Ep 132: Alex’s Birth Story – Cholestasis and Induction

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In today’s birth story episode we have Alex. Alex is an oncology pharmacist at her local cancer center. She joins us today to share her experiences with loss, pregnancy during Covid, a rare complication, and induction without an epidural.

11 weeks into her first pregnancy Alex miscarried. Three months later she was pregnant again! That pregnancy was mostly uneventful until around 33 weeks when she began to experience severe itching. The itching was presumed to be a symptom of cholestasis and as a result she was induced at 39 weeks. She did not use an epidural and instead opted for fentanyl and nitrous oxide for pain management.

This episode is an example of why it’s so important to have a pain management plan. You don’t know what options will work for you until you try. You need lots of tools in your toolbag which is why educating yourself is so important. You can take my new, quick quiz to assess your knowledge about managing pain in labor.

In this Episode, You’ll Learn About:

  • Why Alex’s doctor recommended against a D&C (dilation and curettage) after miscarriage
  • How Alex’s co-workers helped mitigate the risks of working in a cancer center
  • What cholestasis is and how serious it can be
  • How listening to birth stories helped Alex prepare for a non-epidural birth
  • Why Alex’s doctor induced her in response to her cholestasis
  • How quickly Alex’s pain level escalated and why she regrets utilizing nitrous oxide
  • How effective pelvic floor therapy can be for myriad purposes

Links Mentioned in the Episode

Keywords

cholestasis, fentanyl, induction, itching, nitrous oxide

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Keywords

cholestasis, fentanyl, induction, itching, nitrous oxide

Categories

Podcast

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Ep 132: Alex’s Birth Story – Cholestasis and Induction

Nicole: Hey, hey, it's another great birth story episode. 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 132. Thank you for being here with me today. In today's birth story episode, we have Alex, Alex is 30 years old. She had her baby girl in March of this year. She's been married for four years and they live in the mountains of Colorado. She is an oncology pharmacist at her local cancer center, and she likes to hike, ski and travel. Alex joins us to share her experience of having a miscarriage with her first pregnancy at around 11 weeks. She then got pregnant fairly quickly thereafter, about three months later. That pregnancy was pretty uneventful until about 33-34 weeks. When she started to have really bad itching and she was diagnosed with something called cholestasis of pregnancy, and you're going to learn what that is in the episode. She ultimately was induced because of the cholestasis and she's going to share how she managed her labor induction without an epidural.

Nicole: She's also going to talk about her postpartum recovery and some challenges that she had there. As always, this is an amazing birth story episode. I know that you are going to enjoy it and learn a lot. Now, before we hop into the episode, let's do a quick listener shout out. This is from Rus- I'm just going to spell it. R a C I Z M E. And she left me this review in Apple Podcast. And the title of the review says informative and hopeful. I've been listening to this podcast on and off since my first pregnancy, about a year ago, I'm now on my third, after two early miscarriages. And while I've needed to take breaks for my own mental sanity, I found this podcast to be comforting, hopeful, and more than anything informative. I adore listening to the birth stories with real perspectives, the good and the bad, loss, and ultimately triumph.

Nicole: Dr. Rankins has such a calming, comforting demeanor, and you just feel how she cares so deeply about the process and about guiding each woman through a successful pregnancy journey. I can't wait to dive deeper into her resources and practice these topics in my own pregnancy, praying that I will have a successful pregnancy this time around. Well, I too am praying that you have a successful pregnancy. I am wishing you the absolute best and I so, so appreciate you taking the time to leave me that lovely and kind review. Now, speaking of the resources I provide, I have created a new resource. It is a fun, quick quiz to help you assess where you are in terms of your knowledge about managing pain in labor and the options for managing pain in labor. Its super quick. Super fun. You'll definitely learn something just by going through it. You can check it out at drnicolerankins.com/quiz. It's called the labor pain quiz and the link to that is in the website notes and also in the podcast show notes. All right, let's hop into the episode birth story with Alex. Thank you so much, Alex, for agreeing to come onto the podcast. I'm so excited to have you come one and share your birth story.

Alex: Thank you so much for, uh, for having me I'm excited to be able to share.

Nicole: Yeah. So why don't you tell us a little bit about yourself and your work? Cause I think that is important to your pregnancy as well and your family, if you like.

Alex: So, um, I live in the mountains in Colorado with my husband who is a firefighter and our now three and a half month old baby girl Sloan, and a huge five-year old golden retriever named Benjamin. Um, and I am a pharmacist that specializes in cancer care. And uh, chemotherapy.

Nicole: Okay. So yeah, we're going to talk about how that impacted, cause I'm sure you work with some potentially dangerous medications in the sense that they affect pregnancy. I'm jealous that you live in the mountains. I love the mountains of Virginia, so I'm sure it's beautiful where you are.

Alex: It is definitely fantastic. It was a hard for me this year, not to be able to ski this winter cause that's been a part of my life since I was very, very little.

Nicole: Right, right, right. Well, if your baby is, is three, three months old, then yeah. You were definitely very much so pregnant in the middle of the winter. Oh yeah. With all of the things going on. So, all right. So why don't we have you tell us about, um, uh, cause in order to stand understand birth, we have to understand a bit what the pregnancy was like. So what was your pregnancy and prenatal care like?

Alex: Sure. So, um, I was pretty fortunate, uh, to be able to receive all of my prenatal care and actually deliver in the hospital that I work for. Um, so that was pretty undoubtedly convenient, but also reassuring, you know, that my care team was, was literally in the same building as me. Um, but the OB GYN group, there is a combined physician and midwife practice. Um, so they do cycle you through all of the providers, um, throughout your prenatal appointments. And, um, I was able to, to meet and work with, with most them, um, of course the woman that ended up delivering my baby, I had never met, but, but she was still fantastic. Um, I do think like just, just sort of reflecting on that, that I, I do think I would have preferred maybe just a a single provider instead of being circled through just for continuity and consistency of care did seem like they all had, you know, kind of slightly differing opinions about symptoms and issues.

Alex: Um, but overall I was pretty happy with my care. Um, and then as far as how my pregnancy went, um, I actually initially found out that I was pregnant in early January of 2020, and at around seven weeks started spotting pretty heavily. Um, went in for an ultrasound. They did see a fetal pole and just a little flicker of a heartbeat. Um, but my HCG levels and progesterone levels were very, very low. So they thought at that point called it a threatened miscarriage brought me in three weeks later and of course didn't see a heartbeat. Um, baby was only measuring at eight weeks at that time. So they did diagnose me with a missed miscarriage. Um, the physician recommended against a DNC. Um, so I did do the mifepristone and misoprostol drug protocol to just sort of help pass, um, those retained products of conception. I think they call it. Um, yeah, and that was, you know, obviously very, just rough and, and intense, but thankfully, um, effective. And I was able to get pregnant, um, four months after that. So, uh, didn't, didn't have to wait very long, which was, which was great. And my second pregnancy was largely uneventful, um, kind of until the very end of my third trimester. So I'm pretty thankful for that.

Nicole: Well, good, good. I know it can be like, um, for some people like really, like you said, find it really reassuring that they give birth at the place where they work. Some people are like, dang, I wish I could go someplace else. So I'm glad that you were able to find so that it was a good fit, a good fit for you. And I can totally see, especially if there's like seven or eight doctors in the group, which doctors tend to be like that, you really don't get a connection with anybody. Exactly. And you almost wonder, is it better to like see somebody regular and develop that connection during pregnancy and then prepare for the possibility that, you know, whoever's there, you may not know because it's likely you just, even if you meet everyone once you just don't have that ability to connect. So that's, that's certainly something to, to think about. And I'm also curious, like interesting that your doctor recommended against the DNC. What was usually we present it as a option, were they just like, it wasn't necessary or doing the surgery. I'm curious.

Alex: Well, it was presented as an option, but um, he talked quite a bit about scar tissue and that if I wanted to get pregnant after that, you know, I might have more, more success, I guess, doing, doing the drug protocol instead of a DNC. And, um, maybe it was just his, his preference. I, I really am not sure.

Nicole: Sure, sure. Yeah. Yeah. I mean, I think often very early I tend to lean, I don't, I'm not in the office anymore, but I think that, yeah, for those early pregnancy losses, that combination of medications can work well, it ends up being like a heavy period. Yep. Um, yeah, yeah, yeah. One glad that, um, your second pregnancy was largely uneventful, um, until the end, which will, which we'll talk about. So you said that you are, you are an oncology pharmacist and I'm sure you work with some potentially, um, dangerous medications in the sense that they can have a negative impact on pregnancy. How did you manage that risk?

Alex: So fortunately, um, as the pharmacist, I don't have to, you know, prepare the chemotherapy for infusion and I don't have to administer it. You know, the nurses do that, but I do have this sort of low level risk of exposure just because my office is adjacent to where we mix chemotherapy and where we store chemotherapy. Um, and there's just this potential that, that chemotherapy can literally like be in the air and it can collect on surfaces. So, you know, the, the risk that my desk was just sort of covered in these very small chemotherapy particles was very much a real thing. And there is documented evidence that, um, people who work with chemotherapy can have negative pregnancy outcomes, mainly trouble getting pregnant, um, early pregnancy loss, um, and not a lot of, uh, you know, genetic complications with the fetus, but, you know, definitely, uh, just some complications.

Alex: So I was very worried about it. Um, and thankfully my, my bosses and my colleagues were incredibly supportive of that. And, um, essentially made it possible where other than me sitting in my office, I didn't have to touch the drugs. I didn't have to carry the drugs, be around it. I didn't have to, you know, enter patients' rooms where they had just vomited, and the vomit could have, you know, potentially have chemotherapy in it, all of those kinds of things. And we were able to implement new cleaning procedures and everyone was just incredibly supportive. So I, um, eventually just felt like my risk was, uh, was very low and, um, and sort of got got through it.

Nicole: Yeah. That's, that's really great that you had a supportive team of folks around you who were willing to help you cause that's, that's scary and you just, you know, you just, you just don't know. Um, so that's, that's great that you were able to have that have that, um, have that support for sure. Absolutely. Yeah. Yeah. So, um, you said your pregnancy was going along well, and then around about 33, 34 weeks, things changed. Tell us what happened with that.

Alex: Things did change. Um, I very interestingly just got incredibly itchy, like all over, mainly on like the soles of my feet and obviously, um, my, my belly that was, you know, stretching and growing, um, but went in at 34 weeks and the provider that I saw, um, suspected cholestasis, um, which is this interesting. And as I understand it very rare, but potentially very serious condition, um, that can happen where your bile acids and you can speak more to this, that your bile acids accumulate essentially. And they, they wedge themselves into the little capillaries that are close to your skin and that makes you itch, but it can also go and seed themselves into the placenta and then cause um, lower blood flow to the fetus I think is if that's correct.

Nicole: Well, if that's not a perfect explanation, I don't know what it is. That was excellent. Yes. And because of that increases the risk of stillbirth. So

Alex: Yeah, so they, they had presented to me that, you know, if, um, they diagnose it based on symptoms and then lab tests and they had said, if your, if your labs come back high, you know, we might need to consider induction at 37 weeks. And so interestingly, my labs came back right at that borderline level. I think it's above 10 where you really worry and mine were, you know, in the like right around nine. So they opted to just monitor me very closely. I went in every week, um, for a non-stress test. Like they hooked me up to, to check the baby's heart rate every week and, and thankfully all of that was fine. Um, but it just, it, it never went away and I was just very, very uncomfortable for those last kind of six, four to six weeks of my, of my pregnancy.

Nicole: Sure, sure, sure. What did you do to try to help with the itching?

Alex: Oh my gosh. Just, you know, Aveno baths and just tried to slather myself in all of the lotion. Um, I took the doxylamine, um, just to try to see if that would help. And it did help me sleep through a lot of the itching, which was good. At one point they did prescribe me the Ursa dial, which just sort of helped break down those little bile acids and maybe help you itch a bit less. But I took it for a couple of days and it didn't help. And then I was like, I don't really want to be taking a medication if it's not helping. And so sort of just toughed it out.

Nicole: Gotcha. Yeah. And I don't know if anybody listening, if you ever had a problem with itching. I have weird sometimes. Um, I've had like hives. I think it's a stress reaction where it breaks. I will have broken out and has an itching when you have intense itching and it is all over. It is so uncomfortable.

Alex: And incredibly miserable and almost painful. Yes. Yeah. Yes. Like it's, it's like burning and pins and needles and yeah. You just, when you can't get rid of it it is, it is awful

Nicole: Yes, yes. And to go through it for weeks. So, um, kudos to you for toughing it out, but it is, it is, it is hard. And then you're taking medications that can make you like a lot of the anti-histamines can make you sleepy. Yep. Um, and then you're still trying to work. So, um, yeah. I'm sorry that you had to have that experience, but guys, let me tell you, although it may sound like, oh, you're itching. It's not that bad, intense itching that is, can be really, really, really annoying, interfering with your life. So, all right. So you were dealing with that and then you kind of knew that you were going to probably have to be, um, induced at, at, at some point. What did you do when you knew that that was coming? What did you do to prepare for your birth?

Alex: Um, I did, uh, I did a lot of things actually to, to prepare for birth. Um, initially I, you know, read all the books I read expecting better and I read, I amaze by the childbirth then. Um, did all of that listen to some other podcasts and then found your podcast actually at one point. And it just sort of really resonated with me and clicked with me. And more than anything, I loved hearing birth stories and just, just hearing what other women went through. And, um, I just thought that that was incredibly valuable. Um, and I had it in my head that I really, I didn't necessarily want an, a fully unmedicated birth, but I did want to do it without an epidural. So, um, tried to kind of focus on birth stories where other women had done that. Talk to my friends who had done it without an epidural, just sort of got some advice from, from them. And, um, that was hugely helpful for me.

Nicole: Gotcha. Gotcha. So I'm guessing you listened to the Birth Hour podcast. I know lots of folks listen to that when they want to listen to birth stories.

Alex: I actually, I, I heard you reference it a bunch, but you had enough in your armamentarium that I was able to go back all the way to the beginning. Listen to essentially all the ones that you had done.

Nicole: Oh, I love it. I love it. Thank you. Thank you. All right. So you wanted, um, to do, you know, lower intervention, it sounds like, you know, not no epidural for your birth, anything else that you wanted for your birth?

Alex: Um, not, not really. I was, I was very open to kind of all of the possibilities and just understood that, you know, things can change so quickly. I D I just didn't want to be mentally attached to, to a plan that then would change that. Then I might be disappointed in my birth experience.

Nicole: Sure. Did you think it, did you ever consider a doula or anything like that?

Alex: I, I didn't mainly because of COVID, um, they wouldn't have been allowed in any way. Um, and I have a, well not, you know, medically inclined husband, a very, very supportive husband who just completely followed my lead. And I was able, I'm actually ended up making him a ton of notes, like on a note in his iPhone so that he could, you know, he could have like little things to sort of, uh, remember and then encourage me, like all of the ways to breathe and suggest this position and all of that kind of stuff. So, um, I think, like, I think we had a very good support system in him.

Nicole: Gotcha. And did you just get all your information from books? So did you do a formal childbirth education class at all?

Alex: Again, because of COVID, everything was pretty much shut down to doing in-person class. So we did do one online, um, but I thought was kind of helpful if anything, it was helpful for my husband and I just to like, discuss the possibilities and, um, just sort of learn about, you know, some techniques for pain management and, and those kinds of things. I didn't think it was hugely helpful probably because it wasn't in person and it wasn't personalized anything like that, but, um, it did spark some good discussions.

Nicole: Gotcha. Gotcha. Okay. So let's talk about what was your labor and birth like?

Alex: So, um, like I said, you know, around 34 weeks, um, I developed this sort of intense itching and they were, uh, bringing me in every week, obviously just for followup, but also for the non-stress. And then they were also, um, checking my cervix every week.

Alex: Um, because I think, you know, the thought of induction seemed like it was always on the table, so they were always sort of checking me to see if I was favorable for induction. Um, and around 35 weeks, I was actually already four centimeters dilated it's was just sort of crazy to me. Um, but so, like I said, they were, um just suggesting that I sort of tough out the itching, tough out all these terrible Braxton Hicks, contractions I was having all of the time. Um, and around 38 weeks at that appointment, I was so uncomfortable. I actually requested that they sweep my membranes, um, which they did. And at that point, you know, the midwife was like, you're four centimeters. I just swept your membranes. I assume we're going to see you tonight, if not call us back in 48 hours. And we'll, we'll discuss a plan.

Alex: So of course, 48 hours later, I was not in labor. And I was actually at work called, uh, called the on-call midwife. And she was like, well, you know, run upstairs, I'll see you in L and D triage and we'll come up with a plan. And, um, she, interestingly, um, unlike some of the other providers I had seen was very, very worried about the fact that I was still itchy and essentially said, I don't really care what your labs are. You're this itchy. I don't even want to flirt with the idea that you have cholestasis. I want to induce you today. Um, and I was like, oh, wow. Okay. Um, so, you know, I was like, well, can I, can I go back to my office? I've got some emails I need to write, I need to call my husband. We live like an hour away from the hospital.

Alex: So I was like, I need to get him here. Right. She's like, yeah, sure. You know, come back in a couple hours. So like three hours later, I literally got admitted and, um, they started Pitocin around two o'clock. Um, I was also group B strep positive. So, um, they started ampicillin at that same time. And when I got admitted, I was right around five centimeters and had a really easy time, um, for, for quite a while. Um, my husband and I actually ended up playing cards for most of us most of that time. And so around eight o'clock after I had gotten the two doses of ampicillin, they were able to break my water. Um, and I was at about six centimeters when they broke my water and things just got so intense. So fast, literally within 90 seconds of them breaking my water, I was having 90-second contractions, 90 seconds apart.

Alex: And they were frequently doubling up, which I think is, um, because of the Pitocin. I think it's at least how I understood it. That that was a, that was a possibility. So, um, just really intense, really fast. Um, and in my head, like I said, we didn't really have a birth plan by any means, but we had done a lot of thinking about different positions and being on the ball and being in the tub and all of that. And internally I could only get comfortable in essentially one single position and did not want to move at all once I, I got relatively comfortable.

Nicole: Interesting. What position was that? I'm just curious,

Alex: Kind of like a, I think they called it like a Buddha position almost like they, they raise the back of the bed really high, upright. So I was sitting upright and then put my legs down beneath me.

Alex: And, and that seemed to at least work for me for a while and then around, I don't know, maybe 10:00 PM or so they checked me again. I was seven or eight centimeters. I don't remember exactly, but I started shaking like almost uncontrollably. Um, it was really, really bad shaking. And the nurse suggested that I try the tub, which I did maybe for 15 minutes. And again, just couldn't get comfortable in the tub. So went back to that one position I was comfortable in, but at that time, um, requested a dose of fentanyl and that was, um, hugely helpful for me. Um, not that it took away all of the pain, but that it just really allowed me to kind of dissociate from the pain and focus on my breathing and really just sort of turn inward, um, which was what I knew I needed to do if I was going to do it without an epidural.

Alex: So, um, was able to just really focus and, and also at some point started falling asleep between my contractions, which I don't know how you can fall asleep in 90 seconds, but, but I definitely did. And it, um, it was helpful because at that point, you know, pain, pain is exhausting in a way. And, um, so I, I was very getting very tired. Um, so at the, well, the fentanyl started to wear off. Um, I knew at that point, you know, they were like, you're, you're pretty far along. We don't feel comfortable giving you another dose. So I requested, I requested to do the, the nitrous oxide, which again, didn't really help with the pain, but just helped me dissociate. And I was able to, to use that, well, I sort of breezed through the contractions and that was helpful to me. And, um, maybe around midnight, I was 100% ready to tap out, get an epidural.

Alex: Cause I, like I just said, I was exhausted and thought that at least with an epidural, I could sleep for awhile, recuperate and then have the energy to push. And so she checked me and of course I was at nine and a half centimeters. She was like, we don't really have any options at this point. Um, which was good though, because I had, at that point, you know, really developed the urge to push and, um, was motivated to push for sure. And as soon as I started pushing, I think a lot of women have that, that sensation that it really feels good to push. Um, so in a way was kind of thankful for that, um, and pushed for about an hour, um, which again, very, very intense, um, and got, you know, close to the end when she was crowning. And they had me hold her while she was crowning for a good three contractions. I think if I remember it correctly. And that was, that was very, very intense. The, the ring of fire is undoubtedly a real sensation. Um, and, uh, you know, after that one push to get her head out and, you know, one push to get her shoulders out. And unfortunately, um, we later learned that she was in like the 80th percentile for head circumference. So I, I did, I did still end up with a grade three tear, but, um, but overall, uh, it went pretty well.

Nicole: Gotcha, gotcha. As a fellow, I had C-sections, but as a fellow mother of children with big heads there, my children's heads were always in the 95th percentile. So I understand. Alrighty. So, um, lots of things come up when I think about how, you know, your experience, it's interesting that were, were they offering you the options of like, do you want some IV medicine or do you want some nitrous oxide or did you tell them, like, I will tell you what I, I want, so don't ask and I'll let you know.

Alex: It was very much that way. Um, like I had, you know, done all the research about the fentanyl and about the nitrous. So knew that there was going to be a point that I would probably want one or both of them. Um, the nurse, we had a fantastic nurse, um, and she was very instrumental in just helping me find that position to get comfortable in and, um, just helping me breathe through the contractions. And when I started shaking uncontrollably, you know, she was really right there just trying to help me figure out how I could get through that. And so, um, I asked for the drugs, but she was very helpful with everything else.

Nicole: Gotcha. Gotcha. And then did you have a midwife? Were there were midwives caring for you or was it physicians?

Alex: Correct. It ended up being a midwife, the physicians in that practice, you know, really only come in for, um, C-sections and, and those kinds of things, but the midwives do most of the deliveries.

Nicole: Okay. That's it, that's a ma uh, I just recently, well, at the time when we're recording this, I did a podcast episode on midwifery and, uh, yeah, that is a model that some practices adopt where the midwives literally do all of the vaginal births and physicians only do C-sections or operative vaginal deliveries. That's how it is during the time where they, as things were ramping up where they still increasing the Pitocin, or was it like, how was, what were they doing with the Pitocin?

Alex: No, they were definitely increasing the Pitocin. And I remember asking the nurse at one point, you know, right around seven or eight centimeters, like, can we turn it down, turn it off, stop it. She was like, no, we really can't. And I remember being pretty disheartened by that, but, um, I think, and that was right when I started, you know, like, okay, then I need some drugs.

Nicole: Gotcha. Yeah. Cause it was just really intense.

Alex: It was very intense. Yeah.

Nicole: Yeah. Yeah. And also it sounds like you, you, you had, I think that the beauty is that you had all of these options that you knew in your tool bag, but in the end it was like a couple of things that really worked well for you.

Alex: Absolutely, absolutely. Yeah. I had, I feel like I had done, um, yeah, all of the research and like I said, listened to enough podcasts and read enough, um, that I, yeah, I definitely had a full toolbox and was pretty surprised I think by the fact that I only ended up, you know, in, in one position.

Nicole: Right, right, right. And what was your husband doing, doing during all of this?

Alex: Um, he, he was there with me the whole time, um, and, and very supportive, but I undoubtedly very much turned inward and, and feel like I was very much in a way, not in that room mentally. So I know he was there, um, right at the very end of labor before they let me push. Um, he was incredibly helpful with those, you know, last few minutes of, of contractions. I remember just like staring into his eyes cause it was like the only thing I could do to, to not think about how much pain I was in. And then, um, while I was pushing, he was, he was super helpful right there. I'm sure he had a, you know, a couple broken fingers or a bruised hand, um, after I was done just cause I was squeezing his so hard, but um, yeah, he, he, was super helpful.

Nicole: Love it, love it, love it. So, um, you, you say you ended up with a third degree tear. It, it sounds like, and you didn't have an epidural. So, and I, let me back up and say, I presume they did skin to skin contact and absolutely. Yeah, yeah, yes, no. Um, when you, when it was time to get that repair fixed, what did they do for you for pain management?

Alex: It's a great question. It was interesting. They were using, you know, obviously topical lidocaine to try to numb the area, but it wasn't working for me really at all. And I felt most of quite a few stitches, um, go in. So they let me continue to use the nitrous oxide. Um, which I, I would say was, was kind of helpful. Um, but I, I still felt quite a bit of it and looking back, it was actually kind of sad because I don't really remember a lot of those first moments with my baby because of the nitrous, you know, I was kind of, it makes you feel drunk and I, I just don't remember those very, very precious moments that well, so that was maybe the one part of my birth experience that I was, um, not upset about, but just, um, just a little, sad about.

Nicole: Yeah, yeah. 100%. I can totally understand that. That's one of the things that I know on my side is, is frustrating is when someone doesn't have an epidural, then they need stitches afterwards making sure that they're comfortable during the procedure is, can be tricky sometimes. So yeah, I totally see how, how that, how that unfolded, um, for you, but hopefully it didn't take too terribly long and you were able to, to get started with being a mother fairly quickly.

Alex: Yeah. Yeah. It, it, again, I don't, I don't really remember that well, but let's hope it was that way.

Nicole: Yeah. Yeah. So then what, what is the postpartum period been like for you?

Alex: It's been, uh, it's been a challenge for sure. Um, in delivery, I also ended up dislocating my tailbone. So the first, um, I dunno, like I was uh my tailbone hurt immensely, like, uh, within a couple hours of delivery, it was very, very hard for me to ambulate and one of the midwives came and just sort of pushed on my bones at that point and just sort of made that suspected diagnosis that, that that's what had happened. She said, I don't think you broke it, but it's, there's a very good chance that you've dislocated it or, you know, severely bruised it, whatever it was. But I was in quite a bit of pain from that. And literally it would take me five minutes to get out of bed because I had to move so slowly. Um, so that was, you know, hard as a new mother. Um, but then also, um, Sloan had high bilirubin levels, so she needed to be in under the bilirubin lights, um, for three days.

Alex: So we were in the hospital for, you know, an extra, an extra day. Um, and that's just really hard to see your, you know, your baby in a little, a little box, you know, over in the corner of your room and you can't really cuddle and hang out with them. So that was tough. Um, I definitely had some, some baby blues from about three to six weeks, um, and was, was able to get through that. But it's, it's for sure a real thing just had a hard time bonding, I think. And then, and then at one point it, it, it totally lifted and it clicked, but there was a tough time there for sure. Um, and then also at around three weeks just had this very strange sensation that, um, like something was, was falling out and went to my provider and got diagnosed with bladder prolapse. Um, so have been dealing with that now too, but was able to start, um, pelvic floor physical therapy, um, around eight weeks. And that's been, that's been hugely helpful. I would recommend that every pregnant woman, prolapse or not, go to, to pelvic floor PT, it's, it's amazing.

Nicole: We don't recommend it enough at all and they, they do like magic for sure. Um, yeah. So the, I mean, you actually had a lot going on. I mean, it sounds like you made that you managed it pretty well, but I'm guessing in the moment that was difficult. Like how did you like the tailbone issue? Did you, did it just get better slowly? I mean, that's a big setback potentially right after birth.

Alex: It really was. Um, I have some good friends who are a massage therapists, so kind of ask them their recommendations and they gave me some, um, for stretches and just sort of movements that I could do, like really shallow squats almost that I could do to just sort of gently kind of work it back into place. Um, so that, and around the clock ibuprofen for like a solid three weeks, um, and, and eventually got through it.

Nicole: Gotcha. Gotcha. Now, do you feel like you had support and guidance from the healthcare system in terms of helping you navigate these things in the postpartum period?

Alex: Um not enough. And, and I really wish that, um, postpartum education was more a part of prenatal care. Like they, it's just never mentioned that that those sorts of things can happen. I, I think, um, like I had no idea that bladder prolapse was even a possibility. Um, and I think it would have been nice to, to at least know that and once it got diagnosed, you know, my, my midwife was, um, you know, very helpful and, you know, recommended PT and all of that, but.

Nicole: Yes, for sure. I mean, I've, I've learned this from a colleague and I've said this many times is that it's like, the woman is like this, this rapper carrying the sweet candy and with the candies out, we kind of toss the wrapper away after pregnancy is over. We need to like realize that, that we need to look, um, after, after moms as well, because in order for baby to be healthy, mom has to be healthy also and be able to take care of that brand new human being. But yeah, we definitely need to do it starting in the, in the prenatal period. I had a, uh, a psychologist on the podcast last year and she, or maybe it was the year before that, anyway, she thought we should start talking about it at 28 weeks, like in the third trimester start preparing their postpartum. And I agree we do need to do that more. I absolutely do too. Yeah. Yeah. And then, so did they see you at a typical like six week checkup if you hadn't otherwise have called to make an appointment earlier?

Alex: Correct. That was all that was initially scheduled was the six week. And then, yeah, I had called around three weeks.

Nicole: I think that's just, that's just not adequate, especially after your first baby. I think we just, we're trying, we're getting better about checking in on folks sooner, but six weeks is just a lot happens in those first six weeks.

Alex: Oh my gosh. It's crazy. Yeah.

Nicole: So looking back on things, how do you feel about your birth experience?

Alex: Um, like I said, I thought that it was, I felt very empowered, um, just to start off, you know, that I was able to do it. I was proud of myself. Absolutely. Um, but, um, like I had mentioned was just a little bit sad that I don't have great memories of those, you know, first, maybe two hours after she was born. Like, I remember, um, you know, them calling out that she was a girl, we didn't know that, we didn't know the gender and, um, yeah. And I remember, um, you know, them putting her on my chest, but then after that, it's really a blur. So, um, that I, I do wish I had just been more a part of, um, and that, and, and really just like we were just talking about that. I wish I had known about some of the postpartum complications, um, beyond depression and hemorrhage.

Nicole: Yeah. Yeah. There's, there's definitely more to it, more to it than that. Um, do you feel like, it sounds like you have friends you were able to lean on in the postpartum period or, or community. Do you feel like community was a part of helping you get through that sort of postpartum piece?

Alex: Um, I mean, you, you have, you obviously have children, um, and understand that, you know, that newborn phase, those first six weeks, you're pretty isolated. So, you know, you're really, you're just at home. You're just with that baby. And I actually, I didn't, I saw my friends, but maybe not enough. Um, my husband was home for maybe three weeks after Sloan was born. And so I don't know if I had great support in the postpartum period. Um, uh, my mom came for two weeks and that was super helpful. And, um, my dad lives not too far away. And so he would come over and help out with Sloan. Um, but yeah, maybe I just didn't talk about it enough. Um, I am now, but, um, maybe could have used a little bit more support actually.

Nicole: Yeah. Yeah. It's hard. It's definitely hard. And when you look back on it, it's like, I know for me when my first one who was a preemie, I was like, like hot mess, um, in those firsts that first month. So I think we're getting better about like creating even online communities and things like that where people can reach out and know that, like you said, like the bonding piece, it doesn't always happen immediately that you're just like in love with this, and I'm not trying to project on you. I'm just saying in general, like that you're in love with this person. Sometimes it takes that, you know, they're new, you're new, it just takes a little bit to get all of those things connected.

Alex: Yeah. Without a doubt. And that's, that's exactly how I felt.

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

Alex: Sure. It's kind of a multifactorial, I guess, but, um, during pregnancy deliver and in the postpartum period, I would just say, you know, if your body is telling you something like listen to it, um, you know, you know your body, um, and don't ignore it. Don't worry about bothering your provider or bothering your support system, um, get help when you, when you need it. Um, and then also, uh, just realize that the, maybe the plan that you have in your head or the positions that you think you're going to be comfortable in, um, may not always work. Um, uh, but at the end of the day, um, lean on your nurse and your midwife and your support system, just for help in those moments and that, you know, all the ways that babies make it into this world are, are amazing and beautiful.

Nicole: Oh my goodness. That is just lovely, lovely, lovely. Perfect, perfect way to end. Perfect way to end. I don't know if you're on social media or anything at all. I always offer people the option. Um, are you on social media or, um, open to connect? It's totally fine if you say no.

Alex: No, I, I would be happy to, um, maybe not on social media, but, um, just via email, um, Alexefrederick@gmail.com. I would love to chat with other other moms because I know that that would have been, um, very helpful for me. So yes. Feel free to read, feel free to reach out.

Nicole: I love it. Well, thank you so much for that. Well, thank you Alex so much for agreeing to come onto the podcast and sharing your story. It was really, really helpful.

Alex: Thank you. Thank you again for having me.

Nicole: All right. Wasn't that a great episode? Thank you so much, Alex, for agreeing to come on and share your birth story. Now, after every episode where I have a guest on, I do something called Nicole's Notes, where I talk about my top takeaways and thoughts from the episode. Here are my Nicole's Notes from my conversation with Alex. Number one, Alex had the benefit of a supportive work environment when she was dealing with the exposure to the chemotherapy medications. And that is fantastic, but unfortunately, a lot of women find themselves in circumstances where they are not supported during their pregnancy and work and where they are discriminated against as they are pregnant. This can often be the case in lower paying jobs. Now, I unfortunately don't have a lot of great information and help necessarily to pass along about how to manage that, but I want to make you aware of it.

Nicole: And if you are listening and you have some great resources and definitely shoot them my way, whether it's a DM on Instagram, or you can email me through my website, drnicolerankins.com, but be mindful of that. And sometimes you just have to be careful, but I do want you to know that there are legal protections in place. There's the Pregnancy Discrimination Act. Um, FMLA has some protections in place for pregnant folks and not being discriminated against. So do know that you have those legal protections in place. The problem is sometimes it can be difficult to activate them because of the timing and things like that. And I don't want to like scare you or make you worried, but I do want to make you aware of those realities so you can be prepared just in case. Okay. Point number two from my Nicole's Notes is that you do not know what pain management options will work until you try.

Nicole: Okay. You need to have lots of tools in your tool bag. Alex ments mentioned how like one particular position of sitting up is what really worked for her to help her manage pain. And honestly, you really just don't know until you try, the key is really educating yourself. So you have different options available to you. Childbirth education makes that process a lot easier, especially when it's great childbirth education, like the Birth Preparation Course, it consolidates everything together for you. So you don't have to go looking through like multiple different sources. You can just head to the Birth Preparation Course. I have tons of information in there about all your options for managing pain, unmedicated, birth, epidurals, IV pain, medication, nitrous oxide, all of it is there. And of course there's tons of great information about labor, birth, postpartum education, too. You can check out all the details of the Birth Preparation Course at drnicolerankins.com/enroll. It is incredibly affordable for everything you get in the course. And the third thing that I want to say is just a reminder to listen to your body. I am an expert in what I do. I've been doing this for a long time, 15 years, and I'm an expert in helping babies come into this world, but I am not an expert on you and your body. You are, okay. Remember that and bring that knowledge into your relationships and your encounters that you're an expert on what's going on in your body. So be sure that you listen to your body and those signals that it sends you and communicate that. And remember that you're an expert for you. All right. So there you have it. Be sure to subscribe to the podcast wherever you're listening to me right now, and I'd love it if you leave a review in Apple Podcast, I do shout outs from those reviews and they help the show to grow. Also do check out that brand new quiz the labor pain quiz is drnicolerankins.com/quiz. And let me know what you think about that. So that is it for this episode, do come on back next week. And until then, I wish you a beautiful pregnancy and birth. 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 in 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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