Ep 193: 10 Crazy Things from My Career

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I cannot believe I graduated from medical school in 2002! Looking back at my career, a lot of wild things have happened. On this podcast I get to bring you expert advice, education on important topics, and beautiful of birth stories. But for this episode, I thought I’d do something a little more lighthearted and share 10 interesting things from my two-decade career.

I will be talking about some of the difficult things that happen in my specialty, as well. Some of these stories are going to be a little bit gruesome - I give a warning in the episode before going into anything graphic so you can skip ahead. Overall you are going to enjoy it and hopefully you find these stories funny or relatable.

In this Episode, You’ll Learn About:

  • What makes it impossible for the hospital to prepare your epidural before you arrive
  • Why all kinds of reactions to the arrival of your baby are ok
  • Why certain items absolutely should not be inserted into a vagina!
  • How even I, after 20 years in practice, am not able to predict how quickly a birth might progress
  • Why faster is not necessarily better when it comes to labor
  • Why we need to monitor placenta previa so carefully
  • How we medical providers could be more sensitive to our patients feelings
  • What a notarized birth plan is and what it means (or honestly doesn’t mean)

Links Mentioned in the Episode

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Dr. Nicole (00:00): This episode is a little different today. It's a little more fun, mostly lighthearted episode about 10 interesting things, fun things that I have seen in my 20 year career. Warning, there is some use of explicit language in this episode and also some more adult topic discussion in this episode. Welcome to the All About Pregnancy & Birth podcast. I'm Doctor Nicole Calloway Rankins, a board certified OB G Y N, 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 in 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.

(01:06): Hello, hello, hello there. Welcome to another episode of the podcast. This is episode number 193. If this is your first time listening, I'm so glad to have you, and if you've been here for a while, I'm glad to have you too. So thank you, thank you. Thank you so much for spending a bit of your time with me today. So this episode is a little different. What I thought I would do I've been thinking a lot that I cannot believe I graduated from medical school in 2002, so I have been a doctor now for almost 21 years. And just thinking back on my career, I say, you know what? Lemme share some of the things that have been more interesting, more fun, some lighthearted, some a little bit gruesome things that I have encountered in my career. So I'm just going to lay those out for you today.

(01:57): Hopefully you find some of them funny, relatable. Some of them I said are, as I said, are going to be a little bit talking about some of the difficult things that happened in my specialty as well. But I think overall you are going to enjoy it. Now, before we get into the episode, let me tell you a quick reminder. One of the things that I know for sure that I have learned that is super important as I have been in practice is the importance of childbirth education. And that is exactly why I created my own childbirth education class. The birth preparation Course, it's an online childbirth education class, gets you calm, confident, and empowered to have the beautiful birth that you deserve. And it focuses especially on getting you ready for birth in the hospital. That is what I know, that is what I teach, and I created it just from seeing so many folks have a lack of understanding about what happens in the hospital specifically and just not being fully prepared for birth and just being scared.

(02:55): So I put my heart, soul passion into the Birth Preparation Course. It's a five step process that gets you there. We start off with strengthening your mindset and then you, because that's super important, super duper, duper important, and so key to a great birth experience. And then you learn all the details of labor and birth. You learn about possible things that may occur. Information help you get off to a great start postpartum because really the birth is just the beginning. And then of course, I teach you how to make a birth plan that works, make it the right way so that it actually works to help you have the birth that you want. And folks love this class, folks love it. You get lifetime access. You also get to be a member of my private Facebook community where I do q and a's. That's the only place really these days that I do live q and a.

(03:40): So come join me inside the Birth Preparation Course. You will not regret it, but I will also say that if you don't choose the birth preparation course, choose something. Because childbirth education is really, really important. So important and key to help you have the beautiful birth that you want. So if it's not me, choose somebody because it's important. All right, let's get into those 10 things that I have seen throughout my career. And they're not in any order, particular order or anything. I'm just kind of listed them off the top of my head and going through each one.

(04:12): Okay, first one. And this was such a memorable moment and I'm giggling. I'm not laughing at this woman's pain, but let me tell you, I was the doctor on call and at one of the hospitals where I used to work, the patients used to call before they were coming to the hospital, and we as the hospitalist doctors would be the one receiving those calls. And this patient called and she was in the car and she was like, I need you to have my epidural ready as soon as I hit the door. She was so serious about making sure that her epidural was going to be ready and waiting for her when she got to the hospital. Well, I had to break it down to her that it doesn't exactly work that way. It doesn't work like that at all. And epidural actually takes time. You have to get a bolus of IV fluids through your IV because an epidural can drop your blood pressure.

(05:15): In order to counteract that, we give you some extra IV fluids to keep your blood pressure up. The anesthesiologist has to evaluate you and make sure things are okay. Sometimes you need blood work to make sure your platelets, which help your blood clot are norm normal, because if they are too low, that can be dangerous. It's not common that that happens, but it does happen. And so you can't have an epidural ready by the time it can't be ready for you by the time you get to the hospital. Yes, we can let the anesthesiologist know and get things prepared, but it's going to take a good solid 30 to 30 minutes, sometimes longer, 30 minutes at a minimum before you can get an epidural. So you cannot ask for an epidural from the car.

(06:02): And this kind of underscores the importance of knowing exactly what your options for managing pain during labor are and knowing some techniques for managing pain without medication because it's going to be a period of time where that happens. So if you grab my Labor Pain Management guide, go to drnicolerankins.com/pain. You can learn all of your options for managing pain in that guide. I talk about medication free techniques, which are important. You'll learn about IV medications, nitrous oxide, also epidurals, IV pain medications. So all of that is in that guide. And I have a corresponding podcast episode that covers it too. But the guide has some pictures and things. I think the podcast episode is episode 129. So drnicolerankins.com/episode129. And the other thing I have about pain management labor is a little quiz where you can test your knowledge of whether or not you are ready to manage pain and labor.

(07:08): And you can check out my labor pain quiz at drnicolerankins.com/quiz. Okay, number two, people have different reactions after they have a baby. And for the most part, it's joy and it's excitement, and it's just really happiness that the baby is here. Occasionally that happiness manifests in interesting ways. One memorable experience is when this patient had been pushing for a long time, she had pushed for, I think almost four hours. The baby comes out, baby comes up onto her chest, and she looks at the baby and she says, you are finally here, you little shit. And it was just so, I know it sounds terrible, but I can tell you in the moment it was said with the most love and appreciation and affection, I think she was just so tired and exhausted from pushing, but at the same time, happy to see this sweet little baby.

(08:18): And those were the words that came out of her mouth. So just know that if you don't necessarily feel immediate joy or if some adult language, as my children says, comes out in the context of the birth process, that doesn't mean there's anything wrong with you. It doesn't mean that you don't love your child in the moment. It can be tough. And sometimes that language is what best communicates what you are feeling at that time. Okay. All right. Now the next two things are just sort of I'll say interesting, crazy. Let's just get into it. Let's just get into it. Okay. So the first one is people sometimes put interesting things in their vaginas. The vagina is what's called a potential space, meaning that when there's nothing in it, the walls of the vagina are collapsed together it's closed, but there's a lot of room to put things inside of vagina of the vagina.

(09:27): Remember, a whole human being comes out of the vagina. So it has potential a lot of potential to expand. And I just want to say three of the most interesting things that I have seen people put in their vaginas are, one a light bulb. Yes, a whole entire light bulb inside the vagina, which can actually be dangerous because if it breaks and the glass is there, all of those kinds of things that can be challenging, lots of cuts and things like that. So a light bulb. Another one is candles. On more than one occasion, I've heard and seen candles, people place candles inside their vagina. And then the third thing that was quite surprising and interesting was a deodorant can in the vagina, a whole spray, deodorant can in someone's vagina. Now, sometimes there are some mental health issues surrounding this where people place things in their vagina that's can be a manifestation of mental health issues, but sometimes it's just people curious or they get pleasure from it.

(10:48): And then it's hard to get out. And let me be clear, you can stick whatever you want in your vagina, just because it's your vagina, it's your body. But just know that there can be some consequences from it. And sometimes things get stuck and they can be difficult to get out. But yes, those are three of the most interesting things that I've seen people place in their vaginas. Light bulbs, candles and deodorant cans. All right. The next one is kind of like again, I'm going to just get into it. I'm going to just get into it. People sometimes in the context of gynecology, obstetrics, pregnancy, have sex in interesting places at interesting times when at least two occasions. And I will say some of these things, a couple of these things are things gratefully that I personally have never seen, but some of my colleagues have or so I just kind of know about it.

(11:47): But some things, actually, most things I have seen, but this particular one, sometimes people have sex in the doctor's office. Not that long ago someone was, a friend of mine was telling me one of the ultrasound techs walked in and a couple after their anatomy ultrasound was having sex on the counter or people having sex in the exam room. And probably the most extreme and also most kind of skin crawling. One is we found a couple having sex in the closet in the labor and delivery room like a couple hours after she had the baby, which is my God, you know, just gave birth for goodness sakes. Now listen, I understand the appeal of wanting to, I guess, spice things up or have sex in different places or this, that and the other, but for real, come on in the exam room. Other people are in there, you know, got to go in and out, find someplace else.

(13:01): We're trying to get patients through, sex in the exam room, sex after the ultrasound, hold it together until you can get to someplace, go out to the car, do in the parking lot, I guess, if you know, really need to get it in that bad. But let's refrain from having sex in the exam room, please, and sex right after birth. That's just really a bit extra. A lot of things happen down there. Yeah, hold off on that. Hold off on that. Okay. So yeah, those are probably the most interesting, not probably. Those are the most interesting slash places sex in the exam room or sex right after birth.

(13:46): The next three are things that can happen with birth. One is a little bit more gruesome, and I should say most of the time when I write podcast episodes, I actually write them out in a fair amount of detail. But this one, I'm kind of just doing more so flowing with it a little bit. So just flow with me as I go through these things. All right. The next one is that I have learned that we cannot predict how labor will unfold. No one can tell you exactly when you'll have your baby, exactly when the baby will be here. If people are telling you things like that and they happen to be right, it is completely by chance and not because they were able to accurately guess it. We just don't have a good way of predicting how labor happens. And what I say, and I say that to say, is that you can go from being not very dilated to being completely dilated and the baby delivered.

(14:48): For some people that can happen in minutes. It's not very common that it happens. But I cannot tell you the number of times I have seen the number of times stories I've told or have been told to me where people were like, I was like five centimeters. And the next thing I know, I was like, I have to push. And the nurse didn't believe me and the doctor didn't believe me. And next thing, the baby's coming, things can happen very, very, very quickly sometimes. And that leads into the next one, which means that sometimes babies will come in unusual places, probably inside of the hospital. The place that is always a bit like you know, obviously don't want to happen is I have seen on more than one occasion a baby fall out into the toilet. Babies did fine, no problems, no issues, but things just happened so fast and baby just boop, plop right out into the toilet.

(15:47): I remember one circumstance, I could see it so clearly. I was sitting at the nurse's station and I knew that a patient was getting epidural. I had gotten called. They said, oh, this patient, she's getting epidural. And I forgot why they had called me to see her. But anyway, I was sitting at the nurse's station, I was waiting for the anesthesiologist to finish putting in the epidural, and the anesthesiologist walks down the hallway and she says, oh, well, I didn't have to put in the epidural because the baby is out. And I was like, well, if the baby is out, then why am I sitting here at the desk? Because I'm the one who was supposed to be there for delivery. So what in the world is going on? So I sprint to the room, I get in the room and the patient is standing in the bathroom.

(16:44): The umbilical cord is hanging down in between her legs. She looks like a deer in the headlights. The nurse had managed to get the baby and cut the cord, and they had taken the baby over to the warmer, but the patient was standing there with just looking completely what in the world just happened to me. So we got her over to the bed and everything was fine. But let me tell you, sometimes babies can come fast and a lot of people think, oh, if my labor comes fast, that is really good. It's great it you get it over with quickly. However, I can tell you it can actually be very overwhelming, feel very overwhelming when labor goes so fast, so furious that you don't have time to really process what's going on. It feels like you have no, no control. You can't see what's going on.

(17:54): You don't have control over anything, and it, it's so much is happening to you. And it can be really overwhelming for people when labor goes that fast. So back up and be too like, oh, I hope it goes super fast, because honestly, it really can be overwhelming. You already don't have a lot of control over the labor process, but when things go so fast like that, you can really feel like you have no control. And this kind of also speaks to, of course, there have been lots of babies, people who've come in, and I shouldn't say lots, but well through my 20 year career, a fair amount where babies are born in the car, that kind of thing on the way to the hospital, that does not happen very commonly. Certainly doesn't happen very commonly for first time moms, most often as moms who've had babies before. But when it does happen, babies, they're going to come when they come and when they come fast and furious like that, they're just going to come fast and furious like that. And things tend to be fine. But again, don't always think that it's great for babies to come quickly because it can really be overwhelming. All right, the next one is a little bit gruesome. I don't want to scare you. So if you want to skip this one, hit fast forward a little bit.

(19:10): Women, after having a baby, or in the context of pregnancy and pregnancy issues, bleeding can happen so fast and it can happen so extensively that it's really jarring to be honest with you. It can be to the point where it literally looks like someone turned on a faucet inside of someone's uterus or vagina, and blood is just pouring out a couple of times. I remember one was a patient who was transferred from a home birth for having significant bleeding postpartum, and she was bleeding like nobody's business. I ended up having to give her something like 12 units of blood. It might have been more than that. She ended up being fine, but it can be very, very, very serious. That's one of my concerns about home birth is that you don't have all of the resources and things that we have in the hospital to handle those emergencies.

(20:20): This particular patient got to the hospital very quickly and things ended up being fine. And that's what you want in those circumstances, but you just have to be careful. And then the other probably biggest one, not probably was biggest one, was the biggest one is when there was a patient with placenta previa. Placenta previa is when the placenta is covering the open of the covering the cervix. So it's covering the opening of the cervix. And the issue with placenta previa is that it can have a lot of bleeding. The placenta has a tremendous amount of blood that is going through it during pregnancy in order to support the pregnancy and grow the baby, and all of that blood flow happening right over the cervix. If things are stirred up or if labor starts, there can be a significant amount of bleeding and it can be a significant amount of bleeding that happens quickly.

(21:11): All right, so it's always interesting to me when people ask when they have a placenta previa, is it possible for me to have a vaginal birth? And I absolutely, unequivocally, no, you should not have a vaginal birth because you could very well bleed to death, or your baby could have significant bleeding as well. And in this one particular instance, this patient had placenta previa. She had been to the hospital. She was in the hospital because if it keeps happening, you have to stay in the hospital. And the nurses call me because she was having bleeding and she was having so much bleeding that you could hear the blood running off of the bed and down onto the floor. It sounded like a faucet of water hitting the floor. And the patient looked at me and she looked me dead in my eyes, and she said, I know it's time.

(22:06): And I said, yes, it is. And we raced to the, or did an emergency C-section. Baby was fine, mom was fine. But in that instance, I can't tell you what that feels like, that sound of blood, that can happen very, very quickly. And I'll also say this is where hospital medicine, where we shine in the face of problems, we have a lot to do in terms of supporting low intervention birth and not intervening in birth so much. We certainly have a lot to do with that, but I think where hospitals shine both for moms and babies is problems. And that is where our skills come in handy for sure. So we can move very quickly and mobilize very quickly. Well, we should be able to, because honestly, sometimes people don't mobilize quickly enough in the face of postpartum hemorrhage. It's actually one of the reasons that a leading cause of maternal mortality is when we don't take postpartum bleeding seriously.

(23:11): But in general, hospitals are most equipped to deal with those type of emergencies. But I'm just trying to give you a sense that it can be really, really serious. And the amount of blood that goes through the uterus during pregnancy and what can happen is really, really impressive, for lack of a better word. Okay, last three things. Number one or no, no, no, not number one. What are we at? Seven, eight, no, eight. This is number eight. Okay. Number eight. I've learned that I have to be careful about how I say things. People will interpret things differently. I have to remember, I have to be reminded sometimes that I do this all the time and things that are normal to me are not normal to you because you haven't seen it before. And sometimes I have to remind myself of that and be careful about the way that I frame things or approach things or react to things.

(24:07): And the way this came into play was a patient came to labor and delivery. She was having contractions and in labor, and she asked if Tylenol would help with the contractions. And I just sort of giggled and said, no, Tylenol is not going to help with these contractions at all. And so a couple things come up with that. Number one, I was interpreting. My giggle was more if only in my head it was more like, if only Tylenol could help with labor pain, then that would be fantastic, but that ain't going to cut it right? So I wasn't laughing at her. It was more just like, no, Tylenol is not going to do anything. But she interpreted that as me poking fun at her about asking if Tylenol would help her contractions help her labor pain. She actually wrote a letter to the hospital. Now, she complained about a couple of things during her hospital stay, but that was one of the things that she mentioned.

(25:13): And I certainly didn't mean to laugh at her at all, or I wanted to make her feel like she was, I didn't want to make her feel bad at all. So I felt horrible about that. But a few lessons that I learned from that, it's again, I have to be careful about how I say things and how it's interpreted, especially as a hospitalist, because I don't meet people until they're in labor. So they're just meeting me for the first time then. But I also want to say that it brings up that if she were more prepared and had done childbirth education and knew something about the labor process and new options for managing pain and labor, then she would have known that Tylenol probably was not going to do much for labor pain. So that goes to being more prepared and educated about the labor process and what to expect.

(26:04): I think that's really, really important. And actually, her lack of knowledge about what to expect in the labor process, that was also manifested in some of her other things that she talked about. She talked about how her doctor wasn't there very much during the birth, how the doctor wasn't present. And that is the way labor works in the hospital. Your doctor really only comes in maybe one or two times, two or three times at that. It's not common that your doctor's going to be at the bedside. It's going to be your labor nurse who's there, who's the one that's supporting you during your birth, not your doctor. They may be in the office seeing patients. If it's during the nighttime, they're probably asleep trying to get some rest. So it was some things in her experience were reflective of a lack of knowledge about what to expect.

(26:54): And that's why, again, I say childbirth education is so important. The Birth Preparation Course definitely helps to, or not definitely it help. It teaches you about what to expect specifically in the hospital and how those things work. Again, the Birth Preparation Course is drnicolerankins.com/enroll where you can get all that information. And then the final thing that I want to say about that story is that I appreciated her writing and telling about her experience. We have no way of knowing about things and what we do that impact you if you don't tell us. We can't see that in the moment. So I know that it can be challenging to find the time to write a letter, to make a phone call, all of those things. But it really does help in terms of a couple things. One, it can help you feel better about, you've done your part to get it out of your chest.

(27:50): You've talked off your chest, you've talked about it, you've made it known, you've expressed your concerns. But for those of us, and many of us who I think want to do better, when we hear those things, we listen and we take into account, we value constructive feedback about how we can get better. Remember, we are humans just like anybody else, and we are not perfect, and we can't get better unless you tell us about some of the things that we're doing. So if you have some experience where you feel like you weren't treated well, or you had a concern about something, do take the time to provide that feedback. Be as specific and detailed as you can. Also focus it on how you felt in the moment.

(28:33): If it was clear that you know, felt like the doctor was rude or dismissive, say those things. But also talk about how you felt and what that meant to you with the interaction means to you. Because again, we can't get better unless we hear the feedback. Okay? Number nine is, I've said this before on social media, but I'm just going to say it here. I have been, I've had blood splattered all over me. I have had amniotic fluid go down into a splash, go down in my shirt, into my bra, go all the way down to my socks. I have had people pee on me before while pushing, and they're pushing everything. And pee comes out too, and arced right over onto my scrubs. I have had people pass gas in my face while I am repairing their vagina. All of those things. I've seen tons of poop during labor.

(29:39): That happens really, really commonly. But the thing that really, and all of those things are like, that's just part for the course. That's just part of the job. But the thing that really I do not do well with, and that is vomit. I don't know why y'all, but the sound of it, the look of it is just like, oh my God, my stomach curls and I just have to quietly back out of the room. Now I do a good job of not showing it on the outside, I think, but I will say, Ooh, you know what? Let me go get your nurse. Let me get her to help you get cleaned up. I will tiptoe out of the room so fast when there's vomit because I don't know, it just gets me, the rest of the things don't get me, but vomit just gets me.

(30:33): I remember one instance where this girl vomited and she must've had Mexican, she had beans or something, and it was beans all in her hair mixed in with the vomit. Oh my gosh. So I can deal with blood, I can deal with gas, I can deal with amniotic fluid, I can deal with pee. I can deal with poop, but vomit. That one gets me. Okay. And then the final one that I will say that I have seen, which is interesting, and that is I have seen people come in with a notarized birth plan. Yes, a notarized birth plan. And on first glance, when you hear that, it's like, why are you notarizing your birth plan? What is going on? And I realized that it reflects an attempt to make it be official, make it feel official, okay, that you're serious about this. All right? But in actuality, of course, that doesn't do anything.

(31:39): It's just really someone saying what notarization is. It's your signature. And the other person is saying that it's their signature. It doesn't add any legal weight to it. It doesn't do anything really. So what that reflects, I think, is an attempt to, again, convey that this is serious and important to you. Well, let me tell you, the way to really make this the most serious or make sure that people pay attention to your birth plan is not to do something like notarize it. Really, it's to talk about it during your prenatal visits and make sure that the doctor and the hospital are on your side and supporting what's in that birth plan. You have to ask some questions to do that. So I think sometimes people want, and understandably so, I don't want to say an easier way, but for it to be straightforward, like, well, I've done this and it feels like they've done something too.

(32:40): I've got it notarized and I'm coming in, that kind of thing, when actually that stuff doesn't do or mean anything in terms of helping you to have the birth that you want. And it sets up kind of a weird dynamic with the healthcare team. So really what you want to do to approach making a birth plan to get people to really understand it and pay attention to it, is talk about it during your prenatal visits. And so that when by the time you get to the hospital, it's not a big deal. That's something that I talk about in my birth plan class. Make a birth plan the right way. I only do that live periodically throughout the year. So you can sign up for that at drnicolerankins.com/register to know the next time when it comes, or if you're ready to hop in right now. I also teach you inside the Birth Preparation Course, and that is drnicolerankins.com/enroll.

(33:29): All right, so the 10 things that I have seen that have been interesting things to me throughout my career are asking for an epidural from the car. Someone calling their baby a little shit right after it was born. People placing interesting things in their vagina like light bulbs, candles and deodorant cans, people having sex in interesting places like in the closet right after birth or in the office. You can go from not being dilated to baby being delivered in minutes. Labor can happen quickly. Babies being born in the toilet or interesting places, blood can come very quickly, can sound like a faucet hitting the floor blood, hitting the floor running. It can be very, very dramatic on number eight, I have to be careful about how I say things because it can be interpreted different ways. And in that context, if you have had a doctor that says something to you that you didn't appreciate, then definitely speak about it.

(34:36): Number nine, I hate vomit. I just can't, don't like it. And then the last one, people have me notarized birth plans and what that means. Okay, let me know on Instagram, which one is the thing that is craziest. I'm on Instagram at Dr. Nicole Rankins. Which one sounds like, oh my goodness to you. Or if you have an experience or something crazy during your labor or friend's labor or something like that, please share the story. Let me know on Instagram, DM it to me again. I'm there on Dr. Nicole Rankins. All right, so there you have it. Do me a solid. If you enjoy this podcast, share it with the friend, sharing us caring helps me to reach and serve more pregnant folks. Also, be sure to subscribe to the podcast wherever you're listening to me right now, and come follow me over on the gram. I'm on Instagram at Dr. Nicole Rankins. We can continue the conversation from here. And don't forget to check out the birth preparation course, my signature online childbirth education class that will get you calm, confident, and empowered to have a beautiful birth. So that's it for this episode to come on back next week. And remember that you deserve a beautiful pregnancy and birth.