Ep 122: Kassie’s Birth Story – Opening Up About Pregnancy and Addiction

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On today’s episode we have Kassie. Kassie recently became a first time mom and is a self-described “grateful recovering addict.” Though she’s been in recovery for over 5 ½ years her birth story shows how her addiction affected not only her experience but her daughter’s experience as well.

I have to be honest, the topic of addiction in pregnancy is not something that I’ve felt particularly passionate about. Within Black communities, historically the issue of drugs has been responded to with incarceration. It wasn’t until white suburban women were affected by narcotics use that addiction began to be seen for what it is: a disease. Many of the wrongs inflicted on communities of color have yet to be righted and that’s why this is a subject I have not been particularly moved to speak about.

However this is an important topic and one that isn’t discussed enough due to shame. I’m grateful Kassie came on to share her story in a way that’s very honest and authentic. I was so impressed with Kassie’s self insight. I know that you are going to learn something from this conversation just like I did.

In this Episode, You’ll Learn About:

  • What Kassie’s experiences with addiction and recovery have been like
  • What made her pregnancy care different because of addiction
  • How she had trouble bonding with her baby
  • How she struggled with pain management postpartum
  • How her addiction affected her daughter
  • How the medication used to treat Kassie’s addiction affected breastfeeding
  • What role mental healthcare played in her postpartum recovery

Links Mentioned in the Episode

Keywords

addiction, cesarean, opioid pain management, pain management, withdrawal

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Podcast

Keywords

addiction, cesarean, opioid pain management, pain management, withdrawal

Categories

Podcast

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Ep 122: Kassie’s Birth Story -Opening Up About Pregnancy and Addiction

Nicole: In today's episode, we have a birth story episode around an important topic. Addiction.

Nicole: Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

Nicole: Hello there. Welcome to another episode of the podcast. This is episode number 122. Thank you. Thank you for being here and spending a bit of your time with me today. On today's episode, we have Kassie. Kassie recently became a first time mom with her husband who she's, she's been married to for over two and a half years. Kassie describes herself as a grateful recovering addict. Now, even though Kassie's been clean for over five and a half years, her birth story shows how her addiction affected her own experience during her birth, as well as her daughter's experience. Her daughter, unfortunately reaped some consequences from Kassie's past addiction. And we're going to hear all about that in the episode today. Now I have to be honest that the topic of addiction in pregnancy is not something that I have felt particularly passionate about. And let me tell you why. Back in the nineties, two thousands or so when crack cocaine was an epidemic in black communities, the solution was just to throw everybody in jail and it wasn't until white suburban women started having issues with using pills and, um, narcotic pills, you know, Oxycontin, oxycodone, that we started looking at addiction differently and realizing it for what it is, which is a disease.

Nicole: And that left a little bit of bitterness because people in communities that look like me were treated very differently. And some of those past wrongs have not been righted. There's still people in jail, for instance, for drug related offenses related to use. And, um, whereas that wouldn't be the case if that happened today, also in the vein of, um, speaking about drugs, like the legalization of marijuana has shown that it is primarily so far benefiting white males, really more than anybody else in being able to create really profitable businesses around the legalization of marijuana, whereas black folks and folks in communities of color, where it had been used, but not legally, they aren't able to get the same footing, the same establishment to turn those illegal practices into legal businesses and still issues of past wrongs where people who sold marijuana before are still in jail for that, and don't have the opportunity to create businesses around that. So that is why addiction in general, just hasn't been something that, again, I have felt particularly passionate about.

Nicole: However, I do know, and I 100% recognize, and I appreciate that this is an important topic. I see it more and more and more in my practice. I suspect that, um, you may know someone who's been affected by it because it's really, really common. So we are going to talk about that today with Kassie. So Kassie is going to share with us her addiction journey, how she was able to get clean, how her pregnancy was okay, but the birth and the recovery were actually quite challenging for her. Um, how she struggled with pain management, postpartum, how her daughter was affected by her addiction and had to stay in the NICU for a bit because of that and how she had trouble bonding with her baby and much, much more. Now I know that the topic of addiction can have a lot of shame around it. So I'm really grateful that Kassie comes on and shares her story in a way that's very honest, very authentic and very real. I was so very impressed with Kassie and her self-insight in particular. So I know that you are going to learn something from this conversation, just like I did. So without further ado, let's get into this birth story discussion with Kassie.

Nicole: Thank you so much, Kassie, for agreeing to come onto the podcast. I'm really grateful that you are here to share your story. It's an important story. And, um, like I said, I'm so glad that you reached out to share it.

Kassie: Yes. Thank you. I'm so glad you accepted.

Nicole: Yeah. So why don't you start out by telling us a bit about yourself and your family?

Kassie: Um, I'm 29 years old, um, born and raised in Mansfield, Ohio. Um, I have been married for almost two years and we just recently had our first daughter in February.

Nicole: Alright. Congratulations. Congratulations. Thank you. And, um, if you're comfortable, then please share a little bit about your addiction journey.

Kassie: Well, um, how to summarize that. That was about, it started in high school. Um, I was one of the just weekend partiers and it eventually, um, I was very uneducated about any of the harder drugs and what ended up happening was I got introduced to the harder stuff and I was willing to try everything, um, being very naïve of what the long-term consequences could be. So for about five years of my life, um, I was in and out of rehabs from heroin. And luckily I came to my senses and I've been, um, clean for over five and a half years.

Nicole: Congratulations to you for that. And that is a huge accomplishment. Yeah. What do you think it was that finally helped you to, um, take control of your addiction?

Kassie: Well, I starting out as a teenager, I was started drinking very early. So I don't think I ever learned to cope with any feelings or anything without alcohol or drugs. So once I got a good stretch of what it's like to be a normal functioning human of society, whatever that is, but without drugs, I was like, wow, this is kind of cool. I liked not having something run my life. And I admitted I was powerless and I have this disease that if I pick up anything, I won't be able to control it. And then it just it's been working ever since, take it a day at a time.

Nicole: That makes perfect sense. Perfect. Perfect sense. So you find yourself pregnant and um, why don't we talk a little bit about how your pregnancy care was different because of your history of addiction?

Kassie: So I, this, when I got clean over five and a half years ago, I got put on a medication called buprenorphine or others, know it as Subi tech. So because I have been titrating off that over the years, um, when I got pregnant, um, because I was told it was okay, I checked with my OB. She's like, absolutely. I deal with patients all the time. So we got pregnant with second try. And, um, I had to do, NST's starting my third trimester twice a week, every single week to monitor her. And I saw a physician. And besides that,

Nicole: It was pretty straight forward, nothing out of the ordinary, right?

Kassie: Yeah. They didn't want me to, they, I was able to titrate while I had her in me. They said it that's okay. But not to push it too far, because if I'm withdrawing or feeling uneasy, it could affect her. So I did the best I could to get down as low as I could.

Nicole: Gotcha. So during your pregnancy, you were trying to continually get a lower dose of the medication in order to, um, get as low as doses you felt comfortable with and not go through withdrawal or feel the urge to go back to using heroin again, correct? Yeah. Yeah. Um, and do you feel like, how did you feel was the care and support that you got from your physician?

Kassie: I was very impressed. I never felt judgment at all. It was really simple. Um, I later on the hospitals where I had some issues, but, um,

Nicole: Okay. But you felt like your physician and did you see the same physician, your whole pregnancy, or was it like different physicians in a practice?

Kassie: Um, so there's five physicians there. So what was recommended to me is to meet every single one because babies are unpredictable and I won't know who could possibly be there to deliver her. So I met everybody and then I ended up picking a female who I absolutely loved. And unfortunately, due to my daughter wanting to come a week early, she didn't get to deliver me, but I knew the guy who did at least.

Nicole: Okay. Okay. Well, I'm glad to hear that you don't feel like you faced any sort of, um, judgment because you had a history of addiction.

Kassie: Right? Somehow I hear awful experiences and somehow, I don't know, my mom always told me, you know, we raised you with class and you give off a very classy, demeanor, and she's like, I think people feed off of that and they can see that clearly. Okay. Now I've been lucky, I guess.

Nicole: I mean, yeah. I mean, some of us haven't quite come around yet and judge people for a variety of reasons, um, during pregnancy. So again, I'm glad that you were able to find some, some, some good, good support, and I guess we'll get to what happened in the hospital. Yes. Yeah. So what things did you do to prepare for your birth?

Kassie: Oh, well, I listened to your podcast, 24/7, literally. I was getting my, uh, the nursery done and I just list you're the first pregnancy podcast I found. So I got so much education through there, but then I closer to, I started panicking. I'm like, I need to take a birth class, but because of COVID my, um, doctor's office, they had, um, they were supposed to have them available for zoom. And then by the time that I needed to get one, it was no longer available. So I did, um, online one through, I can't even tell you where, but it was like seven sessions I had to watch and I was, it was all, nothing that pertained to me because I ended up needing a C-section that's another thing is my daughter was breech.

Nicole: Okay. Okay. Got it. Got it. Got it. And, um, did you, were you happy though with the, the course in the sense that if you felt like, I guess if you were going to have a vaginal birth, did you, did you feel prepared for that, but you just didn't feel prepared for the possibility or what could happen with the cesarean? Correct. Okay. All right. And then were you wanting any additional information, like in relation to a cesarean and then the Subutex, or I guess having a baby and how that might affect how being on the subutex may affect your baby? Were you worried at all about that? Or did you feel prepared for that?

Kassie: Oh, I was completely freaking out and I asked my doctor and they told me to expect to stay like after I had her expect to stay, but it just depends, like people can be on, they've had patients on say eight milligrams of this medicine and their baby does not withdraw, or they have people on even lower dose, two milligrams and the baby's in the NICU for a month. It is so unpredictable. Um, but I did not, I was like, okay, well maybe I'll be like being there like five days, but regardless nobody could give me anything or prepare me for this experience. And I tried so hard to find other podcasts and it's just not really talked about.

Nicole: It's really true. You're bringing up something that, um, I don't think we, we realize we definitely, I think have gotten better about getting people through the pregnancy, but we don't have a lot of resources to help people understand what it's gonna be like in the postpartum period, especially in that immediate postpartum period when it's really critical. Yes. Yeah. Yeah. Did you ever consider, like, because you were worried about what might happen and I, and we should say that the, the worry is that the baby can withdraw from the medicine as, as well. Did you ever, um, consider that you were just going to stop taking the medicine altogether because of that concern about what it, what may happen?

Kassie: Um, so that was not recommended by my doctor because I would have went through withdrawal, but from what I have gone through this time, I can say I will not have another child until I'm off of this.

Nicole: Oh, wow. Wow. Okay.

Kassie: It was very bad.

Nicole: And you're, you're absolutely right. We don't recommend that you stop taking it, uh, because, you know, because you need it for your health, but I know that some people think in the back of their mind that maybe they want to, but that's really interesting that you're saying that you, you don't want to have another child until you're off it, I guess. Well, here's some reasons why. Um, so was there anything in particular that you wanted for your birth before, you know, as you were going through the classes and, um, was there anything that you wanted?

Kassie: Well, once I started really preparing, um, taking the classes, so that was my third trimester every well, twice a week. I got confirmation that my daughter was the wrong way. So as much as I was getting prepared for vaginal birth, my daughter was saying otherwise. Gotcha. Um, so as much as I was like, you know, wanting to, because literally the question, it wasn't, if I was having a boy or girl, people were asking me if I was going to get an epidural or not got it. So, and I'm like, I'm going to try not to, but I don't, um, I don't want to be like, I am not doing this without any medication at all. And then jeopardizing her or anything.

Nicole: Yeah. You were open to going with the flow of the process. Yeah. And just kind of deciding in the moment what you felt will work best for you. Yes. Yeah. Yeah. So then what was your birth actually like?

Kassie: Oh boy. So it was a week earlier than anticipated because I went for an NST on Thursday and my fluid was 11 and my 38 week appointment was the next day. Well, we did a confirmation on the ultrasound and make sure my daughter was still breached. And my fluid was down to 6.5. So, um, my doctor said, I'm going to, she's like, I want you to go home and get your bag and get to the hospital. We might be leaking amniotic or amniotic. Is that right? Not amniotic fluid. Um, so she sent me there while I had to go get my husband and get everybody together. And I'm panicking at this point because this, this is seven days earlier than the planned C-section. Um, I did want to say I was offered to flip her, but my fluid was running low all throughout NST's. So doctor wasn't really comfortable with it.

Kassie: I wasn't comfortable with it. Um, so it was looking C-section. It was so we get to the hospital and the doctor didn't run any tests. The doctor on call. He said you are 38 days plus one, your baby is okay right now. Like they put the NST on me and checked her that way. He said, we're just going to go ahead and take her because there's no reason to wait a week and wait for something to be wrong with her when she's okay right now. So then within two hours, okay, let me back up. So then they came in and started prepping me, um, that care was phenomenal. So then they take me to the room and husband could not be in there, but they gave me the spinal. And that was really hard for me because I am numb from the waist down. And that is the first time in a very long time. I have been powerless over part of my body. So that was a little triggering to me. Um,

Nicole: Gotcha. Gotcha. Now I get like, I'm trying to back up for that. So everything happened really fast in a way that you just were just not expecting?

Kassie: Right. It was once I got to the hospital, it was literally within five minutes. I had seven people in my room getting me ready, even though it wasn't an emergency C-section they must have just not had anything to do

Nicole: Because it was just like, let's go you're here. We're here. Let's do it.

Kassie: Yeah. My people asking me questions at once. It was absurd.

Nicole: Oh my gosh. I did that. I mean, how did that feel for you? Was it overwhelming?

Kassie: Uh, it, it was, I did appreciate that everybody was very, um, they talked me through what they were going to do and it was just an awesome team of doctors and nurses. I couldn't have asked for better in that area.

Nicole: That's good. That's good. That's good. So then you get into the, the, oh, are not even, you said two hours after you get to the hospital, not even okay. And then you get this spinal and, uh, even though I'm sure they're talking you through, like, you're not going to feel this, you know, the things, it sounds like you weren't prepared for that feeling of not because you very much have no control over the lower half of the body.

Kassie: Right.

Nicole: And how does that, how does that relate to your addiction and not feeling control? I'm trying to understand the connection, I guess.

Kassie: So the fact that I was laying there and I could have very easily freaked out because I was internally panicking. Um, because I couldn't move. I mean, it probably was just a wave of overwhelming. And I ever since I even got clean, I'm very, uh, I struggle with identifying my feelings still. So the fact that my lower, like my arms were, you know, out in a T and I had my husband, I just kept squeezing his hand because that reminded me that, okay, you have control over this. You just need to breathe. And, um, talk saying this stuff in my head and talking to him, but just my legs. I can't, I really, I was almost speechless. Um, cause when, when you're using drugs, at least for me, what happens is the drugs get such a, hold on. You it's eventually no longer a choice. Like the drugs are running your life. You no longer are. And when I couldn't move my legs and I didn't know any better, like I couldn't connect that. Oh, I'm about to have a baby girl in 15 minutes. It was just like this sucks. Yes.

Nicole: Wow. Wow. That I, I just, I don't think I could have ever imagined that perspective. That's really powerful that you're able, able to communicate that and then makes you know, perfect. Not that my opinion of it matters, but to me it makes perfect perfect sense. So then how, how did you, how did you feel when your daughter was born?

Kassie: So that was another thing is I did not realize this was not prepared for it ahead of time, but when they took her out of me, well, surprisingly, they let my husband stand up and watch her being removed out of me. Um, which was super cool. Cause not every, um, father gets to do that. And she had, um, she whimpered instantly, but she had some fluid in her lungs. So they had to take her straight over to get oxygen. And her feet also up by her head. She was breech. So it was like they were working on her for a minute. And finally, um, my husband asked the anesthesiologist like, is everything okay? And he's like, uh, they're normally not. They normally don't take this long, let me go see what's going on. And once again, I'm stuck on this table. Um, and I'm just like, I have no emotion right now.

Kassie: I am in shock. And um, then once they did bring her over to me, they laid her by my head and the anesthesiologist got pictures of me and my husband. Um, I still like no emotion. Um, my husband actually was crying. I was still, um, in shock. I didn't like that. I couldn't hold her. I was out in a T it was just, it was awful. Um, and then they had to take her back away cause she needed oxygen and she went straight to the NICU for fluids. This was nothing to do with the medication yet.

Nicole: Okay. Okay. Cause sometimes when babies are born by cesarean, they don't get the same squeeze as when they go through the vagina. So sometimes they have fluid in their lungs and it's just a little bit, um, you know, they have a little bit of trouble transitioning plus she was a teensy bit, a bit early. So I'm guessing that probably contributed to it as well.

Kassie: Yes. And that's exactly, um, what they explained to me and I'm almost grateful because I also wasn't prepared for the pain after the cesarean. So I'm almost grateful that I had her in the NICU for them to take care of her because I don't know how I could have.

Nicole: Oh, wow. Wow. Wow. Wow. So then they took her to the NICU still. Wow. They were finishing up your cesarean, is that right? He's closing me up. Okay. Okay. And then what was that postpartum period like for you, you already alluded to some difficulties with pain. How, how else was the postpartum period? Like I guess both for you and your daughter?

Kassie: Well, I was struggling in the sense that, um, so I asked to go, my husband was able to go see her and hold her before I could. Um, the nurses had, I had some major issues getting a medication, which we can get that to that later. But, um, so I did not get to hold my daughter. She was born at 3:30 PM and I did not get to hold her until 2:00 AM. Um, which is when I asked, can you please wheel me down to see her? And um, even holding her, like I couldn't grasp in my head that she was mine. I had probably for my whole stay at the hospital, which was 17 days. Um, I had a hard time accepting that she was mine. And I don't know if it's, cause I didn't physically like push her out of me or see her taken out of me, but it, the bond and the connection was a serious struggle.

Nicole: Wow. Wow. Did you, did you feel comfortable sharing that with anyone because you know, this isn't helpful now, but that actually is not that uncommon that people have trouble bonding with their baby, but did you feel like, I can't tell anybody this or I don't know how to say this or anything like that?

Kassie: Well, in the hospital, because I was dealing with, um, her withdrawing, um, that I really was not focused on my, I had to break down episodes in the hospital. Um, and I shared them with my husband, um, also in recovery as well. And cause I knew he would get it, but then once I got out, um, back home that is, um, I did reach out to my counselor because I was starting to panic. I'm like, it's been almost a month and I still do not feel a connection with her. And she really helped put it in perspective for me that it was just like you said, not that uncommon. And sometimes it takes time to build relationships.

Nicole: So let's talk about, we'll talk about your daughter withdrawing, but if you don't mind first, I'd like to, I'd like to touch upon, upon your pain control after a cesarean, because we often use narcotics to control pain and there's a worry that that could trigger a relapse. Like how were you able to manage it? How were you treated?

Kassie: Well. So the, because of, I don't know how to say this, the correct way. Basically my doctor had, I talked to my doctor about this ahead of time. Like, what do you normally do? Like, is this something I can manage with just Tylenol? Because I have, within the past two years, I've had another, um, surgery where I did use narcotic successfully just for the pain. And I was done with it took me a long time to get there. So this time the doctor had narcotics prescribed, but the nurses took it upon themselves to not give them to me that I needed to try telling off first, which I just, I was fine with that. I said, okay, well I'm starting to feel stuff. It's becoming a numb. Like I let them know hours ahead of time. And uh, they were all different like, oh, well the doctor prescribed this, but with your history, we were just going to give you Tylenol.

Kassie: I'm like, that's fine. I'll try that. Um, I didn't like how I knew what the doctor prescribed and they were taking in their own hands judging me clearly. Um, but once we, it took, literally I rang in the nurse bell it'd been about three hours and I still hadn't gotten not even my Tylenol. And I was starting to get angry at this point because I was hurting very bad and my sister had to call into the hospital and she was like a mess. And they of course couldn't tell her anything. But then when I called back on the nurse line, they said, they'd be right in. And nobody came. And then 45 minutes later, I called again and a nurse came in and from that point forward, I made sure to stay on top of my pain meds because I was not dealing with that nonsense.

Nicole: Gotcha. So now can you take ibuprofen?

Kassie: Uh, yes I could after I had her, but they were, I think they had me mixing. Um, so after the Tylenol didn't work, then we just did Motrin alternating with Vicodin.

Nicole: Okay. So here you are saying as early as possible, Hey, I'm feeling some pain. Can we get on top of things and then you didn't get a response for four hours?

Kassie: It was almost five.

Nicole: And then at that point, do you feel like, was there ever any like, oh now she's drug seeking?

Kassie: Uh, I felt like that because of how panicked I was starting to get, because the pain was increasing. My brain automatically goes there. Um, they didn't the girl who came in and brought my tylenol, she's like, I'm sorry, the pharmacy, they blamed it on the pharmacy, but I don't know why it's so hard to get Tylenol probably because he didn't have it prescribed for me if that is the case.

Nicole: Yeah. I mean, it really shouldn't be that difficult to get something that your husband could have ran out to Walgreens. Um, so, um, it's just, uh, you know, it's just a little bit first. I mean, I just can see how that it just feels hard that you were trying, but you know, especially I think in your circumstance for sure want it, and even you said like, I've done, I want to try to just do, um, you know, I'm open to try these things, but when you meet that resistance, especially in the beginning of the recovery, it could have the recovery from the surgery, I mean, it can really set you back when you get behind on the pain.

Kassie: That's what I was trying to avoid. And I, I really feel maybe I could have been okay on Tylenol if they would have gave it to me three hours earlier. I don't know that I've never done this before.

Nicole: Oh, sure. Sure. Even a lot of times we alternate and we do a scheduled ibuprofen and Tylenol and ev- give it to people, even if they aren't necessarily hurting because the risk is low and we can kind of stay on top of the pain that way. Did they offer you that option or did you have to, did you have to request pain medicine all the time?

Kassie: So I had to request it until finally I said, can we please just do this every four hours? Because what was happening is if they weren't in my room, right. When I was due for it, I was back worse again. Um, and we only had to do this for, I think it was like maybe a day and a half, but it took me a minute to get them get, you know, I got a new nurse every 12 hours. So I had to get them in the swing of things. Like, please, the only thing I'm asking is stay on top of my medicine. Um, and that right there made me feel like I was acting like a drug addict because of how prominent I was. But I'd been in pain so many times that were out of my control. I was frustrated at that point.

Nicole: Absolutely. Absolutely. I mean, I can see that 100%, 100%. So then after the end of the day and a half is, is can be a long time. I mean, a cesarean a major surgery, you know, that's a long time to be potentially be struggling with pain. But do you feel like after that time you were able to get into a decent rhythm?

Kassie: Yes, absolutely. Like the doctor came and checked on me. I think it was. So I had her on a Friday. He came and checked me on Saturday. I'm just like this pain is awful and come to find out. He actually prescribed me two Vicodin every four hours, but I'd only been taking one and that had been doing it. So I'm glad to have heard, um, that cause just how my brain works. I can't say that I, I can't completely trust myself with pain medicine. Like what, sure. The, what was it the third day I might be jumping ahead a little bit, but I asked to stay an extra day. The doctor was going to release me on Sunday and I said, can you wait until Monday? Just because the pain was still, it was getting better, but I was scared to be without nurse care. And he said, yes, that's fine. But he still wanted to prescribe both medicines to the pharmacy. So my husband went and filled them. And after two days of taking them, I gave the pills to my husband. I said, you need to take these. I no longer need them. So I do not want them in my care. So he took them.

Nicole: Yeah. Yeah. Yeah. Well, good for you. Good for you again, trying to control the things that you can control. Yes. Yeah. Yeah. So tell us about what happened with your daughter.

Kassie: So she was, um, in the NICU from fluid and so she never stayed in our room. Like most babies. I think it's natural for them to go straight in the room with the mom and the dad.

Nicole: Yeah. Especially for 38 weeks. Yeah. Vast majority would. Yeah.

Kassie: So once they got the fluid under control, then, uh, she is actually Valentine's day was on Sunday. She got to come in and stay in a night with us in the room. And then that morning her, uh, jaundice levels were high. So she had to go back in. Well, what else happened that morning was she started scoring outrageously high with their system. They use, which I don't know if you can explain the scoring.

Nicole: Yeah. So there's a system that they use to determine whether or not a baby is having withdrawal symptoms. And I don't know it off the top of my head. Cause honestly, once mom and baby are separate, I don't know a whole lot about what happens with the baby. But, um, essentially they score things like crying, their reaction to things, how they look it's like a whole system to decide if they're withdrawing based on how the baby's acting.

Kassie: Yes. So she, um, it was like she needed three nines and they score her every feeding. So every three hours and she was like 11, 14, uh, 11. It was like, she clearly was starting. Um, so then after three nights, that's when they decide to start her on morphine, which starts the whole NICU adventure.

Nicole: Yeah. And how, how were you, how were you feeling at that point?

Kassie: Well, I knew it was like the pediatrician in the, in the NICU said if she was going to, you know, would take about three days because subutech has a very long half-life as it does for adults. Um, so come day three, you know, it was like clockwork. She was, and I was glad that they did it. You know, they were very careful. They waited, they waited at least five days to send home babies to see if they're going to withdrawal or not. So the day three she started and from then she got put on morphine. I was like, this is all right. I did not realize I was getting set up for over two weeks' stay. Um, my feelings about it were okay at first, but after going in, because I was breastfeeding, um, and watching the symptoms, um, which weren't so bad while she was on morphine it's once we started weaning off morphine that, um, really brought out some feelings in me.

Kassie: Um, I felt like I was living vicariously through her. In the sense of we were both stuck cause I was boarding the hospital, let me stay there with her. Um, that every time I went to rehab, I, it was always, I would be out on the streets if I didn't stay. So I was always stuck there. I never wanted to be there, but I had to do it, um, up until this last time. And so those feelings are what was coming out in me, and then watching, like, you know, this is my fault. My consequences are now being portrayed on another innocent human being. And as much as I've gotten my life together and done the right thing, this sucks. And I, at some points couldn't handle the effects of watching her go through it.

Nicole: That's just, that's a lot to deal with a lot to deal with. Do you feel like you had help, did the NICU provide any type of, um, connection with resources or did you have your own counselor that you could talk to?

Kassie: Um, during my stay I had reached out to, they have a, mom's getting sober group. That's actually run by one of their anesthesiologists. So she came in and saw me, which was super great. And then they have a zoom meeting. They did every Wednesday. So I jumped on that still felt a little uncomfortable. I, I didn't know these people. Um, I it'd been nice to talk to a counselor or something because my feelings were really just getting portrayed to my husband, which I think I also sent him back to work because I wanted, he had a week to use and I wanted him to do that when we were back home visiting every day. But because of COVID, once he left, he wasn't allowed back. So he had to pick a stretch to come stay and then they had this awful sofa bed thing. They call it a bed, but it's not. And so I wasn't going to make him even stay with me on the weekends, like go home, get an, a good night rest because I was, um, you know, walking down to the NICU to feed her every three hours. Gotcha. So my sleep was getting tested too.

Nicole: As it does with newborns. So she was ended up being in the hospital for 17 days. And was that just to get her completely weaned off of the morphine?

Kassie: Uh, yes. So let's see here increased. She, once she got on the morphine, she had to be increased two more times before her, uh, withdrawal was managed. Um, and then once we started titrating, we, uh, so February 18th, wow. Nine days we, it took to get her off of the morphine.

Nicole: Okay. Okay. Okay. And then when, when you went home, she was off of it?

Kassie: Uh, yes. So once she, once she was off of it, then we had to have two observation days. Um, and then she had to stay under a certain score for those two days. And luckily we didn't have any setbacks, like didn't have to have, because sometimes babies have to get back on it. And then once they're back on it, they gotta wean and then have two more observation days. I thought I was never getting out of there, but I also didn't want to take home a withdrawaly baby, which they definitely wouldn't have done.

Nicole: Gotcha. Gotcha. And how do you feel about the care that she received and the, how you were involved in her care while she was in the NICU?

Kassie: Well, the NICU nurses were excellent. Um, I had to, in order to stay in my room and be a border mom, I had to participate in 50% of her care. And I forgot that they had told me that because I was involved in a hundred percent, I was down there like clockwork. They were coming to my room. Like you got, um, do you have her milk? Cause I had a little trouble with my supply at first. Um, but once I got to know them and regardless, they were just awesome. Like I was not treated in any sort of way. Um, cause there was other babies in there with withdrawing off of other stuff. And, but still they must just be trained super well because they had nothing. They just, every baby got treated the same and they let me be mom when I was in there and were available to answer any questions I had. I was very impressed.

Nicole: NICU nurses, I swear are angels. Having my own first child in the NICU for eight weeks. But I mean, they are just, you run into some special ones who are just like, yo, they just they'll be like, okay, come on and get in here. You're going to do this. You get into, I mean they just get you right involved. They're just lovely, lovely people.

Kassie: Yes they are.

Nicole: Yeah. Yeah. So then once you got home, how were things once the two of you got, got home?

Kassie: Well, the first night was from hell. It was really bad. And I think so when, as you know, I'm sure you know, how their cribs in the NICU or uh, not really a crib they're those little they're kind of smaller. So to say, um, so all we had at home was a bassinet and a crib. Well, both of those are way bigger spaces than she was used to. So trying to get her to sleep for some reason, even like during the day she was, she just screamed the first 24 hours she was here and then we were both panicking. So I'm sure she was feeding off of that. So luckily she had heard her, uh, follow up pediatrician appointment the next day. And once we left there, we had a total different baby. Gotcha. Because we had our question answered. We were freaking out.

Nicole: Sure. Of course, of course you've never done this before. And then like babies can scream in the absence of having to go through the withdrawal piece. They can scream period. So then you have, you know, you don't know if it's that or if it's because of the issues, I'm sure you had a lot.

Kassie: Right. And then I had, um, well I was breastfeeding and doing formula because she wasn't getting enough. Um, so it was actually pump only pumping and breastfeeding once we got home. So then I had to deal with, um, once I decided the pumping was getting, it was interfering with my sanity after about a week that I had to be careful and wean her off my milk, just in case this slight chance there was any medicine getting through there that we didn't affect her again.

Nicole: That makes perfect sense. That makes a lot of sense. A lot of sense. So now she was born in February and now it is as we're recording this, it is April. How are you feeling?

Kassie: Well, I ended up, um, talking to, or getting back on my antidepressant. So ever since then, I, because I was feeling the disconnection bond thing in the beginning and I was just as bad as this sounds like when we were home, it was like a job. That's all I could feel is like now I have this little person to take care of and that's all, I couldn't feel anything more than it was a job to do. And I didn't feel that was right. And, um, talking to some other friends and stuff, they're like, you might be starting to get some postpartum. I was just getting really discouraged. And then I was home by myself every day. Um, so first time I checked in with my psychiatrist, I'm like, everything's good. This was about 10 days after we got home. And then it like five days later stuff.

Kassie: My thoughts, I was just like, not, I don't know if you want to call it the baby blues, but I was on antidepressants before I had her and I had been on them since I got clean. So did very well not being on anything while she was inside of me. But, um, I was not going to, because of my history play around with when I knew I was headed down a downward spiral. So, um, back in connection with my psychiatrist and then from, um, I've talked to my mental health counselor once I'll be talking to her monthly, I feel I'm getting a grip. My daughter just started daycare this week and I just went back to work this week as well.

Nicole: Okay. Okay. That's a big transition. Yes. Yeah. Do you feel like the connection has improved?

Kassie: Yes, tremendously. And I think I had expectations of her. Like I felt like she didn't know who I was and I'm still struggling with that a little bit. She's just now starting to smile. So that's helping because when anybody picks her up, she'll stop crying. Like everyone's like, she knows who you are and I'm like, but she acts the same to everybody else. Cause there's no, there wasn't before any facial expressions or anything to say, like that's my mom. Right. Um, so I'm, I'm coming around.

Nicole: Gotcha. Gotcha. A work in progress, but headed in the right direction.

Kassie: Yes. Yeah. Yeah.

Nicole: And then, so after all that, I want to come back to, you said that now you won't have another baby without being off the subutex completely. Yes. Okay. You just don't want to take the risk.

Kassie: No. And it's going to take, um, cause I do, I do want to have another child. I want her to have a sibling, um, a lot of hard work, but I did from being in the hospital. I was introduced to a doctor who ironically is somehow associated with my work and he is very well known in the area to help people get off of this because my doctor that I am on is, um, I'm just a number to him. So he's not going to be the one to help me get off of it. Okay.

Nicole: Okay. Okay. All right. Well I'm glad that you have found someone who will, will help you, you know, get off of it. So you feel comfortable going forward with your next pregnancy and, and your life I suppose. So, yes. So as we wrap up, what is one thing that you want people to know about what it's like to have an addiction?

Kassie: Oh gosh. I would say that you're not alone. And that I remember being, um, when I was using thinking like just that I had to accept, this was the only way, and this is just what the rest of my life was going to be like. And it's, there is another side, but you have to be ready to allow yourself to see that, see that you can change. You have to be willing. Nobody will be able to force you to, and until you're willing and ready, um, which hopefully you are because if not, people are dying left and right. Um, you can, you can do it. And there's so many of us out there, like all you have to do is reach out for help.

Nicole: Gotcha. Gotcha. And then what is one piece of advice that you would tell other women as they get ready to have their baby?

Kassie: Well, I would say that prepare yourself, have a support set up of people that can understand because at least for me, feelings of addiction and my past came up and I was very blindsided. So I would say be prepared that you could be triggered in ways that you didn't even know existed. So it's best to have whoever your support system is out there for your addiction to have them on call checking on you daily. Hmm.

Nicole: Very, very good advice. Well, Kassie, I cannot thank you enough for coming on to the podcast. Um, your story is very powerful and it's very personal and I really, really appreciate you coming on. And I'm really grateful that you are here to tell your story because there are so many people who do not make it to the other side from having an addiction.

Kassie: Absolutely. You're welcome.

Nicole: Wasn't that a great episode. Thank you again to Kassie for coming on and sharing her story. Of course, I'm wishing her all the best in her recovery from here and going forward. Now, you know, when we have someone on the episode, I do something called Nicole's Notes where I talk about my top three or four takeaways from the conversation. And here are my Nicole's Notes from my conversation with Kassie. Number one, not feeling a connection with your baby right away is really, really common. Yes. There are some people who will you'll look into your baby's eyes and you'll feel that connection and you'll feel that love, but that does not happen for everybody. And that is totally, totally normal. Doesn't mean that you don't love your baby. Um, it's just, it takes longer to connect for some people. This is new for you, it's new for your baby.

Nicole: So don't be surprised if you don't experience that connection right away. Now this is where community can be so incredibly important. Okay. Where you can bring these types of concerns to a community that you know is nonjudgmental. There is no shame. You can ask whatever and feel like you're going to get a useful and helpful response. That is the type of community that I have created as part of the Birth Preparation Course. The Birth Preparation Course is my online childbirth education class. And part of the Birth Preparation Course is an online Facebook community because I really believe that social media communities can be very meaningful and helpful as well. And in the Birth Preparation Course community I am in the group, of course the community manager of the group is an experienced doula Kesha, but I honestly think the best part of the group is the ability for you to be able to connect with other pregnant folks and get your questions answered.

Nicole: Some of the things that have come up are like how to store breast milk. Can I please hear your, um, stories about induction? Tell me about your experience with an unmedicated birth. Um, there was one post recently where a member felt like, um, she thought for sure her uterus was prolapsing and she was kind of freaking out. So community members were able to rally to, to help her feel a little bit more at ease. So community is really, really important. And again, that's one of the important pieces about the Birth Preparation Course is not just community during your pregnancy, but community in the postpartum period as well. And I'd love to have you as part of that community, check out all the details of the course at drnicolerankins.com/enroll. All right, number two, it was really inexcusable how the nurses didn't respond to Kassie's request for pain management.

Nicole: That was great that she had her sister to advocate for her. And I highly suggest you have someone with you in the hospital to advocate for you as need be as well, but that was really inexcusable. Now with that all being said, I will also add that postpartum pain management can be tricky, especially if you have a cesarean, which is considered a major surgery. So you want to be a, or if you had, I would say like significant vaginal tears, that can also be tricky as well. So you want to have your pain under control and be able to move and function, but there is a real risk that if you use narcotics for actually, it can be as short as five to seven days, depending on your own sensitivity to it. Um, I would say seven days or more on a regular basis that there is, it does increase the risk of having a long-term issue with it.

Nicole: Um, I'm sure you've heard lots of stories where people have gotten addicted to pain medication after having a surgical procedure. So what I recommend for postpartum pain management is that you try first with acetaminophen, which is Tylenol and Motrin, which is ibuprofen and you alternate those two things around the clock. They actually work synergistically together. So you alternate them and you take them around the clock, whether you're having pain or not. Okay. So you want to get ahead of the pain. Its so hard when you get to a situation where you're trying to play catch up with the pain. So you've like gotten like it's so bad and then you're trying to play catch up. So you don't want to do that. So for the first two to three days, you want to take those, alternate them around the clock and whether you're you're, um, hurting or not, and that can be every four to six hours. And then you can use narcotics if need be to help for any pain that's breaking through. So then you can use narcotics and the lowest dose that's necessary in order to help with what's called that break-through pain.

Nicole: And some hospitals are not good about offering you Tylenol and Motrin first, sometimes they default to the narcotic medication. So you want to be careful that you ask for, let me try Tylenol and Motrin together first. Okay. Also, I really think for a vaginal birth where you don't have any tears or you have a minor tear, most people will not need narcotic medicines in order to recover. Really those narcotics like oxycodone, um, uh, Vicodin, Dilaudid. Those things are really more for more severe tears, or if you have a cesarean birth. The other thing I want to say about postpartum pain management is that you also have to do things other than just pills. So counter-intuitively actually getting up and moving around, can help with recovery after surgery. And some of the worst pain after a cesarean is gas pain. And getting that, that those bowels moving can help relieve that pain more so than narcotics or, or Motrin or Tylenol.

Nicole: So moving around an abdominal binder can be really, really helpful for pain management. Also topical sprays, numbing medicines, using a peri bottle to spray water. I talk about this in detail, also in the Birth Preparation Course, but that gives you a flavor of some of the things that you can do and how to approach that postpartum pain management. Okay. And then the last thing I want to say is that let's remember that addiction is a disease. It is not a moral failing, and we need to help people when they have an addiction problem, not judged them. Okay. So there you have it, be sure to subscribe to the All About Pregnancy & Birth podcast in Apple podcast, wherever you listen to your podcasts. And I really appreciate you leaving an honest review in Apple podcast in particular, it helps the show to grow and it helps other women to find the show. Also be sure to check out the details of the Birth Preparation Course at drnicolerankins.com/enroll. So you can come join us in that community as well. So that's it for this episode, come on back next week. And until then, I wish you a beautiful pregnancy and birth.

Speaker 2: Thanks so much for listening to this episode of the All About Pregnancy & Birth podcast, head to my website, drnicolerankins.com to get even more great information, including free downloadable resources on how to manage pain and labor and warning signs to look out for after birth. You'll also find information on my free online class, on How To Make A Birth Plan That Works as well as everything you need to know about my signature online childbirth education class, the Birth Preparation Course. Again, that's drnicolerankins.com and I will see you next week.

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