Episode 80: An IVF Journey that Includes repeated miscarriage….and pregnancy: Amy’s Story, Part II
Episode 79SN: An IVF Journey that includes repeated miscarriage…and a pregnancy: Amy’s Story, Part I
This is a show that shares true experiences of pregnancy to help shift the common cultural narrative away from the glossy depictions of this enormous transition to a more realistic one. It also celebrates the incredible resilience and strength it takes to create another person and deliver them into the world. I’m your host, Paulette Kamenecka. I’m a writer and an economist and the mother of two girls. In this episode you’ll hear suggestions about what to do with repeated miscarriage and gain insights about the highs and lows of the often challenging process of fertility from the former writer who covered the “fertility beat”, before such a thing existed, for the New York Times. What follows is the first part of our conversation about her experience working her way through the infertility gauntlet.
You can find Amy’s writing, and her book The Trying Game, here
You can find Dr. Kutteh’s work on recurrent pregnancy loss here, here and here
Chromosomal abnormality
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845039/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349251/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925012/
Recurrent pregnancy loss numbers
https://pubmed.ncbi.nlm.nih.gov/34326658/
https://www.acog.org/womens-health/faqs/repeated-miscarriages
Hashimoto’s and fertility
Audio Transcript
Paulette: Hi, welcome to war stories from the womb. This is a show that shares the true experiences of pregnancy to help shift the common cultural narrative, away from the glossy depictions of this enormous transition to something more realistic. It also celebrates the incredible resilience and strength it takes to create another person and deliver them into the world. I’m your host, Paulette Kamenecka, writer and an economist and a mother of two girls. In this episode, you’ll hear suggestions about what to do with repeated miscarriage and gain insights about the highs and lows of the often challenging process of fertility from a writer who covered the fertility beat before such a thing existed for the New York Times. What follows is the first part of our conversation about her experience working her way through the infertility gauntlet.
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?
Amy: Hi, I’m Amy Klein, and I’m talking to you from New York City. Yeah, I’m a journalist and a writer.
P: Yeah, I saw your book The trying game which is a great title. I’m assuming about your journey trying to get pregnant.
A: Yeah, it’s called the Trying Game: Get through fertility treatment and get pregnant without losing your mind.
P: Amy that feels like a tall order.
A: Well, you know, I had fights with them about “get pregnant” in there because it’s not just for people getting pregnant especially not only for people who are doing for Tony, who are struggling without losing your mind I mean, that is a tall order. Overall how to keep your sanity. I want to do with
P: I appreciate that disclaimer. And one thing I want to just note off the very top I had a hard time getting pregnant also. And one thing that was interesting to me about your book just superficially is that we’re trying I’ve never been a part of my vocabulary until apply that word to getting pregnant. Because, you know, as you say, in your book, as many people say, you know, we walk into this with the idea of you know, we’ll have unprotected sex and will be pregnant
and then moving along.
A: Right, and then it’s not easy. I mean, that’s what I thought okay. I’ll just do I promise you a miracle baby. You know, you just go to the doctor and boom, you get pregnant to try and represent that liminal state between the baby and not the baby.
P: Yeah,
A: not being pregnant.
P: So just to give you a sense of what code try means and Amy’s life. Here’s an excerpt from her book, The trying game, she writes, here’s an embarrassing confession. When I started writing the fertility diary column, my New York Times editor and I thought I write about trying to get pregnant for a bit, then transition over to “regular pregnancy issues.” “Probably three, six months,” she said, HA!, how naive we both were about fertility treatment. Then she writes, it was only after I married Solomon at 41 and found myself pregnant a week later that I realized I really want to have a child. Over the next three years, I 10 doctors, nine rounds of IVF, four miscarriages, three acupuncturists, two rabbis. One Reiki healer, five insurance companies to egg donors. 1000s of pills shots and supplements and band aids, and amazing repeat pregnancy loss specialist. And one real live baby. One beautiful baby.
So let’s go let’s start way back here. Do you have siblings?
A: I do I have three siblings.
P: Growing up in a family with siblings. Did you imagine that you’d have a family of your own.
A: I wasn’t sure if I would ever have children. I mean, when I was growing up, that wasn’t an option to be child free by choice. When I was I grew up orthodox actually, in a community where people had four or five kids not like 10 or 11, but four or five kids. And so that wasn’t really an option to me, but I just, you know, I have friends who got married at 22,23 24 and I just said okay, I’m gonna get 25 and then 25,30 30 I’m not gonna get married at 35 Then at 35 I was no longer religious but I started noticing Oh, you know, like, not just people and other people have babies and families too. I really let it sit down and think about because I can’t just keep pushing it off. At a certain point I have to decide whether I want to have kids or whether I don’t want to have to at 35 that’s when I kind of started sat down and having that dialogue with myself. Like do I want to have children right now? And for me, I think for anyone going through a journey in life where you have to change something even countries you lose a parent, something happens in your timing or 30 and I left the religion that I was raised on you know, that takes you out of your life and that takes some time to recover and that’s, you know, may take time before you start your family or before you can meet someone until you are like a whole person and for me, you know, leaving my religion in my 30s definitely took a long time and I had to look at myself say oh, do I want and then I realized you know even though I grew up in a very family oriented community, oh, you know what, even if I’m not part of that communityI think I still want to have kids if I meet the right partner, and I didn’t meet my husband till I was 39.
P: Okay, and so, describe how you crossed that threshold how you decided okay, I do want kids.
A: A lot of therapy.
P: Okay
A: For me, after I left the religious community and also realized, well, I don’t really know how to raise kids, if I’m not in that framework. I started doing a lot of kind of my nieces and nephews and I realized that I wouldn’t be the same parents as my parents were and I didn’t have to do that parenting and just going through seeing my brothers kids who were very religious, not like me, and I was like, oh, you know what, I think I am able to do this. And I don’t have to do it the same way that I was raised, I don’t have to do it with the same parent exam. And I think I can do a good job. So that made me realize that I was going to be a mother. I wanted to be a mother and I also thought I could. I don’t think I didn’t think I’d be able to get over on my own issues with my parents. Unless I had I wanted to move on and have a family of my own in order not to repair the past, but just to move beyond and you know, inculcate my own values. And that took me a while but I also knew that I wasn’t equipped to do it on my own. Like I knew I couldn’t be a single mom, I didn’t have the resources and I didn’t have the system of support. And that was, you know, everyone has equal choices. And I’m sure if I made these choices today, if I was a 35 year old today, I might make different choices as well. I may have seen the child in the community and set out totally valid. But that’s where I was when I Oh,
P: yeah, yeah. All that makes sense. So you met your partner and and take us on this journey. So you from your book, it sounds like you got pregnant pretty easily the first time.
A: So your partner right away. Interesting story Is he is he said like three or four months day, why don’t we just get pregnant, and I still had too much of like, my religious upbringing. I couldn’t just get pregnant and skip all the steps. So you know, we we got engaged.
P: wait, are all the steps like getting married? Is that what the steps are?
A: the steps are like dating for a longer time, making sure that like, because it was only three or four months, and I’m impulsive as a general. You know, and I talked about this in my chapter and regrets because we didn’t get married. So I was 41. And I did get pregnant the week after the wedding. And then I miscarried. And then we went on our honeymoon and I got pregnant again and miscarried again. And I talked about this in the chapter the regrets people always talk about like, and I say, oh my god, what if I had said yes to my husband and I would have just gotten pregnant at 39 instead of 41. Like and that’s a beautiful story that I could tell myself, but you know, can play on that whole story. Well, what if I had gotten pregnant? I was 39 and I miscarried once and then I miscarried again and maybe we didn’t know each other that long, which is why I wanted to in general, miscarry, it’s fine. So we’d only been dating at like, for my boyfriend. I’m out of here. I dont’ want to….So a lot of people have a lot of regrets. And I talked about this. This is before IVF. You know, what about the abortion I had in college? What if I hadn’t had that abortion? What if I hadn’t done this and there’s a lot of things that you can go back at what you’ve done differently. But as a therapist I spoke to in the chapter said, you do the best decision that you can. And if you likely play out that scenario, like you wouldn’t have made any different decisions. So when you’re faced with anything, any challenge you’re like, Oh, you look back in time, but you know, I didn’t want to get married after three months, because I didn’t think we knew each other. Well, I didn’t want to get pregnant. I didn’t think we knew each other well enough. They wouldn’t, you know, it would have been nice to know that I wouldn’t have had to go through four years of infertility and four miscarriages. but I don’t think I could have made a difference at the time
P: Yeah, yeah. It’s impossible to know. And pregnancy is such a complicated state. That it’s also impossible to know what it would have looked like two years earlier or you know, maybe you were doing something two years earlier that you weren’t doing later and that would have you know, I don’t know played it more than four miscarriages right like you just there’s no way to know you know,
A: right and likely to be you know, I finally, my miscarriage was we’re actually not due to the age of my eggs anyway, in I mean, I started this journey, you know, we got pregnant twice. Naturally, we had two miscarriages and then we started IVF. And then I still had two more miscarriages, and it wasn’t because of the age of my eggs, it was because of my body.
P: So so let’s go slowly through this so So usually, I thought after two miscarriages then that’s a inflection point where you go for help because more than one miscarriage potentially signals something Is that true or or what was your experience
A: it should have been an inflection point but I was just an OB GYN and some OGB OB GYN especially. Well, and this is like, my daughter seven now. So this was 10 years ago. I just realized, we do have a daughter. So this was let’s say it was like 10 or 11 years ago. The OB GYN first of all at my age after the first miscarriage should have been helping me and once the second one, she I did go to a fertility clinic, but then sometimes even now, fertility clinic are not always the best. Place for repeat miscarriage because they might just start you on fertility treatment when you don’t even need fertility treatment. Took me a while I went to one fertility clinic and they just told me I needed some more vitamins and that’s why I have moved here and it took me another miscarriage and another doctor to look back and say, Oh, no, that miscarriage was normal. It was nothing wrong with your eggs. There was nothing wrong. It was your body. And it took a long journey because things are changing right now. I just want to backtrack for one second about miscarriages because you asked my advice to anyone who is undergoing a six or seven week miscarriage is if they can to always have the products of conception. Because even though it might cost more money, you can know for certain if the embryo was chromosomally normal or chromosomally abnormal.
P: Okay, so what is chromosomal abnormality? Chromosomes are the physical basis for genetic inheritance. You’re supposed to get 23 copies from your mother and 23 from your father. chromosomal abnormalities can refer to a situation in which there’s something wrong with the structure of a chromosome, or the number–chromosomes can be missing or duplicated. Having the wrong number of chromosomes is the most common abnormality usually happens during cell division is the leading cause of miscarriage and is random so you can’t really affect it.
A: And that will tell you if the embryos from somebody after all that meant it was about likely and you know, try again, and if it wasn’t if the embryo was good. If it was not due to chromosomal abnormalities, then it’s time to start investigating, even with one chromosomally normal miscarriage.
P: Let me just elaborate on what Amy’s saying here. chromosomal abnormality is a normal part of human reproduction. Even at peak fertility experts think that on average chromosomal abnormalities affect roughly 20% of a woman’s eggs. And this percentage increases with the age of the mother for a variety of complicated reasons. There are more chromosomal issues with eggs than sperm, but it’s also the case that an embryo could have a chromosomal anomaly thanks to division of somatic cells or other cells in the body. And then if the embryo was chromosomally normal, that means something else went wrong. And the list of things is not in substantial. creating another person is a really complicated undertaking. And all the hormones have to be right at just the right time. And the endometrium has to be right at just the right time. And the signaling between the lining of the uterus and the embryo has to work appropriately and the immune system has to behave and the list goes on and on.
A: you know So there are women who are older or younger because you know, 25% of early pregnancies and that could be a reason to start IVF if you have bad embryos, they can find the way to do good embryos but if you have common something or miscarriages it’s time to investigate something else because it’s not the embryos, it’s your body in some way that is not holding on to a pregnancy that might be to due to structural problem. And that might be also in my case. Which was due to immune issues, which is a very small subset and one of the reasons I don’t blame necessarily IVF doctors For not specializing because the women who you know, like 3% or something. miscarriages are women who are chronically miscarriage after miscarriage more than two chromosomally normal miscarriage.
$$P: Okay, keeping in mind that all this stuff is hard to measure accurately because a lot of people have miscarriages and they didn’t know they’re pregnant. recurrent pregnancy loss describes the experience of having two or more miscarriages according to ACOG. This affects 1% of women and other estimates put it at 3%. These numbers mix those with chromosomal abnormality with other causes, the traditional methods of analyzing the cause of miscarriage or a high failure rate, which is to say that many women don’t find out what went wrong. I interviewed Dr. Pete, a fertility specialist in Episode 68 And he’s the co author of a new approach to investigate the practice of consumption believes he can attain a significantly higher rate of successful analysis. So check that out if you’re interested in this topic.
A: I was one of those lucky people. So you know, I had four miscarriages and it took me to find the specialists in the field who are five or six in America who deal with women who have a miscarriage. And IVF industry is actually waking up a little bit to this fact like oh, we have to do immune testing. So there’s ways that doctors can look at they can see, Oh, is there something structurally wrong with your body? Baby not getting enough oxygen? You know, uterus helped it. Is there something structurally going on? Is there a scar tissue? And there’s also a whole field of immunologist who say is your body rejecting the baby?
P: So I want to get into this with you more. But interestingly, we’re following the same path here because I had trouble because of immune issues too. But it wasn’t. It wasn’t found out till halfway through the pregnancy when things really kind of tanked for me,
A: Oh wow
P: but what was interesting about this and I went through the infertility gauntlet as well and where they’re testing fallopian tubes and uterus, and ovaries and it felt to me like there’s so much that’s unknown, because what if you’re physically fine? Then you’re in the into the vast, open hole of something else is wrong. They just cast you into the pool of, you know, some kind of fertility help. And firstly, just put us into IUI because the story was we don’t something’s wrong with you. We just want to what, let’s try this. This whole process is so complicated. I know it took a long time and a lot of effort, but I’m impressed that your doctors were able to pinpoint your problem at some point.
A: I didn’t need IVF at all is the whole thing.
P: Oh, wow.
A: I have found this doctor. And there’s a lot of doctors who will work with you conceiving naturally. I mean, I have a friend who’s pregnant with her second child. She had so many miscarriages so many places that I try to get you know, she went to so many different people and she went to the side who said she had like, like basically antibiotics and infection that was the normal standard, but like six miscarriages you know, so I mean, I think you know, like with endometriosis, it says it takes an average of seven years for a person to get ends and insurances diagnosis, which is crazy.
P: Yeah. that’s a long time
A: so I don’t know like, I think the doctors are doing a lot more immune testing these days. Even though they might not be the rep like I still think the president should go to a specialist and not a regular IVF doctor. But you know if people have I don’t know if you have any idea disorder, like do you have diabetes?
P: I have Hashimotos, which I got when I was 19. So Hashimotos is an autoimmune problem where your white blood cells mistakenly attack the thyroid gland, and they can decrease important hormones released by this gland. One hormone called thyroxin or T4 name for it is important in the process of ovulation and low levels or lower levels of T4 can stop the release of an egg or lead to an irregular egg release which can interfere with fertility. If the condition is managed through thyroid hormone replacement, you can eliminate this issue.
When I was going through it, there is just this huge vast space of not knowing this, and everyone’s just kind of thrust through the IV F tunnel which it sounds a little bit like you were as well given that you actually need IVF
A: I mean my husband likes to say whenever you when you know when you’re a hammer everything looks like a nail.
P: yeah, Yeah.
A: I do think there’s some like, first of all, anyone you know, and it affected her also say, oh, doesn’t matter if your question letters or diabetes or whatever, lupus or any kind of immune disorder of anything, you know, you should be with someone who’s going to help you. You know, and it could be an actual naturopathic or there’s many routes. It’s not only my way, but it just your system is so delicate that you need help with any kind of immune issue. So yeah, I don’t have I don’t have any diagnosis and I still I can’t really understand my 20 page report. Like my doctor said I had a little bit of everything. I don’t know if I have celiac. I do have the predisposition to gluten sensitivity to celiac I have I think it’s called CDQ gene which is also a marker for immune issues. I haven’t done the celiac test but I usually am gluten free. I went on to gluten free for my pregnancy. for fertility and her pregnancy and I mostly nothing will happen to me badly. If I eat gluten. I don’t know if I have celiac but I do know a few little things that are markers or immediate issue
P: from my understanding because I didn’t go the IVF route but that was you know, threatened with it. It’s really involved and emotional and physically difficult. Was that your experience with it?
A: Yeah, I mean, forget that we hit let’s IVF you know when I started this in 2011 in the fall. I didn’t believe that nobody was like it was felt like I was entering this secret world that you had had women standing online at six o’clock in the morning before they went to their Wall Street jobs. And then you talk to people and you’d be like then you find out that all these people had issues, but nobody was talking about in 2011
P: wait, they’re standing online like outside the clinic waiting for it to open or what’s the line for
A: some of them…that’s what the line was for because they need their seven o’clock. Appointments. But the lines open. I mean, thankfully, you know COVID I don’t have any good COVID But one of the great things about COVID at least in the fertility world. They schedule appointments now because it used to be like a cattle call. You know, we do monitoring which is check your blood work from seven to 10 am so the people have had to get to work because nobody was telling their bosses. There was no fertility coverage. You know, nobody was telling anybody. So I mean, it’s just so you know, in 2011 it definitely felt like a secret world when I started going through it and writing about it. And so it was it felt like a big secret. And today it doesn’t feel like a secret. It feels like people talk about it, but it’s still so stressful. It’s so it’s so hard on your body taking all the hormones. It’s hard on your relationship, just dealing with all the disappointment. You know, anyone who’s trying to get pregnant for a while whether you’re doing IVF or not, it’s a lot of disappointment. You know, even if you’re trying for a year, that’s two weeks of every month, that’s six months of your life a long time to be like waiting, and then you know, you think of IVF as these three little words. Oh, she’s doing IVF but like, you can’t schedule anything, you can’t travel you can’t see anybody. You can’t make plans and can’t drink. You can’t go to the jacuzzi… So it’s really stressful on your body and on your emotions and on your relationship.
P: But why is it so constricting of your time other than like the windows were like, Oh, we I guess I don’t even know what the windows are what like what
A: so let’s say you have to go in on the first day of your trip but you don’t know where you’re going. You don’t know when anything you don’t know when your first scene is you don’t know when your third day and you don’t know when your fourth. You’re not supposed to be drinking. Usually I’m not a doctor so I’m not giving any medical information but a lot of people don’t drink and let’s say don’t even do drive thru or whatever because they don’t want to ruin their psychology. You know, marijuana can cause problems documented. So if you’re not drinking, let’s say you go on the first day of your period, they get to go the third day, the fourth day seven you have to plan this around your work. Then you have to see how your body then you’re taking medicine to increase the egg. Whether you’re doing an IUI or an IVF it does add medicine so you don’t know how the medicine might keep you up at night. You might be sleeping, you might be bloated. Then you have to do a retrieval which is like a half a day off because you’re under anesthesia and so you don’t know if you could go away because you don’t know is there going to be on the 14th or the 16th but you have to find out am I doing a transfer Am I can’t bring the embryo back to me and am I gonna rest take it easy those days that I have to wait two weeks or a week and a half to find out if I’m pregnant or not. And then I might be a little bit pregnant
and then I might not I mean I don’t even taking over your entire life.
P: Yeah, yeah, that is dramatic.
I’m gonna start my conversation with Amy here. In her book, the training game. She shares an anecdote that illustrates the challenge of living life while on the short IVF leash. She writes, Sal and I were headed to a small college town in the Catskills, where we’d sometimes holed up at a cheap motel in the woods go for hikes by day watch the waterfalls, and drink local wine and beer in the pub is by night. I probably wouldn’t be drinking too much on this trip. Read at all, as we were in the middle of an IVF cycle, but it was still wonderful to have a little break. I promised myself that for the next two days. I wouldn’t talk about IVF about how many follicles were currently colonizing my ovaries. About what kind of side effects I was feeling from the meds. I would spend the days after my transfer so it would result in a better outcome the second time around. No, I wouldn’t fret over my past losses my lost time the embryos on ice, the feeling or itching to start and the life we were yet to begin. I was gonna enjoy the stunning palette of fall foliage, the unseasonably warm weather the vast fresh outdoors and my relatively new husband. I was gonna live in the moment and enjoy our freedom. And then we got the call. Hi, this is Kallie said a woman who I belatedly recognized was calling from my fertility clinic. The doctor would like someone to come back tomorrow. Tomorrow I said so loudly that Solomon clutched the wheel. Tomorrow, she repeated. There’s been some mixup with the results of my latest monitoring and they weren’t check my eggs again to see if perhaps they would trigger me ie give me medication that would force me to ovulate the next day so they could do a retrieval. Tomorrow. I said again, there would be no break. No hiking no motel. No not thinking about IVF the only foliage we were going to see was on the way home. Solomon had already turned the car around even before I hung up. Both knew I was heading back to the fertility clinic the next morning.
To hear how Amy’s story ends. Part two of our conversation will be available next Friday. Thanks for listening. If you liked this episode, feel free to like and subscribe. I appreciate Amy sharing some of the challenges of this experience. I look forward to sharing these inspiring conclusion next week.
Episode 77SN: Ambivalence About Stepping into Pregnancy: Courtney’s Story, Part I
Today’s guest shares her experience of pregnancy, birth and motherhood, none of which conformed to her expectation. She walked into pregnancy ambivalently ….and to her surprise loved many of the aspects of the experience that people often find difficult; because of a lifelong struggle with insomnia, the nine month hormone bath of pregnancy gave her luxurious periods of long sought-after sleep; she approached the pain of delivery as a unique experience between herself and her future daughter, and those early sleepless months with a newborn, which so many find challenging, turned out to be a period she’d been trained by her insomnia to manage better than most. I’ve spoken to hundreds of women about their experiences, and I’ve never heard this perspective….what follows is the first part of our conversation.
Find Courtney’s Book, The Year of the Horses, here
Find Courtney’s other writing, here
Audio Transcript
Paulette kamenecka : Hi, thanks so much for coming on the show today we are lucky to have Courtney Maum who has written a number of books, the most recent of which is a memoir called The Year of the Horses, which is a beautifully written book that I totally enjoyed. And if I had to summarize it in one sentence, I’d say it’s the story of your reconnection with horses, a childhood passion that leads you back to a deeper understanding of yourself in the midst of some significant midlife challenges.
Courtney: absolutely nailed it.
P: Which I feel like doesn’t isn’t loving enough. about horses but I am going to be honest right from the beginning and say that I’m kind of afraid of horses so while your book challenge that view, and I
C: I’m glad you brought that up because this is a book I really think it’s more for non horse people than horse I mean a horse people will. Inevitably I think feel connected to it, but I really I wanted to write this for the type of person who, you know, love to swim as a young person or dance or make up songs on the piano or wear funny hats and for whatever reason, you know, being an adult and a responsible person who has to you know, pay the rent or whatever it is, they’ve lost access to that part of joy and fantasy that was in their youth. So it was horses for me, but it you know, could have been something else.
P: Usually when I talk to people, I think childhood can shape your view of family what family is what you expect it to look like, if you want a family if you grew up with a sibling. I know from your book that you grew up with a brother. And I’m wondering if you can tell us how did you growing up with a brother are other aspects of your young life impact your ideas about kids having kids?
C: Let’s see I Oh, that’s a really interesting question. My brother Brendan is five years younger than I am so I spent the first five years of my life you know, it was like a fairy tale Princess childhood. My dad at that time was a big wig on Wall Street. This was the 1980s in Connecticut. You know, stay at home mom who had cocktail parties every night. You know, it was a it was a scene it was it was a very fortunate childhood. And then my brother was born and my dad hadn’t actually wanted a second child. I didn’t know that, you know, I mean, I something was wrong because they were fighting all the time, but I didn’t know that until later. And as it turned out, my brother had a lot of learning developmental issues that made parenting him different than parenting me. You know, he had to have special schooling and lots of medical treatment. And things like that.
So I will say that as a young person, I staunchly did not want kids. And I think it probably has to do with the fact that when the dynamic of our family was changed, for many reasons, it drove my parents apart. I love my brother. You know, our relationship is a complicated one, because everything that I value about myself and I think the way in which I communicate with people, fundamentally is through writing. Even when I speak to people I see the world as a writer. And my brother can…he can barely read. You know, so our love language really comes down to just spending time in each other’s physical space, which doesn’t get to happen very often. He lives in Florida, and you know, we’re at our best when we’re fishing off a dock together and eating pizza such simple simple things, but you know, that means that I am thus burying a lot of parts of myself that are vital, like my reading and writing life and that you know, he’s too he’s quite religious. I’m not you know, I think it’s a it’s a work in progress. But definitely, if for nothing else, just the cost and effort that I saw in parenting the way it was modeled for me because my brother was so sick. He spent a great wafts of time I’m talking months and months in the Yale New Haven Children’s Hospital and watching my mom, first of all, not be able to be there for me, you know, physically and the cost of the hotel room and at that point, they were already divorced and money. Things had changed. You know, financial pressure was back on just I thought, Oh, my God, I already knew I wanted to be a writer. And so it seemed to me that the way forward was to support myself and get to a place where I could support myself financially and just not have kids and then there’s no one competing with myself for my time. You know, and, and to be honest, I hadn’t really wavered from that mindset what happened and I married a man who felt pretty similar. You know, he’s a filmmaker and was really keen to just have our schedule, be our own and travel the world and whatnot, and it wasn’t until I was around 33 years old. That he changed his mind and decided he actually did want to try out and I really didn’t I really didn’t we it was two years of have come to Jesus you know, disagreements it I mean, I’m, I love my daughter had the perfect daughter for me. And she’s amazing, but it could very easily it could have could have gone a different way because I still I didn’t have that change apart. He did.
P: So that’s particularly interesting because you know, you’re the one with all the hard labor of pregnancy and all that stuff. So I’m hoping that it was easy to get pregnant.
C: Oh, well, it was so easy that I didn’t even know I was pregnant. I was practicing abstinence because I actively did not want a child. And we you know, hopefully this isn’t too much TMI, that’s what we’re here for. But it was a Christmas Eve conception where my husband and I we’ve long since stopped traveling to relatives for the winter holidays. It’s sort of nice and calm to just do it with friends or be be alone and I love champagne, and I love good champagne and I think I you know mostly drank the entire bottle and I didn’t we both forgot that you know, we had sex basically. And it wasn’t until two months later, I was just a wreck. I thought I had Lyme disease. I didn’t I thought I had mono. And I had forgotten to you know, and I went to the doctor, I didn’t even have health insurance so I had to pay out of pocket. This trashy clinic. And the female doctor told me that I had she highly suspected I had diabetes. I went through all these expensive tests.
P: Wow.
C: Yeah, it was a lot of nonsense. So by the time I mean it was so silly. I thought I finally got it because $7 CVS kit and I was I was more than two months along. When I thought I had Lyme disease, you know
P: wow, what were you what were your symptoms really throwing up or you just didn’t feel wasn’t throwing up?
C: But I felt carsick all the time. I mean, I now know that it was nausea. And I mean, it just sounds ludicrous. You know, I’m a well educated person. This sounds so dumb, but I things were tasting different. My husband, he’s French, so we often have wine at dinner, and I kept telling him like, you, where are you getting this wine? It’s off, you know, and he’s like, No, yeah, so it’s just tastes weird. I don’t want it. And then I remember, I like baking soda, toothpaste. That’s my brand of choice. And that I was like, Oh, they changed their logo, which is something I noticed because I work in Marketing. And I said and they must have changed their formula and I wrote a no like, I so type A I wrote a note to their customer service something saying like, you know your taste is I mean, just Hello. And ultimately what happened was, we often celebrate Christmas Eve with a with friends who were Jewish, and they messed up and they thought it was Christmas Day. And my my girlfriend reminded me after the fact she’s like, you told me on Christmas Eve like Oh, it’s good that you got the dates wrong because we’re gonna have sexy time we like got a bottle of champagne. All of a sudden that came back to me. We did consummate the relationship that night and I made a kid so it was a one time one time was stop and shop.
P: That sounds pretty easy to be fair to you. It is all of those symptoms are if you’re not anticipating them and looking for wacky and you know, all hail pregnancy chemistry that’s keeping you from wine without you knowing it. Right, like
C: totally and we at that point, we lived in the southern Berkshires, which is just an area laden with ticks. So many of my friends have struggled horribly from Lyme disease. So it wasn’t that nonsensical that I thought that that’s what I was struggling with. And you know, again, not having health insurance at that time. I was always really slow to go to a doctor something was up so you know, but it was a it was a baby.
P: And how was the pregnancy?
C: Oh my gosh. I loved it. I mean, funnily enough, was some of the most healthy and delightful moments of my life because I’ve struggled with chronic insomnia from a very, very young age had horrible sleeping problems, which really affects my mental health. And oh my gosh, should I say I was able to nap for the first time since being you know, in the single digits of life. I napped, I felt benevolent all the time. It was glorious. To be honest. I had a really nice pregnancy.
P: Well, that’s an amazing gift for someone who walks into it. ambivalently
C: Yeah,
P: and actually, why don’t you tell us about the birth first and then I want to read one quote from your book about your experience with pregnancy and motherhood going into the birth What were you anticipating what were you hoping for?
C: I did enlist a doula. I didn’t necessarily have strong you know, I did not like I wanted to do a home birth but I did try to I wanted to go without medication. Because I’m someone whether it’s recreational drugs or medication, I tend to have the reverse effect you know, of whatever’s supposed to happen. And I wanted to just handle whatever pain and sensations were coming my way. First of all, I wanted to be present. But also I thought I just handled it better without anything and I did a lot of prepping for the birth thinking about pain management. And when I was 16 maybe about to turn 16 I had a horrible accident where I was biking and I was hit and run over and dragged by a car.
P: Oh my god.
C: And I often would think about, I bet it can’t hurt more than that. You know, and I would think I think that I’ve already dealt with a level of physical pain that probably, I hope can’t be revisited. And so I just thought mostly about pain management, which was great because I was super calm through the contractractions. So calm that the nurses said it was a problem because I was resting through my contractions. But then, but then when it came to the pushing, I hadn’t given any thought to the pushing. I didn’t go to any classes. No one people don’t talk that much about pushing. They may sound like oh, it’s like a bowel movement when it needs to come out. It comes out and it didn’t. That was not how it was for me. My baby was in a normal position and everything that I could not. I couldn’t get her out. I had been laboring for a long time and I was really exhausted, but I also just had given no, it was like I’d been asked to all sudden do an advanced ballet move that I’d done no training. I was astonished how ill prepared I was for the pushing. Ultimately, I ended up having to have an episiotomy, which I didn’t know a doctor had ever even told me.
P: Oh,
C: and I didn’t know until two days later I tried to get up and go to the bathroom by myself and I almost fainted and a nurse came in and said you know you’ve had an a Pz on me and I said no one no one told me that. So, you know, other than the kind of the final moments. I loved the birth as well. I mean, I It wasn’t possible because of my age but I had you know I was thinking about surrogacy I just I really enjoyed being pregnant. I thought I the birth thing. I have so much affection for that experience because it was so visceral. I’m someone who’s always in my mind and I overthink things. And my mind is always in 100 different places and the brute physicality of birth. You couldn’t there was nothing to focus on. But the task at hand. And I loved that I found that peaceful. You know, I mean, I was fortunate that I was I made it to the doctors right I had that point I did health health insurance and, you know, wasn’t worried about what it would cost because I have health insurance. So I was fortunate enough to be able to focus on the good things, but I just loved the sheer presence that that was required by my mind and my body in order to do this thing and I also thought like, how amazing that my body can create these feelings that have not been hit by a car that this is feeling the way it does. Because of what’s inside my body that I’ve created myself. I thought that was like wild.
P: That is pretty amazing. And then it sounds like you didn’t do an epidural
is what that sounds like
C: they did. They did a spinal tap right before the piece what they they came in and they said you’ve been laboring for too long and honestly everyone needs to was changing shifts. And the doctor who’s coming on now he’s gonna give you a C section is what they said. So they were like, You got two choices. Either we go straight to C section, or you do spinal tap and we give it like a half hour or more. And so I thought okay, that’s not so they did the spinal tap and then without telling me they did the episiotomy and then off we were off then I had a baby.
P: Wow. Well that’s a that’s an interesting and obviously not predicted route for that but amazing that you’re appreciating that physical experience and that you can use your past experience to call me with a present because I think most people go into it with a fair amount of panic about the pain they may suffer and pain is one of those things that you I think you don’t you can’t have a visceral memory of it anymore. Like it is kind of exists only in a moment and although you remember the bike thing as being really painful, probably you can’t recall, like the pain you can’t recall
C: I can unfortunately, I actually have pretty good recall of pain and I remember the physical sensations of birth very well. I find it really interesting. I can really call them up I mean, you know part of it is that I wrote I write about these things. You know they are they are somewhere but no I can access them. I feel like I cannot access them and I have a friend who she just gave birth but we were talking this summer and she was so worried about pain. really freaked out about it. And you know she’s she’s an incredibly accomplished writer herself. She’s also a polo player. And I said you know what it feels like when a horse scallops away with you and you then you’re not in your mind anymore. You just have to deal with the sensation at hand. And it’s also kind of thrilling, it’s thrilling and scary. And there’s nothing else to think about and you should start building up almost some excitement and respect for the sensations that are come coming your way because they’re going to be completely yours for the rest of your life. And you’re going to be overwhelming in a way that it’s it’s it’s just you and this thing you know you’re gonna have to overcome this and and even if you have a great support system, you know, but it’s this is a once in a lifetime thing even if you have multiple pregnancies. I think that each each is different and it’s it is special and something that only us women for better or for worse can experience it’s it’s a not everyone wants to and not everyone should you know but if if, for whatever reason you are going to give birth, you know, you might as well practice some form of gratitude, just recognize what’s happening. You know,
P: that’s super interesting, and I usually think it’s very hard to prepare someone else for birth because you can’t find the words that will help them feel what’s coming in can’t translate that experience in a way that that will make someone else understand it and it is entirely experiential.
C: You know, I mean, I you know, I can talk about how it was for me, but that doesn’t mean that it will be that way. For other people. But I mean, to me, I just, I always told people I was at sea during this horrible storm, and I could see each wave coming at me almost like the movie The Perfect Storm when the waves you know, 100 stories high. And I knew that when the wave hit that it would hurt but that there was 15 seconds between each wave where there was some fear, but I knew I would get through the wave because I’d gotten through it before and then you just get into this rhythm on the ship. That’s how I felt it and that’s how I you know if people wanted to know I didn’t go willy nilly telling people this, but that’s, you know, I just kept reminding myself that after each crest, there’s there’s a moment of peace. Right.
P: So the other thing that’s interesting about that is I think you have this analogous experience with horses where when I was getting the contractions it was for me a really scary sensation of my you know, having no control over the body. I’m in like, I’m in this thing, but I can’t, I can’t turn it off. There’s only one way forward. But it sounds like with your with your horse experience. You have kind of felt that in a different context and maybe not necessarily pain, but the sense that you don’t have control about what’s going to happen to your body in the next three minutes because the horse is that we’re just controlling that.
C: Right? I mean, we like to pretend that we have control but we lose control. Every horse person is going to lose control even on the ground. You know, I have a horse right now who’s so dangerous on the ground. You know, if I’m going to be injured, probably it’s going to be on the ground while I’m just walking her somewhere and something scares her and she rears or kicks, you know. So when you’re those horrible, horrible moment when you know you’re about to have a car crash, that’s not really a lack of control you want to celebrate, right?
P: right, for sure
C: No, I would never say that. But I remember when my contractions first started coming. I thought, Okay, well, you very well might never live these sensations again, and we can’t go backwards. So, you know, let’s stay present and just think through this as like an artistic experiment. And I remember very well, when my contractions hit, we had a little log cabin and my husband had a film studio, a place where he worked out of in the back it was not at all connected to the house and I didn’t have my phone. I had been sitting with him that day because I was feeling a little weird. And I was listless and I had no idea what to do with my energy. And I left and I gone to the house, and I weirdly started I’ll never forget this. He started watching this French movie, based off of real facts about a group of like 17 teenagers that all get pregnant at the same time. I was watching this movie, this beautiful pregnant female bodies. And all of a sudden I was like, that is hard to describe this weird, something’s happening. I drew a bath and then I had all these contractions in the bath but the problem was I left my phone in a place with my husband and I at that point, I couldn’t get out of the bath but I also didn’t know how long it would take. You know, he disappeared into work. I was there forever. I pulled towels down and blankets and I think it was an hour and a half he finally came in and I was like oh my god. Call the doula but I remember even in the bath I just thought this is amazing. I’m in a dream of my own making like those sensations you have when you’re dreaming or having a nightmare and you know that sometimes you wake yourself up because you’re about to fall, but I I was awake and I had that falling sensation into my own body.
P: Yeah.
C: And I really did think like, this is incredible. It’s not like, you know, necessarily like I don’t love nausea, you know, but it was like an irrevocable sensation. And I just, I learned that I was like my daughter and myself creating this experience. It was very exciting. I think
P: this is an amazing way to talk about it and and I’m sure you will be surprised like not the view that a lot of people share but it is it’s moving right it is if only I could have other kids that would walk into it that way.
So I’m going to read a little section of your book here to kick us off with the next question you write you write the people most shocked by the fact that I had a baby or in order my mother then myself. But I loved it. Love the everything on early motherhood, my changing body the shifting of priorities even though once in a lifetime ravages of birth. I was at my healthiest and most productive as a pregnant woman. I felt beautiful and vital. After his birth those positive feelings didn’t go away. I was anchored I felt necessary as a food source. I was all I could think of during my last year was that I wanted all that back to Easy sleep, the focus mind the permanent anchor.
So what’s interesting to me about this is that you So reluctantly are drawn into this, but it is wonderful in ways you couldn’t anticipate and it sounds like you really like that newborn period, which most of us find, so challenging, and taxing and for someone who didn’t want necessarily a draw on her time. I mean, you have no time and that period, right?
C: Well, a couple of things like my child when she was a baby and of course everyone counseled us against this, but very early on, she started this routine where she would breastfeed for an hour at a time. But then she would sleep for five hours. Oh wow. Right. So instead of every 20 minutes, every whatever it is, that’s what we ran with for quite a long time and I am not joking. I understand five hours sometimes for but long periods of time where she was just napping and then and the breastfeeding sessions were I mean, I write about them in the book. They were never deeply and I looked forward to them because they were so long. And I had a comfy chair and a book and I’d read by you know it was just beautiful. Now of course, I didn’t get to do that for long because it my body didn’t get the signal to produce a lot of milk. Your body produces more breast milk when it’s there’s frequent smaller feeds so inevitably, she wasn’t getting enough weight because I wasn’t producing enough milk and we had to go to a formula. But in the first couple of months, I think I held out for three months it was really, it was really blissful. But ultimately I mean, I was well prepared for that period of motherhood because of my chronic insomnia. So functioning pretty well. on very little sleep was sort of a baseline thing, kind of where I was already coming from, and whatever hormones were going through my body unlike all the times before where I thought, oh my god, how am I going to face my day on three or four hours of sleep? How am I going to do this like whatever? book tour give a talk host dinner party without cracking in half I was buttressed by just oxytocin. You know, I didn’t feel stressed out about it also didn’t know it’s very lucky I was self employed. It’s important to point out that I wasn’t stressed right like I could, if I felt really sleepy, well then maybe my writing that day or whatever it was I was doing the emails were going to be a little wacky, but it’s not like I was going to lose a client at an office so the stakes were lower and then just for Virgo type A type person like me, ticking off boxes, just identifying what my child or infants needs. Were they were so easy to meet again, if she was healthy, right. I’m not talking about being an ICU or something. But it is just this checklist. Is she hot? Is she cold? She’s hungry. Is she tired? Is there a tag that’s scratching at her neck? Did we forget her favorite blanket? And honestly, I think there weren’t even there were less than 10 things and normally if you check those boxes, and we’re always prepared. I like people people who know me well can tell you on like a masterful picnic prep you know, I’m the one who always at a moment’s notice. You want to pick them I’ve had little salt packets in my purse. I have like a Swiss Army and I’m just always ready for anything. And and so that’s how I operated you know whether in the house or driving around, just had everything on hand all the time. I was very prepared. And thus I felt very successful and very happy about the ways in which I was meeting your needs and then you know, for me the the dark stuff came and I started to really unravel and feel that I was failing as a mother when she turned two and instead of, oh, she’s crying because she’s hungry. She’s crying because she wants attention. She’s crying because she wants to be played with and I’m like, Oh, that’s not something I can put in a car or in a bag or order. You know, that has to come from me. And a place of play. And time and attention and and then everything came apart. i That’s That’s for me. Like where the real mothering came in and it’s beyond survival. It’s about emotional nourishment, and I succeeded less, let’s say
P: Well it’s interesting that early motherhood so clearly suited a lot of your native skills, and it’s like a kind of an experience. You wouldn’t have known that those two matchups so well, and once they become real people at about two become significantly harder, right that’s I think that is true across the board. And that is kind of a spot where your own experience as a child, I think plays in really strongly in many ways that we’re totally blind to, like we
C: Yeah, I think that’s true. And I think I think that some people that’s when they start to shine as parents you know that for instance, my husband really suffered with type stuff because he’s the type of person he’ll go to the grocery list and forget the list. Yeah, you know, he’s, he’s not terribly forgetful, but he’s not he’ll drive somewhere and not realize that we’re driving through lunch and not think to pack sandwiches, you know, whatever the heck it is. And that stuff matters a lot. That level of organization matters a lot when you have an infant, but it matters less. That’s yeah, that’s when he really rose rose to the challenge was dropping everything to play or come up with a funny game, or throw a ball who makes the sounds and I just, I could do that for like five or 10 minutes, but then I had my own stuff I wanted to move on to I just didn’t have that. I guess I could put this in the present. I still don’t really have that emotional generosity, you know and that I could have guessed but the other stuff that I would love early stuff so much. Yeah, I didn’t see that.
P: And when you’re you say your mother was surprised is that because she thought you would focus solely on career?
C: Because I made it clear to her from a transit of teenager. My mom loves kids. She loves being a caretaker and I’d always said Don’t Don’t count on me, you know, and then she was just it was always there because my brother you know had been counseled not to have kids and just his was taking medication that a certain point I you know, rendered him incapable of having kids. And so my mom’s just really identified as someone who wasn’t going to have grandchildren and she was deeply upset about that. And it had gotten to a point where she called our cat giant man who had you know, to be like, how’s my grandson and had really come around. So just accepting that she probably wasn’t going to have grandchildren’s. So she was, I mean, beyond like, I can’t it was incredibly moving to see how excited and invested she was. And it was a really beautiful time in our relationship to because I don’t think I’ve ever needed my mom like that. You know, and all of her characteristics that sometimes makes me frustrated with her which is selflessness, her ability to self efface space and time and you know that time in my life when when I really needed someone to drop everything and be there for me and she she was wonderful that way.
P: Yeah, a lot is forgiven for good grandparenting
C: Yes, Absolutely. That’s well said,
P: I wanted to read this quote because I as I loved it, it sounds like you went to your first pregnancy appointment in France and I want to roll out my very dusty French accent. So I hope you’re sitting October. I said, I’m interested in natural childbirth, you know, laboring without any medicine. Do you have any thoughts on that really low, closed her ledger my checks for appointments functioning as a bookmark that she said is a question for a therapist, not a gynecologist. I love that because no gynecologist here would say that.
C: Absolutely not. No. Oh my god. She’s. I wrote an essay about her recently. If you Google my name and letter to a stranger, this is a wonderful special thing and a literary magazine, where people write letters to strangers. She’s not really a stranger, but this was a long time ago. And I wrote a whole essay about my obsession with my French gynecologist, and she was hardcore. She’s very hardcore. And you know, that section goes on where I ask questions about breastfeeding and she says if you want to ruin your breasts, you know Knock yourself out and just Oh, and then drinking. She said, Only drink two drinks a day. Just completely flew in the face of everything that we tend to say in America.
P:
I’m going to stop my conversation with Courtney right here….where we can all take a minute to think about Marie Laure’s, what I would call, woman centric approach to pregnancy, birth and breastfeeding…..thanks again to courtney for sharing her experience. I particularly appreciate her willingness to discuss the challenging issues around this transformative event so openly. It’s the kind of conversation that should be part of our larger public conversation–there are few other decisions we make in life…I’m at a loss to think of any other–that change your life so completely like pregnancy and birth–walking into a decision that casts such a large shadow with some ambivalence makes sense, not that everyone harbors uncertainties but it makes sense to me that people have them, and despite that, most public discussions about this topic are cast in much starker terms and really the only culturally acceptable response is unvarnished happiness. I also appreciate Courtney’s expansive appreciation of birth, both because it recognizes that the experience involves pain, but it celebrates the fact that each birth is unique and its a connection, or an experience or a memory that you’ll have with the newborn forever…and that seems like a true and useful way to approach it….Courtney and I talk about what led her to her second pregnancy, and about that pull of our imagination toward lives unlived, and…just a bit, about horses.
Thanks for listening.
We’ll be back next Friday with the rest of my conversation with Courtney Maum.
Episode 77: Ambivalence about Stepping into Pregnancy: Courtney’s Story, Part I
Episode 76: A Late Visit from a Preeclampsia Diagnosis: Joy’s Story, Part II
Episode 75: A Late Visit from a Preeclampsia Diagnosis: Joy’s Story, Part I
Episode 75 SN: A Late Visit from a Preeclampsia Diagnosis: Joy’s Story, Part I
Today’s guest walked into pregnancy carefully. She is a health journalist who had researched and reported on pregnancy issues and this work influenced her ideas about the kind of birth she wanted to have. Things began swimmingly, and it wasn’t until the third trimester when the first signs of what would become preeclampsia began to emerge, but nothing is diagnosed at this point. The birth was the beginning of a chaotic couple of days in the hospital. It’s not until after the birth that preeclampsia is caught and the turmoil of her experience really impressed upon her the challenges of navigating a complicated medical event. What follows is the first part of our conversation.
I also had the opportunity to interview two scientist physicians who have researched preeclampsia and have tended to women with the condition. We’ll hear more from these doctors in part 2 of the conversation.
Relationship between morning sickness and pregnancy viability
https://www.verywellfamily.com/does-no-morning-sickness-mean-miscarriage-2371250
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2553283
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2553283
Epidurals and lower blood pressure
https://pubmed.ncbi.nlm.nih.gov/23021700/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276328/
Audio Transcript
Paulette: Hi, welcome to horror stories from the womb. I’m your host, Paulette Kamenecka. I’m a writer and an economist and a mother of two girls. Today’s guest walked into pregnancy carefully. She’s a health journalist who had researched and reported our pregnancy issues. This work influenced your ideas about the kind of birth she wanted to have. Things began swimmingly. And it wasn’t until the third trimester when the first signs of what would become preeclampsia began to emerge, but nothing is diagnosed at this point. The birth was the beginning of a chaotic couple of days in the hospital. And it’s not until after birth that preeclampsia has caught a turmoil of her experience really impressed upon her. The challenges of navigating a complicated medical event. What follows is the first part of our conversation. I also had the opportunity to interview two scientists/physicians, whose research papers yet attended one with a condition, both here wanting these doctors to have this conversation.
Let’s get to this inspiring story.
P: Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from?
J : My name is Joy, and I live in Austin, Texas.
P Excellent, Thanks so much for coming. Joy. So here we are. We’re going to talk about the family that you feel that you have right now. And sometimes the family you have is a reflection of the family that you’re from. Let’s just talk briefly about the family that you have come from.Do you have siblings?
J: I have one younger brother. He’s six years younger than me and he lives in the northern suburbs of Austin and round.
P: Oh, nice to boost age. Yeah, we’re close by and did growing up with a sibling make you think I want kids or not really.
J: Being six years younger, there was enough of an age gap. You never really want to play together, that sort of thing. And then by the time I was in high school, I did my own thing.So no, I
wouldn’t say how did you know at some point that you want a family?
J: I met my husband after a few years that we were together. We talked about it a lot. But we were also very hesitant about the state of the world at the time, which now seems depressing.
P: Quaint?
J: Yeah, exactly. And I had a lot going on in my own personal life with my mother’s health, which definitely derailed me for a few years as well. And so yeah, it was it’s not the kind of decision that the two of us would ever make lightly. It’s something we’ve put a lot of just like any major decision,
P when you go to get pregnant is easy to get pregnant.
J: Yeah, it was pretty easy to get pregnant. I think it took like four or five months. Kind of trying, you know, but not like being very serious. didn’t need any help with it.
P: Okay, good. And what’s the first trimester like
J : the first trimester was really pretty easy. I did not have any morning sickness, which is sometimes can be a bad sign. Because it’s an indication of all like the hormones and all the things that are changing in the body.
P : So this is a good question. Does morning sickness have a deeper meaning? Does it mean that pregnancy is doing well or poorly? It looks like in general the answer to this is no. Lack of morning sickness doesn’t imply that pregnancy is on the wrong path. There was an article in 2016 in an important medical journal that found that for women who had one or two previous miscarriages, morning sickness was associated with reduced risk of pregnancy loss. But this finding is limited to people who have previously experienced miscarriage.
J And I really didn’t have too much of that. I don’t even remember being all that tired when that I hear no quite calm. So it really wasn’t that bad first trimester.
P Okay, good. Did you have I should have asked this before, but did you have a concept of what pregnancy would be like before you stepped into it?
J Yes, I have been a health reporter in New York City at that point for a long time. For a while I had worked in White Plains, New York, which is a suburban community north of New York, and it’s very wealthy. And really the health concerns there are dramatically different than the health concerns where I grew up in Corpus Christi. And I had met women who were debating things and looking at the science journals, and interventions in birth, and really, they really approached it from this very privileged standpoint of like there’s too many interventions in birth. And that kind of influence my view, by the time I got ready, I really was like, Oh, my gosh, the C section is that should not be happening to me and I tried to go for very, quote, natural childbirth as much as I could, you know, it’s about that was sort of the background approach.
P So does that mean you went to like midwifery instead of a traditional OB
J Yes, I went to my OB. When I got pregnant. She didn’t have privileges or whatever at a one hospital in Manhattan that had a birth center, which was at the time the sequence was about and so I switched to a mid wave clinic and have more midwives because they I had a birthing center at the hospital that I liked that it was within a hospital if anything went wrong. I was already there.
P Yeah. That seems like the right kind of insurance.
J: Yeah, exactly. Yeah. So we’re, we toured the birth center in those early days and yeah, and it seemed like a good setup.
P So does that mean that your your care is more kind of gentle and sporadic throughout your pregnancy?
J I wouldn’t say sporadic I think you have just as many appointments as you would. I mean, I don’t know for sure, as you would have been OB and you have those sonograms you know starting at the regular schedule, and you have a lot of visits. And so I think the I don’t know what the big difference would be there might have been less testing and you know, bloodwork, maybe I’m not sure, but I remember having that doing the glucose test, all that sort of stuff.
P Okay, so that sounds familiar. And maybe a birthing center that is situated inside a hospital is slightly different than a birthing center on its own, because it’s just
J: yeah,
P: by proximity and selection and all these other things. And so second trimester still doing well.
J : Yeah, doing pretty well. I remember we traveled to Costa Rica and it was a good trip. And yeah, second, second trimester. I think they’re, you know, looking back in hindsight, if there was a little bit of an indication the baby’s growth wasn’t like it’s starting to slow down near the end of the second trimester, the belly measurements, you know, towards towards that end of the second trimester. I remember seeing them like, okay, and I didn’t look super pregnant by the end of the second trimester. I remember people saying I looked less pregnant than I was. People don’t hold back with their opinions.
P: Yes, yeah. Pregnant women seem to be public property. I do remember having to like fend off paws that were coming my way. To touch the pregnant belly, which I don’t remember selling tickets. You are not in line. Don’t. Don’t touch me that way. So the baby’s baby going a little bit slower, but no one’s upset about that.
J: No,no, and I you know, I don’t even remember, I went through a process of looking exhaustively, looking through my medical records after the fact. And it’s hard to say if at the time I was really thinking about it, I definitely remember looking at the record. Oh, there might have been some signs here.
P Yeah, I mean, it’s interesting when you look after the facts, right that things look a little bit different, but we’ll get to that because I read your story in cosmopolitan, which is, I’m glad that it’s published because it is important and kind of shocking. As shocking as it was to experience it’s it is shocking to read.
J: Yeah.
P: So we’ll get we’ll get to that. So third trimester rolls around and what’s that like?
J That’s really hard, really hard. And I remember what to say around like week 33-34 My hands started. It was like a burning sensation. It started hurting, hurting to write which I was a writer and a reporter and you know, using my pen taking notes in a meeting or whatever, my hands would just start hurting and they were kind of bright red. They weren’t really swollen like with edema, but they hurt. And I started developing an upper gastric pain of pain on my right side up towards the top and I went to my midwife, I complained about it and in my chart, it said, you know, suggested ice packs for hands and she called the belly pain. The ligament pain like the
P: round ligament?
J: round ligament like yes, yeah, that was written in my chart. It was actually my liver but that was you know, was written in my chart. And then I also had a couple of times where I went in with high blood pressure. And I remember distinctly going in there once and the midwife you’d see different midwives each time, which I think was not a good thing that there were that was not consistent way of getting care, and they were also had way too many patients. I mean, the waiting room waiting was atrocious, sit out there for a really long time to see your midwife. Um, you know, in hindsight, it just was not a good experience.
But one of the times that I was having my blood pressure measured, it was high. She’s like she’s she Shepherd shuffled me over to a second room that was dark and heavy lay down on my side, I retook my measurement, and that’s what ended up in my chart. And at the time, I don’t know what was going through my mind. I knew I kind of you know, was vaguely aware of what preeclampsia was but I also had this attitude that that that wouldn’t happen to me. I don’t know why. But you know, that was really dangerous but she did. And that was probably week 36,37. When when stuff like that was happening, and I was definitely just miserable those last few weeks not feeling good. And I went all the way to 41st week.
P: Wow.
J: Yeah.
P: So So let’s talk a little bit about that third trimester no one’s running tests to check stuff.
J: No, no, I didn’t get any bloodwork done. And I you know, I’m really curious now, if that would have shown anything with the liver enzymes. Yeah, just the regular go in, take your blood pressure. Take your vitals, measure the belly. Again. The belly growth was a week or two behind what you would see normally.
P And are you worried or you’re you’re trusting entirely the midwives?
J I’m not worried. Yeah, I’m miserable. And I’m in because I did go and I told them, you know, I’m having these issues, and they said it was these other things. You know, I just was like, Okay, I guess, I guess this is how it’s supposed to be. I also had really bad insomnia, because I was so uncomfortable. And I just remember like, being up all night, like trying to find a comfortable position to lay in and just not getting any sleep and I thought, okay, I guess that’s normal too. You just it’s hard to know what’s normal and what’s not and tell you a full range of like Swelling is normal, your ankles swell, you know, that sort of stuff.
P It is it is interesting, and I’m completely and fervently of two minds about all this which is on the one hand, so little is known about pregnancy. And all these complications that you easily could be in that bin of nothing serious going on here. And preeclampsia it while it’s significant issue is not super common. It’s not like 30% of the people have preeclampsia; at the same time. We need to be screening everyone in the fall. It’s not serious then to make sure they’re in the right bit. Right.
J: Yeah, yeah. And you’re reminding me of an important thing that happened one way that my case was different, you know, they were doing the urine checks. Every time I go in my urine was always normal throughout the entire thing. My kidneys were always fine. I never had protein in my urine and but I did have elevated liver enzymes, quite high and right around around November after I gave birth about six or seven months after ACOG. The American College of Obstetrics and Gynecology changed their guidelines to say we should not rely solely on protein in the urine and high blood pressure. You should just be high blood pressure at that point you need to do the full battery of tests because protein can be some women go into this variant of the liver versus the kidney and that that was me and I think that might have been one of the ways I was felt they were thrown off by me.
P What year is this?
J : this is 2013
P: And how old are you?
J: I was 36 Mine delivered.
P: Okay, so the definition of preeclampsia has changed over time to become
J I haven’t Yes, I haven’t looked into it really since then. I got very involved with it. And three years after I gave birth in terms of I know I was on the Patient Advisory Council for the preeclampsia Foundation, wrote that article and since then, it may have changed. But I do remember that year they updated those guidelines because they knew they were missing. They knew they weren’t missing people by being that narrow.
P 12:47
Yeah, it continues to evolve that now for sure they say it does not require protein in the urine to be defined as preeclampsia. I brought this question of the definition of preeclampsia to two experts.
Today we’re lucky to have not one but two amazing scientist/ physicians who research issues around preeclampsia on the show. The first is Dr. Suzanne Oparil. Who if I introduce Dr. Oparil, with all the professional designations that follow her name, the society she’s a part of and the groundbreaking work she’s done. we’d be here all day. So I’m going to I’m going to summarize here. I’ll say that she’s a cardiologist at the University of Alabama Medical School of Birmingham, who was interested in the fundamental mechanisms of cardiovascular disease. She’s authored tons of work on preeclampsia, among other things, and is on the Medical Advisory Board of the preeclampsia Foundation. And we’ll talk about one of the groundbreaking clinical studies that she’s a part of a little bit later. And I also want to introduce Dr. Rachel Sinkey, who’s an Assistant Professor of Obstetrics and Gynaecology, in the Division of Maternal Fetal Medicine at the University of Alabama medical school, who has also authored just a zillion papers on hypertension in pregnancy and preeclampsia. Doctors this feels like a dream team. So thank you so much for spending some time with us this morning.
Dr. Oparil: You’re welcome. It’s an honor to work with Rachel who taught him 90% Of what I know about preeclampsia.
Dr. Sinkey: That’s so not true but it’s an honor to be on your show today with Dr. Oparil
P: Well we’re glad to have you both. We’re gonna start off with what I’m hoping is a softball. Can you tell us what is preeclampsia.
Dr. Oparil: go fot it.
Dr. Sinkey: Absolutely And since this is my bread and butter, we see this so often. It’s just so important to teach our trainees but basically it is either new onset hypertension in a patient who didn’t previously have hypertension, plus either protein in the patient’s urine or other signs of end organ damage. Or the patient has a history of hypertension, then it can be associated with worsening hypertension. Worsening proteinuria and potentially end organ damage.
P Okay, so it sounds like in that definition, you have essentially told us how it’s usually diagnosed. You’re looking for those markers.
Dr. Sinkey: Exactly.
P: Today, we’re here to talk about Joy’s experience. She had a new onset of high blood pressure and heightened liver enzymes. But wasn’t diagnosed as ill after delivery. So I’m guessing there’s something tricky about making a diagnosis of preeclampsia on someone is that consistent with your experience?
Dr. Sinkey: You’re exactly right all it and the thing is it’s very tricky is that if you are diagnosed before delivery of the infant, then you still have circulating hormones in your body even after delivery and for some women, yes, most women are delivered diagnosed prior to delivery. However, there are some women that aren’t diagnosed until after delivery. And so trying to explain to explain it to families is really challenging and it can it can be a tricky diagnosis.
P Do we know what causes preeclampsia?
Dr. Sinkey : We blame the placenta. We are still investigating the underlying causes and I think not having an exact clear understanding of the underlying pathophysiology of preeclampsia also may help to explain why we don’t have treatment yet. So I hope that over the coming decades as our huge appreciation and respect for our basic scientists, colleagues who study this on a daily basis, hopefully as we learn more about the underlying causes, we can also develop therapeutics to prevent it and anti trade.
Dr. Oparil: I would guess though there are going to be multiple underlying cause it’s not going to be one thing, one molecule probably.
P : Okay, so now you’re not feeling great. It seems like maybe it’s normal because everyone’s telling you it’s normal. That’s another thing that’s like a dissonance right where you’re like, Okay, so this terrible feeling is what everyone does, like, yeah, that doesn’t seem like the marketing I hear around pregnancy. And so what you’re imagining like a birth with an epidural or what’s your picture?
J : right, I would that’s what I was. That a was you know, just as few intervention as possible. If I could make it without it. I wasn’t opposed to an epidural but if I can make it without it, I wanted to try it. I come from this like stock of women. That so my grandparents my my grandmother was a twin and she was one of 13 siblings. My great grandmother had 13 children in a log cabin by herself. Yeah. And I had that. There was a newspaper article written about her. She was like so anachronistic. Even in the 60s, she wore a bonnet and had a log cabin and I had a newspaper clipping off her when the headline mentioned that their teen children in the Log cabin I was like give an event living can do it then you know I can do that sort of attitude. And you know, I did not inherit those genetics apparently. Yeah, I definitely changed my mind on the pain control pretty quickly.
P Well, it is an interesting thing. I remember being terrified of birth, like once I was seven months pregnant. Yeah, kind of that idea that this baby that you’re growing is gonna have to exit your body somehow. Yeah. And how’s that going to work?
J: Right.
P: And I too, took stock of like this has happened for eons. Yeah, we’ve been having giving birth in fields by themselves. But unlike you, I thought I’m not one of those women. Yeah, that’s in the field. That’s not me. But so I like your your spirit and your and the mindset that you’re going in with but at least it feels like empowering to think I can do this. My body can do this.
J Yeah. Yeah. But I, you know, if I could go back in time, I think I would have never seen a midwife I would have stayed with an OB. And yeah, I would have been more open minded to everything. I think my biggest lesson was like don’t have a birth plan. The baby has a birth plan, you know,
P : it’s hard not to get attached to some form of control, which I think is what that birth plan is because you’re walking into the unknown. So it makes sense to me that people would want a little something to cling to but But you’re right, that doesn’t always land.
J Right. Exactly
P: So now you how do you get past your due date? You just do. There’s nothing going on.
J: You know those days are a little hazy because I was definitely feeling really bad but I remember I made it to my final week appointment. And, and then yeah, a few days after that. I started having contractions. But yeah, those last few days are definitely blurry.
P : So so how do we get to the hospital? Does your water break or like what take us to the day?
J Yeah, I had two trips to the hospital. So the first was around. I had been laboring all day and calling into the clinic and reporting to them on timing and contractions. I had your back contractions I had a lot of pain in that in the back. Just I just know hammering is the way I refer to it. I remember sitting on the first of all, my husband kind of pressing on my back and I was just, you know, at that point, you’re starting to realize like this is this is just the beginning.
P You and You knew this was a contraction.
J: Yeah, yes. Because it was coming in. It was coming in, wakes up and it would go away and then it would come back. And we were timing them and I think they got to five minutes. Although I don’t remember that precisely. But we went in, I wanted to go in and it was like when in the morning went into the hospital went into the triage of labor and delivery and I was only dilated to one centimeter. And so they sent me home but I also have high blood pressure I had it’s like 145 over 90, and I had a racing heartbeat. And I remember the midwife it was a different one this time asking my husband like, Oh, does she have anxiety? Does she get anxious easily? And I think he said, You know, I think he was sort of like well, you know, I guess like he didn’t quite know how to answer that. What you think would have come up before I’m in triage. And so they sent me home at one inches dilated and say you know, you know, keep in touch and call us and I can’t remember exactly what the designation was to call back in. So we go home, and things continue like that for a while but I start feeling worse and worse. And again, it’s so hard to know like, is this labor or is this something else?
P: you feel worse means that you’re getting a headache now
J: I have I was kind of like a flu type feeling like a general just generalized fatigue and anxiety. My heart was elevated probably for a month really. But you know, this sense of like impending doom, which is my favorite experience and then at a certain point I call it and I think I felt lightheaded. And I called him to the midwife and I was like I don’t feel good. And so she said, Oh, you’re probably dehydrated. So Brendan my husband ran out and got some power rate. And then I drink that power away and I proceeded to vomit all over the kitchen. And as I’m throwing up, my water breaks.
P: Wow….no shade for your husband, but Powerade sounds vile.
J : I happen to like the red one. Reason Yeah, when it’s really cold, the red one kind of spot. I don’t drink it often. But you know, we were trying to I didn’t have much of an appetite and if she you know she wanted me to stay hydrated. So
P: okay absolved…sounds like he did the right thing
J: Yeah, yeah, exactly. Yeah, well, eventually, but it did get all over the kitchen. And yeah, and then the water breaking was like this. You know, just these two things. Two things happening physically at once was insane. And even then I have been learning a birth class. But sometimes when we get to the transition phase of labor, they grow up or they feel nauseated. And so I told Brendan I was like, I think this is normal, like you know, to be growing up and have your water break and things just feel like they’re accelerating. So at that point, my biggest concern is that I’m about to have a baby. And so we go into the I call the midwife and she says come in right away when I when I said that I’ve just been throwing up
P let me ask you a question this transition is like seven centimeters dilated right so yes yeah,
J but this one had been like 12 hours on a triage so I you know, I could
P: okay totally legit Yeah, okay.
J: Yeah. And it’s, it’s kind of you know, with the, for me, you know that’s a bad thing to be just just handle your decisions on how much the dilation is happening and keeping you at home as long as possible. In my situation where I’m already having all these vital sign issues and stuff, who cares when I’m dilated? I need to be in a hospital.
P: agreed
J: But that was missed. You know that that wasn’t caught and so ended up getting very sick at home. And I remember taking we’ll take a cab into the city and there’s a lot of traffic was lunchtime, just like driving around the west side of Manhattan feeling like shit covered in vomit at that point.
P: So, so how does this feels a little bit like a TV movie here?I know the cab drivers happy to take you or where you’re going to get back from the cab or
J: I don’t remember. I really don’t remember I remember like looking at all the like fancy shops in Midtown. And we’re just kind of crawling along. Yeah. And then I get to the hospital and the midwife meets us down in the lobby and she’s like Where were you? Really we were in traffic, you know, like, drive as fast as we can. And then she like escorted us up to triage.
P: Are you feeling scared now? Or what are we now we have anxiety? Yes, yeah, exactly. Right.
I’m feeling scared for you. And obviously I know how this turns out but you still worried about the high blood pressure and the fast heart rate and, and a fast heart rate. The thing that’s bad about that as opposed to high blood pressure is most people say you can’t feel high blood pressure necessarily. Right. But the fast heart rate is a freaky thing to feel.
J Yeah, it is. Yeah. And it’s and it feels exactly like anxiety. So yeah, and so there was this this, I was definitely anxious. And at that point, one weird thing that happened to me. And I don’t and I’ll never know if this was anxiety or if this was the high blood pressure or both. I started hearing like an ocean sound kind of a shot like that. He was holding shells up to my ear. And I went into some sort of other space at that point where I was listening to the sound. I was very calm. And I didn’t say anything to anybody, but like hearing the sound. I don’t think I was really aware of it. In that sense. Like I should say, thing was just like intense. I think it was just the intensity, everything. And in triage, I get a cervical exam and meconium spills out, which is the baby’s first bowel movement. And if it happens in utero, it’s usually a sign of distress, and the baby can accidentally aspirate or swallow it and then get very sick and so once they saw that I think I still wasn’t dilated enough technically to whatever be admitted, but at that point didn’t take me to the hospital because of the meconium. And I said right away I want an epidural men so
P: I’m gonna pause you right there though for a second to say the thing that gets you in as a sign of distress for the baby. All these things have happened to you. You don’t sound entirely lucid once you have the shell sound right, which is a little disconcerting in a way that you can’t access or communicates. None of that none of that gets you access. To the room. Right? That’s a problem. That’s what I remember.
J: You know, it’s t’s because it is such a chaotic situation. That that that is what I remember being the like, being almost relieved, you know that. There’s no way they’re gonna send me home. I don’t have to go do this by myself. Yeah.
P Crazy. So they put you in a room and and what happens then
J :I get the epidural pretty quickly. And then they give me Pitocin very quick. The you know, depending on what hospital on what OB I might have had, I think a lot of situations they probably would have given me a few sections that the employee but they chose to continue with labor, vaginal labor, and so I had the idea of getting the Pitocin and then the epidural, it actually can lower your blood pressure and and women who have normal blood pressure, it can go into too low. In my case, it just made it look normal. Basically, I’d have to look back at the charts at what it was reading at but it was a high or low and that can be a side effect of getting an epidural anesthesia.
P: How does an epidural lower blood pressure so epidural block affects nerve fibers that control muscle contractions inside the blood vessels. This can cause blood vessels to relax lowering blood pressure. This doesn’t happen for all women who use an epidural but does affect a significant share of women.
J So that might have been another situation where that threw them off like once they got me in. And I had midwife looking at my case at that point, not an OB yet and so an OB might have been like well, she came in with high blood pressure and when she got the epidural and drop, this might be preeclampsia. You know that connection wasn’t as far as I knew, they might have been. It didn’t stay in my chart around that time like watch BP closely. So I think they were aware of something was going on. Like there’s a diagnosis.
P Well, this is all a little scary. How’s your husband faring since he’s present?
J: Yeah,he seems to be doing okay. Like it’s we both felt relieved once I was in the room and had the fetal monitor on me and had the the constant attention of a nurse and all that sort of stuff. And I was so much calmer once I had the epidural and I was laying down and can focus a little bit more. I didn’t feel great, but I you know, again, I’m like, How are you supposed to feel? And it took a long time still, though even with all the Pitocin for things to speed up enough to get to the pushing stage of things.
P: so even though they’re worried about the meconium for the baby, this is not a rush situation.
J : I went in and went in the afternoon, that’s like a time and then I delivered at like 130 in the morning.
P: Okay. And so what’s what’s delivery like with you feeling so awful?
J: Yeah, it was it was scary because they knew that, you know, they knew that she had the meconium so they had a neonatologist from the ICU standing in the room. And I have brought in like the little or big kind of almost looks like an x ray table where they examine the baby. She was standing in the corner like watching my birth, the last like hour took a long time. And I hope that she was watching the heart rate monitor and the fetal signs. They don’t know. I just remember being like I don’t know who this woman is, and she’s standing there. And so yeah Adela is born and very quickly, they rush over to table and the neonatologist takes a tube and aspirates her so my first look at Adela is her with a tube down her throat having fluids suctioned out and so that was just like, you know, you’re just terrified. Hoping she Okay? don’t really understand what’s going on.
P: And my guess is there’s no crying because they don’t want her to cry because their afraid she’ll aspirate
J: Right, exactly. There’s no crying and then they do hand her to me. But it’s brief and I can see that she’s not breathing normally she’s like that panting
P: Yeah.
J: And so basically, you know, you can hold her for a few minutes but we need to take her to the NICU and meanwhile they’re stitching me up I have like an internal tear and an external tear. Can’t feel it but you know, the midwife has done our stitching me up and then they take her to the NICU. And then yeah, the next like three days are just absolute hell for me
P: This already sounds like way too much. Delivery where their silence is terrifying. Right, right. When she when she exits her body and you cannot hear Yeah, I wish we’ve all been trying to listen for sound scary on it’s own. Not feeling well. Then they’re gonna take her away again.
J: Yeah, Her birthday was six, six pounds, nine ounces, and considering the gestational age being at like 41 weeks she was small. She was like at 10% or eight to 10% of what’s normal and that, to me, it was like that’s the sign of growth restriction. She was like getting the nutrition from my placenta that she should have been no one. No one ever discussed that with me though. But when I saw the numbers, I was like, wow, she’s I thought she’s going to be huge based on everything that happened.
P: Yeah, yes. So now they have moved you into recovery. I’m assuming and, and baby Adela is in the NICU?
J: Yeah, she’s in the NICU and I moved to this flip the floor or an area of the hospital. We’re just NICU moms, which I didn’t know was a thing. Either, but I’m sharing a room which I really hated with another woman who had had twins, and I think she was having twins have been there a little bit longer, and they immediately want me to start pumping, because I have a breast pump. And though again, like the sleep was such at that point, I was so sleep deprived going into it. And then it’s like 130 in the morning and they’re really wanting me to try to use the breast pump. And then I remember sharing, it’s just like a curtain between us.
P: Yeah,
J: she’s a twin mom and she is using the breast pump constantly. It’s right by my head and I just cannot sleep I brought earplugs and like an iPod you know, trying to drown out the sound and she’d have family coming in and out. You know, it was just like, you know, so noisy and, you know, just hazy. And I think I think I made one visit to Adela before we started to get more concerned about me. You know, I didn’t feel good. The like 12 hours after I gave birth and it kept me on the IV pole for a while. I guess I was on the IV pole for a really long time but they hadn’t taken out the Pitocin they had I don’t know I guess they keep it in after delivery to continue to shrink the uterus But my nurse at that point it was really the the that RN who picked up and she was like your blood pressure is high. Your blood pressure is high. And she kept telling me this. I was like, you know, I don’t know what it was I don’t know how to respond. I was like, you know, and you know, and she just like she’d come in and she was just concerned. She was concerned. She was the surgeon and so she called the midwife and the midwife came in. And she told me Oh, I think we might you might have preeclampsia and at that point I started crying
P:I’m going to stop my conversation with Joy here, and we’ll pick up the rest of the conversation next Friday. For now I’ll say that this experience of medical care is harrowing to hear about, so I can’t imagine what it was like to experience it. I appreciate that Joy shared it with us, because as hard as it must be to talk about it, it’s important to examine and understand how this is happening to someone at one of the most vulnerable times of her life. Birth is one of those experiences that stays with you for the rest of your life…which doesn’t mean it should be perfect, but to the degree we can keep it from being traumatic, that should very much be our goal. I find Joy’s ability to analyze and relate her experience a real testament to her strength and resilience and it’s inspiring to hear how she used that experience to help other women who ran into preeclampsia
Thanks for listening.
We’ll be back next week with the rest of Joy’s story and more from Dr. Oparil and Dr. Sinkey who share more about their exciting work on preeclampsia
Episode 73: A Birth Visited by Too Many Medical Interventions: Nicole’s Story, Part I
Episode 73SN: A Birth Visited by Too Many Medical Interventions: Nicole’s story, Part I
Today’s guest walked into pregnancy with an expectation that the process would be as smooth for her as it had been for her mother, as it was for the farm animals she’d been surrounded by for her whole life, as it was from 50,000 feet: civilization depends on this process and women’s bodies were made for this project. Although the pregnancy part was relatively straightforward, the ways in which her first birth unfolded deviated profoundly from her expectation. In this first part of our conversation we’ll hear how she processed that first experience, and how she used what she learned in this experience to alter the births that followed.
Relationship between Pain Medication & Fever
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976662/
https://www.karger.com/Article/FullText/504805
Audio Transcript
Paulette: Hi Welcome to War Stories from the Womb. I’m your host Paulette Kamenecka. I’m a writer and an economist and the mother of two girls
Today’s guest walked into pregnancy with an expectation that the process would be as smooth for her as it had been for her mother, as it was for the farm animals she’d been surrounded by for her whole life, as it was from 50,000 feet: civilization depends on this process and women’s bodies were made for this project. Although the pregnancy part was relatively straightforward, the ways in which her first birth unfolded deviated profoundly from her expectation. In this first part of our conversation we’ll hear how she processed that first experience, and how she used what she learned in this experience to alter the births that followed.
Let’s get to her inspiring story
P: Hi, thanks so much for coming on the show. Can you tell us your name and where you’re from?
Nicole: Sure. My name is Nicole. I hail from the Midwest, Indiana. I’m halfway between Chicago and Indianapolis.
P: Okay, so let’s talk pregnancy. You have three kids?
N: Three. Yep, that’s right.
P: And what’s the one of the ages?
N: three alive? I’ve three alive. Yep. So my kids are 420
P: Wow, nice. That’s well spaced. Well done.
N: I couldn’t have done it better if I planned it.
P: Yeah. Yeah, totally. I agree. So before you got pregnant, what did you think pregnancy would be like? What were you imagining?
N: Uh, well, uh, so it all kind of happened kind of fast for me. My husband and I have been married now I think for seven years but we have been together for about 20 years.
And yeah, you know, when we were kids, we knew we knew we were gonna have kids, when we were kids, and that was something we always talked about when we grow up when we get married when we have kids. So we always had this, like far off distant idea. of in the future we will have children, but being unmarried teenagers, you know, we’re like avoiding that like the plague.
P: yeah
N: We don’t want to be pregnant. We don’t you know, we don’t want that. You all have that. So we got married, and month and a half later, we were pregnant. It wasn’t quite the honeymoon baby. But we didn’t plan that we weren’t trying it wasn’t intended was not intended, but we were very surprised by it. And so my experience with it was going practically my whole life avoiding pregnancy.
P: Yeah,
N: to now being pregnant and it being socially acceptable, where like, so I didn’t have that time for my mind to shift from avoiding it to desiring it. So that was what what really struck me about my first pregnancy easy Yeah, that emotional trip into dealing with what what was happening?
P: Well, good to good you know, struggle with the front end. Did you find out with like a home kid or how did you how did you find out you’re pregnant?
N: I had an inkling who and I took a test and it was positive. And I, at that time, didn’t think you know, anything could happen. If the home pregnancy test says it’s positive than it’s positive and we just went with it. You know, we, you know, immediately called the doctor because that’s what you do when you’re pregnant, right? You go to the doctor, so we call the doctor we make the appointment we waited the traditional three months to tell everybody you know, in case something bad happened. We did all of those things like the way the cultural norm is so we went we went through all of that and that was all I mean, it’s still like deer in the headlights. You know, I just went from avoiding this to now everybody’s excited about it.
P: That’s kind of amazing. I wonder where the three month rule. I feel like my doctor told me that although I did not follow it at all and had a miscarriage and just had to tell everyone but I think it’s I think it’s from I think my doctor said you might want to wait, but I can’t remember where it comes from. Anyway,
N: I think that’s an old rule when I don’t know when doctors first started playing a big important role in pregnancy and they just advised you know, you want to save face. If you do have a miscarriage. You don’t want to have to go around telling everybody your business that you had a miscarriage and, you know, we thought we thought that that must be important. So that’s what we did.
P: Yeah, yeah. So it was the first trimester easy.
N: The whole pregnancy was pretty easy. Really. I didn’t have a lot of morning sickness. I craved pickles. I was working in a factory at the time. I was on my feet a lot time and that was the big joke like crazy pregnant lady drinking pickle juice. And I did I am but I had heartburn in my third trimester and that was really the hardest thing. You know, everybody has the discomfort and the tiredness and that part of it. But looking back on it, it was pretty easy. I know though that there were days when I was like, Oh my gosh, I can’t do this anymore. Like in the moment you deal with that, but But when it’s not extreme, and there’s not medical conditions and things like that, you just say Oh, this must be what everybody does. This is
P: we just sort of accept it because it’s because how else is it gonna go right? That’s what you’re told. Yeah. So take us to the day of the birth. How do we know today’s today? And then let’s walk slowly through that day.
N: Yeah, sure. So. So looking back on everything that happened where my expectations didn’t really match up to what was happening was like with the birth part of it, and, and that was where, like, the experience just hit me like a Mack truck. So I grew up on a farm. You know, I assumed pigs and cows and horses. You know everything goats, sheep, I’ve seen everything be born. I know like, I knew when I was a kid like population how that happens. So I’ve always known this and I’ve been around forever. And when I got pregnant, my mom’s advice to me was, you know how this works. Don’t read the literature that they give you. It will scare you to death. You know how birth works. You’ve seen it done. Trust your body and it will happen. And my mom, in my mind was a warrior. She had four kids and the first three were born in a hospital completely naturally. The fourth one was a C section. You know, and there’s, you know, the story around you know, how the baby wouldn’t come down to the birth canal and that’s just how it was and whatever. But, you know, I had this wonderful example in my life of how birth was supposed to work. So I thought, okay, I don’t need to read anything. I don’t need to prepare my body knows what to do. I’ve seen it done. It’s going to happen. So I didn’t read anything, not What to Expect When You’re Expecting I didn’t watch videos. I didn’t blogs, nothing.
And my husband says he knew that I was going to go into labor because I came home and I was like, our yard is a mess. I hate it. We’re going to clean it. All up like the baby is coming. I don’t want to have to come home and deal with a messy yard. We’re going to mow it and we’re going to weed it and we’re going to pull all the shrubs out of the flower bed. And you know, I just had all this energy and he said, you know, he reminds me of sitting on the couch after doing all of that work. I was just sitting there saying, I don’t know why everybody says pregnancy is so tiring. And I don’t know why the third trimester is supposed to be so bad because I just have all this energy and I feel so great. He’s like, uh huh, he knew what was coming.
So that night after doing all of this yard work and just feeling so amazing. I got up to go pee at midnight. And as I was sitting on the toilet, I heard like an audible pop.
P: Oh wow
N: That is a gush of water. You know like the things that doesn’t happen to everybody but that’s what it was. And it was read amniotic fluid and I like immediately just began shaking with fear like head to toe overcome with fear, like my whole body to the core was shaking. So I had to wait for this session to stop I had to go wake my husband up in the middle of the night. I have to say you know it’s time we have to no it didn’t take long once he heard me say it’s time like he was immediately awake and alert and up and out of bed and I had a bag packed and you know I am prepared that much at least we did not have a car seat. It was not in our car, but we’re like that’s the least of our worries. We’ll figure it out later. So we grab our bag and we go to the hospital and I didn’t think you know amniotic fluid was gonna leak I had no idea so I just put on jeans and you know I’m still leaking in the car. we didn’t have a trash bag. I made a mess of the car. I walked into the emergency room entrance of the hospital just like water still pouring down my legs and my husband got me a wheelchair and the people are like looking at me like what are you doing here? And I’m like, my water broke and they were like, oh, and then it became an emergency to get me checked in a wheelchair and to the labor and delivery. And so, all of this time though I’m still shaking with fear. We get to labor and delivery and we have this whole big rig mo row. Are you really in labor? Are you feeling contractions? Is this really your water breaking? And, you know, then the they had to do an amniotic test where they had to like swab me to determine that the fluid that was coming out really buzzed amniotic fluid. When it came back positive then they decided that I must really be in labor and I will be allowed to stay because they were so busy that night.
P: That is like a little circus environment there. Although I think most people don’t experience the kind of dramatic and obvious water breaking that you did. So So I think some people are really unsure themselves like oh my Warbreaker broke or not although it seems like yours is pretty clear.
N: absolutely it was
P: And so at this point you’re not feeling contractions are you are
N: i i probably had some pain in my back but I wasn’t feeling like miserable countable contractions I just my water had broken, but I’m also still shivering with fear. And, you know, in the birth that I’ve had since then, when looking back at that situation, I know that that fear response in my body was stopping any contractions that would have happened with that. So like this fear, this flight response that I was having definitely shut down. Anything that was happening.
P: Yeah, there’s a lot of chemistry involved in that in that response. Right. So you can imagine it is telling your body like not now.
N: Oh, well yeah, I mean, an animal’s in labor and there’s an ear Okay. Body says don’t be born because you’ll be taking your days and that’s, that’s what my body was going through. Because even though I like mentally knew that my body was capable of giving birth, I didn’t believe in my body like in my subconscious mind, you know, like, my body was fat and ugly. I hated it. I was constantly putting it on diets and berating it and saying, you know, I hate you all of these cultural stories that we have about women’s bodies. And and that was what was putting me into this fear like this mental juxtaposition of I know I can do this as opposed to the true like deep down beliefs that I have that my body was a piece of garbage like a piece of garbage can’t do something amazing. And and that’s that what, what, threw my first birth off the rails for sure.
P: Yeah, that sounds like a really hard thing to work through in the moment. And did you have
N: I was not aware of it in the moment. took several years afterwards to come to that.
P: Well, you probably knew you were fearful. Right?
N: Yeah, I definitely knew I was afraid and that but you know, I just thought, you know, my, I’m afraid but my body’s gonna do it. And when it happens, I’ll just go along with it. Yeah, okay.
P: And so, since you’re waiting for and stopping contractions at the same time, how does that progress?
N: Yeah, it doesn’t.
It doesn’t progress at all. So after it was about six hours, they have me hooked up to machines and they were measuring my contractions and I was kind of sleeping off and on but I wasn’t feeling the pain and I felt poorly, but I wasn’t feeling regular measurable contractions. So they
Come in and they hook up an idea that kind of, I think it was they started hanging Pitocin at that time. And looking back on it. I see you know, the audacity that they had to come in and talk to my husband about this. They didn’t talk to me about any of it. I didn’t give my consent. Obviously, I wasn’t going to disagree with them at that time. But it was not me giving consent.
P: why aren’t they talking to you?
N: I was tired. I was sleepy and he was awake. So rather than, you know, trying to rouse me and have a conversation with me, they just went right to my husband and talked with him. Because like yep, if that’s what we need to do, then that’s what we need to do. And over the next six hours, they have three bags of Pitocin
P; oh Wow.
N: Which was causing back labor. So by noon, 12 hours after I had been admitted. To the hospital by noon, I was ready for pain medication.
P: Yeah, no kidding
N: They hung up a pain medication. And still they were measuring contractions and saying you know, we see you’re having contractions, you’re in labor. They were checking my dilation constantly which you know, that’s a whole another story of invasion of self being uncomfortable and just adding to those to those hormones that are slowing down labor. But so yeah, by noon then 12 hours later, I was on Pitocin and pain meds
P: man, this is this is hard.
N: So what not what I expected when I went to the hospital, that’s for sure.
P: Did you think it would be fast like what what was the image in your mind? Yeah,
N: so So in my mind, I thought you know, this is gonna be quick and easy. I’m just gonna lay there and my body will take over and do what it’s supposed to do. And eventually a baby will pop out. And I will have this baby in my arms. And that’s, that’s all the thought. That’s all the space. I allowed this event to have in my mind.
P: Yeah, that makes sense. I think people are fuzzy in describing birth, right? They kind of walk fast by that part. And I think it’s hard to find the right vocabulary to make you viscerally appreciate the pain
N: for the first two births. For me that was true by my third birth that wasn’t so true anymore.
P:Interesting. Well, I’m interested to hear how we get there.
N: Yeah.
P: So how do we progress like how do we
N: Yeah, so noon, they start giving me pain medication and then from noon to six, my temperature starts to increase which they attributed to possible infection because my water has broke and that’s the risk of having your why you have to go to the hospital when your water breaks, is because of that risk of infection.
They don’t talk about how the pain medication that they were hanging, for me causes your body temperature to rise.
P: Okay, so Nicole mentions of the pain medications in labor may have caused her fever. So this turns out is not entirely straightforward. Like many things about birth. There are some studies that suggest that an epidural can be associated with a non infectious rise in temperature, but there are many other factors that can contribute to fever, including things like a long duration of labor, and a long time separating ruptured membranes from delivery. I put some links in the show notes on this topic. If you’re interested in the details.
N: so my temperature is rising possible infections still not feeling contractions, six o’clock comes and the on call doctor for the evening comes on to the ward and there’s lots of other women in birth the whole word of school they have women in other rooms of the hospital who are in labor, but can’t come into this labor and delivery and it’s a pretty small rural hospital, really, it was a private kind of thing. It wasn’t part of a huge network. So it’s not a huge fancy place. So the hospital is dealing with their own constraints besides me. Taking up this room, progressing really slowly. Around 6pm They say you know your fever is starting to go up. We need to start doing fetal heart monitoring to make sure that the baby is safe while your body temperature is increasing. You know, we went to to walk we want you to do things to try and move things along. Because if you don’t, and that’s what they started telling me around six o’clock that evening, so 18 hours after I got to the hospital. If you don’t, then we will do a C section. So that kind of also starts weighing on my mind like oh my god, am I not capable of giving birth? Am I going to have to have a C section?
So you know, I’ve got all of that going on. I do the walking they give me more pain meds, they increase I think probably the day to start working on the contractions and around nine o’clock. I went ahead and took the epidural, the first epidural
P: Oh wow,
N: labor doesn’t progress. nothing’s really happening. Around 11 o’clock. They come in and say you’re going to push I think they weren’t declaring me to be around nine centimeters dilated, but by the measurements of the contractions I was having something should have been happening. They criticize the way I’m pushing and say you’re not doing it right. This is how you do it and 11 o’clock goes by and they keep making me push and I’m pushing according to readings on a machine. Not according to my body. Like I’m so out of my mind. I don’t really even know what’s going on. Like I’m I’m desperately afraid of what’s happening right now. And it came to like 1130 and the nurse went and got the doctor and said, You know she’s pushed, nothing’s happening. They decided your body temperature is too high. At 1130. They decided you’re going to have a C section so they started prepping that they started checking my epidural. I could feel where they were poking and all the tests that they were doing so I had another epidural and the anesthesiologist that came in and did it. He had to come in from home wherever he was at to do it. And he just said I’m going to give you two to make sure that you get through the next however long it’s going to take you because again the hospital has a lot of other constraints they were dealing with. He wanted to make sure he didn’t have to do it again right before they did the operation.
It was between 1130 and 1145 or so they do the extra epidurals they have my husband and they put him in you know the full HEPA suit with his beard cover and all of that and
P: wait How are you feeling? Are you are you upset or where are you?
N: I’m drugged out of my mind at this point. I’m still shivering with fear but I just like so out of my body that I I’m I’m not capable of giving consent. I’m not capable of not giving consent.
P: Yeah,
N: I’m just I’m just going along with it. I’m desperately afraid of what’s happening. I’m in fear. I’m disappointed because, you know, I never thought that I would need the epidural. I never thought I would need the pain meds and I’ve taken all of that and now they’re telling me that my baby is in danger. Heart rate might be low that my body temperature is increasing, who’s going to be born with an infection? Just fear.
P: Okay, so this is the issue of fever if the epidural is a catalyst for a fever, but it’s a non infectious source, then we’re not worried that the baby will be born with an infection. Some theories suggest that the epidural along with other factors may induce an inflammatory response in the mother’s body. If this is the case, then it’s not likely that something is transmitted. To the baby and the baby doesn’t need antibiotics. So although we don’t have a definitive answer yet to this, this is an, important focus of study.
N: Yeah, everything was here. Everything was saved my life saved my babies life
P: yeah,
N: and they went we went into labor and delivery and the C section was fine and maybe boy was born. And they put me in a room and my in laws. Got to see my baby before I did.
P: Wow.
N: Yeah, yeah. And looking back that was one of the thing that was hardest for me, especially, you know, in the postpartum recovery was they put me up in the surgery board. They did the surgery. I saw that like they helped the baby’s butt up like you have a boy here he is. And they cleaned him up and took him away. And then they took me to a room to get cleaned up. And I don’t even know what happened what they were doing. You know what happened while they were cleaning me up but they gave me a picture. A photograph of this naked squirmy little thing that had salve in its eyes, you know had on its head and like, that’s how I got a picture. And, and that was like, again, like so surreal. So out of body. There’s not nobody nothing in my arms. My belly is soft and squishy. And I don’t have a baby. And, you know, we had we had called people before I went into surgery just because you know, again, kind of like the three months rule with announcing your pregnancy. It’s you call people because what if something happens while you’re in surgery? Which again shows how fearful we were?
P: yeah
N: what if someone dies with this C section. So my in laws were at the hospital. My mom had come to the hospital and my husband followed the nurses with the baby to see them wash baby after he was born. And he has very fond memories of walking into the room and talking and, and my son like instantly looking for him recognizing His voice. So
P: yeah, so that’s cool
N: has fond memories. Yeah. But it was I don’t know, maybe an hour before I got to even see him. And then like, just the surreal moment of is this little thing. This score me a little baby my and having them that first hold your baby.
P: It feels like you’ve been put through a very weird version of a birth in which you’re present but not entirely and they’re like not treating you like your president at any point. Right? It’s wacky to criticize you’re pushing Oh, you mean from the 1000s of times. I’ve done it before and you know,
N: absolutely
P: the consent thing is weird and shuffling too often. You have the baby off to different rooms, like Okay, we’re done with her. Let’s just that’s just weird.
N: Yeah. And you know, at the time, I don’t have the presence of mind or the perspective that I gained over the next few years to know to say something’s wrong with this. Yeah, yeah. You can’t say what you don’t know. And I absolutely did not know in that moment.
P: But it sounds like it fell off. You have nothing to compare it to.
N: Right. But it just has nothing to compare it to. Yeah, yeah. So you know, then I have the whole hospital stay and you know, people come to see the baby. And I was I was really dedicated to breastfeeding and that didn’t really work well, and baby was kind of grumpy. And it turned out that he had high bilirubin so he was orange and they wanted him to lay under this light. So not only do I have like the surreal meeting of my son, but now they say don’t hold him put him under this light. You know, don’t interact with him except to feed him you know in the hole coming in all the time to check your temperature so you never really get any sleep and just all of the things just was not a great bonding time.
P: Yeah,
N: my mom came to stay with me which really felt good, which was really good. Besides that, just the birth experience of not being considered an active participant in the birth to a person to whom it was happening, that they had to deal with in the process.
P: Yeah, all that sounds really hard to manage emotionally. And certainly your experience didn’t match your expectation at all. What’s postpartum like?
N: My dad came to stay with me after the birth, which was an incredibly generous gesture on behalf of my dad. But in hindsight, and even in the moment, like it was so awkward, like my parents were splitting up in the moment. My dad was like, one upping my mom by being able to be the one who was there. With me. He is not really a baby or a kid person. He was trying to like treat me like his kid. And at the same time, allow me space to be a mom. It was really uncomfortable. So I have these five days, you know where my husband is gone. He had to go back to work and I have to deal with this and driving back and forth to the doctor and baby not nursing and nobody. I had zero support of people saying yes you can rescue they were all saying Oh, baby’s not latching right give him formula. Like no person said, Oh, he’s not laughing. Let me help you.
P: Yeah.
N: And it was only my stubborn persistence that did that but he finally latched on to finally nurse and I finally did that and when that got easier, then I get this you know, whole emotional wave of you know how did that happen? And I think it was probably after my second child was born. But I look back on that time now and I say that that was trauma in my day.
P: Yup, yup
N: I knew that it wasn’t right that what happened wasn’t right and after baby was born, the next morning the surgeon had come in and you know, I expressed to him my disappointment in what had happened. And I said, is it going to be possible for me to have a vaginal birth in my next pregnancy? You know, I’m already planning my next one and I just got the first one in my arm. And he says, no, no, no, V backs are dangerous. You know, in the 90s. We pushed everybody to do it. It was this big thing and we damaged a lot of women, we damaged women in the V back process and we don’t do that anymore. So if you ever see sex and you always have a C section, and besides, your hips are too small, you’re really too small of a person to be giving birth anyway. And that was just that was his answer. And it kind of was weird in the moment when he said that because my mom might know again, my example in birth is smaller than me. And she had these three babies naturally and and she was fine. So how was that the case? And it was about 18 months. I finally am starting to heal. I say, you know, that was a really sucky experience. I never want to have that again. I know I’m going to have kids in the future. And I’m never doing that again. And you know, I start reading things on the internet. I start watching YouTube videos, and around the time that I’m thinking about all of this, we got pregnant again. Like we weren’t trying it. We weren’t not trying but it just happened. And it was good timing and it was right. And so I’m pregnant now. And I’m thinking about all of this, and that freaking doctor was absolutely wrong. I am capable of giving birth and I’m gonna prove it to him.
P: Thanks again to Nicole for sharing her experience. With this first birth.
Her experience of the hospital has a steep learning curve that she uses in future births her attempt to get the birth she was hoping for.
Thanks again. Thanks again to Nicole for sharing her story. Her experience in the hospital has steep learning curve that she uses in future births and her attempt to get the birth she was hoping for. Unlike many women who go into birth with a fully formed birth plan, it calls hoping to avoid another experience. She feels like a disposable contributor to the whole event.
Episode 72: Becoming a Mother without my Mother: Melissa’s story, Part II
