Episode 56 SN: A Run in with Gestational Diabetes, among other things: Tabitha’s Story

In general all the stories women shared on the show reflect on Roe in part because they show how challenging pregnancy can be both physically and mentally even when pregnancy is highly sought after. That’s one of the major take homes from this podcast real women sharing their actual experiences and hopefully contributing to a more realistic narrative around pregnancy and birth. And today’s story is very much in this vein. My guest today walked into pregnancy unsure about whether she wanted to have a child. Ultimately she and her partner decided they did. She ran into gestational diabetes which effected how she felt about the pregnancy and her ability to control her blood sugar, and had a significant impact on the delivery, which happened in late fall of 2019, so she also had to contend with a six month old when the first lockdown happened. She and her partner managed it all and now are enjoying their 2 and a half year old.

To find Tabitha’s writing, click here, here and here…or search for her on the web

Gestational Diabetes

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120181/

https://pubmed.ncbi.nlm.nih.gov/3542067/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290225/

The Placenta in Pregnancy wrt GD

https://www.ncbi.nlm.nih.gov/books/NBK1668/

https://diabetesjournals.org/care/article/30/Supplement_2/S120/23944/The-Human-Placenta-in-Gestational-Diabetes

https://www.gestationaldiabetes.co.uk/gestational-diabetes-placenta/

https://www.karger.com/Article/Fulltext/455904

GD and preeclampsia

https://www.everydayhealth.com/gestational-diabetes/gestational-diabetes-and-preclampsia.aspx

Induction and Breastfeeding

https://www.sciencedirect.com/science/article/abs/pii/S0378378216302122

https://www.sciencedirect.com/science/article/abs/pii/S0889854517301158

https://www.liebertpub.com/doi/full/10.1089/bfm.2017.0012

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947469/#:~:text=Compared%20to%20all%20other%20study,lower%20oxytocin%20levels%20during%20breastfeeding.

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. A few things to mention before we get going. First, this episode is late, because COVID essentially grounded me for the better part of two weeks that I’m recovering and episodes will roll out on a regular schedule again, starting now. Second, since the last episode, Roe v Wade was overturned. I still have too much rage about this outcome to talk about it. But in future episodes, we’ll address this specifically. In general all the stories women shared on the show reflect on Roe in part because they show how challenging pregnancy can be both physically and mentally even when pregnancy is highly sought after. That’s one of the major take homes from this podcast real women sharing their actual experiences and hopefully contributing to a more realistic narrative around pregnancy and birth. And today’s story is very much in this vein. My guest today walked into pregnancy unsure about whether she wanted to have a child. Ultimately she and her partner decided they did. She ran into gestational diabetes which effected how she felt about the pregnancy and her ability to control her blood sugar, and had a significant impact on the delivery, which happened in late fall of 2019, so she also had to contend with a six month old when the first lockdown happened. She and her partner managed it all and now are enjoying their 2 and a half year old.

Let’s get to this inpsiring story

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

 

Tabitha: My name is Tabitha Blankenbuehler. I’m an essayist I live outside of Portland, Oregon.

 

P: So nice. Well, let’s go back before children for the very start. You grew up with siblings?

 

T: I did. Yeah, I’m the oldest obviously she had a brother and a sister. My sister was three years younger than me. And my brother was nine years younger than me. So he was kind of like, you know, I sort of got that mothering experience a little more with him. And still think of him as like a child.

 

P: Yeah, my sister is eight years older than me and her little nickname in my email is kiddo. So I’m with you. And so we were just talking about before we went to tape, the fact that for a lot of people growing up in a house with siblings makes them think, oh, I want a family. I’m definitely gonna have kids. And it sounds like for you that was not the case. So why don’t you tell us what your experience was?

 

T: Right? Yeah. I mean, I had, you know, a really great childhood. My parents were loving, supportive people. You know, the kind of people that you would say, okay, they were like born to be parents. I guess. For me. It wasn’t so much that I was that I didn’t have a good childhood that I wanted to recreate or anything like that. It was just sort of that I saw how much time and how all encompassing. Parenting was especially, you know, for my mom and I just didn’t want to do that. Like I wanted to do other things. I wanted to be a writer and you know, I had a bunch of other things I wanted to do be president and all these things. I really wanted to take precedence over having a family and I also kind of thought, you know, well, my family is really great. I don’t need more. 

 

P: Yeah, yeah, yeah 

 

T: I have, I have what I need. So also, when I was growing up, I just didn’t really like you know, I was an oldest child and I was very stereotypically the oldest child. You know, I was like, best friends with my teachers. Oh, all the adults around me and people pleaser and all those sorts of very boilerplate things. So I didn’t like kids. I had a hard time with other kids. I just didn’t relate to people my age. So I think there was that too, but just that I don’t like kids, even though I am one. I don’t want to be I can’t wait to not be one anymore. So

 

P: Well, I think seeing your mother in that way is wildly insightful. So maybe you were just kind of ahead of the curve there. And I for sure have you know, most people don’t know how they’re going to jack in a child to their existing life. And, and a lot of people, myself included, just kind of threw my hands like up, people figure it out. I assume I’ll be one of them. But it seems to me very smart to look at that and say Holy shit, that’s a lot of time. I can do other things. Right. And now that you’re on the other side, right, you’re right. It is time consuming. Yeah. So how did you move from the I don’t like kids. I don’t want kids to look I’m pregnant.

 

T: Yeah, it was, you know, really unexpected. Journey, I suppose. So, in 2018, I was on the end of my book tour I was doing I was completely absorbed in that in the writing pursuit and everything. And towards the end of my book tour, I realized I was you know, a few days late on my period, and being very obsessive about everything. I just took a pregnancy test. I figured, oh, well, there’s no way that I’m pregnant. I’m on birth control, blah, blah, blah. And it I took it in my office bathroom, and it was positive. Yeah. And, you know, completely threw me for a loop. It was the last thing I was expecting. And my first instinct was that I didn’t want to have a child and I wasn’t going to keep this pregnancy. So I went in and talked to the doctors at Planned Parenthood. I had caught the pregnancy super early, just because of being so conscientious about my schedule. They wouldn’t have been able to do an effective procedure at that time. And so when I just kind of sat and thought about it for a while, you know, it just sort of gave me the opportunity to react in a way that I didn’t expect because my initial reaction is I don’t want to do this, which is a completely valid response. 

 

P: Totally, especially especially when you’re on birth control, right? Yeah. This was not my intention, right?

 

T: No, no, and we totally wasn’t and I think we always kind of said, my husband and I, well, maybe when we feel like the time is right, like, you know, whatever the hell that means. means nothing. Yeah. Yeah, the longer I kind of just sat and thought, I realized, maybe this is something that I want to do. I sort of feel a connection to this pregnancy that I didn’t expect to have and you know, I’m just I’m feeling a way. I didn’t know I’d feel. So we had a discussion and we decided that we were going to keep it and was we were really excited. And then a few days later, I had a miscarriage, which is super common in those early pregnancies, but you know, it was devastating as it is in any stage in a pregnancy. So after recovering from that a little bit, we still wanted to try and we still wanted to go down that path that had been presented to us. So we did and fortunately, we were pregnant a few months later.

 

P: So it sounds like it was easy to get pregnant the second time. 

 

T: It was 

 

P: good. 

 

T: Yeah. 

 

P: So that’s great. That’s one hurdle over. And then this time, you’re excited to check the pregnancy tests, I’m assuming.

 

T: Oh, yeah. Yeah. Super excited. My big reveal my husband had to go to work trip to Arizona when I was able to take the pregnancy test. So I was flying down to visit him while he was working. And so it took the pregnancy test and my carry on, and I wrapped it up in a little plastic bag. And I picked up In & Out on the way to the airport and I put it in the bag with the double double is like the happy meal price. So yeah, we it was it was all a big party. We were really excited. 

 

P: That’s a cute reveal. So that’s exciting. And then what’s the first trimester like 

 

T: first trimester was pretty good for me. As far as you know, I didn’t get very sick and I didn’t have a lot of problems. The complications for me started to start about I’m sure the second trimester when I had to get the gestational diabetes check. And I ended up getting diagnosed and it was a case where I couldn’t control it no matter how hard I tried with diet, you know, I counted out all my grapes and didn’t do anything that I wasn’t supposed to do, but it just like would not work which was extremely disheartening and induced a lot of guilt. Because it’s like, no matter how hard I try, no matter what I do, I can’t make my body it feels like safe for this child.

 

P: So there are a lot of different ways to respond to that right to some degree. Your body has already shown that it has a pretty good autopilot in that like you can get pregnant and you’re you’re pregnant and you don’t have any control over that chemistry. Right. It is what it is. But for some reason you’re feeling guilty over the gestational diabetes, which I also assume is like a chemically induced shift in your ability to process blood sugar that you also don’t really have that much control over.

 

T: No, no, I don’t. Nobody does. 

 

P: Right. 

 

T: But you know, there’s just like any sort of condition. You go and you try to find your answers. And there’s a lot of conjecture about, oh, well, maybe you should have been this weight when you got pregnant or maybe should have thought of that before. Your parents had diabetes are all these all of these things that make you second guess yourself?

 

P: Is it in your family? 

 

T: Yeah, I have risk factors from both sides of my family, which isn’t necessarily a indication that you will get it but it does of course. Yeah. increase your chances. Yeah.

 

P: Well, that sounds hard. I flirted with gestational diabetes, which is to say like, I think I had to do like a week long trial where you prick your finger with a needle to measure blood glucose levels at home, which is so wildly unpleasant. I think after day three, I was like who do you say, Well, I don’t eat. There’s no reason to, you know, to scrap the whole system. So that sounds really hard to do. You have to prick yourself every day. You’re nodding yes. On paper. It’s a small thing, but in reality, I thought it was really uncomfortable from the oh my god, the middle of the second trimester.

 

T: Yeah, right about then yeah, I started to have to do the finger pricks. And then like I said, I couldn’t control it with the diet alone. So I started having to take insulin, and the amount of insulin I had to take just kept going up and up and up. And you know, which was also really distressing. You know, as the vile just kind of keeps like going and going and going and you have to stick it in your stomach, right? Yeah, like, I mean, obviously, I know. Like scientifically or biologically I can’t hit the baby, but it still feels like you’re just jamming it.

 

P: Yeah. That’s not a great visual. No, I agree. 

 

T: No, it’s not. It’s great.

 

P: So we took some questions about gestational diabetes to an OB today and we’re lucky enough to have Dr. Mehta Thiago on the show a fabulous OB from California who’s got a lot of experience with these issues. So Dr. Mathis Yeah, who thanks so much for coming on.

 

Dr. Matityahu: Thanks so much. Paulette, I love being on your show. Great.

 

I’m wondering first of all, if you can just define gestational diabetes.

 

Dr. Matityahu: So gestational diabetes is basically elevated blood sugar in pregnancy. We test for it around 25 to 28 weeks because as the placenta develops, your placenta is basically making the insulin not function as well. And so your blood sugar’s begin to run higher, and for some women, they run high enough that you’re considered diabetic. And so if you’re someone who maybe has a family history, or borderline would become diabetic later or just isn’t following a very good diet, you’re you’re likely to have issues with managing your blood sugar later in the pregnancy because your insulin isn’t working as

 

well, 

 

P: I neglected to ask them to Dr. Matityahu more about the placenta when we spoke but then I found some articles that suggested that every pregnancy independent whether you have diabetes or not, involves a placenta that churns out more hormones over the course of the pregnancy, some of which block the effects of insulin, which will lead to higher blood sugar levels, the mother’s pancreas will release more insulin but if it’s not enough to compensate for placental changes, and you can end up with gestational diabetes, although there are numerous routes to gestational diabetes. If you have that condition, your needs for insulin will grow as the pregnancy progresses because of an increase in placental hormones. 



P: does it feel Like any like not the needles obviously the needles are uncomfortable, but having gestational diabetes doesn’t feel like anything.

 

T: No, no, you don’t feel different, but only way you’d feel different is just being hungry. 

 

P: Okay, yeah. So once they put you on insulin, does that free up the constraints on your diet or no, then you still have to eat like, grass?

 

T: Yeah, yeah. They still want you to have really low numbers compared to someone that you might know in your life with diabetes, like type one or type two. The numbers that a gestational diabetic has to get to are so much lower,

 

P: as I understand that the numbers for gestational diabetes to qualify you as as having that condition are relatively low compared to diabetes outside of pregnancy.

 

Dr. Matityahu: Yes, we have very strict guidelines of where your blood sugar should be in pregnancy. And so we’re super super tight with sugar control in pregnancy and blood sugar’s that may not at all be considered diabetic for someone who’s not pregnant. We consider that diabetes in pregnancy. 

 

P: Is that because of something that a higher level of blood sugar does to a pregnancy to a fetus? 

 

Dr. Matityahu: Yes. So high levels of blood sugar causes high levels of sugar in the amniotic fluid in the baby’s bloodstream. And so then the baby reacts to that high sugar, high blood sugar by producing more insulin and that puts weight on the baby. So now the baby starts gaining and getting like big and so the body of the baby can get if it’s uncontrolled. So really high blood sugars that are not controlled, would cause the baby to start gaining a lot of weight. So the body of the baby gets much bigger. The baby starts peeing more and so the amniotic fluid is managed by the baby drinking and peeing. And so in a person when they have high blood sugars will drink a lot more fluids and will pee a lot more to kind of dilute the sugar in our bloodstream. The baby will do the same thing will start drinking and peeing more and that also makes the amniotic fluid start to expand because now the baby’s peeing a lot more. And so it causes weight gain on the baby increase in the amniotic fluid and and it can over time they get to like the baby’s lungs don’t develop as quickly as they should. And so it so it can cause a lot of problems with the baby. So one of the problems with the baby getting so big is the baby can get pretty large, the head can come out and now the body is way too big because the baby gained too much weight and so you get what’s called Shoulder Dystocia where the baby can get stuck.

 

P: So aside from all the difficulty with the needles and the food, like how are you taking this emotionally because it sounds like you’re someone who’s detail oriented. So that seems like

 a lot of pressure. 

 

T: Yeah, yeah. You know, it was sort of back to the days when I was in college and on Weight Watchers and writing down obsessively everything I ate and being really obsessive about food and yeah, it was extremely depressing just feeling like no matter how hard I tried, it wasn’t good enough and just being worried that something could go wrong. I think it’s a really common condition but a lot of people don’t really understand it. Like so many things with pregnancy. It’s like unless you’ve actually been with child you don’t know it exists. Like I had to explain it to everybody in my life. 

 

P: Oh, that’s interesting. 

 

I’m wondering if we know why sometimes you can control diet and sometimes you can’t.

 

Dr. Matityahu: We can’t predict we don’t know. What we know is if you can control your blood sugar’s by diet, or even if you’re controlling them with medication, the baby’s going to do great for women that can control it with diet. We don’t even consider them high risk. That you know you have gestational diabetes, but if it’s diet controlled, you’re a normal risk pregnancy you’re not even a high risk pregnancy. Once we give you medication, we consider it a little bit higher risk pregnancy and so we follow that pregnancy differently. Can we predict who’s going to do well with diet and who’s not? No. And a lot of times even for women like Tabitha who are incredibly meticulous in like cutting out almost all sugar in their diet and doing like the perfect combination of foods doesn’t always work. And, and yeah, and so women also will easily feel like I’ve failed because I have not been able to control how my body responds in all aspects of life. And yes, the reality is we don’t have the ability to control how our body responds in all aspects of life. And we just have to let that go. It’s similar to women who end up with a C section and feel like I’ve failed. I you know, my I wasn’t able to make my pelvis deliver a baby. You know, vaginally we just don’t have control. We just have to accept that all of us type A people have to accept that like we cannot micromanage every aspect of life and how our body responds to things. And I think you know, most of us that have kids quickly learned that you know, we can’t manage how our kids come out and, and grow up either.

 

P: I mean, one thing that’s interesting about your experience is when things are screwed up, like on the front end, like we could not get pregnant and you do feel like your body is failing you and I you know, why can’t I reproduce and but that’s a totally different feeling than being like waist deep in a pregnancy and having things go a little topsy turvy because now there’s no way but through, right. So that’s a little s and now like you’re very much thinking about the baby that you’re growing and how’s this affecting him or her and like it just seems like it’s a much harder thing to manage.

 

T: Yeah, yeah. So it just caused a lot of stress. I also had a lot of stress going on in my job. So it was kind of just compounding all of that. And yeah, it was it was a bad final trimester. So for sure, 

 

P: also, like everyone’s telling you not to stress out right, stress is just as bad for the babies. You’re like I’m not freaking out because that’s the one thing I can control kind of not really. So that sounds like a time so take us to the day that you’re it’s your daughter, right? 

 

T: Yeah. 

 

P: Take us through the day your daughter was born. How do we know today’s the day? What does that look like?

 

T: Yeah, well with the way that my gestational diabetes progressed. I knew fairly early on that it was likely to be an induced pregnancy. Because another thing that happens when you have gestational diabetes is that the baby develops faster, grows bigger. So she already was sort of predisposed to be a larger baby. My husband was 10 pounds.

 

P: That sounds like a threat.

 

T: Yeah, it’s not good. When every time you go to the doctor, you get this like ooohh face when they ask about it. So yeah, it just sort of was coming from all sides there. And we kind of had like this tentative date for about a month. or so. So I was sort of working with that. And by that time, I was going into the doctor at least once a week to check on it. And the day before we went into the hospital. It was let’s see. Over a week before this date that we were going to originally induce my doctor, she ran some tests, looked at some things and she said, oh you know you’re kind of borderline for some things and I don’t know I’m sort of thinking we should maybe have the baby sooner and ask okay sooner, like this weekend or what? No, why don’t you come in tomorrow morning. So all of a sudden, I mean, this was a I remember it’s a Wednesday so I had just come off work. hadn’t really obviously prepared to be going yet. But honestly, that was kind of my silver lining of having this condition was sort of the feeling of control and knowing when it was going to happen even if it was like 12 hours. 

 

P: Yeah, yeah. 

 

T: So like nicely packed my bag. We stopped at Starbucks on the way to the hospital. I dressed up and took a selfie by the doors. I mean, it was it was very that so that was sort of a little bit of retribution for all the stress but

 

P: I like you making the most of it. That’s that’s a good way to do it. Let me ask you before we get to the actual birth, are you imagining giving birth in a tub surrounded by angels strumming harps, or like what what what image did you bring to the delivery?

 

T: It was so hard for me to imagine because I did all of the classes that the hospital offered and did all of those things and it was all centered around a natural uninduced birth, or they also have a lot of good information for mothers that were getting a C section, which is great, but I kind of raised my hand and asked what happens when you’re induced and they’re just like didn’t really have a very good answer. We toured the hospital before we went so I did see the little jacuzzi and I thought that sounded cool. But yeah, the reality was that with the monitoring for preeclampsia and everything I had to be stuck on an IV the entire time. So all my dreams were very quickly squashed and I just sort of wanted things to be, you know, I want to make use of all the drugs, very happy with modern science love it. So my birth plan was all laid out with those sorts of things. And I remember bringing the printout and pointing at them and everybody just basically was like Oh, cool. we’ll recycle that for you. Yeah,

 

P: great. That’s a lot of support at the hospital. New Plan. 

 

T: Yeah, 

 

P: so you check in when you’re supposed to and have a blackout I feel like induction is usually thought of as kind of painful because it’s your like ginning your body up in a way that puts it on a schedule that might not naturally be on, which is a hard thing to manage.

 

T: Right? Yeah, it wasn’t. It wasn’t painful, especially at the beginning, basically, the first 24 hours when I started taking the initial medication. Were just boring, you know, just sitting in the hospital and since I did have to be hooked up and monitored and poked. They took my numbers for my diabetes every couple hours or whatever. I couldn’t go up and move around, but couldn’t go sit in the tub and couldn’t do a roll around on the ball. You just had to sit in the room. And I remember binging probably 20 episodes of restaurant impossible with Robert Irvine. So I always, you know, kind of think of him when I think yeah, the hospital and so yeah, it was just kind of sitting and just trying to figure out if something was happening, like just sitting and trying to listen to my body, you know, is anything happening? How will I know what’s happening? And I think that was another issue I had was that I didn’t know what labor pains were going to feel like. And I don’t know how someone has to describe that to you. I don’t know how you prepare for that. But what I was thinking was not at all accurate. I am going to go ahead and blame Hollywood and producers and directors because every TV show and movie it made it seem like someone was stabbing you in the gut kind of pain. When it’s actually that feeling that you have to take the world’s worst shit. It’s like the most terrible constipated sort of feeling. So since I felt like that I kept getting up and going to the bathroom thinking I had to poop when I was really starting to have contractions. So oh my gosh, I was really far along by the time I finally asked for my epidural. I think I was I can’t remember like which centimeters or which at this point, but it was like they were kind of saying I’m glad you told us now because you weren’t getting really far along before kind of raising your hand and saying I might be having the baby. So that’s when things started to get painful was when it finally kicked in 24 hours or so later. And that wasn’t so much I don’t think that I was induced it was just sort of the way Well, no, I guess it was sort of that I was induced because some of the things they had to do. They might not have had to do if it was my body’s natural response, like they had to go in and break my water. And that was the most uncomfortable and painful thing in the entire process.

 

P:Wow. 

 

T: Yeah,that really was awful.

 

P: Because the cause the getting the thing in your cervix is painful or because the actual breaking of that amnion is painful.

 

T: Kind of I’m not sure which was which but the whole thing and they had to use the needles so they poked my daughter in the head. You know what she did? I was fine, but it wasn’t fun for anybody. And

 

P: also when they bring it in, I’m sure you’re like get that crochet needle away from it. Right Like what are we doing here?

 

T: It’s really terrifying. Yeah. And it was the middle of the night. It was must have been like 3am or something. So everything is very surreal. Yeah, very bad. And then after that, because it was about 5am that I got my epidural. And they missed my spine with the needle. So they had to do it twice. 

 

P: Oh that’s bad

 

T: Oh my God…But then again, it’s, I think when you’re at that point, it’s just like whatever. I don’t care.

 

P: I remember being terrified of delivery and I got some comfort from the fact that I knew that at some point, things on the outside would be so bad that I would say, Do whatever you have to to, you know, the threat of an epidural needle seems small compared to having my body crunched from the inside, right. So

 

T: exactly. Yeah, yeah, you can just whatever, whatever makes it go faster, whatever makes it over. I don’t care. Take my fingers. Take my toes.

 

P: Yeah. So you get the epidural and then does that calm everything down because now you can’t feel it or where are you?

 

T: It did a bit but then Yeah, it did for a while. I remember a few hours where I kind of fluttered in and out of sleep. But then slowly those contraction pains started, you know, making their way through the medication I could. I really felt that that was coming. I remember telling my husband you need to go get the nurse now. It is time. It’s amazing how much you know it is time. I had no idea when to know but I did. And unfortunately, I thought that I thought my worst case scenario was like okay, well, once I get to this point, it’s going to be 45 minutes or so. I had to push for three hours. Three hours.

 

P: yeah that’s a long time. That’s an amazingly long time.

 

T: It was so long, and I don’t know how. I don’t know how I did it. You know, it’s it’s exhausting. It is the most exhausting thing I’ve ever done or will ever do. And, you know, it’s really easy to say from here. And from before and from any other angle that well you always find a way to do it. Your body knows what to do. It’s natural. Okay, yeah. But when it’s happening, you really feel like you’re going to die. There feels like there’s no other alternative than this is just going to destroy you. And I guess it kind of does in a way. I mean, by the time you’re done, you really are a different person. 

 

P: Yeah. 

 

T: You’ve been through something that I don’t think is necessary. I don’t think anybody has to go through childbirth to you know, live a full life or experience things, but that very specific feeling is just so I don’t know how it could be recreated in any other capacity.

 

P: Yeah, I mean this to some degree, which is ironic in a conversation between two writers but is something that kind of defies language, which is why no one can tell you what it’s going to feel like when you’re having contractions There are no analogies that are fitting, right. So usually you can sidle up to something similar, but there’s not really anything that’s like it. 

 

T: Yeah, no and yeah, the funny story was my doctor or the doctor who was delivering the baby just kept telling me with each push, one more push, and then you’re a mom. One more push. Gonna be and this went on like five or six. times and I just like screamed “where’s my baby?”.

 

P: Yes, this is very much like it’s just around the next bend right there. Yeah, that sounds frustrating. So but once the head crowns and all that then it was quick.

 

T: Yeah, yeah, I had to have an episiotomy which was in my birth plan is don’t do that. But when they brought up the options, like yes, anything now, yeah. So there was you know, that kind of final complication, which also I was surprised how long that took honestly to recover from postpartum you know, I had a lot of issues with sort of pain and things with it and sort of feeling it being there for probably six to nine months after giving birth. So I think, you know, I think it’s a good thing that it was done, but you know, it’s also I think it gets brushed off a lot like, oh, it’s not that big of a deal. But it’s, it’s kind of a big deal. It kind of really sticks with you for a while.

 

P: Yeah, I wouldn’t I wouldn’t even say kind of, I would say and actually a big deal and it’s a little bit like it falls into the postpartum black hole. And you are everything falls where you just we don’t talk about it anymore. And I find in the discussions of pregnancy, there’s a constant kind of conflating of common and easy 

 

T: hmm, 



P: episiotomies maybe common, but it has these real repercussions as you have experienced for a long time, you know, postpartum as some people think it lasts a year after birth, right, which kind of makes sense because at six weeks, your uterus shrinks down to its normal size, but there’s so many other things that don’t either never go back to the way they were or take much longer to heal or so six weeks is kind of I think the date we all have in our head, but right it’s a little bit false. Yeah, I’m jumping ahead a little bit. Your baby is born. They put her on your chest.

 

T: For a second, and then they had I think she had some of that fluid. So they had to really quick like grab her and start doing some things that really alarmed My poor husband, who could actually see them. But no, she was she was great. She was fine. Of course, the most beautiful thing I’d ever seen and all the all the good things all the good, happy feelings for sure.

 

P: That’s awesome. That feels fitting after three hours. And then what happens to gestational diabetes does that how does that resolve?

 

T: Fortunately I the first thing that I made my husband do after I had given birth and kind of got the all clear like okay, you can take a drink of water you can have some food and a little bit. I sent him down the road to Five Guys. He had to bring me a double burger fries and a milkshake. He didn’t think I could finish them which was hilarious. Yeah. after that. But uh, yeah, so they have to test you they keep testing you on when you’re in the hospital to make sure nothing weird happens. And then for the rest of my life, I’m going to need to be screened for diabetes, I believe on a yearly basis, especially with my family’s history and everything but so far I’ve I haven’t had any signs that it’s back or it’s coming back. And neither is Sophie. They have to check her a little more to because that does raise her risk. But no, it’s it’s gone.

 

P: If you have gestational diabetes doesn’t resolve with the birth.

 

Dr. Matityahu: Yes, once the placenta comes down, then you go back to having normal blood sugars in the future. About 50% of women can develop diabetes. We usually have women we remind them like every year or so check your blood sugar to make sure that you’re still doing okay.

 

P: And we think that’s because the pregnancy exerted this extra stress on their body and that has changed the trajectory or we think they were going to get it anyway or there’s no way to know.

 

Dr. Matityahu: It’s more that they were they were at risk of getting it anyway and with the placenta causing an issue with their insulin. It pushes them just over the edge while they’re pregnant. But if they continue to have a high carb high sugar diet for the next five or 10 years, then they’re going to continue to push their body into becoming diabetic. A lot of diabetes is diet related and not for everyone. So it’s not to say that everyone that has diabetes is has a poor diet because that is that’s not it at all, but but for a lot of diabetics is that we’re giving our body too much sugar and our body’s insulin can’t handle it. And so our blood sugar ends up being high and for some diabetics that’s the issue for others. It doesn’t matter. You can have the most strict, you know, low carb diet and you’re still going to have issues with your sugars because for some people, they just have issues with their insulin production and it has nothing. It has nothing to do with how well controlled or strict they are with their diet.

 

P: Other than physically healing. How did you find the fourth trimester?

 

T: I wasn’t I wasn’t prepared for it. I’m sure that might have been said before once or twice Yeah. I was not prepared at all for the hormonal issues and changes. I didn’t sleep for about the first week after having her and it was it was literally making me insane. I felt like I was losing my mind. And I got misdiagnosed. When I called the doctor as having postpartum depression, which wasn’t my issue. It was just it was more I have anxiety. So it was the anxiety manifesting itself. And so the combination of not being able to sleep and the anxiety of just, you know, when I lay down to sleep, and she’s right next to me, I’m like, listening for to breathe, afraid that something’s going to happen. Or on the reverse side. I didn’t have this is like tripping me up. I didn’t want to miss anything. I didn’t want to be asleep while she did something. And I would miss it. I don’t know what I was looking for. You know her to sit up and start talking to me or something. But I felt like the time that I was there was so important. And so precious that if I slept it would it would be gone or something.

 

P: I mean there’s there’s something real there right like they are one day old once that’s it ever again. So so and they develop so quickly in that period that there’s a lot there’s a lot going on. There’s a lot to watch. There’s a lot going on

 

T: I also had a lot of trouble because of being induced. my milk would come in. Yep. So I had physical problems feeding my daughter I was going to try and breastfeed. It wasn’t the end all be all to me. I just wanted to make sure that she had food. So when I started having troubles, I wasn’t opposed to using formula or any of those things. But the frustrating and heartbreaking part was you know, she’s telling me she’s crying and she’s telling me that she needs to eat, she’s hungry, and I physically can’t help her I have to wait for my husband to go in the kitchen and mix up a bottle. And so that was really heartbreaking. Not so much that we had to make a change but just that in those moments where she needed me, I couldn’t immediately help her. The way I wanted to

 

P: and did that wane as she got older because you got more in a rhythm or didn’t have that the whole time?

 

T: Yeah, I think I continued for about two months to try and feed her breastfeed her and and I supplemented with formula. And by that point, it had become so unpleasant for me. And obviously unpleasant for her because if it’s not pleasant for me, it’s not going to be pleasant for her. And also she was just very not interested. You know, she learned like, oh, this bottle is already to go and I don’t have to do anything. So why am I messing around up here? Yeah. So you know, she was more into that and the process of trying to pump and everything was making me miserable. So one day I had to do a long drive to visit family and during the drive you know my I got those painful over just painful feelings and I just got to home I’m like I’m done. You know, I feel like my body has sort of stopped gotten angry. We’ve done some things during this drive. So we’re just gonna donate the equipment and move on. So 

 

P: yeah, that seems smart. I mean, if you think of all the things your body is doing to get pregnant to stay pregnant, to grow a baby to deliver, and then also to breastfeed, you know, you’ve done like 87 of them. So, all of which are amazing, right?

 

T: And it’s very weird to see one of my sister’s best friends. She had her baby right around the same time we all kind of clustered together and she was posting on Facebook saying I have so much extra milk and is taking up all my freezer. How is that possible? If I I was taking cell phone pictures of a vial like this big that I’m able to fill like I am having an amazing day and other people are filling up their freezer. It’s very inequitable, it feels like

 

P: Yeah, yeah, it is like randomly distributed. Yeah, 

 

T: right. Exactly.

 

P: So how old is your daughter now?

 

T: She’s just shy of two and a half. Yeah, she was born in September 2018. So Wow.

 

P: So just before the pandemic,

 

T: she turned six months old when the lockdown started. So we were just you know, at that point where the newborn infant days was ending, and we were going to go into the world. And then everything stopped. So

 

P: wow, you’ve been one of the people who’s been shut in with a runaround baby. How’s that going?

 

T: Yeah, I it’s been very difficult. But at the same time, I am infinitely grateful that she was here. Yeah, it definitely shifted sort of certain priorities. And it shifted different priorities and timelines for our family. So you know, we’re going into six months old and I’m thinking, Oh, we have to start planning your first trip to Disneyland. Oh, we’re going to go to the zoo all the time. You know, all these sorts of social, fun, interactive things. And then all of a sudden, we’re right back into the space we were in, which was a small house that had been purchased. When my husband and I were envisioning a life where it was just the two of us. And it was small. It wasn’t very kid friendly. All these things which wasn’t going to be a huge problem if we were out doing things and having a life out in the world. But then all of a sudden, we were spending all of our time in this small house. So instead of the life I think we were looking at with her for when she was a toddler of doing traveling and doing this class and that group and all these things. We concentrated instead on moving so we’re in a new house or in a bigger house. So that’s been a huge positive change, because there’s so much more room for all of us to move around. Plus, yeah. And we weren’t also not planning for my husband to be working from home for most of two years. 

 

And that’s another silver lining because he’s been able to bond with her in a way that he never would have been able to before the pandemic. She’s really close to her dad and it’s really beautiful, to see that relationship, and also just have that support. I mean, even now when he’s home, it’s nice to just be able to run outside and get the mail or drive out and pick up some curbside groceries without having to necessarily take her with me. It’s just an extra pair of hands and eyes that is super helpful but you know also sometimes you just want to do things yourself and have your time so just the same as anybody. There’s a lot of that give and take with balancing everybody in the same space. 

 

And when I was growing up, my mom was a stay at home mom too. And so, I wasn’t initially planning that for myself or for us. I had a situation with my work where I was going to take an extended maternity leave unpaid so I saved up for all my pregnancy so we’d be able to survive a few extra months, but it was really important to me to be able to be with her for those first six months. Because, I mean, I was very privileged to be able to do that. I think everybody should have that option. 

 

P: Yeah, 

 

T: well, weeks is nothing. 

 

P: Agreed. It doesn’t make sense. Yeah. Yeah. 

 

T: Unfortunately, a few weeks before I gave birth, my company rescinded our agreement. Until me I’d have to be back within 12 weeks. And by that time, I had already made my child’s childcare arrangements with the original timeline in line. And as you know, as any mom or dad knows, finding a daycare and setting up that timeline is not a simple task. Does not magically shift on a dime. You know, I was on waitlists for daycares that I didn’t hear back from until she was talking. So 

 

P: yeah, yeah. 

 

T: So it really kind of forced me to say okay, well, I am going to have to quit this job and stay home with her and that wasn’t my plan, but faced with either I mean, you know, no childcare or

 

so, once I made that decision once our family made that decision, I thought a lot about my childhood growing up and what my mom was able to do with me. And my favorite memories and those are all really simple things. Those are going to the park and splashing around in the pool, the public pool and doing picnics and all of these things that she was able to do when we were able to do together. And that was super important to me to give to my daughter and experience with her. And so not being able to in so many ways. In so much time you know there’s been those patches here. And there where okay, we’ve gone to the zoo, and then we can’t again this not going back and forth. That’s been really for sure painful and just makes me feel like I’m not not giving her what I wanted to Yeah,

 

P: although I totally hear what you’re saying. For every parents of every kid at a different age. There’s something that’s being sacrificed in the pandemic. But yeah, but for all of us who are lucky enough not to get sick or get over the sickness quickly. There’s also something gained for like every single age I have friends whose kids are in college and they say like, oh, the kids had to come home and now we get to spend time with them in a way we never would have gotten before and it sounds like your husband has gotten this amazing gift of it and you have the gift of your husband getting that gift right so there are all these things that kind of no way to manage this easily or beautifully. And this is sort of how it falls so I can see how it’d be a bummer if you had plans for music school or all that stuff to be gone but I’m imagining now your two and a half year old has an amazing vocabulary. I haven’t been around to adults. for them.

 

T: It’s insane. I can’t believe the things she can say and do and you know that’s of course me saying and I haven’t been around enough kids to know but it certainly seems impressive. She knows she has a state puzzle. And she knows almost every single state by sight and can assemble America. I still that’s 

 

P: that’s amazing. That’s amazing. My high school seniors like where’s Illinois? 

 

T: Exactly. 

 

P: Kudos to you. Well done. So does she have any tricks that you want to talk about at two and a half?

 

T: She keeps asking Alexa for her favorite songs. So right now it’s always Alexa, talk about Bruno.

 

P: So funny. Talk about digital natives. Good Lord. 

 

T: I know it’s awesome. 

 

P: Very fun. So here’s a question for you even though she’s pretty young still. If you could go back and give younger Tabitha advice about this process. What do you think you would tell her?



T: I think I would say just to keep trusting your gut and not what not even what other people think. But what you told yourself you were going to be and what you were going to do. You need to stop holding yourself to what you were thinking when you were 10 or 20 or even 30 Because yeah, I needed. I trusted my gut when I had my first pregnancy and changed my mind. I trusted my gut when I thought that I’d have to quit my job. And you know, all these all these times that I made decisions that I never would have thought I would have made and probably wouldn’t have supported. Somebody else making To be honest, but they all turned out to be the right thing. Or the thing that has brought us to the here and now which fortunately, is a really beautiful, wonderful place to be we’re really lucky. So yeah, if I would have kept trying to be the person that I thought it was going to be. It would be a miserable mess for nobody but me.

 

P: What can you say but that a lot of life is experiential…10 or 20 or 30 year old you couldn’t have imagined a lot of the events that happened–getting pregnant despite using birth control correctly? The flip flopping of your work agreement? That sounds like good advice to follow. I wish we had more time to talk about your writing.



I’ve read some of your work. You’re beautiful writer. Where can people find your stuff?

 

T: My website is Tabitha blankenbuehler.com. And I’m the only type of the blank and biller so if you find it, you’re there. That’s good.

 

P: That’s good to know. Excellent. Well, thanks so much for coming on and sharing your story. I certainly appreciate it.

 

T: Of course. Thanks for having me.

 

P: Thanks again to Dr. matityahu for sharing important information about gestational diabetes, and thanks also to Tabitha for sharing her story. I regret that we didn’t talk about her writer, she is a beautiful writer; I will leave links to her website in the show notes, where you can also find links to some of the medical issues that came up. You can find those show notes at war stories from the womb dot com. Thanks for listening. We’ll be back soon with another inspiring story.

 

 

 

Episode 50SN: A Pregnancy that Outran Scary Predictions: Lisa’s Story

Today’s guest has an interesting spin on the difference between her expectations for the pregnancy and birth and her experience going into pregnancy. She had a number of health conditions that lead to a lot of cautionary talks about the many things that could go awry. And then when she actually was pregnant, she more or less skated through a problem free pregnancy. So she’s left with feeling grateful to have outruns so many serious issues and sad about the fact that she didn’t get to enjoy what was basically a straightforward pregnancy because she was constantly on alert.

You can find Lisa’s writing here

PCOS

https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
https://www.webmd.com/women/what-is-pcos
https://www.cdc.gov/diabetes/basics/pcos.html#:~:text=What%20is%20PCOS%3F,beyond%20the%20child%2Dbearing%20years.

Epilepsy
https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093

https://www.webmd.com/epilepsy/default.htm

Epilepsy and Pregnancy

https://www.cureepilepsy.org/webinars/epilepsy-pregnancy-contraception/
https://epilepsychicago.org/what-is-epilepsy/sudep/?gclid=Cj0KCQjwpcOTBhCZARIsAEAYLuU8fRCTSVMxWjho2b1pckFcUOEhXYtS6Nvros5kCvTJZgKhCcC3EUsaAncmEALw_wcB

Fetal Surgery for Spina Bifida

https://www.ucsfbenioffchildrens.org/clinics/fetal-treatment-center
https://www.ucsfbenioffchildrens.org/conditions/spina-bifida?campaignid=71700000085986996&adgroupid=58700007287088131&adgroup=FTC-NT+-+Conditions+-+Spina+Bifida&creative=537193062435&kwid=43700065426505077&matchtype=p&network=g&adposition=&target=&device=c&devicemodel=&feeditemid=&loc_physical_ms=9031971&loc_interest_ms=&targetid=kwd-803521056122&utm_source=GOOGLE&utm_medium=cpc&utm_campaign=FTC-NT+-+Conditions+All&utm_term=spina+bifida+fetus&&campaignid=14146813904&adgroupid=125672267659&adid=537193062435&gclid=Cj0KCQjwpcOTBhCZARIsAEAYLuVdDLyuSmXsok5GdMl3I_JALDEjLXlO00R2JNSHebSUzLG5DWzjA6QaAn3mEALw_wcB&gclsrc=aw.ds
https://www.chop.edu/treatments/fetal-surgery-spina-bifida/about

Pyloric Stenosis

https://my.clevelandclinic.org/health/diseases/4524-pyloric-stenosis-hps#:~:text=How%20common%20is%20pyloric%20stenosis,condition%20requiring%20surgery%20in%20infants.

Breastfeeding across the US

https://www.cdc.gov/breastfeeding/data/facts.html

Episode 38 SN: Many Challenges can Visit a Pregnancy and Birth (including Covid): Erin’s story

Having spoken with a lot of women about their experiences with reproduction, many of them report having one or possibly two issues that visit their pregnancy or birth that alert them to the fact that they have very little control over the momentous task of creating another person in the confines of their body. Today’s guest was visited by many, many issues, including miscarriage, hyperemesis, gestational diabetes and the coup de gras, issues with breastfeeding, all of which happened (drumroll please) during Covid….so yeah, it was a lot. But now that she and her partner are on the other side of that experience, and getting to enjoy their beautiful six month old, she can appreciate how many of these challenges taught her valuable things about herself. 

Japanese Art of Grieving a Misscarriage

http://deathtalkproject.com/on-the-japanese-art-of-grieving-a-miscarriage/

https://embryo.asu.edu/pages/mizuko-kuyo

Engagement

https://www.healthline.com/health/pregnancy/baby-engaged#engagement-explained

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. Having spoken with a lot of women about their experiences with reproduction, many of them report having one or possibly two issues that visit their pregnancy or birth that alert them to the fact that they have very little control over the momentous task of creating another person in the confines of their body. Today’s guest was visited by many, many issues, including miscarriage, hyperemesis, gestational diabetes and the coup de gras, issues with breastfeeding, all of which happened (drumroll please) during Covid….so yeah, it was a lot. But now that she and her partner are on the other side of that experience, and getting to enjoy their beautiful six month old, she can appreciate how many of these challenges taught her valuable things about herself. 

After we spoke I went back into our conversation and included some details about medical issues that came up, and also had the opportunity to speak to a fantastic midwife and listening to her empathic and intelligent answers to my questions, I can see that she also teaches all of us what we should all be looking for in a midwife.

Let’s get to this inspiring story.

Thanks so much for coming on the show. Can you tell us your name and where you’re from?

 

Erin: My name is Erin Donaghy, and I’m from Melbourne in Australia.

 

P: Oh, wow. Cool. I’m jealous. It’s beautiful right?

 

E: It is very beautiful. We were just in fall at the moment. So it’s gotten very cold all of a sudden but it is a wonderful place in the world. Yeah,

 

P: I don’t think I realized it ever got that cold…

 

E: Everyone thinks  is always beautiful and sunny. There are some parts which are definitely much warmer. But yeah, we’re right down south. So it does get a bit cool.

 

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

 

E: I do. Yeah, I am one of three. I have a brother and a sister. So my sister is two years younger than me and my brother is eight years younger than me so he was a little bit of a surprise but a very welcome surprise to the family.

 

P: I’m the third of four and I have a sister who’s eight years younger than me and she’s like the best one. So thank God for surprises. 

 

E: Thank goodness she came along. 

 

P: Exactly. Did you imagine that you would have a family someday?

 

E: That’s I think, always probably did you know, my brother being eight years younger than me. I was always called his second mom, you know? So I think now to an eight year old and I’m not sure I would trust an eight year old with what I was trusting during that time. But you know, it was the 80s and maybe things were a little bit different, but I think I probably always did but then as I got into my 20s I became quite career focused and my mum is very maternal and was always has always been having you kids was the best thing ever. Having kids is the best thing you know, you’ll regret it if you don’t, and I was always a little bit different. You know, I was like, Look, I can imagine having a family but I think it’s also possible to that I may not have a family. So yeah. And then that sort of changed as I got into my Well, I suppose I was more towards my mid 30s where I started to think actually, yeah, this is something that I want. So I am an older mum. Just kind of how life has worked out. So

 

P: Erin and I are on zoom so I can see her and Aaron does not look like an older mom. So I feel skeptical. so before you got pregnant, what did you think pregnancy would evolve?

 

E: I think that because I am a little bit older. I’ve had lots of friends and you know my sister she has two beautiful boys and so she’d had kids as well. So I sort of I had an idea that could be tough. I didn’t have this vision of this. You know, I’d seen women that look beautiful and growing with a beautiful perfect bump. I didn’t necessarily expect that for me, but I think there’s nothing quite like a lived experience. Right? So no matter how much you can seek, you know, or you think you’ve seen from your friends or your family, nothing like living at yourself. So I think probably the main gap in my expectations was well pregnant during COVID So that was completely and and then I think probably how my birth kind of ended up but that’s a process. You know, it’s a process we go through when we go and so I have this tension. You know, I’m so happy to be here talking to you about this because I think it’s so important that we share our experiences in order to demystify, de stigmatize so many things. And also I understand that there’s nothing quite like doing it, to be able to know what it’s like so,

 

P: but it’s useful to hear many people’s stories about pregnancy, when very few of us have this Hollywood image of you know, it was easy, and I looked beautiful the whole time and i i loved it, every bit of it. So it’s interesting to hear people’s experience. So did you get pregnant easily? 

E: I did. So as I said mid 30s and sort of early to mid 30s I decided something I wanted to do. I was married at the time, and we had started trying for family and then our relationship broke down. So I went through a whole process of grieving that thinking, Well really, maybe I won’t become a mom because I was in my mid 30s. And what did that actually mean? So I went through the whole process of wondering if it was something I wanted to do on my own, but decided that going through that grieving process was not the time to make that kind of decision. So I went through a complete life change left my corporate job, started up my own business, did lots of travel, and then met my now partner we talked for a long time before we actually met in person but I think things are often meant to be in the way that they turn out. So we were together for two months. When I found out I was unexpectedly pregnant, which was a wonderful, beautiful, happy surprise, completely overwhelming but you know, we both very much wanted it. It was earlier than we wanted. Unexpected, but that’s why it happened. But unfortunately that pregnancy ended in miscarriage quite early on around about seven week mark. I had some bleeding, which, you know, led to a prolonged period of bleeding, some scans that were inconclusive, so that I had to wait a couple of weeks and unfortunately the time my partner was overseas so I was dealing with that on my own in a very good health system in Australia, but not particularly empathetic. So I found the process to be quite I mean it was a difficult it’s difficult going through a miscarriage of course, but I think because it happens so early on and in the medical world they deal with it quite regularly. I don’t feel that I got a great amount of support.

 

P: Yeah, That’s really hard. I’m sorry, they didn’t find someone who had good hands for that job and hard that your partner was gone.

 

E: Yes, it was. It was a full time as I said it was very early on in our relationship and not at all expected. So yeah, it was one of those things and when I look when I think back now I think I don’t really remember that month post it. I think I was quite numb like I am quite a spiritual person. I’m quite an emotionally self aware person and I’ve learnt to the feelings as they arise but at that time Yeah, I think back to that month I you know, I came back to my business. I just kept going because I thought that was what I had to do. And you know, I think one of the things that again it’s lived experience because I think I probably haven’t been completely very empathetic in the past when it’s happened to people when I’ve known about it. It’s all the hopes and dreams that you attach to a pregnancy this little being that although just a little bean at the time, everything you imagined for that what that means for you your relationship for creating beautiful little life sort of disappears in a flash and I don’t think there’s a lot around to actually deal with that. And because we don’t talk about pregnancy till sort of the 13 week mark when it’s safer to do so I think it’s not until you actually start talking to people that you realize how common it is.

 

P: I feel like we need some kind of rituals around it to help to help us grieve and just something to help us get some sort of closure on it right because it feels so finished and unexpected and you have no control right one way or the other. 

 

So I took this question of rituals to a midwife. today. We’re really lucky to get to talk to a certified nurse midwife. Her name is Ann Richards Ann thanks so much for coming on the show.

 

Ann Richards: Thank you so much for having me. I am a birth podcast fanatic and listen to them all the time and I’m just giddy that I get to be here on one 

P: Erin’s first pregnancy in a miscarriage and instead of about seven weeks, she said she didn’t really think it was dealt with very empathically I’m guessing that you see it often in your practice, and wondering how midwives are trained to deal with miscarriage and if there’s any effort afoot to develop rituals around this because it’s so common,

 

Ann: that’s interesting. So you know the training for it is very different. I think, depending on where your practices in school, we didn’t learn a whole lot about how to manage it. Oftentimes it’s well if it you know, a fetus in the uterus without a heartbeat, and obviously the body hasn’t passed that that non viable pregnancy then you’re usually just consulting and passing the patient off to an obstetrician who then is talking about management options. And so it’s kind of brushed over to be honest because we call that a missed AB or missed abortion slash missed miscarriage, meaning the body has not recognized that that the pregnancy is no longer viable and so you can kind of lay out how do we help the body to pass this non viable pregnancy? So it wasn’t until I was in my current practice where I worked collaboratively with obstetricians that I got to see those discussions regarding management. But whenever you diagnose someone with a miscarriage, you know, maybe they come in for that very first ultrasound, that very first prenatal appointment and there is no heartbeat. It’s devastating. It is for me personally, knowing that I have no idea how devastating it is for the patient. You know, it’s so hard to say you know, not knowing exactly how that was dealt with by the midwife she saw but I’m I’m just really sorry to hear that. You know, because it is that’s something every time I see a patient for her first visit, I have a huge lump in my throat until we see a viable pregnancy. And if we don’t, it is incredibly hard to navigate because I’m totally tearing up thinking about it. You can’t help but just feel helpless, you know, as a provider, and I can’t even imagine as the patient you know, wondering, why did I do something wrong? You know, which of course the patient hasn’t it’s such a difficult situation to navigate and there’s no right answer. There’s no easy answer in counseling someone but there’s of course, an empathetic way to approach it and recognizing that this for that that person in that family is is a lost life is a lost idea of life and at the last family pains, my midwife Heartseeker that she didn’t receive the compassion that that she needed and certainly deserved.

 

P: I feel like everyone I speak with agrees that we need some kind of ritual, kind of manage and move on. I don’t know where that’s going to come from. I don’t know if you think that it makes sense that it comes from medical practice or it will come from somewhere else.

 

Ann: I think it should originate with us. I mean something I actually recommend my patients now that it’s called the Japanese Art of miscarriage is a beautiful, just very raw approach to to miscarriage and helping families it’s from a patient’s perspective but I think it’s called the Japanese art of miscarriage and it’s what I personally use in counseling people if I think they’re ready for that.

 

P: So If you’re interested in exploring this, I put a link to it in the show notes. Feel free to check that out. 

 

And so did you try to get pregnant immediately again or how’d you handle it?

 

E: Yeah, so we did to my plan is Filipino so he was in the Philippines when it happened. And so I went over, um, towards the end of his trip to visit him. We spent a bit of time there, recuperating. The advice from the hospital was to at least wait one full cycle, trying again so we started trying again after that. Our relationship went through a bit of a very rocky patch, but we then did become pregnant again. And we found out in February 2020s. So it was six months post. So I think in hindsight that six months felt very long at the time, you know, that every time you’re paying on the stage hoping and wishing and thinking and and you know, the I think you said before, you know, one of the things about pregnancy is that so much out of your control. And so yeah, thinking about the six months was not a long time to wait but it felt excruciatingly wrong at the time, but yeah, we got the wonderful news in February 2020 that we were expecting. And then months later, we went into lockdown. We actually took a holiday to Bali, and it was sort of an early babymoon and I’m so so glad we took it now. Time we were coming and going it was sort of on the precipice of things before they got really crazy. We knew that there was potentially a race I was quite seeking. They sickness but it felt like the right thing to do and it was we got back just in time before everything really kind of shut down.

 

P: Remind me how far is Bali for you guys not that far.

 

E: Not too far. So it’s a five and a half hour flight from Melbourne. Okay, so

 

P: not too bad.

 

E: Not too bad at all. No. And it was you know, it was lovely. It was a beautiful, beautiful time and as I said, potentially quite risky but it was very different over there at the time, you know wasn’t a lot of precautions happening. It was a little quieter but just not necessarily a great thing about the precautions but it was nice to escape it a little bit. Yeah. Before heading back into what was the year that has been so

 

P: god yeah, in hindsight, it’s genius. Well done.

 

E: It worked out beautifully. The universe was definitely protecting us. So then we came back and I ended up admitted to hospital because I was vomiting and I was diagnosed with hyper. Yeah, yes, very, very bad morning slash all day sickness. 

 

P: Do we know what generates hyperemesis? 

 

Ann: It’s very largely suspected to be related to pro pregnancy hormones that HCG are the hormone that is tested for via blood or urine when you do a pregnancy test and the higher that hormone, which tends to be much higher in multiple gestation pregnancies, the higher the nausea I really feel for patients who are going through that a lot of women are prepared to maybe not feel their best or not go well in the first trimester. But hyperemesis is just a different beast. It just lays you up and most women have a singleton Or one baby pregnancy and the gamut of what’s normal for how they feel in early pregnancy is so wide what woman you know, feel mildly nauseous or not nauseous at all and other women have hyperemesis or vomiting multiple times a day every day. It makes no sense. It’s just kind of mind boggling. It really attests to the fact that we know some about pregnancy and birth but we don’t know a lot more than we do  know

 

E: I ended up medic medicated for that up until about 16-17 weeks, I think and that was sort of, I guess the beginning of the discomfort for me around wanting a more natural type of birth. I had a lot of fears around giving birth, but I was working through them. I really don’t like taking medication unless I have to you know, modern medicine is wonderful, but I try to avoid it as much as I can. Particularly when I was pregnant. You know, I didn’t know what these tablets were going to do. But I was just so sick. I couldn’t function without it. So I think that’s probably the first real step of letting go. That, you know, I have to be the best I can be in order to grow the baby the best I can so

 

P: yeah, not being able to eat is definitely a barrier you’re gonna have to cross right so yes, 

 

E: yes, exactly. 

P: So was the second trimester easier.

 

E: second trimester got better not immediately. You know, I was sort of hanging on to the 13 weeks thinking is going to get better. It’s going to get better. And it didn’t immediately but it did. It did go on to get better. I was in my second trimester and so I was diagnosed with gestational diabetes, which was also a pretty average experience because the reason I was sent for early testing was because of my BMI. I’m a size 16 Australian, which I think is like a 14 us sizes. You know so I’m a curvy girl, but I was made to feel bad, to be honest about my size. I understand why, you know, you’ve come up as a risk kind of factor. We flagged this but it was the way in which you know, I got an email from the midwife thing for the very procedurally does why and it’s because of your BMI. And that was kind of it. So that was a that was a tricky experience, too. Because then I went for the testing and the hospital told me I didn’t have it and then they called me back a different person told me I did have it. So I was very borderline. I think the cutoff for the sugar ratings of five or 5.1. And I was just over that, like 5.1 or 5.2. So that was difficult again, I felt like I failed. And it’s sort of ridiculous in hindsight, but I felt like I was being told that I put my baby in danger. You know, there was no sort of questions around how active I was, you know, whether I was healthy, whether I had health issues, it was all sort of based on these numbers that I have a bit of an issue.

 

P: Of course, we’re in the US and Erin’s in Australia. So other things may be different but in general is BMI, the only marker for screening for gestational diabetes.

 

Ann: All women, all pregnant women get get screened for gestational diabetes, regardless of their BMI. And that tends to be between 24 and 28 weeks of pregnancy because that’s when the way the body metabolizes carbohydrates in pregnancy and how sugar crosses the placenta to the fetus is really affected and late second early third trimester, but there are risk factors for developing gestational diabetes being over the age of 35. The Grand Old Age of 35 is is the primary risk factor. And then having a pre pregnancy BMI of 30 or greater. We do encourage women with higher BMI entering pregnancy to get screened a little bit earlier. And so it sounds like what happened in her case, and 

 

P: is there at all genetic components gestational diabetes. 

 

Ann: If you have immediate family members, one or more with non pregnancy, diabetes, non gestational diabetes, that automatically puts you at increased risk. It’s not just BMI like there is definitely a family link.

 

P: And this is totally speculative. But in the course of four or five months and gets both hyperemesis and gestational diabetes, do you think anything’s going on there?

 

Ann: It’s really interesting. You wonder if she says really sensitive to pregnancy hormones, including the hormones that affect glucose metabolism. So that could be it. 

 

E: And when I got to the endocrinologist, the specialist specializing National Diabetes, she said that to me, she said no because what he said I was pretty I was a bit of a wreck, to be honest. She said to me, Look, BMI is one of the indicators but she said it’s probably most likely getting your mum may have had it, it’s most likely passed on in that way. And she said the more and more research that I do the less and less I believe it’s related to that. So that helped at the time. I don’t know, she was just trying to appease me, but you know, again, it’s one of those things that I just got to the point where, after a very emotional and rocky time, just got to the point where I accepted that I was going to get extra help through my pregnancy because of this condition and that whatever was good for the baby I needed to do. So again, I was quite resistant to wanting to go on insulin. I was like I can manage this by diet and exercise. And I did for the most part but my sugars overnight, were not well managed, for whatever reason and again, there was absolutely nothing I could do about it. So I ended up on very low doses of insulin, you know, to the point that by the time I got to the end, a lot of the risk factors that were associated early with the gestational diabetes didn’t end up sort of being there. So they started to somewhat treat me like a more normal pregnancy as opposed to this higher risk pregnancy.

 

P: Well this doesn’t sound like an easy trip. Good Lord.

 

E: I know. But they will say how is the pregnancy like, oh, it was pretty good and there was nothing. There was nothing majorly, you know, big, big issues that happen but there was a lot of small issues. I think it was just kind of this ongoing pace of it felt like a lot of hurdles to jump through. And ironically, you know, where I was sort of sensitive about being an older mom, it never really came up as part of the conversation. You know, I never got called whatever the geriatric pregnancy is. Yeah, it was interesting. I think I was probably a little bit sensitive about that, but it didn’t end up being a thing at all.

 

P: And so when you get to the end of your pregnancy, it sounds like gestational diabetes is you just being monitored or how are we handling that?

 

E: Yes. So um, so one of the parts of one of the lots I guess, of being pregnant through COVID Was that access was quite limited to healthcare. So we had a very hard lockdown last year in Melbourne, which is paid benefits now, but we weren’t allowed five kilometers away from our home. And we were only allowed outside for one day of exercise and what that implication was in the medical side of things was that we had to attend appointments on our own. A lot of appointments were transitioned to telehealth, but because of the diabetes, I was able to continue seeing the team so my OB, the OB and the endocrinologist, in person weekly or fortnightly sort of as it went through and I also got extra scans. So I went through our public health system, meaning that I didn’t have a dedicated OB, and I think having had that experience again, taking away the positives from it. Had I been a regular pregnancy or not a high risk pregnancy or may have gotten very, very little care during that time or very, very little face to face care. So take it as that but it was fairly routine from them. The scans were going really well until we sort of got towards the end of the pregnancy and she was so we knew that having a baby girl. She was measuring bigger. So then the kind of alerts the medical kind of alerts go up and the red flags come up. And that was really stressful because again, I was quite conscious of everything that I was doing and what the impact that might have on her throughout the pregnancy and because everything had been going pretty well. You know, Mike was really well controlled small amounts of insulin. And then to get this kind of red flag around. She’s measuring large on the scan, which we think we all know well. I’ve learned that a so so unpredictable and so not accurate. So then the flag sort of went up again and then we were heading down the path of she was also she wasn’t in position. So she was great. So then we headed down the path of discussing C sections, which was not something that I wanted. So I think I mentioned before I had a fear around birth, but I had been working through it, you know, I’d been reading Hypno birthing books. I was really sort of working towards hoping to have as natural as possible birth but then there’s conversations kind of that say section induction and I wasn’t super keen on induction either. So that was quite stressful and my partner wasn’t able to be there. At these appointments, which wasn’t great. And I don’t think it’s great for the partners either. You know, I think sometimes, you know, obviously I used to have this impression that you know, the prime is not the one going through the pregnancy and so, you know, they’re not going through the pain and the carrying, but I think also on the flip side of that they don’t necessarily get that very early connection and the experience that comes through pregnancy. So yeah, that was difficult. I think it was difficult for me not having him there and I felt like it was difficult for him not being there as well. Yeah, I was relaying everything secondhand with all of my emotions and but the next scan I had, you know, sort of closer to the time again, she was measuring back normal again. So that kind of alert went down and it was all calm again. So I was really excited because I was getting to sort of the 36 week mark when that’s often when if you’ve got gestational diabetes, they’ll trying to induce your encourage you to have a C section and everything was going well and it was all fine. And then I went in to on the 37th week wanting to have a meeting with the induction midwife. As I said I wasn’t keen on induction and I was still in this very much in this mindset of if she’s not engaged. And my gestational diabetes is under control. Are we rushing her it was sort of this real challenge because of like, I’ve got these medical people who know what they’re doing and are the risks far more than I do versus the more sort of feminine spiritual side of me that’s really trying to connect with my baby and saying, but hang on, she’s not giving us signs that she’s ready. So it was really it was a tension and no my partner was he was worried he wanted to make sure that both of us were okay. And actually, like the doctors are telling you to do this. So you go in, you do it. So that was really challenging. So I went into the induction meeting and they said, Look, she’s not engaged. You’re almost at full term. We’re not going to induce her…that’s just not advise at this stage because she’s not engaged.

 

P: Okay, engagement refers to the position of the baby’s head relative to its mother’s pelvis as the pregnancy progresses, the ligaments around the pelvis loosen making space for the baby. This is good and important because to make it out of the mother’s body, the baby will have to travel through the pelvis. Once the widest part of the baby’s head has entered the pelvis, the baby is determined to be engaged. So if the baby’s not engaged, it’s not in a position that suggests that it’s ready to be born.

 

E: We’re really worried about the risk of if your waters break that her cord will come out first. And one thing I didn’t mention before so my mom had a stillborn baby before me. Who’s done his cord was wrapped around his neck. So in the late 70s It was a very different proposition to things how things are now, they didn’t know that at the time, but so that caused our um for us because this has been a very real experience in my family. So basically three days out. He went on the path of a Plan C section, and I still wasn’t convinced that it was the right thing to do. Had you date was the 18th of October. My 40th birthday was the 14th of October, and the C section was then scheduled for the 15th of October. So which also happens to be my nephew’s birthday. So she shares a birthday with the cousin which is lovely. I went through the whole process of just assessing I guess and accepting the fact that my birth was not going to be I that I wanted it to be. I think it’s it’s that point of letting go of control as a parent you learn pretty quickly you have very little control. 

 

P: Yeah. 

 

E: And I, you know, might have a tendency to like to control things in my life, but that’s one thing that you know, the pregnancy, being quite sick and not having the same amount of energy that I had then COVID and not being able to do what I would normally do. I think probably prepared me beautifully. As tough as it was for how much you need to let go of control as parents so

 

P: that is a useful lesson. So did you have any contractions when you went in or felt like a business meeting?

 

E: No. So I did beautifully driving into the hospital. I started having contractions. 

 

P: Oh, wow. 

 

E: So I’ve got goose bumps now so that that made me feel happier. You know, it made me feel like although I know that those early contractions were nothing like what they would have ended up being it made me feel like she was ready to come and it gave me a little bit of a so I’ve been getting Braxton Hicks for quite a while. And so I knew that this felt different you know, that kind of rising up kind of feeling was how I described it and now we’re coming quite close together. So that was nice, but it was very strange kind of waking up in the morning, packing our bags and going we’re going into have a baby today. 

 

P: Yes. 

 

E: But you know, with all of the stress that had come the challenges, I think there was something nice about not having that chaotic rush to the hospital. Oh my gosh, what’s happening? My waters are broken. We need to urgently get there. There was something very nice about the calm way in which we did it. So we popped on in I was very lucky that my partner was able to be there because they were early stages during COVID where Partners weren’t able to be there. It did feel a little bit clinical, you know, you walk into a theater but the anesthetist was wonderful. She talked me through everything. was as I said it was quite calm. You know, I didn’t I couldn’t get my you know, my own burning all my music going or any of that sort of stuff that I didn’t visit envisaged in this beautiful hypnobirth that I wanted, but at the end of the day, we were there together and I held her up over the curtain. That feeling itself was amazing. And whether I went through natural birth or a C section. It was at that point in time that I just realized She’s here and she’s safe. And that is the most important thing. So yes, that magical moment when they’re then passed sort of back to you for that first skin to skin and just the three of us there. Although we were in this surgery theater, just everyone else really disappeared, I guess. Yeah. So that was just beautiful and she’s a beautiful, healthy seven pound nine. So three and a half kilos, good size, you know, good size baby. The babies in my family are nine pounders. So. She was much smaller than I expected. Yeah, just beautiful. Beautiful that that moment. It was a little bit strange because then my partner took went with her as they you know stitch me up and and those sorts of things. So being away from her and feeling a bit groggy and weird and but I knew that she was with her dad, so I was okay. Yeah. And then we headed down to recovery. I heard a baby cry and I’m like, oh, that that might be mine. wasn’t mine. She was so chilled, very, very chilled baby. And they put her on to me to latch and we did a bit of a feed there which seems to go really well. Again, I was fortunate because I’d had the C section. I’ve got a private room so my partner was able to stay again during COVID It was amazing and I don’t know how I would have done it without him you know that first night especially with you know, still not being able to really move a lot. I don’t know how I would have done it. I suppose I would have just had to call the midwives but I mean being that was absolutely amazing. You know,





E: From but it was sort of around the time where the gestational diabetes would happen. And I’d been dealing with so many different people that I felt like bringing another person into my care was would have been difficult. And also I didn’t know if she would be able to be present at the birth because of the COVID restriction. So I decided not to, again, because I was focused so much on the lead up to the birth and the birth itself. I didn’t really appreciate what that support would have been like for us post. 

 

P: yeah, that sounds that sounds smart. I think a doula or other living or some other support system for sure in the US that postpartum care is really, really thin. You don’t see your gynecologist again for six weeks, which is six weeks. Time, right? Yeah, so maybe that’s something we all need to put a little attention on to figure out how that can be. Improved.

 

E: So we had the midwives visit from the hospital but that was again limited somewhat because of COVID. And we have a maternal child health nurse system here where but that’s really about the baby. That’s about making sure the baby’s okay. I think the six week or eight week mark, they ask you the questions the standard questions about postnatal depression but my nurse as lovely as she was, she was sitting at a computer facing away from me asking this question and sort of a tick box activity. I’m not sure that they’re skilled up to really deal with the gravity of those types of situations and I did not have postnatal depression. I don’t believe there were things in our house that we’re taught, you know, there were we’re dealing with this whole changing dynamic, you know, and I think having a child brings up stuff from your own childhood, whether consciously or unconsciously, so, yeah, so 100% agree with you, I think much more care and particularly focusing on the emotional side of things post birth is something that we could all benefit from.

 

P: It is a little too medical. I totally agree with that. So how old is your daughter now?

 

E: She’s six months old Isabella? And she is a delight. She has a beautiful girl she is as I said she came at a very chilled baby. And she is for the most part very chilled, but she sort of goes from zero to 100 She’s also very cheeky and she’s starting to realize that when she does things she gets certain reactions. So she she like this morning she woke up singing now she’s found her voice and she just wakes up smiling every day. So bless her as I said, she’s a very, very good sleeper, which has been wonderful. So we’ve just removed the dream feed. So she’s sleeping from 730 ish to 630 so 

 

P: wow. 

 

E: Yeah, yeah, that definitely definitely helps.

 

P: That’s awesome. How fun. So you’re so close to this experience. I’m going to ask you this anyway. Is there any advice you would have given to your to your pre pregnant self?

 

E: Yeah, I think the one around the doula engage a doula. That’s kind of a very practical piece of advice. I think. From a bigger picture perspective. Advice I would give is, don’t be afraid to speak up. I’m not generally a person that’s afraid to speak up but something happens to me when I walk into a hospital. I think hospitals don’t realize how hierarchical and overwhelming they are, you know, the medical side of things is something they do every day, but it’s very new to us. So don’t ever feel bad for asking questions. Don’t ever feel bad for saying that doesn’t feel right to me. I need to think about it. And don’t be afraid to ask for extra help both physical and emotional I think you know, it’s okay to say I’m struggling a little bit with this got to the point where you know, people wouldn’t be offering food and I would normally say no, we are okay because my partner’s a chef by trade. So where I kind of got that covered and I actually got to the point of just saying, actually, that will be lovely. Thank you so much. Because even though you might be okay one day, something might happen that you’re just you know, something might not happen you might just wake up feeling not so great. Yeah. Except the help you know, it is a particularly vulnerable time. I thought I gave myself time to recover despite the fact that we returned to work early. I really was very conscious of being present when I was with her and still am, but your body has been through an amazing and massive thing and we are emotional, spiritual. I went through a big transition when I was pregnant. I knew my life would change when she arrived. But I had underestimated how it would change as soon as I was pregnant. So she kind to yourself, trust your intuition and let go of control, I guess.

 

P: Yeah, that’s a good that’s a good lesson that you will learn quickly as a parent, right. So

 

E: absolutely. I was grateful to learn it earlier on. So she, she teaches me every day. Cue reminds me every day but yeah, it is you know, there it’s it’s now much less about any of that than it has been before.

 

P: It’s such a great story. Thank you so much for coming out and sharing your story. I totally

 

E: appreciate it. It’s my pleasure. Thank you for allowing me to tell my story.



P: Thanks again to Erin for sharing her story, and to Isabella for doing her part to ease her parents into family life. Thanks also to Ann Richards for her insights about a wide range of issues from miscarriage to breastfeeding–I appreciate your time, expertise and empathy.  Thank you for listening. If you liked this episode feel free to share it with friends. We’ll be back soon with another inspiring story.

 

 

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.