Ep 125: Casie’s Birth Story – Looking on the Bright Side

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On today’s episode of the podcast we have Casie. Casie wanted to share her story because she is striving to passionately empower others based on her experience. I’m going to give away the ending of this birth story: Casie wound up pushing for 5 ½ hours, she had a forceps birth, a fourth degree tear which is the most severe tear you can have, and a fistula as a result, which is a communication between her vagina and rectum and is something that will need to be surgically repaired at some point.

Casie read stories of this happening to others and it sounded like she would never be the same. However, Casie has recovered and she is arriving. She knows that her journey isn’t over but she also believes that she will be just fine. She keeps it real about some touchy subjects in this episode, including some slightly more adult content towards the end - so if you have kiddos listening, keep that in mind.

In this Episode, You’ll Learn About:

  • Why Casie described her doctor as “wonderful”
  • How Casie’s preterm labor almost went unrecognized
  • Why she opted for an epidural when she was planning on an unmedicated birth and how it’s just fine to listen to your body and change your plan
  • What makes healthcare workers such terrible patients
  • What the definitions of a fistula and fourth degree tear are and how they can be repaired
  • How difficult it can be to find healthcare in rural areas
  • How Casie stayed so positive through a very unpredictable pregnancy, birth, and postpartum period

Links Mentioned in the Episode

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Ep 125: Casie’s Birth Story & Looking on the Bright Side

Nicole: It's another birth story episode and as usual, this is a great one.

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. Hello. Welcome to another episode of the podcast. This is episode number 125. I'm so glad that you are spending some of your time with me today. On today's episode of the podcast, we have Casie. Casie is a lover of travel. She's a mom to a nine month old wild baby boy, she and her husband and her baby boy recently moved to Florida. She's a pastor's wife. She loves volunteering. She is also a soccer referee. She's a nurse who has trained in pediatric care, but is now transitioning to adult care. Casey wanted to share her story because she is striving to passionately empower others based on her experience. Now, in this case for this birth story, I'm going to give away the ending for this one. Casie ended up pushing for five and a half hours. She had a forceps birth, a fourth degree tear, which is the most severe tear you can have and a fistula as a result, which is a communication between her vagina and rectum.

Nicole: It's something that will need to be surgically repaired at some point. Now, when Casie was reading other stories of this happening to other people, it sounded like she would live in pain. She would never poop or have sex comfortably again, and maybe even hate her child. However, Casie has recovered and she is thriving. She knows that her journey isn't over, but she also believes that she will be just fine. She keeps it real about some touchy subjects in this episode, including some slightly more adultish content towards the end. So if you have kiddos listening, just keep that in mind. You are really going to learn a lot from this episode and definitely be inspired by Casie's story. Now, before we get into the episode, let me do a quick listener shout out. This is from mama Mendez and the title of the review is a hundred percent best podcast for expecting mothers.

Nicole: The review says this podcast is so informative and insightful for soon to be moms. I wish I had found it sooner. I have listened to a ton of podcasts and watch a million YouTube videos, and this is hands down the best, most thorough resource out there. I love how Dr. Rankins is such an advocate for women and passionate about fixing the problems in women's health. We need more physicians like her. Well, thank you. Thank you, mama Mendez. I really appreciate that lovely, lovely kind review. I strive to provide information that is informative and helpful and thorough. Just like you mentioned. Now, another great resource that I have is my free class on how to make a birth plan. I have actually just updated the class. So there's some brand new content there. You can sign up for the class at drnicolerankins.com/register. Again, it is completely free and you'll learn how to make a birth plan that works to help you have the birth that you want.

Nicole: Um, you'll learn information about what to include, how to get doctors and nurses to pay attention, questions you must ask before you write a single word of your birth plan, again, completely free drnicolerankins.com/register. Check that updated class out. All right. Let's get into the birth story episode with Casie and I have to apologize because I said her name wrong in the beginning. So my apologies, Casie, for that, I hate it when I do that. And I always like to get people's names, right. So I'm sorry about that, but let's get into this great episode. Thank you so much, Casie, for agreeing to come on to the podcast, I'm really excited to hear your story because things didn't, you know, spoiler alert things, didn't go exactly maybe as you anticipated, but it seems like you've made the best of it. So I'm really excited to hear, hear your story today.

Casie: Awesome. Yeah, it wasn't quite what I expected, but in the end I still had, you know, a happy, healthy boy to bring home.

Nicole: Yeah, absolutely. Absolutely. So why don't you start off by telling us a bit about yourself and your family, if you'd like.

Casie: Yeah, so, um, a little bit crazy, but we just moved to Florida two weeks after my son was born. So are you serious? Yeah, so he was actually born in Northern Kentucky. Um, and now we live in the panhandle of Florida. So we moved from, um, some of the best healthcare in the world to a very rural remote area. So that was, um, definitely a switch for me. Yes.

Nicole: Sure. 100% with a two week old. Oh my God. And moving is one of the most stressful things. Like if I had to rank the top three things that I hate to do in life moving is one of them.

Casie: Yeah. Yeah. Um, but I mean, in the end, I'm glad we moved when we did, my husband took his new job, um, offer in June and we didn't move til the end of September. So we could have our baby with our doctor in Northern Kentucky. So I'm glad we were where we were when it all happened.

Nicole: Well, that's good. That's good. That's good. So why don't we hop into, what was your pregnancy and your prenatal care? Like, how'd you feel about the care, all of that good great stuff?

Casie: Um, I loved my doctor, so she had actually been my primary care doctor prior to getting pregnant. Um, a friend had linked me up. My friend was a resident and this was her senior resident at the time. Um, so when Dr. Ford became a, uh, what is it when she got her own practice? Um, my friend was like, Hey, you should go see her. I think you'll really like her. And I did. I loved her for several years. Um, so when I was pregnant I was like, well, Dr. Ford, who do you recommend? And she was like, well, you can see me if you want. I was like, oh, for real.

Casie: Um, it was a wonderful experience. Just that continuity of care. I already knew her. She already knew me. Um, especially cause, uh, the only appointment I was able to go to with myself and my husband was the confirmation you're pregnant before COVID hit. Um, so already knowing my doctor made a huge difference. Um, you know, he trusted her and he would sometimes send me with a list like, well, I need to know this from Dr. Ford. Um, so throughout the pregnancy, I always had her to fall back on. She did have one other partner. She practiced the OB GYN part with, um, and she was also in family practice. Um, they were at different locations, so I just, every other visit went to visit one and every other visit went to visit the other.

Nicole: Nice, nice. And we should say you, are you yourself work in healthcare.

Casie: Yeah. But I was, um, a pediatric trauma background. So pregnancy was not, if someone was in labor in our ER, there was a problem. Right.

Nicole: You know, it's funny, we all know our own our own areas. Like I know pregnancy, like don't ask me, people ask me a lot things that happen after the baby comes out and I'm literally, like, I really don't know. All I can do is get them here.

Casie: Yeah, even adult, ER, we, I mean, I, you think we're joking, but we have families come in with someone in labor and we literally yell squeeze your legs shut, sit in this wheelchair and let's go.

Nicole: Yes,

Casie: And they can be one centimeter dilated. We don't care.

Nicole: Goodness. Goodness. All right. So it sounds like you had a great, um, prenatal care experience. Everything went great, even despite COVID it sounds like you were able to make the best of it.

Casie: Yeah. Um, you know, the only downfall honestly was that he didn't get to see the ultrasounds. For him, that connection point, um, cause I was a small pregnant person, so I didn't show. Gotcha. So, you know, for him he's like, okay, you don't look pregnant. Um, and I haven't seen any proof of this, so maybe you just have the flu.

Nicole: That is funny. Oh, alright. So what did you do to prepare for your birth? If anything?

Casie: Um, so I had preterm labor at 28 and a half weeks and had not prepared yet. Um, and I had been listening to both your podcast and another one and I was like, well, I know I want to do something, but none of the courses are available.

Nicole: I'm curious what was the other, I always like to tell people they're more than there's more than one option for folks to listen to. So you can certainly say, what was the name of the podcast you listened to?

Casie: Um, so her podcast doesn't even exist anymore, but it, um, it was done by a doula.

Nicole: Oh, interesting. Okay. Yeah, it is nice. You can, can go back and find older podcasts and things that are there and the information is still relevant. So anywhere sorry. So you got, have preterm labor at 28, 29 weeks. And then what, what happened there?

Casie: Yeah, I had, um, passed out in the dentist chair several times and um, I thought it was just cause I was tired from night shift, um, working, you know, and I was like, oh, it's no big deal. So I drove myself to Panera. I ate food, still didn't feel great. So I went and walked around TJ Maxx and the fellow nurse saw me and she was like, Casie, you don't look good. And I was like, well, I mean, I'm pregnant. We haven't worked together for several years. It's no big deal. So I called my doctor friend and I was like, oh Melissa, this isn't, this, this happened. And she was like, and you haven't told Dr. Ford. I was like, no, I just passed out. It's no big deal.

Nicole: Healthcare workers are the worst. I swear to God.

Casie: As I was driving home. I called Dr. Ford. Okay. Um, she was like, okay, um, do you have contractions? I was like, no, please. So, um, I got home, I laid down, kept drinking fluids. Um, Dr. Ford said she would meet me in triage at six. And I was like, okay, my husband got home and he's like, you look fine. I was like, yeah. And I actually feel pretty good. He's like, so do we have to go? Because at this point it's like June 6th and my insurance switched on June 1st or July 1st, whatever. So we were going to have to pay for the whole ER visit. I was like, okay, well we're got to pay at some point. So let's just go. They said they are expecting us, you know? Um, and we got there and the nurses were so sweet, but at first they were like, huh, you know, we don't take people up here in OB triage till 18 weeks. I was like, yeah. Um, I know

Casie: So they got us in a room and then they were like, oh, the monitor for watching contractions isn't working in this room, we're going to get it fixed. You know? So they put the baby monitor on me and I was like, that's fine. And they did my blood work, my pee, all that. And everything was fine. Finally get the machine, working to monitor my contractions. Then my doctor looked at me and Dr. Ford was like, do you not feel any of this? And I was like, what are we talking about? And she was like, you're contracting every three minutes. And I was like, oh, okay. Um, and I was, at that point, I was, um, what we call like a house supervisor in the hospital. So you work with, you know, getting admissions moved slowly from another hospital into yours and doing all that. And uh, one of my friends was like, oh yeah, we saw your name pop up on the NICU board at children's.

Casie: I was like, ah, they're like, so yeah, we understood why you called off. Right. They gave me medications and everything and they didn't want to admit me because of COVID. So they did let me go home at like 3:00 AM. And then I followed up the next day at 9:00 AM for an hour monitor at the office again.

Nicole: Okay. Okay. Were you dilated at all?

Casie: Just two centimeters.

Nicole: Okay. Okay. But still, wow. I mean you really, for your first baby, you really shouldn't be dilated, um, at all. Did the, I mean the contractions did they slow down or?

Casie: They did. Okay. And then they sent me home on a medication for if I felt any pressure again. Gotcha. Um, and I've had to follow up with a cardiologist since I had all the passing out episodes.

Nicole: Gotcha. Okay. And then did you get the steroid injections as well? Yep.

Casie: The magnesium, and since I hadn't felt the contraction to start with both of those made me feel so sick and the nurses were like, do you feel better? And I was like, I think I feel worse.

Nicole: Oh goodness. Well, I'm glad that ended up not being anything, but I guess at that point you're like, uh, so I guess I need to get ready for this birth. So what did you start to do to prepare?

Casie: Um, well, I like actually went and bought baby clothes. Um, and since we're in the process of getting ready to move, we actually set up a baby nursery in our house just for the showing aspect. So this room looked like it had a purpose and not just a storage room. Got it. Got it. Um, and then we did start, I did take a birthing course and it was through a doula. So I listened a lot to your podcast and, um, just love that you encouraged having a doula. Um, and then I listened to one done by a doula and I just loved how simple, um, her phrasing was for my husband. Who's not medical. Right. Um, and he listened to a few of your shows and he was like, okay, okay. Yeah, we got this. And you know, we talked about, you know, epidural or not epidural IV medications or not.

Casie: Um, and that kind of stuff, knowing that we were going to be just on our own. And at that point we didn't know if our doula would be allowed in or not. Um, and my doula was actually a nurse I had worked with previously in the children's ER, yeah. She had decided that she loved being a nurse, but what she really loved was working with mamas during birth. Okay. So she had just started her practice as a doula. Um, so we were one of her first patients, but she was all in, she, you know, would text me and check on me. So she was great.

Nicole: Nice, nice. So it sounded like you, you were you between the class, you know, listening to podcasts, you felt pretty prepared going into the experience. Yeah. Yeah. Um, did you read any books at all?

Nicole: No.

Nicole: I feel like, you know, I hate to say like, books are antiquated, but like I feel like most people these days aren't necessarily reading a lot, a lot of books that they are they're listening to on like audio or, or things.

Casie: Yeah. And I did a lot of that because my drive to work was an hour, so that's why I depended heavily on the podcast. And, um, I did listen, I did read, um, happiest baby on the block. That was afterwards and my husband actually read that one too. Okay. And he took the swaddling part to heart because that, that was going to be this thing and he perfected it as best he could. And he was a very good at it.

Nicole: That is so sweet. All right. So what are some things that you wanted for your birth?

Casie: So I knew I really wanted to try, um, going unmedicated just because I wanted to be able to reflect back and remember the process and feeling, um, I wasn't against an epidural if it had to happen. Um, but I was like, you know what, I'm athletic and I'm young. I'm going to walk a lot. This'll be great. And I was like, and I want to try being in the water. Um, cause that'll help like a natural epidural. Right. But I honestly didn't know too much of what to expect. Cause my preterm labor, I had not felt so going into it, I wasn't real sure, sure, sure, sure. And they were monitoring pretty closely cause my son had a few D-cells in the office, but they weren't prolonged. So they were like, we're not really sure. You know, so they kept monitoring real close. Gotcha. Um, so at 39 weeks. They took me into the hospital overnight and they wanted to try induction. Um, but uh, they put the medication in, um, that they do overnight. Um, Cervidil maybe or Cervidil and he d-celled with that. So, um, and they weren't sure if that was the exact connection, but they took it out, um, and ruptured my membrane and sent me into the worst labor right away.

Nicole: So they decided at 30, did they decide at 39 weeks that it was better to go ahead and be induced just because of everything that had been going on or did you want to be induced?

Casie: Yeah, I did not want to be induced. I was like, no, let's just, you know, I wanted to walk miles and miles. I did all my friends, CPR for them on the dummy at work, but between the move and then just these weird events, my doctor was like, you know what? I'd rather have control of the situation before something happens.

Nicole: Gotcha. Gotcha. Or as much control as we can. I forgot to ask, did the cardiologist issue before we get into what happened with your labor and birth, did that settle out like the passing out?

Casie: Um, so actually they had me start drinking more coffee. Interesting. Other stimulants. Cause what was happening was my heart rate was getting really fast and my blood pressure was getting real low. Um, and my grandmother has that and my grandmother passes out. So they said it's probably, you know, it's genetic. But um, so yeah, I was the pregnant lady walking around with the large coffee.

Nicole: Coffee is okay in pregnancy. So in moderation for sure. Okay. Well I'm glad that ended up being okay. Okay. So you went in for the induction, they did the Cervidil that, um, but that's one of the benefits of it. If, if it causes changes in the heart rate, we can take it out as opposed to some other, um, methods and then they, they broke your water and it was like, it's, it's go time.

Casie: Yeah. So they broke it at my doctor's rounds between five 30 and six. Um, and in the morning and I had told my doula, I would call her when contractions hit. But at that point they were talking emergency C-section or let's, you know, get the Cervidil out and give you an opportunity to progress naturally. And so I called my doula and she came right away, which was a blessing because when they ruptured my membranes, it was about to be shift change for nurses. And they were, you know, they were talking, um, emergency C-section or not. I was like, okay. And I was like, well, that must mean I'm going to be one of the first people that my new daytime nurse is going to check on. And no one came back and when the contractions hit, they can, they hit so hard and so fast. And I had been, they put me in this position, in the bed that would best monitor my son's heart rate. And so I'm stuck sitting in the bed in the most uncomfortable position as these contractions came. And my husband's like, well, call out. And I was like, no, it's shift change. Someone will come in and I don't want to be that patient. He was like, no call out. And I was like, no, I don't want to be that patient again. I know healthcare workers are the worst we are the worst. I was like, but I know it's shift change. Right. If you're discussing emergency C-section, you know, so my Duala showed up and she was able to come in. Um, she was great. She was like, Casie, it is chaos out there. They have babies popping out of every corner of this room and building and hospital right now, but you need help.

Nicole: Oh my gosh.

Casie: I hadn't eaten any food since the day before at lunchtime. So, um, I was just lightheaded and in pain. And so she called out and they came in and they helped me get into a more, more comfortable position with my duala's assistance. Um, and they brought in, I believe it's called a Novi monitor. So it like attaches to your belly. Um, and then they brought in a birth ball and my doula helped me into the shower. Um, so between the shower and then standing up, um, in the room and then using my husband to like lean on and different things, I progressed on my own until 1:00 PM and I got to about eight and a half centimeters. But at that point I was so lightheaded from not having eaten. Um, I was blacking out and I was like, I don't like this feeling, the contractions that are painful. Yes. But I was like, when this baby comes, I want to be able to see the baby. And remember the moment I don't want to like struggle so much to get the baby here that I pass out. And so at that point I said, you know what, let's go ahead and do the epidural. And so we did, um, and it worked almost instantly for, um, I know it doesn't always, it was a really fast, um, and my husband came back in the room and he's like, oh, you're like a human again.

Casie: Yeah. Because he was very supportive of his quotes throughout the whole thing where, uh, or special, faster. And it just, you know, the dad jokes are nonstop with him. Um, and at that point I just felt like, okay, Nope, we can handle this. Now my doula was able to go get herself and my husband lunch. Um, and then I just continue to nap and then progress slowly. Um, and my doctor at that point switched all her normal visits from her office to being like virtual, which COVID allowed to be more of a common thing. Um, so she was real close at hand the whole evening. Um, and at five they're like, okay, are you ready to start pushing? And I was like, yeah. And I pushed for the next five and a half hours.

Nicole: Okay. Oh my gosh. Okay. Yeah. Wow. That is, that's a long time.

Casie: Yeah. And my doctor the whole time said, you know, I don't ever let patients push this hard. You're an athlete. Um, I referee soccer professionally. Um, so she's like, you know, and you can see the baby's head the entire time I could reach down and touch it the whole time. Seriously. And I had a walking epidural in the end, so I was able to be in all the different positions. I almost, I only pushed on my back at the very end.

Nicole: W w where you, I mean, where was your mental space?

Casie: It was actually really good. I mean, I was shocked. I mean, and at one point, you know, we ended up with the entire emergency team in the room and everyone was just joking. My day shift nurse stayed the whole time. So I ended up with my night shift nurse, the day shift nurse, the emergency team, the NICU team.

Nicole: Wow.

Casie: My poor husband thought that was completely normal

Nicole: Just because the heart rate kept dropping?

Casie: Or dropping, but because the baby was right there, she didn't want to run to or sure. Sure. Um, and she reached up several times trying to see, she was like, Hey, it's like the cord is tangling him up. But, um, she couldn't, she couldn't feel anything in there.

Nicole: Got it. Got it. So then I guess, and let me ask, I know you had, it sounds like you had a family medicine doctor who was trained in OB. Is she also trained to do C-section? Yes. Okay. Okay.

Casie: OB is her background. And then she did family as her secondary.

Nicole: Got it, got it. Okay.

Casie: And, um, several of my friends are nurses at that hospital in the labor and delivery ward and they said she is their favorite doctor. So that speaks super highly. Sure. Absolutely. I mean, she has one of the lowest C-section and complication rates for that hospital.

Nicole: Yeah. All, all, all very important. So you've been pushing you pushed five and a half hours. You could see the baby and you're just like, you keep pushing, keep pushing what brought things to a conclusion where you finally were able to meet your baby?

Casie: So I was getting real tired towards the end. Sure. Yeah. I was like, well, we're going to get this baby out at that point. You know, they're like still had the C-section room. Then one nurse came in and she was like, it's available now. And my doctor's like, okay. And I was like, oh no, I've pushed this long we're not gonna abandon ship now. Right.

Casie: Um, and at that point, my child's heart repeat D-cells completely. Uh, and, um, we didn't know if was a boy or girl yet. And my doctor looked at me and she said, I'm going to apologize right now, but I'm taking over completely. And I was like, oh, what? Okay. You know? And, um, I saw these giant Clippers come at me and I was like, oh, okay. Um, and so she did a small episiotomy

Nicole: Cause, um, I I'm guessing she was like this. We have to get this baby out. Yep.

Casie: Yep. She's like, we're getting it out. Um, so she did the small episiotomy um, and then went in with the forceps. Okay. Um, she said there was too much hair to even try a vacuum. She hadn't even been able to put the internal monitor on because of all the hair. Um, and she said she doesn't like vacuums on first-time moms. I was like, okay, well I trust you. And so she went in with a forceps and baby still would not come out. Um, so then I ended up, she had to reach up in there and she found the cord was around his neck. Um, so I ended up with the forceps and the cord and then a fourth degree tear.

Nicole: So how, I mean, did you just eventually keep pushing and, and he came?

Casie: Yeah. So she got her hands in there. A nurse pulled on the forceps. My doctor pulled on the cord and the baby and I pushed real hard and we got that baby out. Wow.

Nicole: Okay. What, what did he look like when he came out?

Casie: He was black and blue. Um, and he had a small red mark next to his eye from the forceps and then one on his scalp. Um, and he was really angry. Um, at first he didn't want to breathe, but they didn't have to do any emergency breaths. They ended up just having to stimulate him.

Nicole: Okay. Uh, on your chest or did they take him to the warmer?

Casie: They started on my chest and then took them to the warmer. Okay. Okay. Because like I said, he just did not want to cry. Sure. He, she was looking at them angry and it wasn't taking a breath. Wasn't taking a breath, just looking at them. I guess I was in too much shock. I was like, oh my gosh, like what the hell just happened? Right. Pictures. In the video, my doula caught, my hands are still holding my husband's hands above my head. And I'm like, what is this thing on my chest. Okay. Um, yeah, so they took him to the warmer and then got him to cry, cleaned them up real good and brought him back. Okay. Yeah. So I spent the whole first hour, um, skin to skin with him while my doctor was doing repair work.

Nicole: Nice. Nice. Well, that's good. It's a good distraction for sure.

Casie: Well, and I was more than thankful for my epidural at that point. Yeah.

Nicole: Yeah. Well, speaking of repair work, um, guys, a fourth degree tear is when, uh, it, the tear goes all the way through the vagina all the way through the rectum. It's the most severe vaginal tear that's that someone could have. So when did you realize, or when did your doctor say like, Hey, this is fourth degree.

Casie: So at first she thought it was a third degree and she was going in to do the repair work. And again, I had a brand new baby on my chest and I was like, you know, what what's done is done. I'm not even gonna worry about it right now. Um, my sweet husband looked down and said, oh my gosh, it's a war zone down there.

Casie: My doctor looked at him and said, Thomas, you can look at your baby, go in the corner, shut up, shut up. He was like, yes, doctor Ford. Okay. And he had this shirt on that said I'm a nervous wreck, but a big T-Rex on it. So, um, and he was like, after all of that, he didn't even cut the cord. He was like, ah,

Nicole: oh my gosh,

Casie: Just take care of them. So as she was doing the repairs, she started, you know, getting doing stitches. And at one point, um, she found that it had ripped through one of my hemorrhoids and then carried into the rectum, but the hemorrhoid had covered up the complete tear.

Nicole: Got it, got it, got it. So, um, it takes a long time to repair fourth degree. Um, I'm sure she was there probably for about an hour-ish

Casie: Just over that. Um, cause she lost a needle at one point the port. She was so stressed out. Okay. Okay. Yeah. Um, and she actually said, we'll talk about this later. And she was, you know, leaving. She's like, you know, I'll come check on you when you're in the next recovery unit. And I was like, okay. Um, and she told my doula, it was a fourth degree tear, but she hadn't told me yet. And I was okay with that. Um, we're still we're at that point trying to figure out breastfeeding. Sure. My sweet friend, she does rounds on her patients in the hospital. And so she had come down and she had watched from the doctor's lounge, watched the d-cells happening. Oh my God. And so she was stressed out and she had texted my husband, like, are you guys okay if I stay here? Like, I don't want to, you know, break your privacy and stuff. And my husband was like, no, you had been our backup person anyways. Like Casie is completely fine with you watching

Nicole: As your friend in OB?

Casie: No. She's in family practice. So she rounded. Yeah. She, her badge gets her into all the areas. Um, and so she came in after Dr. Ford left and she was like, oh, Casie it's a fourth degree. I'm so sorry.

Nicole: Oh,

Casie: Cuz she had passed Dr. Ford in the hallway. And I was like, oh, you're like, what? Okay. And again, I was like, it is what it is at this point. Sure. But my poor husband started Googling at that point, um, that we, you know, figured out breastfeeding, moved over to the postpartum unit. And one of our best friends was our overnight nurse over there every night that we were there. Um, and so she was so great. And every nurse, when they hear the word fourth degree spoil you. They brought all the ice packs, they were just always, and they were just a great unit in general. I could just see that they were checking on their patients and making sure my pain meds were on time. Um, yeah, making sure I felt comfortable getting up to the bathroom, giving me my mirelax.

Nicole: You want to keep your stool soft. You don't want to be straining against that repair.

Casie: Yeah. Yeah. And you know, they would check it as gently as they could. Um, so they were great. Um, and then, you know, Dr. Ford came back around and we discussed the fourth degree. Um, and at that point she said, you know, you might actually need to follow up with a neuro gynecologist, but, um, we were getting ready to move. And so I was like, well, um, you know, we'll see what we have down where we're moving. And in Cincinnati we had everything on our back doorstep. Sure. And I got used to that and I didn't realize it was not that way in the rest of America. Um, and so Dr. Ford followed up with me and my son, um, three times in the following two weeks.

Nicole: Oh, that's, that's more than typical for, I guess. Well, since she was seeing the baby too, so that's one of the benefits of people who are family medicine trained is that they can do both.

Casie: Yeah. So she was able to check the fourth degree and um, my husband went one of the visits and I had to re-torn some. Um, so she fixed that up. Um, and what would fit? She was like, how do you sit when you're holding your son? And I was like Indian style and she's like, oh, please don't do that. So, um, yeah, my mom ended up, she was gonna come out and help us with the move. Um, but when I had the fourth degree, she ended up driving right out, right away from New Hampshire and she brought her SUV rather than flying. So then I could ride in the SUV rather than our little Honda civic when we moved. So everything worked. Um, you know, I wasn't able to help with packing, but maybe that was for the benefit of recovery. Um, you know, cause if I hadn't had that fourth degree, I probably would've been doing too much.

Nicole: Yes.

Casie: So we moved and I ended up visiting one of the local OBs in our town and that was a rough experience. I went in and I said, you know, my doctor said she wanted me to follow up at six weeks to check the tear repair and get an OB GYN referral and a pelvic floor referral. Right. And he was like, oh, you don't need either of those. I was like, oh, without even looking at you. Yeah. I was like, oh, okay, well, um, shouldn't you look at it? Like, he was like, uh, you want me to look at it? And I was like, am I in the right office? Like what is going on? But you are OB aren't you.

Casie: And I was almost in tears. I had all the hormones going from postpartum. We had just moved. Um, you know, and I had, they kept me sitting in the lobby for over an hour and a half, um, with a newborn. I was just like, what is going on? So I left there and I was like, I'm going to try different OB. And I thought, I followed up with a different one and he was wonderful. Um, he checked it, you know, he didn't make it this awkward event. He was very appropriate. He looked and then he said, you know, um, it's healing really well. I've actually not seen one that looks this cleanly healed and well stitched back together in a long time. Um, and I was like, oh good. Okay. Um, and a few weeks later I called him back and I said, I think you need to check it again. I said, there's some weird things happening down there. And he was like, okay, well explain them to me. Um, and I was like, well, I think I'm farting out of my vagina. And he was like okay. Come on in. I was like, okay. Right.

Casie: Um, I went on in and um, you know, he was like, you know, I just had to ask over the phone and he said, cause some people expect, you know, when I give them, when I clear them that they're gonna be able to return to having intercourse and all these things normally and working out and he said, that's not, you're going to have to progress real slow. Right. That's why I gave you the referral to the pelvic floor therapist, but she'll monitor all that. And I was like, yeah, I understand that. But the farting thing is just really weird. Right. Right. And so he looked, um, and he had to, he did some blue dye and, um, found that I had a fistula.

Nicole: Okay. Okay. Okay. And guys a fistula is a connection between the vagina and the rectum. So literally the air that should have been coming out, like when you normally pass gas was coming through your vagina. Yeah. And you don't have any control over it. Like,

Casie: No. Uh, and it, it does not sound like a fart either. So if you're in, like I'm a nurse, so I'm in patient rooms and if it happens, I'm like, you know, everyone was looking around like, what is that? And I'm like, huh, that was a weird sound and move right along. Yeah. You can still, it's not repaired yet, so.

Nicole: Oh, okay. Yeah. Okay.

Nicole: Okay. All right. All right. You have a remarkably, incredibly positive attitude for everything that's going on.

Casie: It's not that I was like, okay, well, where do I follow up? And he was like, oh, Birmingham, Alabama. Then I was like Birmingham, Like, like I live in Florida. Wow. And the closest doctor for me is four hours away in Birmingham.

Nicole: Wow. Okay. Okay. That's one of the things of living in a rural area, for sure. Yeah.

Casie: Well, we went and saw her and she is amazing. Um, you know, I got there and she said, you know, normally we do the ultrasound and the visits separate, but since you live so far away, I'm going to ultrasound you myself and do it all right here. Okay. Awesome. Good. And so she did, um, all of that. She didn't tell me she was so sweet explaining the ultrasound and I had had an internal ultrasound when I was pregnant. Um, but she didn't tell me it goes into your rectum.

Nicole: Oh, okay. Details, details. Yeah.

Casie: She had explained, you know, it's only the size of my finger, yada, yada, yada. Yeah. I've had these before. I'm good. I'm good to get like, oh

Nicole: Wait.

Casie: And then she went in and I was like, oh, oh, okay. So, um, you know, I left that visit and my husband had texted me, he's hadn't been allowed to come because of the COVID restrictions. And he's like, so how did it go? And I was like, I'm still figuring that out. Yeah. But she said, you know, it's small enough that only air is going through. I'm not worried about infection at this point. And she said, you know, you've spent so much time recovering already. She said, what were your goals postpartum before any of this happened? And I said, honestly, you know, I have my job as a nurse, but I love my side job, refereeing soccer. I said, so my biggest goal was to get back on the field. And she said, well, you know, once I repair it, you're basically going to be postpartum again for another eight weeks. And she said, you know, and how heavy is your son?

Casie: And I said, well, he was born at seven pounds, but he's now at chunky 23 pounds, 10 months old. Um, and she said and he's not walking yet, I said, no. And she said, well, I want to wait until he's walking. Cause you're not going to be able to lift him much after I do the repair. Um, so she said, tell you what go do what you want to do. Live the life you love on the soccer field and when your post season comes, you know, and you have that time off to do the repair. Okay. So we're looking at, you know, a winter repair at this point. Okay.

Nicole: Yeah. Okay. Okay. And then I should, uh, if you don't mind me asking, like how is how are normal activities like sex, is that bothering you at all? Or is that

Casie: So, yeah. Um, there's still certain positions I can't handle, um, just cause the extra weight, um, my perineum area just feels very weak still. Gotcha. Um, and then afterwards I can be a little sore, but we're able to have sex now. So that's been a relief because you know, you read these stories and it's like, oh, you never can have sex again. Right, right. Right. So, um, having a lot of that normality back in life has been huge. Yeah.

Nicole: That's good. That's good. And then what about the pelvic physical therapist? Did you, how did that go?

Casie: She was really good. Um, she was able to do a full assessment and give me a lot of strengthening exercises and things. And she was able to help me rebuild back to the point that I was able to do, um, squats with the, the, the big bar again and run, um, and have more self-confidence in all those areas. Um, and then I still will leak, I leak stool sometimes and I leak urine sometimes. Um, so I just wear a pad if I'm running. Um, and then she's cleared me for now and then we'll follow up more after the surgery because it's so weak down there and she's, they're gonna have to recut that whole fourth degree back open and reattach it. So she said, you know, we'll definitely work together again after that, but at this point you're at, you know, you're as good as we're gonna get you until that's all repaired.

Nicole: Okay. Gotcha. Gotcha. And then how did you manage your mental health during all of this? Because you said you're now 10 months out at the time that we're recording this though. How did you manage your mental health? Cause this is a lot,

Casie: Um, honestly like my husband, let me talk it out a lot for man. Um, and then I just had a lot of really supportive friends. Um, you know, one of them is a postpartum nurse and she lives in Colorado. And so she's like, she's never had a fourth degree tear. Um, she pushes all her babies out in 45 minutes ish, but she has the sweetest heart and the most understanding, just talking it through and talking through like even using the words like trauma. Um, and you know, she's even texted me before. She's had a fourth degree tear as a patient. She's like, what can I do to help them the most? Um, so learning that I can be a resource for others has been huge. And then just having a healthy son has been huge, you know, just knowing, okay, he's okay, I'll heal. Um, you know, it didn't, I didn't leave with a pulmonary embolism or other things that I've seen now as a adult care provider in the hospital, there are so many other things that could have happened here. I'm just thankful we had the experience we had. Um, so, and I'm thankful I had my doula to work through it. Um, and she followed up several times afterwards, too. So, you know, in the end, a lot of things went well and knowing that has been a big part.

Nicole: I love that. It's like, you're looking on the bright side for the things that are, that are good. Like being intentional about that. I mean, there's still hard days. Of course. Absolutely. Absolutely. So what are your thoughts about having another baby? Have you thought about that?

Casie: Yeah, we've thought about it. It's still still processing the logistics of it. Um, you know, we live an hour from the hospital now, but it used to be in my backyard and I'm like, okay, well, if I have preterm labor again, or if I have this or that, um, so just working through all that and figuring out what those logistics would look like, um, would I even want to attempt a vaginal or would we do a scheduled C-section

Nicole: We certainly offer a scheduled cesarean for people who have a history of a fourth degree. Yeah.

Casie: Yeah. So, and you know, and that's been offered and then, you know, the doctors are also very honest on how little research there is. So yeah, just working through all those different logistics and enjoying my son where he's at right now.

Nicole: Yeah. Yeah. Love it. Love it. And getting back on the soccer field.

Casie: Yes. That's been huge. I'm like okay I have this one goal we're going to make it happen and then we'll figure out everything else.

Nicole: Yeah. Yeah. So as we wrap up, what is one thing or your one piece of advice that you would tell other women as they get ready for their birth?

Casie: Um, just going into it with an open mind, my, my friend that's labor and delivery, you know, she, she talked about how expectations really impact people. Um, and before I even had my son, she talked about going in and she had friends that had been had plans a day, all natural unmedicated and ended up needing medicated and then ended up in C-section and how they struggled so much mentally afterwards, um, feeling like a failure and hearing that I was able to work through that a little bit beforehand, um, and understanding that there's only so much control I can have, and my doctor gave me as much control as she could give, but ultimately having that healthy baby was the goal. And so having that mental preparation was huge. Yeah.

Nicole: So, so, so important. I could not have said it better myself. Well, thank you so much for agreeing to come onto the podcast and sharing your story. You are going to help somebody for sure, with your openness and your realness about, about your experience and how to see the bright side. I'm, I'm grateful that you were able to share today. Absolutely positively. Fantastic. Um, yes. She had a very difficult story, but man, did we learn a lot about how to first persevere through difficult times? I really appreciate Casie sharing her story. Now, after every episode, when I have a guest on, I do something called Nicole's Notes where I talk about my top three or four takeaways from the episode, here are my Nicole's Notes from my conversation with Casie, she brought up so many important points. It was actually hard for me to choose.

Nicole: So the first point is I want to talk for a second about family medicine doctors. A lot of people don't realize that there are family medicine, doctors who also practice obstetrics. Family medicine doctors are general practitioners who kind of do a little bit of everything. And there are many who actually do OB. They typically tend to do, um, people who have low risk pregnancies, if they have any complications and they go to an OB or into a maternal fetal medicine specialist. The benefit of family medicine doctors who do OB is that they can also take care of the baby after the baby is born. So you get to see one person for both. It's not a common occurrence that family medicine doctors also do OB, but it is something that happens. So if you see it, don't be surprised. All right. Point number two care in rural areas can really be tough.

Nicole: There are actually what we call like obstetric deserts, where people have to drive many, many hours, even in order to get to a hospital that has labor and delivery. It can really be a challenge and it can especially be a challenge when it comes to finding specialists. I think this is where online options can help fill in some gaps for things, especially like childbirth education. And, you know, I have an online option for childbirth education, the Birth Preparation Course, that's my signature online childbirth class that gets you calm, confident, and empowered to have a beautiful birth. So online options can help not only for, oh, and you can check out the class at drnicolerankins.com/enroll. Um, but online options can help. Not just for things like childbirth education, they can help for things like community. We're actually working on, or some places are working on doing things like telehealth options, where you might like take your blood and listen to the baby's heart, rate yourself at home, and then send that information electronically to an appointment. We're working on all kinds of things to, to help with that.

Nicole: This is one of the areas where I think it's important to pay attention to politics and policy in order to increase resources that are available for these rural areas. It can be important for us to advocate for policies and things and in money really that helps to increase again, the resources cause labor and deliveries are expensive. You have to staff them 24/7. They're hard to staff because the number of patients is very unpredictable. So again, that care in rural areas can be tough. Some things that can help are online options to fill in the gaps and then also pay attention to policy efforts in your area to help fill some of those gaps. And then the final Nicole's Notes. And I just think this needs to be said again, we can all learn from Casie's bright side approach for when things don't go, as we expect, she's not ignoring that things are difficult.

Nicole: She's not ignoring that there are challenges about what she has to face, but what she's doing is she's being intentional about finding things to be grateful for finding things to enjoy. And that can just make such a huge difference. We all have choices for how we approach problems. Problems are in an evitable part of life. And it is how we approach them. That makes all the difference in Casie's approach has just been really, really inspirational. And as a matter of fact, when we were recording this episode, she was on the road at a destination to referee a soccer game. All right. So there you have it. Be sure to subscribe to the podcast in Apple Podcast or wherever you're listening to me right now. I would love it if you leave that honest review in Apple Podcasts in particular, it helps the show to grow. Um, also helps other women to find the show. And I do shout outs from those reviews from time to time, do check out my updated class on How To Make a Birth Plan That Works. You can register for that class at drnicolerankins.com/register. Again, it's free online on demand offers several times a day. So do check that out. All right. So that's it for this episode, come on back next week. And until then, I wish you a beautiful pregnancy and birth.

Nicole: 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 time.