Ep 258: Jodi’s Birth Story – Forceps With No Pain Medication

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For many parents, selecting where they’re going to deliver is an important part of the planning process. However, Jodi lives on a small island with only one hospital and didn’t have a choice in the matter.

Though she and her baby are healthy, the birth was intensely challenging. Jodi’s pain went under-treated and many procedures were done without adequate communication. While I want to acknowledge that rural and remote medicine is complex, the pain Jodi suffered is unacceptable.

In this Episode, You’ll Learn About:

  • How long it took to get from Jodi’s home to the hospital
  • How her “advanced maternal age” affected the care she received
  • Why she was unable to leave the bed during delivery
  • Why doctors were in a hurry to get the baby out
  • How doctors could’ve done a better job of communicating
  • Whether forceps are still commonly used
  • What it was like for Jodi to experience an episiotomy & forceps delivery without adequate pain management
  • What steps were taken to deliver/remove the placenta

Links Mentioned in the Episode

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Dr. Nicole (00:00): In this birth story episode from Jodi, she shares what it's like to give birth under circumstances where you don't have a lot of options available to you. I have to say that this was a difficult story for me to hear.

(00:19): Welcome to the all about pregnancy and birth podcast. If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies. I'm Dr. Nicole Calloway Rankins, a practicing board certified OBGYN, who's had the privilege of helping well over a thousand babies into this world. I've been a doctor for over 20 years, and I'm here to help you take back your power, advocate for yourself, and have the beautiful pregnancy and birth that you deserve. This podcast is for educational purposes only, and it's 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 258. Whether it is your first time listening or you have been here before, I am so grateful that you are spending some of your time with me today. Jodi is a relatively new registered nurse. She started her career in the spring of 2020 during the height of Covid, her first nursing job was on a medical surgical floor at the one and only acute care hospital on Maui, where she stayed for just over a year before making the transition to working for a local nonprofit hospice agency where she has been ever since. Jodi has lived on Maui for 18 years in a small town called Laina. You may recognize that as it was in the news recently for the devastating wildfire that took place there on August 8th, 2023. Now, Jodi listened to many, many birth stories on this podcast, and she would hear that for many parents selecting the hospital where they choose to give birth was an important part of their birth plan.

(02:09): But for her, she lives on a small island with only one hospital that's over an hour drive. So for her, she had this element of not being able to control that aspect of her birth, and she had to accept that she would not have certain options that were available to her that are often available at larger hospitals. She did have a birth plan, but she never anticipated that her labor would progress so quickly, and even though she wanted to avoid an app episiotomy or any type of assistance to bring her birth, all of that went out of the window when her baby was in distress and her baby had to get here quickly. She ended up having an app episiotomy and a forceps and vacuum birth with no pain medication. And then after birth, her placenta had to be removed hand manually in pieces, and that took over an hour.

(03:03): And again, that was also without pain medication. This was a very hard story for me to hear that she had to endure so much without pain medication because it really doesn't have to be that way. However, Jodi felt that because she went into her birth with an understanding that things may not progress according to her plan, and she gave herself permission to accept interventions that she may not have anticipated wanting or needed that helped her to remain pretty calm and focused during what was a difficult vaginal birth. I promise you, you are going to learn so much from Jodi's story today. Now, Jodi mentioned that she had a birth plan, and I would like to invite you to come make a birth plan the right way in my live free class on May 20th at 7:00 PM Eastern standard time. In it, we actually do talk about some of the things that can be done when you have limited options, so I highly encourage you to join the class. It's a fantastic class, folks. Love it, love it, love it, and I love teaching it live. So join me on May 20th. You can register for the class at drnicolerankins.com / birth plan. All right, let's get into the birth story with Jody.

(04:28): Thank you so much, Jody, for agreeing to come onto the podcast. I'm excited to have you share your birth story today.

Jodi (04:34): Well, thank you so much, Nicole. I'm very happy to be here too.

Dr. Nicole (04:36): Yeah, so why don't you start off by telling us a bit about yourself and your family?

Jodi (04:41): Well, I am 39 years old, and I was 38 when I had my son. He was my first and only baby right now. He's now 15 months old. And so we live in Maui, Hawaii. We actually live in Laina, which you guys, some of the listeners might have remembered was in the news about six months ago. We had a really, really devastating wildfire here. We're fortunate in that our home was spared. We live about eight to 10 miles from where the burn zone was, but it really just completely destroyed our whole town, unfortunately. And so my boyfriend and I, we've both lived here for almost 20 years. Oh,

Dr. Nicole (05:26): Wow, okay. And

Jodi (05:27): So we've really made this our home and like I said, we just have our one son. He's 15 months now, so he was born in November of 2023. Okay.

Dr. Nicole (05:37): Okay. All right. And has the town started to recover from the wildfires?

Jodi (05:44): It's really, it's going to be a very long, slow process. We just had the six month mark on February 8th, and really we only are in the very beginning of the cleanup phase. So I think for anything to actually be rebuilt could be many years down the road. Some people are saying it could be anywhere from five to 10 years until the town is actually back to what it may, it'll never be back to what it was, but yeah, still a very ongoing struggle out here.

Dr. Nicole (06:14): Oh, goodness. Goodness. Yeah. Well, if you have any resources or things where folks can help, then please feel free to share. I don't know if there are any organizations or things or do you know of anything?

Jodi (06:28): I know the Lah Strong movement is a really good local movement. I'm sure they do have a presence on social media, on Facebook, so they're sharing the ongoing issues that are still coming up as far as housing, which is really the big one. I mean, there's still lots of folks, thousands of people living in hotels at this point, no end in sight. So I think the LA is strong movement would be a good one that people could maybe look at and see some of the issues.

Dr. Nicole (06:56): Okay. Well, we will put that link in our show notes. Oh, thank you. Well, I'm glad to hear that you weren't affected by it. And I'm also glad, as I said, for you to come and share your birth story. So in order to understand what happens with the birth, we got to understand what happens with the pregnancy. And I think a little bit, your story also is important because you were in a little bit of, in a different environment in terms of the choices that you had available to you. Yes. So why don't you start off by telling us a bit about your pregnancy and your prenatal care. What was that like?

Jodi (07:28): Yeah, I had a pretty, I don't know, uneventful pregnancy. I feel like I was pretty luckily as far as I didn't have any complications starting off first trimester. I had a little bit of, not even morning sickness, but just sort of ongoing. I would describe it as car or motion sickness throughout the day, just feeling generally really tired and just kind of that queasy feeling. But I never threw up or I never had anything that was to that extent. So I was pretty fortunate in that. And then really once I hit the second trimester, I think I just had a lot of the normal discomfort, but nothing that wasn't tolerable. I was able to continue working the whole time. And then fortunately with all my prenatal appointments, everything was normal. It was just a lot of the risk factors that go with being 38 and having it be my first pregnancy. They really just put me into sort of, I guess a different level of care as far as being advanced maternal age. But other than that, I really felt pretty good throughout most of my pregnancy. Okay.

Dr. Nicole (08:42): Okay. Were you otherwise healthy other than being advanced maternal? Yes.

Jodi (08:47): Yes. I don't have any other risk factors or anything going on. It was just my age, really.

Dr. Nicole (08:56): And how did they make you feel, I should say, about

Jodi (09:00): Being the provider with 35?

Dr. Nicole (09:01): Yeah,

Jodi (09:03): It really depended. So I have Kaiser for insurance. They're a large network out here, so I saw probably eight different doctors. Each appointment was somebody different, and so I never really built that great of a relationship with any one of the OBGYNs. It was just always somebody different. And of course, I didn't know who was going to be on call when it came time to deliver my son. So it was good that I got to see each of them. Some of them were very supportive and just don't mind the fact that you're over 35, just we're going to go by what you feel and what's going on with the baby. And then others, I really felt like, especially when it got closer and I went to my final 40 week appointment, the doctor I saw for that visit, he really was pushing to induce me that day. And it was all based on just my age and was even, I remember I went to that visit the day before my due date, and he wanted me to go get induced that day, even though I wasn't really, everything was fine,

Dr. Nicole (10:14): Right? There were no

Jodi (10:15): Problems. I wasn't dilated. There was no problems. But again, he kept citing this one study, and I can't remember the name of the study, but there was something that he kept citing as the reason why I should go get Induced.

Dr. Nicole (10:28): Like the Arrive trial maybe? Yes. Yes.

Jodi (10:32): That was the one I remember. It's funny because it even got to the point where I told him during the visit that I was feeling good. I didn't want to get induced. I wanted to keep going. It wasn't even my due date.

(10:45): And you could tell he was kind of half listening to me, but not really hearing me. And then I got in the car and I drove away from my appointment and I'm feeling great, and I'm just in a good mood. And he even called me as I'm driving away from the appointment just to say, I just want to check in one more time. I'm going through your history. I really think that induction might be a good, something that we should really, really consider. I'm like, did you just call me after we just went over this?

Dr. Nicole (11:13): That's

Jodi (11:13): Crazy. But he did. Yeah.

Dr. Nicole (11:15): Interesting. I mean, what made you stand strong and say, no, thank you. I'm not interested.

Jodi (11:23): Just, I mean, because I was feeling great still. I guess at that point, I hadn't had any Braxton Hick. I had lost my mucus plug at that point, but he did do a cervical check at that visit. I wasn't dilated. My blood pressure was great. There was nothing, there were no concerns. And my birth plan, I knew I was going to have a hospital birth, but I was really hoping for low to no interventions. So I had no problem really just telling him, no, I am a nurse, even though my world is not babies at all. But I think just maybe having a little bit of that background going through nursing school, I just felt like, no,

Dr. Nicole (12:10): I'm good. Right. Okay. What kind of nursing do you do?

Jodi (12:13): Right now? I do hospice nursing, so I'm on the exact opposite end of the life

Dr. Nicole (12:19): Spectrum. You are on the exact opposite. Very important work though. Anybody who's called to do hospice work, I feel like is always special a calling. I don't think that's something that you just kind of flippantly decide to do. Yeah. So what did you do to prepare for your birth?

Jodi (12:40): I listened to a lot of birth stories, and I listened to your podcast a lot. I came across your podcast. I think I was listening to somebody else's podcast that you were a guest on, actually. And so I just liked your approach to things. I felt like you offered both the sort of regular hospital route being a background as an md, but you also were open to hearing the alternative side of things. And where I felt like most podcasts were either one or the other, either full home birth, that whole route or full hospital wasn't open to

Dr. Nicole (13:23): Both.

Jodi (13:24): So I listened to your podcast a lot and birth stories, and really that was mostly it. I thought about having a doula at one point, but I just thought that I'd be able to do it on my own. Okay.

Dr. Nicole (13:37): Okay. All right. Well, what are some things that you wanted for your birth?

Jodi (13:40): Like I said, I knew I wanted to have a hospital birth. I wanted to avoid a C-section. I feel like a lot of mothers do. I didn't want to have any pain meds if possible. I wanted to be able to move around freely if possible. But other than that, I was really open to just kind of seeing how it goes, how it went, and I think that actually helped me when it came time to give birth, because things didn't go perfect as planned, and they never do. Or maybe they do sometimes, but often they might not. And so I think that was actually helpful. And I remember at one point I was like, I don't really want an iv. I don't really want to be connected to anything. And then one of my friends who works in labor and delivery, she's getting a little fluid sometimes is really not the worst thing when you're giving birth. And I'm like, yeah, she might be. So I kind of was open to what would come. Okay.

Dr. Nicole (14:40): Okay. So was there anything that you were scared or worried about?

Jodi (14:44): Honestly, a c-section was probably, I was really scared about that. Just the idea of having, I don't know, just something about the possibility of a c-section was really what scared me more than the pain of having a vaginal delivery without any pain medicine on board. I don't know

Dr. Nicole (15:06): Why. Gotcha. I mean, that's totally normal. I mean, it's a surgery, it's a big surgery, so totally normal to be concerned about it. And I should ask, what did you do? How were you planning to manage pain? Were you going to do, what were your thoughts on that?

Jodi (15:25): Just breathing techniques that I kind of looked into a little bit. Just really, I remember when I was having contractions, I was able to, even if I was really tense in my upper body, like gripping the railings or needing to just feel tense in my arms, I was really focused on just staying relaxed from the waist down. And somehow I do feel like I was able to do that throughout most of the contractions. I think that helped it. I did dilate pretty quick once I went into active labor. I don't know if that had anything to do with it, but just my breathing techniques is what helped. Okay.

Dr. Nicole (16:06): Okay. Alright. And yeah, people don't realize it's really hard, or I should say people don't necessarily understand how powerful breathing can be in terms of helping you manage things that come up in your life. Really. It's really hard to stay tense if you're focused on relaxing your breathing. It's hard to keep those two energies together. So breathing is a really powerful and important thing that I think is underutilized for sure.

Jodi (16:33): Yeah. Yep. Yep. It helped.

Dr. Nicole (16:36): Let's get into what was your labor and birth? So how did everything go?

Jodi (16:42): I guess I should start by just saying a little bit about how things work here at Maui. It might be a little different. In a lot of the podcasts, I heard mobs when it came time to pick which hospital they wanted to go to, just trying to see which hospitals offered what type of interventions. And here on Maui, we only have one hospital, so it took a lot of the, I knew where I was going to deliver. There was no alternative. And then the hospital is an hour from where we live. So just kind of keeping that into the equation too, knowing that we would have at least an hour drive to get in there.

Dr. Nicole (17:22): Gotcha. Yeah. Were you scared? I mean, obviously you're not the only person who gives birth there, so people are sort of used to it, but still, how does it make you feel? I got a whole hour before I'm going to get to where I need to go.

Jodi (17:39): I felt like it was my first, I knew maybe I would have a little bit more time. I do know people who live in the area where I do, who went to the fire station and didn't make it to the hospital seriously, and gave birth over here. So I have heard at least two stories of people not making it, but I know a lot of people have an hour commute probably to commuter drive to the hospital. I know it's not uncommon, but it was just something in my mind having to prepare for that. And then just knowing that I might be having really intense contractions in the car for an hour and not really being able to move around. So that kind of made me a little nervous, but it wound up being okay. The drive wasn't an issue at all. Okay. And so I was due on a Friday, and like I said, I went to that appointment where they were really forced trying to push me to get induced that day.

(18:35): I didn't dilated at all at that time. I wasn't having any sort of Braxton Hicks at that time or any contractions. And then that Sunday night, probably around 11 or 12 midnight, I started feeling contractions, but they would maybe come anywhere from five to 20 minutes. So I knew they weren't regular, and some of them felt intense, but some of 'em I could rest sort of comfortably through. So I didn't wake up my partner at that time, I just figure let him sleep. I was up pretty much that whole night though. I don't think I slept at all. And so then Monday morning came and I told him that I had been awake all night having contractions, and I called my doctor and they said, why don't you come in and get checked and we'll see how things are going. So I went in and got checked again, hour drive, and I was dilated. She said I wasn't really dilated at all, but when she did the check, I kind of like, she almost dilated me to a centimeter.

Dr. Nicole (19:41): I don't

Jodi (19:42): Know. She said, you were right there. And then she did the check and it kind of opened up a little bit, but really not dilated at all. And so they did an NST, is that what it Yep. And everything was okay with the heart rate and everything. And so she said basically just go home and act like you're 35 weeks pregnant because you could still go like this for days. We don't really know. So that was a little disheartening because I was still having contractions and I was not hoping to still have days like that. But we went home.

Dr. Nicole (20:20): Did she offer you the option to stay and be induced or anything like that? Nope, not

Jodi (20:25): At that point. They pretty much, and I don't even think I saw a doctor at that visit. I think I just saw a nurse.

Dr. Nicole (20:31): Got it, got it, got it. Okay. Okay. That's probably why, because I'm guessing a doctor would've maybe said, just try to stay and be induced, but yeah. Okay. So that makes sense. Okay. So you ended up going

Jodi (20:46): Home? I up going home, same thing all that night. So this is Monday night now, had contractions, they felt a lot worse at night. I don't know if that's a thing or if it was maybe just because I wasn't distracted by anything. So again, Monday night had contractions most of the night, and then Tuesday just stayed at home or stayed close to home. We went to the beach that day, just tried to relax. And then Tuesday night, or Tuesday evening, around five o'clock is when I could tell the contractions were becoming more intense closer together. I was using a contraction timer, so I knew, okay, we're looking at now, they're consistently every five minutes. It kind of felt like Tuesday night is when

Dr. Nicole (21:33): Things

Jodi (21:33): Really, it became real. Okay.

Dr. Nicole (21:36): You're like, okay, now this is what they meant when they said that things were going to be intense. Gotcha. Gotcha. So when did you go back to the hospital?

Jodi (21:44): So we went back to the hospital Tuesday night, around nine. I called the nurse and spoke with her, told her what's going on. She told me to come in. And then we got to the hospital maybe between nine and 10 on Tuesday night. And then when they checked me in, I was already dilated to a six.

Dr. Nicole (22:00): Okay.

Jodi (22:00): All right. So that was reassuring. I was like, okay, this is something now.

Dr. Nicole (22:05): Yeah. Okay. So then it was like, all right, it's go time. Yes. And then what happened from there?

Jodi (22:11): So they hooked me up to the toco, to the monitor, started my iv, and then just kind of had me relax for a little bit. Like I said, she checked me. I was a six. My water still hadn't broken, but the nurse just kind of left and let me do my thing in the room. The doctor came in shortly after and offered me an epidural. I told him I wasn't really interested in it. He said, the anesthesiologist is here on the floor, we can do it now. I said, no, I'm okay. And so I did ask the nurse, I think shortly after that if I could take the monitor off and walk around a little bit. And she told me that because my son's something with his heart rate, she really didn't feel comfortable having me not on the monitor. And then they gave me, because of his heart rate, she did wind up giving me some fluids at that time, like a liter of fluids just to try to, I'm not really sure what, yeah. So she gave me some fluids in my IV and just told me I needed to stay hooked up to the monitor. Okay.

Dr. Nicole (23:17): Okay. So then how did things progress from there? I guess I should say at least. Did you have any mobility in the room?

Jodi (23:27): To me, it was really hard. I mean, with the monitor on, I couldn't get out of the bed, I guess. I don't know if I could have, to me, the monitor was really uncomfortable because even if I would just try to shift, those bands would just go into the wrong position. So I really, honestly, from the second I got to the hospital and I was in the bed, I did not leave that bed until my son was delivered. I never once got up and walked the hallway or used the bathroom or anything. Okay.

Dr. Nicole (23:57): I

Jodi (23:57): Was in the bed the whole

Dr. Nicole (23:57): Time. Okay. Alright. That was tough when you're trying to manage labor without medication, I'm sure. Yeah.

Jodi (24:07): I mean, I was able to shift. I remember she kept having me go position me on my side, I think because he was having frequent decelerations with each contraction. So she kept trying to do position changes with me. But yeah, it was hard just to be in the bed

Dr. Nicole (24:27): The whole time. Yeah. And did they offer for you to maybe sit on a birthing ball or anything like that? Nope. No. Okay. That's unfortunate.

Jodi (24:36): I feel like we have the peanut called

Dr. Nicole (24:39): The peanut. Yeah, the peanut.

Jodi (24:41): I think our hospital had those and maybe we had birthing balls too. I didn't see one in the room, but it was definitely never

Dr. Nicole (24:48): Offered, brought up, offered up or anything. Okay. Alright. Alright. Yeah, that's tough. So then how did things proceed after that?

Jodi (24:59): So I think because of his, again, they just kept mentioning his heart rate as being concerning. So the doctor came back in the room and he wanted to break my water to try to get the birth going, to try to speed things up. He said, we really need to work on, we need to work on getting this baby out, so let's break your water, which I agreed to. I said, okay, I'm okay with that. So he did, and I don't really remember the contractions or anything changing that much after he broke my water.

Dr. Nicole (25:31): Okay. And how long had you been there? I

Jodi (25:34): Want to say maybe two hours. It gets kind of rough, but yeah, roughly I think maybe two hours.

Dr. Nicole (25:40): Okay. And had you dilated more at that

Jodi (25:42): Time? I was still a six as far as I know. Gotcha,

Dr. Nicole (25:46): Gotcha.

Jodi (25:46): Okay. Or maybe, yeah, he didn't mention anything about that, but he broke my water and then he did offer me an epidural again. And he explained to me, he said, the way things are progressing, there is a chance that you're going to need a C-section. And he said, if you don't have an epidural, then you'd be looking at general anesthesia. Your partner or dad can't be in the room. We're looking at more of a surgery surgery where if we do an epidural for you now, and we do have to do a C-section, at least you can be awake and dad can be in the room. And that scared me because like I said, the C-section thing was always something I was really scared of in general anesthesia just, I don't know, the idea of it just really is scary to me. But I still said no, I felt really pretty strongly about not having an epidural. So I said, no, I understand the risks of not getting it. But yeah, I declined it again. Okay.

Dr. Nicole (26:46): Okay. All right. So then how did things, and I should ask, had you gotten any sleep at

Jodi (26:50): All? No, not since Saturday night probably. I mean, I slept off and on, maybe a little bit on Sunday night, maybe a little bit on Monday night. But now we're into Tuesday, one in the morning. I really did have 48 hours of contractions at

Dr. Nicole (27:06): Home

Jodi (27:07): Before I even went to the hospital.

Dr. Nicole (27:08): Gotcha, gotcha. Were you

Jodi (27:11): Tired? I think just because of everything going on and the pain and the adrenaline. I mean, I was in it at that point.

Dr. Nicole (27:19): So he broke your water, and then what happened after that?

Jodi (27:23): And then he left the room and he kind of left me just to, again, I was having contractions. I remember I was laying on my left side, just gripping the bed rail with both hands, just kind of riding out the contractions with my partner in the room. And then I remember at one point when it came time to deliver the baby, the lights were off and it was just the two of us in the room. And then all of a sudden full lights came on in the room. And then the doctor, my nurse, and I don't know, probably a total of eight people all just came in the room at once. And the doctor said to me, because they were watching something with the heart rate and he was having frequent, I want to say late decelerations, he said that they really needed to get the baby out. Now, I dunno why it became, and so it was kind of an intense moment. Like I said, the lights were kind of damn and the two of us, and then all of a sudden was like

(28:24): Everybody was there. Even a pediatrician came in the room too. So yeah, so he checked me and I was a nine and a half. He said, you're not quite 10 centimeters, but you're going to start pushing. And so I was like, okay. I was ready at that point. And I remember the way that he phrased it was actually, it stuck with me. He said, you're going to curl up and around your baby and you're going to push down. And for whatever reason that clicked, it made sense to me what he was saying and the way I needed to push.

(28:56): And so I started pushing. And I don't know at what point during pushing, he told me I was going to need to have in a epitomy, which was something that I really wanted to avoid, but I feel like it wasn't even a discussion at that point. There was no, this is why you're going to need one. Or even giving me the option to maybe decline it. He just was like, we have to get the baby out, and so going to, this is what I'm going to have to do. So I just kind of went along with it. I was like, okay, you do what you got to do.

Dr. Nicole (29:29): So do you know how long you had been pushing at this point?

Jodi (29:32): I don't think I was pushing for very long. I would say not an hour, maybe an hour, maybe an hour.

Dr. Nicole (29:44): And so then he says he recommended an app episiotomy, but with no anesthesia?

Jodi (29:50): No anesthesia, no. I mean, he did a local, of course, anesthetic. I'm assuming he did. I didn't really feel it. So I think he did a local, but still I had the app episiotomy, which I really didn't want to have, but it happened. And then shortly after that, I kept pushing and everything. I mean, again, this is my first baby, so I don't know what's normal or not, but I just felt like the energy in the room was just so intense. I mean, I had nurses, nurse aide, doctor, everybody was just screaming at me with each contraction to get the baby out. And I don't know if it was, he did wind up having the cord wrapped around his neck twice. So I'm not sure if that's why it became what felt like an emergent situation. So the epitomy happened and then the doctor ended up having to use forceps for my delivery for pretty much, I mean, it felt like he started using them early on in the contractions. And so that part was just, it was just awful forceps delivery without any pain meds. It was pretty bad. It was really painful. Yeah.

Dr. Nicole (31:05): Okay. Oh wow. Okay. Did he say why? I mean, was it just, we just need to get the baby delivered?

Jodi (31:14): It always felt like it all came back to his heart rate and that we needed to get the baby delivered to avoid a c-section. But to me, that was always the conversation. That was my understanding.

Dr. Nicole (31:27): Sure.

Jodi (31:28): But it just felt like, so there was just so much pressure for me to push him out and get him out. And then, like I said, the forceps was just, I mean, he used them with each contraction. I would push three times, and so it felt like with each contraction he was using the forceps. I could feel what felt like just being ripped apart. Honestly. It was very, very painful.

Dr. Nicole (31:55): Okay. So do you know when he mentioned the forceps and when he mentioned the episiotomy, which one came?

Jodi (32:04): The episiotomy? Definitely, he mentioned it first just to create more space, I think was kind of what he said. Create more space to get the baby out. And then the forceps was mentioned. But again, I feel like everything just was happening so fast that I didn't really get to ask if it was really necessary. I just felt like there was a lot of, like I said, pressure for me to get the baby out.

(32:31): Sometimes I have to wonder, because one of the nurses at one point came in and I heard her kind of giving the doc a little report on the side that they had gotten another call that a mom was coming in and she was either a scheduled C-section or they knew she was going to be a C-section. So I don't want to think this of the team, but I'm like, I wonder if knowing that another mom was coming in, if he was the only doctor on call, did they try to quick really hurry up my delivery? I don't know. That's just,

Dr. Nicole (33:04): Yeah, I mean, you hate to think that, but Oh goodness. Okay. So then, I mean, typically we only use forceps over about three contractions, I mean, at the most. Oh, interesting. Yeah. So I don't know. It is just hard to say what happened in your own situation without seeing, but you felt like,

Jodi (33:27): I felt like he used them with each contraction. I think so. Again, hard to say because it was just, now I'm going to ask my partner then if he remembers, because he said it was just kind of shocking for him too, to see the four steps,

Dr. Nicole (33:45): And I dunno

Jodi (33:46): How they're being used.

Dr. Nicole (33:47): Was this an older doctor or?

Jodi (33:49): No, he was a younger doctor. Is interesting though, because my postpartum nurse said that of the care team, the eight Kaiser doctors, he is really the only one who uses, who he's ever seen use forceps.

Dr. Nicole (34:06): Okay. I was scared to say because not a lot of people use forceps so much anymore.

Jodi (34:11): And that's what then when I saw the doctor, I saw postpartum was not the doctor who delivered my baby. It was a different doctor who had come on at that point. And she told me too that she doesn't use them. She said that it's really because a lot of doctors don't feel comfortable with it. She said, the doctor who delivered my son, he feels comfortable and he can use it. An extension of his hand is the phrase she used.

Dr. Nicole (34:39): But

Jodi (34:40): I still, I've never talked to anybody who's had, none of my friends or people I've talked with has had a forceps delivery.

Dr. Nicole (34:46): So yeah, it's not, most more doctors use vacuum as opposed to forceps. I

Jodi (34:54): Had that too, but I didn't know I had a vacuum until the day after postpartum. Wait, what postpartum? Yeah, he used the vacuum as well, but I had no idea that I had the vacuum at the end is what they said.

Dr. Nicole (35:08): How did you find them

Jodi (35:09): Out? The doctor who came in and saw me the next morning, she was just telling me a little bit about the birth and she said, I see you're a surgical. She called it a surgical vaginal delivery. You had forceps and a vacuum. And I'm like, oh, I didn't even know that I had a vacuum. Nobody told me while I was giving birth, and I didn't feel that part of it. I dunno. But yeah, that never came up in the delivery room. And then my partner, he said, he was like, oh, yeah, yeah, they did use that at the very end just to bring him out all the way, but I didn't know. Okay. They never asked me about that. Right,

Dr. Nicole (35:45): Okay. Wow. Okay. So it's unusual to use both, is it? Yeah, it's not typical. I mean, that would be, doing a C-section at that point would be extremely difficult. So sometimes we get into the decision of what's the best thing if the heart rate's down to get the baby out. So maybe, obviously I can't Monday morning quarterback what happened, but just definitely interesting. Okay. So baby comes out and you said he had a nuchal cord twice around his neck, but how did he look? Was he response?

Jodi (36:23): I think he was totally fine because he had the nuchal cord. I didn't get to do delayed cord clamping or have him on my chest right away. They pretty much just whisked him off to the corner where the pediatrician was. But he was totally fine. I mean, no concerns at all. His Apgar score was good. He was great.

Dr. Nicole (36:47): Did they bring him back to you pretty quickly?

Jodi (36:51): I'd say maybe 15 minutes or so. Not right away. It was not right away.

Dr. Nicole (36:56): Was he screaming or did it take a bit for him to cry

Jodi (37:01): Or No, no, no. He was crying. I mean, maybe not right away, but within the first minute he was crying, I could hear him. Right. But he didn't come back to me. Maybe it wasn't 15 minutes, but I feel like it was at least 10. It was not just a minute or two that he was with the nurse with them. Yeah. Okay.

Dr. Nicole (37:20): Yeah, no, I just wish we can resuscitate babies on mom's chest and that often helps. So we usually like to try and give it a chance on the chest, but Well, that's

Jodi (37:33): A shame to hear that stuff. Yeah,

Dr. Nicole (37:37): But it just goes to show, just we kind of practice in silos and people, hospitals just sort of get used to the way they do things and not realizing that there's a different way that things can be done, especially if it's just the one hospital, they're not going to see a lot of different ways that it's very easy to get into your own thing. Not that anybody's trying to do anything wrong. You just sort of get used to doing what you do. Let's talk about what happened with the placenta, because I know it was more after that. So what happened with that?

Jodi (38:15): Yeah, so the short of it is that I didn't deliver the placenta even with Pitocin. So I remember they brought my son back and he was on my chest and the doctor told me that he was going to start working on my repair, which took a long time. He said, when I asked him how many stitches I had, he said, it's a lot. We don't count, it's just a running stitch. But he said, I had quite a few internal and external stitches, so he was working on the repair. I had my son and then my IV had failed, so they didn't give me Pitocin in the IV to kind of stimulate contractions for the cent to come out, but they gave me an IM injection of Pitocin, and then nothing was really happening at that point. I think maybe a little piece came out or he tried to go up and manually remove it, but it wasn't coming out.

(39:19): They didn't give me any more Pitocin, just that one injection. And really, it's hard for me to tell how much time had passed, maybe a half hour at least while he was working on the repair and still the placenta wasn't coming out. So he told me that he needed to manually remove it or essentially scrape it out, which again, after having no pain meds at all, not even a Tylenol or anything, the forceps delivery, the app episiotomy, and then he scraped essentially the placenta out in small pieces. And I feel like that took at least an hour to do because it just wasn't coming out. And so he would push really hard on the top of my stomach or on top of my ears, be pushing, and then using what my partner said looked like a back scratcher, for lack of a better term. He said the thing looked like a back scratcher that

Dr. Nicole (40:23): He, it's called ID, it's called a banjo Curette. I know exactly what he's talking about.

Jodi (40:30): So it was pretty painful. That actually was almost just as painful as delivering my son just because I think of all the trauma that had happened down there. And at that point, I didn't have the adrenaline on board. My son was here and he was fine, so I was just feeling everything so, so much more. And it came out, I was kind of looking forward to seeing my placenta and this nice beautiful presentation and I mean, it just came out in little inch pieces kind of. Yeah. Oh my God, it's painful.

Dr. Nicole (41:07): Did they offer you pain medicine?

Jodi (41:09): No. I think she gave me maybe an Advil or something like that. They offered me at that point. Yeah, definitely. They didn't offer me anything stronger iv. They did start a new IV on me and just kind of hep blocked it. But yeah, they didn't offer me anything else, and I didn't ask. I know I could have asked for something, but I didn't. I felt like I was handling it okay. But in hindsight, just with all the pain that I had postpartum, I feel like it could have maybe helped, at least for those next 24 hours being in the hospital. The pain just, it lasted.

Dr. Nicole (41:56): I can't imagine. So then once everything was settled, then, what was the postpartum period for you?

Jodi (42:06): Postpartum?

(42:09): I mean, we stayed in the hospital for your standard, I guess one night, one extra night, and then we were discharged. I would've really loved to, had the opportunity to talk to my doctor who did my delivery again. And like I said, it was just so unfortunate that the next morning I saw a different doctor because I was trying to ask her questions. I wanted to hear about actually what happened and what interventions I had and the reason why we did all this stuff. And she didn't really, I mean, she didn't really know much of the details. At one point she was like, I'm going to go get the computer and bring it in the room so I can actually try to explain things. So I just didn't feel like I got good closure in that way. But we stayed in the hospital for 24 hours. Sorry, there's a dog barking side. You can probably hear him. And yeah, I just had a lot of pain, a lot of vaginal pain for weeks, months actually after birth.

Dr. Nicole (43:11): Oh my God. Okay. So did you ever see a physical therapist or anything?

Jodi (43:17): No. And I almost wish that I would have, again, it's like 15 months out now, but when I went back for my six week visit, the doctor said that I still wasn't healed at that point, told me, but he never recommended that I come back, so I never went back after six weeks. But yeah, I feel like, because I still have a little bit of not pain down there, but it's still not quite right. So I think seeing a physical therapist or a physiotherapist maybe would've been a good thing for me to advocate more for myself. Right,

Dr. Nicole (43:57): Right. So how are you feeling? I, how are you feeling? Just looking at you? It feels like it was a lot. And thinking back, it feels like it was a lot.

Jodi (44:12): Yeah. Yeah. I mean, it was a lot. Of course, I wish things would went different. I wish I would know because like I said, this is my first baby and I wish I would know what was normal interventions or actions to, based on what was happening with my son. Because talking to some people, they're like, I don't know if doctors are able to try to undo the nuchal cord while the baby's still in the birth. Yeah, no,

Dr. Nicole (44:45): That we can't reach. It can't. Okay.

Jodi (44:48): Yeah. So I've heard just a lot of like, well, they should have done this, or they could have done that, and I don't know what could have been possible or what could have been avoided in the moment. I just was just kind of going for it because I just felt like there was so much pressure to get my baby out. Something was going to be really wrong with him, so it was like, we're going to do this, this, and this, and there was no real discussion about it. In hindsight, I wish I would've felt like I had the opportunity to maybe ask more questions. Maybe I've avoided some of this or some what happened.

Dr. Nicole (45:27): Yeah. So then how do you feel about your birth experience?

Jodi (45:33): I mean, at the end of the day, my son was healthy and he was great. So to me that was the most important piece. That was the most important part. Of course, I went in it with what I wanted, things that I wanted to see how I wanted it to go. But like I said, I was very open and very flexible to being like, okay, it might not be perfect and it might not go the way I want to. Sure. So I don't really hold on to, I dunno, I don't really hold on much from what happened. It's more like I just want to know if what happened was normal, just because nobody that I've talked to felt like they had to have, and especially the forceps. I mean, I don't want to be dramatic, but they really, really hurt and it just felt really, maybe it could have been avoided, I

Dr. Nicole (46:30): Guess. Gotcha, gotcha, gotcha. And I should ask, did you breastfeed? Yes. Okay. How did that I'm still

Jodi (46:35): Breastfeeding. Oh,

Dr. Nicole (46:36): Okay. Well then that went well then. Okay. So at least that it doesn't sound like it interfered with you being able to breastfeed.

Jodi (46:44): Yeah, no, no, all that was normal right from the get go, he latched on real good.

Dr. Nicole (46:51): Okay. So then as we end here, what is your one favorite, what is your one piece of advice that you would want to give to someone who's about to have a baby?

Jodi (47:02): I guess it's just feeling comfortable being able to speak up for yourself and if you don't feel comfortable maybe having a doula or some sort of a support person that can do that, I felt really comfortable and confident being able to advocate for myself and speak up for what I wanted for me and for my son. And then when it came down to it in that moment, even just having somebody that could help me ask the questions that I couldn't ask, when everything got so intense, it could have been really helpful. I think. So just knowing that even if you think you got it and you're like the type of person that can usually handle things on your own, and this might be one of those cases where it's good to always have someone else who can help you speak up. Sure.

Dr. Nicole (47:54): Absolutely. Absolutely. I know you said that you're not very active on social media, so if anybody wants to reach out to you afterwards, you guys can reach out to us and then we can connect you with Jody. That's probably the easiest thing to do. And then I just want to say thank you for coming on to share your story. I mean, it brings up so many points and things that are going through my head and thinking about, and I'm glad everything turned out okay, but that was a lot.

Jodi (48:22): Yeah, yeah. No, thank you so much for having me. It was wonderful to be able to talk with you.

Dr. Nicole (48:33): Alright, wasn't that something in that episode? I so appreciate Jody coming to share her story on, again, that was really difficult and challenging to hear and I appreciate her having the strength and courage to come share that with us. Now after every episode when I have a guest on, I do something called Dr. Nicole's notes and here are my Dr. Nicole's notes. From my conversation with Jody, I do want to say that rural and remote medicine, and particularly labor and birth, can be very challenging. Actually. I do want to make some space for that. They're often doing a lot in trying to serve communities without the same level of resources as bigger places. As a result, more and more rural places are closing because they can't keep up and unfortunately it's leaving people without options. Now when you don't have a lot of options either for your doctor or for the hospital because of where you are located, there are a couple things that are really important.

(49:39): One is education. Education is going to be so, so important so you are able and ready and informed to advocate for yourself. You can do an online childbirth education like my online childbirth education class, the birth preparation course. That's a great option when you don't have a lot of options around you. You can check out the birth preparation course at drnicolerankins.com / enroll, and if you use the code Dr. Nicole, you can get 10% off. But education is going to also potentially include reading books or it's going to include listening to podcasts or some sort of other combination of things so that you're really informed going into your birth experience. That's going to be crucial. Another thing that's going to be really, really important when you don't have options is understanding what you're getting into and asking those questions. Again, I talk about that in the birth preparation course and then also in my birth plan class as well.

(50:42): But having a doula or an advocate, someone who is with you, who can help advocate for you if need be also may be really, really, really important so that you have that extra layer of support when you don't have other options. In episode two 18 of the podcast, that's dr nicole rankins.com/episode 2 1 8. I go through a step-by-step process to help you choose a doula, including asking if they feel comfortable advocating for you and some strategies to help you get a doula if you have some financial restrictions, all of that great stuff. The last thing I want to say is how sometimes in OB GYN we undertreat pain, and it's something that is becoming more and more prevalent because of people sharing their experiences on social media, but there's definitely some element of tough it out, go through the pain without offering adequate pain medication for procedures.

(51:43): Something that's on social media that has gotten a lot of attention is IUD placement, so intrauterine device placement and how some people have had very painful experiences with that and felt like they haven't been offered adequate pain medication for that. In general, I think we just don't necessarily take the pain of women seriously. And if you're from a marginalized community like a black person or a woman of color, then that can be even more of a problem that your pain isn't taken seriously. Jodi absolutely should have been offered more pain medication or even going to the operating room to help get that placenta out. She should not have had to endure an hour of trying to get this placenta without adequate pain medication on board. That just is absolutely unacceptable. Now, I will say in my own experience, I have had to try and quickly remove a placenta or address bleeding and remove clots from the uterus without pain medication or as pain medication is being administered.

(52:57): Generally, my process is that I'm going to say, this is going to be painful. This is going to hurt, but it's not going to take long. So do you want me to give you pain medicine to get through it or do you want to just go ahead and it'll take a few seconds and we'll get it done? So I offer people that option. Now, there are some circumstances where even waiting for the pain medication isn't safe because there's so much bleeding that we need to get it under control right away. And in that case, I'm very much so explaining. I'm so sorry. I'm so sorry. This is going to be uncomfortable. I'm so sorry, but I have to do this because the bleeding is so severe. I need to get this done because this bleeding is too heavy and it's getting life-threatening. So I communicate that as clearly as I can to the woman, to the family so they understand what's going on.

(53:48): And then we get pain medication as soon as possible. Definitely if I anticipate that things are going to be longer, or if I'm using any sort of surgical instruments, then I'm taking someone to the operating room in order to address a placenta that isn't coming out. I'm not going to sit at the bedside and do that for so long because that just breaks my heart that anyone would have to have that sort of experience. Okay, so there you have it. Please subscribe to the podcast wherever you are listening to me right now, and I'd love it if you leave me an honest review in Apple Podcast. It helps other women to find the show and it also helps me to hear what you think about the show. I do read all those reviews and I love to hear what you think. And I do shout outs from those reviews from time to time.

(54:37): Also, please come join me in my live free class, make a birth plan the right way. You are going to love it, love it, love it. It is jam packed with information and at the end I stay for about half an hour and do a Q&A where I will answer any of your questions about pregnancy and birth. So it's a great way for us to connect outside the podcast. You can sign up for that at drnicolerankins.com/birth plan. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.