Episode 36 SN: Stroke in Pregnancy, A post partum Tale: Lauren’s story

Lots of different inputs go into the project of starting a family; for many of us this includes a host of doctors: fertility doctors and OBs and anesthesiologists…and for today’s guest that list is even longer, extended to include pain doctors and ER doctors and neurologists because she had a stroke after her delivery.  Some of the doctors who participated in her project did so because the symptoms she suffered after the delivery were attributed to a spinal headache instead of a stroke. Her’s is a story of amazing amounts of resilience and an inspiring amount of overcoming and it’s also one that highlights some of the glaring holes in the medical system.

If you are looking for Lauren’s work, you can find her book, Why She Wrote here, and her podcast, Bonnets at Dawn, here.

Birth control and blood clots

https://www.webmd.com/sex/birth-control/birth-control-methods-blood-clot-risk

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-updated-information-about-risk-blood-clots-women-taking-birth-control

Serena Williams birth story

https://www.vogue.com/article/serena-williams-vogue-cover-interview-february-2018

Racial disparities in pain managment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/

https://pubmed.ncbi.nlm.nih.gov/29688509/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905121/#R7

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.  Lots of different inputs go into the project of starting a family. For many of us this includes a host of doctors: fertility doctors and OBs and anesthesiologists…and for today’s guest that list is even longer, extended to include pain doctors and ER doctors and neurologists because she had a stroke after her delivery.  Some of the doctors who participated in her project did so because the symptoms she suffered after the delivery were attributed to a spinal headache instead of a stroke. Her’s is a story of amazing amounts of resilience and an inspiring amount of overcoming and it’s also one that highlights some of the glaring holes in the medical system.

After our conversation I spoke with an assistant professor of neurology to walk us through some of the medical things that come up.

Let’s get to the story.

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

 

Lauren: Sure. Thank you for having me. My name is Lauren Burke, and I am from Chicago, Illinois.

 

P: That’s fun. So I lived there for many years. Where do you live?

 

L: I’m a life long northsider

 

P: Oh nice….So let’s talk about pregnancy before you got pregnant, I’m wondering, what did you imagine pregnancy would be like?

 

L: So here’s something kind of weird. I was not going to have kids, I decided. So I was sort of like, you know what, I don’t know if this is going to be the right track for me. And that’s partially because I had had so many friends who just had terrible experiences. And then also I live in the city and a writer, money just like that. That whole situation. So I was like, You know what, I don’t think that that is going to be the right scene for me. I was terrified. of childbirth, as well. completely terrified of it. I think this was like my late 20s.

 

 I had done this thing where I was like, You know what, I need to get in better shape and have this like cystic acne that keeps recurring and I keep trying everything and let me like, just really work out really hard. And let me go to the dermatologist and get all of these things under control before I’m 30 this was like my goal. It’s like I have all these goals before 30. So I went to the dermatologist and she was like, Okay, I’m actually let’s put you on Yaz. And that will clean up your sleep that. 

 

P: What’s that?

 

L: So yes, is a birth control. 

 

P: Okay

 

L:  Because she was like, you know, the reason why nothing has been working for you, is because it’s hormonal. So let’s get you on birth control. And then exactly six weeks later that my follow up appointment. That day, I was feeling really weird. I was like, out of breath. I was really dizzy. My friend actually offered me a ride like out of nowhere. Just offered me a ride to the doctor’s office cuz she was like you You seem kind of weird last night. So do you need a ride? I was like yes. Please. So we go to the doctor’s office, and she’s like, well, your skin looks great, but something’s going on with you. And she sent me to the ER, and I was having a pulmonary embolism. 

P: Oh my god. 

 

L: Blood clots everywhere. is basically how the nurse came back and she was like, yeah, they’re in your legs. They’re in your lungs. They’re all over. 

 

P: Oh my god. 

 

L: Yeah. So I was hospitalized.

 

P: I brought question about the link between birth control and blood clots to neurologist today. I’m excited to have Dr. Nichols sir on the show. She’s an Assistant Professor of Clinical neurology from the Miller School of Medicine at the University of Miami. Dr. Sir, thanks so much for coming on the show.

 

Dr. Sur: It’s my pleasure. Thanks so much for having me. Why birth control create the risk for blood clots. 

 

Dr. Sur: So the risk there is really due to the to the hormones, mostly estrogen so birth control are basically hormonal pills and there are estrogen in the birth control. There’s estrogen and progesterone, which is another hormone birth control. And the risk mostly comes from the actual estrogen because estrogen increases the concentration of clotting factors in the blood when there’s increased concentration of clotting factors, the blood can be more prone to clotting. 

 

P: So estrogen is sending signals to your bone marrow to make more clotting factors.

 

Dr. Sur: That’s correct. That’s kind of the pathophysiology.

 

P: One thing I wanted to add here is that according to webmd, blood clots are rare even with birth control. The rate is something like a point three to 1% over 10 years, you’re at a higher risk for blood clots with pregnancy than you are with birth control. And that’s again because of hormonal shifts.

 

L: You know, I also had a pleurisy let’s call it so I had this irritation in my lungs and it was very painful. And there was like 12 hours of just pain. And it was really bad.

 

P: And that sounds like a 17th century problem. 

 

L: Yes. Like it does. it’s so weird. And I was at Northwestern. So I had all these residents that kept coming in because they were like, Oh, this is this is interesting. We don’t see this every day. And after 12 hours of that, like turned on my husband. I was like, You know what, I think I can give birth because like, that was awful. I survived it. And I just like had this weird change of heart in the hospital. I was like, You know what, I think I want to be a mother. I want to take a kid to Disneyland. I don’t know what it is and she was like, Okay, let’s give this a couple of years and figure this all out. 

 

P: Yeah, 

 

L: at that point, that’s when I started sort of maybe eating up a little bit more on pregnancy and then I saw a ton of doctors because obviously I just had this PE and we needed to see if I had some sort of blood clotting condition or if it was just provoked by Yaz. And then what we needed to do so then. Yeah, so then I went on sort of like a fertility journey, which was a fun time.

 

P: Yeah, I mean, this will be this will be interesting if you actually did have to go through the fertility gauntlet went because I too, went through the fertility gauntlet at Northwestern. 

 

L: Oh, did you? Yes. Oh, we’ve probably crossed paths. Yeah. Because that was a couple of years of going to various doctors, lots of blood tests. I did find in OB that really specialized in this and he was very much of the mind that it was provoked and that I could have a normal pregnancy we would probably put me on a low dose blood thinner. And he said like no epidural. So that was kind of my plan. 

 

P: Wow. 

 

L: And then I had sort of a journey getting pregnant because it was not happening. It was just not happening right away. 

 

P: Yep.yep.

 

L:  And then I had some miscarriages as well, which then kind of triggered the doctors because they’re like, Well, maybe she does have a blood clotting issue. Maybe this is related. They really wanted to kind of tie it back to that PE so there was a couple of years of just trying to figure out why I couldn’t carry on a pregnancy what was going on,

 

P: let’s go a little slower here for one second. So first positive pregnancy tests you are pretty excited right my friend in a miscarriage also I guess people say oh, you’re not supposed to say okay, at least you can get pregnant, but I’ve been trying for a year and a half. So for me, right for me to get was actually a big deal to get pregnant at all. Up until then there was no evidence that I could, yeah, did you have that feeling as well? Or were you was it still just

 

L: totally very excited? Yeah. Really? Just like, Yes, this is this is it at that point, too. We had just purchased our house, and I just really felt like the timing was right. I felt like I was at a good place with work. Like it just felt like the stars were aligning. 

 

P: Yeah, yeah

 

L:  super happy about it. And I think and I lost that baby. I think I was I mean it was like 13 weeks. 

 

P: Uugh..that’s late

 

L: So it was late. It was late. And it sucked because I did definitely I told my mother of course first. Like a weekend was very much like don’t tell anyone.

 

P: So that’s a weird cultural thing. Right? I talked to a therapist who wrote her dissertation on the idea that we all I mean, I feel like my doctors told me Don’t tell anyone. So after the first trimester is over, Oh, for sure. But the therapist was like That’s nuts because you’re going to need support

 

L: and like in 11 weeks, I was like, this is fine. 

 

P: Yeah, yeah, totally 

 

L: So my family was like super excited. I had not told work yet. That was the only thing I was really nervous about because I was nervous about what are the one of the repercussions of this honestly, yeah. What projects will I have taken away from me? 

 

P: Yeah, 

 

L: was really the thought but that kind of sucked because then I had my miscarriage. And I had it on my birthday too, which was insane.

 

P: The gods have their backs turned. That’s not fair. That’s not cool

 

L: It was crazy. Not cool. Then I just kind of like politely ducked out of work. And I think everyone thought I just was going to celebrate an early birthday and no one had any idea it was going on. And then I just didn’t want to tell them and it just was kind of a whole awful awkward situation. 

 

P: Yeah. 

 

L: I was like, I need a few days off. It’s personal. I don’t want to talk about it

 

P: Yeah. Did you have support when that happened?

 

L: Yeah. And I think I’m the kind of person to like, I want I want to take care of everything. So I think with that miscarriage I kind of almost just powered through my friends were great. My family, they were great. My husband was great, but I kind of was just like, well, we’re just gonna carry on. We’re gonna soldier through 

 

P: Yeah, yeah. 

 

L; And I was almost feeling part of me was feeling almost a little positive because I was like, Well, I know I can get pregnant. Okay, so that’s a good thing. So we know that but what’s going on? You know, I can’t carry on this pregnancy. So yeah, but then I got pregnant again, probably two or three months after that. 

 

P: That’s awesome. 

 

L: That was great. Yeah. And that that was Audrey. So that is yeah, my daughter, so 

 

P: oh Wow, good, 

 

L: okay, that worked.

 

P: And so are you again, are you nervous for the first trimester or do you handle it differently?

 

L: Totally. Totally. Like, won’t tell a soul completely terrified. Yeah. Yes, absolutely. I remember my husband’s a marathon runner. 

 

P: Oh, wow. 

 

L: And so I found out the day of the Chicago Marathon. 

 

P: Oh, wow.

 

L: I woke up and was nauseous and felt like I had the flu. And it was like the first marathon I’d missed. Like, in 10…11 years. I was like, I can’t believe I can’t make it to your marathon today. And ended up being like his best time ever. And then he came back and I was like, I have not taken a pregnancy test. But I know that I’m pregnant. This is not the flu. And he was like, Okay, so let’s, yeah, we’re just gonna keep this one under wraps. But I went to the doctor immediately because of the the blood clotting issue. We knew that we had to we had to do a scan and we had to make sure that the you know, everything looked good. Because they were going to start me on a blood thinner pretty quickly. That was and that was, I think, yeah, maybe just a couple weeks after that. And then I was doing heparin shots twice daily.

 

P: Wow. So that sounds like they determine you did have a blood clotting issue.

 

L: This has been back and forth. This is the great mystery of me. Someday, someone will figure it out. But they were ruling that they didn’t think there was a blood clotting issue, but in case there was 

 

P: okay, 

 

L: we’re just gonna do it to be safe.

 

P: And for some reason because of this blood clotting issue and she you can’t have an epidural because your blood will pool while you’re laying there.

 

L: Yeah, so gosh, how did he describe it? So I will say this doctor who was like, Don’t do the epidural didn’t give me a ton of details. He was very much like, I remember him being very flippant. about it. He was like, Don’t do it. They don’t really work anyway. Just great for the hospital surveys. It was something along those lines. It was very flippant. He’s like don’t do it. It’s gonna mess everything up just as long as you don’t do the epidural, you’re fine. And then he had referred me to an OB who was a woman is great who’s still my OB. And I said, What do you think about this? And she’s like, actually, no, I’ve had women that have come in with the same thing. And her thought really was that you know, yaz, was the provoked the blood clots, and she’s like, honestly, we’re just doing this to be safe. I think you can still have the epidural. We’re going to you’re going to be on Heparin at that point in your pregnant pregnancy. And at that point, we will just time it out. We’ll try to time it out. So like you’re in between shots. Okay to give you the epidural 

 

P: So, Quick question, Dr. Sur. Why are we concerned about the epidural if Lauren’s on Heparin?

 

Dr. Sur: It sounds like the issue there may have been because of the treatment, the way you treat blood clots circulating in the blood, especially if they’re enough to cause PE or pulmonary embolism. So a blood clot in the lung. So that’s treated with blood thinners. Or anticoagulation. So now the risk instead of clotting, the risk is then bleeding. And so it’s kind of weighing the risk of clotting versus bleeding. So so with an epidural, it’s essentially a spinal puncture so the risk is bleeding on anticoagulation

 

P: and then once you cross the first trimester, feeling better, how do we feel?

 

L: Feeling great, was traveling. I had some stuff going on for work. Still not telling anyone didn’t tell like partly what I told my best friend who was dabbling with but didn’t really tell a ton of people that I was pregnant until I started showing, honestly, 

 

P: okay, that makes sense

 

L: Yeah. And then I was like, surprised.

 

P: And then how was the rest of the pregnancy? 

 

L: Great, besides giving myself shots constantly, which was a pain in the butt, especially when I was traveling. Yeah. My pregnancy was fantastic. until like, the very end when I was just I was just sore all the time, obviously, like just normal stuff, but nothing. Nothing out of the ordinary. It was like very smooth sailing. I think that was one of the things that like, threw everyone off. Later on, because everything was so great blood pressure, great weight, great, like everything.

 

P: So how far did you make it? Did you make it to 40 weeks?



L: Yeah, so my daughter’s due date was June 11. And she was born on June 8. 

 

P: Wow. So take us to the day like how do you know today’s the day what what happens to your house?

 

L: That Day was insane. There was recently an article about this, but I was actually that day on the phone between Northwestern and Blue Cross who was my insurer, because they were sort of arguing over the payment for a scan that I had when I was pregnant with the child that didn’t make it miscarriage. So they were like, Oh, we’re billing you full price because it ended in a miscarriage. And I was like, was pregnant when I had the scan.

 

P: That that’s nuts that insurance companies live in their own bizarre world. That could be a podcast itself, right. 

 

L: it could be it absolutely could be. So I was going back and forth. And there was things that were coded incorrectly and and I was like, Can we code it correctly? Yeah. So it was back and forth with them for a really long time. And at one point, I had to leave the video conference and go to the bathroom and I just felt really weird. And I came back to the video conference, and I just was like, have you guys worked it out yet? And they were like, we’re still talking about the codes and bla bla and I sat down and my water just burst. 

 

P: Oh, wow. 

 

L: Like comedically, like like it was in a movie. And I said, Well, I have to go because my water has broken and I’m going to have a baby. So I really hope we can work this out at some point. And that was about four o’clock on a I think that was a Friday. And I was like, oh my god, I can’t believe this baby is coming like at rush hour or Yeah. And it’s so Adri now that I know her. I’m like, Yeah, you would do that.

 

P: That’s very funny. I hope we live close to Northwestern at this point

 

L: seven miles. 

 

P: oh….that’s not close in Chicago

 

L: In Chicago traffic that is not close. And I was waiting I waited for my husband to come home. So he got on the metro and he was home pretty quickly gets home by five and we right at five like we get on the highway to go to Northwestern and we are just sitting in traffic for a while. Yeah, we got to the hospital around like 615 ish. Yeah, I want to say and everything was calm, like everything was just chill. It was very fun. It was fine. 

 

P: were you having contractions? 

L: they were far apart. Okay. But I had called my OB and I was on the phone with her nurse and she was like, why don’t you to come in right away? Because we need to get blood tests going and stuff like that. Yeah. And I was like, all right. I feel great. I feel fine. I’m just like in the car. Listening to music. I’m like, strolling into the hospital. Everything’s fine. I think until like seven 730 And that’s when the action just like hit me like a train. 

 

P: uh Oh, 

 

L: that’s when they were like, oh yeah, this birth is happening. Like very quickly. So I remember I was in sort of, you know, they bring you in that like first room, I guess. It’s like the triage. Like, yeah, at Northwestern, and then it’s just chill. And then it was around 730 I was like, oh contractions big time. Everything’s happening. And they’re like, Okay, let’s take you upstairs. To the mainstage with all the lights. 

 

P: Yeah, yeah. 

 

L: Yeah. And then contractions were coming very hard and very fast. And they had taken my blood as soon as I got in there because they wanted to know, you know, when was my last heparin shot? 

 

P: Yeah. 

 

L: The blood results were taking forever. I think they even took a second set of bloods at one point. We just weren’t getting the results inside. It just felt like it felt like forever. Yeah, just waiting and waiting and waiting. And I don’t know what time it was, but I was just like, can I have an epidural? Because this is happening. I thought, I’m going to give birth like soon and the OB wasn’t there yet. Because they’re like, It’s first time waiting on bloods like, just, you know, we’re just going to work through the pain and I was like, No, I think this baby’s like, coming tonight. And everyone thought I was crazy. But then I remember at one point a resident came in and she was like, it’s coming fast. Like this is actually quite fast like we do. We actually do need the doctor here very soon.

 

P: So that means you’re pretty dilated.

 

L: I was pretty dilated. I think I was about I was like like maybe 8 when results came back by then they just ran in the anesthesiologist. And at that point, I was having some pretty hardcore contractions. That is when I had my epidural, which kind of set off the chain of events that were not so great. So 

 

P: yeah, I mean, that alone is pretty tricky, right? Because you’re you’re supposed to bend over and be still which is not relaxing. Right? 

 

L: I could not be still at that point. Yeah. So I yeah, I remember sitting up on the bed. Really. It was, it was hard. And he’s doing the epidural and suddenly my right leg just like shot out. I said Starburst. Everyone was like what? And the anesthesiologist was not super kind. He came around and he said, Well, you should have told me that you had scoliosis. I was like, I don’t have scoliosis, to my knowledge. And he was like, Well, I think you do. And he’s like there’s a puncture. And you might have a spinal headache. Or you might not might be fine who knows? And then he just kind of left 

 

P: Good Lord. 

 

L: I was like, what happened there? And I felt really strange because obviously, the epidural didn’t take. I was leaking spinal fluid. Oh, so yeah, so it was dizzy. And I was still feeling everything. Yeah. Still just yeah, basically just gave natural childbirth. So yeah, I remember saying to the nurse, I don’t think that worked. And she was like, Oh, what happened there what was going on? Because he didn’t really communicate with anyone else in the room as far as like what had just happened. And so you know, she had to kind of go after him and was like, what, what’s going on? And, you know, we need to talk to the OB who still was not there at that point. 

 

P: Yikes. 

 

L: So it was kind of like loose chaos. Yeah, I was in a lot of pain. And I know they gave me something but I’m not sure what it was. At one point. And then, very soon after, it was just like, it was just time it was just time to give birth because it was just happening. Like, it was just like a freight train. It was crazy. So I gave birth at 2am. So you know how so? Yeah, it happened to start at like 730 

 

P: that is fast…thats 10 hours…

 

L: Yeah, it was really, really fast. I remember to at one point, I looked at B nurse and I said, How many babies do you think you’ve delivered? And she was like, Oh, I just I couldn’t even I couldn’t even begin to tell you and I was like, Okay, we’re gonna do this because I’ve got to push. I’ve got to do it. And she was like, No, can you wait like 20 minutes? I was like, I absolutely cannot wait 20 minutes and she was like, okay, so then we just did it. And I didn’t push for very long. I pushed maybe maybe for an hour. I remember Audrey was actually on her way out like she was it was the last push. And the doctor came into the room and she goes, Oh, we have a baby. 

 

P: Wow

 

L: We do. So yeah, so that was Santa to ham. All good. I felt very dizzy or really

 

P: are we doing anything. For the leaking spinal fluid, or do they patch you up or something?

 

L: I think at that point that OB had, did not know or was not briefed just yet as to what was going on. So we were just kind of carrying on as normal pretty much and then it wasn’t until they got me down into the room. I think it was like the head of anesthesiology came in and he was assessing me and he was like How are you feeling? I heard about what happened like what’s going on? And I was like, I just feel really dizzy. And he’s like, okay, he’s like no headache. No like no stiffness in your neck. No, like, no. I mean, I’m just completely out of it. I don’t know. I just had a baby. This might be normal. 

 

P: yeah, Yeah. 

 

L: And he was like, Okay, so we’re gonna continue to monitor you. And then I kind of knew it was serious, maybe like an hour or two later because I kept getting visits from like, anesthesiologists. I guess they kept coming in. 

 

P: Yeah, that’s unnerving.

 

L: Yeah. And I was like, oh, something’s wrong, because I didn’t really know what a Dural puncture was right. I was like, I don’t know what went wrong like some spinal fluid leak. Does that mean it sounds bad? But yeah, no one’s freaking out. So yeah, it seems like this might resolve itself. And also when he left the room, he was so casual like, well, you might have a headache. So

 

P: okay, so what’s a dural puncture and how does it cause a headache?

 

Dr. Sur: So the way that an epidural is done they use a spinal needle so long needle and the needle is placed in between the vertebral bodies which are the you know, the bones that make up the spine. And in between the vertebral bodies you have a disc you pass the needle through this disc and through the spinal ligaments and into what’s called the epidural space. So this is outside of the dura, which is the membrane that covers the spinal cord. The idea is to not touch the dura, it’s to land the needle just before the dura and allow the medication to pass into the epidural space. The anesthesia numbs the pelvic area so that you don’t feel the pain of the delivery of the labor. It’s a very small space. And one of the risks is that the needle has passed too far and hits the actual dura. Then you’re in the compartment of fluid that bathes the spinal cord and bathes the spinal nerves with a Dural puncture. This is commonly done when patients have what’s called a lumbar puncture or a spinal tap. So the needle is intentionally passed through the dura to collect the cerebrospinal fluid or if that’s not the objective in an epidural anaesthetic, the CSF or cerebrospinal fluid leaks and that will change the pressure is dynamic around the spinal cord and within the skull, and that can cause a headache that low pressure can cause a headache.

 

L: I mean, I guess I’ll have a headache.

 

P: spinal fluids is one of those things that sounds like it needs to be on the inside. Yeah, any on the outside.

 

L: It seems it seems like a serious situation. But I just was like maybe this is okay, because everyone’s acting very calm about it until they were Yeah, yeah. Until about 5am. Yeah,

 

P: you’re dizzy laying down.

 

L: Yeah, and I tried. I was trying to explain it at one point like, like an old tube TV like when it sort of like blinks? 

 

P: Yeah, 

 

L:  was kind of like what my vision was like, like it was like I couldn’t settle. Just kind of couldn’t focus on one thing. It was kind of like I was like blinking out a little bit. So that was an even lying down. So yeah, that was what I was experiencing at that moment. I told someone that I was like, I can’t really like, focus on you. Everything’s kind of going hazy. I felt like a plane that had been depressurized, I guess in a way just sort of like waving in the wind and weird that point they were like Okay, so we’re gonna try a couple of things. And this was also very complicated because I’m back on Heparin, now back on a blood thinner. And they’re like, Okay, we’ve got a timeout a couple of different treatments for you. So one was a sort of like hormonal therapy that I didn’t quite understand to hopefully patch up this leak, and the other was a blood patch. Which would they would take some of my blood and that they would create a clot. Yeah, and actually patch up the look. So I said okay, so we kind of had a time that out between heparin doses. Yeah. So they get me down there. And doing a blood patch with residents. My mom worked at a teaching hospital for years. My whole family is like in the medical profession like…love teaching hospitals. But here’s where one of the issues I had was like, I think we need to get someone really experienced in here. Yeah, this already went wrong sort of in the epidural stage, but they brought in a resident and they brought in a nurse and neither of them had done a blood patch before. So that was really tough. And also I was just super dehydrated. Getting blood from me, it was like impossible.

 

P: So your your veins were like collapsed. 

 

L: Yeah,

 

P: yeah. 

 

L: So I’m in there. And they’re even just trying to get a line in for this like hormonal therapy that they’re going to do and they couldn’t do it and I feel like this whole process should have been think they were like, Oh, it’ll be like an hour because we were also trying to time it out because they’re like, Well, you’ve got to feed the baby. So to feed the baby gotta get your blood shots. It’s a whole thing. But I think I was down there for about three or four hours. 

 

P: Oh, wow. 

 

L: It was them trying to get blood out. of me trying to get a vein and then the blood patch went wrong.

 

P: Well, I can imagine if you’re taking blood from someone with heparin, right, they’re putting out your clotting factors. So how’s that gonna work?

 

L: Yeah, yeah, it was all very tricky and like it just it was not going to work that time and they also just couldn’t even get enough blood from me at for that blood patch, 

 

P: are all these attempts painful because your body has already been through the Marathon of getting birth. So

 

L: yeah, that was one of the worst things that’s ever happened to me, but that three or four hours I was down there because I was in a lot of pain. It’s basically another epidural is them going into your back with needles. So I had to be very still. Yeah, I just remember like everything in My body hurt and then I was also very, very dizzy and I just felt like I was going to pass out. And at the end of it when they were like, Well, we think we may have gotten it. 

 

Because that was the other thing. They’re like, Okay, can you feel it here? Is it here or here? And I’m like, I can’t. I’m about to pass out. I don’t know what Yeah, I don’t know what’s left or what’s right at this point. But I remember at the end of that, just kind of like looking back in the room as they were wheeling me out and there was blood everywhere. Just everywhere. And I was like I feel like I was just butchered. I was completely butchered and I have no idea what happened in that room. I was trying to communicate with people to as far as like, what are we doing and what’s happening and what went wrong. And but I know at that point, I was not getting my words out very well.

 

P: I took this question about blood patches to Dr. Sur: In a perfect world. How does the blood patch work and how long do you think it would take?

 

Dr. Sur: So in a perfect world it shouldn’t take very long. What you do in a blood patch is that you you draw blood from the actual patient and then you insert the blood back into the epidural space with the idea that the clotting factors in the blood will patch up the leak, and so this is something that’s done it when a patient is suspected of having a low pressure headache from a CSF leak, typically after like a spinal tap, and when other conservative measures have been exhausted with really no improvement on the patient side then blood patches is considered 

 

P: And your husband’s not allowed to be in there for this.

 

L: No, and he was with our daughter at the time. And also he I mean, he did leave for the epidural as well. And he didn’t know if he could handle it. And I was like if you can’t handle it, it’s cool. Just go at that point. I did want him to stay with our daughter. And yeah, I was like I don’t know if I’ll be able to come back and feed her because Yeah, who knows what’s gonna happen down there. And so I got back up to the room. And I just remember the nurse saying to me, Well, you took too long so we had to bottle feeder. I was like I didn’t take too long.

 

P: Yeah, no kidding, good lord.

 

L: So she was very disappointed that Audrey was not breastfed at that point. But it was what it was.

 

P: That’s another hobbyhorse I have about the pressure to breastfeed when other things are going on. Right right. We’re doing our best lady

 

L: I was like I’m trying I have no idea what’s happening.

 

P: I’m apparently donating all my blood out my back. So I don’t have time to Yeah, it’s not it’s kind of a bummer because you’re also emotionally fragile after all that right you are just given birth and you do have hormones swirling everywhere. And like be nice

 

L: I haven’t slept I have. Yeah, yeah. Been just freaked out as far as what’s going on. And I remember like they had Audrey at that point and I kind of went to lay down and I had a feeling that nothing worked. anesthesiologists had come in and they said, well, let’s see how that took. You know, let’s give it you know, a few hours. See how you feel. Hopefully, you know, you’ll feel better soon. I texted my best friend. I was like, Dude, I just want to let you know like things did not go well. I just I love you and I don’t know. I’m gonna make it out of here. It was like it was pretty like it was pretty dark at that point.

 

P: That’s really intense. Now, did they tell you like there’s a risk that that you’ll die from this or like, what why do you feel this way?

 

L: I think it was just everything that went down in that room like I’m trying so hard. I knew they didn’t get enough blood. I knew that it probably didn’t work. I felt like I hadn’t held up my end because when we were doing the blood patch they were very much like okay, we need you to communicate with us and tell us is it here is it here? Is it here is it here and I was like I just guys I don’t know. I don’t know where you should put the needle? I don’t know. And so

 

P: I don’t know if I could do that today. On coffee Right? Right even not even counting all the things that you went through. Like it’s just not that easy.

 

L: So I just felt like I had failed. That point. And I didn’t feel well. And I just was like this is not this is not good. Just so you know. 

 

P: Yeah. 

 

L: But then I went to sleep for like a minute. And I woke up and I was able to stand up and like walk around. Everyone was like really happy like I could see like OB was just like everyone looks so relieved. Like she’s walking. It’s okay. Looks like everything’s maybe going the way we want it to go. I did feel like pretty decent overnight. And so I was like okay, well maybe maybe I’m all right. 

 

P: So less dizzy. 

 

L: Less Dizzy was walking around, was talking fine. Like everything seemed okay. So they let me go home the next morning. 

 

P: aaaahhh

 

L: So they said yep, we think you’re good. Go home. And it was crazy because it was like as soon as I got home as soon as I walked in the door. I was like, oh, no, something’s wrong. And I just again like the dizziness came back. I couldn’t focus I couldn’t see. I was very, very weak. And I just immediately had to go to bed and couldn’t move. The anesthesiologists. They wanted me to call like every couple hours, to sort of update them my condition. So that was kind of what the next I think the next 24 hours where I was calling them and I was like, I can’t get out of bed like I can’t move. I don’t know what’s going on. My neck was so stiff. Just I could I couldn’t turn my head.

 

P: Is this ringing a bell because the the senior anesthesiologist had said Do you have a stiff neck?

 

L: I know right. And I kept telling them that as like I have a stiff neck. What does that mean? Because I remember he said something about it.

 

P: So the anesthesiology team keeps asking Lauren about neck stiffness after the dural puncture were they looking for where’s that mean?

 

Dr. Sur: So that’s associated with infections of the meninges again, the infection of the dura for example, or the membrane that covers the brain and spinal cord. And there can be stiffness in something like meningitis.

 

L: And one guy I remember that I kept calling That night. he was like he was the guy manning the phones, I guess. he was like, well, I don’t know. I mean, you just gave birth.

And you gave birth pretty quick. It’s gotta be he probably just pulled a muscle. so that’s he’s like, that’s normal. it’s very normal. and I was like, well, I’m really weak. like I can’t make it to the bathroom like my husband was having to get me, you know, to the bathroom, which is like four feet out of our bedroom. And he was like well you just gave birth you lost a lot of God, I don’t know like just lay down and I don’t know. 

 

I started having these insane like very intense headaches. I kept calling them back and I was like, my head is bursting. I don’t know what to do I seen lights like things are not going well. And they’re like, Okay, well you need caffeine. So we’re going to get you some caffeine, like some pills. Just drink soda, drink anything coffee, just get your your caffeine levels up. So that was like the start of the caffeine rush, which I think lasted for a long time.

 

And I was just and I was just high on caffeine. 

 

P: This seems very bad because you haven’t slept. You’ve been through this ruinous thing.

Now they’re saying  chug Mountain Dew. This feels wrong. 

 

L: Yeah, yeah, it was It was wild. Yeah, it was wild. So yeah, so I’m caffeine. Still could barely move. My head was not right. My mom who thankfully at one point was a neuro nurse. 

 

P: Wow. 

 

L: She was ER for career but she also didn neuro as well. She was just like, This isn’t right. She’s like you got to stop calling These anesthesiologists we need to call just other doctors. And I literally was just like calling random doctors at Northwestern trying to get my you know my doctor my my OB like just anyone I could be just anyone I could and just sort of get them on the phone and explain to them like what was going on. So I think it was my primary care physician who was just like, okay, because this was like an info dump for her. 

 

P: Yeah, yeah, 

 

L: no idea what’s going on. And she was like, I want you to go to the Pain Center at Northwestern because maybe, like maybe something went wrong with this. And we just got to get you in there. Right away. And that was a whole situation of trying to get me scheduled to go into there and 

 

P: but you can’t just show up right? 

 

L: You can’t just show up, right. You can’t just show up. They have wait months for days. And yeah, I remember initially like we called and they were like, well we can get you in and you know, I’m like three weeks and they’re like no, she needs someone right now right now. So they were like okay, can you get here in like 20 minutes and we’re like, no, but we’ll try. Yeah. So I showed up and I probably got there 45 minutes later because of traffic. 

 

P: Yeah, 

 

L: this poor girl who was working the front desk. I think this was like her first day and I show up, I can barely move. And I’m like, I have this appointment. And she’s like, Oh, I’m so sorry. Like you missed it. And I think we can reschedule for like a few weeks and I’m sorry and she just like didn’t know what to do. And again I’m very much a person that doesn’t like, I don’t want to make a scene, but I just couldn’t like I couldn’t stop crying. And I don’t know why at that point. I just want to walk across the street and go to the ER but I was just like, I’m in so much pain. I don’t think anyone’s taking it seriously. I don’t know what to do.

And I was sobbing. And this woman who was in the waiting room goes, I don’t know what that woman has been through, but she can have my appointment, because this is wrong. Yeah,

 

P: that’s nice.

 

L: It was nice. So she was like she can have my appointment right now. Just get her to see a doctor right now. And the girl at the desk ran and grabbed a doctor and they brought me in and we did some X rays. We of course establish that the blood patch did not work. And so they said we’re going to do another blood patch, this time under X ray. So they did that and they’re like, You should feel like in an hour after we do this blood patch like you should feel relief. Like okay, so they do the blood patch it takes 15 minutes really, really quick. Yeah, 15 minutes tops. They put me in a room. Lay me down. And I felt like pretty decent when I was laying down at that point, and then they were like, Okay, we’ll give it an hour and then we’ll lift you up and we’ll see how you feel. gave it an hour. I get up and I’m just like, no. Still feel bad. So my neck hurts. I can’t, something’s wrong. They were just like, well, go home. 

 

P: NOOO

 

L: Take some pills. Lay down. And again, this one doctor said, you know, you’ve just given birth. It’s a lot probably just stressed. I was at the point crying. I couldn’t really communicate very well. He was like, You’re just I mean, it basically was like you’re just hysterical. You’re hysterical woman. Who’s probably hurt her neck and childbirth. And yeah, there’s nothing we can do. Like we did the blood patch. It’s great. You’re gonna be fine. Just give it some time. 

 

So I go home. And again, in terrible, terrible pain and I just start this round of phone calling again. Just calling people like something’s wrong. And I get on the phone with my OB nurse. I’m just explaining everything that happened to her and she was like, This is not right. Like none of this is right. And she’s like you need to go to the ER right now. And before before I had talked to her actually, what was something that was really crazy. There was another doctor I was talking to who had access the records from the Pain Center. Because he was like, Well, let me see what they said. Let me see. You know what the notes are and in the notes, the doctor who basically told me to just go home and lay down had said, You know what, her brain should be scanned for clots. That was not communicated to anyone that was not communicated to my primary care physician. It was not communicated to me it was not communicated to my OB we don’t

 

P: I don’t understand how it made it in the notes but not to anyone’s notice why it made no I didn’t he order things and if that’s what thought 

 

L: unclear, that’s like a big question that I have big question. And I actually even called up the Pain Center and I mean I at this point was just like, just nuts. I just losing my mind and I said, you know, this is what this anesthesiologist told me. This isn’t the notes Was anyone going to tell me Was anyone going to tell me are you gonna call me and they were like, oh, yeah, we were, you know, he went he went out. He left he went to lunch. He hasn’t come back yet. But yeah, there’s an order here for you to go to the ER.

 

P: Oh my god. was we were telepathically sending you like yeah sending you 

L: Yeah. And just it just was not communicated. So I was like, Okay, well, I’m going to the ER please send that order to the ER. FYI. Yeah. Um, and they were Yeah, and they were like, Okay, we’ll send it right now. cuz then I get to be er, and they’re like, We don’t have an order here. But thankfully, I had everything on my phone and they were like, Okay. And then a nurse came over the nurse that was assigned to me and she was about eight months pregnant. And at that point, I could barely move. I was just crying. I just handed her my phone. I was like, just read anything on here. I don’t I don’t know what to say. And I just remember like, she started to cry. She was like, she couldn’t hold it together. And I was like, Well, this is bad. I don’t know what what happened here, but this is all bad. And like, she brought me back she brought me back, you know, they were taking my blood pressure and doing all that stuff. And she just was like, disturbed as sort of my husband was kind of telling her what went down. And then they took me into another room and a doctor came in and we kind of went over everything but at that point, I was in so much pain. I was just gripping the hospital bed. And I was just my jaw was just like grind grinding, I couldn’t talk and my husband was doing all the talking for me. And the doctor was very straightforward. He’s like, Oh, yeah, she’s had a stroke. Yeah. What? He was like, Yeah, this is the stroke patient right here. No one knew that. I knew like he knew immediately. It was like two minutes in.

 

P: Good lord. Yeah. 

 

L: And he was like all the signs were there. He was like, Oh yeah, the the weakness and she’s like weak on her left side and it’s yeah, the blinding headaches where she’s seeing lights and all of the things that you described. Yeah, she’s had a stroke.

 

P: can you tell us what happens in a stroke and why women are at higher risk during pregnancy and after delivery?

 

L: So a stroke is essentially a sudden, acute neurological deficit. One type of stroke is a clot in the venous system of the brain. So ischemic stroke is typically thought of a clot in the arterial system in the arteries of the brain. And then there’s the hemorrhagic types of stroke which is rupture of the arteries typically, and then there can be clotting within the veins of the brain that can also contribute to stroke the risk of that is higher. So in pregnant women, the risk of stroke is actually three times greater than in non pregnant women. of the same age. The risk is essentially in the peri partum period, and in the postpartum period of just up to six weeks after after the delivery. So she kind of was in that very high risk period of developing a stroke. In the peri partum and postpartum period,

 

P: because we have so much more blood volume or because of the estrogen, there’s a lot of clotting factors running around.  why are we at higher risk?

 

Dr. Sur: So what it’s all related to the kind of physiological changes that happen during the delivery and so right after the delivery, essentially, the body is going into kind of clotting mode, because all of the blood vessels and all of the vasculature that fed the fetus is no longer necessary, and to prevent essentially postpartum hemorrhage or bleeding out from those vessels. They all have to kind of clot off and that’s why the uterus also contracts a lot immediately after the the delivery to try and then close off the vasculature to the uterus, which is no longer necessary once the fetus has been delivered. So you’re essentially in this pro thrombotic state where clotting factors are elevated and and so it’s, that’s why it’s a high risk period.

 

L: part of me was almost relieved, in a sense, because I was like, one believes that something’s wrong.

 

P: Yeah. Yeah, that was like that nurse was the first person to have a human reaction. To everything you’ve been going through, right?

 

L: Yes, absolutely. I think everyone else was very much like, she’s a problem. She keeps calling like, we just need to shuffle her off. And yeah, so he’s like, Yeah, we need to get her CAT scan, He’s like, Yeah, let’s get her in there. And see what’s going on. And so this was kind of almost funny. I mean, my husband and I laugh about it now, but I was like, I don’t know if I can go in there because I was in so much pain and I just needed something to like, hold on to 

 

P: Yeah. 

 

L: And so they’re like, Okay, we’re gonna give you something to calm you down. They were just like, is there any chance you could be pregnant? But absolutely. 

 

P: good news…Yeah. 

 

L: And they’re like, Are you sure? And I was like, I just had a baby like two days. ago. Yeah. And they’re like, Well, yeah, you know, sometimes people. I was like, they do not, they do not. I was like, I promise you. There is absolutely no way I’m pregnant. I said it maybe 15 times. They’re like alright, okay. So then they give me the Dilaudid and do the scan. And then after the scan, the next thing I remember as I was in the ICU, and I was hooked up to many machines, and there were lots of residents and we were talking about the stroke and how it had affected my right side. My right side was very weak. And my speech at that point was not good. And my neck was very stiff, and I couldn’t I couldn’t really move bad scene. And then I think it was like Audrey’s first appointment with a pediatrician. I can’t remember what time this was. I feel like it was like maybe two in the morning or something. And John was like, I’ve got to go take her to the pediatrician at 8am. And I was like, Okay, I was like, just go like, You should go. 

 

He was a mess. So I was in the ICU for quite a while. Which is a weird thing I remember. Maybe it was the next day or the day after. They have an occupational therapist come in and they’re like, Okay, today we’re going to work on putting on socks and maybe taking a walk up and down the hall. Do you think about that and you’re like, wow, I have a little baby at home who I never seen. How am I gonna change a diaper? 

 

P: Yeah, 

 

L: you know how to put on my socks. So yeah, so that was a thing and I was just trying to push through and I was I was in there as like you know what, I’m gonna just I’m gonna beat it. I’m gonna put on my socks. I’m gonna like run around in the hallways. I’m gonna show them that I’m like, I’m fine. But it was very much not fine. So then finally I get to a step down, ICU. And just so many tests, so many things. are going on. So many people are talking around me, including all of the residents of the neuro like it’s, but no one’s talking to me. 

 

P: Yeah, 

 

L: essentially, which I think, say the first five days in the hospital. That was pretty much the case. I was in a lot of pain. And I didn’t know what the source of the pain was. And again, I kept talking to them like, Oh, my, it really hurts at the epidural site, like it’s I’m really, like really sore, and they’re like, Yeah, you’re gonna be sore. And I’m like, I still can’t move my neck like what’s going on with my neck? And they’re like, oh, you know, the patch is sealed. Like we’re getting your blood under control. Like, let’s, we’ll see it just like no answers. And I remember I hadn’t slept for days. It was again middle of the night. And this nurse comes in and I just was like I said before you do anything, like we need to have talk as like, I just need I need someone on my side. And I don’t know what’s wrong with me. I don’t know if this is normal. Do you know if it’s normal, but I’m in so much pain, and I just feel like I just I’ve just I feel like I’m gonna die tonight. Like, this is really bad. And she was like, okay, she’s like, first of all, let’s get a scan because they wanted to make sure I didn’t have a bleed and my brain scan comes out like normal. You know, there’s clots in your brain. But nothing’s bleeding. 

 

So, blah, you’re fine. She comes back. And she’s like, well, you know, do you feel better? What do you think what, you know, this is what happened. They said, You know, it’s the same. I’m like, something is wrong. Like, I can’t I can’t move. And she was like, well, has anyone given you like Gabapentin and I’m like, no, like, I’m just on like, Tylenol. 

 

P: Oh my god. 

 

L: And she was like, Okay. And so she like, grabs a doctor and she’s having this conversation with him. And I hear them get into an argument in the hallway where she’s like, just try it. Like it’s not gonna hurt her. Why can’t we just try it? She’s in a lot of pain. She can’t move. She can barely talk to us. This is insane. And he’s like, Fine, whatever. And he approves it. And I felt like the Gabapentin had saved my life. Like as soon as I started it, I felt like I was just a stone, just like a statue before it was so everything was so tight. I couldn’t move anything. And then as I was taking gabapentin, as I was sort of like ramped up on it, it suddenly like move again. And I could talk and suddenly I was like myself and I told that to one of the doctors. And he was like, oh, you know what, now that we think about it. So where the blood clots were in my brain, it was sort of blocking the blood flow from like, just guess exiting your brain and that pressure was building up and it was putting pressure on my nerves. So that’s why I couldn’t couldn’t move my neck. So it was all that pressure. And he’s like, yeah, he’s like, I guess that would be painful. 

 

P: Oh, my God. Now that we think of it, yeah, what were we doing last few days?

 

L: What were we doing? What were we doing? And I know I’ve read all of my my notes, which I requested from Northwestern and I had hundreds of pages of them. And it’s marked in the chart like the difference there like oh, one day she was just gripping, but could not get up, gripping the side of the hospital bed, would not move and would barely communicate. And literally the next day was standing up and was talking to us like okay, what’s going on guys? What’s happening? 

 

So yeah, it’s like in the charts and it was just wild. And then the hospital experience was very different after the Gabapentin I was like, I’m taking control of this situation. Yeah, I was quite motivated. I had a lot of adrenaline in a sense, like, especially after that Gabapentin. It was like, Yeah, after that change. I was just like, Oh, I’m taking control of this whole situation, and I’m going to be fine. And you guys need to all tell me like how I need to get there. Yeah, one of the things I need to do I need to lift weights do I need to get on the treadmill every day for 30? Like I was just like, we’re gonna do this because I couldn’t figure out how life was gonna be with my daughter especially in those first six months. Or even the first three months when I had my new those clots were still in my brain. And what if a clot moves? Or what if my brain started bleeding? Yeah, I think that was really scary to me. I was really scared to be alone with my daughter for a really long time.

 

P: Yeah, that sounds super scary. And they just resolve on their own. Is that how we let that

 

L: be to the to us you’re Yeah, and you’re on the blood thinner until they resolve and mine did resolve this all went down in June. I believe I had my MRI, it was like late September. And they’re like, Okay, great. They’re gone. And I remember seeing my neurologist after that, and she was like, you’re really lucky that all just took away. It’s like they were never there. And I was like, Okay,

 

P: wow, that is amazing. 

 

L: Yeah. 

 

P: Ultimately, it was the epidural. That was the problem. Right. 

 

L: And yeah, ultimately, what we found out was the epidural, of course, like set off that chain of events, so it was botched and then the blood patch. At one that was like a three hour blood. Yeah, ouch. Yeah. That was the one that sent those clots actually up into my brain. Wow. So instead of actually feeling that Leah, that’s where they went. And then the second blood patch is the one that finally patched it and sealed it, but at that point, stroke time. 

 

P: good Lord, so it’s like all those compounding things. Right.

 

L: And it’s, it’s a wild situation, right? Like none of this is typical, but it was pretty crazy. I think. Also, it was really hard for like a lot of the anesthesiologists who were also residents that I was like calling and dealing with, was that the spinal headache symptoms are, I mean, they’re kind of similar to a stroke. And so they kept going to the spinal headache thing saying like, well, I don’t know the headache. Yeah. And she’s weak. She just gave birth. So they just kept deferring to that it never occurred to them, that there had been a stroke. I mean, I guess it It occurred to the guy at the Pain Center, but he didn’t say anything. But when I went to the ER and that doctor was just like, oh, yeah, she’s had a stroke. Like, guys, come on.

 

P: Yeah. Yeah. Because you passed through many hands before you got there.

 

L: Yeah, they didn’t realize that was the thing. 

 

P: Let’s now reflect on the things that we have learned from this unbelievably traumatic experience. Yeah. If you could go back. What would you tell younger you and what do you take from this experience?

 

L: Well, I think it’s been more of an advocate for myself in those situations, which is hard. It’s really hard with a doctor because they’re the expert, right? They went to school for so long. They’ve been doing this forever. They’ve seen so many people, but I do think, especially in this case, a lot of people were very disconnected from me as a person. And they didn’t see me as a person. They saw me as problem. And remember, even we’ll say I was about seven months pregnant somewhere around there. Saw that Serena Williams Vogue story about her childbirth experience.

 

P: In case you missed it, Serena Williams gave birth and 2018. The day after the birth she became short of breath, and she worried that it was a clotting issue, given that she had a serious blood clot in her lungs in 2011 that required emergency care. The shortness of breath she felt after the birth very much reminded her of that earlier experience. When she tried to get help for it. She was dismissed numerous times by medical people around her. Ultimately, they found that she did in fact have a blood clot in her lungs

 

L: and I remember taking that into my doctor’s office, because I was terrified when I read that story. And I was like, Oh God, what if this happens to me, I’ve had this you know, clotting issue like this could easily happen to me and still get in there. And like how do we make this not happen? Like have you read this and I will say that I was easily dismissed was like, ah, that won’t happen to you. This is not the same blah, blah, blah just kind of brushed it off.

 

P: How can it not be the same? I mean, I I definitely had a fear of God reaction to that in that Williams is beloved famous, wealthy. You know, right, powerful. If she can’t make it happen. How’s anyone else gonna make it happen?

 

L; I know. No. And I just was like, how do we like I just was like, how do we learn from this? I learned from this Yeah. And I remember everyone be like, It’s fine. Don’t worry about it. Just just, you know, just trust us is basically what was the message? And I think in all of that, and especially in those two days, when I was just calling people and I wanted to believe those anesthesiologists who were saying, like, just lay down, like, just lay down. You know, you’re gonna feel great after hours asleep, like taking ibuprofen, like it’d be fine. And I really wanted to believe that but I knew something was wrong. And I think I should have been in that moment, a stronger advocate for myself, I should have just gone immediately to the ER and been like something is wrong. I really should have listened to that inner voice because it was right. Yeah, essentially. 

 

P: Yeah. 

 

L: So that has been what I’ve really taken into my healthcare practice today is Yeah, I do treat it almost like a business. I don’t feel like I should have to but when I do go to the doctor. I mean, I bring a notebook. They document a lot of things. Yeah. And I run it like a meeting. And I talk a lot. Yeah, and I ask people to clarify things and repeat things. Some doctors don’t care for it, but some are absolutely fine with it, especially once they have seen my medical history. 

 

P: Yeah, yeah. 

 

L: They actually are okay. And I feel like I’ve had a much different experience now. And I’ve even been really upfront with some doctors where I’d say like, listen, it feels like you’re sort of brushing me off right now and I have not had a great past. So can we go over this again? Or do you think maybe I would be a better fit with someone else? And some people are they really, you know, change after you are that direct? They really start to see this more as a partnership. Oh, that’s been really beneficial. 

 

P: I’m gonna steal that language that that is a really good way to say it and to get their attention apparently, right. 

 

L: Yes. Yeah. I mean, I get it too, especially now. I mean, with COVID Everyone’s stressed out. Everyone’s been working too much. Again, family, they’re all nurses. My some of my best friends. It’s a high pressure situation. So I have a lot of respect for them. But also, I’m just like, I’m gonna need you to give me time and your full time and attention right now.

 

P: Yeah. Yeah. Well, I’m glad that you’re back. Thank you. We’ve recovered everything that’s awesome. And inspiring. And what is your three year old into now?

 

L: Oh, gosh, DC Superhero Girls loves that. Yes. Loves the cape just runs around back and forth. Bubbles. Wow. Bubbles are a hit. But if you Yeah, she’s very cute. She’s very, very active. She’s always just yeah, she’s on time. She’s early. She’s ready to go up every day at seven o’clock. Just like what do we do and where are we going?

 

P: Very cute. that does sound like the baby who comes in 10 hours instead of 23. 

 

L: Yeah, exactly. 

 

P: Well, Lauren, thank you so much for coming on and sharing your story. And I think if I’m right when we talked in the very beginning of this, you’re a writer so you’re sharing stories all the time, right?

 

L: I am indeed. You know what’s insane is that when I was in the hospital, I had had this like book proposal that was just on my desktop at home and I got home I was like, I’m gonna send this off. And I wrote a very cocky proposal letter and I was like, You should publish this book because it’s great. And then the publisher responded like seven hours later and they said, Okay, we will. So yeah, that you know, near death, adrenaline that was going through me, 

 

P: that’s  awesome 

 

L: But yeah, I have a podcast called bonnets of dawn, which is about 18th 19th and 20th century women writers. And then my book is called why she wrote and it is about 18th 19th and 20th century women writers.

 

P: That’s super cool. Awesome. Thank you so much. Thanks so much for sharing your story. 

 

L: Yeah, thank you for having me. 

 

P: So thanks again to Dr. Sur for sharing her medical insights…and thanks to Lauren for sharing what is a really important story. Likely we will never know the full picture of what happened; how did so many people fail to show a requisite amount of interest in her experience, how did so many lack real curiosity about her case…it’s hard to get your mind around. 

 

It’s possible that when so many people brushed past her complaints about pain and told her to just go and lie down it’s a reflection of, among other things, a cultural view of women after birth, and in Lauren’s case, maybe also how the medical establishment views not just women but especially black women. There’s a fair amount of literature documenting the fact that black patient’s pain is often managed differently than pain for white patients .  It feels wildly unfair that one of the take aways from Lauren’s experience is that after you’ve birthed a baby and your body is wrung out, you are responsible not only for this new human being’s survival, but also your own advocacy…please share this story with friends, because even though it feels like too much to ask, it’s where we are today.

 

Thanks for listening,

 

We’ll be back soon with another story of overcoming.

Episode 35 SN: Vagonominal: A vaginal delivery and a cesarean visit the same birth: Kristy

Today we are lucky to get to talk to a midwife who shares her experience of a twin pregnancy. The process of getting pregnant and giving birth did not look at all as she had planned–and she had a lot of real information on which to base her prediction. Although she didn’t have the specific birth she originally envisioned, she successfully carried twins to term, and gained personal experience with more styles of delivery in one pregnancy than most mothers of twins–she delivered one twin vaginally and the other through cesarean section–which she described as a vaginominal, thus the title.  Now she can bring her hard won knowledge to her midwifery work.

Relationship between sleep and birth outcomes

https://academic.oup.com/sleep/article/43/12/zsaa110/5851407?login=true

https://pubmed.ncbi.nlm.nih.gov/29103944/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836666/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824023/

Preeclampsia

https://academic.oup.com/jn/article/133/5/1684S/4558569

https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

Maternity leave laws in US

https://worldpopulationreview.com/state-rankings/paid-maternity-leave-by-state

https://www.bls.gov/opub/ted/2017/establishments-with-fewer-than-50-workers-employed-60-percent-of-construction-workers-in-march-2016.htm

https://www.patriotsoftware.com/blog/payroll/states-with-paid-family-leave/

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. My kids are in their late teens, and talking with todays guest, who has kids of the same vintage, its really interesting to acknowledge how much has changed in the world of pregnancy between the time we had our kids and now. And that comparison is made possible by the fact that today’s guest is a midwife.

The process of getting pregnant and giving birth did not look at all as she had planned–and she had a lot of real information on which to base her prediction. Although she didn’t have the specific birth she originally envisioned, she successfully carried twins to term, and gained personal experience with more styles of delivery in one pregnancy than most mothers of twins–she delivered one twin vaginally and the other through cesarean section–which she described as a vaginominal, thus the title.  Now she can bring her hard won knowledge to her midwifery work.

Let’s get to her inspiring story.

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

 

Kristy: I’m Kristy Culp-Leonard and I’m from California. 

 

P: Cool. Thanks for coming on the show Kristy. One thing I should bring up before we really get into it is that you are a midwife, which is super cool. So But before we talk about your kids, why don’t you tell us how you came to midwifery?

 

K: Oh, wow. Well, that’s a long journey ago. I’ve been a certified nurse midwife since 2002. I was my in my early years in college, I did public health work in Latin America, and was very much interested in Spanish speaking culture and then found myself to also be interested in public health and working with families and decided to go on to nursing school with the idea was going to be a nurse practitioner and work with women and families, and then learned about becoming a certified nurse midwife and being able to really care for women through their lifespan and work with them. Through labor and birth and empowerment and post birth. So that’s how I ended up being a certified nurse midwife.

 

P: That’s very cool. Where are you in Latin America, what countries.

 

K: I have an in Paraguay twice. Costa Rica. And Mexico twice. 

 

P: I assume you’re fluent in Spanish. I’m totally jealous. Oh my god. That’s very cool. Did you become a nurse midwife before you had kids? 

 

K: I’d graduated from the University of San Francisco with my bachelor’s in nursing. moved to Houston Texas. Wow get work experience knowing that I wanted to be a nurse midwife. So my app the time fiance but now husband, we just packed up and moved there and and I worked is an OB nurse in labor and delivery are about five years before I went to midwifery school at University of Texas in Galveston.

 

P: Okay, so you’re a midwife first. So how do you step into pregnancy? Many of us who you know we’re just civilians, we walk into pregnancy with this very idealized view of what it’s going to look like. But I wonder how people in the know might approach it.

 

K: so we were very plans. husband went to law school, some work experience. I was getting my graduate degree in midwifery getting all of our degrees out of the way. Kind of like a lot of Silicon Valley couples these days. 

 

P: Yeah, 

 

K: and work experience and then decided on having a family also decided to go back and get a master’s degree which kind of threw a wrench in it all. But that’s, that’s okay. I was a professional as an as a certified nurse midwife at the time, and then we encountered some trouble getting pregnant and had to seek out some assistance there. So that kind of threw us for a loop because I had at the time done a lot of internships in birthing centers and home birth and just really had this dream of a beautiful waterbirth with my colleague in her birthing center, and all of a sudden those dreams came to a halt because we had to work on getting pregnant, not the most traditional way at home. So but we were pregnant with our first try through assistance. Twins. 

 

P: Wow. I remember when I was pregnant, and we got that first ultrasound, and they’re like, I see a heartbeat and I was like checking CVC and other one was keep looking around there. So that to me feels like a feels like a lottery win. When were you excited for twins?

 

K: I was not my husband was super stoked. He was like, oh two for the price of one. I immediately as a midwife, and having previously worked as a high risk OB nurse. I was stressed, worried about premature birth. Worried about being laid up at home in bed all the time during pregnancy. I was not excited at all. In fact, it probably wasn’t really embracing it until about halfway through the pregnancy.

 

P: So this is a difference between knowledge and no knowledge, which is you and me because I would have no idea what the risks are. So I like your husband will be like oh my god, this is so great. We only have to do this once. 

 

K: Right? And I was not feeling that and you kind of at the beginning of pregnancy in general. You don’t feel that great or most people don’t feel that great with morning sickness and just feeling really tired. I think with twins, you have a much higher risk of morning sickness. So just knowing that in my mind, I kind of went full force with all of the natural remedies like taking vitamin B and trying all of the other natural remedies like ginger and just making myself eat a snack every two hours regardless of how I felt. So I think that kind of stuff was really important at first I was also extremely worried about the future, looking all the way forward to school days with twins and parenting twins. And is it right to have them in the same class or not? And so I’ve all of a sudden had to like start reading general lay persons literature about parenting twins and trying to not look at it from a clinical perspective.

 

P: yeah, yeah, You’re right that it does obviously bring up 100 different challenges for parenting that you may not have. It just does having twins mean you can’t do the waterbirth 

 

K: correct

 

P: okay, so you also do that? 

 

K: Yeah. Oh, yes. During our pregnancy, we went to a cloth diapering class at my friend’s birthing center. And it was it was the first time my husband had ever been there. But I had been there to seeing as a student nurse midwife, and assisting in birth, I said, Hey, let me show you this place and we walked around and he was like, Oh, my gosh, this is seems so awesome. Why can’t we have the babies here? And I was just like, Oh, you just like crushed my dreams.

 

P: Yeah I’m on a slower learning curve with your husband there. It was. It would have taken me going as well to be like, Oh, this idea. So how was the pregnancy?

 

K: Actually my pregnancy went pretty well. Probably around 12 weeks of pregnancy. I let most of my co workers know. I was pregnant and they were super kind and took me off of night calls. So I didn’t have to do night call in the hospital.

 

P: So it occurs to me that very few professions would be so understanding about pregnancy in terms of what your schedule was like, is there are they just being kind or is there clinical evidence to suggest you need to sleep or you shouldn’t have interrupted sleep or anything like that?

 

K; that’s a Good point. I think that we know being mindful and having less stress is really important for pregnancy. And however, there’s not a lot of great supports in the workplace for that. We experienced this with all kinds of professions I do when I’m caring for patients. And they happen to have the night shift whether they’re working at Home Depot stocking housekeeper for a hotel or a nurse in the hospital. Yeah, and there’s really not much as a professional that I that we can do except for just saying, you know, it’s really important to manage your life when you’re not at work. Make sure you’re getting adequate sleep for me because I’m a nurse midwife. We work in the office so we have daytime work hours as well as nighttime work hours, and you swap back and forth a lot. So I think if there was another person in my practice that had a singleton pregnancy, the group might not have been so supportive. But knowing that this was twins and I think some people knew that it was challenging for us to get pregnant. They were supportive 

 

P: kudos, to practice for doing the right thing.

 

P: so I was impressed by the nurse midwives in Kristy’s practice before I did a lot of research but it turns out that researchers think there is a relationship between sleep and birth outcomes. There’s some studies in both humans and racks that suggest as you might expect, that sleep deprivation is associated with worse outcomes for mother and baby. It’s associated with higher rates of gestational diabetes in the mother, which is probably not super surprising. Since there’s a bunch of research about how sleep deprivation interferes with glucose metabolism in people who aren’t pregnant. But in pregnancy, this problem can be shared with the fetus and affect this development. One study found a higher rate of preterm births. Another found that sleep deprivation of the mothers was related to higher BMI. And higher risk for overweight or obesity in girl babies, but not boys. It’s nice to see a practice treating one of its own in a way that is consistent with good birth outcomes. Now we just need the rest of the workforce to follow suit and think more carefully about how pregnant women are treated since it fell in love who’s affected it’s also the baby which translates into public health.

 

K: I was still working a solid 40 to 50 hours a week. Yeah, it’s the removal of night call was extremely supportive and helpful. Yeah.

 

P: That’s awesome. So, so 12 weeks you tell everyone and you’re doing pretty well. And then for twin pregnancies, does it start imagining and starts to feel harder to carry the pregnancy just kind of physically earlier than it does for a single family? Is that your experience? 

 

K: Yes. When I was 12 weeks pregnant, my tummy was probably more like 18 to 20 weeks sighs maybe still you can hide it and scrubs. 

 

P: Yeah, 

 

K: at work. Well, yeah. And then around 30 weeks, I looked like I was gonna deliver. Yeah, it’s just extra heavy weight and little ones growing in there.

 

P: Are there any recommendations for twin pregnancies like different levels of vitamins or something else you’re supposed to do?

 

K: Yeah, I did do some early reading in the pregnancy and what I was basing it off of was like a twin mom book that I had read about vitamins and protein being really important to try to prevent preeclampsia in pregnancy.

 

P: One thing that’s interesting about talking to Kristy is that she’s in the medical field so likely in touch with the most up to date information. And in the last 20 years since she’s had kids, information, ideas about preeclampsia have changed. So for example, around the time when her kids were born, doctors used to say that preeclampsia resolves with the delivery of the baby in the placenta. And now doctors think that preeclampsia is not a condition cured. By delivery. And long term women who experienced preeclampsia are an increased risk for heart and kidney issues. Researchers used to think that protein intake might be related to the incidence of preeclampsia, as well as calcium, sodium, iron and folate. But now more extensive studies suggest that we can’t link protein or these specific micronutrients to the development of preeclampsia. So medical community has known about preeclampsia for something like 2000 years, but we still don’t know what causes it. Having said that, you can’t really go wrong by pursuing a healthy diet. The only trick there is defining healthy

 

P: are you at higher risk with twins? 

 

K: Yes. 

 

P: Okay. 

 

K: higher for gestational diabetes, preeclampsia. And so I just really managed my nutrition really well. And made sure my body was nurses like those cupcakes. Eating those I was like, I’m not doing it. I because I don’t have a lot of space, right? 

 

P: Yeah, yeah. 

 

K: So it has to be pure value if I was eating it.

 

P: That’s an impressive thing to follow. Because it takes a lot of willpower and you’re already tired with my first pregnancy. I was really careful about eating what I imagined in Olympian would eat. And with my second one, I was nauseous the whole time and only ate hotdogs and I’m a vegetarian. So it’s disgusting and under no circumstance should anyone consume that many hotdogs but I just I couldn’t I couldn’t hold anything else down so I’m impressed that you that you kind of traveled the straight and narrow….that’s a hard thing to do.

 

K: Well, interesting thing is, this was back so they were born in 2004. Yeah, so it was near the end of my pregnancy. I think I remember reading an article about professional article about mere mercury and fish and really the types of fish we should be limiting during pregnancy. Like all of that information started coming out. Yeah. One of the things was albacore tuna. Oh, my main sources of protein during my entire pregnancy was albacore tuna. So I stopped eating the albacore tuna probably about and went to chunk light tuna, probably only about a month before they were born. That was really science.

 

P: Totally, totally it you know, you’re you’re doing your best and you’re you’re better than Mrs. Hot dog. So that’s a we’ll take a week yet. So how far do you get to your in your pregnancy?

 

K: Well, that’s an interesting situation. They were born 39 weeks and four days. Wow. That’s 2004 Oh, so about I think it was about a year or two after that recommendation from maternal fetal medicine was that twins should be delivered by 38 weeks of pregnancy because of risks of the placenta, just aging and maturing a little bit faster and maybe not functioning as well. At the end of pregnancy, also risks of hypertension in the mom.

 

P; So did you make it to that late date intact? Is there any obvious cost to you for going longer?

 

K: But I worked all the way until 39 weeks? Oh, wow. I was living in Texas. We don’t have state disability there. So I had to work. And I actually I probably had preeclampsia in retrospect. And they were most likely some pretty solid signs of it starting around 37 weeks.

 

P: What so what happened that what happened that wasn’t caught by her practice?

 

K: well, I think there was this feeling of oh, she’s gonna be fine. When she lays down her blood pressure goes down. So a couple things we look at when there’s preeclampsia and pregnancy is maternal blood pressure. If it’s elevated, then that signs of at least hypertension, high blood pressure and pregnancy and then if there’s protein in your urine that’s a latter sign of eclampsia as well. So I had intermittently small amounts of protein in my urine, but when I would lay down my blood pressure wasn’t really elevated at all. So 

 

P: are the guidelines for the blood pressure positional 

 

K: not really like your body shouldn’t be shooting high blood pressures, intermittently like that? 

 

P: Yeah. 

 

K: I’m currently speaking about hypertension from my current knowledge and what the guidelines are currently. Yeah, this is back in 2004. 

 

P: Yeah, 

 

K: we weren’t as strict okay about hypertension in pregnancy. So I would go into the office and be checked and then I would take a couple breaths and my blood pressure would be fine. And then I would go home and I feel fine, no headache or anything like that. And then at 39 weeks, in a couple of days, I had an office appointment. And my blood pressure was sustaining of pretty high, pretty high numbers. In that practice. I was sent home to rest with a plan to be induced the next day, when a bed opened up. If I had at that time if I had seen a person in my practice with those blood pressures. He would have said Beeline it to the hospital right now. But I was in a different practice slightly different guidelines at that time. So I said, okay, I’m fine to go home because I’m in my heart. I didn’t want to be induced. But clinically, I knew it was right to be induced.

 

P: Well, that sounds like a tricky thing. And advances in medicine take a really long time. This doesn’t seem all that long, right? It’s like 17 years. Right? So it’s interesting how much we have learned about pregnancy in the since well, I have a 2004 birth also. So since those kids yeah, I feel like a lot has changed. 

 

K: I’m going to rewind a little bit. So just share one of the things about twin pregnancies, 

 

P: yeah. 

 

K: And route of delivery though. So it’s in twin pregnancies. We have to be concerned about the two babies and the position that they are in the womb. So ideally, you have babies in the womb that are both head down. And we checked out at the end of pregnancy and if a person’s desiring a vaginal birth, and we move forward with plans for vaginal birth twins are both head down. 

 

So in my pregnancy at around 28 weeks, first baby twin A is head down but Baby B was Baby B had prior to that then head down or vertex so he continues to be breach breach breach, and I started going bonkers thinking I’m not having a cesarean birth and talked to my OB was in support with my midwife and I said I know you have a lot of experience with a breech extraction. And we need to have an honest discussion about this because I really want to have a breech extraction with Baby B. And he kind of was not giving me like an absolute solid answer on that. Well Kristy, we’re just gonna kind of roll with it and see how it goes. And let’s just seeing it that baby turns. I start getting stressed about this and start at around 

 

P: thats  a stressful answer. 

 

K: right? I think it’s yeah, it probably didn’t help that my husband is an attorney either. So we have a midwife patient and houses an attorney and honestly, so I enlisted some support of local pregnancy natural support people in Houston. First I went to my acupuncturist said we got to do something to help this baby turns her head down and they’re like, no, what we’ve got we we do have tricks for that, but not when there’s a twin pregnancy. You can do some acupuncture to help with relaxation. Oh, I did that. Then there’s a doula massage therapist in Houston at the time, who was known for pregnancy massage and helping open up the lower back and the mostly the lower back of, of the pregnant woman at her hips. In her massage techniques, and frequently breech babies would turn to head down. So I started seeing her like two to three times a week, around probably around 35 weeks of pregnancy. It wasn’t cheap. It was well worth it. Initially, I knew there was an OB physician in Houston. That’s known for his technique at doing vaginal breech births, which now is more of a lost art, especially for the first time mom and I had actually like looked into going to him to transfer care. It was like 37 weeks of pregnancy. 

 

P: Yeah, 

 

K: really late. 

 

P: Yeah. 

 

K: So if I did transfer care to him, though, it was going to be extremely tricky. It was going to definitely be induced labor because of his call schedule and where he worked. It was going to be a lot more medicalized than I was really desiring so I decided to stick with my team. I was super nervous about being in the hospital, even though I work in a hospital and literally went on two tours of the labor and delivery unit with my midwife. I was just like, oh, I have to see where I’m going to be. I have to see the operating room. I know I’m going to give birth in there so I’ve got to got to feel comfortable here. So fast forward to about that 39 week visit where my blood pressure is going up. We do an ultrasound and lo and behold, Baby B is head down as well. 

 

P: Oh, Wow, 

 

K: so I’ve got two babies that are heads down. And at this point, I was like, Okay, this is great. I’m totally on board with being induced. I know I have high blood pressure. This is a bummer but I can do this.

 

P: Is it riskier to be induced? What if you have high blood pressure?

 

K: not necessarily, I mean, it’s risky to stay pregnant, 

 

P: okay. 

 

K: Depends on how high your blood pressure how high the person’s blood pressure is, and if we can control it, so sometimes there’s people depending on where they are in their pregnancy in the way the baby’s laying that do need a cesarean birth as a  result of their high blood pressure, okay? 

 

P: but You’re not that person. So, now I’m imagining your bag is packed and you go in for your induction.

 

K: Well, my bag is packed. And I go home and I from the office and I sleep right? And then we call the next morning. We’re ready. Like when should we go in and they’re like, You know what, we were really busy all night. We don’t have a bed. So, 

 

P: wow. 

 

K: So eventually that evening, have a bed for me. And so we go in to be induced 

 

P: and how did that go? 

 

K: We get there and one of the midwives from the group, probably I would say the people always have personality clicks, right. And so she’s like one of my favorite midwives in the group. She was on call that night. So she comes in and she checks my cervix. And I was thinking I was like, you know, maybe a half a centimeter dilated or one because my physician the day before checks me and she looks at me with all honesty and she said you know, Kristy, I think doctor was really generous. Yesterday, your cervix is rock solid. 

 

P: Oh 

 

K: hard and you are not dilated. So I’m just gonna start this induction

 

P: so you’re starting from ground zero 

 

K: there is what I’m starting from ground zero and we started with Pitocin and my IV from ground zero.

 

P: Well, that doesn’t sound comfortable already.

 

K: Really, but here’s the thing. Things that happens when a woman has preeclampsia and I’ll be honest, I don’t truly understand the physiology of this but a true a person with true preeclampsia many times once their body is into labor, they just go and their bodies like we know we have to cure this by delivering the baby in my case babies and placenta so also as pretty. I feel like I’m fortunate my mom has really good birthing genes. She’s just kind of like that person that accepted labor contractions and just went with it and had a baby in a normal ish amount of time. So I just kept thinking about my mom during the labor and go and thinking like I’ve I’ve got my mom’s genes on my side, I can do this. My husband and I did have a doula with us. It was someone that I had worked with in the community, so I knew her do her techniques. I felt super comfortable with her. 

 

So she was there for our labor. The beginning of the labor, we started with Pitocin it was a little rough. I had a newish nurse caring for me. So this was the hard part. Because remember, I had been a nurse before I was a midwife I have ideas and how a nurse should be 

 

P: Yeah, yeah. 

 

K: And I don’t think we were a good personality fit. That’s okay, but one of the things for me was don’t offer me pain medicine. I’m very much aware of what the options are. I’ll let you know if I want it. And the first couple hours all of a sudden into labor I just had some excruciating pain in like, of my lower quadrants on my abdomen and it would not let up at all.  In retrospect I think it was probably one of the babies like just elbowing me and was just like, This is what I’ve got to do to come out so deal But The team was pretty like worry about my level of pain, because it wasn’t related to contractions. It was like this severe shooting pain and rare but we’re always concerned what if there’s a spontaneous uterine rupture like it’s thin and it ruptures or something we’re more concerned about that of course and someone that’s having a vaginal birth after cesarean but the twins do create an over distended uterus, so we turned off the Pitocin for a while. And the nurse of course offered me pain medicine. 

 

And I was like, we’re not going there. My doula will be in in just a moment. And I think like at that point, I was probably only like, one and a half centimeter dilated or maybe even one. Like I knew this was gonna be a long night and a long next day, and I’m sure everyone in the background was like just shaking their head and rolling their eyes at the midwife laying in the bed in room, whatever. But my Doula Nadia came and when she was there, I just felt like super confident and comfortable. And something just changed. And I said, let’s start that Pitocin backup. Come on, like we’re not going to sit here all day. 

 

P; Yeah, 

 

K: or really. It was at night. And I think we started the Pitocin backup around midnight. And things just truly picked up at that point in they did not have any option for like cordless monitoring or anything like that and the bathroom was across the room from the fetal monitoring.

 

But I felt the best sitting on the toilets. So I had every like side effects like nausea, vomiting, and and I was like, Well, I’m gonna I’m gonna go to bathroom. I need to go to the bathroom. And I just kept getting off the monitor and going to the bathroom. And I begged my midwife please can we just like let me take five minutes shower. Like because I was trying so much just be in the shower because I knew that water is like what we call an agua dural. So water is super helpful for support but I couldn’t be in there. Because they had to monitor the high risk pregnancy. And keep in mind I had high blood pressure too. My midwife had to come in and give me a little lecture on how it was really important to be on the monitor. So we went back to the bedside, and I was on the monitor and then the nurse kept fiddling around with the monitors on my tummy which drove me crazy because the night before I got into so I broke out with a rash called pups, which is an itchy rash all over it was all over my lower abdomen and thighs. 

 

And so I was extremely sensitive to fetal monitors. I was just getting annoyed with them adjusting them the whole time. So my bag of water had broken and my husband was super stoked and excited things are moving along. And Nadia and I just looked at each other and we’re like, we’re not gonna make a big deal out of this out the bag of water breaking and we just kind of just kept laboring because we felt like the more the nurse wasn’t in the room, the better it was for my mental state and progress, which absolutely was true. They should have changed I should have asked for a different nurse or they should have changed us or something.  Bad personality fit but that’s okay. 

 

At Some point my husband goes outside to get ice and water and he’s just so excited and he tells the nurses all we think her bag of water broke about an hour ago.

 

P: Oops.

 

K: Exactly. So Nadia and I when we heard that, that he did that we were just shaking our heads because we knew we were like doing this on the down low or not telling anyone because we knew the babies were fine like listening to their heartbeat. And we knew that they had central monitoring outside of our room and they could see their heartbeat tracings. So it was fine. So the nurse comes in, you know, we get scolded, how come you didn’t tell me? Because everything’s fine. That’s why we didn’t tell you I literally I had to calm her down. I said because everything’s fine. That’s why we didn’t tell you. And then she, she looks through the pads and she’s like, there’s Meconium in the amniotic fluid. I said yes, there is. It’s like meconium but everything is fine. So there’s nothing we’re going to change about this. We’re just going to keep supporting my labor. I mean, I’m having to labor support my nurse, literally so as much as possible that we could get her keep her out of the room. It was great. 

 

At that point I said you know what, I’m I’m done with you pressing around on my tummy. Can we just put scalp clip on baby as head because it’s hard for you to monitor and I can’t I can’t handle you touching me all the time. And so we agreed to that. I was four to five centimeters already. I was probably like, at three in the morning. Literally. We started Pitocin around midnight, and that was probably around three or four in the morning. 

 

P: That seems fast. 

 

K: oh Yes. It was. And I was really like, don’t really want to be in my mind. I was like, I don’t want to be checks because in my mind I was thinking oh my word. I’m only going to be one centimeter and it’s going to be so depressing. I don’t want to know that I’m one centimeter but I’m bracing myself mentally. I can do this if I’m one centimeter right. And then she’s like, you’re like four to five. Okay, that’s pretty impressive. We put the scalp electrode on the baby and then probably about an hour and a half later I’m still standing at the bedside standing getting on my hands and knees just moaning with each contraction and just taking one at a time. No pain medicine at all. And then probably about an hour and a half later. Started like showing signs of transition shaking. Things were just getting really intense. 

 

I think we had to check on one of the babies or something at that point. Or it could have been a time when Titi was telling me I needed to stay on the monitor again because I was sitting on the toilet a little too often. And so she checked me and I was already seven to eight centimeters. 

 

P: Oh Wow. 

 

K: It was really intense. Pretty sure she left the room and went and called the doc because he was probably at home I’m assuming to say hey, you’re not going to believe this or midwife twin patient is almost complete. And so about an hour, hour and a half after being seven centimeters I was fully dilated. 

 

P: Wow. 

 

K: Yeah. 10 centimeters and bearing down spontaneously. 

 

P: Wow. 

 

K: Yeah. Kind of how my mom’s? I think labor went like smooth that way. Like literally like I really only had like six hour labor though. 

 

P: Wow. So is the delivery smooth now that we’ve gotten complete,

 

K: right? So my doctor, he comes in and he’s just like trying to you know, talk to me and I’m just having contractions back to back. And I’m on my hands and knees and I just keep looking at him going.  This is so hard. This is the hardest work I’ve ever done. This is so hard. That was my mantra. I never said like, I can’t do this. How much longer nothing like that. I just kept acknowledging how challenging the situation was my doula and I didn’t really want to start pushing in the operating room. We really were hoping to like do some of the pushing in our delivery room but with twin deliveries, you need to go to the operating room for the just in case 

 

P: Yeah, 

 

K: there was a scenario and my midwife told me, Oh, Kristy, you’re doing great. You’re not going to push that long. Which I will never say that to a patient because that was the longest hour in my life. So we go to the operating room, and unfortunately in the operating room, you’re laying on a table meant for surgery. It was much different than my my ability to be free standing or on my hands and knees and moving around and squatting. And I was just laying there and with my over distended tummy it was plopping over to one side or the other was very challenging to get my pushing efforts together. There’s probably about like 10 or 15 people in the operating room, which I didn’t really feel or notice, because I think I was used to that. 

 

P: Yeah, 

 

K: but my husband was like, Oh my gosh, what’s going on here? So we just working on pushing a lot of like the nurses had to do a lot of coaching. Eventually, they pulled in this nurse who I had actually worked with when I was a labor and delivery nurse before I was a midwife, and I really admired her and thought she was a great nurse. She just got in my face and was really screaming at me like come on, you can do this. You’ve got this that’s exactly how to do it. And that is truly what got me to help birth my baby. Some people really want to have a calm pushing experience. But I needed somebody to be in my face, coached me through this to give me the feedback. 

 

Additionally, I was like, Wait a minute. It was just running around in here and nobody’s helping me hold my tummy. I was lucky enough. They let my Doula go in. And I think that’s really because possibly my persistence and me being a midwife, and they knew that we had this really good teamwork bond going on. 

 

P: Yeah. 

 

K: And they also they they knew this doula really well. And so usually you can only bring one person into the OR with you but husband and doula both gotta go. And Nadia knew her place and she sat there and she just like worked with me and helps me.  She helped hold my tummy in place. And then I was like, Don’t you know, have a mirror in here so I can see what I’m doing. They got that mirror in there and the nurse was super helpful was coaching me then we had baby A.  so Baby A was born and was handed to the pediatric team I barely got to see are our babies were our their genders were surprised. So that was exciting. 

 

P: that is exciting

 

K: it was a little girl. And I totally didn’t believe my husband when he announced it. That was one of the like the the most important thing I had a birth plan. The most important thing to me on it was nobody announced the gender of our children let my husband look and say it’s everything out like if I got an epidural or something like that, I’d be okay with it. That was the most important thing. So he told me and I was like you got to be like, I don’t believe this. I said, Okay. And then I just remember looking up at him and going, Oh, my God, I got to do this again for the next one. So at that point, there’s in a twin delivery there’s a lot of poking and prodding and everything into the vagina and feeling the cervix and breaking the bag of water and think, you know, ultrasound on your tummy to check the position of baby B and that was that was pretty stressful. So we confirmed Baby B was head down. they broke the bag of water which Ideally,

bring the baby’s head down to the cervix and then you just push the baby out. That’s not what happened in my case. 

 

So my cervix moved back to be about eight centimeters dilated 

 

P: No, 

 

K: yes. But I didn’t know that. And baby’s heart rate started having these huge dips, which I was not aware of because part of me trying to be mindful and in the moment of labor and birth was I absolutely didn’t follow. I didn’t look at the fetal monitoring or anything like that. I was not interpreting anything that was going on. I just said, You know what, I’m just going to take care of each contraction at a time, push the babies out. You’re my clinical people. Trust that you’re monitoring the monitors. Right? 

 

P: Yeah, 

 

K: It’s not my job. My job is to go through labor. Not a midwife today. Oh, I didn’t know his heart rate was doing all these changes. Everyone in the room starts to get a little worried. Doc was in there and you could see the look on his face like oh, he’s like, listen, we have to have a true discussion here. Baby B’s having a lot of decelerations on the monitor. This doesn’t look good. I’d really like to deliver baby soon. But we can go through a few more contractions and see how it is a baby will tolerate it. So we go through a few more contractions and at this point, they turn the volume up on the monitor so everyone knows what’s going on. And then I hear it and I can just hear the dunk. Which is a very slow rate, right? Oh, yeah. And I was just like, Oh no, this isn’t good. I practically sat up on the operating table and I was like, I give you permissions. Put a vacuum or forceps on baby B right now. Let’s just do it and he looks at me and says, You know what? I can’t do it. You’re only eight centimeters.

 

P: Are you surprised by that? Is it normal for the cervix to close? Well, there’s another baby in there.

 

K: I mean, it could but it’s not that like usually in all of my experience. Between deliveries. You break the bag of water. The baby mom bears down the cervix stays dilated. 

 

P: Yeah, 

 

K: you have the next baby. There’s usually like a, like a 10 minute difference in their age or something like that. 

 

P: Yeah. 

 

K: No. And so we try a bunch of position changes to alleviate heart rate changes, and that didn’t work. So I decided that I needed a cesarean birth for the Cesarean birth though I remember I don’t have any pain medicine. 

 

P: Oh, yeah. 

 

K: So I just started to mentally prepare myself that I was going to have to have general anesthesia be put to sleep 

 

P: because that’s faster acting than a seat get an epidural. Right?

 

K: Yeah, I started to get like a little teary eyed and freaked out but I was like, I can’t do that. Because if I’m freaking out, going under, I’m going to be freaking out coming out. Need to just calm down. And I remember the anesthesiologist, just saying in his like lovely think it was a British accent. Listen Kristy just roll over to your side and push your back out and let me see if I think I can get a spinal anesthesia in you really fast. And I was probably the most compliant person ever. 

 

I rolled over. I was laying there for probably like two minutes, maybe three, pushing my back out towards him. Watching the fetal monitor and watching that baby’s heart rate go super low. And then he’s like I got it in control over now. Oh, who’s like the most grateful person ever? Because that is not very common. 

 

P: Yeah, 

 

K: it was literally like three minutes. I rolled over. I looked at the team and I said because you have to have a Foley catheter in your bladder before surgery to keep your bladder empty. And I was like, alright, team, let’s put in that catheter and let’s go then I was kind of a midwife telling them what to do. Then they started the Cesarean birth, and I looked up at my husband and that was really scary. I looked at him knowing what I saw on the fetal monitor and I said this might not be good. It might not come out screaming and crying right away. That’s why we have this neonatal team in here. We’re just gonna like, be calm right now, but this might not be good. And that was sTinker came out. screaming and crying. 

 

P: Awesome. Well done. 

 

K: Yeah, I joke now that it was a vaginal birth. One vagina, one abdominal.

 

P: I feel like you’ve coined a useful phrase here.

 

K: Yeah. I’m like super grateful for the anesthesia team for their skills. Getting that spinal anesthesia in me. I’m super grateful because like, literally that was about three minutes. And they’re under some stress. 

 

P: yeah, Yeah, 

 

K: trying to feel through this and also thinking like, I’m not gonna mess this one up. Yeah. You any wasted three minutes. 

 

P: Yep. Yep. 

 

K: So I’m very grateful for that. Then my husband was like, Oh, we have a boy. So we had a we have a girl and a boy. And I was like, that’s great. Make sure he’s tagged and there there was a nursery and I was like, I need to recover. I’m extremely nauseous and vomiting right now. I can’t enjoy these babies. Send them to the nursery. 

 

P: Yeah, that’s probably smart though,. Right? That that is again, like I think evidence of what real knowledge is helpful for? 

 

K: I think, yes. So for me, I needed to take care of myself so that I could start parenting them better. Yeah, and a couple of hours. I really had to get past the nausea and vomiting because that was horrible. And then I was confident about, you know, the security and the nursery. So going into pregnancy, I thought I was going to have this like singleton waterbirth at my friend’s birthing center, and waddle back to a queen sized bed and have that bonding golden hour after birth with a baby on my chest. But I didn’t I got to see them about two hours after birth. And they were on my chest for months and months after that. 

 

P: Yeah, no, honestly. It Sounds like because you know so much you kind of expected from challenges in your pregnancy and that went pretty well. I mean, that went shockingly well, to make it so late.

 

K: Yeah. I just had to like mostly let go a couple times. I called my Doula one time when I was at work, and I was like, I think I’m having contractions. This is so stressful. I put myself on the monitor and she’s like, Kristy, you gotta take your clinical mind out of this. Go with what how your body’s feeling. I want you to lay down right now and be patient and her support in that sense was super helpful. I wasn’t that person that went home. And listened to the baby’s heartbeats with a Doppler all the time. I have my own Doppler. I could do that. 

 

P: yeah, Yeah, 

 

K: I only did ultrasounds during pregnancy when I needed them. I didn’t I never did them for fun at work. Because I was worried not even to check position. 

 

P: yeah. 

 

K; So I’m, I mean, I’m grateful for my ability to be able to do that. Well, and the support of my Doula friend.

 

P: that seems amazing. Since your kids have been born. Have you seen any other twin births like yours?

 

K: I have not. I don’t think so. Something I’ve been present. Of course, there have been people in our practice that have had vaginal and unnecessary and but most of the time, I have not either somebody chooses to have an elective Cesarean birth for twins, or they have successful vaginal birth times two 

 

P: that is totally interesting. 

 

K: Yeah, one of my best friends who is a labor and delivery nurse, I would have wanted her to be with me if she could have been with me, but she was living in a different state at the time. But she hears my story and she’s sometimes a little bit more on the high risk end and I’m on the low risk end of like, how things go and how we approach and and she’s like, wow, that’s a bummer. Wouldn’t you have just rather just had a cesarean birth to begin with and I was like, No, I got to experience labor and birth 

 

P: yeah, Yeah. 

 

K: And even if I had gotten an epidural, I still would have experienced labor in my mind, but I am happy that I truly experienced a full labor and vaginal birth without an epidural.

 

P: My guess is it’s a boon to your patients. That You have this pretty wide experience in one pregnancy, 

 

K: I could have a better idea of how they feel. 

 

P: Yeah, 

 

K: you know, actually on that note, like it’s, it’s definitely helped me coach people and be genuinely honest with them before having a cesarean birth and what their recovery will look like. Because we talked to people about to cesarean birth, and we’re just really, oh, these are the risks, you know, infection and bleeding and da da da, but we don’t really talk to them much about the sensations, yeah, of recovery. Say a little bit about like, what you might feel during the actual birth, but not all of the recovery, but definitely has helped me change the way I speak to people before Cesarean birth, how their recovery is going to be and also just being supportive with them, even a year after their Cesarean birth if I just meet them for the first time talking to them about the sensations they have, because there’s a lot of things that go on with when your nerves start waking up and the sensations like on your skin level. The tingling and the itching and pulling in the corners of your scar and how weird it is. 

 

P: Yeah, 

 

K: and that’s ignored. 

 

P: Yeah, I mean, that falls into the giant, bottomless postpartum bucket in which wrecks many things are shoved right without examination. How was your postpartum with twins?

 

P: There wasn’t much sleep. I forced myself to take a nap every single day. The whole time. I was on maternity leave, which was only 11 weeks so 

 

P: oh, Wow, good lord.

 

Let’s talk real briefly about maternity leave while we’re on the topic. The US currently ranks 36 Rock Bottom among OECD countries for the carrot provides new parents for maternity leave. Probably everyone listening heard that the attempt to pass a paid leave bill is precarious right now in Congress. current federal law requires 12 weeks of unpaid leave for companies with at least 50 employees. Basically, this leads to about 12% of Americans getting paid leave for 12 weeks. States have passed their own paid leave bills in 2018 and 2019. And these states are basically on the east or west coasts, and they vary in their generosity.

 

K: I was in Texas and I didn’t have a lot of benefits and I guess it was just all I got was my FMLA. That’s it.

 

P: here FMLA is money from the Family Medical Leave Act.

 

K: So it was 11 weeks and the whole time I was on maternity leave for 11 weeks. I made sure I took a nap every single day I was scared to death of getting postpartum depression because I had the blues that was definitely apparent and I probably had some depression but just kind of worked my way through it, keeping my chin up and acknowledging it and taking naps and then once I went back to work, I only went back to work part time which I’m super grateful for my employer, allowing me to change my status. I only worked in the office, so I stopped doing call in the hospital, but every single day I was off. I still took a nap. So we were woken up frequently for a very long time. In fact, our children didn’t really ever sleep through the night until probably about three or four years old. And I nursed 100% A little over a year. 

 

P: Good lord. Wow.  that’s a lot of work…

 

K: I had helped a lot of people with breastfeeding and nursing and the minute they came out of the nursery, I was like alright, we got to nurse these little babies and did send them to the nursery. Again to try to get like a three, three or four hour solid nap in because I was like this was like maybe day two postbirth is one of my midwives from the practice came in to round on me and I got an earful in a lecture from her about how silly it was to send those babies to the nursery. They needed to be with me mammals are never left by their left by their mom, almost pulling their baby cubs every two hours to offer them milk to keep them alive. They need it for survival. I loved Theodora she was also one of my other favorite midwives in the group for background was breastfeeding support and also doula support. The babies had already been latching and stuffing perfectly so I was feeling like pretty overly confident. That’s why I sent him to the nursery but she she must yourself into that nursery brought those two babies back and was like, alright, what is it then you need to nurse them for survival. And honestly with that little pep talk and lecture. I didn’t have any issues with milk supply. I mean, I had to work hard when I got back to work and I was pumping and all of that would pump in my car on the way to work and do crazy things like that, but I never had to purchase formula.

 

P: and Now there have one foot out the door for college right?

 

K: Mm hmm. 

 

P: Amazing. 

 

K: Yep. 

 

P: Thank you so much for sharing your story.

 

K: Thank you

 

P: Thanks so much to Kristy for sharing her story and her insights about pregnancy in general and twin pregnancy, given her professional life as a midwife.  And thank you for listening. We’ll be back soon with another inspiring story.

Episode 33 SN: The Hard Limits of Control Over your Own Body: Melissa’s story

Today’s guest walked into pregnancy with reservations. She’d done a fair amount of research, as is her way, and understood that pregnancy, birth and postpartum were potentially a more difficult undertaking than movie depictions suggested.  Despite her avid preparation, she was, like most of us, taken by surprise.  She had to manage a hemorrhage during a miscarriage, and a birth experience that both tested her physical limits and her emotional resources, as her newborn required some experimental medical help. A few years out from these experiences, she can look back and appreciate all that she went through and what she learned from the experience, and revel in the joy of her energetic toddler.

LH

https://medlineplus.gov/lab-tests/luteinizing-hormone-lh-levels-test/

https://proovtest.com/blogs/blog/will-an-ovulation-test-be-positive-if-i-m-pregnant

Hypothermia for brain injury in neonates

https://www.nature.com/articles/pr2016198.pdf?origin=ppub

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. Today’s guest walked into pregnancy with reservations. She’d done a fair amount of research, as is her way and understood that pregnancy, birth and postpartum were potentially a more difficult undertaking than movie depictions suggested. Despite her avid preparation, she was like most of us, taken by surprise, she had to manage a hemorrhage during a miscarriage and a birth experience that both tested her physical limits and her emotional resources as her newborn requires an experimental medical help. A few years out from these experiences, she can look back and appreciate all that she went through and what she learned from this experience and revel in the joy of her energetic toddler. After a conversation, I went back into the interview to include some medical details and to get the insights of a fantastic OB and a pediatric critical care doctor.

Let’s get to this inspiring story. 

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

 

Melissa: Yeah, my name is Melissa Tamara, I’m from Salt Lake City, Utah, in the United States. 

P: Cool. Let’s talk pregnancy. How many kids do you have.

M: Yeah, so I have one daughter who’s biological and then I have a nine year old stepson.

P: Okay. It sounds like you have child experience with your stepson, so we’ll get to that. But, before you got pregnant with your daughter. What did you think pregnancy be like,

M: That’s funny because I literally thought it was gonna be hell. And it was.

P: wow… you’re like the first one to nail it, so why did you think it’d be hell.

M: me as a person, I’m very much like a data driven individual. I will do research at friggin nauseum, to try to understand what I’m getting myself into, before I get there, just because I really like to make as many educated decisions in my life as I can. kids was one of those funny things in my life where I was a bit ambiguous about it, like, kind of, If I could get pregnant okay cool if I couldn’t get pregnant. Okay cool, like, it just didn’t have a huge tie to it, but I married a Latino man. And he obviously has a child already, and so he was very like, I want more children and I kind of was just like, alright, well if you feel passionately about it then. I’m just kind of along for the ride, but I have friends who’ve had children before I did. Some of them loved pregnancy, some of them hated pregnancy and so I feel like I got a good amount of stories beforehand, related to like what pregnancy is like it did a lot of research when, you know, we were getting closer to a place where it’s like, okay, we should start thinking about having kids, and a lot of research on that. Lots of horror stories literally everywhere, and so I felt like I had a decent understanding as much as one can before 

P: Yeah, 

M: get pregnant, right. I don’t know that I knew the extent of how bad Mine would be, but I knew that it wasn’t going to be fly but

P: okay so was it easy to get pregnant

M: I was, I’ve been on birth control probably since I was like 14 or 15. So and, to be completely fair I’ll be 27 this year so I am very young, and got pregnant, pretty young as, like, the world standards go. So, I was on birth control, starting in about 15 ish and was on birth control, up through when my husband and I decided that we were ready to start having children. It took me probably four months to regulate and kind of come off of birth control, and then I got pregnant. Oh, not a huge amount of time as the first pregnancy goes, but I was 11 weeks along. When I lost that pregnancy.

P: Oh wow. 

M: Yeah So, total for us to conceive my daughter. It took about a year from when I got off birth control when we started actively trying to update to when I got pregnant with my now daughter. So, you know, not a terribly long time but you know there were obviously some hiccups along the way. 

P: The miscariage must have been a surprise

M: Yeah, yeah. It’s one of those weird things where, I should also mention, I think bodybuilding before, which, you know, no in hindsight, like when you have a miscarriage, there, there’s no way unless the baby’s like really far along, and they can do an autopsy, they, they can’t really tell you like what happened if you have a miscarriage in the first trimester, so they just kind of attributed it to like, oh, there’s just some genetic thing that happened in the body was like nope, not working, so I was a bodybuilder is very low in weight going into trying to get pregnant, which I tend to think may have caused some problems. It also is possible I guess it could have been, birth control or it could have been any number of things right.

P: so I’ve heard this before, in cases where people are ultra athletes like Melissa, that they sometimes have trouble getting pregnant or staying pregnant, so I took this question to an OB. 

Hi Dr Matityahu and thanks so much for coming on the show.

Dr. Matityahu: Thanks for having me. I love being on your show. 

P: What’s the relationship between body fat and menstrual cycle and pregnancy, how does that all work. 

Dr. Matityahu: So, there’s a fair amount of evidence out there about really low body weight and body fat and how it can impact our ability to regulate well need to be ovulating well to pregnant to conceive, and the fat in our body converts to hormones. So the, our body fat has a lot of impact in the whole cycle of creating estrogen in allowing us to ovulate.

M: So, got pregnant, was really excited about it and immediately gained, like, a whole bunch of weight, which now obviously looking back, I’m like, Oh yeah, it’s because my body was like, we don’t have enough weight to like sustain this pregnancy, right. So I gained a bunch of weight, I wasn’t nauseous at all which I came as a surprise to me there were a lot of things that I’m like oh this isn’t as bad as, as I thought it would be, which who knows that could have been a sign right that things weren’t right, but had about, I think it was maybe, I think I was just before 11 weeks. When I started spotting and right before that I had this weird feeling of like Something’s just not something’s not right. Like I’m almost 12 weeks at this point like things just don’t, I don’t feel pregnant, it was that thing of like, I just don’t feel like I’m pregnant, which in your first trimester, obviously like that can happen, right, like there are times where anxiety kicks in and you’re like I’m not pregnant anymore and you freak out. But for me, I had this just this gut feeling of like something’s not right. 

It was a Monday morning, and I woke up, I started spotting, and I remember being hysterical. I remember being in the kitchen with my husband, bawling just hysterically because I knew, I knew I was having a miscarriage, it was just like the combination of things, I knew what to look for as far as like this was different than implantation bleeding which I did have in the very beginning stages. This was different, and so I told him, like we need to go to the emergency room because I was freaking out. He, he’s like, no, no, it’s fine. I’m sure everything’s fine. You need to calm down, go to work, Call the OB GYN when you know they open at 9. So I went to work, of course I’m a blubbering mess, I can’t get any work done for the first hour I call my OB GYN have me come in. 

My husband had to go to work, that morning and so I could not be at that appointment, and when I got that appointment they told me that they couldn’t find a heartbeat. And so, to go through that and go through that alone to you know. 

P: yeah, yeah

M: It’s one of those things that, in my adult life. It was a huge shift, I went from being an ambiguous about being a mother to all of a sudden, like, Oh, my God. Like I didn’t realize how much I wanted to be pregnant and to be a mom and to do all the things right. And I remember the conversation that my OB GYN had with me, and she had to walk through all the things of like, this is not your fault. This is not something that you did, there’s no real reason for this to happen, so don’t internalize it, but that’s a nice fun thing to say to somebody like but the nice thing you’re like oh yeah don’t internalize it and then you’re like, great. I’m gonna go and cry. So, they then you know present you with three options of, you can have a DNC, which is where they physically remove everything, and a lot of times your sedated for that. They allow you to have a pill like a Cytotec where you met you know you insert the medication, or you can basically just wait for nature to take its course, so I didn’t like the idea of nature taking its course can last up to like four weeks, And I didn’t know what I was getting into, so I was like, I’m not going to go that route, but I also didn’t like the idea of having to like schedule this surgery this like minorly invasive surgery, so I was like, just give me the pills. Luckily, you know, when I told my bosses, I was able to take, you know funeral leave is what they gave it to me as to handle this problem, and basically pass all the tissue and deal with the emotional stuff that was going on and kind of all the things I was very fortunate in that respect, I know people don’t always have that where they like to just keep going, which is crazy to me.

P: It is crazy, and I’m impressed with your bosses for kind of calling it what it is, right, that’s impressive thing to do, and I’m so sorry you went through that, it’s so hard at the cusp of the second trimester. 

M: Yeah, 

P: but I’ve think heard all kinds of numbers tossed around about how frequent miscarriages and it’s obviously, we have miscarriage too, as someone who has had one, you know, there are many people who don’t realize they’re miscarrying so how could you count it accurately. But if you knew it was you know one and for you, it may be easier to not internalize it, because that’s just, you know, you roll the dice and that’s what happens, but But it’s hard not to not to take some ownership of it, given that it’s in your body.

M: right. our whole instinct is like around protecting this life, not to get like too primitive or whatever but if you get to like caveman thought processes is like that’s what you do as a woman, it’s like in your nature to bear children and care for those children and bring them up to be humans and so I think that when you have a miscarriage, there’s just this primitive instinct of like how do I prevent this moving forward, like how can I fix this. And so immediately your, your brain starts going into like overdrive of like, I’ve been drinking coffee like maybe I should, I need to give up caffeine oh I had a glass of wine before I knew I was pregnant maybe that did something like, just all the things. And it’s, it’s traumatic There are some people that I’ve talked to that seem to handle it better than others but for me, it, it was traumatic. And we ended up having complications with the actual tissue like coming out, it didn’t all come out and so when I went back to my one week appointment where they like check to make sure that everything’s fine that everything’s gone. I assume you’re fine with like some graphic described 

P: yeah yeah yeah blood and guts are welcome. 

M: So, so you know they have the lawn right now, but the wind up in there to poke around and make sure everything’s gone.

P: If you’re unfamiliar with it, the ones that Melissa is talking about is, interventional ultrasound.

M: And so she has his wand up there, which we thought this appointment was going to be just super standard so my husband ended up getting called into work and he had to go. Luckily, a friend of mine when I told her that my husband was not going to be able to be there she insisted that she come, which in hindsight, I’m really thankful for, but anyway so I’m in this office. She’s got this one up there, and my friend is standing here next to me and she says, it looks like not all the tissue came out, it’s not a ton but it’ll probably shed here in a couple of days, we should probably make you another appointment to like double check that it goes away, like okay no problem, you pulls the wand out and immediately. Like, I hear. Just like splashing all over the floor, and I’m like, plus I can’t see what’s happening. And so immediately she’s, you know, she springs into action and starts yelling out the door to get nurses to come in with some big long needle full of stuff and she goes, it looks like you’re hemorrhaging I have to basically scrape this tissue out and cauterize whatever’s causing this like immense bleed  and you know I see blood like spattered up on the walls and it was so crazy, so this nurse comes in and she has to numb my uterus, I remember shaking so badly like just, I’m assuming from adrenaline, they’re doing a DNC and they numbed everything up. And so I’m awake, and they’re doing this DNC inside of this like doctor’s room in a clinic, it was so bonkers to me to go through that and oh my gosh like I never would have thought that something like a miscarriage, would result in this crazy chain of events, you know with miscarriages, especially because people don’t talk about them a ton, I don’t think people realize that like, there can be a complication there, there are things that go on when you have a miscarriage that can be very challenging and very traumatic and you know all these things so that was like traumatic event number, like, two at this point. So,

P: good Lord, I’m really sorry about that, that sounds very difficult given that you research everything, like the shock on top of it to be like What on earth is going on like I’ve never even heard of this, it’s sort of amazing, I had no idea that they could address it in a clinic.  did you need a blood transfusion do they make you stay there, like how do they handle it, so they

M: they made me stay for a little while to make sure that like everything, stabilize but it happens so quickly and I tell you, when I set up after everything was like over and done with, because they had to give me water and you know something, to try to like everything now look like somebody had been murdered in this room. It was, it was so crazy and I think that I just looking back at it now and like I definitely was just like, yep okay I guess we’re doing this like you just like shut off. 

P: Yeah, 

M: and my OB GYN is really great. She’s, she’s female and she’s and she’s a mother too so I think she just hasn’t this extra like nurturing piece of her, but she didn’t tell me like how much blood she bought like she didn’t tell me really anything, even while it was happening, she was like, alright, we’re just gonna do this thing real quick. Okay quick pinch like don’t worry about it like was very, calm, through the whole thing. So, it sounded bad but I have no idea like how bad it really was from a medical perspective, I just know that like, they had to bring me water and you know they had to like bring people in to clean up the mess while I was waiting and it was like a whole, it was a whole thing but yeah, I didn’t know that they could do that either I didn’t know that they could do just like DNC procedure in such al rushed fashion where you’re like a wait time for

P: Dr. Matityahu, likely most of us have heard of a hemorrhage during birth but I’ve never heard about a hemorrhage during miscarriage what’s going on there

Dr. Matityahu: with the medication that we give to help pass all the tissue and the medication, let people know, yes, anticipate heavy bleeding, but then it should, within a few hours, decrease and fade and if not come to the emergency room because sometimes with the medication, not all of the pregnancy tissue in the placental tissue detach completely from the uterus and anytime there’s even a fragment of tissue left behind stuck inside of the wall or stuck onto the wall of the uterus, the uterus wants to rinse it out, doesn’t want it there and so how does the uterus, integrates out that tissue it bleeds, and contracts, bleeds and contracts and that they can’t pass that tissue, it just keeps getting in contracting to rinse the tissue out is why some women will then need even after the medication will need to go in and get a DNC meaning we go in and DNC is dilate and curate meaning we dilate open the cervix and we take this little scraper and just kind of scrape tissue off the walls of the uterus. So what it sounds like happened is she probably started passing some tissue, for whatever reason, there was something stuck inside of the uterus and when that happens, women will just bleed and hemorrhage. It’s not pretty, and it’s an emergency situation. And so when that happens, whether you’re in the office or in the emergency room, that the only option is to go in and scrape out the uterus, on the spot because the woman will not stop bleeding and hemorrhaging. Till the tissue is scraped off from the inside of the uterus.

P: I think Melissa was pretty surprised by how much blood there was can you try to walk us through what happened there.

Dr. Matityahu: So the inside lining of the uterus is really vascular it’s just plush full of blood vessels. Every month we have our period and the lining gets thick bleeds out because get sick and bleeds out. And so that’s like sort of very controlled bleeding but when you’re pregnant. What happens is there’s placental tissue that is embedding into the lining of the uterus and brings in an additional blood supply. So, the blood vessels inside the uterus get bigger get. 

P: Yeah, 

Dr. Matityahu: nice and juicy and start going into the placental tissue, because it wants to supply them. And then, when there’s a miscarriage and everything comes out when there’s all these open blood vessels in this big juicy blood supply that’s in there that bleeds, especially if there’s a piece that’s stuck in there then it is even more to rinse it out

M: but I guess, you know I mean maybe it’s just this area while you’re awake, sort of like, well, yeah, although.

P: Although this seems a lot more DIY. Yeah, you will then I’ve had a DNC and they knock me out and, you know, I woke up later in recovery, You know it definitely looks like surgery. so thank God that they addressed it really quickly, but now. Now what’s your thought process for like you know what I’m gonna try this again.

M: Yeah, so obviously after that, it’s again almost like this primitive thing where it was like I unlocked this piece of myself that didn’t really exist before where I was like, Okay, I recognize that this didn’t work the first time around, but I now really want this for myself, versus the first time I got pregnant, it was like, Okay, here we are. It took a long time for everything to stabilize afterwards which I’m sure probably happened to you too, but I remember researching, so much to try to figure out like how long is it gonna take for me to get pregnant again, like I remember looking like every day I was so stressed out about it, so I bought this armband and measure my basal body temperature I was testing ovulation, every day, like I was in it, I was in all the fertility things. It took four months, from, you know where we were having sex all the time just alone. Yeah, I don’t know, I had no idea how to like, deal with ovulation, I ended up doing so much research about the body temperatures and the spike that happened and like all the things, so I’m doing all this research we’re having sex all the time, nothing is happening. I remember feeling so defeated. Maybe this just isn’t really in the cards for me like maybe this is just not meant to be. And so,

P: although let me stop you right there for one second. Yeah, we all have this expectation that as soon as you have sex, you will be pregnant. Now that you look back, four months is not super long. But I also had trouble getting pregnant and every month you get the negative pregnancy tests, you’re like, okay, so apparently I can’t do this like, there’s no, but it’s a bummer that we all come to this with this idea that as soon as you try to be pregnant and so if you’re not pregnant, something’s wrong.

M: Right, well and husband got a girl pregnant in high school. So, with that knowledge as well as like, is it like had an accident. And so I think that, you know that plays into it as well. It’s a lot it’s a lot of like mental stress to go through this process, regardless of whether you have a miscarriage or not, like, even those four months I was like I’m gonna shoot myself in the eye like this crazy Android like strap myself out we’ve had a couple of months where I thought I’d get pregnant and didn’t get pregnant, and my ovulation was all wacky, and it was the first week of April where I was just like, I’m exhausted. I need a break. A break from sex, I need a break from everything, and I just want to relax, and that’s the week we got pregnant, we had sex one time that whole week, just happened to be like a day or two before I ovulated. Had no idea. And it just happened. And so, it’s one of those funny things where it’s like you have no control over anything is like the whole story of pregnancy and birth right, you just don’t have control your body like you think you do. 

P: Yeah, I can imagine, especially for a bodybuilder where you’re probably for years doing all these things in a way that suggests you have control over your body.

M: Yeah absolutely and I’m a control freak, the most anal retentive you could possibly be as a human, that would be me, and I’m a ball of anxiety, this whole process, I’m like, this is the this is the test of my lifetime, like this is just crazy. And at the time I was 23 or 24. So, I’m young but my parents had a hard time getting pregnant, it took them 10 years. 

P: Wow. 

M: So, with all an IVF and the whole shebang. Funny enough, they actually got pregnant with both me and my brother when they were not doing IVF. So it’s funny how. 

P: Yeah, yeah

M: you really control it all 

P: so this time did you feel pregnant when you got pregnant. 

M: Yeah, so when I got pregnant immediately my boobs hurt so bad, so funny enough, because I was like tracking my ovulation, and I was pregnant on the stick. I didn’t know that I was pregnant, and so I’m tracking my ovulation. After this, this one week where we kind of had like a hiatus where we just had sex, like the one time. And so back to tracking my ovulation, all of a sudden I get a positive LH surge,

P: what Melissa is talking about here, LH is luteinizing hormone which rises just before ovulation, an increase in LH triggers the release of an egg from the ovary, which is important because this is the sign that you’re coming up with your fertile window. The time when an egg can be fertilized,

M: so I’m like, Yes, perfect. Okay, great. So, I’m testing it and then it’s like, day four of me peeing on this stick and getting a positive LH, and then day five of me getting this and I’m like, you’re not supposed to ovulate for five days what’s happening right now, so then I look it up online and it’s like, oh, it can mean that you’re pregnant, because sometimes it will catch that hormone, and it mistakes it so.

P: So here, let’s just talk about what can happen, your ovulation kit tests for LH to identify the fertile window, but it can mistake, LH for another hormone called HCG which is released by an embryo after implantation, although they have totally different functions, LH and HCG have really similar structures and some ovulation tests can’t distinguish between the two.

M: I took a pregnancy test. And I’m pregnant. I was like, oh my god, like, 

P: that’s awesome. 

M: When did this happen. I think I was maybe three weeks along so like, really really early. Yeah, so, obviously, then all of a sudden these emotions of like, it’s still really early it’s possible we can have another miscarriage, and of course, you can’t go to get an ultrasound until you’re like, between six and eight weeks or something like that. So now I have to wait, right, so now I have to practice more patience, of like, hey, is this gonna stick. We don’t even know. Am I even really pregnant I tested multiple times like over the next couple of weeks, to make sure, so at about four or five weeks that’s when my boobs started hurting, and then at six weeks, I started getting morning sickness. So, 

P: triumph!

M: I know I was like, I never thought I’d be so excited to be sick but I was like, if I throw up today, it means I’m still pregnant, every day, and I did and I throw up every day for like 16 weeks. So it’s funny because, like I’d brush my teeth, and the brushing of my teeth would make me throw up and so was this funny little reminder that like you are still pregnant. 

P: Yeah, 

M: you know, like these things that don’t normally make you throw up or still making you throw up, or if you’re really hungry it makes you nauseous, which, you know it’s not normally the case like I can usually not eat until lunch and be fine, but in the morning I wake up, but I’d be so hungry that I’d vomit. So that was this, this nice little thing of like a breath of fresh air, like we have morning sickness, things are good, we didn’t have this before so after you pass the morning sickness phase, then there’s occasionally times where you’re like the babies don’t move in. So there’s that.

P: The second trimester is quiet, more or less. 

M: Yeah, so the second trimester was not too bad, I stopped throwing up like I said around 16 weeks so I have probably a solid weeks where I was just like cutely pregnant and like kind of uncomfortable, people always say things like, Oh, the second trimester like it’s fine, I’m like, I don’t know about you but I’m waking up three to four times a night to pee and that’s not fine for me. 

P: Yeah, yeah, 

M: It’s not fun.

P: Are you are you enjoying it at all. Are you still like,

M: No, for me, I get so cranky if I don’t get sleep, and like waking up several times a night. It’s frustrating because you’re uncomfortable, you can’t sleep well and when you’re not sleeping well, it just, It just kind of sucks, go through the second trimester, things are relatively quiet, just regular normal uncomfortable being pregnant stuff

 I’m a small individual, my daughter 30 weeks ended up dislocating for my ribs, because 

P: Oh my God, 

M: she was really kicky, like all the time, always moving, which got really nicely for me. Luckily not during the middle of the night, which was nice but you’re very kicky I have tons of videos on my phone of her like she’d have the hiccups or she you know she’d be super crazy in the womb which is very indicative of her personality, now she’s absolutely bonkers like a ball of energy. And so, so at one point she picked out for my ribs, and my OB GYN was like, oh, go to the emergency room and get an x ray because I think she cracked your ribs. 

P: Oh Wow, 

M: so. So, to the emergency room, they did not give me an x ray, they gave me a lot of unnecessary things. Monday, I had a chiropractor appointment to go to the chiropractor appointment, and I tell him I’m having this insane pain and I can’t even sit down, like I had to lay down because I’m so it was so painful. He checks it and he goes oh yeah four of your ribs are dislocated, I was like, okay, so he puts them back then while I’m there. And then, as the muscle relaxer and was able to like resume my normal life, but just so crazy.

P: Yeah, that is crazy. He so once, once he readjusted, which I’m assuming is not comfortable. Then it’s back to normal though, and you feel better

M: back to normal, so we didn’t have any other issues with that. Everything went fine throughout the rest of the third trimester, and then, you know, went into labor naturally and and

P: so tell me about that day, like what were you doing, how did it happen. Did you know it was Labor

M: so that Day, so that day, it was funny because the day before I thought my water had broke. My husband and I had sex. Like, I think, 24 or 48 hours before. And, you know, because we’re trying to like, yeah, things moving, and so I wake up one morning, this was December, I think the 22nd December 22 I wake up and immediately I have, like, this gush of water, like wasn’t a, it was more than normal, but wasn’t like a whole bag of  the water popped somewhere in the middle of that. So, I don’t think too much of it on my. Okay this is strange, but maybe it’s fine. What I said something to my husband. Later that day, he’s like, You should call the doctor, so I did. They track everything and they’re like, Nope, it’s fine, like everything’s fine, water levels look fine bag still seems to be intact. I was dilated to like a two, at that point, so still not in labor but like things were moving like 

P: are we at 40 weeks now where are we,

M: yeah yeah, so this was 39 and a half or so. I literally gave birth the day before my due date. So I was wow, I think partially because we knew the exact date that I got pregnant so easier for us to pinpoint things but on the 22nd at night. I lay down to go to bed, and it like I’m having these weird pain, it felt like I just ate something that maybe didn’t agree with me, I’m having this really painful gas bubble, give it an hour away. So after about an hour. This keeps going, and it started to get more regular and so that’s what I like this labor, I start tracking it, and consistently every five minutes, I’m having this pain, you know, progressively getting worse as the night goes on so I’m transferring between taking bathes and, you know, getting in the shower and coming back out and all of these things, my husband is sleeping through all of this, I think it was like five or six o’clock in the morning, and these are now, like two minutes apart,

P: Oh wow, 

M: okay, at five or six o’clock in the morning, I wake them up and I’m like hey I’m in labor like we need to go. We need to go. And he’s like, Are you sure because we had just gone to the hospital like a day and a half or two days before. Yeah, so I’ve been in labor for like six hours. I’m tracking it, we’re two minutes apart if you don’t get your ass out of bed, like I’m leaving you. Like, we need to go. And because the hospital we were going to was 45 minutes away. 

P: Oh wow, 

M: I may have waited too long as he’s getting ready, I’m calling my doula and I was planning on doing a water birth with a midwife at our university hospital, so we go. I’m basically yelling the entire way there because I’m in a lot of pain at this point and they’re like every half, two minutes they were right on top of each other. When we were almost to the hospital, we were probably 10 minutes away from the hospital, and my husband had to pull over, so I could throw up on the side of the road. I remember this so vividly because I was having traction, and pulling up at the same time so it was screaming. On the side of the road, and it was, it was so hard I’ve never that was like the hardest, it’s ever been for me to throw up because your body’s like doing all these different things so are we get to the hospital, we get checked in, they checked me and I’m at five centimeters so they admit me, and everything’s fine, we get to a point where we’re back in labor and delivery and we’re in a room that has like a tub in it. I think it was like 9am At this point, I’m in the tub and I’m like trying to labor in the tub. But the problem is that the tub that they provided was super narrow couldn’t get comfortable, and the it was almost making the labor worse because I was so uncomfortable in this tub. 

We’d been in the hospital for like two hours, since they first admitted us and checked me the first time, so I was like can you track me again because I’m throwing up regularly at this point, and they won’t let me have any water and like all these things. I’m like, can you check me because I feel like I feel like I’m at like a seven or an eight like I’m dying. And so they checked me and they’re like, you’re still at a five. They’re like, Oh my god. So I felt like maybe it’s just because I’m not relaxed, but at this point I was like, I don’t think I can do this if I’m still at a five after two hours of this, let’s just do the epidural, they give me the epidural at, like, 11, and after they give me the epidural I dialated to a nine and a half, my daughter was sunny side up so you know the wrong direction

P: i feel like this question should come with a diagram but how does the baby being sunny side up, affect the delivery. 

Dr. Matityahu: Definitely when the face is down, it’s a much easier, smoother delivery, because of the way the baby’s head can flex and then come through the birth canal so when the baby is Sunny Side Up meaning, the baby is facing straight up, it can’t bend its neck forward and curve out of the birth canal so easily. And so it’s not impossible to deliver a baby that’s face up, but it’s much more challenging, I mean the baby needs a lot more room to come out because it can’t fold and maneuver as well as when it’s facing down. 

P: And they were saying that I was, I wasn’t dilated to attend yet, because, at last little like clap of whatever caught on something, and they tried to let it happen on its own, they popped my water. When they popped my water they were like, oh it’s clear and then all of a sudden they were like, Oh there’s meconium. So then all these people come in and I might pay. Are we having a C section, and they were like, no, no, we’re gonna, we’re gonna wait just a second and see how things go because it was clear at first, and we think that what happened is when we popped it maybe that like triggered meconium so we don’t necessarily think that she failed it because it was clear when we first popped in. So they were like, we just have these people here in case. All of this goes on at like 6pm is when I started pushing and pushing them, pushing them, pushing for four hours I push 

P: Oh my god. 

M: Yeah, really long line. I even ended up about halfway through after like two and a half hours I was like, this isn’t it happening, like when, let me stand up like let me use the squat bar or whatever, and will gravity we’ll let gravity like I’ll pull this out so numb from the waist down, and I’m holding myself up, um you know having a contraction, and so my husband and my mom on one side and then his mom and the doula on the other side, holding my legs up, cuz I can’t stand on them, so we’re pushing them, pushing you did that for another hour and a half by like they were like, right, she’s not moving past that zero station that hip bone. 

P: Yeah. 

M: And so, what we can do is we can give you an episiotomy. Or we can just go straight to the C section. They were like if we do get the episiotomy, we still may have to do the C section. So the way they explained it to me, was like we just think that her head is too big for your pelvis, and it’s not coming past that bone so we can do the episiotomy and try to Suction her out. And you know, so they’re explaining this and I’m like, I’m not going to end up with two surgeries, it sounds like what you’re describing the episiotomy, it won’t do anything because it’s a soft tissue. Yeah. So I’m like, that’s not going to change the bone structure, let’s just skip and do and I was exhausted, so I’m like the baby wasn’t super stable at this point. So Mike, let’s just go straight to the C section. They’re like, they come in and they give me this higher dose of whatever to numb you from the top down. So this more intense epidural. So they give this to me and they start rolling me back. Well, with both with both my first epidural and with this epidural, my blood pressure tanked, both times difference was that the second epidural, that I had, I was so exhausted I’ve been up for 24 hours have been pushing for four, so I passed out. I don’t really remember getting back to the operating room. My husband tells me that I coded So they called the code blue

P: oh shit

P: so when Melissa got the epidural her blood pressure went too low, what’s going on there.

Dr. Matityahu: So a lot of times with epidural. What it will do is it relaxes us so much that it makes a lot of our blood vessels dilate and it completely drops our blood pressure, so that’s a pretty common side effect of any epidural, which is why, before we give women epidurals we usually give them a liter of IV fluid to really beef up how much fluid is inside the blood vessels so when the blood vessels dilate with the epidural, it doesn’t bottom them out and tank their blood pressure, it sounds like. Her blood pressure went so low that passed out

 in the labor room when we call a code, there’s different levels of code and it allows us to bring in people needed one code is the moms delivering the babies coming out in the baby’s not doing well, so not only the OB team and the respiratory team will come but also the pediatric team. There’s other codes where it’s just for the mom, I mean if somebody passes out you, you’ll call a code because you just want all hands on deck in case things get worse, 

M: he could not go back, because they were like dropping or whatever skis in just the room that we were in where I was laboring, I remember coming to in the operating room. They’re like, Oh, can okay she’s awake hey can you feel this they’re like poking my stomach with a knife and make sure everything’s fine and I’m like, I don’t feel it. So then they’re cutting me open, they bring my husband in, and they pull the baby out and I remember kind of like coming in and out of consciousness, this whole time and I’m shaking uncontrollably. At this point I was like, super cold shaking uncontrollably, and I felt like I had to vomit, so I had like this bag right here we’re growing up into, and I’m like trying to keep myself awake. So, my husband’s right there, nobody’s telling me anything, so they get the baby out really quickly, and I don’t hear crying, and I just remember like, as I’m coming in and out I kept thinking to myself like, why isn’t the baby crying. Why isn’t being fine. I couldn’t even ask, like I couldn’t ask them what was going on because I just kept like I could fall asleep and wait wait, what’s going on and then, you know,

P: yeah,

M: this weird thing where I just I had no, I had no energy. I remember hearing this voice every time I’d like fall asleep I thought I was falling asleep, and be like, You selfish b-word like you. you need to wake up like your baby’s not crying, ask them why. Ask them why the baby’s not crying, you’re over here trying to take a nap like wake up when they pull the baby out. My daughter had been without oxygen for a full minute. So they had to resuscitate her. So they take my daughter to the NICU and my husband went with. So he tells me at this point, like they, the baby had to be resuscitated and is now going to the NICU, so I’m gonna go with the baby. And so I’m like okay, whatever. So, as they’re like stitching me up, and, you know, shaking uncontrollably and nauseous and this blanket keeps like falling off of me, and so I’m freezing my butt off, and I still have no idea what’s going on. It felt like I was getting stitched forever. It felt like an eternity, because I, I still wasn’t like 100%. There, I felt so tired, felt so tired, were like kept going in and out. And so finally, they’re done, and they’re getting ready to take me out at night. Finally, ask them like what’s going on with the baby. And they’re like, she’s fine. She’s stable, she’s with her husband like don’t worry about it. So at this point, I remember falling asleep as they’d be back to my hospital room after I gave myself some time to sleep. They explained to me. She is now in a medically induced coma. It’s like a medically induced hyperthermia where they drop your internal body temperature down really low and then attempt to keep your brain from swelling, so they’re like, we’re trying this, this method it’s technically experimental for children we use it on adults but we’re doing this, your husband signed off on it like, you know this, what’s going on,

P: doctor matityahu suggested I take these next set of questions to Dr. David Kornfield the director of the Center for Excellence in poner biology and the Department of Pediatrics at Stanford, thanks so much for coming on the show Dr Cornfield.

Dr. Cornfield: My pleasure, thanks for having me I appreciate the opportunity to help people understand a little bit more about what goes on in this critical neonatal time period.

P: Why does, why does it stop and oxygen lead to brain injury in particular.

Dr. Cornfield: All of us are absolutely contingent upon having oxygen in our bloodstream, and absolutely contingent upon having oxygen going to our brains at every moment, and there’s no cell in the body that is more dependent on the presence of oxygen at all points than the brain. So, the in the absence of oxygen, a whole cascade of injurious phenomena unfold in the neurons of the brain that can lead to significant damage, and it’s true in babies, just as it’s true in adults, but in babies that time period between being in the womb, and moving on to air breathing life is critical, and the changes that happen from a cardiovascular perspective, are really without precedent. Give it a moment of consideration. Just a moment, think what happens in those few moments. Normally, a baby’s born. Blood flow does not go to the lungs in utero. The first few breaths of life, there is this dramatic change so that 100% or even more, I could explain how I get that gets to the lungs, and all of a sudden that placental circulation is cut off, and all the responsibility for oxygenating the blood is subsumed by the lungs, that were just moments ago completely filled with amniotic fluid. It is a remarkable transition in context of that oxygen has to get into the bloodstream. And sometimes, for many reasons, especially those who have been pregnant and now mothers, understand, that is a fraught time interval.

P: Melissa said that because her daughter suffered this oxygen deprivation that she had to put in a temperature induced coma, could you tell us a little bit about how that works. 

Dr. Cornfield: the term for this injury is hypoxic ischemic encephalopathy. So it’s an injury to the brain that’s due to hypoxia, which is low oxygen in the bloodstream and ischemia which means a compromise or no blood flow to the brain as well, where there’s not enough oxygen going to the brain for some period of time. There is a whole cascade of events that unfold, at the cellular level, and that really leads to injuries of the cells that comprise the brain, neuronal injury unfolds really, over the course of many hours. And one way to sort of interrupt that cascade of events is by decreasing metabolic demand. And by cooling the brain. And there’s really very solid data in the neonatal world that the sooner you can institute brain cooling or total body cooling, after the injury, the more likely you are, or one is to mitigate the extent of the neuronal injury. So time is critical at that point, most centers, really, place a high premium on getting it done within six hours, the data in animals are really suggested instituting hyperthermia within three hours is better still. And usually this sort of temperature that people shoot for is somewhere, depending on whether they do the whole baby or just the head somewhere around 33 and a half degrees centigrade.

P: for Those of us shamelessly wedded to Fahrenheit that’s about 92 degrees Fahrenheit,

Dr. Cornfield: thirty seven degrees centigrade is the normal temperature, the 98.6 range. I also want your listeners to recognize it’s not an unheard of phenomenon to do this, but not as common as one might think. So the data are about two in 1000, infants have this hypoxic ischemic encephalopathy, which is by no mean an insubstantial number, but it’s also not to be taken as an overwhelming number of children who are afflicted with this problem 

M: at this point I finally get to go see her. She’s got all these things all over her head, because they’re monitoring procedures, and she’s hooked up to all these tubes and stuff and she’s not awake and the whole time I was in the hospital I feel like I was numb, or it’s just like, this is just what it is….And so at that point my maternal instincts kick in and I’m like, All right, time to pump to get the milk stimulated because it’ll have the baby so do this and pumping all the time, to give them milk that they can give to her. So I do this and we’re getting the milk put together and after three days, they finally are bringing her body temperature back up, we can finally hold her at this point, and it was just so crazy so she was in the NICU for eight days after, and you know when they slowly had to bring her back to some semblance of normalcy where she’s eating normally where she, you know latched on to breastfeeding, where they made sure she’s having bowl movements there there are no residual stuff like she had to have an MRI, to make sure there was no brain damage and we’re very fortunate because everything. Everything’s been fine she’s now almost two and a half. And we’ve had incredible support from the hospital, because we did this experimental thing, we got two years continued checkups and things with them and with specialists over there that was no cost to us. All of these things so you know, a really traumatic.

P: Good Lord. wait all this medical attention was focused on her because she had been deprived of oxygen for a little while. 

M: Yes, yeah. Okay, so, because they had to resuscitate her. They were really worried about 10 potential brain damage that that could have caused. We got all this additional medical attention.

P: I get that in that circumstance you don’t feel like you have a lot of choices, but I can’t even imagine how many people you have helped by doing that. Right, so that they get experienced with the process they understand how it works better. I wonder if it will be the standard of care at some point. 

M: And it’s the standard of care for adults. So when they explained it to us, you know, it was nice because I said you know, it works in adults, this, this is a common practice for brain injury patients, We, we do this for a couple of days here, we’ll give you the MRI, and we’ll check everything and we’ll monitor her really closely. So we felt really confident going in to that, it made sense to us and you know it’s an added bonus, that if that research leads to being able to help other people, not experience, you know brain damage in their children, then that’s a win win situation because it worked for us. She has no signs of any long term brain damage, and has had just the best care. As a result, so, you know, it’s been, it’s been really great.

P: That is amazing. My firstborn did not have a brain issue but she had a super rare life threatening heart issue, she had open heart surgery the day after she was born. But I am much farther back in the line than you are in your line. So as someone who has benefited from people like you who were brave enough to take that step, I thank you from all of us. I’m going to speak on everyone’s behalf and say thank you for all of us, that is amazing, and what she into now.

M: She loves learning so she’s in like a, it’s an at home preschool right but she’s only two and a half but she knows all of her ABC she can counsel 13 Like 

P: wow

M: she does how incredible things are I’m like, no two year old should be doing this but she learned so quickly, and I’m just so happy that that’s something we could put behind us and my husband and I are talking about trying again at the end of this year, and you know it’s taken it’s taken a lot of work to get to a place where I feel comfortable doing that because of how traumatic it was there was a lot of therapy involved afterwards of nightmares all the time with my child dying or being taken for me, that it required a lot of work to move past those things and be able to feel comfortable moving forward with another child. 

P: All that makes sense right this is unbelievably traumatic experience, what do you think you’ve learned from this first experience that you’ll use for the second. 

M: So, I think the biggest takeaway here is just that I’m, I’m not in control. And while I think I knew that to an extent, the first time around I knew that there was nothing I could do about it. It’s different now because I went into it like with a birth plan and like all the floofy fun feel good things like yeah I’m in control of my birth story and it’s like, no, you’re not. We’re just along for the ride and you have to enjoy what it is for what it is right now.

P: I think that’s a great message and I think probably as you found the idea of having no control and the feeling of having no control or to kind of different things but, but now you know what the feeling is so it will be easier to do and I know you run a management company. So, being out of control doesn’t seem like it’s on your daily agenda.

M: No, I  manage, I manage online businesses for entrepreneurs all over the place, and so I am used to being in control and not being in control was, it was a lot, I’m better for it as much as it really sucked at the time. 

P: Yep, 

M: I’m a better person for it. So,

P: Melissa, thanks so much for coming on and sharing your amazing story your, I will revel in your triumph all day.

 

M: I’m So glad if it can bring you some joy and some happiness and some strength. For that, I appreciate you letting me share it.

P: Thanks again to Dr. Matityahu for sharing insights about how our bodies work and giving us a doctor’s perspective on labor, and thanks also to Dr. Cornfield for sharing some details about the delicacy of the newborn period, highlighting all the complicated mechanical changes that happen to the baby at birth, and walking us through the current approach for managing a possible brain injury for a newborn. Thanks also to Melissa for sharing her story, filled with resilience. It’s fantastic to imagine her two year old, running around–a ball of energy, bearing no evidence of her tricky birth

Thanks for listening…we’ll be back soon with another story of overcoming

Episode 32 SN: When the Fourth Trimester is a Bear: Laura’s story

Today’s guest had to reexamine her expectations at various points in the process of growing her family. She enjoyed a relatively straightforward pregnancy, but had real fears of what the birth would be like.   Importantly, both births were totally successful, but they didn’t necessarily progress the way she imagined they would. The real challenge for her came after the birth: in the fourth trimester. The monumental change of going from being a part of a couple, just two adults, to caring for a newborn was a pretty staggering life change, and the first time around it came with postpartum anxiety. Ultimately she used her experiences to shape her new career path: she’s become a postpartum coach, using all her hard earned lessons to help other women navigate this tricky time.

To find Laura online, you can check her postpartum work out at:

https://www.facebook.com/Motherhood-Mentoring-100434231871954

Preeclampsia diagnosis

https://journals.lww.com/greenjournal/Fulltext/2020/06000/Gestational_Hypertension_and_Preeclampsia__ACOG.46.aspx

Audio Transcript

Paulette: Hi Welcome to War Stories from the womb. I’m your host Paulette kamenecka. I’m an economist and a writer and the mother of two girls. I came to pregnancy with my own set of expectations about how things might go, and had to abandon them very early in the process, when I had a hard time getting pregnant. 

Today’s guest also had to reexamine her expectations, but much later in the process. She enjoyed a relatively straightforward pregnancy. She brought fears of what the birth would be like to the experience, and while, in the end, it went well, the births didn’t necessarily progress the way she imagined they would. The real challenge for her came after the birth: in the fourth trimester. The monumental change of going from being a part of a couple, just two adults, to caring for a newborn was a pretty staggering life change, and the first time around it came with postpartum anxiety. Ultimately she used her experiences to shape her new career path: she’s become a postpartum coach, using all her hard earned lessons to help other women navigate this tricky time.

Let’s get to her inspiring story.

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

Laura: Yeah, I’m Laura Spencer, I’m from coming Georgia just north of Atlanta. 

P: Oh wow. 

L: Yeah.

P: So Laura, tell us a little bit about yourself. Do you have siblings.

L: I do, yes I have a younger sister she’s four years younger than me, and we have been super close. Ever since she was born, when she was younger, I was like, a little mommy, and as we have become adults, she is just my go to person for every thing, like she and I are just on the same wavelenght our souls, we’re just connected

P: that’s awesome

L: you know, it really is, because I know that a lot of people don’t have that kind of relationship with their sibling. And so I feel very very blessed and thankful to be able to call her my absolute best friend. 

P: That’s lovely.

So let’s talk about pregnancy. Before you ever got pregnant. What did you think it would be like,

L: oh gosh, I think I thought it was weird and this is so funny that I’m having this conversation with you today, because one of our really good family friends we just met up with them yesterday, and their daughter is 20 and she’s getting married in July. You know, I just had my second son in February, and so she’s like kind of scared of babies. And she’s like, I’m gonna adopt a 10 year old. And I was like, I remember saying that when I was about your age too, because it is part of our culture, but it’s also not, it’s kind of like separate and silent from our culture is just kind of like, oh, let’s admire the pregnant lady, but from afar, you know, and not like actually learn about the experiences from young on, to be able to really be prepared for what’s to come. So I would say I was similar to her. That’s why I shared that story, you know, I don’t know that I want to have to go through and it wasn’t even really the pregnancy part is more like the birth part. 

P: Yeah, 

L: imagining a human child coming out of your vagina, that’s kind of scary when you’ve never been around it before you’ve never actually seen someone do it before except for what’s in mainstream media, which is complete BS. So

P: well, I think that’s where all of us get that picture right it’s like it is, you’re pregnant and it’s easy and you, you know, go to the hospital and 10 minutes later you have a baby.

L: Right. Yes, exactly. And then all is well, and your body, you know, goes back to normal. 

P: Yeah, 

L: I’m using air quote area, like the next week. Yeah. And so when you have a baby and look at your body the next day and you look like you’re still five months pregnant. 

P: Yeah, 

L: we’re like, um, wait a second. The baby’s out. Pregnancy wise, I wasn’t really sure what to expect but I can definitely tell you I was terrified of birth.

P: Yeah, that seems that seems legit. So did you get pregnant easily

L: pretty easily. Yeah, my, my husband I was our first, we tried for a couple months, I remember using ovulation tests, and that was just awful. I hated it because it was so stressful. Some people love it for me, it was, it just added an extra layer of stress to it. I spoke to my doctor about it and she’s like, just do every other day. Like when you know that you’re ovulating just do it every other day. And that was, that’s how we ended up getting pregnant, so I think we tried for total like three months, so month three egg. Yeah, it was my first yeah I mean, for me it seemed like, Oh we were trying but then I know so many people who struggle with infertility and take years to get pregnant and, gosh, the mental game of just a couple months I can’t, you know, I really feel for those people who are struggling with infertility,

P: well but also this is another good point right that images that you will get pregnant the first time you try.

L: Exactly, yes, you’re right. I feel like it often happens to the people who are like, not again. Someone with my second son, my husband and I, we just got pregnant, like, we’re really trying. I was just like, Um Hey, pregnant. And I feel like it happens when you least expect it sometimes. 

P: Yeah. So how was that first pregnancy

L: first trimester, was tough with my first, you know, had some morning sickness and more like all day, nausea, gagging and dry heaving is more like what I had.

P: Yeah, That’s hard, what so what do you have any like tricks to kind of live with it or

L: I remember one of my, one of my husband’s friends she recommended a certain type of ginger ale. It’s called Red Rock, I think it’s like really potent ginger ale and then there’s little ginger candies called Gin-gins ones love those. And then the preggie pops those worked pretty well too, for me, and then I also did for a couple weeks I think you can do a combination of vitamin B six and unisom. This is not. Yes, this is do not listen to this and just go ahead and do it please ask your doctor about this first. But yeah, you can do a combo of vitamin B six in unisom, and take that before bed and then that seemed to help me for a little while, too, but yeah the nausea, the smells like smells really got to me.

P: Does that abate after the first trimester.

L: Yes, for me it did. Yeah, and then second trimester was great. Most of third trimester was great to till I got towards the very end and then it just I mean, it just gets uncomfortable, you know.

P: So take us to the day of the birth like how do you know, today’s the day and did you make it to 40 weeks and,

L: yeah, so I knew that the day was the day because I had to be induced by blood pressure started spiking, I went in for a checkup around 38 weeks, and my blood pressure had been high, and that was kind of a consistent trend that had been going on for the past week, two weeks and so they sent me over to hospital. 

P: did you have the high blood pressure before you’re pregnant or no just at the end of pregnancy

L: just the end of my pregnancy. Yep, it started probably about week 37 I don’t know exactly what caused it, but I do know that I was working as a teacher at the time and I was also holding the leadership position, the time in which I had my baby with. I had him in March and so it’s a pretty stressful time in the school year. And so, you know, I was always rushing to appointments and I was always just not super stressed but definitely had a higher level of stress and so that could have played a part in it.

P: Could you feel the high blood pressure or no, you just got to the clinic and they told you.

L: No, it didn’t feel like anything. Yeah. And, yeah, like my body didn’t feel any, any different. So it was it was a little bit surprising I think and that’s it kind of messed with me a little bit I guess because I didn’t feel it so like is this really happening, so I’ve gone to the hospital for some testing and ended up getting my blood pressure down they sent me home for the weekend. went for a follow up appointment the next Monday and it was so high. And so that’s when the doctor was like I think we need to go ahead and move forward with induction, and by that time I was 38 weeks and five days, 

P: and had you imagine like a lot of Earth with, you know, people with trumpets…

L: good question, I hadn’t, I did not plan a water birth for my first because the hospital that I was planning to birth that did not allow that. I was planning on, you know, being able to labor at home and be kind of like in my own element and honestly I think at that point like that was a Monday, I had to go in that evening for induction, I literally packed my hospital bag that day so like I was in denial that I was going to need to be induced I was in denial that like, I was about to have a baby. So that’s kind of how I went into having a baby and so then it ended up kind of rocking my world, but as far as, you know what I pictured, I can’t say that I necessarily like had an exact idea of birth. I went into it knowing, I wanted to do my absolute best to not have an epidural, I just did not want it. my husband knew I didn’t want it. And I also really wanted to not have a cesarean birth, my mom had an emergency so Syrian with me that just kind of left some scars with me. 

P: yeah. Well that all sounds scary and it’s like not according to your plan and, and, yeah, as you say, which I think is totally normal and most of us grow up with like you’re afraid of the birth. I remember halfway through my pregnancy thinking like this baby is too big to get out it’s intended escape room, Like I don’t know how this is gonna work, so it makes sense to have all those feelings and then, because you’re not having contractions and, you know laboring at home for 12 hours like you don’t really get the mental space to prepare for, like, Okay, what’s next. So if you’re with you. This is stressful. 

L: Yeah and then the whole induction process to was it Luckily, my husband was there with me for the whole time and, and he was distracting you know like, so it wasn’t like we were sitting there waiting, but and I think that they did kind of forewarn me that it could take a little while, and it did you know I was induced on a Monday night and didn’t have my son until Wednesday afternoon. So I think that that’s something too that people don’t necessarily aren’t necessarily prepared for is that induction. If you’re not really I think I was maybe a centimeter dilated. So I had a good little ways to go. 

P: So, when they put you on was really put you on Pitocin and they give you some help in the cervix and all that,

L: they did so when I went in that first night they, they did serve Adele, which is a cervix softener. And the next day they, they put me on Pitocin for almost the entire day, and nothing really progressed I honestly don’t really remember that day because it wasn’t super painful, and then they did another cervadil that night, and then the following morning they put me on Pitocin again, and, and then that that did it kicked in, to active labor,

P: and What was that like, would it feel like 

L: I remember  They had me on the fetal monitors and I was in bed and my water broke and I was like, pretty sure my water just broke something funny happened I feel like I just felt like a little bubble burst, almost. So they’re like, Oh, yep, your water broke and then after that, it was like, go time. And things really, really, they went pretty fast and furious, and luckily I had the midwife on call who really was familiar with my birth plan. Well, I didn’t really have a birth plan but just like some of my, my really deepest desires in preparing I did know how much being in water can help. And so they had tubs, they don’t allow water birth but they have tubs and showers and so I was like, I want to be in the water and so she that and that’s not necessarily something that often happens with when you’re on Pitocin and you’ve got an IV and, you know, all those things, but she was willing to let me do it. And so I was very thankful for that. So I was in the tub for a little while laboring and that was helpful, and then man once transition got there I was like, who I don’t know about this.

P: Yeah. So did you get an epidural or how did that, did you avoid the C section.

 

L: Yes I did, avoid the C section, I got out of the tub and things things were things were tough, and I didn’t really at that point is when I felt, probably most unprepared for what was what was happening. And looking back on it, I’m like, Man, that probably would have been the point of having a doula to help me with positioning because I got out of the tub and I was, you know starting to get exhausted. And so I’m like, I just want to lay down, but like laying down is literally the worst thing you can do especially when you’re at that the end of active labor you’re transitioning,

P: is it the worst thing you can do because it’s uncomfortable or because it will stop labor,

L: just because it’s probably most like the most uncomfortable position you can be in. Yeah, yeah, I did labor in the bed for a while, my midwife, did some amazing counter pressure on my legs which I was after she left I was like hubby, get on it, like, this is your job now. And at that point too, I was like alright let’s, we can ask my mom to come in because I, We had set a boundary with her and said, you know, we just want to be just the two of us, if we asked you to come in, then you can come in. 

So at that point we asked her to come in, and I think it was just like, too intense, she was just like, just get the epidural just do it just get, you know, make it go away kind of thing. And so I opted to get a dose of fentanyl. And honestly, they were like alright we’re giving it to you, and five minutes later I was like, Are you, are you sure. Can I have another one, because I don’t think that works. So that was a little bit disappointing, but I didn’t really let it get to me and then finally I was, I asked for an epidural, and so they started prepping me for an epidural I got some IV fluids, and the anesthesiologist walked in, and he’s like, All right, Go time, and they had, how, like how do we get off the bed switch positions kind of stand up to get prepped for it. And as soon as I got off the bed I felt the baby just moved down my birth canal and then, like I started feeling urges to push, and I just looked at the nurse and I was like, you know, I’m kind of making grunting noises and she’s like, are you pushing. I was like, yeah, and she’s like stop pushing I’m like I can’t but my body is like doing it, you know. And so, you know, I just remember like I was hunched over my husband completely naked, and the anesthesiologist who walked in I remember just like looking up at him probably like with a deer in headlights like there’s no way that I can sit back down on this table for you to do this, and sit still for you right now. And so, the nurse looked at me because she saw my face and she’s like, Do you still want an epidural and I was like, nope. She’s like, What do you want and I was like, I want the midwife to come in here and check me because it’s time. And so she did, she came in she checked me it was 10 centimeters like let’s go. So, yeah, my son was born without an epidural.

P: Wow. And 

L: yeah, 

P: did you push for a while or 

L: he was pretty close, I think I pushed for maybe like 30 or 45 minutes. Looking back after I’ve done more research. So with all this my, my first birth and postpartum experience it’s led me to my new career path, which is postpartum coach and childbirth educator

P: cool

L:  and so through all of this education that I have continued through all this knowledge that I’ve continued to require realize that the way in which I pushed him was probably not the most productive way of doing it because I can remember just my face and my eyes feeling really swollen and so I ended up doing what’s called Purple pushing that was, that was kind of tough it’s very strenuous, because you have people yelling at you to push, instead of just like, listen to your body and when you feel the urge to push then push which is, you know, a little bit more helpful….you don’t burst blood vessels in your eyes when, when you do that instead. This is something else that I have learned and what I like to communicate to my prenatal clients is that there’s so much that you can know and you’re like, you’re not going to be able to know it all and so at some point, you have to be okay with not knowing, and be okay with trusting yourself to make the best decision for you in the moment. 

For me, the best decision was listening to my midwife, pushing the way that I did my son came out, I went with it, right. So, sometimes when we then look back on it, we’re like, oh, I don’t know how I feel about it and so it’s that, you know, processing it and saying maybe I could do something differently next time, but knowing that you did your best, and knowing to just offer yourself compassion and love in that moment for, for doing your best with with what you had. 

P; Yeah, So that sounds ultimately successful. 

L; Yeah

P: blood  pressure comes down after you leave the hospital.

L: Oh, that’s a great question. No, it did not. In fact, it stayed elevated for a couple of weeks, actually, and again going back to your other question about if I felt different. I really didn’t, and you know I would get blood pressure readings that were like, 170 over 110. And, you know like crazy high blood pressure, but I wasn’t feeling any sort of symptoms along with it,

P: did they ever call it preeclampsia or it was just hypertension or were they,

L: it was really it was just hypertension because I never had, like, the proteins that went along with preeclampsia.

P: I just want to quickly note here that the criterion to diagnose preeclampsia, or there’s a moving target. As scientists and doctors learn more about the condition, they have changed the ways in which it’s identified so it used to be that the diagnosis was based on high blood pressure and protein in the urine, but now you can get that preeclampsia diagnosis without the protein in the urine component, if other things show up in the bloodwork or if you have a headache or a pain in your abdomen on the right side. So just keep an eye out for that. 

L; But I know that that was why they were really encouraging the induction, because you know I can remember sitting in the doctor’s office and he’s like, it is ultimately your decision, but I would highly recommend going ahead with induction because you’re just going to get sicker, like I remember him saying that. And to me, again because I hadn’t felt any symptoms with it. I was like well, I mean I don’t feel sick right now so that that was a tough thing to also reconcile I’m saying how sick, can i get how sick Am I willing to get to, to avoid induction, you know what I mean. And so that was something to that after, after the whole experience that I had to go back and reconcile because I’m like, you know, maybe I could have gone a couple more days and I would have gone into labor naturally. You know, I have no idea, and I won’t ever know, and but again, that’s just something that you have to say, You know what I made the best decision for with what I had

P: if you do any research about preeclampsia. Oh, you absolutely made the right choice because you want to avoid that at all costs so

L; well and yeah, I know.

P: So that, kudos to you for making that hard choice because I think there is a disconnect when you can’t feel it, to say like, yeah, what do you got, what exactly is going on here because, in part because of pregnancy you feel so much right yeah, and yes, a little kick and move and so, so, but he didn’t give you like blood pressure medication it just went down on its own. 

L: No, it did okay, yes. Yeah, so I, I went in for a checkup, about a week or so after having him. And because like it was still elevated, but it wasn’t high enough for them to say, we need to put you on blood pressure medication they really just keep monitoring it and if it goes back up, then we might need to consider medication, but it didn’t end up doing that and it stayed down and

P: good okay good, so that’s being managed and then, new, new baby comes home and how baby comes home, how’s that.

 

L: Oh. Can I curse. Okay. Can I curse?

P: yes you can

L:  It was just a complete mindfuck, and just, I tell people that I felt like I got hit by bus. And I think that that was probably partially the sleep deprivation. Yeah, but, like, having going from simply taking care of yourself and nurturing your marriage to having a tiny fully dependent, human, leaving you 24-7 and having your world changed from revolving solely around you to revolving around keeping this infant child alive. It was a lot.

P: Yeah, it’s a dramatic change right it’s a

L: completely dramatic and nothing can prepare you for it. Again, this is something that is inspired me to become a postpartum coach because while nothing can prepare you for it. the way that our society is now set up is completely not supportive of new moms, especially in that fourth trimester, we are left alone. There’s the saying that takes a village to raise a child. Literally, it does because in those first three months, you need so much outside support, but the way that we now live separately from each other, it really, it doesn’t warrant that luckily my mom is very involved, and so she did stay with us for about a week after we had the baby, but once she went back then it was just me and my husband for a week, and he had only had off for two weeks and so I was left alone with a two week old. 

P: Yeah, 

L: and it was my first and I was like, it was insane, and then after that, you know, breastfeeding was hard, I watched one breastfeeding video of like how to get the baby to latch. Before I had him, and I knew I needed help, but I was in such a, I was in such a mental state that like literally just trying to figure out who to ask help from was overwhelming. 

P: Yeah. that’s fair

L:. So I now with new moms, I’m like, go ahead and research lactation consultants in your area, know who they are, so that way you know like you have someone to reach out to my son had issues with latch and also again with the dramatic change. I was like, I don’t want to say I was unwilling but it was just like, oh my god you want to eat again, like, Can I sleep, you know, and so I would try and stretch it out as long as I could just try and like, get some extra sleep you know like, even another 15 minutes. And so I think that by the time that I would end up start feeding him, he would just be angry, and then he had already had issues latching and then it was extra hard, so we were using a nipple shield by like week four or five, I was exclusively pumping because he would just not even latch at all. 

We got back to it and we ended up nursing for 15 months, but I really had to fight through it and sometimes I look back on that and I’m like, did I sacrifice my mental health, for, for nursing. 

P: Yeah, 

L: because I probably did the weirdest thing happened to me around, probably week three, or four, I started getting kind of like a rash on my thighs. and I just thought maybe it was from like having the Boppy constantly on me that maybe it was like heat rash or something, and it spread down my legs like kind of the inside of my legs like spread up on my stomach around my stretch marks. And then around my, my boobs, and I’m like, Why in the world and it was so itchy. And so I did some research and the closest thing that it that it came to was the PUPPS rash, so I don’t know if you’ve heard of, 

P: Np, what’s that, 

L: basically it’s a rash that usually happens to pregnant women in their third trimester if they’re going to get it. And so because it’s most common during pregnancy. You know, I called my doctor about it I’m like I think that this is what it is, and they’re like, No, that’s not it. And like, I didn’t even go in I just call it was like I have this rash and I’m like, oh you know it’s just hormones. 

It ended up going away, but like, having to deal with sitting there holding your kid, while like your boob itches your stomach issues your leg itches, and feeding him, and then, like, trying to wrap your mind round like actually taking care of yourself, and taking care of baby, it was just like one more thing to have to take care of myself after going through weeks of changing my own diapers along with my, my child’s diapers,

 

P: yeah, yeah, that sounds like, that sounds like too much, but it sounds like it was a lot.

L: It was a lot. 

P: I remember feeling like it was a lot to have to feed myself, I was like, How is this possible, why do I

L: can you please just be okay with me laying you down for five minutes so I can eat too. Yeah,

P: yeah, well so it sounds like you have another, you guys eased into something more manageable.

L: I probably went back to work. I ended up developing postpartum anxiety. So that took months to really, I identify and come to terms with, and then get help for, and by that time it had been, you know, kind of stewing in our marriage and so we really did have a really tough time my son’s first year, both of us, you know, kind of individually and then together as a married unit, that’s just one more thing that has inspired me to, to help women through that time because I think it’s something else you, again, going back to mainstream media you see women going to the hospital, have a baby look deeply into their husband’s eyes, you know, it’s this magical moment. We’re going to be this beautiful family, and then you flash forward a couple months and it’s like everything is beautiful and lovely and. And that’s not how things are. 

P: Does it just make you laugh to hear. We’re gonna have a baby to save the marriage.

L: Oh god.

P: Oh, yeah, hard to imagine how that works right.

L: Yeah, and I’ve done again because I take some of this, you know, I take my full experience to what I offered to to the women that I work with, and one thing that I’ve learned through my research is that one in five couples will separate in the first year of baby’s life. 

P: Yeah, it’s hard. It’s really hard. Yeah, 

L: which is really interesting because one in five women suffer from postpartum depression, or a postpartum mood disorder, and honestly that statistic is probably higher those are women who actually end up reporting it, I see a bit

P: it’s probably more common. Yeah,

L: for sure because again we’re, we, we tend to hold those kinds of things in questioning whether or not we’re normal or if we admit it. Does that mean that I’m a bad mom and all of those things all those thoughts swirl around in our head and end up making that whole experience just even crazier.

P: I’ve talked to so many people who say, I didn’t realize I have postpartum depression or anxiety either until the second birth, or until many years later and I wonder if they have in their mind, this image that this should be fabulous and I should be loving every minute. So, it’s just me, right, which is not the case.

L: Okay. And I think too, you know I was just thinking about this the other day so I’m so glad that you said that, you know, my son had some latching issues right like we had some, some breastfeeding issues, but like, he wasn’t colicky, he was a happy baby. He was a pretty easy baby. Things were pretty good. You know, we’re financially stable, and I think that for a lot of women it’s that I should be grateful, I should feel this way, I should I should I should, and we should all over ourselves, and end up just spiraling, because we’re trying to convince ourselves to be better be happier be whatever. And we just can’t. 

P: Yeah, 

L: and we need support, but then again we’re like well I should be able to do this, I had a baby, I decided to have a baby. I should be able to do this. And the reality is that, well, yes, you absolutely can. You have the power to do it, but gosh there’s so much power and asking for help.

P: Yeah, yeah. Yeah, that’s a great point and a really useful thing to hear because I think postpartum depression is so common and anxiety is so common that it would make sense to have a much better developed network kind of around you. 

L: Yeah, no period. 

P: Yeah, well I’m glad you guys made it through that point and then was it hard to decide to have another or that point you were saying,

L: we, we didn’t know I mean we knew that we wanted at least two. Yeah, but when the day we found out we were pregnant with my second, we literally looked at each other and we were both like, we probably could have waited another year like we really we weren’t ready to start planning on it, and you know at that point was you it was this past June, that we found out we probably found out on father’s day that we were pregnant, you know, so we’re still living in a COVID world, and at that point too I had made the decision to not go back to my teaching job. This upcoming school year. And so there were a lot of outside transitions happening, you know things happening that we really wanted to get a little bit more accustomed to, before bringing a new baby in but he was like nope I’m, I’m coming, I’m making an entrance, we just ended up having to make it work.

P: So what was that pregnancy easier did you go through the exact same kind of route of the first one, or was it unique.

L: No, I’d say honestly it was maybe even a little bit easier, just because I knew what to expect. 

P: Yeah. 

L: The only thing that was different and a little bit more difficult was that I was exhausted, especially my first trimester that the exhaustion really hit me. And I would just sleep. And my husband was fabulous and he has taken our toddler under his wing and luckily he is such a daddy’s boy, so he doesn’t mind it at all, sometimes doesn’t even notice that mommy isn’t around because he’s like all about Daddy, the cooler. I guess cooler thing about being pregnant. The second time around was involving my toddler in it. And so like when my belly really started showing we would talked to him a lot about his brother, you know there’s baby in there there’s brother, and this is that he’s developing his language as well. And since he’s repeating us and we decided on a name because we ended up doing a gender reveal with this, this pregnancy, and so we, we talked to him a lot about his brother so as soon as his brother came, he knew exactly who he was, and there were no question that it was really really lovely and then credible thing was that like, he literally came out of my belly and then is now an actual baby. And my toddler didn’t question it at all. I was like, Yep, this is Sutton. Here he is. So that was really really cool.

P: How was your blood pressure for the second one,

L: do we were really fine, I didn’t have to be induced I ended up going into labor naturally which was different, you know, and I had I had expectations, this is the hard thing about birthing for a second time, is that, with the first time you have. You have no idea what to expect. The second time you have an experience to relate it to, but really you shouldn’t because every experience is unique. 

P: Yeah, 

L: but it’s really hard and I was in my head, almost the entire time just trying to almost like set a timeline for myself of like, okay, like basically when is this going to be over. So I ended up laboring at home for almost 24 hours, and then finally I was just like, we have to go into the hospital because I know that we have to be there. And I think that that kind of mental block, honestly was kind of stalling my labor a little bit, so

P: do they do they take you when you came. I found

L: Yes, yes, they did were in triage for a couple hours because I had to have a COVID test, so that was obviously different as well. You know the whole experience of like going to the hospital in labor like that, that was all first time experience for me, we hadn’t done that with my first and again I think that there was an element of fear there for me. Maybe not fear but just like anxiety is like, again the unknown.

P: So I had a similar to you and that my first one was a planned C section because I had all  issues, and the second one I had planned another C section but she came early. And I remember going to the hospital thinking, is this how people do it This is nuts. Yeah, the baby decides and all of a sudden, like, 

L: yeah, yeah, 

P: that felt sort of crazy to me but that’s how everyone does it right.

L: Yeah, it is how we all do it, and you know what is really crazy so I was lucky in that I was able to take a couple weeks off around my due date and so I was just home, but so many women in our country don’t and I feel like that is a fear of like, am I gonna go into labor at work. Yep. Yeah and I have friends who live outside the US, and they’re like, you know, like, around 36/37 weeks, we start getting our maternity leave and then they have maternity leave for at least three months, if not six, yeah, it’s just like, oh so you don’t even have to worry about your fear of going into labor at work unless your baby’s like premature, right, you know, right. Anyway, yeah, this one, my son decided to come at 40 Almost 41 weeks. So that was different. I, you know carried him for almost two weeks longer than my first, and then again like the mental waiting game or just like is today going to be the day. 

P: Yeah, 

L: it’s pretty tiring, but, you know, so once we got to the hospital, things did progress a little bit more, and I did plan for a water birth with this child we’ve switched hospitals to a hospital that allows them, but I had to wait for a little while to get into the pool. Before I had actually, you know dilated enough, and because of his position I ended up having more back labor with him and so it was, it was tough. It was a hard labor, the harder part was until I have gotten to like transition, like when you get into transition and you’re doing it without drugs. You just go to this complete other world, really like you have no idea what’s going on around you, you, you know, like when you’re in active labor you’re having those really hard contractions in between those contractions and even during those contractions, you’re still kind of aware of what’s going on around you. Like I remember shushing, the nurse that was in there with us because I’m like, laying on the bed because I had to get fetal monitoring so with this time around to you I didn’t, I wasn’t hooked up to an IV, I can freely move as much as I want to.

This nurse just like talked every time she came in about something she had a story to tell and I’m sitting there like writhing on the bed, and I just put, like, just shut up, please like, Have some respect for the woman in here in pain, and shut up. That was interesting as well that felt really good to just like get that out, you know the other thing too, I just went through like a whole range of emotions with, with this one, I did have a doula you know, obviously I’m surrounded by nurses and my midwife, but they’re all focused on my physical health and recovery. Right, I need someone there that’s specifically there for my comfort for my emotional well being, 

once we finally got into our laboring room after triage, I just wanted to get in the shower, but the water in our hospital room wouldn’t get hot. And so, she, she got it warm enough for me and then we get into the bathroom and I get in the shower, and there’s just this draft of air and so I can literally remember just standing in the shower just shivering and contracting, and it was just so disappointing and so she got me out. She wrapped me in like a warm sheet. And I just looked at her, I was like, I think I need to cry and she’s like, just let it out and I just like wailed I mean I just wailed, and that was not something I did my first is not something that I antcipated and I’m like why am I having this kind of emotional release you know like I’m not upset about having a baby, now looking at is like, just like that disappointment in the moment and also just like when is it going to be over like I’m just so I’m ready. And I asked for an epidural again with this one and it’s ended up, he, he was ready to come again. And so didn’t end up having an epidural, again, and I didn’t have a waterbirth either I did end up. I labored in the birth pool for probably three or four hours, and again by that point, once I got into the tub. I just completely zoned out, and the, my favorite thing that I had this birth as well, was an iMac, I wore an iMac almost the entire time once we got into our burger and just keep it completely dark, so that way I was not distracted with what was going on, and that was lovely. 

P: that’s a good idea. Did it take a lot of pushing with this one, or he was also no.

L: I kind of did, but I also kind of listened to my body a little bit more. And what’s really funny is I looked at my doula. I was about nine and a half centimeters, and the midwife had checked me and she’s like, I think you’re actually the 10. She’s actually talking to my husband, my Doula at this point because, again, I was just completely like out of it, like, let’s just get the baby out, however we can. 

I had an inflamed cervical lip. That was kind of preventing a little bit of the dilation, or just kind of the general space in my cervix and I think because of that interior lip like my midwife was really really involved with kind of helping the baby out like her fingers and her hands were like all in there, kind of like stretching to make sure that the baby was coming out, 

I think I pushed for like 15 minutes with him, he came out pretty, pretty quickly but his shoulder did get stuck a little bit and so again, with the positioning, that was probably the best position for the midwives to be able to kind of work with that he came out he was, he was good. We were good, I tore a lot less with him and go had to have just a couple little stitches with him and with my first I did have a decent tear I had like a second degree tear so that contributed to my recovery as well with my first, and with my second, you just kind of have that experience, and I think sometimes with our with our first we tend to push ourselves a little bit more because we haven’t been through it with my second I was like I’m going to do everything possible to stay in bed as much as I can. And so I really just set up, you know, for sleep space for him. I set up a little diaper caddy on my nightstand, and I, and I told my husband like my goal is to stay in bed as much as possible, and I’m going to need some help with other things. 

P: Yeah, that sounds like a lot was learned between one and two. 

L: Definitely, definitely. 

P: And the fourth trimester, breastfeeding and all that was easier with the second one.

L: Yes, it has definitely been easier. Initially, it was about the same, but I knew this time around so just go ahead and get some help. So we ended up seeing a lactation consultant with him, I think he was only like a week and a half old. When we ended up going because I could tell if he was having some trouble with this latch, 

I’ve learned this time around of how to almost put myself first, it sounds a little bit selfish but really it’s not I’ve learned that if I want to be my best for my boys and for my husband, I need to make sure that I’m taking care of myself too. And so that is something that I’m holding myself to more this time around as well.

P: Yeah, that sounds like a super important thing to do, especially in a, in a culture that doesn’t do it for you, right like someone that someone has to be taken care of for you. So what is your older one into now.

L: Everything He just turned to on March 13 And he loves animals, my mom watches him every Friday they have bird feeders out in their backyard, and so he’s been obsessed with birds and birdhouses. Whenever he would build something with blocks, I’d say what what did you make big birdhouse. Okay, but everything was a big birdhouse,

P: two, is a super fun age right there’s so much going on. 

L: Yes. And the other thing that has been super funny he’s totally into his brother, I mean, he is not ignoring him, There hasn’t been like, Please take him back. My youngest is seven weeks old, having my husband holding the baby with the toddler around his immediate response is getting upset, you know, he’s kind of feeling jealous, like, and holy even still say now he’s like my Daddy. And I’ll say Sutton’s daddy too, and he started repeating that twos like setting study to like, you know weekend, or he would see my husband holding him and immediately say, Mommy hold him. Mommy hold him like that he please know like this is not your baby It’s mommy’s baby.

P: If you could give advice to your younger self, about this process. What do you think you would tell her.

L: Oh gosh, something that I’ve learned about myself is that I honestly probably struggled with anxiety before having a child and I just didn’t really realize it I thought it was just the way that people operate. I have very perfectionistic tendencies, I came into motherhood with this expectations, hearing the phrase, just do your best, right, just do your best to me when I hear that I interpret that as do it perfectly, like that’s just the way that my brain registers that there is no. Do your best and leave some margin for error. It’s like your best should be perfection. So, if I could go back and I’m still working on this, but this is something that I’ve definitely identified in myself that I hadn’t before that I ended up bringing into my motherhood experience that I think ultimately really led to my postpartum anxiety I was trying to do everything the best that I could and again pushing myself to do it perfectly pushing myself do better, you know, it could be better, I’m not doing a good enough I’m failing, you know, all these things and all these thoughts that were screaming in my head and so my advice to my younger self would be to go ahead and heal from that perfectionism.

P: Yeah, that’s a hard thing to carry. 

L: Yeah, yeah 

P: that’s good advice. you mentioned that you do postpartum clients services so how can people find you for that.

L:  Sure, yeah. Right now you can find me on Facebook, I have a Facebook page, motherhood mentoring, and I also have a Facebook group called motherhood mentoring, you can find me on Instagram at motherhood mentoring but I’m definitely more active on Facebook right now. I helped my clients kind of overcome their overwhelm and anxiety of having to do things the right way, you know, kind of overcoming that perfectionism of motherhood. 

P: that sounds awesome. Thank you for sharing your story today.

L: Thank you for giving me the space to do so.

P: Thanks again to Laura for sharing her story. I think her experience highlights the fact that it’s helpful to walk into this transformative period with limited expectations–so much change is afoot and we have real limits on the degree to which we can control any outcomes…If you want to find more about Laura and her postpartum mentoring work, you can find her links in the show notes, available on the warstories from the womb website.

Thanks for listening

We’ll be back soon with another story of overcoming

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

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

Ways to Find Ashley & her Fitness Center and Videos

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

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

Rh incompatibility and RhoGAM

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

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

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

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

Low body fat and infertility

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

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

Exercise during pregnancy

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

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

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

Autoimmune disease and pregnancy

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

Audio Transcript

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

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

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

Let’s get to this inspiring story.

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

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

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

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

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

A: Yeah. 

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

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

P: Yeah,

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

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

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

P: wow

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

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

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

A: It was terrible 

P: Good lord, oh my God,

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

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

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

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

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

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

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

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

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

like be hopeful. 

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

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

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

P: that make sense. Yeah,

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

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

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

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

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

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

A: it was their first leaving grandbaby 

P: Yeah, yeah.

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

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

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

like. 

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

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

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

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

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

P: Oh good, okay good.

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

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

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

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

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

P: Yeah, 

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

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

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

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

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

P: Yeah, 

A: exponentially incomparable.

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

 

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

P: wait, with you or with her. 

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

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

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

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

  

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

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

 

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

P: Yeah, 

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

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

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

P: Yup 

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

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

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

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

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

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

A: You’re welcome. 

P: And how was that pregnancy.

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

P: Oh my god, 

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

 

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

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

P: And then what was the birth like

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

P: yeah

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

P: Oh my, God 

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

P: oh wow. 

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

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

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

P: Yeah, 

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

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

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

P: what’s your not complete mean?

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

P: Yeah.

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

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

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

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

P: Wow, 

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

P: yeah. 

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

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

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

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

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

P: Yeah, 

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

P: yeah, 

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

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

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

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

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

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

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

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

A: Oh yeah. 

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

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

P: yeah

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

 

P: Oh wow.

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

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

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

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

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

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

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

Thanks for listening. 

We’ll be back soon with another inspiring story.