveletter to becoming a parent–it showcases the many challenges that sometimes have to be overcome to get there…

Episode 26 SN: The Press of the Postpartum Period: Dana’s story

Today’s guest sailed pretty smoothly through the process of starting a family–she got pregnant relatively easily, carried her pregnancy without too many hiccups and gave birth in a way that wasn’t too far from her expectation–and then she hit a breastfeeding wall, which likely contributed to her experience with post partum depression.  Now she’s focused on helping women build a better relationship with their bodies.  She clearly articulates the mental and emotional struggle so many of us experience as this process transforms our bodies into something new we’ve not experienced before, and aims to guide women to a more compassionate understanding of all the amazing things our bodies do. Today’s episode is a little different from previous episodes because not only do we talk about my guest’s experience, but because of the work she does, we also discuss the press and pressure of postpartum expectations many women have, and talk briefly about one route out of what can be a really challenging fourth trimester. 

You can find Dana, and more about her work, at wellnesslately.com

To find more about Dr. Golden‘s work, click here

Breastfeeding research

https://pediatrics.aappublications.org/content/145/4/e20183696?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3A%20No%20local%20token&utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=Pediatrics_TrendMD_0

https://www.sciencedirect.com/science/article/pii/S0974694312000163

Audio Transcript:

Paulette: Hi Welcome to war stories from the womb.  I’m your host, Paulette Kamenecka

I’m an economist and a writer and the mother of two girls who taught me very early on about my lack of control over the process of growing a family. Today’s guest sailed pretty smoothly through this process–getting pregnant easily, being pregnant without too many hiccups and giving birth in a way that wasn’t too far from her expectation–and then she hit a breastfeeding wall, which likely contributed to her experience with post partum depression.  She’s focused her work on helping women build a better relationship with their bodies.  she articulates the mental and emotional struggle so many of us experience as this process transforms our bodies into something new we’ve not experienced before, and aims to guide women to a more compassionate understanding of all the amazing things our bodies do.

In this episode, I include a brief clip from my interview of a professor of the history of science, because she provides some historical context for our current cultural understanding of breastfeeding.

Let’s get to the conversation.

Hi, thanks so much for coming on the show, can you introduce yourself and tell us where you are.

Dana: Sure I am Dana Baron, I’m an intuitive eating and body image coach and I’m in exotic suburban New Jersey outside of New York City. Yeah and I help women to basically escape the diet mentality that keeps them trapped and cycling through restrictive diets and then binge eating and emotional eating and beating themselves up and really build body image resilience. So that’s the work I do

P: That sounds like we’ll have a lot to talk about. excellent.

D: Yeah. 

P: So let’s talk a little bit about pregnancy, before you got pregnant, I’m sure you had the image of where it would be like, what did you imagine you were stepping into

D: I imagined I you know coming from the sort of, quote unquote wellness industry I imagined the pregnancy glow, and just feeling like a goddess of fertility. And, you know, just being absolutely enamored with my body and the miracle of life and all that kind of stuff it was not the case for me I’ve had two I’ve had two babies. My oldest is three and my youngest is 17 months so, 

P: oh wow, 

D: something fresh for me yeah,

P: good Lord well, people listen to you can’t see, but you don’t look like you have two babies in the morning. 

D: Oh, 

P: you look rested and you know there’s a lot of work at that age, so

D: yeah, I’m glad I look rested, we are. Everybody is sleeping through the night so 

P: oh, nice

D: that is a huge, that’s, yeah so I do get regular sleep but yeah I mean in COVID preschool clothes, no babysitters coming running a business, so it has definitely been a wild ride over here so I’m glad I look rested.

P: Yeah, my kids are older, my kids are teenagers and you know my younger one just got her license so 

D: Wow, 

P: I’m Literally completely superfluous, which is, you know, he relatively easy and COVID, so yeah but my sister has young kids and so I think about your cohort, a lot like, oh my god imagine.

D: Yeah, I mean, on the one hand the physical like manual labor is endless. At this point you know even my three year old can barely get himself dressed just yet. We did potty training in COVID all of that but, so that is a lot but I also think about, you know, the older kids, all the things they’ve missed and all the things they are grieving right now and certainly being setback academically like I, I’m glad I didn’t have to teach my kids math that would have been a real issue for all of us. I think there’s different challenges and especially, you know, a teenager just getting their license I’m sure there’s a whole new world of emotional and anxious, navigating, you know, at that age because right now they’re just always kind of home with me and safe under my care but you know they go out in the world, it’s a different, a different type of exhaustion, I would assume.

 

P: Yeah, you know, I have two girls and they’re both extremely competent. And so, I’m not super worried, you know, they’re both really cautious so the real thing would be they get pulled over for going too slowly or something, you know, 

D: that’s me. 

P: Yeah, me too. That’s me a good problem to have. Yeah, so let’s talk about your experience did you get pregnant easily.

D: I did, I actually think in hindsight I don’t I don’t think I knew enough at the time but we started trying, maybe in November and I do think I had a very very very early, not even pregnancy detected yet miscarriage because of what had happened with my cycle that month and that was the first time we tried and then, you know, the, I think a month after that I was pregnant or, you know, six weeks or whatever it was so.

P: Oh good Lord I’m glad it happens that way for some people because we all have that story in our head and, and it seems like it may not be true but it is so yeah, thanks for that. Okay,

D:  yeah. 

P: And how was the pregnancy.

D: It was very straightforward and no complications besides for sciatic stuff after you know after I guess that’s more postpartum but yeah it was really straightforward and I was really lucky to just both of us healthy, the whole time 

P: Good

D: and I know she’s was your vision for the birth, something you experienced. It was, I come from a long line of nurses, half of my, you know, half of the women in my family are nurses two of them labor and delivery nurses. Wow, so I always just expected a hospital birth, an epidural, sort of the straightforward Western medicine so I didn’t have. I definitely run on the anxious side especially, I lost my father at 18 and it’s sort of very quickly and he wasn’t sick, it gave me a little bit of my girl syndrome so like a little hypochondria. So I always feel safe around medical establishment. So in my sort of anxious line of thinking I just wanted to get to the hospital and get the baby out safely. That was the sort of the only thing in my mind I didn’t have any expectations really 

P: well that’s like a smooth way to do it.  What was the birth like did you have contractions and did you know what they were like What was all that like,

D: yeah, so I never went into labor, my OB practice basically schedule you for an induction if you were eight days past your due date, that was just what you agreed to when you went to this practice essentially so it was, I never went into labor, my best friend came out of the city we watched the Office all day on my due date I was like wait, I had no idea what to expect, and I just never went into labor so I went in they scheduled me for a Monday evening, to go in and get, I don’t know cervadil or whatever the, yeah, yeah, well one of the first stage of it but when I went in, they realized that I was like a centimeter or two dilated, so they said we’re going to skip that just go to Pitocin. So, I was given Pitocin and about 930 at night, and then I by one I think I asked for the epidural. I didn’t know what to expect and I, my aunt had my aunt who is a labor and delivery nurse said that if you do have to be induced. You might want to just be able to walk around as long as possible because once you do get an epidural now you’re in the bed, and you don’t know what’s going to happen, you could be in that bed for 18 hours so 

P: yeah, 

D: so I just kind of had that in my mind and then at some point I just said, You know what, and they checked me and I was moving along pretty rapidly, so I just got it at that point and then I think I pushed for like an hour and a half, maybe, and he just kind of came right out by 7am So it was a very quick. 

P: That’s awesome for a first birth 

D: yeah, it was great. I think I got like one stitch it was, it was very straightforward. I was very relieved. 

P: That’s awesome. And then, how long did you say the hospital? Just a day, or?

D: I think we got lucky, because here I don’t know if your audience is global, but here in the states you get like a certain amount, 

P: Yeah, 

D: from one. And we, oh I think it was like if you checked in. I forgot. Anyway, we got the longest amount possible so I think I was there two nights. Yeah and it was really interesting because my grandmother was actually upstairs at the same hospital like going through the process of the end of life. 

P: Oh wow

D: So she got to come downstairs and like me so we were all, it was a very full circle moment because my entire extended family was coming in and out of the hospital to be with my grandmother and then to come, you know, check on me too, so it was very I mean this is obviously all pre COVID

  

P: yeah, yeah, yeah, Yeah, That is kind of special and unexpected. Huh. And so two days after the baby’s born, you’re sent home. And what does that feel like was the fourth trimester.

D: It was sort of bewildering, the first really the first change in the emotional space around it was that they very quickly realized that my son wasn’t getting enough nutrition. I was trying to breastfeed. And, you know, I was so out of it, it was sort of like an out of body but you know the pumping wasn’t working his latch wasn’t happening I wasn’t they didn’t seem to see any colostrum, what does that colostrum? 

P: yeah, colostrum

D: So it was devastating to me sort of like 233 o’clock in the morning when the nurse comes in to check and he’s, you know, he’s not. He doesn’t have enough output, so they’re like we have to we need to give him formula he needs to eat this is too long and I was just like, I was beside myself I like just I never imagined that happening, I don’t know why, in hindsight is, feels ridiculous to me in hindsight but I just was so attached to breastfeeding, that was sort of all you hear when you’re pregnant is how good for the baby and my mom and my aunt and everybody my family breastfed it and I’m here I am like in the wellness industry, you know like, and it just wasn’t working so the first like that there was something so devastating about watching this nurse and stranger, give my son his first bottle in the middle of the night because the baby needed to eat and I was not doing well. And I just remember my husband and the nurse standing there with their backs to me like feeding my baby and I just was so like I felt like I had already failed. 

P: well also in your case where everything else had gone smoothly, you think Oh I can I can trust this, this is a process that’s working right. So, do they give you like classes or have a have, lactation consultant

D: we did it all. We did it all they had the lactation consultants in and out my aunt, my mom everybody squeezing my boobs all day. I even went in and I was just so attached to this you know I went in. My mom and I brought him back in maybe like five or six days later for like a lactation specialist and this is like a big Regional Hospital. My mom worked out for 40 years, there’s plenty of support and care here right. They have a whole team there, I went in, they measured the baby, they we breastfed on both sides we measured the baby again like trying to figure out exactly how many ounces and I was basically producing like half an ounce from one of my breasts, and I had had a breast reduction when I was 20, which the work I do now it’s like a very interesting to have done. So they told me, but I was, you know, 20 years old I wasn’t thinking about breastfeeding and the surgeon was like I cannot guarantee like I have to tell you that this could interfere. For most women, it’s not an issue but it could prevent you from being able to produce enough. So I’m kind of assuming that that’s what happened. So all those things combined I don’t know why it was so shocking to me but, yeah, so it’s like coming home my husband having to Google the right formula we had no bottles. It was, yeah, it was a mess. So, yeah.

P: And then, it sounds like you got that sorted or what was that process like

D: yeah I mean, about three and a half, four weeks of doing the. Yeah, in hindsight it’s very interesting, doing the skin to skin breastfeeding. And then I’d have to give him a bottle, and then I’d have to pump. And this was around the clock because I was told that you know you got that first few weeks of a window to get a supply going, and it just wasn’t happening.

P: You want to get into the weeds on breastfeeding, you could argue that it starts in puberty when the breast is being formed and is subject to all kinds of influences, but let’s fast forward to birth. Once the placenta is birthed, a bunch of hormones shift your breasts gear up for breastfeeding on demand, but what’s required for successful breastfeeding is the coordination of physical and biological factors. Essentially, you need to breastfeed, to be able to breastfeed because the process releases more hormones that encourage milk production. A study in the journal Pediatrics from 2020 collected all the most recent research about breastfeeding and said that colostrum that thick early milk, usually comes in in the first days, but that milk changes after a few days and consistency and volume. The authors here say that most women, and I put most in quotes, get the second stage of milk supply within 72 hours after birth, but that about 35% of first time mothers didn’t really get this milk in until four days or more after delivery. This delay could be linked to a first birth C section or a higher BMI, or things like gestational diabetes, or the Apgar score for the baby. But for a fraction of women between five and 8% this milk doesn’t really come in at any volume and for these women, the theory is that there might be something wrong with the breast architecture, or it could be consequence of breast surgery, or a hormonal disruption like an issue with the thyroid or PCOS. For more information check out the show notes.

D: And I was just at this point, you know, anyone has that a newborn. Breastfeeding bottle feeding and then pumping, there’s literally no time in between that, 

P: yeah, yeah

D” So I basically haven’t slept in three weeks. Can’t let go of this and finally, like it was like my mom and my husband had like an intervention with me and my aunt came up from North Carolina and it was just like, you can just feed this baby formula like Don’t miss this whole newborn phase because of this like it’s okay to let go of this struggle, and I was just I was a mess. Mess, you know,

P: well also not sleeping at all doesn’t in any way contribute to like a happy, balanced, you know view of the world. So, 

D: yeah, 

P: I’m sympathetic to that. And I’m impressed that your family, many of whom are in the labor and delivery world are supportive because I hear so many stories about people who say, Oh, the nurse said, you have to breastfeed or I don’t know, people just feel the pressure and I, I guess I’m assuming is coming apart from medical establishment. Maybe I’m wrong. Tell me.

D: well, I think I think there’s a I mean, at least in my world there’s that general consensus like even if you don’t want even if you just don’t want to breastfeed, like that’s your right as a woman and a mother and I understand the push for it right to because there’s sort of like, there’s been a sea change around the thinking. But what about the mothers who can, what about the mothers who don’t want to it. Where’s the space for them, especially in the prenatal care, everything is about breastfeeding. There’s no at least in my experience, there was no and if it’s not your choice to breastfeed, here’s how you find the right formula. Here are the different bottle options there isn’t any of that. So you really feel like you’re failing on a profound level as a woman I found maybe that was just my mentality I’m sure not everyone has the same experience but the old I have a generation of women in my family who– do curse on the show. And if you don’t want me to. They just, they could care less about anybody else’s opinions, and they just thought I should just give it up like let go of it like you just need to take care of yourself to like you don’t need to be attached to this. So, yeah,

P: so that sounds awesome that you were supported. And did you, you know, it’s hard to let go of something that you have, you know, packed away in the back of your head and had for a while but it sounds like you were separated from the idea at some point. And what was Do you remember that what that was like did you feel freed were you, you know, was it easy.

D: It was an epic relief. 

P: Okay, good

D: My husband could do middle the night feedings and I could sleep friends could come over and help you I could leave the baby for more than a few hours. So once that relief flooded in I was over it, you know, pretty quickly at least consciously I was over it pretty quickly like it felt like a relief for sure.

P: That’s awesome and it is, it is a lot of pressure. and I hear a lot of women say, No, I was told every woman could breastfeed.

D: yeah

P: it’s what Your body does. So yeah, 

D: and it’s so much better for the baby, that’s all you hear. 

P: Yeah, yeah, 

D: and then my grandmother. Yeah, go ahead. 

P: Sorry. Go ahead you can tell your grandmother story

D: I was just gonna say she told me, like, in her age, she had too much of a supply but everyone was telling her that the formula was better so she was like, You’re never get they’re never gonna let you get it right, so just do what you need to do for your family and your sanity, basically,

P; that’s a totally interesting perspective. It just so happens that I recently talked to a professor of medicine about the changing cultural appreciation of breastfeeding, I want to include a small clip from our discussion right here, a special welcome to Dr Janet golden, a professor at Rutgers who specializes in the history of medicine, history of childhood, women’s history, and the American social history. She’s the author of several books, including most recently, babies made us modern how infants brought America into the 20th century, which is a very intriguing title, thank you so much for coming on Dr golden. 

Dr. Golden: Oh, thank you for inviting me. 

P: One thing I want to talk about today is breastfeeding and sort of how we got where we are now culturally.

Dr. Golden All right, that’s it, that’s a great question and I think we can say that there’s a very long history of horses, promoting breastfeeding and forces opposing breastfeeding. In the United States by the 19 post war period 1950s Breastfeeding is just out of fashion it seems primitive It seems something that poor women do the modern scientific way is to bottle feed, and then it’s very precise you can measure how many ounces did my baby, drink some baby books had you weigh the baby before you fed the baby and then feed the baby and see how many ounces, they took in, and then people began to push back against that and saying no. Why should this commercialized enterprise these be in charge, why should medical authority dictate over what’s natural for women. Let’s go back to breastfeeding and of course there is good scientific literature that says it’s, it’s a better alternative, you know, cows make milk for calves women make milk for babies, you know it’s it’s a natural correctly designed product, but of course not everybody can do it and not everybody wants to do it so we live in a world now where two things are true. One is that I think we can stipulate that scientifically medically speaking babies are better off drinking milk, designed for babies, which is from human females, but we can also say that. Secondly, we live in a world where we get clean water, we can properly prepare our formulas the formulas are well designed, and not everybody can or wants to breastfeed their babies so both things are true.

P: So why did you, you want to walk us through like how you got to the other side.

D: How I got to the other side of the of the breastfeeding situation., 

P: yeah 

D: Yeah, I thought it was, I thought it was quickly, I thought I was cool, but then I had some like late onset postpartum depression. When you’re in it you don’t recognize that that’s what’s happening. I also think my circumstances played a role in in I, you know, nobody was really around during the week, we had moved close to my mom, but she hadn’t retired yet and she had a sick boyfriend and a dying mother so she just wasn’t she couldn’t physically be there as much. And my husband was commuting and out of New York 5:30am to 730 at night. And so I was just home all winter isolated with this baby, and, you know, it looked like a lot of watching Outlander in my bathroom all day, not realizing that that was not normal. 

P: Yeah, 

D: cuz I just didn’t. I just I sort of felt like this really culminated in the early spring when I just told my mom I felt like I didn’t have anything to look forward to, like I was just so overwhelmed, taking care of this kid, losing myself, having no time to even shower, let alone like have pursuits or a career of my own things like that. I remember I used to like knowing what time my husband would come home, that’s when I would like put normal clothes on so that he wouldn’t like worry about me. 

P: Yeah, 

D: and I think when my best friend who’s single and has this very adventurous sexy life in New York as an actor and comedian, she came out to see me and was just like none of this is okay, like what is going on here and I was just like, Well you never had a baby, you don’t understand she’s like, I have seen plenty of people with babies and like you are not okay. And I just, I just didn’t realize it and in hindsight, my husband, seemed to think that he was on top of it because he knew but he never discussed it with me and my mom is of an old school generation that’s not super open to therapy and mental health care and was just kind of like it’s the baby blues so you’ll get through it, you know, so I was pretty annoyed by all that. But I think moving to a new home having community around me it becoming spring getting involved in baby class activities and meeting other new mothers like just being out in the world again. Certainly was sort of how I got through it like I just think moving to a new place, and honestly spring I always have a little bit of seasonal depression, just before kids too, so I think it was just sort of like I certainly didn’t do anything proactive to get out of it. Unfortunately, I didn’t even really recognize it until it was in hindsight.

P: Well, kudos to your friend and you articulated really well that it’s hard to see when you’re in it. 

D: Yeah, 

P: which is a great explanation for why most people may not usually help comes from the outside because you’re not in a position to be proactive. 

D: Yeah. 

P: So, this regrettably sounds like an all too common story where many people are sent home from the hospital told they have to breastfeed, there’s no other way. And it doesn’t work out for one reason or another, and they just feel terribly. and there are bunch of other things that contribute to women feeling overwhelmed in the postpartum period, taking care of themselves and a new baby, maybe taking a break from work, and that world they knew well, and dealing with your post pregnancy body, whether it’s fatigure or brain fog or pregnancy weightSo can you talk to us a little bit about like what your work is focused on and how maybe you help women in this circumstance.

D: Yeah, I mean, so we generally work with women around their relationship with food and body. And from my perspective, a contributing factor to the postpartum issues women face is the pressure we’re putting on ourselves to return, quote unquote, to this pre baby body this expectation of losing the weight quickly getting back into exercise very quickly. And I think that that contributes to this feeling of failure because especially with your first child. It is such an overwhelming experience that you literally don’t even have time to shower so how you going to prep keto meal plans or whatever the hell you’re trying to, you know what I mean. Yeah, so there’s this added layer and I think what’s really sad about it is that it’s not. It’s a moment that we dread for our bodies. Typically, and it should be a moment of celebration its a rite of passage like this becoming like this journey from made into mother should be celebrated, and instead we have hardly any support in any area and there’s all these different ways that we’re already, it’s sort of baked in that we’re not going to meet these expectations in some way, whether it’s breastfeeding or being able to stick to a diet or whatever it is. So we really help women around, letting go of the diet mentality in the first place so that they can actually nourish themselves instead of restricting themselves, and also starting to see our bodies as more than a body, right, like we are full human beings and our bodies deserve respect and appreciation and care and nourishment, even if we don’t currently find them beautiful right so it’s a really it’s a, it’s mostly a shift in perspective, this is all an inside job as opposed to, like I said meal planning or something like that.

P: That seems super valuable and super useful and now that you’re talking about this, I do remember being worried getting pregnant that I’d gain all this weight, which. And what would happen after and you know who knows why, then, so I definitely somehow I’ve gotten that message too. Do you have a sense of like where it comes from or like how we change it, you know, more broadly.

D: Yeah I mean it’s a narrative of diet culture. The diet culture that we live in and this expectation that women’s bodies are never supposed to change. Right we’re battling our bodies from puberty on most of us in our culture, battling weight gain which is very normal in puberty and then, you know, pregnancy, it’s just this idea it’s this narrative we all subscribe to because of our culture and the way that we were raised, and it tells us that we should have the same body after children that we had before, which, if you really think about it like all women’s bodies do is change throughout our lives. And this idea that we’re all supposed to get back like where did your body go What do you mean you have to get it back like you’re still in your body it’s just this new version of your body. Right so again it’s the expectation thing right like there’s this myth we’re all living by that we’re supposed to look the same, our entire adult lives like why do I have, you know 38 After two children, why would I expect to look like I did when I was 17 before I had children or even if children are involved, you know. So it’s really just starting to wake up I think media literacy is really important and also just waking up to this narrative that we’re all living by right like I think I’m supposed to get my body back. Like what does that mean why, you know starting to ask those questions.

P: Yeah, when you see it that way it does not take account of all the massive changes that pregnancy brings and watch a dramatic change in everything is wrought by pregnancy as if it’s this easy thing that you just 

D: bounce back from, 

P: yeah. Oh my god. Yeah, that is kind of a crazy story that I can’t imagine who wrote that script because somebody who never had, who was never pregnant is my guess

D: I always pictured Don Draper 

P: poor Jon Hamm….

D:  So handsome. He’s doing fine…

 P: I’ll worry less about him… It does, it does sound like a, like a 1950s ad executive kind of thing to sell diet pills or some something crazy right that does not,

D: well yeah I mean, you know this, I think it was Naomi Wolf who says like this, these a culture obsessed with female beauty and this is not her direct quote but it’s not about beauty, it’s about obedience right if women spend all of their time and energy and resources and mind space, trying to control their body that doesn’t want to be controlled, then they don’t have that time energy resources mind space to look up and recognize that there’s so much wrong in our world that if we use those resources, maybe, like what would the world look like if women didn’t diet.

P: yeah, That’s amazing. That is a really good question because there is a lot of a lot of energy. I can imagine that is super prominent in the postpartum period and I hear a lot of people say that they did have body image issues when they were pregnant, and I, I’m not sure I had body image issues but I definitely said to my husband as I started develop a belly, I’m doing this wrong, this can’t possibly be what’s supposed to happen because I’ve never heard anybody talk about how weird this feels and how strange I look right this is such a weird feeling

D: I couldn’t wait to fit in to pregnant to maternity clothes because I felt like that in between, I was, you know, with my first pregnancy, it’s like you just don’t look like yourself. 

P: Yeah, 

D: but you don’t look that cute pregnant look at, you know, and just the fact that we all think about this so much as is the problem, right. 

P: Agreed

D: But yeah it is and I would say that we, you know, the postpartum space is really is really vulnerable and I think a lot of times what happens is women come to us after that and are thinking that they, their whole battle against food in their body is a lot of times wrapped up in wanting to get their body back right like wanting under this illusion of control that we have that we can eat our way back into our pre baby bodies right and that comes up a lot in pregnancy is a massive body image disruption, right, just like trauma can be a body image disruption or illness or, you know, a comment from your mother or something about your body right there’s so pregnancy and childbirth alone are massive body image disruptions because your body is so foreign to you after you give birth, right, nothing is in the same place nothing feels the same, you know, and I think, especially if you are breastfeeding, you feel like your body’s not even yours anymore, so it’s sort of this out of body experience. So, you know, working to heal that body image and to start to respect your body for everything it does and is outside of the way that it looks right and I’m starting to think in terms of body respect, especially when it comes to what’s going on in your brain. How am I speaking about my body, how am I speaking to myself about my body. That’s really sort of where the work is for sure. 

P: That’s amazing. That sounds so valuable. I have never heard anybody else talk about it in the terms that you’re using,

D: really. 

P: Yeah and it’s, I mean not maybe because I live under a rock like. But, but it is like now that you’re saying this I realize all the stories I’ve been telling myself are basically the wrong thing right. I’m not sure I I’m like not organized enough to do, to stick to a diet, or, you know, eat 1000 calories a day or something crazy like that but, but I definitely, I definitely have that voice, I definitely have that voice telling me to Oh, don’t eat

D: it would be uncommon not to have that voice right because we have it from the beauty ideal side but now we also have it from the medical and wellness industry side where we have these food police and we’ve moralized food choices right we think we’re good or bad around eating clean and dirty all these things so there’s, there’s a lot going on in our brains about food and our culture for sure there’s a lot of anxiety and guilt and shame around food choices.

P: Is there any international example where you think they’re doing it right. 

D: Wow. Not that I know of no so there’s an interesting study done in Fiji, a while back where you know the culture there had historically preferred in terms of beauty ideals, a more robust figure food and eating and being in a larger body were seen as a positive thing. And then Western, they got Western television, and basically eating disorders were virtually non existent in the culture there, and then they got Western television and eating disorders skyrocketed they’re seeing the girls on 90210 Right, so the beauty ideals shifted. And it’s become a problem there as well so I think any corner of the world where Western culture and media has reached, because these are European beauty standards right that are really impacting everybody in terms of their body image. So, yeah, there’s a lot tied up in it but not that I know of, maybe, you know that I’m sure there are so many cultures that haven’t been touched by Western culture at this point but not that I know of. 

P: Is there any other measure of the degree to which we’ve strayed from, you know, just have a healthy body other than like eating disorders, any other way to recognize like oh this is like eating disorders is a clear measure that we’ve done something wrong.

D: Yeah, so we look at it as like and I think it’s interesting because I think that the issues around alcohol have some parallels here in terms of we no longer see it as an alcoholic or not an alcoholic, there’s this gray area spectrum right of substance abuse, right. And I really believe that a clinical eating disorder. The difference between that and actually you know just the average woman who diets is really just the behaviors and the mind and the thinking is very similar, right, but it’s the frequency and severity and percentage of time and energy right, so I like to look at it as a spectrum, right and most women in our culture have dieted or will diet at some point in their lives, and it’s really, it’s not a question of like do I have an eating disorder or not, but the average woman diets, I think the latest data I’ve seen is 25 to 60% of her time each day thinking about food in her body. 

P: Oh, that’s a crime

D: that’s just the average woman that diets right because someone’s suffering from anorexia could be dreaming about it 110% of the time, right, yeah. That is the mind space and the energy we’re talking about here and that is just the average woman who’s googling Paleo Meal Plans. Right, so it is something that impacts everyone really and essentially it’s anti fatness, it’s a fat phobia that we have, and it’s just drilled into us, you know, from, from the womb, basically.

P: So what would be a healthier mind space for like to think about food just obviously this is a long term project and you can, you know, if it could be crystallized in a sentence, we don’t know what it was but, like, just give me a sense,

D: yeah sure so intuitive eating and Health at Every Size, are the framework that we work with and intuitive eating is essentially eating based on your body and your body’s cues, instead of what’s going on in your brain. Right, 

P: so that seems like retraining, 

D: it is if you look at a toddler dieting yet or hasn’t had their food controlled, they eat when they’re hungry they stop when they’re full. Many of them eat a variety of balanced foods right and they just listen to their bodies. 

P: Yeah, 

D: we’re the ones who have all these rules in our heads and really the dysfunction begins when we try to make our bodies something they’re not right, our natural genetic makeup has a weight setpoint determined by our genetics our bodies want to be in this certain range healthy and whole. We try to manipulate that and that’s where the dysfunction begins right it’s the binge eating the emotional eating the diet rock bottom of like, I can’t stick to it was 30 days now it’s 10 days and that was one day and now I’m just thinking about starting a diet all the time I’ve never actually dieting, and you feel addicted to food you feel out of control certain foods are off limits you’re cutting your food groups down to nothing, right, and all of this is sort of in the name of health, but at the end of the day, it’s really about weight, and everything tangled up in that for women, which is a lot

P: I’m grateful to you for doing this work because that sounds like literally your audience’s everyone, and 

D: yes, yes, well a lot of mothers for sure. Oh it is it is 

P: as I mentioned before the phrase bounce back is like she’d come with like a trigger warning or something because it, I definitely that’s planted somewhere in me. So I know that that is out there a lot. And,

D: yeah, I mean all we see is celebrities how they lost the baby weight all over every magazine like women’s weight somehow makes national headlines, Adele Gwenyth gaining weight and in quarantine, I mean, the world makes our weight news. There’s a global pandemic we’re talking about Adele’s weight. So like, of course, we think that, of course, we think about our body, our own bodies and, and whether or not we’re going to be able to lose the baby weight or the pandemic weight and all that stuff. 

P: Yeah, that does seem like a colossal waste of time and energy for the person who wrote the article the personal research theoretical everyone who’s reading it right, 

D: a lot of money to be made, though, as you know, the stuff about what is Wait comes out at the same time she promoted the book about I’m not even gonna say the title because I don’t want to trigger people into. 

P: Yeah, yeah, yeah…

D:  that’s what you follow the money and it’s a $72 billion industry that selling things to women to change their bodies and all the mind space and energy follows.

P: yeah, At the same time you’re supposed to have a beautiful pregnancy to the you know, 

D: goddess of fertility, no hemorrhoids no sciatic pain, none of that. 

P: Yeah, no kidding. That, that is such a de legitimization of, you know everything you’ve actually gone through. 

D: Yeah, absolutely. 

P: If you could go back and talk to your younger self and give her advice. What do you think he would tell her.

D: Just stop messing with your body and just eat. I mean I came to this word through my own struggle with disordered eating and body image and the term that comes to mind the most for me is waiting on the wait, like not feeling qualified for the life that you want to live or the person you want to be until you reach this expectation in your brain about how your body should look or be, and it’s usually not something that’s attainable for anybody because we know from our own lived experience and from the research that we can’t actually manipulate our weight, so just let your body be, stop messing with yourself is what I would say you know and to really stop seeing yourself as an object and be in a dynamic relationship with your body so that when things like illness or pregnancy or weight gain happen, you still have the same level of self respect and self worth that you had in a smaller body.

 

P: So, that’s amazing advice. Thank you so much for coming on and sharing your story, Where can people find you if they want to dive more deeply into this work that you’re doing. 

D: Sure, so we’re at wellness lately.com We have a free masterclass at wellness lately.com slash masterclass that will take you through the five shifts to start to relate to food and your body differently to start to heal from this diet rock bottom that you might be in. So that’s why obviously the.com slash masterclass and everything can be found on our website.

P: That sounds amazing. I’m going directly. 

D: Fantastic. Yeah, 

P: thank you so much for talking, I totally appreciate our discussion. 

D: Yeah, thanks for having me. This is great.

P: Thanks so much to Dana for sharing her story and for her work to help women appreciate their bodies in whatever size and shape they find themselves in. You can find more about Dana’s work at wellnesslately.com And thanks also to professor Golden for her insight about the historical context of today’s breastfeeding culture. 

 
Thanks so much for listening. If you are listening in the car or on a walk, when you get home, feel free to like, subscribe, or write a review…we totally appreciate views because it helps other people find the show…
 
 
If you are interested in the idea of “how did we get to our current culture around pregnancy and breastfeeding, tune in for the next episode where I interview two professors of the history of medicine and we talk about how ideas about pregnancy and miscarriage, epidurals and breastfeeding have changed over time…to land us in the spot we find ourselves in today…

 

Episode 25 SN: This Birth led to a Skydive, a Triathlon, and an English Channel Crossing: Gill

This episode could be titled “Overcoming: A Guide”.  My guest overcame the challenges of premature birth, and a fourth degree tear, and a misdiagnosis, and a fistula and a stoma. Having had so many elements of her life overturned by her experience of birth, she was reborn in a way, as a complete badass tackling every physical thing that previously induced fear in her. She’s challenging all the ideas that have created limits on her life and in the process, raising awareness and money for others who have experienced birth trauma and changing our perception of what life with a stoma can look like. I’m also lucky to include the medical insights of a fantastic OB, who happens to be the co founder of an organization called Beyond Fistula, helping women in Kenya who are working to overcome their own challenges with obstetric fistula.

You can find out more about Gill at: https://www.stomachameleon.com/

You can find out more about Beyond Fistula: https://beyondfistula.org/

Thank you to artist Nancy Farmer for the beautiful cover art. For more glorious pictures of swimming and light in the water, see : www.etsy.com/uk/shop/WaterDrawnArt
or: www.waterdrawnart.com

What’s a Show

https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/signs-that-labour-has-begun/#:~:text=A%20%22show%22%20can%20signal%20the%20start%20of%20labour&text=It%20may%20come%20away%20in,cervix%20is%20starting%20to%20open.

False labor

https://my.clevelandclinic.org/health/articles/9686-true-vs-false-labor

How common is tearing?

https://www.rcog.org.uk/en/patients/tears/tears-childbirth/

Stoma

https://www.webmd.com/colorectal-cancer/colostomy-stoma

Sepsis

https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12623

Audio Transcript

Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka This is Episode 25, which feels like a milestone of sorts, and as such, I have a particularly powerful story today. I’m inspired by the women who share their stories with me, because these stories showcase strength and resilience that often the women themselves didn’t know they have. Today’s guest is an amazing example of this, and this episode could be titled overcoming my guest overcame the challenges of premature birth, and a fourth degree tear, and a misdiagnosis, and a fistula and a stoma. Having had so many elements of her life overturned by her experience of birth, she was reborn in a way, as a complete badass tackling every physical thing that previously induced fear in her. She’s challenging all the ideas that have created limits on her life and in the process, raising awareness and money for others who have experienced birth trauma and changing our perception of what life with a stoma can look like. I’m also lucky to include the medical insights of a fantastic OB, who happens to be the co founder of an organization called Beyond fistula, helping women in Kenya who are working to overcome their own challenges with obstetric fistula.

Let’s get to this inspiring story. 

Hi, Thanks so much for coming on the show, can you tell us your name and where you’re from.

 

Gill: Hi. Yes, sure. So my name is Gill Castle , and I’m from Northern England on the border with Scotland 

P: nice, lovely How many kids do you have?

G:  I have one I have some who, a little boy who’s nine and a half. 

P: Oh wow, that’s a fun age, 

G: yeah yes I’m just striking out getting out, or wanting more independence. So, yeah.

P: So Gill before you had kids I’m imagining that you had some ideas about what you thought pregnancy, like, what did you imagine it would be like,

G: oh, a piece of cake. You know, I was fit and healthy, I’m not an ill person, so I don’t do illness, I don’t get ill, you know, don’t really get colds, never had chest infection, you know, there was just, yeah, Well, I was going to get pregnant, and I was going home, baby. And that would be it really. Pretty much.

 

P: Okay, well it’s a good way to go into it, I guess, as good as any. And did you get pregnant easily.

G: Yeah, I did actually didn’t take long at all. Basically, that we tried for a couple of months, My husband worked away. He then went away and came back and we got pregnant, and literally the day came up. 

P: Oh wow, well done. 

G: Yeah, yeah, I mean, and the reason I know this is, it was some sort of freak chance because my period was due. Three days later, and it never came. And I mean I don’t really know how that even works but the child has definitely his. 

P: Did you find out with like a home kit?

G: Yeah, we just did a, just from the supermarket. 

P: Yeah, 

G: and get the whole pee on the stick thing and there we are, the two lines I can’t even remember now….if it’s two lines or cross or whatever. But anyway, I was pregnant. And, yeah, and I remember actually my husband not being sort of I mean he didn’t like jump up and down. He’s not a jumping up and down kind of person anyway. Yeah, but he, he was just like, alright, well yeah. 

P: Taking it in stride. Okay. 

G: But it’s still quite exciting. Yeah, yeah.

P: I’m assuming because you’re in England, you plan to go with a midwife.

G: Yeah, well, in in England. Yeah, well, Yeah, we have midwives, but you don’t, well you’re meant to have a dedicated midwife throughout your pregnancy, but not necessarily they’re not the ones that are at the birth but yeah, it was just going to be midwife. I was going to be an uncomplicated pregnancy so I wasn’t high risk or anything like that, but there was nothing really, you know, to cause alarm, to be honest for pregnancy, so yeah that was just the plan just to be with a midwife and just give birth in the, in the hospital in the city,

P: was the pregnancy easy? did you have, you know morning sickness? or 

G: no not the only thing I did have which I would actually rather have morning sickness, none whatsoever…because I had a couple of bleeds, which obviously is really, really stressful, so I had a couple of early scans, but they were always absolutely fine. But yeah I mean I didn’t get heartburn. I didn’t get stretch marks, mind you, that’s probably because I, I gave birth six weeks early so I missed out on that final expansion of the stomach. But yeah, no I was really, really fortunate I was, I was absolutely fine I’ll continue walking. I continued working as well, it was no problem, 

P: and then, you said you delivered early so, so what happened there?

G: So what happened was I was a police officer at the time, and I, we were working seven days on, and then four days off. I just finished my seven day set, and I was woken up the following morning. And it was exactly seven o’clock in the morning because I remember looking at the clock woken up at seven o’clock in the morning with a really sharp pain, which I now know was a contraction. And this was six weeks before my due date, so I just had this really sharp pain, then it stopped, and I went to the toilet and there was like just a little bit of pink on my underwear. And I thought, it’s a bit weird but you know it wasn’t in any, any discomfort like the pain it just disappeared. 

P: Yeah, 

G: so I left it for another hour and a half and then I had another contraction. But again, you know it wasn’t, you know it’s just like a quick kick in the stomach isn’t it, so I just thought, oh, oh. Whoa, that was strange, so I rang the early pregnancy unit at the local hospital and explained what had happened, and they said oh right, you’ve had a show, which is what the pink discharge was in my underwear

P: Show is part of the mucus plug blocking the cervix that starts to come away when labor is starting. It’s liberation from your vagina means that the cervix is starting to open. It might contain a little blood, which is why it’s pink

G: And yeah, you better just put on get checked out but you know we’re not worried. Just just come along and I told my husband, who said, Oh, but I’m about to go and get my haircut. No you’re not. We’re going to the hospital. There was a pause as we  both looked at each other and then he was like, right okay we’re gonna go. Yeah, we took all the hospital bags off we went. And I was put under observation, and they said oh you know, you might be having contractions but they were really, really far apart, you know, an hour and a half apart. They said, You know, we’re just going to monitor you. We’ll see what happens if you progress, but what it might be, is false labor. 

P: Yeah, 

G: so there’s my order was written just completely stop, and then you’ll go home. Yeah, so I sort of had this in my head that this was all just fake it was all false wasn’t gonna go anywhere . That was our that was, I was fine, really, was doing my knitting, and I wasn’t really, I don’t know why I wasn’t bothered it just wasn’t, I wasn’t concerned. 

P: I have to say I’m impressed that you brought your husband along I would definitely have dismissed my husband thinking like to try to make it so.

G: Yeah, yeah. Well, I think, number one, I don’t like driving into the city anyway, and the parking at that particular hospital was an absolute nightmare. So, and it was sheer, good luck and good fortune that he was there. Yeah, cause he works away, and he was actually due to be back until two weeks. But I think the week before the baby was due. So he just happened to have come home, and he was due to leave again a couple of days later. So, I mean if this had happened a week later he would have been on a boat in the middle of the North Sea, unable to come back. So yeah, that was one of the lucky things, not many lucky things but that was one of the,

 

P: so you’re at the hospital, and how long are you there and they’re monitoring and like what what’s going on.

G: So we got there about nine o’clock in the morning, I lost track of time really. All I know is that by, say, two o’clock in the afternoon, I was in established labor, and obviously the contractions have been getting closer and closer together. And because I was in early labor they needed to monitor the baby, so they had lots and lots of wires and things were strapped to my stomach and I couldn’t get off the bed I couldn’t walk around, couldn’t get myself comfortable at all. And when I was really in full swing of labor, I remember saying to the midwife. Oh is this. Oh, is this actually labor. Am I having a baby today, and she said oh yeah you’re very much having a baby, you’re going to have a baby really quite soon. And I was like, Oh, I just couldn’t. I couldn’t quite get my head around what she was saying, so so so yeah that’s when I sort of realized mid afternoon that I was on my way to have a baby, 

P: That is kind of shocking especially the way they treated you when you came. 

G: well yeah you know just, I mean they did sort of laugh in the delivery, delivery suite and my husband did as well because to them it was obviously really really big but I was, I just kept saying, oh this console and I did sort of say, oh thank God for that because I’m not coming back in six weeks time and do this all over again. Better be a baby or the other. All right, so by about four o’clock in the afternoon. That’s when I was in, I was in the grip of it all, but, as in the UK it’s probably similar in America but in the UK we have the opportunity to write a birth plan. 

P: Yeah. 

G: Which is nonsense most of the time isn’t actually level, level gets followed but now for one reason or another, and I’ve forgotten. I’ve written in my birth plan that I didn’t want to have any pain relief until I asked for it. 

P: Yeah, 

G: because I thought well I’m going to be the best judge of what I need, and I don’t want people given it to me too early. I want to be honest for as long as possible because then I’ll get the maximum benefit from the pain relief…I’d forgotten that said that. So then I was thinking well I don’t want to ask for pain relief, because they’re not giving me any, so they mustn’t think that I’m fat enough yet to be given pain. So I was laboring away but I’ve seen no gas and air with absolutely nothing until eventually I said you know, pain relief yet, and we’ve been waiting for you to ask it’s on your birth, no it’s not that you are like, Oh my gosh. Anyways, well you can try gas and air but we don’t think, you know, I think you’re a bit far gone for that and they were right. 

P: Yeah, 

G: I took a bit of gas and air and I was like well, for quite a lot, basically said This is rubbish. But then that’s when it all started to get a bit complicated because, obviously, you will know this but when a baby’s born, it actually has to help itself out with a birthing canal, at the end. 

P: Yeah, 

G: but because was only four pounds seven and he was tiny, he, he got tired, was exhausted, and he was back to back as well. So, his heart rate dropped, and then all hell broke loose. So I just remember all of us in numbers there’s loads and loads of people there, and they said right we’re gonna have to get you into theater give you an epidural and and get this baby out. You know, they said, no time to do a C section or anything like that we’re just gonna have to get the baby out. But they didn’t really say that quite as explicitly as that. I just remember lots and lots of people, and just the conversation of right we’re going to theater. And, you know, we’re going to get the baby out

P: that’s super interesting to me that they said like, this is an emergency. There’s no time for a C section, because I would imagine that vaginal delivery would take longer. 

So I brought this question to a doctor. Today I’m lucky enough to talk to Dr Matityahu who’s an amazing OB and the co founder and executive director of beyond fistula, an organization in Kenya, that helps women who have encountered fistulas in childbirth. Her organization helps women heal and rebuild their lives working out social and economic issues that these injuries can create, and she actually introduced me to Gill–an introduction I’m entirely grateful for. Hi Dr Matityahu thanks so much for coming on the show.

Dr. Matityahu: Thanks for inviting me again I love speaking with you and I love everything that you’re doing to inspire other women so thank you.

P: So one question I have is Gill talks about how they say, we’re gonna have to get this baby out and there’s no time for a C section isn’t C section the fastest way to get the baby out.

Dr. M: I mean it’s either C section or vacuum or some people will still do forceps. If the head is crowning and you can, and it’s right there and you can just sort of put a vacuum on the head and gently pull or put forceps on and gently pull and get the head out within a minute or two, then you would do that if the baby’s head is a little bit higher up and there’s no way to immediately encourage delivery and C section.

G: Well, you would have thought, you know, but they, I mean, considering that I went into theater, and it took three attempts for me to be given the epidural. 

P: Yeah, 

G: because they couldn’t get it in my spine. And I do remember being absolutely petrified at that point because of course they say you know this is really sharp needle, you have to keep as still as possible, because it’s going in your spine. And, I mean, there I am sitting on the bed holding a pillow to try and keep them but having contractions and trying to keep reliving, I mean, so, I mean it took them three attempts and then they finally got it in as soon as I got the epidural in. I Do you remember how she lined back and sort of going, Oh, right. Hi everyone. Hi, nice to meet you, sorry I’m not normally that awful, I’m horrible. I’m really sorry and, and I looked at my husband and I said oh have you been here all the time. And he said he was absolutely gutted, because he was starving, he said, You mean I could actually let you go and got something to eat,

P: so they get it in and then do you have a long period of pushing or are you already ready to push or how’s that all work.

G: To be honest, I don’t remember any pushing at all. I don’t remember anyone saying anything about pushing to me. I remember literally just lying back and saying hi everyone, and then they fiddled about, and then they brought out this baby. 

P: Oh wow, 

G: literally, literally, you know, and I remember they sort of reduced this white mucousy covered while baby, literally in front of us, and I was a bit like oh and then he was whisked away straight away to where they put them on the side and the works on him. We heard him crying, so I wasn’t, I wasn’t that concerned, and they had said you know, we’ve, we’ve given you the steroid injection, because the lungs are the last thing to develop in a baby so we’ve given you that to his lungs when he was grunting which is fairly common with newborn premature babies. Anyway, he was taken off to special care and that’s when I was stitched up and really that’s when the catastrophe happened

P: they take the baby and he’s off. You said he’s like four pounds seven ounces, something like that, yeah, yeah, that’s a pretty decent size for thirty four weeks

G: Yeah, that’s right 

P:  the person’s dishing up is an OB. Yes, she was a consultant, and she’s the one who told you that situation.

G: Yeah, so, so they said, you you’ve sustained a tear. And so while you obviously the epidural is still working. We will, she’s going to repay it. So you just lie there and she’s going to repay you. And, you know, don’t worry about it. You’ll then go back on the ward and be reunited with your baby. But because I couldn’t feel anything, because I’d had the epidural, I really had nothing to worry about. I mean, I was kind of aware that women could tear giving birth but I didn’t really know anything about I didn’t really understanding, to be honest, the significance of having a tear on the extremity of the tear, of course. 

P: How common is tearing?

Dr. M: tearing is pretty common, we grade the tears by numbers so a first degree tear would be a really superficial tiny tear in like the vaginal mucosa or some of the tissue around the entrance of the vagina. A second degree tear is probably the most common, and it’s sort of through the vaginal mucosa and and through some of the muscle, and a third degree tear and they call it a partial or a full third degree tear is a tear that goes through the vaginal tissue and into the sphincter around that the rectal sphincter, so it’s a tear that’s either a partial sphincter tear or a complete sphincter tear is a third degree sort of partial third degree or full third degree, and then a fourth degree tear is a tear that goes, again, through the vaginal mucosa of vaginal muscle through the rectal sphincter, and in addition, through the rectal mucosa so it’s a tear that goes right through and into the rectum, that’s a fourth degree tear those are much less common,

P: to put some numbers to this discussion, according to the Royal College of Obstetricians and Gynecologists in England, up to nine in every 10 First time mothers who have a vaginal birth will experience some sort of tear graze or a episiotomy for third and fourth three tears the numbers are a little different. They say six out of 100 or 6% of first time mothers experienced this

 

G: yeah, I just wasn’t worried cuz I didn’t feel anything so far as I’m concerned, I was just like well this is normal. I want a baby, I’ve torn she’s gonna stitch me up and I’m gonna go back on the ward and meet my baby, and it’ll all be fine. 

P: It sounds like she didn’t present it as something to be worried about. 

G: Well no, that’s because she didn’t think it was at the time which we found out in the nature investigation that she, she completely misdiagnosed me

P: so as far as you know she stitches you up and you go back to the ward 

G: yeah, yep so she says, and, and they said Ryan, you’re going to go back on the wards and all you need to do is you just need to keep the wound clean. So even though it’ll be painful, you must, You know, have a shower, keep it clean and dry. Don’t avoid having a bath or shower or anything like that. And I thought well that’s absolutely fine that’s, you know, that makes sense to me. If I can do that no problem at all. So once the epidural wore off. And we finally met our baby at two o’clock in the morning, he was born at 20 past eight at night finally met him on the ward at two o’clock in the morning. And that was very surreal because the ward was really dark, and we were terribly British about the whole thing, so we didn’t want to make any noise. We didn’t want to disturb anybody, so we didn’t even want to turn on the light, so we I mean this is ridiculous. So we turned on our mobile phone cameras are the lights that we can actually look at our child for the this time so I mean a lot of all of that you know obviously affected the bond that I had, because the very first time I saw him he was twisting my face for literally two seconds, and he was away. Then when we met him, we weren’t allowed to, we should have done really, really well I think about it with some of the other people on the ward. It should just put the light on, but we didn’t and I think, you know that that impacted as well, the emotion you felt able to feel. 

P: Yeah, why did they have him  for so long. What were they doing for all those hours?

G:  they didn’t have the staff to discharge special care. 

P: Okay, 

G: so there wasn’t actually any need for him to be in there, because after he’d been in there for about two hours or something, they said right yeah he’s absolutely fine, he’s ready to come on to the world, but he needed to presume he must have needed to be signed off by a consultant or, or the registrar or somebody must have needed to sign him off the ward and they didn’t have that person, so that’s why we had to wait so long, not because they were doing anything significant.

P: Okay good, so he’s totally fine. 

G: He was absolutely fine. 

P: But this process  messes with your ability to bond and, 

G: yeah, yeah, 

P: I am totally sympathetic to the impulse to be quiet for other people it’s, it’s hard to have such a, an emotional experience in a packed house.

G: Yeah, and in a dark house when you know, people see things, and you just think, you know don’t want to, and I’m sure you know when I look back I think noone would have cared. 

P: Yeah. 

G: Expressing joy over seeing their baby you know but you just saw yeah we never had a baby so we were just still in the motions of not having a baby, you know. So, we were on the ward and it was really shocking, actually, because my husband was a Royal Marine. When we were on the ward we were looking at all these women, who was literally staggering about holding onto walls, grimacing with pain, barely able to walk some of them, and Chris my husband looked at me and he said you know Gill, this reminds me of a field hospital. 

P: Wow. 

G: Yeah, and it really does a study, and never envisaged some ward looking like this normally when you see women with babies they sit at home on a property, or they go along the street with a prom or buggy or pushchair. You don’t see them when they’ve literally just had a baby, but in a way, made me feel a bit better, because all right well they’re just as much pain as me so that kind of normalized it a bit. 

P: Yeah, 

G: but at the same time, couldn’t sit properly. I could barely walk. It was really painful but that’s the kind of person I am I just thought right well I’m not going to get beaten by this you know all I’ve done is have a baby. Loads of people. Loads of people have tears, so I’m not going to make any sort of complaint or fuss, I’m just going to get on with it. So that’s what I tried to do, but as the day’s progressed, the pain just got worse and worse and worse, and the very next day after having the baby. I noticed like a brownie discharge on my underwear. And I said to the midwife. I’ve got like brownie sort of discharge on my underwear not much but there’s obviously something interesting oh no that’s fine. No, that’s fine, that’s just sort of the tissues all fixing together that’s just a bit of mucus and you know it’s nothing to worry about. 

P: Yeah, 

G: so I was like all right okay and then I thought well I know when I’ve like fallen over in the playground and scraped my knee. You do get a jelly mucousy type stuff on your knee when it’s healing. So I just thought well maybe, maybe that’s what it’s from

G: Gill talks about brownie discharge on her underwear, should that have been a red flag.

Dr. M: I think that if someone just said I have some brown stain, you know, when blood is exposed to air and is oxidized and dries, like, it turns brown and so if there’s just a little bit of brown staining. You know, I’m guessing that a midwife might think, oh it’s just some old, blood that sort of oxidized and dried on your underwear,

G: the pain just started to get worse and worse and worse, and after about two days, I started getting poo in my pants. And I thought, Well, no, but I wasn’t really because I wasn’t very much, I couldn’t really work out where it was coming from because it didn’t really seem to be coming from the normal area. 

P: Yeah, 

G: and then it was getting to the point that every time I went to the toilet. I was pulling the emergency buzzer, because I was in so much pain I was frightened to go to the toilet. 

P: Yeah, 

G: I have to add something that the toilet is going to go rific and, and then I clearly remember, after three days, I was in so much pain and so much distress, I had a shower. And I remember I mean this is, you know so mortified when you think about it, this is what you do when you’re in it. And then so I was in the shower. I could not work out where this poo was coming from and basically I couldn’t work out what was part of my body and what wasn’t. And a midwife came past, and I was completely naked in the shower and I bent over and showed her my backside and said, right, is my bottom in the right place. I said I can’t, I can’t I can’t work out what’s happening I said there’s poop coming out all over the place and I’m just, I can’t work out why my bottom is, and she’s looked at me like I was completely insane, and said, that’s absolutely fine, it’s fine. Just finish your shower, go back to your bed, sort yourself out, you know so yourself.

P: Okay, I want to stop you right there. Now looking back, do we think she should have known that something was off.

G: Oh 100% I mean, I remember being hysterical in the shower, you know and I clearly remember saying, I don’t know why I’m about this I don’t understand what’s happening to my body like where is it all coming from, can you just show me where it is. 

P: you don’t feel like the normal bowel movement. 

G: No, no. Yeah, I always remember that she just sort of like she didn’t examine me obviously she didn’t come close to me she obviously just glance and said, Oh, you’re absolutely fine basically make it out that was completely mad. And I actually thought I was mad because I knew that there was something seriously wrong. But I couldn’t, I couldn’t get anybody to understand what I was saying.

P: So, I have to tell you as an objective third party that I find this so frustrating to hear I’m so desperately frustrated on your behalf that you’re not being taken seriously. 

And then Gill tells the story about the poo coming out in the shower, and she doesn’t know what’s going on with her body, is this a red flag.

Dr. M: If anyone were to say, me or I’m sure one of my colleagues, like I feel like there’s poop coming down my leg in the shower, I think we would say we need to examine you like why would that be coming out, best case scenario I think maybe you have diarrhea and you’re just, you know, things are in pain down there and your rectum sphincter is relaxed, but even with the benefit of the doubt, I would wonder like why would you have stool running down your leg that is not a complaint that is typically heard at all. So, so I think that would make me immediately worry and say wow I really need to investigate like why is there stool, coming down your legs and that is not normal.

 

G: so then I went back to my bed, staggered back to the bed, and by this point, I could smell poo. I remember I was visited by a friend who’d come to see me and the baby, and she’d said, it smells like poo in here….And I was like oh, it’s the baby, and then I think well that’s not like that’s not long. She can smell something. Yeah, so I said to the midwife. On the evening shift I said, I think I’ve got poop in my pants. She was like really, and I said yes. And I said, I definitely have, and I said I don’t know what’s going on because I didn’t have this couple of days ago. So the way she looked and she was like oh I can’t see anything. And I said, But I’m in so much pain, I said it doesn’t seem to be getting any better. And she said what everyone had said to me repeatedly whenever I’d said how much pain I was in, they just said, Oh, the heat that you can feel around your body around the area that is just the tissues knitting together, and they are producing heat when they’re getting back together. I was sort of thinking, well, well okay, that makes sense, but I’ve had cuts in the past, and they haven’t got this hot, I mean I knew it was a big would but all the same, you know, it just doesn’t make any sense but that’s what everyone just kept saying to me, so I told this to the midwife been through my pants and she looked at me and she said no I can’t do anything. So the next morning, there was a change of midwives. And then the next midwife came on and she said oh you know how you said oh well I’m absolutely fantastic apart from the fact that I’m poo in my pants, you know, apart from that I’m great. And you know what you’re talking about. I said, there’s not be mentioned on her, Handover. Is this not on my notes, shut down and are we talking about what I was like, right. Last night I told the midwife that I poo in my pants. That my friend is about to come in the room. That’s the situation. And she said oh so she had a look and again so it looks like it’s healing fine. Yeah, no, You’re okay. So again, it was like, well this is just, like, completely mad like two people examine me now I would say that there’s not a problem, and everything’s healing. Yet, I know I’m pooing my

P: two midwives check her on successive days and say she’s healing, even though we know ex post there is a problem. Why does it look like there isn’t a problem.

Dr. M: So, you have to do a really good exam to see what’s happening underneath your repair. 

P: Okay, 

Dr. M: so if you’re just looking into the vagina, and you see your suture line that the vaginal mucosa is sort of closed up on top, you’re not able to look at what’s underneath that and so it’s the layer underneath. That’s not closed until unless you do a rectal exam or put your finger into the rectum and see, do I feel an opening do I feel a defect or is it completely closed off and smooth. You don’t do a rectal exam you don’t know what’s happening underneath. You have No idea. So I mean, it looks nice on top, it’s like if you had a bullet wound in your abdomen, and I just put a shirt over it and you’re like yeah that’s sure it looks great. 

P: Yeah, 

Dr. M: so like the top layer looks great, everything’s closed off and smooth and looking fine but underneath I’m hemorrhaging. so it’s sort of like it’s the deep layers that have to be evaluated and if you’re just looking and you’re like, everything looks good on top. That’s not telling you the whole story.

G: later that day I was trying to work on a project but by this point, I couldn’t really walk. Essentially I collapsed in the corridor. And I was found by a male midwife. And he said, you know, you’re right and I said no, I can’t do this anymore. I said I literally can’t do this. And I remember like my voice was really weak. And I was just saying, I can’t, I can’t, I just can’t, I can’t do this. It’s so painful, I just can’t cope anymore. And you know what he said to me, said oh, maybe it’s your perception of the pain. 

P: Oh my god.

G:  Yeah, and I thought, are you having a laugh, like, oh so I’m a wimp. Yeah, part of it died at that point because I just thought right. Oh my god, I, you know, literally just collapse in the corridor. I’ve said to this man that I cannot cope and he said to me, maybe it’s your perception of the pain. And then he said oh, what would you like me to tell you, and I was like no I’m fine thank you. I don’t want you coming anywhere near me. 

P: No kidding. Oh my god, 

G: you know, and then I just thought that when I am just going to go back to my bed, and I’m going to die because no one’s taking notice of me and be seriously wrong. And while you can probably guess, you know, I’m quite articulate, I’m more than capable of sticking up for myself, I was a police officer for heaven’s sake, but I was in so much pain and I was so weak I wasn’t able to speak up for myself but I could I didn’t have the energy to fight with people to be seen. 

P: Yeah, I mean, this is, this is the tricky thing you learn in medical contexts that you have to be your own advocate, but it’s wildly unfair to make a woman who’s just given birth, be her own advocate. Yeah, you’re filled with hormones, you’ve just basically run a marathon by giving birth, these two things don’t go together.

G: Exactly, exactly and my body was fighting too much to give me the energy to then fight for support and help. So that’s my bed but obviously this midwife must of thought Better go and see what’s going on. So another female midwife came and said oh you know I hear you, collapsed, and I examined you. Yes, if you can, but I’m sure like everybody else you’ll say there’s nothing wrong with me. This is after now five days. And she tries to examine me, and I remember she basically put her hand toward where the tear was. And then she immediately brought her hand back And she said, Wow, I couldn’t even get near to it I could feel the heat coming off you, I was basically hovering over that and she said and you, you jumped back on the bed. Yeah, and I was like well yeah I mean an awful lot of pain. That’s right. We need to get you examined by the consultants, the consultants gynecologist. 

P: Yeah,

G:  came down to examine me, and they actually had to give me gas in it, because they couldn’t get anywhere near me. And the consultants, really look for that long to be honest and she said, right, you’ve got a fourth degree tear, which has been missed. And she says you’ve got an enormous abscess around the tear, she said that’s now burst, and you’ve also got a rectal vaginal fistula, which is where you have a hole between the lining of the rectum and the vagina. You’ve got poo coming out of the vagina. And, and I remember actually being really relieved. I was like, you know, thank God for that. Like there actually is something seriously wrong with me. 

P: Yeah, 

G: so she said right, well, I’ll have to get the colorectal surgeon to come down and see what he thinks. But she said I think the only way out of this is to give you a stoma, so that we can divert the feces away from this area, give a chance for everything to heal, we can repair you reverse the stoma. And you know, get on with your life. 

P: what’s a stoma is an opening on the abdomen, that can be connected to either your digestive or urinary system to allow waste to be diverted out of your body. If it can’t move through your rectum bowel movements leave your body through the stoma and are collected in a pouch that you empty out, it can be temporary or permanent. There are a number of different reasons to get a stoma, like Crohn’s disease or bowel cancer or for obstetric reasons.

 

G: I was just relieved to be honest if it said to me, we’re going to chop off both legs I would have said I don’t care. That takes away the pain to do a heavier light so they went off and I burst into tears obviously and ushered off into it, I finally got my own private room. Do you remember joking and saying, Gosh, what you have to do to get up. So yeah, so then that was the next the next stage really but, I mean we’re only talking about less than a week after having a baby, the fistula tract was actually septic. And that was septic for a year and how on earth I didn’t get sepsis. During those five, you know. Well, I think I must have been pretty close, because I, you know, I just remember just being so weak and unable to function. 

P: When they examined you and finally sort of validated everything that you had been describing for days. Did you understand exactly what they were saying like what the process was and what they’re going to do

G: well by sheer good fortune. One of my friends who I met in the city that I was living in had had a stoma, in the last year, but she had a different one she had had an ileostomy, which is the small intestine, and I was going to get a colostomy. So as I was like right, I do actually have a vague idea of what this kind of entails because I’m remember talking to her about a bags and all this sort of thing. I did have like a little bit of an idea but at the same time it was just too much information really 

P: Yeah, 

G: I mean I knew that a fourth degree tear was bad. I knew a fourth degree tear was like the worst that you could possibly get. Y

P: Yeah, yeah,

G:  I mean obviously I wasn’t particularly overjoyed about getting the stoma but you know I just thought, you know it’s only for 12 weeks. Yeah, only for 12 weeks. So this is fine 12 weeks 12 weeks, and then look at all the life.

P: Yeah, and it sounds like a fix. Right, so,

 

G: yeah, it was just, oh, you know, that’s fine and I thought well you know my friends you had a stoma and, yeah, she’s another great time with it but I thought well, it doesn’t matter, because it’s only 12 weeks. And I was just relieved. I was just so relieved because right we have a solution to my problem, and I’m going to get fixed and I’m going to get better and I’m not going to have this infection, and people are actually going to start taking me seriously.  And they did. 

P: Yeah and it is so and so, this whole time. Is the baby with you or how’s it going are you breastfeeding.

G: Well I tried to breastfeed, but obviously, because he was premature and like obviously my body just was too busy. 

P: Yeah, 

G: I didn’t have any milk supply. 

P: Yeah, 

G: and really, I don’t know what it’s like in America but in the UK, they’re pretty obsessed with breastfeeding. 

P: Yeah, same here

G:  which I can understand why I know that it is best for the baby. Understand this, but because I wasn’t very well, I didn’t have any sort of energy to to argue with him and say that I wanted to do it in any different way so they I mean, they were trying their best to give me the best chance to be able to breastfeed, but you know I mean I was expressing, and I was breastfeeding. I was like struggling to survive. 

P: Yeah, 

G: and I didn’t have any milk whatsoever, so so yeah. At that point I was exclusively breastfeeding. After a week, but it was eight days, eight days after the baby we were transferred to a different hospital, so that I could have the surgery. And of course, after I had the surgery, you know, my body was just like, No, yeah, there is no milk. There is no milk, like we have nothing to give this baby. And it was after that that I said right this is it. Like, I am not breastfeeding anymore. My baby is hungry, I’m exhausted. Just put him on a bottle. And I remember the poor little so the first time I had a bottle, he just, he was just so you know, gluging it down. Finally, really full for the first time the poor little thing. And  someone else cand do it

P: totally…in the in the US, there is a press now to say fed is best, yeah. Breastfeeding is best because there are all kinds of things that can make breastfeeding just too challenging. And when you go to the other hospital your baby can come with you.

G: You know, my poor husband, so I had to go in the ambulance. Yeah, but my son couldn’t go in the ambulance. and my baby was tube fed. So my husband had to take this tiny tiny little baby who’s being tube fed in the car, the very first time across the city to this hospital neither of us have ever been to. Yeah, and you know what it’s like the first time you, you have your baby in the car. 

P: Yeah. 

G: One of you is always looking at his breathing. We crushed the chest but yes, he didn’t know anyone that and he didn’t really know what he was doing and he was following the ambulance and so it was just so stressful to get across, city with this time and of course some was tiny as well I mean, 4.7 pound is not small, but it was a small for the car seat

  

P: ours too when we put her in the car seat we were like, oh she doesn’t fit at all….my baby was born early too and if it makes you feel any better. As soon as my husband dropped us off on like the lawn in front of our apartment. He crashed the car, driving it back to the garage he crashed it like it’s stressful. 

G: Yeah, totally, totally. So I had my surgery, but I had to then go on the adult Ward, because the head you know the midwives can’t cope with someone who’s just had a stoma, and they said the adult colorectal Ward can’t cope with a premature baby, that’s been too fast. So he had to actually go into special care. Just so that that was somebody with them all the time, which was you know, that was an eye opener and put things into perspective for us because at the end of the day, we have a lovely healthy little boy. And yeah, I you know was in my wheelchair being wheeled across the sea and we felt guilty actually that he was in special care because he was around, babies who needed to be in special care. Yes, that was, you know, it helps to have a dose of of perspective sometimes I think,

P: yeah, but I’m glad he had that opportunity because this is probably the only circumstance in which you and your husband feel confident that he’s totally cared for by people who know what they are doing

G:Yeah, that took that pressure off…I was on a separate board for two or three days I think and filled with old people’s the youngest person there, and I remember the women on the ward, sort of saying oh you know. Well, it’s worth just got round, but I literally just had a baby, and you have to leave your baby at like eight days old and you know this is a horrific but it decided to probably last because I didn’t really care. Yeah, but you know I can’t be upset about that because I’m just now trying to deal with this stupid bug, that’s on me and leaking all over the place and, and, yeah, couldn’t bend over, I couldn’t do anything. I still obviously had all my tear, my abscess injuries. You know, it’s just the complete mess basically everywhere.

P: That sounds super challenging and I bet you were on high dose antibiotics for the abscess and

G: yeah so, essentially because of the fistula tract was septic but it wasn’t fixed for a year. I had But, basically, a year on metronidazole, which is a really strong. It’s a really strong antibiotic. I was I was basically on that about, well, I was on up pretty much every month for you. It just kept flaring up and getting worse and then it needed drained. As an emergency and hospital and. 

P: Wow

G: Yeah

P: So tell me what happens when you pass the 12 week mark when you’re supposed to be going in for the reversal of the bag

G: Well, we didn’t know it was way before that we realized that it wasn’t going to happen, really, because the hospital wrote to me after I’d been home for a month, and up until that point, I kind of just thought, you know, I’ve just been unlucky. This is just what happens sometimes when you give birth. 

P: Yeah, 

G: but the hospital wrote to me and said, It is not normal. What happened to you, will launch an investigation, and I was like, oh, oh right, so hang on. What do you mean, like the you obviously know something’s up here. 

P: Yeah, 

G: and I was invited to meet the consultant who delivered the baby, and she was profusely apologetic and, I mean, they found out she wasn’t entirely truthful at that meeting, and I stand by what I said to her I said you know I’m not bitter about the whole thing, you’re a human being at the end of the day and you’ve made a mistake, and yes it has had a catastrophic consequences me but if you hadn’t got my baby out when you did, he would have died. Maybe I should have had a C section but I just I don’t know it just didn’t feel right to me to be to.

P: Yeah,

G:  I don’t know angry about it. And I’ve never genuinely, genuinely, never been bitter, just think it’s a pointless emotion. 

P: Yeah, 

G: it wasn’t gonna get me anywhere at all. So I just, I just kind of accepted that she had made a mistake and it has happened but I didn’t realize at that point. Exactly what mistake she had made until I got the results of the investigation, 

P: that seems like a generous response then is also life lengthening for you, because it’s a lot of work to carry around anger for something that happens, that was a mistake.

G: Oh, exactly and, you know, there’s certain members of my family that are extremely bitter about things that have happened in their past life and I’ve seen how that can destroy you. 

P: Yeah, 

G: and how pointless it is and I just think, you know, just so I’m not, I’m not going to go there, it’s it Yeah, it doesn’t, it wasn’t going to make me any better., I mean some people say, Oh, she was sacked. And I said why would you want it to be so like I would feel awful. I said that wouldn’t make me feel any better, 

P: yeah, yeah. 

G: But but yeah so then got the results of the investigation and the investigation found the consultant. Initially, diagnose a second degree tear. She stitched me up with this in mind, and then she thought no, hang on a minute. I actually think I’ve got a third degree tear here, so she took all the stitches down and stitched it back up again. She thought I was fixed. So, she’d  actually missed the fact that I had a fourth degree tear, and the fact that I had a rectovaginal fistula

P: Gill says that the consultants confused what kind of tear she had with the obvious what kind of tear has that work. Well, I mean, it’s hard to say, Would it be obvious 

Dr. M: It’s hard to say would it be obvious….tissue is usually just shredded and bloody and raw and it’s really hard to see clearly what’s happening down there, and it takes, it takes a lot of experience to always be right. And so you can see that the sphincter is torn and you know, I mean you just you just have to be really thorough and do a rectal exam and really check to make sure that things are intact because it’s not so obvious, it’s not just in your face like you have to be a detective to like look and evaluate and really see what’s going on underneath, to be sure that you’re getting the whole story fourth degree tears are not that common… three tears are not that common you know third degree tears are definitely more common, but even that is not as common, and you know you get a third degree tear and you’re like, Oh, is it really a full third degree or is it just partial oh no it can’t be full, no I can’t have done that much damage you know just like symptoms I think we talk ourselves out of how how severe something is, you know, and then once you realize like, okay, it’s a 3rd degree tear, let me fix it,

P: it’s totally interesting to hear because I think as a patient you think everything is over once the baby is out. You think the birth is over, like there’s nothing else to happen, it’s by no means over.

Dr. M: No, by no means over and and you know all repairs are not the same and and all of us do not do the same quality of repair. So I just it just makes me sad. It just makes me sad that it wasn’t fully evaluated it was missed and it Wasn’t repaired. 

G: There was a little bit of debate about whether the fistula was caused by the abscess bursting really sure, well when that was caused to be honest, or it could have been through forceps or just not sure. And it was brought up that you know when she wasn’t entirely sure what she was dealing with, she should have called for the colorectal team to come down for advice, but she didn’t she just carried on. And so as a result, because she used all of this tissue twice to create two lots of stitches, it was really friable yeah and it left no viable tissue to do a repair. So she essentially left me a irrepairable, but also on top of that, my sphincter was so badly damaged externally and internally, which obviously is what a fourth degree tear is but the damage was so profound, I couldn’t be repaired anyway. The way that she she’d she’d made it in part like literally impossible, and it was all because she didn’t want she missed it. So, I mean to cut a long story short, I sued the NHS and I won in two years, which is unheard of. Normally it takes six or seven years. 

P: Oh wow, 

G: but it was pretty it was pretty clear cut, You know she missed it. She botched it. So she didn’t obviously reveal that to me, that would mean. Yeah, but it is what it is.

P: Yeah, certainly not what you expected when you entered this process.

G: No, and I remember things my mother I you know, could I not just had a premature baby did I have to have this on top, you know, a fourth degree tear and then the rectal vaginal fistula, and then abscess and then the stoma….now, still, and because I had a stoma I ended up losing my job, police officer so it was all just like one, it was just snowballing like a wrecking ball..going through my life just throwing things, and yeah, like you say, you know when you get pregnant, especially when I’ve got pregnant so easily and my pregnancy had been so easy. I wasn’t used to being incapacitated in any way, and vulnerable and reliant on anybody. So that was quite difficult. It’s just not who I am, who I have to be. 

P: Yeah, I saw on your blog, you mentioned that in the US we call them near misses, I think, which is seems like a silly way to categorize it but there are 30,000 women in the UK who suffered a severe pregnancy complications after birth.

G: Yeah well it’s 30,000 women every year new UK experiences. Well, as a traumatic birth, there’s can be anything really, but they do say I think something like 20% of women suffer some sort of extensive tearing, and that’s a lot. 

P: That’s a huge number

G: it is a lot. I mean, my particular injuries. Very very slim chance it’s like naught point 5% or something ridiculous I was extremely unlucky but. But yeah, I think it’s cool as a result of childbirth and injuries as a childbirth is so much higher than people realize. Yeah, one of my things is, obviously I’ve got my blog, I’m really open on talk about my injuries, I don’t really care. Who knows what, but also the flip side of my blog is about the fact that you can overcome all of these things and have a positive and happy life, etc, etc, but a few people have said to me oh you know I don’t want to share your blog with my pregnant friends or with people I know that want to get pregnant, because I think it’ll frighten them. I said this is the problem that we have…that people patronize women, and they think that we’re not strong enough to take information. And I said, you know, I wish I had known all the signs and symptoms, were of a fourth degree tear this down right, the day after having a baby if I’d see brown discharge on my underwear out straightaway would have said, Excuse me, I am demanding to be seen I think this might be possibly to this species. This is not right. Yeah, the end of the day, it’s up to women, whether they access this information that they’re don’t not give it to them in the first place. 

P: No, I agree, I agree, more information is probably better to know, especially since you’re supposed to be your own advocate. Yeah, except to some degrees, it is on your shoulders, you know, no one cares about your health more than yourself. So 

G: yeah, exactly, 

P: you sort of need to do need to know these things and he would never tell like a cancer patient not to look at everything that happens when he had cancer. But yeah, absolutely. Yeah, absolutely. Yeah so I totally agree with your message. And going back to your blog, I don’t know what word to use, other than to say you’re an incredible athlete. I mean all the things you do I’m pretty risk averse and so I’m looking at the list of this skydiving in the triathlon,

G:  but I’m, I’m quite risk averse, 

P: your about to  swim the English Channel that doesn’t sound risk averse.

G: Oh no, I mean I’m nature frightened about the thing that skydivers off awful. Oh my gosh it was. 

P: So wait, so tell us about all this, so you’re, you’re not pursuing police work anymore and then and then how do you kind of turn it around.

G: I remember seeing on forums people describing their stomas, and saying, Every time I look at my stoma. It reminds me of a horrific reason why I have it, you know, most people have them as a result of bowel cancer or Crohn’s and colitis or whatever. And I remember reading that and thinking well I am not going to look at my stoma like that, because I haven’t saved. That’s going to every day of my life I’m going to be miserable. Yeah, because I’m going to have. So I thought right I’m not actively not going to think like that. So I accepted my stoma pretty early on in that way. It wasn’t until about two or three years down the line that I read an article by an athlete who has a stoma. And she said she had hers as a result of Crohn’s and Colitis, which is a really nasty disease in the, in the bowel, which people suffer, lots of pain for many years. Yeah, then they get a stoma, and it makes them a lot better. And she said you know I’m so thankful for everything that the stoma has given me..it was like a light bulb, and I suddenly thought, well, hang on, it’s all been about what the server’s taken away, took away my job, it took away my bond with my baby. it took away my lovely maternity leave. You know, it’s, it’s taken away so much. And then I thought, well no, hang on, I actually think about this, what does the stoma do why have you got the stoma. Was that right, well I’ve got it because otherwise I would be incontinent, I’d be pulling my pants. And if that was the case, I’ll be wearing adult nappies or diapers, or I wouldn’t I wouldn’t be leaving the house, so I thought, oh, actually. Look what it’s actually enabled me to do. I can leave the house and go for walks and go swimming and it was it was a revelation. So then I looked into it a bit more, and looked into what stoma products used to be like in the like the 1950s, and what we’ve got now these are amazing, but they’re so discreet and waterproof and you could just do whatever you want with a stoma so then as you start to think right. I am going to go out there and I’m going to do absolutely Every single thing that I’ve wanted to do, because I’ve had. Yeah, definitely. While I was completely incapacitated by the fistula and everything else yeah I just thought, you know, I’m not incapacitated anymore. I just need to get out there and make the most of the life that I’ve got. And that’s not right. Well, the first thing I’m going to do is I’m going to lose weight, cause obviously I was heavily overweight, so I joined as an indoor cycling class. I thought right well I could do that because there’ll be a toilet nearby. It’s not scary. So if, if I get absolutely exhausted after 45 seconds. I can just stop I’m not gonna be in the middle of the countryside. So join the cycling class, and I loved it. I was really unfit though I could only stand up like once on the pedals. But it was actually run by a local Triathlon Club. and I’d always wanted to do a triathlon, when I was younger, because I’ve always been pretty sporty, but I’ve always said you know I couldn’t do that. I couldn’t do that…far too tiring and but then I just started to think, Well, why shouldn’t you like all these other people do traveling, why shouldn’t you have a go and you actually now have the ability to do this, you know, just remember that year when you couldn’t even walk anywhere, or you can’t. And I thought right that’s it, I’m going to sign up to do a triathlon. So I signed up to do a triathlon sorted out my swimming and got back into running and cycling, I mean I wasn’t by any stretch of the imagination, spectacular, but I was able to do all these three things, and I went to this first triathlon and the organizers were fantastic, because they’ve never had anyone with a stoma do it before and I had like 10 million zillion questions about what happens if I got badly, and well I get disqualified about to go and change it and all these sorts of things and, you know, there were really kind and there was sort of saying you know this isn’t the Olympics, you’re not getting this, you know, it will be fine. So I went off and did it and I was just so I just thought right well there you go that’s one thing you thought you could never do. Do not cry describe life is like. It’s all about getting the little bricks, and that was like my first little brick. Yeah, so then I went to get my next little brick, and that was like the next stage talks on I did. And so that was after. After that, the tribe club on mass decided to enter a half Ironman, which is a 1.2 mile swim, a 56 mile bike ride, and a 13.1 mile run. I just thought I might want to get right I’m going to do it so I signed up to do it, but part of doing this. Half Ironman was I had to do open water swimming. Now I’m terrified of open water swimming about absolutely terrified. You will no doubt remember the ridiculous film jaws. 

P: Yes, 

G: which we all so, you know, I watched that when I was eight, and it terrified me out of the sea for 30 odd years. I had to face up to that fear really to do that section of it, and I did. I mean I went off and did my half Ironman. It sounds really easy but it wasn’t really hard, 

P: nothing about this sounds easy. I assure you…

G: And that was actually when I decided to come really public about my story and what has happened to me, because I decided to raise money for the birth trauma Association, So I went in the local paper and all that sort of thing and on the BBC Radio Newcastle and I was out there for the first time with my whole story, I raised 5000 pounds for the birth trauma association which was, I was really pleased with that was like the next brick. And the next one that I wanted to get was I wanted to get back my love of the sea. My love of open water because when I, when I was eight, I was actually learning how to sail, and I was like a little, I was like a little fish, I was always in the water. And I thought, You know what I want to reclaim that and it was all about getting back control over my life. Because so much that had happened to me had been out of my control, I lose my job and my injuries and all that sort of thing. And then I just thought, no, you know what I’m not having fear like me what I can and can’t do. So anything that I’m frightened of. I’m gonna damn well beat it because I’m in charge of my life. So I joined a local group of sea swimmers, and I mean it’s a bit of a joke between us all, because for a year and a half, literally a year and a half, I couldn’t open my eyes when my face was in the water, because if I couldn’t see what’s underneath me, I’d have a panic, like a panic attack. 

P: Yeah, 

G: I mean I went to the same beach, with the same people all the time, and they were all really really confident, and eventually a friend said, you know, if you don’t open your eyes in the water, you can swim into a rock, it’s actually a practical benefit. 

P: Yeah. 

G: Okay, so I then tried like three seconds at a time, five seconds at a time opening my eyes and, and then I did it when it was the water was really clear and then I could see that there…then just all of a sudden I don’t know my brain must have just got anything tonight. Okay, it’s fine. Fine, you can do this and I can’t get that really I mean I do still have a lot of fears of open water sample I would never, but I say never, I’m gonna have to swim on my own for the open water, and swimming in the dark… It’s really liberating and exhilarating and addictive actually overcoming things makes you feel really powerful. And the more that I overcome the more powerful, I feel, and yeah I just I don’t like to be beaten, really. A big part of it is, it’s showing my son that what happened during his birth hasn’t ruined my life by any stretch of imagination, you know, it’s actually ended up empowering me. 

P: how did you end up skydiving?

G: We only went skydiving, because my two friends were going skydiving, and I had a little thought in my head was, wonder what it’s like everyone says it’s amazing. And my husband said but Gill You cry on aeroplanes and you’re terrified of heights. Everyone says that. And I was like, Yep, I do want to get to like 80 and be like, Oh, I really wish I do not skydive so I mean I did it and I was completely hysterical before. I mean hysterical. And when, when I landed. it was being videoed, and the guy was attached to the guy that was filming that was some exit that wasn’t it was just awful. I’m sure I gave myself PTSD all over again. It was awful. But I did it and so then again I was just like well yeah, we go I never thought I could do that so well I just spent the whole winter in a bikini, three times a week in the North Sea so raising money again for the birth trauma association so that was something I never thought I could do stand out in the cold like that and get my stoma bag and public for everybody to see. So they were two more things I wondered if I was able to do was set that up. Good, gave me more confidence. Ultimately, I’ve signed up to like you said before from the English Channel solo, And I’d be the first ostimate to do so, but I’m saying that really blase but actually inside I’m quite hysterical

P: that this is an amazing list of accomplishments, how long is the English Channel. How wide is it. 

G: It’s 21 miles, but you end up somewhere about 25 Because of the current. 

P: Good lord and how long is it supposed that take 

G: about 14 hours. about…

P: And you don’t eat while you’re in the water. 

G: oh no,  you do. So there’s, yeah there’s really strict rules on what you do, so you have to wear a regulation size swimming costume. Basically nothing that covers like your legs or arms. Swimming cap, goggles. That’s it. And then once you’ve started swimming you’re not allowed to touch the boat, and no one is allowed to touch you. So to get fed, they get a pole, and they, they use it either a cup or a bowl or something, to give food to you and then you can get it out of there, but you can’t stop to feed for too long because the current so strong that you could be swept like 500 meters, which doesn’t sound like much, but 

P: who’s making rules, there’s a governing board?

G: the English Channel Swimming Association because you actually have to have a channel observer with you on the boat, making sure that all the rules are followed, it’s the pinnacle of open water swimming, and more people have climbed Everest than have swim the channel.

P: I bet, good lord

G:  Yeah, so when you swim the channel you, that’s a bold start at Dover stove is where you start off and there’s a board with people’s names on who’s from the channel. 

P: Wow. 

G: Yeah, so you don’t get to put your name on our board unless you follow exactly the same rules as everybody else so you really could do without all of that but wouldn’t be official.

P: That is totally amazing and it makes complete sense to me that more people have climbed in the Himalayas, which I’m superficially I’m sure it doesn’t seem as hard as it actually is although I think people can well understand how hard it seems to swim 25 miles in open water. I am totally gonna donate to that effort, I’m so excited for you. I’m very excited and a little upset that they will let you wear a wetsuit

G: Oh yeah, I know, no, that’s the challenge isn’t it. And this is what attracts me to swim in the channel as well as opposed to something like the Himalayas, because in the Himalayas, you can get to boots and somebody else, you can get a sherpa who’s going to carry all your stuff, you know like, there are ways to make it easier. Yeah. When you swim the channel, it’s, it’s you that you can’t it there’s nothing that you can do that is going to make it easier for you compared to somebody else, you know, other than your training and things like that it’s all down to you. So that’s why I find it so when you cross it, that is, that is your achievement obviously you’ve got your whole team behind you, so they’re part of that but it is you in that channel.

P: So, that is totally amazing. I hope they filmed part of it.

G: I am in the documentary I am being filmed for a documentary so no pressure at all

P:  good. Well, again, hopefully they’ll be good editing if it’s necessary. 

G: Yeah,

P: I am super excited for you. That sounds awesome. Your story is a prime example of taking the challenges of birth and being resilient with them and sort of turning it all around so I’m so appreciative that you share this story for us today, it is amazing and I think another thing that’s kind of really relatable in your story is that so many women get dismissed when they bring up pain or other elements in the birth that they found challenging, you know almost everyone has a story where that that plays some small role, where they say, Oh, is this, and someone says no, you’re fine, which has to be changed his crazy approach to healthcare, and as in the UK, the US the near misses, which are considered severe pregnancy complications, is like, on the order of 60,000 women every year. And here for sure it’s categorized hemorrhage or hysterectomy or some kind of clot that doesn’t count all the trolls, I’m sure if you counted everything that was traumatic it would be a much larger number. Yeah, but it is something that I think we need to we need to fix for kids.

G: Yeah, I mean at the end of the day with us. We’re the ones bringing the next generation into the world, so we need to be looked after we’re important. The mother is the cornerstone of the family, family unit and if we don’t look after our mothers that we’re not looking after our family unit, and therefore we’re just not looking after society, so it should be discussed it should be talked about and we should be supportive and we should be relieved. We’re not asking for much. But yes, asking for basic rights.

P: Oh completely and my guess is it’s even trickier in the UK because maternal mortality rate is really good internationally. Yeah, yeah, yeah. And that’s when people focus on,

G: I mean since I’ve become more public the amount of women that I know that have contacted me and have said, you know, gosh I had x y and Zed and, thank you so much for speaking out and you just think that so many women are just suffering, suffering in silence and, and the winter bikini challenge that I did, I had a sign on the beach saying I have a stoma, as a result of traumatic childhoods, I’m trying to raise awareness of these issues. The amount of women that stopped me on the beach and we, we didn’t necessarily have long conversations. For a lot of them, they just said, Thank you so much, and that’s all it says. And that’s all there. Needless to say, Well, they didn’t even need to say that but now, and that was countless women that I met, and I just think you know and I just live in the Northeast of England. But I think there is, I think there’s definitely gonna be more more of us being more vocal about it more prepared to Cooper first and, you know, breaking down the stigma of being so public about it and saying, This is not a failure of our bodies here. We’re not bad mothers because we haven’t given birth properly, that’s not nothing to do with that. I think that’s messages gradually getting through to women so that feel more able to speak up. Yeah, you

P: know, the alternative name of this podcast was gonna be, it’s only fucking reproduction. Yeah, right. Yeah. Yeah. To expect to do it seamlessly it’s just Yes, doesn’t even make sense right it’s, 

G: yeah, Yeah, exactly.

P:  So I totally appreciate your story, I will look forward to posting all, all the snippets I can from your site on in the show notes so people can follow you. Over this Thank you. I’m assuming we can donate to the effort just from the channel right sponsor you, or something.

G: Yeah, so it’s on my website which is www dot stoma chameleon.com It’s on the very first page of it, there’s a little bit of blurb and a link there to sponsor me. It’s actually on a GoFundMe, but you’re not giving me money to do this when all the money is good the charity and I’ve had to do it that way because I’m fundraising for three separate charities, so I was there any way I could do it. So the first is the birth trauma Association. Second is colostomy, okay. And then the third one is the Jacobs well appeal, which is actually really important to me because they send out products and supplies to countries like the Philippines, where they don’t have anything like that. You know kids are using things like plastic bags and tin cans and things like that, Lord,

P: yeah that sounds amazing. That sounds like amazing work.

G: Yeah, it’s so important so you know I just want them to have the products to enable them to live the life that it just even to go out and go for a walk. Yeah, so that’s what I’m fundraising for and that’s where you can find, find the details.

P: Thank you again so much for coming on to share your story,

 

G: but thank you very much for inviting me on very, very honest we’ve been outstanding you very much.

P: Thanks so much to Gill for sharing her story. You can find her at stomachameleon.com, and follow her quest to cross the english channel, and raise awareness and money for women who’ve experienced birth trauma, and for other stoma patients. Thanks also to Dr. matityahu for her expertise, and for alerting people to the occurrence of fistula, which she said is uncommon in well resourced countries, because if women push for 3 hours unsuccessfully, they can get a C section, but in under resourced countries women can push for days, which she said often leads to death for the newborn and life changing physical consequences for the mother. You can find her organization, beyond fistula at beyondfistula.org

Thanks so much for listening. If you liked this show, feel free to like or subscribe, or go to Gill’s page or dr. matityahu’s to get more details about the incredible work they are doing.

we’ll be back soon with another story about how women handle the challenges they face in their efforts to grow their family

Episode 24SN: Birth Before and After becoming a Doula: Keisha

If you look at birth over time, it used to be the case that women were always attended at their births by other women, and sometimes midwives, and these births happened at home. In the 1930s american women moved those births into hospitals, in part to pursue effective pain relief and the allure of more safety–but for a good decade it was not actually safer to have births in hospitals. And over the next 50 years the process of childbearing became more heavily medicalized–with benefits: lower maternal mortality rates and less pain in delivery. But by the 1980s, in part to push back on the increasing rate of C sections, doula’s started to attend women in the hospital–they were trained attendants who had been to other births and could advocate for a laboring women who was too involved in the process of birthing to also be involved in all the decision making…


Studies suggest that doula’s can have a very positive effect on a woman’s experience and today I’m excited to talk to a doula, both to hear about her birth experiences and her work.  And in fact, in this case, my guest became a doula in large part in reaction to her first birth experience…

You can find Keisha on Instagram @keishadoeswork or on doulamatch.net under Keisha Graham

Cervix ready for birth

https://www.healthline.com/health/pregnancy/cervical-effacement#effacement-vs-dilation

https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/stages-of-labor/art-20046545

https://www.healthline.com/health/pregnancy/cervical-effacement#diy-measurement

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205862/#:~:text=Summary,occurs%20prior%20to%20spontaneous%20labor.

Giving Voice to Mother’s Survey

https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-019-0729-2

Nitrous oxide

https://academic.oup.com/bjaed/article/16/3/87/2897753

https://emedicine.medscape.com/article/1413427-overview#a2

Failure to progress

https://mail.google.com/mail/u/0/?zx=crujqgpvkn4o#inbox?compose=VzqbCVPFZTlKDkdWzQFWSZGzChwXsZQzTKrHFdVnLdNKtWgkktZwtzNtHsGSVctmfVtdrMwNGVnWVLncFqcvtLQPZbXkrQXTSzWmSXJMzPBKFkZJhBcDqMxFMtMLKLHRplfKTjdgxhrWvkhRjBQstVkcPMFkspmQgqlMVdkWSmjrZZRctZLVzdzfvGjvjTLGbflmzBMcNmCdMsPqQqfwgjvnQqzDLXhZzlXRSRRjPnhtCQGwgfhllgSC

C section risk versus risk in a vaginal delivery

https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655

Biggest C section risk: your hospital

https://www.consumerreports.org/c-section/biggest-c-section-risk-may-be-your-hospital/

Audio Transcript:

Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka. I’m an economist and a writer, and the mother of two girls. I didn’t have a straight path through any part of the process of growing a family, and my experience was complicated enough that I never considered a doula, in part because I had no choices to make at the delivery, all those choices were being made by doctors. 

But if you look at birth over time. It used to be the case that women were always attended at their births by other women, and sometimes midwives and these births happened at home, in the 1930s American women move those births into hospitals in part to pursue effective pain relief, and the allure of more safety for a good decade it was not actually safer to have births in hospitals but that evened out. And over the next 50 years the process of childbearing became more heavily medicalized with benefits, lower maternal mortality rates and less pain in delivery, but by the 1980s in part to push back on the increasing rate of C sections doulas started to attend women in the hospital. They were trained attendants who had been to other births and can advocate for labor woman who was too involved in the process of birthing to be involved in all the decision making. 

Studies suggest that doulas can have a very positive effect on women’s experience, and today I’m excited to talk to a doula both to hear about her birth experiences and her work. And in fact, in this case, my guest became a doula in large part in reaction to her first birth experience.

 Let’s get to her story. 

Hi, thanks so much for coming on the show, can you tell us your name and where you’re from.

Keisha: Yeah, my name is Keisha Graham and I’m from Richmond, Virginia. 

P: Great….And Keesha How many kids do you have, 

K: I have two, two girls. My oldest is 12 and my youngest is six. 

P: Oh nice. 

K: Yeah, we’re a household of girls so no one knows how old we are, we all lie about our age.

P: Excellent, good as long as you keep in the family, it’s perfect.

K:  Exactly. 

P: So before you got pregnant with your first, he wants to have some idea about what pregnancy, like, what were you imagining it would be like?

K: The only thing I knew about pregnancy before I gave birth was what I saw on TV, and I had a cousin who had a baby a little bit before I did she have two babies actually and I had spent some time with her like her husband was deployed so I went to her state and helped her raise her two little kids but I didn’t see her, Like be pregnant I knew kind of what raising a family was like, but pregnancy was kind of like foreign to me, except for what I saw on TV.

 

P: So does that mean that you’ve thought it would be easy or, you know, you’d be gorgeous the whole time or

 

K: I didn’t, I didn’t go in, I’m somebody who just doesn’t go in with anything with any high expectations, so I thought that if there was anything that I needed to know I definitely would get it from my provider or, you know, my mom or my grandma would tell me or my cousins, I just thought that it would be simple and like straightforward. 

P: Okay, that’s a good setup. Alright, here we are. So, did you get pregnant easily the first time?

K: Yeah, it was an oops, 

P: I’m glad. I’m glad to meet an oops because you’re the story we’re all chasing right? everyone thinks like…. so good that’s true in some cases. 

K: The first one is easy but the second time is hard, is the second time we were planning and it took a while. 

P: So let’s focus on the first one, and you found out with like a pregnancy test I assume like a home kit. 

K: Yep, I went to CVS, I find out that I always find out that I’m pregnant pretty early. So on my lunch break, I went and got a pregnancy test and took it and, you know, text, my boyfriend, my husband now that we were having a baby. 

P: Oh wow. 

K: Yeah.

 

P: And how was that first pregnancy, what was that like?

K: it was pretty easy, it was pretty straightforward. I had no sickness had no complications. You know, it was the ideal pregnancy, you know, heartburn, that was the biggest thing that I think I threw up once.

 

P: Great. So far this is great, this is going great…so take us to the birth and like, are you 40 weeks and I myself, maybe I’m the only one I didn’t know what a contraction would feel like so I didn’t know I was having contractions when I was, like, tell us that whole story.

K: My birth story. Yeah, is when things get different, so yeah I thought I was going to get everything from my provider, I trusted my provider. So my due date was December I think it was the 16th and then I think I went to my 40 week appointment on the 22nd. And so they did an ultrasound, and the ultrasound tech said, your fluids are a little low, but nothing to be concerned about. I went to see my OB, and she was like, Do you want to see your baby today, and I was like, Sure, 

P: yeah. 

K: And never told me anything about what my cervix was doing if my cervix is ready to be born.

 

P: Okay, what does your cervix look like in labor in early labor your cervix starts to open or dilate and it stretches and gets thinner which is called a placement or softening or ripening. If your doctor is testing the readiness of your cervix, it will be closer to ready when it’s softer as labor progresses the cervix which is about four centimeters long, thins to the width of a piece of paper, and will open from the width of a blueberry to the width of a melon about 10 centimeters, you’ll be given the go ahead to push. If you’re being induced doctors may use drugs to ripen the cervix, that try to mimic the hormones, your body will produce to get that job done, and the hormones cause the cervix to thin and your uterus to contract

K: that inductions sometimes take a while, and mines ended up being two and a half days.

P: Oh my God, that’s a long time. So, so did you get to like go home and get your stuff and then come back to the hospital or how did that go

K: No, I just went right up to labor and delivery, my boyfriend was supposed to go to work that day so we had to pull out of work. I had my mom bring my stuff up, and you know, We thought it was gonna be pretty quick. She said, Do you want to see your baby today so I thought, you know, maybe midnight I would at least, you know, have a child.

P: Yeah, today implies today. I’m with you. Yeah, so they get you in the hospital room. Did they put you on Pitocin or what was the process.

K: So that part’s, it was a blur. So I started with a servo, I do remember I started with some Adele, and it was hard, just like any cervical ripener, it was sharp and crampy. And I wasn’t given like the option of what drugs, I could take or what my options were at that point, everything was just. Here you go, this is how we’re going to do it, do you want me to refill your water, so I started with cervidil  and after that took a while, that took a long time and then

P:  I had no idea It felt like anything. 

K: Yeah, it feels like cramps, it feels scratchy on your cervix. Well, this was my experience, it was scratchy on my cervix, and I felt it being there, and then I felt like really strong crampy sensation after, 

P: so uncomfortable is what it sounds like, 

K: yeah, it was terrible. 

P: And then what happens next. 

K: And so then, at that point I get Pitocin. And then, I was on Pitocin for a while, and then after Pitocin I will while I was on Pitocin. I ended up getting an epidural.

P: Did your contractions start with Pitocin like does that work.

K: Yeah, I think, with the cervical it was working for a little bit but they weren’t as strong and then serve it only takes you, but for, you know, so far, it only like ripens the cervix is not going to dilate the cervix so at that point after I was as ripe as I was going to get I guess they were like Pitocin is next. Sorry, I was in a while. 

P: And what was that like, 

K: pitocin was hard but then I got an epidural. So, everything, where everything else that I felt physically was fine after that point. So I have a lot of introduction like interventions. After that point, and you know I kind of breeze through them, it was pretty simple.

 

P: So they give you the epidural and then and I just kind of waiting right till you’re dilated enough.

K: So the nurses come in again. They like roll check your cervix after X amount of time they check it it’s not where they want it to be so they introduce another intervention. So then after the Pitocin. I get my water broken, actually, with this birth, it wasn’t like there was no consent, it was, I’m in here. I’m gonna break your water, it’s done.

P: I’m already feeling like this is a bummer because this doesn’t at all sound like, do you want to see your baby today, like it not just that does not, I would not feel and that’s what this means, right,

 

K: it’s in a baby factor you know we need a bed, so we’re gonna do all of these things, so that we can open up the spin, but you’re not going fast enough, you’re not on our time clock so this is what we’re going to do.

P: Yikes, so, so do that, are you there for a full day before they break your water or how does that all go.

K: Water was broken, the next day so I did the cervidil and the pitocin from the first day. Yeah, and then chosen overnight and then my water was broken. The next morning, 

P: and then it sounds like you labored that whole day. 

K: Still laboring day. At that point you know they’re just cranking up the Pitocin. Yeah, just to get my contractions where they want it to be. And that’s the second day.

P: : And then can you feel that or has the epidurall worn off at this point or

K: no it’s still going, and I had a really strong epidural one stronger than what I needed. Yeah, so I’m just lying in the bed like no one’s telling me that I can move like what I know about labor now is that even with an epidural, you can move a little bit, and that helps progress the labor, no I was kind of just laying there, waiting for the staff to do something next to me. I didn’t know if he like an active participant at all.

P: Yeah that doesn’t sound pleasant Good lord, so then…now you’re there for two nights. And then what happens the next day.

K: The next day is Christmas Eve, and my doctor comes in and says well you have to have this baby by noon because I’m going on vacation. And so I’m just like, look at her like, there’s at this point I’m already feeling defeated, I’m already feeling like, you know, you’re just doing stuff to me you’re not telling me what’s going on. Not knowing that I could ask questions because this was my first hospital stay, it was, you know the first time, yeah that I’ve probably ever been in the hospital I don’t think I’ve ever like this had to visit anyone in the hospital. So you don’t know what questions to ask you don’t know what you can say to your doctor, you know you’re looking to them as the, as authority figure at this point, and that person comes in and tells you that you’re not working on their timeline, and it just feels so defeating

P: that I have to say that’s crazy to verbalize I’m going on vacation and you have to go. I can imagine someone’s thinking that but not saying,

K: yeah, it was Christmas Eve, and it’s like my family just Christmas he really big like we all get together and I just thought that I would be home with my baby. 

P: Yeah 

K: because you told me I think my baby today, so she that’s what happened that day, she told me, I’m leaving. At this time, and so she left. At that time, even though we were just continuing to wait I didn’t have many other interventions at that point, they did an internal monitor right before I started pushing my baby’s heart rate was descending. So they gave me an internal monitor, and then it was time to push and I pushed for two hours. Yeah, they got pushed for two hours just about a vacuum was used to get my baby out, and then she was born. When she was born she was brought to my chest, but I didn’t want her there, I kinda was like, no, just because I wasn’t feeling anything like I knew that after you give birth, you’re supposed to feel all these things, and it’s supposed to be this like beautiful moment but I didn’t feel like that. So I, you know, told them to take her over to the warmer, and you know I saw her from there but I just, it just didn’t feel right at that time because of everything that I went through over the last two and a half days.

P: Yeah and it from the stuff I read if you have Pitocin but you aren’t producing it yourself. It’s a totally different. You’re in a totally different mindspace right if your body was producing Pitocin you would have gotten it in your brain, which helps with the connection. But if we’re getting it artificially 

K: Yeah,

P: you’’re not getting that right so

K: right, we are my girl I work with likes to say it’s called like the Oscar award winning speech after you have the baby you have like this, oxytocin high does oxytocin rush so you’re like, thinking everybody you’re checking fingers and toes you’re doing all of these things, because, you know, oxytocin does that to us. That’s why they call it like the love hormone, but yeah Pitocin doesn’t it just brings on contractions, it just does what it’s supposed to do. Give you contraction, Stop hemorrhaging.

 

P: Yeah, so it sounds like. It makes sense how you are feeling right like you’re responding to everything that has happened over the last two and a half days which is just disappointing. And but the baby’s fine. 

K: She’s fine, she was healthy 12 fingers 10 toes. She’s amazing and she do

P: How long do you guys stay in the hospital after that,

K: we stay there for I think two days. Yeah, we went home on the 26 I nursed you know her, she was a great nurse or it was fine, but yeah I’m sent home with this baby, and trauma from my experience in my labor.

 

P: And did you recognize it in the moment, like, did you think oh this was traumatic.

K: Oh, no, it wasn’t right, but I didn’t think that it was traumatic and so after processing my own postpartum depression and postpartum anxiety that I had throughout the time, like my postpartum period.

 

P: Well that sounds really hard from the stuff I’ve read it looks like one in seven women have postpartum depression. And somewhere, I think in the Cleveland Clinic I read some article that said, it’s the most common condition of childbearing. 

K: Yeah, oh yeah, it’s really up there. 

P: So, did you recognize, like in the fourth trimester that you were having postpartum depression or did you just think, oh my god, this sucks.

K: The postpartum anxiety was the thing that postpartum depression didn’t get to me as much as my postpartum anxiety did. I had very bad intrusive thoughts, and I kept saying to myself, This isn’t normal. This isn’t normal but I didn’t have anyone to talk to about it. I had a trusted network of friends, I didn’t have a professional that I could go to about it. I wanted to talk to my doctor, but I didn’t like her. 

P: Yeah. I bet

K: And then we would do screenings at the pediatricians appointment but I didn’t feel that I can talk to them about it as well, or the things that I did say they were like yeah that’s just baby blues, but by the time I really realized that I had postpartum anxiety I think I was, I was well out of it, which is great but also could have, it would have been beneficial for me to get help sooner or couldn’t recognize the signs sooner. 

P: Yeah, that’s the story I hear from a lot of women. I think it’s hard to recognize while you’re in it, because you’re busy being anxious or you know whatever right so and so did you become a doula between the first birth and the second birth or tell that story.

K: Yup…I became a doula between the two. So after my birth experience, I went to births with like friends and family, just as someone who had seen it before, because I, when I gave birth in my early 20s I think it was 21 when I had my daughter, so by the time my group of friends, like started to have their own children, I had already been there done that so I wanted to go with them to just help them out, because I knew my experience wasn’t typical or should not have been typical but found out that my experience was, was typical, 

P: I was curious about how common it was for women to have bad birth experiences, like the one Keisha described, and found a giving voice to Mother survey published in 2019 that sought to better understand women’s lived experiences giving birth.  The survey didn’t include a huge sample but it was just over 2000 people. And basically what the researchers found was that one in six women who filled out the survey were mistreated in some way during this very vulnerable period, during and after birth, they reported issues like loss of autonomy, being shouted at scolded or threatened and being ignored refused or receiving no response to requests for help, and the factors is associated with a lower likelihood of mistreatment, so you’re more likely to have a better experience if you had a vaginal delivery, a community birth a midwife, you were white, you’d have a baby before you were older than 30 years old.

K: I knew that that couldn’t be right because it’s not what I saw on TV. That’s not how I saw, you know, whoever on Friends give birth, is that how I saw like white women being treated. So I had a friend who told me she was like well you should be a midwife. And I was like okay that sounds cool and I looked online and saw that that required a lot of school and I was like, No. So then I had the same friend said well you should be a doula. And then I looked at that and I was like yeah doula work is more my speed. It’s something I really want to do.

 

P: So tell us how like has it, what’s that like was the training like and, and what was your experience and

K: that the universe like really lined up for me to be a doula after I found out what doula. What a doula was, I was working at a location that was recording podcasts for a doula training organization to labor. And so we just happened to be in the same space where I was talking about it. And the owner of that organization was there and she’s like yeah you should come and do one of our trainings. And so I looked it up and they were local so I did the three day training to become a birth doula. It took me a while, but from the time that I decided that that was something that I wanted to do till the time that I took the training. It took me a couple of years, but I think I was going to births I was doing the work, and I think it’s nice seeing that people weren’t being treated the way that they should and labor was really what gave me that momentum to say okay yeah I need to do this work. I actually attended the training after my second labor. 

So my second labor I changed providers. It was my third pregnancy. So as my second pregnancy I miscarried and I miscarried pretty early, but I had changed providers pretty early with that pregnancy, and then I had a provider, that was so amazing so supportive. I remember when I did miscarry pretty early, she, you know, I mean my husband come in her office, and I remember like crying in her office and she and I told her I said something like, I know you have other patients to see today and we’re leaving to get out of your hair and she’s like, No, you say, and process this, however you need to. And so I just knew that this was the person that needed to deliver my kids, any more than I have after this. So then, 

P: that sounds lovely 

K: yeah she was amazing. I still love her.

P: So we’re so this is the pregnancy where you said it was hard to get pregnant, this time.

K: So it took a while for me to pregnant again and but I get pregnant again. And, well, I thought it was gonna be so easy because the first few times were so easy, it was just like, they just happened…. the one I was really thinking about it, like I was going to try again, it took it took a while, so we got pregnant. A year later, and yeah, had a very empowering labor I still had lots of interventions, but I had a provider that made the time to tell me my options and my choices, and gave me the power that I needed back into my labor. 

P: So maybe what walk through that slowly so, so people can see the difference between the first and the second. 

K: I had a lot more information in the prenatal period, I was more than just my blood pressure my fundal height peeing in a cup and then asking if I had any questions. She was very forthcoming with all of the information that I needed to know just by asking me, Hey, have you taken any childbirth education classes do you know where to find them. These are the options that we have here in our office, but I’m sure there’s some more around, you know. Feel free to go look. She was telling me about my baby how my baby was growing, the things that I could do, you know, to help my baby grow, just a lot of information in the prenatal period. So I felt safe. When I went into labor. I just knew that I was going to go into, into this through an induction because I was induced last time so I just knew that I was going to be induced. But I ended up going into labor on my own at home and I stayed home for as long as possible, which was something that I didn’t think that I could do, but my provider made me feel really comfortable in doing that. But when I got to the hospital I was in active labor. 

P: Oh wow, really well. 

K: Yeah, I progressed really well. And then, at six centimeters hit a wall, I was like, No, I don’t want to do the same or it’s 2021 Give me all the drugs, or it wasn’t 21 it was 2014 Give me all the drugs so I have been told that it was, I will actually, before the epidural, I get Nitrus nitrous oxide.

P: Nitrous oxide, otherwise known as laughing gas is a form of anesthesia that you inhale, it sounds like it’s a pretty weak form of anesthesia, it’s usually used in pediatric dentistry, to give you a sense, but it does do something and it works quickly,

K: and that held me over for a while, while I couldn’t get into the shower, so I had to come out of the shower every hour or so for monitoring of the baby. I think at that time this particular hospital didn’t have wireless monitors so I had to get out of the shower to come get monitored, and so that was very hard, like contractions are really hard when I was out of the shower. So at one point I didn’t want to keep going back and forth so they gave me a nice choice, and that was really good pain relief option, and then the tank ran out. It was, I think I was probably like the second person in the hospital to ever use it or something but they were telling me it was very new to the hospital system at this time. So the tank right now, the nurses, even know how to use it at first, it was a mess. But it was helpful when I was able to use so after it was done I said I’m going to get an epidural. And then I got my epidural, and labor beautifully after that, I don’t think they needed to break my water until the very end because I had just a little bit of space left my baby was Opie which is occiput posterior Sunny side up. So, my cervix didn’t dilate all the way. So she was looking up instead of looking down when she was supposed to be, you know, the other way. 

P: Does that, does that mean a C section or 

K: No, no, sometimes it means longer Labor’s, and then in my case, it meant that my cervix didn’t dilate completely. Uh huh. It dialated, almost completely. So she broke my water to help try and get it to dilate more was like, like a half a centimeter, I guess, of dilation that needed to happen before they wanted me to start pushing, so she broke my water because of that, and I was like okay with that because she said either we can wait a while, or we could break your water, she gave me both options. And I was like no I’m tired. So let’s go ahead and do this, she broke it, we still waited a while, nothing happened. So we kind of just pushed past that little bit of dilation, which was fine. and I the second kid was born in 15 minutes. 

P: Oh Wow, well done.

K:  It was like three pushes 15 minutes is very quick. Yeah, so when it was time for me to push, I remember my doctor was sitting on the bed and saying, you know, all right, go ahead and push and I was like well, don’t you want me to put my legs on the stirrups Don’t you want me to do all of these things she’s like No, I’ll just do whatever you want. And that was just so empowering. It was just the greatest moment ever. So, I had a birth, that was traumatic but also had one that was so rewarding and empowering and I knew this is the type of birth that everyone should have.

 

P: That does sound like a story book kind of birth, where you’re making all the choices. 

K: Right. 

P: Yeah, that’s amazing. So now tell us I was saying to you before when I was having children, I don’t know if doulas were a thing or not but I, I was not aware of them. So give us a sense of what you’re doing for other people because I can’t, I can’t really imagine, doctors, kind of backing down if they’re if they’re sort of not approaching appropriately. 

K: Yeah, advocacy advocacy work is what I do, it was one of the things that led me to doula work was being able to, you know let people know of their options and their choices when they feel that they don’t have any or letting them know that it’s okay to ask questions. I never want to speak for anyone but just saying, you know, maybe there is another way, just ask, because you can ask questions to your doctor, and that’s okay. And they should give you that information. Consent is very important in this work as well making sure that everyone has informed consent for everything that happens throughout pregnancy, labor delivery in in their body and with their baby Afterwards,

Doula work is a lot of educational support in the beginning, especially, I mean, bindable free care, when you’re in the midwifery program it were free model care, you do tend to get a little bit more information than those who birth with an OB But yeah for those with an OB but or actually anyone in general really is just giving them evidence base, up to date information on whatever it is that they are going through in the pregnancy journey at that time, or that you may think that they need to know it’s anticipating folks needs as well.

P:  I’m guessing that you’re, you really shine in the labor and delivery room right because that’s when I think for sure for your first birth, most women don’t understand the degree to which they’ll be compromised when when everything’s going down right like all of a sudden you can’t really speak for yourself because you’re in excruciating pain or whatever you don’t know what’s going on. So, is it the case that like you’re having the talk with the mother or and then she’s communicating to get into the doctor like how does that all work.

K: We all talk together like I have no problem asking questions why providers are in the room where you know sometimes people might want a little bit of privacy or something like that to have conversations. I don’t know if we talk prenatally about some common complications that may come up and how to address them, giving you all of the tools that you need creatively to ask the right questions if something comes up, and then reminding you that you have those options to ask questions in the moment you can always ask, what are the benefits to this, what are the risks. Are there any alternatives. And then also, mostly advocating for more time for people.

Very rarely are people rushed into an emergency C section where they’re pulling cords out of the wall and then brushing them back to the or anything outside of that I’m always advocating for people to ask for just a few moments for them and their partner to talk about what’s going on, or to process what they just heard, so that way they’re not moving into the next steps with any doubt or worries, which they may still have but at least they have some, a little bit of time to process everything that’s going on and they can confidently move into that next step.

P: And you talked a little bit about your birth versus what you had seen for white women. I interviewed a woman at the Center for American Progress, and she works on maternal health issues among other things, and she was saying that for black women, the ways that racism finds its way into the delivery room are not always overt. So it’s not always like an obvious thing like, I don’t know that this woman was being racist with you but that’s an outrageous thing to say to a laboring woman…I don’t know what the was driving that her treatment of you but I wasn’t there but, but I’m imagining most of the circumstances are not quite as upfront as that.

 

K: Right, yeah, yeah, it’s, you know, biases that, yeah, yeah, that’s the face that people of color face when they are in labor. It’s a lot of, I don’t want to say the same type of stereotype, only because I am used to it and I, because it’s lived experience for me so I know what to look out for, but it is a lot of not ignoring or ignoring folks of color, their pain or their pain tolerance or thinking that they are exaggerating when they’re saying that something is wrong with them. It is a lot of ignoring their needs, and, you know, attending to the needs of someone else, ahead of them or something like or a white person’s needs, I should say, versus a person of color,

P: so in that instance you can go in like advocate for them and say no, she really needs another epidural or whatever like more.

K: Yeah. And luckily, I mean, The good thing about being a as a doula being able to see both sides and being able to be in the room for all types of people is that I can say, well, if they, if I have a nurse or a provider that says oh this is not how we do things here I can easily go back to experience that I’ve had with a white person is a well, actually this is how you did things how you’ve done it before, and this day and time, look at my notes. But

P: That seems super, that seems super powerful. That’s a great, great leverage to have.

K: So, yeah, it’s nice being able to advocate for folks in that way to say, you know, if they say, This isn’t how they do things I know that they do them, the opposite way,

P: I can imagine that is an unbelievably frustrating thing to hear when you’re in the mix and your client is in pain and need something right. 

K: Yeah, 

P: that sounds like a lot, so how long have you been a doula for.

K: So I’ve been professionally trained as a doula for four years, but I’ve been doing the work way before that.

P: That’s cool. So I bet you’ve been to a lot of births.

K: Yeah I think by the end of this year I will be probably well over 100 births. 

P: Wow, that seems like life affirming work. 

K: Yeah, it’s pretty exciting right. It’s always exciting, it’s always something new, 

P: and I’m imagining again when I was having kids there was no skin to skin, there was no like delayed cord clamping and that sort of stuff so it’s probably cool to be in a field where there’s constantly new and different things coming out.

K: Nice to be in a field where we’re bringing things back to the family, and out of the medical complex out of the doctor’s hands and bringing it back to the family like the skin the skin the delayed cord clamping. I even advocate for fathers to try and catch their babies we talk a lot about that. 

P: Oh, that’s cool. 

K: Yeah, because, I mean, they mean my job is to make sure that partners, I should say fathers, but partners are active participants in their labor as well like this is a family events, and not something that doctors have to oversee completely.

P: That’s super cool and I know that my husband had no idea what to do, I mean I had c sections but he’s still like, I want to go hide in that corner and you call me, so it’s nice to have someone who knows what he’s doing to kind of guide that process.

K: I think that I biggest, another one of my biggest roles is normalizing the process as well, so that partners don’t have to worry so much about advocating and, you know, answering all the questions and knowing all of the things, while the birthing person is in pain in going through their stuff. So I’m able to be like oh, that’s normal. Yeah, she’s throwing up, that’s okay.

P: Yeah. Don’t mind her yes that’s very funny. I thought that most states don’t allow insurance to cover doula services is that your experience. 

K: Yeah, in Virginia, we don’t take like the insurance companies don’t cover the list services. There are current bills being passed or laws going into effect, that where doulas can be covered by Medicaid. But I haven’t seen much where doulas are covered through private insurance. A lot of folks can use their HSA or their FSA account to pay for doula services, okay. Yeah, medical insurance.

P: That’s super cool. That is very cool work and it’s a totally interesting way to go into it right to have had your experience and think like I can fix this. 

K: Right, yeah, 

P: God how rewarding that’s cool. So, how do people find you if they’re in Virginia, the Virginia area, I’m assuming you don’t work outside of Virginia.

K: I do virtual work. Yeah, I mean this pandemic has opened up so many lanes for doula work since a lot of hospitals were closing their doors to doulas, we still needed an avenue to get into help families, so we do virtual work so I do virtual doula work for anyone, anywhere. If they need a doula. But if you are in Virginia, and you’re looking for someone local, you can find me on Instagram at Keyshia does work, or on doula match dotnet, and under my name Kesha Graham,

P: so that’s awwesome, I’ll put that on the show notes so people can find it. What’s it like to be virtual for birth, or do they have you in the labor and delivery room like on phone.

K: yeah, I mean FaceTime or we can check in every now and then where we can ask questions, if it’s really tailored to whatever it is that you need but yeah I mean I’ve done like FaceTime, where I’m just like on a tripod. Like, you got it. You can do it, you know it’s a lot of coaching at that point but also reminding families that you know they have choices they have options they have power in their experience and they should wield that power.

P: That’s amazing. And I can imagine, if I were in the circumstance where I actually had to push a baby out. I would probably trust you more than my husband because you’ve seen it before. Right, yeah. You know I can do it. He’s got no idea. So that’s super cool that’s an awesome job.

K: Thank you. Yeah, I love it. It’s really amazing. I love I love seeing families, work together, I am of the same like mindset that you are like, let the doula handle it. A lot of a lot of partners really get this like power inside of them that they don’t know is there when they’re faced with their partner going through something really hard that I really like to see. Yeah, I like the best births and when I just stand in the corner and get to watch families do their thing.

P: That’s amazing. What’s your ideas about C sections and like the stuff I’ve read is that, you know, there’s obviously serious surgery and you’re much more at risk to have some kind of complication if you go through a C section. And the other thing I saw that was kind of damning said the biggest predictor of whether you’ll have a C section or not is the hospital you’re in, as opposed to your medical condition. So that’s suggestssomething wacky is going on, what’s your experience because C sections of do you try to turn them around or how do you deal with that.

K: I’m not there to give anybody medical advice.

P:  Okay, 

K: so if the doctors are calling for a C section, you know, the only thing that I am able to do within my scope is to have the family ask questions and then help them come up with the questions to ask to see if it’s a true emergency or if they have a little bit more time, my own opinion on C sections but they are here for a reason. But with the current rates of C sections in knowing that there isn’t this big decline with mortality, mortality and morbidity, then we still know that C sections are being over utilized

P:  Yeah. 

K: From what I see sometimes I feel again me as someone who only took a few day training and has attended a limited amount of births I feel that sometimes you know, maybe things just need a little bit more time. And then I do feel that they are a little bit rushed, but, you know, again, I’m not a medical professional so

P: yeah I mean it just you’ve heard these stories where like the baby’s not in distress or anything. And they have a C section and you’re watching like any there’s the mother, so

K: that’s why provider choice is so important. That’s why place a birth is so important there is a thing of birth culture, like, your hospital is going to have their own individual birth culture, culture, so it is important to talk to families who have birth at the place of birth, where you’re going to birth, and have been with the provider that you’re going to see when weighing those options about C sections and I think it’s important for everyone to talk about C sections because we don’t know who is going to need a surgical birth, versus, you know, a bachelor one,

P: I assume there’s no like scorecard where you could see kind of what your hospital does, or is there some way to evaluate the, the environment you’re about to go into

K: some states have C section rates listed on their state website or you can find it on the hospital website, But sometimes, information if it looks kind of unfavorable it’s kind of hush hush so you kind of have to scour the internet and the message boards to find out that information,

P: but but usually someone is keeping track of that, so

K:  it’s out there is out there, but

sometimes it’s outdated I think for in my seat I think some of the information is a couple of years old.

P:  Okay. Okay, interesting. Well, that’s also a good idea. So reason number 87 to get a doula is to be made aware of all these things that you should be checking on. 

K: Oh yeah, definitely for sure. 

P: Thanks so much for coming on, I totally appreciate your time and your story. 

K: Thank you. Appreciate it.

Episode 23 SN: One Woman’s Story of Surrogacy: Cheney

In this episode, my guest tells her own story of pregnancy and she shares her experience of being a surrogate for another family.  It is, as you can imagine, a very involved process in part because it involves IVF, which always sounds to me like a full time job. Despite the fact that the pregnancies were relatively straightforward, there are challenges along the way, like postpartum depression, which can make other issues that come up more daunting to manage and we discuss those, too.

Tests to verify that your water has broken

https://www.healthline.com/health/pregnancy/premature-rupture-tests#diagnosis

https://www.qiagen.com/us/products/diagnostics-and-clinical-research/sexual-reproductive-health/maternal-fetal-testing/amnisure-rom-test-10-min-us/

Epidural

https://pubs.asahq.org/anesthesiology/article/129/3/448/22292/Maternal-Body-Mass-Index-and-Use-of-Labor

https://pubmed.ncbi.nlm.nih.gov/15477051/

Surrogacy

https://www.cdc.gov/art/key-findings/gestational-carriers.html

Surrogacy laws differ in different states

https://www.thesurrogacyexperience.com/u-s-surrogacy-law-by-state.html

https://www.hatch.us/blog/best-worst-states-for-surrogacy

Postpartum depression

https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617

https://www.webmd.com/depression/postpartum-depression/early-warning-signs-postpartum-depression

https://www.webmd.com/depression/postpartum-depression/postpartum-depression-baby-blues

Audio Transcript

Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka. I’m an economist and a writer, and the mother of two girls. I had trouble getting pregnant and being pregnant, and at some point my husband and I considered using a surrogate. Although we ultimately didn’t end up going that route. I’ve always been interested in surrogacy. Maybe because when we were repeatedly failing to get pregnant, it seemed like such an amazing thing for one person to do for another. So I was particularly interested to talk to today’s guests. 

In this episode, my guest tells her own story of pregnancy, and she shares her experience of being a surrogate for another family. It is, as you can imagine, a very involved process, in part because it requires IVF, which always sounds to me like a full time job, despite the fact that the pregnancies were relatively straightforward. There are challenges along the way, like postpartum depression, which can make other issues that come up more daunting to manage, and we discussed those too.  After our conversation I went back into the interview to add information about medical issues we discussed.

Let’s get to this inspiring story. 

Hi, thanks so much for coming on the show, can you tell us your name and where you’re from. 

Cheney: Hi, yes. My name is Cheney and I’m originally from San Diego, California. I’m currently in Louisiana, however,

P: wow, that’s a big shift. 

C: It’s a huge shift.

P:  So let’s talk about pregnancy you have a really interesting story in part because you have the experience of a surrogate and the experience of having your own child, which I’m totally interested in.  My husband and I, at some point, were thinking about using a surrogate, because I have all kinds of medical problems, so I’m interested to learn from you. Why did you get into surrogacy. What did you imagine pregnancy would be like and, and we’ll get into like how it was different as a surrogate and bearing your child for yourself. So why don’t you tell me first. How did you get into surrogacy?

C: My now ex husband and I, we, he was in the military. So, you know, we moved around, and I was a stay at home mom with my one child, and we had friends of ours that she had done a few surrogacies And she was like, you know, it’s such a great way for you to still be able to stay home and make money. 

P: Yeah, 

C: right? and she’s like if you had an okay pregnancy. If you know, because she knew like I didn’t want another one I was kind of a one and done. So she knew I didn’t want to have another one so they like need for another baby wasn’t really there, so she’s like I think that you would be a perfect candidate because you know it is a great way to make a little extra income, I mean yes you are having a baby, but you know it’s just a good way to get a good chunk of money to pay off some bills and things like that so that’s kind of how it got started was just like a friend of ours was like, I’ve done it, she’s like on her third baby now and like, she’s like, it’s so great and fulfilling and you know all the stuff and I was like sure, like, let’s do it.

P: So that’s super cool and I could see, I mean it’s an amazing thing to give to someone else so I could see like why you might be attracted to it, but, but then let’s hear about your pregnancy first because this must be what, in some ways convinced you that this would be a thing to do. So before you got pregnant the first time, what did you think pregnancy was going to be like?

C: I didn’t really know. I didn’t really hot like my sister was pregnant, she had twins, the first go round. So I was like oh man if I get twins, that’s gonna be hard, but, um, but yeah I didn’t really like have any expectations I didn’t really know what to expect, what not to expect just like things that my sister had been telling me, you know, I asked my mom how her pregnancy was, you know, a few friends of mine, and they all were like it was fine. I didn’t have any issues you know yeah morning sickness sucks but then it goes and it’s just like it’s fine, you know like they went about their merry way and it wasn’t like a big deal. So, I was just like okay cool, it seemed really easy, I guess, to get pregnant, nobody in my immediate group had trouble getting pregnant, so the IVF and all that stuff I didn’t know about any of that because I hadn’t experienced it, so 

P: that’s a good entrance right like yeah, you know, it’s good,

C:  it’s easy. Yeah, my sister had to write that in there first time and I’m like okay, we’re fertile, you know, 

P: yeah, exactly.

C: So did you get pregnant easily.

C:  The first time I did, yes. Yeah,

I stopped taking, I was on birth control. I stopped taking it. I get I did all the, you know, proper protocols when the doctor said, Okay, we’re going to try, you know, made sure everything was good to go. And then I stopped taking the birth control. And then after three months I was pregnant.

P: Good that is pretty good. 

C: Yep. 

P: And then, what was the way you want to walk us through pregnancy is there anything that kind of stands out as, oh, I wasn’t didn’t expect this, or this is not what I would be. 

C: I didn’t expect to get pregnant so quickly. Yeah, so that was kind of a shock when I I just on a whim took the pregnancy test I wasn’t like oh my god I’m a weak lead and you know like I wasn’t kind of that. I’m not an overly excited person just naturally. 

P: Yeah, 

C: so I just took it on a whim and I was like well I think I’m supposed to start today I’ll just take it right, and then then the pregnant and I was on my way to the gym. And I was like, Oh, I just left it. My husband was still sleeping. It was early, and I just left it in the bathroom. And he was still sleeping and I was like let’s just see like if I get a call right so I went to the gym I was being a friend you know I still went to the gym and did my thing, and never got a call never nothing I called him and I was like, Hey, did you notice something in the bathroom and he was like, What, no, and I was like, Oh my gosh. Can you go look in the bathroom and he was like, Oh my God, he’s like, go buy another one make sure this is right. Okay, so I went and bought another test and I was pregnant.

P: that is sort of that, that is the tricky thing about getting pregnant quickly is there’s no Runway Right, 

C: yeah, 

P: for people who, it takes a little while he get used to the idea and I mean you have nine months he’s the idea but it is kind of immediate right,

C: yes. Yeah, and you’re just like, wow, my life has now changed. 

P: Yeah, 

C: this is weird, you know, but yeah, and then it was like the anticipation of like, Am I gonna get sick, am I gonna get sick, you know, like I just kept waiting to get sick and I never did.

P: Oh, that’s interesting. 

C: Yeah, 

P: and so was it the second trimester also easy everything’s easy.

C: Yeah, everything was super easy. The only thing I’m about Super stood out was, because I am I was waiting to get sick because my sister had gotten really bad morning sickness. So, I was still working full time, you know I was a manager at a sporting goods store at the time, and I was just working and working you know and I remember this one day I did go out to get lunch and I ordered a iced tea, which I normally do. And it did not sit that I had to immediately go, you know, let it all out. And since that day I have not been able to touch it, 

P: oh, no

C: yeah, so that’s kind of that weird thing of like wow, I totally like him and smell it. Yeah, wow, you know, yeah, it was it’s so that’s like the thing that I didn’t really. The surprising thing that came out of it was Yeah, well I can’t drink iced tea anymore. Cool,

P: yeah that’s that is like a surprising thing after drinking it all the time, right,

C: right, and then just that one time and it was like right at the very tail end of my first trimester, and that was the one time that I ever got sick and it was because of the iced tea, and I was just like that is so bizarre.

P: Yeah, that’s weird. And so, it’s smooth, up until the third trimester and then take us to the day of the birth like how did you know today was the day.

 

C: Yeah, so my water broke at work. 

P: Oh, Wow. 

C: Yeah, yeah. 

P: was it like a Hollywood splash?

C: No

P:  Okay good. 

C: No, thankfully, yeah, thankfully it was not like that, I yeah I had an early shift that day and I was the only manager on the floor. At the time, you know until we opened, there was just like one manager, looking over, like the truck. 

P: Yeah 

C: and so I was there early, and I was just like, kept kind of leaking. And I was like, what is happening you know because it would just like dribble and I’m like pee, like what’s happening so I kept like running back to the bathroom and I’m like, It’s not pee. And then I would stand up and stuff would dribble and I’m like, This just seems really weird. 

P: Yeah, 

C: So, so I went up and I told one of the team leads and I was like, Yeah, can you call like the other manager like I needed to come in early, I think my water broke and everyone of course freaked out. And I was like, No, it’s totally fine. Like, I can wait until she gets here, you know like I was super nonchalant about the whole thing. You know so she got there and then I was able to leave and I drove myself to the hospital, you know, I called 

P: so no contractions at this point, 

C: no nothing. 

P: Okay, yeah, 

C: just some leakage and yeah so I called my husband and he drove like 45 minutes to work was like hey have you left yet and he’s like No, and I was like yeah you might not want to I’m headed to the hospital, you know, Can you meet me there. And so we did and you know they did the test of, I guess there’s like a paper strip that they can stick down there to see if it is actual breaking. Yeah, or nothing.

P: So if your water breaks the way Cheney’s did without much fanfare and there are no contractions, there are a few tests available in the hospital to determine if it’s amniotic fluid. Some use a paper strip to test the pH of the fluid because amniotic fluid is more alkaline than normal vaginal fluid which is more acidic, and there are newer tests to try to measure the presence of certain protein markers that are highly concentrated in amniotic fluid to verify that the liquid leaking down your leg is, in fact, evidence of your water breaking.

C: and it was, my water broke, so but it was just like yeah just a super slow trickle and I was like, I was like okay, no, no contractions, no nothing. This was like it probably eight in the morning I think I got to the eight or nine in the morning I got to the hospital. 

P: And are you like 40 weeks are you close to your due date, 

C: I’m 38 weeks, okay 38 weeks. 

P: Yeah, yeah, 

C: so a little early, I mean, around. It wasn’t until I really started, they did they induce, no I don’t think we did, but it wasn’t until my, you know contractions started getting stronger, that’s when, kind of, I was just like, oh my god what am I getting myself into, you know, that’s kind of when it all hit me was like it’s been so easy. 

P: Yeah, 

C: and no one has really told me about the aftermath, and the actual birth that I was like, wow, like, this hurts. Yeah, yeah.

P: And it is a weird feeling of this is happening to my body and I have no control,

C: Yeah, totally, like zero control. Now I ended up throwing up and I was like why did I just do that, like, what the heck you know and the nurse was like happens a lot, like almost everybody because of the hormones and you know, it’s just like, it’s like came out of nowhere and, you know, I ended up getting the epidural. And it didn’t take all the way. So I felt a lot of everything.

P: So wait did you, you just so you can imagine like I want a natural birth or if you just thought it will

C: I knew going in that I would get the epidural, okay. We didn’t go to Lamaze classes I didn’t, you know, think about doing the, you know, learning how to breathe correctly and all of that in hindsight, I totally wish I would have done all of the breathing techniques and stuff like that, like, you know, because now I’m super into yoga and breathing and it’s like, you know how I feel my body. After some other stuff that happened but, but at the time I wasn’t super into yoga or anything like that. So, so yeah I didn’t, I knew, like I was like yeah I’ll just get an epidural and I’ll be fine. That was kind of my thought going into the birth. 

 

P: good, well good. Like, it’s nice to be on kind of the mainstream path but you won’t be flustered when they offer you an epidural you’ll be like, Sure, I’ll take two, right, like there’s right yeah, yeah. 

C: Can you just make sure it all just works. 

P: So you said it didn’t really work, what was the one side of your body, or

C: basically yeah yeah I felt. I think my left side was actually numb, but my right side I could feel everything. And because it was the first one I guess, everything was obviously still super tight. 

P: Yeah, 

C: down there I hadn’t ever been that large, it doesn’t know what it’s doing. 

P: Yeah, 

C: never need to expand. And it just felt I could feel how tight it was, she was coming through, and that on top of the pressure pain was so unbearable. I just remember like screaming it hurts so bad it hurts so bad you know. 

P: Yeah, 

C: they’re just like push you to make better hurts you know, yeah, yeah, it’s just yeah, it wasn’t good like no one told me oh the epidural might not work all the way. Yeah, yeah, I have another backup plan in case this happens because I can’t redo it, you know like I wish that I would have had that kind of like, make sure that you do understand the breathing that you’re able to calm your body you are able to get through the pit you know like I’ve used other techniques in place. If the epidural doesn’t work

P: well so I’m assuming pretty early on you report to them like I can feel everything and what do they say, so sorry. 

C: Oh yeah, sometimes that happens and I’m like Wow, guys. Thanks. Excellent. 

P: As of 2018, roughly 70% of birthing women get an epidural, according to a study out of Stanford, some fraction of these epidurals don’t work. The most recent article I can find on the subject is from 2004. And those authors report that 12% of the time epidurals fail, they attribute the failure to three things in general. First, labor progresses too quickly, it takes something like 20 minutes for the payments to kick in. Second, the needle is inserted into the wrong space in the back, or third, there are some anatomical issue that compromises the effectiveness of this kind of anesthesia. 

Pain is a really hard experience to describe appropriately.

C: It is because everyone experiences it differently as well. You know some have higher pain tolerance, lower pain tolerance is, you know, I always thought I was on the higher pain tolerance and childbirth is a whole other different ballgame,

P: I was gonna say, maybe you are I’m not sure childbirth yeah but right 

C: yeah exactly. 

P: So did you labor for a long time and was the pushing a long time or how did all that go. 

C: No, I didn’t have to push for a long time, Maybe 30 minute 2030 minutes. 

P: Oh good. 

C: Yeah, so it, it was smooth, though I didn’t have any complications from the time my water broke, and then she was born at 5:50pm. So you know, like, eight, nine hours, like that was it. So no, I can’t say that I had this like long tremendous horrible labor I wasn’t, you know, pushing for five hours or anything like that, you know, you know, it, it was fine. My biggest struggle was the aftermath.

P: So what So tell us about that like so she’s born, and then, yeah, 

C: so she’s born, the umbilical cord is wrapped around her neck twice. 

P: Oh wow. 

C: Yes, so she wasn’t breathing right away. And, you know, they put her in my arms and I like was crying just like, you know, breathe, breathe you know when she finally did and everything was fine, but I ended up tearing, just so painful, which nobody talks about. 

P: Yeah, 

C: or told me about anyway. And so then they had to stitch all that up, the hemorrhoids, the breastfeeding, you know, like, she couldn’t latch on. And it was just it was so frustrating like you have this, now human that you need to keep alive. 

P: Yeah, 

C: and you yourself feel like death, because you’ve been through this like traumatic experience basically. And I was just like my hormones were crazy. It was just it was such like a huge shock that I didn’t expect it to be so hard. You know because I’m, you know see pictures of people with their babies and they’re so happy and I was just like, I was so miserable. 

P: Yeah, yeah it’s babies are really hard right the first month so much work, and you just, I feel like, very few people are prepared for it the first time. Yeah, it is really hard so, but it sounds like you probably did not like imagine I breastfeed for a year and a half or something you just thought you would breastfeed for a while and see how it went.

C: Yeah I mean I wanted to at least breastfeed for a year. That was my plan was to go for the year, and I was determined to breastfeed. So I was like, No, like she’s gonna latch you know she’s been like, maybe I’ll get full 24 hours and she hadn’t eaten because I she wouldn’t latch. And this nurse finally came in and she’s like baby tried this nipple shield, and I was like, what, what is this Why did someone give this to me like the second they saw she wasn’t latching you know, and that was a total game changer. 

P: Oh that’s awesome.

C: Yes. Yeah, so I was able to do the nipple shield and she was able to drink from that and I had to then use that the whole entire time that I was breastfeeding, 

P: wow 

C: I couldn’t get her off of the, the nipple shield. 

P: Well, you know if it works 

C: exactly what they are, don’t fix it, and I had to it took me a while because I was so determined to breastfeed like, you know, do it naturally and to me naturally was beyond breast. Yeah, and having this other foreign object between us, like, to me it was like the but that’s not breastfeeding, you know, so it kind of took me a little bit to let go of that and be like, it’s working and it’s fine you know she’s getting what she needs just leave it alone. But then when I had to go back to work, it actually made the transition from me to bottle so easy because she was basically having the bottle on my boob. 

P: Yeah, yeah, 

C: you know, so then my mother in law was able to feed her when I was at work, and I was able to pump at work and no I mean it all worked out. But yeah, I mean it took like a amount of time for just that one nurse to be like, try this. You know, 

P: yeah, yeah. I mean it’s described as natural which doesn’t mean it’s easy, right, it just means. 

C: Nothing’s easy. 

P: Yeah. It also like every part of this process like even like the birth right to coordinate the cervix opening and the hormones and the, you know everything, occurring at the right time. Doesn’t always work that’s like a tricky thing. So 

C: yeah, 

P: and to have your baby have the right latch to match with you perfectly is awesome. You know there’s no guarantee of that. And so it’s great that you figured out a way to make it work.

C: Yes, yeah, thankful and I’m very thankful for nipple shields and I’m thankful that that nurse introduced me to.

P: So it’s interesting that you, that sounds like a relatively straightforward experience. Although having gone through the birth, you’re willing to say yeah, I’ll do it again. 

C: Yeah, because the pregnancy part of it is so easy that nine, the nine months, you know 38 weeks. So easy, that I was like, Yeah, I can do that again, like the birth is one day. But then I don’t have to care for this thing after I can just heal and be done recover. 

P: Yeah, right. 

C: So for me it was like yeah by, you know, let me heal. Let me recover, let me get back to my life. Let me get back to my daughter, you know, and then it was, it was fine. So in my mind it was, it was kind of an easy yes because the first pregnancy itself was so easy. 

P: That makes sense. Okay so for people who have no experience with surrogacy like, walk us through how it works, how do you find a family or how do they find you and how does that stuff all work out. 

C: Yeah, so there’s a couple of different ways that people can do it.

P: A little background here, so it looks like there are two kinds of surrogacy gestational surrogacy in which the surrogate carries the pregnancy of another woman’s egg, and the father or donor sperm. There’s also traditional surrogacy, which the surrogate egg is used to create the embryo she’s carrying surrogates can be altruistic so they carry the baby for another family, and only their medical bills are paid, or commercial surrogacy, which as the name suggests, involves a fee beyond the medical bills. How common is it. The CDC estimates that between 1999 and 2013 2% of all assisted reproductive technology cycles are for gestational carriers, which amounts to about 13,300 deliveries and 18,000 babies, half of the pregnancies have multiples.

 C: I personally went through a agency where you’re kind of put into this database, like, it’s almost like match, right, so you’re put in this database you like fill out your profile you put pictures of like you and your family what you like what you do you know all these things. And then this other family comes in and views, the profiles, and then they pick what one they think is best. So through this agency we were matched, and then it’s like this whole long process of making sure that I am physically fit and able to go through the IVF treatment. And they also had to test my husband, they had to do some blood tests and things on him, to make sure that he was clean, you know from STDs and things like that, 

P: yeah, 

C: obviously, you know, still gonna be having intercourse with this other person’s day but you know so they had to make sure all that was clear. So it was a lot of blood work, it was a lot of back and forth to the IVF facility that we were using. So, yeah, it was a lot of doctor’s appointments, 

P: and the people who are, who are giving you the embryo, they’re, they’re covering all that, are they going with you to all these things. 

C: No so the couple that we ended up matching with didn’t live in the States. 

P: Oh wow

C: So, I Yeah, we didn’t end up meeting them until I was six months pregnant, I think, wow, that’s when we finally met them like we were emailing, you know, back and forth, we had phone conversations and we would communicate via email, but we didn’t actually meet them until they were able to come to the States. And I was like six months pregnant.

 

P: Wow. So what they just they shipped the sample over to you and then is that is that is that how it worked.

C: So what happened. Well this with my particular instance, the mother, her eggs weren’t viable at all. So they had been trying to do EBF the IVF themselves for a few years 10 years I think. 

P: wow

C: And she just couldn’t get pregnant, and it ended up being her eggs just aren’t viable. So they ended up getting an egg donor and the husband, flew in donated his sperm, and then you know flew home, so the facility was able to do what they needed to do with the egg and the sperm. So all I had to do was just go then to the facility and get implanted

P: and is that painful or it’s easy.

C: No, it’s, it’s not painful at all. It’s a little awkward. So, my couple wanted a girl, they were very like they want, so they did the gender they can figure that out, like, you know what they, what the embryo is. So they ended up having I think three boys and one girl embryo. So they only implanted the one. 

P: Yeah, 

C: with like, you know, oops, that that one would attach because I know they like to do multiple, yeah, yeah, eggs, but we only had one egg that was a girl. So my process into being ready to then be implanted, um, if you’re not familiar with the IVF process is that I’m getting injected with hormones to prepare my body to accept this embryo. So it’s basically tricking myself into thinking that I’m pregnant. 

P: Yeah, 

C: so that my body will accept this embryo, so for the, I think two or three months prior to getting the implantation. I was injecting myself with hormones and taking them orally as well. So then I, you know, so I was ready to go, everything’s good. They measured my cervix. Think beforehand before all this started part of the process was also measuring the cervix so then they knew exactly where to implant the embryo. So they had all this so I’m ready to go, you know, two months later, I’m full of hormones, and I go in and they put you on this table right with your legs up in the air basically like you’re giving birth, and then they tilt you backwards. So my head is at an angle, it’s like a 45 degree angle or my head is down at the bottom and my legs are up. So, I guess gravity helps them 

P: Yeah, 

C: put in this embryo and then I have to lay there in that position for a couple minutes, um, that was, that was the the awkward thing like it didn’t, wasn’t painful or anything at all, it was just super uncomfortable and I was like wow I really don’t want to be hanging upside down. Okay, yeah. But, but yeah other than that it was super easy they implanted real obviously took, and, and then I had to continue doing the hormone replacement for the first trimester. I was doing it before the implantation and then for through the whole first semester was doing.

P: That’s interesting. That’s interesting because your body at this point is pregnant. So why do they need to supplement your hormones, after you’re like I understand the pre pregnancy thing to some degree but once you’re pregnant. Isn’t your body supplying the hormones you need. 

C: Yes, but they wanted to make sure that it was getting the hormones that it needed that the embryo was getting the hormones because there. There was a very high risk of the pregnancy failing within the first trimester, 

P: okay 

C: at the IVF so that’s why they just wanted to make sure that I was getting all the hormones that I needed, so they just kind of upped it.

P: can you feel that made you feel the hormones like Do you feel anything at all.

C: No, I mean I felt, I felt fine before the implant. Yeah, after the implant natural hormones kicked in, plus I was taking the added rounds, and I was sick time. 

P: Oh 

C: nauseous 24 hours, I would get sick, in the evening. Nothing tasted good, like it was bad, I was sick, and I was like I didn’t get sick, the first time but it was because all the added hormones on top of everything. Yeah, so then I ended up getting very sick. The first three months it was great.

P: Yeah, well now you know what your sister was talking about, 

C: I’m sure she’s Yeah no I do it. 

P: And so what’s the rest of the pregnancy like.

C: So after I was able to stop the hormones. Yeah, the added in hormones. It was fine. The pregnancy was great. I didn’t have, you know, after the first trimester, my hormones balanced the baby was doing great. I had a great pregnancy, it was actually during the baby was much better for an easier the second time around. I just remember the first time just being so uncomfortable and I gained a lot of weight. But my daughter didn’t gain a lot of weight she was only five pounds 10 ounces, when my daughter was born, and I have gained like 40 pounds. So, I know I had gained all that weight…where in this instance, I didn’t gain a lot of weight.. I didn’t retain liquids like I did the first time. The baby was getting all of the weight. The second go round so I this I thought that was kind of interesting how my body, almost, I guess it remembers right how what it’s supposed to do so the second time around it was like, Oh, yes, you get all the nutrients you’re good, you know like, We don’t need to hold on to all this extra water in the face and get fat and gross, you know, and it was like just the baby got it and it was fine nice the pregnancy was totally fine, and

P: that’s super interesting and do you feel like, like emotionally it was different for you or you thought it felt the same or

C: emotionally I think I was fine and I knew, you know, we have to obviously sign contracts that I’m not gonna steal the baby and all those Yeah, and that’s funny enough, that’s why a lot of people come to actually California when I was doing the surrogacy I was in California. California surrogacy laws are the strictest laws. So a lot of people come to California, to do the surrogacy because of the laws, which I found kind of interesting. 

P: They’re strict in terms of like their surrogate can’t keep the baby is that the issue. 

C: Yeah, I mean that’s the gist everywhere but I don’t know like the legal obligations, I just remember that each state has specific laws to pregnancy, all of them do state know you can’t keep the baby, but I just knew that California is laws were, there were more laws in place, I guess, to do the surrogacy, 

P: that’s interesting. And yeah, yeah. 

C: And this was like, you know, a few years ago so the laws may changed now, but we’re

not being super that’s why a lot of international couples were coming to California because of the laws that makes sense.

P: It looks like surrogacy laws differ in each state. Many states don’t have any laws at all like Georgia, Hawaii, Idaho and Kansas to name a few. And some states have restrictive laws like Louisiana passed a bill in 2016 that says that gestational surrogacy is restricted to married heterosexual couples using their own egg and sperm, but there are all different kinds of restrictions. For example, Texas says the parents have to be married he’s a surrogate and California as Cheney suggests, is considered a surrogacy friendly state because laws protect both the intended parents and the surrogate, and they’re very good IVF clinics in the state so ostensibly surrogates wouldn’t have to travel far to initiate that part of the process. And if you want to be a surrogate, or use a surrogate, you should look into the laws in your state, as things change frequently. 

And so, when you meet them at six months is that an exciting meeting.

C: Yeah, it was really fun. The mother didn’t speak any English. So, a lot of the communication was through the Father, and there were just the sweetest people, they were so nice so genuine. You know obviously super happy to be becoming parents, and they were just so sweet and yeah it was a really good meeting.

P: That sounds amazing and I could just imagine, you know, from the mother’s perspective how grateful she is to have this, right after like 10 years of not working, this seems amazing.

C: Yeah, she was just she was so, so grateful that you know that it was working and she, she could like see it grow, you know what I mean, like seeing growing we’d send pictures and things like that and I think for her it was just like, this is actually happening, you know, kind of surreal for her and it was just it was such a cool experience to have.

P: So do they get to be at the birth, or how does that work.

C: Yes. So, remember, they were coming to the states around 38 weeks just to make sure that they weren’t close by. Yeah, and yeah so then when I, I ended up having contractions. And, yeah, and then I you know I emailed him and was like hey you know I’m having contractions, you know, I’ll let you know obviously want to head to the hospital. And, you know over I think it’s like two hours or so that contractions started getting closer and closer together. So I was able to get to the hospital and then they met me there. When I got to the hospital was already seven centimeters. 

P: Wow. 

C: Yeah. The second time around I was like, I was prepared, I guess, like it wasn’t super painful like the contractions were intense but I wasn’t in excrutiating pain or an Yeah. So by the time I ended up getting to the hospital I was seven centimeters, and I remember them like checking. And they were like, yeah, like how much longer can you go like pain wise and I was like, Yeah, I’m done, I would like the epidural. Okay yeah, let’s do that right now. Great, so I was able to get the epidural really quickly and my water had never broke, he’s like I can feel the sack it’s like there, it’s protecting the baby’s head right, that’s it. He’s like it hasn’t broke yet. Yeah I was just kind of there, and it’s like weird. Okay, so I was able to

P: did the epidural work this time?

Ca little better than the first. Yeah. Yeah, it took, I could feel the. My body was having a contraction. I a sharp pain running through the back of my right leg. That’s when I knew I was having a contraction. 

P: Wow. 

C: Yeah, but other than that it did. It did work, so I was able to push you know better and more concentrated because I could feel that sharp pain I was like oh I’m having a contraction, and they’re like, how did you know that I was like I have a sharp pain running down my leg. So yeah, the second experience was, was much better, and the parents were in the room with me, so it was just my husband and then the parents and then obviously all the nurses and doctors were in the room, and I pushed her out. And they swept her away in, that was it, and then I got to watch the parents like hovering over her and they cleaned her up and, you know, the dad was holding her and he was crying and I was like that was totally worth it. Like just that, seeing that, you know, 

P: that’s amazing. I want to cry at the thought of that so I just I can’t even believe how generous that is for you to do that. I understand that it’s a job and you’re, you know, there, there are other things that come with it but it just seems like the best thing you can do for another person.

C: It truly is giving life right to someone who tried and yearned for it for so long just giving that to them it was just it made all like the whole process worth it

P: That’s amazing. And so how long ago was that 

C: that was six years ago. 

P: Do we get to hear about their little girl like do you guys keep in touch or 

 

C: they went back to, to where they live in. Yeah, they went back four weeks after the birth, they were able to travel and I pumped for them, for those four weeks. And that is something I will never do again. It was so painful to just strictly pump. Yeah, nipples were raw, and bleeding off the whole four weeks. It was horrible. It was horrible. I was like I’m not getting paid enough, it wasn’t enough extra money to, 

P: yeah, yeah, that sounds hard, 

C: I had agreed to it and then I was like wait, how much is it I was like oh that’s not worth it but I already agreed.

P: Aren’t there milk banks for babies are isn’t, isn’t that a thing.

C: It is a thing, and I realized that after, because I was producing so much milk. I was like well what am I going to do with all this extra so once they leave, you know, I was like do I keep pumping and selling it and or donating it or you know whatever I was like you know what, no, I’m done, like, 

P: yeah, yeah, yeah

C:  I want my boobs back. So, um, so I pumped as much as I possibly could and I would portion it out into bags, the breast milk bags, you know I would portion it out like you know three ounces for ounces however much she was drinking at the time, and you know I told them, you know, because first time parents right I’m like hey just like put it in warm water and let it like slowly warm up and then just add it to the bottle, so I had it all perfectly portioned out for them and then they ended up being able to put, put it in a cooler with dry ice, so they were able to take whatever I had back to their country. 

P: That’s awesome. 

C: Yeah, yeah, they had no I haven’t heard from them or spoken to them since. So, well,

P: I’m sure yeah I’m sure every family has their own way to handle it right.

C: Yeah, and you had the option to either stay in touch or not stay in touch. You know, due to some other circumstances, we, you know, I ended up needing to change my telephone number and email address and all that stuff so the agency doesn’t even have my current, you know, contact information, so even if they were trying to contact me, I wouldn’t even know that, you know Yeah. So, but that was it was a really, really good experience and I have been asked to do it again and I don’t want to.

P: Yeah I mean it’s a lot of strain on your body right it’s like a hard thing, I mean, even though it was relatively easy for you like it is a lot to go through.

 

C: Yeah, physically I was fine. It was the emotional and mental health part of it, so I ended up getting bad postpartum depression with my child. And then, it was never taken care of properly. So when I had the second child, 

P: wait, so let me pause right there, no you’re not taken care of appropriately because you didn’t know what was going on or like what happened there.

C: Yeah, I didn’t know about postpartum depression. I mean I knew that hormones got wacky, and they were fine, but no one in my immediate family or friends group had really bad postpartum depression so I didn’t know what was happening I just chalked it up to, oh it’s hormones because I had a baby, but you know I remember just like hating her so much. No, and I was like why do I feel this way you know I was just like I had so many emotions and I didn’t know what to do with them properly, you know I wasn’t seeing a therapist. You know I think I was ashamed or scared to tell my doctor that I was having these feelings, so they don’t want to do, 

P: they didn’t have you fill out like a little depression form or whatever like a survey,

C:  I’m sure, but I was like yeah normal normal normal. Yeah,

P: so it’s really tricky, you know, I, I’ve talked to a bunch of people who’ve had postpartum depression and it’s the most common side effects of pregnancy.

Which is kind of shocking given that almost everyone says what you have said which is, I had no idea, right i i couldn’t kind of see it in myself and one woman I spoke, it was a therapist, and she was like I you know I still couldn’t see it in myself. So it seems like a really tricky thing to, to fix or address because many people going through it don’t recognize it maybe until the second pregnancy or something changes, or there’s something to compare to 

C: right and I yeah and it was like I just showed me because this was like, you know, a week after I was home with her and I was just like oh my god like trying to figure out, like she wasn’t sleeping and our sleep schedule and, you know, my then husband just sleeps through everything and I was mad at him because you know I’m like I’m the one absolutely you know, feeding her every two hours and you’re just frickin sleeping, you know what I mean so of course there was like anger there and confusion and then the depression on top of that and.

P: Okay, Web MD says, 80% of women experienced baby blues, feeling overwhelmed or exhausted and having mood swings, which makes sense given that introducing a new baby into your lives is a dramatic change in circumstance. It comes with a lack of sleep and hormone swings, but feelings associated with baby blues, usually wane in one to two weeks and peripartum or postpartum depression is a much more intense version of this. According to the Mayo Clinic here are some of the symptoms of this kind of depression. Depressed mood or severe mood swings, excessive crying, difficulty bonding with your baby withdrawing from family and friends, reduced interest and pleasure activities you use to enjoy an intense irritability and anger. I’ll include the full list in the show notes, but it’s important to communicate with your doctor about this to get help. 

C: Yeah, I didn’t really know about postpartum and how bad it could get until after the fact, until after the second pregnancy, and then I got it again. You know, and then I was like, I refuse to get out of bed, you know like with Elise I would get up with her you know like, we would be doing things I would still be doing my normal activities, so maybe that’s why I didn’t think it was so bad because I could still do everything I needed to do. 

P: Yeah, 

C: you know, as a mom as a wife and things like that. But the second time around. I just didn’t want to go to bed. I was just done with life. I just didn’t care, and, and that I think is when it hit me and my husband was like yeah sums up, like, you know, let’s say, going to the doctor. And that’s when we went to the doctor and you know I felt comfortable enough telling him exactly what happened and he’s like yeah, you’ve probably been dealing with depression, and now you’ve had, you know this traumatic experience and your hormones are all out of balance, so that you put me on antidepressants and. 

P: Was that helpful. 

C: No, it made me feel worse. 

P: Oh no, yeah. So, how did you find your way out. 

C: Um, that’s a whole other story. No, I don’t know. Honestly, there. Like I was saying there was a whole lot of other factors to my story than just the pregnancy, my husband, ended up being a drug addict, so I was dealing with that, he told me that he was addicted to pain pills, Three days after I had birthed my birthed our daughter. 

P: Oh wow, 

C: he told me that, so I was dealing with a lot. 

P: Yeah, 

C: and our relationship, and his addiction just kept getting worse and worse and worse and worse as time went on, and I agreed to do the surrogacy I was under the impression that the money was going to be going to pay off our car to pay off credit cards, things like that. Well, he ended up using all the money for his addiction. So there was like a lot going on in my world. 

P: Yeah, 

C: and I ended up because of my depression I think and because of, you know this codependency relationship that I found myself in, you know, I knew I needed help. I knew that he needed help. So I ended up having family take my daughter and I ended up using with him. and the uppers that I was using actually kicked my depression. Not saying that that was the right thing, 

P: yeah yeah yeah yeah, 

C: but because I was so low. 

P: Yeah 

C: the uppers that I was using boosted the, you know, endorphins or whatever. and it actually ended up balancing that out 

P: Good Lord, that is not a straight path through 

C: It was a lot it was a lot, and you know that’s a whole other podcast but, but that’s honestly how I how I got out of it was by doing drugs, and I don’t want anybody to take my how I got out as a way to get out, don’t do it that way, you know, go to the doctor do it the right way, tell them this isn’t working and they’ll put you on something else that will work, but, but yeah, because of all my other circumstances, it just I lead I, I let myself go down that path and help my depression. 

P: All I can say is, Cheney, you seem like an incredibly, incredibly strong person to get through all that each of those separate things, has enough weight that it will take long to get through sort of mix them all together, is, is just seems like way too much, right, like

C:  it was, it was a lot. Yeah, 

P: so that’s amazing to have you on the other side.

C: Yes, yes. Yeah, and you know I wouldn’t be here without the support of my, my family, they they took me in, when, when things got really hard and, you know, kind of showed me their love again and I was able to, to get out of this situation to get away from him, you know, and start building this this new life for just my daughter and I and it’s been pretty amazing. 

P: That sounds awesome. How old is she now. 

C: She is almost nine. 

P: Oh, wow, what she into 

C: dolls. She loves the imaginary play with dolls I think she has 15 right now. 

P: Wow, 

C: yeah it’s getting a little obsessive, but she you know will do her chores and earn her allowance and then she you know buys them herself. But it’s, it’s just so funny and then she watches these YouTube videos of this other little girl who plays with the dolls for YouTube and then she’s now creating her own YouTube channel, playing with her dolls, it’s just it’s really cute to watch.

 

P: That’s super cute my kids were very into dolls too, which is fun like to listen to those conversations right where they’re making sense of the world around them in this relationship they’re creating it’s very cool.

C: Yeah, it’s so funny and new she’s like disciplining them you know and it sounds like me and I’m just like this, you know, or it’s like better I was like oh I wish I would like a thought of, that’s a good idea, like I’m gonna use that on you later, you know. Yeah, insane. Yeah, that’s really good.

P: That’s very cute. So I’m wondering, now we’re down this road and looking back, is there any advice you’d give to your younger self about like the pregnancy stuff.

C: Gosh….ask more questions. Don’t hold back. After the fact, like let the doctor know let people know around you how you’re feeling, you know because you’re not the only person who have felt that way, like it’s an okay feeling to be struggling, and to not shut people out. 

P: Yeah, 

C: well I should have let more people in.

P: I mean, clearly, I think most people do it your way so that seems like a natural response but it is, you know the statistic is like one in seven women experienced postpartum depression you know so it’s really common and, and it’s just a matter of people understanding that like, oh I need help with this and this can, You know where there’s a way to manage it and

C: and not be ashamed of having these thoughts because you know if you have them, then other people have them too.

P: Yeah, and  think of all that your body has gone through right, it makes sense that there’s some expression of that experience. 

C: Yes, yeah. Absolutely. Awesome, well that’s great advice. 

P: Thank you so much for sharing your story is super interesting to learn about surrogacy. And that’s such a amazing thing to do for someone else so it’s like a nice, nice No it’s going on. 

C: Yes, yeah.

P:Great, thanks so much for coming on.

C:Thank you so much for having me. It was fun.

Episode 22 SN: Don’t Tell her No, SMA & Pregnancy: Sarah’s story

If I had to use one word to describe today’s guest i’d say driven, or maybe fierce–truly, and maybe it’s because of these personal attributes that her life in the world doesn’t match the predictions you might make if you looked at her health status on paper. She was born with a neurodegenerative disease that dramatically affected her mobility–she’s never walked and has been wheelchair bound for almost her whole life…and despite the challenges this kind of condition invites, she’s a school psychologist and importantly for this podcast, had a baby. In general, in the medical community, time and time again doctors have told me that pregnancy is an enormous stress test on anyone’s body–to have her condition and successfully manage a pregnancy is next level. And although lots of people enter pregnancy underestimating how it will effect their body, today’s guest had no such luxury. 

You can access Sarah’s class Destination Tomorrow, and her children’s book Differences are Dynamite!

Spinal Muscular Atrophy

https://www.mda.org/disease/spinal-muscular-atrophy/types

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Spinal-Muscular-Atrophy-Fact-Sheet

https://my.clevelandclinic.org/health/diseases/14505-spinal-muscular-atrophy-sma

https://pubmed.ncbi.nlm.nih.gov/19692244/

CVS Testing

https://www.mayoclinic.org/tests-procedures/chorionic-villus-sampling/about/pac-20393533

Carrier for SMA

https://www.acog.org/womens-health/faqs/carrier-screening-for-spinal-muscular-atrophy#:~:text=About%201%20in%2040%20to,children%20are%20born%20with%20SMA.

Journal article on women with SMA and pregnancy

https://www.jns-journal.com/article/S0022-510X(18)30106-0/fulltext

NIH site about treatments

https://rarediseases.info.nih.gov/diseases/4945/spinal-muscular-atrophy-type-2

Discussion with Dr. Abati about treatments

Audio Transcript

Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette kamenecka. I’m an economist, a writer, and the mother of two kids who very much enter the world on their own terms, as babies often do. But for today’s cast, there was a lot of effort put toward controlling the elements of this process that could be controlled. If I had to use one word to describe today’s guest. I’d say driven early be fierce, truly, and maybe it’s because of these personal attributes that her life in the world doesn’t match the predictions you might make, if you looked at her health status on paper. She was born with a neurodegenerative disease that dramatically affected her mobility. She’s never walked, and has been wheelchair bound for almost her whole life. And despite the challenges this kind of condition invites. She’s a school psychologist, and importantly for this podcast, she also had a baby. In general, in the medical community, time and time again, doctors have told me that pregnancy is an enormous stress test on anyone’s body to have her condition and successfully manage a pregnancy is next level. lol lots of people enter pregnancy under estimating how it will affect their body. Today’s guest had no such luxury after our conversation are back into the interview to add some details about medical issues that we discussed.

Let’s get to her inspiring story.

 Hi, thanks so much for coming on the show, can you introduce yourself and tell us where you’re from.

 

Sarah: My name is Sarah Manuel and I am from Northern California. So, like, not like the San Francisco part of Northern California, like the real Northern California where, you know, horses are our neighbors and we grow rice.

P: Nice, that’s really nice. I’m from the fake Northern California– in the Bay Area, but I’ve driven up to where you are and it’s beautiful.

S: Yeah it is. and we love going to San Francisco too

P: That’s that’s having it all, that’s great. Do you want to tell us a little bit about what you do. 

S: Yeah, so I am a school psychologist by day, and on the side I am a life purpose coach, and part of that and I’m really excited to share with people, this course I have called destination tomorrow, which is three different ways to visualize your future so you kind of know what you want your future look like so you know how to get there. And when I made my first vision board that I still have because it’s relevant in so many ways, my life now. There was definitely a picture of a baby on there so I knew as part of the feature that I wanted to create for myself, and I just I didn’t really know how to, how it was going to happen but I knew that I wanted it to happen.

P: Okay that sounds cool. I know you have one child, let’s talk about how you got there, how you made it happen.  Before you got pregnant with that child. What did you imagine pregnancy would be like?

S: So I was born with a genetic disease called spinal muscular atrophy, it’s, it has historically been known as the number one genetic killer of kids under two, and I wasn’t supposed to live past age of four or five, and even though I didn’t have that circumstance. I do live my life in a wheelchair, the disease is progressive so I’m stronger today than I will be five years from now, and I am extremely weak so one pound of weight is heavy.  The fact that I was, you know, still alive when I met my now husband. I just assumed that I wouldn’t be able to have a kid and he’s the one that says, Sure, you can’t Why couldn’t you. So we started talking to doctors, and it was really frustrating because we would have one doctor say, Oh yeah, you can do this and then the next one day I don’t think so. I was really scared about what the pregnancy would be like we really didn’t know how my body was going to respond.

P: Let me stop you for a second, will you tell us a little bit more about your condition, were you diagnosed at birth or later than that,

S: my mom started noticing something was off. I started pulling myself up, and then I stopped. So I was around say six or seven months when she said take me to the doctor. And when the doctor told her, don’t panic, you’re still within the normal limit so we’ll give it some more time than when she took me back and, of course I hadn’t worked at that point, and we started doing a series of tests so I was probably around one or so. When I was diagnosed and they thought I had the more severe, to type one is the most severe and I have type two.

P: Okay, well that’s lucky, have they figured out it was type two?

S: because I lived. 

P: Oh wow. Good lord.

S: Yeah, 

P: well that sounds stressful for you and your parents.

S: Well for me I didn’t know any different, because I was so little I know that the types of medical procedures that I had to go through, were very traumatic and painful. And one that I do remember when I was nine years old, they wanted to do a muscle biopsy to confirm the disease but they didn’t have the blood tests and all that back then, so they can numb the skin to do the biopsy, but they couldn’t numb the muscle when they edit because they said that would be it would throw off the results. So I remember it being in the doctor’s office screaming, and they gave me headphones with Smurf music I think that will hold me down, But I really felt them cut my muscle. 

P: Oh, I’m not sure I’ve heard of Smurfs as anestesia before. 

S: Yeah. 

P: Was it from your leg or where was it from 

S: Yeah, he was in my left thigh. 

P: Oh, wow, that sounds unbelievably painful.

S: Yeah, I get a Cabbage Patch Kidl out of it. So that’s pretty great

P: I remember that being pretty coveted. 

S: Yeah, and I got it before the Christmas rush that that season so I was like that, you know, number one, kids school because I have my cabbage patch kid,

P: yeah, that’s, well done on your parents part,

S:  yes. 

P: So as Sarah suggested spinal muscular atrophy or SMA is a genetic condition that you can inherit, if both parents pass on a copy of a flawed gene. This gene allows for good communication between cells in the brain and spinal cord that affect voluntary muscles with SMA signals from the brain don’t reach the muscles, making muscles weaker over time and limiting a person’s ability to move the genetic test for this condition was developed in 1995, almost 20 years after Sarah was diagnosed, it looks like between 10,000 and 25,000 children and adults have si in the United States in the last five years, new treatments have been developed, the attempt to fix the flaw gene and improve the connection between brain, spinal cord and muscles. 

So, so you’re going around to different doctors and some are saying yes and some are saying no and what are those conversations like like are they yes people convincing or they know people convincing or they’re both convincing. What are they telling you.

S: Well, there was one in particular I remember we had guided an appointment and it was like a ninth wedding anniversary and I thought oh this is a great sign she’s gonna tell us to go for it. So we go to the appointment, and she lays out like seven to 10 reasons why it would be really dangerous for me to get pregnant, and then she just says, I recommend that you don’t get pregnant. And I started to cry. And she said, Did I say something wrong. And I’m just looking at her like 

P: 7 to 9 things wrong 

S:  I came to you wanting to get pregnant and you just told me I can’t, and, like you have no emotion, like, so that was like the one that stood out in my mind and it was after that, maybe even a month or two, one of my colleagues at work, was like, why don’t you get another opinion. And I don’t know why we didn’t think about that before but probably because we have gotten opinions less formal, but we’ve gotten opinions from doctors for years. So by the time that he said that, like, oh, well, I guess we could go see another high risk OB GYN and see, because that was the first high risk OB GYN that we thought I said that.

P: Before you get this next answer to the things that she said resonate with what you knew about your body,

S: Not really because I had always beaten the odds like when somebody tells me I can’t do something. I make it a point to go prove them wrong and say, I can do it. 

P: Yeah, 

S: so it just felt like she didn’t know me. She liked my personality she didn’t know what I was capable of. I was just a name on a piece of paper, and she was looking at the black and white, and not looking at anything else which is what she’s trained to do. 

P: Right. 

S: It felt like that door was closed pretty tight. Yeah, that’s it, that’s why it’s hit me and stayed with me for so long.

P: So one thing I want to capture is that when I’m reading about SMA, it seems like it would be a real challenge to be pregnant, do you have you see your arms.

S: I, when I look at myself, compared to other people with my disease and my severity. I think I’m, I’m on the stronger side, like I’m able to put my own makeup on, I’m able to write, I’m able to type. I’m sometimes my arms get tired and they just don’t really got extremely tired during the pregnancy and especially as my work year because I work as a school psychologist, so I had summers off, I got pregnant in May so I was that first trimester just finishing up the school year and normally I would just like down a bunch of tylenol or ibuprofen to deal with the arm pain I was able to do that course. So, my arms, didn’t work as well as they normally do. But yeah, in terms of my day to day post pregnancy and pre pregnancy I’m unable to move my arms, but I’m still considered technically quadrapalegic, and say I have such limited use of my music I can’t raise my arm. Like I can’t lift up my elbows. So, the strength I have is like for my elbows to my hands. Yeah,

P: yeah, fair. Okay so now you have been convinced to go get another opinion and is there anything to your any method to your search to find another maternal fetal medicine doctor like I don’t know how I would identify someone who might be more open.

S: So the first one was referred to you by my muscular dystrophy specialist. Then we went to, I think just my regular general practitioner and said can you refer to a high risk OB GYN for another opinion. And so, that doctor was like heck yeah you can do this, you could even have natural delivery and yeah you’re capable, I’ve done it before we can do this. So then it was just a matter of having that conversation of, is the risk worth the benefit. When do we just go for it, or do we not, and after we talked about it for like three months we decided, our lives would be so much one in which by trying and knowing one way or the other than to always wonder and have that void.

 

P: Yeah. So two questions. Number one, do you have muscular dystrophy community, do you know other people around you with a similar condition

S: at the time and no. 

P: Okay, so they don’t have examples of like other women who’ve done it.

S: Correct. But it was interesting because when I was pregnant. There was another category of like the USA weekly, you know weekly magazine that comes in the Sunday paper. Yeah, there were a woman with my my disease exactly that was pregnant and telling her story, and I was like this is like six months long or whatever. So we actually got in touch with her and talked to her and got more information

P: wow, That’s amazing. I did find one article from 2018. That’s a review article, and they looked at the medical literature and obviously not everyone with SMA or neuro degenerative disease, who’s been pregnant is captured in the literature, but from 1950 to 2018. It was 67 people.

S: Yeah, 

P: which is not a ton. 

S: That’s why at one point we just had to make a decision, my husband and myself to whether to take the risk or not, because they did medical advice but only get us so far we had to just, you know, make a personal decision and, and, for us the risk was worth that the huge reward on the upside of things had worked 

P: it is a huge leap of faith. 

S: Yes, definitely. 

P: What are the risks?  

S: death 

P: why is it potentially fatal?

S:  They were very concerned about my lungs, and if my body was able to tolerate that component of it, there were risk of blood clots and and that kind of thing. Those are the two biggest issues. 

P: Okay, well pregnancy as many people say is a stress test so I guess that makes sense. I guess I was imagining that it was mostly muscular and not like organ related. 

S: Right, so it’s every muscle in your body right, so an example, my lungs, normally develop but the diaphragm muscles are not because it’s a muscle it’s impacted. 

P: Yeah, 

S: so my breathing capacity is lower than a typical person. 

P: Okay,  I apologize for my sixth grade understanding of anatomy.

S: Oh, No, it’s, it’s good to have the questions. 

P: Okay, so you decided that you’re going to get pregnant super exciting. And how does that go.

 

S: It’s couldn’t have been easier we got an ovulation test, found out when I was ready and got pregnant the first try.

  

P: Oh my God, that’s awesome. That is totally awesome. you know so many people have a tough time getting pregnant and I’m so grateful. In your case that it was not hard at all because you might have attributed it to something else.

 

S: Right, and I in the back of my mind I’m thinking, okay, nine years of marriage, we’ve never had an oops. Is it because I can’t get pregnant. 

P: Right, 

S: so it was a relief when, what do you know, I was capable

P: Super exciting and then are you, I’m assuming they put you straight to high risk, you don’t go with a regular OB.

S: It was interesting because I would go see the high risk to do like the CVS testing to make sure the baby didn’t have my disease.

P: Okay so CVS testing or chorionic villus sampling is a prenatal test, in which they take a little piece of the placenta and test it for a variety of genetic conditions, including SMA cystic fibrosis and Downs in Sarah’s case She’s clearly a carrier for the genetics that create a SMA, and they didn’t know if her husband was, it looks like it’s pretty common to be a carrier between one and 40 and one of the 60 people. This test is usually done between weeks, 11 and 14 before amniocentesis can be done.

S: But like the regular OB GYN managed me the entire time.

P: Oh great, that’s nice so it’s less stressful.

S: Yeah, and he was like cuz we were assuming I would just go straight over there, and he’s like, Oh no, we can do this. 

Okay, great, 

P: that’s awesome. And so what was your pregnancy like were you nauseous in the first trimester.

S: Nope.

P:  Nice.

S: Understand how you know that show they used to have, I didn’t know I was pregnant. To me, like, it’s like how do you not know you’re pregnant and except for the missed periods, I wouldn’t have known, like it was the easiest thing in the world.

P: That’s awesome. I think if anybody should be given that gift, it should be used so I’m glad you got it.

S: Yeah, one of the nurses said well we something’s easy for you. 

P: Yeah, 

S: I saw my muscular dystrophy specialist more often. And I got his attention because these doctors at these teaching universities, once you become someone they can write about their research papers they become very interested in you so that was good that I had his full attention. So yeah, it was, it was pretty easy pretty clear cut.

P: That’s awesome. And so, take us to the day of the birth like how do you know, today’s the day and what happens.

S: Oh well, actually let me back up because there was a time I was maybe six to eight weeks it well first of all, they were just hoping I would get to 32 weeks, because that would be a point where the baby could be born, and the lungs would be pretty okay if there would be a good survival rate, and I was able to work to 35 weeks and I went up to 38 weeks to deliver him full term.

P: Oh, let me ask one question about that. So, when I was pregnant the first time the baby was sitting in a way that made me My husband used to say I sound like Darth Vader, when I was breathing because like the baby was like laying on my lungs, you didn’t feel any of that, that was easy for you.

S: that was easy for me. In fact my lungs got stronger as the pregnancy went on because they did lots of pulmonary function tests on me, and they kept improving the further into the pregnancy I got, like, Wait, this is the opposite of what was supposed to happen. 

P: That’s totally interesting. 

S: Yeah, it was amazing. There was one night I remember where he turned, he actually turned himself from being head down to going side to side. And at the time I thought maybe I was going into labor you know going into labor or something. And it turned out to be such a blessing because he was just running around because I’m not a big person, so he turned. So he sat sideways in me and it gave us, you know, an extra month in there. It was very painful, when he did that but  is allowed for more room for both of us. So he was very compliant… like even when I would have to go to the bathroom, you can just see his little butt stick out so he wasn’t on my bladder. He’s a very good boy,

P: I like that, it starts from the very beginning, 

S: yes. 

P: That’s awesome. What do you have to do for gestational diabetes I know you have to do the little prick test all the time.

S: Yeah, I was able to manage mine with just what I was eating I didn’t have to take insulin and everything, but I did have to do the blood tests every time I ate, and that kind of thing.

P: I feel like I was partially on that train and so I remember doing all the blood prick the finger prick stuff. 

S: Yeah, 

P: so that’s kind of a pain but it sounds like it resolved once you delivered me 

S: Yeah, it was fine. 

P: So now take us to delivery day you’re at 38 weeks. And are they are you scheduled a C section or you’re going to have a vaginal birth.

S: Well we had kept asking questions and talking about the different options, and there was one point when they said, if you have an actual delivery, an epidural isn’t possible because I have scoliosis, which is the curvature of the spine. So when I was 10 they put in metal rods to straighten that and they fused it with bone from my hip so it’s like glued there. So in order to get an epidural, they would have to drill through that it’s like okay that’s not happening. 

P: Oh good lord, no thanks. 

S: Yeah, yeah. So if I were, it was either, it would either be natural with no epidural or a C section, and what finally made the decision was they told me if something happened, Your our primary concern and not the baby. And it’s very hard for them to intubate me, so that it would take them a long time to do that. So it’s like okay well then that’s just not an option, we’ll do a scheduled C section.

P: Yeah, that makes sense right have as much control over it as you can.

S:  Right. 

P: Do you have any contractions at all before you go in.

S: Nope

P:  Yeah, that’s I had the exact same experience, no contract felt like a business meeting, because like I show up at the hospital and you don’t feel anything and you just like wheeled to your room. Yeah. So what was the C section like,

S: Well, it was in a general surgery, operating room, because they were going to have to put me under anesthesia. But in order to do that, like I said, it takes them a while to intubate me, so I had to be awake while they intubated me, and I couldn’t take any sedatives or anything because it would have affected the baby. So, I am literally wide awake while they are sticking this tube down my throat.

 

P: That does not sound comfortable are you are you freaked out or how are you handling it.

S: It was an amazing anesthesiologist, he was fantastic, and he talked to me the entire time he went at my pace. They were not interested in rushing things. So, that which is better than because I’ve been intubated while sedated and that was horrible because I would come to and feel like I couldn’t breathe and all that, they would tell me if you’re fine, and it was horrible. So, being awake and having them actually care and talk to me and listen to me was a much favorable experience than the other.

P: Yeah, I mean a good doctor goes a long way. Right, they can definitely take you through some really hard things so I’m also grateful that you had a good anesthesiologist because that’s super valuable in that context. So, once they get the tube can they then like knock you out.

S: Yes, so as soon as they got the tube in. They put me under he was under anesthesia for no more than, you know, four or five minutes right before they let him out.

P: Yeah, the C sections really fast. Right, 

S: yeah, yeah. And it was actually the doctor who prefers the C section was the one who told me not to get pregnant and why are you crying, and I made a point I said, I don’t want her to be the one. And I told them why and she happened to be the one on the calendar that day they didn’t have any control over it. So when she came back in to check on me after delivery, you know, it felt kind of like told yourself. 

P: She didn’t say anything. 

S: Not that I remember now if it stands out. So, if she did a great job sewing me up and everything because you can’t even see it. So, that’s amazing. Yeah, and somebody told me, Well, maybe it did her good to see how she said not to do it and it turned out better than okay

 

P: yeah yeah I agree. I mean it’s a learning, learning opportunity for her, and in my movie version of your story. She’s apologizing at your bedside, while you’re holding your baby. Just so you know, that’s when I when I write the movie. Yes. So, does it take a while to come out of the anesthesia after those whose section.

S: I don’t really know how much time went by, I remember what you know how they have to do the massaging of the uterus when you have a C section. 

P: Yeah, 

S: that was killing me, and they’re just like, I don’t understand why and then I realized later, I didn’t have an epidural. Usually these women aren’t feeling this…it was torture. And, but yeah and I remember before I had the baby I told me how it’s been, Joe come see me just stay with the baby. Don’t worry about me. And then in my recovery, I guess I totally flipped and like I want to say my husband. So he was like are you sure cuz she told me to stay with the baby.

P: It is, you know, you never know what you’re gonna feel like in that circumstance, yeah beforehand right so, so that makes sense. And then, and I’m assuming your son was fine, aced his APGAR.

S: Yeah he was, I don’t know what his APGAR was he was in NICU for four or five hours. And the other interesting thing is my husband did not get to be part of the delivery, because it was a surgery. Wait, and they said, you know you we would usually like the husband’s end to be moral support for the wives but you’re not going to be awake so he will not be there, so that was kind of a bummer for him, but he went and spent, you know they came and got him immediately, and they went to NICU together.

P: That’s awesome, did why did your son go to the NICU was because of the general anesthesia.

S: Yeah. Yeah, they just wanted to watch him, and he was only in there for a couple hours before they moved him to the maternity ward without me.

P: That’s like a drive by, that’s nice. 

S; Yes. 

P: And then what was that what was your recovery like in the hospital.

S: So they insisted that I go to ICU that night, just to be extra cautious, and at first they won’t even let me see the baby, and my husband’s like, No, you need to get her up here so she can see her son, so I got like five minutes in the hallway with our son before they took me to ICU. 

P: That’s real hard right…that’s a hard thing to be separate in the beginning, 

S: very hard.  And I remember like I was wide awake in the middle of the night, they tried to bring in some pumps to help me get that going. But I didn’t have my baby, which that’s all I want it was my baby,

P:  yeah, yeah, yeah…And so, how long were you in it, I see I’m assuming they just don’t want babies in the ICU.

S: I guess and I don’t remember them saying why they just put him in with my husband in a maternity room on the, on the ward. So and it was a private room because we got lucky with that. Um, and my husband like looking back, he’s like, I was kind of happy to have that time because you got him this whole nine months. I got him.

P: That is kind of nice for your husband. Yeah, I interviewed someone else who was in the ICU after her birth and she said they had a rule that there were no babies in the ICU because they’re worried about germ exchange between people in the ICU and a new baby and 

S: that makes sense. Yeah. 

P: So, I’ve definitely heard that that part before. And so, like, did the pumping work, how does that how does that go,

S: it didn’t go very well. It just, I tried once or twice but it didn’t work

P: And did you have any notions of like I definitely want to breastfeed or were you

S: Yeah, I was set to where this was going to happen. And we, I tried many times, it just didn’t, and I just finally said okay, this isn’t what’s important. You know, I let go of it, because it was better because my husband was going to be the one to get up in the middle of the night to feed. So it was,it was better. 

P: that makes sense. Yeah. And did you have any like notions of like I definitely want to breastfeed or were you 

S: Oh yeah, I was set to where this was going to happen. And we, I tried many times, it just didn’t, and I just finally said okay, this isn’t what’s important.

P: That’s amazing perspective because I’ve definitely I’ve seen my friends struggle with it, but there is like a lot of pressure to breastfeed just everywhere. So it’s a little bit tricky to to carve your own path in the beginning, so that’s hard so kudos to you for being able to give it up in a, in a way that makes sense for your family. 

S: Yeah, 

P: all those formulas have DAPA now and all the, you know, stuff that breast milk has and certainly it’s not exactly the same but it seems a much better substitute than maybe like our parents. 

S: right I would agree. 

P: And so, what was your recovery like when you got home,

S: I was pretty weak at first, but you know within a week or two I was fine like I remember he was born December 9 And my mom worked at the school I grew up in, so they had a Christmas program, like maybe a week later, and I remember we took him there so he could see Santa. 

P: Wow, 

S: yeah so we can have our first picture with him the Santa, because I didn’t want to take him to the mall yet. 

P: Yeah, 

S: and I would be kids good I worked with the school here as a school psychologist so all the kids wanted this you know they saw me pregnant so they were thrilled to see the baby and so that was fun. But yeah, 

P: awesome. 

S: I’ve been around and doing stuff. 

P: How big was he when he was born, I neglected to ask

S: he was five pounds five ounces. 

P: So that’s a good size. 

S: Yeah, 18 inches tall, and he had the biggest feet it’s like his feet were the only things that had room to grow. 

P; That’s very funny. 

S: Yes. 

P: And how old is he now. 

S: He is 10 

P: Wow, awesome. So what’s the into 

S: He loves cars like Hot Wheels car video games Minecraft, your typical boy step Roblox that kind of thing.

P: That’s super cute both of my kids were addicted to Minecraft, at some point.

S:  Yes, I think that’s a right of passage

P: no kidding. That’s very fun. So, what an amazing and triumphant journey you have had here. I’m so glad to hear it and I hope that you are, you know, shouting from the rooftops so everyone who follows behind you knows like yes this is possible or get a second opinion.

S: Yeah, and since then I’ve met up on Facebook with other women with my disease who have also had babies. So, if that had been the case, I wouldn’t have felt so alone so like we’re no charting new territory so that I think is helpful too.

P: That’s amazing. So, I am interested to hear if you could go back and give advice to your younger self, what do you think you’d tell her.

S: Just don’t stop believing it. And it was interesting because as soon as I got pregnant, I had this sense of peace come over me that the baby was going to be fine. So I wasn’t really stressed out, there wasn’t really a point where I said oh I wish I wouldn’t have done this, I just was very calm and like excited and like I knew everything was going to be okay. So, I think I would go back and tell her, everything’s gonna be okay, right, you can do this, and you’re going to be fine. 

P: So why don’t we talk a little bit about your book 

S: in the spring, I put out a children’s book, I have actually written in grad school, so it’s been, you know, just kind of sitting around for 13 years and I find the guy the illustrated consequences are tiny. And it’s about some animal friends who, instead of being embarrassed or ashamed that the ways that they’re different. they’re different in all different ways, they, they look for the differences and other people and they encourage it and celebrate it, so that they are, you know, proud of who they are as individual and that, you know, together we’re stronger with our differences and trying to be just like everyone else.

P: That sounds super cool, and you’ll send me a link and I’ll people will be able to find it. 

S: Yeah, absolutely. 

P: Okay, awesome. That’s awesome, that’s so that’s such a great story. I totally appreciate you sharing it with us. Thanks so much for coming on the show. 

S: Thank you so much for having me. 

P: One thing I didn’t understand before I became a mother is that becoming apparent requires a lot of toughness, both physical and mental and serious toughness have been tested her whole life. She seems wildly overqualified for this job . Her story is also a good example of what it’s like to live on the edge of medical understanding. As she said she and her husband just had to make a decision to have the baby at some point, because her experience is unique enough that their decision, couldn’t be guided by medical expertise. Thanks again to Sarah for sharing her amazing story. I’ll put a link in the show notes for Sarah’s class destination tomorrow, and her book differences are dynamite. Hope you enjoyed this episode, feel free to like and subscribe and leave a review if you can. It helps other people find the show. Thanks for listening. We’ll be back soon with another story of overcoming.