Ep 184: How Your Microbiome Can Affect Your Baby with CEO and Founder of Tiny Health, Cheryl Sew Hoy

Cheryl Sew Hoy

Cheryl Sew Hoy , CEO of Tiny Health standing with arms folded and smiling.

I’m really excited to bring this interview to you today. Our guest, Cheryl Sew Hoy, is CEO & Founder of Tiny Health, a gut microbiome startup that focuses on expecting parents and their babies. I met Cheryl because she reached out to me about being a medical advisor for Tiny Health and I was happy to do so. I do want to be transparent: my role as medical advisor does involve financial compensation but that's not why I agreed to the role or why I wanted to have her on the podcast.

My fascination with the microbiome actually goes back a long way. When I was a faculty member in academic medicine at the beginning of my career, that’s what I had planned to research. If you don’t know, the microbiome is the collection of microbes (bacteria, fungi, viruses) that live in and on us - we actually have at least as many microbes as human cells! Now, the microbiome and how it affects health is an emerging area of study so keep that in mind if you decide to pursue testing. However I really believe that as time goes on we’re only going to learn more and more about its importance.

In this Episode, You’ll Learn About:

  • Why are gut and vaginal health testing important during pregnancy or even when trying to conceive
  • How Cheryl’s own experience lead her to start Tiny Health
  • How microbes are passed along to baby
  • What factors impact the vaginal and gut microbiome
  • What vaginal seeding is and how exactly it’s done
  • What the most common microbes are and which ones you want
  • How the Tiny Health tests work, the results and reports you get, and some surprising results they’ve found

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Dr. Nicole (00:00): This is a birth story episode where things didn't go exactly as anticipated. Megan had something called Pups, cholestasis, and a vacuum assisted birth, but she was ultimately very satisfied with her experience, and you're gonna hear all about that in the episode. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OBGYN, 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.

(01:01): Hello there. Welcome to another episode of the podcast. This is episode number 182. Thank you for being here with me today. In today's episode, we have a great birth story with Megan. Megan is a mother to Noah and wife to Joel. They are a military family, currently located in the National Capital Region. She is a social worker by training and is passionate about mental health and helping people in trauma recovery. Megan enjoys reading, baking, and painting. She is here today to share her experience of moving cross-country during her pregnancy, having to find a new ob, and then needing to be induced at 39 weeks after being diagnosed with something called pups, P U P P S and cholestasis. And although things didn't go exactly as she would've liked, she was ultimately very happy with her experience. And she says a big part of that was because of the education that she got from being a member of the Birth Preparation Course.

(02:09): If you haven't heard of it, the Birth Preparation Course is my online childbirth education class. And it is designed to make sure you are calm, confident, and empowered going into your birth, no matter what their circumstances are. Because as you'll hear, birth is an unpredictable process. And so much of being able to ride those waves of unpredictability is being prepared and being knowledgeable and being ready with education. And that is exactly what you get inside of the Birth Preparation Course. You get childbirth education created by me an OBGYN, who's been in practice for a long, long time. I graduated from medical school 20 years ago, um, have delivered well over a thousand babies. And I put my heart, soul, everything into this course to make sure you are really ready for hospital birth. And that's what I know, hospital, hospital, birth. So that is what I teach. And the course covers everything from mindset to everything about labor and birth, possible things that may happen, like a vacuum birth, which you'll find out that's what happened with Megan today. And then things to get you started in the postpartum period. Questions to ask. Tons of good, great stuff. So check out the birth story episode, and then after that, go check out the Birth Preparation Course at drnicolerankins.com/enroll. All right, let's get into this birth story episode with Megan.

(03:36): Thank you so much, Megan, for agreeing to come onto the podcast. I am so excited to have you here.

Megan (03:41): Thank you so much. I am very, very excited to be here today.

Dr. Nicole (03:44): Yeah. So why don't you start off by telling us a bit about yourself and your family?

Megan (03:49): So, um, I have been married for five years to my wonderful, incredible husband, Joel. Um, we have a 10 month old son who is just the best. His name is Noah. Um, we're a military family. Okay. So, um, we just moved to the National Capital Region. We're just outside of DC. Okay. Um, and before that we were in Maryland, or excuse me, we were in, um, California. So we spent several years in California and now we're in Maryland. Um, I'm a social worker by training, um, currently staying home, uh, with Noah and hanging out with him, and that's been a real joy. Um, but I'm a social worker by training. I'm really passionate about mental health and, um, helping people recover from trauma. So that's kind of my calling and I, I, I miss doing that and I'm excited to get back into that, hopefully here, um, in the future. Um, when I, when I have free time, I know, um, taking care of a kiddo has a lot of work, but when I have free time, um, I enjoy baking. I really enjoy, um, I've actually been reading a lot, which is surprising. Um, I thought once I had a kid that I wasn't gonna be able to do that, but I have actually probably read more this year than I have, um, ever before.

Dr. Nicole (05:06): Oh, that's cool.

Megan (05:07): Yeah, and I'm also, I've become a pro napper, so I'm, I'm of the philosophy that when the baby naps I nap. So usually in the afternoon you can find us both taking a nap at our house.

Dr. Nicole (05:18): Gotcha, gotcha. And you can, you can turn it on when you need to.

Megan (05:22): Yes, yes,

Dr. Nicole (05:23): Yes. All right. So let's hop right into it. So first, in order to understand what the birth is like, I think we always have to talk about what the pregnancy and the pregnancy care was like. So what was your pregnancy and prenatal care like?

Megan (05:35): Yeah, so mine was actually kind of interesting because I moved in the middle of my pregnancy. So we were in California when I found out I was pregnant. And we were there basically through my first trimester. Okay. And I was seeing an OB, just a single OB. Um, and I had actually seen her, um, the year prior, um, when I had a, a miscarriage. I had a miscarriage at, uh, seven weeks. And, um, she was fantastic, um, through that process. And so I obviously stuck with her. And so I saw her for my first trimester of care, and she was really great. Um, she was very, she would answer any of the questions that I had. She was very warm, but I discovered that she wasn't gonna necessarily like, volunteer or educate me myself. Like she was gonna answer the questions that I had, but she wasn't gonna volunteer a lot of information, so I had to know the questions to ask.

(06:31): Gotcha. Um, so that was, I learned that very early on. Um, and then we moved, like I said, at the end of my first trimester, and I had no idea, like we had never lived in the area. And so I was looking for recommendations from people, um, that were local, that had, that had, you know, enjoyed their providers. So I went with a group and I, I don't think I realized this when I first showed up, but it was a group of, um, OBGYNs, nurse practitioners and PAs. And so I didn't see the same person, like at all. Like, I, every time I went in, it was a different person. And so I wasn't expecting that and I didn't love that. And so I had a conversation very early on when I had transferred my care and um, said, Okay, like, who's eligible to deliver my baby?

(07:21): You know? Right. And so they kind of explained like which providers were available. The front desk at that office was fantastic because they were able to schedule me with all of the doctors that were eligible to deliver. She's like, you know, we never know who it's gonna be cuz I was on call and, you know, babies come when babies want to. Um, and so I was able to meet with a lot of the doctors. Um, but it turns out that the doctor that ended up delivering Noah, I had never met him before. So, you know, I did, I did my best. Um, and it, it didn't quite work out how I envisioned it, but, um, and I found the same thing was true once we had moved that, you know, they were gonna answer any questions that I had, but I had to know the questions to ask. Gotcha. Gotcha. Um, so I kind of, um, I took it upon myself to be, to educate myself as much as I could. Right. Um,

Dr. Nicole (08:17): So what, what did you do? What did you do to prepare Yeah. For the process?

Megan (08:20): Yeah. So when I moved, I was in my second trimester and I was like, Okay, now's a good time to like, you know, start exploring what birth looks like, what labor looks like. And so, um, I found the Birth Preparation Course and I was like, everybody needs to take this cause this is amazing. Um, so I, I went through that myself, um, I think later in my second trimester, I can't remember exactly. Um, and I went through all the modules and I, it was really, really helpful. So I did that. I read, um, inamays Guide to Childbirth. Um, I would, when I couldn't sleep in the middle of the night, that was what I was up reading. Um, and we did do, um, labor and delivery education through our hospital. It was still virtual because of the pandemic, you know, lingering.

(09:10): Sure. So it was like a four week virtual class that my husband and I did together. And, um, it was, it was good. It just wasn't super organized. That was one of the things that I really enjoyed about the Birth Preparation Course was like, it's very clearly like, outlined it, like the succession of things made sense to me. And this, the, the hospital, it was great in its own right. But it was just a very different type of education. Gotcha. Um, gotcha. So we did that, and then I watched, I don't know how many, like, birth documentaries on YouTube, like just like birth blogs, people out there, you know, like, Okay, my water broke and I'm going through contractions and now we're going to the hospital. So I watched a lot of that. Right. Um, for more of the experiential piece of it, not necessarily like the data and the facts and that kinda thing. Sure, sure. Um, so I did a lot of that kind of research. Um,

Dr. Nicole (10:04): Yeah. You, you, you were prepared, like you

Megan (10:07): Yeah. Yeah. And I'm sure some of that was probably me trying to birth is such an unknown thing when you're a first time mom. And, you know, people can tell you like, Oh, this is what it's like, but you just have no clue, you know, until you're there. And so I think that was my way of trying to take some of the unknown out of it, was to prepare myself and, you know, educate myself as best I could for Gotcha. What was gonna come.

Dr. Nicole (10:32): Gotcha. And it sounds like you, you did just that, and I wanna go back to it. Um, you know, what you were saying about your prenatal care, because something, uh, stuck out to me that you, you really had to take it upon yourself to get the things out of it that you needed. And it wasn't that anybody was mean or anything. Part of it is probably just a way, unfortunately, that practices sort of work in the way that we, I don't think anybody intentionally like leaves things out, but, um, it sounds like if you hadn't brought up questions, if you hadn't said, Hey, can I be scheduled to meet all of the potential people, that those things wouldn't have happened?

Megan (11:10): Yeah. Yeah. Um, and it's, I I, I, I can empathize because I think when you've, you're in a field and you know, like, you know what you know, you don't necessarily know what other people don't know. Um, and so I, it, it can be hard, you know, when you have somebody who's new to your field who doesn't know a lot, you just kind of assume that they know things. Um, but yeah, it was hard, um, having to like, you know, come in with my list of questions every appointment. Sure. Right. And, and, um, but I, I was, I tried to be, I tried to work from a place of empowerment and really advocate for myself for the things that I wanted and the things that I needed. So

Dr. Nicole (11:50): Absolutely. Absolutely. I love it. Love it. Love it. It, So what, what are some of the things that you wanted for your birth?

Megan (11:56): Um, so I, what I wanted and what ended up happening were very different things. Um, but I, my, I didn't have a lot of like, super specific things. It was more just kind of broad brush strokes. Um, I was hoping to labor at home as long as I could and then go to the hospital. I want, I guess my overarching theme was kind of minimal medical intervention, but I'm not against medical intervention. Sure. Um, so like for an epidural, I was like, I'm gonna labor as long as I can. And then if I can do without epidural, great. And if I can't, that's okay. Um, so I was kind of minimal intervention. That was kind of the, the goal. Um, and I just really wanted to connect with my providers and like, as anybody in a situation like that wants to be treated with dignity.

(12:45): And that Absolutely. And that definitely did happen. I, I will say like that all the providers, like all of the nurses, all the doctors that I encountered over my very lengthy labor, um, they were all fantastic. And so, like I said, I didn't have a ton of like, real specific things that I wanted, um, but just kind of a, I wanted to be more natural and not necessarily, like, that was one of the things I learned when I was researching and learning is like, I think a lot of people tend to treat pregnancy as like a medical condition. Right. Versus like a natural part of life. Yeah.

Dr. Nicole (13:22): Absolutely. Yes.

Megan (13:23): Yes. I think I fell in the camp of like recognizing like, this is a natural part of life, but like for sure, like, you know, relying on medical intervention as needed.

Dr. Nicole (13:33): Yeah. Yeah. Yeah. So then what happened with your labor and birth? Let's talk through it all.

Megan (13:40): Yeah. So I had a relatively, like uncomplicated, very easy pregnancy. Until I hit like 37 weeks. Okay. And at about 37 weeks, I, I, like, I hadn't had stretch marks anywhere on my body until 37 weeks. And then these stretch marks popped up and like, literally overnight, I started getting this rash inside of my stretch marks. And I was like, What is this? And I'm so itchy. And so I went into my provider and I said, Hey, look like here's what's going on. I'm super itchy. Please help me. Right. And so the provider that I saw, she was like, Oh, this looks like something called pups. And I was like, What is that? What, what are you talking about? Right, Right. And so she kind of explained it to me and she's like, you know, if you have itching that spreads to other parts of your body, call us back and let us know. And she's like, basically, there's not much we can do for you. Like just, you know, um, like hydrocortisone cream and, and that's kind of it. So I was like, Okay. So I went home

Dr. Nicole (14:41): And lemme ask, how bad was it? Was it like really

Megan (14:42): It was bad. It was bad. It was real bad. Like, it was, it was real bad. I looked, actually took a picture and I looked back at it and I was like, Oh, like that's bad. Right? Like, that does not look comfortable. Right. And so within, I would say probably four to eight hours after I had been to the doctor, like my entire body is itching, like my whole body and, and like severe itching and

Dr. Nicole (15:09): And you can't not scratch, like

Megan (15:10): You're just, Yeah. You can't not scratch it. And so I was like, cuz I didn't wanna like break my skin, obviously, I knew that wasn't like a good way to go. So I was taking like dish towels and like rubbing my stomach. Like, you know, it was very, very uncomfortable. And I tried, I tried everything. I tried, like,

Dr. Nicole (15:29): What did you try? I,

Megan (15:30): We, I tried, um, I got a recommendation from my nurse to do like an oatmeal bath. So I tried an oatmeal bath. And the hot water would not gel with my skin. I was like, wasn't on fire. That was not it. Um, I tried doing hydrocortisone cream. Um, I tried, oh gosh, I, the only thing that really my, like, slightly helped was ice packs and it's like the middle of winter and I am just like laying on the couch, like just covered in ice packs. Like that was really the only thing that helped me get any kind of relief. So I had like a rotating, you know, thing of ice packs on my body. And so I went and

Dr. Nicole (16:12): Did you try Benadryl or anything or?

Megan (16:14): Um, I did try Benadryl. Yes. I did try Benadryl and that was not helpful. Nothing. Okay. Um, so I finally, I went into my doctor again. I said, Look, y'all, something is not right. Right. Like, we've gotta do something. Right. So the doctor, I remember her saying very clearly, she's like, Well, I don't think it's cholestasis, but on like the 1% chance that it is, like, let's go ahead and do your blood work. And I said, Okay, great. Sure. And so my test results came back, um, the day after Thanksgiving. So everything was kind of on holiday hours, you know, and so I get my results back and turns out I had cholestasis. So they called me in and they said, Hey, you know, can you come in for, um, an ultrasound and to do a stress test to like see how baby's doing? Right. And I was like, Okay. So I like rushed to get to the hospital and

Dr. Nicole (17:03): Right. And this was the day after Thanksgiving.

Megan (17:04): This was the day after Thanksgiving. And like my mom was in town and we were trying to coordinate. It was, it was chaos . It was chaos. Um, so I go to the hospital for my stress test and everything was fine. Like baby was fine, I was fine. So that was Friday and they made the decision to induce me on Monday. And so I was hoping and praying. I was like, Please let me go into labor naturally. Please let me go into labor naturally. So I was walking and doing all the things. I was only, I was just shy of 39 weeks when I found out I had cholestasis. So. Okay. Um, so I, like I said, I was hoping that I was gonna go into labor naturally, but I was just so miserable from all the itching that I was like, I can't, like I just need something. I need some kind of relief. Right, Right. So I went in on Monday morning at 7:00 AM .Well before that I was like, I know I'm need to eat a good breakfast because I'm gonna be in labor. I had my sights set on IHOP and it was a 24 hour IHOP and we showed up and it was closed

Dr. Nicole (18:12): See now that's just, and I was, I was so like, what going on? Right.

Megan (18:17): I, I was so sad. I was so sad. So I was like, this is not a good sign. Like this is not gonna go well. Anyway. So we get to the hospital and they, you know, they check me in and everything and they wanted to start Pitocin pretty much right away.

(18:35): Okay. And were you already dilated some or?

(18:37): Yeah, so let me back up. So I was dilated to three centimeters. Okay. And so I was very excited about that. Okay. Um, that was on the Friday when I found out. I had like, I got my cholestasis diagnosis and they knew they were gonna induce me. And so I was like, Okay, this is not at all what I thought it was going to be. Right. Um, so over the weekend, my husband and I both sat down and watched the induction module on the Birth Preparation Course. Cause I was like, Okay, like this is the route we're going.

(19:05): Like let's, you know, like, let's do the things. And so I show up to the hospital and they immediately wanted to start on Pitocin. And so I asked, I said, Look, I'm trying to do like a gradual on ramp to this. Like I'm not trying to, you know, have all the big drugs right out of the gate. And so I asked, um, about a foley bulb and I asked about like cytotek. And so they said that I wouldn't be a good candidate for a foley bulb because I was already dilated, um, to three centimeters. But they were like, We can do cytotek if you want. Um, and like, reassess, you know, in a few hours. So I was really proud of myself that I was able to advocate for myself. Yeah. Um, to get, like I said, what I wanted cuz I wanted a gradual Sure.

(19:46): You know, on ramp. So I had cytotek and I was having contractions when I was admitted to the hospital, but I wasn't feeling them. Like they were reading on the monitor, but I wasn't feeling them. So they gave me cytotek about 8:30 and I was hanging out and they were like, Yeah, you're like, you're not, you're not there yet. Like, you're having contractions. But I'm like bouncing and playing Yatzee with my husband. And then like, you know, like not knowing what is to come. Right. So the doctor came back like that afternoon, early afternoon and said, you know, okay, let's go ahead and start Pitocin. I said, Great. Sounds good. So they gradually titrated me up on Pitocin. And, um, probably around it, it, it gradually increased till about midnight. Um, and at that point I was just getting so impatient.

(20:37): I was so like, just from the itching and from just being, you know, I was like, Okay, like let's move this along. So, um, they had offered to rupture my membranes a couple of times and I declined But then when they came in at midnight, I was like, Sure, go for it. It like, let's do it. Right, right. Um, so they ruptured my membranes around midnight and I was like, and, and labor really, really kicked in at that point. And I was like, Okay, like this, this is what I have been preparing for. This is, you know, this is it. And so, um, I labored for about four hours, um, unmedicated and just, you know, did the best that I could breathing and moving around and being on the bouncy ball. Like, I tried all of those things and then I just got to a point, I was like, Okay, I would really like the doctor to come check me if I'm close.

Dr. Nicole (21:31): Right.

Megan (21:31): We'll keep going. Right. If I'm not close, we're gonna have to do something because I can't do this. Gotcha. They checked me at like four in the morning and I was only at six centimeters and I was, I'll

Dr. Nicole (21:43): Say, I mean, although that was great progress, but I mean

Megan (21:46): I know, I know. I was, I was, I was happy that I had progressed. Right. But I was like, my, my threshold for like pain tolerance is rapidly declining. So, um, so I, I decided to opt for an epidural. Okay. And in hindsight, I'm very glad that I did that. That was the right choice for me. It was a very emotional decision. Right. Um, I like cried and cried and bless the anesthesiologist, she was incredible. She was so great. Um, and she was so patient and calm and like Right. She was amazing. But I was like, I was a wreck. I was like, Ugh, you're gonna stick a needle in my back. Like, it was, it was a big deal for me.

Dr. Nicole (22:27): Gotcha. And I'm sure your nurse was probably helping you too in the moment to kind of like

Megan (22:31): Yes. Yeah. To help kind of calm me down. Right, right. And so I got my epidural at like 4:30 in the morning. Okay. And honestly, I really don't remember a lot from like 4:30 in the morning until I started pushing it like 2:00 PM Okay. I think, I think I did.

Dr. Nicole (22:47): Did you fall asleep?

Megan (22:47): Yeah, I think I slept, um, off and on. Um, my husband was like, I was awake the whole time watching you. And I was like, Well that's great cuz I was not awake watching you. Like, um, so yeah, things kind of progressed and then around two o'clock they came to check me and I was complete and I was like, gosh, let's, Right, let's do it. We're finally like, this is, cuz I feel like when you're in labor like that, before you get into transition, like you're just kind of passively letting things happen. But then when you start to push. It was very empowering actually. Right. Like, I was like, okay, like I can actually do something to really like, help move this along. Right.

Dr. Nicole (23:29): Oh, lemme ask before that time. Yeah. Were the nurses like moving you in different positions or, um, like the peanut ball or any of those things?

Megan (23:38): So I didn't use the peanut ball. The peanut ball did come into play, um, while I was pushing. But I didn't use that a ton. But I was able to, like, on my side, Um, I think they did help even though I had the epidural. I think they let me get on the birth ball at one point just to kind of bounce. I think I the world kinda, you know. Sure. It was a little hazy when you're in labor. Right. Um, but they were helping me move around, um, and kind of, you know, reclining sitting up, like that kind of thing. Okay. They, they were helping me do that. And so they come in, they say, Hey, you're complete, we can start pushing. And I was like, Great. And the labor and delivery nurse that was there, she was fantastic. My only gripe with her and I'm like, If you're a labor and delivery nurse, listen to this. Don't say this to your patients. I pushed like my first two contractions and she's like, Oh, you're doing so great. She's like, Your baby's gonna be here in like 30 minutes. Like, you're gonna be like, you're gonna be totally fine. Like, your baby's gonna be here so soon. Right. So I was like, Okay. 30 minutes. And I pushed for two and a half hours.

Dr. Nicole (24:45): Okay. Okay. So, okay. So you were, you had, when you heard that it just, you got excited like, okay, this is is not much longer. And then, and then it was a lot longer.

Megan (25:00): It was a lot. Yes. Okay. And so it was weird, like didn't, it didn't feel like two and a half hours to me it definitely felt longer than 30 minutes cuz I was like, you know, okay, where's the baby? Right. Um, but it didn't feel quite as long. Um, but I was just reaching the point of exhaustion. Like I just, I, I had nothing left to give and I actually was starting to consider like asking for a C-section because I just, like, it

Dr. Nicole (25:28): It was exhausting

Megan (25:28): I couldn't. Okay. And I actually, I would have a contraction and then I would fall asleep. Okay. And then I would wake up and push and then I would fall asleep. Like I was just, my body was like, you know. Gotcha. Gotcha. So the doctor came in and he obviously saw that I was very tired. And he, but he was really great. He was very calm. He was very direct. And very, uh, concise, which is great to have when you're in the throes of labor. Uh, and he asked if I would be interested in a vacuum assisted delivery. Okay. And thanks to all the education and doing the Birth Preparation Course, I already knew what that was. And so I asked him, I remember very clearly asking him, Okay, talk to me about vacuum assisted delivery. What does that look like? What does that do for, you know, my push time, like, you know, talk to me about that. And he, you know, he explained the process and it mashed up with what I had learned before I had gone into the hospital. And I was like, Yes, anything to help me get this baby out would be wonderful.

Dr. Nicole (26:35): You're like, I'm ready, I'm ready to meet this baby.

Megan (26:37): Yes. And so, um, they, they put the little, little suction thing on his head. And, um, I pushed twice and he was born like it was

Dr. Nicole (26:51): Oh, nice. It was So Was it pretty straightforward vacuum?

Megan (26:54): Oh yeah. It was very simple. Okay. Um, I pushed once and he crowned and then I pushed once and we got a shoulder and then everything, you know, came after that. Gotcha. And so Gotcha. Obviously I was like, just so relieved. And I remember the nurse saying, she was like, Oh, he's gonna be a, he's gonna be a pretty like big baby. Like, he's, he's gonna be a heavy baby. And I was like, Really? How do you know? She's like, I can just, you know, they see lots of babies. Right. And so we did skin to skin, um, for the first hour, which was amazing.

Dr. Nicole (27:26): Aw. Did they do delayed cord clamping?

Megan (27:28): We did delayed cord clamping. Okay. Um, that was one of our, our wishes. So they, they did delayed cord clamping. Um, and they, they put him up on my chest and it was actually kind of funny. They put him really high up on my chest. And I'm like looking, I'm like, I can't see him. I can't see him. Where is he? Like, and I was like, You're so close, I can't see you

Dr. Nicole (27:50): Right, right,

Megan (27:51): Right. Um, so we did skin to skin for the first hour, which was really great. And um, and they weighed him. And so he was nine pounds, five ounces. Oh, so he was a pretty chunky guy.

Dr. Nicole (28:06): Yes. He was a pretty junk. It was, You were tired, but trying to push that nine pound baby out.

Megan (28:14): He was a chunky guy.

Dr. Nicole (28:14): Oh goodness. Did you have any tears at all?

Megan (28:17): So I had a second degree tear.

Dr. Nicole (28:20): Okay. Thats not much. Yeah.

Megan (28:21): I, yeah, I, I, I, again, with all the research that I had done before, I knew that that was gonna be a possibility. Um, so I was kind of prepared just, you know, for that. And I don't know, cause I still had an epidural at that point, but I distinctly remember when they were stitching me up, I was like, this is really uncomfortable. Like this is, this is like, this is uncomfortable. Like, not just like pressure or like,

Dr. Nicole (28:46): But pain. Right. You could feel stitches like the needle

Megan (28:47): Feel like, but like painful

(28:51): Yeah. And so I had to be like, y'all have gotta do something. Like, so they gave me more meds, um, to, to help with that, which Okay. Was much better. Okay. Um, okay. Okay. So yeah, they stitched me up and um, I was like, Okay, this baby is here and like, nows a mom. Yes.

Dr. Nicole (29:10): And I can't return him, so you Right, right. Like he's yours.

Megan (29:16): Yes. So from the time that I walked into the hospital to the time I was born, to the time he was born was a almost 36 hours, just shy of 36 hours. Okay. Um, I knew from, again, all of the research that I had done that it could be days. Potentiall. I feel like for an induction it wasn't bad, but when you're in it, it just feels like forever.

Dr. Nicole (29:40): Right, right, right. It, it certainly can. It certainly can. It's like different people changing and it's like, but I'm still here. Yep. Yep. Oh, and I forgot to ask, did your epidural, um, could you feel some with your epidural or was it super duper, Were you super duper numb? Or do you remember?

Megan (30:00): I feel like, well I remember like pushing the button for more drugs.

(30:06): At several points cuz I was like, um, I feel like I felt some Okay. I was definitely not completely numb. Okay. Um, oh. And I do, so now that I'm like rehashing it again. Yeah. So I had back labor at one point, which I knew was indicative, could be indicative of like baby's positioning. And so that's where the peanut ball came into play. Um, cuz I was like, Yeah, my back is really hurting. Even though I had the epidural, I was like, my back is hurting. Right. So she flipped me onto my side, and we did the peanut ball and probably, I don't know, maybe five to 10 contractions later, it had resolved. And so they were very, I I everybody was very excited about that. Cause I was like,

Dr. Nicole (30:54): Yeah, he probably probably turned. Yeah.

Megan (30:55): Yeah. Yeah. So, um, yeah, the nurses were very helpful in getting my body into position because I was like, I can't I can't do much of anything right now.

Dr. Nicole (31:09): And did you, did you breastfe?ed

Megan (31:11): I did. Um, so he was born with, um, was it low blood sugar? High blood? I think he was low blood sugar. He was born with low blood sugar. Okay. Um, and so we tried breastfeeding. And again, that's another thing that like you can read and people can tell you what it's like, but until you have a baby that's trying to latch

(31:35): It's a totally different ballgame. Yes. Um, so we tried that with like intermittent success. So we did have to supplement with bottles in the hospital for the sake of his blood sugar. Sure. Um, and we were able to get that under control, um, within the first 24 hours, which was really great. Okay. Um, cause they were gonna take him to the NICU for monitoring, um, if his levels, you know, hadn't gotten to where we needed them to be, so. Right. Thankfully that was resolved and he got to stay with us the whole time, which was great. Um, and so I met with a lactation consultant, I think twice in the hospital. Okay. And, um, they were wonderful. I'm like, man, lactation consultants are like the angels, like they're amazing.

Dr. Nicole (32:18): 100%. Yes.

Megan (32:19): They just know so much and they've done, like, they've helped, they supported so many women, so I really appreciated them. However, when we got home, um, cuz I, they had me on a nipple shield, um, before they sent me home because they thought he had a high pallet, which turns out he didn't have a high pallet. We just weren't latching correctly. So I was on a nipple shield and by day like three, I'm in pain. My son's like screaming in pain, like, he's not happy. No one's happy. Okay. And so I was like, I need help right now. Like, I need someone to come to my house and help me. Like, I need help. And I had a really, that was a, a big, probably my biggest postpartum frustration was getting support breastfeeding because it feels so immediate, like urgent, like, you need help. Like, my baby's gotta eat, but I'm in pain.

(33:16): Right. And they're unhappy. Right. And my husband's looking at me like, Well, I don't have those body parts. Like, I can't help you. Right. You know, and so I, I looked at like Le Leche and, and, and I think the area that we live into is also not, um, well serviced with those kinds of resources. So I think that was part of it. Um, but it was really hard. And so I actually ended up, um, one of the moms that went to our church came over and kind of helped me, like, she's not trained or anything, but she breastfed, you know, three or four kids. And so she has the experience at least. So she was able to come and help until we were able to schedule with, um, the lactation consultant that was at her pediatrician's office. Okay. So she was like, I can see you, but I can't see you for like a week. And I'm like,

Dr. Nicole (34:07): Well, what, what am I supposed to do for a

Megan (34:09): What am I supposed to do for the week? So, um, so yeah, it was, it was a really big struggle. The first like three weeks honestly were really, really, really hard. And I was like, Why am I doing this? Like, do I quit? You know? Right. And so I stuck with it and I'm glad that I did. Okay. And, um, he was growing, gaining weight sufficiently and so we breastfed till about four months. Okay. And then I had just started having issues with supply. Like I was, he was eating more than what I could produce. And so we started supplementing and then eventually just for my mental health. Yeah. I was like, we're gonna have to call it quits. And that was a really big decision for me. I was very sad about it, but it was the right decision for me.

(34:55): Like, as soon as I decided to like stop pumping and trying to supplement bottles, I felt so much better. Like it was, and it just was, I was like, Oh, I can hand a baby to you to feed. Right. I can hand a baby to you to feed. Like, it wasn't all on me Yeah. To be the person feeding. So I was really grateful that, you know, that I made the leap after it was all said and done. It was an emotional decision, but, um, it ended up being the right one for me.

Dr. Nicole (35:26): Yeah. Yeah. That's always a tough one. I I went through something similar myself and you, even though, you know, like I'm, the baby's going to eat, the baby's gonna be be fed, it's, it's still hard. Yeah. So,

Megan (35:39): Yeah. Yeah.

Dr. Nicole (35:40): Yeah. Yeah. And then when did your, um, when did you see your doctor postpartum? Was it not until six weeks?

Megan (35:47): Uh, it was not until six weeks. Um, and, and I knew that was like standard and, and my postpartum appointment, like it was just so like nonchalant I guess or it was just very basic. It was, you know, and, and thankfully I had a really good postpartum recovery, like my physical recovery. By the time I was at my six week appointment, I was, I won't say like a hundred percent, but I was pretty close. Like, I had a very good recovery. Sure. Um, but even though like, I don't know, I just feel like I'm like, ask me about my day. Like, let me tell you about my kid and how like, you know, how many times I'm getting up at night or like, you know, just the, And also like, I think it would, I know this is something they screen for is like, um, postpartum depression.

(36:43): Um, and I think the questionnaire, you know, has its place, but I'm also like, have a conversation with me. I don't think I had postpartum depression at that point. I think mine was a little later of an onset. Okay. Like closer to like, probably five or six months, um, postpartum. But it just felt very like routine or mechanical. Like, here's this questionnaire. Okay. I'm gonna ask you this question, this question, this question. Okay. You're great. Okay. We're gonna like send you on your way. So, um, yeah. I think it would've been great to have something at like two weeks. Cause I remember calling my doctor and I was like, my feet are swollen. Right. Like, my feet are real swollen. Right. Like, why are my feet swollen? Right. And so it would've been nice to have a touch point at like maybe two or three weeks to answer those kinds of questions. Um, but yeah, I got the six week standard follow up and it was pretty standard

Dr. Nicole (37:40): Yeah. Yeah. Yeah. And that's just, we, we have to redo postpartum care in the United States. It's just, it's just really bad. Um, it, there's, I mean there's just no way around it. It's just bad when you hear other countries and they're like, Oh, a nurse comes to your house and this, that, it's like. Wait, what?

Megan (37:59): Yeah. Yeah. It's, and it's one of those things that like, I never paid attention to. Cause I've never been in, you know, a postpartum season before. Um, and so it's like you don't know until you're there. And now that I've been through that, like, I had a friend who got pregnant, um, right before our son was born. And so I kind of got to walk with her through her pregnancy. And, and trying to encourage her, you know, to advocate for herself and, and, and do the things, you know, that I felt like I had taken away from my journey. Um, but I was like, Yeah, postpartum care is gonna be this.

Dr. Nicole (38:35): You, I mean, you're basically on your own. Yeah. It's sad, but yeah. Not at least, at least from the medical system perspective, Yes. You're you're pretty much, pretty much on on your own unfortunately, so

Megan (38:48): Yeah.

Dr. Nicole (38:48): Yeah. Yeah. Yeah. So, um, how do you feel overall about your pregnancy and birth experience?

Megan (38:55): Um, so my pregnancy, like I said, the first large portion of it was pretty unremarkable, very, you know, run of the mill. Um, the last two weeks were brutal, like they were very uncomfortable. And I had a hard time getting relief from all the itching and, um, yeah. It was really, really hard. So, and that is a big factor in us considering to get pregnant again, is like, I know that I can't get pups again, but cholestasis has a decent recurrence rate. And I'm like, Man, one of the nurses in the hospital, she's like, Yeah, I got it at like 16 weeks and had it, you know, And I was like, Oh, that doesn't sound pleasant for me. Like, I'm glad I got mine at least later, but if it's possible to get it earlier anyway. Um, but as far as my like birth experience went, it wasn't, in some ways it wasn't what I envisioned, but I'm overall happy with how it went.

(39:53): And I think the biggest contributing factor to that was the fact that I had done so much research in educating myself that I kind of knew. I didn't know it necessarily the exact path that we were gonna take, but at each decision that had to be made throughout my labor process, I knew, oh, my option is either this or this. And I felt like I c could relatively know what to expect between the two. And so I was like, Okay, I'm going to choose this option. Um, and I think that really helped me feel empowered. And it wasn't just like I was in the hospital having this baby and all of these people are making decisions for me. Yeah. It was very, um, it was an empowering experience for me. Yeah. So

Dr. Nicole (40:35): Yeah. You were an active participant in, in the process. Yes.

Megan (40:39): Yeah. Yeah. So overall I am happy with it. Um, and I think, I mean, I got my sweet little baby boy and yeah,

Dr. Nicole (40:46): He's the best. So as we wrap up them, what is your one thing or one piece of advice that you would give to folks who are, are pregnant now?

Megan (40:59): Oh man, that's like a big question.

Dr. Nicole (41:02): I know. Oh, everybody always said that. Yeah.

Megan (41:06): I would say, I would say, you know, have your expectations of what you desire for your birth, but hold those things very loosely and, and try to, try to just go with the flow as much as you can. Um, I would say that, and then educating yourself as much as you can on all of the different things that could potentially happen. Um, as far as interventions, I think that knowing what your options are can help you feel like you're more able to go with the flow. Um, if you kind of know what's available, you can kind of, to a certain degree, pick and choose kind of sure you know, what you're, what you're comfortable with. And, uh, yeah, like I said, have your, have your desires and make your wishes known, but hold them with very loose hands.

Dr. Nicole (42:04): There you go. There you go. All right. So where can women connect with you? You can say nowhere if you're not anywhere.

Megan (42:09): You know, I was singing, I saw that and I was like, um, Yeah, via email, I guess?

Dr. Nicole (42:15): Yeah. No, it's totally fine. If anybody wants to reach out to you, they can reach out to us. I don't like to put people's emails like in

Megan (42:21): Okay, perfect.

Dr. Nicole (42:21): Because it just, it invites spam and all of those kinds of things, but, um, Yep. So yeah. No, totally, totally fine. Well, thank you so much. This was a great conversation. I am so grateful that you came more, you have such lovely energy and,

Megan (42:34): Um, Oh, thank you so much.

Dr. Nicole (42:35): Just a joy to talk to you and I'm grateful that I could help that you were part of the Birth Preparation Course too.

Megan (42:40): Yes. I am so grateful that I found you, um, and, and found your work. And I'm very grateful, um, for practitioners like you that, um, really try to approach the whole pregnancy and labor and delivery process through a place in empowerment. I'm very grateful.

Dr. Nicole (43:04): All right. Wasn't that a great episode? Megan has such lovely energy. I so enjoy talking to her and hearing her story. And I'm grateful that I got to be a part of her story through education from the Birth Preparation Course. Now, you know, after every episode when I have a guest on, I do something called Dr. Nicole's Notes where I talk about my top takeaways from the conversation here on my Dr. Nicole's Notes from my conversation with Megan. One thing we didn't talk about in the episode is what is pups and what is cholestasis? So I wanna tell you about that really quickly. So PUPS stands for pruritic urticarial papules and plaques of pregnancy. And what it is, it's a rash that happens in pregnancy. It's itchy, have like bumps that tend to form in the str stretch marks on your belly. And sometimes it can spread to other parts of your body When you're pregnant, the condition does not harm you, it doesn't harm your baby, it usually really doesn't need any medical treatment, but you typically need something to help with the itching.

(44:04): So that's pupps. It's an itchy rash that can happen during pregnancy, not a threat or danger or anything like that. Cholestasis on the other hand, uh, the long name for it is intra hepatic cholestasis of pregnancy. But cholestasis is actually a condition that originates in the liver and it happens in late pregnancy. And this condition also triggers intense itching like pupps can. However, typically coli does not have a rash and the itching of cholestasis typically occurs on the hands and feet, but it can occur in other parts of the body. And the thing about cholestasis that's different from pupps is that cholestasis, there is a greatly increased risk of stillbirth. So we usually recommend labor induction in the setting of colles stasis. So that's pupps and that's cholestasis. I wanted to tell you about that. Okay. Other quick Doctor Nicole's Notes.

(44:58): One of the things Megan mentioned is that her doctor was great and they would answer questions, but they weren't really educating or volunteering information. She needed to know what questions to ask. And let me tell you, that is extremely typical in the way prenatal care is provided today, especially by physicians. Unfortunately, doctors are busy, they have too many patients to see and not enough time, and they don't really have time for education. Education is generally relegated to handing out a pamphlet or something like that that nobody really reads, right? So you have to know what questions to ask. That is exactly why something like childbirth education is so important. And the Birth Preparation Course is something that's gonna be really helpful for you. So you know what questions to ask going into your appointments, especially going towards the end of your birth. Um, there's a whole module on making birth wishes or a birth plan.

(46:03): I say birth wishes cuz you can't plan birth. And it's questions for, if you want unmedicated questions, if you want, um, an epidural, just all kinds of great things for you to know so you know what to expect going into your birth. So check out the Birth Preparation Course. Again, that's drnicolerankins.com/enroll. Another thing that Megan said, and I don't know if you heard this, and we're like, Oh my God, maybe you did, maybe you didn't. But she says she pushed for two and a half hours. That is really not a typical first birth baby at all. Pushing up to four hours is considered normal for a first baby and you have an epidural. So that's another thing that childbirth education will help you understand is that that is not something that's, that's atypical. You can push for quite some time, but the first baby, sometimes you'll push longer and four hours is like a mark when we should kind of evaluate and see what's going on.

(46:55): It's not a hard and fast, you have to stop pushing. Sometimes people occasionally push longer. Now sometimes, of course it can be shorter. Some people push for 15 minutes, 20 minutes. It really just depends. But again, childbirth education will help you know, that something like that is not an not unusual. So two and a half hours of pushing is not that bad. And then the final thing I wanna say is postpartum care in this country sucks. We know this, it's terrible. You know, we have a typically a six week postpartum check and there's just not much help in between then, um, in terms of really supporting you in the postpartum period, that's the sad reality of of care in the us. And one of the things that you very well may need help with is breastfeeding well before six weeks. Um, breastfeeding can really be challenging.

(47:41): I've always called it a labor of love. I've said that many times in the podcast. I felt like breastfeeding for me was a labor of love. So I loved how Megan had a mom friend who could, who could help her with breastfeeding when she had an urgent need. Like I've always said, you should identify a lactation consultant. But sometimes you need somebody like right then who can maybe help you talk you through something and that maybe a lactation consultant, maybe they may be able to talk, talk you through things or help you over the phone. But maybe if you can find a mom friend who can help you in the moment, who has breasted, who can give you some words of advice or encouragement when you have that urgent need, just tuck that person in your back back pocket. Have someone identified who you can call on if you need to.

(48:29): And then also regarding breastfeeding. It's okay if you stop, like do the best that that you can, but it's okay if you stop if you find that that's best for your health and your mental health. Cuz you have to be your best self in order to give your best to a baby. Yes, we know that breastfeeding has lots of benefits, but a fed baby, of course, is the best baby. So it's okay if you stop. I would say don't beat yourself up, but we always beat ourselves up when we do things like that. You know, I still beat myself up about stopping breastfeeding, even though my children are, you know, teenagers and healthy and smart and all that good, great stuff. But know that it is okay. Give yourself some grace. It's a, it can be a challenging process and again, a labor of love.

(49:11): So give yourself some grace with that. All right, so there you have it. Please be sure to share this podcast with a friend. Sharing is caring, sharing helps more people to get all of this good great information that we're given in the podcast and it helps me to reach and serve more folks, which is my heart's soul and passion in my work. Also, subscribe to the podcast wherever you're listening to me right now. Leave me a review, in Apple Podcast. I love to read what you think about the show and it also helps other women to find the show. Also, you can follow me on Instagram. I'm on Instagram at Dr. Nicole Rankins where we can continue the conversation there. I provide lots of great, helpful tips and inspiring quotes and fun stuff and videos. I do reels there. So come follow me on Instagram at Dr Nicole Rankins. So that is it for this episode to come on back next week and remember that you deserve a beautiful pregnancy and birth.