Episode 41 SN: A Pandemic Pregnancy with Surprises Large and Small: Kaila’s story

Today’s guest stepped into pregnancy relatively easily, and while she had some pretty common early challenges–extreme fatigue, congestion, and sensitivity to smell (her husband called her a blood hound–which feels like high praise in the right context… ).  The challenges really picked up at the birth, which was visited by a hemorrhage after a vaginal delivery and a bad reaction to morphine.  And by the way, all of this went down during Covid before vaccines.  After taking some time to settle after the physical and emotional turmoil, she is now enjoying chasing after her nearly two year old.

You can find Kaila at Parent Tell podcast, https://podcasts.apple.com/us/podcast/parent-tell/id1539221609

Postpartum hemorrhage

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375891/

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-complications-data.htm

https://www.medscape.com/answers/275038-187540/what-are-risk-factors-for-postpartum-hemorrhage-pph

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/12/quantitative-blood-loss-in-obstetric-hemorrhage

Audio Transcript

Paulette: Hi, Welcome to War Stories from the Womb. I’m your host Paulette Kamenecka. I’m an economist, a writer and the mother of two girls. 

Today’s guest stepped into pregnancy relatively easily, and while she had some pretty common early challenges–extreme fatigue, congestion, and sensitivity to smell (her husband called her a blood hound–which feels like high praise in the right context… ).  The challenges really picked up at the birth, which was visited by a hemorrhage after a vaginal delivery and a bad reaction to morphine.  And by the way, all of this went down during Covid before vaccines.  After taking some time to settle after the physical and emotional turmoil, she is now enjoying chasing after her nearly two year old. 

Let’s get to her inspiring story.

P: So today we’re lucky enough to have a fellow podcaster Kaila on who’s got the podcast parent tell which is an awesome podcast about birth and parenting and everything else that goes with it. Is that right Kaila?

Kaila: Yes, we are talking about before you have the baby after you have the baby when you’re thinking about having the baby, everything, everything all parenting because I feel like in a sense it does start when you are pregnant,

P: Yeah, agreed. I read a post somewhere. Maybe it was Instagram that said just to be clear postpartum is every day after the birth forever. So yeah. Your podcast is an accurate reflection of that.

 

K: Yes, I am. 18 months postpartum. Thank you. 

P: wow, good lord

K: Oh, yeah. Yeah. Which like sounds like so much. But when you think about it, and also when you look at how little he still is, it’s not a lot of time at all.

 

P: want to hear all about him now. We’ll save that for later it was four times. So two questions before the before times you have any siblings?

K: Yes, I do. I’m the middle child. I have one older sister and one younger sister. 

P: Are you guys spaced far apart? Yeah. My older sister is a little over two years older than me and I am five years older than my younger sister. Yeah. So the gap between my younger sister my older sister is gosh, so it’s like seven years. Yeah, but for me, I’m kind of right there in the middle.

P: Nice. And Did you always know you would have a family?

K: I think so. I would say yes. I’ve always known that one a family, but not in the like, and no shade at all to people who are like this. It’s just not how I relate to it. I have not, you know, kept like my clothes to give to my children since I was like 10. That’s not something that I necessarily like day dreamed of when I was a kid. But it was something that I did see myself doing. For sure.

P: So before you ever got pregnant what what did you imagine pregnancy be like?

K: I imagined it was gonna be a lot easier physically. Where it was almost just like something that you don’t really notice until of course, you know, right before your due date. And then you’re like, oh, okay, yeah, now I am really like fat and miserable and pregnant. But I did not anticipate it just my body feeling so different. Right away. And then for the next 10 months, like that was not something I thought it would almost just be like not an afterthought that makes it sound really flippant, but just kind of like this thing. And it’s not necessarily altering my life in any way. But for me, it did and that was before I was super big and bad and couldn’t bend over.

P: you see pregnant women doing everything that everyone else does. And so I think it would be easy to infer from that. Okay, just just a thing that happens. Yeah. So was it easy to get pregnant?

K: For me? It was it took it was two months. Yeah. Yeah, pretty fast. Yeah. It’s when you know, you’re not supposed to stress about it, right? Because then if you’re stressed about even I get pregnant. That was really hard for me. Like the not stressing about it, but it kind of worked out that we were in the middle of moving from the West Coast to the East Coast. So my brain was preoccupied enough but not too stressed to kind of just have it work I guess at least that’s, you know, that’s what I tell myself.

P: That’s awesome. And so, did you find out with a home kit?

K: I did. I was still teaching at the time kindergarten teacher and so again, we just moved so like brand new state city, house, school everything so it was a really busy time and I knew my period was supposed to start soon. And my boobs hurt so bad, like three or four days before my period. But this was on another level. Like I would sit down and the gravity I’d be like, Oh, okay, so I was at school and I remember it was a Friday. In the first six weeks of kindergarten every Friday is like a different color day. So it was red days, like all the teachers were wearing red T shirts. And I remember this so clearly because we took a picture and that’s the last picture that I have of myself when I was pregnant and I didn’t know it. 

K: Oh, wow. 

P: Yeah. So like I have photographic evidence of my giant sore boobs and my tired face and I was pregnant. I just didn’t know. Got home. It was a long day since beginning of school year and it’s very much survival in the kindergarten level. Like get them on the right bus. Get them to the right adult at the end of the day. You did a great job. So I was congratulating myself for a job well done. My husband just had to leave the house for work even though his evening time and I went to pour myself a glass of wine and we have a lot of plastic wine glasses for a reason because I am very clumsy and I will they’ll break in the dishwasher or I’ll just like accidentally knock it over. And that’s exactly what I did. I poured a glass and I turned to put the bottle back in the fridge and I like knocked it off the counter. It was plastic. So like, okay, sad, whatever. And I remember being sad about the windings build. I was like I really like yeah, I’m gonna put another one. So I pour another glass and I go to sit down and drink it. And it tasted like rubbing alcohol. 

P: Oh, wow. 

K: Yeah. And I just was like, Who, what? And I was just really thrown off and like, kind of confused and didn’t really want to drink it. And I didn’t really I didn’t think like oh, this means I’m pregnant. I was just kind of like, okay, that’s really weird. And then I’m sitting watching an episode of Grey’s Anatomy and like tear jerker on a standard like on a level one to 10 Probably like a six or seven for some people. I was full on like, Niagara Falls, and it wasn’t even a super sad part. And that’s why I was like, whoo, I really am about to start my period like okay, whoo, this is this is heavy. There’s something happening. And I went to sleep like didn’t that I didn’t really think about it. I took the test the next day. My husband, I were hanging out in the living rooms, we had just moved into this house. We’re renting and so we were unpacking stuff and like, you know, our TV was like on the floor and we’re eating like sitting on coolers and stuff and like travel chairs. And I was like, I’m just gonna go do it. Because my boobs hurt. So like, there’s no way I’m just gonna go do it. And I didn’t say anything to him. I just like walked out the room, went to the bathroom, took the test and you have to wait two minutes, three minutes. 

P: Yeah. yeah

K:  The longest, you know, three minutes of your life. And I told myself I was like no, I’m I’m gonna like, I’ll wash my hands and I’ll leave the bathroom and I’ll go do something like I’m not going to sit in here and wait, that’s not going to work for me. I’ll just come back. It’s not going to move. And I came back and I looked at it and I kind of expected it to be negative. Especially I feel like I’ve never had you know, I’ve never had a kid before. So it’s not I didn’t really had enough no idea what I was walking into. And I lift it up and I said oh shit. And I ran out to the front living room and I showed my house and he only has been eating breakfast because he had a doughnut in his mouth. And as I’m like, I’m like welling up I’m holding it and I’m like, I’m pregnant and his mouth is full. And he’s like, Oh my God…. So that’s like a really happy funny memory that I have. And I remember we hugged and we cried. And then I posed with the stick and he took my picture. And yeah, and that’s how I found out and I had to wait. It was like two weeks to go to the doctor or for them to confirm so funny. I went to the doctor. They’re like all right, we’ll probably call you tomorrow because it was an evening appointment. And they called me like 30 minutes later, they’re like, Yep, you’re really pregnant. 

P: Wow, that’s a good call to get. 

K: Yeah, yeah, yeah. So for me it was it was easy to get pregnant. And it was like a happy, positive initial experience. It was very like, I mean, I said oh shit for a reason. Like I was excited but also at the same time, like, what have we done? You know, like, it’s very like, oh, oh, okay, here we go. 

P: There’s this sense of like hearing a door closed behind you. Right, like so then what was it? What was the first trimester like it feels like your body’s kind of sensitive because you are getting all these signs early. So how did that go?

K: yeah, I’m very, I’m very in tune with my body. And I feel like I’ve kind of always been that way, which is good and bad though, because you just feel everything. The first trimester overall, it really wasn’t that bad. The fatigue though. was unlike anything I’ve ever experienced in my life. I felt like a literal zombie. And I had just never 

P: Yeah, 

K: never felt like that knockdown drag out, tired in my life. And of course, again, beginning of the school year, I was also in grad school at the time, and I was just like, barely keeping my eyes open for at least eight to nine weeks. It was It was rough. I didn’t puke. I picked one time. This is really gross. Can I say gross things? 

P: Yeah. 

K: Okay. I don’t think I’ve ever told anyone this except for my husband is here to witness it. We had like cauliflower pizza and it just like didn’t sit well with me and I also didn’t like the smell of it. Smell was a big thing for me. It was pre was pre pregnancy. So then I was basically a bloodhound when I was pregnant. And it was really rough some time. Not my words, my husband’s words. He’s going to call his bloodhound which like, that’s fine. Thank you. I just was like, Oh, I really really don’t like that smell. I need to leave. I think we had had it. Maybe the previous days. Maybe it was like leftovers. Maybe that’s why it smelled extra funky. So I went to go do number two. The smell of my own poop made me vomit. And that’s the only time I vomited during my pregnancy. And it was because of me. So I was double dragoning at about like, six, seven weeks pregnant and that was like one of the lowest lows.

P: That’s pretty bad. I feel like I would love to top you. I can’t.

K: It was yeah, it was it was really gross. And it was I mean me screaming like, can you come bring me a bag? Because you know as I’m like, Oh no, this is not this is not good. This is not good. But other than that, I got nauseous, probably like around the same time every morning and I no longer liked to drink the tea that I normally drink. I can drink it now but it tastes like cigarettes at the time. 

P: Oh wow. 

K: other than that, I didn’t have any any effects that like, made me have to leave my classroom and run to the bathroom or anything. I was super fucking tired. And also just constantly felt like I had eaten a ginormous dinner. Like 24/7 Like just the bloat.

P: Right, despite the fact that the embryos still is so tiny and I unlike you, I’m not in tune with my body at all at that point in my life. But I remember I was in grad school. I just remember waking up and lifting my head from the keyboard I have like, like keys and printed on my forehead and just be confused about like, what am I doing in the computer room surrounded by people you know, I have just fallen dead asleep. Yeah. It is a different kind of weariness. 

K:  yeah, it’s not just this is not just like mentally tired. Like you’re deeply physically exhausted. Yeah. Yeah. And that was hard. That was hard for me to be teaching and then come home and in school myself. That was a rough rough time. For me.

P: That seems amazing because kindergarten looks like you know, the center of chaos. So

K: it is an active Yeah, I mean, it’s herding cats. Especially Oh my god. So I am not the beginning of the school year type of gal. I despise the school. Year in kindergarten, because they just don’t know anything. That’s like I’m literally teaching them how to stand on the line, which is exhausting. You know, so it was I’m glad I got pregnant when I did. You know everything worked out. But it was very, very difficult at the time just so tired and then try not to be stressed because stress is bad for the baby. Because cortisol is such a powerful hormone. And yeah, that was another thing running through my head too.

P: Yeah, that’s a tricky dual space to occupy where you’re like I’m not freaking out because freaking out was bad but I’m not not freaking out. Cause I’m pregnant. 

K: Yeah, yeah. 

P: Was the rest of the pregnancy smooth?

K: Yeah, honestly pretty much it. second trimester I fully understood. I was called honeymoon trimester because starting around week i members week 11 I woke up one day and it was like I was awake for the first time in about 11 or 12 weeks and it was just like whoa, I can sit here and not want to fall asleep and it was kind of like I not got my life back but I was just awake again. And that made a huge difference for me. 

My brother in law has this big or pre COVID had this big Halloween party at his house every single year. And I had kind of coerced all of my husband’s family into doing a big group costume because it was our first time on the East Coast in three years. So we did Marvel. 

P: Well, that’s fun. 

K: Yeah. And so I told Jimmy my husband I was like okay, we’re going to take a picture like in our costumes. So I’m going to say like, Oh, we’re gonna take a picture in our costumes, like, let’s all stand in the same position. Like before without our costumes and I have gotten this shirt that said, you can stop asking when I’m having a baby now because my mother in law is classic. She loves babies and she loves her grandchildren. And she’s just so excited. And I was like, okay, lady, leave me alone. I love her but I was like, okay, back off. we convinced everyone to take this picture. And we had like when the neighborhood kids took the picture and I gave him my phone I think and I was like, make sure you say one two three before you take the picture, which is like, good practice anyway. Because right after he said three, I yelled, I’m pregnant. And so we caught everyone’s reaction.

P: Oh, that’s awesome. Yeah, it was well done.

K: Thank you. You know, I wasn’t thinking about being a mom when I was 10. But when I was 26, 27, I was thinking about stuff like that, like, oh my gosh, like what would be a really cute way to tell our families that I’m pregnant. So that was a really cute moment. Yeah, second trimester was easy

 

P: let me just say that you’re you’re nailing it so far. Everything here is I like the pregnancy reveal to your husband and to the family. This is going swimmingly. Okay. Keep going. Yeah.

K: Thank you. Thank you to my dad. It was much more just like, right it was because also like know your audience like yeah, it’s not, you know, like, he’s a very like cut and dry, stoic kind of person. And so he came to visit us and we were just talking and he said something like, Oh, why aren’t you going to drink or something like that? And I like slightly lift up my shirt. And I was like, because I’m praying you know, it’s very chill, or very chill person. 

P: Yeah, 

K: I got really bad. sinus congestion, though. Oh, my words. Yeah. Towards the end of my second trimester, like couldn’t breathe out of my nose for two months. Three months. Wow. It was awful. And so, you know, your nasal passages swell up when you are pregnant naturally, because you have more blood running through your body and it’s just how it works. But for me, it just completely blocked me up. So I was pretty miserable for a little while. And of course, when you are pregnant that you can’t take anything so I could take flown days. So I mean, I was shooting up that flown is at least at least two or three times a day like just to have any sort of relief. I had heartburn really wasn’t anything that was overtly hard. I would say that I had a harder time with my body image. 

P: Yeah, 

K: so it was harder on me mentally in terms of my body is changing and I did not give you permission to change necessarily.

P: It’s dramatic and strange, right? I remember in the second trimester for the first child. I kept showing my husband my belly saying I’m doing it wrong. It can’t be this is what everyone looks like. This is bizarre. I look like I’m a pear. Like it’s just weird, right?

K: Yeah. And everyone carries differently, which is I think something else that I learned too. While it was happening to me and I, because I would receive so many comments, which again, did not help my body image at that time. I would get my god you’re so tiny. Are you even pregnant? In the same day? I would get Wow, you look really pregnant today. I’m just like cool, cool, cool….. Oh, please, please, please stop talking about my body. 

P: Yeah, 

K: and I think pregnancy actually brought up a lot of dormant feelings that I maybe had when I was in early college late high school and or feelings that I didn’t necessarily know that I had about my own body and not feeling comfortable in it and also really not wanting and not being open to accepting comments about my body from other people. And I mean, you’re basically a moving target when you’re pregnant. So it was that’s really hard,

P: that’s a weird thing right? Is it is you somehow become like public property and people want to feel your belly. It’s a weird time. Your disdain for that seems right on. Yeah, it shouldn’t be. That shouldn’t be right.

K: Yeah, it was very cringy sometimes for me and I felt like it was very much like Don’t look at me like Can you can you stop How can I concave my chest to make myself smaller? So maybe people don’t even notice? You know, I wasn’t thinking those thoughts all the time. 

And I feel like it’s after. I mean, really starting for me, like at week 25. You’re like, your body is different every day, like every week, and it’s really it’s really hard to keep up not only like in terms of clothing, but mentally preparing yourself or like getting used to what you’re going to see in the mirror which is completely different from what you have seen. For the past 1015 20 years. It was very, that was very jarring for me. 

P: it’s also weird to have something like an autopilot installed in your body in a way that has never been used before. So your body is different in ways that you have no control over and it’s not like working out or going running where you’re making changes to your body in this very blunt, purposeful way. It’s kind of happening to you, right? So it’s weird.

K: Yeah. To wake up one day and just be you know, walking the same path from your bed, to your bathroom and all of a sudden you’re hit with lightning. crotch and you’re just like, fuck, like, yeah, now we have to deal with this. And I already am dealing with all of these different things. No one told me those things. No one told me that it was going to be I love your analogy of the autopilot because that that is what it is.

 Your body already came equipped with that you just didn’t know you’ve never used it. You’ve never read the manual and so you have no idea how it’s gonna work. And so it’s going to completely throw you off. And I just was so caught off guard by that but I will say by right around like late February, early March. So right before the pandemic hit and everything really shut down here. I was able to kind of let go and just be at peace and also appreciate the fact that my body is doing something amazing. 

P: Yeah. 

K: And yes, it’s without my permission. But it’s so strong and so resilient to be able to do these things while I basically just go about living my life. Like I’m laying on the couch, and I’m growing a foot. Yeah, hello. Yeah, I mean, I was able, yeah, I was able at the end to just learn to embrace it, essentially, and still complain and still struggle with it. But at the same time, I was able to see the beauty in my own physical body. And it took me I mean, a solid three or four months so like, basically, I would say, almost the entire second trimester but I got there and now looking back any and all pictures of me pregnant. My first thought is like, oh my god, so cute. You know, like, I’m not sitting there like, Oh, I’m so fat and ugly or like, I hated that. I’m not sitting there picking it picking it apart. I don’t think of the negative things. I just look at the pictures and I smile and I’m filled with almost this like peace. Like oh my gosh, I did that

P: well that’s amazing. What did you want for yourself? Are you imagining did you write a whole birth plan or what did it look like for you?

K: I wanted to go as unmedicated as possible. I read this great book one of my my cousin’s wife recommended to me it’s called Ina may’s guide to childbirth and Ina May is this like world renowned midwife. She’s done like, hundreds of 1000s of births at this point. And I liked the book because she is very centered on like home births. Homeopathic, but real people wrote in to her. Most of the people that she had helped give birth and a few people who she had not, and it ranged from. I gave birth at this birth center on a farm in Kentucky. And it was beautiful and I was out in the forest underneath the night sky. I had a C section like it ran the gamut. So it gave me a really good picture of what I could expect I guess. 

And then at the same time she also provided information about like, what is Pitocin what is an induction everything you kind of as a soon to be parent who’s the person you’re going to get you’re the ones giving birth and you might not know these things, because I’ve said many times before on my podcast like our sex education system is trash in our country. It’s really a sad it really is sad but so we go more than half our lives, just not really knowing what is actually going to happen and also not knowing like how to advocate for ourselves. So I think the book taught me a lot about like, okay, here are all of my options. Cool. Here I’m gonna like cherry pick the ones that I would like to use knowing full well it might not go the way I want it to go. And then also, here’s a way that I can advocate for myself. I wanted to go as unmedicated as possible for as long as possible. I was open to the idea of getting an epidural. I wanted to just try my hardest not to and because the pandemic happened towards the end, it changed how often I went to the doctor because they were just trying to keep us pregnant people home as much as possible. So at I think one of my second to last appointments, I said you know I really want to go unmedicated you know, but I was told you know, you go, they said go to the hospital when your contractions are three to five minutes apart if you’re a first timer. And I said, you know, I really don’t want to feel pressure to get any sort of intervention. And one of the nurse midwives she was really, really good. She said, Stay home, stay home as long as you can. Because if you’re in your comfort zone, you’re going to be able to push through more. And you’ll also if you want to avoid any interventions, and being at home is an amazing way for you to do that. So that’s what I tried my hardest to do 

P: Okay so the day your husband was born: how do we know today’s the day? 

K: so my due date was May 12 and all these people texting me on May 12 me my DD one they were texting me happy today, which was like, I didn’t know that was thing but I love that like that’s so fun. So cute. But then of course, other people. So you have the baby like it’s not you know, hold the switch I wish now and my son was born one week Exactly. So later so may 19. But that whole week, basically just people like pregnant so you’re pregnant so as I’m just like, angry typing, like, leave me alone, but I’m really saying yes, I’m so pregnant. Thank you like when you don’t hear from me when there’s like some radio silence. That’s what I’m busy pushing a baby out. Of my vagina. Thank you. 

I was feeling very done. And so I actually I was avoiding it. But I scheduled an induction for Tuesday evening, Tuesday, May 19. The day he was born. I was supposed to go in at like 5pm and I was doing all the things I was eating the spicy foods. I was drinking the raspberry leaf tea. I was sitting on the bouncy ball I was going on walks and nothing was happening. I was walking around one to two centimeters centimeters dilated for a week or two. So like it was happening. 

P: Yeah 

K: progressing. But I was just so over it. And then Monday, the 18th it was the afternoon I was like huh. And again like contractions that’s a whole nother thing where it’s like, what is the contraction? Like how do I know what does the contraction feel like?

P: I kept asking people when they wouldn’t tell me. I’m like yes, I helpful.

K: So many people said, oh, yeah, you’ll know the one person one of my teammates on my kindergarten team. She said honestly, it’s gonna feel like you have to poop. It’s like a poop cramp. And then when you have to push that it literally feels like you’re about to poop your pants. So I was like, Okay, thank you for at least. Yeah, so I was thankful that someone explained it at you know, at least a way that I finally was like, Okay, I think now I might know what you’re talking about. And it was like the early afternoon and you know, essentially my husband was at work but he was on call, essentially. I was  feeling like almost crampy and so I texted him is maybe like 2pm I was like yeah, I think maybe I’m having like having a contraction or two these like okay, and an hour later, they were a little more intense still very far apart. So I texted I was like, 

P: Yeah, 

K: I mean, like if you want to come home now, so I’m not here by myself. That’d be nice. Yeah. So he came home and we did an episode where it was just he and I talking we were talking about like basically my birth story and he said I didn’t know before but on the episode he said that like he was racing home just like speeding home and very nervous, very anxious. And I said I mean, I had no idea when you walked in the door you seem very cool. Like that. So thank you for like providing that energy to me that I really just hung out. I think I was like watching the office laying on the couch for a couple hours. Dinnertime came, they were getting stronger. And I was not hungry obviously because my body had other things in mind. 

But my husband kept saying like, you know you need to eat like you’re going to need the energy like you shouldn’t have a completely empty stomach. You know, like, you don’t need to be there right now. Like let’s eat something, let’s eat something. And I just couldn’t have some fruit. And I was there’s video evidence because I asked him I was like, Look, I just especially you know, COVID were completely by ourselves, which is kind of what we had wanted before anyway, but it felt even more isolated because of COVID I said you know, please take as many videos and photos as I will let you take in the moment so there is a video of me. I think I’m like getting fruit out of the fridge. And again looking at I’m just like, holy crap. I was so pregnant. And I’m like joking and like oh, and like, you know, you need to eat like, you’re going to need the energy like you shouldn’t have a completely empty stomach. You know, like, you don’t need to be there right now. Like, let’s eat something, let’s eat something. And I just couldn’t have some fruit. And I was, there’s video evidence because I asked him I was like, Look, I just especially, you know, COVID were completely by ourselves, which is kind of what we had wanted before anyway, but it felt even more isolated because of COVID. I said, you know, please take as many videos and photos as I will let you take in the moment so there is a video of me. I think I’m like getting fruit out of the fridge. And again, looking at it like holy crap, I was so great. And I’m like joking and like oh, contraction like messing around with him. We just like LOL, cuz five hours later, it was not so funny. And I was just kind of hanging out. It was probably around 10 o’clock, where it got to the point where again, this is on video and that’s I feel like that helps my memory where I no longer was talking while I was having a contraction and instead was just like closing my eyes and trying to breathe through them. I took a shower. And we were trying to wait, maybe until like midnight to go to the hospital just to see like Alright, how long can I push it? How long am I comfortable doing this until I feel like I need to have medical professionals in the room just for my peace of mind. 

We left our house right around like 1245 1am and the hospital was very close. Like less than 10 minutes away. I gave birth. My husband’s in the military. I gave birth on base. It’s actually the same base that he was born at. So 

P: oh Wow. that’s fun

K: Yeah. Yeah. So super cute. And we get there and I’m having contractions like walking to the hospital door. And when we got there I was five centimeters dilated. 

P: well done

K: Oh yeah. So like, I mean, I remember feeling relieved like okay, halfway. Yeah, fine. Okay. And it had been like just under 12 hours. Okay. All right, doing okay, you know, like triage checked in all that stuff. They started to get very very painful for me probably around 4am And I was so exhausted. I was falling asleep in between the contractions. They’re probably only about two minutes apart, one to two minutes apart. Yeah, I was sitting on the exercise ball and my husband was behind me kind of like supporting me. And he was literally having to like, I’d be like, Hmm, like in pain and pain, Awake, awake, asleep. It was almost like narcolepsy. 

And he said in the moment it was scary for him because it was just very strange to have screaming in pain and out like a light but I did that for probably two hours and actually remember, yeah, sucked. But I actually remember I was having bad dreams. Like when I fell asleep, not nightmares, but it was just like, I was not even you know, like was even having pleasant dreams. I would have a contraction, fall asleep and I would I would sleep so hard. And that minute to two minutes, that I would dream and I remember it’d be a bad dream to 

P: Well, that’s gonna make sense, right? I mean, yeah, the life is being squished out of you. Yeah. It’s hard to think of, you know, unicorns, and roses, right? It’s 

K: Yes, yes. And I’m already naturally like, not a unicorny person. So yeah, I was doing it. I had made a playlist in the moment. It was not playing, looking back and I just brought this up with my husband. I asked him I was like, we didn’t have the playlist playing until after I got the after all right. He said, Yeah. And I said, Man, you know, I wish we had thought of it. We were obviously a little busy. But I wish we had thought about it. Because I am very responsive to music. I love music. And I made that playlist, you know, chose the songs that I chose for a reason and most of them were actually like, feel good like 90s Hip hop like dance party songs on purpose to kind of distract me. So I do wish we had had the wherewithal to put the music on but that’s okay. Obviously, we didn’t 

P: my husband and I made a playlist to and then after, you know, my crazy birth story, but after my birth, we laughed at the people who made that playlist. We’re like, Haha, you fools. Who would’ve played that playlist? Not me…

K: yeah. Yeah. Like, whoa, hold on. Let me open my Spotify real quick. Sorry, baby. Hold on one second. 

P: Very funny. 

K: Yeah, so we were we were not mentally in playlists land until afterwards when I got the epidural and it was around closer to like seven or eight. I looked at the nurse and I said I can’t do this anymore. And I was near tears and I because I just was in so much pain and it wouldn’t stop it was for me like I can’t even maybe I could keep going if I could get a break for a second. Yeah, there was no break. And you know, she’s obviously trained and she just said it was so simple, but it was the tone in which she said it and she like met my eyes. And she said yes, you can and I was like, not taking it back. But I was like, okay, like, Okay, thank you like, you’re right. Yes, I can, but I will take that epidural, please. 

So I got an epidural. I had to sit still through two massive contractions as they put the epidural on my back. And I’m like, bruising my husband’s hands because I’m squeezing them so hard because it’s an anesthesiologist. Yeah, and he’s like, Okay, you cannot move you have to stay still, us I’m like, oh, fuck, okay. Yeah, so I’m just like, clenching with all of my night. And then I mean, 20 minutes later, I took a nap. And it was amazing. 

P: Oh, nice. 

K: Yes. My husband says that when I was sleeping. He was you know, sitting there awake. The nurse came in. Like look, I saw him sleeping she said and she turned her down like yep, I knew that’s exactly yeah, that’s what you needed. You just needed to sleep and my son was born 6:36pm So the epidural, definitely, yes. slowed me on down so I bought I mean I lay there and we’re watching the monitor. As I mean, these giant as contractions. I’m just like, Can I have another popsicle, please? You know, I’m just like sitting there. That was like first time ever experiencing medicine that powerful. 

P: Yeah. 

K: And my first time ever being numb from like, the midriff down, which was very strange. And I was trying to explain it to my husband. I was like, No, I literally can’t and not move my legs. Like, my brain is saying like, okay, come on. And I can’t so he said. So he was like You mean if I pick your leg up, it’s going to fall? Yeah, do it. My son Robin. His heart rate was like dipping here and there sometimes. So I was my legs were on the peanut ball, and I would be on my left side and I switched my right side. So he lifted at one almost like a clamshell exercise lifted up one leg like go and it comes crashing down. He’s like, Oh, I guess I told you like it’s cool when it’s like strange and kind of scary at the same time. Mostly cool though. 

I pushed for two hours which flew by, like did not seem like two hours at all. It was almost exactly I think it was like two hours and four minutes. They told me or something like that. And I I always responded well to a deadline. The shift change was coming. The shift change was coming and I loved my nurse. And she made a joke. She was like, alright, like I’m out of here at 730. So what are we doing? And that was probably at like 530 and my son was born an hour later it took a couple pushes to like that’s a you know, that’s a learning curve in itself, pushing out a baby and then pushing out a baby when you can’t feel it. 

P: Yeah, 

K: I did feel that urge of like, Oh, I’m gonna poop. I’m gonna put my pants right now. But I remember telling her like, Hey, I’m not like it feels like I’m about to poop like here we go. We need we need to start but it did take some coaching from her and just like some experimenting to figure out. How do you do this? And especially how do you do it when you cannot feel they gave me like a big mirror on wheels. So using a mirror like being able to see that really, really helped me to have a visual and then that’s also like a motivator because as I saw his head crowning it was like, Oh my gosh, like okay, like, here we go. Here we go. So close. So close. So a birthday came out. Everything was great. Everything’s cool. He had like a 10 on the Apgar. Score, and I was like, yes, that’s my child. And I gave birth to the placenta, no problem. And they were still down there like sewing me up. And I noticed it, but obviously I’m very distracted by my son and really just enjoying that moment. And it was almost like the unspoken thing between myself and my husband where we were both like they’re still there. 20 minutes later, they’re still there. 20 minutes later, they’re still there. That’s not there’s something more more doctors coming into the room. When you are far outnumbered. Yeah, by the medical professionals, never a good sign. 

P: Yeah, no kidding. 

K: And yeah, so we’re both kind of just like looking at each other 

P: wait,  no one’s telling you what’s going on?

 Oh, it took a while for them to say anything. And my husband first was like, hey, whoa, like what’s going on? And they said so like, she’s still bleeding too much for our comfort. You know, like, it’s just more than normal. So we’re trying to maybe see where’s the source of the bleed? They couldn’t find the source of the bleed for probably like the first 30 minutes to an hour. Yeah. And then so in total, I was laying there for two hours pleading 

P: And they didn’t call it hemorrhagin or they did call it hemorrhaging. 

K: So they did call it hemorrhaging by the I would say like, if I had to estimate again, I have very little concept of time and this is also where, because of the blood loss My memory is a little hazy, which really, that’s something that’s like been really hard for me because I wanted to remember this stuff so badly. So it’s been frustrating that because, you know, losing blood just takes that it literally takes everything out of you and it affects your memory. 

P: Remembering your birth is so important because it’s so much a part of your own story too so I took this question about people’s memories of their births to a fantastic OB. Hi, Dr. Matityah. Thanks so much for coming on the show. 

Dr. Matityahu: thanks for inviting me again. I love coming to the show. 

P: Today we’re going to talk about Kayla and hers is actually a story of hemorrhage. Kayla’s disappointed after the birth that she doesn’t have the sharpest memory of everything that happened. How typical is this for after birth experiences

Dr. Matityahu: when you’re lying there. He just pushed out a baby. You’re exhausted. We’re exhausted because now you’re losing even more blood than your normal blood loss from a vaginal delivery. All the sudden you’re launched into a new phase of life. Most of us our brains don’t process everything that’s going on around us. I mean, I think it makes sense that you’d be lying there. You’re looking at your baby. You’re wondering, what are they doing down there for so long? Most of us don’t remember the exact details of our birth I can say that I’ve retold my birth story and my husband basically said no, that’s not what happened. 

K: I don’t remember a whole lot of a lot of my husband a lot to tell me what happened. So like the head surgeon came in because it was a teaching hospital so the head surgeon came in and she said okay, so cervical tear, not abnormal, not ideal, not super normal. And they couldn’t fully confirm where it was and they could not stitch it up. Me laying in the bed like that. 

P: I Wondered why it was so hard to identify where the terror was to this question to Dr.Matityahu. Can you give us any sense of like what you’re looking at after a vaginal delivery, and why it’s so hard to identify as a source of the bleed and one thing I should add is that there were tears she had second degree tearing. 

Dr. Matityahu: So after vaginal delivery, there’s a few different places where you can have bleeding. One is from inside of the uterus or the placenta detached other is there could be a tear on the cervix which is less common but could be a source of bleeding. Could be a tear deeper inside the vagina is causing bleeding that’s hard to see and there could be just bleeding from there the vagina tour. There’s a couple of different places where you can have a tear and or a source of bleeding. And after delivery of that tissue is it stretched or torn? Not always easy to identify exactly where bleeding is coming from because a lot of times there’s a fair amount of blood anyway. After vaginal delivery from the uterus so that bleeding which is normal bleeding, be obscuring or places that might bleeding in addition to that. It makes sense that it would be at times hard to find the exact source of the bleeding. 

K: Jimmy always says yeah, like that one surgeon came in she was like what like, move like what are you guys doing? Like this is and I that I do remember her attitude being not towards me at all towards the other doctors in being like why is she been laying here for this long like what are we doing? So I was told I needed to go to the OR and they would be able to fix it nilar Because they have better equipment and they would be able to tilt my bodies they could actually see to cauterize it basically and so I’m like, okay, as I’m, you know, basically in shock, I just gave birth to a baby. I’m exhausted. I’ve also been bleeding for two hours. I’m really weak. I’m just like, alright, well, I’m like the brakes. Here we go. Yeah. And I remember I do remember being wheeled out of the room and Jimmy is holding Robin as I’m sure he’s internally like really like and I literally just waved like I I was very much in shock but I think I also a little bit was like, let me comfort him like it’s okay. Like, I will see you like it’s okay, casual. It’s fine. See in an hour. 

P: That’s why you’re getting the I’m on the deck of a ship kind of wave. 

K: It’s just like, Fine. Have a great boy. Yeah, so it was about an hour and end up having to cervical tears. So that might have been why there was so much blood and both of them they just could not see them when I was laying in the bed like the way my body was. So what they did have you ever seen like a like an old school meat locker, like those giant hooks and they like have the meat hanging from the giant hooks. 

P: please don’t tell me they hung you upside down? 

K: Yeah. Okay, so I wasn’t upside down but literally, my like, from my lower back down was up in the air if that makes sense. It’s almost like I can’t remember the name of the yoga pose when like your mid back and up on the mat. And everything else 

P: it’s like a shoulder stand. 

K: Yes, yes. Yes. I remember at the time I was just like, this is in sane. 

P: Are they a ladder like I don’t understand how that’s helping. 

K: So they put my legs in even my legs in and they explained everything and was so out of it from I think the blood loss and all of the above that I had them I was like I’m so sorry. Can you tell me please one more time like what you’re about to do? I remember they’re like oh my god for like poor girl. Yeah, like are you okay? So they were like so you have to cervical tears. We cannot access them with your body laying on the table are going to need to lift your body up and then the doctor will be able to access and cauterize them from there. Okay, cool. 

P: Kaila, so they are hung her at a pretty steep incline and the surgeon is on like a stepladder and wondering how that helps with axcess. 

Dr. Matityahu: One reason to put her in that position is maybe maybe her blood pressure was dropping a little bit and that helps her blood flow to her head and her heart number two if the bleeding from the uterus is obscuring whatever you’re able to see inside of the vagina, sort of hanging her little bit upside down might just keep some of the blood in the uterus so that it’s not flowing out as briskly so that you can probably see more of what’s happening in the vagina and the cervix. I agree with them going to the operating room. Usually we don’t wait two hours to take someone to an operating room if they’re if they’re bleeding and we can’t figure it out. Yours will go much faster to the operating room because number one you can give the person more anesthesia so they’re more comfortable and the lighting is better. And we have instruments that you know instruments and additional hands that can sort of help open up the area and get a much better look inside the vagina because most of the time when we’re in the room, it’s us and a scrub nurse and usually hands and sometimes their hands helping but when you’re in the operating room, you can kind of call in more people and you have different instruments in the operating room that we obtained in the delivery room and so you can really issue in the container and really look inside and get a better view of what might be happening. 

K: So So couldn’t feel anything. Thank God completely numb. They gave me like a little shot of morphine to to kind of like make sure I stay chill and not in any pain. And I think she might have been standing like on a stepladder and she had one of the headlamps. It was like 45 minutes an hour max. And there were compression pads like on my legs. 

P: Yeah. 

K: So that was actually really nice like that felt nice and I remember the his anesthesiologist but he wasn’t you know, he’s want to give me the morphine. He was so nice because you know, they sit at your head and it was so nice and he was constantly like, are you okay? Are you cold? Like, please let me know like the second you’re in any pain and I wasn’t I think I even like almost tried to go to sleep. Because I was just like, I’m just gonna close my eyes because I was getting kind of nervous. I was like, yeah, just gonna let me close my eyes. 

But you know, surgery was great. It was unexpected, like emergency hemorrhaging surgery, but I didn’t have to go the pacu they wheeled me back to the delivery room. I had a bad reaction to the morphine. I’m sit Yeah, I’m sitting there talking like talking to Jimmy, talking to the nurse and all of a sudden everything slowed down. I felt like I had just gone to a concert. They’re ringing in my ears. And Jimmy told me I was slurring my speech. Like I was super super drunk.

P: that’s terrifying… good lord. 

K: Yeah. And I remember just saying like, I don’t feel good, but it probably came out like oh no, like it was because I saw their faces like and I knew this is the only other time I vomited, but I knew it was coming. Of course me being like, this shows you let me like get on my feminist stepstool real quick. This shows you just like how ingrained it is in us to take up as little space as possible and to make everything more convenient for everyone else. Because how dare we take up space? Like how dare I puke right after I gave birth. So I’m literally trying to hold it in my hands covering my mouth. And I’m pointing like huh, like it’s about to go down. And just in the nick of time, I’m given a bag and so we’re all good. But then you know, of course they’re really concerned. So they kind of scrambled for a little bit and they found out I had a bad reaction to the morphine and I was pretty out of it. For the next I like the next almost 24 hours. I would fall asleep like while the doctors were talking to me, because I just I couldn’t stay awake and they said you know like fatigue. This type of fatigue is obviously a symptom of your blood loss. 

P: Yeah, 

K: so you’re gonna feel this way for a little while and it wasn’t. It wasn’t ideal, but I do remember probably like 12 hours before we got discharged from the hospital. I started to feel a whole lot better and could actually like keep food down. But it was really those first 48 hours after giving birth. Were just a cluster and kind of like one thing after another, not to mention learning how to breastfeed and try and you know, like all those other things having to do with the baby while I’m also dealing with all of these things of my body. So that was really, it was a really hard time and I think I actually was in shock about the hemorrhaging for a long time and almost in denial to the point where I was like it was so traumatic that I just kind of shoved it away. And I didn’t really come to terms with it until gosh, like almost a year ago when my son was already almost seven months old. When I started to learn more about hemorrhaging and how common it is 

P: really common. Yeah. Yeah. Worldwide, postpartum hemorrhage is the leading cause of maternal mortality. The American College of Obstetricians and Gynaecologists report that roughly 11% of maternal deaths in the US are due to hemorrhage. And then a giant share of these deaths are later deemed preventable. The rates in the US have been on the rise, but it’s not obvious what’s driving this increase could be a number of factors. I brought this question to Dr. Matityahu. When I looked on the CDC webpage about birth complications statistics, it looks like the incidence of hemorrhage has increased pretty dramatically in the last 20 years. I’m wondering if this is like a counting issue like it actually hasn’t increased, but we are more aware of it or if something else is going on? 

Dr. Matityahu: It’s a great question. I’m not sure I know that in the last few years we’ve been tested being much more diligent at measuring blood loss after vaginal delivery and C sections are either will even weigh the gause pads to see how much blood they collected.  In the past we used to just eyeball and make an educated guess. I was being a little bit more specific at recording blood loss. So so it could be just an account like a difference in how we’re accounting for the blood loss and how we how we calculate it, or noticing like, Oh, this is much more than we thought it was. 

P: One final note on this:  A lot of things make the list of risk factors for postpartum hemorrhage, including things like lacerations retained placenta instrumental delivery, and some studies suggest that other factors like obesity and age could be contributing factors for the risk of postpartum hemorrhage. Both obesity and age at first birth have been increasing over time. 

K: It’s taken me a while to kind of talk about it without trying to just humor my way out of it and like disregard it because I used to say like, oh my god, you know, like, it’s fine. I still say that but at the same time, I still in my head know how serious it was and how potentially life threatening it really was. And I think that really impacted my initial postpartum experience as well. That was really hard like the baby blues hit me so so hard. Another thing that I wasn’t, wasn’t expecting and also, it’s that thing where you don’t fully understand it until it happens to you and you’re like, Well, God,

P:  it’s experiential for sure. 

K: And I remember when I was in labor, they’re like, Oh, your blood pressure. A little highs is not fair at the epidural, but I was just kind of like, I don’t want to be rude. So I didn’t say I just okay. Thank you. In my head. I’m like I’m in labor. 

P: Yeah, 

K: yes. My blood. Yes. Yes. It is a little high right now. Thank you. Thank you. But then looking back on it. That is one of the signs of preeclampsia and I did not have that. Thankfully, it was kind of you know, it’s a separate issue. Having cervical tears is different than having preeclampsia. But if I was willing to kind of blow it off in my head like, it’s fine. That’s what we all do, especially women be Oh, like that that big, scary things are happening to me. No, no, like that happens to other people. It’s fine. I’m fine. 

P: that’s totally true 

K: it’s still a more extensive change and transformation than you think it is. No matter how much research you’ve done, no matter how many people you’ve talked to, that are how many people have been real and honest with you. You still are not going to fully grasp what it is. Until it’s happening. 

P: it took me 10 months to get into this state. It’s gonna take a while to get back and I think the six week mark, which is the first gynecology appointment Yeah, that’s only the amount of time it takes for your uterus to shrink down to its size. But 1000 Other things have not gone back. Right so 

K: yeah, or and never will potentially. Yeah, yeah, talking about disappointing. I don’t know about you, but my six week appointment was nothing like I thought it was going to be I thought it was going to be very like how are you Yeah, it was not it was literally Alright, let’s see if your stitches have healed. Okay, you’re looking great. What kind of birth control do you want? None…I’m good. I’m not even like, I’m not having sex right now and be like throwing a hot dog down a hallway like I’m so good. And I also know like, the military culture, the stereotype, it’s a stereotype for a reason because it’s true. Well, there’s a lot of babies walking around. So they were pushing extra hard like, Are you sure you don’t want birth control? Are you sure we have the birth to clinic from this time of this time this day this day? And I I had to kind of get like, hey, stop, I’m fine. I’m telling you. I’m fine. I’m really not going to be pregnant in a month from now. I can guarantee you like I’m good again. I know my body. You know, they didn’t ask me like your breastfeeding. Like how’s it going? Would you like to at least talk about that with someone it was it was also a doctor who I had never met before. You know, they’re on a rotation. I had never met them before. So I didn’t necessarily even feel comfortable being like on can we talk to this for a second. It was just so bare bones. 

P: Yeah, 

K: when needed so much more than that and all birthing people need so much more than like, Oh, let me just check your incision site. Let me check your vagina. Okay, here’s a patch. Here’s the pill. See you later you know, like we deserve so much more than that. And the six week postpartum appointment is not a one size fits all deal. That’s really what we’re given. And I remember just be walking out of there and just being like, the fuck, like what just happened? Like that was just not what I expected. 

P: Yeah, it feels like a box checking exercise as a medical front, right? 

K: Yeah, yep, that’s exactly what it was. And that’s exactly what I felt like, like you weren’t even. This was not an individualized personalized appointment. This was my name was on the paper. You checked it. You signed it. And you said Have a great day. Very disappointing…

P: Kayla and I talked a bit about postpartum care. And she said when she went to see her doctor at six weeks, essentially it was a very medical visit it does that surprise you. And do you think that postpartum care is in any sort of transition away from something more medical, there’s something more holistic,

Dr. Matityahu: I would  like to think that it’s going towards something more holistic, and There’s, I think more of a trend toward really connecting and having compassion and being empathic and you know, asking people how they’re doing and so I think that there’s much more of a trend that way especially in my hospital, and that’s kind of sad to hear that you know, she she wanted more and wasn’t wasn’t able to express herself, or talk to her experience with her doctor. 

P: It was disappointing and she said, she felt exhausted and overwhelmed and sad at times and there’s really nowhere to put those feelings. 

Dr. Matityahu: You’re exhausted anyway after a vaginal delivery, you know, or any delivery, you know, between the hormone changes. You’re up all night, all of us lose. Load when we deliver and that’s a normal part of delivery and then leaving a significantly larger amount of blood that makes her even more exhausted. I don’t know about you, but when I’m exhausted, my emotions are all over the place. I cry much more easily when I’m exhausted like that. And so all makes sense to how it just all of the exhaustion and the life change and not sleeping and low blood count. I mean, it all leads to just being tired and sad. And I mean, it’s hard and so it’s even harder when you don’t even have you know, when you’re anemic. You don’t even have enough blood volume to keep you focused and awake. It makes sense that it would be incredibly hard for her. I feel terrible. 

P: This postpartum thing is really a tricky issue. It seems like because it’s more than medical 

Dr. Matityahu: 100% and the hard part is we have 15 minutes. Yeah, to do it all to check in you know, to check someone medically to check in with them. If it’s someone that has never met her before. They’re probably looking to see okay, you lost a lot of blood. How’s your blood? How are you feeling? Are you bleeding anymore? Is everything okay? Like, medically Are you like, okay, or do I have to do anything? And then I think sometimes people forget like, wow, I lost a ton of blood or going you know, lying on the table for two hours. Like when we look at the note that’s not always we noticed or what was obvious to us, like, we’ll see. Okay, there’s blood loss and now you’re doing Fine, thank goodness, but we don’t know the emotional journey that someone has taken. Unless we’re someone that’s going to ask and then sometimes, if you’re like, Well, I have 15 minutes. I don’t want to get into that. I don’t have the time and then what am I going to do about it anyway? I think some people will consider approaching physicians and providers and midwives. Sometimes we forget that just asking and validating and expressing our compassion about what they’re going through is sufficient. Like, that’s what people need. And that doesn’t take long. A lot of people are afraid to do it because they don’t realize that it’s not going to take time that they think it’s gonna take and the impact that has is huge. 

P: So now, Robin is 18 months, 

K: he’ll be actually 19 months and about in less than two weeks. Oh my gosh, what 

P: so what are his tricks? What can he do? 

K: he’s fluent in four languages. 

P: Can he walk? 

K: He started Yeah, I started walking around 11 months. Oh, wow. Yeah. So he was walking by his first birthday. I mean, I feel like I can’t remember the last time I saw like it walk. He just runs everywhere now. Like 

P: oh my god, that’s awesome. 

K: That’s yeah, that’s so fast. I genuinely can’t remember. Like he does not walk. And he’s really heavy footed do so you just have to think oh, here comes Robin.

P:  Very cute. Feel thanks so much for coming on the show. This is such a great story and I so appreciate you sharing it. 

K: And thank you so much for having me. It’s always nice to talk about my birth story a little bit more because it always just gives me a clearer perspective about it each time I bring it up out loud and it’s, you know, it’s not really something I talk about that often so it’s been nice to kind of just revisit and think about how it was and it’s so funny, because on some level, it almost feels like a dream. Yeah, you know, like, What do you mean like he’s always been here? Yeah. Yeah, like he’s just been around forever. Yeah, yeah. Yeah. The best. The best reality because I don’t know. Yeah, like, I don’t know what I would be doing. If I didn’t have him, which is really wonderful to think about because it just makes me think of like, well, then it’s so I don’t know what I would doing but in that case, it’s so amazing that I have him. 

P: Yeah, that’s awesome.

Episode 40SN: Pressure Makes Diamonds: Dr. Crevecoeur’s Story

My guest gave birth for the first time more than two decades ago and had a wide breadth of experiences in pregnancy and delivery in the course of her four pregnancies. She has hyper emesis for all of the pregnancies and learns to manage it despite her busy OB practice. A whole host of surprises visit her in the five years of pregnancy, including what I’ll call an enthusiastic cervix (you’ll see what that means as you listen to her story), postpartum challenges, milk supply issues, and once the kids are older, health surprises of her own. Whether it’s her medical training or her intuition, she makes a number of critical decisions that keep her from what could have been complete catastrophes and She manages the various ups and downs with grace and wisdom.

Surfactant

https://pubmed.ncbi.nlm.nih.gov/18446178/

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02371

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104445/

https://www.sciencedirect.com/topics/chemistry/surfactant

Fetal lung maturity

https://www.futuremedicine.com/doi/full/10.2217/bmm.14.7

https://www.uptodate.com/contents/assessment-of-fetal-lung-maturity

Corpus luteum

https://www.verywellfamily.com/corpus-luteal-cyst-in-pregnancy-2758590

https://www.yourhormones.info/glands/ovaries/

https://www.verywellfamily.com/ovulating-and-getting-pregnant-1960229

Audio Transcript

Paulette: Hi Welcome to War Stories from the Womb. I’m your host Paulette Kamenecka. I’m an economist and a writer, and the mother of two girls. 

Here we are at the end of 2021 and you may be feeling nostalgic for easier times, pre pandemic life…we visit these times in today’s story. my guest gave birth for the first time more than two decades ago and had a wide breadth of experiences in pregnancy and delivery in the course of her four pregnancies. She has hyper emesis for all of the pregnancies and learns to manage it despite her busy OB practice. A whole host of surprises visit her in the five years of pregnancy, including what I’ll call an enthusiastic cervix (you’ll see what that means as you listen to her story), postpartum challenges, milk supply issues, and once the kids are older, health surprises of her own. Whether it’s her medical training or her intuition, she makes a number of critical decisions that keep her from what could have been complete catastrophes and She manages the various ups and downs with grace and wisdom.

Let’s get to her inspiring story.

Today, we’re really lucky to interview Dr. Crevecoeur, who has an amazing story and many titles that I’m leaving off here by just referencing her background as a doctor as an OB, in fact. So Dr. Crevecoeur, thanks so much for coming to the show. And will you please give us a more extended sense of the things that you’ve been doing. 

 

Dr. Crevecoeur: Oh, well, thank you for having me. First of all, I really appreciate this opportunity to speak to your listeners. I’m a retired OB GYN and I stopped working maybe about 20 years ago, because I have five kids, and I stopped to homeschool them. The community that we lived in was not very conducive to learning. They really needed to be challenged. I stayed home and also because of the fact that my middle child was injured by the babysitter. We had no family in the area. So baby sitters was such so difficult for my husband and myself. We’re both physician and so we always had to compare our call schedule, application schedule. And then when the educational thing came in with my six year old, my five year old, then I figured, okay, you know what, this can’t go on like that. So then I took off my medical training hat that I worked so hard for, to put on my teacher homeschooling hat, which also was an amazing experience and I loved it. I I you know, looking back at it, my kids are adults now. Also beautiful, but of course, there was some difficult moments. Then I became an author I wrote about my experience, and my memoir, pressure makes diamond. And I talk about some of my war stories which I love your title of the podcast because people don’t understand that. Having a baby being pregnant, there is a lot of difficulty that occurs if there’s even tough that occurs with either my my two patients that I’m dealing with the unborn child and the mother and sometimes they’re in conflict of each other because the unborn child will try to do whatever they can to survive. 

 

P: It’s an amazing journey, and I think many of us can think relate more completely to the idea of homeschooling after the pandemic. And what an unbelievable undertaking that is. So I’m excited to hear this whole story. Let’s start from the early phase here. Do you have siblings? 

 

Dr. C: Yes I do. I have five siblings. I am kind of like the before the youngest on my little brothers. That is the youngest. I’m also an immigrant. I came to this country from Haiti. I left Haiti at the age of two, but I came to this country at the age of five because I traveled with my my parents. I was at that age where I wasn’t in school, like my oldest siblings, and I wasn’t a baby like my little brother, so I could travel with them and I kept my mom companion while my father pursued all these different avenues of where he would live with his kids. And so my father was an intellect a mathematician and a lawyer. And so he had a lot of offers at that time, especially in the late 60s With all of these social upheavals, civil rights movement and everything else. And they wanted a lot of black educators to come to this country and to other countries. So we lived in France for a year we lived in Africa for a year. Before we settle down in Brooklyn, New York. And then the rest of my family came and joined us. Yeah. And I love my siblings to death. They’re my best friend. And that was one of my main reason for wanting a large family. And when my husband and I got together when we were dating, I told him how important it was for me to have a large family. And he came also from a large family. So at the time, we thought it was perfect. We agreed. But once we had my girl and my boy, my oldest, my husband said we’re stopping at two and I said, No, you can’t renege on our promise. So then eventually, we settled for four, but I cheated because my last pregnancy with twins a girl and a boy. 

 

P: Well done. 

 

Dr. C: Thank you. Well, it was a touch and go pregnancy. That was my hardest pregnancy, actually. 

 

P: So let’s talk about the pregnancies. Were you already a doctor before you got pregnant? The first time?

 

Dr. C:  Yes. Yes, I was. 

 

P: So you unlike most of the people I talked to you probably stepped into pregnancy with a different set of expectations. And a different view about what it might be like so many people come on the show and say oh, you know I’d been on Instagram and I you know watched all the movies and I assumed pregnancy I’d be beautiful it would be fun and I could eat whatever I wanted. And it’s just a glowing aura around the idea of pregnancy that doesn’t necessarily match the experience. So I’m wondering what you were thinking about pregnancy before you got pregnant. 

 

Dr. C: Actually, I could say I was probably like he the other people you spoke to. I saw a lot of the mishaps in pregnancy, but I never expected it to be to me, you know,



P: yeah, that’s fair

 

Dr. C: I always felt that I ate right I exercise right.  So I knew what to do. I knew all the pre counseling that I gave my patients so I knew how to protect myself, my prenatal vitamins and everything else. I never expected to have twins that did not want to in my family. So that was a different aspect. I never tended to have preterm labor. I mean, how could you prepare for that? But I wasn’t treating labor and of course, the pain because of the fact that my husband’s anesthesiologists I wanted to feel that pain of pregnancy that my patient spoke about and I know some of it was was really hard but my husband told me Colleen and you’re sort of having these contraction now you become a moving target and if you decide to get epidural later on, it’s so much harder. Why don’t we just put in the catheter now and if you need to be topped off if you need medication, at least it’s already there. So I said fine. We’ll compromise oh my goodness, I have one I had one contraction that I could relate now with my other patients. after that. I told my my husband get me the anesthesia. 

 

P: You know pain is a hard thing to describe and to prepare for. It is it really feels like

 

Dr. C:  I felt like my back was going to break open. My oldest sister did not get an epidural and she went through the whole lamaze method. I didn’t go through that but because of everything she told me I figured that if she could do it, I could do it. And no after that first pain I said there is no reason for me to go through pain like this when I don’t have to. 

 

P: Yeah, 

 

Dr. C: so at least I know what that first pain felt like. And then I go maybe joyful. All of my kids. 

 

P:  feel like your husband will feel useful. 

 

Dr. C: Oh yeah, he used what he felt very. It’s not sensual. But I think it helps when a doctor could relate to what their patients are going through. And I’m saying that very cautiously because we know that we have a lot of male physicians that can’t go through that. So I’m not saying that women physician are necessarily better, but I just feel that when you been in that kind of situation. You could probably relate on that aspect better. 

 

P: Yeah, experience is a real educator, especially in pregnancy where There’s so much going on. It’s really hard to describe in a way to make someone else which is why we walk in and think yeah, I won’t need the epidural. I remember when I had contractions and I didn’t even get that far. I felt like I must be doing it wrong because it hurts so much. there’s no reason it should it should be feeling like this but so I’m with you. Was it easy to get pregnant?

 

Dr. C:  It was very easy. 

 

P: Good. 

 

Dr. C: It was even too easy. And I could always find my pregnancy so we had let’s get pregnant here so we could have you know plan on vacation and it usually work. But you know what though? I felt guilty because I had Kate patients that were infertility treatment. I was there. We’re going through infertility treatment. And I was pregnant almost five years ago. So a period of time I have five on the five so and I wanted them that close because this is an eye with that close, 

 

P: Although I think it’s like it’s a beacon for the rest of us. Right I did not get pregnant easily but it’s a good story to have in the world and a good experience that’s hopefully someone’s getting pregnant easily. Right that that 

 

Dr. C: It is unless you’re dealing with your infertility patients or you’re dealing with patients that have previous miscarriages and I had a patient that you know, twice in a row she had her miscarriages when I was pregnant. 

 

P: That’s hard 

 

Dr. C:  so I saw her again and when they call to tell me Oh, that the critical we have a case you know, miss a bush, you know, I’m thinking who’s the patient and give me some history you know, I’m on my way. And when they would say the name I’m thinking oh my god not heard God you know, and I felt so awful. And here I am coming in with my pregnant belly. You know, she’s looking at me and I and as much condolences that I try to offer to her. She’s like, you don’t know what it feels like, you know, you’re pregnant every year. You know? Of course she doesn’t say that. But that’s how I could envision it. And I just felt guilty. I really did. 

 

P: Yeah, I can see what you’re saying is as someone who had trouble getting pregnant, whenever I went to my OB office and was surrounded by pregnant women, I was like okay, your’e make him look easy.

 

Dr. C: How was the first pregnancy? Well, my pregnancies I had hyperemesis I grew up throughout my whole pregnancy. When I would see patients I would say excuse me, I’ll be right back. I would go to the bathroom and I got to be really good at that. It wasn’t a big deal. But I was dehydrated. My husband being done anesthesiologists, he had to be in the office line by seven o’clock. He had to be in my nine. So he would hook me up to an IV and that’s how I would be hydrated. And in the evening he would hook me up again if I needed it. If I didn’t have him I know I would have been in the hospital a couple of times just getting IV fluid in and because that’s how bad things were. For me. So that helped a lot. But that happened throughout my whole entire pregnancy for all of my pregnancies that was something that I just had to get used to. 

 

P: Let’s talk about her emesis for a second. My understanding is that we think it’s driven by a hormonal issue. 

 

Dr. C: Yes, 

 

P: is there any more that we know about? hormones? 

 

Dr. C: not at the moment. Your body’s getting used to a lot of changes when you’re pregnant. And sometimes we see it happen with the first pregnancy and it doesn’t happen as much with the remaining pregnancies. And we see it mostly happening in the first trimester. And so as your body is getting used to it, you’re getting better handling it and then we see some pregnancies like myself but my own. It happened throughout the whole pregnancy was worse. I would say the first trimester then the remaining months, but it still was present different food elicited different reactions from us. That’s still the basis of it. Do we do give patients besides fluid we give them antiemetics or medication? I never really liked those so much. They didn’t seem to help me that much. 

 

P: So did you manage it with gingerale and saltines and the IVs or what was your approach?

 

Dr. C:  It was basically, um, ginger and fluids. Okay, that was my approach. And it was 

 

P: and is it does it run a family to any of your siblings have it? 

 

Dr. C: that’s a really good question. It really doesn’t matter and family and none of my two sisters ever complain? About so I was the only one. 

 

P: So that’s interesting. And hard. Good lord. Yeah. Especially since you had your pregnancies close to each other. It’s a long period of time to not enjoy food. I know right? 

 

Dr. C: You know, I enjoyed food is just I didn’t stay down. It didn’t enjoy me. As much. 

 

P: You only got to enjoy briefly. Okay. So with the first one, so we have hyperemesis and then someone is following you, I assume and and talk about the preterm labor. How did all that develop? 

 

Dr. C: Yeah, pre term labor and I don’t know, there’s a lot of theories about preterm. Labor. And now there’s also talking about vitamin D deficiency, and that’s something new that we never really associated with preterm labor, and of course, different infections could cause preterm labor. But for me, I was usually always healthy and exercising. I always tell my patients that if you’re healthy and exercising you shouldn’t stop doing that. And if you’re used to running marathons, or whatever your body’s used to, you should stop doing that. Well, I was very active, but I remember coming back from seeing my parents, my parents lived in Florida at the time and in Pennsylvania. Like I said, we didn’t really have any family members. And I was getting to this really depression like I miss my sister. I miss my mom, you know, my husband says you’re off next weekend. Why don’t you go take a trip and I was pregnant with my first child. I you know, if my mom was gonna fly in on time, I didn’t know my sisters. Were going to be there. So I went and I saw that my state as long as possible and when I was I laughed I was gonna miss the plane. So I was doing one of these running down that airlines getting down you know, the run, you know, like trying to catch my plane. And, and I was maybe around 20-24 weeks with my adult daughter. After that, I had the most severe pain. If I made the plane, I was in so much pain. Then I felt I was having these contractions these mild contractions I was so contacted my doctor right away. She hooked me up to the monitor, and she told me that I was contracting. She put me on medication and everything and I and it kind of stopped. Ever since then, all of my other kids. My contractions started earlier, and I was able to deliver my daughter at 37 weeks, but each child after that son was 36. My other son was 35. Then my twins were my earliest authority to 

 

P: talk about the first delivery because that that’s a must be a bit of a surprise. 

 

Dr. C: So my first delivery besides the preterm labor and the hyperemesis and once I got my epidural, it was uneventful. So my doctor and I, we both decided that, you know, I could get off the video, gentlemen, the lung, my baby’s lungs should be mature because that’s the main thing that we worry about with preterm deliveries is the lung majority because babies are not breathing in utero for good reason. The mom is doing it for them. The lungs are not functioning and when they take their first breath, that’s when the lung starts functioning. So we know we don’t have any basis of knowing when the lung maturity is going to occur. And we think that by term, it should be fine. So preemies we do worry about the lung maturity they can’t read. And you know, and this is why we have so fast and now which helps the alveoli in the lungs to keep it open so it doesn’t collapse. 

 

P: Okay, so quick note about surfactant factor is a liquid made by the lungs that keep the air sacs or alveoli open. This liquid prevents the air sex from sticking together with a baby exhales making breathing possible after birth. A fetus starts making surfactant at about 26 weeks and the baby’s born before 37 weeks. There’s a concern that not enough of this liquid has been made and the baby may have breathing problems. When it’s born. The whole issue of surfactant was first identified in 1929 by a scientist in Switzerland. And it wasn’t until the 1980s that researchers were testing various animal surfactants and manufactured surfactants on preemies. 

 

Dr. C: That was what my research has a residency. That was what I did. My husband had helped me and that’s when we work together. And I was looking to see how so fat that really work. And could Is there any basis of putting it in the amniotic fluid because we do, although babies don’t really breathe. We do know that there are some instances and so I wanted to try to see if we could help these preterm babies earlier than wait until they are born to give them that dose of a surfactant in their lungs to help keep the alveoli open. So I understood all that and I was always 

 

P: wait that sounds like very cool research. Did you find out that if you inject surfactant in same fluid, it has an effect or 

 

Dr. C: it wasn’t statistically significant. And so that’s why we don’t do it. How was it when you took the first one home? Was it what you expected because you came from a big family or your siblings had kids or 

 

Dr. C: It was in November and we had a lot of snow we were in central Pennsylvania and that first three months or so I think my family did come but they didn’t stay too long they came to and we had snowstorm so it was really hard to get to us. And I stayed home with my oldest for six months before I went back to work. My husband was busy working and felt I was going crazy. As a mom just being with my daughter and not really having anyone to talk to. I felt totally isolated. I had all these plans to do things with her. But she was just a baby. And so it was difficult. You know now that you’re making me reflect on this. If you know you really hit a really great question. It was difficult those first three months I really wanted to do things for her. We were stuck in there was a big snowstorm. Remember, I couldn’t even go out. I couldn’t even drive around places would have my husband was always on call and we had no family in the area. So it was a very lonely period with her. I talked to her constantly and this is why she’s so smart, you know, until I have the other kids until my family came but that was a good question. It was different from what I expected. 

 

P: The kind of all demanding quality of a newborn is the another thing that’s sort of hard to translate or prepare for. 

 

Dr. C: Right as much as I tell my patients about breastfeeding and everything else. I wasn’t sure if I was gonna breastfeed to be honest. But I did my daughter just latched on before I even had a choice in the matter, which was so interesting. But that’s another thing with the breastfeeding. I liked it and I was thinking I would breastfeed, you know, for three months or something. And I was only able to breastfeed for six weeks because of what I did it for all my other kids six weeks after that my breast milk just dried up. So that was also something that I didn’t know if I was doing wrong and it’s so funny when the lactation nurse came in and say Oh, Dr. Crevecoeur, you know, I’m gonna teach you this but you’re a pro at this. I’m thinking No, I’m not a pro at this. I’ve never done this before. Don’t assume anything. Just make sure you’re talking to another patient you know, because you’re adopted they just assume you know all this my don’t so 

 

P: that’s amazing. Also, your body has its own limits, right. It’s you’re gonna have hyperemesis whether you want it or not and it sounds like your milk production is there for six weeks. So enjoy. Yeah, yeah, it’s over. I’m guessing that with your other pregnancies between your daughter and the twins, and it was pretty easy to get pregnant. Right? And then you have the hyperemesis. But was it a little bit better each time or was it equally bad? 

 

Dr. C: It was equally bad. I think I got better at it. I got it better. What’s your anticipate? And so but I think it was equally bad. 

 

P: Do you need the IV support at home for each one? Oh, wow. I did. 

 

Dr. C: I don’t know if you want to go to the incompetent cervix because I also had that. 

P: Sure. I mean, whatever you want to tell us about did that happen for the second one or happen for the second one and all of the remaining ones? I had traction throughout all my pregnancies and I was on medication for that. And I was on bed rest take it easy, Carlene and all these other things that I try to do and

 

P: Can I ask  a question. What is the medicine do how does that worked? 

 

Dr. C: The whole thing of how the ritigin works? 

 

P: Yeah, 

 

Dr. C: it’s supposed to uterine relaxation basically, supposed to counter the contractions 

 

P: it sounds like it more or less worked for you. 

 

Dr. C: It did. It did till until it didn’t until the baby’s like I’m coming out regardless of what you do. We move we stayed in Pennsylvania, but we moved maybe 30 minutes away from where we were living to a bigger house because now we were going to have two kids. Basically, we had our house a month before we actually moved in so that it wouldn’t be too crazy things would be put away. I remember that day. I called my husband I said, you know, I’ve been contracting throughout the day and I don’t think this medication is working. And my contractions weren’t anything severe but it was just, you know, I felt them. And he told me Well, Carlene, I’m on call today. I said, you know, I think we should go to the doctor. I think we should go to the hospital because I’m a little concerned. It’s not stopping. And he says Well, I’m on call today. Could you hold it? I said okay, I’m gonna go with or without you because I’m concerned. 

 

P: Yeah, 

 

Dr.C: he  goes, Okay, I’ll find someone to cover me. I’ll go with you. We go to the hospital and I’m sitting in waiting for my doctor. And I’m just common anything and then he examines me and he says, Carlene your seven centimeters.

 

P:  Oh my god. 

 

Dr C.: Seven that day two was an ice storm. And so while we were driving to the hospital, I wait for my husband got home. He was sliding. I could have had that. baby at home easily. Because if we waited until I was pushing, you know, 

 

P: what are you 36 weeks at this point? 

 

Dr. C: I was 36 weeks. 

 

P: So let’s agree that we need a different term other than incompetent cervix. I don’t love as a trainer. I have to figure out something else for that. I agree. But essentially, your cervix is opening because the uterus is contracting. Is that as it should? 

 

Dr. C: Yes. And I not really feeling that pain, because it’s kind of floppy. So So yeah, that’s basically what it is. It’s not holding tight. And what’s so remarkable about the organs in our body. Now cervix when we have pap smears and you have an abnormal pap smear and the doctor says, Oh, we could freeze it. We could do cryotherapy or we could take a piece of it. uncomfortable but it’s not painful. You know, if you’re doing a freezing technique and you’re telling your patient how are you doing? Are you okay? And they say yeah, I’m fine. We don’t have nerve endings for that in our cervix, 

 

P: okay, 

 

Dr. C: because I’ll start with never felt like they will be in a situation they will be frozen or they would be taking bites off. So there was no reason to put nerve endings there like we do enough skin. But we do have nerve endings for dilitation. And so when you’re dilating, you feel that pain, because your body’s telling you your cervix is opening up, you’re getting ready to deliver a child and you should know this other than that we don’t have nerve endings for anything else. It’s just like your bowel too we have no nerve endings for distension but if I take a piece of your bowel, my bone it you probably won’t feel that or at least you won’t feel it that way you’ll feel it on your skin. So when you have a quote incompetent cervix, your dilating, without me knowing you’re doing this on your own, which is dangerous, because then I could go to the hospital, or I, you know, I don’t know if I’m fully dilated. 

 

P: So so that’s really interesting because as you’re talking your cervix should be dilating when your uterus is contracting. That’s how the whole thing works. But for this condition, you don’t feel it the way you would at a normal time of labor. 

 

Dr. C: Exactly. 

 

P: Okay. If you’re seven centimeters, there’s no going back. 

 

Dr. C: There’s no going back. I guess I was contracting so continuously that the doctor felt that the long maturity of my my son would be fine. So as soon as he just broke the water, yeah,the amniotic  fluid I delivered. I delivered in like less than an hour. 

 

P: Wow. 

 

Dr. C: Yeah, I deliver very fast at that time. It would have been at home and if I didn’t go to the hospital when I did. 

 

P: I don’t know if it was your doctor training. Or your own intuition. But how smart to leave. Oh, no, thank god. Wow.

 

Dr. C: Yeah. And you know, and it was just continuous in the medication that seemed like it was helping, and it wasn’t painful, but it was not stopping. So with my history, I just want and then I think I heard that there was going to be an ice storm. And I knew that it was bad. So at least I wanted to be in a hospital in case anything had to be done. You know, even if they sent me home, no Carlene you okay, you will give me some fluid and send y’all you lose nothing. 

 

P: So the contractions feel like cramping. Is that what they feel like? 

 

Dr. C: Yes, they felt like cramping. Okay. Because when I have patient my time to seven centimeter you’re screaming your screen, I give me an OB doorwall Why did you do this to me? And so the fact that I was seven centimeter and it was just some mouth and traction that, you know, was dangerous. 

 

P: That’s a little scary. So it sounds like you and your husband took a little pause for a second to work out. How many kids are we going to have between the second and the third? 

 

Dr. C: Right a year

 

P: and and then you came around good work. And then do they put a stitch in your cervix immediately or how is our that usually work? 

 

Dr. C: that usually goes after the first trimester? That makes sense? 

 

P: Yeah. 

 

Dr. C: Because if you’re gonna have a miscarriage for whatever reason, then you don’t want to put a stitch there. But you want to definitely put it before the pregnancy gets much heavy and before you start dilating. 

 

P: So that’s enough to that first of all, the stitch Can you feel it or no because again, you said like that, that part of the cervix has not innovated. They had an epidural for that. 

 

Dr. C: Okay, you had an epidural and they took me to the O R, and they put the

stitch in 

 

P: and is it literally one stitch? That’s enough to keep your cervix closed?  

 

Dr. C: Yeah. Oh, yeah. It helps. 

 

P: So what happened with the third one because that one was even earlier? 

 

Dr. C: that one was at 35 weeks? I think I did have an amniocentesis for that where they take out the fluid to see the level to see the ratio of the lungs maturity. 

 

P: ok What you’re hearing is an edited version of my conversation with Dr. Quebecor, because we’re going to talk about prematurity. We talked briefly about the lab test to measure the lung maturity of a preemie. As she suggests it’s an amnio that examines the ratio of two I think their fats in the amniotic fluid. It’s called the LS ratio, and it provides a way to estimate lung maturity, given that lungs are the last organ to develop in utero. breathing problems are a big issue for preemies. In a 2014 article in a journal called Future medicine, the author suggests that this kind of testing doesn’t improve neonatal outcomes. So it’s becoming a less common way to manage premature babies, but I did it with my firstborn and it sounds like Dr. Crevecoeur did it with her third baby. 

 

Dr. C: So because my my child’s lung was mature, my doctor said, okay 35 weeks we’re gonna go and we’re gonna cut you a stage off and so by then I knew that I would probably go into labor. I did rounds that day. I told my patients that it I’m checking out it won’t see until six weeks later and everything because I’m probably going to go into labor. And my husband came with me afterwards they cut the stitch, So I started going into labor, and they just kept me broke my order and I delivered, but I remember going in the morning seeing my patients setting somehow. And so I think that one was more plan because my oldest son that was like rushing and everything else so this one was better. Plan as far as my schedule, my husband’s schedule. 

 

P: so that one sounds a little less stressful because you’re taking all the information you learned from what exactly to this. 

 

Dr. C: Yeah, exactly. And just when you think you learned everything, you get a curveball with twins. 

 

P: So let’s talk about that. Obviously, you know, by eight weeks or how long does it take, can you use HCG to say this is off the charts? It might be more than one? 

 

Dr. C: No, no, I did not expect it to be more than one. I knew that I was pregnant, and I expected it to be one I was hoping forI was hoping for a little girl because I had already two boys and one girl and my sisters are my best friend. So I really was hoping for the girl and I already agreed with my husband had a big fight. And he said one more we’re going to have four and if it’s a girl or not with stopping and I had said, Okay, fine. So because he gave in I figured, you know, I’ll choose my battle. 

 

P; Yes. 

 

Dr. C: So he was in the hospital, and I was with my three it was in the evening I come home from work, and I was in the kitchen, washing some things or getting water or whatever. And I felt a pain searing across my pelvis. And it was extremely painful. It was spontaneous one minute I was fine. The next minute I was bent over in pain 

 

P: how far along are you at this point? 

Dr. C:  eight weeks 

 

P: Okay, 

 

Dr. C: I just limped over to that family room. And I told my oldest who was one five years old so at the time to take the kids upstairs and put them to bed and she was like so mature and she was my strength. I counted on a whole lot of things. So she put them to bed. You read them a story she was reading by then. She was so proud of her older sister, you know, role that she played. And I called my husband and I told him, I’m having a lot of pain. And I think I’m having a miscarriage. And he says, Okay, I’ll find someone to cover me I’ll come home. And I said, Sweetheart, this is eight weeks. There’s nothing you could do for me to just hold my hand. I said, I’m not bleeding yet. But I’ve never felt such bad pain in my life. And, and so for you to come home and hold my hands. It’s not gonna help. I just need to let this play out. He said are you sure and I said, Of course. I’m sure then he stayed. And I went over to the couch. And I started crying because eight weeks is nothing you’re going to do you know, the next day, I felt great. And I looked and I was in bleeding and I’m thinking what just happened here? And so I took the kids to preschool and daycare and everything else. I went to the ultrasound. I told my friend who was really my good friend could you scan to see what’s going on. I’m pregnant, but I thought I was having a miscarriage. It was so painful last night. When she did the ultrasound. sHe found out that I was having twins, but that’s not what caused my pain. My corpus luteum the dominant follicle that releases the egg becomes the corpus luteum that supports your pregnancy before the placenta could take over with progesterone 

 

P: In case you are like me and didn’t entirely follow along on the brief bio of the corpus luteum here’s a refresher. As a woman you are born with all the eggs you will ever have something on the order of 2 million by the time puberty hits about 400,000 eggs. Between 405 100 of these eggs will mature during your reproductive years. All the immature eggs are enclosed in a single layer of cells known as a follicle that supports the egg. Each cycle hormones encourage follicles to grow and release a mature egg. Sometimes too, but usually only one mature egg is released during ovulation from this dominant follicle. The empty follicle seals itself off and becomes the corpus luteum which produces progesterone and estrogen to prepare the lining of the uterus for potential pregnancy the role of hormone production is taken over by the placenta between 10 and 12 weeks if you become pregnant, 

 

Dr. C: that ruptured, there was fluid, right? You could see fluid behind my uterus. You could see that accumulating. And what’s so interesting about it is that could kind of see it and as it’s a carving in a way, a lot of times you assume that’s what happens to patients because of what how they describe it. But by the time you do an ultrasound allow that fluid has been resolved. And so you don’t see that so this was like it was happening to me but it was also so interesting, because I was able to see and I was new was happening. I did not expect that.

 

P: for the civilians in the room. Is this supposed to happen or it’s not supposed to happen? 

 

Dr. C: Oh, no, it’s not supposed to happen. We don’t want the copy studio to rupture before it’s ready. And in some patients that does what we do is we give them suggestions, depositories. And the reasons because of the corpus luteum is gone. It’s not doing the job. And the placenta is not yet developed enough to take over because at one point the placenta will take over. So and we think that this is why some patients have miscarriages. And so sometimes when the patients describe what I was describing, I would just give them suggestions repository to see if we could maintain that pregnancy

 

P: and that sends a signal to uterus to do what

 

Dr. C:  to basically protect the developing fertilized egg. It helps the villa the finger like projection of the placenta to embed itself. In the end, it helps develop that also kind of wrote out the description to myself, and I did it you know, and I did it right away and that saved my pregnancy. So after my first trimester, 

 

P: Good Lord, okay, so you’re the doctor, you’re the patient. You’re the saving the kids hear this a lot going on here. So how long do you have to take the suppositories for 

 

Dr. C: about the first trimester because by then you believe that the placenta will take over? 

 

P: Are you ultrasounding all the time now or how do you manage this? 

 

Dr. C: Well, I wasn’t ultrasounding all the time. That we saw to gestational sac to little tiny fetuses starting to develop. So one of them look the normal size, it’s going it’s symmetrical, and we’d like to see that the other sack was kind of irregular. That scares us. Because then we think that either that first sack absorb the irregular sack, which happens in two entitlements to choose and syndrome and all these other stuff that we know about twins. And we could still have a Miscavige because the bigger twin for whatever projection was left remaining. Maybe that twin was able to develop better and faster than that other point that we don’t have enough for. And so that irregular sack look like I could have lost if not both of the pregnancies, at least one of the pregnancy that was very concerning. So at 12 weeks, though, so once we knew that the pregnancy was viable that’s when you would put this a collage and I think get us a collage. 

 

P: What’s your emotional state between eight weeks and 12 weeks? I think I would be ultrasounding every day just to be like, Okay, we’ve still got it

 

Dr. C: I don’t know if itwould have helped me to know that. I was just saying that. Just gonna do a projection this is going to work out because again, you’re not going to do a C section at eight weeks to protect the baby. So it’s either it does or it doesn’t work. And so because of the fact I was still working and because of the fact I still had my little ones at home, I needed to get my mind off that and just carry myself to To 12 weeks. We’ll know what we have to do that I saved the pregnancy. How am I going to get us a car do I move on? 

 

P: That seems like a lot. It was it was like to some degree thank God for all the stuff he had going on so that you can focus on other things. 

 

Dr. C: That’s true that does help after when the doctor puts into succotash and says Coleen, you have a history of preterm labor. With twins, it’s even more just because of the whole pressure and everything else that we really need to be careful with you. I want you to go on bed rest very early in your pregnancy. So I said okay, so you told me Don’t go crazy. Don’t do anything abnormal or anything too strenuous because of my history. And because now I was having twins at 24 weeks. My ceclage ripped open. 

 

P: Oh wow

 

Dr. C: Yeah, yeah. We were in, in North Carolina at a family reunion of my husbands. And during that time, again, I felt contractions in the religion, the medications that are we’re on, we’re really not helping, and it wasn’t bad contractions but with my history, I said to my husband you know, let’s go to a local hospital. Let’s just somebody checked my cervix because I don’t know if I’m dilating on her in that’s what he says Colleen, you have this a card. I said here but times you can break through this o’clock and open up the cordless. And so he really didn’t want to leave. He says, Okay, we’ll call tomorrow, you know, and then it was a death of his family. And so this family reunion. We all were having a wonderful time in North Carolina had to be cut short. So everybody had to leave as soon as we got home. I caught one of my nurses who was really in I’m one of my OB nurse and I told her, you know, I’ve been having contractions throughout the whole trip, and I really think I’m dilating. Would you mind coming to my house and checking me out and she was so wonderful. She says that the critical I’ll be right there. She comes over and she says you’re four centimeters.

 

At 24 weeks I was four centimeters. 

 

P: yeah, that’s too soon

 

Dr. C:  that’s way too soon. And I always tell my mother in law she recently passed away that it was her father passed away. The kids grandfather, he saved my kids because my husband did not want to leave. So we would have waited probably too long and I don’t know what would have happened. I had bulging membranes and I was four centimeters. So I get rushed to a tertiary care center in Johnstown. Which is like an hour away from us because my local hospital is not a tertiary care center. And if I delivered those kids, those preemies we wouldn’t have the facilities, the proper facilities to either 

 

P: you need like a NICU or something 

 

Dr. C: exactly. But NICU where we will so we drove over to the hospital that did have a NICU, they put me in Trendelenburg which is basically they turned my bed like almost upside down where my head would be down just so that the gravity and the pressure would be alleviated off my pelvis and, and they put me on IV medication and fluid, and even antibiotics because sometimes when you have contractions like that there as soon as could be an infection. And he told me Coleen, you have both your membranes we’re going to do our best but in putting that stitch in we could also ruptured your cervix because you’re already four centimeters. So we’re going to put another stitch in we’re going to try to stop your contractions but you have all people know this that involve, you may lose babies. 

 

P: Okay, three questions. Question number one at subsequent ultrasounds, Baby B looks fine. Doesn’t 

 

Dr C: Yes. 

 

P: Okay, good. 

 

Dr. C: Yes, baby. He looks fine. And Baby B was my daughter. And by that I knew that idea was a boy and a girl. So yes, so I was eight. I was telling my husband that after this pregnancy, hopefully everything’s fine. You could cut my tubes. You could burn my tubes you could do whatever you want with my tubes. I signed the consent form that said I was done. So I was going to get my little boy, my little girl afterwards. 

 

P: So second question is why do we think bedrest works? Do we still think progress works? 

 

Dr. C: I don’t think again, we have a lot of sense that we can, you know, so we hope that helps because you’re being less active. And like I said, when I was with my first pregnancy when I was running down the airport and everything else I had some bad pains and I think that started everything. So we don’t know how much it else but we know that it doesn’t hurt. And so when I told patients, I’m going to put you on bed rest because I just want you to take it easy. And they said how do I do that with three toddlers? How do I do that? And the reality is, it’s so hard. 

 

P: Why do we think if your resting will affect a delivery date? 

 

Dr. C: That’s a good question, but it’s also not actively because of gravity pounding on your cervix pounding on your uterus. 

 

P: Okay, so basically we’re just trying to alleviate the pressure of gravity. 

 

Dr. C: Yes. 

 

P: Okay. Tell me I was gonna ask Golgi membranes is that the amniotic fluid and 

 

Dr. C: that’s what we we say all the cervix is closed, you know, or the service is one centimeter. You know, you can move your membrane very well. But by the time the service is for 10 centimeters, you could kind of feel membrane, but when it’s bulging, you have fluid there and so it’s easy to rupture the membranes and the fluid comes out and then the head comes out. So when you have bolted membranes like that, you really want it to be pushed back. Up, especially if you’re going to be putting in a stitch. The last thing you want is to put a needle through that membrane. 

 

P: Yeah, 

 

Dr. C: you know, the uterus is pretty a sterile area. You don’t want to introduce infection there. And so once your water breaks, don’t really the patient on any kind of tocolytic medication to stop their contraction because now you’re increasing the risk of infection. 

 

P: So now we’re back with you and you’re kind of tilted in a way that does not seem comfortable to keep your cervix closed and they’re about to do another sir collage. Yes. Okay. So okay, sorry, play, okay. So,

 

Dr. C:  it doesn’t surprise that he tells me the risk 50 You know, that I could lose a baby and of course, I cry, but I understood it helped that I knew what could happen. You know, he didn’t have to go through all the information, although he did and I appreciate it that I go through it. It’s successful. My contractions kind of diminishes. And he tells me on strict bed rest for the remaining of the pregnancy. And this is where family comes in. My in laws came in for a weekend so my parents flew in from Florida, they stayed till 32 weeks when I went into labor again. 

 

P: Oh, okay. So for those eight weeks, right, are you are you just lying flat? Are you inclined or

 

Dr. C: I am just up flat. Okay, the incline was more so they could put the stitch and move the membranes away. So by the time I get home, I’m just lying flat. 

 

P: And how do you feel?

 

Dr. C:  I feel okay, you know, the surgery was a success. I feel happy my family was able to come to help my babies were still doing okay and now I had to be on steroids injections. Because of the lung maturity. We knew that most likely they were going to be delivered early because of my history and because of pain points in general. But one thing about twins because of the fact that they are in a smaller space and a single tenant already fighting with each other for space. They’re very stressed. The cortisol level the stress level actually increases with the lung maturity. 

 

P: that’s interesting

 

Dr. C: So yeah, so that was good to know. Plus, because of that, I was also getting injections of steroids to help with their lung maturity and at 32 weeks, I was contracting again and I went to the tertiary hospital because that’s where I was going to go. Now when he examined me my first one which was turned out to be my boy was a footling breech 

 

P: uh oh

 

Dr. C: footling breech, the foot is coming out first and you don’t want to stress a premium out and you don’t want to deliver anybody. footling first, and I’ve had three successful vaginal deliveries. I left the hospital before 24 hours. I’ve never stayed after delivery. I’ve never stayed in the hospital for more than 24 hours. The reason was because not only did my husband Hurry up wanted me to come home, but my husband we are an interracial couple. He’s White, I’m black. And so a lot of the reasons why they want you to stay in the hospital rather than 24 hours because they’re learning all of these genetic tests on your baby to make sure that everything is fine before they send your baby home with your baby. And a lot of these test takes at least 24 hours for the results definitely for my case being black. They will get sickle cell they will look at anything that’s prevalent in the black community and for him and the white community would do that. And so we’re both physician and so I said, Sweetheart, we can’t leave now they’re running tests and you know, and he says Colleen, what is the likelihood we are both carrying a recessive gene. Our kids are going to be dominant on he says the things that’s gonna run in my family is not gonna win. In your family. And when he said that, I was like, Oh, and this is an aside but I feel that people go outside of their race or their ethnicity of the chances of us have having kids that are affected with genetic abnormalities is better. And at some point, I’m thinking, was that the reason for doing all these race, and we haven’t decided that when we all stay without own blue? We’re making things worse. 

 

P: Yep. 

 

Dr. C: And so because of how you see your god i This is not meant to be a religious discussion. But I think it’s ingenious. I think the more we realize that we need each other and that we’re better together and that we have less of a chance of these genetic abnormalities being predominant. I think the better it is 

 

P: totally agree with your larger point here, and then with respect to your smaller point, I think you’re going to stay longer than 24 hours because you have preemies, right?

 

Dr. C: because of the fact that they were pre knees because of the fact that one of them the first one was afoot language had to put a foot out there, and I was contracting. My doctor told me that he’s gonna do a C section. And before he did that, they did test the lung maturity of my babies. And they found that at 32 weeks, the lungs were mature. They said, Okay, we’re going to schedule you for a C section first thing in the morning, and they did

 

P: and how did you find that experience. 

 

Dr. C: Oh, boy. That was hard. Because again, like I said, I never had a C section with my other baby. And after having a vaginal deliveries, I was up and walking around. I felt great. It felt wonderful. And this is one of the reasons that I really tried hard not to give one of my patients C sections if they didn’t need it 

 

I was in pain after that C section. I’m thinking oh my god, is this what I do to my patients, you know, it’s painful. It really is. Also as doctors we have a habit of taking out the uterus, putting it kind of on the abdomen and sewing it right there and pushing it back in when we finished because you have a clear view of it. And I saw what people you know, when you keep the uterus inside and you sew it from there, it’s less trauma to the uterus. It’s less potential adhesions later on that you’re, you know you’re doing and so of course the patients only see the finished product and they’re always worried about the scar out of there Scott looks but there’s a lot of other things that you have to consider for your patients in their healing process. 

 

P: So are we trying to direct the show from the operating table? 

 

Dr. C: Oh, no that at all. I really liked my doctor and I was very confident that he was going to do everything he could to give me as minimal amount of pain as possible. And my husband he was the one that kept peeking over the to see what was doing and he goes oh my god call me the first boy he’s he’s five penalty so big. So my kids were five pounds and four pounds my daughter.

 

P: wow

 

Dr. C:  Yeah, they were in the NICU just observation, but they did well and in three days they were able to go home with me. 

 

P: So they would have been giants, if you kept them in are much longer. 

 

Dr. C: I know I know. My second pregnancy my son, Michael, he was my biggest pregnancy at like seven pounds, you know, just barely seven pounds all my others were like six and I told them if you’re bigger than seven pounds, you’re staying in there. I’m not pushing out a bowling ball. 

 

P: No kidding. Wow. And only NICU for a day is kind of awesome for 32 weeks, right? 

 

Dr. C: Yeah. But like they did the preliminaries. They did the lung maturity I was getting you know test the amniocentesis, I was getting steroids, you know, so all of that. 

 

P: That’s amazing. So how many days do you have to stay in the hospital with the C section 

 

Dr. C: C section is normally three days and I was so distended afterwards because they heard bowel sounds. You’re not supposed to eat anything. You know, we tell patients until we have bowel sounds. But my husband listen, then he goes, Oh, I could hear bounce. I’m so hungry. I’m starving. Well, I think he got food for me or the nurse. Somebody did I wasn’t supposed to eat and I did eat and my bowl once you maneuver the bow it stops working for a while and 

 

P: yeah, 

 

Dr. C: just stay there. Well, I didn’t take that advice. I was so distended afterwards, I was in pain. And my parents were with me for how long like six, eight weeks. They were excited and they came to see the babies but after that, I think my dad booked a ticket at one way back. They gave up a lot and you know, as soon as I heard they were leaving. I had five little ones now. Yeah, I had a C section. I was so shocked that okay, Colleen, you’re fine. You’re doing well. We’re leaving. I was like, How could you do that? But I could say that I couldn’t be you know, just to give myself but I was a little sad that they would choose to leave me like this. My husband did have a week off. I think he had like the following or, but he didn’t have that time off. And it’s not like we had this paternity leave at the time at all. No one was doing that. 

 

I remember getting up out of bed taking care of my twins taking care of my three little ones in so much pain. One or two of my neighbors stopped by to pick up my daughter to take her to daycare or preschool. I remember them helping me. But other than that I was on my own was harder than when I had Danielle at first that we talked about walking around when you have just had your abdomen open up that was extremely painful. 

 

P: The whole thing is kind of nuts right that you’re sent home after major abdominal surgery to take twins no less and other kids. Yes. And even six weeks seems like a crime so that people go back to work after that. Yeah, it’s a lot is a lot.

 

Dr. C:  There’s a lot that was very painful. Not even having my husband to be able to take paternity leave. So I could have been home I had leave but being by myself and not having a supporting spouse to help you. It’s really hard. 

 

P: Yeah, seems unbelievably hard. Yeah. They’re all grown. 

 

Dr. C: Yeah, they all go. Remember I had when I stopped working for some reason. I guess I was telling my kids I used to be a doctor. You know, things like that. And I remember my daughter, my oldest thing that she wants to be an OBGYN. I don’t think she ever had a clue of what that is because she wanted to be like Mommy, and I was so touched by that and I’ve always wished that I was worthless. I could take her to my practice with me because I’ve done that with medical students. I’ve done that and high school students to let them assess. And so now that my daughter is in her second year, they did like a minor introduction to all the specialties and she was Oh Mom OB is so interesting. And I just like oh my god. Oh, that’s always nice when your kids want to follow in your footsteps.

 

P: That’s amazing. That’s awesome. Yeah. So wondering, other than these experiences helping you to connect with patients? Is there anything you learned yourself that you’d say Oh, if only I could speak to younger, Carlene, I would tell her.

 

Dr. C:  I think I try planning everything in my life from my medical school experience from working to put myself through medical school to college, and everything when I was going to have my babies and when I was going to take time off and planning everything, and plans don’t always work. It’s good to have plans though because it helps you have a goal. It helps you to be able to pivot but you always have to remember that ready to pivot. Because, plans do change everything is not set in stone. And I think when I saw my plans changing, I became so upset because how dare they change on me, you know, this is how it’s supposed to happen and life doesn’t happen like that. I didn’t think I was going to quit my job to homeschool my kids 

 

P: right

 

Dr. C: but the situation happened and I had to learn how to pivot. And so doing so causes anxiety, so I need to know or tell my younger self to relax. Because getting upset over things you can’t change doesn’t help you take a deep breath and you say, Okay, how do I pivot? 

 

How do I turn this into a positive and even with my own cancer diagnosis, which was a very depressing and low part of my life. I had to find a silver lining and that one of my silver lining that helped me move forward. Not only was I still homeschooling my kids, and I did that on my weeks that I wasn’t on chemo, but also when it came back and I was diagnosed with stage four. I said, You know what? I may die, but I’m not going to look at this like, by me God or like, why not me? I had a terrific life because of the fact that I was able to with my kids, and during that time was somewhat the part of my life. I enjoy that immensely.

 

 Life is gonna throw you a curveball all along. How you approach the curveball. How you try to enjoy your life helps you move forward and helps you to live. 

 

P: Yeah, that’s an amazing lesson to have pulled from that really only what we see really hard experiences. Yeah, it’s awesome. 

 

P: Tell us about the book where we can find it, what is called and a description of your book. Let’s talk about that. 

 

Dr. C: Oh, yeah. Right. Yeah, it is cool. Pressure makes diamonds. From homeschooling to the Ivy League. It’s a parenting story. And call the pressure makes diamond because of the fact that we put ourselves through a lot of pressure as wives as mothers as teachers has member of society. We place a lot of pressure on ourselves and sometimes I think we just need to stop. Take a deep breath, especially mothers, I think we try to be perfect. And everything our kids do or don’t do somehow it’s our fault. 

 

And we don’t have an algorithm to motherhood. We don’t have a previous book that we could describe the perfect mother or the perfect child. And I think it’s left up to us to make that definition for ourselves. And our family and not be pressured by why society thinks you should do. 

 

P: Well. It’s amazing advice and the book is called pressure makes diamonds. From homeschooling to the Ivy League a parenting story. I know we can find it on Amazon because I looked it up and you have a author website. 

 

Dr. C: Yes. And it’s my last name WWW dot Kolleen primer core.com. And when you go on that website, you kind of get an introduction to the family. You get in you get different places where you could purchase the book and yes, you could get it at Amazon but you can also get it at bookshop that org and then if you live locally, I have some local bookstores that are carrying my books and so it’s really nice. I like that. 

 

P: Dr. Crevecoeur thank you so much for sharing your story gratulations on your amazing kids and and on your recent election. Thank you. It’s been great talking to you and I so I’m looking forward to sharing this story. 

 

Dr. C: Thank you so much. I really appreciate talking to you



Thanks again to Dr. Crevecoeur.  I have links to her book up in the show notes which You can find that on the war stories from the womb website.  and thanks for listening. If you liked this show, feel free to like and subscribe, and share it with friends.

 

As the year closes We are going to take a little break on the podcast, to plan for next year’s shows. If your expectations of getting pregnant, being pregnant or giving birth didn’t match your experience and you’d like to share your story, contact me through the website. and we’ll be back with new episodes later in January.

 

Have a great holiday and a happy new year.