Episode 14: Help! This Pregnancy Has Taken Over my Body: Alasen
Episode 14 SN: Help! This Pregnancy Has Taken Over my Body: Alasen
Today’s guest stepped into her first pregnancy relatively easily,getting pregnant within a few months of trying…… and that was the last easy thing she experienced. She describes herself as someone who is “not a pregnancy unicorn”. She had body image issues while pregnant, felt nauseous, swollen and was generally physically uncomfortable for most of the pregnancy. And then postpartum recovery was even more challenging. A hormonal imbalance caused a too dramatic weight loss, she was visited by postpartum depression and anxiety, and a baby who wasn’t particularly interested in sleeping through the night added to her ‘non-unicorn’ status. In an effort to dig herself out of a hole, she started researching nutrition and found a much better way forward for the second pregnancy, and ultimately for life. I learned a lot talking to my guest today and hopefully you will too. You can find her at https://thenutritiondoula.com/ and in Instagram @thenutritiondoula
Body dysmorphia
https://www.womenshealth.gov/mental-health/body-image-and-mental-health/pregnancy-and-body-image
Adrenaline in labor
https://link.springer.com/article/10.1207/S15327558IJBM0801_04
https://www.sciencedirect.com/science/article/pii/S152169342030033X
Diet and depression
https://www.health.harvard.edu/blog/diet-and-depression-2018022213309
https://www.medicalnewstoday.com/articles/318428#antioxidants
https://academic.oup.com/nutritionreviews/article/79/3/247/5843529?login=true
Audio Transcript
Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette kamenecka Today’s guest first steped into pregnancy, relatively easily getting pregnant within a few months of trial. And that was the last easy thing, she experienced. She describes herself as someone who is as I quote, not a pregnancy unicorn. She had body image issues while pregnant, felt nauseous for a large chunk of the pregnancy and physically uncomfortable, then postpartum recovery was even more challenging. In an effort to dig herself out of a hole, she started researching nutrition and found a much better way forward for the second pregnancy, and ultimately for her life. I learned a lot, talking to my guest today and hopefully you will too. I’ve paused our conversation in places to add medical details and to include the insights of a thoughtful OB.
Let’s get to the story.
Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette kamenecka Today’s guest first steped into pregnancy, relatively easily getting pregnant within a few months of trial. And that was the last easy thing, she experienced. She describes herself as someone who is as I quote, not a pregnancy unicorn. She had body image issues while pregnant, felt nauseous for a large chunk of the pregnancy and physically uncomfortable, then postpartum recovery was even more challenging. In an effort to dig herself out of a hole, she started researching nutrition and found a much better way forward for the second pregnancy, and ultimately for her life. I learned a lot, talking to my guest today and hopefully you will too. I’ve paused our conversation in places to add medical details and to include the insights of a thoughtful OB. Let’s get to the story.
Episode 13: Your Placenta, Best Friend or Frenemy: Brooke
cover art care of Francee Greer
Episode 13 SN: Placenta: Best Friend of Frenemy? Brooke’s Story
Today’s guest is no stranger to hard labor. As a strength and training coach she’s seen how disciplined effort produces results. But long runs and weight lifting sets didn’t prepare her for some of the consequences that the complicated chemistry of pregnancy can produce. Through the course of her different pregnancies she tangled with HELLP syndrome–a pregnancy complication that requires emergency attention, and a visit by gestational diabetes. Now, with three kids under 5, she can add a new exercise to her regimen: child wrangling.
Find out more about Brooke here: https://www.wreckingroutine.com/
HELLP syndrome
https://www.healthline.com/health/hellp-syndrome#risk-factors
https://emedicine.medscape.com/article/1394126-overview#a6
https://www.sciencedirect.com/science/article/pii/S0925443912001901
Difference between preeclampsia and HELLP
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692334/
Gestational Diabetes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515446/
https://www.sciencedirect.com/science/article/pii/S0925443919300237
GD by population group
Audio transcript
Paulette: Hi, welcome to war stories from the womb a podcast where women tell stories about getting pregnant, being pregnant and giving birth, with a focus on the difference between their expectation of the process and their experience. I’m your host Paulette Kamenecka. I’m the mother of two girls, and while I thought pregnancy would be challenging, I had no idea how challenging it would be for me. I had trouble with every part of the process—I definitely didn’t make it look easy, and I’m totally grateful to have made it through. Today’s guest is no stranger to hard labor, as a strength and training coach, she’s seen how disciplined effort produces results, but long runs and weightlifting sets, didn’t prepare her for some of the consequences that the complicated chemistry of pregnancy can produce through the course of her different pregnancies, she tackled with HELLP syndrome, a pregnancy complication that requires emergency attention, and was visited by gestational diabetes. Now with three kids under five. She can add a new exercise to her regime child wrangling. Let’s hear how she managed all the uncertainty of these trying situations.
P: Hi, tell us your name and where you live.
Brooke: Hi, I am Brooke and I live in Minnesota.
P: Oh wow.
B: Yeah.
P: How many kids do you have,
B: I have three.
P: Wow.
B: Yeah, three kids, we have three kids and under four years.
P: Nicely done.
B: Thank you. That was not what we thought would happen but that’s what we got.
P: So that’s usually the way it goes, before you got pregnant. What did you think pregnancy would be like?
B: oh man I you know honestly I don’t know if I thought that much about it, but I probably had this like vision that was going to be this like magical thing I was gonna be so in tune with my goddess body and like it was gonna be super easy and, you know, that whole thing, and I mean there’s definitely the magic, and all of that and then there’s all the other things that come with pregnancy, which I was much more adept at being aware of, rather than like this goddess SNESs that you tend to see around social media, yeah,
P: yeah, yeah, pregnancy has good marketing,
B: it really does. And there’s so many things that people don’t talk about.
P: Yeah,
B: like, even my sisters, you know, and it was like, come on guys like give me the down and dirty and they like, wouldn’t they wouldn’t, you know, so it’s a chat with your girlfriends.
P: Yeah, no kidding….Did you get pregnant easily the first time
B: we did, yes, we, so I’m a teacher, or I was a teacher, and at the time of my first pregnancy I was teaching so we were timing, or trying to time the birth of the baby with summer vacation because that I would get more time at home with the baby. I think we missed our goal, we wanted to like give birth in May, and ended up being June so it, it took us an extra month out of, maybe two or three months of trying, pretty close.
P: pretty close…did you find out what the home kit or how did you find out you were pregnant
B: yeah oh man I’m trying to remember. I think I found out really early, you know, they say wait till your periods late and all of that but I, I kind of knew that something was up. So I took a test around the three week mark, and it came out positive a home pregnancy test and I kept it a secret for a whole day my husband and I tell each other everything I kept it a secret the whole day. I was very proud of myself. And then I had bought, he’s from Minnesota, so I bought him a twins, their baseball team, like little onesy, and I like wrapped up and I gave it to him after work one day and that’s how I told him.
P: that’s good that’s a good reveal
B: yeah that’s like a first pregnancy standard.
P: well done
B: the subsequent one’s You’re like, Guess what,
P: and how was that pregnancy.
B: It was, it was good. It was great, everything was textbook baby was growing well she was breech. For a while I was nervous about that but around the 36 week check she had flipped. So that was good. Everything was fine.
P: Were you thinking natural birth.
B: I was very open, I wanted to go natural as long as I could stand it. Yeah, so I was preparing for all the like Hypno birthing I you know I was, I wasn’t in any one camp I’m gonna do this method but I definitely wanted to try and go natural you know I’m a runner so I run long distances, I run marathons and things so I was like well I can you know I can get through that so I could probably get through this. So, I was preparing for that.
P: Yeah, we should mention you’re like, you’re like a strength coach Aren’t you
B: yeah I’m a personal trainer and a health coach.
P: Okay, wow. Well, then I’m glad the first part for easy.
B: Yes.
P: So what happened at the end of the pregnancy.
B: So I went for my 36 week checkup. So I was teaching summer school, my first baby was born in June. So I was teaching summer school because in Colorado where I was teaching school ends, the end of May. So then there was summer school so teaching summer school so my 36 week check didn’t come till 36 weeks and like five days because I was busy teaching I couldn’t get in. The day before my appointment I was feeling kind of funny I woke up feeling funny, but you’re 36 weeks pregnant, you know you’re everything feels funny at 36 weeks pregnant. You know, I had this pain in my side a little bit under my rib cage I was really tired, like, just all those, all these things so the next day I went in, I had an early morning appointment went in, and she did a urine, I felt fine the next day, she did a urine sample. She did a blood draw. Went about the day she took the baby heartbeats good she had flipped she’s no longer breech, awesome. We’re good. Let’s schedule your next couple appointments we’ll schedule an induction day just in case, etc so I’m scheduled out for you know, five more weeks. So my husband I went ran some errands. And then, my doctor calls. So I was on the phone with my mother actually she was asking me how the appointment went I’m telling her, am I the Call Waiting kept keeps going and keeps going and keeps going, I’m like, Mom, this is my doctor I gotta go. So I call her back and she says, You are Man What does she say she said something along the lines of you need to go to the hospital immediately you are having a baby today. So basically there Oh, it was there’s protein in your urine. So that essentially means that you have preeclampsia, or what I had what she could tell from my blood work was I had hellp syndrome. your blood pressure is sky, like, very very high. So you could stroke out at any minute.
P: Well, that’s terrifying
B: Yes….we’ve not, you know it’s your first pregnancy your first baby, all of those that is not what you want to hear and the only things I’ve been preparing for are this like, I’m waiting for my water to break it’s gonna, I’m gonna feel the birth pains you know the labor pains and we’re gonna go to the hospital, it’s gonna be this like magical almost romantic thing, and suddenly it was like if you’re not at the hospital in an hour, you could die. And it was like, Oh, okay.
P: I talked to the maternal fetal medicine doctor I did get some insights about some of the medical issues, Brooke is facing. Hi Dr. Robertson thanks so much for coming on the show, can you introduce yourself and tell us about your specialty.
Dr. Robertson: I’m Patty Robertson, I’m a professor at the University of California San Francisco and I provide obstetric care to high risk women, specifically the subspecialty of maternal fetal medicine.
P: Okay great, we’re in the right place then. Do we know why hellp syndrome strikes people.
Dr. R: Well we know that some women are high risk for developing preeclampsia, and a subset of women who have preeclampsia, which is high blood pressure and protein in the urine, actually get help, h e l p stands for hemolysis where the blood, or hemolyzed is or breaks up elevated liver enzymes are part of it, and often low platelets, so any woman with Preeclampsia is at risk for help and help can be life
P: It Looks like the cause of health is unknown. There are a bunch of theories about the source of the problem, like a dysfunctional placenta, or immune system disagreement between the mother and the fetus. It’s a rare disorder affecting less than 1% of pregnancies. Risk factors include being over 34 Being Caucasian, having diabetes or kidney disease, having high blood pressure or a previous pregnancy.
B: And I, you know, I’m in disbelief talking to my doctor, so I said to her on the phone because I find humor in situations I shouldn’t. And I, I said, you know, the carseat is still in the box, can we do this tomorrow. You know because they’re supposed to have all the things right
P: yeah, yeah
B: and she was like, No, that’s not funny. Move it, and I was like, okay. So it took us like…
P: it sounds like I didn’t feel that badly.
B: I felt fine. I felt totally fine, my blood pressure was high when I had gone to my checkup so my blood pressure. I don’t know my bottom number but my top number is in the 90s, usually. So it was definitely above that. I can’t remember what it was but through the duration I was 140 or above by the hospital for the next, you know, week,
P: but it’s hard to feel a sense of urgency when you can actually feel anything. Right, right. I can feel it didn’t feel real.
B: Exactly like if she had told me this the day before when I wasn’t feeling good, I would have believed her.
P: Yeah,
B: I was tired I had pain, like I get that. But this next day I you know I went to a five mile walk that morning like I was good. So, yeah, that was hard,
P: so I’m imagining you, you put together the car seat quickly.
B: I think we threw the box in the trunk. So I took a shower and you know I’ve been listening to all these birthing podcasts, so I made sure I ate something I showered I cried, I called my family I packed the go bag because I hadn’t done that yet, you know 36 weeks. And then off we went. It took us, so she wanted me at the hospital in an hour and that hospital is a 45 minute drive from where we live, and it took me like two hours to pack shower, eat and stop crying.
P: Yeah,
B: So it was a three hour process,
P: so you get to the hospital and how are you received?
B: it was, it was really terrifying, like not very well done at all but so we we walk in and we had toured the hospital ahead of time we did all those first time, you know, pregnancy things we toured the hospital we knew where we were going. And so we go up to the pregnancy floor and they they’re expecting us like the doctors called ahead they’re on their way. So we walk in, they say, Are you Brooke Selb and I said yes, so they scooped me right into the room that’s like right off the entry doors like you don’t, I didn’t even go in the ward, you know, right there. They had me change into a robe, when, at that point I changed in the bathroom like no modesty was gonna continue but it’s like changing the bathroom whatever and they’re like all like kind of waiting like tapping their foot outside the door, So then they tell my husband, they say, Okay, you go down and move the car and go park the car and get her bag, and come back up within the 10-15 minutes that it took my husband to do that I was in a gown in a bed, hooked up to I think it was three different IVs.
P: Oh wow
B: And, yeah, like just hooked up strapped up all these things and I was like, What is going on, and my husband comes in after he took the car to the parking garage and he was like, he just looked at me like a deer in headlights, like, this is nothing what we talked about like we’re not we’re not prepared for what this, what is this,
P: yeah.
B: So we were there for a while so I got put on magnesium sulfate, which helps with the reduces your chance of having a stroke.
P: Okay
B: so, so I got put on that, and you have to be on that. I want to see it was 24 hours on that before they were going to induce me to get the baby out. So basically just watching me and making sure that I wasn’t going to have a stroke.
P: Right, so that sounds scary.
B: It was terrifying and it took to my, my health insurances such that whatever doctor is on staff is the doctor who will deliver you. So we saw, I think two or three doctors before one doctor came in and actually looked at us and saw we were so terrified and he said, has anyone explained to you what’s going on. And we said, No. And so he like pulled up a chair he sat down and he explained to us what my condition was what the care plan was, what the result could be good or bad.
P: Wait so go slowly here. What did he tell you.
B: So he, he told us that, you know, because this is HELLP syndrome. It means you’re an organ failure, your kidneys and liver are going down, it could result in stroke you could have a seizure. And if, if we do not get the baby out, it this could kill you and the baby.
P: Okay, a quick summary. Both preeclampsia and HELLP construct quickly without much warning, although doctors are working on finding biomarkers to identify women who are at higher risk for these conditions, and effort to alert them before everything goes south, some people think HELLP is a severe form of preeclampsia, but there’s also a camp of researchers who think HELLP is its own separate disorder because some women experienced help with symptoms that are different from those typical for preeclampsia, so maybe the jury’s out on the exact relationship between these two conditions. But in any case, both are serious, and both require immediate attention.
B: So then I was on the magnesium sulfate. And then they started Pitocin. And he said that if the Pitocin wasn’t going to work then I would have to have a C section which was the absolute last thing that I wanted to do.
P: Right.
B: so yeah and he actually has the same doctor that delivered my second as well.
P: Nice,
B: Yeah, yeah,
P: Could you feel the magnesium sulfate.
B: Yes, it makes you crazy, so it makes you super tired I couldn’t keep my eyes open for more than 20 minutes at a time so I kept like falling asleep. I’m need glasses for distance driving at night, and I had to wear them all the time because I couldn’t, everything was blurry or seen anything and I was like so hot, it makes them really hot and everyone in the room my poor husband, They were freezing because they turn the air down really low, and he was just freezing the whole time because you’re just like, sweating, so it makes you really out of it.
P: That seems like a hard state to be in to push out a baby.
B: Yes, and, and you can’t eat anything. And then they have me on Pitocin. So you’re just all whacked out right. And then the other issue with HELLP syndrome is your blood platelets drop. So, if my blood platelets dropped too low, they would not be able to give me a epidural, because they can’t get it in for risk of bleeding out.
P: Oh wow,
B: so my nurse who thankfully for us on thankfully for the woman before me, the week before she had had a patient who also had HELLP syndrome so she knew exactly what to do. They were testing my blood every like two hours so she rushed ordered a test, and said look if your blood platelets are at this specific level I want to say it was under 100,000 I’m not great at my medical but it was somewhere in there. She said if your blood platelets are still above this number, I’m going to have him put in the epidural port, essentially, like we don’t have to turn it on, but you have to get it in. Thank goodness because they got, they put in the epidural. And then my next blood draw my platelets were too low to have done it.
P: Oh wow.
B: Yeah, so if anyone has ever pushed in a bed or like gone through labor in a bed where you can’t get up and move around, it is so uncomfortable like you want to be moving and, you know, rocking and you can’t do that when you have HELLP syndrome. So that was really wonderful of her, and then I ended up using the epidural, so it was great, it was there,
P: and you just had a birth, just with the epidural.
B: I did so it took three and a half hours of pushing, I was on oxygen in between pushes because I kept passing out.
P: Oh my god,
B: yeah. They finally let me eat ice chips. During pushing, and I was like, downing them because I hadn’t eaten anything in quite some time. And they made me like stop at one point, they’re like you have to stop eating ice chips you need to focus on pushing and I’m like okay but I’m like really dehydrated, you know, whatever. So three and a half hours, and then the doctor who was a different doctor than the one who explained everything to us because rotation. She started pulling out the, the suction.
P: Yeah,
B: right. And I was, I was done, I still had some fight left in me, magically, and it was like I do not want another intervention. Like my friend just had a baby that had to get suction and the poor baby’s skull was all like bruised up, you know all of this, and so I just started. Forget pushing with contractions, I just started rage pushing, essentially. Everything I have is going into this right now and then out she came.
P: Oh nice.
B: Yeah it was great that Rob said the doctor almost missed her because she came out so fast she like barely caught her and
P: that’s a pretty good ending after the, after the birth, how do you feel,
B: I felt very tired but you know you’re euphoric, because all of a sudden the baby comes out and they popped her on my chest. And this doctor was so great, she, she knew that I was so upset my birth plan had completely gone out the window., you know my like mental birth plan I didn’t type it out or anything but my mental birth plan. And she said, What else was in your birth plan that you really want to have happen. So I had a couple things I wanted delayed cord clamping I wanted to push with contractions and I wanted immediate skin to skin, so she was able to give me all three of those until you know three and a half hours and where she’s like, Forget contractions, you know, So then you know I get this like baby on my chest and, you know, all of a sudden you’re like totally fine.
P: Yeah, that’s lovely.
B: It was and then it was hard because you still, if you have health syndrome, I still have to be on magnesium selfie. For a number of hours after birth, you know you deliver the placenta. Essentially that’s supposed to remedy help syndrome, you’re supposed to just like, almost snap back to normal.
P: If the placenta is the bad actor in HELLP syndrome causing all these problems. Why is it that once you deliver the placenta, all the problems don’t subside. Well, that is a great question, and nobody even really understands preeclampsia that well we’re study, trying to figure out why you get it, and we know how to cure it, which is to deliver the baby and the placenta, but for some women, it triggers a hypertensive response that persists. And in fact, even women who have a normal blood pressure normal delivery and then let’s say four weeks later they get a severe headache and they go to the emergency room, they can actually have preeclampsia, you can get it for whatever reason, up to 12 weeks. Now a lot of older moms have preeclampsia it’s one of the risk factors and they’re also at risk of high blood pressure, perhaps genetically in their family. So, pregnancy is kind of a stress test, it might bring things out that you’re determined genetically to have in 10 years or 30 years, like diabetes or high blood pressure, and we know that one of the leading causes of maternal death is cardiovascular disease which includes stroke. Now usually stroke occurs at a top blood pressure number of 160 or greater, but with HELLP, we’ve seen stroke occur at 140 over 90, which we use as the enrollment level for blood pressure, high blood pressure, diabetes, they both can persist and need to be acknowledged by the woman that it could be a chronic condition for her.
P: I want to just add here that numerous sources suggest that women who experience preeclampsia eclampsia or help are at a lifetime increased risk for cardiovascular disease, and so are the babies that were a part of the preeclamptic eclamptic Or HELLP pregnancies, so it’s important to follow up with your doctor to keep track of these risks, after the pregnancy is over,
B: but I couldn’t be left alone with the baby for a full 24 hours while this stuff got out of my system because I might drop her I still couldn’t get out of bed, you know, the whole thing, so that made it that made it feel, it was hard to bond with her because I couldn’t. If I was already holding her I was still stuck in the bed I couldn’t get up and like put her in the bassinet I had to have my husband or have a nurse.
P: Yeah,
B: take her and then put her down and then you’re you know you’re trying to establish a breastfeeding relationship and you know my body wasn’t ready to give birth so that was hard and
P: yeah,
B: it’s just a whole you, you enter into the next phase of tough, and that’s with any with any newborn.
P: Yeah, it’s hard. The fourth trimester is harder than also harder than marketing.
B: I, people need to talk about that more the fourth trimester is the worst. My third is eight months old right now and I feel like I’m just coming out of a fog. Yeah, so it’s a long process.
P: and babies are a lot of work,
B: they really are.
P: After this unbelievably like physically challenging thing right that’s like the next the next up, you’ll be up for many hours in a row, do they let you leave the hospital right away or not.
B: My blood pressure would not come down. So, I we were there, five days in total. Five days. We left when our baby was, she must have been four days old. Most people leave that when they’re babies a day, maybe, you know.
P: Yeah,
B: they kept waiting for my blood pressure to come down and it wouldn’t, to the point where, on day four, they’re like okay, you’re gonna be discharged a one more blood pressure tech and then we’re gonna, you know, most likely let you go when I was like, awesome. So I’m like, I’m dressed on packed like babies in her going home outfit you know all these things were ready, they come in, they do my blood tests and they check my blood pressure and they’re like, we can’t let you leave, I sobbed like ugly cry. My poor husband man like she hasn’t even been out so I was you know the whole thing like You’re so crazy emotional at that point and you’re just like nonsensical. So on day five, the doctor comes in and is the same one who explained a lot to us in the beginning and he was like, Okay, I hear you’re really upset. I don’t want you to leave but I will let you leave if you promise to test your blood sugar I’m sorry, different pregnancy test your blood pressure. Yeah, thank you. Every day, and you have to be blood pressure medications, I was like, Okay, I’ll do it, I’ll do it. Where do I sign let me out. So then we got to leave. Thank goodness and it took about another week or two, a blood pressure medication for it to finally come down, and then it hasn’t gone up since,
P: could they explain why it didn’t snap back after the placenta was birthed.
B: No, no, but there are some women who even develop preeclampsia, after birth.
P: Yeah. Right, right. Yeah. wow, but that baby was fine and then you were fine and
B: she’s great. She was born at 36 weeks and six days, so she was considering late term premiee you to write that on all your paperwork she missed the cutoff by three hours. This was really frustrating since she was little she was six pounds when she was born, you know, cuz she needed another three weeks to be good, Maybe a good nine pounder right. Oh,
P: six pounds is nothing to sneeze at…that’s like, you know that’s a legitimate weight.
B: Well, let’s get into my next one.
P: You bring her home and how long before you get pregnant again
B: Yeah, two years, they are exactly two years apart.
P: And how was the second experience.
B: So it took a year to get pregnant again. The second pregnancy was great textbook, I was taking a baby aspirin every day up to 36 weeks to prevent preeclampsia and HELLP syndrome again, so that was some new research that had come out every, everything was great, went into natural labor, did the whole like magical experience going to the hospital did get an epidural, thank goodness, and then pushed, he was out, it was it I think I pushed five times or something and he was out and he was nine pounds one ounce.
P: Wow,
B: that was a little different. Yes. He was a Big Boy
B: are you and your husband tall?
B: yes I’m six feet and my husband is 6’5”
P: Okay, well that makes sense then you’re gonna, have a big baby
B: yeah, my husband was 12 pounds when he was born. It was very large
P: Oh my…that feels very Guinness records kind of
B: yeah, right…his poor mom, she’s like really tiny.
P: But that one was that one went smoothly so
B: he was great he was like my little textbook baby.
P: That’s all. Yeah. So now you have to at home. Yes,
B: but then a year later you get pregnant for the third time oh my gosh, eight months later I don’t know what we were thinking. Yeah, so I got pregnant for the third time and it was one of those like I’m, it’s the middle of the night, it’s like two in the morning I’m feeding the eight month olds, you know, and I’m like thinking in my head, you know, because your head starts running at that time of night and you’re like, No, no, wait a minute. No, and then I go take a home pregnancy test I’m like digging in the back of the door, only got my husband you know, where’s this thing and I take it and I, I, I really cried. I was not ready.
P: Yeah,
B: it’s really close and people do it and they do it a lot closer than 19 months apart
so much respect, it is hard,
P: it is hard. Yeah, yeah. But also, like, you can’t, it’s hard to also time.
B: Exactly, exactly.
P: Yeah, so you kind of get what you get. And so how was the after you recovered, and, you know, got excited found some joy for the third one. How was that experience,
B: a mess. It was a mess. So I was diagnosed with gestational diabetes, so everything was fine. And then I got gestational diabetes. So that was,
P: is that like halfway through or,
B: yeah, so you do the, when do you do the sugar test,
P: it’s like 20 weeks
B: 20 weeks 24 weeks I want to say, and I failed it. But at this point we had moved to Minnesota. So my first two babies were born in Colorado and then we moved to Minnesota. So diagnosed with gestational diabetes with some new doctors, etc. And I was so upset about it I’m a health coach. I’m a personal trainer I run, I eat mostly healthy foods you know I’m not like a sugar monster, but I just, I couldn’t mentally wrap my head around the fact that I had this,
P: it’s emotional for Brooes to get this diagnosis because she thinks I take care of myself. I exercise regularly and I’m careful about diet. How did gestational diabetes fall on me,
Dr Robertson: but another way to look at it if she hadn’t been so big. The consequences of both of those diseases could have been much worse.
P: Yeah, yeah, just,
Dr. Robertson: you just don’t know. But no matter how hard you work at perfect health. It’s not totally under your control.
P: Yeah,
Dr. Robertson: so many of our patients are in their 20s and 30s and 40s, and they don’t feel that they deserve a diagnosis of diabetes, even if they had it during pregnancy, and then they don’t go back for follow up testing so they don’t know. And then they eat their regular diet, and then they end up with complications because they haven’t been followed, appropriately, like to check their eyes if they have diabetes once a year to make sure there aren’t extra blood vessels growing to be associated with blindness later on.
P: So it sounds like you were saying, if you have gestational diabetes, you’re potentially at risk of developing type two diabetes later.
Dr. Robertson: Yes, and sometimes actually women have type two diabetes in don’t know it. And then we don’t really know until she comes for the follow up test after her pregnancy is over whether she’s a type two or pre-diabetes are totally normal.
B: My sister had it with her third baby and my mom had it with her third baby which is actually me. So you know there’s that component. You’re also more likely to get it if you’ve had a nine pound baby. And my second was nine, one, yeah. And you have to be over 25 How old was I 34 Yeah, so, you know, I had some of the precursors to getting it but I eat healthy and I exercise and like this isn’t me, you know, whatever. So I would, I tried diet I tried exercise, I tried everything to not have my blood sugar numbers be above what they should be. So you know I got up at two thirty in the morning and I had a protein snack and then I, I went for walks before bed and I tried testing it before I even got out of bed in the morning and I tried testing it right before you know I tried all these variations and it just, it wasn’t happening so I ended up on insulin for nighttime insulin because it was my morning fasting number, that wouldn’t come down, right, for most of it towards the end, the last three or four weeks. It was mostly all day that my, I really had to be careful about what I was eating, to make sure my blood sugar was within range. I was so hungry the entire pregnancy. I was so hungry. Oh man, because you can eat a lot of fruits, wheat, a ton of fruit, you know, things like quinoa beans, you know, all those things would spike it, so no different for everybody, what spikes you. Yeah, so like something my sister recommended I try I couldn’t have, because it would spike me. So it was a lot of trial and error.
P: That sounds hard to manage just kind of in general but especially with two little kids.
B: Yeah, and I was, I was not pleasant to be around, like I was cranky, so
P: that sounds really hard and, and I think I just saw an article suggesting that doctors think there’s some genetic component to gestational diabetes.
B: My parents are not diabetic. So, I don’t know I mean,
P: I don’t think you need to be diabetic but I think the thing I read said that type two diabetics have some genetic component, so there’s some familial thing passed passed down, and diabetes you also have some kind of genetic component that affects how you process insulin, and pregnancy obviously is a big chemistry experiment, and so that also all which is to say that even if you’re running every day and eating perfectly well. You can still have it. Right, yeah.
B: Yeah, and I mean there is, you know it’s your plus the reason you would get it is your placenta is making hormones that are causing the glucose to build up in your blood. So it’s like your placenta the hormones in there is doing it. Same thing with, you know HELLP syndrome is you have to get the placenta out it’s like all these things were like my body and the placenta, are not communicating very well,
P: and that’s that is genetic right that is you and your husband’s DNA are, are kind of duking it out to figure out like how invasive the placenta will be and how it will operate
B: It’s crazy.
P: I remember with my second eyes. I must have failed that the sugar test, because I had to prick myself for, you know 10 days or something and that was, um, that’s not pleasant.
B: No, and you probably have to do it four times a day. Record your numbers and don’t lose the paper and, it’s a mess
P: that’s what is it, what does gestational diabetes do to the birth, anything.
B: So they just they not a ton, they had to induce me, which I was very upset about, because you know I had such a magical experience with my second of going into natural labor, but the fear is if you end up with a nine pound baby, you know, the longer your pregnancy goes the heavier the baby will be, if you’re a gestational diabetic you’re likelier to have a larger baby, and because I’d already had a nine pound baby. They were very fearful that I was going to have another
P: Yeah,
B: which creates a lot of complications, so I was induced at 39 weeks, which is good, they let me go that long which I was saying before, and then they test, you have to test your blood sugar regularly throughout the day, you’re limited in what you can eat during induction just so exhausting. I mean, let us eat Please Like we have to push you know there’s this whole like mission at the end. And then they test once the baby’s out, they continue to test both of you for the next 24 hours,
P: and how did that go.
B: It was the birth was the mess induction wasn’t, it was fine. It was a long day, you know they want you there at 7am to get started on all the things and I wanted to do it as naturally as possible so I had the balloon catheter first. I tried all the remedies and then still ended up on Pitocin.
P: Yeah,
B: so two babies through Pitocin right. It was a long day so we were there at seven in the morning, and the baby wasn’t born till I want to say nine at night.
P: Oh, that is a long day
B: it’s just exhausting and like contractions were would come if I was standing up, if I sat down, they stopped. So you know you’re just trying to you’re on your I was on my feet, the whole day.
They don’t let you eat, you know by the end of it I did get an epidural because I was just so exhausted, and they, you know, I was like, Oh, this hurts something hurts or you know I’m fine whatever maybe we should check or something and they were like, oh you’re having a baby right now. I was like, Oh great, like my epidural was working really well too well. So there was a race actually between me and the woman in the room next door who also got induced that morning of who was going to go first and the doctor was delivering both of us, she was suiting up for the woman in the other room she was going to push the nurse goes running to go get her and go stop. Come over here. It was like okay, so she got suited up baby was out in a push. I pushed the doctor made a joke, I laughed, made a half push and the baby was that
P: that’s how it’s was done ladies and gentlemen.
B: She’s a very happy girl.
P: Was she big?
B: she was eight pounds six ounces.
P: Oh, so that’s not so bad.
B: But if we went, you know, if we went to 40 weeks she would have been nine pounds.
P: yeah. For sure
B: So they were right.
P: And then does the gestational diabetes goes away after the baby’s born.
B: Yes, so we will both were instantly fine, but you do. For me, I have a higher risk of developing type two diabetes. Now, you know, later in life. So, even more important to eat. Not all the Halloween candy.
P: Yeah, yeah that’s tricky. I agree. Okay, so you brought her home and the other kids are excited how did that all go, oh
B: yeah, our, so we had them come to the hospital to meet her are then three year olds, our oldest girl she was very excited to meet her. They hit it off right away our son he was 19 months at the time, so it took him a little longer, as it does, you know, it took him about, I’d say a month, a month to six weeks to kind of be like alright, she’s not leaving, I better, you know, get on this train, and now he is her biggest supporter. He keeps an eye on her. He picks up her toys when she drops them like he’s just in love with her.
P: So that’s super cute. So how old are they now.
B: Oh gosh, so four. So everyone’s almost a half so four and a half, two and a half, and nine months.
P: Wow. It’s a busy house
B:, we’re tired. There’s a lot of joy, but there is a lot of teaching them how to be a little humans who are kind and respectful. So, yeah, yeah. And I, you know, when we moved to Minnesota a year and a half ago I left my teaching job to be home with the kids. So it’s, it’s a learning experience so I’ve been home now for almost a year and a half. And I don’t think I’ve ever done so much self reflection and like self checking than than I did in 11 years as an educator, so
P: yeah it’s it’s a totally different process, right
B: it really is, it’s a different beast,
P: but it makes you think about how you were raised right like,
B: oh yeah, there’s a lot of that to think about,
P: oh, this is how my mom did it. What does that mean,
B: right, or what should I do differently or, You know, all those things.
P: Yeah, that’s awesome. So, what is the oldest one into
B: anything make believe. So, any like pretending we don’t know each other and we knock on each other’s doors and we know she likes to play house, but like pretend that we don’t know each other to play house it’s not like she’ll play house with dolls, we have to play in person she’s super social, which is weird because my husband and I are introverted, so she’s like our little butterfly,
P: that’s fun to watch.
B: Yeah it is, it’s good for us to she like just chats up like she’s very little stranger danger which is not great she’ll just chat people I’m like okay, like they don’t need to know.
P: Yeah. Is your son Similar.
B: No, he’s our little introvert so even if we’re just hanging out as, you know, our family of five, you know, after a little while he kind of wanders off by himself to a different room to play by himself for 10 minutes and then he wanders back super into trucks and animals, like,
very boy, you know,
P: yeah, yeah. And do you have a line on the little one yet.
B: She’s She’s feisty. She’s redheaded, You know, so there’s that. The other two are blonde. She’s our little redhead, anything her big siblings do. That’s what she wants to do she wants to be in the mix, she doesn’t want to know she doesn’t want to eat. She wants to be with them.
P: Can she walk yet or is she still crawling?
B: No…She’s almost crawling she’s doing the rocking she’s almost figuring out the weight distribution on one side to the other can be any minute I’m terrified.
P: That’s a very cute. Well, it sounds like, people look after her.
B: Right, yes that and we have to like bolt everything down.
P: That’s very funny, so are you, are you still training, are you still doing the training.
B: Yes. So I personal train online and run coach online, which is really great.
P: and who are your clientele?
B: so I predominantly work with women with young kids who want to lose weight or cross the finish line, so anywhere from a 5k to a full marathon.
P: Wow that’s cool.
B: Yeah, its so much fun. I love it and it gives me something during the day, you know, in those like downtimes, to think about.
P: Yeah,
B: which is really, it’s very sanity, keeping
P: yeah, it’s nice to have something something adult
B: yes then to have something else on my brain,
P: so and that sounds like a useful thing for like a postpartum period right when everyone wants their body back
B: oh my gosh yes it takes so long, I mean I’m nine months out and I’m still getting there, so it takes a long time but yes I work with women who are postpartum. I work with beginners, the whole nine.
P:That sounds awesome.
B: Yeah,
P: I think I have your, your website is it called wrecking routine is that what it’s called
B: wrecking routine because I am not a fan of routines, except when it comes to my kids and their time for bed.
P: Yeah,
B: so it’s about doing something different, and seeing what happens.
P: That sounds awesome, I will I’ll put a link to that in the notes so people can find you.
B: Great, thank you,
P: thank you so much for sharing your story, you have a lot of adventure in that in that in those experiences I’m glad that your son was super easy, but you have like a contrast right you experienced at all. It’s not so easy to make another person.
B: No, it isn’t. Takes a lot,
P: but luckily you paid off with the joy in the end.
B: Yes. Yeah, and I get to be home with them and so
P: yeah that’s lovely.
B: It’s really nice.
P: Awesome. Thank you so much again for sharing your story.
B: Thank you, I appreciate it.
Episode 12: A Double Sided View: pregnancy through the eyes of an OB: Dr. Nicole Rankins
Cover Art from David Janelle https://www.etsy.com/search?q=pregnancy+OB+david+janelle
Episode 12SN: A Double Sided View: Pregnancy through the eyes of an OB: Dr. Rankins
It seems self evident that most doctors would agree that being the doctor and being the patient are two entirely different experiences. And being the patient as a doctor is a third, different path. Today’s guest is an OB, and got pregnant with her first daughter when she was still in residency. Unlike many guests, she probably knew too much about the world she was stepping into–which led her to have an anxious first pregnancy. As it turned out, that anxiety was well placed, as she did run into some complications in that pregnancy, and a delivery at 32 weeks. But what she learned from that first experience informed her next one, which was a much smoother ride. Dr. Rankins and I discuss advice she gives to mother’s to be, and the crisis in maternal health facing women of color. We are joined by a senior policy analyst at the Center for American Progress who offers her insights on racial inequality in maternal health. Listen to this inspiring story.
Cover Art care of David Janelle at https://www.etsy.com/search?q=pregnancy+OB+david+janelle
Dr. Rankin’s website:
Dr. Rankin’s podcast: All about Pregnancy & Birth
Racial inequality in maternal healthcare
https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/
Maternal mortality report
The Measured Effect of Doula Services on Birth Outcomes
Black Mama’s Matter Alliance
https://blackmamasmatter.org/bmhw/toolkit/
Changes in postpartum coverage for women on Medicaid
Get involved with the Momnibus Act of 2021
https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus
Audio Transcript
P: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka Today’s guest is an OB, talking to her feels a little like peeking behind the curtain to see how a magic trick is done. As someone who’s been on both sides of this interaction, her perspective and her story are totally interesting. She entered into pregnancy with much more real knowledge about the world she was stepping into the most of us do. Despite this information, or maybe because of it. She did have an anxious first pregnancy, and did run into some complications. But what she learned from that first experience informed her next one, which was a much smoother ride. After we talked about her experience in her own pregnancies, Dr Rankin’s and I discuss advice she gives to mothers to be, and the crisis in maternal health facing women of color. I also include the insights of an amazing researcher at the Center for American Progress, let’s get to this inspiring story.
P: Hi, welcome to the show. Can you introduce yourself and tell us where you’re from?
Dr. Rankins: Yes, I am Dr. Nicole Callaway Rankin’s I’m an OB GYN, and I live in Richmond, Virginia.
P: Dr. Rankin, thanks so much for coming on the show it’s very fun to have an OB, because your story will be super interesting for people listening.
Dr. R: Yeah,
P: the first question I usually ask people is what did you think pregnancy to be like. And for you, did you have your children after you were already a doctor?
Dr. R: That’s a good question… so I had my first daughter, when I was just out of my residency training so I had gone to medical school had done my four years of residency I was in the middle of a fellowship, when I got pregnant with my first daughter, and I was terrified.
P: That’s not what I was expecting to hear; but maybe you know too much. Maybe that’s what it is…
Dr. R: Yes, so, I as you might imagine, is that I’m a little bit of a type A ish person. And, number one, it took us longer to get pregnant than I thought it would. So, in this, please don’t, you know, crucify me for those who really seriously struggle with infertility, but at six months, I was like, this is, this is crazy like what’s going on what’s happening. And then I discovered I had been on birth control pills before then for a really long time. And once I came off birth control pills, like I had terrible ovulation pain like I would be like curled up in the corner on the floor like this hurts. So I just thought that there was wrong I thought I had endometriosis, I didn’t know what was going on. So when I found out that I was pregnant. It was like it was just as I was about to say, I need somebody to look inside my belly and see what’s going on because this isn’t right, and the pregnancy test popped up positive and I was like what am i Wait, what am I really pregnant. And then I immediately went to the dollar store because dollar store pregnancy tests work just as well. And I got like four more. I told my husband that we had to go get like a bunch more, and we did get a bunch more and they all confirmed that I was indeed pregnant.
P: That’s totally exciting I think most of us go through life with the myth that the minute you start trying you’ll be pregnant. We ultimately absolutely needed fertility help but I know that every month, up to the point at which that was discovered. You know I assumed I’d be pregnant because that’s the story that you’re told
Dr. R: exactly and it can feel like and you feel like there’s people around you who get pregnant like they sneeze and they get pregnant and you’re like, like why is this and then you look around and you see other people and you’re like why is it that me, it can be a lot.
P: Yeah, yeah, and you hear a lot of people who got pregnant by accident right anything
Dr. Rankins: Yes.
P: and you think, how’s that possible?
Dr. R: Yeah.
P: What was your pregnancy like?
Dr. R: So I was like I said I was a little bit anxious from the start, and things were fine until like the summer we’re not, maybe like nine or 10 weeks I had an episode of bleeding, where I bled, like all the way through my clothes.
P: Oh wow
Dr. R: So, which of course terrified me. So I went in to the office, caught you know call my husband, he was out of town, it was like a lot everything ended up being fine, but that episode certainly made me nervous. And even before that I would like, you know, check to try and ultrasound myself here and there. But definitely like ultrasounded myself a couple of times to try to look and see what was going on so I was a little bit like just nervous and anxious about what was what was going on but, you know, physically I felt, I felt fine I didn’t have like nausea or vomiting or anything and other than that bleeding episode. Things were very reasonable and I had finally like, calmed down, but it was like, okay this is good, around about 24 weeks I had to have a follow up ultrasound because at my 20 week ultrasound. The doctor noticed that there was a little bit of extra fluid like not not a ton, but a little more than she would have liked to see so I went back for a follow up ultrasound. And that was the first ultrasound where I really felt like relaxed about everything. And it turns out that that was the ultrasound where our daughter was diagnosed with having a problem during the pregnancy so an intestinal malformation. So, ended up being something called duodenal atresia. So at that ultrasound. And you would think that I knew what I was looking at but I was trying to stay like fairly neutral and not. I was do a better job like not trying to be my own OB, so she was doing the picture that she took lots of pictures and she came in, and, you know, she said, the baby had a ton of I had a lot of extra fluid at that point because the problem that she had, it happens in about one in 10,000 pregnancies in, where the first part of the intestines is not connected together. Well, and though she can’t couldn’t swallow the amniotic fluid so it was like backing up so I had a lot of fluid they saw the issues and then, you know, we had to go from there. This is sometimes associated with chromosome problems particularly Down syndrome so then I had the next hurdle of what were we going to do about that. My husband and I decided that we wanted to know more information so I ended up getting an amniocentesis, and the chromosomes ended up being fine that she does not have Down syndrome but that was certainly a stressful time, waiting for that.
P: A lot of people say they’re worried about the amnio Were you worried that it would have some kind of effect,
Dr. R: no, not really. Well for one thing I knew I had enough fluid, I think anybody could have reached like shot a needle from across the room and like flew it was the easiest aim, like, I probably will let a student do it because it was I had so much extra fluid that it was so easy to do. So the procedure itself I wasn’t worried about it was just more the anxiety of getting the result back.
P: So that sounds a little stressful. I assume there’s nothing during the pregnancy for that.
Dr. R: No, no, it’s all like you have to figure out, you have to wait until until after the baby’s born so then what happened is, then I got calmed down again because we met with a pediatric surgeon who said and I delivered at the same place where I did residency so at Duke, and we met with a pediatric surgeon and he was like, you know, this, this typically doesn’t end up being a huge problem. The most of these babies are born full term, they have surgery three or four days after after birth, and then we fix it, they stay in the hospital for a week or so go home and like things end up being fine. So I felt reassured that Okay like I know I have this issue but you know we have a plan and most of the time things end up being fine and I felt just a lot better and then having the amnio back the chromosomes and I just felt a lot more reassured that the things didn’t end up going the way that we thought,
P: well, so what happened then did you make it to 40 weeks?
Dr. R: No, I did not. So on a Friday, I had been having contractions, on and off, because I had the extra fluid can make you have contractions so I’ve been having contractions and then
P: wait let me ask you one kind of silly question, did you know that it was contractions. Did you know what was going on?
Dr. R: I did, yeah, I did and I knew that they were not like they weren’t painful, they just, I could just, they would happen, cramping and then it would go away, so it wasn’t like anything major. And when I got put on the monitor for like testing and things like that, it, I could see that they were happening but I actually did know that they were, they were contractions. And I also knew that, on that Friday morning that they were different, so they started getting regular before they were like, here and there and then that they started getting regular and I was 32 weeks and zero days exactly, they started getting regular. They were painful and just consistent and I told my husband I was like you know something isn’t isn’t right, this is different, I need to go to, you know, I think we need to go to the hospital, and my husband is lovely. We’ve been married for 15 years, but he knew I was like, tending towards anxiety and he’s like, Are you sure do we really need to go, I was like no, I really think this is different. And he said that he knew that something was wrong because on the car ride he could see me clutching the door handle of the car. Yeah, yeah, yeah.
P:So what happens when you get to the hospital.
Dr. R: Yeah, so I got to the hospital and, again, I felt comforted, because I knew I knew the staff and this was so that helped a lot, but the where I work, they had midwives, they still do have no bias and she checked me in and she’s like, Oh yeah, you’re a centimeter dilated and your cervix is effaced, and I was contracting every two or three minutes, so I was definitely like going into labor so then I had an ultrasound, because the length of the cervix can help predict, like whether or not you’re going to go into preterm labor and my cervix was like, longer than two centimeters is good. Mine was like, millimeters like,
P: oh wow,
Dr. R: yeah so I was definitely like going in to labor…
P: so there’s nothing they can do to stop it at that point you can’t take medication or…
Dr. R: well they thought, well, they said like, Okay, let’s try. Let’s try taking off some of the fluid, like some of the amniotic fluid because I have a lot so they thought maybe if it decompressed the size of the uterus a bit that things will quiet down so then I had another. It’s like an amniocentesis except they connect the needle to a drain, and they drained off like a liter of fluid.
P: Wow.
Dr. R: Yeah, it doesn’t hurt you just kind of sit there and the fluid comes out, but it did nothing I just continued to keep having contractions and then they said, well that’s maybe, you know, then I got admitted, of course, and I don’t recall getting any medicine like I didn’t get magnesium or anything to try and stop the contract like I didn’t get a whole lot to try and stop
P: once your cervix is effaced that’s not game over?
Dr. R: No, not necessarily, no. Sometimes you can still, still try and stop it yeah I don’t remember getting a lot to try and stop the contractions but I don’t think anything would have worked like I just rapidly progressed to like six centimeters. So, I did get ended up getting an epidural, and that’ll kind of play into the story later. Not because I was in a terrible amount of pain, but they just kind of thought like, just in case and maybe it might help like slow things down because epidurals will slow down labor a little bit but not, not a lot but I think we were all just kind of like pulling it whatever we could to try and see if we could slow this slow this down. So I just progressed, my water broke and I got to eight centimeters, and then she started having these big drops in her heart rate, and of course I know what that, that means you know big drops in the heart rate so the doctor.
P: Wait, what does that mean?
Dr. R: It’s a sign of distress. So when babies, yes on the heart rate monitor it was, it should normally stay in the range of like 110 to 150 and hers would drop down to like 80 or 90 beats per minute, you know, so it was dropping low and coming back up dropping low coming back up. So the doctor on call was like well maybe you can go ahead and just try and push, because I was like eight or nine centimeters and at 32 weeks we knew she was going to be smaller. So maybe just try and push through not a completely dilated cervix, but that just made the heart rate changes worse. So then, decision was made to go to C section, and at the C section so normally in a C section we do something where we, we, we test where we do a little clamp test to see if the patient is numb and making sure they can’t feel well I shouldn’t say… that makes sure they can’t feel pain like you’ll feel pressure and you’ll feel touching, but you shouldn’t feel like pain and they did the clamp and I was like no, I feel that like it felt like a distinct, it was pinching, but because her heart rate had been low, they went with the C section anyway and I, and I completely felt it,
P: Yikes!
Dr. R: yeah. Yeah, it was it to this day I will never…. It makes me stop whenever someone says they can feel it because it’s a, it’s not, it’s obviously a terrible feeling. And my husband just said I was just clutching, you know his hand saying like, you know, wait wait wait wait wait wait wait, but they just, you know, kind of went, and it doesn’t take long to get a baby delivered.
P: Yeah,
Dr. R: especially you know, for first time C section, It can be easily, a minute or two. That’s it. But it’s during that time it was very painful and then I remember they gave me something through the IV to help, to help with the pain medic, you know, help with the pain, and it was like, made me all like woosey. I remember I said, You just gave me some happy drugs that. And then the next thing I remember distinctly is like the surgery being over, and being transferred to the bed and I should take that back, I do remember before that because they don’t give you the medicine until after the baby’s born, so I do remember the moment when she was born. And I said I have to see her, I have to see her and they held her up over like the surgical drape. She looked like a monster. She had like her hands like up and claws and she just like she was like ready and she was like fighting and ready she was a little skinny squirrely big headed thing, but she looked pretty vigorous so that made me feel better and then I got the medicine and then like I said, next thing I remember it was, it was over.
P: So as a doctor. Do you think he would have proceeded with a patient like you in the same way.
Dr. R: You know that’s that’s a great question and I don’t think anybody’s ever asked me that. Probably yes, honestly because you feel like the anesthesia is telling you like we can get it under control. You know the baby’s heart rate is low, you want to get the baby dellivered so you’re trying to find the right balance so Yeah, honestly I probably probably would probably have, you know, before. So, yeah, but if I can at any moment like pause and say hey we need to work on this if there’s time then yes for sure. I pause and like we need to do something different
P: for your daughter’s condition does she produce a normal apgar or does
Dr. R: she, you know, do so yeah so she came out fine she came out bigger she never needed to be intubated. So she had she, she was fine, I should say I had had steroids betamethazone which is a steroid medication that you get that can help mature the baby’s lungs I had that the week before, only on a hunch, from my doctor that well, you’re at this point in pregnancy you are starting to have some contractions, let’s do it just in case, and it ended up being needed. So she came out, she was fine and she went to the NICU, she had surgery. Three days after she was born. When she came out of it and I first saw the pictures that were added as far as immediately. She went to the NICU my husband went and saw her and got pictures. I was like, is she okay, because like her ears don’t look like they’re in the right spot and like her aid so like, what is going on with that is that look to me. I don’t know if I was just anxious just again she ended up being fine she’s a beautiful girl but those first moments when I looked at that preterm baby I was like, Okay. And I should also say that in the recovery room. After the C section, I was so hungry I had not eaten all day, and I had Chick fil A like one chicken tender and like five french fries that was the best meal, I have ever had in my life
P: How much did she weighed.
Dr. R :Okay, so she weighed. Three pounds seven ounces or, I remember the grams because it was 1555 grams, because a very low birth weight baby is 1500 grams and I was excited that she was over 1500 grams at 1555 grams.
P: Well Well done for her the first hurdle is 32 weeks like I know that for preterm babies. They’re there kinds of markers of like early preterm and late preterm like where’s 32 weeks is that …
Dr. R: it’s, it’s kind of in the middle, like late preterm for sure is after like 34 weeks so it’s not like super duper early survival is great at 32 weeks but they’re gonna spend a little bit of time in the hospital
P: and she because she had the beta metazoan like her lungs were fine or…
Dr. R: she never needed any additional like oxygen she was fine breathing on her own.
P: So she’s in the hospital just to grow them and like gain body fat and
Dr. R: grow gain body fat and to have certain have the surgery to fix her intestines.
P: So we had surgery on our daughter to for the heart problem. The day after she was born and that’s kind of a terrifying thing, but our daughter was a whopping six pounds.
Dr. R: Okay,
P: I’m imagining three pounds is a little stressful.
Dr. R: It was, it was, it was an, she, it definitely was she had born on Friday had surgery on Monday, And at the surgery went great. But then after the surgery, they extibated her or took the tube out a little too quickly, and I happened to be we happened to be visiting and at the bedside when that happened, so that was another stressful moment, you know, watching as I could, You know hear her oxygen level, dropping and see that she’s not breathing and they tried to usher me out of the room and I like refused to move like I couldn’t move I just like, No, I need to stand here, so they re-intubated her, and then kept her on the ventilator a little bit longer just took a little bit longer to recover from the the anesthesia than they had anticipated. Um, so that was a scary moment but thankfully that was the last of the scary moments.
P: That’s great. I’m assuming that the surgery is required for her to like metabolize food,
Dr. R: so she could nothing can pass through her intestines I mean babies back in the day before they knew about this with, I mean if you can’t, if your intestines aren’t connected and they, you can’t eat you can’t absorb any nutrients while she’s inside of me she’s getting all the nutrients through the placenta so she doesn’t really, you know, babies don’t need their intestines but on the outside they need their intestine so literally they just made a little incision cut her open and connected the intestines back together.
P: That’s amazing.
Dr. R: It is it. The surgeon, the surgeon, he was, he was, we remember he was German, because my husband’s mother is German, and he was very like, you know, like, he comes out and he says, the child did very well in the surgery. Okay. You clearly you call them all the child, so you don’t have to remember, who’s the boy who’s a girl but it was, like, the child did very well.
P: that is was very funny. The German version of like Captain.
Dr. R: Yeah.
P: Very funny. Yeah, also to call her the child since she’s like a teeny baby whose five minutes old
Dr. R: Yes, but exactly he said the child.
P: It’s very funny but, you know, thank God he did a good job. So, yeah, so how long do they have to keep her in the NICU.
Dr. R: So she was in the NICU for a month, just feeding growing getting bigger and I will say, NICU nurses are some of the most remarkable people on the planet, period. Like, don’t get me wrong, my colleagues, the doctors, the nurse practitioners people who round we saw them like maybe once it you know they come through, they check and do things but it’s the NICU nurse who is like, they are with you know come visit when you call they talk to you. They’re the ones who were like come on you’re going, bathe This baby because you need to take care of this child. You’re gonna change these diapers. Come on, we can do this here we go, and they are just, they just, they’re remarkable.
P: In our experience, they were the most competent people I’ve ever met and my when we were kicked out of the hospital which is the way we see it, we were willing to stay… that you know we were like trying to get someone to adopt us, we were like, what, how can we just go home with you.
Dr. R: They are amazing. They are amazing, and it was a similar sort of like one day the NICU doctor was like, if you guys want to have any more time alone and you should go out this weekend because she’s going home next week, and we were like, What, wait What,
wait a minute, like wait a minute.
P: You’re like didn’t this baby just have surgery?
Dr. R: like didn’t like what happened, like what, and people would always say, like, Yes, I’m a doctor and, but I’m an OB GYN, I don’t know what to do with a little person like. Please stop, like, just forget I’m a doctor like I’m just so scared mothered figure out what’s what, but she went home exactly a month after she was born she weighed a little over five pounds when, when she went. When she went home and home, you know since then she’s been she’s been she’s 13 Now, 13, and five and a half inches taller than me and the year ahead and school. So very very very smart yes yes but in the beginning it was a little bit like you were and I’m sure you had the same thing when you go home you worry like every little thing like one time she threw up, and it was just like, oh my god, something’s happened where the connection is, it’s bad. We’re going in. We went it was almost like a snowstorm a snowstorm was about to start and I was like no, no, no, we’re going to the pediatrician. When you look when I look back at it, it was like, you know, it was like a little like terrible, but you just until you, they get a little bit bigger, It just, you have that like anxiety for a while, I think,
P: Oh, for sure, for sure, and I remember my daughter had a heart condition and I would call the nurses and say, she seems really tired and they’d say, put her to asleep. Like, there’s no magic like
Dr.R: Right. Right. Right. Right, yeah, you know, And we had to feed her every three hours.
P: Oh wow.
Dr. R: For a long time, like the doctor was like you have to scout, you have to feed her every three hours social growth, so we had to do that whole schedule and pumping and supplementing and all of those things. So yeah, I mean, ultimately you figure it out if you get you get past it, I’ll tell I’ll tell everyone. When I share my experience because occasionally I’ll share it with patients when they have preterm babies, I don’t like to push my whole story but like you never ever, ever forget. Having a child who’s in the NICU just never forget it. But you do get past it.
P: I think that’s totally true. Totally true. Yeah, yeah. So what she into now?
Dr. R: she is into reading, so she is a very avid reader, she is into smart comments back to her parents.
P: that sounds like 13
Dr. R: She is, she is she really is smart, she’s interested to get interested in like social justice issues, she’s not quite into athletics yet. I think she’ll run track once things have like settled down with, you know, COVID times she’ll probably run track she’s, bless her heart, she’s not the most coordinated of people always asked if she played basketball, I was like no, she’s I don’t think she’s like
P: do they say that because she’s tall?
Dr. R: yeah, because she’s tall, but I think that track she can run fast in a straight line so she’ll probably run track but she loves to read. She loves to read, we have another daughter, and their younger daughter and they’re their best friends so that’s all healthy happy.
P: That’s awesome.
Dr. R: Yeah.
P: So what was the second pregnancy and getting pregnant and being pregnant, and the birth easier?
Dr. R: Funny story, the second time. I’m grateful that the second time around I was like okay, if I can go through all that, like, I can, this, this is going to be okay, like we’re, we can handle whatever kind of comes our way so I was much, much, much more relaxed about the whole process, and then I felt like I had done some like personal work like meditation and things to try to like to calm myself down so I posted a totally different way so the way that I found out we were like, Okay, our first daughter’s a year old like okay let’s start trying, you know I was 32 to 33 when the first one was born so I wasn’t getting any younger. So we started trying and then I was at work one day and I was like, I don’t think I’ve had my period in a while, like, I don’t think it happened and my husband was like, he literally texted him I was like, I haven’t seen my period in a while and he’s like, genius, this is genius. You’re an OB GYN go take a pregnancy test.
Like, oh yeah, I should probably do that. And lo and behold, yes. I was indeed pregnant.
P: Oh good, that’s a nice, it’s a nice way to slide into it the second time, right?
Dr. R: yes yes and that pregnancy was fine except I did have nausea and vomiting, a bit with that pregnancy and like weird food intolerances, I don’t know why we can tolerate some food to something, some things like Cheerios would make me vomit like profusely, it was just weird. Once at work in the bathroom. I’m not lying. I threw up. And it went on three walls like, I don’t know what it was, it was awful. I felt so bad I told the cleaner I’m so sorry I’m so sorry I just said, is terrible and she’s like it’s fine I’ll fix it so that only lasted the first trimester, but otherwise the pregnancy was completely fine, I didn’t have any issues at all ultimately ended up having a scheduled repeat C section, which to some degree, I regret because I did it more so because it was convenient for work, you know, and looking back like when you make those decisions for work like it’s never worth any more than a job anymore, you know,
P: yeah, yeah,
Dr. R: it wasn’t worth it I think I would maybe try for for the back but otherwise the pregnancy itself and the repeat C section was, was marvelous like it was, there was no pain or, or anything and it’s how I knew that I wasn’t crazy because honestly thought for a second like was that just exaggerating like was I crazy to think that I felt this way at my first C section, you know, it was definitely what I had this second one, that it’s solidified that no this is a completely different experience than what I had the first time,
P: I’m impressed that you went for this C section the second time after the first experience.
Dr. R: Yeah, yeah, I don’t, I don’t know what just so I think the, the type eight is still up like I can schedule it on a certain day was just. And then I pick, I’m not gonna lie hand picked like everybody who I wanted to be there so that’s I see so for the anesthesiologist was like can you be there, you know, so that the nurse everybody so that made me feel better.
P: Well, that totally makes sense that actually in that context if you can control that element then that seems just wise, yeah. And so if you have an early birth, you’re not at risk to have it again or?
Dr. R: you are actually you are that’s one of the biggest risk factors to have another preterm birth, but for me it didn’t, didn’t, the second one was full term,
P: and is there anything they do to monitor you for the second time around.
Dr. R: So they do have links at measure the length of your cervix, during the pregnancy, that’s the most the strongest predictor, sometimes we do progesterone in order to help reduce the risk the second time around, I did not do progesterone, the second time around it wasn’t as in favor, then I mean my younger one is 11, so that was a while ago
P: that birth what sounds like a day at the office because it’s. scheduled I’m assuming there’s no contractions and
Dr. R: yeah I had just started like literally that that morning starting to have a few contractions but nothing terrible but that but that was like. Easy peasy lemon squeezy. Like the C section itself was straightforward. I stayed in the hospital two days. Today I hate hospitals that Yeah,
I hate being a patient. So I went home two days afterwards, and I felt fine.
P: Wow. That’s amazing.
Dr. R: Yeah, yeah, yeah,
P: and what’s the 11 year old into.
Dr. R: She is also into reading as well, she is into drawing, so actually painting like she likes to paint. Sometimes she’s into pushing back against her older sister can smell her oldest is was a little bit bossing sometimes, but they’re actually in many ways very similar and the things that they like she also likes racecar driving. So,
oh wow, that’s cool.
Dr. R: Yeah, yeah,
P: hopefully that will mellow by the time she gets her license.
Dr. R: Yes,
P: a little runway
Dr. R: Yes, yes, yes.
P: So, that’s an amazing story I’m glad the second time it was totally smooth. Yeah, it is, um, the bar is set so kind of low after the first one right, like anything less than that kind of high pitched excitement seems very easy.
Dr. R: Yes it does, it does
P: so that’s nice.
It’s lucky to get the opportunity to interview and OB about her pregnancy experiences. I also want to ask her about her work in educating women about pregnancy, and about her perceptions of the way the field of obstetrics manages issues like racial inequality when it comes to maternal mortality. Obviously you have a podcast called all about pregnancy and birth, which I listen to religiously.
Dr. R: Oh thank you,
P: It’s fabulous. on your web page, you have stuff about a birth course and a birth plan, and the birth plan is particularly interesting to me because most people I’ve spoken to have said like, oh, I had a birth plan but then X happened. I’m interested in your birth plan, what the theory is behind that and do people get to use it and like how does that work.
Dr. R: Yeah, so I say birth plan this because what people commonly use but like one of the first things I say in that free class is that we have to change it to birth wishes, because birth is a completely unpredictable process, and none of us can control birth, even if physicians tell you like, oh, we can just induce you and it’s, we don’t actually have control over what ultimately happens it’s, it’s unpredictable. So it’s really about wishes and things that you want, want for your birth experience and how to get that and then also just understanding, like the two biggest factors that will influence your birth and that’s the hospital where you give birth, and whoever is caring for you during your pregnancy and birth. so it is really asking questions so you’re informed about the way that they practice and that it’s in line with what you want for yourself so one of the biggest things I say and stress is that birth is unpredictable, this is really about riding the waves of that unpredictability, because when people aren’t satisfied with their birth experience it’s most often because they were not prepared for the fact that it could then it may not go as they, they saw that they wanted it to go or as they thought it was gonna go. So when you’re prepared for the unpredictability then you, you feel good about the experience, either way and you don’t blame yourself or feel guilty if things don’t go exactly like you anticipate
P: that sounds super smart That’s good advice. And the other thing I’m wondering about is, you know, if you read the statistics about black women and maternity. It’s like, it’s like criminal, like I don’t know what word would better describe that situation. do want to talk about that a
little bit.
Dr. R: Sure, so yeah I mean, black women are three to four more times likely to die in relation to childbirth compared to white women and that is completely due to racism, there’s, you know like, full, full stop.
P: To get a broader view of this issue, I talked with a senior policy analyst, at a think tank in Washington DC. Hi, thanks so much for coming on the show, can you introduce yourself and tell us about your professional background.
OA: Sure. Well thanks for having me so much Paulette, so my name is Osub Ahmed, I’m a Senior Policy Analyst for women’s health and rights on the women’s initiative team at the Center for American Progress, I work on all issues around women’s health and rights including birth control, abortion, and of course maternal health,
P: good Lord You must be busy.
OA: We’re very busy team. Yeah.
P: So first I wanted to have you lay out the statistics for us
OA: in terms of looking at the US versus other developed countries, there was a recent study from the Commonwealth Fund, that looked at the US is rate compared to attend other developed countries and in 2018 The US is rate with 17 maternal deaths per 100,000 live births, and that is about double what other high income countries, rates are that distinction is not a good one, we’ve been having this conversation around our maternal mortality crisis for years, but this rate hasn’t gotten better, and I think it’s something that we really really need to develop policy solutions around in order to ensure that women don’t have to be scared when they get pregnant and face you know the childbirth or it should be a joyous experience,
P: and I’m guessing that that number hides this racial disparity issue where the 17 doesn’t really reflect the rate for everyone.
OA: Absolutely yeah there is a racial disparity embedded in that larger rates, women of color and black men specifically are three to four times more likely to die from pregnancy related complications compared to white woman. And so, there, there are many reasons for that of course first and foremost is that racism is embedded in our healthcare system, and it affects the quality of care that black women receive their ability to access coverage and the resources they need to have healthy pregnancies, and even in the postpartum period, there are many issues that prevent women from having healthy perinatal experience
P: when I have looked at the numbers before it looked like white women in the US have almost the same number as white women in other countries that are doing well so literally, black women and people of color are really the ones who are mostly impacted by this terrible maternal mortality rate.
OA: Yeah, absolutely. There’s so many issues I mean it’s a very complicated issue. And I think that, you know, of course, like I said, racism and sexism is at the core, but when you break it down, you know you’d look at for instance issues around health coverage, you know, that is very important especially, you know, childbirth and pregnancy is very expensive.
P: Yeah,
OA: out of pocket, and so having insurance is critical to make sure that you can go for your prenatal visits that when you go to the hospital and come out with, you know, come back with your baby that you’re not gonna be saddled with these incredible bills, and that in the postpartum period that you can still go and seek out that health care. I think that that is, that is one very very important area, of course, other things related to weathering and impacting literally a person’s physical health and their body, their mental and physical health, they’re all things that cause black woman to ultimately experience these higher rates of mortality, when they’re pregnant and after they give birth,
P: and we’re talking about insurance, which to some degree, is a reflection of income, but black women across the spectrum face this higher mortality rate it’s not just income right so there’s many other things going on right it’s not like, If only everyone was insured this wouldn’t happen.
OA: Absolutely. So that’s a really important point to make, and there’s a lot of research that suggests that, whether it’s your income, your class where you live in the country. These things are not protective factors I think that there are some statistics that show that black woman who are more highly educated tend to have higher rates of preterm birth compared to white women that are not as well educated, so it just again shows that it doesn’t matter if you’ve been able to, you know, achieve all the things that you think would make sure you’re in a safe position, it ultimately your interactions with the healthcare system are going to put you at a disadvantage literally because of the color of your skin.
Dr. R: And it’s hard for people to wrap their heads around that because they think of racism and they think of like slavery or the KKK or things like that or maybe what we saw at the capitol for God’s sakes, but it’s but it’s actually more tends to be more more subtle, where people have implicit bias, they’re, they’re treating people differently and they don’t realize it.
P: Let’s talk about the insidious ways that race plays a role in these cases.
OA: If you look at this from a sort of, at different levels at the individual level, you can look at people’s interactions with the healthcare system, and with providers for instance, it can be very very subtle interactions that indicate to you that you aren’t valued, that you won’t be heard or listened to, there is the story which, you know, I think is a very important story but you also have to remember there’s many other stories around Serena Williams and her where she knew that there was something wrong, and she, she insisted to her doctor and they didn’t listen and she had to insist again and again. That is just an example of so many other black woman’s experiences that they have higher pain tolerance, and so they’re just, you know, or they’re being aggressive or, or just dramatic or just that what they are telling you is not true. And that is not only dangerous in terms of health consequences but it is, it impacts you on a deep emotional level as well. Looking more on a structural level, everything from access to doulas and midwives, it is difficult to pay out of pocket for a doula.
P: Yeah,
OA: and oftentimes doulas will lower their rates to make sure that women can afford their services but you know that hurts ends up hurting both the woman and the doula access to doulas is critical because they help to navigate the healthcare system and be an advocate, but if you aren’t able to afford a doula, because your state has decided not to allow for Medicaid reimbursement for example, that puts a woman at a disadvantage, and I fully believe that if black women had more doula support, that there would be better outcomes around maternal mortality, there’s a lot of issues around the health care system where we don’t ensure that women can access the things that they need, particularly women who are on some public insurance programs like Medicaid, there are a lot of things that can be done to reform Medicaid. And these are very clear things and yet, policymakers and legislators haven’t made those moves yet. And I think that that its clear that black woman in particular will need some of those reforms.
Dr. R: One of the biggest things is that our concerns aren’t often taken seriously enough. There’s story after story of concerns not being addressed not taken seriously enough pain not being addressed. And when you look at the factors and this is even for educated, black women, then that leads to sad outcomes related to bleeding after birth related to high blood pressure issues after birth so it’s really related to just not listening. So this is why I say especially honestly the way our maternity system in the US in particular is the patriarchal is based on, you know patriarchy and taking away power and control and choices from women about what to do in their own bodies and we’ve gotten better. We’ve definitely gotten better, we’re not like where we were in the 50s or 60s or whatever you know where everyone was like knocked out you couldn’t have anybody in the delivery room, but we still have some room to go and I say all that to say like, everyone actually needs to have someone who can advocate for them on their behalf during pregnancy and birth, and the idea is hopefully you don’t need it because you end up being in the supportive system, but sometimes you don’t know until you get there, but it’s really important for black women and people of color to have advocates for you to be educated and empowered with information so you can both advocate for yourself or if you’re not in a position to do so you have someone there who can advocate for you on your behalf, that’s really key.
P: So like a doula would be a good thing to bring to the
Dr. R: 100% Yeah 100% A doula would be a great thing to have.
P: Oh, you know, I was gonna ask about if there’s any data about doulas and our measured impact.
OA: So yeah, there actually is, is data out there about doulas and their impact on birth outcomes. So there are studies that have found that when birthing people have doula support, they have better maternal infant health outcomes so that includes lower rates of preterm birth, lower rates of C sections again having an advocate in the room to, you know, if it does fall into an emergency C section conversation they can be there to push back if necessary. Also, higher rates of breastfeeding initiation. So there’s a lot of really great things that come out of doula support during the birthing and postpartum, as well as really prenatal experience, it’s all part of the woman’s sort of journey and when a doula is present, the woman does better, and her baby does better too.
Dr. R: And I tell people its hard because you don’t want to be seen as like the difficult person or like make a scene or those kinds of things but ultimately it ends up being like, your, your life, potentially, you know, you start from a place of kindness and human connection and saying hey I’m scared I’m worried, help me, those things that if that doesn’t work, then you may need to elevate it to a level of like I am demanding that you come see me and you can do something about this. You have to actually like involve people in their care, you can’t make those, those choices for them in that case of consent in, in particular, this comes up with things like breaking people’s water without consent or stripping membranes without consent, those are things that just, that just shouldn’t happen and it all comes down to whether it’s listening to the patient or explaining things it’s like really just putting that birthing person at the center of the experience and if you work from that, then you’ll be fine.
P: It’s probably most acute in OB work because it’s so intimate and so, you know everyone remembers their birth forever like, as opposed to like a gallstone, exactly.
Dr. R: Yeah, exactly, exactly. Yeah,
P: so it is super important. So, is there any other suggestion you have other than getting a doula is there anything else we can do.
Dr. R: Yeah childbirth education, I think is really important, we’ve gotten away from childbirth education and people routinely doing time with education, I think that’s key. It’s not, obviously not going to give you the same level of knowledge and expertise that I have it, you know 15 years of experience, but you will be able to communicate intelligently about things when you go through a good childbirth education class and there’s lots of options you have to find something that works for you, you know, as you said I have an option for online classes geared particularly for women who plan to give birth in the hospital, but do something like that’s my plea to please do some childbirth education because that really makes a difference, and your partner should do it too.
P: Oh that’s a good suggestion. So you can definitely, either you can be your own advocate or he or she can, because
Dr. R: yeah, yeah, yeah. Yep.
P: I think that’s another thing you don’t know before your first pregnancy is how compromised you’ll feel in the moment right you’re, you were in extreme pain right so how can you possibly kind of steer the ship.
Dr. R: Right, exactly, yeah,yeah, for sure.
P: Well, I totally appreciate your amazing story and your podcast and your, your website with the birth course and the birth plan that seems super helpful. And hopefully it will do, do people good to have more kind of knowledge to get the pregnancy and birth they want.
Dr. R: Yeah, thank you thank you I certainly appreciate that and if you to anybody who’s interested in my website is it okay if I mentioned it, absolutely. So the website is Dr. Nicole Rankin’s comm so that’s pretty easy to remember and you can find all the stuff there for the podcast and free downloadable resources like the warning signs to look out for after birth the free birth plan class and then as far as social media Instagram is my favorite place to be. So I’m there at Dr. Nicole Rankin’s also.
P: Okay, great. Well, I will put that in the show notes also so people can find you.
Dr. R: Yeah. Well thank you so much for having me on. I appreciate it.
P: Thanks so much for coming on. I really appreciate this conversation. Thanks again to Dr Rankin’s for coming on the show and sharing her experiences, both as a new mother and as an OP. Thanks also to also, for giving us an insight into the scope of the maternal mortality problem facing women of color and black woman in particular, and for giving us a sense of what’s being done and what needs to be done to resolve these long standing issues. Our conversation was longer than the clips included here. We talked about some of the progress that’s been made in particular, Miss Hoffman, talked about the federal package of legislation that was introduced by Congresswoman Lauren Underwood, Congresswoman Alma Adams, Congresswoman, all the Adams and former senator Kamala Harris and the members of the Black maternal health politics. It’s called the Black maternal health omnibus of 2021. It’s a package of wonderful bills they tackle a number of different issues around maternal health, including the 12 month postpartum Medicaid coverage investments in rural maternal health, the promotion of a diverse perinatal workforce and the implementation of implicit bias training. If you want to get involved in this issue, see the show notes for episode 12 on the war stories from webpage. In the shirts I also included links to Dr Rankin’s work, and to some of the studies that this aspect talks about. If you liked the show, we could really use your reviews, because these help other people to find the show. If you’d like to share your story, go to war stories from the womb. COMM And sign up. Thanks so much for listening. We’ll be back soon with another story of overcoming.