Episode 56 SN: A Run in with Gestational Diabetes, among other things: Tabitha’s Story

In general all the stories women shared on the show reflect on Roe in part because they show how challenging pregnancy can be both physically and mentally even when pregnancy is highly sought after. That’s one of the major take homes from this podcast real women sharing their actual experiences and hopefully contributing to a more realistic narrative around pregnancy and birth. And today’s story is very much in this vein. My guest today walked into pregnancy unsure about whether she wanted to have a child. Ultimately she and her partner decided they did. She ran into gestational diabetes which effected how she felt about the pregnancy and her ability to control her blood sugar, and had a significant impact on the delivery, which happened in late fall of 2019, so she also had to contend with a six month old when the first lockdown happened. She and her partner managed it all and now are enjoying their 2 and a half year old.

To find Tabitha’s writing, click here, here and here…or search for her on the web

Gestational Diabetes

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120181/

https://pubmed.ncbi.nlm.nih.gov/3542067/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290225/

The Placenta in Pregnancy wrt GD

https://www.ncbi.nlm.nih.gov/books/NBK1668/

https://diabetesjournals.org/care/article/30/Supplement_2/S120/23944/The-Human-Placenta-in-Gestational-Diabetes

https://www.gestationaldiabetes.co.uk/gestational-diabetes-placenta/

https://www.karger.com/Article/Fulltext/455904

GD and preeclampsia

https://www.everydayhealth.com/gestational-diabetes/gestational-diabetes-and-preclampsia.aspx

Induction and Breastfeeding

https://www.sciencedirect.com/science/article/abs/pii/S0378378216302122

https://www.sciencedirect.com/science/article/abs/pii/S0889854517301158

https://www.liebertpub.com/doi/full/10.1089/bfm.2017.0012

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947469/#:~:text=Compared%20to%20all%20other%20study,lower%20oxytocin%20levels%20during%20breastfeeding.

Audio Transcript

Paulette: Hi, welcome to war stories from the womb. I’m your host, Paulette kamenecka. I’m an economist and a writer and the mother of two girls. A few things to mention before we get going. First, this episode is late, because COVID essentially grounded me for the better part of two weeks that I’m recovering and episodes will roll out on a regular schedule again, starting now. Second, since the last episode, Roe v Wade was overturned. I still have too much rage about this outcome to talk about it. But in future episodes, we’ll address this specifically. In general all the stories women shared on the show reflect on Roe in part because they show how challenging pregnancy can be both physically and mentally even when pregnancy is highly sought after. That’s one of the major take homes from this podcast real women sharing their actual experiences and hopefully contributing to a more realistic narrative around pregnancy and birth. And today’s story is very much in this vein. My guest today walked into pregnancy unsure about whether she wanted to have a child. Ultimately she and her partner decided they did. She ran into gestational diabetes which effected how she felt about the pregnancy and her ability to control her blood sugar, and had a significant impact on the delivery, which happened in late fall of 2019, so she also had to contend with a six month old when the first lockdown happened. She and her partner managed it all and now are enjoying their 2 and a half year old.

Let’s get to this inpsiring story

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

 

Tabitha: My name is Tabitha Blankenbuehler. I’m an essayist I live outside of Portland, Oregon.

 

P: So nice. Well, let’s go back before children for the very start. You grew up with siblings?

 

T: I did. Yeah, I’m the oldest obviously she had a brother and a sister. My sister was three years younger than me. And my brother was nine years younger than me. So he was kind of like, you know, I sort of got that mothering experience a little more with him. And still think of him as like a child.

 

P: Yeah, my sister is eight years older than me and her little nickname in my email is kiddo. So I’m with you. And so we were just talking about before we went to tape, the fact that for a lot of people growing up in a house with siblings makes them think, oh, I want a family. I’m definitely gonna have kids. And it sounds like for you that was not the case. So why don’t you tell us what your experience was?

 

T: Right? Yeah. I mean, I had, you know, a really great childhood. My parents were loving, supportive people. You know, the kind of people that you would say, okay, they were like born to be parents. I guess. For me. It wasn’t so much that I was that I didn’t have a good childhood that I wanted to recreate or anything like that. It was just sort of that I saw how much time and how all encompassing. Parenting was especially, you know, for my mom and I just didn’t want to do that. Like I wanted to do other things. I wanted to be a writer and you know, I had a bunch of other things I wanted to do be president and all these things. I really wanted to take precedence over having a family and I also kind of thought, you know, well, my family is really great. I don’t need more. 

 

P: Yeah, yeah, yeah 

 

T: I have, I have what I need. So also, when I was growing up, I just didn’t really like you know, I was an oldest child and I was very stereotypically the oldest child. You know, I was like, best friends with my teachers. Oh, all the adults around me and people pleaser and all those sorts of very boilerplate things. So I didn’t like kids. I had a hard time with other kids. I just didn’t relate to people my age. So I think there was that too, but just that I don’t like kids, even though I am one. I don’t want to be I can’t wait to not be one anymore. So

 

P: Well, I think seeing your mother in that way is wildly insightful. So maybe you were just kind of ahead of the curve there. And I for sure have you know, most people don’t know how they’re going to jack in a child to their existing life. And, and a lot of people, myself included, just kind of threw my hands like up, people figure it out. I assume I’ll be one of them. But it seems to me very smart to look at that and say Holy shit, that’s a lot of time. I can do other things. Right. And now that you’re on the other side, right, you’re right. It is time consuming. Yeah. So how did you move from the I don’t like kids. I don’t want kids to look I’m pregnant.

 

T: Yeah, it was, you know, really unexpected. Journey, I suppose. So, in 2018, I was on the end of my book tour I was doing I was completely absorbed in that in the writing pursuit and everything. And towards the end of my book tour, I realized I was you know, a few days late on my period, and being very obsessive about everything. I just took a pregnancy test. I figured, oh, well, there’s no way that I’m pregnant. I’m on birth control, blah, blah, blah. And it I took it in my office bathroom, and it was positive. Yeah. And, you know, completely threw me for a loop. It was the last thing I was expecting. And my first instinct was that I didn’t want to have a child and I wasn’t going to keep this pregnancy. So I went in and talked to the doctors at Planned Parenthood. I had caught the pregnancy super early, just because of being so conscientious about my schedule. They wouldn’t have been able to do an effective procedure at that time. And so when I just kind of sat and thought about it for a while, you know, it just sort of gave me the opportunity to react in a way that I didn’t expect because my initial reaction is I don’t want to do this, which is a completely valid response. 

 

P: Totally, especially especially when you’re on birth control, right? Yeah. This was not my intention, right?

 

T: No, no, and we totally wasn’t and I think we always kind of said, my husband and I, well, maybe when we feel like the time is right, like, you know, whatever the hell that means. means nothing. Yeah. Yeah, the longer I kind of just sat and thought, I realized, maybe this is something that I want to do. I sort of feel a connection to this pregnancy that I didn’t expect to have and you know, I’m just I’m feeling a way. I didn’t know I’d feel. So we had a discussion and we decided that we were going to keep it and was we were really excited. And then a few days later, I had a miscarriage, which is super common in those early pregnancies, but you know, it was devastating as it is in any stage in a pregnancy. So after recovering from that a little bit, we still wanted to try and we still wanted to go down that path that had been presented to us. So we did and fortunately, we were pregnant a few months later.

 

P: So it sounds like it was easy to get pregnant the second time. 

 

T: It was 

 

P: good. 

 

T: Yeah. 

 

P: So that’s great. That’s one hurdle over. And then this time, you’re excited to check the pregnancy tests, I’m assuming.

 

T: Oh, yeah. Yeah. Super excited. My big reveal my husband had to go to work trip to Arizona when I was able to take the pregnancy test. So I was flying down to visit him while he was working. And so it took the pregnancy test and my carry on, and I wrapped it up in a little plastic bag. And I picked up In & Out on the way to the airport and I put it in the bag with the double double is like the happy meal price. So yeah, we it was it was all a big party. We were really excited. 

 

P: That’s a cute reveal. So that’s exciting. And then what’s the first trimester like 

 

T: first trimester was pretty good for me. As far as you know, I didn’t get very sick and I didn’t have a lot of problems. The complications for me started to start about I’m sure the second trimester when I had to get the gestational diabetes check. And I ended up getting diagnosed and it was a case where I couldn’t control it no matter how hard I tried with diet, you know, I counted out all my grapes and didn’t do anything that I wasn’t supposed to do, but it just like would not work which was extremely disheartening and induced a lot of guilt. Because it’s like, no matter how hard I try, no matter what I do, I can’t make my body it feels like safe for this child.

 

P: So there are a lot of different ways to respond to that right to some degree. Your body has already shown that it has a pretty good autopilot in that like you can get pregnant and you’re you’re pregnant and you don’t have any control over that chemistry. Right. It is what it is. But for some reason you’re feeling guilty over the gestational diabetes, which I also assume is like a chemically induced shift in your ability to process blood sugar that you also don’t really have that much control over.

 

T: No, no, I don’t. Nobody does. 

 

P: Right. 

 

T: But you know, there’s just like any sort of condition. You go and you try to find your answers. And there’s a lot of conjecture about, oh, well, maybe you should have been this weight when you got pregnant or maybe should have thought of that before. Your parents had diabetes are all these all of these things that make you second guess yourself?

 

P: Is it in your family? 

 

T: Yeah, I have risk factors from both sides of my family, which isn’t necessarily a indication that you will get it but it does of course. Yeah. increase your chances. Yeah.

 

P: Well, that sounds hard. I flirted with gestational diabetes, which is to say like, I think I had to do like a week long trial where you prick your finger with a needle to measure blood glucose levels at home, which is so wildly unpleasant. I think after day three, I was like who do you say, Well, I don’t eat. There’s no reason to, you know, to scrap the whole system. So that sounds really hard to do. You have to prick yourself every day. You’re nodding yes. On paper. It’s a small thing, but in reality, I thought it was really uncomfortable from the oh my god, the middle of the second trimester.

 

T: Yeah, right about then yeah, I started to have to do the finger pricks. And then like I said, I couldn’t control it with the diet alone. So I started having to take insulin, and the amount of insulin I had to take just kept going up and up and up. And you know, which was also really distressing. You know, as the vile just kind of keeps like going and going and going and you have to stick it in your stomach, right? Yeah, like, I mean, obviously, I know. Like scientifically or biologically I can’t hit the baby, but it still feels like you’re just jamming it.

 

P: Yeah. That’s not a great visual. No, I agree. 

 

T: No, it’s not. It’s great.

 

P: So we took some questions about gestational diabetes to an OB today and we’re lucky enough to have Dr. Mehta Thiago on the show a fabulous OB from California who’s got a lot of experience with these issues. So Dr. Mathis Yeah, who thanks so much for coming on.

 

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

 

I’m wondering first of all, if you can just define gestational diabetes.

 

Dr. Matityahu: So gestational diabetes is basically elevated blood sugar in pregnancy. We test for it around 25 to 28 weeks because as the placenta develops, your placenta is basically making the insulin not function as well. And so your blood sugar’s begin to run higher, and for some women, they run high enough that you’re considered diabetic. And so if you’re someone who maybe has a family history, or borderline would become diabetic later or just isn’t following a very good diet, you’re you’re likely to have issues with managing your blood sugar later in the pregnancy because your insulin isn’t working as

 

well, 

 

P: I neglected to ask them to Dr. Matityahu more about the placenta when we spoke but then I found some articles that suggested that every pregnancy independent whether you have diabetes or not, involves a placenta that churns out more hormones over the course of the pregnancy, some of which block the effects of insulin, which will lead to higher blood sugar levels, the mother’s pancreas will release more insulin but if it’s not enough to compensate for placental changes, and you can end up with gestational diabetes, although there are numerous routes to gestational diabetes. If you have that condition, your needs for insulin will grow as the pregnancy progresses because of an increase in placental hormones. 



P: does it feel Like any like not the needles obviously the needles are uncomfortable, but having gestational diabetes doesn’t feel like anything.

 

T: No, no, you don’t feel different, but only way you’d feel different is just being hungry. 

 

P: Okay, yeah. So once they put you on insulin, does that free up the constraints on your diet or no, then you still have to eat like, grass?

 

T: Yeah, yeah. They still want you to have really low numbers compared to someone that you might know in your life with diabetes, like type one or type two. The numbers that a gestational diabetic has to get to are so much lower,

 

P: as I understand that the numbers for gestational diabetes to qualify you as as having that condition are relatively low compared to diabetes outside of pregnancy.

 

Dr. Matityahu: Yes, we have very strict guidelines of where your blood sugar should be in pregnancy. And so we’re super super tight with sugar control in pregnancy and blood sugar’s that may not at all be considered diabetic for someone who’s not pregnant. We consider that diabetes in pregnancy. 

 

P: Is that because of something that a higher level of blood sugar does to a pregnancy to a fetus? 

 

Dr. Matityahu: Yes. So high levels of blood sugar causes high levels of sugar in the amniotic fluid in the baby’s bloodstream. And so then the baby reacts to that high sugar, high blood sugar by producing more insulin and that puts weight on the baby. So now the baby starts gaining and getting like big and so the body of the baby can get if it’s uncontrolled. So really high blood sugars that are not controlled, would cause the baby to start gaining a lot of weight. So the body of the baby gets much bigger. The baby starts peeing more and so the amniotic fluid is managed by the baby drinking and peeing. And so in a person when they have high blood sugars will drink a lot more fluids and will pee a lot more to kind of dilute the sugar in our bloodstream. The baby will do the same thing will start drinking and peeing more and that also makes the amniotic fluid start to expand because now the baby’s peeing a lot more. And so it causes weight gain on the baby increase in the amniotic fluid and and it can over time they get to like the baby’s lungs don’t develop as quickly as they should. And so it so it can cause a lot of problems with the baby. So one of the problems with the baby getting so big is the baby can get pretty large, the head can come out and now the body is way too big because the baby gained too much weight and so you get what’s called Shoulder Dystocia where the baby can get stuck.

 

P: So aside from all the difficulty with the needles and the food, like how are you taking this emotionally because it sounds like you’re someone who’s detail oriented. So that seems like

 a lot of pressure. 

 

T: Yeah, yeah. You know, it was sort of back to the days when I was in college and on Weight Watchers and writing down obsessively everything I ate and being really obsessive about food and yeah, it was extremely depressing just feeling like no matter how hard I tried, it wasn’t good enough and just being worried that something could go wrong. I think it’s a really common condition but a lot of people don’t really understand it. Like so many things with pregnancy. It’s like unless you’ve actually been with child you don’t know it exists. Like I had to explain it to everybody in my life. 

 

P: Oh, that’s interesting. 

 

I’m wondering if we know why sometimes you can control diet and sometimes you can’t.

 

Dr. Matityahu: We can’t predict we don’t know. What we know is if you can control your blood sugar’s by diet, or even if you’re controlling them with medication, the baby’s going to do great for women that can control it with diet. We don’t even consider them high risk. That you know you have gestational diabetes, but if it’s diet controlled, you’re a normal risk pregnancy you’re not even a high risk pregnancy. Once we give you medication, we consider it a little bit higher risk pregnancy and so we follow that pregnancy differently. Can we predict who’s going to do well with diet and who’s not? No. And a lot of times even for women like Tabitha who are incredibly meticulous in like cutting out almost all sugar in their diet and doing like the perfect combination of foods doesn’t always work. And, and yeah, and so women also will easily feel like I’ve failed because I have not been able to control how my body responds in all aspects of life. And yes, the reality is we don’t have the ability to control how our body responds in all aspects of life. And we just have to let that go. It’s similar to women who end up with a C section and feel like I’ve failed. I you know, my I wasn’t able to make my pelvis deliver a baby. You know, vaginally we just don’t have control. We just have to accept that all of us type A people have to accept that like we cannot micromanage every aspect of life and how our body responds to things. And I think you know, most of us that have kids quickly learned that you know, we can’t manage how our kids come out and, and grow up either.

 

P: I mean, one thing that’s interesting about your experience is when things are screwed up, like on the front end, like we could not get pregnant and you do feel like your body is failing you and I you know, why can’t I reproduce and but that’s a totally different feeling than being like waist deep in a pregnancy and having things go a little topsy turvy because now there’s no way but through, right. So that’s a little s and now like you’re very much thinking about the baby that you’re growing and how’s this affecting him or her and like it just seems like it’s a much harder thing to manage.

 

T: Yeah, yeah. So it just caused a lot of stress. I also had a lot of stress going on in my job. So it was kind of just compounding all of that. And yeah, it was it was a bad final trimester. So for sure, 

 

P: also, like everyone’s telling you not to stress out right, stress is just as bad for the babies. You’re like I’m not freaking out because that’s the one thing I can control kind of not really. So that sounds like a time so take us to the day that you’re it’s your daughter, right? 

 

T: Yeah. 

 

P: Take us through the day your daughter was born. How do we know today’s the day? What does that look like?

 

T: Yeah, well with the way that my gestational diabetes progressed. I knew fairly early on that it was likely to be an induced pregnancy. Because another thing that happens when you have gestational diabetes is that the baby develops faster, grows bigger. So she already was sort of predisposed to be a larger baby. My husband was 10 pounds.

 

P: That sounds like a threat.

 

T: Yeah, it’s not good. When every time you go to the doctor, you get this like ooohh face when they ask about it. So yeah, it just sort of was coming from all sides there. And we kind of had like this tentative date for about a month. or so. So I was sort of working with that. And by that time, I was going into the doctor at least once a week to check on it. And the day before we went into the hospital. It was let’s see. Over a week before this date that we were going to originally induce my doctor, she ran some tests, looked at some things and she said, oh you know you’re kind of borderline for some things and I don’t know I’m sort of thinking we should maybe have the baby sooner and ask okay sooner, like this weekend or what? No, why don’t you come in tomorrow morning. So all of a sudden, I mean, this was a I remember it’s a Wednesday so I had just come off work. hadn’t really obviously prepared to be going yet. But honestly, that was kind of my silver lining of having this condition was sort of the feeling of control and knowing when it was going to happen even if it was like 12 hours. 

 

P: Yeah, yeah. 

 

T: So like nicely packed my bag. We stopped at Starbucks on the way to the hospital. I dressed up and took a selfie by the doors. I mean, it was it was very that so that was sort of a little bit of retribution for all the stress but

 

P: I like you making the most of it. That’s that’s a good way to do it. Let me ask you before we get to the actual birth, are you imagining giving birth in a tub surrounded by angels strumming harps, or like what what what image did you bring to the delivery?

 

T: It was so hard for me to imagine because I did all of the classes that the hospital offered and did all of those things and it was all centered around a natural uninduced birth, or they also have a lot of good information for mothers that were getting a C section, which is great, but I kind of raised my hand and asked what happens when you’re induced and they’re just like didn’t really have a very good answer. We toured the hospital before we went so I did see the little jacuzzi and I thought that sounded cool. But yeah, the reality was that with the monitoring for preeclampsia and everything I had to be stuck on an IV the entire time. So all my dreams were very quickly squashed and I just sort of wanted things to be, you know, I want to make use of all the drugs, very happy with modern science love it. So my birth plan was all laid out with those sorts of things. And I remember bringing the printout and pointing at them and everybody just basically was like Oh, cool. we’ll recycle that for you. Yeah,

 

P: great. That’s a lot of support at the hospital. New Plan. 

 

T: Yeah, 

 

P: so you check in when you’re supposed to and have a blackout I feel like induction is usually thought of as kind of painful because it’s your like ginning your body up in a way that puts it on a schedule that might not naturally be on, which is a hard thing to manage.

 

T: Right? Yeah, it wasn’t. It wasn’t painful, especially at the beginning, basically, the first 24 hours when I started taking the initial medication. Were just boring, you know, just sitting in the hospital and since I did have to be hooked up and monitored and poked. They took my numbers for my diabetes every couple hours or whatever. I couldn’t go up and move around, but couldn’t go sit in the tub and couldn’t do a roll around on the ball. You just had to sit in the room. And I remember binging probably 20 episodes of restaurant impossible with Robert Irvine. So I always, you know, kind of think of him when I think yeah, the hospital and so yeah, it was just kind of sitting and just trying to figure out if something was happening, like just sitting and trying to listen to my body, you know, is anything happening? How will I know what’s happening? And I think that was another issue I had was that I didn’t know what labor pains were going to feel like. And I don’t know how someone has to describe that to you. I don’t know how you prepare for that. But what I was thinking was not at all accurate. I am going to go ahead and blame Hollywood and producers and directors because every TV show and movie it made it seem like someone was stabbing you in the gut kind of pain. When it’s actually that feeling that you have to take the world’s worst shit. It’s like the most terrible constipated sort of feeling. So since I felt like that I kept getting up and going to the bathroom thinking I had to poop when I was really starting to have contractions. So oh my gosh, I was really far along by the time I finally asked for my epidural. I think I was I can’t remember like which centimeters or which at this point, but it was like they were kind of saying I’m glad you told us now because you weren’t getting really far along before kind of raising your hand and saying I might be having the baby. So that’s when things started to get painful was when it finally kicked in 24 hours or so later. And that wasn’t so much I don’t think that I was induced it was just sort of the way Well, no, I guess it was sort of that I was induced because some of the things they had to do. They might not have had to do if it was my body’s natural response, like they had to go in and break my water. And that was the most uncomfortable and painful thing in the entire process.

 

P:Wow. 

 

T: Yeah,that really was awful.

 

P: Because the cause the getting the thing in your cervix is painful or because the actual breaking of that amnion is painful.

 

T: Kind of I’m not sure which was which but the whole thing and they had to use the needles so they poked my daughter in the head. You know what she did? I was fine, but it wasn’t fun for anybody. And

 

P: also when they bring it in, I’m sure you’re like get that crochet needle away from it. Right Like what are we doing here?

 

T: It’s really terrifying. Yeah. And it was the middle of the night. It was must have been like 3am or something. So everything is very surreal. Yeah, very bad. And then after that, because it was about 5am that I got my epidural. And they missed my spine with the needle. So they had to do it twice. 

 

P: Oh that’s bad

 

T: Oh my God…But then again, it’s, I think when you’re at that point, it’s just like whatever. I don’t care.

 

P: I remember being terrified of delivery and I got some comfort from the fact that I knew that at some point, things on the outside would be so bad that I would say, Do whatever you have to to, you know, the threat of an epidural needle seems small compared to having my body crunched from the inside, right. So

 

T: exactly. Yeah, yeah, you can just whatever, whatever makes it go faster, whatever makes it over. I don’t care. Take my fingers. Take my toes.

 

P: Yeah. So you get the epidural and then does that calm everything down because now you can’t feel it or where are you?

 

T: It did a bit but then Yeah, it did for a while. I remember a few hours where I kind of fluttered in and out of sleep. But then slowly those contraction pains started, you know, making their way through the medication I could. I really felt that that was coming. I remember telling my husband you need to go get the nurse now. It is time. It’s amazing how much you know it is time. I had no idea when to know but I did. And unfortunately, I thought that I thought my worst case scenario was like okay, well, once I get to this point, it’s going to be 45 minutes or so. I had to push for three hours. Three hours.

 

P: yeah that’s a long time. That’s an amazingly long time.

 

T: It was so long, and I don’t know how. I don’t know how I did it. You know, it’s it’s exhausting. It is the most exhausting thing I’ve ever done or will ever do. And, you know, it’s really easy to say from here. And from before and from any other angle that well you always find a way to do it. Your body knows what to do. It’s natural. Okay, yeah. But when it’s happening, you really feel like you’re going to die. There feels like there’s no other alternative than this is just going to destroy you. And I guess it kind of does in a way. I mean, by the time you’re done, you really are a different person. 

 

P: Yeah. 

 

T: You’ve been through something that I don’t think is necessary. I don’t think anybody has to go through childbirth to you know, live a full life or experience things, but that very specific feeling is just so I don’t know how it could be recreated in any other capacity.

 

P: Yeah, I mean this to some degree, which is ironic in a conversation between two writers but is something that kind of defies language, which is why no one can tell you what it’s going to feel like when you’re having contractions There are no analogies that are fitting, right. So usually you can sidle up to something similar, but there’s not really anything that’s like it. 

 

T: Yeah, no and yeah, the funny story was my doctor or the doctor who was delivering the baby just kept telling me with each push, one more push, and then you’re a mom. One more push. Gonna be and this went on like five or six. times and I just like screamed “where’s my baby?”.

 

P: Yes, this is very much like it’s just around the next bend right there. Yeah, that sounds frustrating. So but once the head crowns and all that then it was quick.

 

T: Yeah, yeah, I had to have an episiotomy which was in my birth plan is don’t do that. But when they brought up the options, like yes, anything now, yeah. So there was you know, that kind of final complication, which also I was surprised how long that took honestly to recover from postpartum you know, I had a lot of issues with sort of pain and things with it and sort of feeling it being there for probably six to nine months after giving birth. So I think, you know, I think it’s a good thing that it was done, but you know, it’s also I think it gets brushed off a lot like, oh, it’s not that big of a deal. But it’s, it’s kind of a big deal. It kind of really sticks with you for a while.

 

P: Yeah, I wouldn’t I wouldn’t even say kind of, I would say and actually a big deal and it’s a little bit like it falls into the postpartum black hole. And you are everything falls where you just we don’t talk about it anymore. And I find in the discussions of pregnancy, there’s a constant kind of conflating of common and easy 

 

T: hmm, 



P: episiotomies maybe common, but it has these real repercussions as you have experienced for a long time, you know, postpartum as some people think it lasts a year after birth, right, which kind of makes sense because at six weeks, your uterus shrinks down to its normal size, but there’s so many other things that don’t either never go back to the way they were or take much longer to heal or so six weeks is kind of I think the date we all have in our head, but right it’s a little bit false. Yeah, I’m jumping ahead a little bit. Your baby is born. They put her on your chest.

 

T: For a second, and then they had I think she had some of that fluid. So they had to really quick like grab her and start doing some things that really alarmed My poor husband, who could actually see them. But no, she was she was great. She was fine. Of course, the most beautiful thing I’d ever seen and all the all the good things all the good, happy feelings for sure.

 

P: That’s awesome. That feels fitting after three hours. And then what happens to gestational diabetes does that how does that resolve?

 

T: Fortunately I the first thing that I made my husband do after I had given birth and kind of got the all clear like okay, you can take a drink of water you can have some food and a little bit. I sent him down the road to Five Guys. He had to bring me a double burger fries and a milkshake. He didn’t think I could finish them which was hilarious. Yeah. after that. But uh, yeah, so they have to test you they keep testing you on when you’re in the hospital to make sure nothing weird happens. And then for the rest of my life, I’m going to need to be screened for diabetes, I believe on a yearly basis, especially with my family’s history and everything but so far I’ve I haven’t had any signs that it’s back or it’s coming back. And neither is Sophie. They have to check her a little more to because that does raise her risk. But no, it’s it’s gone.

 

P: If you have gestational diabetes doesn’t resolve with the birth.

 

Dr. Matityahu: Yes, once the placenta comes down, then you go back to having normal blood sugars in the future. About 50% of women can develop diabetes. We usually have women we remind them like every year or so check your blood sugar to make sure that you’re still doing okay.

 

P: And we think that’s because the pregnancy exerted this extra stress on their body and that has changed the trajectory or we think they were going to get it anyway or there’s no way to know.

 

Dr. Matityahu: It’s more that they were they were at risk of getting it anyway and with the placenta causing an issue with their insulin. It pushes them just over the edge while they’re pregnant. But if they continue to have a high carb high sugar diet for the next five or 10 years, then they’re going to continue to push their body into becoming diabetic. A lot of diabetes is diet related and not for everyone. So it’s not to say that everyone that has diabetes is has a poor diet because that is that’s not it at all, but but for a lot of diabetics is that we’re giving our body too much sugar and our body’s insulin can’t handle it. And so our blood sugar ends up being high and for some diabetics that’s the issue for others. It doesn’t matter. You can have the most strict, you know, low carb diet and you’re still going to have issues with your sugars because for some people, they just have issues with their insulin production and it has nothing. It has nothing to do with how well controlled or strict they are with their diet.

 

P: Other than physically healing. How did you find the fourth trimester?

 

T: I wasn’t I wasn’t prepared for it. I’m sure that might have been said before once or twice Yeah. I was not prepared at all for the hormonal issues and changes. I didn’t sleep for about the first week after having her and it was it was literally making me insane. I felt like I was losing my mind. And I got misdiagnosed. When I called the doctor as having postpartum depression, which wasn’t my issue. It was just it was more I have anxiety. So it was the anxiety manifesting itself. And so the combination of not being able to sleep and the anxiety of just, you know, when I lay down to sleep, and she’s right next to me, I’m like, listening for to breathe, afraid that something’s going to happen. Or on the reverse side. I didn’t have this is like tripping me up. I didn’t want to miss anything. I didn’t want to be asleep while she did something. And I would miss it. I don’t know what I was looking for. You know her to sit up and start talking to me or something. But I felt like the time that I was there was so important. And so precious that if I slept it would it would be gone or something.

 

P: I mean there’s there’s something real there right like they are one day old once that’s it ever again. So so and they develop so quickly in that period that there’s a lot there’s a lot going on. There’s a lot to watch. There’s a lot going on

 

T: I also had a lot of trouble because of being induced. my milk would come in. Yep. So I had physical problems feeding my daughter I was going to try and breastfeed. It wasn’t the end all be all to me. I just wanted to make sure that she had food. So when I started having troubles, I wasn’t opposed to using formula or any of those things. But the frustrating and heartbreaking part was you know, she’s telling me she’s crying and she’s telling me that she needs to eat, she’s hungry, and I physically can’t help her I have to wait for my husband to go in the kitchen and mix up a bottle. And so that was really heartbreaking. Not so much that we had to make a change but just that in those moments where she needed me, I couldn’t immediately help her. The way I wanted to

 

P: and did that wane as she got older because you got more in a rhythm or didn’t have that the whole time?

 

T: Yeah, I think I continued for about two months to try and feed her breastfeed her and and I supplemented with formula. And by that point, it had become so unpleasant for me. And obviously unpleasant for her because if it’s not pleasant for me, it’s not going to be pleasant for her. And also she was just very not interested. You know, she learned like, oh, this bottle is already to go and I don’t have to do anything. So why am I messing around up here? Yeah. So you know, she was more into that and the process of trying to pump and everything was making me miserable. So one day I had to do a long drive to visit family and during the drive you know my I got those painful over just painful feelings and I just got to home I’m like I’m done. You know, I feel like my body has sort of stopped gotten angry. We’ve done some things during this drive. So we’re just gonna donate the equipment and move on. So 

 

P: yeah, that seems smart. I mean, if you think of all the things your body is doing to get pregnant to stay pregnant, to grow a baby to deliver, and then also to breastfeed, you know, you’ve done like 87 of them. So, all of which are amazing, right?

 

T: And it’s very weird to see one of my sister’s best friends. She had her baby right around the same time we all kind of clustered together and she was posting on Facebook saying I have so much extra milk and is taking up all my freezer. How is that possible? If I I was taking cell phone pictures of a vial like this big that I’m able to fill like I am having an amazing day and other people are filling up their freezer. It’s very inequitable, it feels like

 

P: Yeah, yeah, it is like randomly distributed. Yeah, 

 

T: right. Exactly.

 

P: So how old is your daughter now?

 

T: She’s just shy of two and a half. Yeah, she was born in September 2018. So Wow.

 

P: So just before the pandemic,

 

T: she turned six months old when the lockdown started. So we were just you know, at that point where the newborn infant days was ending, and we were going to go into the world. And then everything stopped. So

 

P: wow, you’ve been one of the people who’s been shut in with a runaround baby. How’s that going?

 

T: Yeah, I it’s been very difficult. But at the same time, I am infinitely grateful that she was here. Yeah, it definitely shifted sort of certain priorities. And it shifted different priorities and timelines for our family. So you know, we’re going into six months old and I’m thinking, Oh, we have to start planning your first trip to Disneyland. Oh, we’re going to go to the zoo all the time. You know, all these sorts of social, fun, interactive things. And then all of a sudden, we’re right back into the space we were in, which was a small house that had been purchased. When my husband and I were envisioning a life where it was just the two of us. And it was small. It wasn’t very kid friendly. All these things which wasn’t going to be a huge problem if we were out doing things and having a life out in the world. But then all of a sudden, we were spending all of our time in this small house. So instead of the life I think we were looking at with her for when she was a toddler of doing traveling and doing this class and that group and all these things. We concentrated instead on moving so we’re in a new house or in a bigger house. So that’s been a huge positive change, because there’s so much more room for all of us to move around. Plus, yeah. And we weren’t also not planning for my husband to be working from home for most of two years. 

 

And that’s another silver lining because he’s been able to bond with her in a way that he never would have been able to before the pandemic. She’s really close to her dad and it’s really beautiful, to see that relationship, and also just have that support. I mean, even now when he’s home, it’s nice to just be able to run outside and get the mail or drive out and pick up some curbside groceries without having to necessarily take her with me. It’s just an extra pair of hands and eyes that is super helpful but you know also sometimes you just want to do things yourself and have your time so just the same as anybody. There’s a lot of that give and take with balancing everybody in the same space. 

 

And when I was growing up, my mom was a stay at home mom too. And so, I wasn’t initially planning that for myself or for us. I had a situation with my work where I was going to take an extended maternity leave unpaid so I saved up for all my pregnancy so we’d be able to survive a few extra months, but it was really important to me to be able to be with her for those first six months. Because, I mean, I was very privileged to be able to do that. I think everybody should have that option. 

 

P: Yeah, 

 

T: well, weeks is nothing. 

 

P: Agreed. It doesn’t make sense. Yeah. Yeah. 

 

T: Unfortunately, a few weeks before I gave birth, my company rescinded our agreement. Until me I’d have to be back within 12 weeks. And by that time, I had already made my child’s childcare arrangements with the original timeline in line. And as you know, as any mom or dad knows, finding a daycare and setting up that timeline is not a simple task. Does not magically shift on a dime. You know, I was on waitlists for daycares that I didn’t hear back from until she was talking. So 

 

P: yeah, yeah. 

 

T: So it really kind of forced me to say okay, well, I am going to have to quit this job and stay home with her and that wasn’t my plan, but faced with either I mean, you know, no childcare or

 

so, once I made that decision once our family made that decision, I thought a lot about my childhood growing up and what my mom was able to do with me. And my favorite memories and those are all really simple things. Those are going to the park and splashing around in the pool, the public pool and doing picnics and all of these things that she was able to do when we were able to do together. And that was super important to me to give to my daughter and experience with her. And so not being able to in so many ways. In so much time you know there’s been those patches here. And there where okay, we’ve gone to the zoo, and then we can’t again this not going back and forth. That’s been really for sure painful and just makes me feel like I’m not not giving her what I wanted to Yeah,

 

P: although I totally hear what you’re saying. For every parents of every kid at a different age. There’s something that’s being sacrificed in the pandemic. But yeah, but for all of us who are lucky enough not to get sick or get over the sickness quickly. There’s also something gained for like every single age I have friends whose kids are in college and they say like, oh, the kids had to come home and now we get to spend time with them in a way we never would have gotten before and it sounds like your husband has gotten this amazing gift of it and you have the gift of your husband getting that gift right so there are all these things that kind of no way to manage this easily or beautifully. And this is sort of how it falls so I can see how it’d be a bummer if you had plans for music school or all that stuff to be gone but I’m imagining now your two and a half year old has an amazing vocabulary. I haven’t been around to adults. for them.

 

T: It’s insane. I can’t believe the things she can say and do and you know that’s of course me saying and I haven’t been around enough kids to know but it certainly seems impressive. She knows she has a state puzzle. And she knows almost every single state by sight and can assemble America. I still that’s 

 

P: that’s amazing. That’s amazing. My high school seniors like where’s Illinois? 

 

T: Exactly. 

 

P: Kudos to you. Well done. So does she have any tricks that you want to talk about at two and a half?

 

T: She keeps asking Alexa for her favorite songs. So right now it’s always Alexa, talk about Bruno.

 

P: So funny. Talk about digital natives. Good Lord. 

 

T: I know it’s awesome. 

 

P: Very fun. So here’s a question for you even though she’s pretty young still. If you could go back and give younger Tabitha advice about this process. What do you think you would tell her?



T: I think I would say just to keep trusting your gut and not what not even what other people think. But what you told yourself you were going to be and what you were going to do. You need to stop holding yourself to what you were thinking when you were 10 or 20 or even 30 Because yeah, I needed. I trusted my gut when I had my first pregnancy and changed my mind. I trusted my gut when I thought that I’d have to quit my job. And you know, all these all these times that I made decisions that I never would have thought I would have made and probably wouldn’t have supported. Somebody else making To be honest, but they all turned out to be the right thing. Or the thing that has brought us to the here and now which fortunately, is a really beautiful, wonderful place to be we’re really lucky. So yeah, if I would have kept trying to be the person that I thought it was going to be. It would be a miserable mess for nobody but me.

 

P: What can you say but that a lot of life is experiential…10 or 20 or 30 year old you couldn’t have imagined a lot of the events that happened–getting pregnant despite using birth control correctly? The flip flopping of your work agreement? That sounds like good advice to follow. I wish we had more time to talk about your writing.



I’ve read some of your work. You’re beautiful writer. Where can people find your stuff?

 

T: My website is Tabitha blankenbuehler.com. And I’m the only type of the blank and biller so if you find it, you’re there. That’s good.

 

P: That’s good to know. Excellent. Well, thanks so much for coming on and sharing your story. I certainly appreciate it.

 

T: Of course. Thanks for having me.

 

P: Thanks again to Dr. matityahu for sharing important information about gestational diabetes, and thanks also to Tabitha for sharing her story. I regret that we didn’t talk about her writer, she is a beautiful writer; I will leave links to her website in the show notes, where you can also find links to some of the medical issues that came up. You can find those show notes at war stories from the womb dot com. Thanks for listening. We’ll be back soon with another inspiring story.

 

 

 

Episode 24SN: Birth Before and After becoming a Doula: Keisha

If you look at birth over time, it used to be the case that women were always attended at their births by other women, and sometimes midwives, and these births happened at home. In the 1930s american women moved those births into hospitals, in part to pursue effective pain relief and the allure of more safety–but for a good decade it was not actually safer to have births in hospitals. And over the next 50 years the process of childbearing became more heavily medicalized–with benefits: lower maternal mortality rates and less pain in delivery. But by the 1980s, in part to push back on the increasing rate of C sections, doula’s started to attend women in the hospital–they were trained attendants who had been to other births and could advocate for a laboring women who was too involved in the process of birthing to also be involved in all the decision making…


Studies suggest that doula’s can have a very positive effect on a woman’s experience and today I’m excited to talk to a doula, both to hear about her birth experiences and her work.  And in fact, in this case, my guest became a doula in large part in reaction to her first birth experience…

You can find Keisha on Instagram @keishadoeswork or on doulamatch.net under Keisha Graham

Cervix ready for birth

https://www.healthline.com/health/pregnancy/cervical-effacement#effacement-vs-dilation

https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/stages-of-labor/art-20046545

https://www.healthline.com/health/pregnancy/cervical-effacement#diy-measurement

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205862/#:~:text=Summary,occurs%20prior%20to%20spontaneous%20labor.

Giving Voice to Mother’s Survey

https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-019-0729-2

Nitrous oxide

https://academic.oup.com/bjaed/article/16/3/87/2897753

https://emedicine.medscape.com/article/1413427-overview#a2

Failure to progress

https://mail.google.com/mail/u/0/?zx=crujqgpvkn4o#inbox?compose=VzqbCVPFZTlKDkdWzQFWSZGzChwXsZQzTKrHFdVnLdNKtWgkktZwtzNtHsGSVctmfVtdrMwNGVnWVLncFqcvtLQPZbXkrQXTSzWmSXJMzPBKFkZJhBcDqMxFMtMLKLHRplfKTjdgxhrWvkhRjBQstVkcPMFkspmQgqlMVdkWSmjrZZRctZLVzdzfvGjvjTLGbflmzBMcNmCdMsPqQqfwgjvnQqzDLXhZzlXRSRRjPnhtCQGwgfhllgSC

C section risk versus risk in a vaginal delivery

https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655

Biggest C section risk: your hospital

https://www.consumerreports.org/c-section/biggest-c-section-risk-may-be-your-hospital/

Audio Transcript:

Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka. I’m an economist and a writer, and the mother of two girls. I didn’t have a straight path through any part of the process of growing a family, and my experience was complicated enough that I never considered a doula, in part because I had no choices to make at the delivery, all those choices were being made by doctors. 

But if you look at birth over time. It used to be the case that women were always attended at their births by other women, and sometimes midwives and these births happened at home, in the 1930s American women move those births into hospitals in part to pursue effective pain relief, and the allure of more safety for a good decade it was not actually safer to have births in hospitals but that evened out. And over the next 50 years the process of childbearing became more heavily medicalized with benefits, lower maternal mortality rates and less pain in delivery, but by the 1980s in part to push back on the increasing rate of C sections doulas started to attend women in the hospital. They were trained attendants who had been to other births and can advocate for labor woman who was too involved in the process of birthing to be involved in all the decision making. 

Studies suggest that doulas can have a very positive effect on women’s experience, and today I’m excited to talk to a doula both to hear about her birth experiences and her work. And in fact, in this case, my guest became a doula in large part in reaction to her first birth experience.

 Let’s get to her story. 

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

Keisha: Yeah, my name is Keisha Graham and I’m from Richmond, Virginia. 

P: Great….And Keesha How many kids do you have, 

K: I have two, two girls. My oldest is 12 and my youngest is six. 

P: Oh nice. 

K: Yeah, we’re a household of girls so no one knows how old we are, we all lie about our age.

P: Excellent, good as long as you keep in the family, it’s perfect.

K:  Exactly. 

P: So before you got pregnant with your first, he wants to have some idea about what pregnancy, like, what were you imagining it would be like?

K: The only thing I knew about pregnancy before I gave birth was what I saw on TV, and I had a cousin who had a baby a little bit before I did she have two babies actually and I had spent some time with her like her husband was deployed so I went to her state and helped her raise her two little kids but I didn’t see her, Like be pregnant I knew kind of what raising a family was like, but pregnancy was kind of like foreign to me, except for what I saw on TV.

 

P: So does that mean that you’ve thought it would be easy or, you know, you’d be gorgeous the whole time or

 

K: I didn’t, I didn’t go in, I’m somebody who just doesn’t go in with anything with any high expectations, so I thought that if there was anything that I needed to know I definitely would get it from my provider or, you know, my mom or my grandma would tell me or my cousins, I just thought that it would be simple and like straightforward. 

P: Okay, that’s a good setup. Alright, here we are. So, did you get pregnant easily the first time?

K: Yeah, it was an oops, 

P: I’m glad. I’m glad to meet an oops because you’re the story we’re all chasing right? everyone thinks like…. so good that’s true in some cases. 

K: The first one is easy but the second time is hard, is the second time we were planning and it took a while. 

P: So let’s focus on the first one, and you found out with like a pregnancy test I assume like a home kit. 

K: Yep, I went to CVS, I find out that I always find out that I’m pregnant pretty early. So on my lunch break, I went and got a pregnancy test and took it and, you know, text, my boyfriend, my husband now that we were having a baby. 

P: Oh wow. 

K: Yeah.

 

P: And how was that first pregnancy, what was that like?

K: it was pretty easy, it was pretty straightforward. I had no sickness had no complications. You know, it was the ideal pregnancy, you know, heartburn, that was the biggest thing that I think I threw up once.

 

P: Great. So far this is great, this is going great…so take us to the birth and like, are you 40 weeks and I myself, maybe I’m the only one I didn’t know what a contraction would feel like so I didn’t know I was having contractions when I was, like, tell us that whole story.

K: My birth story. Yeah, is when things get different, so yeah I thought I was going to get everything from my provider, I trusted my provider. So my due date was December I think it was the 16th and then I think I went to my 40 week appointment on the 22nd. And so they did an ultrasound, and the ultrasound tech said, your fluids are a little low, but nothing to be concerned about. I went to see my OB, and she was like, Do you want to see your baby today, and I was like, Sure, 

P: yeah. 

K: And never told me anything about what my cervix was doing if my cervix is ready to be born.

 

P: Okay, what does your cervix look like in labor in early labor your cervix starts to open or dilate and it stretches and gets thinner which is called a placement or softening or ripening. If your doctor is testing the readiness of your cervix, it will be closer to ready when it’s softer as labor progresses the cervix which is about four centimeters long, thins to the width of a piece of paper, and will open from the width of a blueberry to the width of a melon about 10 centimeters, you’ll be given the go ahead to push. If you’re being induced doctors may use drugs to ripen the cervix, that try to mimic the hormones, your body will produce to get that job done, and the hormones cause the cervix to thin and your uterus to contract

K: that inductions sometimes take a while, and mines ended up being two and a half days.

P: Oh my God, that’s a long time. So, so did you get to like go home and get your stuff and then come back to the hospital or how did that go

K: No, I just went right up to labor and delivery, my boyfriend was supposed to go to work that day so we had to pull out of work. I had my mom bring my stuff up, and you know, We thought it was gonna be pretty quick. She said, Do you want to see your baby today so I thought, you know, maybe midnight I would at least, you know, have a child.

P: Yeah, today implies today. I’m with you. Yeah, so they get you in the hospital room. Did they put you on Pitocin or what was the process.

K: So that part’s, it was a blur. So I started with a servo, I do remember I started with some Adele, and it was hard, just like any cervical ripener, it was sharp and crampy. And I wasn’t given like the option of what drugs, I could take or what my options were at that point, everything was just. Here you go, this is how we’re going to do it, do you want me to refill your water, so I started with cervidil  and after that took a while, that took a long time and then

P:  I had no idea It felt like anything. 

K: Yeah, it feels like cramps, it feels scratchy on your cervix. Well, this was my experience, it was scratchy on my cervix, and I felt it being there, and then I felt like really strong crampy sensation after, 

P: so uncomfortable is what it sounds like, 

K: yeah, it was terrible. 

P: And then what happens next. 

K: And so then, at that point I get Pitocin. And then, I was on Pitocin for a while, and then after Pitocin I will while I was on Pitocin. I ended up getting an epidural.

P: Did your contractions start with Pitocin like does that work.

K: Yeah, I think, with the cervical it was working for a little bit but they weren’t as strong and then serve it only takes you, but for, you know, so far, it only like ripens the cervix is not going to dilate the cervix so at that point after I was as ripe as I was going to get I guess they were like Pitocin is next. Sorry, I was in a while. 

P: And what was that like, 

K: pitocin was hard but then I got an epidural. So, everything, where everything else that I felt physically was fine after that point. So I have a lot of introduction like interventions. After that point, and you know I kind of breeze through them, it was pretty simple.

 

P: So they give you the epidural and then and I just kind of waiting right till you’re dilated enough.

K: So the nurses come in again. They like roll check your cervix after X amount of time they check it it’s not where they want it to be so they introduce another intervention. So then after the Pitocin. I get my water broken, actually, with this birth, it wasn’t like there was no consent, it was, I’m in here. I’m gonna break your water, it’s done.

P: I’m already feeling like this is a bummer because this doesn’t at all sound like, do you want to see your baby today, like it not just that does not, I would not feel and that’s what this means, right,

 

K: it’s in a baby factor you know we need a bed, so we’re gonna do all of these things, so that we can open up the spin, but you’re not going fast enough, you’re not on our time clock so this is what we’re going to do.

P: Yikes, so, so do that, are you there for a full day before they break your water or how does that all go.

K: Water was broken, the next day so I did the cervidil and the pitocin from the first day. Yeah, and then chosen overnight and then my water was broken. The next morning, 

P: and then it sounds like you labored that whole day. 

K: Still laboring day. At that point you know they’re just cranking up the Pitocin. Yeah, just to get my contractions where they want it to be. And that’s the second day.

P: : And then can you feel that or has the epidurall worn off at this point or

K: no it’s still going, and I had a really strong epidural one stronger than what I needed. Yeah, so I’m just lying in the bed like no one’s telling me that I can move like what I know about labor now is that even with an epidural, you can move a little bit, and that helps progress the labor, no I was kind of just laying there, waiting for the staff to do something next to me. I didn’t know if he like an active participant at all.

P: Yeah that doesn’t sound pleasant Good lord, so then…now you’re there for two nights. And then what happens the next day.

K: The next day is Christmas Eve, and my doctor comes in and says well you have to have this baby by noon because I’m going on vacation. And so I’m just like, look at her like, there’s at this point I’m already feeling defeated, I’m already feeling like, you know, you’re just doing stuff to me you’re not telling me what’s going on. Not knowing that I could ask questions because this was my first hospital stay, it was, you know the first time, yeah that I’ve probably ever been in the hospital I don’t think I’ve ever like this had to visit anyone in the hospital. So you don’t know what questions to ask you don’t know what you can say to your doctor, you know you’re looking to them as the, as authority figure at this point, and that person comes in and tells you that you’re not working on their timeline, and it just feels so defeating

P: that I have to say that’s crazy to verbalize I’m going on vacation and you have to go. I can imagine someone’s thinking that but not saying,

K: yeah, it was Christmas Eve, and it’s like my family just Christmas he really big like we all get together and I just thought that I would be home with my baby. 

P: Yeah 

K: because you told me I think my baby today, so she that’s what happened that day, she told me, I’m leaving. At this time, and so she left. At that time, even though we were just continuing to wait I didn’t have many other interventions at that point, they did an internal monitor right before I started pushing my baby’s heart rate was descending. So they gave me an internal monitor, and then it was time to push and I pushed for two hours. Yeah, they got pushed for two hours just about a vacuum was used to get my baby out, and then she was born. When she was born she was brought to my chest, but I didn’t want her there, I kinda was like, no, just because I wasn’t feeling anything like I knew that after you give birth, you’re supposed to feel all these things, and it’s supposed to be this like beautiful moment but I didn’t feel like that. So I, you know, told them to take her over to the warmer, and you know I saw her from there but I just, it just didn’t feel right at that time because of everything that I went through over the last two and a half days.

P: Yeah and it from the stuff I read if you have Pitocin but you aren’t producing it yourself. It’s a totally different. You’re in a totally different mindspace right if your body was producing Pitocin you would have gotten it in your brain, which helps with the connection. But if we’re getting it artificially 

K: Yeah,

P: you’’re not getting that right so

K: right, we are my girl I work with likes to say it’s called like the Oscar award winning speech after you have the baby you have like this, oxytocin high does oxytocin rush so you’re like, thinking everybody you’re checking fingers and toes you’re doing all of these things, because, you know, oxytocin does that to us. That’s why they call it like the love hormone, but yeah Pitocin doesn’t it just brings on contractions, it just does what it’s supposed to do. Give you contraction, Stop hemorrhaging.

 

P: Yeah, so it sounds like. It makes sense how you are feeling right like you’re responding to everything that has happened over the last two and a half days which is just disappointing. And but the baby’s fine. 

K: She’s fine, she was healthy 12 fingers 10 toes. She’s amazing and she do

P: How long do you guys stay in the hospital after that,

K: we stay there for I think two days. Yeah, we went home on the 26 I nursed you know her, she was a great nurse or it was fine, but yeah I’m sent home with this baby, and trauma from my experience in my labor.

 

P: And did you recognize it in the moment, like, did you think oh this was traumatic.

K: Oh, no, it wasn’t right, but I didn’t think that it was traumatic and so after processing my own postpartum depression and postpartum anxiety that I had throughout the time, like my postpartum period.

 

P: Well that sounds really hard from the stuff I’ve read it looks like one in seven women have postpartum depression. And somewhere, I think in the Cleveland Clinic I read some article that said, it’s the most common condition of childbearing. 

K: Yeah, oh yeah, it’s really up there. 

P: So, did you recognize, like in the fourth trimester that you were having postpartum depression or did you just think, oh my god, this sucks.

K: The postpartum anxiety was the thing that postpartum depression didn’t get to me as much as my postpartum anxiety did. I had very bad intrusive thoughts, and I kept saying to myself, This isn’t normal. This isn’t normal but I didn’t have anyone to talk to about it. I had a trusted network of friends, I didn’t have a professional that I could go to about it. I wanted to talk to my doctor, but I didn’t like her. 

P: Yeah. I bet

K: And then we would do screenings at the pediatricians appointment but I didn’t feel that I can talk to them about it as well, or the things that I did say they were like yeah that’s just baby blues, but by the time I really realized that I had postpartum anxiety I think I was, I was well out of it, which is great but also could have, it would have been beneficial for me to get help sooner or couldn’t recognize the signs sooner. 

P: Yeah, that’s the story I hear from a lot of women. I think it’s hard to recognize while you’re in it, because you’re busy being anxious or you know whatever right so and so did you become a doula between the first birth and the second birth or tell that story.

K: Yup…I became a doula between the two. So after my birth experience, I went to births with like friends and family, just as someone who had seen it before, because I, when I gave birth in my early 20s I think it was 21 when I had my daughter, so by the time my group of friends, like started to have their own children, I had already been there done that so I wanted to go with them to just help them out, because I knew my experience wasn’t typical or should not have been typical but found out that my experience was, was typical, 

P: I was curious about how common it was for women to have bad birth experiences, like the one Keisha described, and found a giving voice to Mother survey published in 2019 that sought to better understand women’s lived experiences giving birth.  The survey didn’t include a huge sample but it was just over 2000 people. And basically what the researchers found was that one in six women who filled out the survey were mistreated in some way during this very vulnerable period, during and after birth, they reported issues like loss of autonomy, being shouted at scolded or threatened and being ignored refused or receiving no response to requests for help, and the factors is associated with a lower likelihood of mistreatment, so you’re more likely to have a better experience if you had a vaginal delivery, a community birth a midwife, you were white, you’d have a baby before you were older than 30 years old.

K: I knew that that couldn’t be right because it’s not what I saw on TV. That’s not how I saw, you know, whoever on Friends give birth, is that how I saw like white women being treated. So I had a friend who told me she was like well you should be a midwife. And I was like okay that sounds cool and I looked online and saw that that required a lot of school and I was like, No. So then I had the same friend said well you should be a doula. And then I looked at that and I was like yeah doula work is more my speed. It’s something I really want to do.

 

P: So tell us how like has it, what’s that like was the training like and, and what was your experience and

K: that the universe like really lined up for me to be a doula after I found out what doula. What a doula was, I was working at a location that was recording podcasts for a doula training organization to labor. And so we just happened to be in the same space where I was talking about it. And the owner of that organization was there and she’s like yeah you should come and do one of our trainings. And so I looked it up and they were local so I did the three day training to become a birth doula. It took me a while, but from the time that I decided that that was something that I wanted to do till the time that I took the training. It took me a couple of years, but I think I was going to births I was doing the work, and I think it’s nice seeing that people weren’t being treated the way that they should and labor was really what gave me that momentum to say okay yeah I need to do this work. I actually attended the training after my second labor. 

So my second labor I changed providers. It was my third pregnancy. So as my second pregnancy I miscarried and I miscarried pretty early, but I had changed providers pretty early with that pregnancy, and then I had a provider, that was so amazing so supportive. I remember when I did miscarry pretty early, she, you know, I mean my husband come in her office, and I remember like crying in her office and she and I told her I said something like, I know you have other patients to see today and we’re leaving to get out of your hair and she’s like, No, you say, and process this, however you need to. And so I just knew that this was the person that needed to deliver my kids, any more than I have after this. So then, 

P: that sounds lovely 

K: yeah she was amazing. I still love her.

P: So we’re so this is the pregnancy where you said it was hard to get pregnant, this time.

K: So it took a while for me to pregnant again and but I get pregnant again. And, well, I thought it was gonna be so easy because the first few times were so easy, it was just like, they just happened…. the one I was really thinking about it, like I was going to try again, it took it took a while, so we got pregnant. A year later, and yeah, had a very empowering labor I still had lots of interventions, but I had a provider that made the time to tell me my options and my choices, and gave me the power that I needed back into my labor. 

P: So maybe what walk through that slowly so, so people can see the difference between the first and the second. 

K: I had a lot more information in the prenatal period, I was more than just my blood pressure my fundal height peeing in a cup and then asking if I had any questions. She was very forthcoming with all of the information that I needed to know just by asking me, Hey, have you taken any childbirth education classes do you know where to find them. These are the options that we have here in our office, but I’m sure there’s some more around, you know. Feel free to go look. She was telling me about my baby how my baby was growing, the things that I could do, you know, to help my baby grow, just a lot of information in the prenatal period. So I felt safe. When I went into labor. I just knew that I was going to go into, into this through an induction because I was induced last time so I just knew that I was going to be induced. But I ended up going into labor on my own at home and I stayed home for as long as possible, which was something that I didn’t think that I could do, but my provider made me feel really comfortable in doing that. But when I got to the hospital I was in active labor. 

P: Oh wow, really well. 

K: Yeah, I progressed really well. And then, at six centimeters hit a wall, I was like, No, I don’t want to do the same or it’s 2021 Give me all the drugs, or it wasn’t 21 it was 2014 Give me all the drugs so I have been told that it was, I will actually, before the epidural, I get Nitrus nitrous oxide.

P: Nitrous oxide, otherwise known as laughing gas is a form of anesthesia that you inhale, it sounds like it’s a pretty weak form of anesthesia, it’s usually used in pediatric dentistry, to give you a sense, but it does do something and it works quickly,

K: and that held me over for a while, while I couldn’t get into the shower, so I had to come out of the shower every hour or so for monitoring of the baby. I think at that time this particular hospital didn’t have wireless monitors so I had to get out of the shower to come get monitored, and so that was very hard, like contractions are really hard when I was out of the shower. So at one point I didn’t want to keep going back and forth so they gave me a nice choice, and that was really good pain relief option, and then the tank ran out. It was, I think I was probably like the second person in the hospital to ever use it or something but they were telling me it was very new to the hospital system at this time. So the tank right now, the nurses, even know how to use it at first, it was a mess. But it was helpful when I was able to use so after it was done I said I’m going to get an epidural. And then I got my epidural, and labor beautifully after that, I don’t think they needed to break my water until the very end because I had just a little bit of space left my baby was Opie which is occiput posterior Sunny side up. So, my cervix didn’t dilate all the way. So she was looking up instead of looking down when she was supposed to be, you know, the other way. 

P: Does that, does that mean a C section or 

K: No, no, sometimes it means longer Labor’s, and then in my case, it meant that my cervix didn’t dilate completely. Uh huh. It dialated, almost completely. So she broke my water to help try and get it to dilate more was like, like a half a centimeter, I guess, of dilation that needed to happen before they wanted me to start pushing, so she broke my water because of that, and I was like okay with that because she said either we can wait a while, or we could break your water, she gave me both options. And I was like no I’m tired. So let’s go ahead and do this, she broke it, we still waited a while, nothing happened. So we kind of just pushed past that little bit of dilation, which was fine. and I the second kid was born in 15 minutes. 

P: Oh Wow, well done.

K:  It was like three pushes 15 minutes is very quick. Yeah, so when it was time for me to push, I remember my doctor was sitting on the bed and saying, you know, all right, go ahead and push and I was like well, don’t you want me to put my legs on the stirrups Don’t you want me to do all of these things she’s like No, I’ll just do whatever you want. And that was just so empowering. It was just the greatest moment ever. So, I had a birth, that was traumatic but also had one that was so rewarding and empowering and I knew this is the type of birth that everyone should have.

 

P: That does sound like a story book kind of birth, where you’re making all the choices. 

K: Right. 

P: Yeah, that’s amazing. So now tell us I was saying to you before when I was having children, I don’t know if doulas were a thing or not but I, I was not aware of them. So give us a sense of what you’re doing for other people because I can’t, I can’t really imagine, doctors, kind of backing down if they’re if they’re sort of not approaching appropriately. 

K: Yeah, advocacy advocacy work is what I do, it was one of the things that led me to doula work was being able to, you know let people know of their options and their choices when they feel that they don’t have any or letting them know that it’s okay to ask questions. I never want to speak for anyone but just saying, you know, maybe there is another way, just ask, because you can ask questions to your doctor, and that’s okay. And they should give you that information. Consent is very important in this work as well making sure that everyone has informed consent for everything that happens throughout pregnancy, labor delivery in in their body and with their baby Afterwards,

Doula work is a lot of educational support in the beginning, especially, I mean, bindable free care, when you’re in the midwifery program it were free model care, you do tend to get a little bit more information than those who birth with an OB But yeah for those with an OB but or actually anyone in general really is just giving them evidence base, up to date information on whatever it is that they are going through in the pregnancy journey at that time, or that you may think that they need to know it’s anticipating folks needs as well.

P:  I’m guessing that you’re, you really shine in the labor and delivery room right because that’s when I think for sure for your first birth, most women don’t understand the degree to which they’ll be compromised when when everything’s going down right like all of a sudden you can’t really speak for yourself because you’re in excruciating pain or whatever you don’t know what’s going on. So, is it the case that like you’re having the talk with the mother or and then she’s communicating to get into the doctor like how does that all work.

K: We all talk together like I have no problem asking questions why providers are in the room where you know sometimes people might want a little bit of privacy or something like that to have conversations. I don’t know if we talk prenatally about some common complications that may come up and how to address them, giving you all of the tools that you need creatively to ask the right questions if something comes up, and then reminding you that you have those options to ask questions in the moment you can always ask, what are the benefits to this, what are the risks. Are there any alternatives. And then also, mostly advocating for more time for people.

Very rarely are people rushed into an emergency C section where they’re pulling cords out of the wall and then brushing them back to the or anything outside of that I’m always advocating for people to ask for just a few moments for them and their partner to talk about what’s going on, or to process what they just heard, so that way they’re not moving into the next steps with any doubt or worries, which they may still have but at least they have some, a little bit of time to process everything that’s going on and they can confidently move into that next step.

P: And you talked a little bit about your birth versus what you had seen for white women. I interviewed a woman at the Center for American Progress, and she works on maternal health issues among other things, and she was saying that for black women, the ways that racism finds its way into the delivery room are not always overt. So it’s not always like an obvious thing like, I don’t know that this woman was being racist with you but that’s an outrageous thing to say to a laboring woman…I don’t know what the was driving that her treatment of you but I wasn’t there but, but I’m imagining most of the circumstances are not quite as upfront as that.

 

K: Right, yeah, yeah, it’s, you know, biases that, yeah, yeah, that’s the face that people of color face when they are in labor. It’s a lot of, I don’t want to say the same type of stereotype, only because I am used to it and I, because it’s lived experience for me so I know what to look out for, but it is a lot of not ignoring or ignoring folks of color, their pain or their pain tolerance or thinking that they are exaggerating when they’re saying that something is wrong with them. It is a lot of ignoring their needs, and, you know, attending to the needs of someone else, ahead of them or something like or a white person’s needs, I should say, versus a person of color,

P: so in that instance you can go in like advocate for them and say no, she really needs another epidural or whatever like more.

K: Yeah. And luckily, I mean, The good thing about being a as a doula being able to see both sides and being able to be in the room for all types of people is that I can say, well, if they, if I have a nurse or a provider that says oh this is not how we do things here I can easily go back to experience that I’ve had with a white person is a well, actually this is how you did things how you’ve done it before, and this day and time, look at my notes. But

P: That seems super, that seems super powerful. That’s a great, great leverage to have.

K: So, yeah, it’s nice being able to advocate for folks in that way to say, you know, if they say, This isn’t how they do things I know that they do them, the opposite way,

P: I can imagine that is an unbelievably frustrating thing to hear when you’re in the mix and your client is in pain and need something right. 

K: Yeah, 

P: that sounds like a lot, so how long have you been a doula for.

K: So I’ve been professionally trained as a doula for four years, but I’ve been doing the work way before that.

P: That’s cool. So I bet you’ve been to a lot of births.

K: Yeah I think by the end of this year I will be probably well over 100 births. 

P: Wow, that seems like life affirming work. 

K: Yeah, it’s pretty exciting right. It’s always exciting, it’s always something new, 

P: and I’m imagining again when I was having kids there was no skin to skin, there was no like delayed cord clamping and that sort of stuff so it’s probably cool to be in a field where there’s constantly new and different things coming out.

K: Nice to be in a field where we’re bringing things back to the family, and out of the medical complex out of the doctor’s hands and bringing it back to the family like the skin the skin the delayed cord clamping. I even advocate for fathers to try and catch their babies we talk a lot about that. 

P: Oh, that’s cool. 

K: Yeah, because, I mean, they mean my job is to make sure that partners, I should say fathers, but partners are active participants in their labor as well like this is a family events, and not something that doctors have to oversee completely.

P: That’s super cool and I know that my husband had no idea what to do, I mean I had c sections but he’s still like, I want to go hide in that corner and you call me, so it’s nice to have someone who knows what he’s doing to kind of guide that process.

K: I think that I biggest, another one of my biggest roles is normalizing the process as well, so that partners don’t have to worry so much about advocating and, you know, answering all the questions and knowing all of the things, while the birthing person is in pain in going through their stuff. So I’m able to be like oh, that’s normal. Yeah, she’s throwing up, that’s okay.

P: Yeah. Don’t mind her yes that’s very funny. I thought that most states don’t allow insurance to cover doula services is that your experience. 

K: Yeah, in Virginia, we don’t take like the insurance companies don’t cover the list services. There are current bills being passed or laws going into effect, that where doulas can be covered by Medicaid. But I haven’t seen much where doulas are covered through private insurance. A lot of folks can use their HSA or their FSA account to pay for doula services, okay. Yeah, medical insurance.

P: That’s super cool. That is very cool work and it’s a totally interesting way to go into it right to have had your experience and think like I can fix this. 

K: Right, yeah, 

P: God how rewarding that’s cool. So, how do people find you if they’re in Virginia, the Virginia area, I’m assuming you don’t work outside of Virginia.

K: I do virtual work. Yeah, I mean this pandemic has opened up so many lanes for doula work since a lot of hospitals were closing their doors to doulas, we still needed an avenue to get into help families, so we do virtual work so I do virtual doula work for anyone, anywhere. If they need a doula. But if you are in Virginia, and you’re looking for someone local, you can find me on Instagram at Keyshia does work, or on doula match dotnet, and under my name Kesha Graham,

P: so that’s awwesome, I’ll put that on the show notes so people can find it. What’s it like to be virtual for birth, or do they have you in the labor and delivery room like on phone.

K: yeah, I mean FaceTime or we can check in every now and then where we can ask questions, if it’s really tailored to whatever it is that you need but yeah I mean I’ve done like FaceTime, where I’m just like on a tripod. Like, you got it. You can do it, you know it’s a lot of coaching at that point but also reminding families that you know they have choices they have options they have power in their experience and they should wield that power.

P: That’s amazing. And I can imagine, if I were in the circumstance where I actually had to push a baby out. I would probably trust you more than my husband because you’ve seen it before. Right, yeah. You know I can do it. He’s got no idea. So that’s super cool that’s an awesome job.

K: Thank you. Yeah, I love it. It’s really amazing. I love I love seeing families, work together, I am of the same like mindset that you are like, let the doula handle it. A lot of a lot of partners really get this like power inside of them that they don’t know is there when they’re faced with their partner going through something really hard that I really like to see. Yeah, I like the best births and when I just stand in the corner and get to watch families do their thing.

P: That’s amazing. What’s your ideas about C sections and like the stuff I’ve read is that, you know, there’s obviously serious surgery and you’re much more at risk to have some kind of complication if you go through a C section. And the other thing I saw that was kind of damning said the biggest predictor of whether you’ll have a C section or not is the hospital you’re in, as opposed to your medical condition. So that’s suggestssomething wacky is going on, what’s your experience because C sections of do you try to turn them around or how do you deal with that.

K: I’m not there to give anybody medical advice.

P:  Okay, 

K: so if the doctors are calling for a C section, you know, the only thing that I am able to do within my scope is to have the family ask questions and then help them come up with the questions to ask to see if it’s a true emergency or if they have a little bit more time, my own opinion on C sections but they are here for a reason. But with the current rates of C sections in knowing that there isn’t this big decline with mortality, mortality and morbidity, then we still know that C sections are being over utilized

P:  Yeah. 

K: From what I see sometimes I feel again me as someone who only took a few day training and has attended a limited amount of births I feel that sometimes you know, maybe things just need a little bit more time. And then I do feel that they are a little bit rushed, but, you know, again, I’m not a medical professional so

P: yeah I mean it just you’ve heard these stories where like the baby’s not in distress or anything. And they have a C section and you’re watching like any there’s the mother, so

K: that’s why provider choice is so important. That’s why place a birth is so important there is a thing of birth culture, like, your hospital is going to have their own individual birth culture, culture, so it is important to talk to families who have birth at the place of birth, where you’re going to birth, and have been with the provider that you’re going to see when weighing those options about C sections and I think it’s important for everyone to talk about C sections because we don’t know who is going to need a surgical birth, versus, you know, a bachelor one,

P: I assume there’s no like scorecard where you could see kind of what your hospital does, or is there some way to evaluate the, the environment you’re about to go into

K: some states have C section rates listed on their state website or you can find it on the hospital website, But sometimes, information if it looks kind of unfavorable it’s kind of hush hush so you kind of have to scour the internet and the message boards to find out that information,

P: but but usually someone is keeping track of that, so

K:  it’s out there is out there, but

sometimes it’s outdated I think for in my seat I think some of the information is a couple of years old.

P:  Okay. Okay, interesting. Well, that’s also a good idea. So reason number 87 to get a doula is to be made aware of all these things that you should be checking on. 

K: Oh yeah, definitely for sure. 

P: Thanks so much for coming on, I totally appreciate your time and your story. 

K: Thank you. Appreciate it.