Episode 82: A Doula (and Mother of 5) offers Miscarriage Support and Much More: Aliza’s story, Part II
Episode 81SN: A Doula (and Mother of 5) Offers Miscarriage Support and Much More: Aliza’s Story, Part I
This is a show that shares true experiences of pregnancy to help shift the common cultural narrative, away from the glossy depictions of this enormous transition to a more realistic one. It also celebrates the incredible resilience and strength it takes to create another person and deliver them into the world. I’m your host, Paulette Kamenecka, I’m a writer and an economist and a mother of two girls. In this episode, you’ll hear advice about managing miscarriage or a woman who has experienced numerous miscarriages intermingled with the births of five children, and she’s a doula. She also shares how each experience taught her something valuable. Today, you’ll hear the first part of our conversation.
To connect with Aliza, check here
Audio Transcript
Paulette: Welcome to war stories from the womb. This is a show that shares true experiences of pregnancy to help shift the common cultural narrative, away from the glossy depictions of this enormous transition to a more realistic one. It also celebrates the incredible resilience and strength it takes to create another person and deliver them into the world. I’m your host, Paulette Kamenecka, I’m a writer and an economist and a mother of two girls. In this episode, you’ll hear advice about managing miscarriage or a woman who has experienced numerous miscarriages intermingled with the births of five children, and she’s a doula. She also shares how each experience taught her something valuable. Today, you’ll hear the first part of our conversation.
Let’s get to this inspiring story.
Hi, thanks so much for coming on the show Can you introduce yourself and tell us where you’re from?
Aliza: my name is Aliza Said and I’m so excited to be here. Thank you for having me. I am a mama marriage coach. I’m also a birth doula actually, and this podcast is very relevant. I’m a mom of five and I live in Israel. My main passion is helping moms who are feeling really overwhelmed and as I like to say feel like they’re drowning in dishes and dipers to be able to reconnect to themselves and to the people around them that they love. So that’s what I that’s my main task in this world now.
P That’s awesome. And, you know, my sense is that the Senate moms you’re talking to are all of them. Five kids, you lucky duck. That’s awesome. Oh, yeah.
A 1:42
Yes, very lucky.
P 1:44
So I love to start us off before the kids before Did you know growing up that you wanted a family? Do you have siblings? Was there something else that kind of sparked that interest?
A 1:55
Yeah, so I come from a big family as well. We’re six siblings. And from the time I remember myself as a little girl, I always had a doll with me. I was always like mommying something. I always wanted like a chimpanzee pet just so that I could be a mommy. Like I always wanted to be a mother at every age like so it was definitely something that I always dreamed about. I really wanted. I was able to see really empowered moms around me. And that’s just who I wanted to be. So that was really special.
P 2:32
That’s super cool. So I’m imagining that the first baby came before you became a doula or is that not right?
A 2:38
Before before I only became a doula before my fifth baby.
P: Okay, okay. Yeah, I will have a right yeah,
A: so actually, the first birth is what sparked my desire.
P 2:54
So for the first one, did you get pregnant easily?
A 2:57
I mean, what’s easily? To me. No. And it was really hard for me because I thought, and this is what I saw all around me that people get married and 10 months later that they have a baby. And that didn’t happen to me. And we also had a miscarriage a few months after getting married. And that to me, nobody around me ever spoke about miscarriage. I never heard about someone having a miscarriage. That was like, completely heart wrenching for me like I’m also not pregnant right away like everybody said, now having a miscarriage and I felt like a failure. I felt like my body wasn’t working. I felt like everybody was able to do it and only I couldn’t and that was really difficult. Now I noticed that it was one of the biggest gifts that we were given as a couple and me as an individual because it definitely made the mother that I am today but in those moments, it was really tough. we actually had an appointment to go start in fertility treatments. And we decided that before we start, we were gonna go on a vacation and we found out that we were already pregnant.
P: Oh, wow.
A: Yeah. Which was very, very exciting. But yeah, it was definitely a journey. And I now say that I’m so grateful for it, even though it was really really difficult and those moments
P 4:22
Now age is not the only thing that can affect your, your journey. But how old were you for the first one?
A 4:28
So I was really young, we got married very young. I always say I needed my husband to grow up like I needed to get back and really on, because we needed to grow together. I was 19 when we got married, and I had my first baby 21 and a half
P 4:45
So like today we say that’s young because people are having babies later and later but historically that’s not super young at all. That’s like right in the wheelhouse. Right, it’s when there’s when your body knows to be pregnant.
A 4:56
Right? And I remember even the doctor saying to me like when I had the miscarriage she’s like, well, you’re so young and healthy and like I ate really, really healthy and I was exercising like, super healthy. She’s like, you’re gonna get pregnant really fast. And then it didn’t happen. So like it doesn’t always go according to the books. And I think that that’s also part of the beauty of it, that it’s kind of the gateway to go into parenthood. It doesn’t all go according to the books and there’s this element of learning to let go of control and to be able to, you know, ride the wave.
P 5:32
Yeah, it’s such a it’s such a good lesson if that’s the way you interpret it because it’s totally true and everything you know, parenting will teach you whether you want it or not that you have no control. But this is a very good lesson that and I think most of us grew up even if you I live in the US and even if you didn’t grow up here, most of us grew up in the US. Okay, well, you grew up thinking I will have sex and I will be pregnant. And that’s how it works. And that’s not really how it works. That’s not that’s how it works. Sometimes right? That’s not that’s not really a thing. So how was the pregnancy?
A 6:04
So the pregnancy Well, I just want to also say to what you just said right now, that also it doesn’t always happen like that and also miscarriages happens. And I like make it a point to talk about I had two miscarriages probably another one in the middle over there. And I talk about it a lot. And I think that it’s so important to talk about it and like I say it’s kind of like awakening this silent tribe of women out there that we’re all in this together. So how was the first pregnancy the first pregnancy was beautiful, blissful, amazing. We were just like so in awe of the miraculous thing happening. And it was really beautiful. Like I felt amazing. I was really just every minute of it.
P 6:48
So take us to the birth. What are you envisioning? And then how are we doing today is the day
A 6:57
so what am I envisioning? Well, once I became pregnant, I was like, Okay, I’m going to do this in the most empowering, beautiful way that I can and I started researching and like really learning everything I could and reading a lot and and I found hypnobirthing. And I would like watch these home births and I was like, that’s what I want. And everybody around me said to me, just wait it’s your first birth. You’ll never survive without epidural. It all sounds nice and everybody around me was saying all these different things and I was trying to believe it could be beautiful
A 7:37
My husband was at a party. He was working in education, and he was with this student until like two in the morning. They have this party. He came back we were like we were like talking until late and then four in the morning. I started feeling like period cramps. I was like meaning I think something might be starting here. I put like a warm bottle and we were just like kind of soaking it up. We put on our music and my playlist that I got ready. And we started just enjoying the day and the wave started coming and the contraction started. We went out for a walk to go see the beautiful view and I was like it’s gonna take time. So the first birth and we were just having a lot of fun together. And I wasn’t counting contractions or anything because I was like it’s gonna take time, but my mother kept calling and she was like, okay, that were two minutes in between contractions like you gotta go. And we were just I was not in pain at all. I was completely like riding the wave, like I said before, and just really breathing through it like swaying with my husband and going on a walk in nature. The doula came to my house. And I said to her, I think we should start going out because we lived kind of apart from the hospital. And I said, I’m a little nervous because when there’s contractions, and I’m breathing, I feel like something’s coming out. Okay, let’s go so we finally got to the hospital and I walk in and I’m like, swaying and swinging and singing to myself and the doctors let the midwife who who was there when we got there like Okay, first birth, it’s going to take time I see that you’re excited, but then she was like really not acknowledging that I was far along. And then she checks me and she’s like, you’re fully dilated.
P: Oh my gosh.
A: And she was like, completely shocked. My husband started hysterically crying and we were just like, so excited. And she was like, Okay, I’m getting you a wheelchair and I don’t need a wheelchair. I’m gonna walk. So I walked in. I walked into the laboring room, and I was like, Okay, now what? So the midwife was like, Okay, start pushing, even though now I know I was not ready to push at all. I did not feel the urge to push at that point. But I was fully dilated and she said to push so I started pushing.
P 9:55
So I put three hours well, let me only stop you there for a second. Yeah. Do you know how push have we taken a class like what happened to the homework? That seems like that flew out the window?
A 10:06
Well, that at that point, I wasn’t gonna have homebirth yet. I only had at my fourth grade. I had like a real journey with each birth. So the so I knew how to put we did like a course with with my doula. We kind of spoke about pushing, but I was in such an endorphin bubble, that I was just completely blissful. Like the midwife asked my husband, what did she smoke at home? I was really just enjoying every moment of it, and we were singing and we were like, completely enjoy it. And it wasn’t even like aware of things I was saying, like I opened my eyes and I know that everybody’s crying around me, because I was like, pouring out my heart and I was like, I was completely drugged on endorphins. So in I mean, now I know to say that I did not need to push for two and a half hours, but in those moments, I was really enjoying it. We were singing all the doctors there was like a line outside of the room because they all wanted to come in and see the beautiful spiritual experience that was going on in the room. So I remember the doctor said to me, you know, we need to put up a big screen so everybody can see how it could happen. So after two and a half hours of pushing, she finally came out and it was just a beautiful moment like unbelievable. It was really blissful. And yeah, so that really was what started my journey and understanding what an unbelievable power we have as women and what we can birth into this world. second birth was completely different.
P 11:40
We’ll get there that so that’s awesome. That is such a lovely story. And I can imagine if that were my first birth, I’d have five kids also. Because I’d be like, I always just want to do this more. Right. That sounds great.
A 11:54
Absolutely. I say some people like to go bungee jumping. I like to have kids.
P 11:59
Yeah. Yeah, they’re I think there are some people who have like, the just so physiology and all that and so it’s awesome to meet one of them. Thank you for coming on. So that sounds lovely. That sounds amazing. And then how’s the how’s the fourth trimester fine, and how does it go?
A 12:17
So yeah, so also that like we were completely blessed, I’m telling my first story, but hold on for a second. Like it sounds too perfect. That’s alright. Life gets real, but the first one was very blissful. Also, she was the easiest baby ever. She completely like made it so easy for us to do the transition. She slept when we wanted her sleep. She didn’t like she was just you smile when when she was awake. Like she was the easiest baby ever. All right now she’s, you know, teaching us what kind of parents we need to be. But, you know
P 12:49
And she’s still have like that character.
A: No.
A 12:56
I mean, what’s the character like?
P: Is she really easygoing
A: She suddenly like easy, you’ll have a lot of power in her. Okay. Okay. Like, I mean, she has all of that but ya know, she has a lot of a lot of inner fire.
P 13:09
Good. I like to hear. So now let’s get to the second one and ensure you have this first one and how old is the first one were you before you think oh, let’s have another. So
A 13:20
we were really thinking I was on birth control. But it didn’t wait. I was on birth control and then I had a miscarriage. And then that was again, not so easy. But even though it was a completely different experience, going through it with my baby on top of me. That was when she was around seven months old. And then I got pregnant again. Then I went to like, I also went to like a natural doctor and someone who was actually a traditional midwife, and then she went to go there in Chinese medicine. And we did like acupuncture and herbs and lots of different things, which was a very good healing process for me. And then about a few months later, I kept telling her I want to start trying to get pregnant because once I start trying, it’ll take me like a year and a half at least, like it takes me time. Like, let’s give me the time and she kept telling me no, no, give yourself time to heal yourself and to heal. And then I think it was my daughter’s first birthday. She’s like, okay, you can start trying, but like on a low burner. And then I got pregnant right away, which was like really miraculous and really amazing. So I also want to say in parentheses. There are many people that wait much longer, and like my story is, you know, a small little time that we needed to wait and this was the journey we needed to go through. And I just want to say that I send so much hugs and empathy to anyone who’s waiting much more than me less than me and I feel like those months gave me the ability to understand and have much more compassion towards women who go through that, like I really, I’m very lucky I didn’t have to wait so long. But I it was such a significant part of who I am. Because it gave me that compassion to all the women out there even though I understand only a tiny bit of what they’re going through. So I just want to say that
P 15:17
that’s nicely said Wait, let me ask you one thing before you go on in your journey of the five kids. You had two miscarriages total or you had more
A 15:27
two probably three but we didn’t really like two, two official.
P 15:31
So as a as a doula and someone who’s in this space and maybe you didn’t do for yourself because you weren’t there yet. But do you have an idealized ritual that you would tell people to do or something you wish you had done? Or, you know, something you’ve learned both from your personal experience and your experience as a doula that you might want to share with people about you know, I have found this is particularly helpful in miscarriage.
A 15:57
Yeah, well, I’ll say two points that I find is really important, from my personal experience and from the women that I work with. One is to really give yourself permission to grieve debris. And it doesn’t matter how many weeks you were pregnant it doesn’t matter if you wanted the pregnancy and, and it happened or if you weren’t expecting a pregnancy and you happen. It doesn’t matter what the circumstances are. Allow yourself to have this time of real grief. And I feel like today we’re so quick to go back into life. I just spoke to a friend who went through a miscarriage many more weeks than I was she was almost halfway through
P: Wow.
A: She felt like a need to go right back and she’s a dance instructor and she like uses her body a lot and she went like right back and and after a few weeks she completely crashed and she said I didn’t give myself that time to like, really just sit with it and be okay with it that this is what my body’s going through and to give myself that time and to go through all the feelings and and sometimes it’s all different feelings and sometimes they’re scary feelings and sometimes they’re contradicting feelings, and all of that is okay and give yourself that time for that vessel. When I think that that is super important. Then know how to contain that vessel and go from there, but I feel like there needs to be more of a permission slip to all women out there to go through that.
And the second point that I want to say is to really recognize how different the way that me and my partner are going to grieve. Many times it can cause a lot of friction, it can cause a lot of resentment, a lot of blame a lot of a lot of things. I think that recognizing that we both go through this in a very different way. But we’re both going through it is so important and to be able to open up and talk about it and to be able to know how to listen to the other person. And even though it’s my body that went through it. My husband also went through a loss and to be able to also recognize that and to be able to really go through it together and not just expecting him to be able to see what I’m going through or this is something I see a lot with my clients, whether it’s miscarriage and also birth, you know also in a birth, a husband is also going through all of these things, even if it’s not his body, but really recognizing that we’re both going through these big transformations here. And being able to recognize that and know how to really work with that instead of working against it.
P 18:33
Yeah, those are two really good suggestions. I wish I wish in American culture we had a well defined set of rituals for miscarriage like we do for the funerals of people who have been alive a long time or even or even babies right we have a whole set you know the Irish have a set of rituals Jews have a set Indians have a set so many different cultures have a way that they process those feelings. And the step by step this of it is really useful when you’re in the deep emotional well of sadness and grief. And I wish we had something like that for miscarriage, which you know, or I guess our process is to ignore or move on. Right? That’s our ritual, but that doesn’t seem very satisfying or useful.
A 19:16
Right. And also, I feel like when we’re able to do when you expand your heart to feel the really hard emotions, then you’re also expanding your heart to be able to feel the good emotions, you know, in such a stronger way. So yeah, I I I encourage everyone to do their own ritual and to do whatever I mean, there’s so many different things. I don’t want to share personal stories of clients this Yeah. Permission to share their own personal but there are so many things that people do as you write as Jews we have our own rituals that we do after and yeah, it’s definitely very really soul encompassing like it kind of gives you this you know, place to really go through it.
P 20:01
Yeah, that’s totally Well said Aliza. So your point about you have to feel the bad to fill the gap. Right it’s it’s a continuum and you have to open the door to feel at all so but I interrupted you on our on our second baby. So now we’ve passed two miscarriages, we get pregnant again. We’re so excited.
Okay, go…then what?
A 20:19
Again. Pregnancy is beautiful, amazing. feel amazing. Have a baby with me, but really enjoying every minute of it. My baby was home with me. I mean, she was she was home with me. Yeah, at that point. She was home with me, and I’m just really enjoying. Then I was really ready. At the end of the pregnancy. I was like feeling really ready. Okay, let’s go. Let’s get this happening. We went on a really long walk. We lived like in this mountainous desert area. And we went like, climbed up mountains and came back. And I was like, I just want to wash the floor. I started washing the floor and as I watched the floor Park I heard it like burst my water. My water broke. It was a good thing. I was washing the floor because it was like
A 21:11
yeah, I was like okay, I guess it’s it’s starting but I wasn’t having any contractions.
P: I’m down here already
A: Now I was already going into this birth was like a lot of expectations because after the birth that I had, I would like I’m probably gonna fly through this one. It’s gonna be beautiful and I like I was still kind of a perfectionist at that point. Now I’d say I am a recovering perfectionist, but then I was still kind of a perfectionist. And to me, you know, okay, I had a perfect birth and here I am gonna have it again. So it started with the water breaking and that kind of got me nervous already because I knew that having your water break, you know, there’s probably more of a chance that anything can happen from there. If if nothing starts if that you know too much time passes, and they’re gonna have to start intervene. And I didn’t want all of them I was I was like, Okay, this is how it started. Let’s get the contractions going.
P 22:05
So, so just to interrupt you for a second. I think what you’re saying is once your water breaks, the clock starts right because you need to because of fear of infection, or you need to get things moving. So so now you feel like things have to happen.
A 22:20
Exactly. There’s a wide range of how long that clock is. I mean, there’s some hospitals here in Israel. There’s some that is 24 hours, some 48 hours. I know I also had a baby in Uruguay and there it’s called hours. So like it really varies where you are. I actually heard of a place of 72 hours. It really depends. So anyway, I knew that my clock was ticking, and there were no contractions at all. So we decided that we were going to send my daughter to my father in law because I wasn’t gonna eat my car. I came to pick her up and bring them bring her to their house. And we were like, Okay, let’s just make an oxytocin kind of kind of environment. So we turned off the lights and we put on candles and we started singing and dancing and just putting like good, good aromas in the house that I liked and just tried to really bring out good energies and then contractions started coming. And when they started coming at a good pace, we’re like, okay, maybe we should start going out because, first the first birth went kind of fast for our first birth, maybe the second will be even faster. I’ll just say in parentheses, it was not. It was the longest birth ever. So at one contraction, like I had a whole lot of water coming out and I felt like maybe I felt something and I was like, Okay, maybe we should get in the hospital, get into the car and go to the house. So we get into the car and really as we left the house and started driving towards the hospital, the contractions completely stopped. Like nothing, nothing at all. And we spoke I spoke to my Doula on the phone, and she said, Well, maybe go back home. See if we were in far from the house and she said maybe you know, try and bring it on again. And then you guys could go so we went back home started again. And again, the contractions started coming. And again, we leave and again the contractions are like almost met. And it was so clear to me that I was that I was kind of like blocking. Like I was nervous what was gonna happen and the whole time I was very aware of what was going on inside of me and how much it was really affecting the way that the birth was going on inside of me and how much it affected me. So we get to the hospital where
P 24:28
the first one was so well like why what what’s bringing on the nerves that you want it to be as good as the first is that what the what’s going on for you?
A 24:36
Okay, there were a lot of things going on. One was that that I had these really high expectations. Second, I was like the poster girl of birth like I had to bring back this beautiful story so that everybody could see how beautiful birth could be like I felt like I had huge pressure on me. I also was at the time we were like not sure if we were moving, not moving. My husband had given up his job because he thought that we were moving and then we decided we were like we were in this like really really turmoil kind of time that just wasn’t sitting on me well and there were like a lot of stressors in my life at that time. And I wasn’t like I wasn’t coming from a settled peaceful place. Like I was the first time.
P: Okay.
A: Also I was really nervous that maybe I was gonna have to go to the bathroom. This is like a real fear that I have and a lot of my clients also have, I was so afraid that we’re gonna have to go to the bathroom during birth. So I was like holding myself every time that I had a contraction. So then we get to the hospital and I said I still don’t want to go in I’m not in my bubble yet. Let’s walk around in the in the parking lot. Now it’s freezing cold in the Jerusalem air and it was freezing and here we are walking around in the forest. For about two hours. We were walking around and I was enjoying every minute of it because I was like swaying during my contractions. And I felt like I was bringing them on in a good way. My doula and my husband told me afterwards that they were freezing cold and they like, but they just wanted to be there for me and they were then we finally go in and I was six centimeters. And I was like Okay, good. We’re enjoying. We started actually playing backgammon haven’t really played back at me my husband at that at that time, and then contractions kept going. And then I got to eight centimeters. And I got stuck for six hours at eight centimeters. And it didn’t matter what we were doing. I put my foot up on a chair. Maybe he was the wrong position. I tried doing like all these different exercises with my doula and nothing and every time they would check me and again eight centimeters, eight centimeters. And at that time, I said to my husband, I know that these things are bothering me, like I gave him a list. And that’s why I’m not able to completely let go. And I like I’m not. I’m not completely relaxing and I know that I’m holding it up. And I was like aware but at that moment, I couldn’t yet let go. And then a doctor came in after six hours. And he said to me, Listen, we gave you a long time. And also I want to say that this time. It was painful, like this time when I wasn’t able to let go it was very painful and I like knew now what they mean when when pain when pain can be really real in childbirth. And that was new for me because my first and thank G-d my others were not. So I knew what it was and I really felt like it was when I was holding myself then it was painful. And then the Dow employment and so
P 27:38
So it’s like resistance is the issue.
A: Yes.Yes. Like when you work with your body. It doesn’t have to be painful. You feel a strong power and a strong surge going through your body. But it wasn’t painful at any moment. Like even our at my first birth a doctor came in. I wasn’t aware that I said this only told me afterwards that a doctor came in and to call the other doctor that was there because somebody wanted an epidural. And they told me afterwards that I said No Tell her not to get the epidural. She doesn’t know what she’s missing out on. Like I was just so enjoying. I don’t judge anyone that takes an epidural who ever needs an epidural. Whoever wants an epidural? You know? No, no shame to that at all. Not because that’s not why I said it. It was just like in that moment. That’s what I was feeling. So anyway, the doctor came in and after six hours of being an eight centimeters he was like okay, we really tried giving you as much time as we could, but that’s it in 10 minutes. There’s nothing new. We’re starting Pitocin I looked at my doula and I’m like, nope, what’s going on here?
P 28:43
I’m gonna stop my conversation with Aliza here. In a second. It was very much and up to this point, mirroring the beautiful and easy birth like she hoped it would. On the one hand, it’s easy to relate to these a stress feelings about trying to walk footprints left by Erzberg at the same time to vaccinate. And he’s gotten almost science fiction feel to Yes, of course you can do things to reflect your own state of mind and relaxation and those who’s getting pregnant and being birth is often early parenting. Thanks for listening. If you enjoyed the show, if you learned something or felt connected to or just appreciate these stories of real please go over to Apple or Spotify or wherever you’re listening. It helps we’ll be back next Friday with the rest of my conversation. She shares how his second birth went down and talks about her other
Episode 81: A Doula (and Mother of 5) Offers Miscarriage Support and Much More: Aliza’s Story, Part I
Episode 79: An IVF Journey that includes repeated miscarriage…and a pregnancy: Amy’s Story, Part I
Episode 75: A Late Visit from a Preeclampsia Diagnosis: Joy’s Story, Part I
Episode 75 SN: A Late Visit from a Preeclampsia Diagnosis: Joy’s Story, Part I
Today’s guest walked into pregnancy carefully. She is a health journalist who had researched and reported on pregnancy issues and this work influenced her ideas about the kind of birth she wanted to have. Things began swimmingly, and it wasn’t until the third trimester when the first signs of what would become preeclampsia began to emerge, but nothing is diagnosed at this point. The birth was the beginning of a chaotic couple of days in the hospital. It’s not until after the birth that preeclampsia is caught and the turmoil of her experience really impressed upon her the challenges of navigating a complicated medical event. What follows is the first part of our conversation.
I also had the opportunity to interview two scientist physicians who have researched preeclampsia and have tended to women with the condition. We’ll hear more from these doctors in part 2 of the conversation.
Relationship between morning sickness and pregnancy viability
https://www.verywellfamily.com/does-no-morning-sickness-mean-miscarriage-2371250
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2553283
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2553283
Epidurals and lower blood pressure
https://pubmed.ncbi.nlm.nih.gov/23021700/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276328/
Audio Transcript
Paulette: Hi, welcome to horror stories from the womb. I’m your host, Paulette Kamenecka. I’m a writer and an economist and a mother of two girls. Today’s guest walked into pregnancy carefully. She’s a health journalist who had researched and reported our pregnancy issues. This work influenced your ideas about the kind of birth she wanted to have. Things began swimmingly. And it wasn’t until the third trimester when the first signs of what would become preeclampsia began to emerge, but nothing is diagnosed at this point. The birth was the beginning of a chaotic couple of days in the hospital. And it’s not until after birth that preeclampsia has caught a turmoil of her experience really impressed upon her. The challenges of navigating a complicated medical event. What follows is the first part of our conversation. I also had the opportunity to interview two scientists/physicians, whose research papers yet attended one with a condition, both here wanting these doctors to have this conversation.
Let’s get to this inspiring story.
P: Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from?
J : My name is Joy, and I live in Austin, Texas.
P Excellent, Thanks so much for coming. Joy. So here we are. We’re going to talk about the family that you feel that you have right now. And sometimes the family you have is a reflection of the family that you’re from. Let’s just talk briefly about the family that you have come from.Do you have siblings?
J: I have one younger brother. He’s six years younger than me and he lives in the northern suburbs of Austin and round.
P: Oh, nice to boost age. Yeah, we’re close by and did growing up with a sibling make you think I want kids or not really.
J: Being six years younger, there was enough of an age gap. You never really want to play together, that sort of thing. And then by the time I was in high school, I did my own thing.So no, I
wouldn’t say how did you know at some point that you want a family?
J: I met my husband after a few years that we were together. We talked about it a lot. But we were also very hesitant about the state of the world at the time, which now seems depressing.
P: Quaint?
J: Yeah, exactly. And I had a lot going on in my own personal life with my mother’s health, which definitely derailed me for a few years as well. And so yeah, it was it’s not the kind of decision that the two of us would ever make lightly. It’s something we’ve put a lot of just like any major decision,
P when you go to get pregnant is easy to get pregnant.
J: Yeah, it was pretty easy to get pregnant. I think it took like four or five months. Kind of trying, you know, but not like being very serious. didn’t need any help with it.
P: Okay, good. And what’s the first trimester like
J : the first trimester was really pretty easy. I did not have any morning sickness, which is sometimes can be a bad sign. Because it’s an indication of all like the hormones and all the things that are changing in the body.
P : So this is a good question. Does morning sickness have a deeper meaning? Does it mean that pregnancy is doing well or poorly? It looks like in general the answer to this is no. Lack of morning sickness doesn’t imply that pregnancy is on the wrong path. There was an article in 2016 in an important medical journal that found that for women who had one or two previous miscarriages, morning sickness was associated with reduced risk of pregnancy loss. But this finding is limited to people who have previously experienced miscarriage.
J And I really didn’t have too much of that. I don’t even remember being all that tired when that I hear no quite calm. So it really wasn’t that bad first trimester.
P Okay, good. Did you have I should have asked this before, but did you have a concept of what pregnancy would be like before you stepped into it?
J Yes, I have been a health reporter in New York City at that point for a long time. For a while I had worked in White Plains, New York, which is a suburban community north of New York, and it’s very wealthy. And really the health concerns there are dramatically different than the health concerns where I grew up in Corpus Christi. And I had met women who were debating things and looking at the science journals, and interventions in birth, and really, they really approached it from this very privileged standpoint of like there’s too many interventions in birth. And that kind of influence my view, by the time I got ready, I really was like, Oh, my gosh, the C section is that should not be happening to me and I tried to go for very, quote, natural childbirth as much as I could, you know, it’s about that was sort of the background approach.
P So does that mean you went to like midwifery instead of a traditional OB
J Yes, I went to my OB. When I got pregnant. She didn’t have privileges or whatever at a one hospital in Manhattan that had a birth center, which was at the time the sequence was about and so I switched to a mid wave clinic and have more midwives because they I had a birthing center at the hospital that I liked that it was within a hospital if anything went wrong. I was already there.
P Yeah. That seems like the right kind of insurance.
J: Yeah, exactly. Yeah. So we’re, we toured the birth center in those early days and yeah, and it seemed like a good setup.
P So does that mean that your your care is more kind of gentle and sporadic throughout your pregnancy?
J I wouldn’t say sporadic I think you have just as many appointments as you would. I mean, I don’t know for sure, as you would have been OB and you have those sonograms you know starting at the regular schedule, and you have a lot of visits. And so I think the I don’t know what the big difference would be there might have been less testing and you know, bloodwork, maybe I’m not sure, but I remember having that doing the glucose test, all that sort of stuff.
P Okay, so that sounds familiar. And maybe a birthing center that is situated inside a hospital is slightly different than a birthing center on its own, because it’s just
J: yeah,
P: by proximity and selection and all these other things. And so second trimester still doing well.
J : Yeah, doing pretty well. I remember we traveled to Costa Rica and it was a good trip. And yeah, second, second trimester. I think they’re, you know, looking back in hindsight, if there was a little bit of an indication the baby’s growth wasn’t like it’s starting to slow down near the end of the second trimester, the belly measurements, you know, towards towards that end of the second trimester. I remember seeing them like, okay, and I didn’t look super pregnant by the end of the second trimester. I remember people saying I looked less pregnant than I was. People don’t hold back with their opinions.
P: Yes, yeah. Pregnant women seem to be public property. I do remember having to like fend off paws that were coming my way. To touch the pregnant belly, which I don’t remember selling tickets. You are not in line. Don’t. Don’t touch me that way. So the baby’s baby going a little bit slower, but no one’s upset about that.
J: No,no, and I you know, I don’t even remember, I went through a process of looking exhaustively, looking through my medical records after the fact. And it’s hard to say if at the time I was really thinking about it, I definitely remember looking at the record. Oh, there might have been some signs here.
P Yeah, I mean, it’s interesting when you look after the facts, right that things look a little bit different, but we’ll get to that because I read your story in cosmopolitan, which is, I’m glad that it’s published because it is important and kind of shocking. As shocking as it was to experience it’s it is shocking to read.
J: Yeah.
P: So we’ll get we’ll get to that. So third trimester rolls around and what’s that like?
J That’s really hard, really hard. And I remember what to say around like week 33-34 My hands started. It was like a burning sensation. It started hurting, hurting to write which I was a writer and a reporter and you know, using my pen taking notes in a meeting or whatever, my hands would just start hurting and they were kind of bright red. They weren’t really swollen like with edema, but they hurt. And I started developing an upper gastric pain of pain on my right side up towards the top and I went to my midwife, I complained about it and in my chart, it said, you know, suggested ice packs for hands and she called the belly pain. The ligament pain like the
P: round ligament?
J: round ligament like yes, yeah, that was written in my chart. It was actually my liver but that was you know, was written in my chart. And then I also had a couple of times where I went in with high blood pressure. And I remember distinctly going in there once and the midwife you’d see different midwives each time, which I think was not a good thing that there were that was not consistent way of getting care, and they were also had way too many patients. I mean, the waiting room waiting was atrocious, sit out there for a really long time to see your midwife. Um, you know, in hindsight, it just was not a good experience.
But one of the times that I was having my blood pressure measured, it was high. She’s like she’s she Shepherd shuffled me over to a second room that was dark and heavy lay down on my side, I retook my measurement, and that’s what ended up in my chart. And at the time, I don’t know what was going through my mind. I knew I kind of you know, was vaguely aware of what preeclampsia was but I also had this attitude that that that wouldn’t happen to me. I don’t know why. But you know, that was really dangerous but she did. And that was probably week 36,37. When when stuff like that was happening, and I was definitely just miserable those last few weeks not feeling good. And I went all the way to 41st week.
P: Wow.
J: Yeah.
P: So So let’s talk a little bit about that third trimester no one’s running tests to check stuff.
J: No, no, I didn’t get any bloodwork done. And I you know, I’m really curious now, if that would have shown anything with the liver enzymes. Yeah, just the regular go in, take your blood pressure. Take your vitals, measure the belly. Again. The belly growth was a week or two behind what you would see normally.
P And are you worried or you’re you’re trusting entirely the midwives?
J I’m not worried. Yeah, I’m miserable. And I’m in because I did go and I told them, you know, I’m having these issues, and they said it was these other things. You know, I just was like, Okay, I guess, I guess this is how it’s supposed to be. I also had really bad insomnia, because I was so uncomfortable. And I just remember like, being up all night, like trying to find a comfortable position to lay in and just not getting any sleep and I thought, okay, I guess that’s normal too. You just it’s hard to know what’s normal and what’s not and tell you a full range of like Swelling is normal, your ankles swell, you know, that sort of stuff.
P It is it is interesting, and I’m completely and fervently of two minds about all this which is on the one hand, so little is known about pregnancy. And all these complications that you easily could be in that bin of nothing serious going on here. And preeclampsia it while it’s significant issue is not super common. It’s not like 30% of the people have preeclampsia; at the same time. We need to be screening everyone in the fall. It’s not serious then to make sure they’re in the right bit. Right.
J: Yeah, yeah. And you’re reminding me of an important thing that happened one way that my case was different, you know, they were doing the urine checks. Every time I go in my urine was always normal throughout the entire thing. My kidneys were always fine. I never had protein in my urine and but I did have elevated liver enzymes, quite high and right around around November after I gave birth about six or seven months after ACOG. The American College of Obstetrics and Gynecology changed their guidelines to say we should not rely solely on protein in the urine and high blood pressure. You should just be high blood pressure at that point you need to do the full battery of tests because protein can be some women go into this variant of the liver versus the kidney and that that was me and I think that might have been one of the ways I was felt they were thrown off by me.
P What year is this?
J : this is 2013
P: And how old are you?
J: I was 36 Mine delivered.
P: Okay, so the definition of preeclampsia has changed over time to become
J I haven’t Yes, I haven’t looked into it really since then. I got very involved with it. And three years after I gave birth in terms of I know I was on the Patient Advisory Council for the preeclampsia Foundation, wrote that article and since then, it may have changed. But I do remember that year they updated those guidelines because they knew they were missing. They knew they weren’t missing people by being that narrow.
P 12:47
Yeah, it continues to evolve that now for sure they say it does not require protein in the urine to be defined as preeclampsia. I brought this question of the definition of preeclampsia to two experts.
Today we’re lucky to have not one but two amazing scientist/ physicians who research issues around preeclampsia on the show. The first is Dr. Suzanne Oparil. Who if I introduce Dr. Oparil, with all the professional designations that follow her name, the society she’s a part of and the groundbreaking work she’s done. we’d be here all day. So I’m going to I’m going to summarize here. I’ll say that she’s a cardiologist at the University of Alabama Medical School of Birmingham, who was interested in the fundamental mechanisms of cardiovascular disease. She’s authored tons of work on preeclampsia, among other things, and is on the Medical Advisory Board of the preeclampsia Foundation. And we’ll talk about one of the groundbreaking clinical studies that she’s a part of a little bit later. And I also want to introduce Dr. Rachel Sinkey, who’s an Assistant Professor of Obstetrics and Gynaecology, in the Division of Maternal Fetal Medicine at the University of Alabama medical school, who has also authored just a zillion papers on hypertension in pregnancy and preeclampsia. Doctors this feels like a dream team. So thank you so much for spending some time with us this morning.
Dr. Oparil: You’re welcome. It’s an honor to work with Rachel who taught him 90% Of what I know about preeclampsia.
Dr. Sinkey: That’s so not true but it’s an honor to be on your show today with Dr. Oparil
P: Well we’re glad to have you both. We’re gonna start off with what I’m hoping is a softball. Can you tell us what is preeclampsia.
Dr. Oparil: go fot it.
Dr. Sinkey: Absolutely And since this is my bread and butter, we see this so often. It’s just so important to teach our trainees but basically it is either new onset hypertension in a patient who didn’t previously have hypertension, plus either protein in the patient’s urine or other signs of end organ damage. Or the patient has a history of hypertension, then it can be associated with worsening hypertension. Worsening proteinuria and potentially end organ damage.
P Okay, so it sounds like in that definition, you have essentially told us how it’s usually diagnosed. You’re looking for those markers.
Dr. Sinkey: Exactly.
P: Today, we’re here to talk about Joy’s experience. She had a new onset of high blood pressure and heightened liver enzymes. But wasn’t diagnosed as ill after delivery. So I’m guessing there’s something tricky about making a diagnosis of preeclampsia on someone is that consistent with your experience?
Dr. Sinkey: You’re exactly right all it and the thing is it’s very tricky is that if you are diagnosed before delivery of the infant, then you still have circulating hormones in your body even after delivery and for some women, yes, most women are delivered diagnosed prior to delivery. However, there are some women that aren’t diagnosed until after delivery. And so trying to explain to explain it to families is really challenging and it can it can be a tricky diagnosis.
P Do we know what causes preeclampsia?
Dr. Sinkey : We blame the placenta. We are still investigating the underlying causes and I think not having an exact clear understanding of the underlying pathophysiology of preeclampsia also may help to explain why we don’t have treatment yet. So I hope that over the coming decades as our huge appreciation and respect for our basic scientists, colleagues who study this on a daily basis, hopefully as we learn more about the underlying causes, we can also develop therapeutics to prevent it and anti trade.
Dr. Oparil: I would guess though there are going to be multiple underlying cause it’s not going to be one thing, one molecule probably.
P : Okay, so now you’re not feeling great. It seems like maybe it’s normal because everyone’s telling you it’s normal. That’s another thing that’s like a dissonance right where you’re like, Okay, so this terrible feeling is what everyone does, like, yeah, that doesn’t seem like the marketing I hear around pregnancy. And so what you’re imagining like a birth with an epidural or what’s your picture?
J : right, I would that’s what I was. That a was you know, just as few intervention as possible. If I could make it without it. I wasn’t opposed to an epidural but if I can make it without it, I wanted to try it. I come from this like stock of women. That so my grandparents my my grandmother was a twin and she was one of 13 siblings. My great grandmother had 13 children in a log cabin by herself. Yeah. And I had that. There was a newspaper article written about her. She was like so anachronistic. Even in the 60s, she wore a bonnet and had a log cabin and I had a newspaper clipping off her when the headline mentioned that their teen children in the Log cabin I was like give an event living can do it then you know I can do that sort of attitude. And you know, I did not inherit those genetics apparently. Yeah, I definitely changed my mind on the pain control pretty quickly.
P Well, it is an interesting thing. I remember being terrified of birth, like once I was seven months pregnant. Yeah, kind of that idea that this baby that you’re growing is gonna have to exit your body somehow. Yeah. And how’s that going to work?
J: Right.
P: And I too, took stock of like this has happened for eons. Yeah, we’ve been having giving birth in fields by themselves. But unlike you, I thought I’m not one of those women. Yeah, that’s in the field. That’s not me. But so I like your your spirit and your and the mindset that you’re going in with but at least it feels like empowering to think I can do this. My body can do this.
J Yeah. Yeah. But I, you know, if I could go back in time, I think I would have never seen a midwife I would have stayed with an OB. And yeah, I would have been more open minded to everything. I think my biggest lesson was like don’t have a birth plan. The baby has a birth plan, you know,
P : it’s hard not to get attached to some form of control, which I think is what that birth plan is because you’re walking into the unknown. So it makes sense to me that people would want a little something to cling to but But you’re right, that doesn’t always land.
J Right. Exactly
P: So now you how do you get past your due date? You just do. There’s nothing going on.
J: You know those days are a little hazy because I was definitely feeling really bad but I remember I made it to my final week appointment. And, and then yeah, a few days after that. I started having contractions. But yeah, those last few days are definitely blurry.
P : So so how do we get to the hospital? Does your water break or like what take us to the day?
J Yeah, I had two trips to the hospital. So the first was around. I had been laboring all day and calling into the clinic and reporting to them on timing and contractions. I had your back contractions I had a lot of pain in that in the back. Just I just know hammering is the way I refer to it. I remember sitting on the first of all, my husband kind of pressing on my back and I was just, you know, at that point, you’re starting to realize like this is this is just the beginning.
P You and You knew this was a contraction.
J: Yeah, yes. Because it was coming in. It was coming in, wakes up and it would go away and then it would come back. And we were timing them and I think they got to five minutes. Although I don’t remember that precisely. But we went in, I wanted to go in and it was like when in the morning went into the hospital went into the triage of labor and delivery and I was only dilated to one centimeter. And so they sent me home but I also have high blood pressure I had it’s like 145 over 90, and I had a racing heartbeat. And I remember the midwife it was a different one this time asking my husband like, Oh, does she have anxiety? Does she get anxious easily? And I think he said, You know, I think he was sort of like well, you know, I guess like he didn’t quite know how to answer that. What you think would have come up before I’m in triage. And so they sent me home at one inches dilated and say you know, you know, keep in touch and call us and I can’t remember exactly what the designation was to call back in. So we go home, and things continue like that for a while but I start feeling worse and worse. And again, it’s so hard to know like, is this labor or is this something else?
P: you feel worse means that you’re getting a headache now
J: I have I was kind of like a flu type feeling like a general just generalized fatigue and anxiety. My heart was elevated probably for a month really. But you know, this sense of like impending doom, which is my favorite experience and then at a certain point I call it and I think I felt lightheaded. And I called him to the midwife and I was like I don’t feel good. And so she said, Oh, you’re probably dehydrated. So Brendan my husband ran out and got some power rate. And then I drink that power away and I proceeded to vomit all over the kitchen. And as I’m throwing up, my water breaks.
P: Wow….no shade for your husband, but Powerade sounds vile.
J : I happen to like the red one. Reason Yeah, when it’s really cold, the red one kind of spot. I don’t drink it often. But you know, we were trying to I didn’t have much of an appetite and if she you know she wanted me to stay hydrated. So
P: okay absolved…sounds like he did the right thing
J: Yeah, yeah, exactly. Yeah, well, eventually, but it did get all over the kitchen. And yeah, and then the water breaking was like this. You know, just these two things. Two things happening physically at once was insane. And even then I have been learning a birth class. But sometimes when we get to the transition phase of labor, they grow up or they feel nauseated. And so I told Brendan I was like, I think this is normal, like you know, to be growing up and have your water break and things just feel like they’re accelerating. So at that point, my biggest concern is that I’m about to have a baby. And so we go into the I call the midwife and she says come in right away when I when I said that I’ve just been throwing up
P let me ask you a question this transition is like seven centimeters dilated right so yes yeah,
J but this one had been like 12 hours on a triage so I you know, I could
P: okay totally legit Yeah, okay.
J: Yeah. And it’s, it’s kind of you know, with the, for me, you know that’s a bad thing to be just just handle your decisions on how much the dilation is happening and keeping you at home as long as possible. In my situation where I’m already having all these vital sign issues and stuff, who cares when I’m dilated? I need to be in a hospital.
P: agreed
J: But that was missed. You know that that wasn’t caught and so ended up getting very sick at home. And I remember taking we’ll take a cab into the city and there’s a lot of traffic was lunchtime, just like driving around the west side of Manhattan feeling like shit covered in vomit at that point.
P: So, so how does this feels a little bit like a TV movie here?I know the cab drivers happy to take you or where you’re going to get back from the cab or
J: I don’t remember. I really don’t remember I remember like looking at all the like fancy shops in Midtown. And we’re just kind of crawling along. Yeah. And then I get to the hospital and the midwife meets us down in the lobby and she’s like Where were you? Really we were in traffic, you know, like, drive as fast as we can. And then she like escorted us up to triage.
P: Are you feeling scared now? Or what are we now we have anxiety? Yes, yeah, exactly. Right.
I’m feeling scared for you. And obviously I know how this turns out but you still worried about the high blood pressure and the fast heart rate and, and a fast heart rate. The thing that’s bad about that as opposed to high blood pressure is most people say you can’t feel high blood pressure necessarily. Right. But the fast heart rate is a freaky thing to feel.
J Yeah, it is. Yeah. And it’s and it feels exactly like anxiety. So yeah, and so there was this this, I was definitely anxious. And at that point, one weird thing that happened to me. And I don’t and I’ll never know if this was anxiety or if this was the high blood pressure or both. I started hearing like an ocean sound kind of a shot like that. He was holding shells up to my ear. And I went into some sort of other space at that point where I was listening to the sound. I was very calm. And I didn’t say anything to anybody, but like hearing the sound. I don’t think I was really aware of it. In that sense. Like I should say, thing was just like intense. I think it was just the intensity, everything. And in triage, I get a cervical exam and meconium spills out, which is the baby’s first bowel movement. And if it happens in utero, it’s usually a sign of distress, and the baby can accidentally aspirate or swallow it and then get very sick and so once they saw that I think I still wasn’t dilated enough technically to whatever be admitted, but at that point didn’t take me to the hospital because of the meconium. And I said right away I want an epidural men so
P: I’m gonna pause you right there though for a second to say the thing that gets you in as a sign of distress for the baby. All these things have happened to you. You don’t sound entirely lucid once you have the shell sound right, which is a little disconcerting in a way that you can’t access or communicates. None of that none of that gets you access. To the room. Right? That’s a problem. That’s what I remember.
J: You know, it’s t’s because it is such a chaotic situation. That that that is what I remember being the like, being almost relieved, you know that. There’s no way they’re gonna send me home. I don’t have to go do this by myself. Yeah.
P Crazy. So they put you in a room and and what happens then
J :I get the epidural pretty quickly. And then they give me Pitocin very quick. The you know, depending on what hospital on what OB I might have had, I think a lot of situations they probably would have given me a few sections that the employee but they chose to continue with labor, vaginal labor, and so I had the idea of getting the Pitocin and then the epidural, it actually can lower your blood pressure and and women who have normal blood pressure, it can go into too low. In my case, it just made it look normal. Basically, I’d have to look back at the charts at what it was reading at but it was a high or low and that can be a side effect of getting an epidural anesthesia.
P: How does an epidural lower blood pressure so epidural block affects nerve fibers that control muscle contractions inside the blood vessels. This can cause blood vessels to relax lowering blood pressure. This doesn’t happen for all women who use an epidural but does affect a significant share of women.
J So that might have been another situation where that threw them off like once they got me in. And I had midwife looking at my case at that point, not an OB yet and so an OB might have been like well, she came in with high blood pressure and when she got the epidural and drop, this might be preeclampsia. You know that connection wasn’t as far as I knew, they might have been. It didn’t stay in my chart around that time like watch BP closely. So I think they were aware of something was going on. Like there’s a diagnosis.
P Well, this is all a little scary. How’s your husband faring since he’s present?
J: Yeah,he seems to be doing okay. Like it’s we both felt relieved once I was in the room and had the fetal monitor on me and had the the constant attention of a nurse and all that sort of stuff. And I was so much calmer once I had the epidural and I was laying down and can focus a little bit more. I didn’t feel great, but I you know, again, I’m like, How are you supposed to feel? And it took a long time still, though even with all the Pitocin for things to speed up enough to get to the pushing stage of things.
P: so even though they’re worried about the meconium for the baby, this is not a rush situation.
J : I went in and went in the afternoon, that’s like a time and then I delivered at like 130 in the morning.
P: Okay. And so what’s what’s delivery like with you feeling so awful?
J: Yeah, it was it was scary because they knew that, you know, they knew that she had the meconium so they had a neonatologist from the ICU standing in the room. And I have brought in like the little or big kind of almost looks like an x ray table where they examine the baby. She was standing in the corner like watching my birth, the last like hour took a long time. And I hope that she was watching the heart rate monitor and the fetal signs. They don’t know. I just remember being like I don’t know who this woman is, and she’s standing there. And so yeah Adela is born and very quickly, they rush over to table and the neonatologist takes a tube and aspirates her so my first look at Adela is her with a tube down her throat having fluids suctioned out and so that was just like, you know, you’re just terrified. Hoping she Okay? don’t really understand what’s going on.
P: And my guess is there’s no crying because they don’t want her to cry because their afraid she’ll aspirate
J: Right, exactly. There’s no crying and then they do hand her to me. But it’s brief and I can see that she’s not breathing normally she’s like that panting
P: Yeah.
J: And so basically, you know, you can hold her for a few minutes but we need to take her to the NICU and meanwhile they’re stitching me up I have like an internal tear and an external tear. Can’t feel it but you know, the midwife has done our stitching me up and then they take her to the NICU. And then yeah, the next like three days are just absolute hell for me
P: This already sounds like way too much. Delivery where their silence is terrifying. Right, right. When she when she exits her body and you cannot hear Yeah, I wish we’ve all been trying to listen for sound scary on it’s own. Not feeling well. Then they’re gonna take her away again.
J: Yeah, Her birthday was six, six pounds, nine ounces, and considering the gestational age being at like 41 weeks she was small. She was like at 10% or eight to 10% of what’s normal and that, to me, it was like that’s the sign of growth restriction. She was like getting the nutrition from my placenta that she should have been no one. No one ever discussed that with me though. But when I saw the numbers, I was like, wow, she’s I thought she’s going to be huge based on everything that happened.
P: Yeah, yes. So now they have moved you into recovery. I’m assuming and, and baby Adela is in the NICU?
J: Yeah, she’s in the NICU and I moved to this flip the floor or an area of the hospital. We’re just NICU moms, which I didn’t know was a thing. Either, but I’m sharing a room which I really hated with another woman who had had twins, and I think she was having twins have been there a little bit longer, and they immediately want me to start pumping, because I have a breast pump. And though again, like the sleep was such at that point, I was so sleep deprived going into it. And then it’s like 130 in the morning and they’re really wanting me to try to use the breast pump. And then I remember sharing, it’s just like a curtain between us.
P: Yeah,
J: she’s a twin mom and she is using the breast pump constantly. It’s right by my head and I just cannot sleep I brought earplugs and like an iPod you know, trying to drown out the sound and she’d have family coming in and out. You know, it was just like, you know, so noisy and, you know, just hazy. And I think I think I made one visit to Adela before we started to get more concerned about me. You know, I didn’t feel good. The like 12 hours after I gave birth and it kept me on the IV pole for a while. I guess I was on the IV pole for a really long time but they hadn’t taken out the Pitocin they had I don’t know I guess they keep it in after delivery to continue to shrink the uterus But my nurse at that point it was really the the that RN who picked up and she was like your blood pressure is high. Your blood pressure is high. And she kept telling me this. I was like, you know, I don’t know what it was I don’t know how to respond. I was like, you know, and you know, and she just like she’d come in and she was just concerned. She was concerned. She was the surgeon and so she called the midwife and the midwife came in. And she told me Oh, I think we might you might have preeclampsia and at that point I started crying
P:I’m going to stop my conversation with Joy here, and we’ll pick up the rest of the conversation next Friday. For now I’ll say that this experience of medical care is harrowing to hear about, so I can’t imagine what it was like to experience it. I appreciate that Joy shared it with us, because as hard as it must be to talk about it, it’s important to examine and understand how this is happening to someone at one of the most vulnerable times of her life. Birth is one of those experiences that stays with you for the rest of your life…which doesn’t mean it should be perfect, but to the degree we can keep it from being traumatic, that should very much be our goal. I find Joy’s ability to analyze and relate her experience a real testament to her strength and resilience and it’s inspiring to hear how she used that experience to help other women who ran into preeclampsia
Thanks for listening.
We’ll be back next week with the rest of Joy’s story and more from Dr. Oparil and Dr. Sinkey who share more about their exciting work on preeclampsia
Episode 73: A Birth Visited by Too Many Medical Interventions: Nicole’s Story, Part I
Episode 73SN: A Birth Visited by Too Many Medical Interventions: Nicole’s story, Part I
Today’s guest walked into pregnancy with an expectation that the process would be as smooth for her as it had been for her mother, as it was for the farm animals she’d been surrounded by for her whole life, as it was from 50,000 feet: civilization depends on this process and women’s bodies were made for this project. Although the pregnancy part was relatively straightforward, the ways in which her first birth unfolded deviated profoundly from her expectation. In this first part of our conversation we’ll hear how she processed that first experience, and how she used what she learned in this experience to alter the births that followed.
Relationship between Pain Medication & Fever
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976662/
https://www.karger.com/Article/FullText/504805
Audio Transcript
Paulette: Hi Welcome to War Stories from the Womb. I’m your host Paulette Kamenecka. I’m a writer and an economist and the mother of two girls
Today’s guest walked into pregnancy with an expectation that the process would be as smooth for her as it had been for her mother, as it was for the farm animals she’d been surrounded by for her whole life, as it was from 50,000 feet: civilization depends on this process and women’s bodies were made for this project. Although the pregnancy part was relatively straightforward, the ways in which her first birth unfolded deviated profoundly from her expectation. In this first part of our conversation we’ll hear how she processed that first experience, and how she used what she learned in this experience to alter the births that followed.
Let’s get to her inspiring story
P: Hi, thanks so much for coming on the show. Can you tell us your name and where you’re from?
Nicole: Sure. My name is Nicole. I hail from the Midwest, Indiana. I’m halfway between Chicago and Indianapolis.
P: Okay, so let’s talk pregnancy. You have three kids?
N: Three. Yep, that’s right.
P: And what’s the one of the ages?
N: three alive? I’ve three alive. Yep. So my kids are 420
P: Wow, nice. That’s well spaced. Well done.
N: I couldn’t have done it better if I planned it.
P: Yeah. Yeah, totally. I agree. So before you got pregnant, what did you think pregnancy would be like? What were you imagining?
N: Uh, well, uh, so it all kind of happened kind of fast for me. My husband and I have been married now I think for seven years but we have been together for about 20 years.
And yeah, you know, when we were kids, we knew we knew we were gonna have kids, when we were kids, and that was something we always talked about when we grow up when we get married when we have kids. So we always had this, like far off distant idea. of in the future we will have children, but being unmarried teenagers, you know, we’re like avoiding that like the plague.
P: yeah
N: We don’t want to be pregnant. We don’t you know, we don’t want that. You all have that. So we got married, and month and a half later, we were pregnant. It wasn’t quite the honeymoon baby. But we didn’t plan that we weren’t trying it wasn’t intended was not intended, but we were very surprised by it. And so my experience with it was going practically my whole life avoiding pregnancy.
P: Yeah,
N: to now being pregnant and it being socially acceptable, where like, so I didn’t have that time for my mind to shift from avoiding it to desiring it. So that was what what really struck me about my first pregnancy easy Yeah, that emotional trip into dealing with what what was happening?
P: Well, good to good you know, struggle with the front end. Did you find out with like a home kid or how did you how did you find out you’re pregnant?
N: I had an inkling who and I took a test and it was positive. And I, at that time, didn’t think you know, anything could happen. If the home pregnancy test says it’s positive than it’s positive and we just went with it. You know, we, you know, immediately called the doctor because that’s what you do when you’re pregnant, right? You go to the doctor, so we call the doctor we make the appointment we waited the traditional three months to tell everybody you know, in case something bad happened. We did all of those things like the way the cultural norm is so we went we went through all of that and that was all I mean, it’s still like deer in the headlights. You know, I just went from avoiding this to now everybody’s excited about it.
P: That’s kind of amazing. I wonder where the three month rule. I feel like my doctor told me that although I did not follow it at all and had a miscarriage and just had to tell everyone but I think it’s I think it’s from I think my doctor said you might want to wait, but I can’t remember where it comes from. Anyway,
N: I think that’s an old rule when I don’t know when doctors first started playing a big important role in pregnancy and they just advised you know, you want to save face. If you do have a miscarriage. You don’t want to have to go around telling everybody your business that you had a miscarriage and, you know, we thought we thought that that must be important. So that’s what we did.
P: Yeah, yeah. So it was the first trimester easy.
N: The whole pregnancy was pretty easy. Really. I didn’t have a lot of morning sickness. I craved pickles. I was working in a factory at the time. I was on my feet a lot time and that was the big joke like crazy pregnant lady drinking pickle juice. And I did I am but I had heartburn in my third trimester and that was really the hardest thing. You know, everybody has the discomfort and the tiredness and that part of it. But looking back on it, it was pretty easy. I know though that there were days when I was like, Oh my gosh, I can’t do this anymore. Like in the moment you deal with that, but But when it’s not extreme, and there’s not medical conditions and things like that, you just say Oh, this must be what everybody does. This is
P: we just sort of accept it because it’s because how else is it gonna go right? That’s what you’re told. Yeah. So take us to the day of the birth. How do we know today’s today? And then let’s walk slowly through that day.
N: Yeah, sure. So. So looking back on everything that happened where my expectations didn’t really match up to what was happening was like with the birth part of it, and, and that was where, like, the experience just hit me like a Mack truck. So I grew up on a farm. You know, I assumed pigs and cows and horses. You know everything goats, sheep, I’ve seen everything be born. I know like, I knew when I was a kid like population how that happens. So I’ve always known this and I’ve been around forever. And when I got pregnant, my mom’s advice to me was, you know how this works. Don’t read the literature that they give you. It will scare you to death. You know how birth works. You’ve seen it done. Trust your body and it will happen. And my mom, in my mind was a warrior. She had four kids and the first three were born in a hospital completely naturally. The fourth one was a C section. You know, and there’s, you know, the story around you know, how the baby wouldn’t come down to the birth canal and that’s just how it was and whatever. But, you know, I had this wonderful example in my life of how birth was supposed to work. So I thought, okay, I don’t need to read anything. I don’t need to prepare my body knows what to do. I’ve seen it done. It’s going to happen. So I didn’t read anything, not What to Expect When You’re Expecting I didn’t watch videos. I didn’t blogs, nothing.
And my husband says he knew that I was going to go into labor because I came home and I was like, our yard is a mess. I hate it. We’re going to clean it. All up like the baby is coming. I don’t want to have to come home and deal with a messy yard. We’re going to mow it and we’re going to weed it and we’re going to pull all the shrubs out of the flower bed. And you know, I just had all this energy and he said, you know, he reminds me of sitting on the couch after doing all of that work. I was just sitting there saying, I don’t know why everybody says pregnancy is so tiring. And I don’t know why the third trimester is supposed to be so bad because I just have all this energy and I feel so great. He’s like, uh huh, he knew what was coming.
So that night after doing all of this yard work and just feeling so amazing. I got up to go pee at midnight. And as I was sitting on the toilet, I heard like an audible pop.
P: Oh wow
N: That is a gush of water. You know like the things that doesn’t happen to everybody but that’s what it was. And it was read amniotic fluid and I like immediately just began shaking with fear like head to toe overcome with fear, like my whole body to the core was shaking. So I had to wait for this session to stop I had to go wake my husband up in the middle of the night. I have to say you know it’s time we have to no it didn’t take long once he heard me say it’s time like he was immediately awake and alert and up and out of bed and I had a bag packed and you know I am prepared that much at least we did not have a car seat. It was not in our car, but we’re like that’s the least of our worries. We’ll figure it out later. So we grab our bag and we go to the hospital and I didn’t think you know amniotic fluid was gonna leak I had no idea so I just put on jeans and you know I’m still leaking in the car. we didn’t have a trash bag. I made a mess of the car. I walked into the emergency room entrance of the hospital just like water still pouring down my legs and my husband got me a wheelchair and the people are like looking at me like what are you doing here? And I’m like, my water broke and they were like, oh, and then it became an emergency to get me checked in a wheelchair and to the labor and delivery. And so, all of this time though I’m still shaking with fear. We get to labor and delivery and we have this whole big rig mo row. Are you really in labor? Are you feeling contractions? Is this really your water breaking? And, you know, then the they had to do an amniotic test where they had to like swab me to determine that the fluid that was coming out really buzzed amniotic fluid. When it came back positive then they decided that I must really be in labor and I will be allowed to stay because they were so busy that night.
P: That is like a little circus environment there. Although I think most people don’t experience the kind of dramatic and obvious water breaking that you did. So So I think some people are really unsure themselves like oh my Warbreaker broke or not although it seems like yours is pretty clear.
N: absolutely it was
P: And so at this point you’re not feeling contractions are you are
N: i i probably had some pain in my back but I wasn’t feeling like miserable countable contractions I just my water had broken, but I’m also still shivering with fear. And, you know, in the birth that I’ve had since then, when looking back at that situation, I know that that fear response in my body was stopping any contractions that would have happened with that. So like this fear, this flight response that I was having definitely shut down. Anything that was happening.
P: Yeah, there’s a lot of chemistry involved in that in that response. Right. So you can imagine it is telling your body like not now.
N: Oh, well yeah, I mean, an animal’s in labor and there’s an ear Okay. Body says don’t be born because you’ll be taking your days and that’s, that’s what my body was going through. Because even though I like mentally knew that my body was capable of giving birth, I didn’t believe in my body like in my subconscious mind, you know, like, my body was fat and ugly. I hated it. I was constantly putting it on diets and berating it and saying, you know, I hate you all of these cultural stories that we have about women’s bodies. And and that was what was putting me into this fear like this mental juxtaposition of I know I can do this as opposed to the true like deep down beliefs that I have that my body was a piece of garbage like a piece of garbage can’t do something amazing. And and that’s that what, what, threw my first birth off the rails for sure.
P: Yeah, that sounds like a really hard thing to work through in the moment. And did you have
N: I was not aware of it in the moment. took several years afterwards to come to that.
P: Well, you probably knew you were fearful. Right?
N: Yeah, I definitely knew I was afraid and that but you know, I just thought, you know, my, I’m afraid but my body’s gonna do it. And when it happens, I’ll just go along with it. Yeah, okay.
P: And so, since you’re waiting for and stopping contractions at the same time, how does that progress?
N: Yeah, it doesn’t.
It doesn’t progress at all. So after it was about six hours, they have me hooked up to machines and they were measuring my contractions and I was kind of sleeping off and on but I wasn’t feeling the pain and I felt poorly, but I wasn’t feeling regular measurable contractions. So they
Come in and they hook up an idea that kind of, I think it was they started hanging Pitocin at that time. And looking back on it. I see you know, the audacity that they had to come in and talk to my husband about this. They didn’t talk to me about any of it. I didn’t give my consent. Obviously, I wasn’t going to disagree with them at that time. But it was not me giving consent.
P: why aren’t they talking to you?
N: I was tired. I was sleepy and he was awake. So rather than, you know, trying to rouse me and have a conversation with me, they just went right to my husband and talked with him. Because like yep, if that’s what we need to do, then that’s what we need to do. And over the next six hours, they have three bags of Pitocin
P; oh Wow.
N: Which was causing back labor. So by noon, 12 hours after I had been admitted. To the hospital by noon, I was ready for pain medication.
P: Yeah, no kidding
N: They hung up a pain medication. And still they were measuring contractions and saying you know, we see you’re having contractions, you’re in labor. They were checking my dilation constantly which you know, that’s a whole another story of invasion of self being uncomfortable and just adding to those to those hormones that are slowing down labor. But so yeah, by noon then 12 hours later, I was on Pitocin and pain meds
P: man, this is this is hard.
N: So what not what I expected when I went to the hospital, that’s for sure.
P: Did you think it would be fast like what what was the image in your mind? Yeah,
N: so So in my mind, I thought you know, this is gonna be quick and easy. I’m just gonna lay there and my body will take over and do what it’s supposed to do. And eventually a baby will pop out. And I will have this baby in my arms. And that’s, that’s all the thought. That’s all the space. I allowed this event to have in my mind.
P: Yeah, that makes sense. I think people are fuzzy in describing birth, right? They kind of walk fast by that part. And I think it’s hard to find the right vocabulary to make you viscerally appreciate the pain
N: for the first two births. For me that was true by my third birth that wasn’t so true anymore.
P:Interesting. Well, I’m interested to hear how we get there.
N: Yeah.
P: So how do we progress like how do we
N: Yeah, so noon, they start giving me pain medication and then from noon to six, my temperature starts to increase which they attributed to possible infection because my water has broke and that’s the risk of having your why you have to go to the hospital when your water breaks, is because of that risk of infection.
They don’t talk about how the pain medication that they were hanging, for me causes your body temperature to rise.
P: Okay, so Nicole mentions of the pain medications in labor may have caused her fever. So this turns out is not entirely straightforward. Like many things about birth. There are some studies that suggest that an epidural can be associated with a non infectious rise in temperature, but there are many other factors that can contribute to fever, including things like a long duration of labor, and a long time separating ruptured membranes from delivery. I put some links in the show notes on this topic. If you’re interested in the details.
N: so my temperature is rising possible infections still not feeling contractions, six o’clock comes and the on call doctor for the evening comes on to the ward and there’s lots of other women in birth the whole word of school they have women in other rooms of the hospital who are in labor, but can’t come into this labor and delivery and it’s a pretty small rural hospital, really, it was a private kind of thing. It wasn’t part of a huge network. So it’s not a huge fancy place. So the hospital is dealing with their own constraints besides me. Taking up this room, progressing really slowly. Around 6pm They say you know your fever is starting to go up. We need to start doing fetal heart monitoring to make sure that the baby is safe while your body temperature is increasing. You know, we went to to walk we want you to do things to try and move things along. Because if you don’t, and that’s what they started telling me around six o’clock that evening, so 18 hours after I got to the hospital. If you don’t, then we will do a C section. So that kind of also starts weighing on my mind like oh my god, am I not capable of giving birth? Am I going to have to have a C section?
So you know, I’ve got all of that going on. I do the walking they give me more pain meds, they increase I think probably the day to start working on the contractions and around nine o’clock. I went ahead and took the epidural, the first epidural
P: Oh wow,
N: labor doesn’t progress. nothing’s really happening. Around 11 o’clock. They come in and say you’re going to push I think they weren’t declaring me to be around nine centimeters dilated, but by the measurements of the contractions I was having something should have been happening. They criticize the way I’m pushing and say you’re not doing it right. This is how you do it and 11 o’clock goes by and they keep making me push and I’m pushing according to readings on a machine. Not according to my body. Like I’m so out of my mind. I don’t really even know what’s going on. Like I’m I’m desperately afraid of what’s happening right now. And it came to like 1130 and the nurse went and got the doctor and said, You know she’s pushed, nothing’s happening. They decided your body temperature is too high. At 1130. They decided you’re going to have a C section so they started prepping that they started checking my epidural. I could feel where they were poking and all the tests that they were doing so I had another epidural and the anesthesiologist that came in and did it. He had to come in from home wherever he was at to do it. And he just said I’m going to give you two to make sure that you get through the next however long it’s going to take you because again the hospital has a lot of other constraints they were dealing with. He wanted to make sure he didn’t have to do it again right before they did the operation.
It was between 1130 and 1145 or so they do the extra epidurals they have my husband and they put him in you know the full HEPA suit with his beard cover and all of that and
P: wait How are you feeling? Are you are you upset or where are you?
N: I’m drugged out of my mind at this point. I’m still shivering with fear but I just like so out of my body that I I’m I’m not capable of giving consent. I’m not capable of not giving consent.
P: Yeah,
N: I’m just I’m just going along with it. I’m desperately afraid of what’s happening. I’m in fear. I’m disappointed because, you know, I never thought that I would need the epidural. I never thought I would need the pain meds and I’ve taken all of that and now they’re telling me that my baby is in danger. Heart rate might be low that my body temperature is increasing, who’s going to be born with an infection? Just fear.
P: Okay, so this is the issue of fever if the epidural is a catalyst for a fever, but it’s a non infectious source, then we’re not worried that the baby will be born with an infection. Some theories suggest that the epidural along with other factors may induce an inflammatory response in the mother’s body. If this is the case, then it’s not likely that something is transmitted. To the baby and the baby doesn’t need antibiotics. So although we don’t have a definitive answer yet to this, this is an, important focus of study.
N: Yeah, everything was here. Everything was saved my life saved my babies life
P: yeah,
N: and they went we went into labor and delivery and the C section was fine and maybe boy was born. And they put me in a room and my in laws. Got to see my baby before I did.
P: Wow.
N: Yeah, yeah. And looking back that was one of the thing that was hardest for me, especially, you know, in the postpartum recovery was they put me up in the surgery board. They did the surgery. I saw that like they helped the baby’s butt up like you have a boy here he is. And they cleaned him up and took him away. And then they took me to a room to get cleaned up. And I don’t even know what happened what they were doing. You know what happened while they were cleaning me up but they gave me a picture. A photograph of this naked squirmy little thing that had salve in its eyes, you know had on its head and like, that’s how I got a picture. And, and that was like, again, like so surreal. So out of body. There’s not nobody nothing in my arms. My belly is soft and squishy. And I don’t have a baby. And, you know, we had we had called people before I went into surgery just because you know, again, kind of like the three months rule with announcing your pregnancy. It’s you call people because what if something happens while you’re in surgery? Which again shows how fearful we were?
P: yeah
N: what if someone dies with this C section. So my in laws were at the hospital. My mom had come to the hospital and my husband followed the nurses with the baby to see them wash baby after he was born. And he has very fond memories of walking into the room and talking and, and my son like instantly looking for him recognizing His voice. So
P: yeah, so that’s cool
N: has fond memories. Yeah. But it was I don’t know, maybe an hour before I got to even see him. And then like, just the surreal moment of is this little thing. This score me a little baby my and having them that first hold your baby.
P: It feels like you’ve been put through a very weird version of a birth in which you’re present but not entirely and they’re like not treating you like your president at any point. Right? It’s wacky to criticize you’re pushing Oh, you mean from the 1000s of times. I’ve done it before and you know,
N: absolutely
P: the consent thing is weird and shuffling too often. You have the baby off to different rooms, like Okay, we’re done with her. Let’s just that’s just weird.
N: Yeah. And you know, at the time, I don’t have the presence of mind or the perspective that I gained over the next few years to know to say something’s wrong with this. Yeah, yeah. You can’t say what you don’t know. And I absolutely did not know in that moment.
P: But it sounds like it fell off. You have nothing to compare it to.
N: Right. But it just has nothing to compare it to. Yeah, yeah. So you know, then I have the whole hospital stay and you know, people come to see the baby. And I was I was really dedicated to breastfeeding and that didn’t really work well, and baby was kind of grumpy. And it turned out that he had high bilirubin so he was orange and they wanted him to lay under this light. So not only do I have like the surreal meeting of my son, but now they say don’t hold him put him under this light. You know, don’t interact with him except to feed him you know in the hole coming in all the time to check your temperature so you never really get any sleep and just all of the things just was not a great bonding time.
P: Yeah,
N: my mom came to stay with me which really felt good, which was really good. Besides that, just the birth experience of not being considered an active participant in the birth to a person to whom it was happening, that they had to deal with in the process.
P: Yeah, all that sounds really hard to manage emotionally. And certainly your experience didn’t match your expectation at all. What’s postpartum like?
N: My dad came to stay with me after the birth, which was an incredibly generous gesture on behalf of my dad. But in hindsight, and even in the moment, like it was so awkward, like my parents were splitting up in the moment. My dad was like, one upping my mom by being able to be the one who was there. With me. He is not really a baby or a kid person. He was trying to like treat me like his kid. And at the same time, allow me space to be a mom. It was really uncomfortable. So I have these five days, you know where my husband is gone. He had to go back to work and I have to deal with this and driving back and forth to the doctor and baby not nursing and nobody. I had zero support of people saying yes you can rescue they were all saying Oh, baby’s not latching right give him formula. Like no person said, Oh, he’s not laughing. Let me help you.
P: Yeah.
N: And it was only my stubborn persistence that did that but he finally latched on to finally nurse and I finally did that and when that got easier, then I get this you know, whole emotional wave of you know how did that happen? And I think it was probably after my second child was born. But I look back on that time now and I say that that was trauma in my day.
P: Yup, yup
N: I knew that it wasn’t right that what happened wasn’t right and after baby was born, the next morning the surgeon had come in and you know, I expressed to him my disappointment in what had happened. And I said, is it going to be possible for me to have a vaginal birth in my next pregnancy? You know, I’m already planning my next one and I just got the first one in my arm. And he says, no, no, no, V backs are dangerous. You know, in the 90s. We pushed everybody to do it. It was this big thing and we damaged a lot of women, we damaged women in the V back process and we don’t do that anymore. So if you ever see sex and you always have a C section, and besides, your hips are too small, you’re really too small of a person to be giving birth anyway. And that was just that was his answer. And it kind of was weird in the moment when he said that because my mom might know again, my example in birth is smaller than me. And she had these three babies naturally and and she was fine. So how was that the case? And it was about 18 months. I finally am starting to heal. I say, you know, that was a really sucky experience. I never want to have that again. I know I’m going to have kids in the future. And I’m never doing that again. And you know, I start reading things on the internet. I start watching YouTube videos, and around the time that I’m thinking about all of this, we got pregnant again. Like we weren’t trying it. We weren’t not trying but it just happened. And it was good timing and it was right. And so I’m pregnant now. And I’m thinking about all of this, and that freaking doctor was absolutely wrong. I am capable of giving birth and I’m gonna prove it to him.
P: Thanks again to Nicole for sharing her experience. With this first birth.
Her experience of the hospital has a steep learning curve that she uses in future births her attempt to get the birth she was hoping for.
Thanks again. Thanks again to Nicole for sharing her story. Her experience in the hospital has steep learning curve that she uses in future births and her attempt to get the birth she was hoping for. Unlike many women who go into birth with a fully formed birth plan, it calls hoping to avoid another experience. She feels like a disposable contributor to the whole event.
Episode 58: The Power of Hormones, Hyperemesis & Postpartum Depression Visit a Pregnancy: Laura’s story
Episode 58 SN: The Power of Hormones, Hyperemesis & Postpartum Depression Visit a Pregnancy: Laura’s story
Today’s guest had a pregnancy marked by extremely easy things and significantly hard things. Getting pregnant was consistent with the kind of fertility you see in a romantic comedy instantaneous, but the first trimester morning sickness was more like a sci fi thriller, totally extreme and requiring all kinds of medical help. And after a pretty challenging pregnancy, she ran into postpartum depression after the birth but her’s is a story of overcoming. She found help and recovered and she’s deeply immersed in the joy only a five year old child can bring.
(image courtesy of https://www.girlsgonestrong.com/blog/articles/pregnancy-hormones/)
Links to some of Dr. Meltzer Brody‘s work
https://scholar.google.com/citations?user=6CCrvBEAAAAJ&hl=en
Audio Transcript
Paulette : Hi, welcome to war stories from the womb. I’m your host, Paulette kamenecka. I’m an economist and a writer and the mother of two girls. Today’s guest had a pregnancy marked by extremely easy things and significantly hard things. Getting pregnant was consistent with the kind of fertility you see in a romantic comedy instantaneous, but the first trimester morning sickness was more like a sci fi thriller, totally extreme and requiring all kinds of medical help. And after a pretty challenging pregnancy, she ran into postpartum depression after the birth but her’s is a story of overcoming. She found help and recovered and she’s deeply immersed in the joy only a five year old child can bring. After we spoke, I talked to a fantastic psychiatrist who’s done lots of research on postpartum depression, and gives us a sense of what the field might look like in the future. One more thing to add. My dogs were desperate to be a part of this episode. So you’ll hear their contributions at certain points, which in no way reflects the many efforts I made to keep them happy and quiet. Sorry about that.
Let’s get to this inspiring story.
P: Hi, thanks so much for coming to the show. Can you introduce yourself and tell us where you live?
Laura : Sure. Thanks so much for having me. My name is Laura Nelson. And I live in San Francisco, California.
P: Nice, lovely. And Laura, how many kids do you have?
L: I have one child and one husband.
P: well said and before you got pregnant, I’m sure you had an idea about what pregnancy would be like. What did you imagine it would be like?
Laura : Oh, well, I imagined I didn’t imagine it would be magical. I didn’t imagine it would be like a fairy tale. I think I took worst parts of pregnancy depicted on TV and media and went yeah, that’s probably what it’s gonna be like.
P: Well good. There’s only up from there. Right? That’s that’s a good way to start.
L: Yeah.
P: And did you get pregnant easily the first time?
Laura 2:09
Oh, yeah. First first try. We pulled the goalie pregnant.
P: Good lord. You’re the story we all hear. Everyone. Everyone thinks they’ll get pregnant as soon as they try. But it doesn’t happen all the time. Right? But this is the perfect example. That’s so good. I’m glad that was easy. And you found out with like a home pregnancy test.
L: I found out I was I was house sitting for my parents and their dog. And I went to I didn’t know I was pregnant, obviously. But I went to Long’s and I got I was like, I really needed some kulula And why not like a pregnancy test? So I had some grua and I took some more pregnancy tests and all of them are positive. And I was like, well yes, that’s that’s what it is. You know, truthfully, I was like, I was a smoker. And so I was like, I called my best friend and I was crying. So it’s just like such a shock. And I was smoking. I was like, it doesn’t count until the doctor says it right. And she’s like, you’re fine.
P: Yeah, that’s kind of a shock.
L: Yeah, but it was it was nice. It was good. And a good reason to quit smoking. So how about that?
P: And how was the pregnancy? How did it start off?
L: What was it like? Oh, the pregnancy was in a word traumatic. I think it started off with violence, never ending nausea and vomiting. So throughout the course of my pregnancy, I lost 30 pounds.
P: Wow
L: and then I think, so weeks, six through about 20 is going to the hospital three times a week for IV infusions, because I couldn’t even hold down ginger ale and crackers. I was just unable to eat food without taking. I ended up taking what was called Zofran. I took sublingually as well as intravenously. So if you are experiencing severe morning sickness and you’re worried about Zofran I took it pretty much the whole pregnancy and there were zero adverse side effects other than I could pull down food, which was nice.
P: so that seems like a violent entrance into a pregnancy like what it happened once and you thought, Oh, this is just once or like, did you react to a food or it was all food or how does it work?
L: It’s all food, all food and all smells and I was throwing up Bile or food. On a good day. 10 times I was throwing up.
P: Wow, that sounds unbelievably intense. So did it. It happened one day and you went to your doctor like how did it how did you kind of sort it out?
L: Oh, it happened in happened for a few days in it. I thought like, Oh, this is morning sickness. Right? Like This must be what everybody talks about. And then when I was showing signs of dehydration, and I like couldn’t actually function and was feeling very sick. I went to my OB and she said, Oh yeah, no, you need to hyperemesis Gavardiam you need to get fluids we need to give you medicines or you can eat and we need to give you something so you can not be nauseous all the time.
P: So they think like oh, maybe you have the flu or because it’s pretty distinct.
L: yup
P: So even though they gave you the medicine you lost all my weight.
L: Yeah. So I gained again Yeah, back towards months, eight and nine, nine and a half. Right. But But yeah, in the beginning, it was dramatic
P: That sounds super unpleasant. And where are you at? Were you working?
L: I was I was working. I was going into the office. I you know once I was able to announce my pregnancy, which I had to do earlier than I wanted, because I was so sick. You know, it would just be I’d be talking with people about plans and then I thought oh lord is gonna go vomit and I’m gonna throw up and then come back and keep working. But yeah, I was a very understanding very parent focused company. So I was very lucky that, you know, the CEO had kids and everyone I was working with was already a parent.
P: Yeah, that sounds intense. And so it sounds like it got a little less prominent later in the pregnancy.
L: So weeks 20 to about 32. I would say I was normal. So I was eating food walking around. I had a good normal pregnancy and then weeks 33 to 42. It came back and then
P: No, no, is that normal? Was that what they say?
L: Yeah, you’ll either have it just for the first semester or you’ll have it for the first semester and we’ve got like school for the first trimester or you’ll have it for first trimester in the second trimester and the third, so I was lucky that it got a little less severe. For the second semester, trimester. But It came back.
P: Oh my god, I’m so sorry to hear it. Good Lord. That must have been so disappointing the first time you threw up after you have the break.
L: for sure,
P: and so you get to 40 weeks and what happens?
L: I get 40 weeks and and nothing happens. You get to 41 weeks may be scraped the inside what’s it called an induction
P: Yeah. they strip the membranes or something or
L: yeah, they stripped the membranes and then they send you home so they gave me an induction I was induced. They said go home out should start happening. When it’s less than five minutes apart. Come back.
P: so this is this exciting. Because you’re done.
L: Oh, I am ready to not be pregnant. Yeah. Yeah. So I go home as they’re happening and laboring, and it never retiming them. It never gets closer than five minutes eight eighths and spicy food. And it still stayed farther apart than 4-5 minutes. So I called and they said no, if you if you came in, we wouldn’t be able to admit you. I said okay. So 41 weeks, 2 days, I go back. We’re doing health checks. They’re doing the screens. They induced me again, go home labor. bounce on a ball. again It doesn’t stay closer than five minutes. So finally at 41 and five, said okay, well it’s time to come in. so We went down. We checked into hospital it was so I think the one of the nicest and most surreal things about going to the hospital knowing that you’re going to have the baby is you have this like brand new car seat. That you take with you. And you’re like, Okay, we’re taking carseat with us and like we’re leaving, we’re entering the hospital as just us and we’re gonna leave as a family like that. That’s just like it’s definitely a beautiful moment. So
P: let’s talk about your labor for a second. Were you like imagining a natural labor or I want to be in a bathtub or what was your you’re already shaking your head? What were you hoping for?
L: No, I took some birthing class classes with liars. They all said they wanted natural childbirth with flowers, and I said, my vision was epidurals just all of the like as many natural drugs as you can give me. Yeah. Was my natural birth vision. Plan.
P: good, I feel like you’re moving in the right direction then.
L: Yeah. So we go I’m in. I’m induced, they give me they give me Pitocin. I labor for about 12 hours. So that’s fine. We’re just me and my husband all night or just watching 30 Rock and I’m like, a little bit of pain, but not too bad. Then the doctor comes in and checks on me and she says, All right, you’ve been laboring for 12 hours and you’re not even one centimeter. And at this point, I was like, No, like really? Are you kidding? And so she said very plainly. She was a wonderful, wonderful doctor. She said, we think your baby’s really big. Can you either labor naturally over the weekend, and if things get bad, we’re going to have to do an emergency C section. Or we can get this baby out of you in the next two hours
P: oh wow
L: and do a C section right now.
P: yeah, I’ll take the door marked baby now.
L: I said yeah, let’s get this baby out. Like right now. And so the so it just went from a having a baby in two hours. So anesthesiologist came in and the anesthesiologist assistant who looks like Jessica Alba it might have been the drugs I was on but I swear I still tell my husband I’m like man do you remember that anesthesiologist. She was just she delivered kisses from angels with the epidural and she’s out of this world attractive. So anyway, I had the epidural. Seeing your partner scrubbed up in scrubs is just like, interesting.
P: I sort of felt like it you felt like you want to do an SNL skit
L: a little bit
P: come in with all the blue scrubs in that and hair cover and stuff. It’s so weird.
L: Yeah, just like Alright, we’re gonna go have a baby and then I didn’t expect can’t have your husband in when they give you the epidural. So you’re on your own and they’re having you bend over. You’re like gigantic pregnant belly. Yeah, this point I’m like basically 42 Weeks Pregnant I would say again to our baby and me. As the room is so cold, and you’re naked, your butts expose. Just jabbing you with a needle
P: It’s glamorous.
L: Yeah, then I had what’s known as a gentle C section. So I was able to listen to music which was nice we put on Lyle Lovett and put on allow love it playlist. So I was now they put up the curtain and they tested they said let us know if you feel this and just looked at my husband and said it’d be funny if I said it out. And he’s like, No, it would not be funny if you sat down. So we listened to music. Baby came out beautifully and immediately instead of wiping her off or when her they just immediately her on my chest and I was able to breastfeed her while they sewed me up.
P: Oh, wow. That’s amazing.
L: So that was really beautiful. And then they weighed her. And, you know, whisked us off to the recovery room. Once everything was all done. It was life changing in a lot of ways but I think having that gentle entrance into the world surrounded by so much chaos was just very nice bookend and blessing.
P: I was thinking gentle C section was marketing, but that sounds like a gentle C section. That sounds really nice.
L: Yeah,they just give you the baby right away.
P: That’s awesome.
L: Being able to breastfeed even though like I couldn’t feel my arms was nice.
P: Maybe the best way to do it. So you up, you’re in recovery. And then how long do you stay in
the hospital?
L: I was in the hospital. She was born on the 10th and went home on the 13th.
P: All right. And how do you feel when you go home?
L: Oh, I was loopy for sure. I think one thing that I was grateful for from just another friend who was a mother was I was taking the stronger pain medicine. It wasn’t Vicodin. I think it was Percocet and was actually causing like panic and me taking such a strong as soon as my friends had stopped taking Percocet, only take Motrin and so I switched to Motrin, and immediately the panic went away.
P: Oh good. I’ve never heard of that. That’s interesting to know that. It’s like well known enough that someone could give you a nice,
L: yeah, it was very good advice. Yeah, went home. tried to figure out how to be parents, and it was it was nice, but it was also very hard because I had a C section and I was on the I lived on the third floor walk up. And so the doctor says don’t do don’t take any stairs or I live on a third floor walk up. You know in retrospect, they after the kid is born, they have you come back or the next day or two days later for a sort of wellness check to weigh them and make sure they’re eating and maybe even get another shot. In retrospect I should not have gotten to that appointment into that with my husband. And if I had to do it again. I would say I’m gonna lie down. You can take the baby to go get a check up
P: because it was painful to manage the stairs and all that.
L: Yeah, the stairs were just brutal. I ended up popping a stitch.
P: Oh No. Oh my god.
L: but, that’s okay. I mean, the grand scheme of things. It was worth it.
P: What’s it like in the fourth trimester when you’re home?
L: Oh, yeah. So the fourth trimester be brutal for me, who loved my daughter? I think know that I had a lot of unhealed trauma from both the pregnancy and the birth that I didn’t address and being isolated in apartment–not that I couldn’t go outside but that going outside meant downstairs and eventually you know popping a stitch and hurting myself. A lot my husband took two weeks of paternity leave and to care for me and and us and the first day he went back he was let go.
P: Oh, my God that is crazy. Yeah.
L: So I had, I’m a mom, and I’m the sole breadwinner and I feel literally trapped in my apartment. So I should have seen The chips stacking up earlier than I did. But it wasn’t until it was about six or seven months old. I realized I was not well, I had severe postpartum depression. And I just had a breakdown one day where I just could not stop crying and it wasn’t that I didn’t love my child because I did I loved her so much was that and I thought of postpartum depression. The only things I thought of were very black and white. It was you had it or you didn’t. There was no gray area of you have it a little bit and then drawing on media and growing up. The only postpartum depression that I’ve ever seen talked about was that woman who drowned her kids in the bathtub.
P: Oh, wow. Yeah.
L: And I thought well, I don’t want to drown my kidney bathtub. So I obviously don’t have it
P: I brought the topic of postpartum depression to an expert. Today, we’re lucky to have Dr. Samantha Meltzer Brody, a psychiatrist who’s the director of the UNC Center for Women’s mood disorder, and the author of many, many scientific papers on the topic of perinatal, and postpartum depression. Thanks so much for coming on the show Dr. Meltzer-Brody.
Dr. Meltzer-Brody: Thanks for having me.
P: Harming your children is one small one small aspect that might present but there are probably many ways many things that postpartum depression can look like. So maybe you can define it for us.
Dr MB: Absolutely. So postpartum depression is a mood disorder that occurs in the postpartum period. However, it comes with often many co occurring symptoms, including anxiety, also, according to the DSM can start during pregnancy. So oftentimes, hear the word Peri, partum, or perinatal, used to define symptoms of anxiety and depression. That occur either over the course of pregnancy or postpartum. If we’re talking specifically about postpartum depression exclusively, oftentimes, you’re not seeing symptoms creep in until late pregnancy or they start in the postpartum period. They can have a range from very mild to very severe with everything in between. So if someone is having the most severe symptoms, they may have suicidal ideation and tenor plan. Most rarely, you have co occurring psychotic symptoms that can be associated with postpartum psychosis which is not postpartum depression. It’s a severe postpartum psychiatric disorder that is thankfully because it’s so devastating, more rare and can be associated with thoughts of harm to the baby. But then can have a range of symptoms that can include anxiety, worrying, or being able to sleep even when the baby’s sleeping because of worrying about the baby not being able to enjoy the baby feeling keyed up on edge, feeling overly tearful, feeling completely overwhelmed having difficulty concentrating. Again this can be on the more mild side to the to the severe side but in general, they are going to last more than two weeks it is not the baby blues, so most women immediately upon giving birth are going to feel more emotionally exhausted because birthing is very powerful, profound time. Most moms will get their sea legs if you will, but for the one in eight women that continue to have clinically significant symptoms or up to 15% of women postpartum. It’s much more complicated. So what you will hear the terms, perinatal or postpartum mood and anxiety disorders. You’ll hear the term maternal sort of mental health, maternal mood and anxiety disorders to sort of be more broadly inclusive. So we’re not having any one woman gets stuck on one particular symptom as you stated that doesn’t resonate with her
L: but I did and I think that there’s so many different layers of postpartum depression that people don’t talk about. People don’t understand there wasn’t even you know, the right level of support even now, looking back that I was able to get, you know, I broke down i i called my doctor and I said, I’d like a really need help. And so I did three months of intensive outpatient therapy. So I was going in three days a week to the hospital to get talk therapy and medication and art therapy and group classes and group therapy and it really just only let me heal and focus but just realize that I wasn’t alone and that there’s nothing wrong with me as mom. There’s nothing wrong with what I was doing as a parent or how I was loving or how I was living. It was literally a cat, something’s wrong with your brain and you just have to fix it or work on it. So eventually, I found the right mix of medicine
P: One tricky issue with postpartum depression is it seems like it might be hard to identify in yourself or to rely on someone else to identify for you. I’m wondering if something like biomarkers might help here
Dr MB: well the use of a biomarker is, you know, variable depending on what biomarker you’re talking about. But for example, ideally there’d be a biomarker that would show women who are either at risk or to have someone start treatment in a preventative way or start path that would prevent symptoms from happening. Or biomarkers can be used to track response to different treatment or you know, indicate that someone’s going to be differentially responsive to a certain antidepressant or whatever it may be. So they can be used in lots of different ways at this point We do not have a reliable biomarker that’s ready for primetime. And so that’s an interesting area of investigation, both looking at genetic signature, but then looking at other types of biomarkers that can either help with diagnosis or help dictate treatment to be most targeted and effective. And that’s often when we think of precision medicine, or precision psychiatry, rather than saying, you have postpartum depression and we don’t know what treatments going to be most effective for you. So we’re going to, if we say pick an antidepressant that may or may not work for you, biomarkers when they are more sophisticated, can really help guide a specific line of treatment to be most effective.
L: I’m A huge fan of Lexapro I’m like a lexa pro cheerleader. But yeah, the days are brighter and heart is healed and I’m just so full of love and of being a parent, but I think one thing I would say to everyone who’s either expecting to have a child or just had a child and it’s in the fourth trimester is there’s absolutely nothing wrong with you. If you are feeling a little sad if you are feeling like you can’t make it if you’re feeling like things just aren’t adding up to help because it’s really easy and there’s nothing wrong with you. You’re doing a great job.
P: I think that’s a great message and I’m impressed that you were able to see it in yourself. And I’ve talked to a lot of women who have talked about postpartum depression and a lot of them don’t recognize it or think this is just what motherhood is, or I’m just a bad mom, or some version of that.
P: I talked with Dr. Meltzer Brody about some of the challenges inherent in identifying PPD: I’m imagining we don’t have a biomarker and we don’t know which medication would help you if you require medication because postpartum depression is really a constellation of things. And there are many, many roads lead to postpartum depression. So it’s not this this one thing. In the same way you’re describing all these different symptoms that could be sort of a postpartum depression diagnosis. Because there are many ways to get there. Is that Is that accurate?
Dr. MB: I think that there’s not going to be any one reason a woman would have postpartum depression. So in the same way, that there’s not any one type of breast cancer either, so I think one of the things we’ve seen as we get much more sophisticated in other fields of medicine in terms of precision medicine, as we get very tailored and targeted on the specific treatment, that’s going to lead to the best outcome. So 25 years ago, most women with breast cancer you may have gotten the same treatment. It turned out that didn’t work very well at all. And we now are much more specific and targeted based on you know, receptor type and hormonal responsiveness and any number of things where I hope we can get to with postpartum depression and all forms of depression is similarly so that there’s not one form of depression and that people are going to become depressed for any number of reasons and that there’s going to be obviously the psychological psychosocial factors that render someone more vulnerable, but ultimately, it’s going to be the biologic processes, right? So is it immunologic in origin? Is it inflammatory markers in origin? Is it genetic in origin? Is it epigenetic, you know, or dysregulation of the HPA axis or dysregulation of a specific neurotransmitter system? So all of these are hypotheses. It’s very likely going to be an interaction of those but also that some people differentially are going to have a specific sort of past that’s driving there’s for which a specific treatment may be most effective. Now, we are not there yet at all, but I think the hope will be that we can be looking forward to that in the next I would, I would like to say aspirationally decade,
P: generally speaking, it seems like postpartum depression is thought to arise from hormone shifts, during or after pregnancy, in particular, a big drop in progesterone but it sounds like all these other bodily systems are affected immune system HPA access other systems. So it does that contribute to why it is tricky to establish a link between hormone drops and postpartum depression.
Dr. MB: So I think that we know that all women who give birth have rising and then falling levels of estrogen and progesterone, female ganando hormones, that’s a normal part of physiology. They rise dramatically during pregnancy and they fall at the time of delivery and that is part of physiology and so there’s no difference in the rise and fall in any particular way that’s been studied for someone that has postpartum depression or not, what the current theories are, and you’ll hear the the expression, differential sensitivity meaning a woman who gets postpartum depression may be differentially sensitive to the rising and falling the normal, rising and falling in a way that someone else is not. Now, we haven’t necessarily gotten able to refine that exactly, not even close. And it’s very likely that some women are differentially sensitive to the rising, falling and they have postpartum depression for that. rising, falling and they have postpartum depression for that reason, it’s also very likely that other women have postpartum depression because of a different trigger. So, the dysregulated system is not necessarily going to be hormonally based it may be something else and so this is an active area of investigation is understanding what are all the different factors and how they interact and what may be driving that for any you know, individual person
P: In Laura’s experience she have really significant hyperemesis I’m wondering if someone like Laura, who is presenting with evidence of a sensitivity that’s really strong to changes in hormones is more likely to get something like postpartum depression because obviously her system is sensitive to these fluctuations.
Dr. MB: So there’s there’s some data and we actually looked at this in the Danish registries and published out there is data showing that women that have hyperemesis gravidarum are at higher risk of having perinatal mood and anxiety complications than women that do not have it for an individual person who experiences hyperemesis gravidarum. It’s an extremely miserable experience, and I think it is just psychologically miserable. The second thing though, it also makes sense that whatever is happening in that individual person that makes them more sensitive to have the severity of symptoms in that way. There may be something happening in their body that works differently, that may make them more susceptible to other things. So I think it makes sense in a number of different ways. But we don’t understand deeply and at the biological level, exactly what’s going on. And I think that that’s what’s exciting right now is trying to get much more precise and dive deeper into the underlying pathophysiologic processes. So if I looked back over the last number of decades in our field, it it took decades in this country for even routine screening to take place and for us to move towards seeing this as a one of the greatest complications of pregnancy. And the postpartum period to do routine screening and all pregnant and postpartum women, to have it become part of public awareness to you know, work to decrease stigma so that people could talk about it. So we could get more women screened and more women into care and over what we’ve seen in the last 20 years is pretty remarkable in terms of a positive sea change in that direction. So where we need to go next is taking our understanding of what’s driving it, what’s the underlying pathophysiology, what are continued to be novel ways of diagnosing and treating, how can we be more precise and targeted and doing that and there’s a lot of work being done, which makes me encouraged on what may come next.
P: I have spoken to a couple of people at UCSF I don’t know if that’s where you were but they were saying that they are making an effort to have way more postpartum visits that aren’t normally scheduled because it is pretty spare.
L: Once you have a baby, it’s all about the baby and then six weeks, six week checkup, they’re like, Okay, hey, mom. You know,
P: and it does seem like it’s almost entirely physical. Have your wounds healed, and then we’ll send you on your way.
L: Yup
P: You know, having been through it, which seems bizarre.
L: Great. Yeah. UCSF has they have a really good postpartum depression group. I wasn’t able to join it. But I would have if I could have,
P: Yeah I’m guessing where and from whom you get care may make a difference because there’s a lot going on in the field of postpartum depression.
The future of postpartum care may not look much like the past I asked Dr. Meltzer, Brody about new medications. One thing she talks about is GABA, which if you’re not familiar with it is a chemical messenger in your brain that has a calming effect.
It looks like in 2019, the first drug was approved specifically for postpartum depression. Is that right?
Dr. MB: Yes. So in 2019, the drug Brexanalone was approved for postpartum depression. It was the first FDA approval for a drug specifically for postpartum depression. And it’s a novel drug it’s a neuroactive steroid. So it works on GABA, which is different than other drugs. And it’s actually a proprietary formulation of allopregnanolone, which is the neuro active metabolite of progesterone. So you have levels of allo that normally rise very high during pregnancy, just like progesterone does, because it’s a metabolite of it and then fall rapidly. Postpartum. And so we were able to do the first open label study and then proceed through the double blind placebo controlled studies of using brexanolone for treating postpartum depression at at the University of North Carolina at Chapel Hill. It’s an IV drug. It’s a 60 hour infusion. It’s powerful. And you see this rapid onset of action within the first day and so we continue to have a robust clinical program. We’re continuing clinical trials and then there’s also an oral being drug being developed by Sage therapeutics, which is the pharmaceutical company that’s developed brexanolone And now is arann. Alone. Saran alone is also a neuroactive steroid, but it’s different. It is not an oral form of bricks and alone. It’s not an oral form of allopregnanolone it’s a bit of a different interactive stereo. And there’s been multiple positive studies showing its effectiveness after a two week course for postpartum depression, that that could be a new tool in the toolbox available in a year plus.
P: Well, that’s super exciting.
Dr. MB: it is a really nice example of using pathophysiology to develop treatments leading to new treatments and a new tool for postpartum depression. And I think that approach hopefully, can be used in lots of different ways. Who’s going to be most responsive? For whom is this drug going to be the best fit? Or drugs like this and as we get much more refined understanding what treatments are going to be best for an individual patient that will lead to the best outcomes and brexanolone works fast and it works really fast. And so that’s so important in the perinatal period in the postpartum period, and having a rapid acting antidepressant that can work within a day is powerful and unlike most things on the market, a number of current therapies that we have take time. take days to weeks to months or longer, and then we unfortunately have people who don’t respond to the current therapies. So having new tools and new treatments that can act quickly and more quickly than what we’ve previously had, and then can increase effectiveness or be more effective to peep for people that haven’t responded to other treatments is really important.
P: How old is your daughter now?
L: She’s five and a half.
P: That’s so fun. That’s a great age what she into.
L: So if you ask her what she wants to be when she grows up, she will tell you she wants to be a mom, doctor, astronaut scientist. So she’ll go to space, but she’ll still be able to drive her gets to school.
P: well that’s the dream isn’t it? Seems like the right ambition. She sounds busy. is very busy.
L: She’s very smart. She’s I think she’s smarter than me. She’s five and a half and I’m pretty sure she’s smarter than me. She’ll be like, Mom, do you know what the biggest magnet on Earth is and no one should be like it’s Earth. Like okay
P: I feel like she needs a YouTube channel. These are just some real nuggets.
L: We’re not gonna stage mom her yet. We’re gonna try to keep childhood in its little bubble
P: is she goes to kindergarten or is it high?
L: So we did distance learning we did like a week of online kindergarten, because we live a half a block away from our public school. We found out very quickly that Zoom learning is not the way to go. It’s just not she hates it. enforcing it was not worth it. So we are in another year of transitional kindergarten, which is private and falls under the preschool rule so it can be in person rich, she’s thriving. And moms are think of
P: I think of kindergarteners socializing. And so that’s a hard, hard thing to do. So I’m glad that you guys have worked it out so that she can be out.
L: Even in the core things to work on like she’s an only child so sharing can’t can’t even do that in person preschool now because they all have their own pieces of art supplies and paper so they don’t contaminate.
P: Hopefully next year,
L: fingers crossed back to normal.
P: So if you could give advice to your younger self about this process what do you think you would tell her?
L: Oh, I would say two things. One, I would say Laura depressed get help. So okay. Yeah, because if I got help sooner, I just think it wouldn’t have been as bad as it was. The other thing I would say is, you’re going to be a great mom, don’t worry about messing her up. In 2020 it’ll all make sense. Because I feel like everything I could have done and did do like once we had to just pause and have her home and be a family and just sort of figure it out like it’s really mattered, you know?
P: Yeah, it is nice to have her home at this age. Right because five is so fun. I remember my when my oldest was five or went to kindergarten, I missed her so much.
L: uh huh
P: And she got she had walking pneumonia for like a week and a half and it wasn’t like that was technically the diagnosis but she didn’t seem very sick. And I was like, walking around with my arms in the air like this is the best week ever to get her back. So it’s kind of nice.
L: It was sad to knock at the end of preschool when she was turned five during this when she was four and a half. And we were lucky to be like Okay, let’s see, like there’s no, there’s no school. You’re gonna stay home with mom and dad. And she’s like, great. No school home. I get to stay home with you and dad. Cool.
P: that’s Awesome. Well Laura, thanks so much for coming on and sharing your story today. I really appreciate it.
L: Yeah, thank you so much for having me.
P: Thanks again to Laura for sharing some of the challenges in her pregnancy and the really really about her experience in the postpartum period, her recovery and her ultimate joy. And a big thank you to dr. meltzer brody for sharing her insights on the current state of PPD and what the future may look like. I’ll link to some of Dr. Meltzer Brody’s work in the show notes if you want to read more about these new medications for PPD.
Thank you for listening.
We’ll be back soon with another story of overcoming