Ep 267: Katie’s Birth Story – An “Amazing!” Birth Center Birth

Dr. Nicole (00:00:00): In this birth Story episode, you are going to hear about a lovely birth center birth.

(00:00:12): 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. Hello there. Welcome to another episode of the podcast. This is episode number 267. Whether this is your first time listening or you've listened before, thank you for spending some of your time with me today.

(00:01:06): In this birth story episode, we have Katie. Katie lives on a ranch in northern California with her husband Connor, her daughter Rowan, and son Elias. They moved there just after her daughter was born, and she's been really lucky to be able to stay home with her children. Prior to having kids, she worked in early childhood education with a focus on nature-based and outdoor education. We're good to hear about Katie's second birth. She calls it an amazing birth experience night and day from her first. Her first birth experience was the standard hospital birth, a group of obs, an epidural, and it wasn't until she got pregnant with her second baby that she really began to process her first birth. Her first labor and birth were fine, but this time she wanted a more supportive, intimate and holistic prenatal experience. So she chose to give birth at a private birth center with a group of amazing midwives.

(00:02:06): She felt the midwifery route was incredible empowering. Her midwives offered a safe space for her to be vulnerable. She ultimately had an unmedicated water birth with totally spontaneous pushing. She described the whole thing as an incredible experience and you are going to hear all about it in this episode. I don't usually share birth center birth stories on the podcast because I don't know much about birth center birth For this podcast, I tend to stay in my lane, so to speak, which is hospital birth and share hospital birth stories. But as I want to do more to improve our US maternal healthcare system, I need to learn more about different types of birth experiences, and I learned a lot from this birth center episode and I know that you will too. Now, before we get into the episode, do come join me in my next live class, make a birth plan the right way. The class is totally free In it, you're going to learn how to make a birth plan that actually works to help you have the birth that you want. You can sign up for the next live class@drnicolerankins.com / birth plan. Okay, let's get into this birth story episode with Katie.

(00:03:25): Thank you so much, Katie, for agreeing to come onto the podcast. I'm excited to have you share your story. This is going to be a little bit different because you actually didn't give birth in the hospital, but we're getting to all those details in a minute.

Katie (00:03:36): Yeah. Thank you so much for having me. I'm super excited. I listened to your podcast throughout both of my pregnancies, so I'm excited to be here.

Dr. Nicole (00:03:44): Well, thank you. I appreciate that. I appreciate that. So why don't you start off by telling us a bit about yourself and your family?

Katie (00:03:49): Sure. My name is Katie and I live up on the northern coast of California in Humboldt County with my husband Connor and our two littles, Rowan. My daughter is two and a half, and my son Elias is just about to be six months old.

Dr. Nicole (00:04:05): Okay. Alright. And do you work at all or or I should say outside of the home?

Katie (00:04:10): Yeah, no, I'm actually home with the kids now, but I was in early childhood education for years and I actually was sort of focused on nature-based outdoor education and moving up here is, it's Redwoods Beach, ocean. Beautiful. So it's kind of fun to raise my kids in this area. Oh

Dr. Nicole (00:04:29): Yeah, that's pretty cool. That's pretty cool. And I always have a soft spot in my heart for people who are in education because I know from my mom being a teacher for 50 years, my sisters are both educators. It's a tough spot to be in.

Katie (00:04:42): Yeah,

Dr. Nicole (00:04:43): Yeah, love to. Yeah. Yeah, it's challenging to say the least. Alright, but why don't we start off, like I said, this is going to be a little bit of a different birth story because this is about your second birth and you gave birth in a birth center for that birth. But in order to understand how you got to that, then let's tell us a little bit about what happened with your first birth.

Katie (00:05:07): Sure. So my first birth I would say was just a very standard hospital birth. My prenatal care was through an OB practice. There were five obs rotating throughout my pregnancy and I would see someone different each time. Then the birth was aside from giving birth, it was nothing super exciting. We went to the hospital, I ended up getting an epidural, had pushed for an hour. The baby was super healthy. The labor and delivery nurses were wonderful. I guess it was just kind of somewhat predictable. There was nothing traumatic about it or anything like that, but it was just kind of what you would think of when you think of sort of a standard hospital birth.

Dr. Nicole (00:05:58): Okay, so it's not that anybody was mean or you had any challenges or difficulties?

Katie (00:06:06): No, I will say I didn't really start processing my first birth until I got pregnant again with my son and I mean until I got pregnant again with my son, I really loved my prenatal care and I loved my hospital birth. I just sort of started thinking more about, well, what was missing there and kind of what I really wanted. And I had realized that there were moments I started remembering I really wanted to chat with my doctor about my birth preferences and there was something inside me that was just really intimidated to do. So I remember I had a doula for my first birth and she was fantastic and she kind of helped me work through that. She told me just to write it down and so I just can read the questions off to my doctor. But yeah, there were just these little moments that I started thinking back on of what do I want to do differently this time around? And I realized that most what I was craving was more of a community and a more holistic experience. We were still somewhat in the covid guidelines, so my husband couldn't come to any of the ultrasounds, so he was sort of left out of the loop there. Yeah. So I would say it was fine, but what I realized was I could have more than fine. I think that I wanted to have something a bit more.

Dr. Nicole (00:07:43): Gotcha, gotcha. And by community, did you mean community of other pregnant women or community or just feeling like there was more connection with your prenatal care provider? What do you mean by community?

Katie (00:07:58): Yeah, more connection with my prenatal care provider more. I think more just kind of tapping into the emotional side of just this big journey of pregnancy and birth and bringing my husband along and really making him feel part of it. We're doing this together and I honestly didn't even know where to look for this. I just knew that's kind of what I wanted. I wanted women around me. The doctor that delivered my firstborn was a man, which was fine. He was fine, but again, it's just kind of fine. I really wanted something that it just felt very, I was craving that sort of more of excitement and really getting into the true experience and how you're feeling and what you truly want for this experience because I would say with my first birth, it almost felt like you gave birth and that was it. And I kind of just wanted it to be a little bit more magical, I guess is what I was looking for.

Dr. Nicole (00:09:08): Okay. So then how did you end up deciding to go with the practice that you went with and the model that you went with?

Katie (00:09:15): Yeah, so I was at sort of a playgroup with my daughter and I was talking with a friend. I was really early on in my pregnancy and I had already gone to get the initial blood work and ultrasound done at a similar practice that I had done before, and that just kind of sealed the deal in my mind. You know what? I really want something different. And I had said I didn't know what that really meant, but I was sort of expressing this to a friend and she said, well, you should go through this birth center where she had delivered her baby. And then within the next 10 minutes, a few more women started chiming in like, oh, sorry to interrupt. But yes, I loved this place too. And oh, I had a really good experience too that sort of opened up the world of a birth center to me.

(00:10:06): I had kind of always thought that it was either hospital birth or home birth. I didn't really know much about what a birth center birth or prenatal care was. I didn't know much about the midwifery philosophy, but I did know just by chatting with these women that it was a group of three or four midwives and it was a very holistic experience and it just really sparked my interest. And so I ended up giving them a call and doing sort of a consultation and they really walked us through what it means to give birth at a birth center. You also had the option to do a home birth with them, but we live out in the middle of nowhere and it just made me a little nervous. So I did end up doing the birth center and they walked us through everything. They kind of gave us a tour of the facility, which was absolutely beautiful and so peaceful and just felt like you were in a bedroom. It was just really, really calming and natural. And then they kind of walked us through the financial aspect of it and it was pretty immediate that both Connor and I were like, yeah, this is where we're going to go. Okay.

Dr. Nicole (00:11:22): Okay. So you brought up the financial aspect. Was it covered at all by your insurance?

Katie (00:11:27): So it was interesting because my insurance, there was a portion of it that you could get covered with a birth center, but because we live in sort of a rural area, this birth center was not in my network, but they had a biller that worked directly from the birth center to the patients, which was really helpful. And she basically said, well, this is the only birth center in this region, so you can apply for what they call as a gap claim that basically says, hey, there's no other option. So they allowed us to do the in-network sort of insurance plan. So I got about 60% of it covered, which was great, but it was kind of nice. We just paid everything up upfront and we just knew that was it. So that sort of took a lot of that insurance complication out of it.

Dr. Nicole (00:12:20): Sure, sure. Well, that's nice that they helped you figure that out and how to figure out how to decrease the cost.

Katie (00:12:26): Well, and it's so confusing with all the insurance.

Dr. Nicole (00:12:29): It's so confusing. I've been a physician for 20 years, I don't understand it. I have yelled many times on the phone with insurance company. It's like they purposely make it difficult.

Katie (00:12:40): They

Dr. Nicole (00:12:41): Do. Yeah. I mean completely difficult. So do you mind giving us a range of about how much it costs? And you're in California, so I take it it may be a little bit more expensive.

Katie (00:12:49): So we're in California, so for the whole thing, and that covered all of the prenatal appointments, everything that having to do with the birth four, no, sorry, five postpartum appointments and then just anytime you wanted to chat, anytime you wanted to come in or whatever you needed. The whole thing cost roughly about $7,000, but we got about half of it back, which was so it was actually a lot more doable than I had originally thought. That's

Dr. Nicole (00:13:22): Also a lot cheaper than a hospital birth. A lot, lot cheaper.

Katie (00:13:30): Yes, I know. I mean, I did all of my blood work and ultrasounds and stuff outside of the birth center, which was just covered by standard insurance, but so it was sort of a win-win in all aspects.

Dr. Nicole (00:13:45): Okay. So then tell us about what was your pregnancy and prenatal care and then how did that compare to the care you have for your first pregnancy?

Katie (00:13:54): Yeah, so I would say my prenatal care was absolutely incredible. I had a rough pregnancy and we can talk a little bit more about that, but I will say that if I had been anywhere else, I think that it would've been much, much harder to get through. But yeah, I mean my prenatal care, so like I said, we went through a birth center and there were three midwives who were all amazing. I just love them. I just wanted them to be in my life forever. I still email them, just send them photos, so sweet. And I remember my first appointment, your first appointment when you go is about two hours because they just want to get to know you. They were asking all of these questions about our family, how Connor and I met really processing through the first birth. And I remember at one point they were like, sorry, this is taking so long.

(00:14:55): And Connor and I looked at each other and we're like, we feel like we're on a date. This was just so fun. We were just sitting on the couch chatting and that just was sort of how it felt throughout the whole whole journey. Every appointment was an hour long and we really dove into everything in terms of the medical side to how are you feeling? Even just the language that they would use just made you feel really, really comfortable. One thing that kind of stands out in my mind is they never required you to take your weight. They were just very aware that that can be triggering to some people. And so their first question was kind of, what's your relationship with your body? What's your relationship with food? And that's sort of how they presented a lot of these what could be sensitive subjects to some people. So they just instantly made you feel really comfortable, which was just much different than my first birth or my first experience. It was much more in out, like I said, I was a little bit intimidated to ask those questions where here I really felt like I could dive into any type of fears that I had, any type of questions, any sort of feelings that I was going through. They were just very, very willing to listen and offer factual insight.

(00:16:33): And so I really just loved, I really loved it. It was just a very comforting space to be in, just being pregnant and vulnerable and figuring out what life is going to be like with a newborn and a 2-year-old, and they were just really there for all of that. And yeah, it was just really wonderful.

Dr. Nicole (00:16:54): Yeah, it sounds amazing. Yes, it sounds like it was just absolutely wonderful.

Katie (00:17:01): Yeah.

Dr. Nicole (00:17:02): So then what about your pregnancy was difficult?

Katie (00:17:05): So my pregnancy, it started off, my first trimester felt pretty normal, similar to my first pregnancy, nausea, just kind of feeling that in your stomach throughout the day, but nothing too out of the ordinary. And I was sort of waiting to get into the second trimester thinking, okay, once the second trimester comes, it sort of calms down thinking that it was going to be sort of the same as my first. But as I kept going in my pregnancy, I just was continuing to be really tired. The nausea subsided, but I was just super, super tired and equated it to, I have a toddler, I am just tired in general. But I was just noticing too, I was just really swollen and I was getting bigger than I had prior to my first pregnancy. But again, all of this, I was like second pregnancy, everything's different.

(00:18:10): It's all kind of, you just never know. You never know what's going to happen. But I went in to the birth center, I think it was at 28, 29 weeks for my screening for gestational diabetes, which they just did the finger prick. And a couple days later that came back somewhat high, which my midwife said, don't worry about it. Sometimes it can just depends on what you ate that day, whatever, but let's go and get you an appointment to do the fasting glucose test. So I went in, I did that, and of course I'm starting to get a little bit anxious. I don't really know much about gestational diabetes, but also in the back of my mind I'm like, I didn't have it before. It's fine. And so I do the test, I go home and then I'm constantly refreshing the results page of my profile, like, oh my gosh, okay, let's go. Go. It comes in, I see it before my midwife diet does, and my numbers are very high, which indicates that I had tested positive for gestational diabetes, and it was a huge shock. I immediately went through every single possible emotion. Like I said, I didn't know much about it, so shame, guilt, fear, all of those emotions just sort of came rushing in. What does this mean? How did I do this?

(00:19:48): I think I'm a fairly healthy person. I didn't have it with my first pregnancy. Oh my gosh, have I been eating too much mac and cheese, all this stuff just starts really flooding in and I just go down the rabbit hole. I'm Googling everything and all I'm seeing is the risks to yourself, the risks to your baby hip dysplasia. 50% of women could end up having type two diabetes after birth. All of these sort of red flags and I just really didn't know how to process it. And when you're not educated on something like this, you go to the worst. Sure. I call my midwife and she sees the numbers and she's very calm. She says, yes, they're high, and this does indicate that you have diabetes. Come in tomorrow and we will figure out a plan. Don't go down the rabbit hole. I was like, too late, too late, but I'll stop.

(00:20:58): Yeah, damage has been done. So my husband is a very, I am just this emotional wreck and he is very like, okay, let's figure out, let's make a spreadsheet. Let's put down all the stuff we need to buy for this diet. Let's do all this. Really trying to fix the problem, which is so sweet. But I'm just still in this state of like, we can't fix the problem. This is where I am. I'm so overwhelmed. So that night was a little bit overwhelming, but the next day I went in and was immediately met with just, it's okay. My midwife gave me a hug. She looked at me, she's like, this sucks. I know this sucks, but it's fine. I promise you we'll get through this together. Let's go in, let's talk. So we went to the appointment room and we just started chatting and she just sat next to me and was like, okay, this is what it is.

(00:22:06): So my first question was, is my baby okay? How does this affect my baby? And she was like, your baby is fine. This is why we do these tests before at this stage because whatever is happening has not yet reached a stage to where it could affect your baby. She just started going through the facts and how we're going to get through this. Basically from that day throughout my pregnancy, I had to get a glucose monitor and I pricked my finger four times a day. So I did a fasting when I woke up and then an hour after every meal recorded it did all this recorded what I ate along with those meals. And the goal was to have 80% of your numbers had to be within range to keep you out of any type of other intervention, insulin or whatever medication might have to come along with that.

(00:23:06): Gotcha. So I was really just at that moment I was like, okay, we can do this. So I just decided I'm going to just get this under control. I'm going to do the diet, I'm going to exercise. This is just, I'm doing it. So basically from then on it was I cut out all sugars, all carbs, which is in their third trimester. All you want is a burger or not have to think about what you want to eat. You just want to grab and go. So it was challenging because I really had to think the night before, what am I going to eat the next day? But in hindsight, it was a little bit of a blessing because I felt so much better once I started going on this diet and I started exercising 30 minutes a day and within a couple of weeks I just felt better.

(00:24:12): My swelling went down, my energy was back. Obviously I wish I hadn't have had gestational diabetes, but it really sort of put a new perspective on the pregnancy in that I could take control of how I felt and there were moments of just feeling really overwhelmed. I just wanted to be done. It took me a little bit to get over the embarrassment of it, I guess, just because I don't think a lot of people know about it. And so when I would say that I have gestational diabetes or I would just not eat the pastry or whatever for the first few weeks because there was still some weird stigma that sat with me that it was embarrassing and I don't know why it just sort of felt that way. But the moments I would get overwhelmed, I remember my midwife telling me that, and this is good to know for anyone who goes through gestational diabetes, is if you have gestational diabetes and you have it under control through diet and exercise, you are no different than a pregnant woman who doesn't have gestational diabetes in terms of your risk. So as long as it's under control, diet and exercise, you really are okay. The baby is totally fine. So I just kind of kept that in the back of my mind that if I could keep this under control, I'm no risk. I don't have a high risk pregnancy if I can really keep it under control. Definitely,

Dr. Nicole (00:25:52): Definitely. And I take it, you were able to continue to never had to get on

Katie (00:25:56): Medication. I never had to get on medication within the first, I think it was maybe eight weeks or so, I did the prick every four times a day. And then because my numbers were starting to show that it was under control, I could kind of start cutting back on the finger prick. But when we started chatting about it, she was like, for the first couple of weeks, just experiment. Because some people can eat rice and their blood sugars are fine. Some people it spikes. So she told me to kind of experiment with everything, but I was just, no, I went cold Turkey and I cut everything that could potentially spike my sugars. I'm just going,

Dr. Nicole (00:26:49): Well, I'm glad then, and I guess I should ask, if you needed to have medication, would, would you have had to not be at the birth center anymore?

Katie (00:27:01): Yes. So that was another sort of motivator for me to really try to keep it under control is because that was a risk out factor. There were a few things that risked you out of the birth center and that would've been one of them. And so that was a big motivation to try my best to stay under control. Sure.

Dr. Nicole (00:27:23): Sure. Okay. Alright. So let's talk then about your birth. Was there anything that you felt like you, well, I should say, what did you do to prepare for your birth? Or did you even feel like you had to do anything to prepare? Yeah,

Katie (00:27:34): No, I did. I listened to a lot of visualizations and meditations on this app called Gentle Birth. It was super, super helpful. It was really, I had sort of read the hypnobirthing book, but for some reason it never really clicked with me. I couldn't really use those visualizations. I felt they were just a little complicated. But this app was really wonderful because it went through visualizations for contractions, visualizations for actually pushing how to breathe during this time, how to, all these different sort of opportunities to take a moment and relax. And so that was a really good app that I used. I went to pelvic floor therapy this time around, which was really, really helpful. I had a little bit of prolapse from my first birth, and so that was something that I really wanted to work on and make sure that everything was strong and I sort of knew what was going on. So that was super, super helpful for my prenatal. And then I also went to a prenatal lactation consultant, which didn't really prepare me for the birth itself, but we got on a plan for immediately after and sort of what I could do before giving birth to help my supply. I had had trouble with my first nursing, and so that was something that was really important

Dr. Nicole (00:29:14): To me. Gotcha. All of that makes perfect,

Katie (00:29:16): Perfect sense. And then of course listening to your podcast.

Dr. Nicole (00:29:18): Yeah. Well, awesome. Awesome. So was there anything that you particularly wanted for your birth?

Katie (00:29:26): Yeah, I mean I had said I wanted just women around me that was really important to me. I wanted my mom there. She wasn't able to be there for the first, I wanted to catch my baby. That was a big thing. I wanted a water birth and I wanted to be able to catch my baby and just I wanted the delayed cord clamping and the skin to skin, which is all standard practice and midwifery care. And yeah, I think I just wanted to feel held, I guess. Yeah,

Dr. Nicole (00:30:09): Absolutely.

Katie (00:30:10): Absolutely. And I wanted an unmedicated, but that also was just the, I wanted unmedicated, but that also was like you had to have unmedicated. When you give birth at the birth center,

Dr. Nicole (00:30:23): You don't really have a choice in the birth center. And I should ask, did you want unmedicated for your first Yeah. And then that didn't happen or

Katie (00:30:31): I did. I, yeah, I wanted an unmedicated for my first birth, but I just ended up, I think around seven or eight centimeters. I was like, I'm ready for the epidural and I got the epidural and I will say, as much as I wanted an unmedicated birth, and that did play into the birth center a little bit wasn't why I chose the birth center. It was actually I wanted more of that. I had said that sort of holistic woman driven sort of feeling and the unmedicated aspect of it just sort of came along with it. I was kind of fearful of it. I didn't do it for my first birth and a lot of this throughout my prenatal was preparing for that and just trusting that I can do it and that the people around me are going to support me through that. Yeah.

Dr. Nicole (00:31:29): So then was there anything else you were afraid of when you thought about giving birth at that birth center or birth in general?

Katie (00:31:37): I mean, there were the little things of what would happen if I had to get transferred to the hospital in the case of any type of emergency. I also was a little bit fearful about once the baby is born, there's a potential for the baby to have hypoglycemia because of my gestational diabetes. So there was that sort of fear of that. It was just an unknown that I was sort of having to process through.

Dr. Nicole (00:32:07): Okay. Did they have a transfer plan in place for you?

Katie (00:32:10): Yeah, so we spent a lot of time talking about any type of situation of why or when you would get transferred to the hospital. They were very clear that they were like, we have no ego in this. We are are constantly checking if we see anything that makes it seem like you should be at a hospital or getting a different type of support we take you. They're like, we can really count in the 30 years how many times we've actually had to call the ambulance because they're just so in tune and really, really making sure that it doesn't get to that point. But what was, if you do have to go to the hospital, they continue their care for you. The only thing that they can't do is actually deliver the baby, but they do their best to keep your birth preferences and really advocate for you.

(00:33:10): And there are also are a lot of people who sort of get to a point in their labor and decide to go to the hospital to get the epidural and they go with you and they help you through all of that. Gotcha, gotcha. We felt very in the know. Good, good, good. So then what was your labor and birth? Yeah, so I, let's see. I went in on my due date and I got my membrane swept sweeped, and I was about two and a half centimeters dilated. And so I went home and I didn't really feel anything. I felt kind a little bit crampy, but nothing that really was, Hey, this is starting. But I went home, got through that night, went through the whole next day, and about seven o'clock that night I started feeling just super, super mild. I was talking like this, no one even knew that anything was happening, but I just kind of started clocking it.

(00:34:18): And the reason I should say too, my first birth, I was two minutes from the hospital and so I was able to labor at home for a long time. This birth, I was an hour from the birth center and I also live, like I said, kind of out in the middle of nowhere. So that was a big part of our plan. And my midwives were like, if your water breaks, you come in immediately. But they were just like, we don't need you to labor at home. You just come in just because second births can be kind of wild too. You don't really know what's going to happen with your second as much.

(00:34:56): So that's kind of why I started clocking these like, oh, okay, I probably wouldn't even want to paid attention to them. But I put my daughter to bed and I realized, oh, they're coming every 10 minutes. And I thought, well, okay. So I called my midwife and she said, well, you are overdue, so this isn't nothing, but why don't you just hop in the tub? Because usually taking a bath can sort of calm them down and see if they're continuing. And if they're continuing, why don't you just come in, you can take a nap. Just make the journey up here. So around 9 45 I started, they just were continuing to be pretty consistent. So we got ready, we called my mother-in-Law to come stay with my daughter and my husband and I drove to the birth center, my mom followed, and when we were in the car, they started kind of amping up.

(00:36:00): We were still kind of joking and talking and I had my gentle birth meditations on. I had my eye mask on and I was just trying to be calm and just getting through it, but it was nothing. I definitely wasn't in active labor, but I was having those little contractions. And so we got to the birth center around 10 and just so it could not have been more different, my midwife and the birth assistant who's so wonderful too, opened the door. There was candles and they were just, come on in, let's get you into bed. And there was plants. It was just so beautiful. And they got me in bed and we brought our food, put it in the kitchen. And by this time I was definitely having to sort of stop and breathe through my contractions, but then just kind of go about my conversation.

(00:37:01): And so she checked me and I was about five and a half centimeters when I got there. So I was like, okay, this is great. We're going to do this. This is just going to go, I'm going to have this baby and it's going to be just so beautiful. And they kept coming and my midwife was like, well, she just kept encouraging me to just relax and just take this time because it's going to get more intense. So while you can try to sleep, try to rest. I was a little bit antsy. I kind of wanted to get up and walk around and get it moving. But she kept sort of nudging me, get back in bed, just take a minute. So I finally decided, okay, I'm just going to get in bed. It was like a regular sized king bed. And then there was a couch that my mom was hanging out on.

(00:37:59): And basically I didn't sleep that night. I labored throughout the night to the point where I would have to get out of bed to sort of get on my hands and knees and my contractions were amping up a little bit. And then my midwife came in and said, I think it was around midnight, she checked me again and nothing had progressed, but it'd only been a couple of hours. And then again at three she checked me and still no movement. And there was talk about, well, we could eventually talk about breaking your waters if you wanted, but you're still okay right now. Let's just keep this going. And I remember at one point her coming in and being like, wow, this is just such a gentle birth. I was like, oh, ding, ding. That's my app.

(00:39:00): So it kind of kept going that way. I would sort of be able to sleep and then I would get up and I would have a contraction and rest again. And then around 6:00 AM my other midwife came. So the one that was there could go home and she was like, it sounds like you haven't really slept. I was like, no. So she gave me a little sleep tincture. It was just different, essential, I'm not really sure what it was, but herbs and stuff like that. And I was able to fall asleep for about 45 minutes. And when I woke up, I was like, wow, that was great. I don't remember if I had a contraction. Maybe I did. I couldn't really, couldn't remember. And we just started talking. And then I started realizing, oh, I haven't had a contraction for a little while, maybe 15 minutes. And then it was like every 20 minutes I would have one, and then every 30 minutes and then it would come, and then it would fade away and it would come and it would fade away.

(00:40:16): And she was like, I'm noticing that you're not really having as many sensations. And so she gave me another tincture, which was supposed to sort of help induce contractions, another kind of set of herbs. And it tasted really horrible, but I took it and kind of helped. I had another one, but it just, it's basically my labor stopped. It just stopped. And I had been laboring all night, so I was just, okay, didn't really know what was going on. And she said, well, why don't you, let's, you're still fine. I don't want to break your water because there's no reason to. And once we break your water, you're sort of on this timeframe of more potential for intervention and all of that. And so she said, why don't you guys go for a walk? Go get some food. So my husband and I got our stuff and went for a walk around the block and I had a few contractions, got some food, came back, she checked me, and I was still five and a half centimeters.

(00:41:37): I hadn't progressed at all from 10:00 PM the night before, and it was now noon the next day. And I was just filled with, what have I been doing the last 12 hours? What was that all for? I'm so tired. And she said, again, she's like, she consulted with the other midwife. I was like, we really just don't think it's a good idea to break your water because you are okay. Which is so different than the hospital because at that point I probably would've been given some sort of maybe Pitocin or something to really amp up the contractions and get going. So that was a big difference between those two philosophies. And so we started talking about the options that we had, and she was like, you're technically not in labor right now. You have not had a contraction in a long time. You're not progressing, so maybe you want to go home.

(00:42:46): And I was like, I can't go home. We're an hour away. The last thing I want to do is come back in active labor. So there was a hotel next door and we thought, okay, I guess we'll just check into the hotel and come back when my contractions are about five minutes apart. And we told my mom, go ahead and go home. And when my midwife walked out of the room, she was going to go make another call. I just lost it. I just started crying. And it was just this huge flood of just exhaustion and frustration and just, I didn't want to be away from my daughter any longer than I thought. And just all of this sleep deprivation, I just a flood of emotions and just sort of broke down. And my midwife came back in and was like, okay, I'll discharge you, but why don't you just stay here?

(00:43:48): You're the only person here. Take a nap. You're in a space that you've already made comfortable. You don't have to move. Just take a nap. And when you wake up, then let's think of a plan. And that was really helpful because I think just the thought of packing up and leaving at that point was just really overwhelming. And so I got in bed and after this gush of emotion, and I think that was at maybe around noon, and by one 30 I was like, oh, okay. So they coming on a little bit. I remember getting out of bed and okay, these are much stronger. I think it was just this release of emotion that really sort of kicked my body into gear. And I remember at one point finally my midwife came in and was like, wow, those sound good, just so positive. That sounds great. Those are so different. And I'm like, yeah, they sound really good.

(00:45:06): So my husband kind of secretly started timing them and I mean within 20 minutes they were going, it just started, I was on my hands and knees moaning just like we were going for it. And I remember being like, call my mom. Get her back here. So my poor mom had driven an hour and then basically had enough time to, I dunno, drink some water and had to come turn around. But I remember at one point, so at the birth center too, you had the option to use nitrous oxide, which I wasn't sure if I was going to use it or not. You have to sign a waiver. So I had signed the waiver just in case, and you remember at one point being like, I want to try it. And so they brought it in and basically, so with nitrous oxide, you have to breathe in through the mask and then you have to breathe out through the mask so the fumes don't get everyone else all loopy.

(00:46:21): And so I remember I did it, I used it maybe twice, and I hated it. I felt really claustrophobic because it was also it hard to breathe in and push it back out. And I was realizing just the way my labor was going, I really liked to sort of moan out my contractions and not being able to have that freedom kind of made me claustrophobic. And then I tried to experiment. I was like, maybe if I take a big inhale in between contractions, it'll last. But that just got me super loopy and I was like, whoa, I can't be like this right now. So I stopped it and I kind of remember at that moment when they turned it off in my head being like, okay, this is all you. There's no other intervention. You're going to do this all on your own. And I remember asking, can I get in the tub?

(00:47:27): And they said, let's wait a little bit. We don't want it to slow your contractions down. You're in such a good rhythm, let's just wait. And then right after that, I had a two minute contraction. It was a whopper. I remember saying, it's not stopping. And they were like, you can do it. They were rubbing my back and after that they checked me and I was seven centimeters and that was around four o'clock. So this intense active labor had been going on for about an hour and a half I would say. And so I was seven centimeters and they said, you know what? We're okay with you getting in the tub. So I got in the tub thinking it was just going to be this rush of relief, but it wasn't, was extremely intense. And I remember just feeling like I just couldn't find my footing, but I really was thought back, I remember this state of mind of, you have to go back to your breathing, go back to your breathing.

(00:48:38): You're going to get through this inhale, exhale. And I had told my husband, that's what I want from you. I want you to look at me and snap me out of those moments, any type of feeling of defeat. And he was really great and would see those moments and just look at me and just not say anything, but just sort of breathe with me. And I remember at one point just kind of saying, I think I'm going to collapse. And my midwife was just so calm and matter of fact, and she just said, you're not going to collapse. And it just really was what I needed to hear. And then all of a sudden it was totally spontaneous. I just was like, oh my gosh, I'm pushing. I just started spontaneously pushing. I had no control over it. It was such an interesting, crazy experience and it's completely out of body.

(00:49:44): And I was on my hands and knees in the water, and this was at 4 35. I started pushing and then it would stop and it was just silent in the room. That's another thing that was so different is everyone was so hands-off in a positive way. I was just on my own, was me and my baby. This was our deal. We were going to do this together. And then all of a sudden I started pushing again and I remember just thinking like, oh my gosh, I couldn't stop it. My body was just doing everything on its own. And then his head popped out and no one noticed. So I was like his head's out. And my midwife was like, okay, do you want to still catch the baby? Do you want to still catch him? And I said, yeah. So she sort of helped me position myself.

(00:50:52): She called it kind of like a runner's pose when you're getting ready for a race, you're on one knee and then you're kind of bouncing on your tiptoe on the other one. And I got in position and it was one more push and he just floated up and I just caught him. And that was at 4 45. So I pushed for 10 minutes. He just kind of floated up and it was just so surreal and amazing. And I just sat there in the tub with him and my mom was right there, my husband was right there, and everyone was just kind of gave me that space. And I just sort of soaked in those few moments. And then it was just so natural. I don't know. I felt, I laughed now because I was like, I felt like a crazy lioness. I was

Dr. Nicole (00:52:01): Just so powerful. It was

Katie (00:52:03): Just such a wild, yeah, totally. So powerful. And so they let me kind of sit in the tub for a little bit and they sort of helped me so I could look at him and then helped me out of the tub and onto the bed. And on the bed is where I delivered the placenta in the midwifery practice. And at the birth center, they keep everything attached for as long as you want. So they put the placenta in a bowl next to me and kept the cord attached. And just immediately that skin to skin and starting to kind of try to nurse, and it was just so normal, I guess, is what was so cool about it was we just went through this profound experience. Then we were all just hanging out on the bed. It was just the most natural thing that had just happened. Okay.

Dr. Nicole (00:53:21): Ever. And this is random. Did you ever have any concerns about being in the water and then bodily fluids in the water or blood or anything like that? Did that even cross your mind?

Katie (00:53:34): I mean, it didn't cross my mind while I was doing it, but definitely before I was like, oh God, what if probably going to poop? And I had to tell my husband that, I dunno what this is going to look like afterwards. I should go back. And I remember actually before I started pushing, there was a pop and that was my water breaking, but I had no idea. I had forgotten about my water needing to break. So in that moment in my head, I was like, oh my gosh, the water, you have these moments of coming back to reality like, oh, that's going to look gross or whatever. So yeah, I definitely had those thoughts.

Dr. Nicole (00:54:28): Gotcha, gotcha. And was your husband in the pool with

Katie (00:54:31): You? No.

Dr. Nicole (00:54:31): No. No. He wasn't.

Katie (00:54:32): Okay. No, no one was there with me. That was an option. They said they always tell the husbands or the partners bring their bath suits if they want to go in, but that wasn't, yeah.

Dr. Nicole (00:54:46): Gotcha. Connor said, I'm just going to support from the side. Very close, but not quite in the water.

Katie (00:54:50): Yeah,

Dr. Nicole (00:54:53): Exactly.

Katie (00:54:54): Yeah, he was supportive from a bar.

Dr. Nicole (00:54:57): Yeah. Yeah. How long did you say at the birth center after the birth?

Katie (00:55:00): Four hours. Okay. Yeah. So we got in bed and we had brought a bunch of food and I was very clear, I no longer have gestational diabetes, so I was, yeah, like so we brought a ton of food. They were so amazing and warmed it up and put it on plates and did all this, made it all very nice. Yeah. So we had some food on the bed, we worked on nursing, got him to latch, and they went through all the newborn care and did all the checks, and I had to do one little suture.

Dr. Nicole (00:55:46): How was that? To get stitches?

Katie (00:55:48): It was fine. It hurt to get the, I guess guess it's lidocaine or whatever. It was just the topical number, so it wasn't too bad. The other thing that was really cool about that immediate postpartum is they took the placenta and then they just sat on the bed with us and laid the placenta out and talked to us about it and showed us everything, which was really cool. It was just kind of fun to be really up close and personal with that.

Dr. Nicole (00:56:19): Yeah, yeah. So then you stayed, you were at the birth center for four hours and then

Katie (00:56:23): Yeah, so we were there for about four-ish

Dr. Nicole (00:56:27): Hours. And then you went back home, I guess. And then when did they see you after that?

Katie (00:56:34): So they came to our house 24 hours later and did a newborn check and weighed him. And then they came back again within the 72 hour point. And then after that, we went back every two, four and six weeks to the birth center for postpartum appointments. But it was just so nice. We never had to leave. It was just they came to you, which is just really nice to just be able to sort of be in bed and not have to worry about getting your little newborn back in the car.

Dr. Nicole (00:57:10): And I take it for your first experience, you didn't have a postpartum check until six weeks. Yeah,

Katie (00:57:16): That's correct. And I had had a really rough time nursing, and so I had gone back to the hospital to do different consultations. And this time the lactation consultant also came to our house, which was really nice. And so yeah, it was just sort of this really special time that we could just be a family. And the other thing too that I just was throughout my labor, the birth assistant that was there, I just kind of kept noticing she was typing on her computer and it didn't bother me, but I just remember being like, what is she typing? And everything from after the birth when we're all sitting down, she just kept typing and typing and typing, what's going on? And then a couple days after I got home, I logged into my little profile and she had been recording minute by minute quotes and all of this, everything that we were saying to each other when he came out. And so it was so cool. It says 4 47, Katie says, Hey buddy, and all these things that you just aren't going to remember within those first moments.

Dr. Nicole (00:58:25): Sure, sure.

Katie (00:58:27): So that was really

Dr. Nicole (00:58:27): Special. That's really wonderful. Yeah. So obviously this sounds like it was a very lovely experience for you. It

Katie (00:58:34): Was. Yeah. It was amazing. And the postpartum period was, my body felt really good. I wasn't in very much pain. Oh,

Dr. Nicole (00:58:49): Yeah. How do you feel like the recovery was physically between having a hospital birth and a birth and a birth?

Katie (00:58:54): For me, it was really night and day. My postpartum with my daughter was really, really hard. I mean, I was super, super sore for almost eight, nine weeks. I just couldn't really walk around. I just was in a lot of pain. And this birth, I mean, I had to remind myself that I just had a baby. I, I don't know if it was the water birth or just sort of all these different, no intervention. I'm not really sure the different, I gave birth on my hands and knees versus pushing on my back, the spontaneous pushing. There's all these different factors that could have led to it, but it was a really positive postpartum experience. So that's what really, if I were to have another baby, that was a big green flag of doing it again because I was just able to sort of bounce

Dr. Nicole (00:59:53): Back. And did you have stitches with your

Katie (00:59:55): Daughter? I did. I did. I had a second degree tear with my daughter and this one I had a

Dr. Nicole (01:00:01): First. Gotcha, gotcha. Okay. So then as we wrap up, what is your one favorite, what piece of advice would you give to people who are considering having a baby or who are pregnant and having a baby?

Katie (01:00:13): Yeah. I would say you might not be able to control your actual birth and your labor, but you can make the prenatal experience and your support team what you want. I think I would just empower people to really listen to their intuition, and you don't have to have a traumatic experience beforehand to decide to change and find another route. I think it's just listen to your body and listen to yourself and trust yourself that the path that's best for you.

Dr. Nicole (01:00:50): Absolutely. Absolutely. So then where can women connect with you? You can say nowhere if you're not on social media. Yeah,

Katie (01:00:56): I mean, I'm just on Instagram. It's just Katie Hackett or Katie Rowe Hackett is my Instagram. Okay, okay. It's just a personal account.

Dr. Nicole (01:01:04): Gotcha. Gotcha. All right. Well, thank you so much for agreeing to come on and share your story. Yeah, this was just really, really, really lovely story and really story just enlightening for me to think about ways that we just have to reimagine our whole maternal healthcare system and just opportunities for us to do better.

Katie (01:01:23): Sure, sure. Can I also just say one more thing? Yeah, please. Yeah. I just want to be, I really did have, I really did have a positive experience in the hospital too. I don't want to say that my medical experience was terrible. It really wasn't. It just wasn't for me. So I just wanted to just let people know that whatever works for you works for

Dr. Nicole (01:01:48): You. Thank you. I really appreciate you saying that. It's really about just finding what you think is going to work best for you to help you have the best, most supportive and uplifting and joyful birth experience.

(01:02:10): Wasn't that a great episode? I appreciate Katie coming on to share her birth center birth experience, and I hope you enjoyed it. Now, after every episode when I have a guest one, I do something called Dr. Nicole's notes where I talk about my top takeaways and thoughts from the conversation. Here are my Dr. Nicole's notes from my conversation with Katie. The first one is that birth should be more than just fine. She said her first birth experience was perfectly okay. There wasn't anything that was particularly terrible about it, but it just wasn't that holistic experience that she was looking for. And so often I think in the US maternal healthcare system, we look at outcomes for birth. If the mom is alive and baby is alive, then it's like, okay, great. And we really should look for more than that. People deserve to have more than just a fine experience.

(01:03:04): We want people to have a great experience. Just coming out of birth physically alive is like the absolute bare minimum we can and must do better than that. Now along with that is that we have to look at ways to create connection for everyone giving birth. Not everyone is going to be able to give birth in a birth center. There are also going to be instances where you may see different providers during your birth. I mean, the way birth is set up now, very often you're not going to have met the doctor who is there for your birth. And I know that it's more ideal if you can see the same person during your pregnancy and they're going to be there for your birth, but that's just not the reality of the way it is. I believe that we can create those connections even in the short term.

(01:03:55): I do that all the time as an OB hospitalist when I come in and meet people just during their birth experience. It does take some work and some challenges, but we have to look at ways to create that connection for everyone giving birth so that they all have that great birth experience. The last thing that I want to put a plug in for is policy and the importance of policy. She says she pays $7,000 out of pocket for this birth and her birth, or I think insurance covered part of it. And some places insurance is not going to cover a birth center birth, even though it can be cheaper. Like an average hospital birth can easily be $20,000. So it doesn't make sense, right? The insurance would cover that, but wouldn't cover a birth center birth. That's cheaper. Things like that are going to change with policy, and that means you have to pay attention to what's going on in the law and in the government, both in the federal level and your state level about policies related to maternal health.

(01:05:00): It's easy to not think about things because you have your baby, and then the issues of pregnancy care and prenatal care and postpartum don't necessarily affect you anymore. So it kind of goes out of sight, out of mind, and I would challenge everyone that we're all going to have to step up and get in order to help bring about that change. Now, obviously we can't all be involved in every single thing, but pick something that is important to you and maybe that thing is maternal health. Follow that pay attention to it. Invest some bit of time, maybe even money and candidates who support the things that are important to you because it is policy that will ultimately help move the needle for things. The government shouldn't be involved in making choices and decisions for us, but the government should help expand the options that are available to us and help us to have equitable access to options.

(01:05:57): So that's where policy can really, really be important. Okay, so there you have it. Please share this podcast with a friend. Also subscribe to the podcast wherever you're listening to me right now. Leave me a review, an Apple podcast. I'd love to hear what you think about the show. Or you can shoot me a DM on Instagram and let me know what you think about the show as well. I'm on Instagram at Dr. Nicole Rankins. Do come join me in my live birth plan class. Make a birth plan the right way. Sign up for the next live class 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.