Episode 60SN: Managing Abortion and Postpartum Depression as a Psychiatric Nurse: Nina’s Story, Part I

Today’s show features a guest that can give us some perspective on the current climate around two important topics: abortion and postpartum depression. She’s a psychiatric nurse practitioner, who experienced an abortion in the 1970s and peripartum and postpartum depression in the 1990s. She’s written about her experience. In a piece, titled “No Stranger”. Here are some excerpts from her writing. First, she writes:

“How do you know?” the patient might ask. I lean forward a bit in my

office chair, a magic mix of science and empathy, or so I would like to

think. The woman sitting across from me may be dabbing at her eyes

with her fingers. If her nails are chewed to bloody shreds, I will fold my

own more tightly in my lap.

“I’ve been a nurse practitioner for a long time,” I will say. “More

women than you think go through this. It’s hormonal…”

And a little later in the piece she writes:

Early on I figured that postpartum depression was

a risk for me, but expected I could balance my emotional happiness and

stability against my physiological tendency towards clinical depression,

if I was ever so lucky as to get pregnant. And besides, I was a

professional. With training and resources.

So here’s the thing with training and resources: Depression robs

you of the clarity to use any of those skills or supports.

One note to add: I’m changing the format of the show a little: sharing people’s stories in more manageable pieces. So you’ll hear the front half of the story right now, and the back half next Friday…and with that, we’ll get to the story

You can find Nina’s published work here

Information on the newly approved drugs for postpartum depression

https://www.zulresso.com/about-zulresso

This episode includes the interview with the UNC MD researcher working on PPD drugs

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 show features a guest that can give us some perspective on the current climate around two important topics: abortion and postpartum depression. She’s a psychiatric nurse practitioner, who experienced an abortion in the 1970s and peripartum and postpartum depression in the 1990s.

P:  Here are some excerpts from her writing. First, she writes:

“How do you know?” the patient might ask. I lean forward a bit in my

office chair, a magic mix of science and empathy, or so I would like to

think. The woman sitting across from me may be dabbing at her eyes

with her fingers. If her nails are chewed to bloody shreds, I will fold my

own more tightly in my lap.

“I’ve been a nurse practitioner for a long time,” I will say. “More

women than you think go through this. It’s hormonal…”

And a little later in the piece she writes:

Early on I figured that postpartum depression was

a risk for me, but expected I could balance my emotional happiness and

stability against my physiological tendency towards clinical depression,

if I was ever so lucky as to get pregnant. And besides, I was a

professional. With training and resources.

So here’s the thing with training and resources: Depression robs

you of the clarity to use any of those skills or supports.

One note to add: I’m changing the format of the show a little: sharing people’s stories in more manageable pieces. So you’ll hear the front half of the story right now, and the back half next Friday…and with that, we’ll get to the story

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

Nina: Oh, my name is Nina gaby long i Long A I am originally from Rochester New York and I now live in Central Vermont.

P: Oh wow nice. Oh is that cold for colder? Is that the trade

N: cold for we came to Vermont like got a on an adventure.

P: Nice Vermont’s Nice. So do you will you define your profession?

N: So I am a psychiatric nurse practitioner and clinical nurse specialist. And you know some of your listeners may know that that entails being an RN and then becoming an advanced practice RN with additional clinical experience and a master’s degree and many are getting doctorates now to become nurse practitioners. and it’s a state by state kind of certification. So in the state of Vermont, I have prescriptive authority. So I can prescribe medications, I diagnose people, evaluate them, give them complete workups psychiatric works up workups and then I, I prescribe medications and then I follow them. And I do psychotherapy, when time allows

P: Okay, so that’s a that’s a pretty broad specialty. And I imagine you’ve seen a lot of things in no small part because of the writing that you sent me which we will get to because I have read your piece called No stranger. I know more than I do going into Most interviews. So why don’t you tell us about the first pregnancy first just to kind of set the stage.

N: The first pregnancy was in 1974 and it was an unwanted pregnancy. And I forever will be so thankful to Roe v Wade it allowed me to go on with my life. I would not have been able to have been a good mother. At that time. I was in a relationship that it had been an International Love Affair once we were speaking the same language it it wasn’t working well at all. I had just graduated with my first degree, which was a bachelor’s in fine art. And I had already set up a studio and I already not even out of college had orders for galleries. From again, I was very fortunate from Hawaii to Cape Cod, fine, fine craft galleries. So I was just on the precipice of my life and despite significant birth control. I found myself pregnant in a relationship that I could not handle. I was drinking heavily and there was no way I could have been a mom and I

P: Yeah, was looking for. I saw you said two forms of birth control or something like that.

N: I had you remember to remember the old Dalcon shield.

P: You know that’s before my time. So I’ve heard of it but I don’t know how it works.

N: So it looks like it’s like a little bit like a scorpion with lots of legs coming off of it. It is a an evil looking thing and hurt like hell all the time. And I don’t want to get pregnant i mean I knew I thought I knew what I was doing. So we use, you know, condoms and we were so incredibly careful. And nonetheless, you know, pregnancy happens no matter how careful we are. And so yeah so that was the first pregnancy and then the second pregnancy.

P: Wait, so wait before you before you get to the second one. You say Can I quote your piece? Yeah, say I recall. Now my preoccupation with how how maybe because I’d had an abortion at 23 I would never be allowed by the powers of the universe to ever get pregnant again. This is not normally the way I think and finding it crazy. I mentioned it to no one.

I think I think a lot of people do carry that with them.

N: I also think that people don’t talk about it. Yeah, I mean, I think we would have to, so when I was thinking that way I was in you know, kind of throes of depression leading up to the pregnancy and I was I was already depressed because I was turning 40 And I wanted to have a baby and now I was I was so stable now I was sober for some I had been sober since I was 29 years old. I had a wonderful solid relationship of, a really solid marriage. I had a career a career that, being an artist was a wonderful career but, moving into healthcare was significantly more stabilizing. So I had decided I wanted to have a baby because I could be a great mom

P: yeah

N: and provide for that baby and it was a whole different thing. And then it wasn’t getting pregnant and pro and prone to depression and anxiety anyway. And so, as that was happening, I was just I was approaching 40 I was really depressed and that’s when that’s that’s kind of crazy cause and effect, thinking, you know, that magical thinking stuff starts happening where it’s like, oh, I’m being punished by the universe, which is not not what happens. that’s not why we don’t get pregnant. There’s a lot of reasons why we don’t get pregnant and that’s not one of them.

P: I 100% agree, right. that’s not scientific. I just think I’ve talked to a lot of women who get an abortion for one reason or another, and then condemn themselves and feel like, come up and say or whatever happens, right, they’re joining to things that are unrelated 

 

N: easy to do, isn’t it? Because, I think when we first you know had access to safe and legal abortion, we were kind of on a high from that, and when we didn’t really, think that much about it. I mean, I really don’t know that many people who didn’t get abortions at some point because they were, women who were thinking through their lives, and this is what I need to do right now and I can’t do this right now and you know, just, make these decisions and then probably you remember more and more, like Saturday mornings, you’d go to the farmers market and there’d be, people protesting abortions and then people lining up in front of the abortion clinics and, screaming and shaming people and more and more it got no, it it got much more difficult to ignore the fact that there was a faction. I don’t know if you recall Dr. Bernard Slepian. from Buffalo, New York, but he was an abortion provider and in in Buffalo, and he was shot through his kitchen window and kill and I was still living in Rochester at the time. So it was,right next door of city right next door to us and route called, the lambs of God took some responsibility for that, for that murder. Although I don’t think they actually were ever charged would have nobody was from that group was ever charged with doing it.

P: According to his Wikipedia page, Dr. Slepian murder was the climax of a series of five sniper attacks in four years in Northern New York and Canada. In 1988, he was the fourth doctor in the United States to be murdered for performing abortions. He’s killer James cop went on the FBI 10 most wanted list and was ultimately found hiding in France in 2001. That cop was extradited, tried and convicted of second degree murder in Buffalo and is currently serving a 25 to life sentence. cop was also convicted of federal charges and sentenced to life in prison without parole.

N: But they came to Rochester and threatened another doctor Dr. Wartman we’re applying a whole bunch of us went to Dr. woman’s house and we circled the house to protect him you know and have the like these anti abortion people on one side of the street and then the news people were in the middle of the street and we were on the other side of the street. And I’ll never forget it was it was so interesting because the news people really wanted a story. And you know what happens? You know, I walked across the street and I started chit chatting with one of the anti abortion people and somebody else came across the street and started talking to us and before you knew it, we were all in the middle of the street talking. There was no news there was no shootout. But more and more of those things kind of started to happen. And so we really started to realize that maybe there was something to all this you know, I don’t know, I I think I changed my mind every few minutes about what all that means. But yeah, 

P: that’s a lot. The politics around this is so loud, it’s hard to have a real conversation. Okay, so now flash forward, you’re 40 you do get pregnant. 

N: I get pregnant. Yep. On my 40th birthday. 

P: Oh, wow. 

N: It was really I mean, I I bought up pregnancy tests because all of a sudden I realized, oh my god, I haven’t gotten my period. I feel like I’ve been PMS thing but I don’t have my period and so I woke up on my 40th birthday and, and the you know, the little pink lines happened and and so well that was great. Until Until a lot of the hormones started to kick in. It wasn’t it wasn’t a fabulous pregnancy.

P: So what hormones kick in pretty quickly. Does that mean the first trimester was hard or

N: the first trimester? I was working a very intense job. I was working on a crisis team. It was my job to work with people with very, very severe mental illness who were very symptomatic. And nobody wanted to use up the hospital beds for for psychiatry. So they created the crisis team and I was just immersed in it. I mean, I was working so so so hard, and so I didn’t really think that much about too much. and we were buying a house so that we would have a nice house and a tree lined street because we’ve been living in a in a strange little place. So we were like, we’re gonna get a real house and the closest picket fence, I think. Um, so the first trimester it was like really exciting because everybody you know, had a lot of colleagues and everybody was really happy for me and,then I I just really started to get more tired and I didn’t want to admit that I wasn’t going to be doing the Stairmaster on the day of my delivery date. And I think I mentioned in the, in that piece that I wrote that I did know a lot of women who we’re having these beautifully filmed births, home births, and like literally expensive mascara and French lingerie, and,it’s like, I was getting more and more ungainly. I was gaining all this weight. I was so tired and then I took on more and more I was teaching a class as well as working full time and we had just moved into a house and we hadn’t even gotten it. the inside rooms painted and, it’s really, I was going about 20 hours a day and then my my body just said no more. And I had a case manager who was my teammate, and she said, Something’s very wrong. And I said, I’m fine. I’m fine, I’m fine. And she said, No, something’s really wrong. And she said, you’re short of breath and you’re just not yourself. And so she, she came into my office, she locked the door behind her. She sat down, she shoved the phone over at me and she said, you’re going absolutely no place until you call your OBGYN and she and she was right. I called my OBGYN and he said I don’t want I don’t like the way this sounds come on over. What was holding me together was work. Like work was work with holding me together. I mean, these patients and they needed me and, I was so vital and you know how it is. And I went over and he said, you’re starting to efface. And what you experienced the other night probably was losing your mucus plug. And so I’m at seven months, right seven months, and he said, so. I’m gonna go lie down and you don’t get up again until I tell you you can put this like his little plastic basket up against my cervix to hold my cervix shut. 

P:Wow. 

N: And, and that was that I was on bedrest. So these are all

P: he’s putting on divers to prevent premature delivery. And what you mentioned that he said, Oh, that thing that happened before was probably the mucus plug. Did you have something that happened that alarmed you? 

N: Yeah, well, I was totally in denial about it. Like oh, what’s that? Well, you know, I don’t know. And so here I was a health care professional. And I was just not, you know, ready to pay attention to my own fallibility. And, and that’s you know, that’s when the the postpartum stuff the pre postpartum stuff really started to kick in because there I was, you know, lying on the couch. Living for Geraldo Rivera Rivera. I mean, that way, he was just, you know, he was he was my guy, and I, you know, I’ve always it’s my guilty pleasure. I love soap operas.

I have since I was a child with my you know, in what would watch them with my grandmother.

N: So, you know, I would I got like, totally, there was soap operas then on all day long. And so if anybody called me while the soap operas around to see how I was, I wouldn’t answer the phone. You know, I mean, I got I was really getting crazy. And then

P: that sounds pretty difficult to go from the whirlwind of all the cases in the crisis center to bed.

N: Bed, right. That sounds pretty bad. Yeah. Yeah. So it was it was it was a very, very difficult time and of course, we don’t know how different I mean, I would hope that it would be different now. I did not feel as though though I was part I was I was in a good OBGYN practice. I mean, they’ve been around forever and, and an artist for so long and the reason I knew my OB GYN was because his wife was an artist and they used to buy my work. So I felt a connection and you know, it wasn’t like I was completely dismissed. But I think the emotional, emotional component of what someone like me a woman of you know, high powered woman, like me goes through when suddenly dreadful I don’t, I don’t I don’t think that I was not tended to. Well, I was I afterwards, but I refuse to let anybody know how bad things were afterwards because I was convinced that once I told anybody how crazy I was, that they would take my daughter away from me.

P: Well, we’ll get to that because it’s totally interesting. And it is. I mean, it highlights how difficult it is to find someone’s postpartum. You know, even even therapists and people who are trained in this field, don’t necessarily recognize it in the most in themselves. So it’s a really difficult thing, but why don’t you take us to the birth I guess it sounds like you were not imagining a home birth with French lingerie and a video camera. But But what were you hoping?

N: No, I actually kind of was initially and then my, my OB GYN said, Don’t you be thinking about none of those births or nurse midwives or anything like that because I had shared with him that when I went into when I went to nursing school, I had thought about becoming a nurse midwife. That’s a whole other story. And so he was like, that’s not happening. You are going to do exactly what I tell you to do. You’re going to have amniocentesis, you’re going to have this you’re going to have blood glucose levels. You’re going to you know, you’re going to do you know, your elderly primigravida And you’re going to do what I tell you to do. So, the birth was two weeks late, because once I settled down, nothing happened. And so they actually, they actually lied to me about my water. Having broke I asked them if they thought my water had broke, because you know, when when the baby is lying very heavy on your bladder, you can leak urine, or you wonder did my water break in? Is it slowly very slowly leaking out? So he told me yes, that’s what he thought. He thought my water had broke. So then I knew enough that you know, baby had to be born with in a certain amount of time. And when I didn’t progress, labor wise, told me I had to have a C section. I didn’t want a C section. More than anything I didn’t want to see section.

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



 

Episode 51 SN: Race, Identity & Motherhood: Naomi’s story

Today’s guest, like many of us, encountered some unexpected twists and turns at the delivery that were challenging to manage in the moment. But the focus of the story she shares today is about race and identity–she gives us a sense of what it’s like to live in the world both as a daughter who doesn’t resemble her father, and as a mother who doesn’t superficially look like her son…what assumptions people make and share and what these assumptions suggest about how we define motherhood.

You can find Strength of Soul, here

More of Naomi’s work: The Hidden Curriculum and Rethinking Race in the United States

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, like many of us, encountered some unexpected twists and turns at the delivery that were challenging to manage in the moment. But the focus of the story she shares today is about race and identity–she gives us a sense of what it’s like to live in the world both as a daughter who doesn’t resemble her father, and as a mother who doesn’t superficially look like her son…what assumptions people make and share and what these assumptions suggest about how we define motherhood.

Let’s get to her inspiring story

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

Naomi: Absolutely. Thank you, Paulette, for having me. My name is Naomi Rachel Enright and I am based in Brooklyn, New York.

P: Oh, wow. That’s lucky. Brooklyn’s like the place to be.

N: It’s a pretty cool place. I must say. I do love it. I love it. My son is being raised here was born here too. I do love it. And I love New York in general. Like I grew up in New York, in Brooklyn and the Bronx, actually, I went to high school in Manhattan. So I am a New Yorker through and through for sure.

P: Wow. So we’re here to talk about family so before we’re talking about the family you created let’s talk about the family you came from. 

N: Okay. 

P: So why don’t you tell us Do you have any siblings?

N: I do. I have one older brother. His name is Nikki and he is six and a half years older than me and also lives in New York. So that’s that we’re both still here. Yeah. And so

P: you have kind of an interesting story of your family moving here. Why don’t you tell us a little bit about that? Because I want to get a sense of whether the context you came from affected the context you thought you wanted.

N: Oh, wow. Okay. Yeah, no, that’s a great question. So I was raised in New York, as I said, but I was born in the La Paz Bolivia by chance actually, my father had a job there for two years. And so I was born there and spent the first 10 months of my life there and I am, ability and citizen but my origins are Jewish American on my father’s side. My paternal grandfather came to Ellis Island in 1910, from Russia. And my paternal grandmother was the daughter of Lithuanian immigrants. I mean, I think, you know, sort of the borders have changed over the course of time and so I’m sure maybe that you know, it’s like modern day Poland. What do I know but Eastern European, and my mother is from Guiaquil Ecuador, and did not come to this country until age 19. She came here on a scholarship at Tulane University. So she left at age 19 for that. And my father, my mother met through the Peace Corps. Actually, my father was a Peace Corps volunteer. He was teaching English and he was teaching English in Guiaquil, and my mother was one of his students. And so that’s how they met and fell in love. And were married for 44 years, I suppose. And my brother actually was born in Guiaquil. They had thought they would live in Ecuador. They were there for a few years before my brother was born. And then they came about the time they left Bolivia so he was about 10. months, I think as well. And then my mother jokes that she’s like a salmon because the salmon returns to its birthplace right to have its children. She wanted us born if not in Ecuador than in South America. But looking by birth, yeah, she was like this will do. So that’s my origins, you know, sort of ethnic, you know, familial origins, or

P: I know from your book that having an American father and Ecuadorian mother those two backgrounds together, played an important role in your life, and we’ll get into that. But on a more basic level, did you know that you would want a child?  Did you think I’m going to have a family?

N: Yes, it’s funny that you asked that because when I was expecting my son, and I’m the mother of one child, in his first almost year of life my father was we told me that I had been preparing for motherhood since I was about five he would joke because I did I always wanted to have children. I always thought a lot about becoming a mother, wanting children how I would raise them. I used to in fact as a little girl, I would name my kids so I have these list of things for my future unborn children. So it was definitely a want of mine, you know, a desire of mine. And I think that you know, there was some truth with my father said it wasn’t a preparation, a lifelong and I’m also an educator. And so I work with children of all ages for many, many years, you know, nearly 20 years and I have a way with kids I relate very well to children, and I relate well to actually a wide range of ages…I always had some younger cousins I would take care of and use or pretend they were my babies. I have a, my youngest first cousin, I actually named him and so, you know, I felt this real, you know, sort of very connected to him. I always joke that he was my first baby, which my son does not like he’s like, actually, I’m your first baby and your only baby. So yeah, so motherhood was definitely something I wished for. And I’m very, very lucky and happy that that I achieved it. I am a mom.

(4:45) &P: Yeah, amazing. So before you got pregnant, what did you imagine pregnancy to be like?

N: Wow. It’s funny, you know, because I think that a part of me always thought of pregnancy sort of in the abstract, and I did not think of what the reality of being pregnant and and bringing a child for a lifeforce would, would be like. I remember clearly sort of the first inkling that I was pregnant, and I had, you know, sort of cramping that was out of the timeline of when I would be having cramping. And I remember thinking, Wait a second. That’s strange, right. And I had actually been my parents also sitting over there for some reason. And so the next morning I texted my husband, I said, you know, I had this strange cramping and it woke me up in the middle the night and he said he instantly thought she’s pregnant and he was like, she’s definitely pregnant. So he had the first inkling that I was, despite my having the physical sensation, he, he was really convinced that that was the, the, you know, my our child or future child making his presence known.

P: And that’s a testament to your abstract notion of pregnancy,

N: I guess. Exactly. That was like, I don’t know what that is. But But yeah, and so then it was confirmed within I guess, about two weeks from that. And my pregnancy itself was quite healthy and easy. I remember my hair looked great. I felt really great. So I would say my son was good for my curls when I was pregnant. And I was thrilled and excited. But as the pregnancy became closer and closer to the actual birth story, I remember feeling very nervous and very scared and you know, sort of this realization that you know, this is not abstract anymore. You know, this is going to happen, I’m going to give birth to a human being and I was terrified. And I ended up having a very, you know, not really complicated but it was it was a tough story because I went into labor

P: let’s go slowly here. Yeah. So tell us how how are we know today’s the day that you’re gonna go into labor like what what happens that day?

N: Well, that’s funny. Yeah, that’s part of sort of, you know, you know, the best laid plans, right. I remember packing my bag for the hospital and, you know, having it ready for whatever, two weeks or so in advance of my due date. My due date was November 24 2010. And so I had it packed and I had my novel, I had my lollipops, you know, I was like, Oh, this would be great. Thinking I was going to like to have some resort. And I remember that on was it it would have been I actually tried to have labor pains on the 24th. And so on the due date, and it looked like I might go into labor. And my husband, it was all like, you know, ready to he was like, alright, you know, we’re gonna go and we call the doctor and then it stopped. And so, you know, it’s an essence post labor and I was deeply distressed by that. I remember I was very upset because I had felt like oh, you know, this is it. You know, we’re ready. We’re gonna go we’re gonna have his kid. And it was not to be and I remember I texted uh, one of my best friends was pregnant as well and expecting very close to my date as well. And I told her and I was like off I’m so annoyed, right this this kid does not want to get out. And she said, we looked that way. It looks like he wants to see in the belly and you know he was expecting a boy. And I said, as long as he’s not past December 1, I was like, You better be born at least within a week. I said, and so you know, that week went by and that Monday before the first time where I had acupuncture, you know, sort of like get things rolling. And then that Tuesday the 30th it really started to get in motion and surgical contraction in this sort of thing out this is really going to happen you’d like we’re close you know maybe was even the mountain the night actually Monday night it was Tuesday went to the doctor you know as waddling along could barely walk, you know, huge It was huge. And I’m a fairly small statue you know, I’m not even five three and I had this huge belly and I was for waddling along and in a lot of pain I remember I love sciatic pain because of the weights and so my back hurt and I couldn’t walk I was so so uncomfortable. And went to the doctor and they said you know I think your close so you can go to the hospital and so are they actually said you can go like have a like a bite and then go to the hospital. And my doctor was of course in a realm of you know, in the neighborhood of doctor or you know, as my son was born in what was then Brooklyn Methodist Hospital, and my doctor was just about two blocks away from there. And then we went up to some diner and my in laws were in town and so my in laws and my husband and I went to have to food sort of you know, it was like, let’s have food and see what happens, you know, then we’ll take her in and sort of leisurely to the hospital. And I couldn’t hold on the food and I was not well and they all were like you know what, I think we just need to go to the hospital. We walked the block and a half or so that it was to the hospital. And I remember I remember sort of the you know, the wailing and the pain and really immediately asking for an epidural and I had I had not what I would want one I have I had totally the whole pregnancy tradition which is natural law. You know, I can do this, you know, women, you hear me roar. And

P: I hear some Brooklyn in there, 

N: did you but all of that went out the window. Right? As soon as it really came you know the pain was there and the contractions and the reality was setting in what was to come I immediately was like, give me all the drugs. And of course, you don’t get that right away. And so I had to wait to whatnot. But I remember when they gave me the the epidural and I remember immediately calming down and being like, Oh, this is a really nice room. We’re gonna get the show on the road. So it’s a very funny switch of energy and behavior. And we really thought that it would come you know, fairly soon right that I would have like contractions I would dilate and I would give birth and we’d have this baby in our arms and be shorter lives as parents and as a family of three. But oh, that actually was not the case and I dilated to eight centimeters and I ended up I remember they had to give me I was GBS positive, I remember. 

P: Yeah. 

N: And I remember that when I for that I needed to be given antibiotics, right so they wouldn’t affect the baby. And I developed a fever from the antibiotics. It’s so funny to be remembering all this right? Because it’s so so long ago really in this way it was over a decade ago. But it’s so vivid, right? It’s like I remembered as if it were yesterday. I tried to use the case ready for any transformative experience. And so I did I developed a fever, and there was a horrible, horrible storm. I remember that night there was this rainstorm, and the wind was howling and there was the rain was hitting the window. And I have all these very vivid memories of the contraction and so looking at the different points in the room. I had my different points there. I’m of the doctor and my husband everybody told me to focus on as the contractions came. And I remember one of those points was the window and so I would see the rain and I would see the branches and it looked very ominous, frankly, you know, look very scary to me. And I was like This is terrifying. Like I don’t know what is about to happen and I’m so nervous.

P: I’m not sure you want to give birth on a dark and stormy night.

N: Exactly. I was like this is not making me feel good. And of course with a fever you feel awful anyway, right? Like I had the muscle aches. I mean, it was just awful. And I don’t know my doctor I loved loved, loved my doctor, you know, I felt like he was almost like an uncle. You know, he just adored him. And he was so kind to me and so good to me. And he was a jokester a little bit, you know, they’re a funny and this is with him, you know who make me laugh and he was very funny and light hearted and warm. And so I had this very comfortable rapport with him. And I remember he said to me, you know, Naomi, I think that you’re gonna have to have a C section. And I thought he was kidding, because he’d always been funny, right? So I started to laugh. And he was completely the most serious I’ve ever seen him and he said, No, Naomi, I’m serious. It’s like we have to get this baby out, and you’re not dilating and you’re feverish, and you’re delirious because I had barely slept. And so he’s like, you’re gonna have to have a C section. And I was very upset by that, because I had always throughout the pregnancy said as long as it’s not a C section, I don’t want a C section. And so I was deeply distressed to realize that I would, in fact be giving birth via C Section.

P: Some people have overlaid feelings about the C section beyond that it’s a surgery and that there’s recovery, but that it means something about the birth. Is there any of that going on or you just don’t

N: that was 100% What was going on? For me it felt like then I hadn’t done my job I hadn’t followed through a you know, as like the woman who gives birth vaginally and I was just very upset. You know, I felt kind of like, but that’s not what I’m supposed to do. Right? I’m supposed to give birth vaginally and I’m very upset by this. So it was entirely about the narrative of what is the quote unquote, right way to give birth. 

So yeah, so that’s what it was. And of course, I was frightened of the surgery. I was and knowing that the recovery would be alongside caring for a newborn. So that was there. But I would say the overriding feeling was certainly you know, sort of that societal narrative and societal pressure of the right or wrong way to to give birth or to have a child period right to become a mother and so yeah, and so I remember I was very upset by it, and he had to really calm me, you know, they were like, listen, like you need to, you know, like you need to get this baby out and we need you to be in a good place as well right for you physically as as well as emotionally. And so you know, eventually was like, Okay, right, I guess this is this is how I’m gonna give birth right? 

And I remember, you know, wheeling me into the room preparing the whole scene, the curtain ray in front of me and my husband has scrubs and of course, my husband hadn’t slept at all either, you know, he was delirious as well. Not feverish, but he was delirious and about to become a father and so for him was also you know, this is a latch, right, and we’re not even parents yet. And I remember in the operating room, being very cognizant of not seeing what was happening, and being very frustrated by that, you know, so very sort of divorced from my own birth story. You know, I sort of felt like am I even here, right? Because the curtain was in front of me, and I couldn’t see anything. And I could only make out certain things either by what I saw or what I heard more of what I heard them saw.

P:  let me ask you a question about that. So I see section two before they put up a curtain I was like, You’re not gonna make me watch right. I don’t want to. I don’t want to see the woman sawed in half. That’s, that’s not my game. But people have said that they sometimes surgeons allowed like to have a mirror on the other side so you can see what’s happening. I wonder if that was an option for you or

N: no, that was never brought up that was never offered and I don’t think I would have necessarily wanted that per se. For me, it was more about not seeing the action of the doctor, you know, and the nurses and my husband, you know, that was more of the frustrating part to me. You know, I felt sort of alone despite having all these people surrounding me. And that bothered me, right and I remember when they finally did get my son out and I heard his cries. I said, my baby, my baby, that’s my baby. I want to see my baby. And I had to wait, you know, because of course, you know, they have to cut the cord and you do the weight and all that stuff. And so it felt to me like a lifetime. I was like, I hear this baby who I’ve been trying for the last 41 weeks, and I want that baby. I was like, give me the baby. And I couldn’t hold him of course, right? Because it’s a C section. And so my husband, he brought him you know, all wrapped up and clean. And I kissed him and I remember thinking he was the most gorgeous thing I’d ever laid eyes on that he was just precious precious. And I was then wheeled away which right I had to go to the recovery room. And that also was upsetting. I was like so I just kissed this baby who is in a world now thanks to my body and my husband, you know, and I’m not happy that I can’t be with him. And I’ll never forget that as they were really getting out. There were nurses wheeling, of course, right the gurney and they were having a conversation. But at one point I thought they were talking to me and they said to me like how are you? And I started to answer and then within moments I realized they weren’t talking to me I was like I’m actually not really here. Like no one’s talking to me was also sort of, you know, this kind of alienating isolating experience and in the recovery room. The first person I talked to on the phone beside of course. My husband of course, who was in the room with me was my cousin and my cousin is my first cousin. He’s the son of my mom’s sister, my aunt, and we grew up together. And I consider my brother, right for me I really feel that I have two older brothers and I adore him and so I always remember that he was the first person I got to talk to after becoming a mom and for him who is my older brother in essence right and has seen me grow up for him. He says you know, I can’t believe my little cousin’s a mom and remember, he was like, that’s crazy. So you know that that conversation sort of sense you know that wow life is really about to change, like it has changed. It’s about to become very different. And so I was in there and I couldn’t have water I had to do is chew my ice cubes which also aggravated me I was like I am thirsty. Like I want water and my baby. And I don’t know how many hours later it was you my son was born I think at 1:36pm and I didn’t see him till I guess like 730 or eight o’clock at night, something like that.

P: wow

N:  Maybe it was early and it was like 630 but it was you know significant chunk of time. And they’re you know when I finally got to see him and hold him in the room was just phenomenal. And my husband were watching the video and I said to him in my arms I said you grew nice and strong in there because he grew he was eight pounds and 21 inches you know he was he was a very sturdy he was a strong baby’s born with muscle you know, it’s like you were like doing like push ups or something because he was so strong and so healthy. And so Did you know In retrospect, of course it took many years to come to peace with this but I in retrospect it was absolutely right call for me to have that C section. But it was a very hard way to to become a mom and to then navigate feels initial days and weeks and even months, perhaps even years of motherhood. 

Yeah,

P: I have to say we have some similarities in our story. We both had C sections. Yeah. And a lot of the things that you described, I’ve never focused on in my own story, and you’re totally right. All that stuff is really alienating and it’s so weird to be wheeled to the recovery room. Just like you after the C section I was alone, but everything that unfolded after your C section is strange. I understand that the nurses can talk to their colleagues during work. But it’s strange to have that conversation literally right over you and ignore you in the process.

N: precisely

P: the lack of interaction sounds industrial, really just contrary to the spirit of what you’d expect after birth. Why was there such a long period before you got to eight your son?

N: I’m not sure I have a feeling perhaps had to do with having been ill right having had a fever and not having slept and maybe they thought they right from time. 

P: that makes sense

N: But it was a it was like I’m not going to sleep like Are you joking, right? I was like I still want to see my baby. So that’s not going to happen, right? I didn’t sleep at all. You know, all I did was talk to my cousin and sort of you know, count the hours until I got to see and hold my child but I think that was the thinking the thinking was you know this woman needs to rest on before we really thrust her into the the ring.

P: for so many women that that last piece does not happen. It doesn’t people don’t dilate. Fully. Exactly. What would you do? Right?

N: Exactly. No, it’s that’s actually a really good point. Because I remember you know, my family saying to me, and you know me if this had been another time or another context, there you or your son would have been in danger, right? I mean, and that really also helped me to come to peace with with a C section as well. But I remember even people you know, even people initially in those first couple of weeks and whatnot, you know, saying like telling you their own birth stories in a way that I was like, I’m not really interested in your story right now. Right because I just went through it yesterday. Right? And it was traumatic on a number of levels. And I remember that upsetting me, right that people should be like, Oh, for me, it was so simply and I went in and I went out I had a baby. And I was like awesome for you. Right? Bully for you. Right? Because that’s just not what you say to, in my opinion to to any woman who’s just given birth like it’s actually about your story. It’s not right. It’s like in that moment, it is that mother and her baby and and that journey that they took to reach that point. And and so that was also upsetting to me in those first couple of weeks. I had more than one person you know, and I get it to I get like we want to reminisce you remember, especially now right now that’s years later like it, it’s so vivid, I get it right. I get that, you know, this is a transform experience that all parents remember and want to share and share. But I think you know, timing is everything. And so that was rough too. Yeah,

P: I agree. I do think it’s like traveling to a place that people who haven’t been there, just have no idea what it looks and feels like. That’s right. It’s just it’s a really hard thing to translate into language just like just like the pain of delivery, right? Like you imagined like, you know, I’ve hurt myself before and I’ve toughed it out like this is a pain that kind of defies defies analogy, right? It’s not like anything else. So it’s really hard to kind of get there. 

P: Now that we’ve heard about your experience, I’d like to talk about how you’ve written about your experience. I don’t know if you’ve written more than one book, but you’ve written strength and soul. Is that the name of the book? That’s probably my one and only look at, which is super interesting. Take on your well, maybe I’ll let you describe it. So can you describe it?

N: Sure. Yes. So So interestingly, so you know, I describe my ethnic background, right Jewish father and Ecuadorian mother, and And so growing up there were lots of questions about like, my family, a lot of assumptions made a lot of othering you know, is that your real dad? Are you adopted, you don’t look like him this kind of thing. And so I was grew up with this way of people sort of making an oddity out of my family. And it’s always it was something that I think sparked a lifelong interest in examining identity and and racism and understanding the ways that we conceptualize of ourselves and of the world around us, and of history, and the assumptions we make and how that’s connected to to systemic racism.

P: So when we start, let me stop you there for a second because this is totally relevant to your story. So I read that beginning piece of your book about people asking you on the playground is that your dad when he comes up to you and how people treated you differently when it was just your dad and you and your brother versus all of you? Yeah, and I’m wondering how that I mean, that lives in your head. So how does that affect your thinking about I’m going to start my own family?

N: That’s a really great question. It’s interesting because my husband is white. My husband is of Irish and German origin. Grew up in the Midwest grew up in Ohio. And when I you know, when he and I became serious, and you know, certainly after we were engaged in married, and planning a family, letting a child let’s just say because we were already family, I had more than one person for sure. There were my father’s saying, you know, if you have a kid or kids, they’ll more than likely look white, right because adults my husband is white, and you are largely European in your heritage, right, and your ancestry. I mean, I’m brown skin, but I’m got a lot of European running through my veins. And so there was sort of this, you know, sort of this question, you know, what would this kid look like, you know, what would our kids or kid look like? And I remember when I was pregnant, thinking, like this, these can be light skinned, like there’s no denying in my head, and more than likely this child will be light skinned. So it’s really prepared for that possibility and more than like pure reality. And I remember once having a dream a very vivid dream, not too long before giving birth around the summer, I don’t know. And it was a sort of a golden skinned baby with, like, sort of caramel eyes and like, just very golden hair, you know, and I remember thinking, the urge, you know, maybe like that kind of maybe it’s my baby like, maybe that’s gonna look like my kid. And the truth is, I wasn’t far off because my son completely looks completely white American. There’s no one who would ever look at my son and think that he’s a brown skinned mother, and an even darker skinned grandmother and dark skinned biological family members. 

No one would ever think it and so as soon as he was born, I looked at him I was like, wow, really? This kid is way lighter than even I expected. Right? I was like, I was kind of prepared for me to be light skinned, but this light skinned you know, I mean, he looked completely white. And I remember thinking even in the hospital room, like hmm, you know, it’s gonna be interesting right to be in the world with him. A little did I know just how interesting and how challenging and exhausting frankly, it would be right to navigate motherhood with a child that most people do not associate with me. And many people discard me as he’s not afraid to discard the possibility that I could be his his mother. And that was very painful for me. Because growing up it was hard. You know, I hated when people ask me those questions. I my brother, in fact, looks just like our father. I mean, I used to joke that my brother was our father dipped in milk chocolate. It’s my father’s face. Like he is my father’s you know sort of doppelganger, really, and I look less physically like my dad, but I certainly have shared physical traits of my father. And what made it even more challenging, sadly, is that my father right to my white parent, and just falling ill soon after my son was born, you know, he fell ill in January 2011. And I was very convinced it was very serious. And, frankly, the family didn’t really believe me. And they were like, Well, you’re a new mom. You know, you’re not sleeping like you tend to be a very a worrier. I’ve always been a worrier. This is true. And so they kind of thought I was over blowing things, and they were like, oh, Naomi, he’ll be fine. He’s fine.

But I was like knowing that right was like he’s losing weight. He’s not giving him an appetite. This is not the father. I know. Right. My father always been very healthy a good eater, you know, Walker. So I was just deeply, deeply concerned from that point from January 2011. And over the course of that year, which is the course of the first year of my son’s life, my father was dying. He was dying at year and we did not receive confirmation of that until September

P: oh wow

N: September 2000. Let him I thought it was diagnosed with stage four pancreatic cancer which we know is different. Right? And he died November 29 2011. And so the very day a year before that I had gone for acupuncture. I’m beginning to you know, begin the journey of of giving life and having a challenge becoming a mother my father died and left this world and was deeply traumatic, deeply traumatic, because not only was I close to my dad, we were the best of friends, but I lost the connection, the context in essence, the physical context or contextualization, I should say for my son from my side of the family. And so when when I’m out in the world, my mother would think goodness is alive and well. People are just scratching their heads. They’re like, how did this happen? Right because my mother looks to the naked eye people think she’s black American. People look at me and think I’m Latina, or Middle Eastern. Maybe when people look at my son, I think he’s white. And so we are three generations of the same family. And yet, right and so there’s this real fatigue, you know, and being out in the world and even with my husband and son, you know, people often just or I can just tell you, you know, they’re looking back and forth and sort of trying to figure out, you know, what’s the connection here? You know, that’s the mom, you know, I’m gonna people that actually voice these things. It’s not just that I can tell by expression and because I have a lifelong experience with people staring and wondering. They have voiced it you know, I’ve been asked how long I’ve looked after him. 

P: Oh, my God. 

N: And this is from, you know, when he was relieved, I mean, now it’s different because he is, I’ve raised my son, you know, we’ve raised our son to have a very clear understanding of the way through the assumptions that people will make about us, and how those are always a reflection of their reality. Right? Like, what they know what they want, they think they know, and not of us, which was how I was raised. I was raised to know that the questions people pose to me, were not a reflection of me. And I always felt very empowered by that. And so I think that because of that intentionality, and my parents raising of me and my brother, I was prepared to be my son’s mother. That’s what I always say. I always say to be my parents daughter prepared me to be my son’s mother. Because I was you know, super heavy armor you know, I had the armor to be able to handle the questions you have to handle the the comments, and although you know, I’m not no one is made of of iron, and so it was very painful for me often and it was particularly painful because I didn’t have my dad and so I don’t have my dad. And so it was Yeah, and my son has my father’s eyes. And so that’s another thing that’s interesting is that people are very struck by his eyes. His eyes are really striking they are he has a blue green eyes that change with the light or what he’s wearing. And so they’re really a beautiful shade. And he also it’s interesting, because it has its shape of my mother’s eyes, and so they’re almond shaped. And they’re really striking, right? Because you don’t tend to see that shape without that color. But people always say that, you know, people are like, Oh my God, he’s got the most beautiful eyes. And I have to often be like, yeah, they’re my dad’s eyes, right? And so I’m always sort of reminded of his absence, you know, in those interactions, and people often assume he’s got his dad’s like, oh, he must have his father’s, which is always actually kind of annoyed me. 

Because, right the assumption is, there’s no way that can come from you. So when I wrote this, you know, my book is is an examination of the contrast in the assumptions that were made about me with my mother and father, particularly my father, versus the assumptions made about me as a mother. And so as a mother, I’m assumed to be his nanny, his caretaker. And then growing up it was assumed that my father had adopted me. And I think there’s a lot of that’s a loaded, loaded assumptions. Because they are sort of attached to privilege and power and inequity really, right. And so I was just fascinated. I was like, Wait a second, you know, there’s something here right that there’s this huge contrast and was a suit about the same person me in the roles that I hold with these two people, one who gave me life and one whose life I brought forth, right, it was like this is fascinating. 

And of course, it also sort of coincided with my lifelong interest in examining these issues. And I’ve also worked in around this all my life, too. I was a language teacher and in my Spanish teacher and in my language classroom, we were talking about identity a lot about culture. And all of this has just been a lifelong passion of mine. And so, you know, then having a child and sort of being given this, the huge responsibility of raising a person which is just in and of itself, a huge responsibility, preparing them for the world, and then visa vie all these issues. And then of course, you know, the wrench of my father’s death, you know, sort of the twists, you know, my father having died so early on in my child’s life, and in my journey as a mother, right, like that was so, so painful for me very traumatic, very traumatic and remains a source of pain for me, you know, I think I will always be sad about it. I will always feel that absence but luckily, because of my, my writing, really, I write a lot about loss as well. And Strength of soul is also born out of that loss as well. And so I feel like you know, language for me has always been a healer. And when I’m able to write about my father and my journey as a mother, I find each and every time it feels like balm for my soul, and it’s also a gift for my son, I feel, you know, I feel like I’m giving my father to my son. My son really sort of has a sense of who he was. 

And my son has a sense of who he is right? My son knows that despite how people see him, and the assumptions they make about him, right. People do not think that he’s bilingual. People do not think that his name is pronounced in Spanish. Or of course, they don’t think I’m his mom. He’s so so at this point. He’s 11. Now, you know, he’s just ready to take it all on, right. Like, knows who he is. And I’m feel that that’s totally because of the efforts on my husband and our families parts. And so I feel very proud of that. And I feel sort of empowered by that because it feels to me like you know, the outside exterior is not going to dictate for us, you know, who we are and how we feel basically, in the world.

P: It is a tricky thing that you’re describing. And I can imagine as a child was confusing for people to constantly asked about is this your father, and to question your role as your son’s mother, maybe suggesting that there’s something that’s not right or that doesn’t make sense about a mother who looks like you having a child who looks like your son. Maybe that’s what feels offensive.

N: I mean, I think that we make assumptions as human beings regardless right? And assumptions about everything assumptions about you know, belonging, about family about what language you might speak, you know, where you’re from, etc. And, you know, I feel like that’s just a human quality, right that we’re going to do that sometimes. However, I think there’s a distinction between assuming and acting on the assumption. Right, I That, to me was the fascinating part, particularly as a mom that people would voice these things to me I was like, really, you know, I’m like you like That’s why you should keep to yourself, right? Like, why would you ask that?

P: I’m always thinking, you know, I can hear you say that out loud.

N: Like you said out loud. Exactly, exactly. I mean, the thing is, over the course of my son’s life, I have learned how to handle it so so well, I have to say because initially, I would just get upset, you know, making the anger I would feel hurt. And I would you know, just not want to leave the house. You know, I hated those mom and baby groups. I hated them. Because for me, it was like, you’re all staring at me. Like I have no place here. And I could tell that you’re like, how did that happen? You know, how is she that kid’s mom? And then I’ve only spoken to my son in Spanish in essence since his birth, right and so there’s and that to me, it’s been a godsend. It is protection for me because even though Spanish is not a private language, particularly in New York City, it is our own little sort of secret in a way right? It’s like people do not expect the child to respond to me in Spanish and they certainly don’t expect him to be like mama, blah, blah. Blah, right. And to me that feels like yep, you know, you figure that out rarely let people sort of sit there and you know, sit with that right that makes me feel you know, sort of empowered and and happy. But you know, in the beginning wasn’t like that of course right? When he was pre verbal right when he was pre verbal is like, gosh, right? Like no one knows anything here. He can’t you know, also speak to them. But I have a memory two memories that stand out from when he was quite small. He was about three when I was asked how long I’d been looking after him. I remember I was on a train platform with him and someone asked me, you know, how long have you he’s so cute. How long have you been looking after him? And without missing a beat I said since he was in utero. 

P: Oh, that’s a great answer.

N: Thank you. Yes, I was pretty proud of myself. And she kind of blanched it was like, Oh, he’s yours? And said, yep. And she goes, Oh my god, I’m so sorry. You know, I was like, I mean, I guess you know, he’s really looked like you which is not true. He does not look at me look like me. Superficially, I always say, actually, he does not look like me. But for those who look beyond the surface, the child looks a lot like me, and particularly now that he’s older, but he has my lips. He has the shape of my eyes. He has my smile. He’s a lot of my gestures. And so it was like this kid is definitely looks like me, right? But people they just see, you know, his, his light skinned his late eyes and his light hair versus my dark skin, dark eyes and dark hair and they’re like, No way, right? 

But I remember she was you know, apologetic and then ended up saying, you know, well, you know, you’re very cute and gratulations and I was like, Thanks, you know, and so ended up being sort of a passive exchange, it could have gone very differently, right. And I was trying to spin those moments to become sort of a learning teachable moment, which to also take psychic energy like that’s a little tiring for me, but I’d rather that then it becomes sort of you know, contentious, but I have another memory where he was not much older. He while he was like four. We’re on the train. And someone was staring at us. And I think sort of gone by that point, even at that tender age, was accustomed to people looking at us. And he was in his little brain trying to, you know, be like, oh, like, what is the big deal? Like, what are you looking at? You know, and I remember, he pointed at me and then look back at the person and said, Mama, and I was like, My job here is done. Like, it felt so, so affirming. To me. I was like this, my child gets it really he gets that people are gonna question I’m going to disbelieve and he’s gonna let them know what time it is. And that was at four right and so now he’s 11. And he’s just, he just knows what’s up, you know, and it makes me feel it makes me feel really good. It does. Because it’s been a hard road

P: what a moment to feel seen right when you’re when your four year old is like schooling the other train riders.

N: Exactly, Mama.

P: That’s amazing. And he’s bilingual.

N: He is he’s a native speaker of both. Yes, he is.

P: I’m So jealous because he so do you still speak to him only in Spanish or nowadays?

N: Well, you It’s funny you asked that because more and more the older she gets, you know for for particularly when it’s all of us together. It’s going to be in English right? But just the other night you know, we were having a conversation all of us you know my husband and I and after it was a dinner agenda generally, you know, the always the three lesson to speak in English but then after dinner I remember I was doing the dishes or whatever. And he started to chat with me again in English. And I said sufficiente Anglais I was like enough English, right? I was like, massive, but I will order Caressa which means like, gives me a headache. And so I told him he was like, switch, right? And so he switched, right so I feel like for my relationship with him for our own dynamic. I prefer it in Spanish right? And I’ll speak to an English in with his daughter, my husband and with other family members or like, you know, with a friend this kind of thing, but the minute I can or we can I want it to be in Spanish. And I think that’s in part because I don’t want him to lose it. You know, I feel that if he’s not using if you will lose it like any other skill. And I also for me, it’s also sort of a the cocoon of it. You know, it feels very safe and warm to me, right? I mean, it was interesting to me because when I was pregnant and expecting my son, I would speak to him in Spanish in utero. And I remember being taken aback by this because I go back and forth seamlessly for me both languages exist in my brain and had my entire life. I was also a Spanish teacher, right? So it’s like these two languages are entirely both minor, right? But all of a sudden, there was something about motherhood or impending motherhood, or Spanish became what I wanted to use. And I realized quickly that it was because my own mother spoke to me in Spanish speaks to me in Spanish, and it’s my language. Of, of comfort, I guess. Right? It’s like it’s my language of comfort in my language of safety and protection. You know, I’m sure I have even some, you know, subconscious memories of being saying you too in Spanish, you know, are you being soothed in Spanish as as a baby and as a toddler and so that was very eye opening for me, you know, to realize like, wow, like this is this language is definitely more significant in that sense. And so I remember you know, I remember when speaking to him and uterine Spanish, my husband saying who are you talking to? And I said, our son

P: in your family where you were raised, your mother spoke Spanish, did your dad speak English?

N: It’s funny. My dad was bilingual. My dad did speak. Both. But in general, yes. In general. My relationship with my father was in English, and my relationship with my mother is in Spanish. And then when we were the four of us, or as my brother got older and left the house and it was the three of us, I would go back and forth, but generally for us, like at dinner time, even if it was for three of us, it would be Spanish actually, because my dad spoke it. My husband does not and so that’s why it’s not Spanish in those moments.

 I mean, my husband however, I will say, understands, I’d say like 90 to 95% of what is said. So like whatever I say to Sebastian, he will reiterate, right like your mother just said Go put on your shoes, whatever it is, right. So he understands. And I also always say that that my son would not be bilingual without my husband’s participation. Right. My husband’s agreement, right. My husband could have gotten in the way of it, you know, it could have been like, well, I don’t speak and I don’t want to not understand what my kid is saying, you know, he could have gone there. And he did not right I think he really understood how important was to me in Tripoli, given how the world receives us, right? He knows how that is for us. And I think sometimes it makes him feel saddened and frustrated, right? Because he knows it’s not as quote unquote, easy for me in the world with our son as it is for him. And so I think

P: I’m not sure I would quote unquote.

N: Well, I say up because I say, you know, there’s other ways it’s challenging to be a parent. Right? So it’s like, it’s hard for him in other ways, basically, but in this way, you’re right in this way. It is not hard for him at all. And so I think he really was like, You know what, our kid will be battling Well, you know, like, that’s an asset. It is. It is great that you want him to be really well. And here he is, right. And he you know, I mean, he even he told me recently they were reading a book about a Mexican American character. And so there’s a lot of Spanish in the book and the girl’s name and whatnot. And he said to me that he had corrected his teacher that that it wasn’t pronounced. He said, I told the teacher that we don’t say Gente, that the G is pronounced like an H. So it’s gente, which means people and I was just for me, it was just like, this beautiful, beautiful moment of him identifying so closely right with being a Spanish speaker and with being part Latin American, and saying we you know, he was like, you don’t say, right, I was like, Oh, my God, that is so beautiful, right? Because he gave me my son, you know, because of his presumption of whiteness has a very different reception in the world, you know, than I do from incidentally as a male as well. And so, I feel sometimes that he defies you know, all of these notions, you know, of who he is and, and that, to me, feels, you know, just just, it’s a celebration for me, because I think he needs to know all of who he is in order to, to, I think, to be more present in the world and to hopefully be more connected to people in the world. That’s That’s my thinking, you know, and that’s what’s behind the whole intentionality of his name and his and his bilingualism.

P: That’s super cool. Well, let me ask you a question. Looking like now that you know what, you know, looking back, is there anything you would you would have told younger you for this journey? 

N: Wow.

That’s a great question. I think the one thing I would have told the younger me is to be prepared for, for surprises, you know, to be prepared for the unexpected. I think that when I had been thinking about motherhood, and certainly when I was closer to my within reach, right when I was married and whatnot, and you know, planning it with my husband, I had this idea that I would raise my kid with both of my parents alive and well and their participation in their involvement and I didn’t quite imagine necessarily having a kid who looks so white and wouldn’t be assumed to be mine. And I was wrong on both counts. Right. I ended up having this child with his physical appearance, and losing my father and having to navigate this new normal and this the reality versus sort of the ideal that I had concocted in my brain. 

And so I think it would have helped me to know that the unexpected may happen. And I wish I could have been more prepared, I guess, in that sense. You know, I would have told my younger self she knows me like you don’t know what’s going to happen and be prepared for anything to happen basically, because he was he was a rude awakening to realize, like, Oh, this is gonna be a very different journey than what I expected. What I thought I would have and I think now certainly since losing my dad, and since you know, sort of having these immensely transformative experiences happen within a year of each other. I am now that person right now, I know not to think I know what’s going to come. Right. And like, actually, the only thing we know is that we don’t know what’s going to happen. Right. And I think that is actually healthy, sort of more of a protection in a way right? I mean, even with a pandemic, right. I mean, as devastating and as traumatic as it’s been, you know, in gradations, depending on what your personal story is, but I think it’s been globally traumatic, in a way I sort of was like, Okay, this is what we have to live with. Now. Right? This is what we have to deal with to roll with the punches over what they signify. So live in a global pandemic and wear masks and get vaccinated and do remote school and all these pieces. And I feel like my own tragic loss, kind of prepared me for that in a way you know, that tragedy will and may, you may or her and you have to find a way to integrate that tragedy and continue forward.

P: Yeah, that’s good advice for all of us. For younger you and for all of us now. 

N: That’s right. Yeah. 

P: Naomi thanks so much for sharing your story and I will put a link in the show notes to your book on Amazon.

N: Yes, a link to my book. And if you’d like I can also I can send you a couple of other links to other like through sites of of my work, and you could link those as well. I’m I’m very active on LinkedIn. So maybe that’s also linked if people wanted to connect or so I’ll send you those. I’ll send you more links for you to include in the in the episode.

P: Awesome. Thank you. So much.

N: Thank you, Paulette. This has been great.

Episode 42 SN: Anything But Restful, a Bedrest Story: Aileen

If there’s one thing I can relate to directly, it’s the story of a high risk pregnancy. But the pregnancy that my guest encountered was something I have no first hand knowledge of: she ran into an issue that threatened a premature birth, which caused her doctor to prescribe bedrest–for five months, 150 days for anyone who is counting–of being horizontal, she was more or less plucked out of normal circulation and we talk about what that was like and how she managed it, in the midst of also juggling a move from brooklyn to a farm, which in part means a move from an apartment to a 100 year old farmhouse, and everything that comes with this dramatic change…

You can find more about Aileen and her work at her website  www.aileenweintraub.com 

Here is the amazon link to Knocked Down: A High Risk Memoir

And here is the link for signed pre-orders

Fibroids

https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288https://www.uclahealth.org/fibroids/what-are-fibroids
https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids

size of the uterus

https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/uterus-size-during-pregnancy/

Bedrest article by Dr. Mazaki-Tovi (et al.)

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198949

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. If there’s one thing I can relate to directly, it’s the story of a high risk pregnancy. But the pregnancy that my guest encountered was something I have no first hand knowledge of: she ran into an issue that threatened a premature birth, which caused her doctor to prescribe bedrest–for five months, 150 days for anyone who is counting–of being horizontal, she was more or less plucked out of normal circulation and we talk about what that was like and how she managed it, in the midst of also juggling a move from brooklyn to a farm, which in part means a move from an apartment to a 100 year old farmhouse, and everything that comes with this dramatic change…

I also included a conversation with a researcher and professor of obstetrics and gynecology from Tel Aviv who, with colleagues, recently published some groundbreaking research on bedrest. He is incredibly interesting, and I regret that the recording quality from our conversation is not perfect–but I think you’ll want to hear what he has to say…

So 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?

Aileen: Hi, my name is Aileen Weintraub and I’m from Brooklyn, New York. And I moved to the Hudson Valley about 20 years ago. And that’s where my story really starts. 

P: Alieen. Thanks so much for coming on the show and I’m excited to hear the story because I read your book Knocked Down, which was awesome. I’m assuming not all the bits made it into the book. So I’m excited to hear the details straight from you. Do you have any siblings?

A: Yes, I have one older brother, who is still in Brooklyn with my family. And we have a great relationship. We didn’t always have a great relationship and actually, my experience with my pregnancy really brought us together. 

P: Wow, that’s nice.

A:  Yeah. 

P: And did having a brother or growing up in your family create a desire you to have a family of your own?

A: Yes, absolutely. So I grew up in a conservative Jewish community. And the emphasis was on family. And I was really born and bred to have a big family. I was taught how to be a good wife, a good mother from a very young age and I wanted a lot of children. And so when I became pregnant and ended up on bedrest and had all these complications, it kind of changed my plans in a big way. And so that was really hard to, to take in and live with. 

P: Okay, so that’s totally interesting. So when you were thinking of a big family, were you thinking of like six kids?

A: Exactly. That was the number I had in my head that I was gonna have six kids. I was gonna be like Mary Poppins is going to be amazing. They were all going to just surround me. And you know, the birds would sing when I got up in the morning and it was it was a total fantasy, and obviously it didn’t work out that way. And and that was a lot to come to terms with

P: like you are I have imagined a big family. Not I wasn’t so ambitious for six. Although when I see families like that, I’m like,lucky. So does that mean that you walked into pregnancy, imagining it would be easy?

A: Yes. So by the time I became pregnant, most of my friends already were on their second, third kid. And I just assumed I would get pregnant and have an easy pregnancy and just start popping out kids and, you know, maybe work maybe work part time and that would just be my role for a long time. That’s really what I wanted. And it was shocking to me. And so it was a big disappointment when I was faced with all these complications and realized that that wasn’t going to happen for me.

P: Okay, so let’s walk into this. Was it easy to get pregnant?

A: Yes, it was very easy to get pregnant. And there’s actually a very funny story, which I I talk about a little in my book. It was New Year’s Eve, and my husband had the flu. And he was he was so sick, but you know, we were still newlyweds. So we didn’t even wait we got married. And really, this is the plan. Let’s start right away. And so it’s new year’s eve and I was ovulating. And I was like, Listen, this is it. And, you know, and it was super easy on me. And I got pregnant immediately. And so 

P: wow. 

A: I thought that was a great omen. And the first few months were typical. I had morning sickness, but nothing I couldn’t deal with. Yeah, that was a little surprising for my husband, you know, he would cook dinner and I would I would be like you’re cooking fish you can’t cook fish in this house. And so that was a learning curve for him. But other than a little things that you you would expect everything was completely fine. And then one day we were walking in New York City we were just strolling It was a beautiful spring day. And suddenly, I felt this pain in my lower belly. 

P: wait, how far along are we here? 

A: Right so I was four months along. Okay. And we were planning to go to a baby event where they showcase different baby products and, and things like that interview information, pamphlets. And that was the thing I was so into, like all these baby books and I was prepared. I was going in prepared and I was reading everything, researching all the safest products and it was all happening that day. Suddenly I have this pain and I don’t know what to do. So we decided to pack it up and go home. I call the doctor and of course you don’t get to speak to your doctor. You speak to the nurse if you’re lucky. And she kind of dismissed my symptoms. And said your probably find everybody experiences like cramping and things like that. And she wasn’t really taking me seriously but I was also kind of relieved because that’s what I wanted to hear. 

P: Totally. Yeah. 

A: And it was getting worse and worse and I happen to have had my appointment the next evening anyway, just my regular exam. And I’m assuming that everything’s going to be fine. You know, even though this pain is persisting. As we go into the exam, it’s later in the day. It’s almost evening I think I might have been the last appointment and you can see the doctor looked carried and rushed and wanted to get out of there. 

P: Yeah, that’s a bad sign. 

A: And I wanted to get out of there too. We had plans to go to this cute little restaurant on the water in Kingston. And all of a sudden, the energy in the room changes she’s saying something, I can’t even process what she’s saying. But I look at my husband’s face and I see the look on his face, and then it all kind of comes together. And I’m being rushed into an emergency sonogram and it turns out that I’ve three huge fibroids in my uterus

P: Okay, so here’s a quick primer on fibroids. If you aren’t familiar with them, uterine fibroids are non cancerous growths of the uterus, thing grow inside the walls or inside the main cavity or outside of yours. Many women have fibroids and don’t know about them because they might not cause any symptoms at all. Researchers from UCLA estimate that 70 to 80% of women will have them in their lifetime and are more likely in your 30s and 40s. And right around menopause. It can be a variety of sizes. To give a sense of dimension here and to maintain consistency with a fruit theme that will emerge later in the episode. At the end of the first trimester, the uterus is the size of a grapefruit and it grows to the size of about a watermelon by the third trimester. fibroids can be the size of a pea or a much bigger mass. So size and placement and the number you have may determine if you run into trouble with them or not. And for the magic question, we have no answer. We don’t know what causes their development

A: and one is pressing on my cervix, causing early effacement. And she basically says to me, you’ll be lucky if your baby makes it to 24 weeks.

P: Good Lord. Oh my God,

A: it was so shocking, because just the day before everything was fine, and we were horrified

P:  so let me ask you something ex post. So my fibroids or anything like that, but I also got very direct and not positive news from the OBS. And in retrospect, I understand it as they’re managing my expectations. How do you feel about that kind of response to now do you still think it’s not appropriate or what do you think of it? Now?

A: that’s  a really good question, because I think it’s important for doctors to manage expectations. But I also think there’s a way to do it, where you’re not putting so much fear and anxiety into the person you’re talking to. 

P: Yeah, 

A: who’s already feeling so emotional. So raw and so vulnerable. And I think there’s a balance 

P: Yeah, you’re right. The other thing that helped me to process that kind of thing is to remember that my doctor is a person and just like me get’s nervous about stuff and Dr. Raven freaking out and unfortunately she entirely sure that with you.

A: Right, exactly. And you can tell she was already tired and but that’s not an excuse when you’re delivering bad news. You have to have some sense of professionalism and, and she was she was professional and she was a good doctor. I don’t want to say that she wasn’t doing a good job. It was just very overwhelming in that moment. And I’m not one who needs things sugarcoat it, I left information. I understand the doctors job is to be a doctor give me the best care the doctors job isn’t to be a therapist. But the healthcare community I feel like is especially when it comes to women’s health and maternal health has a long way to go. The way they speak to women, the way they speak about women’s bodies and the terms they use. So for example, the word incompetent cervix, 

P: yeah, 

A: is so offensive to begin with

P: agreed. 

A: What it does is it puts shame on the woman before they even understand what’s going on. Yeah, my left feeling I had caused this. Yeah. You’re basically saying there is a part of you that is incompetent. 

P: Yeah, yeah. Yeah. 

A: And they’re these terms are outdated. There’s terms like hustle uterus, geriatric pregnancy. All these terms should be retired and we need to change the dialogue on that.

P: I totally agree. I’m maybe in the shownotes or at the end of the episode, we’ll try to rebrand incompetent cervix. You and I right here. Make it happen. Well, that’s a terrifying prognosis. And then she send you home or what do you do with that?

 

A: so the next day she had sent me to a specialist. I can see and the specialist basically confirmed what she had said but made it sound a little less tragic. So he did the job of saying okay, you know, we’ve got this going to go on bed rest for five months. And we’ll see how it goes. And hearing that bedrest for five months to just expect a woman to check out of life. Almost half a year to become basically an incubator is a big thing to expect. And it shouldn’t be something that is done lightly and at the time, almost a million women a year were put on bed rest. We are lucky to

P: When I started to research the issue of bedrest, I came upon an article published in 2018 published by a group of doctors out of the Sackler School of Medicine in Tel Aviv and they used a brilliant technique to really get at the heart of what bedrest does and doesn’t do and we are lucky enough to talk to one of the paper’s authors: have Dr. Misaki Toby on the show a Professor of Obstetrics and Gynecology, and a researcher who has investigated the efficacy of bedrest for a variety of outcomes. Dr. Mazaki Toby, thanks so much for coming on. 

Dr. Mazaki Tovi: Thank you very much for the time. Thank you for having me. 

P: the Idea for bedrest came up in the 1830s I can’t remember what that said you know what, what instigated that idea,

Dr. MT: the root of the to do and the the initiative for this bill was actually came from orthopedic issues. We’ll come to think about it. It’s it’s it’s a logic if you broke a leg, somebody that you will not have you’ll have a bedrest and will not put a stress on your broken leg. And then obviously, it was extended to other disciplines in medicine. And another thing that I must say that actually may facilitate the use of bedrest in obstetrics is the fact that 100% of the population is women. So, yes, I must say that well, my my feeling is that if you have to prescribe that was for women and to men and that can be a manifestation of prejudice against women because you said okay, usually, you know, the other spouse in the provider. and the women you know, they should be at home to begin with, so if you’ve discovered bedrest then you didn’t have given harm too much. So my feeling is that said that we’re dealing with women with actually made the dependences so to speak of this treatment to set rates a little bit easier.

P: That’s a whole lot of outdated there. That’s a whole lot.

Dr. MT:  Absolutely. 

A: and now finally, I’m starting to read a few articles and journals here and there about how doctors are prescribing it a little less, but it’s still very prevalent. And I think we don’t take into account not only the physical aspects of what it means to be on bedrest. The mental load that it’s putting on a person who has to lay there for five months and give up their autonomy. Their finances have to shift their career and that’s another place that the healthcare community can step up and provide resources. I’m not an expert, so I would never ever advise somebody not to listen to their doctor, but I would advise them to do some research and really think about advocating for themselves and making sure that they understand what’s expected and what’s not. And why.

P: and I think what we should be doing is pressing the research community. I mean, the doctor I spoke with yesterday said, part of the reason we do that is because we just don’t know and it’s such a vulnerable period. We want to be as cautious as we can. But there’s all kinds of measurable consequences of bedrest, and we don’t want to works also the way you say it, to say to a woman, okay, now you’re going to leave your job or whatever you’re doing and your family down for five months is crazy. 

A: exactly they’re you’re not taking into account that goes along with invest. It’s kind of like the stock app. Oh, we don’t know. What’s wrong with you. We don’t know how to fix it. Yep. All we can offer. And more research really needs to be done and more money needs to be put into research on bed resting women.

P: Consistent with what Aileen is saying, we do need more research on bedrest, and although Dr. Mazaki Tovi’s study focused on preterm labor, and not on the specific issue that brought Aileen to bedrest, he has a lot to teach us.. Dr. Mazaki-Tovi, can you actually define bedrest? I’ve talked to a couple of obese about it. And maybe doctors mean different things when they say bedrest.

Absolutely and this is one of the difficult this therapeutic measures is exactly what do you mean by by bed rest. For some it means only that doing the work. Others is just decrease, you know the household it is for others is just practically to be a bit weird. And so there is a lot of confusion about it. And actually this so called therapeutic visual is ill defined. So the poor woman don’t exactly know what they have to do.

P: Yeah, I’m assuming  that there are multiple reasons for bed rest. Why doctors prescribe bed rest?

Dr. MT: Yes, actually. The so called bed was has numerous indication it looks different than it was to prevent discourage twins. Or triplets. Also had an abortion, placenta previa. Sure, it seems that bedrest for many, many physicians and healthcare providers will seem like a silver bullet like medical therapeutic measure,that can prevent all complications indication of pregnancy and the tourists is actually the other way around.

P: So why don’t you tell us a little bit about your study on bed rest and what makes it so unique and so important in the literature on bed rest?

Dr. MT: I will say that the implicit argument bedrest is that you won’t increase your level of activity, then you will harm your pregnancy and you will harm your baby. Nothing can be further from truth. I meet a lot of high risk pregnant women, and I noticed that almost all of them had a self belief guilt, about doing too much physical activity. And this is because of this activity that nothing has happened to him with preterm labor or bleeding will discourage and so on and so forth. And that encouraged us to conduct a study in which we try to quantify the level of activity so until now, activity was not objectively quantified, that means if a physician prescribed to you a bedrest then you know exactly what does it mean and actually there is no way we can follow up and see whether or not you are indeed in bed rest. 

So what we decided to do is to try to objectively quantify it and we did it by pedometer, a special device that can count the number of steps that you do a day. And we give this device to pregnant women with extremely high risk for preterm labor and we ask them to wear it for at least one week, including one weekend. It wasn’t them actually use it for two weeks or more. And one important thing that I have to do to remind you that didn’t have access to the data and also dependents women have access to the data. So we are completely blinded. How many steps each and every woman took during the study. And what we found was actually amazing, but what’s surprising I must say, found that more steps you’ve taken the the lesser risk for preterm labor. So it’s counterintuitive. 

P: Yeah, 

Dr. MT: so don’t do that we’re bedridden, and it takes to actually deliver earlier. So not only is not helpful can be dangerous. So we found out that if you do approximately like 4000 steps a day, that’s fine, to be no harm.

P: One thing that’s so interesting about your study is when you said you’re objectively quantifying activity, what I understand that to mean is that other studies are basically asking women to self report how much did you walk around but then I’m guessing that happens with like a survey to say a lot a little not much. Which is a super hard thing to keep track of right it’s it’s not even a

DrMT: that was the initiative. For the study, we try to quantify. We thought about the load how we how can you quantify physical activity, because as you mentioned correctly, until the study, they will only questionnaire that the dependent living had to to fill in, usually days and weeks and months. After the pregnancy and you know there is a recall bias, you don’t think that you remember what you did when you didn’t do is obviously some activities like swimming, so on were less unreported. So we decided to have a very, very objective way to measure the activity in the book actually uniqueness of the study.

P: That’s amazing. That was such a good idea. The other thing that makes you think when when I read your paper was, Oh, we don’t really understand what causes preterm labor. So it’s weird to think if you lay down it won’t happen. 

Dr. MT: Absolutely. You’re absolutely correct. You know, if you if you ask the leading individual that investigate preterm labor understand that preterm labor would actually syndrome. So, you can have preterm labor because you have problems with the service and you can you may have become able to cause a problem with the uterus or with the placenta. Because you’re having to  triplets. It’s all because you’re having an infection. And the idea that one solution will solve all these problems scientifically is absolutely ridiculous. 

A: I Think there’s a scene in my book where I actually Google bedrest and research and there are no studies at that time where there’s so few studies but so I started just researching like, stupid studies just to see what people are actually studying. Right. And so there’s a line in my book that says, Oh, well, we now know that spider man isn’t real because someone put time and money into researching, but these bed resting women who cares about them, they’re not as important and that’s really what needs to change.

P: Yeah, I mean, your story is a good one to spotlight many things that should absolutely be known or studied at this point that are not….but let’s focus on your particular story: so you’re told you have to go on bed rest and what what actually happens.

A: So it’s really interesting because now I live in the Hudson Valley and New to the Hudson Valley. I just recently moved from Brooklyn to my husband’s rickety old farmhouse that’s possibly haunted. In the middle of nowhere, and he has just bought a power equipment business, and actually the timing couldn’t have been worse. The day we got home from the specialist was the day he signed the papers of ownership. 

P: Wow, 

A: this and he had to go like he’s like he dropped me off. We ate lunch and he’s like, I have this business now. I gotta get the keys and, and that just plunged us into chaos. And we had all these plans that I worked at the business, I would be part of it. I was still doing freelancing. We were financially struggling just because we invested all our money but we had a plan and that plan just fell apart and I didn’t have a support system, my whole community was in Brooklyn. So that day, I’m alone in the house. And I’m about to get into bed and I’m like, Am I really going to do this and I pull back the sheets and I was like what let’s think about this for a minute and it was a really hard decision. Especially for someone who wasn’t used to staying put for so long.

P: Are you still in pain? Or how’s that going?

A: So I was in pain for a very long time and then it would kind of come and go for a while because your uterus ships. And so sometimes there’ll be a lot of pressure. Sometimes there will be less pressure, but I was always incredibly uncomfortable. And as I’m bed resting, my body is continuing to fail my muscles start to atrophy. I develop hip dysplasia. So even if I want to walk can’t walk my hips freeze up. I develop gestational diabetes, and I have to prick myself with a needle five times a day. 

P: Oh, that’s so terrible. 

A: Just one thing after another. 

P: I brought a question about the physical toll of bedrest to Dr. MT. So one specific issue that Aileen dealt with was hip dysplasia. Can you kind of walk us through why that would be a consequence of bed rest?

Dr. MT: Well, absolutely. You know, when you are bedridden  the I mean, you have to understand that that was prescribed by the physician. So as far as we were concerned, this is this is the a theraputic measurement like taking a pill or taking the short women will do missing dependency to be successful. And the will of the women to help the dependency successful is absolutely see the dramatic power. In fact I this is the most powerful thing I ever made. So they’re very devoted to dependency are committed to dependency and then we’ll do that and then we’ll come to bed with someone will just lie down all day that not integrate only, you know only only for photonic period. Yes and nothing more. That can be disastrous for the for the musculoskeletal system, it because it can cause dysplasia and also decrease the intensity of the bones and decrease the frequency of the muscle tone and all the thing can definitely happen from just lying in bed  all day

A: And theres also a scene in in the book you know, we’re in bed and I’m not getting very many visitors I did have one or two people come and bring lunch or a scone and that was life saving one of my friends actually brought me the happy days DVD at the time and and it was the most beautiful gift like just hours and hours of Happy Days. And but other than that I was really alone. You know, my mother was still working at the time. She hadn’t retired yet, and she would come up from the city and she was my saving grace and her relationship just blossomed during that time and I learned to appreciate her and all she was doing and all she had done for me that I never really understood when she came up to visit and we would talk about so many things we would talk about marriage and how hard it was to be married and understand each other especially during difficult times. She cleans she would cook she was really my savior.

P: Yeah, parenting has taught me so much about my mom that makes me appreciate all these things I look at differently now.

A: Right? All of a sudden my mother was one of the smartest people in the world.

P: That’s awesome. Yeah. So beggars sounds unbelievably hard, especially in this context where you’re away from everyone and your husband’s gone and you’re just alone in the house with the ghosts all day, right? Is there any magic? How did you get through it?

A: How did I get through it? I get through it one day at a time and actually one of the things that helped me get through it was writing about it. You know, I’m a writer, and suddenly I couldn’t spend a lot of time writing. I couldn’t balance the laptop laying down. I was in too much pain. And so I began writing these little journals about my day and trying to find humor in my day. Even though things were so hard because I really feel like even when there’s so much trauma, if you can find a little joy or something a little ironic or little funny, really helps you get through and so I started writing these one or two paragraph journals, and I emailed them to my brother or my friend just as kind of a connection. And that was really when my book was born. Those were the seeds from my book and from those journals. Years later I went back and read them and each chapter was basically from a journal.

P: That’s very cool. I will say that the medical experience provides a lot of absurdity. So there’s it’s right there’s things that I think people in medicine experience daily which are new to civilians like us when we go in. I feel like there’s a there’s a pretty wide divide between those two things which can sometimes be entertaining unintentionally.

A: Absolutely. And I’ve had so many doctors because out my practice, had this rule that you had to see every doctor in the practice because you didn’t know who’s going to be on call. So you wanted to know them all. And each doctor would tell me something different. 

P: Yeah. 

A: And give me some different directives. And it was driving me bananas because I was able to do this. Well, this doctor said that and we’re saying this. And so I finally decided to say I need to have one doctor. And that’s how I started to advocate for myself along the way. So instead of just accepting the diagnosis, accepting everything, people were telling me I hit the brakes on that I began to empower myself. Okay, I am in control of my body and I’m going to have a say in how this goes what happens to my body and so I picked one doctor, who I felt was a really good surgeon who I had a good rapport with, and that definitely made things go a lot more smoothly. 

P: Okay, good. Good. And Are they checking you every week? Or what’s the schedule like?

A: That was the only time I got to be released from my bed rest sentence was to go to the doctor so I didn’t even mind it so much. And I would go every two weeks, either to the specialist or to my doctor. There was always an appointment to go to. And you know, then there was the gestational diabetes appointment, which was in a lab where I had to stay for I think was three hours because I failed the first test and then they give you a second testing and drink this awful fluid and they take your blood every hour. I can’t remember exactly, but there was a lot of blood being drawn. And those were really the only times I left the house.

P: Yeah, so I can see how they became special. 

A: It’s very sad as special.. 

P: as forms of escape.

P: The one saving grace before that was that my husband would come home for five minutes with a milkshake every day, and then I would get to see his beautiful face. He was so busy. And half the time he would come home and the phone would be propped up to his ear and he just kind of dropped it for me and he didn’t have any time at all. The lady used to know exactly what time he was going to be there and just have it on the counter. So you have to waste a single minute, but it was so important to me that milkshake. It was the connection I really needed during the day. And then when I got diabetes, it was really hard and I began to have to deal with prenatal depression, prenatal anxiety. That was a whole other experience I had no plan for

P: Yeah, that seems unbelievably hard. 

P: As Aileen suggests, bedrest can be really mentally taxing, an issue that Dr. Mazaki Tovi addresses. 

 Aileen was slotted into bedrest because her cervix was opening prematurely. But I’m guessing that this only happens thanks to a complicated series of signalling, so she was saying that her doctors prescribed bedrest because they didn’t have a better way to manage those problems and it probably wouldn’t make the problem worse.

Dr. MT: Exactly. So actually, this is a very common misconception because Okay, so if you go to a physician or healthcare provider will describe bandwidth. The idea is that, okay, if it won’t help will hurt. Again, this is a this is a huge mistake, because bedrest is a tremendous toll from the woman It has physical toll, like dramatic emotional impact of talking about stress, and depression and feeling of of course, about all the economic importance, and all those things that are actually affecting them dramatically without providing help.. Tragedy of this treatment.

P: bedrest does seem like a sentence, right? I think people who don’t experience it and from the outside might say, Oh, it’s so nice. You can watch TV or do what you want. And that’s fine, probably for like two days. And then

A: and I think people understand that now much more with the pandemic. 

P: yeah, totally. 

A: I wrote this piece for the Washington Post about how bed rest prepared me for this pandemic. What I had to do every day is self care. And it was really just starting to appreciate small things that you don’t notice. So for example, I began to realize that there were these birds that would come every day at noon and circle the yard. They were the same birds every day and this was their territory. And I had never noticed that before. I began to appreciating the smell of the lilacs on the tree outside on my deck. You know, there was a tree right by my deck. So there were small things that I started to really notice. And so that was a little bit of a saving grace and growing experience for me.

P: yeah I can imagine coming from Brooklyn, moving to a rural area, and being on bedrest is a pretty dramatic slowdown. I’m assuming life in Brooklyn is much faster

A: than it was terrifying. So out of my comfort zone living in an old farmhouse to begin with, yeah, and then not to be able to leave that farmhouse. No to see people was so hard for me because in Brooklyn, you walk outside your door, and you see people and there’s a hustle and bustle 

At one point by marriage really just starts to crumble under the strain. There’s such a financial strain. We’re trying to renovate the house for the baby. There’s the house has been renovated in probably almost 100 years 

P: Oh Good Lord, 

A: it was my husband’s family’s farm. There were so many ridiculous things that you can’t even imagine going on his house, and we were having a baby we needed to kind of get up to speed. At one point. Things got so bad. I had to leave. And I went back to Brooklyn and I stayed with my mom and just being in her apartment in Brooklyn and smelling the food from the neighbors and hearing the sirens and the traffic and the kids playing outside. It was so cathartic and my friends came to visit and we talked about things other than pregnancy and other than bedrest and that made me feel whole again.

P: Yeah. That’s, that’s true. Now that you mentioned that I can see how your world has shrunk to this. You know bed that you’re on. You don’t have reminders in that new house of kind of your life before pregnancy,

A: right. And the other thing is this house because it was a family farmhouse. There were so many memories in it that weren’t mine.

P:  Yeah. 

A: so the paintings on the wall, the furniture, none of that was ours. And it was really like being in a stranger’s house and we were trying to make it our own. And we knew it would take time, but we had a plan and then the plan kind of fell apart.

P: Yeah, yeah, it sounds like you’re relieved or bed rest at some point. How does that happen?

A: I wasn’t relieved of bed rest, at  the very end I was given an hour a day to be right, who’s like parole like you get an hour a day to be out in the world. And now I’m nine months pregnant, and I can barely walk and now I’m afraid to go out. I’m depressed I have anxiety. I am petrified How did they expect me to just pick up my life and start over so then I was able to

P: wait so let’s talk about that a little bit what happens about appointment and because that does seem like they so don’t understand what your life is like on bedrest to say like, oh, we put you on pause, but now we’ll hit play.

A: Right You know, I was seeing a specialist and I was seeing my OBGYN. They didn’t always agree. The specialist said at some point, I’m not sure you need to be on bedrest. And my OBGYN was like let’s hold up on that you’re doing really well. So why mess with it now you’re almost at the finish line. And I kind of agreed with that. And I had so much fear that I was gonna mess it up. Yeah, do something and be responsible for something going wrong. So I was like, Well, you’re right. This is working. 

P: What’s the way forward?

What do we do now? Now that we have a sense that but rest is not the answer. What what do you do?

Dr. MT: Well, it’s extremely hard because you know, discovering business is actually entrenched into the DNA of the medical system. It’s extremely, extremely hard to take it out. But I would start with just approaching the women is complication of pregnancy and let them know that they cannot hurt the pregnancy. They don’t. Any complication that happened in pregnancy is not because of the woman is not because they work too much or the rain, or the babies or the client service. It has nothing to do with the complication of pregnancy. First and foremost, and this is more important to be from educating the medical staff is to educate women and let them know that they are not guilty of anything, this is the most important thing. The other thing is to educate and change in the perception of the asker and that unfortunately will take at least a decade or so. More and more studies that we did are coming in hopefully that will change the indications in the in the widespread use of bedrest and the therapeutic measures, but unfortunately I must say that will take place a decade.

A: So I was like your right. away, we still inside my body. So that’s where my baby needs to stay right now. And so I’m going to keep doing what I’m doing. So my OBGYN said well, you can have an hour a day. Right? That helped with my mental health. A lot

 P: And what  WHAT WAS THAT based on? Why did they change their their mind? To some degree?

A: They didn’t really share that with me so much. 

P: Oh, wow. 

A: That’s the thing. Like it’s like you are a magician like one day. This is what I’m supposed to do one day, this is what I’m supposed to do. And there were no clear answers. But my feeling is that I had made it far enough along the same for me to start adding in more activity. I was past the danger zone

P: and how are you feeling now emotionally about that? Because I imagine some amount of pressure has lifted so that in this point if the baby is born from that day on, we think there’ll be okay.

A: In my book, you’ll see that it’s broken up by week. Each chapter is a different week. As I check off the weeks I feel safer that my baby will make it and survive and live and that’s my one and only goal on bedrest is to keep this baby alive. So I’m checking off weeks and I actually start watching morning show with produce Pete who talks about vegetables and he tells you what the week vegetable is and what’s in season. I’m like if I can only get to Apple season when my baby supposed to be born. And that’s what I was basing it on fruit and vegetable

P: that gives us a sense of state of mind. Okay, and then do you make it to 40 weeks or how do you how far do you make it

A: I do you make it to 40 weeks? 

P: Wow. 

A: And that was really shocking to me because all I can think was that moment when my doctor said you will be lucky if your baby makes it till 24 weeks and to make it to 40 Weeks was amazing. I went into the doctor’s office and all of a sudden they’re saying maybe late, like prepare for being late. And I’m like what are you talking about?

P: Oh, by the way, you have triplets we forgot to mention.

A: Exactly. I’m like so then I started to really question the whole medical community, like, how could I go from being on bedrest Because he thought I was gonna give birth any second to not giving birth for another three, three weeks.

P: So that is so now that we’ve had this conversation that puts in context for me that first scary phrase, and they should never give you a date. They may say like you may go too early because your cervix is a face to say 24 weeks now seems nuts because how would you know how would you know the you know magic?

A: And that’s what I learned is that doctors don’t always know as much as we think they know or want them to know. And that’s okay. They don’t always have the answers and there isn’t the research. I don’t put the blame on doctors at all for that. It’s just how that information is communicated.

P: I totally agree. And actually the way I picked doctors is if they say they don’t know something, I think you’re the doctor for me. I want to hear you. I want to hear you don’t know, right? I don’t I don’t expect you to know everything and I want us to be honest about the boundary. 

A: Absolutely. 

P: You want to feel totally different if that first doctor had said, I don’t know how this is gonna go. But your cervix is facing too much and we’re gonna have to like change up what we’re doing.

A: Right. Well, these are my concerns. Right? Right. 

P: So I can’t believe you’re going to be late. Take us to the day that baby is born like how do you know today’s the day? Are you late? How does that all go?

A: This is actually very funny story. It’s four o’clock in the morning. I wake up and I’m wide open and I feel this kind of swirly feeling. And that’s the best I can explain it and it’s just like a feeling I’ve never had before I don’t have any pain. I just feel swirly. I can’t go back to sleep. I finally kind of doze off a little my husband gets up goes to work. And I spend the day watching movies and taking baths.

P: feeling swirly the whole time

A: the swirling starts to change into excruciating back pain. Wow. And goes now I’ve been on bed rest for five months. I’ve had so many aches and pains. There was one point in this whole experience where my fibroids start shrinking. The pain from that was so excruciating. I didn’t know how I was going to get through it. So I just assumed that this was just another pain that I had to work through. My doctor told me I was going to be late and I’m not feeling any contractions and so the whole day passes like this and they’re getting worse and worse these pains in my back. Finally my husband comes home later in the evening. And at one point I think the pain is so bad I end up on the floor. 

P: Oh Wow, 

A: I kind of have this idea that maybe I should check in with my Doula who I hired to advise me and she says to me, it sounds like you’re in pre labor. And so I take your word for it. And I’ve tried to pretend nothing’s happening, but I I just can’t get off the floor now. And my husband’s preoccupied. He’s on the phone. He’s doing all this work stuff. And my Doula happened to be at a party that day when I called her that evening and so I didn’t want to bother her again. And this is something women do right. Like they’re they could be having a medical emergency but they don’t want to upset anybody else, or help themselves by imposing on somebody. How do I say I’m going to call my doctor and the doctor was like, to come in and I was like, No, it’s kind of late, I don’t really want to…. And Doctor is insisting and I’m like, What is wrong with you? This is good. There’s no reason for me to come in and just giving you a heads up. So finally, the doctor says, Tell me the hospitals. Let’s just take a look. 

So now everyone knows something that I have yet to discover for myself. And we’re trying to get out the door and I can’t get out the door because the pain is so bad. Every time we start to leave I have to get on the floor. And at one point the dog gets so upset with me. The dog is pawing at my face kind of woke me. Why is everyone acting so strange? I just have some back pain with my husband kind of herds me to the car, and he’s like you just gonna take the bag we packed and I’m like, don’t be ridiculous. We’ll be home in an hour. I didn’t just in case I finally get into the backseat. I can’t even get into the front seat. And laying down in the back of this car and we’re going over the Kingston Rhinecliff bridge and my husband says to me, Listen, I don’t want you to be upset, but I have something to tell you. And I’m like, what could you possibly have to say right now that would upset me. 

And he says just listen to my thoughts on this. I think you might be in labor. I’ve been timing you and it seems like maybe you’re having some contractions. And then I think about it for a minute and I’m like, wow, this is the moment I’ve been waiting for. Since I was a four year old child in Brooklyn learning how to swaddle my Holly Hobbie doll. This is it. This is happening. So we get to the Birthing Center, which is absolutely beautiful. It’s attached to the hospital, but it’s like a little house with a beautiful porch. And by this time, I think I could let my Doula know that we’re heading over to the hospital and she meets me in the parking lot. And she’s  like I want you to breathe and want me to take a deep grounding breath and I basically push her aside and say, lady, I don’t have time for this I gotta get to the hospital. So so that’s how it started. That was that was how I finally acknowledged that this was finally happening.

P: I remember asking people, What do contractions feel like? And every single person said, Oh, you’ll know and also back Labor’s not what you expect are not what I would expect. I wouldn’t know what to do with that either.

A: Absolutely. And no one told me anything about back labor but didn’t have a single traditional contraction. Yeah, it was it was hard. It was very painful. And they said that the reason that I was in Back labor was because of my fibroids. I don’t know if that was true. I didn’t really have time to research it in the moment but they said your this is because of your fibroids that you’re not having traditional contractions.

P: wow so when you get to the birthing center, are you imagining a vaginal delivery or where are we on the delivery

A: right? So did you happen and I obviously don’t want to give away the whole story for my book, but the doctors had gone back and forth about that quite a few times whether I was going to have a plan C section because of the fibroids, whether I could deliver vaginally and pretty much towards the end of my pregnancy. They switched it up and said you can deliver vaginally and I wasn’t at all prepared for that. Because I had been planning on a C section, okay. And so that’s what I was going for, and I was going for that for 36 hours.

P:  Oh my God. 

A: And so here I am in the hospital, 36 hours of labor, and I’ve been in bed for five months. And now I’m going to have a baby on a sleep deficit.

P: I was gonna say you must be like Looney Tunes at this point. Right? That’s

A: And it’s so ironic. I spent five months in bed and now I’m having this baby completely exhausted. 

P: Yeah. 

A: I will never catch up from this. And it took a long time to catch up.

P: before  you encountered any trouble with your pregnancy. Had you imagined no waterbirth or angels with harps coming just from by your ears or like what was your picture of what delivery be like

A: I had planned to be in a hospital with a doula from the start. We hired the doula before there were any issues. We had checked out the birthing center. It was really a comfortable homey place attached to a hospital so it was the perfect ideal place to give birth and I did I did get to give birth there luckily.

P: Oh Good, good. And that was a success. I’m imagining.

A: Yes. So we’re in labor for 36 hours. They have a birthing tub. We’re trying everything. And most of this time up until 25 hours I’m doing this without any drugs. And I finally call it and say Listen, I need some relief. And so they gave me all sorts of different things at various points. And now we’re an hour maybe 34 and the doctor says you’re nine centimeters dilated. I just had some sort of cocktail. I don’t know if it’s an epidural and I don’t even know what they’re giving me at this point. But I can’t feel anything. And the doctor says I can kind of push that last meter for you. So you can start pushing but I don’t think you can. I think you’re exhausted and I think that your baby’s heart rate is climbing and we need to get this baby out now. I was like I can push. She’s like you can’t push. And I was like no no I can push and she was like, Man, I’m things and she was right there. I couldn’t feel a thing. There was no way I was pushing but in my mind, I felt like I could reel this baby out of my body.

P: Well you willed it in. Also, like are you appreciating the irony of like, we’re worried your cervix will pop open at any moment and now you’re like at nine and it’s not

A: and the baby will come out babies like and I think honestly I’m it’s been so much time and energy holding this baby in. 

P: Yeah, 

A: that in truth it was hard for me to let go and understand that it was okay to give birth and they will be in for a C section and everything went pretty smoothly from there and I had a beautiful baby boy

P: such a great ending. And how old is the baby now?

A: Well, let me start by saying that it took a very long time to process this story and to write it took even longer. My son is 15 now so

P: awesome. It does take a long time to process this is a good long runway now that you’ve had this time to process it. Is there anything you would have told young Aileen into this process that would help her

A: I try to think of it. What would I tell a woman on bedrest? Yeah and what I would say is the most important thing is to say this is your body and you need to advocate for yourself and make sure you are heard and do your own research and that no matter what happens You’re a strong woman and you will get through this because I didn’t know any of that at the time.

P: Yeah, yeah. There’s no test like this test right? It is like physical and emotional and in pressing in ways that nothing else is.

A: Right. And I think that what is important to understand is when you go on bed rest it’s not just laying down for five months and reading some book, Your whole life changes and that’s important to know and to be prepared for continued steps and also to acknowledge your emotions and feelings and know that they’re real and that you have a right to feel those things and that there are people you can talk to about it. And you should reach out for help. And I had felt so much shame that I had somehow caused this that embarrassed by my fibroids by my incompetent cervix. I didn’t know if I could talk to anybody about it. And I think that would have made a big difference if I felt more supported in that way.

P: It does sound like you’re toughing it out by yourself in in a space that you shouldn’t be alone. And it’s such good advice to tell other women that having more support around you can make a difference. It’s challenging to be pregnant and it’s hard to live in a body that’s not always compliant.  All you can do is adjust when things don’t go as planned–and you made major adjustments to see this pregnancy through, and in the end your body cooperated with that… To honor the pledge i made at the beginning of our conversation, I am thinking about enthusiastic cervix instead of  incompetent cervix, but we can we can work on that and your book is called knock down. Is there a subtitle?

A: Yes, it’s called knock down a high risk memoir and it is available for pre order now it is out on March 1 wherever books are sold for signed copies if someone would like to order from rough draft barn books is an amazing indie bookstore in Kingston, New York and the link is on their website. And they’re fantastic. Anyone is local to Kingston. I suggest you go visit them the bread the coffee they want most amazing books. It’s one of my favorite places.

P: I will put a link to that in the show notes and this sounds like the perfect book for many people but if you are on bed rest and wondering if you are alone in this might pick up knock down 

A: I think this is a book for women who’ve had children for bed resting women and for Gen X women and any woman really who wants to hear a funny story about a very serious topic. And I think that this is something that most people can relate to. There are also aspects of growing up in a Jewish community growing up in Brooklyn dealing with trauma marriage, so there’s something for everybody in this book.

P: that sounds awesome So those when I read it and thought it was great, it’s really emotional, which I think is a hard thing to communicate as a writer and I think that like I will remember this book. This will stay with me because it I definitely felt it 

A: thanks so much. 

P: Thanks so much for sharing it. Thanks so much for coming on the show and good luck.

A: Thank you so much for having me this was a great conversation.

P: I want to again thank Dr. Mazaki Tovi for taking the time to come on the show and talk about his research. I think one important take away from his work is that if you are prescribed bedrest it’s a good idea to talk very specifically about what that means in your own case…and thanks also to Aileen for sharing her story and her book. I will put links in the show notes to the research on bedrest and to the bookstores that Aileen mentioned. I hope you enjoyed this episode. Feel free to subscribe to the show and share it with friends.

We’ll be back soon with another story of overcoming