Ep 228: Amanda’s Birth Story – Unexpected Yet Beautiful Cesarean

Dr. Nicole (00:00): This birth story episode from Canada is about an unexpected, yet beautiful cesarean birth. Welcome to the all about pregnancy and birth podcast. I'm Dr. Nicole Callaway 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.

(00:52): Hello there. Welcome to another episode of the podcast. This is episode number 228. Whether you are a new listener or a returning listener, I'm so glad you're spending some of your time with me today. In today's episode, we have Amanda sharing her birth story. Amanda is from Saskatchewan, Canada. Ooh, that was a mouthful. She lives there with her husband and their baby boy, jj. She is a lawyer and she mostly does work related to litigation in medical malpractice cases. Her own birth experience made her passionate about all things pregnancy, birth, breastfeeding, and it gave her a strong desire to share her positive experience with others. Her positive experience was a cesarean birth that she describes as incredibly beautiful, which she never thought was a possibility. She says that her birth wasn't scary or traumatic. It was gentle and an empowering. She believes it's important for women to hear that cesarean birth can be wonderful and does not need to be feared or considered less than, and I could not agree with her more, which is why I'm so excited for her to share her story today.

(02:05): Now, I usually do not share birth stories from people who give birth in other countries because I don't know those systems, and therefore I cannot comment on them. My lane is US hospital birth. However, sometimes it's nice to hear about other places because we can learn from them and we can learn things that we can improve in our own system. So again, I'm so excited for Amanda to share her story today. Now, before we get into the story, let me give you a special announcement. One of the important things about having a beautiful birth experience, no matter how it turns out, is being prepared and making a birth plan. It's a great way to help you feel good going into your birth, and I'm excited to share that my birth plan class, make a birth plan the right way is about to become a prerecorded class that you can look at whenever you want, absolutely free.

(03:00): I have been doing the class live every few months, but now I'm going to make it a really simple prerecorded class you can watch at your leisure. You get a workbook to go with it. So I'm super, super, super excited to give that to you. Now, in order to know exactly when the class comes out, hop on my email list at drnicolerankins.com/email or head to my website, drnicolerankins.com and check for updates. So you can go ahead and hop on this class, folks. Love it, and I know that you will too. Okay, let's get into the episode with Amanda. Hey, Amanda, thank you so much for agreeing to come onto the podcast. I'm excited to have you here. I've never had anyone share their birth story from Canada before.

Amanda (03:45): Thank you so much for having me. I'm very excited. I'm a huge fan of you and your podcast, so it just feels like a dream come true to get to be here.

Dr. Nicole (03:53): Oh, thank you. Thank you. So why don't you start off by telling us a bit about yourself and your family?

Amanda (03:58): Sure. So we live in Saskatoon, Saskatchewan, Canada. If you don't know where that is, it's in the middle of the Canadian prairies. It's a big city for where we are, but probably a small city compared to what a lot of your listeners will be living in. It's myself, my husband, Brandon, and our 10 month old Jameson. So it's just the three of us here. Yeah.

Dr. Nicole (04:16): Awesome. Awesome, awesome. Is it warm there, cold there? What's the weather like there?

Amanda (04:20): Well, today's very rainy. Normally, summer is pretty warm, but we get all four seasons. We get a really cold winter, a really slushy spring, nice summer, and then into a really shortfall and then winter again.

Dr. Nicole (04:32): Gotcha, gotcha, gotcha. Alright, so in order to understand the birth, we have to understand a bit about what the pregnancy was like. So what was your pregnancy like and your prenatal care? I'm really curious what prenatal care is in Canada and if it's any different.

Amanda (04:47): Yeah, so I don't totally know how it works in the States, but for me, I just started with my GP is what we call them here, the general practitioner.

Dr. Nicole (04:54): So

Amanda (04:55): My family doctor, she cared for me up to 28 weeks of pregnancy.

Dr. Nicole (04:59): A

Amanda (04:59): Lot of gps here have what's called a plus one, so they can do labor and delivery. Mine doesn't do that.

Dr. Nicole (05:05): So

Amanda (05:05): She referred me to an OB when I was 28 weeks is when we started under the OBS care, and then that's who took care of us for the latter part of my pregnancy.

Dr. Nicole (05:13): Okay. And was it the same OB that you saw the whole time?

Amanda (05:16): Yep.

Dr. Nicole (05:16): Okay. Okay. And then do you have a choice as to who you see, or do you get sent to a specific person?

Amanda (05:25): Yeah, so we had a choice, but how it works is you can't just book in. You have to get a referral.

Dr. Nicole (05:31): And

Amanda (05:31): So we requested a referral to a specific ob. She didn't take us. Most of the obs here will only take high risk pregnancies, and I wasn't

Dr. Nicole (05:39): Got it.

Amanda (05:39): Thankfully, my practitioner had a relationship with the OB that we ended up getting with, so she took us even though she normally wouldn't. So we got pretty lucky here.

Dr. Nicole (05:48): Gotcha, gotcha. So then who do the low risk people mostly go to?

Amanda (05:52): Yeah, they're gps, they're practitioners, they're family doctors.

Dr. Nicole (05:55): Okay, interesting. Alright, and then did you have any problems or issues during your pregnancy?

Amanda (06:01): Not really. I was quite nauseous the whole time. I ended up on lectin, which worked wonders for me. It doesn't for everybody unfortunately. But then once we did get into the OB care, she did an extra scan, which normally wouldn't happen here. We get one at eight weeks for dating

Dr. Nicole (06:16): And

Amanda (06:16): Then one at 20 weeks for the anatomy scan. And that's normally it, unless you have any concerns. But she just wanted a scan. She does it in her office. Normally we would have to get a referral to go to the clinic, but she could do it right there. And so she wanted to just take a look. So she had a more up-to-date picture of what was going on, and baby was measuring very large. This was at 35 weeks that she took a look and baby was measuring 40 plus weeks already. So she said, I want to take another look in a couple weeks, see how fast he's growing in there. So he ended up being expected to be quite large. I think at 38 weeks he was measuring nine pounds already. So that's when we kind of started talking induction at that point.

Dr. Nicole (06:56): Okay. All right. And then I guess we'll save it to see what he ended up weighing at the birth. So then how did you feel about the care you received?

Amanda (07:05): I was really happy. I had a great pre-established relationship with my family doctor. She's been my doctor since I was probably seven or eight years old, so she knows me really well. Yeah, so she was phenomenal. She knows I'm quite high anxiety and she knows that, and so she just took really good care of me. And then when we got to our ob, she was also so phenomenal. She took really, really good care of us. We were so happy with the care we received from them during pregnancy and while we were in hospital. All the care providers we had were amazing, which is great. Oh, good,

Dr. Nicole (07:33): Good, good. Did you have to travel a long distance for any of your care?

Amanda (07:37): No. So like I said, our city's not super big. The farthest appointment we had, I think was a 15 minute drive, and that was downtown. We live in, I guess what would be kind of a little suburb, and the hospital is a seven minute drive, so nothing was ever very far. Okay.

Dr. Nicole (07:50): Awesome. Awesome, awesome. All right. So what did you do to prepare for your birth?

Amanda (07:55): Yeah, so like I said, I'm a little bit high anxiety, so I like a lot of control, but in pregnancy and birth, you don't really have any. So I over-prepared in a way to kind of grasp at any sort of control that I could have. So I listen to your podcasts a lot. I listen to Mumby labor nurse. I don't know if you know her. She has Instagram. I listen to her content, I subscribe to her emails. Dr. Sterling ob gyn was another one. I listened to a lot of hers. There's a local podcast here called Mooney, Bertie Stories. I listened to that a lot. It was more specific to Canada Birth, and then I did a hypnobirthing course through the positive birth company, I think is what it was.

Dr. Nicole (08:33): Okay. Okay. Were you planning for an unmedicated birth?

Amanda (08:36): The hope and someone, I think it was maybe mommy labor nurse who said, try to have preferences, not a plan. And so I went in with the preference being I wanted to try to go unmedicated, but I was open to, if I was really exhausted or overwhelmed, I would get the epidural. So we tried to be more open, but in my mind, if everything went the way I was hoping it would go, it would be an unmedicated vaginal breast.

Dr. Nicole (08:58): Gotcha, gotcha. Okay. What are some other things that maybe you wanted for your birth?

Amanda (09:01): Yeah, so we wanted the compress to help prevent tearing. We wanted to be able to be upright and walking around throughout the birth, not kind of stuck to the bed on the monitors, and we were just hoping that labor would happen spontaneously.

Dr. Nicole (09:17): Those

Amanda (09:17): Were all our hopes.

Dr. Nicole (09:18): Gotcha, gotcha, gotcha. Now doulas, how are doulas in Canada?

Amanda (09:23): Yeah, so there are doulas. I wouldn't say there's a ton where we are. They are out of pocket expenses, whereas all the other care midwives included are covered under our provincial health plan. So we did not have a doula because it just wasn't in our budget. We did apply for the midwifery program. We weren't able to get accepted. It's very, very hard to get in because there's so few midwives that work in our area. So that's why we went with our OB

Dr. Nicole (09:50): Care. Gotcha. So you have to apply to see a

Amanda (09:53): Midwife? Yeah.

Dr. Nicole (09:54): Okay. Yeah,

Amanda (09:54): And I applied the day. I found out I was pregnant and we were too late. They were full for the month of September, which is when I gave birth.

Dr. Nicole (10:02): Wow, okay. And I presume, obviously you can't apply before you're pregnant, so

Amanda (10:08): No, because you have to know your due date roughly.

Dr. Nicole (10:12): Okay.

Amanda (10:12): Interesting.

Dr. Nicole (10:13): Interesting. And then all of your care is paid for? Yep. So you don't pay anything out of pocket at all?

Amanda (10:20): No. We paid, I think we had to pay a hundred dollars for my son's birth certificate after he was born, but that was the only out-of-pocket expense that we paid.

Dr. Nicole (10:29): Okay. Do you pay health insurance premiums at all or anything, or just

Amanda (10:33): No. So for something like chiropractor, physio, things like that, my employer pays that, and I have that through work. But for anything like this, no. It's all just probably in taxes. I don't really know the logistics of it,

Dr. Nicole (10:50): But

Amanda (10:50): There's nothing that we have to go set up or anything.

Dr. Nicole (10:54): So you just go make an appointment and that's it. Yeah.

Amanda (10:57): Wow.

Dr. Nicole (10:57): Okay. Lord, that does not happen in the United States. Yeah, from what I've heard, it's quite

Amanda (11:03): Different.

Dr. Nicole (11:03): Yes. Definitely different. All right. So was there anything that you were afraid of about giving birth?

Amanda (11:09): Yeah, everything. My biggest fear was that I was going to have to have a cesarean section. My friend, the year prior had had to have an unplanned one with her daughter, and she had hoped for an unmedicated vaginal birth as well. And it ended up being great. Everyone was healthy and happy, and things went well. But the thought of having to lay on an OR table, I have never had any sort of surgical procedure before. I've never been in hospital before. The whole experience to me seemed really scary because it was so foreign, but especially having to go into an operating room seemed really, really scary. And then I was also very, very scared of the epidural since I was a child. The thought of an epidural has just petrified me. I thought I was going to end up paralyzed or dead, and I don't know where this fear came from. I know no one in my family has ever had an issue with their epidural, but

Dr. Nicole (12:00): You just were like, I

Amanda (12:01): Just was petrified. Okay.

Dr. Nicole (12:03): Yeah. So then let's get into what was your labor and birth?

Amanda (12:08): Yeah, it was absolutely everything. I didn't plan. Oh, goodness. So we ended up getting induced when I was 39 weeks because baby was measuring so big. Our OB was so wonderful. She knew what my hopes were. She was very understanding. She suggested that we get induced,

Dr. Nicole (12:25): But

Amanda (12:26): She was very open to what we were hoping for and what we wanted to do. So we went in when I was 39 weeks, and I remember she just walked into the room and she put her hand on my lap, and she said, how are you doing? What are you thinking?

Dr. Nicole (12:37): And

Amanda (12:37): I said, I'm actually ready. Let's do an induction. At that point, I was uncomfortable. I was not sleeping. I wanted to meet this baby that was inside of me. And so I don't know when I had the change of heart, but it was overnight. One day I just was ready to go with the induction. So she tried to sweep that day and nothing happened. So we went in for the induction the next day. So I was 39 and one, and we, we started with the Foley catheter. So I was just dilated enough that we could do that. So we went, and the way our hospital works is that once you go there and you have your room, that's your room for your whole stay. So you get induced there, you labor, you deliver, and then you recover there. So it was really nice to just settle into our room. You

Dr. Nicole (13:22): Stay there the whole time?

Amanda (13:23): Yeah.

Dr. Nicole (13:24): Interesting. Okay.

Amanda (13:26): So it's really nice setup because we unpacked our bags.

Dr. Nicole (13:30): We

Amanda (13:30): Put up some Christmas lights, we put out some candles and affirmations, and we just got to settle into our room,

Dr. Nicole (13:36): Which

Amanda (13:36): Ended up being our room for five days. So it was really nice that we kind of had this little home base. So I had the Foley catheter once it was in, and they did their monitoring, and baby and I were okay. We were actually allowed to leave for a few hours, so they wanted us back there to sleep that night, but we were allowed to go out. This was about two in the afternoon by the time we got it in. So we went to my parents' house who live really close by and just had some food, watch some tv,

Dr. Nicole (14:00): And

Amanda (14:00): Then I ended up having some contractions, and very unexpectedly, I got very nauseous and sick, which is not normal for me, but in pregnancy, it was somewhat normal for me. So then I just wanted to get back to the hospital. I wanted to be in our hospital room, have a care team there to take care of me. My poor 19 year old brother was also home, and he just was not okay with what was going on. So I decided we would go back to the hospital.

Dr. Nicole (14:25): Around what time was that?

Amanda (14:27): This was probably at about four 30.

Dr. Nicole (14:29): Okay. Okay. So you left for a couple hours and then was like, I'm

Amanda (14:31): Just going

Dr. Nicole (14:32): To head on back. Yeah. Okay. I

Amanda (14:33): Just want to go back to the

Dr. Nicole (14:34): Room. Okay.

Amanda (14:35): But

Dr. Nicole (14:35): Wait, you leaving? You left your stuff in the room. They were just like, go have dinner, go do whatever, and then come back.

Amanda (14:43): Yeah.

Dr. Nicole (14:44): Wow. Okay.

Amanda (14:46): It was really nice.

Dr. Nicole (14:47): This doesn't happen in the us, but No, go ahead. So you get back to the room and then

Amanda (14:53): Yeah, we got back to our room, and so I just explained to the nurses, I wasn't feeling well. They brought me all sorts of goodies, which was lovely. I had so much apple juice and ginger ale and some gravel, and I started to feel a lot better. And so we just kind of hung out and they did their monitoring every, I can't remember how often they were checking vitals and getting baby on the monitor to make sure he was doing well. And we just hung out kind of for the next night and day in our hospital room.

Dr. Nicole (15:18): Okay. So how long did the catheter, did the Foley stay in?

Amanda (15:21): Yeah, it never fell out. So they ended up taking it out when it had been 26 hours.

Dr. Nicole (15:27): Wow.

Amanda (15:28): Yeah.

Dr. Nicole (15:29): Okay. And then did they do Pitocin during that time, or,

Amanda (15:32): Yes.

Dr. Nicole (15:32): Okay.

Amanda (15:32): No, after they took it out, they're like, let's start Pitocin now. They were hoping the Foley would work, and it just never really did anything for me. But I was exhausted. I hadn't slept. The Foley was uncomfortable, and I was contracting while it was in, so I hadn't slept that whole night, and I just asked if I could have a break now that the Foley was out before we started Pitocin thinking the Pitocin would really kick things into gear. So the care team was wonderful. They let me have a little nap, and then we started Pitocin, and I can't remember the dosage. I think it was five mils is what we started at. And then it increased two mils every 30 minutes.

Dr. Nicole (16:07): Okay. And I'm sorry, so a nap. They were like, oh, just take a little nap whenever you wake up. We'll start Pitocin.

Amanda (16:13): They said, I'll give you an hour,

Dr. Nicole (16:16): Is

Amanda (16:16): What the nurse said. Got it. So she came back in and checked on me. I was sleeping. My husband was awake. So they talked, and then she gave me another, I think 45 minutes, and then she came back and I was awake, and we started

Dr. Nicole (16:25): Pitocin. Got it. Okay. Okay. Okay. Okay, all. So start the Pitocin, and then how did things go from there?

Amanda (16:30): Yeah, so nothing really changed. I was having regular contractions. They weren't doing a lot in terms of dilation. I think I ended up at four or five centimeters overnight at about four in the morning. So we started Pitocin probably at 4:00 PM on the Thursday. We had gone in on the Wednesday, and by about 3:45 AM they came in and they said, we want to try to break your waters, see if that will get things going. So they did that.

Dr. Nicole (17:01): And was that your doctor or was that,

Amanda (17:03): Yeah. So the way it worked here, when you have an ob, once you go in, you're under the care of whoever's on call.

Dr. Nicole (17:08): Got it.

Amanda (17:10): It was whatever on call OB was there, and they were all fantastic, which was really nice for us, but it wasn't our personal ob.

Dr. Nicole (17:15): Gotcha. Gotcha, gotcha. Okay. So you hadn't met any of the people before?

Amanda (17:20): No.

Dr. Nicole (17:21): Okay. Got it.

Amanda (17:22): So that was another source of stress for me because it was all strangers. Our OB actually wasn't even going to be on call because she was in Ireland, so

Dr. Nicole (17:31): So there was no chance that you were going to

Amanda (17:32): See her? No chance. Got

Dr. Nicole (17:33): It. Got it. Okay. Okay. Okay. So they came in and they broke your water, and then,

Amanda (17:38): Yeah. Sorry. I got ahead of myself. They came in, they said we would like to start breaking your water, and now I think they maybe gave me my epidural. They broke my waters and then gave me my epidural. They both happened right back to back, and I don't really remember which happened first. Gotcha,

Dr. Nicole (17:52): Gotcha.

Amanda (17:52): Yeah, it was the same doctor and same nurse that did both. So they broke my water and gave me an epidural in kind of the same half hour.

Dr. Nicole (18:00): Gotcha. Gotcha. Was it just that, did you want an epidural or did they I did.

Amanda (18:05): I wanted the epidural. I asked for it about midnight before my waters were broken. I was contracting, I was exhausted. I wanted to sleep thinking I would probably be delivering shortly. And so I'd asked for an epidural. They got too busy, they weren't able to come,

Dr. Nicole (18:22): And

Amanda (18:22): So by the time the anesthetist was able to come, they were in there just breaking my waters or just about to, again, I can't remember which happens

Dr. Nicole (18:29): First. Got this all happened.

Amanda (18:30): Yeah.

Dr. Nicole (18:30): Gotcha. Okay. Okay. So how long did you have to wait to get the epidural?

Amanda (18:34): I ended up waiting like four hours, and I was stressed because they just had a slew of people come in who delivered really quickly, and so they were busy. They were very busy that day or that night,

Dr. Nicole (18:48): But

Amanda (18:48): I got it. So

Dr. Nicole (18:49): It was good, and it worked well.

Amanda (18:51): It was great. It was

Dr. Nicole (18:52): Just

Amanda (18:53): So wonderful compared to all the fears I had built up in my

Dr. Nicole (18:56): Mind, I was getting ready to say. How did you wrap your mind around being terrified of getting it and then going to,

Amanda (19:02): I'm

Dr. Nicole (19:02): Just going to get it. How did you get to that point?

Amanda (19:04): I think it was the point of exhaustion that I hit, because at this point we're on our second night, and I haven't really slept besides that nap. And I voiced my fears to the nurses and the doctors, and they were so wonderful about it. They ended up giving me some anti-anxiety medication. I can't remember what it was, and it helped massively. And then they walked me through the procedure. They had my husband holding my hands, and they just were so wonderful in helping me manage my fears so that I could get the epidural, and I felt so empowered when I was actually able to get the epidural, and it went fine.

Dr. Nicole (19:39): Okay. Good, good, good. And you said you were about how dilated at that point?

Amanda (19:44): I think I was about five centimeters dilated

Dr. Nicole (19:46): At

Amanda (19:46): That point.

Dr. Nicole (19:46): Okay. And then after that, what happened?

Amanda (19:49): So after that, I got to about six, but I was only 25% of face, and my cervix was very, very high. So they said, we're going to give you some more time. Unfortunately, you've hit the dose of Pitocin where the nurse couldn't just bump it up. She had to wait for the OB to come back. So we just waited, I think it was about an hour, and they came back and checked me again, and I had swelled down to four centimeters. So unfortunately, that was not what they were hoping would happen. So that's where we hit our fork in the road, and they said, we could keep trying to get you dilated to go for the vaginal delivery. Here's kind of the risks of doing that. You've had a lot of Pitocin. Here's the risks of continuing on Pitocin, et cetera, et cetera, or right now you can choose to go for a cesarean birth, and here's the risks, here's the benefits of going that route. And then we just ask for some time to think about it and talk about it between myself and my husband because we were overwhelmed at that point.

Dr. Nicole (20:40): Sure.

Amanda (20:41): They gave us some time, I think it was maybe 10, 15 minutes. It wasn't a huge chunk of time, but it was enough. And I right away just turned to my husband and said, I think I want to do the cesarean. I don't like the sounds of all these risks that can come with staying on Pitocin. I'm swelling. I'm bleeding. I'm so tired. My body is not handling this very well. And so I was ready to go for the cesarean. Shockingly, I still don't really understand how I went from being so terrified to just being fully comfortable with it. My husband was more hesitant because I think it's different for him because it's my body that would have to go through that.

Dr. Nicole (21:20): He

Amanda (21:20): Was very worried about me. He knows I was exhausted. Am I thinking clearly? But ultimately, he thought, you know what? I think this is what's best.

Dr. Nicole (21:28): And I guess plus he knew that you wanted to avoid it, so he was like, is this really

Amanda (21:35): Exactly. Yeah,

Dr. Nicole (21:37): It

Amanda (21:37): Was a big 180 for me to do.

Dr. Nicole (21:39): Right, right.

Amanda (21:40): Yeah. But we ended up deciding to go for the cesarean, so I think that ended up being nine 30 in the morning when we made the decision.

Dr. Nicole (21:48): So

Amanda (21:48): Then they brought in the team, they all introduced themselves. It was a fresh shift, which was really great. So everyone was chipper and excited. We had a wonderful, wonderful team. We couldn't have had a better team if we hadn't picked them. And baby was born at 10 18. He was in my arms on the operating table at 10 18. So 48 minutes after we decided to go, we had baby in our arms, which if we had known that at the start, we might have chosen to go that way much sooner.

Dr. Nicole (22:14): So then I want to ask, so when you got into the operating room, got on the table, how did you feel?

Amanda (22:21): I was so happy and peaceful and excited, and I

Dr. Nicole (22:25): Really

Amanda (22:26): Never would have expected it before we went in. I said, can I get another dose of that anxiety medication? I was speaking to the anesthetist and he said, I understand why you want that, but I'm going to tell you right now, this is the birth of your first baby,

Dr. Nicole (22:40): And

Amanda (22:41): You're going to want to be fully alert and fully aware for this moment. And so I'm going to be here for you, and your husband's going to be here for you, and I know you can do it without that medication. And I am so thankful to him for saying that to me because he was so right to,

Dr. Nicole (22:54): I

Amanda (22:54): Was

Dr. Nicole (22:55): Just

Amanda (22:55): So blissfully overjoyed and excited. And I remember every moment of them, we had the clear drape, which was also just

Dr. Nicole (23:03): Amazing.

Amanda (23:04): And so we were able to see him. They held him up to us, and then my husband got to go cut the umbilical cord, which is also amazing. He needed a little bit of stimulation for breathing, and then they brought him to me, and we just got to snuggle while they did their business down there. And I remember it all, and I'm so thankful to that anesthesiologist for suggesting to me that I try to do it without any sort of anxiety medication.

Dr. Nicole (23:26): Right. Do you remember was the feeling or the sensation during the C-section, any issues or anything like that?

Amanda (23:34): There was no issues. Thankfully, that friend of mine had mentioned she felt all this pushing and tugging, not pain, but just the pressure. So I had remembered that because she remembered being really spooked by that. She wasn't expecting it,

Dr. Nicole (23:46): And

Amanda (23:46): So I just expected it. It felt normal. He was very, very high up and really wedged in, so they had to do a lot of pushing.

Dr. Nicole (23:55): Got it.

Amanda (23:56): Got

Dr. Nicole (23:56): It.

Amanda (23:56): And he had very broad shoulders, and we found out. And so there was quite a bit of pushing and tugging, and they eventually got him to come out, but it wasn't unexpected, and I was just so giddy with excitement that I didn't care. I was talking to my husband, an anesthesiologist, and it was just amazing. It was so amazing. I can't even describe how unexpectedly wonderful that experience was.

Dr. Nicole (24:19): Oh my goodness. And yeah, it's a weird sensation. Something's happening,

Amanda (24:23): But

Dr. Nicole (24:24): It's like, what's going on? Exactly. Then of course, the big question is how much did he weigh?

Amanda (24:30): He was nine pounds, six ounces. So nothing outrageous, but big enough the issue, not the issue, but the thing with him was how broad his shoulders were. So he was nine pounds, six ounces, but I think he was only 19, 20 centimeters long. Very broad shoulders,

Dr. Nicole (24:48): Just solid.

Amanda (24:49): He was a very solid dude. And so when they pulled him out, they actually thought he was going to be macrosomic like over 10 pounds. They were guessing 13. But yeah, it was the broadness of him that really threw everyone off in terms of his size. And thankfully, they said, we absolutely made the right decision. It would've been a pretty nasty shoulder to Sosa if I had kept trying to go with a vaginal delivery the way he was wedged in there, and so broad.

Dr. Nicole (25:14): Gotcha.

Amanda (25:16): So that was a really big relief for us to hear and get that affirmation from the surgeon and the doctors that were there.

Dr. Nicole (25:23): Gotcha. Got it. And was the surgeon, the ob, whoever was there that day?

Amanda (25:27): No, she was some new OB we had never met. She came in just to start her shift that day just before we had decided, I texted my mom and she said, oh, she's fantastic. Maybe she'll get to do your delivery for you. And I just remember being, oh, that's awesome. We were googling her and she seemed so wonderful. So it worked out really nicely that she ended up being the surgeon who did the cesarean because she is very, very wonderful.

Dr. Nicole (25:54): Okay. Okay. Awesome, awesome. So is that pretty routine in the hospitals that it's just the ob whatever OB is there?

Amanda (26:00): Yeah, so unless it's a scheduled cesarean, it's just whatever OB is on call.

Dr. Nicole (26:05): Okay. Okay.

Amanda (26:06): Very

Dr. Nicole (26:06): Interesting. All right. So then what was your recovery like from the C-section?

Amanda (26:11): Yeah, so obviously completely unexpected. I had expected a vaginal birth. We didn't really prepare,

Dr. Nicole (26:17): And

Amanda (26:17): We live in a two story, so the stairs were really tough for me, but I mostly just kind of camped out in our bedroom with our baby, and my husband did the going up and down the stairs, and it was honestly fine. I didn't really realize you also continued to bleed after a caesarean burst. So that, and I had to really be on top of my pain meds and the gas X meds, which was very important.

Dr. Nicole (26:42): The gas is almost worse than the

Amanda (26:44): Pain.

Dr. Nicole (26:45): It's like unexpected. Yeah, it can be really challenging. Unexpected. Yeah. Yeah. Oh, and how long do you stay in the hospital after you have a cesarean?

Amanda (26:51): Yeah. So they keep you for 48 hours

Dr. Nicole (26:53): And you were still in the same room. You were still in the same, okay, this is just interesting to me. Yeah,

Amanda (26:58): Besides, well, I mean, and then

Dr. Nicole (27:00): You be back to the room after the war. Yeah. Okay. Okay. Okay. So you stayed for 48 hours afterwards, you said

Amanda (27:05): After the cesarean? Yes.

Dr. Nicole (27:07): Okay. Is that typical?

Amanda (27:08): Yeah.

Dr. Nicole (27:09): Okay. Alright. Alright. So then did you breastfeed?

Amanda (27:12): I did, yeah. So as soon as we got into the recovery room, he latched and breastfed like a champ. I had also harvested colostrum ahead of time and brought it with us. So they brought that down because he was big, they were a little bit worried about his sugar levels. So we supplemented him with my colostrum and that went great. And then, yeah, he fed like a champ and still breastfeeds like a champ today.

Dr. Nicole (27:32): Okay. Okay. Do you have lactation counselors? Is that part of the care that you get? We do.

Amanda (27:37): Yeah. So they come check on you? Once I asked her to come back, just because I really wanted to make sure things were okay, and yeah, she said it seems great. He seems great. There's called the breastfeeding cafe. It's a free resource that moms and babies can go to hosted by lactation consultants in our city. So you can go to that after your discharge from the hospital. We never ended up having to go, but it was nice to have that contact information and know that I could, if we ever had issues.

Dr. Nicole (28:01): And did you have any issues with postpartum blues or postpartum depression?

Amanda (28:07): I ended up, so the first two weeks and the nurse kind of warned us that those first two weeks are going to be quite intense. I think I cried every day at five 30 on the dot, and there was never any really a reason. It just was my time to emotionally let go, I guess. And then right at the two week mark, I started to feel a little bit better, but for me it was really crippling anxiety, which wasn't a surprise because of how anxious I was before a baby. And especially with regards to his health. It was fall, flu season was starting, R S V season was starting, and I was so anxious about his wellbeing and it's this little newborn that can't tell us how he's feeling and we've never had one before. So I ended up talking to my GP and we got on an anti-anxiety medication and that helped massively.

Dr. Nicole (28:58): Okay. Okay. Alright. Alright. And then does your GP also see your baby or do you have a separate pediatrician?

Amanda (29:06): No, so I think you can get referred to a pediatrician. A pediatrician did check on him in the hospital, was at the birth, et cetera. But then he's just been under my GPS care now since he was born.

Dr. Nicole (29:16): Wow, okay. So that's really nice because your GP knows you. Your GP knows your baby, and

Amanda (29:20): So every appointment is me and him. My husband also came to them as well, and so she would check on him, do whatever she needed to do with him and then check on me physically and mentally, which was great.

Dr. Nicole (29:29): Gotcha. Gotcha, gotcha. Okay. And then what kind of postpartum mental health resources are available? Are there therapists or counselors or things like that?

Amanda (29:40): Yeah, so I guess I can only speak to my personal experience. The therapists that I go to aren't covered under our provincial health plan, so I have to go under my work health plan. So it's separate. I think there are certain services that you can go through, but it's a lot longer of a wait to probably have to get referred and things like that. So I just booked in with a private company and then used my private insurance for

Dr. Nicole (30:04): That. Okay. Okay. All right. And how long is your maternity leave?

Amanda (30:09): Yeah, so I'm doing 13 months, which is a little bit strange. It's generally 12 months or 18 months. So I'm on the 12 month track, but I ended up quitting my job three months into mat leave and starting a new job or accepting a new job. So I will start that in October, which will technically be 13 months after I went on maternity leave.

Dr. Nicole (30:28): Okay. Wait a minute. So you were on maternity leave and quit your job?

Amanda (30:34): Yes.

Dr. Nicole (30:34): And you were able to get another job while on maternity leave?

Amanda (30:38): So the reason I quit my job was because I was approached about this new opportunity. I wouldn't have probably done it without something lined up.

Dr. Nicole (30:45): Gotcha.

Amanda (30:46): So I accepted this new job, asked if I could start in October, and then went back and quit my other job.

Dr. Nicole (30:51): Got it. But they knew that you were going to be on maternity leave and it wasn't like,

Amanda (30:54): Yeah.

Dr. Nicole (30:55): Okay. Do you still get paid when you're on maternity leave or is it reduced or,

Amanda (31:01): Yeah, so it's government payments that come. It's a percentage of your salary, and then there's a max salary. But then a lot of employers, which mine did for a certain period of time, will top you up to what your full salary normally would have been. So I think my topup was 18 weeks and then I was just on the maternity payments,

Dr. Nicole (31:22): So Wow. They were going to give you your full salary for 18 weeks, weeks?

Amanda (31:27): Yes.

Dr. Nicole (31:28): And that's typical?

Amanda (31:30): I would say I think so in my line of work, yes. I guess I don't know about everybody.

Dr. Nicole (31:36): Okay. What kind of work do you do?

Amanda (31:37): I'm a lawyer. A

Dr. Nicole (31:38): Lawyer, okay. Okay. Wow. Wow. It is just very interesting. Okay. And how is it perceived? Is it just totally normally accepted that you have a baby and you're going to be out of work for a year and then you'll come back?

Amanda (31:55): Yeah, I would say so. Again, it kind of depends on your position. I was an associate lawyer, so it was really typical for associates. Some would do nine months instead of the full 12, but for the most part, everyone does the full 12.

Dr. Nicole (32:08): Now,

Amanda (32:08): If you're entrepreneur or a partner at a firm, it's a bit different

Dr. Nicole (32:12): Because

Amanda (32:12): You're not an employee. So it's a bit more complicated that way.

Dr. Nicole (32:15): Sure, sure. But if someone said, I'm only going to take three months, would that be crazy?

Amanda (32:23): It would be shocking, I would say.

Dr. Nicole (32:26): Yeah,

Amanda (32:27): It's so short.

Dr. Nicole (32:30): Can you tell that to the United States government? Oh my God. Because most people, I mean, it's like six to 12 weeks of leave is what people

Amanda (32:40): Get

Dr. Nicole (32:41): In the US even, and it's not a lot of it might be unpaid, completely unpaid.

Amanda (32:46): Oh my God, I can't imagine. Well, even having to be unpaid for six or 12 weeks, but also then having to try to go back to work physically, I don't even think you're recovered and emotionally, certainly not.

Dr. Nicole (32:57): Yeah. Yeah. Okay. Okay. Alright. So then as we wrap up, how do you feel about your whole birth experience?

Amanda (33:06): Yeah, if you had asked me this two weeks ago, I would've said nothing but positive things through therapy. I've been working through that. There is actually a little bit of grief there for me because it went completely not to plan, but my therapist has just hammered home that grief can coexist with the joy and gratitude that I have for what our birth experience was. So I am so happy with how it went and that it brought us our beautiful boy and everything was wonderful, and our care team was wonderful. But I do still have a little bit of grief that I have to work through that I didn't have the vaginal birth I envisioned.

Dr. Nicole (33:41): Sure, absolutely. Yeah, and that's a beautiful way to put it, that grief and joy can coexist

Amanda (33:47): At the same

Dr. Nicole (33:48): Time. Yeah. So what then would be your one favorite piece of advice that you would give to someone who's pregnant now?

Amanda (33:55): Yeah, I would just reiterate that one piece that I don't remember where it was from, but have preferences but not a plan because it will certainly almost not go the way you think it will, but it can still be really wonderful.

Dr. Nicole (34:07): Yeah. Yeah, absolutely. Well, my goodness, thank you so much for agreeing to share your story and for me, peppering you with all the questions about this Canadian system. It's so

Amanda (34:18): Different

Dr. Nicole (34:19): Than what we do here. I mean, it just seems like there's more value placed on mothers and family

Amanda (34:27): In

Dr. Nicole (34:27): General Absolutely. Than what we have

Amanda (34:29): Here.

Dr. Nicole (34:30): So I just really appreciate your time.

Amanda (34:32): Thank you so much for having me. Like I said, I'm such a huge fan. This is such an honor to get to be here and chat with you.

Dr. Nicole (34:45): Wasn't that a great episode? I'm so grateful Amanda came on to share her story. Even though, gosh, there's so many things about the US maternal health system that we need to learn in terms of valuing women and families. The biggest thing, of course that stands out for me is parental leave. It's absolutely crazy that we don't get adequate parental leave in this country. And I'm just going to say this as a separate from my Dr. Nicole's notes. One of the ways that we can help change that is to vote and advocate for policy change. So that's my little plug for voting and staying active in politics because that is the way that maternal health is going to improve in America to get policies that are really family centered and long overdue. All right, so after every episode when I have a guest on, I do something called Dr.

(35:37): Nicole's notes. Here are my top takeaways. My Dr. Nicole's notes from my conversation with Amanda. In addition to getting politically active in voting, number one, voice your fears to your care team. That's one of the things that Amanda did, and this is a really important thing to do for a couple of reasons. One, it helps you to feel better when you've expressed your concerns and you can see the response. And then it also helps you to know how your care team is going to approach your fears. I think this comes up a lot for everyone, but definitely in the context of black women giving birth and being afraid of dying because the increased mortality rates among black women. So express your fears and then see how they respond. You want to have somebody who says, Hey, I understand where you're coming from. Here are the things I'm going to do to help relieve your fears.

(36:31): That's really, really important. Number two, ask for time to think about something. To think about making a decision. Things are actually rarely a true, true emergency in obstetrics. A lot of times people say they had an emergency cesarean, and what they really mean is that they had a urgent cesarean. Maybe it happened within 20 minutes, 30 minutes, something like that. That's actually not an emergency. Cesarean an emergency is when we are ripping cords out of the wall, we are running down the hall, things are moving exceptionally fast. Okay? So you almost always have time to think about things. Take a couple minutes if you have questions, discuss it with your partner or a family member or a doula or something you have there, and think about your decision. So don't be afraid to say, Hey, can I have a minute to think about this? Don't feel like you have to be rushed into making a decision about something.

(37:23): There's generally always a little time to think about it so you feel better about the decision that you come to. And then the last thing I want to say is grief and joy can coexist when you think about your birth experience. In Amanda's case, she was very much so sad that she had a cesarean. She definitely did not want to a cesarean, but she was able to find joy in her birth. Now, a lot of that is she had a supportive care team who helped her to find joy in her birth. But you can definitely have grief and joy coexist when you think about your birth experience, honestly, when you think about life experience. And then I said that was the last thing. But I do want to say one more thing, and that is postpartum anxiety. We talk a lot about postpartum depression, and that is great, but I think we also need to start expanding the conversation around perinatal mental health to talk about postpartum anxiety as well.

(38:17): It's definitely so real, definitely under-recognized. I think it can often be more present in people who are type A, want to control things, that kind of thing. So be on the lookout for postpartum anxiety as well, and do seek out help if you need it. Alright, so there you have it. Please share this podcast with a friend. It helps me to reach and serve more people, helps the show to grow. And I so appreciate your help in helping me reach millions of pregnant folks because that's what I have on my heart, soul, and passion to do. Also, if you're so inclined, leave me a five star review on Apple Podcast. I'd love to hear what you think about the show and it helps the show to grow. I definitely look at those reviews and I appreciate it. And also subscribe. While you're there, subscribe wherever you're listening to me right now, and don't forget to check back in, join my email list, head over and take my birth plan class. Make a birth plan the right way. It's going to be completely free and on demand class that you can take whenever you feel like is good for you. You can head to my website, drnicole rankins.com, or join my email list drnicolerankins.com/email. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.