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

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

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

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

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

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

own more tightly in my lap.

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

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

And a little later in the piece she writes:

Early on I figured that postpartum depression was

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

stability against my physiological tendency towards clinical depression,

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

professional. With training and resources.

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

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

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

You can find Nina’s published work here

Information on the newly approved drugs for postpartum depression

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

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

Audio Transcript

Paulette: Hi welcome to war stories from the womb. I’m your host Paulette kamenecka. I’m an economist and a writer, and the mother of two girls. Today’s show features a guest that can give us some perspective on the current climate around two important topics: abortion and postpartum depression. She’s a psychiatric nurse practitioner, who experienced an abortion in the 1970s and peripartum and postpartum depression in the 1990s.

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

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

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

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

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

own more tightly in my lap.

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

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

And a little later in the piece she writes:

Early on I figured that postpartum depression was

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

stability against my physiological tendency towards clinical depression,

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

professional. With training and resources.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

P: yeah

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

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

 

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

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

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

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

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

P: Oh, wow. 

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

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

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

P:Wow. 

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

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

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

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

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

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

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

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

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

Episode 59SN: Experiencing a Late Term Abortion: Kate’s story

Today’s episode features the story of an extremely challenging pregnancy that ended in a late term abortion, which was difficult for many reasons, and made more so by the politics and legal apparatus around abortion. My guest was well into a pregnancy that felt off to her in ways she could describe, but which didn’t trigger any particular medical action, because first, the diagnosis when it came was for a very rare condition, and secondly, she made it past the 20 week screen with no visible issues on ultrasound. That my guests first pregnancy was visited by a significant hemorrhage and was By comparison, the easier pregnancy gives you some sense. One thing she says that I think bears repeating upfront is that extreme circumstances sometimes lead to extreme actions. 

To connect with Kate:

TFMR group support at Ending a Wanted Pregnancy

Coaching and blog at Nightbloom Coaching

Esquire Magazine article about Dr. Hern

https://classic.esquire.com/article/2009/9/1/the-last-abortion-doctor

Statistics on Dandy Walker Malformation

https://medlineplus.gov/genetics/condition/dandy-walker-malformation/

https://www.ninds.nih.gov/health-information/disorders/dandy-walker-syndrome

https://my.clevelandclinic.org/health/diseases/6002-dandy-walker-syndrome

CDC numbers on abortion

https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm

Audio Transcript

Paulette: Hi, welcome to war stories from the womb. I’m your host, Paulette kamenecka. I’m an economist and a writer and the mother of two girls. Today’s episode features the story of an extremely challenging pregnancy that ended in a late term abortion, which was difficult for many reasons, and made more so by the politics and legal apparatus around abortion. My guest was well into a pregnancy that felt off to her in ways she could describe, but which didn’t trigger any particular medical action, because first, the diagnosis when it came was for a very rare condition, and secondly, she made it past the 20 week screen with no visible issues on ultrasound. That my guests first pregnancy was visited by a significant hemorrhage and was By comparison, the easier pregnancy gives you some sense. One thing she says that I think bears repeating upfront is that extreme circumstances sometimes lead to extreme actions. 

I’ll let her tell her story. 

 

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



Kate: Yes, my name is Kate Carson, and I’m from Massachusetts. 

 

P: Okay, wow, fun. We’re going to talk about families and so maybe we should start this conversation talking about the family you came from and how that may or may not have influenced your ideas about the family wanted?

 

K: Absolutely. 

 

P: Do you have siblings? 

 

K: Yes, I have a younger brother. He’s like two years younger than me. I grew up in a family with both my mom and my dad and my brother. And I have a pretty great family of origin. You know, we would eat dinner together every night at six and we did family vacations together and it was a really solid place to get a start.

 

P: And did you think growing up I want to be a mom.

 

K: Absolutely. Yep. Being a mom is the only thing I ever knew for sure. I wanted to be

 

P: oh well, that’s awesome. So let’s fast forward to the being the mom part.  Was it easy to get pregnant?

 

K: You know, the first child didn’t feel easy to me at the time. But if I known then what I know now I would say yes, that was super easy. It took us five months and then we got pregnant. And it was a beautiful pregnancy. When I was pregnant with my daughter Elsie. I was sick for for the beginning. But then the fog lifted and I was just glowing and I felt incredible. And I loved being pregnant with my first pregnancy. 

 

P: That’s awesome. And how was that birth?

 

K: the birth itself was good. I had planned a hospital birth and again, if I had known then what I know now I might have made some different decisions and different plans but I labored for like 19 hours and then I was tired and I said now I’m gonna get the epidural. So I got the epidural. What’s difficult is I’m a puker, not in life, but in pregnancy and birth, so I was vomiting a lot and that was really exhausting and distracting from the process, because it was also sort of one of those people’s a little afraid of vomit. So they gave me some antiemetics and that helped. And when I did have my baby, I was you know, on my back and they brought a mirror and I really liked that they brought a mirror I just remember her head and merging and there were these decreases in her skull and my husband and I just looked at each other for a second like is this okay? And then we looked at the nurses, and they seemed totally chill and we were like oh it was be normal to come out like a raisin. 

 

And she was born and they had to suck out her lungs because of the meconium. So it wasn’t perfect you know, like she was separated from me for a few minutes at the beginning. If I had been better supported to move around. I might not have needed the epidural that kind of thing. But it was the hospital it was the is the hospital I chosen. It was the birthday of planned for. I had her vaginally. There was a little bit of tearing that much it after a few hours after I had a bleeding emergency and that was not great. That was quite traumatic. 

 

P: Let me slow you down a little bit here. So first question is you didn’t get the epidural till 19 hours in because you were imagining you weren’t going to get one at all. 

 

K: Yeah, that was that was the plan. Okay, 

 

P: you can see the birth is something that’s very hard to plan for because there’s no experience, no experience like it and you have no idea how exhausted you’ll be right until you get there. And then you had a hemorrhage or what happened after

 

K: I did…I had a hemorrhage and it must have been happening in my womb but it was blocked because it was several hours after the birth. I’d eaten I finally stood up to brush my teeth. And it was in the bathroom. I was standing there. It was just like I looked down. It was a small bathroom but I had totally covered the floor was what like the entire entire bathroom was a pool of my blood

 

P: goosebumps. Yikes. 

 

K: Yeah. And I looked at my husband and he looked at me and said call the nurse and he went out in the hall. That was his first impulse was to go out in the hallway and he caught the nurse coming in the hall and he said my wife needs you. she’s bleeding. She needs you. The nurse. Not come. She gave him the Oh, like she didn’t say this out loud. But I know how nurses feel about husbands and blood. You know, she assumed he was being a worse and she went on with her with her. 

 

P: Wow. 

 

K: So I was still standing there looking up at my reflection in this pool of my own blood. And seconds were ticking by and the minutes were and I just looked it up and I was like pull the string. So my husband pulled the string and when they pull the string they have to come so the nurse came back in and she she looked annoyed she was visibly annoyed when she came back in and she took one look at me. And then I could see she was afraid. She was afraid. And I think it was the kind of fear where it was like, um, like she dies on my watch. And I didn’t come you know like it was it was very bad.

 

P: But also scary for you to see her scared. 

 

K: Like totally, absolutely. 

 

P: So how are you feeling physically like are you feeling faint? Are you feel totally fine.

 

K: That moment? 

 

P: Yeah. 

 

K: I was feeling I call it crisis consciousness. So they pushed me down on the bed and they were trying to save my life but to my body to me it felt like quite a violent, extreme thing to have happen where they push you down on the bed. They’re really pumping my body on the womb to try to get it to contract against smaller things are going in every orifice. They’re suppositories going in my anus. They’re like things are putting in my mouth. They’re putting stuff in my veins just to try to get the uterus to contract and stop bleeding. And then the doctor comes in and with love goes on up to the elbow in her hand into my poor body. They just had a baby all the way up to the elbow, and basically wiping out like grabbing for any placenta or anything that was left in the womb. 

 

There was no time so the pain medication was not Kicking in yet. So that was way worse than the birth. When people say birth is the worst kind of pain to me birth has a certain kind of intensity in the body like a really extreme physical power and intensity that sometimes includes pain, but it’s not a pure pain experience. This was a pure pain experience, and so it was scary and it was painful and when I was recovering from my birth, I was also recovering from that. I did not need a blood transfusion fortunately, but it was borderline and they kept waking up the thing about hospitals they wake you up all night long when you’re there. Pretty strange because I really feel that sleep is like the most important thing to healing both physically and emotionally. 

 

So they would take my– they must have been testing my hematocrit or something, testing to see what my iron was to decide whether or not it would get a blood transfusion. My baby, of course had been taken to the nursery during this and my husband had been sent out of the room. When I was discharged from the hospital. We all were invited to go talk to a lactation consultant. So I went down the harmful times that lactuation consulting there were a bunch of all the mothers on the ward were there and the fathers to the lactation consultant asked any of you send your child to the nursery? I raised my hand and she said Did she get any formula? I said yes. They said that they fed her from a syringe a couple of cc of formula. And she pressed me down. She made an example of me in front of all the others. She told me that I would not be successful breastfeeding as I had let them take my daughter to the nursery told her she told me that it was like he would never latch because of that. That that I basically like screwed my entire bonding opportunity. 

 

P: That’s crazy. That’s crazy. What while you’re down I’ll kick you if that’s fine. 

 

K; like he’s like this is supposed to be support for new mothers Right? Like, even have a lactation consultant now to support new mothers. My breastfeeding journey was difficult, but not for latching reasons. And I successfully breastfeed my daughter but even if I hadn’t, you know, yeah, that wouldn’t have been my that wouldn’t have been why all those

 

P: all those things you’re describing suggest weird dissonance between like the medical care that you’re giving the emotion of this whole process, right? They’re like divorced completely and I totally get that they have to save your life in the moment and they need to do the things they need to do but to not have someone there to also be comforting and I understand that kicking your husband out because he’s gonna freak out and it’s terrifying to watch your loved one in this. But then to leave you there as if you’re like, getting a two pulled or something. 

 

K: Yes, 

 

P: on your own. seems weird to me.

 

K: It seems weird to me too. And it’s just even if it was the thing I needed for my physical safety in the moment. feels extremely unsafe in every way like it feels to my body and to my mind, like it is the most violent thing that’s ever happened to me. You know, so it’s so confusing. To have it be like I know my doctor is trying to do the right thing and help me but that’s not my experience of it at all.

 

P: Good Lord. Well, I’m glad you weather that and so sorry that that happened. That sounds like I mean it’s it’s like shocking to hear so I can’t even imagine experiencing it because it’s totally scary.

 

K: I used to be a teacher and now I’m a somatic coach. And so to be a somatic coach had to go through all of these cell processes on myself that I then work with other people, and one of them is a vaginal De armoring process where we do pressure point like trigger point in the vagina and on the cervix. And when I got to the cervix and I applied pressure to the cervix. I got I flashback to this. This is what was in my cervix and I would know enough about my trauma to like usually when I’m dealing with trauma, I’m not dealing with my first birth I’m doing with my second birth but when I went to my cervix versus what was their bleeding event. 

 

P: I mean that’s amazing. I’m telling that like this, this is not the traumatic one. This was not the harder one right? 

 

K: This was not the harder one 

 

P: so you leave the hospital your baby’s fine. So all that is good.

 

K: My baby grew so fast. She was so chubby. My difficulties with breastfeeding were in getting comfortable breastfeeding, but I have made way too much milk. It was super fatty she was thriving. So even the problems they had were not the scary problems. They were uncomfortable problems. I found a really good lactation consultant, really supportive who undid some of the challenge before and the support group and so it was among other moms who are also going through the same things. breastfeeding support. And you know, that part was fine. I didn’t I didn’t have hormonal mood disorders or any I mean, I had some baby blues, but I didn’t have like the postpartum depression. I didn’t have any trouble bonding. I just had trouble figuring out how to breastfeed without pain and eventually with the help of doctors and lactation consultants that settled out 

 

P: okay good

 

K:  yeah, so I would say that it was really good she’s she’s still very strong and bright and calm. And she’s she was an easy baby and she’s very much the same person. Now she was then

 

P: that’s awesome. So how long between the birth of the first child and the pregnancy for the second one?

 

K: Well, there were three miscarriages in there. But I would have been on track to be having a baby like three years later, so two and a half years ish until I was pregnant with the next one that I consider a baby No. First miscarriage was a blighted ovum. And the next one was fairly early, and then the next one was even earlier. So it was hard to go through that and that’s when I sort of learned like, oh, five months of trying and then having a healthy baby is actually not a hard journey to get pregnant. Like now I’m having these losses and I’m afraid what does this mean? What does this mean about my body? What does this mean about my fertility? Right? 

 

P: Yeah, that sounds much more complicated and so interesting, because I think all of us for the first one imagine the minute you start trying to be pregnant because you’ve spent your life until then, like worried that you get pregnant right when you weren’t ready or

 

K: Absolutely my whole life until then. I mean, I can’t tell you how many years I was on the pill. I was on the pill before I was sexually active because of really bad cramps. And then I continued on the pill when I was sexually active. I would sometimes use condoms as well. I had been so careful because it just felt it’s interesting to grow up feeling like my womb is like a ticking time bomb of catastrophe, right? Yeah. Not the relationship I want my daughters to have to.

 

P: That is a really good way to describe it. It is like a tricky, tricky relationship there. So now you’re pregnant and this one sticks. 

 

K: This one sticks, and I’m glad that it’s sticking but I’m also very anxious because of all the miscarriages I’ve had before so it doesn’t it doesn’t feel real for a while I’m very sick for this pregnancy. Second, on second sticky pregnancy. And I’m just like, sick all the time having a really hard time making it through the week. I remember I would take my daughter Elsie was two at the time, take her to the grocery store because she could just like grab up to go meal and I would sit there and eat and I remember there was a week. I could not eat and I know how bad that is. I remember my midwife being like you have to eat but like, easy to say you have to eat. It’s really hard to put food into your body when you’re as nauseous as I was.

 

P: Yeah. And not excited to throw up.

 

K: Yes, I’m fearful of vomiting. But there was this one day at the end of that week where I had asked him not wanting to fast where I just saw the pepperoni pizza and I was like, yes. Nobody asked him a few pepperoni pizza. So I bought one and I ate it and then it got back up and went through bought another one and I ate it and it was like, okay, okay, now I can eat. The pregnancy was a little bit difficult in other ways too. I developed sleep apnea during this pregnancy and that like I was falling asleep on the park bench not just in the first trimester when your hormonal exhausted but like into the second trimester. 

 

You know, I was like 25 weeks and falling asleep at the park because I wasn’t sleeping at night. And I called my family physician. And he immediately referred me to a specialist. The specialist was a neurologist and I went in, he looked at me and he goes you’re pregnant. And he said you don’t have sleep apnea. You have restless leg syndrome because you’re pregnant. I said, I’m quite sure I don’t have restless leg and my husband says I stopped breathing at night. Here hears it. He witnesses it. Can I please have a sleep study and he turned me around and I stood up for myself to a point but not far enough. I did not make enough of a nuisance of myself to get that sleep study and I went home defeated and continued having sleep apnea. 

 

So years later, I did get the diagnosis and I got the CPAP it feels terrible to be discounted that way in your pregnancy 

 

P: yes, yes. 

 

K: Meanwhile, with my obstetric team, I would tell them that I was very anxious about this pregnancy. And maybe because I was using the word anxious. They will be like okay, it’s a problem as anxiety, right? They would take the heart rate they would like measure me they’d be like, everything’s great. And I’d say, you don’t understand like something feels really wrong with this baby.

 

P: No one has explained or understands what led to the repeated miscarriages at this point. 

 

K: correct. My first miscarriage I got a DNC so you go on the internet. And the internet is convinced that everyone has Asherman’s syndrome, which is scarring and adhesions of the womb and there are some women who do so I’m really glad these groups exist, but it there’s a real bias pushing people towards that assumption online. And so I thought I had Ashmans so I got seen by someone who put a scope in my uterus and took a look around in the walls of my womb were very smooth and very pink just the way they should have been. So that was not my situation. I still don’t know why I had those miscarriages. I have no reason why anything that happened to me happened. 

 

P: I was kind of imagining that your anxiety is to some degree related to this uncertainty about what was going wrong before but it also sounds like your body has some intuition that like something’s not quite right.

 

K: Both of those things are true. At the beginning. It was just based on the path of miscarriages I’ve been on and not having any reasons and just like wanting this so badly and feeling so out of control of it. Right. Is very normal. A lot of people Yeah, in pregnancy. The pregnancy progressed, different things felt wrong, like things I could actually point to felt wrong. And I got my scan at like, what like 19 weeks 20 weeks when I got my anatomy scan. They left the room and didn’t come back for like a half an hour. And my husband and I were looking at each other and being like, are we done? They didn’t say goodbye but they also didn’t say to wait. We left and my midwife called and was like, Why did you leave? And they said because I thought it was over. They ended up escalating us for a closer look. I thought they saw something on that ultrasound and they escalated us for a closer look like teaching hospital the level two with the maternal fetal medicine specialist. He took a look and he was like a long look like an hour long like and he said everything looks perfect. I’m so glad to give you this news that everything looks perfect. The genetic counselor was ready to like break out the champagne. And I remember looking at her and saying how short is he? Should we come back for another look like how short is he that everything’s okay? And she said like by overturning that concern. He basically is staking his job on it. That everything’s okay. She’s so sure we said okay, and we went on our way

 

P: and they didn’t tell you what what they saw that caused them to ask for the higher level.

 

K: Eventually they did but no not not when they sent me for the high level they were like just don’t just don’t google it. Just don’t google it. You know, when it was dandy Walker malformation was the thing they thought they saw and they sent me that’s a brain malformation, a set of brain malformations and they sent me to him and he was like No, this baby’s fine.

 

P: Dandy Walker malformation is a brain malformation that occurs during embryonic development and affects the cerebellum area of the brain that helps coordinate movement and is involved in cognition vision and behavior. With this condition, the cerebellum is absent or very small. In some cases, like Kate’s it can also affect other parts of the brain. 

 

K: Well, that hung over me too. 

 

P: Yeah, 

 

K: right. So that was one of the other things that was hanging over me and then this thing I could really point to was the way my baby move was so weird way my baby moved in my womb was so different than her sister. So and Elsie healthy baby was moving around in the womb, sometimes she would be very active and sometimes she would rest. Sometimes she would flutter and sometimes she would like kick her elbow or roll right like there were multiple sensations made sometimes were very active and sometimes there were long periods, hours long periods of rest, while she probably slept. This baby moved all the time. 

 

P: oh, That is weird. 

 

K: No rest. And this baby moved the same way all of the time, and it was spastic tremors and spasms all of the time. So when I would try to say this my medical team I would say something is really bothering me. She moves all the time, and they’d say, that’s great. I will tell you I don’t think there’s any literature on this. It’s been several years since I last looked. I don’t think there’s any literature so they would have no way of knowing what I was talking about. But I knew experientially in my body that it was very, very different.

 

P: So I’m guessing this as a rare condition is a rare condition. It’s really hard to be at the edge of medical understanding where you have a sense that something’s wrong but no one is echoing that back to you because they don’t know what they’re looking for.

 

K: Exactly. They believe it’s one in 10,000.

 

P: Okay, that one in 10,000 statistic may have been what was available and she was going through her pregnancy in 2012. But now doctors estimate that it’s roughly 1 in 30 1000 But Kate’s case is even more rare, given the specific complications that her pregnancy involved. To put them in perspective. According to the National Weather Service, your lifetime risk of getting struck by lightning is roughly one in 15,000.

 

K: But most people end their pregnancies rather than carry when they get this diagnosis. So even though 1 in 1o000 pregnancies may have this not one in 10,000 births.

 

P: Right. Okay. And what is the diagnosis and when did you get it?

 

K: Well, wasn’t until later when I was trying to prepare for my birth at a birth center. And my midwife was asking me how I was feeling and I expressed continued anxiety she said, You know what, we need to get a look at you because I don’t want you heading into your birth feeling this way. So she leveled me up and sent me in for an ultrasound. I was 35 weeks pregnant when I went in for that ultrasound, date of last menstrual period and they did the ultrasound and I was being very chatty. And the technician was being very quiet. I thought she was just having a bad day. She was I didn’t know why. At the very end, I was talking about how having another baby like, I know she’s going to be different but like part of me just imagines that all babies are the same. It’s gonna be just the same as when I had my first baby. And she looked me right in the eye and she said, this one’s different and sort of like froze

 

P: that’s chilling.

 

K: And then she sort of shook it off and she said they’re all different. All babies are different. And she left the room and she got the doctors and the doctors came in. Remember two women clipboards glasses, white coats. I’ve never met them before and they said, you know those problems we weren’t seeing last time you were here. We’re seeing them today. Your baby has dandy Walker malformation, and she may be missing her corpus callosum which connects the two hemispheres of the brain.

 

P: As you can imagine, the cerebellum is already compromised, and now the fetus is missing another part of its brain. As Kate mentioned, the corpus callosum is a C shaped nerve bundle that connects the two hemispheres of the brain allowing them to communicate to be born without this nerve bundle. can lead to a whole host of issues, including seizures, feeding problems, delays and holding the head have racked impairment of mental and physical development and or accumulation of fluid in the skull called hydrocephalus.

 

K: So she has several brain anomalies and they pointed it out to me on the screen. Her brain should have looked all gray all light gray on the screen, but there were big patches of black and that’s where her ventricles had swelled with fluid where you know where there should have been gray matter, but instead there was just fluid. She would eventually probably develop hydrocephalus, but no one could tell when that would happen. If it happened before she was born, it could swell her head to undeliverable proportions. They were telling me all about like, I would need a C section. And I remember I was like, but I want to breastfeed and they were like, Oh, honey, like, I don’t think you understand. You know, I was in such deep denial that I was clinging to things like but I want to breastfeed but I wanted to give birth at the birth center. But if they were like, you’re so far out of that plan right now, but I just couldn’t hear it. And the only thing I heard when they said after telling me all about the plan to stay in the hospital and resuscitate the baby basically told me, We can offer you adoption. We might be able to offer you abortion, but we just don’t know.

 

P: So what’s the prognosis for these kids?

 

K: It’s a really good question. They wouldn’t give it to me that day. But two days later, I had an MRI and I met with a neonatal neurologist. And he said that my baby given the extent of the missing pieces in her brain was not likely to ever walk, talk, support the weight of her head or coordinate swallowing she wouldn’t be able to swallow. I remember hearing the swallowing and saying this is very, very sad, but I know we don’t want a feeding tube. If this baby cannot thrive, we do not want a feeding tube we want her to pass naturally. And someone on my team said you can’t refuse an infant feeding tube. That’s not within what’s legally available to you know, that was when I sort of was like, oh my god, like what? Like, and they kept saying I couldn’t read to hospice because this was non fatal, but they also kept telling me it was going to kill her probably very quickly. So,

 

P: when they say non fatal, though, they may not immediately

 

K: that means I don’t honestly know what they mean. I didn’t know what they mean. From what I can tell. It means 0% of these babies survive more than x number of hours. So not just immediate but complete. And there are so few conditions for which there’s like no question of when a baby dies. You know what I mean? 

 

P: Yeah, 

 

K: but I will tell you that I talked to my friend after later who’s an NICU nurse. She has had a few babies like my baby and she has never seen one leave the hospital.

 

P: Wow….I assume it’s completely overwhelming,

 

K: it was completely overwhelming. And when he just kept saying like all these things, she won’t do this. She won’t do that. She won’t. He didn’t say well, he was very he was very careful with his language. I’m a scientist too, so I recognize what he was telling me. She won’t likely it most likely she will. If she walks it will be after many years of training with braces and therapy. If she talks it will be a few words after intensive verbal therapy for many years. He wasn’t making any promises but he was showing me the spectrum. The outcome was really like this person will have a very limited life if she lives at all.

 

P: And the reason that there’s uncertainty in part is because they’re looking at a scan of her brain in utero, so they can’t quite make out exactly what’s missing.

 

K: and Even if they could the brain is so plastic the brain is amazing. It is totally vital and important to life. So that if there’s a problem that can be a huge problem, but it is also very plastic and that neural networks can form. You know if there’s a normally a message that would go through the corpus callosum across the brain, sometimes the brain can figure out how to make a different network that we were using. Right? So that is how you get your people who really thrive more than expected is that their brains are plastic. Also the brain development is not complete until you’re 25 years old. So if you’re lucky and your brain is able to grow in line with your needs. Best case scenario for my child is that she would have lived, I don’t know maybe to the age of 10 Maybe that she would have been able to do a little bit of mobility for a little bit of time every day after much physical therapy. It’s you would have been able to communicate mostly non verbally. That’s still a very limited life. Right? And when I saw

 

P: it sounds like there’s so many motor functions that don’t work like swallowing and walking was confusing to me is that there are things there that are so limiting. It seems like wild to say in a couple of years. You’re gonna live with a feeding tube for a couple of years with no

 

K: children like my baby would, as long as they live with me either feeding tube or a port right like a child like that would definitely get a port they were also telling me that you know this is a seizure disorder. It will eventually result in hydrocephalus, which will cause further brain damage both the seizures and the hydrocephalus. So if you want her not to get worse as best, she would require brain surgeries. So there was this like really invasive surgery that she would need maybe multiple times over her life. Yeah. would never make her better. It would just slow down the rate of getting worse that would protect against against getting worse. But It’s painful. To all of this and being like all of these things she can’t do. I can put it in my head now because I have a friend who has a child who has survived to to into childhood with this disease or something similar to it. And so I can imagine now because I’ve done my research, but this was really acute early days. And I just couldn’t picture my child and I just wanted a picture in my head of how my child would be not just how she wouldn’t be. I asked him, she won’t do all of these things. What do children like mine do? Do they just sleep all the time? He winced and he said, children like your child are not often comfortable enough to sleep

 

P: God, taking away everything. Good lord. Yeah. So will they will they counsel you about like what to do or

 

K: sort of? It’s tricky. It’s very, very tricky. Now I do this kind of polling. So I understand how it’s tricky. It’s very tricky to hold someone in a values based life and death decision making out, pushing them or shaming them. Right so I did receive counseling from a genetic counselor. And it’s really like just this open space where you’re like, what do you need? And I was like, Well, I need to know how much this is going to cost. And she’s like, Okay, I’ll get you a social worker, who’s going to tell you how much money you need to raise a child like this in the world. I never got that far. That night when we were going home. I call my doctor said I want all my options like I want. I want them all. Please call me back with everything that you have. 

 

And so she called me back I already knew I talked all day with the intervention. Team. So I already knew that like we push for life option, but she called me back and she said, here’s the adoption number. They specialize in medically complex children here and she said, I’m so sorry, but if you want an abortion, we have to hang up right now because you have to call we had a half an hour I had to call in the next half an hour or the week would have been over in the timezone I was calling she said if to call before the end of the workweek mountain time. I remember thinking, mountain time. Right. Now, what is she talking about? But I didn’t want to provide any friction. So I just took the phone number. I said thank you. I called it and the woman picked up in Boulder, Colorado. And she explained to me she’s she again she said I’m so sorry. But if you want this abortion, this was a Friday night she said you have to be on a plane on Monday. You have to show up in Boulder with $25,000 on Tuesday.

 

P: Oh my god. Just being pushed to make a decision that fast already seems like whoa, whoa, whoa,

 

K: I know, I know. But I was 35 weeks pregnant. I did not have time. I did not have time I was 35 weeks zero days pregnant the day that I called the clinic. And she said this is the thing like we don’t have time. It’s a four day procedure. So putting it off till Tuesday is like the latest. We can put it off right this was until 2012 to so Roe v Wade was in place. But the reason I could not be seen at home is because Roe v Wade did not protect my case because it was after these opposing point of viability, which had always legally been measured dates wise and 25 Weeks was about where it was at I was going through this hellscape

 

P: will you just remind us viability just means you can live outside the womb. That obviously doesn’t mean unassisted.

 

K: It’s another one. Fatal where it means nothing to me. Now that I have been down this rabbit hole. What does viability mean? Supposedly it should mean that if you give birth to that baby, you can live without the life support of your body. But my baby clearly couldn’t, right? Because even the feeding tube even though it’s a small intervention, it is still an intervention. So

 

P: well feeding tube forever, right? I mean, it’s one thing to say they’ll need a feeding team for you know, two months until something develops, this is not getting better. So that’s a different thing entirely.

 

K: There’s no getting better from this particular constellation of brain anomalies. There’s only like, you mitigate it, and maybe the brain is plastic enough. To have a good life or like you die real fast. That’s it.

 

P: Well, it sounds like maybe you live for a little while with pain and no way to communicate that well or feel better. And then you die slowly or you die quickly.

 

K: Yeah, I mean, it when it comes down to this, it gets so hard because it’s like, life is beautiful. And even when it’s brutal. It can be really precious and important. And so sometimes people choose to go forward even though they know what the pain is going to be. You know, and I really respect that and I want to hold so much respect for that choice because it is beautiful. Life is a beautiful gift. Sometimes it is brutally hard. And the gift I chose for my baby was peace because in my values for my family. That was the gift I wanted to give my daughter was the certainty of peace. So I always think of it as life and peace and like most pregnancies, most babies, they get to happen both and of course we want to give them both. We all want to give them both. But sometimes like in my situation, I could really only guarantee one of them.

 

P: Yeah I mean for me the hard thing is making that choice for someone else. Right. 

 

K: totally, totally

 

P: So so it’s not I mean, you might choose that for yourself but to choose for someone else to live in out of discomfort is so I mean and I agree with you like it is amazing that other people make a different choice, and I applaud them for that. But I think I would live with guilt of inflicting this on someone else, right knowingly. It’s different when you know, right? 

 

K: Totally. And for me I feel so strongly about it for my baby and for my body. You know, there were 48 hours there between my ultrasound and my MRI. I did not know that abortion was available. I did not know that it was an option they had told me maybe and I had talked to them about it and they had said, No. Where did you use to send women and they say they said oh we used to send women to Kansas but we can’t anymore. And the reason they couldn’t anymore is because Dr. Tiller the abortion provider in Kansas was shot in the face at church because of assassination. Because of domestic terrorism against abortion providers. 

 

P: Oh my God

 

K: Yeah, so and I knew that when she said that, somewhere in my memory, that new story popped up and I was like, oh my god, what am I getting into? So there was this time where I didn’t know there was anyone who would take me I was so pregnant, like I was so pregnant. And yet I knew for sure that I couldn’t do the only path that was legally available to me at home. So I was making all these contingency plans because this is desperation right

 

P: wait, why is it not available in Massachusetts.

 

K: So it used to be you see if I can get this right and please let anyone who knows more about the lock correctly if it’s not believe it used to be that Massachusetts it was legal to provide a termination of pregnancy up to 25 weeks from conception. However, instead of measuring from conception, they would measure from date of last menstrual period. I don’t know why did that bullshit, but it shaved two weeks off. Either way. I was 35 weeks and I was well beyond. Now Massachusetts didn’t have to provide until 35 weeks because Roe v Wade only provided to 25 weeks from date of conception. So they were in line with Roe v Wade. Now I have fought tooth and nail along with several other really prominent activist mothers like myself. We have expanded the laws in Massachusetts called the Roe Act that allows for quote unquote, fatal or lethal anomalies first of all to be determined by the doctor so that we do not actually say what’s legal we let the doctor decide what’s legal, and second of all, to be terminated at any stage of pregnancy, in the case of these legal anomalies. Now, as you and I have discussed, I don’t think my baby would qualify, we thought based on the way they talk about legal anomalies. It was based on the way they talked about them. So I think it still wouldn’t help me but it still would help someone who had say a diagnosis of Trisomy 13. But that’s usually picked up much earlier. Much much earlier. It would help someone who had Oh with something that can happen later in pregnancy like I know someone whose baby had a horrible brain bleed later in pregnancy and she might have been able to access his care. I will fight tooth and nail even if it helps one woman, you know, because I know what it’s like to be cast out of care and right now in this environment in 2012 when this happened to me, to have to go to Colorado was a very rare thing. Right now it’s common in the waitlist to Colorado. I don’t know I haven’t talked to the physician lately, but I would imagine it’s at least six weeks long. And if you’re 35 weeks pregnant, six weeks is too long.

 

P: Good Lord. Oh my god. Yeah. So

 

K: I know if you believe that it is morally superior to get an abortion earlier in pregnancy than later then you have to make abortion early as accessible as possible. Because what happens when men’s produce is that everyone ends up waiting and all the abortions happen later. Even for those of us who don’t think it’s morally reprehensible based on dates, it is unambiguously safer for a woman in her body and your fertility to get the procedure she needs promptly than it is for her to wait. So that’s just my plea for everyone to bring some sanity back to this. But in 2012 I went to Colorado because I was denied care.

 

P: I thought you can’t fly after 28 weeks.

 

K: Oh my god, that was a huge source of stress. For me. That was a huge source of stress for me. So it was in crisis mode. And in crisis. You don’t ask any questions you don’t absolutely have to ask. 

 

P: yeah

 

K: So even though this was in my awareness, I did not ask my doctor. Even though my contingency plans were extremely unsafe and illegal. I do not tell my doctor because if I had told my doctor I was going to do something that might kill me, like go off in the woods and have a medically complex child in the middle of nowhere as far away from the hospital as I can get. She either could have hadn’t. You know like, Okay, now you’re putting your life at risk. And I think you’re sort of suicidal and I’m gonna get you this abortion, or I’m gonna get you put in a mental hospital and then you won’t be able to get an abortion at all right? So like, I knew those two sides of the coin, or this sounds dangerous. We’re going to bring a child protective services and take away the child you have because we don’t think you’re a mother. Right? Like, this is what desperation does, is it gets us against a wall like that. So when I went to Colorado, it was like this door opened. This door opened and I am stepping through it because I can live with myself if I terminate this pregnancy and I might die with my other options that I can ethically live with within myself that are in line with my own values,

 

P: And I’m assuming that your partner is on the same track.

 

K: My partner was so supportive, my husband was incredibly supportive. And you know what? I did not tell him either about dangerous plans. I kept them all the way inside. But he was absolutely like, Yes, I will get the tickets. I will book the hotels. This is a week long procedure. This is not a day. This is like a week of my life. And so he actually was so generous as to say at first when we were driving home from the neonatal neurologist and we were in the car. I knew what I wanted. To do, but I couldn’t say it. It hurts so much to say abortion. And so I looked at my husband, he always wants to please me. And he always likes to say what he knows I want to hear. And so when he looked at me and he said What do you want to do? I said, I need to know what you want to do first and I need you not to try to sugarcoat it. 

 

And he said I think we should ask about the abortion. And it was like I had been in his dungeon and it was like the light just flowed in and like I just felt like fresh air and sunshine when he said that because knowing that he was on my team, and then I didn’t have to do it alone. Something that’s so stigmatized and taboo to at least know that I wasn’t completely alone was incredible. And to know that our values were in line around this. It’s a tricky value situation. 

 

So we went to Colorado and we did not have $25,000 But again, I didn’t ask because I didn’t there are abortion funds and everyone listening should know there are abortion funds and you should ask for money if you need it. However, we do not ask but we did ask my parents so I did tell my mom and I said mom, I think I’m gonna get an abortion and she cried with me and she said I would do the exact same thing. 

 

P: Oh, that’s so nice. 

 

K: Yeah. And she asked my dad because my mom has been you know, she she has run our household and been an incredible volunteer in our town my whole life, but she has not earned money for a long time. So my dad’s the one with all the finances in the family. She asked him and he said this is exactly why these procedures exist. Because when you’re talking about abortion of 36 weeks even there is no safe audience like there’s no one who I can say like would absolutely support that. Right. So I didn’t know what he was gonna say but he said this is exactly why these procedures exist. They pulled money out of the retirement early, because you can do that for medical emergencies. And they able to arrange the finances while we live. 

 

Now Oh, I remember you had said you’re not allowed to get on a plane. So this was a huge source of stress for me. I dressed in my husband’s clothes. He’s much taller than I am. He’s just like a much bigger guy than I am and I dressed in his clothes, so they were like droopy. It’s like when you hear about teenagers who are trying to hide a pregnancy. That’s what I was doing. We were in the airport and just thank God that those counters are so high, you know and that I carry small because right and petite woman and I carry small and we couldn’t sit next to each other because we had booked them just just like the day before, you know so we were opposite ends of the airplane and I just was so afraid someone would stop me because if someone stopped me I didn’t know what I would do. 

 

P: Yeah, 

 

K: I actually told my husband before we did this before we went up to the to the site. I said we need a new story. I’m pregnant with twins. That’s why I’m big. Like I really that was the story I gave him. I Now know women who have asked their doctors for a note of travel that is also an option. So unfortunately you can’t do that if you’re in a hostile state. So if you’re in Texas please don’t ask your doctor for a note of travel because it could get you or your doctor in a lot of legal trouble but I went with the big of made up story. 

 

P: Good, that’s smart

 

K: Yeah. No one challenged me good when stopped me. So we ended up in Colorado. The clinic is quite protected. So I remember we went to look at or it just so we know where we would go in the next morning. And we were like Oh, do you think it’s like the bunker with the razor wire? For us? Yes, it is. We see it in just a nondescript hotel. And again, we don’t want to be seen. So I never came in that hotel, the front door not once I waited out by the emergency exit and my husband would go in and you come up in the door. And then go on stairwell. So every time we came in and out of our hotel I would come in and out the side door. It was a lot of shame. And that particular piece was shame I put on myself like no one made me do that. But I was so afraid. That if I came in this big pregnant lady all week and then one day I came in not pregnant anymore. I was just so afraid. What that would be like to be seen that way.

 

P: It’s so sad and crazy to me that at this time when you need the most support ever and you’re going through so much that you also have to reread this totally that this clinic is fucking surrounded by razor wire, what?

 

K: my physician, Dr. Warren is clinics been shut off before you know and he’s an inspiration. He’s incredible. He used to give obstetric care overseas in a country where abortion was illegal. And he will tell you, you can read it. I think there are articles in Esquire. It’s called the last abortion doctors somebody who’s from a long time ago, but he will he will say like one side of the ward for all these happy women with their babies who wanted to have babies and were ready to have babies on the other side of the board. Were all these women like in dying because they were not ready to have babies and had botched abortions and got really badly. So he gives abortion care at all stages of pregnancy is one of the very few doctors in the country who does and he will say why do I do this? Because it’s the most important thing I could be doing in medicine. And he was there for me in 2012 There were two clinics in the country that would take one of them was closed for the week. So Leroy carhart’s clinic in Bethesda Maryland would have taken me but they were closed. And Dr. Horne Hearns clinic in Boulder would take me there’s also southwest women’s in Albuquerque, but they don’t take women as far along as I was it’s only to 32 weeks or 30 It’s not as far maybe 34 It’s not 36 at that much and then since then one new clinic has opened in Washington DC. So that’s another one to know about.

 

P: I can  imagine that you’re in a particularly rarefied group because your problem is rare. Yes. Right. So they just that’s why they didn’t find it until so late

 

K: and often when people end pregnancies for medical reasons. The problem presents itself early in pregnancy. That’s why we do prenatal testing. So in my next pregnancy, I got a blood test with free cell DNA. So I knew that the most common chromosomal problems I knew my baby was chromosomally normal, right with x and y and 1318 21. Right. So some of these things can be picked up very, very early. And some of these things can be picked up later. Like when people might have a heart defect that tends to be picked up around 20 weeks, but the brain keeps developing. So what I find is that brain anomalies are the most often late detected, 

 

P: under diagnosed, right? Yeah,

 

K: exactly late diagnosed or under diagnosed category of malformations. And of course, problems can come up in a woman’s health as well during a pregnancy. But if I had had a problem with my health, and there was no problem with the babies at 36 weeks, I imagine it would have been crash C section and everything would be a celebration. That was not the situation. Of course though, her having a complicated medical situation complicated my health and safety as well. if her head swelled to those proportions. Her low muscle tone made her harder delivery, right. 

 

P: Yeah, 

 

K: there are things that was no longer a straightforward pregnancy. So the idea of going rogue in the woods was quite dangerous. It was really not a good idea. For my well being,

 

P: I mean going rogue in the woods wasn’t high on the list was it was on the list.

 

K: no, it was a last ditch effort. It was like if nothing else, and I didn’t know them, but I do know now, because Dr. Herring told me that if what you really want is hospice and hospice, you should hit up Johns Hopkins because Johns Hopkins has an infant hospice program, most hospitals don’t.

 

P: God..So much more complicated than politics allows for it to be.

 

K:  It’s extremely complicated. 

 

P: So I’m hoping that people in Colorado are supportive. 

 

K: oh, God, I love them my trauma that I have done a lot of PTSD work on everything. Basically already happened. Once I landed in Colorado, I was so well held that even though this was extremely sad, and extremely hard to not have trauma from my clinic.

 

P: good

 

K: Yes, it is. It’s amazing. Not a guarantee, but that’s the way it was for me it was that I felt so safe and so loved in the care of my medical team. It was enough for me to get through it. So day one is counseling, and then euthanizing. Injection. So at the end of a lot of education and testing, just he won’t treat anyone that he’s not he doesn’t feel can safely go through the procedure. And then there’s a lot of like, this is what’s going to happen. Do you consent to it. I signed my consent. And Dr. Pan was my witness. He removes me from my husband for that because coercion would be a terrible thing in this situation. 

 

P: Yeah, yeah

 

K:  And he really wants to feel like yes, this is this is making a decision and they delivered a euthanizing injection to my baby’s heart, and that was just emotionally devastating. Pain wise, it was it was just like an amniocentesis. It’s just a needle, just one shot. Emotionally. It was so hard. And I remember at the end, he asked, How are you feeling? And I just burst into tears. I said, I’m just so sad, which was great for him because he just wanted to know I wasn’t in some sort of medical shock. You know? 

 

P: Yeah, yeah, 

 

K: he gave me some tissues and have been nurse stayed with me for a long time that day. I thought I wanted dinner. We’ve been at the clinic all day and you can only bring book into the clinic. That’s it. You’re well in the book. Because espionage is such a tactic of the right to lifers. And when we left I thought I wanted dinner, but she moved she hadn’t passed yet. And I was like, okay, scrap that and I went back and lay on the hotel bed until until the movement stopped and she passed away. When I stood up my belly, which had been like so high and so tight was just just drooped like the life has gone. She just drooped so hard. That was emotionally the worst part. After that there were two days of laminaria laminaria these little seaweed sticks that absorbed the water from your body as well. So the first day, they inserted them about hurts, but it’s only 10 minutes of my life

 

P: they insert it in your cervix?

 

K: into the little hole in the cervix, and then they pack the vagina so it doesn’t fall out in the packing has iodine in it to prevent infection and then over the course of the day, it gets bigger and softer. That’s a we took a drive into the mountains we just sort of it was like a weird sightseeing trip. We just went around and we’re in nature went out to dinner the next day. Again, they take the old luminaria out put new ones in that day it started getting cramping and I had to take medicine to make sure I wouldn’t go into labor. I remember taking a little walk in a little park and feeling like I’m gonna throw up now. I’m just taking it easy the rest of the day and then the last day the fourth and final day of procedure. This was a Friday this was 36 weeks zero days from the last menstrual period they induced my labor. 

 

So they gave me Pitocin and the contraction started and I came in four centimeters dilated. Do you remember that first story with the 19 hours of labor? I was four centimeters dilated at 19 hours with my first 

 

P: Wow. 

 

K: And this labor was I have never had a child without some form of pain management right like I have had the epidural so I was a little bit afraid that I wouldn’t be able to do it. But as soon as I got into labor, I sort of got into that rhythm of the body. I go way inside when I’m in labor, and when I close my eyes, I actually see beautiful visions. When I’m in labor. It’s like this altered state of consciousness just like almost like a trance state. And that happened and it was very supportive. I saw very beautiful things on the inside of my eyelids and I knew it wasn’t real. It was not not confusing or disorienting. It was just beautiful. So I labored for two and a half hours. And then I felt like I had to pee very, very badly, very urgently very quickly. And so they hobbled me over to the toilet and I couldn’t pee. Now I know her head was in the way she was descending. My body started pushing and I had never experienced that before because I’d had the epidural. And my body just started pushing and I was screaming I’m pushing I’m pushing. abductor hurt was like stop pushing, which is so silly. It’s such a silly thing to say. It doesn’t make any sense. 

 

P: As if you can control it. 

 

K: Exactly. This was not voluntary. This was not on purpose pushing…it was extremely powerful. So I did manage to get on the table and I delivered my baby into Dr. Hearns hands and he does a quick little evacuation of the uterus to try to prevent a bleed like the one I had, but it was not invasive. The way the other one was. I mean, I’m sure he took his scope and went in but it did not feel the same. It felt okay. And then I went back to rest. Then after some time, he brought my baby to me so that I could see her body so that I can do and really glad that they gave me that opportunity. Because I really just had to see.

 

P: Yeah, this seems completely humane. 

 

K: Yes. It is humane… It is very sad and very human. And so I got to view my baby and after him was there and he asked me if I’d like more time but what I knew when I saw my baby is that she wasn’t there. My baby. This is just her body.

 

P: Yeah, I can’t imagine a more caring choice than the one you made. 

 

K: Yes, I don’t want was made already. Yeah, it’s so much love. It was the only thing I could do for her. I did the best I could

 

P: Do they Like do they have a funeral? Or how do you manage it from there?

 

K: No, that’s a good question. So I had signed up for private cremation. And I went home the next day and that was non optimal. But I didn’t know it’s not optimal to not even 24 hours postpartum women on a flight home like really not great. However, I was the one who booked the tickets and I had to get home to my child. I’d been away from my child this whole time. So you know even though Dr. Harun didn’t love that I was going the next day. What are you going to do? Right? So we flew home. It was my 30th birthday. 

 

P: Oh my God

 

K: The next day was my 30th birthday. And I didn’t cancel my party because it was only very close family friends and I knew they’d want to hold me so I said yes, we’re going to go ahead with it. And my milk came in at my birthday party. And it was just like so freaking sad. But a couple of weeks later, my baby’s ashes came in the mail. Just like a little like a little handful pouch of ashes. And I hung on to them for a year and we spread them on her first birthday and never had a funeral. But we did go to the beach as a family and spread the ashes. 

 

P: That sounds healing I mean some kind of ritual around fairly tragic ends seems like a way forward. 

 

K: totally. Yeah. Ritual is really important and it’s powerful and it sticks to parts of us that logic and reason you just can’t. Yeah. So I learned to appreciate that I was a scientist. I was trained as a scientist. And so I have learned to appreciate ritual more and more through my grief experience and through the holding of other women and other parents in their baby loss and infertility journey.

 

P: Yeah, I think that the kind of autopilot aspect of it. That tells you these are the 10 things you’re going to do to get through this period and this set of things has come from people who have already experienced this and I think that seems really helpful.

 

K: Totally. Yeah, I found a support group and peer to peer support around something that is as rare and big and taboo as later abortion has been extremely important to my healing. More important than therapy. Peer to Peer Support has been more productive for me than therapy has been.

 

P: That is amazing. And getting a lot out of it. That is for some people, it may be hard to relate to just by definition because we’re things don’t happen often. And so there just aren’t that many people who experienced this. We had a rare issue in our pregnancy. And it is so unnerving to be on that edge where even the doctors don’t really have much for you and they can’t say what’s going to happen. And it’s just it’s a really tricky place to be. So I’m so grateful that you were able to kind of suss out something to do some way to manage it.

 

K: Totally, totally. And now I’m at Space folder, that group so it’s called the ending a wanted pregnancy. It’s just an online support. Group. You go to the website, ending unwanted pregnancy, I come to get into the Facebook group. And it’s, you know, basically it’s non optimal. But it’s a way to connect in with rare things as you know, like

Like if you have to. 

 

P: Yeah, 

 

K: look far and wide. Yeah. Sometimes doing something global like that is the way to go for rare support.

 

P: It seems like a particularly hard space because, yeah, there is so much emotional and political weight, and all these decisions and all these outcomes and those things are so black and white and not nuanced and not helpful. And this is kind of experiential, right? So if you have no experience with this, it’s very easy to say I would do this or I would do that and it just, just like birth, it feels different once you’ve been through it.

 

K; Completely. Like if you had asked me before any of this happened, would you ever have an abortion and like when you’re eight months pregnant? I would have been like, Oh, of course not. That’s ridiculous. Who does that? Right? Then it’s like, in a situation, and that’s the best I can do. Okay, but I do it. You know, so

 

P: also the truth of the better is the people who do that or people in your circumstance.

 

K: What I will say is that if an action seems extreme, and I would argue that getting an abortion when you’re eight months pregnant is a pretty extreme thing to do. 

 

P: Yeah, 

 

K: it is because the circumstances are extreme. And I never want to speak for everyone’s circumstances, because there are many different ways circumstances can be extreme. But I have profound trust that if someone’s doing something extreme, because her circumstances are extreme, yeah. I trust her to know that we’re not perfect. It’s not like everyone does the best all the time, but I really would trust a woman and her family, much more than I would trust the government. 

 

P: I totally agree. Oh, it sounds like your family did a lot around that pregnancy and birth and

 

K: yeah, we did. And I will say that my husband and I very much in stuff and together in our crisis. But in grief, there is no together in grief. 

 

P: Yeah, 

 

K: there’s no company in grief. Grief is incredibly lonely. So sometimes when I would want to ritualize he would need not to be there. What I ended up doing for my family is introducing two days of the year, when I bring them into my experience of virtualizing on is girl’s birthday. Baby’s birthday. The day actually birthed her from my body in June. And so what I do that day, I ask LC her sister and now we have another Sister Lucia. I asked them how would you like to recognize your sister’s birthday? Their kids, so it’s like, let’s eat cake. Let’s go out for ice cream. Let’s go to the beach. You know? That’s great. I just let them invite it. The other day of the year is Day of the dead. You make an altar. You put pictures and tell stories about the people in our family who have passed not just Laurel but definitely she’s prominently up there. And then we paint faces, you know we have a nice meal the beautiful holiday that I have made it into my family space just as a place that feels right for a family to remember together.

 

P: You know I like so much about both of these is that it is a way of keeping her in your life in a positive way. So it’s not I mean the whole thing was tragic. And that’s true and that happened. But there’s something to be celebrated about Laurel. And it’s so nice that you and your family have found a way to be with her in a in a positive way. That’s not painful.

 

K: totally…Yeah, and that’s the way I want it. I don’t want to like put the pain of this onto my daughter’s sometimes what I find is that with LC who was two her understanding of it grows with her every year. I think she remembers actually she may not remember everything but I think there’s part of her that remembers in her understanding gets a little more mature. It really shifts every single year whereas Lucia who was not born when this happened, she came later. Forgets she even ever had another sister which is fine. Yeah, that’s completely fine. So I want her to know about her family in a way that doesn’t like force her to be sad about it if she’s not because she’s  Yeah.

 

P: That’s amazing. Thank you so much for sharing your story. If there’s anything else you want to mention,

 

K: I would love to so what group is my volunteer work I also do advocacy and activism as as volunteer. But I have changed my careers to help women and families who have been through loss like this full time. I’m a love sex and relationship coach because what I find is that the fallout is all in matters of love, sex and relationship coach. So I’m a somatic coach and I work at night bloom coaching.com If anyone hears this and it’s like, this is a person I want to help walk with me through the through the grief or help me integrate my trauma I am not a therapist. I cannot diagnose or treat PTSD. But certainly I have found the tools I use to be extremely supportive of living more richly and fully after loss.

 

P: Sounds awesome. Thank you so much.

 

K: You’re very welcome.

 

P: Thanks again to Kate for sharing her story. Her experience is a powerful example of the nuances that color pregnancy–how complicated it can become in a short time span. Interviewing Kate and editing her story, I’ve listened to it a few times now and still have a hard time getting my head around all the desperately difficult things she and her husband had to do to deal with the sharp turn in the health of her pregnancy–the shocking medical news, the flight, the razor wire around the clinic, the procedure itself, and her milk coming in when she got home. That they did, in fact, manage it with the help of some extraordinary doctors and nurses is a testament to their strength.  According to the most recent figures from the CDC, in 2019 almost 93 percent of all abortions happen before 13 weeks. Less than 1 percent occur after 21 weeks.  I particularly appreciate that Kate shared her experience to give voice to what it looks like to be in this one percent, to show the heartbreaking choices some people have to make and how the burden of society’s judgment and legal obstacles make it even more difficult…I think her story dramatically illustrates the importance of allowing families to chose how to meet and manage very challenging circumstances.

 

Thank you for listening.

 

We’ll be back soon with another story of overcoming

 

Episode 58 SN: The Power of Hormones, Hyperemesis & Postpartum Depression Visit a Pregnancy: Laura’s story

Today’s guest had a pregnancy marked by extremely easy things and significantly hard things. Getting pregnant was consistent with the kind of fertility you see in a romantic comedy instantaneous, but the first trimester morning sickness was more like a sci fi thriller, totally extreme and requiring all kinds of medical help. And after a pretty challenging pregnancy, she ran into postpartum depression after the birth but her’s is a story of overcoming. She found help and recovered and she’s deeply immersed in the joy only a five year old child can bring.

(image courtesy of https://www.girlsgonestrong.com/blog/articles/pregnancy-hormones/)

Links to some of Dr. Meltzer Brody‘s work

https://scholar.google.com/citations?user=6CCrvBEAAAAJ&hl=en

Audio Transcript

Paulette : Hi, welcome to war stories from the womb. I’m your host, Paulette kamenecka. I’m an economist and a writer and the mother of two girls. Today’s guest had a pregnancy marked by extremely easy things and significantly hard things. Getting pregnant was consistent with the kind of fertility you see in a romantic comedy instantaneous, but the first trimester morning sickness was more like a sci fi thriller, totally extreme and requiring all kinds of medical help. And after a pretty challenging pregnancy, she ran into postpartum depression after the birth but her’s is a story of overcoming. She found help and recovered and she’s deeply immersed in the joy only a five year old child can bring. After we spoke, I talked to a fantastic psychiatrist who’s done lots of research on postpartum depression, and gives us a sense of what the field might look like in the future. One more thing to add. My dogs were desperate to be a part of this episode. So you’ll hear their contributions at certain points, which in no way reflects the many efforts I made to keep them happy and quiet. Sorry about that.

Let’s get to this inspiring story. 

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

 

Laura : Sure. Thanks so much for having me. My name is Laura Nelson. And I live in San Francisco, California. 

 

P: Nice, lovely. And Laura, how many kids do you have? 

 

L: I have one child and one husband.

 

P: well said and before you got pregnant, I’m sure you had an idea about what pregnancy would be like. What did you imagine it would be like?

 

Laura : Oh, well, I imagined I didn’t imagine it would be magical. I didn’t imagine it would be like a fairy tale. I think I took worst parts of pregnancy depicted on TV and media and went yeah, that’s probably what it’s gonna be like.

 

P: Well good. There’s only up from there. Right? That’s that’s a good way to start. 

 

L: Yeah. 

 

P: And did you get pregnant easily the first time?

 

Laura  2:09  

Oh, yeah. First first try. We pulled the goalie pregnant.

 

P: Good lord. You’re the story we all hear. Everyone. Everyone thinks they’ll get pregnant as soon as they try. But it doesn’t happen all the time. Right? But this is the perfect example. That’s so good. I’m glad that was easy. And you found out with like a home pregnancy test.

 

L: I found out I was I was house sitting for my parents and their dog. And I went to I didn’t know I was pregnant, obviously. But I went to Long’s and I got I was like, I really needed some kulula And why not like a pregnancy test? So I had some grua and I took some more pregnancy tests and all of them are positive. And I was like, well yes, that’s that’s what it is. You know, truthfully, I was like, I was a smoker. And so I was like, I called my best friend and I was crying. So it’s just like such a shock. And I was smoking. I was like, it doesn’t count until the doctor says it right. And she’s like, you’re fine. 

 

P: Yeah, that’s kind of a shock. 

 

L: Yeah, but it was it was nice. It was good. And a good reason to quit smoking. So how about that?

 

P: And how was the pregnancy? How did it start off?

 

L: What was it like? Oh, the pregnancy was in a word traumatic. I think it started off with violence, never ending nausea and vomiting. So throughout the course of my pregnancy, I lost 30 pounds. 

 

P: Wow

 

L:  and then I think, so weeks, six through about 20 is going to the hospital three times a week for IV infusions, because I couldn’t even hold down ginger ale and crackers. I was just unable to eat food without taking. I ended up taking what was called Zofran. I took sublingually as well as intravenously. So if you are experiencing severe morning sickness and you’re worried about Zofran I took it pretty much the whole pregnancy and there were zero adverse side effects other than I could pull down food, which was nice.

 

P: so that seems like a violent entrance into a pregnancy like what it happened once and you thought, Oh, this is just once or like, did you react to a food or it was all food or how does it work?

 

L: It’s all food, all food and all smells and I was throwing up Bile or food. On a good day. 10 times I was throwing up.

 

P: Wow, that sounds unbelievably intense. So did it. It happened one day and you went to your doctor like how did it how did you kind of sort it out?

 

L: Oh, it happened in happened for a few days in it. I thought like, Oh, this is morning sickness. Right? Like This must be what everybody talks about. And then when I was showing signs of dehydration, and I like couldn’t actually function and was feeling very sick. I went to my OB and she said, Oh yeah, no, you need to hyperemesis Gavardiam you need to get fluids we need to give you medicines or you can eat and we need to give you something so you can not be nauseous all the time.

 

P: So they think like oh, maybe you have the flu or because it’s pretty distinct. 

 

L: yup

 

P: So even though they gave you the medicine you lost all my weight.

 

L: Yeah. So I gained again Yeah, back towards months, eight and nine, nine and a half. Right. But But yeah, in the beginning, it was dramatic

 

P: That sounds super unpleasant. And where are you at? Were you working? 

 

L: I was I was working. I was going into the office. I you know once I was able to announce my pregnancy, which I had to do earlier than I wanted, because I was so sick. You know, it would just be I’d be talking with people about plans and then I thought oh lord is gonna go vomit and I’m gonna throw up and then come back and keep working. But yeah, I was a very understanding very parent focused company. So I was very lucky that, you know, the CEO had kids and everyone I was working with was already a parent.

 

P: Yeah, that sounds intense. And so it sounds like it got a little less prominent later in the pregnancy. 

 

L: So weeks 20 to about 32. I would say I was normal. So I was eating food walking around. I had a good normal pregnancy and then weeks 33 to 42. It came back and then

 

P: No, no, is that normal? Was that what they say?

 

L: Yeah, you’ll either have it just for the first semester or you’ll have it for the first semester and we’ve got like school for the first trimester or you’ll have it for first trimester in the second trimester and the third, so I was lucky that it got a little less severe. For the second semester, trimester. But It came back.

 

P: Oh my god, I’m so sorry to hear it. Good Lord. That must have been so disappointing the first time you threw up after you have the break.

 

L: for sure, 

 

P: and so you get to 40 weeks and what happens?

 

L: I get 40 weeks and and nothing happens. You get to 41 weeks may be scraped the inside what’s it called an induction 

 

P: Yeah. they strip the membranes or something or 

 

L: yeah, they stripped the membranes and then they send you home so they gave me an induction I was induced. They said go home out should start happening. When it’s less than five minutes apart. Come back. 

 

P: so this is this exciting. Because you’re done.

 

L: Oh, I am ready to not be pregnant. Yeah. Yeah. So I go home as they’re happening and laboring, and it never retiming them. It never gets closer than five minutes eight eighths and spicy food. And it still stayed farther apart than 4-5 minutes. So I called and they said no, if you if you came in, we wouldn’t be able to admit you. I said okay. So 41 weeks, 2 days, I go back. We’re doing health checks. They’re doing the screens. They induced me again, go home labor. bounce on a ball. again It doesn’t stay closer than five minutes. So finally at 41 and five, said okay, well it’s time to come in. so We went down. We checked into hospital it was so I think the one of the nicest and most surreal things about going to the hospital knowing that you’re going to have the baby is you have this like brand new car seat. That you take with you. And you’re like, Okay, we’re taking carseat with us and like we’re leaving, we’re entering the hospital as just us and we’re gonna leave as a family like that. That’s just like it’s definitely a beautiful moment. So

 

P: let’s talk about your labor for a second. Were you like imagining a natural labor or I want to be in a bathtub or what was your you’re already shaking your head? What were you hoping for?

 

L: No, I took some birthing class classes with liars. They all said they wanted natural childbirth with flowers, and I said, my vision was epidurals just all of the like as many natural drugs as you can give me. Yeah. Was my natural birth vision. Plan. 

 

P: good, I feel like you’re moving in the right direction then.

 

L: Yeah. So we go I’m in. I’m induced, they give me they give me Pitocin. I labor for about 12 hours. So that’s fine. We’re just me and my husband all night or just watching 30 Rock and I’m like, a little bit of pain, but not too bad. Then the doctor comes in and checks on me and she says, All right, you’ve been laboring for 12 hours and you’re not even one centimeter. And at this point, I was like, No, like really? Are you kidding? And so she said very plainly. She was a wonderful, wonderful doctor. She said, we think your baby’s really big. Can you either labor naturally over the weekend, and if things get bad, we’re going to have to do an emergency C section. Or we can get this baby out of you in the next two hours 

 

P: oh wow

 

L: and do a C section right now.

 

P: yeah, I’ll take the door marked baby now.

 

L: I said yeah, let’s get this baby out. Like right now. And so the so it just went from a having a baby in two hours. So anesthesiologist came in and the anesthesiologist assistant who looks like Jessica Alba it might have been the drugs I was on but I swear I still tell my husband I’m like man do you remember that anesthesiologist. She was just she delivered kisses from angels with the epidural and she’s out of this world attractive. So anyway, I had the epidural. Seeing your partner scrubbed up in scrubs is just like, interesting.

 

P:  I sort of felt like it you felt like you want to do an SNL skit 

 

L: a little bit 

 

P: come in with all the blue scrubs in that and hair cover and stuff. It’s so weird.

 

L: Yeah, just like Alright, we’re gonna go have a baby and then I didn’t expect can’t have your husband in when they give you the epidural. So you’re on your own and they’re having you bend over. You’re like gigantic pregnant belly. Yeah, this point I’m like basically 42 Weeks Pregnant I would say again to our baby and me. As the room is so cold, and you’re naked, your butts expose. Just jabbing  you with a needle 

 

P: It’s glamorous. 

 

L: Yeah, then I had what’s known as a gentle C section. So I was able to listen to music which was nice we put on Lyle Lovett and put on allow love it playlist. So I was now they put up the curtain and they tested they said let us know if you feel this and just looked at my husband and said it’d be funny if I said it out. And he’s like, No, it would not be funny if you sat down. So we listened to music. Baby came out beautifully and immediately instead of wiping her off or when her they just immediately her on my chest and I was able to breastfeed her while they sewed me up. 

 

P: Oh, wow. That’s amazing. 

 

L: So that was really beautiful. And then they weighed her. And, you know, whisked us off to the recovery room. Once everything was all done. It was life changing in a lot of ways but I think having that gentle entrance into the world surrounded by so much chaos was just very nice bookend and blessing. 

 

P: I was thinking gentle C section was marketing, but that sounds like a gentle C section. That sounds really nice.

 

L: Yeah,they  just give you the baby right away. 

 

P: That’s awesome. 

 

L: Being able to breastfeed even though like I couldn’t feel my arms was nice.

 

P: Maybe the best way to do it. So you up, you’re in recovery. And then how long do you stay in

the hospital? 

 

L: I was in the hospital. She was born on the 10th and went home on the 13th. 

 

P: All right. And how do you feel when you go home? 

 

L: Oh, I was loopy for sure. I think one thing that I was grateful for from just another friend who was a mother was I was taking the stronger pain medicine. It wasn’t Vicodin. I think it was Percocet and was actually causing like panic and me taking such a strong as soon as my friends had stopped taking Percocet, only take Motrin and so I switched to Motrin, and immediately the panic went away.

 

P: Oh good. I’ve never heard of that. That’s interesting to know that. It’s like well known enough that someone could give you a nice,

 

L: yeah, it was very good advice. Yeah, went home. tried to figure out how to be parents, and it was it was nice, but it was also very hard because I had a C section and I was on the I lived on the third floor walk up. And so the doctor says don’t do don’t take any stairs or I live on a third floor walk up. You know in retrospect, they after the kid is born, they have you come back or the next day or two days later for a sort of wellness check to weigh them and make sure they’re eating and maybe even get another shot. In retrospect I should not have gotten to that appointment into that with my husband. And if I had to do it again. I would say I’m gonna lie down. You can take the baby to go get a check up

 

P: because it was painful to manage the stairs and all that.

 

L: Yeah, the stairs were just brutal. I ended up popping a stitch. 

 

P: Oh No. Oh my god. 

 

L: but, that’s okay. I mean, the grand scheme of things. It was worth it. 

 

P: What’s it like in the fourth trimester when you’re home? 

 

L: Oh, yeah. So the fourth trimester be brutal for me, who loved my daughter? I think know that I had a lot of unhealed trauma from both the pregnancy and the birth that I didn’t address and being isolated in apartment–not that I couldn’t go outside but that going outside meant downstairs and eventually you know popping a stitch and hurting myself. A lot my husband took two weeks of paternity leave and to care for me and and us and the first day he went back he was let go. 

 

P: Oh, my God that is crazy. Yeah. 

 

L: So I had, I’m a mom, and I’m the sole breadwinner and I feel literally trapped in my apartment. So I should have seen The chips stacking up earlier than I did. But it wasn’t until it was about six or seven months old. I realized I was not well, I had severe postpartum depression. And I just had a breakdown one day where I just could not stop crying and it wasn’t that I didn’t love my child because I did I loved her so much was that and I thought of postpartum depression. The only things I thought of were very black and white. It was you had it or you didn’t. There was no gray area of you have it a little bit and then drawing on media and growing up. The only postpartum depression that I’ve ever seen talked about was that woman who drowned her kids in the bathtub. 

 

P: Oh, wow. Yeah. 

 

L: And I thought well, I don’t want to drown my kidney bathtub. So I obviously don’t have it 

 

P: I brought the topic of postpartum depression to an expert. Today, we’re lucky to have Dr. Samantha Meltzer Brody, a psychiatrist who’s the director of the UNC Center for Women’s mood disorder, and the author of many, many scientific papers on the topic of perinatal, and postpartum depression. Thanks so much for coming on the show Dr. Meltzer-Brody. 

 

Dr. Meltzer-Brody: Thanks for having me.

 

P: Harming your children is one small one small aspect that might present but there are probably many ways many things that postpartum depression can look like. So maybe you can define it for us.

 

Dr MB: Absolutely. So postpartum depression is a mood disorder that occurs in the postpartum period. However, it comes with often many co occurring symptoms, including anxiety, also, according to the DSM can start during pregnancy. So oftentimes, hear the word Peri, partum, or perinatal, used to define symptoms of anxiety and depression. That occur either over the course of pregnancy or postpartum. If we’re talking specifically about postpartum depression exclusively, oftentimes, you’re not seeing symptoms creep in until late pregnancy or they start in the postpartum period. They can have a range from very mild to very severe with everything in between. So if someone is having the most severe symptoms, they may have suicidal ideation and tenor plan. Most rarely, you have co occurring psychotic symptoms that can be associated with postpartum psychosis which is not postpartum depression. It’s a severe postpartum psychiatric disorder that is thankfully because it’s so devastating, more rare and can be associated with thoughts of harm to the baby. But then can have a range of symptoms that can include anxiety, worrying, or being able to sleep even when the baby’s sleeping because of worrying about the baby not being able to enjoy the baby feeling keyed up on edge, feeling overly tearful, feeling completely overwhelmed having difficulty concentrating. Again this can be on the more mild side to the to the severe side but in general, they are going to last more than two weeks it is not the baby blues, so most women immediately upon giving birth are going to feel more emotionally exhausted because birthing is very powerful, profound time. Most moms will get their sea legs if you will, but for the one in eight women that continue to have clinically significant symptoms or up to 15% of women postpartum. It’s much more complicated. So what you will hear the terms, perinatal or postpartum mood and anxiety disorders. You’ll hear the term maternal sort of mental health, maternal mood and anxiety disorders to sort of be more broadly inclusive. So we’re not having any one woman gets stuck on one particular symptom as you stated that doesn’t resonate with her

 

L: but I did and I think that there’s so many different layers of postpartum depression that people don’t talk about. People don’t understand there wasn’t even you know, the right level of support even now, looking back that I was able to get, you know, I broke down i i called my doctor and I said, I’d like a really need help. And so I did three months of intensive outpatient therapy. So I was going in three days a week to the hospital to get talk therapy and medication and art therapy and group classes and group therapy and it really just only let me heal and focus but just realize that I wasn’t alone and that there’s nothing wrong with me as mom. There’s nothing wrong with what I was doing as a parent or how I was loving or how I was living. It was literally a cat, something’s wrong with your brain and you just have to fix it or work on it. So eventually, I found the right mix of medicine

 

P: One tricky issue with postpartum depression is it seems like it might be hard to identify in yourself or to rely on someone else to identify for you. I’m wondering if something like biomarkers might help here

 

Dr MB: well the use of a biomarker is, you know, variable depending on what biomarker you’re talking about. But for example, ideally there’d be a biomarker that would show women who are either at risk or to have someone start treatment in a preventative way or start path that would prevent symptoms from happening. Or biomarkers can be used to track response to different treatment or you know, indicate that someone’s going to be differentially responsive to a certain antidepressant or whatever it may be. So they can be used in lots of different ways at this point We do not have a reliable biomarker that’s ready for primetime. And so that’s an interesting area of investigation, both looking at genetic signature, but then looking at other types of biomarkers that can either help with diagnosis or help dictate treatment to be most targeted and effective. And that’s often when we think of precision medicine, or precision psychiatry, rather than saying, you have postpartum depression and we don’t know what treatments going to be most effective for you. So we’re going to, if we say pick an antidepressant that may or may not work for you, biomarkers when they are more sophisticated, can really help guide a specific line of treatment to be most effective.

 

L: I’m A huge fan of Lexapro I’m like a lexa pro cheerleader. But yeah, the days are brighter and heart is healed and I’m just so full of love and of being a parent, but I think one thing I would say to everyone who’s either expecting to have a child or just had a child and it’s in the fourth trimester is there’s absolutely nothing wrong with you. If you are feeling a little sad if you are feeling like you can’t make it if you’re feeling like things just aren’t adding up to help because it’s really easy and there’s nothing wrong with you. You’re doing a great job.

 

P: I think that’s a great message and I’m impressed that you were able to see it in yourself. And I’ve talked to a lot of women who have talked about postpartum depression and a lot of them don’t recognize it or think this is just what motherhood is, or I’m just a bad mom, or some version of that. 

 

P: I talked with Dr. Meltzer Brody about some of the challenges inherent in identifying PPD: I’m imagining we don’t have a biomarker and we don’t know which medication would help you if you require medication because postpartum depression is really a constellation of things. And there are many, many roads lead to postpartum depression. So it’s not this this one thing. In the same way you’re describing all these different symptoms that could be sort of a postpartum depression diagnosis. Because there are many ways to get there. Is that Is that accurate?

 

Dr. MB: I think that there’s not going to be any one reason a woman would have postpartum depression. So in the same way, that there’s not any one type of breast cancer either, so I think one of the things we’ve seen as we get much more sophisticated in other fields of medicine in terms of precision medicine, as we get very tailored and targeted on the specific treatment, that’s going to lead to the best outcome. So 25 years ago, most women with breast cancer you may have gotten the same treatment. It turned out that didn’t work very well at all. And we now are much more specific and targeted based on you know, receptor type and hormonal responsiveness and any number of things where I hope we can get to with postpartum depression and all forms of depression is similarly so that there’s not one form of depression and that people are going to become depressed for any number of reasons and that there’s going to be obviously the psychological psychosocial factors that render someone more vulnerable, but ultimately, it’s going to be the biologic processes, right? So is it immunologic in origin? Is it inflammatory markers in origin? Is it genetic in origin? Is it epigenetic, you know, or dysregulation of the HPA axis or dysregulation of a specific neurotransmitter system? So all of these are hypotheses. It’s very likely going to be an interaction of those but also that some people differentially are going to have a specific sort of past that’s driving there’s for which a specific treatment may be most effective. Now, we are not there yet at all, but I think the hope will be that we can be looking forward to that in the next I would, I would like to say aspirationally decade,

 

P: generally speaking, it seems like postpartum depression is thought to arise from hormone shifts, during or after pregnancy, in particular, a big drop in progesterone but it sounds like all these other bodily systems are affected immune system HPA access other systems. So it does that contribute to why it is tricky to establish a link between hormone drops and postpartum depression.

 

Dr. MB: So I think that we know that all women who give birth have rising and then falling levels of estrogen and progesterone, female ganando hormones, that’s a normal part of physiology. They rise dramatically during pregnancy and they fall at the time of delivery and that is part of physiology and so there’s no difference in the rise and fall in any particular way that’s been studied for someone that has postpartum depression or not, what the current theories are, and you’ll hear the the expression, differential sensitivity meaning a woman who gets postpartum depression may be differentially sensitive to the rising and falling the normal, rising and falling in a way that someone else is not. Now, we haven’t necessarily gotten able to refine that exactly, not even close. And it’s very likely that some women are differentially sensitive to the rising, falling and they have postpartum depression for that. rising, falling and they have postpartum depression for that reason, it’s also very likely that other women have postpartum depression because of a different trigger. So, the dysregulated system is not necessarily going to be hormonally based it may be something else and so this is an active area of investigation is understanding what are all the different factors and how they interact and what may be driving that for any you know, individual person

 

P: In Laura’s experience she have really significant hyperemesis I’m wondering if someone like Laura, who is presenting with evidence of a sensitivity that’s really strong to changes in hormones is more likely to get something like postpartum depression because obviously her system is sensitive to these fluctuations.

 

Dr. MB: So there’s there’s some data and we actually looked at this in the Danish registries and published out there is data showing that women that have hyperemesis gravidarum are at higher risk of having perinatal mood and anxiety complications than women that do not have it for an individual person who experiences hyperemesis gravidarum. It’s an extremely miserable experience, and I think it is just psychologically miserable. The second thing though, it also makes sense that whatever is happening in that individual person that makes them more sensitive to have the severity of symptoms in that way. There may be something happening in their body that works differently, that may make them more susceptible to other things. So I think it makes sense in a number of different ways. But we don’t understand deeply and at the biological level, exactly what’s going on. And I think that that’s what’s exciting right now is trying to get much more precise and dive deeper into the underlying pathophysiologic processes. So if I looked back over the last number of decades in our field, it it took decades in this country for even routine screening to take place and for us to move towards seeing this as a one of the greatest complications of pregnancy. And the postpartum period to do routine screening and all pregnant and postpartum women, to have it become part of public awareness to you know, work to decrease stigma so that people could talk about it. So we could get more women screened and more women into care and over what we’ve seen in the last 20 years is pretty remarkable in terms of a positive sea change in that direction. So where we need to go next is taking our understanding of what’s driving it, what’s the underlying pathophysiology, what are continued to be novel ways of diagnosing and treating, how can we be more precise and targeted and doing that and there’s a lot of work being done, which makes me encouraged on what may come next.

 

P: I have spoken to a couple of people at UCSF I don’t know if that’s where you were but they were saying that they are making an effort to have way more postpartum visits that aren’t normally scheduled because it is pretty spare.

 

L: Once you have a baby, it’s all about the baby and then six weeks, six week checkup, they’re like, Okay, hey, mom. You know,

 

P: and it does seem like it’s almost entirely physical. Have your wounds healed, and then we’ll send you on your way. 

 

L: Yup

 

P: You know, having been through it, which seems bizarre.

 

L: Great. Yeah. UCSF has they have a really good postpartum depression group. I wasn’t able to join it. But I would have if I could have,

 

P: Yeah I’m guessing where and from whom you get care may make a difference because there’s a lot going on in the field of postpartum depression. 

 

The future of postpartum care may not look much like the past I asked Dr. Meltzer, Brody about new medications. One thing she talks about is GABA, which if you’re not familiar with it is a chemical messenger in your brain that has a calming effect. 

 

It looks like in 2019, the first drug was approved specifically for postpartum depression. Is that right?

 

Dr. MB: Yes. So in 2019, the drug Brexanalone was approved for postpartum depression. It was the first FDA approval for a drug specifically for postpartum depression. And it’s a novel drug it’s a neuroactive steroid. So it works on GABA, which is different than other drugs. And it’s actually a proprietary formulation of allopregnanolone, which is the neuro active metabolite of progesterone. So you have levels of allo that normally rise very high during pregnancy, just like progesterone does, because it’s a metabolite of it and then fall rapidly. Postpartum. And so we were able to do the first open label study and then proceed through the double blind placebo controlled studies of using brexanolone for treating postpartum depression at at the University of North Carolina at Chapel Hill. It’s an IV drug. It’s a 60 hour infusion. It’s powerful. And you see this rapid onset of action within the first day and so we continue to have a robust clinical program. We’re continuing clinical trials and then there’s also an oral being drug being developed by Sage therapeutics, which is the pharmaceutical company that’s developed brexanolone And now is arann. Alone. Saran alone is also a neuroactive steroid, but it’s different. It is not an oral form of bricks and alone. It’s not an oral form of allopregnanolone it’s a bit of a different interactive stereo. And there’s been multiple positive studies showing its effectiveness after a two week course for postpartum depression, that that could be a new tool in the toolbox available in a year plus.

 

P: Well, that’s super exciting.

 

Dr. MB:  it is a really nice example of using pathophysiology to develop treatments leading to new treatments and a new tool for postpartum depression. And I think that approach hopefully, can be used in lots of different ways. Who’s going to be most responsive? For whom is this drug going to be the best fit? Or drugs like this and as we get much more refined understanding what treatments are going to be best for an individual patient that will lead to the best outcomes and brexanolone works fast and it works really fast. And so that’s so important in the perinatal period in the postpartum period, and having a rapid acting antidepressant that can work within a day is powerful and unlike most things on the market, a number of current therapies that we have take time. take days to weeks to months or longer, and then we unfortunately have people who don’t respond to the current therapies. So having new tools and new treatments that can act quickly and more quickly than what we’ve previously had, and then can increase effectiveness or be more effective to peep for people that haven’t responded to other treatments is really important.

 

P: How old is your daughter now? 

 

L: She’s five and a half.

 

P: That’s so fun. That’s a great age what she into.

 

L: So if you ask her what she wants to be when she grows up, she will tell you she wants to be a mom, doctor, astronaut scientist. So she’ll go to space, but she’ll still be able to drive her gets to school.

 

P: well that’s the dream isn’t it? Seems like the right ambition. She sounds busy. is very busy. 

 

L: She’s very smart. She’s I think she’s smarter than me. She’s five and a half and I’m pretty sure she’s smarter than me. She’ll be like, Mom, do you know what the biggest magnet on Earth is and no one should be like it’s Earth. Like okay

 

P: I feel like she needs a YouTube channel. These are just some real nuggets.

 

L: We’re not gonna stage mom her yet. We’re gonna try to keep childhood in its little bubble 

 

P: is she goes to kindergarten or is it high?

 

L: So we did distance learning we did like a week of online kindergarten, because we live a half a block away from our public school. We found out very quickly that Zoom learning is not the way to go. It’s just not she hates it. enforcing it was not worth it. So we are in another year of transitional kindergarten, which is private and falls under the preschool rule so it can be in person rich, she’s thriving. And moms are think of

 

P: I think of  kindergarteners socializing. And so that’s a hard, hard thing to do. So I’m glad that you guys have worked it out so that she can be out.

 

L: Even in the core things to work on like she’s an only child so sharing can’t can’t even do that in person preschool now because they all have their own pieces of art supplies and paper so they don’t contaminate.

 

P: Hopefully next year, 

 

L: fingers crossed back to normal. 

 

P: So if you could give advice to your younger self about this process what do you think you would tell her? 

 

L: Oh, I would say two things. One, I would say Laura depressed get help. So okay. Yeah, because if I got help sooner, I just think it wouldn’t have been as bad as it was. The other thing I would say is, you’re going to be a great mom, don’t worry about messing her up. In 2020 it’ll all make sense. Because I feel like everything I could have done and did do like once we had to just pause and have her home and be a family and just sort of figure it out like it’s really mattered, you know? 

 

P: Yeah, it is nice to have her home at this age. Right because five is so fun. I remember my when my oldest was five or went to kindergarten, I missed her so much. 

 

L: uh huh

 

P: And she got she had walking pneumonia for like a week and a half and it wasn’t like that was technically the diagnosis but she didn’t seem very sick. And I was like, walking around with my arms in the air like this is the best week ever to get her back. So it’s kind of nice. 

 

L: It was sad to knock at the end of preschool when she was turned five during this when she was four and a half. And we were lucky to be like Okay, let’s see, like there’s no, there’s no school. You’re gonna stay home with mom and dad. And she’s like, great. No school home. I get to stay home with you and dad. Cool. 

 

P: that’s Awesome. Well Laura, thanks so much for coming on and sharing your story today. I really appreciate it.

 

L: Yeah, thank you so much for having me.

 

P: Thanks again to Laura for sharing some of the challenges in her pregnancy and the really really about her experience in the postpartum period, her recovery and her ultimate joy. And a big thank you to dr. meltzer brody for sharing her insights on the current state of PPD and what the future may look like.  I’ll link to some of Dr. Meltzer Brody’s work in the show notes if you want to read more about these new medications for PPD.

 

Thank you for listening.

 

We’ll be back soon with another story of overcoming



 

Episode 54 SN: The Complicated Emotions that can Accompany an Unintended Pregnancy: Jennie’s story

These days the word mother can mean a lot of different things. As today’s guest shares, she sought out the birth of her first child, but the second pregnancy was unintended. Her preference for family size clashed with her partners, Although she may have been open to terminating the pregnancy, her partner was not; she was living in a state whose majority is not particularly supportive of a woman’s right to choose, and she was brought up in a religion in which abortion is not considered a reasonable choice. and so began a very emotionally taxing pregnancy and birth. She shares how she managed these challenging circumstances which I think is an important story to share, especially right now when such black and white ideas about pregnancy and birth are in abundant circulation.

You can find Jennie’s writing here

Average Time for Labor

https://www.verywellfamily.com/length-of-labor-how-long-will-it-be-2759011

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982443/

Audio Transcript

Paulette: Hi, welcome to war stories from the womb

I’m your host Paulette Kamenecka. I’m an economist and a writer, and the mother of two girls.

These days the word mother can mean a lot of different things. As today’s guest shares, she sought out the birth of her first child, but the second pregnancy was unintended. Her preference for family size clashed with her partners, Although she may have been open to terminating the pregnancy, her partner was not; she was living in a state whose majority is not particularly supportive of a woman’s right to choose, and she was brought up in a religion in which abortion is not considered a reasonable choice. and so began a very emotionally taxing pregnancy and birth. She shares how she managed these challenging circumstances which I think is an important story to share, especially right now when such black and white ideas about pregnancy and birth are in abundant circulation.

after we spoke I talked with a fantastic OB who has much more exposure to ambivalence about pregnancy than most of us and she shares her insights

and one other note to add: Everyone in this conversation has dogs at home, and it seems all dogs were desperate to be a part of this episode..so you’ll hear everyone’s dogs at some point.

Let’s get to this inspiring story.

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

Jennie: I am Jennie Case and I am currently in Conway, Arkansas.

P: Oh, wow. Wow. Cool. Excellent. Jennie. We’re going to talk about the family you and your partner created but sometimes the family you came from influences some of those choices. So I’m just wondering, Do you have siblings?

J: I do. I’m the middle child of three. So an older brother and a younger sister, 

P: Are the three of you close in age? 

J:  my brother is 14 months older than me 

P: Oh wow

J: and my sister is four years younger. So he and I are very close in age. Oh, yeah.

P: So did that influence your thinking at all about how many kids you want or how close you want them 

J: it did when I was growing up? I was close with my brother. Until we both became teenagers, which I think is pretty typical, especially male female siblings. And I wasn’t very close with my sister. She was four years younger, right? And so my brother and I, kind of excluded sometimes from our childhood games. So when we were contemplating having a second child or thinking about having more than one, I worried about the age difference and my kids I have two are four years apart, and I worried that they wouldn’t be close as a result and four years might just be too too large of a gap. 

P: Well, I’m interested to see how that turned out. So when you walked into pregnancy, what ideas did you have about what pregnancy to be like? 

J: I was just curious about pregnancy I wanted with my first child in particular, I just wanted to have that bodily experience that seemed significant, something that it seemed like experiencing life meant, or the fullness of life for me meant also trying to experience the fullness of a pregnancy so I was really curious. What that would be like, and I wanted to hopefully, feel grounded and whole in my body and have it be really a kind of embodied experience for me.

 

P: That’s super interesting. And did you get pregnant easily.

J: I did. Yeah, I was one of those lucky people, I guess.

P: So you found out with a home kit. 

J: uh huh

P: And what was the pregnancy like?

J: The pregnancy it was pretty smooth. With my oldest who’s my daughter. I didn’t have many complications except for the high blood pressure. At the end. I had my blood pressure. I think during the third trimester just kept going up. And so I worked with a midwife and she started to get concerned, which made me start to get concerned. So otherwise, you know, I was interested in an unmedicated birth and I was fairly active you know, kind of a green crunchy vegetarian, so I thought I was doing everything right and was really interested in being as healthy as possible and doing prenatal yoga and then to have my body seemed to rebel by just having a high blood pressure was a strange adjustment.

P: So it sounds like you hadn’t had that experience before. There’s no high blood pressure. No,

J: I usually have pretty low blood pressure.

P: So so let’s get to the birth then. How do you know today’s the day? 

J: That’s with with both my pregnancies that’s a really interesting question, right? Because how I approached pregnancy I wanted to feel my body I wanted just to be really present in that experience. And I was really frustrated near the end of my first pregnancy because I kept having Braxton Hicks contractions every night from like 2am to 5am 

P: Oh, wow. 

J: To where I couldn’t sleep. I thought maybe this is it. Maybe this is it, but then it wasn’t they would go away. You know, as the sun started to come up, and I was so frustrated because I was exhausted from being up for three hours every night. And you know, thinking is this is is this it? So in the end with her I had to I was induced for high blood pressure. So they did Pitocin and everything and so that experience was…

P: wait, so slow down there. So where do you get to the point where they say, Okay, we’re gonna have to induce you and how does that unfold? 

J: Yeah, I had, I think I had a, you know, at that point, I was meeting with midwife once a week. And so I had an appointment on Thursday.

P: And you’re like, like 37 weeks? Are you closer?

J: 38 about 38 Yeah. And it was high. Right. So they made me go to the hospital and their kind of triage area for pregnant women and lay there for a while to see if my blood pressure would go down on its own. And then they sent me home and said I need to be on bedrest that weekend in order to get my blood pressure down, and then go back on Monday and they were hoping the two midwives who I was working with at that point, were hoping that my body would just go into labor on its own or my blood pressure would be down and they could, you know, wait it out a little longer, but instead it was still high. On Monday, of course, right? Because I was nervous.

 

P: Did it feel like anything to you?

J: No, no. it didn’t 

P: that feels like a particular cheat for someone who wants to be embodied. 

J: Right. 

P: that you can’t control and don’t feel 

J: Yeah, exactly generating this birth. 

P: So you come in on Monday, and they say, we’re just we’re gonna have to induce you.

 

J: Yep. I said, Well, we have to do this. It’s not safe. And then, you know, I was rushed off. I think I was crying because that’s not how I wanted my birth to be.  It’s hard to have an unmedicated birth if they immediately start you on Pitocin right.  So it seemed like what I had wanted was sabotage from the start before anything could even happen. 

P: I assume they’ll do an unmedicated birth with Pitocin if you have high blood pressure, or no that’s not 

J: Yeah, cuz they’re worried it’s preeclampsia, or it’s going to develop into preeclampsia. So I think their thinking is if your blood pressure is consistently high like that, it’s not safe and you need to get the baby out.

P: Okay, so does that mean that they’re you’re definitely having an epidural or what does that mean? 

J: They did Pitocin it was up to me and whether or not I’d have the epidural. So what was interesting about my first birth is I was on Pitocin it was fast, right? So I was actually only in labor for about five hours, which I’ve been told is extremely quick for a first time, mother, especially an induction so my body probably was about ready, even if it didn’t start the way I wanted it to so they started me on Pitocin I tried. You know, I kept refusing other pain meds not because I’m against them, but just because my goal was not to have an unmedicated birth. So I kept refusing them.

 

P: And what’s the pain like how do you how do you feel? 

J: It was intense? Yeah, it was intense like I lost. I don’t know if most women feel like this. But I just all the sensations went inward, right? I lost sight of what was what else was happening in the room. Someone could be looking at me their head, two feet away, and I wasn’t entirely aware of them. I was just internal at that point. But so I probably would have asked for an epidural if that part lasted a lot longer but but it didn’t then suddenly. You know, they said it was time to push them.

P: Wow, that is really fast for a first one.

J: Yeah. And I mean, the midwife had come in to check me in the hospital and thought she had more time. So she left to go get lunch or dinner. And then the nurses suddenly had to call her and say no, you need to come back here. She’s about there. So it was unexpectedly quick.

P: It sounds like you’re doing unmedicated, right?

J: Yeah. I had Pitocin. But I didn’t have an epidural. So it was okay in the long run.

P: And was the birth what you expected it to be?

J: It was That’s a good question. I think I was kind of in awe of how physical it was, and how much you don’t control at some point, right. Felt very much probably around the time I was transitioning that your body just takes over. 

P: Yeah. 

J: What I wanted, didn’t matter. It was my body. I wasn’t telling my body to do things. My body was going to do it and he was going to work to get this baby out whether I was ready or not. And that was a really, you know, for someone who wanted that embodied experience that was a really powerful realization for me to just feel my body do what it needed to do.

P: It feels like the high blood pressure is a bit of a teaser. Yeah, like look, you already have no control. 

J: Yeah, 

P: but it’s not  painful yet? Yeah. And then after the birth was that look kind of the way you had envisioned that you were hoping for?

J: it was so physical, right? I wasn’t prepared to be bleeding that long and to have to do so much postpartum care every time you have to go to the bathroom and the smells and everything that was just very surprising to me. And I had stitches because she came so fast. I had a second third degree tear, I forget which one so I have stitches and just all that care surprising. I don’t think I was adequately prepped for that part of it. But so the physicality stood out to me there as well. 

And then I breastfed both of my kids and it surprised me how long it took to become comfortable with that. Like it was those first two weeks are hard and I can definitely understand why. Many women just can’t make it past those. First two weeks if they want to breastfeed, especially if they don’t have supports. I mean, I remember one night my nipple was burning and I couldn’t get my daughter to latch and I was crying and I was frustrated and my husband was calling the clinic to see what to do because he didn’t know what to do. And you know, his crying wife here who can’t breastfeed at 11pm and so that surprised me.

P: You thought it would be more quote natural and 

J: I thought natural easy, right? But natural does not mean easy.

P: Yeah, yeah. I mean, it’s particularly interesting. I just saw some article today about the infant formula shortage. Yeah. And my youngest is 18. And I like it set me in a panic. Yeah, you know, it’s a terrifying thing to imagine. 

J: Yeah. 

P: And people suggesting you should just breastfeed. Yeah. It seems like that is a suggestion that comes from someone who’s never breastfed. 

J: Yes, yes. and who isn’t? I mean, even if you do breastfeed, there are so many challenges you face like, you know, I worked. So pumping has its own issue. balancing all of that, and yeah, it’s complicated.

P: So, how was as the baby in the fourth trimester? She’s fine. She’s,

J: yep. Yep, she she was. 

P: And now it sounds like for the second child, it was unplanned. Is that what you’re saying? 

J: Yeah, this was unplanned. So he was an unplanned pregnancy.

P: So is that you caught that because you missed your period or how that happened?

J: Yep, I’m missed my period. So we had I had actually told my husband I was done having kids. I didn’t want to have any more and then a month and a half after I hadn’t gotten my period. And then I took a test and it was positive. So psychologically, it was a lot to adjust to.

 

P: I can imagine what were there. What was your husband? Looking forward to having more kids or were you guys on the same page?

J: We weren’t so that was part of part of what made it so difficult. He wanted more than one kid a lot more than I did. So we weren’t in agreement there.

P: And that child is how old now? 

J: He’s now five, 

P: five, so obviously, we kept the child Yep. Can you remember that road? How did you how did you sort of get over the initial resistance? The idea?

J: Oh, that took a long time for me. And, you know, I was caught up a lot and questions of choice and questions of bodily autonomy and what do you do in this situation? And you know, that can be a big rift between partners and it certainly was for us and then but what do you do when you’re caught in the middle of it right, and how much do you want to put a relationship that risk?

P: I can look online at places like the Guttmacher Institute or the CDC to see that almost half of all pregnancies are defined as unintended. But to give a broader context to Jennie’s particular experience. I took her story to a trusted OB today…today we’re lucky enough to have Dr. Matityahu on the show a fabulous OB from California who’s got a lot of experience with these issues. So Dr. Matityahu, who thanks so much for coming on.

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

P: Great. Okay, so today we’re gonna talk about Jennie who’s a writer, and I’m gonna read from her writing about her issues. And she’s a piece called the political pregnancy published in the rumpus, and I’m just gonna read little excerpts here. So she writes the spring that Trump wins the Republican primary I discover I’m pregnant with my second child. The pregnancy is unintended. A surprise. A month after I tell my husband that I want to stop at one child. My urine on a stick reveals two pink lines. My reaction isn’t joy. I’m deeply conflicted. But when I mentioned potentially terminating the pregnancy, my husband walks out of the room refusing to discuss it. Earlier that winter when we were still debating a second child. My husband had said his purpose was to be a father. The fact that I no longer wanted a second child snared The Space Between Us, so that it was me holding him back me stopping him from fulfilling his vocation. I’m guessing that this isn’t Jennie’s experience alone. And I’m wondering if women have brought these kinds of issues to you in your practice?

Dr. Matityahu: Yes. And I actually have a couple that I can even think of in particular, because this is a little bit different from someone who’s not in a stable relationship that comes with an unwanted pregnancy. It’s more memorable and sometimes a more emotionally charged conversation when someone who’s in a stable relationship has an unplanned pregnancy maybe has a child already. It’s a really it’s a hard conversation and not I mean, I would say not a hard conversation for me personally, but but definitely I can feel like it’s an emotionally much more challenging conversation and decision for the for the woman

P: and just grappling with all of those and what cultural messages were we bring into the conversations and so that took me I would say, I mean, five years. So work through, I’ve done a lot of writing. I’ve written a lot of essays about motherhood, trying to work through all of the social and cultural and personal issues that came up.

P: talk a little more about the cultural message. What do you mean by that?

J: I think, I guess I don’t think or in my experience, there’s not a lot of supportive cultural messages out there. For women who are experiencing an unintended pregnancy. There aren’t a lot of stories I at least didn’t have access to them. I’m from a Catholic background and there, it’s very clear what you should do if you have an unintended pregnancy, right. There’s no option available. So that’s one cultural message and then I think even within more progressive communities, there’s a sense that you make a choice you want to make and you approach birth or reproduction or pregnancy from as empowered a position as you can. And it was hard to find guidance for kind of that messy middle ground where you know, you just have all these conflicting emotions and you don’t quite know what to do. And it seems like you’re going to disappoint someone no matter what, whether it’s yourself or your husband or your mother, or, you know, whoever voices in your heads and I found that challenging, you know, even especially right now, right, Roe v. Wade is likely going to be overturned or weakened and I’m in Arkansas right, which is I’m now in Arkansas, which is a very conservative area, part of the Bible Belt and most of you know there are a large percentage of the community here is what we’d call pro life. So what happens if someone has an unintended pregnancy surrounded by cultural messages that say abortion or choosing something different is taboo or not something you should even consider? And those can be heavy messages to try and work through especially if you yourself are struggling with what to do

P: outside the doctor’s office, just don’t see the hard conversations that may be happening. I took this issue to Dr. Matityahu And there’s so much cultural baggage around ways to handle unintended pregnancies that you do not want to carry out. So this is very much a struggle for her. So here’s another excerpt. She says, when I say I’m not excited for this child, he says, I’ll be excited for both of us, and something inside of me shrivels and cracks, because what does that mean for him to be excited enough for both of us, for me to become the body carrying your child others want? So when Jennie is living in writing about reflects our larger cultural conversation about bodily autonomy, do patients come to you with questions about abortion and share their conflicted feelings and how do you navigate that?

Dr. Matityahu: So I I have a lot of those conversations. I think those are two two aspects of the of the problem. I often will have the conversation with most women about this decision to keep or not keep the pregnancy will impact you for the rest of your life, no matter which decision you make. This is a life changing decision because for the rest of your life, you will either regret your decision that you kept or didn’t keep the bit you know, like for the rest of your life, you’re gonna say I would have had a one year old at this point, I would have had a two year old I would have had this or for the rest of your life. You’ll say, Oh, I’m so glad I had this baby even though I didn’t want it or you might say I love my child, but I would have completed school I would have kept my job I would have this I would have that. And so it’s an impactful decision no matter which way you go. And I think that most people, it’s about do I keep this life or or do I feel like it’s going to ruin my life either emotionally? Or etc. You know, and then what’s it going to do to my relationship? Like if you’re in a stable relationship, and you’re making this decision, and your partner is against that decision, that has a huge impact on your relationship? Because if you’re keeping the baby because your husband really wants it, but you don’t Okay, now your husband is happy, but you’re feeling resentful and miserable and how what’s that going to do to your relationship is like it’s so charged when you’re in a monogamous relationship. You already have a child together and now, you can’t even have a discussion about a current pregnancy.

P: Oh, I totally agree. And in fact, I’m, I’m working on an episode on abortion. And it’s very hard to get anyone to come and talk about it. 

J: Yeah. 

P: Because whether you’re from a Catholic background or not, that message is so pervasive. feel shame. 

J: Yeah, 

P: I keep I keep saying to people, let’s normalize this care choice. Your reproduction has got to be in your control. It’s too dramatic transformation of your entire life for someone else to decide that for you. 

J: Yeah. 

P: But people are still completely reluctant to talk about it because they feel shame around. Yeah. So what you’re hoping the standard and the ideal is is very much in conflict with Yes, a million other messages

J: And that makes it so difficult in that moment, right when you do have to make a decision. Because I think that decision, many people whether or not to continue or terminate and unintended pregnancy is going to be complicated. Sometimes it’s not right. Sometimes the answer is an easy, yes or no for many women, but I think oftentimes, it’s not an easier yes or no, it’s something people grapple with. And I think it’s hard to grapple with that personally. But it’s especially hard, I think, maybe even impossible sometimes to grapple with that when there’s so many cultural messages and taboos and so much shame associated with with that choice. 

P: So unintended pregnancy is very common, as mentioned before, it accounts for almost half of all pregnancies. The lion’s share of those happen when birth control isn’t used properly and the rest happened when birth control is being used properly. In your experience is unintended pregnancy usually a complicated issue or by the time people get to you they’re they’re more settled.

Dr. matityahu: That’s a great question. I would say off the top of my head maybe it’s like half and half and so so I feel like there’s a lot of young women who come in and unintended pregnancy, maybe they’re not in a stable relationship. They’re not sure what to do we talk through what are the pros, what are the cons? What are they thinking what are the consequences? You know, are they in school, or do they have help? You know, and so, so I think that there’s, there’s definitely a number of women that will come in and be really conflicted. And then you know, there’s women who are married and their husband wants another one. They don’t you know, this is unintended, you know, and there’s a lot of conversation around that. And then there’s a number of young women who get pregnant and they are very clear like they call or they send me a message and say, I’m pregnant How soon can we talk about taking care of this and so for a lot of women, they see a positive pregnancy test. They’re like this is not for me, and then they they just proceed without you know, without having much of a conversation about it because they know what they want. 

And then there’s there’s women who come in they’re like, this wasn’t planned and they’re, you know, they sort of voice through it, and they say, You know what, unplanned but welcomed and so we have a lot of unplanned but welcomed pregnancies where they’re like, Well, you know, I wasn’t careful. I knew this was a possibility. I was just being stupid, but I think I’m coming to terms with it. it really runs the gamut 

P: it reflects that. It’s a complicated issue, right? So there’s a lot of different responses to it. 

Dr. Matityahu: Yeah. And I think it’s a hard conversation to have and I and I sort of applaud women who feel comfortable coming to the office and sitting and having that conversation because I think women that come in I think that they anticipate being judged. there’s so many women that come in with an unplanned pregnancy, and think that they’re supposed to act excited. And when they come to my office and I and I say right up front, how are you feeling about this pregnancy, then sometimes they’ll take a step back and say, you know, I’m actually not sure and you can tell they’re embarrassed to even admit that and it allows me to say you know, there’s no judgement here. Why don’t we have a conversation about how you’re feeling about this? You get to decide on what happens with your body and your pregnancy and there’s no judgment. So if you want to have that conversation, we can have that conversation, and it opens up the door for women who are really embarrassed to talk about their ambivalence about the pregnancy. I think that most people feel like, well, I’m supposed to be happy about a pregnancy, especially if they’re in a committed relationship. They feel like well, I’m in a to committed relationship. I was being stupid about birth control. So this is my fault. I just have to suck it up. And I think that there’s a there’s a lot of hesitancy about bringing up whether they feel okay about the pregnancy people. I think women are embarrassed or uncomfortable or guilty if they don’t embrace a pregnancy and I think that there should be room for them to express their desire not to have a pregnancy or maybe to eventually come around to wanting to pregnancy I think there’s there’s a there’s definitely a discomfort with expressing there’s a discomfort with expressing like not wanting a pregnancy. But But mostly, I think the discomfort is if you’re in a relationship. That’s a committed relationship, especially if you’ve had another kid it’s almost like, like, how could you not know and so there’s a lot more judgment for that subset of women.

 

P: So what was the pregnancy like, given that you were ambivalent?

J: It was hard. I mean, it was really hard. I you know, struggled for someone who wants body pregnancy I felt not very embodied because it was hard for me to feel present in my life at that particular moment. So it was, you know, I struggled a lot with the fact that I wasn’t excited and what that would mean, and if that meant I would be a terrible mother and, you know, if I was ruining his life already, because I wasn’t excited and wasn’t welcoming of the experience. So it was really difficult.

P: As you can imagine, it’s a real struggle for Jennie throughout the pregnancy, and she develops Peri Partum Depression, and she writes, I get counseling and try to think positively about the birth. But a journal entry of mine written in early November is full of fear, fear that I won’t bond and I won’t be happy that something will go very, very wrong. I won’t be a good mother to this child. So I’m imagining, you know, fear of not being a good parent is normal enough. And you know, every first time mom probably has that is a very different situation. And Jennie’s conflict is that she feels so negatively about this baby, that she’s worried about what the consequence of that is. And I’m wondering if you think there is a consequence or is she creating a chemistry that is somehow affecting the baby?

Dr. Matityahu: A couple of different things in that so women that are depressed, anxious having mental health issues during pregnancy? There have been some studies done to try and parse out what kind of impact does that have on the unborn child? I don’t know that we have a great answer for that. But I think in addition to women feeling depressed and anxious, now they’re worried is my depression anxiety impacting my unborn child and so now it just magnifies their depression and anxiety. That’s that’s one thing. Well, I don’t think we have a good answer for that. You know, I wish I could just wave my magic wand and say, Fine, then don’t be depressed and anxious. But that’s not a reality. You can’t just wish that away. You can’t just can’t take that out of the equation. On the other hand, I do have a lot of women who are ambivalent about the pregnancy or just have depression, anxiety and then have concerns about bonding, not feeling excited about the pregnancy, not feeling connected to the pregnancy, worrying that they’re not going to be connected to the baby. And that’s that’s a real concern. That is a part of serious depression and anxiety that needs to be addressed. And so you know, to be able to see a therapist and potentially they need to be on medication during the pregnancy. I mean, that’s one aspect. I have a number of women who after the birth having postpartum depression a huge aspect of that is I don’t feel connected or bonded to my child. I bonded with my first one and I just don’t really feel much for this one. I feel resentment or I just feel disconnected or I just feel tired and aggravated or there’s so many different things that a mom can feel and then they feel guilty. So in addition to not feeling what they think that they should feel, they feel guilty that they’re not feeling what they think they should feel, and then they feel depressed and anxious about what they’re feeling and it just spirals. It’s a form of pretty intense postpartum depression when you’re not bonding with the child not feeling attached to the child not feeling happy about the child. I mean, it’s, that’s pretty serious. And so, again, having mental health support is is incredibly important. And it’s really challenging to get mental health support in this day and age and so there’s that and then feeling maybe ambivalent about taking medication when you’re feeling depressed. Then going back to Jennie, of you know, her peripartum and and postpartum depression has a very strong basis in But the whole lack of communication with their husband and lack of desire for the pregnancy and lack of ability to have that conversation with him in a productive way and come to an agreement where they both feel like they’re heard and and getting their needs met. And so there’s so much baggage behind the postpartum depression that she writes about. That’s not just something that an antidepressant is going to fix, right? And then there’s the religious guilt. So you are adding a whole new dimension of guilt, you know, in addition to society and husband and culture and religious guilt is is pretty intense in real.

P: I’m so sorry to hear it. That sounds really hard to manage. What was it like at your house? Was your daughter excited? At some point when she she was

J: yeah, she wanted a sibling. We ended up my second pregnancy had a boy and she she wasn’t excited about a boy. When we found out the sex of the baby, we told her and she threw herself onto the couch and started sobbing because she really wanted a sister rather than a brother. And then she was playing with her stuffed animals later that day, and she had them go to the hospital and have a baby and then return the baby to the hospital and exchange him for a sister. So she had to work through something.

P:  so I’m wondering for and my sister is eight years younger than me. And I completely remember saying to my mother, don’t come home from the hospital with a boy. 

J: Yeah. 

P: And it was, you know, kind of probably, I wonder if it was probably on the cusp of ultrasound, so maybe they didn’t know the sex. 

J: Yeah. 

P: So I have all sympathies for your daughter. Yeah. thing to do. Was the pregnancy physically relatively straightforward.

J: Yes, that one was physically fairly straightforward mentally and emotionally. It wasn’t. But physically, it progressed pretty smoothly.

P: Well, I’m grateful for that. Because if you had, you know, high blood pressure in the second trimester, yeah, you’d be like, Are you kidding this? Yeah. And it’s hard and really my body. Yeah. So then let’s go to the birth and how does all that unfold?

J: Yeah. So you know, and here, it echoes my daughter’s birth in interesting ways, because I didn’t know what my body starting labor would feel like I just didn’t know. So as the due date, actually was well, he was born about a week early before due dates, you know, they’re all hypothetical anyway. But as the due date neared, I started to have those Braxton Hicks contractions again for like two to 5am and so I was like, is this it? Is this it again and frustrated with that? Once again, and then one night, you know, I was having these Braxton Hicks contractions. I couldn’t sleep but that had been the case for the past three nights. So I was just walking laps around inside the house and you know, eventually they became stronger but they weren’t consistent yet. So sometimes we’d be two minutes apart, and then there’d be 10 minutes apart and it just, you know, I was like body, what are you doing? But then all of a sudden, it just switched. And, you know, they were consistent and they were strong. So it’s like, Okay, I think we need to do something so I woke up my husband, but we aren’t from Arkansas, so we don’t have family nearby. So we needed to call a friend to come watch our daughter’s so that we could go to the hospital and she lived 30 minutes away so we allow for her to come and in the meantime, it’s like, we don’t have 30 minutes. So you know, he was just coming so he ended up being born and in our bedroom.

P: Wow. What so that sounds like a fairly stressful, a fairly stressful thing to understand in the moment like, Oh, we’re not going to get to the hospital. are you doing all this figuring out or your husband is doing it or

J: it was mostly me. But it Didn’t it feel stressful to me it felt like all right, this isn’t happening, right? Are this is happening? Not going anywhere. And again, there’s no choice right? So it felt once again, like, you know, my body wasn’t giving me the option was saying this is what’s happening right now. So let’s do this. I think it was a lot more stressful for my husband than it was for me. He was very nervous. And I was like,

P: it almost seems like the universe heard you say I didn’t want the intervention I wanted unmedicated and they’re like, no problem.

J: Yeah. Yeah, I did. I had I had hired a doula. Who I was working with for that pregnancy. And she ended up saying afterwards, I think you were just in labor denial, because you didn’t want to go to the hospital, which I don’t know maybe, you know, deep in my subconscious that was the case. But I, you know, I was actually pretty pleased with how that birth occurred. I felt more empowered in that situation than

I had expected to just somewhat the 

P: do midwives arrive after the baby’s born or how does that all work? 

J: Yeah, the baby was born in July arrived at our house and then eventually we called in the hospital and ambulance transported me to the hospital to have him checked out and everything.

P: But you guys cut the cord and you deliver the placenta and all that stuff by yourself. 

J: Yep, yep. 

P: Wow, that seems incredible to me. And then you like walk to the ambulance or they carry you out or hearing me out. As the baby was totally fine,

J: and the baby was fine. Yeah, he was a little cold. So they warmed him in a heated incubator for a little bit after we got to the hospital. But otherwise he was fine.

P: And given your entrance into that delivery. Are you feeling in any of the euphoria of having delivered once it’s over?

J:  I think I think a great deal of relief. Yeah, I think I felt a great deal of relief, and I was impressed with what my body did and that my body was able, you know, was able to do that on its own really,

P: and are you happy to jump back into breastfeeding or what’s your relationship with that?

J: I was, it’s so strange because you forget a lot once that time period has passed. I feel like I forgot a lot from my daughter after that time period to hip cast. And then when my son was born, it was like, oh, yeah, I remember this part. I remember what it’s like to wake up, you know, every hour and a half throughout the night and have one half of your shirt soaking wet from milk, spraying out of the other breast while you’re trying to breastfeed on the other side and be wet from those nights so that you get those first few weeks afterwards and yeah, familiar in an intense way. 

P: Yeah, yeah, I bet. I know. High blood pressure this time. No high blood pressure. Yeah. Well, that’s good. That’s excellent. What was this postpartum like?

J: It was? I mean, it was a challenge. Mentally and emotionally much more than it was with with my daughter. So I definitely struggled with some postpartum depression afterwards, just because of how physical that period is and how much work it is right? You can’t half time being a parent of a newborn. Or, you know, it’s it’s demanding physically, mentally, emotionally. And since this wasn’t an experience, I felt I had signed up to do a second time. That was a challenge for me. So I struggled with that adjustment. But persevered I guess.

P: I’m glad you made it. To the other side, although that sounds like a difficult road to traverse, especially if you’re not if the switch does not flicking you at some point during the pregnancy, right? Because it just gets harder to manage and there’s and you know, you thought your autonomy was being pressed when you were pregnant. Yeah, wait till he’s here. 

J: Yeah. 

P: So that sounds difficult. Having gone through that, would you have advice for younger Jennie? If she do it again? Or are you too close in time to the birth of a pregnancy? To have a perspective on it?

J: I mean, my advice for younger Jennie would be. I mean, I guess my advice for myself in the moment during those, some of those difficult periods would be that this is normal, right? I think. We don’t always recognize how normal complicated reactions to pregnancy in the postpartum period can be and it is couched or framed as abnormal or pathological when in fact, you know, any, any woman who is pregnant or raising an infant in a situation where she doesn’t have the support she needs, is going to feel strained right? And is going to be anxious or depressed and things like that. So I would tell myself, it’s normal and that you’ll get through it. I would also tell myself that it’s okay. To be more assertive about your choices and your autonomy.

P: It’s such a good point to say that it’s normal because there are no other experiences that you have in your life that are complicated and first of all, in my experience, nothing as physically demanding. As Yes. Yeah. So to imagine that it’s all not even like rosebuds and rainbows, but that you’ll be happy aboutit all the time  Yeah. Oh, yeah. It’s such a weird fiction. Yeah, that is present everywhere.

J: Yeah. And, I mean, if you think about childbirth throughout the century, especially, I’d say pre, pre modernization, globalization. Women were never alone, right. If they had a baby they had sisters, mothers, grandmothers, aunts, community members around them all the time helping it was a community you know, it wasn’t like what six what I experienced and what I think a lot of women today experiences. It’s you in the baby in a bedroom at night, right? Or, you know, people come by to see the baby and say hi, but there are long stretches of time where you’re alone in the house with a newborn and that’s not normal, right? So no wonder so many women struggle.

 

P: That is totally true.like you. We lived not close to family. And so family would visit for a week and be super helpful for a week and then leave. Yeah, you’re alone. Again. Yeah. It is a totally different experience when you’re doing it by yourself. Yeah, yeah. That is a very good point. Now I’m excited to read about all your writing. Tell it tell us a little bit about what you’ve written and where we can find it. 

J: Sure. I’m gonna let the dog and quickly so he stops barking

P: that’s fine. I’m excited. It’s your dog and not mine.

J: Yeah, well, as a writer, you know, my impulse when feeling conflicted or about something occurring in life is to research it and write about it and try and unpack and understand it that way. So I’ve written a lot about motherhood, and a lot about evolutionary biology in the context of motherhood and feminism. So I written somewhat political essays. About bodily autonomy in the context of the Trump administration when I had my second pregnancy. And then I’ve also written a lot of essays exploring motherhood from that perspective of evolutionary biology and what kind of environment were most humans raising children and during that long hunter gatherer period, and in what ways do we not have those environments in place right now in a manner that causes complexities and makes it especially difficult, or lonely I guess to be a mother today.

P: That’s sounds so interesting, and and so on point and something that gets lost in the discussion of motherhood and what you should be and what the cultural expectation 

J: Yeah, yeah, yes. 

P: Do you have a website?

J: I do. If Jennifer L case.com. There are some links to essays there. So I’ve published some pieces. And I have one in the rumpus and one on breastfeeding and evolutionary biology. Currently in the North American review, and I have a piece and literary mama and eco tome so and then I have a short piece actually, that just came out in diagram magazine that’s available online.

P: Okay, cool. Well, I will definitely link to that. 

J: Yeah, 

P: Jennie, thanks so much for coming on. And sharing your story is so interesting. And I look forward to seeing more of your writing. Yeah.

J: Thank you for having me. It was so fun to talk about.

P: Thanks again to Dr Matityahu for giving us a larger context in which to understand the often complicated set of feelings that come with an unintended pregnancy. Thanks also to Jennie for sharing her story–this is not the kind of thing you’ll see on most social media, instagram and facebook, or Meta now I guess, are for bright shiny moments..and seeing those all the time sometimes makes us lose track of the whole picture. I will include links to Jennie’s website on the War Stories from the Womb website in the show notes. Thank you for listening.  If you liked the show, feel free to subscribe and share it with friends. We’ll be back soon with another inspiring story.