Tag: hypothermia

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

 

Melissa: Yeah, my name is Melissa Tamara, I’m from Salt Lake City, Utah, in the United States. 

P: Cool. Let’s talk pregnancy. How many kids do you have.

M: Yeah, so I have one daughter who’s biological and then I have a nine year old stepson.

P: Okay. It sounds like you have child experience with your stepson, so we’ll get to that. But, before you got pregnant with your daughter. What did you think pregnancy be like,

M: That’s funny because I literally thought it was gonna be hell. And it was.

P: wow… you’re like the first one to nail it, so why did you think it’d be hell.

M: me as a person, I’m very much like a data driven individual. I will do research at friggin nauseum, to try to understand what I’m getting myself into, before I get there, just because I really like to make as many educated decisions in my life as I can. kids was one of those funny things in my life where I was a bit ambiguous about it, like, kind of, If I could get pregnant okay cool if I couldn’t get pregnant. Okay cool, like, it just didn’t have a huge tie to it, but I married a Latino man. And he obviously has a child already, and so he was very like, I want more children and I kind of was just like, alright, well if you feel passionately about it then. I’m just kind of along for the ride, but I have friends who’ve had children before I did. Some of them loved pregnancy, some of them hated pregnancy and so I feel like I got a good amount of stories beforehand, related to like what pregnancy is like it did a lot of research when, you know, we were getting closer to a place where it’s like, okay, we should start thinking about having kids, and a lot of research on that. Lots of horror stories literally everywhere, and so I felt like I had a decent understanding as much as one can before 

P: Yeah, 

M: get pregnant, right. I don’t know that I knew the extent of how bad Mine would be, but I knew that it wasn’t going to be fly but

P: okay so was it easy to get pregnant

M: I was, I’ve been on birth control probably since I was like 14 or 15. So and, to be completely fair I’ll be 27 this year so I am very young, and got pregnant, pretty young as, like, the world standards go. So, I was on birth control, starting in about 15 ish and was on birth control, up through when my husband and I decided that we were ready to start having children. It took me probably four months to regulate and kind of come off of birth control, and then I got pregnant. Oh, not a huge amount of time as the first pregnancy goes, but I was 11 weeks along. When I lost that pregnancy.

P: Oh wow. 

M: Yeah So, total for us to conceive my daughter. It took about a year from when I got off birth control when we started actively trying to update to when I got pregnant with my now daughter. So, you know, not a terribly long time but you know there were obviously some hiccups along the way. 

P: The miscariage must have been a surprise

M: Yeah, yeah. It’s one of those weird things where, I should also mention, I think bodybuilding before, which, you know, no in hindsight, like when you have a miscarriage, there, there’s no way unless the baby’s like really far along, and they can do an autopsy, they, they can’t really tell you like what happened if you have a miscarriage in the first trimester, so they just kind of attributed it to like, oh, there’s just some genetic thing that happened in the body was like nope, not working, so I was a bodybuilder is very low in weight going into trying to get pregnant, which I tend to think may have caused some problems. It also is possible I guess it could have been, birth control or it could have been any number of things right.

P: so I’ve heard this before, in cases where people are ultra athletes like Melissa, that they sometimes have trouble getting pregnant or staying pregnant, so I took this question to an OB. 

Hi Dr Matityahu and thanks so much for coming on the show.

Dr. Matityahu: Thanks for having me. I love being on your show. 

P: What’s the relationship between body fat and menstrual cycle and pregnancy, how does that all work. 

Dr. Matityahu: So, there’s a fair amount of evidence out there about really low body weight and body fat and how it can impact our ability to regulate well need to be ovulating well to pregnant to conceive, and the fat in our body converts to hormones. So the, our body fat has a lot of impact in the whole cycle of creating estrogen in allowing us to ovulate.

M: So, got pregnant, was really excited about it and immediately gained, like, a whole bunch of weight, which now obviously looking back, I’m like, Oh yeah, it’s because my body was like, we don’t have enough weight to like sustain this pregnancy, right. So I gained a bunch of weight, I wasn’t nauseous at all which I came as a surprise to me there were a lot of things that I’m like oh this isn’t as bad as, as I thought it would be, which who knows that could have been a sign right that things weren’t right, but had about, I think it was maybe, I think I was just before 11 weeks. When I started spotting and right before that I had this weird feeling of like Something’s just not something’s not right. Like I’m almost 12 weeks at this point like things just don’t, I don’t feel pregnant, it was that thing of like, I just don’t feel like I’m pregnant, which in your first trimester, obviously like that can happen, right, like there are times where anxiety kicks in and you’re like I’m not pregnant anymore and you freak out. But for me, I had this just this gut feeling of like something’s not right. 

It was a Monday morning, and I woke up, I started spotting, and I remember being hysterical. I remember being in the kitchen with my husband, bawling just hysterically because I knew, I knew I was having a miscarriage, it was just like the combination of things, I knew what to look for as far as like this was different than implantation bleeding which I did have in the very beginning stages. This was different, and so I told him, like we need to go to the emergency room because I was freaking out. He, he’s like, no, no, it’s fine. I’m sure everything’s fine. You need to calm down, go to work, Call the OB GYN when you know they open at 9. So I went to work, of course I’m a blubbering mess, I can’t get any work done for the first hour I call my OB GYN have me come in. 

My husband had to go to work, that morning and so I could not be at that appointment, and when I got that appointment they told me that they couldn’t find a heartbeat. And so, to go through that and go through that alone to you know. 

P: yeah, yeah

M: It’s one of those things that, in my adult life. It was a huge shift, I went from being an ambiguous about being a mother to all of a sudden, like, Oh, my God. Like I didn’t realize how much I wanted to be pregnant and to be a mom and to do all the things right. And I remember the conversation that my OB GYN had with me, and she had to walk through all the things of like, this is not your fault. This is not something that you did, there’s no real reason for this to happen, so don’t internalize it, but that’s a nice fun thing to say to somebody like but the nice thing you’re like oh yeah don’t internalize it and then you’re like, great. I’m gonna go and cry. So, they then you know present you with three options of, you can have a DNC, which is where they physically remove everything, and a lot of times your sedated for that. They allow you to have a pill like a Cytotec where you met you know you insert the medication, or you can basically just wait for nature to take its course, so I didn’t like the idea of nature taking its course can last up to like four weeks, And I didn’t know what I was getting into, so I was like, I’m not going to go that route, but I also didn’t like the idea of having to like schedule this surgery this like minorly invasive surgery, so I was like, just give me the pills. Luckily, you know, when I told my bosses, I was able to take, you know funeral leave is what they gave it to me as to handle this problem, and basically pass all the tissue and deal with the emotional stuff that was going on and kind of all the things I was very fortunate in that respect, I know people don’t always have that where they like to just keep going, which is crazy to me.

P: It is crazy, and I’m impressed with your bosses for kind of calling it what it is, right, that’s impressive thing to do, and I’m so sorry you went through that, it’s so hard at the cusp of the second trimester. 

M: Yeah, 

P: but I’ve think heard all kinds of numbers tossed around about how frequent miscarriages and it’s obviously, we have miscarriage too, as someone who has had one, you know, there are many people who don’t realize they’re miscarrying so how could you count it accurately. But if you knew it was you know one and for you, it may be easier to not internalize it, because that’s just, you know, you roll the dice and that’s what happens, but But it’s hard not to not to take some ownership of it, given that it’s in your body.

M: right. our whole instinct is like around protecting this life, not to get like too primitive or whatever but if you get to like caveman thought processes is like that’s what you do as a woman, it’s like in your nature to bear children and care for those children and bring them up to be humans and so I think that when you have a miscarriage, there’s just this primitive instinct of like how do I prevent this moving forward, like how can I fix this. And so immediately your, your brain starts going into like overdrive of like, I’ve been drinking coffee like maybe I should, I need to give up caffeine oh I had a glass of wine before I knew I was pregnant maybe that did something like, just all the things. And it’s, it’s traumatic There are some people that I’ve talked to that seem to handle it better than others but for me, it, it was traumatic. And we ended up having complications with the actual tissue like coming out, it didn’t all come out and so when I went back to my one week appointment where they like check to make sure that everything’s fine that everything’s gone. I assume you’re fine with like some graphic described 

P: yeah yeah yeah blood and guts are welcome. 

M: So, so you know they have the lawn right now, but the wind up in there to poke around and make sure everything’s gone.

P: If you’re unfamiliar with it, the ones that Melissa is talking about is, interventional ultrasound.

M: And so she has his wand up there, which we thought this appointment was going to be just super standard so my husband ended up getting called into work and he had to go. Luckily, a friend of mine when I told her that my husband was not going to be able to be there she insisted that she come, which in hindsight, I’m really thankful for, but anyway so I’m in this office. She’s got this one up there, and my friend is standing here next to me and she says, it looks like not all the tissue came out, it’s not a ton but it’ll probably shed here in a couple of days, we should probably make you another appointment to like double check that it goes away, like okay no problem, you pulls the wand out and immediately. Like, I hear. Just like splashing all over the floor, and I’m like, plus I can’t see what’s happening. And so immediately she’s, you know, she springs into action and starts yelling out the door to get nurses to come in with some big long needle full of stuff and she goes, it looks like you’re hemorrhaging I have to basically scrape this tissue out and cauterize whatever’s causing this like immense bleed  and you know I see blood like spattered up on the walls and it was so crazy, so this nurse comes in and she has to numb my uterus, I remember shaking so badly like just, I’m assuming from adrenaline, they’re doing a DNC and they numbed everything up. And so I’m awake, and they’re doing this DNC inside of this like doctor’s room in a clinic, it was so bonkers to me to go through that and oh my gosh like I never would have thought that something like a miscarriage, would result in this crazy chain of events, you know with miscarriages, especially because people don’t talk about them a ton, I don’t think people realize that like, there can be a complication there, there are things that go on when you have a miscarriage that can be very challenging and very traumatic and you know all these things so that was like traumatic event number, like, two at this point. So,

P: good Lord, I’m really sorry about that, that sounds very difficult given that you research everything, like the shock on top of it to be like What on earth is going on like I’ve never even heard of this, it’s sort of amazing, I had no idea that they could address it in a clinic.  did you need a blood transfusion do they make you stay there, like how do they handle it, so they

M: they made me stay for a little while to make sure that like everything, stabilize but it happens so quickly and I tell you, when I set up after everything was like over and done with, because they had to give me water and you know something, to try to like everything now look like somebody had been murdered in this room. It was, it was so crazy and I think that I just looking back at it now and like I definitely was just like, yep okay I guess we’re doing this like you just like shut off. 

P: Yeah, 

M: and my OB GYN is really great. She’s, she’s female and she’s and she’s a mother too so I think she just hasn’t this extra like nurturing piece of her, but she didn’t tell me like how much blood she bought like she didn’t tell me really anything, even while it was happening, she was like, alright, we’re just gonna do this thing real quick. Okay quick pinch like don’t worry about it like was very, calm, through the whole thing. So, it sounded bad but I have no idea like how bad it really was from a medical perspective, I just know that like, they had to bring me water and you know they had to like bring people in to clean up the mess while I was waiting and it was like a whole, it was a whole thing but yeah, I didn’t know that they could do that either I didn’t know that they could do just like DNC procedure in such al rushed fashion where you’re like a wait time for

P: Dr. Matityahu, likely most of us have heard of a hemorrhage during birth but I’ve never heard about a hemorrhage during miscarriage what’s going on there

Dr. Matityahu: with the medication that we give to help pass all the tissue and the medication, let people know, yes, anticipate heavy bleeding, but then it should, within a few hours, decrease and fade and if not come to the emergency room because sometimes with the medication, not all of the pregnancy tissue in the placental tissue detach completely from the uterus and anytime there’s even a fragment of tissue left behind stuck inside of the wall or stuck onto the wall of the uterus, the uterus wants to rinse it out, doesn’t want it there and so how does the uterus, integrates out that tissue it bleeds, and contracts, bleeds and contracts and that they can’t pass that tissue, it just keeps getting in contracting to rinse the tissue out is why some women will then need even after the medication will need to go in and get a DNC meaning we go in and DNC is dilate and curate meaning we dilate open the cervix and we take this little scraper and just kind of scrape tissue off the walls of the uterus. So what it sounds like happened is she probably started passing some tissue, for whatever reason, there was something stuck inside of the uterus and when that happens, women will just bleed and hemorrhage. It’s not pretty, and it’s an emergency situation. And so when that happens, whether you’re in the office or in the emergency room, that the only option is to go in and scrape out the uterus, on the spot because the woman will not stop bleeding and hemorrhaging. Till the tissue is scraped off from the inside of the uterus.

P: I think Melissa was pretty surprised by how much blood there was can you try to walk us through what happened there.

Dr. Matityahu: So the inside lining of the uterus is really vascular it’s just plush full of blood vessels. Every month we have our period and the lining gets thick bleeds out because get sick and bleeds out. And so that’s like sort of very controlled bleeding but when you’re pregnant. What happens is there’s placental tissue that is embedding into the lining of the uterus and brings in an additional blood supply. So, the blood vessels inside the uterus get bigger get. 

P: Yeah, 

Dr. Matityahu: nice and juicy and start going into the placental tissue, because it wants to supply them. And then, when there’s a miscarriage and everything comes out when there’s all these open blood vessels in this big juicy blood supply that’s in there that bleeds, especially if there’s a piece that’s stuck in there then it is even more to rinse it out

M: but I guess, you know I mean maybe it’s just this area while you’re awake, sort of like, well, yeah, although.

P: Although this seems a lot more DIY. Yeah, you will then I’ve had a DNC and they knock me out and, you know, I woke up later in recovery, You know it definitely looks like surgery. so thank God that they addressed it really quickly, but now. Now what’s your thought process for like you know what I’m gonna try this again.

M: Yeah, so obviously after that, it’s again almost like this primitive thing where it was like I unlocked this piece of myself that didn’t really exist before where I was like, Okay, I recognize that this didn’t work the first time around, but I now really want this for myself, versus the first time I got pregnant, it was like, Okay, here we are. It took a long time for everything to stabilize afterwards which I’m sure probably happened to you too, but I remember researching, so much to try to figure out like how long is it gonna take for me to get pregnant again, like I remember looking like every day I was so stressed out about it, so I bought this armband and measure my basal body temperature I was testing ovulation, every day, like I was in it, I was in all the fertility things. It took four months, from, you know where we were having sex all the time just alone. Yeah, I don’t know, I had no idea how to like, deal with ovulation, I ended up doing so much research about the body temperatures and the spike that happened and like all the things, so I’m doing all this research we’re having sex all the time, nothing is happening. I remember feeling so defeated. Maybe this just isn’t really in the cards for me like maybe this is just not meant to be. And so,

P: although let me stop you right there for one second. Yeah, we all have this expectation that as soon as you have sex, you will be pregnant. Now that you look back, four months is not super long. But I also had trouble getting pregnant and every month you get the negative pregnancy tests, you’re like, okay, so apparently I can’t do this like, there’s no, but it’s a bummer that we all come to this with this idea that as soon as you try to be pregnant and so if you’re not pregnant, something’s wrong.

M: Right, well and husband got a girl pregnant in high school. So, with that knowledge as well as like, is it like had an accident. And so I think that, you know that plays into it as well. It’s a lot it’s a lot of like mental stress to go through this process, regardless of whether you have a miscarriage or not, like, even those four months I was like I’m gonna shoot myself in the eye like this crazy Android like strap myself out we’ve had a couple of months where I thought I’d get pregnant and didn’t get pregnant, and my ovulation was all wacky, and it was the first week of April where I was just like, I’m exhausted. I need a break. A break from sex, I need a break from everything, and I just want to relax, and that’s the week we got pregnant, we had sex one time that whole week, just happened to be like a day or two before I ovulated. Had no idea. And it just happened. And so, it’s one of those funny things where it’s like you have no control over anything is like the whole story of pregnancy and birth right, you just don’t have control your body like you think you do. 

P: Yeah, I can imagine, especially for a bodybuilder where you’re probably for years doing all these things in a way that suggests you have control over your body.

M: Yeah absolutely and I’m a control freak, the most anal retentive you could possibly be as a human, that would be me, and I’m a ball of anxiety, this whole process, I’m like, this is the this is the test of my lifetime, like this is just crazy. And at the time I was 23 or 24. So, I’m young but my parents had a hard time getting pregnant, it took them 10 years. 

P: Wow. 

M: So, with all an IVF and the whole shebang. Funny enough, they actually got pregnant with both me and my brother when they were not doing IVF. So it’s funny how. 

P: Yeah, yeah

M: you really control it all 

P: so this time did you feel pregnant when you got pregnant. 

M: Yeah, so when I got pregnant immediately my boobs hurt so bad, so funny enough, because I was like tracking my ovulation, and I was pregnant on the stick. I didn’t know that I was pregnant, and so I’m tracking my ovulation. After this, this one week where we kind of had like a hiatus where we just had sex, like the one time. And so back to tracking my ovulation, all of a sudden I get a positive LH surge,

P: what Melissa is talking about here, LH is luteinizing hormone which rises just before ovulation, an increase in LH triggers the release of an egg from the ovary, which is important because this is the sign that you’re coming up with your fertile window. The time when an egg can be fertilized,

M: so I’m like, Yes, perfect. Okay, great. So, I’m testing it and then it’s like, day four of me peeing on this stick and getting a positive LH, and then day five of me getting this and I’m like, you’re not supposed to ovulate for five days what’s happening right now, so then I look it up online and it’s like, oh, it can mean that you’re pregnant, because sometimes it will catch that hormone, and it mistakes it so.

P: So here, let’s just talk about what can happen, your ovulation kit tests for LH to identify the fertile window, but it can mistake, LH for another hormone called HCG which is released by an embryo after implantation, although they have totally different functions, LH and HCG have really similar structures and some ovulation tests can’t distinguish between the two.

M: I took a pregnancy test. And I’m pregnant. I was like, oh my god, like, 

P: that’s awesome. 

M: When did this happen. I think I was maybe three weeks along so like, really really early. Yeah, so, obviously, then all of a sudden these emotions of like, it’s still really early it’s possible we can have another miscarriage, and of course, you can’t go to get an ultrasound until you’re like, between six and eight weeks or something like that. So now I have to wait, right, so now I have to practice more patience, of like, hey, is this gonna stick. We don’t even know. Am I even really pregnant I tested multiple times like over the next couple of weeks, to make sure, so at about four or five weeks that’s when my boobs started hurting, and then at six weeks, I started getting morning sickness. So, 

P: triumph!

M: I know I was like, I never thought I’d be so excited to be sick but I was like, if I throw up today, it means I’m still pregnant, every day, and I did and I throw up every day for like 16 weeks. So it’s funny because, like I’d brush my teeth, and the brushing of my teeth would make me throw up and so was this funny little reminder that like you are still pregnant. 

P: Yeah, 

M: you know, like these things that don’t normally make you throw up or still making you throw up, or if you’re really hungry it makes you nauseous, which, you know it’s not normally the case like I can usually not eat until lunch and be fine, but in the morning I wake up, but I’d be so hungry that I’d vomit. So that was this, this nice little thing of like a breath of fresh air, like we have morning sickness, things are good, we didn’t have this before so after you pass the morning sickness phase, then there’s occasionally times where you’re like the babies don’t move in. So there’s that.

P: The second trimester is quiet, more or less. 

M: Yeah, so the second trimester was not too bad, I stopped throwing up like I said around 16 weeks so I have probably a solid weeks where I was just like cutely pregnant and like kind of uncomfortable, people always say things like, Oh, the second trimester like it’s fine, I’m like, I don’t know about you but I’m waking up three to four times a night to pee and that’s not fine for me. 

P: Yeah, yeah, 

M: It’s not fun.

P: Are you are you enjoying it at all. Are you still like,

M: No, for me, I get so cranky if I don’t get sleep, and like waking up several times a night. It’s frustrating because you’re uncomfortable, you can’t sleep well and when you’re not sleeping well, it just, It just kind of sucks, go through the second trimester, things are relatively quiet, just regular normal uncomfortable being pregnant stuff

 I’m a small individual, my daughter 30 weeks ended up dislocating for my ribs, because 

P: Oh my God, 

M: she was really kicky, like all the time, always moving, which got really nicely for me. Luckily not during the middle of the night, which was nice but you’re very kicky I have tons of videos on my phone of her like she’d have the hiccups or she you know she’d be super crazy in the womb which is very indicative of her personality, now she’s absolutely bonkers like a ball of energy. And so, so at one point she picked out for my ribs, and my OB GYN was like, oh, go to the emergency room and get an x ray because I think she cracked your ribs. 

P: Oh Wow, 

M: so. So, to the emergency room, they did not give me an x ray, they gave me a lot of unnecessary things. Monday, I had a chiropractor appointment to go to the chiropractor appointment, and I tell him I’m having this insane pain and I can’t even sit down, like I had to lay down because I’m so it was so painful. He checks it and he goes oh yeah four of your ribs are dislocated, I was like, okay, so he puts them back then while I’m there. And then, as the muscle relaxer and was able to like resume my normal life, but just so crazy.

P: Yeah, that is crazy. He so once, once he readjusted, which I’m assuming is not comfortable. Then it’s back to normal though, and you feel better

M: back to normal, so we didn’t have any other issues with that. Everything went fine throughout the rest of the third trimester, and then, you know, went into labor naturally and and

P: so tell me about that day, like what were you doing, how did it happen. Did you know it was Labor

M: so that Day, so that day, it was funny because the day before I thought my water had broke. My husband and I had sex. Like, I think, 24 or 48 hours before. And, you know, because we’re trying to like, yeah, things moving, and so I wake up one morning, this was December, I think the 22nd December 22 I wake up and immediately I have, like, this gush of water, like wasn’t a, it was more than normal, but wasn’t like a whole bag of  the water popped somewhere in the middle of that. So, I don’t think too much of it on my. Okay this is strange, but maybe it’s fine. What I said something to my husband. Later that day, he’s like, You should call the doctor, so I did. They track everything and they’re like, Nope, it’s fine, like everything’s fine, water levels look fine bag still seems to be intact. I was dilated to like a two, at that point, so still not in labor but like things were moving like 

P: are we at 40 weeks now where are we,

M: yeah yeah, so this was 39 and a half or so. I literally gave birth the day before my due date. So I was wow, I think partially because we knew the exact date that I got pregnant so easier for us to pinpoint things but on the 22nd at night. I lay down to go to bed, and it like I’m having these weird pain, it felt like I just ate something that maybe didn’t agree with me, I’m having this really painful gas bubble, give it an hour away. So after about an hour. This keeps going, and it started to get more regular and so that’s what I like this labor, I start tracking it, and consistently every five minutes, I’m having this pain, you know, progressively getting worse as the night goes on so I’m transferring between taking bathes and, you know, getting in the shower and coming back out and all of these things, my husband is sleeping through all of this, I think it was like five or six o’clock in the morning, and these are now, like two minutes apart,

P: Oh wow, 

M: okay, at five or six o’clock in the morning, I wake them up and I’m like hey I’m in labor like we need to go. We need to go. And he’s like, Are you sure because we had just gone to the hospital like a day and a half or two days before. Yeah, so I’ve been in labor for like six hours. I’m tracking it, we’re two minutes apart if you don’t get your ass out of bed, like I’m leaving you. Like, we need to go. And because the hospital we were going to was 45 minutes away. 

P: Oh wow, 

M: I may have waited too long as he’s getting ready, I’m calling my doula and I was planning on doing a water birth with a midwife at our university hospital, so we go. I’m basically yelling the entire way there because I’m in a lot of pain at this point and they’re like every half, two minutes they were right on top of each other. When we were almost to the hospital, we were probably 10 minutes away from the hospital, and my husband had to pull over, so I could throw up on the side of the road. I remember this so vividly because I was having traction, and pulling up at the same time so it was screaming. On the side of the road, and it was, it was so hard I’ve never that was like the hardest, it’s ever been for me to throw up because your body’s like doing all these different things so are we get to the hospital, we get checked in, they checked me and I’m at five centimeters so they admit me, and everything’s fine, we get to a point where we’re back in labor and delivery and we’re in a room that has like a tub in it. I think it was like 9am At this point, I’m in the tub and I’m like trying to labor in the tub. But the problem is that the tub that they provided was super narrow couldn’t get comfortable, and the it was almost making the labor worse because I was so uncomfortable in this tub. 

We’d been in the hospital for like two hours, since they first admitted us and checked me the first time, so I was like can you track me again because I’m throwing up regularly at this point, and they won’t let me have any water and like all these things. I’m like, can you check me because I feel like I feel like I’m at like a seven or an eight like I’m dying. And so they checked me and they’re like, you’re still at a five. They’re like, Oh my god. So I felt like maybe it’s just because I’m not relaxed, but at this point I was like, I don’t think I can do this if I’m still at a five after two hours of this, let’s just do the epidural, they give me the epidural at, like, 11, and after they give me the epidural I dialated to a nine and a half, my daughter was sunny side up so you know the wrong direction

P: i feel like this question should come with a diagram but how does the baby being sunny side up, affect the delivery. 

Dr. Matityahu: Definitely when the face is down, it’s a much easier, smoother delivery, because of the way the baby’s head can flex and then come through the birth canal so when the baby is Sunny Side Up meaning, the baby is facing straight up, it can’t bend its neck forward and curve out of the birth canal so easily. And so it’s not impossible to deliver a baby that’s face up, but it’s much more challenging, I mean the baby needs a lot more room to come out because it can’t fold and maneuver as well as when it’s facing down. 

P: And they were saying that I was, I wasn’t dilated to attend yet, because, at last little like clap of whatever caught on something, and they tried to let it happen on its own, they popped my water. When they popped my water they were like, oh it’s clear and then all of a sudden they were like, Oh there’s meconium. So then all these people come in and I might pay. Are we having a C section, and they were like, no, no, we’re gonna, we’re gonna wait just a second and see how things go because it was clear at first, and we think that what happened is when we popped it maybe that like triggered meconium so we don’t necessarily think that she failed it because it was clear when we first popped in. So they were like, we just have these people here in case. All of this goes on at like 6pm is when I started pushing and pushing them, pushing them, pushing for four hours I push 

P: Oh my god. 

M: Yeah, really long line. I even ended up about halfway through after like two and a half hours I was like, this isn’t it happening, like when, let me stand up like let me use the squat bar or whatever, and will gravity we’ll let gravity like I’ll pull this out so numb from the waist down, and I’m holding myself up, um you know having a contraction, and so my husband and my mom on one side and then his mom and the doula on the other side, holding my legs up, cuz I can’t stand on them, so we’re pushing them, pushing you did that for another hour and a half by like they were like, right, she’s not moving past that zero station that hip bone. 

P: Yeah. 

M: And so, what we can do is we can give you an episiotomy. Or we can just go straight to the C section. They were like if we do get the episiotomy, we still may have to do the C section. So the way they explained it to me, was like we just think that her head is too big for your pelvis, and it’s not coming past that bone so we can do the episiotomy and try to Suction her out. And you know, so they’re explaining this and I’m like, I’m not going to end up with two surgeries, it sounds like what you’re describing the episiotomy, it won’t do anything because it’s a soft tissue. Yeah. So I’m like, that’s not going to change the bone structure, let’s just skip and do and I was exhausted, so I’m like the baby wasn’t super stable at this point. So Mike, let’s just go straight to the C section. They’re like, they come in and they give me this higher dose of whatever to numb you from the top down. So this more intense epidural. So they give this to me and they start rolling me back. Well, with both with both my first epidural and with this epidural, my blood pressure tanked, both times difference was that the second epidural, that I had, I was so exhausted I’ve been up for 24 hours have been pushing for four, so I passed out. I don’t really remember getting back to the operating room. My husband tells me that I coded So they called the code blue

P: oh shit

P: so when Melissa got the epidural her blood pressure went too low, what’s going on there.

Dr. Matityahu: So a lot of times with epidural. What it will do is it relaxes us so much that it makes a lot of our blood vessels dilate and it completely drops our blood pressure, so that’s a pretty common side effect of any epidural, which is why, before we give women epidurals we usually give them a liter of IV fluid to really beef up how much fluid is inside the blood vessels so when the blood vessels dilate with the epidural, it doesn’t bottom them out and tank their blood pressure, it sounds like. Her blood pressure went so low that passed out

 in the labor room when we call a code, there’s different levels of code and it allows us to bring in people needed one code is the moms delivering the babies coming out in the baby’s not doing well, so not only the OB team and the respiratory team will come but also the pediatric team. There’s other codes where it’s just for the mom, I mean if somebody passes out you, you’ll call a code because you just want all hands on deck in case things get worse, 

M: he could not go back, because they were like dropping or whatever skis in just the room that we were in where I was laboring, I remember coming to in the operating room. They’re like, Oh, can okay she’s awake hey can you feel this they’re like poking my stomach with a knife and make sure everything’s fine and I’m like, I don’t feel it. So then they’re cutting me open, they bring my husband in, and they pull the baby out and I remember kind of like coming in and out of consciousness, this whole time and I’m shaking uncontrollably. At this point I was like, super cold shaking uncontrollably, and I felt like I had to vomit, so I had like this bag right here we’re growing up into, and I’m like trying to keep myself awake. So, my husband’s right there, nobody’s telling me anything, so they get the baby out really quickly, and I don’t hear crying, and I just remember like, as I’m coming in and out I kept thinking to myself like, why isn’t the baby crying. Why isn’t being fine. I couldn’t even ask, like I couldn’t ask them what was going on because I just kept like I could fall asleep and wait wait, what’s going on and then, you know,

P: yeah,

M: this weird thing where I just I had no, I had no energy. I remember hearing this voice every time I’d like fall asleep I thought I was falling asleep, and be like, You selfish b-word like you. you need to wake up like your baby’s not crying, ask them why. Ask them why the baby’s not crying, you’re over here trying to take a nap like wake up when they pull the baby out. My daughter had been without oxygen for a full minute. So they had to resuscitate her. So they take my daughter to the NICU and my husband went with. So he tells me at this point, like they, the baby had to be resuscitated and is now going to the NICU, so I’m gonna go with the baby. And so I’m like okay, whatever. So, as they’re like stitching me up, and, you know, shaking uncontrollably and nauseous and this blanket keeps like falling off of me, and so I’m freezing my butt off, and I still have no idea what’s going on. It felt like I was getting stitched forever. It felt like an eternity, because I, I still wasn’t like 100%. There, I felt so tired, felt so tired, were like kept going in and out. And so finally, they’re done, and they’re getting ready to take me out at night. Finally, ask them like what’s going on with the baby. And they’re like, she’s fine. She’s stable, she’s with her husband like don’t worry about it. So at this point, I remember falling asleep as they’d be back to my hospital room after I gave myself some time to sleep. They explained to me. She is now in a medically induced coma. It’s like a medically induced hyperthermia where they drop your internal body temperature down really low and then attempt to keep your brain from swelling, so they’re like, we’re trying this, this method it’s technically experimental for children we use it on adults but we’re doing this, your husband signed off on it like, you know this, what’s going on,

P: doctor matityahu suggested I take these next set of questions to Dr. David Kornfield the director of the Center for Excellence in poner biology and the Department of Pediatrics at Stanford, thanks so much for coming on the show Dr Cornfield.

Dr. Cornfield: My pleasure, thanks for having me I appreciate the opportunity to help people understand a little bit more about what goes on in this critical neonatal time period.

P: Why does, why does it stop and oxygen lead to brain injury in particular.

Dr. Cornfield: All of us are absolutely contingent upon having oxygen in our bloodstream, and absolutely contingent upon having oxygen going to our brains at every moment, and there’s no cell in the body that is more dependent on the presence of oxygen at all points than the brain. So, the in the absence of oxygen, a whole cascade of injurious phenomena unfold in the neurons of the brain that can lead to significant damage, and it’s true in babies, just as it’s true in adults, but in babies that time period between being in the womb, and moving on to air breathing life is critical, and the changes that happen from a cardiovascular perspective, are really without precedent. Give it a moment of consideration. Just a moment, think what happens in those few moments. Normally, a baby’s born. Blood flow does not go to the lungs in utero. The first few breaths of life, there is this dramatic change so that 100% or even more, I could explain how I get that gets to the lungs, and all of a sudden that placental circulation is cut off, and all the responsibility for oxygenating the blood is subsumed by the lungs, that were just moments ago completely filled with amniotic fluid. It is a remarkable transition in context of that oxygen has to get into the bloodstream. And sometimes, for many reasons, especially those who have been pregnant and now mothers, understand, that is a fraught time interval.

P: Melissa said that because her daughter suffered this oxygen deprivation that she had to put in a temperature induced coma, could you tell us a little bit about how that works. 

Dr. Cornfield: the term for this injury is hypoxic ischemic encephalopathy. So it’s an injury to the brain that’s due to hypoxia, which is low oxygen in the bloodstream and ischemia which means a compromise or no blood flow to the brain as well, where there’s not enough oxygen going to the brain for some period of time. There is a whole cascade of events that unfold, at the cellular level, and that really leads to injuries of the cells that comprise the brain, neuronal injury unfolds really, over the course of many hours. And one way to sort of interrupt that cascade of events is by decreasing metabolic demand. And by cooling the brain. And there’s really very solid data in the neonatal world that the sooner you can institute brain cooling or total body cooling, after the injury, the more likely you are, or one is to mitigate the extent of the neuronal injury. So time is critical at that point, most centers, really, place a high premium on getting it done within six hours, the data in animals are really suggested instituting hyperthermia within three hours is better still. And usually this sort of temperature that people shoot for is somewhere, depending on whether they do the whole baby or just the head somewhere around 33 and a half degrees centigrade.

P: for Those of us shamelessly wedded to Fahrenheit that’s about 92 degrees Fahrenheit,

Dr. Cornfield: thirty seven degrees centigrade is the normal temperature, the 98.6 range. I also want your listeners to recognize it’s not an unheard of phenomenon to do this, but not as common as one might think. So the data are about two in 1000, infants have this hypoxic ischemic encephalopathy, which is by no mean an insubstantial number, but it’s also not to be taken as an overwhelming number of children who are afflicted with this problem 

M: at this point I finally get to go see her. She’s got all these things all over her head, because they’re monitoring procedures, and she’s hooked up to all these tubes and stuff and she’s not awake and the whole time I was in the hospital I feel like I was numb, or it’s just like, this is just what it is….And so at that point my maternal instincts kick in and I’m like, All right, time to pump to get the milk stimulated because it’ll have the baby so do this and pumping all the time, to give them milk that they can give to her. So I do this and we’re getting the milk put together and after three days, they finally are bringing her body temperature back up, we can finally hold her at this point, and it was just so crazy so she was in the NICU for eight days after, and you know when they slowly had to bring her back to some semblance of normalcy where she’s eating normally where she, you know latched on to breastfeeding, where they made sure she’s having bowl movements there there are no residual stuff like she had to have an MRI, to make sure there was no brain damage and we’re very fortunate because everything. Everything’s been fine she’s now almost two and a half. And we’ve had incredible support from the hospital, because we did this experimental thing, we got two years continued checkups and things with them and with specialists over there that was no cost to us. All of these things so you know, a really traumatic.

P: Good Lord. wait all this medical attention was focused on her because she had been deprived of oxygen for a little while. 

M: Yes, yeah. Okay, so, because they had to resuscitate her. They were really worried about 10 potential brain damage that that could have caused. We got all this additional medical attention.

P: I get that in that circumstance you don’t feel like you have a lot of choices, but I can’t even imagine how many people you have helped by doing that. Right, so that they get experienced with the process they understand how it works better. I wonder if it will be the standard of care at some point. 

M: And it’s the standard of care for adults. So when they explained it to us, you know, it was nice because I said you know, it works in adults, this, this is a common practice for brain injury patients, We, we do this for a couple of days here, we’ll give you the MRI, and we’ll check everything and we’ll monitor her really closely. So we felt really confident going in to that, it made sense to us and you know it’s an added bonus, that if that research leads to being able to help other people, not experience, you know brain damage in their children, then that’s a win win situation because it worked for us. She has no signs of any long term brain damage, and has had just the best care. As a result, so, you know, it’s been, it’s been really great.

P: That is amazing. My firstborn did not have a brain issue but she had a super rare life threatening heart issue, she had open heart surgery the day after she was born. But I am much farther back in the line than you are in your line. So as someone who has benefited from people like you who were brave enough to take that step, I thank you from all of us. I’m going to speak on everyone’s behalf and say thank you for all of us, that is amazing, and what she into now.

M: She loves learning so she’s in like a, it’s an at home preschool right but she’s only two and a half but she knows all of her ABC she can counsel 13 Like 

P: wow

M: she does how incredible things are I’m like, no two year old should be doing this but she learned so quickly, and I’m just so happy that that’s something we could put behind us and my husband and I are talking about trying again at the end of this year, and you know it’s taken it’s taken a lot of work to get to a place where I feel comfortable doing that because of how traumatic it was there was a lot of therapy involved afterwards of nightmares all the time with my child dying or being taken for me, that it required a lot of work to move past those things and be able to feel comfortable moving forward with another child. 

P: All that makes sense right this is unbelievably traumatic experience, what do you think you’ve learned from this first experience that you’ll use for the second. 

M: So, I think the biggest takeaway here is just that I’m, I’m not in control. And while I think I knew that to an extent, the first time around I knew that there was nothing I could do about it. It’s different now because I went into it like with a birth plan and like all the floofy fun feel good things like yeah I’m in control of my birth story and it’s like, no, you’re not. We’re just along for the ride and you have to enjoy what it is for what it is right now.

P: I think that’s a great message and I think probably as you found the idea of having no control and the feeling of having no control or to kind of different things but, but now you know what the feeling is so it will be easier to do and I know you run a management company. So, being out of control doesn’t seem like it’s on your daily agenda.

M: No, I  manage, I manage online businesses for entrepreneurs all over the place, and so I am used to being in control and not being in control was, it was a lot, I’m better for it as much as it really sucked at the time. 

P: Yep, 

M: I’m a better person for it. So,

P: Melissa, thanks so much for coming on and sharing your amazing story your, I will revel in your triumph all day.

 

M: I’m So glad if it can bring you some joy and some happiness and some strength. For that, I appreciate you letting me share it.

P: Thanks again to Dr. Matityahu for sharing insights about how our bodies work and giving us a doctor’s perspective on labor, and thanks also to Dr. Cornfield for sharing some details about the delicacy of the newborn period, highlighting all the complicated mechanical changes that happen to the baby at birth, and walking us through the current approach for managing a possible brain injury for a newborn. Thanks also to Melissa for sharing her story, filled with resilience. It’s fantastic to imagine her two year old, running around–a ball of energy, bearing no evidence of her tricky birth

Thanks for listening…we’ll be back soon with another story of overcoming