Tag: anesthesia

Hi, thanks so much for coming on. Can you tell us your name and where you’re from.

Tabitha: Hi yeah thank you so much for having me. I am Tabitha, and I live up here in Alaska, and I am born and raised. So I’m 100%, authentic.

P: wow, what is it like there right now is it, are you covered in snow or

T: definitely covered in snow, but I have to say it’s like a balmy 20 above today.

P: Yeah, only the locals would call that balmy is my guess,

T: well since you’re in California yesterday is still cold for you but that’s more than for us for sure because this time of year it’s actually not uncommon for it to be 40 below 0

P: Oh, my good lord. Wow. You just established yourself as someone who’s tough so we can go.

T: Well thank you yeah…I think you have to be to live here for

P: I’m sure, no kidding. So how many kids do you have,

T: I have two kids, a five year old son, and two, almost three year old daughter.

P: That’s a fun age,

T: so much fun. Yeah,

P: so before you had kids, maybe you were thinking about getting pregnant. What did you imagine pregnancy would be like,

T: Well, the first thing that I thought is that it would be easy, because from all of your high school sex ed lessons they pretty much say, if you have sex you will get pregnant.

P: Yeah,

T: so I had no idea that getting pregnant is a thing and that there’s only a small window of time during the entire month, when you have a chance. My husband and I originally didn’t want children, and I just always thought that I’d be a career woman.

P: Yeah,

T: and it’d be kind of dual income and we could travel the world and all of those things, but then when it was Christmas, and my parents came to visit. I was suddenly so sad because I was like Christmas isn’t the same without children.

P: Yeah

T: and then I got really bummed out because I was like not even my parents won’t even be here forever and I decided that day was like, I need to be pregnant now. My poor husband was like wait what? But then I just I was so excited to be pregnant, and then I was so frustrated that it wasn’t something that happened instantaneously and like the more I looked into it, the harder it seemed.

P: Yeah,

T: so that was, that was an interesting introduction that was totally unexpected.

P: So, it sounds like maybe you guys had some trouble or what was your experience getting pregnant.

T: Well I had been on birth control for a very very long time, and luckily I had gotten off of hormonal birth control, a year prior. And I hadn’t had my cycle for an entire year and like that would have been incredibly frustrating if we were trying to conceive.

P: Yeah

T: because I always assumed it was just like you get off the pill and then you can conceive, but I was still having long cycles, so my cycle is about 60 days, so we only had a shot, about every other month, and I, I’m kind of the Type A like I just wanted to get it done, I want it now and, I was trying to track ovulation and doing all of that but that was a little tricky because I didn’t have a typical cycle, we did you know quote unquote try for six months, but we only had three shots, and I was doing acupuncture to regulate my cycle which I think help.

P: So that’s pretty interesting acupuncture to regulate your cycle. When I went to look it up, I found a number of articles that suggest it can be helpful, but we don’t fully understand how it’s helping another thing to add is that most of the studies I saw focused on women with PCOS, which is not tariff issue. And I was tracking ovulation and

T: so it’s kind of funny because I went like zero to 60 I was like doing all the things that a lot of couples don’t do until they’ve been like, trying to conceive for a year. Let’s make this happen. I’m gonna control every factor that I can, which doesn’t really isn’t really much was my first introduction to pregnancy and motherhood really

P: yeah

T: so yeah we weren’t trying for long, but it definitely did give me a huge sense of empathy for these couples that I hear of who tried for years.

P: Yeah,

T: I had a small glimmer into that world and I do, it’s tough.

P: I think it is, I think you’re right, we’re all fed a steady diet of, it’s so easy to get pregnant, be careful. Which seems just silly like I think you should just give kids the, the real information. I don’t think it’s realistic to imagine that teenagers won’t ever have sex, but I think it would be good for them to know, you know when they’re at greatest risk. Anyway, so you guys get pregnant on that how is it after that

T: the beginning wasn’t too bad, and I loved being pregnant, I’m actually, I’m somebody who’s always carried my weight in the middle and I just always hated my belly, but then being pregnant I mean we’re talking like two weeks in and you know you’re just bloated you’re not actually showing I was like, All the maternity clothes like that little baby that was like my favorite thing. I was super lucky that I love being pregnant I had toward the end, I had some struggles with heartburn. That was probably my biggest issue but I was super fortunate and you know, this was, I mean almost six years ago now, so maybe I’m just remembering the good things to be totally transparent, but

P: yeah,

T: our son was due in September and so I really loved that I was able to get out and walk even toward the bitter end, which is a sharp contrast to our daughter who was born in February and here in Alaska, it’s very icy I didn’t feel like I was able to get out as much.

P: Yeah,

T: I just really loved getting out getting sun, though I did have the dark spots on my face.

P: Yeah, that was talking about melasma, aka the mask of pregnancy, and it’s caused by higher levels of estrogen and progesterone, which increased melanin production. I link to an article in the show notes about ways to handle it if it bothers you, but it sounds like it fades after delivery or sometimes after breastfeeding.

T: But that was worse because I was getting so much sun because I was outside walking, As much as I could.

P: Yeah,

T: you know I was a little queasy during the first trimester, but I mean I was like that classic  obnoxious woman who takes a picture every single week and looks up all of the baby development and I did kind of this graphically designed photo of me with all the information about how I was feeling how my husband and I were doing how the baby was developing the first child, let me be clear that did not happen with the second, but I did love being pregnant.

P: That’s awesome. Honestly, it’s good to hear a story like that because it mostly sounds like a myth, so it’s nice to have a real person who actually enjoyed it and it was pretty So, why don’t you take us to the, the labor like how did all that started your water break or what happened, how did that work.

T: yeah, so I feel like in every story that I hear about you know trying to conceive pregnancy and then labor and delivery. I just always remind myself that nobody makes it through unscathed, you know if you hear about someone who has an amazing pregnancy, maybe it took them years to conceive or maybe they had a horrendous labor and delivery just nobody gets it easy the whole way through. So I feel like I was super lucky that I had a pretty easy pregnancy, but I didn’t get that labor and delivery that I wanted. I was also I was expecting to go into labor late I wanted that mindset and that expectation, because my mom was late with my brother and I and I just heard so many moms, expecting their baby to arrive on their due date and then being so frustrated at the bitter end just like every day lasts an eternity because they’re just waiting for their baby to come and so I just really put my mind two weeks after the due date. So of course, as my first introduction to motherhood, Our son arrived a week early.

P: oh wow

T: To me it felt like he was like three weeks early. So, it was literally the day of 39 weeks. My water broke at about two in the morning and it was a gush, and I was like, wow, what is this. Yeah, And my husband was sleeping and at the time, we lived only five minutes from the hospital, and I was having no contractions yet. And I originally had wanted to labor at home as long as possible, but I had tested positive for Group B strep.

P: Yeah,

T: so I had to go to the hospital, in order to get the intravenous antibiotics within, you know, I mean not like rushed to the hospital but you kind of have to get there. Once your water breaks, and I was really disappointed that my water broke. I mean before any contractions, it was the very first thing so I didn’t get to labor at home, at all. And my husband is a really heavy sleeper and also really irritable, shall we say when he gets waken up so we live five minutes from the hospital I was like, I woke him up and let him know but I was like I’m just gonna drive myself to the hospital, make sure that this is actually amniotic fluid make sure yeah I am in labor. And so I got to the hospital and checked in and everything, and they confirmed that it was amniotic fluid. I wasn’t dilated at all like, not effaced, least everything was thick, I mean, none of the other factors of labor had happened yet,

P: if your water breaks before labor or contraction start, it’s called pre labor rupture of membranes, or prom. It happens in roughly 8% of pregnancies. In most cases the cause of prom is unknown, the longer it takes for labor to start the greater your chance of infection.

T: and so the nurses kind of got me checked in and everything and they kept telling me, like from my doctor that I should start Pitocin to induce the contractions, and I kept putting them off, I was like oh, we’ll just wait for my husband to get here. I was just really hoping for a miracle and just hoping that my body would kick in and that naturally I could have the contractions and everything without having to do the Pitocin. I originally wanted all natural, labor and delivery and so I did not want to start the negative cascade of interventions by starting with Pitocin, which I had been, I read a ton and I had a very thorough birth plan. And while I think it’s wonderful to be very well informed and know what your decisions are I clung to that as things that I thought I could control, that I could not necessarily control and so I had set up a expectation that it really was highly unlikely that it would have been met. And so that really caused a lot of anxiety and stress for me throughout the entire thing, which ironically will cause problems or delay your labor.

P: You mean because you were stressed.

T: Yeah, yep, I felt like that was, that probably wasn’t helping and then that my mind was just kind of in a negative place and I was so frustrated and to be honest I was mad that I was being told to start Pitocin and then I felt like I didn’t have a choice.

P: were they doing that because of the GBS issue.

T: Yes, because they were saying that I had to deliver the baby within 24 hours I think it was,

P: yeah.

T: And, and so they wanted to do the Pitocin to give me a chance to have enough time to labor to have the baby to have the baby within that 24 hour window.

P: Okay,

T: so I was just hoping that my body would kick in and do everything in time on its own. And so my doctor I kept putting off the nurses and then the doctor came in and finally told me herself and then she, I was like okay we’ll start really slow. And then I all of a sudden was like really anxious because my husband wasn’t there and so I had texted him like okay, you need to be here now thinking, we just live five minutes away. And so he didn’t get my text because he was in the shower so he’d been trying to like arrange his work he was gonna hop through the shower and then he was gonna bring my bags with him later. Anyways, I was a little perturbed. When he arrived because I had wanted him to be there. So I would recommend probably going to the hospital with your husband and not trying to be quite as independent as I was. But he got there, and then I had also wanted my breast pump to be able to naturally induce labor and he’d forgotten that. And again, we’re only five minutes away so I made him go get it, but gosh I was just, I have to say I’m sure I was like that. Angry. Angry laboring woman and it also didn’t help that I felt really judged by the nurses because they were like, Is your husband coming and I’m like, okay, he’s not a deadbeat dad he just, I told him not to come yet, so leave me alone, kind of. So yes, I was really angry and then as the contractions got stronger and stronger. I was so angry and sad. And then they told me that, or baby wasn’t getting enough oxygen. And because I was on Pitocin I also had to have a any sort of I guess intervention. They put a blood pressure cuff on me, so I felt like, Oh and I wasn’t able to move around because I had the blood pressure cuff and because I had the oxygen mask and I couldn’t even really position myself comfortably. So I was laying on my side and I just felt like a pinned animal like just strapped to the bed, not able to move. And when a contraction wave would hit me I would rip off my mask whip off the blood pressure cuff and like that was, I couldn’t have the blood pressure cuff squeezing my arm, in addition to the contractions squeezing the rest of my body like it was, it really felt like pure torture, and then My poor husband like didn’t know what to do. And then of course he did the worst thing that even they told us in the birth class is not to do, like, kind of narrate the contractions like Oh that one wasn’t so bad.

P: oh good lord, oh man…

T: I will murder me.

P: I mean, for better or worse, it’s very hard to express accurately what the pain is like,

T: well I totally agree. I think he was just trying, he didn’t know what to say. And so he was like grasping at things like trying to comfort me. And it was even hard for me because I remember I was holding his hand, but I did not want to be touched, so I was like holding his hand out for my body.

P: Yeah

T: I wanted to hold on to him but I didn’t want my arm touching me and I didn’t want him touching me. And so, our son was our baby was in distress and so the next thing that they did was an internal, monitor, and again this is on the list of things that I didn’t want, but it appeared to not be optional, you know, there were the baby was having low oxygen and the an irregular heartbeat, and so the doctor has her like arm up trying to touch the baby’s head to put the monitor on my uterus and the nurse was struggling to open the package and it felt like an eternity that she was like, struggling to open the package to hand to the doctor.

P: Yeah.

T: Enter homicidal laboring woman again. And then, when the doctor went to put it in. It slipped back out so it didn’t take so then we had to do it again. And then, after we had that in for just a little bit. The doctor was like, we need to do a C section. And I was like, Is there any way you can give me any more time and she was like, 30 minutes. And so I labored for 30 more minutes. And then I was only five centimeters.

P: Yeah,

T: and I was wheeled to the C section, the O R.

P: Yeah,

T: the operating room, and, like, this is really where my negativity and anger. You know, started to reach its full potential. Then I was you know they’re trying to do the epidural and the anesthesiologist is like hold still and I’m like, I’m having contractions, You’ve got to be kidding me now.

P: this is a question I remember from my own C section. When I was asked to hold still while I was having contractions and iPhone is likely to hold still up here as I am to cook you breakfast, so like Tabitha I’m wondering why anesthesiologists are asking us to hold still. I found one who can give us a great answer. Hi, thanks so much for coming on the show Dr Euliano

Dr. Euliano: happy to be here

P: okay good. Will you tell us about your specialty.

Dr. E: I am an obstetric anesthesiologist at the University of Florida in Gainesville, Florida, so that means that I did. Medical School, four years of anesthesia residency and then an additional year of a fellowship, specifically in obstetric anesthesia.

P: So Tabitha is in the operating theatre and having contractions and the anesthesiologist tells her to hold still for the epidural. Why are you saying that to us when we can’t hold still and why are you trying to do that requires us to be still.

Dr. E: So we need to get this needle into what’s called the epidural space. So, without a picture, it’s a little hard to describe but so the first layer is skin. And then there’s some tissue between that and, And the ligaments and so then where your spine is there’s different tissue planes ligaments between the top of the spine, the part that you can touch on your back, and then we need to get between those. And then there’s a couple other layers that we have to go through and we’re going through it entirely by feel that by sensing the resistance of the tissues, and when we get to where we want to be, we’re within half a centimeter of where we don’t want to be. And so we’re touching the needle and you move and we don’t move with you, then we can go to a place we don’t want to be, which can result in you getting a really bad headache. The next day, so, so that’s why we asked you to hold still, or at least warn us if you’re not going to be able to so that we can adjust for that, but yeah it’s entirely a feel procedures so, so we need to be able to feel the resistance of the tissues in your back and if you are moving then that complicates that got I don’t know how you did it.

P: I don’t know how you do it at all…good lord that sounds impossible, and there’s no like press to like use ultrasound or something so you can see, so it’s not just feel.

Dr. E: Yeah, so there’s not really a way to do it under ultrasound, some people will use ultrasound so that they can figure out exactly where to start or figure out what depth to expect to hit the epidural space but those of us who’ve been doing it since long before ultrasound.

P: Yeah,

Dr. E: you get pretty used to what the different layers of tissue feel like, and, and you just know where you are but that’s why it’s good to have somebody with experience doing your epidural,

P: good lord that seems like a sixth sense. Oh, my God. Wow, that’s very cool. All right, well, now everyone should remain still critical.

T: So I held them still as they could and then just the whole time when they’re setting everything up tears just pouring out of my eyes just like, I didn’t want this, and then I had also read a bunch about how like babies who have C sections have more allergies very often, and I mean, as we all know it’s not ideal, obviously, for a lot of reasons. And so I was just so disappointed that I wasn’t gonna be able to give my baby, the best start. And I was just really negative in my head, and something that was interesting. I’ve never heard anyone else describe the side effect of the medication. The way that I experienced it, but I wasn’t able to really speak, it was like I had all these thoughts racing through my head, but I couldn’t really talk, and my husband was kind of watching the C section like he could see he works in, he’s familiar with medical so they let him watch I think a little more than maybe they would just someone off the street and so he was watching the C section so I felt like he wasn’t paying attention to me. Yes, had all of these negative thoughts in my mind I wasn’t able to tell him what I needed from him, and I was in kind of a negative point anyways, so maybe I wouldn’t have.

P: Another thing Tabitha mentions in her experience is that during the epidural she had thoughts racing in her head, but she couldn’t communicate is that a side effect that you’ve heard of before from an epidural,

Dr. E: that would be odd from an epidural, in order for us to be high enough that you can’t speak, it would be too high for you to breathe properly and we would have to put you to sleep so, could be an emotional reaction to the situation where you feel like you can’t speak but physically in order to knock out your ability to actually mouth words, we would be knocking at your ability to breathe and then we wouldn’t be able to keep you awake,

P: she did say that it was like a very emotional thing for her because she desperately didn’t want a C section and so I think there was sort of an inner struggle for her.

Dr. E: Yeah, and it sad the pressure we put on each other as women that somehow you failed if you end up with a C section it’s, it’s a yeah it’s not the way it ought to be, sometimes it’s just the right way. The safest thing for you and your baby and that’s okay,

T: but I just felt like I had ruined my baby. I wasn’t giving them the best start and again I’d had the group B strep so I know there was a somewhat at the time. A more recent procedure where they could swab some of the bacteria vaginal bacteria to put on the baby’s face so that even if the baby isn’t born vaginally.

P: Yeah,

T: they can still get that bacteria, but because we were literally the whole point was to avoid getting the bacteria on the baby. Now that wasn’t an option for me, so I just, oh my gosh I was so disappointed. And this is like, still makes me feel emotional but like when they pulled our son out and they’re taking him over to the little incubator, I couldn’t, couldn’t hear him breathing, and again I couldn’t ask it took me forever to get out. Is he breathing. I could just see the oxygen mask over his face. And my husband, and the pediatrician responded right away now. Yes, yes, he’s fine. He’s doing good. And I just like my first thought was, like, I want to do over like this is ruined, like I already haven’t given my baby. The one thing that I thought I was at least going to be able to give them the perfect start and I was so determined. And I just felt so cheated, that I didn’t get to have that amazing, miraculous experience.

P: When Tabitha talks about not being able to give her baby the best start. She’s talking about research that suggested that a vaginal delivery gives the baby a better microbiome than a C section delivery. A diverse microbiome is a community of bacteria that lives in our gut is now being connected to many different positive health outcomes. So that’s why you’d want it. I just stumbled on this research by Dr Keirsey a guard at Baylor apologies if I’m mispronouncing her name on this very issue. She has a 2016 paper that looks at the relationship between mode of delivery and microbiome and finds that there may not be a relationship between how your baby was delivered, and the microbiome they receive current thinking is that what leads to a poor microbiome is a diet high in fat during pregnancy. So it may not be C sections per se that lead to bad outcomes. Her article notes, and I quote, exposures and events during pregnancy, that may lead to a Cesarean section, but not the surgery itself, maybe the drivers of variation in the microbiome and risk of less ideal health outcomes. So importantly diet during pregnancy is key for this microbiome issue, not necessarily how the baby is delivered.

T: After some processing because it really was traumatic it took such a long time before I could even talk about it without crying. I had a healthy baby like I should have been so grateful…he didn’t have to go to the Nikki or anything, but at the time I was just in such a negative spiral, because I had these crazy specific expectations that were not met, and I felt like a horrible mother like, What kind of mother doesn’t give their kid the best start and I wasn’t able to do that and so I was kind of like maybe I’m not cut out for this,

P: I’m totally sympathetic and I think a lot of this on all fronts is chemistry right like you, I think we all expect that you’ll have contractions, then the water will break and kind of the order of operations which didn’t happen. And I think you imagined that you’ll have the time to have the contractions kind of progress in the way that everyone expects and that also is chemistry too. Right, I mean you can Pitocin them out but that too may take a long time right you just everybody’s different and you are also like, you know, a wash and hormones so yes you’re angry but you know that’s one of many things you probably felt that day.

T: And I feel like it was especially challenging for me because I am generally not a very emotional person. And so, feeling like I had no control over how emotional I felt was also kind of stressing me out in addition to everything else.

P: Yeah. How was your recovery from a C section and like how did you guys leave the hospital.

T: So I left the hospital I think after two days which they recommend for but I was like, get me out of here. And I regretted that a little bit later because we struggled with breastfeeding, which was something I thought would be the most natural thing in the world, but it wasn’t I did heal up really well from the C section. Overall, I would highly recommend making sure you drink enough water and those stool softeners. Don’t skip them because that is an important piece as well.

P: Yeah, I remember being afraid to go to the bathroom after the C section.

T: Yes, so funny, ish story about that so I was terrified as well. And then when I went to go, I couldn’t. So I again super hormonal I went, ended up going this is embarrassing but I ended up going to the emergency room because I, I, like, again, darn research I’d read a lot about how you can have impacted bowels and I was just like oh my gosh I need to get this taken care of, and you know in hindsight I could have just gone to the store to get an enema for me but basically paid a lot more money to do that in the ER, but it was it was terrifying and it was like confirming my worst fear, and I actually had I thought stayed on top of things like I was supposed to do, but perhaps I’m just a little more sensitive to that than other people.

P: Yeah, I remember that being hard I wouldn’t be too hard on yourself and it is a little bit scary if you’re, you know, I remember like trying not to go to the bathroom because you think the C section scar is gonna open or it seems pretty fragile so, so I’m sure you’re not alone. I bet they knew exactly what to do because you’re not the first one.

T: Yeah.

P: So how was it when you had your son home, like you figured out breastfeeding

T: we figured out breastfeeding eventually. Another thing, I ended up. It’s funny because I was also against having to use the shield. The nipple shield I had just heard about how the biggest you get kind of addicted to it and then you can’t breastfeed without it. And luckily one of the nurses who, years later, actually, she’s actually now one of my best friends but the first time we met, she was helping me and she just had like the sweetest gentlest loving way to convince me, you just need to feed your baby like who cares, you have to use shield, like it’s no big deal, it’s not about, you know, achieving perfection or, you know, some unrealistic ideal again or you’re probably noticing a theme here for me. And so we used the shield for a couple of months, and then we were able to get off of the shield and I think he you know you’re just so in gorged, and then my baby was only six pounds, nine ounces, so he was just a little tiny guy, and just physically it wasn’t as compatible and when he got a little bigger, a little stronger, it was no big deal. Oh, there was one night when I was trying really hard to breastfeed him. And I wasn’t able to and I had some formula on hand, again I was against it. I didn’t want to use it but I had to do that and I was all nervous about nipple confusion with using a bottle so quickly, But I mean, he was just screaming in the middle of the night and I literally had no way to feed him so I was really thankful that I had it on hand. And I was able to feed him but there were definitely a couple couple of times when it was just really stressful to try to get him to latch and to eat enough and in hindsight, the field actually worked out well because I did not have nearly the cracking and bleeding that a lot of my friends did. And I think that was because they had kind of a barrier, before I was able to like build up the calluses, if you will, so I, in some ways, it actually worked out really well.

P: Good…that sounds excellent. And so I assume you guys found your rhythm.

T: He did Yep, and then I nursed him until. Gosh, somewhere between 18 months and two years old, I can’t remember exactly but we had a good long run at it for sure.

P: yeah, That’s a long time that that I wonder if that doesn’t override the need to have the vaginal birth for that element of the microbiome.

T: That’s a good point, maybe,

P: you said you had two kids. So did you start, what, what were your plans for the second child, did you start immediately or what were your, what were you thinking

T: we had originally planned to start, I guess our son was born in 2015, I think the beginning of 2017, we had planned to start, and then I actually, we were going to start in January as you can tell, I’m like a planner and so I was still breastfeeding our son. And so that seemed like a good time, a good gap between between kids couple years. And so, we plan to start trying really trying, you know, getting out all the research and metrics and everything. In January, but we weren’t like preventing before that and kind of just, if it happens sooner, whatever. And so I actually I didn’t realize until February. I had actually gotten pregnant in December.

P: Oh wow.

T: Yes. And it was the reason it took me so long to figure it out, was because I had a really light bleed it was like a weird period I thought but I didn’t realize that I had had a period and then had even suspected it a little bit, and took a pregnancy test. But I had two different kinds of pregnancy tests I had the kind of that was two lines was the positive and I had the kind of that was a plus sign was a positive.

P: Yeah,

T: and I think I had like, you know, thrown out the instructions it was just the test and I think, I think I had probably tested positive that first time but was looking for the wrong thing, and I didn’t realize I found out about nine weeks that I was pregnant, and then actually we ended up miscarrying which at 11 weeks, which was devastating. Oh my gosh, it was so awful like so much worse than I ever could have expected and so we miscarried. On February 23 And then, yeah, so awful. I don’t want to go into that because I will cry.

P: yeah, that’s fine I’m sorry, yeah that’s fine.

T: Yeah, but just anyone should know they’re not alone. Um, and then of course I wanted to conceive right away as soon as possible like not that a baby can replace another baby, but I just felt like I needed that and felt like it would be healing, and so I did everything I could to like, prepare my body but also give myself time and so then I think we started trying to conceive again maybe in April, or maybe we did conceive almost right away maybe maybe there was just one or two months of weight, but pretty quickly. And then that pregnancy. I knew right away because I was, you know, paying attention and planning, and that pregnancy was a little more stressful just that I was always worried if everything was going correctly and especially since I miscarried at 11 weeks I had thought I was so close to being in the homestretch, you know, because your, your promised you’re guaranteed at 12 weeks your baby’s going to be fine. I mean, I say that sarcastically but it really feels like that way and you really look forward to that milestone as a pregnant mom. And so I was super nervous the first trimester. And then my second pregnancy was very much like my first pregnancy, the heartburn, again, was probably my biggest issue, and having being largely pregnant in January and February in Alaska was kind of stressful. I was just always worried about falling, and so I just had, I parked close and I had like the, the grips on my boots, and I just I didn’t walk outside, like I had but it was also harder to stay active, I did walk some but I didn’t enjoy walking indoors or on a treadmill nearly as much so I didn’t do it as often. Yeah, but overall, again, I had a really, really good pregnancy, though I did find out that she was breech, we found out that pretty early, I think at our 20 week ultrasound. I tried everything to get her to flip everything natural that I was comfortable with, I was not comfortable with full with a cephalic version because I felt that manually flipping the baby I mean there was probably a reason she was breech you know either she was tied up in the, the umbilical cord or the umbilical cord wasn’t long enough, there wasn’t enough amniotic fluid. I just I wasn’t comfortable physically forcing it.

P: Yeah, that makes sense

T: I did. I did hypnosis, and I also did a few acupuncture treatments. And one thing that was crazy is one of my acupuncture treatments, right after I hopped off the table I was putting my clothes on, and I could feel her try to flip it was the weirdest feeling like, like she was kind of in a hammock sort of with her head under my right rib, And I felt her head go up like between my ribs, and to the point where I had to like lean back in the chair that I was sitting on to like put my socks on. And she was like, I could just feel her like trying to kick over, and she never did, but that was kind of a crazy, a crazy experience

P: that sounds like you gave it the college try. That’s well done.

T: I totally did and I did a little bit of like the handstands and stuff but my goodness I was like okay well I’m trying to flip my baby around I might break my neck, I’m not sure that’s a good idea, but it was an interesting experience. And so I felt like I was, again, a little bit cheated out of my natural birth experience but I wanted, but I was a lot more realistic because I’ve been a mom for a couple years at this point, and knew to, for sure is that my intention and know what I desired, but not hang everything on that, and knew that I would just have to roll with the punches, because that flexibility. If you don’t have that motherhood, you’re gonna be so much more stressed and anxious, and you know when you’re trying to control things that you can’t control. No good can come of that.

P: Yeah, Yeah, also I feel like if the baby’s breech like some of the visions that are kind of out of your hands right like.

T: Absolutely, yes,

P: that is, that’s a definite C section, right?

T: It was yes and so I scheduled this feast actually which I had kind of chuckled to myself I’m like another thing I thought I would never do. And, of course you know had felt so judgmental of people before who did it but I’m like oh well now that I’m in it I see that that really is a necessary thing sometimes.

P:  Yeah,

T: I scheduled it as late as I possibly could. I think it was like, 39 weeks and four days, which was a little bit late, considering it was my second child, and that my first child had arrived at 39 and one days.

P: Yeah,

T: and so I was really hoping to go into labor naturally I just thought that would be nice to at least know the baby was ready, but I did not, and a nice affirmation or confirmation was the morning of my daughter’s birthday. I, there was a huge snowstorm. And so I was just like.

It’s so nice that this is planned like what if there was a crazy snow storm we also we live on a super steep hill we’re just out of town and crazy Alaskan winters, I was like I can’t imagine being in labor, yeah stuck on the side of the road or in a ditch or something like that.

So that was just a really good confirmation that I made the right choice, given our circumstances, I also didn’t really have anyone. A lot of my girlfriends who just had a baby, we all have babies around the same time and so it was my mom was able to come up and watch her son and so I mean, I’ll be totally honest, the logistics were a lot smoother. So that was, I just had to take the wins where I could

P: totally. So, so it sounds like you didn’t your water didn’t break there’s no labor you, you went to the your appointment like it was an appointment.

T: Exactly. So, it was delayed quite a while but mentally I had prepared for that I’m like I know this is scheduled, but I actually worked at the hospital at the time so I was like, I know that it’s probably going to be delayed. So in my mind I was prepared for that. I also had a doula the second time, which was really helpful even though I had done it before. I really wished I would have had her the first time, but it was nice where you know just hanging out waiting joking with the nurses, laughing, I had prepared like through hypnosis, and then just affirmations. So anytime my mind would start to worry or wander, I would, I had all these affirmations at the ready and so they wheeled me into the OR, and I wanted to see my baby being born so they set up a mirror for me to watch.

P: Oh wow,

T: I have all of these affirmations in my mind, and then my doctor. Also, let us drop the curtain. So when they pulled her out and pulled her out of my belly, I got to see it, I got to watch her come out of my stomach.

P: That’s super cool.

T: Oh, it was amazing. I feel so grateful, and then my husband was able to watch the whole thing and the whole thing is on video which is like such a special treasure. I don’t know if a lot of places will let you do that, but, yeah, the experience was completely different. She was, she was able to be skin on skin on my chest which I wanted afterward, which I did not get with our son and I was really upset about our daughter was like snuggled in, and our pediatrician. I knew her also and she was amazing and she was like, Oh, let me take a picture and so we got a picture when she was first born and she made sure my boob wasn’t in it which I appreciate.

P: that’s well done, that’s well done

T: was like, well, you should add that to your list of like your resume. Yes, but she was amazing I just loved because I knew her and that was another pro of the scheduled C section I knew that she was going to be our pediatrician, most likely, so that was also really nice and I got to have our daughter’s skin to skin recipes, breast feeding was super easy. But another thing that we were able to do the second time, second time which I think was actually new technology, they’re able to do what I had researched this before so I knew going in was called a tap block. So they were able to do local anesthetic around my incision, so I didn’t have to have any pain medication for, I think it ended up being 48 hours they said up to 72 but around 48 I could feel it wearing off. But I think that probably helped with breastfeeding also because I didn’t have the pain meds in my bloodstream, it was just local.

P: Oh, that’s totally interesting I hadn’t heard of that, that’s cool.

T: Oh, it was amazing. Like, I highly recommend it was called a tap blocked that made a huge difference because I think the bonding felt so much more amazing to, I still had a little bit of the disconnect from the drugs from the actual epidural and surgery, but it was a lot better and those drugs were off faster, and it was so nice that you do have to be I’d had a C section before so I knew not to push it. That could be the one downside of having that local tap block is having no idea that I mean, you are really healing just because you feel great doesn’t mean you can just say, doesn’t mean you can just do whatever

P: Tabitha talks about a TAP block, can you tell us how that works.

Dr. E: So TAP stands for transversus abdominus plain which is just the name of the muscle that we put the drug, near, and basically all the nerves that supply your abdominal wall from skin down to right before you get inside your abdomen all come from your back around the sides. And there’s a place on your side where we can deposit up a large volume of numbing medicine that will stop those nerve impulses coming from basically the incision, getting up to your brain and causing pain so we can put medicine there that blocks those impulses and it actually works quite well, if, if the anatomy is good so usually we just do it under ultrasound it’s one needle stick on your side we inject a bunch of local and on each side and we’re done. There was a lot of enthusiasm for a while about maybe 10 years ago. But then it turned out that if we use Derma, which is a long acting morphine that we put in if you stay awake for your C section we almost always put it in the spinal or the epidural and adding the tablet didn’t turn out to add any pain relief because they both sort of wore off at the same time.

P:. That sounds like a totally different experience than the first one and quite nice, was amazing.

T: And I did still have some reservations about having a scheduled C section, but my girlfriend that I mentioned who had done, helped me with the nipple shield with our son. She’s a labor and delivery nurse, obviously. And so I talked to her about having a scheduled C section and she was like, honestly, it’s really great because you can have the team you want, they are prepared for you and stay on emergency, so it’s safer. Everything felt smoother and I know a lot of it was me because first of all I’d done it before I knew exactly what I didn’t want.

P: Yeah,

T: it was so nice to have her perspective and like her encouragement, just to be like the staff that needs to be there’s going to be there, you’re going to have the people that you want. And it’s actually kind of funny because our babies were doing our second babies were due a week apart and she actually had her son, that morning. In birthday.

P: That’s awesome. Wow, it was amazing. Yeah, what are your kids into now.

T: Gosh, everything. No, our son is just, oh my goodness, such a loving ball of energy, he is just the sweetest, kindest smartest kid he takes after his dad, and our daughters. She is such a spicy free spirit, but I love it so much because it’s just, she knows what she wants in life and I feel like so often people lose that and it’s such a fun reminder of like there is no question about what she was that girl knows exactly what she wants. And so I’ve definitely learned some from her about knowing what she wants and she is also just so happy and giggly.

P: That’s awesome That’s a very good. It’s a very good end to the story.

T: Yeah, and that is kind of my I think my biggest blessing was just not having these ridiculous expectations that can’t be met and controlling what you can, which is your attitude right, and so that was a big difference was that my attitude was completely different. The second time and everything went so much smoother.

P: Oh my god, that’s so cute oh my god she sounds adorable. Thank you.

T: Just a minute, sweetheart, made most of the way without interruption.

P: You know I couldn’t add better sound effects and that’s perfect.

T: Oh there you go,

Unknown Speaker  8:16 

tell us, and thanks so much for coming on and sharing your story today I totally appreciate it.

Unknown Speaker  8:20 

Thank you so much, I

Unknown Speaker  8:21 

just it’s they’re two of my favorite stories so thank you for letting me share.

Unknown Speaker  8:25 

Thanks again to Dr Uliano for sharing her insights with us. She cleared up some questions I’ve always had about the epidural, I appreciate it and thanks to Tabitha for sharing her story. If you like this episode, feel free to like and subscribe. Also reviews are how other people find the show so we so appreciate your views. If you’d like to share your story, go to war stories from the womb, calm and sign up. We’ll be back soon with another story, the crazy messy hard and beautiful things that can happen in this process, and the amazing things we can do to overcome the challenges.