Ep 272: Nicole’s Birth Story – An Empowering VBAC Followed By a Five-Week NICU Stay

Dr. Nicole (00:00): In this birth story episode with Nicole, she shares about her empowering VBAC and challenging postpartum period with her daughter. 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.

(00:58): This is episode number 272. Whether it is your first time listening or you have listened before, I'm so glad you're spending some time with me today. Nicole is a Midwestern turned southern girl living on the Alabama Gulf Coast. She lives with her two daughters, Savannah and Summer, her husband Melvin, and their spunky dog buttercup. They enjoy cooking together, hosting friends and family, and relaxing by the pool. As a family, Nicole works full-time for a worldwide healthcare company and participates in various community groups. In her spare time, Nicole had an empowering VBAC with a supportive doctor whose goal was to help her have a VBAC after her cesarean for a breach birth six years prior. She also had a doula help her during her vbac, who was instrumental in her birth preparation, which she absolutely needed for her. 41 week induction. Yes, 41 weeks with the vbac, her induction went well.

(01:58): However, shortly after birth, her daughter began to exhibit some health complications, which led to four separate hospital transfers and a five week NICU stay. So, needless to say, her postpartum journey looked substantially different than she imagined. I will give it away that her daughter is doing well, but it took some time to get there. Nicole's story is one of just strength and resilience and navigating an incredibly challenging time, and I cannot wait for you to hear her story. I also cannot wait for you to join me in my live birth plan class, make a birth plan the right way. I'm doing the class live coming up soon. So check out dr nicole rankins.com/birth plan to grab your spot. Folks who take this class absolutely love it. I also stay at the end to do q and a where I will answer any questions you have about pregnancy and birth. So again, grab your spot at drnicolerankins.com / birth plan. Okay, let's hop into this birth story episode with Nicole. Alright, well, thank you so much, Nicole, another Nicole for agreeing to come into the podcast. I'm excited to have you share your story.

Nicole (03:17): Yeah, I'm excited to be here today, big fan. Love your podcast. I'm super excited.

Dr. Nicole (03:22): Thank you. Thank you. So why don't you start off by telling us a bit about yourself and your family?

Nicole (03:26): Okay, so in my family, it's myself, my husband. I have a daughter who's seven years old, and then I also have a daughter who will be one now in just a few days, and also have a doggy baby who's a big part of our family. So it's all of us living together.

Dr. Nicole (03:44): Aw, I love it. And doesn't the time fly by? It's probably hard to believe your little one is one, and then you have another one. You said seven. Yeah,

Nicole (03:52): It's gone really quickly.

Dr. Nicole (03:53): Yeah, it does. It does, indeed. So we are talking about your second birth experience, which was a vbac. So I thought we would start off, and could you tell us why you had a C-section for your first birth?

Nicole (04:05): Yeah, so my first birth did not plan to have a C-section. Everything had been run of the mill with the pregnancy, and I went in labor to the hospital, and it was taking them a few minutes to find her heartbeat. And then a few minutes later, they brought in the ultrasound machine, and I'm like, what's going on? I said, well, were you supposed to come in next week for a C-section? No, planning a vaginal birth. I said, well, your baby is completely breach. So she had turned, and looking back on it, I remember a few days prior, I had an appointment the beginning of the week, and my doctor could feel her head heartbeat was in the same place where I always was. And then I remember a few days later feeling really uncomfortable, and I thought at the time, oh, my body's just getting ready. But looking back, that's probably when she was turning.

Dr. Nicole (04:58): Yep, that's probably exactly when she turned. Yep, yep. So it was a complete surprise for you.

Nicole (05:04): Yep. I was totally surprised and even not fully believing it. I asked them again, I said, well, before you do the C-section, can you check one more time to make sure?

Dr. Nicole (05:13): Sure.

Nicole (05:15): She was head down, and so they did. They obliged me and they checked again, but I ended up having the C-section, which was totally fine, no complications or anything like that.

Dr. Nicole (05:25): Okay, okay. Okay. So then a few years later, then you got pregnant again. At what point did you decide that you wanted to vbac?

Nicole (05:33): I pretty much knew that was something that I wanted to try for right away because I didn't plan to have a C-section the first time, even though I had a totally fine experience, I knew that I wanted just to try for the vaginal birth, and I was open to understanding that I might still have a C-section, but I at least wanted to give the vaginal birth a try, and I had a very supportive provider, had a doula, so I felt like I was doing all the right things to try to prepare myself for a vaginal birth.

Dr. Nicole (06:04): Gotcha, gotcha. Okay. And what part of the country were you in for your second birth?

Nicole (06:09): So Alabama, both times I've been in, I live in southern Alabama.

Dr. Nicole (06:13): Okay. I will say Alabama isn't necessarily known as being the most supportive place for birth and has some of the startling maternal mortality statistics. So how were you able to find a supporter who you felt like a doctor who was really supportive?

Nicole (06:31): Yeah. So I would say I'm pretty fortunate that I actually work in the medical field, had a relationship with my provider and the practice that she's a part of, they take a very natural route to birth, and they're all very supportive of vbac. It's I think four providers in the practice. They're very supportive of VBAC, and they have a lower primary C-section rate to begin with. So once I got pregnant, and my previous provider had actually retired, so I did switch providers, but me and her had already talked about it just on the personal level, and so she was very supportive. I had appointments with a couple of the other providers just in case she was out when I went into labor, and they're all very supportive and very, I think they're very vva friendly, and they're just supportive just in general of how you want to go for your pregnancy, what you're comfortable with, what you're not comfortable with.

Dr. Nicole (07:29): Right, right. Nice, nice. So then it sounds like your prenatal care was great. What was your pregnancy?

Nicole (07:35): Yeah, had an easy pregnancy, good prenatal care. Like I said, I did meet with a few of the other providers, just times that my provider was out just in case I needed to go in with any of them. But overall, it was just really simple, just your basic appointments, nothing, no high blood pressure, nothing major like that. So just pretty run of the mill pregnancy.

Dr. Nicole (07:57): Okay. Okay. All right. So then what did you do to prepare for having a vbac?

Nicole (08:02): So I knew I wanted to have a doula. And again, I'm pretty fortunate that I've got a friend who is a doula, and she is also a nurse by trade as well. So she's worked at l and D for many years. So it's kind of like the best of both worlds. She knows, knows all of the medical side of everything, but then she also has the support of doula side as well. So that was the first thing. As soon as I got pregnant, she was probably outside of my family. She was probably the first person to know.

Dr. Nicole (08:33): Gotcha.

Nicole (08:34): So I hired her as my doula. So she helped me to think of yoga stretches, just different things I could do to try to help prepare my body for the vaginal birth. And then just besides that, just doing my own research, understanding what I did want from my birth, what I didn't want, what I thought would help me to be successful. So I felt empowered and I felt like I knew the statistics, even though, again, my providers, they were not trying to switch anything on me. I wanted to have that information to understand what my risk factors might be and what it wasn't, so that I could feel prepared and no one could try to tell me something different than what it was.

Dr. Nicole (09:16): Sure. Gotcha, gotcha. Now, does your, does she still work as a nurse or does she just work as a doula?

Nicole (09:22): She does some PRN work as a nurse still just to kind of keep all of her nursing licensure up. Sure. But she does primarily does doula work now.

Dr. Nicole (09:31): Okay. Okay. And then did you tell your doctor that you were going to have a doula?

Nicole (09:36): I did, and again, I have probably a really different story than most people. My doula and my doctor actually knew each other. They had previously worked together when my doctor was, I believe in residency. And so during my birthday, were having a reunion. So they were again, working together. Well, the nursing staff was, it was like everybody was all on one accord. I know you hear horror stories sometimes, but I got really fortunate where the nursing staff, my doctor, my doula, everybody was working together.

Dr. Nicole (10:09): So then what were some things that you wanted for your birth?

Nicole (10:12): I knew that because I wanted to do the dba, I wanted to be able to move around. I wanted to be able to change positions, so I didn't want to go all the way natural, but I wanted to try as long as I could before I got my epidural. And I wanted to try just other pain relief techniques, bouncing on the ball, having my doula do the counter pressure laboring in different positions, switching positions throughout labor, just doing all those different things until I got my epidural. And then even once I got my epidural, I still wanted my doula to help, and the nurses, which they did a great job of helping me to move some and use the peanut ball and different things. So I just wanted to do as much as possible to keep baby moving down because I knew that would help me to possibly avoid a C-section.

Dr. Nicole (11:08): Yeah, definitely, definitely. Was there anything that you were afraid of about giving birth?

Nicole (11:14): Not really. I was just the normal nerves of like, can I do this? How is my body going to respond? The first time, I did go into labor naturally, and I did experience light contractions, nothing like what I experienced the second time around. So I kind of had a little bit of an idea of what it would start to feel like once I was in labor. Also, this time around, I actually was induced, so I was a little bit concerned, obviously, about going in for the induction and then how a baby would tolerate that and if that would lead to the, but I tried to just stay really positive and tried to just kind of put that out of my mind and just focus on what was going on at the time and not worry about all the what ifs.

Dr. Nicole (12:04): Okay. Okay. So how far along were you when you got induced, and how did that conversation even come up to be induced?

Nicole (12:12): Yeah, so I was 41 weeks when I got induced. So around week 39, my body was having some changes, but nothing major. And again, wanting to try for the vaginal birth, I was kind of like, alright, let's get into gear. So as I was going towards that 40 week mark, we did do a membrane suite that did nothing. I was curb walking then I'm like 40 weeks now. So I was doing the curb walking, I was having

Dr. Nicole (12:47): Sex. It's just like this baby, we got to get this baby out. All things by any means necessary.

Nicole (12:52): Yes, right. We're doing all the things that they tell you to do naturally to try to help baby come. And as I got to 40 weeks past 40 weeks, then those conversations with my provider, and actually it was one of her partners that he's like, okay, you're past 40 weeks now. You're going to be coming up on 41 weeks, which I also, again, looking at statistics and things, I knew that trying for the vaginal birth after cesarean, you kind of have a finite window where you have a good chance, but then as you get a little bit further out, your chance kind of starts to decrease. So we just went ahead and decided that we would do induction. I was too dilated to do the balloon. So we started off with doing the water break, which did nothing. They think her head may have plugged the hole, it was not doing much. So then some hours later they started Pitocin, and then that did start to get things moving along. It still took a little while for my contractions to get in a regular

Dr. Nicole (14:00): Pattern. Do you remember about how long it took

Nicole (14:03): My time? That day is so, so I went in at six or seven o'clock that morning and they did the water break. That didn't do a whole lot. So maybe mid to late morning they did started Pitocin, and then it seemed like it was going really slowly, and then all of a sudden, by late afternoon, early evening, things just set up. And then she was born by 8:00 PM so I guess it was

Dr. Nicole (14:34): 12. Well, are you

(14:35): Serious? Yeah.

Nicole (14:35): So I guess it was maybe a 12 to 14 hour labor time for my induction total. That's

Dr. Nicole (14:41): Really quick.

Nicole (14:42): Yeah. Yeah,

Dr. Nicole (14:43): Yeah. Okay. So then let me back up and ask, was any hesitation or did your doctors express any like, oh, we shouldn't be doing induction because you've had a prior C-section? Or were they like, no, we can do induction.

Nicole (15:01): They were totally fine with induction as it should be. She let me know that obviously I wasn't the cervical rapers that I wasn't going to be able to do any of those, that it would just be, and because again, I was past stage of the balloon that it would just be they would try the water break, see if that got contraction started, and then I knew that I was still probably going to end up doing Pitocin as well. They said even with the water break, you still might need a little Pitocin to keep you going.

Dr. Nicole (15:30): Sure.

Nicole (15:30): Yeah. And I hate when I hear all of the things and hoops that people have to jump through, because I'm really just thankful I didn't have to do any of that. None of this was, it was just not a big deal to my providers, to her or her partners. Even with scheduling the induction, they were just like, oh, well, we can't do this day, but we can do a couple days from now and you'll just come in. It was just very casual. You'll come in, we'll do this, we'll do this, and then you'll have a bake. I'm like, oh, okay. No big deal.

Dr. Nicole (16:00): Right, right. Okay. I love it. It's just a beautiful example of how it does not have to be difficult. It doesn't have to be difficult. It doesn't have to be. So then at what point did you decide to get the epidural? So

Nicole (16:14): I think when I was about five or so, I may have been four or five centimeters. And I was like, okay, I need some relief. But I wasn't quite ready for the epidural yet, so they said they could give me morphine. So I was like, okay, that'll help take the edge off. That did nothing. That literally did absolutely nothing. And I had been at a five for a few hours at this point, and I was getting really tired, so I might've had morphine for maybe 30, 45 minutes, and I'm like, you can tell them to go ahead and let's just do the epidural because this is not doing anything for me. So at that point, of course, when I wanted it, they were like, well, you got to wait a little while. The anesthesiologist is busy. So I ended up having to wait, I don't know how long it was, at least an hour or so, maybe a little bit more or less, give or take.

(17:13): So I had to wait for anesthesia to come, and the nurse said, we're not going to check you right now. Let's wait. Let's let you get the epidural so you can get some relief, and then we can check after you get the epidural so you'll be more comfortable. So I was like, okay, that's fine. And again, I had been at the four or the five for several hours. So then after I got the epidural and things kind of calmed down a little bit, she checked me and she's like, oh, you're at a seven. And I was like, oh, okay. So things are moving along. And then it seemed like I thought I was going to get all this rest and have all this time. And then it seemed like all of a sudden, all the people started coming in and they're like, alright, it's go time. And you were like, wait, what? I was supposed to be taking a nap. Like what? Yeah. So the time for me getting the epidural to getting ready to deliver was really not that long. It was probably only about maybe an hour and a half

(18:13): At

(18:13): The most. And then they were like, oh, yep, let's check you. Okay. Yep, you're complete. All right. It's time to get ready to start pushing me. Wait a minute. What's going on? I thought I have more time.

Dr. Nicole (18:23): It just went just like that.

Nicole (18:25): But I think somebody was saying sometimes once you get the epidural, your body can finally relax and then you can just kind of float on for those last few centimeters.

Dr. Nicole (18:34): Right. Okay. All right. So how long did you push?

Nicole (18:37): I pushed for about 40, I don't know if it was somewhere between 45 minutes and an hour.

Dr. Nicole (18:43): Okay. Which is great for a first time

Nicole (18:45): Baby. Yeah.

Dr. Nicole (18:46): I mean, you were essentially pushing for the first time. Yeah,

Nicole (18:49): And I got lots of breaks when they saw that I was getting a little bit restless. They would say, okay, let's stop. Let's reset for a couple of contractions, then we'll get back at it again. Everything was very chill. Everybody is just kind of talking and hanging out, and it wasn't a big stress type of situation at all.

Dr. Nicole (19:10): Right. And you were happy with your nurses and everybody? Oh, yeah.

Nicole (19:15): Yeah, everybody. It was really good. Everybody was very helpful. By that time, I think there had been a shift change, so I ended up with a new set that came in before baby was born, but again, my doula was great the whole time, even after the epidural, helping me to move, helping me to use the peanut ball, and just she was having some decelerations, and there were some different things going on behind the scenes that I didn't really know about. But that's where, again, my doula and my doctor were working together, and things just continued on, and when things would happen, they would get me in a different position and just try to correct some things and then keep on going.

Dr. Nicole (19:55): Okay. Okay. Alright. So then you said you pushed for about 45 minutes or so, then when she was Oh, and was it your regular doctor was there for the birth? Yeah.

Nicole (20:06): Yeah, she was there. Yeah. So she had been there throughout the whole day. So she did the water break. She came in and checked on me. Luckily their office was literally across the street, so she was able to come check on me a couple times and gave me some motivation a few times when I was getting a little weary. So it was good that I had my regular doctor.

Dr. Nicole (20:24): Okay. Good, good, good. So then when she came out, then what happened? Did they put her skin to skin? How did everything happen?

Nicole (20:31): So again, it was all of a sudden, it seems like everything ramped up and they're like, all right, she's almost here. Get ready to push, get ready to push. And funny enough, she was born on August 8th, and she was actually born at 8:08 PM So they called the time and they're like, it's 8 0 8. And so everybody's like, oh my God, 8 8, 8, 0 8. So that was, everyone was screaming that in the delivery room, and so they put her on my chest. I actually got to cut her cord. My husband's a little medical clear. He was like, no, thank you. So they were like, well, mom, do you want to cut the cord? So they helped me to get in a good position and give me the scissors so that I could cut the cord. So I thought that was pretty cool. So I got to do that and then cleaned her up. She didn't have any issues, started breastfeeding right away, and that was it. Again, it was super uneventful. Just at that point, everything was still just very calm. She got checked out. She was good. I had had very superficial tears. One of 'em was just more like a skin tear, so it wasn't even repairable. And then there was another one that had a couple small stitches, but that was it. No major issues with bleeding or anything like that.

Dr. Nicole (21:50): Okay. And before we get into what happened afterwards, because things certainly started to get a little different, how was your doula helping to support your husband at all?

Nicole (22:01): So she knows him as well, so she was checking in with him, and we had other friends that were checking in with him as well as everybody knows how he gets kind of nervous because there was one point, looking back on it, while I was in my transition phase, I got really sick and I was vomiting and not feeling well, and just totally not wanting to do anything but lay in the bed. So she did a good job of checking in with him and engaging him as needed. But that was another reason I wanted to make sure I had a doula because I knew that I was going to need a little extra support, and I didn't want him to feel uncomfortable, and I didn't want him passing out or anything like that. Definitely. So he was able to check in. He was kind of checking in with the family, taking the videos and pictures and all that good stuff as well.

Dr. Nicole (22:50): Right. Gotcha. Gotcha, gotcha. Okay. So then what happened because things postpartum didn't go as anticipated, so how did things start to change?

Nicole (23:02): So she was born and they do all of their newborn checkup and everything, and they said, oh, you know what? She has a little bit of a higher bilirubin right now. It's a little elevated, so she's a little jaundice, which I've heard of jaundice. I've had friends who've had babies that were born jaundice since it was the evening. They said, we're going to continue to watch through the night. We're not as concerned about it because she ended up having right away some poopy diapers and some pee diapers. And so that kind of helps. I know, get rid of the bilirubin as well, they said, but in the morning, we will continue to check throughout the night and we'll make a call in the morning if we're going to have you to have the light in your room with her or what we think we should

(23:43): Do.

(23:45): Again, I'm like, no biggie. We went to our mother baby room and I continued to breastfeed her throughout the night. My husband was there, so he was doing the diapers and helping me to get her. I was breastfeeding. And then in the morning, that's when things kind of started to change. They also had done, I guess, an initial blood test on her. So it was determined that we have different blood types. So they were mentioning sometimes that can also impact the bilirubin as well. That's initially what we were just thinking, just because the blood type mismatched in the morning, her bilirubin had continued to elevate even more. So they said, you know what? Actually this has kind of elevated a little bit more. We're going to just take her and have her in the nursery so she can stay under the light and we can keep her in the nursery today. So me, second time, mom, I'm like, cool, I can sleep. They said, we'll bring her to you when it's time to feed her, but you just get some rest. So that's what I did. I was like, I'm going to rest. My husband was going to go home, shower, grab some things from home, and then come back. And then in a matter of, I don't even know if it was an hour,

(25:01): Things escalated even more so up until this point, this had been the nurses or the nurse practitioners kind of relaying this information. Well, the next person who came in was actually the neonatologist, and he came in and said, this is more than just a typical jaundice. There's something more going on. I'm not exactly sure what it is without running additional tests, but this is very serious. And her levels of her bilirubin were doubling and tripling,

Dr. Nicole (25:29): Oh my god,

Nicole (25:30): Rapidly.

(25:32): And that at that point, if they didn't take a higher level of intervention, there could be all kinds of consequences, organ damage, neurological damage, just all kinds of things. So of course, I'm just totally in shock because I thought we were just talking about jaundice, something that lots of babies have, and they get under the light and they're fine. And I'm also there by myself, because again, we're thinking husband can go. My parents were in town with my oldest daughter. I had even told them, oh, she'll be in the nursery. Just wait until, this is the second day of school for my oldest daughter. Just wait until after school and come visit. And then the next thing I'm calling everybody like, Hey, this is an emergency. The hospital that we were at is not our children's hospital. We have a children's and women's hospital. So they decided that they were going to need to transport her to the children's and Women's Hospital for their higher level of NICU and the NICU care there, and so that she could see multiple specialists. They weren't really sure what was going on. So that's pretty much what happened. So then everybody got into gear. My parents immediately came. They brought my daughter so my daughter could see her,

(26:48): Her little sister. My husband basically did a U-turn and came back. My doctor came, well, actually it was one of her partners, I think she wasn't working that day. One of her partners, actually, no, she ended up, she wasn't in the hospital that day, but when she found out what was happening, she came over and one of her partners came over and they asked me what I wanted to do, did I want to be discharged? And of course I said, yeah, I want to go with my baby. So then everyone just kind of started wrapping things up, and then they put baby in the little isolette and the emergency crew came to get her, and they transported her to our local children's hospital. I think at that point, I was just really in shock. I just was like, what is going on?

Dr. Nicole (27:38): Sure.

Nicole (27:39): So we left. We had to wait a little while before we could go and actually see her. They needed time to get her into the hospital, start running their preliminary test and everything like that. So me and my husband later on went and I went from having just this regular looking little baby, and then when I go into the hospital to see her, she's got multiple iv, she's got all these things hooked up to her. And again, so I just lost it because I'm thinking, I've had a totally normal pregnancy. I had a totally normal delivery.

Dr. Nicole (28:13): Sure.

Nicole (28:15): What's going on right now? This is not even in the realm of what I had imagined. So at that point, they were still kind of unsure. They knew at that point that there was something happening beyond a normal just jaundice with her liver, but they weren't sure the cause of it. So they were running tests on her to see if she had some infection. They were asking me all kinds of questions. They went back and were looking through all my medical records to see if there had been any indications for anything, and there really wasn't.

(28:51): And there even asking all those weird things during pregnancy where they're like, do you have a cat? Do you change kitty litter? And they're like, no. So they're asking me all those things about trying to determine if I had some type of infection or if I had gotten sick. And there really wasn't anything that was really remarkable during my pregnancy to connect what was going on. So they were kind of treating her for everything. So she was on multiple antibiotics, multiple, just everything. She had transfusions. She was getting tests run, it seemed like. I mean, they were taking so much blood at one point. It was like they were taking blood to the point where they had to stop taking blood because her body was not able to replace it quick enough. And after about a week at our local children's hospital and things continued to kind of go up and down, up and down, touch and go with her, they decided that she actually needed to be transported again to, so we live in Mobile, Alabama. Birmingham is the next larger center, especially for liver, because there is liver, dedicated liver transplant teams and specialists in Birmingham that for our southeast area, kind of like they're the major center.

(30:12): So it was decided that she needed to transfer again to Birmingham, and this time she was going to fly. So I always say she's special girl. She got to fly in a private jet at one week old. And of course, for me, that was really devastating because it's like, yes, you're going to get more help, but it's escalating. So now we're escalating to another level of care.

Dr. Nicole (30:37): And how far is the drive?

Nicole (30:38): So for us, it's about a four hour drive. So not horrible, but not something that you can do. Oh, a

Dr. Nicole (30:44): Lot.

Nicole (30:45): Yeah. Daily or weekly. So at that point, me and my

Dr. Nicole (30:48): Husband and you have another child at home.

Nicole (30:50): So me and my husband went right after she left. We went a few hours later and my parents stayed with my daughter,

(31:01): Which was pretty difficult. You've got one child that is literally fighting for their life, and you've got another child that has just started school and has a big change going on for their self, but obviously we needed to go with baby summer, so summer is her name. So yeah. So we went with Summer to Birmingham, and we were at the regional NICU and then transferred again to the children's hospital there. And she continued to get treatment. At this point they had landed on, they couldn't fully diagnose her yet because enough time had not gone by, but they were thinking that she had something called gall or gestational autoimmune liver

(31:41): Disease,

(31:42): Which basically our cells were kind of fighting one another. It starts in utero, and the liver starts to become damaged, and then it continues and has to rebuild and regenerate itself.

(31:55): So

(31:56): It takes time for that to happen. And there's treatments that they give to help the liver get some rest and repair itself, and there's other medicines and transfusions and things that happen. But a lot of it is also just kind of time and waiting for the liver to be able to repair itself and watching and waiting and

(32:19): Checking

(32:19): The labs to see which way the labs are going. So that's kind of the holding pattern we were in then for the next month.

Dr. Nicole (32:26): Wow. Oh my gosh. Okay. So how often were you going back and forth?

Nicole (32:35): Yeah.

Dr. Nicole (32:35): Or what were you doing?

Nicole (32:37): So we pretty much stayed there for most of that month. My husband went back and forth a couple of times. I, of course, was the crazy mama bear and didn't want to leave barely, but for a few hours at a time to go sleep, shower, and then come back. So my parents came up a few times and we switched out with them. So they stayed with her

(32:58): So

(32:58): That I could come home and spend some time with my daughter. And they also brought my daughter up a couple of times so that we could spend time and do things. But we were pretty much for the month that we were there month and a week, just relocated to that area and just spent time at the hospital with her every day.

Dr. Nicole (33:18): Okay. Did they help you with housing or did you have to just find a place to stay?

Nicole (33:23): So we just kind of found a place to stay. We ended up renting an Airbnb. We knew after the first day or so that we were there that a hotel was not going to be sustainable, just because, I mean, Airbnb is expensive too, but at least you're getting a whole house or apartment or whatever versus a hotel night to night. And the other housing options, there were other housing options available, but we just felt a little more comfortable having our own space and being able to have, they have restrictions on a lot of those housing options. And we knew my family would be kind of coming and going. So we wanted to be able to come and go and have family come in. My sister came into town and I had other people to come and help for the day or here and there, so we just wanted to have our own space. But there is resources, and there were some other resources that we tapped into for gas gift cards that different organizations provided for the back and forth. We have a super, super, super amazing village. So my friends rallied and we got grocery gift cards. I would wake up and just people would've sent us money in our cash app so that we could pay for the Airbnb or we could put gas in the car. So we had a lot of help and a lot of assistance from our friends and family as well.

Dr. Nicole (34:41): Okay. Okay. I mean, how were you mentally? This came out of nowhere?

Nicole (34:48): Yeah. Mentally I was not doing good, and I ended up being diagnosed with postpartum depression and anxiety because I was really struggling with, and I think a big part of it for me was having everything normal, and then everything just in the blink of an eye changing and going so much different than what I anticipated. So that was really difficult for me. And also the unknown of not knowing exactly what her diagnosis was and what our outlook was going to be. That was also extremely difficult for me to wrap my head around. So again, I was able to get help with that. I would tell anybody. I was like, how are you doing? Not good. Right?

Dr. Nicole (35:47): You were honest.

Nicole (35:48): Yeah. I would joke and laugh about it, but I would tell whoever asked, I'm struggling. I mean, I was crying. It was funny because me and my mom at one point, she'd be like, well, you haven't cried in X amount of hours or you haven't cried all day today. So that was the milestones of how long it had been since I had my last crying and break down. And it's like we laugh about it and we joked about it, and I would try to find little things to bring me happiness and joy, but it was a tough situation.

Dr. Nicole (36:22): It is. I know that feeling when my first daughter was in the NICU and I used to limit myself to crying three times a day, we was like, okay, I got three times and I could just get my three cries in. I would space them out during, it was the only thing I could control. I couldn't control anything else. So then did she just, over time, I assume she just started getting better and things started improving.

Nicole (36:48): So the various therapies, they spaced out when they were giving her the different medicines, and we had all these specialties that were involved at first. And as they started to rule different things out, they continued to narrow in on the diagnosis. And again, part of it was just time. So part of it, she just had to be there. We just had to wait for the labs to be as positive as they could be for a certain amount of time. And even when she got discharged from the hospital, her liver was not all the way back 100%

(37:25): Yet,

(37:26): But it was well enough. And luckily she didn't have any other issues. It was just the liver. So she never had any respiratory issues. She didn't have any feeding issues. So everything else was fine. It was just the liver. So when she came home, she was on some different medications that kind of, we were doing around the clock, and we had a lot of doctors' visits and a lot of back and forth for the first several months for her.

(37:53): But

(37:54): Now, thank God her liver is well, and we just have to do a once a year visit with her liver specialist. And then she just has her normal check-ins with her pediatrician. And we have different things that we look for and that we keep eye on with her. But overall, she's doing

Dr. Nicole (38:13): Great. Okay. Well, I'm glad to hear She's doing great. I've never heard of this. I'm going to have to look it up. It must be pretty rare.

Nicole (38:19): It's very rare. And it's funny because my best friend's father is an OB, GYN. Her mother is a pediatrician. They have, I mean, we're in our late thirties and they've been doctors our whole lives and neither one of them, they're like, we don't even know what this is. We've never seen this in practice. They even had to go into their textbooks and look. So yeah, it's just something that's not very common at all.

Dr. Nicole (38:44): And then does she have to be on any long-term medications at all?

Nicole (38:48): Nope. So her liver is well enough that she doesn't have to be on anything. So it's just continuing every periodically for them to do labs and do a check-in on her. The good thing about it being her liver, as you know, is the liver is like a self-healing organ. So they were able to catch it in enough time that there wasn't any long-term cirrhosis or major damage to her liver. So she doesn't have any specific outlooks other than just we keep eye on certain things. Obviously, if we ever notice any jaundice or any additional bleeding or anything like that, we would take her in. But other than that, there's no other things that she has to do.

Dr. Nicole (39:32): No dietary restrictions, nothing.

Nicole (39:34): No. Upfront there was when she was first in the hospital, but since coming home, if you saw the way she eats,

Dr. Nicole (39:46): Goodness, I love it. And she met all of her milestones or is meeting milestones and things

Nicole (39:51): Like that? Yeah, she's a little small, but she's gained weight really good. So that was the main thing. That was another thing that kind of held us in the hospital was that her little body was just struggling to hold onto the nutrients that it needed to. So she would gain weight and then lose weight. And so she was just a little bit smaller, but she's continued on her growth chart to continue to go up. So she's doing good with

Dr. Nicole (40:15): That. Okay. Awesome. Awesome, awesome. So how long do you feel like it was before you felt like you could exhale?

Nicole (40:22): I would say, okay, this was in August. It probably was not until mid to late February that I felt like I could exhale. That was kind of when we had our doctor's appointment where they gave us a good, we have a positive outlook. We're not concerned about long-term issues with her. We were able to stop some of her medicines around that point. That was when I felt like I could exhale because there were so many things. I mean, they just didn't know. They were like, we don't know if this could be a tumor. We don't know if she could have some rare blood disease. There was so many unknowns. So until all of that weeded itself out, which took time, they didn't know if there was a genetic condition. And there was some tests that took months to come back. So we weren't even sure about certain things until three, four or five months down the

(41:21): Road.

(41:22): So yeah, I would say late winter, early spring was when I started to exhale.

Dr. Nicole (41:28): And then I guess my last question is how do you feel about the care that you got in the NICU and with the specialist and things like that?

Nicole (41:35): I felt like it was actually very well, and again, I've heard so many horror stories, and I hate to hear it because we were in four different hospitals, three different nicu. So I feel like I got a pretty good idea of how things work in the care works each place we went as soon as we got there. We were immediately seen by social workers. I was seen by lactation. The specialist would come around, they had dedicated team, and I think maybe part of it may have been because what she was dealing with was so rare and they were not sure which way to go. So we just had a lot of people that were always checking on us, always rounding on us. So I felt like overall the care was really good. We still had to advocate for ourselves, especially as it got closer to time for her to leave, to really get a good understanding of what the care plan was going to be. And at one point, it felt like we were just in the hospital and we're like, what's the plan here? We're just here for labs and we need to understand what's going on. So we did have some of those more tough conversation, but they were never met with negativity. It was always, okay, well let's get the team on one accord. Let's figure out how we can work together.

(42:56): So overall, I felt like we had really good care.

Dr. Nicole (42:58): Okay, good. And I've always said NICU nurses are angels. They're wonderful.

Nicole (43:02): Oh yeah. Everybody who works with those babies is like, they are heaven sent, and they have so much care and so much love, just the way that they look at them when they're examining them, and it just,

Dr. Nicole (43:16): Yeah. Yeah, definitely. Definitely. So then what is your one favorite piece of advice that you would give to expected moms?

Nicole (43:25): Yeah, I guess I'll do two twofold. Go for it. So for moms that are attempting a VBAC or really want to try for the vbac, I would say just find you a really good provider and take care of all of the resources that you have. So doula, a strong provider, a great hospital, and I know you can't always control all of those things, but really tap into your resources if VBAC is your goal. But also know that it may still not go that way, but at least you know that you done all the things to help yourself. And then for any moms and families that end up in the nicu, NICU is a roller coaster. It's a journey. And you cannot let one set of labs, one set of tests determine your highs and your lows because they'll go up, they'll go down. Just when you think you're going to get discharged, you find out you've got to stay longer. So you have to find something to ground yourself. For me, that's my family, that's my religion, that's my community. And you've got to tap into whatever that is that will help keep you grounded or else you just cannot rely on all of the tests and all the

Dr. Nicole (44:42): Labs. Just a beautiful, just perfect advice. Perfect advice. So where can women connect with you? You can say nowhere if nowhere if you're not on social media.

Nicole (44:52): Yeah. So I am on Instagram and I share some of our story on Instagram. I'm at hello Hitchens, H-I-T-C-H-E-N-S. And then I'm also on Facebook too with my name Nicole Hitchens.

Dr. Nicole (45:03): Okay. All right. Well, we will link that in the show notes. Well, thank you so much for agreeing to come on and share your story. There is so much to learn from it, and I'm so glad that summer's doing well now and that her liver and everything is all healed up. You never forget those types of things when they happen, but it is nice when it starts to be more in the rear view mirror. Absolutely.

(45:30): Wasn't that a great episode? I am so grateful that Nicole came on and shared her story, and I know that you are too. Now, after every episode when I have a guest on, I do something called Dr. Nicole's notes, and here are my Dr. Nicole's notes from my conversation with Nicole. Number one, I want to reiterate, you can be induced if you had a prior cesarean birth. You can be induced with a VBAC if your doctor is telling you that you can't be induced. What they're saying is that they don't feel comfortable doing a labor induction. Studies show that yes, there is a slightly increased risk potentially of uterine rupture with induction, but it's still in the order of 1%. So you can definitely be induced with a vbac. I also think it's interesting that she went all the way to 41 weeks. You don't have to be induced at 39 weeks or even on your due date.

(46:21): She went all the way to 41 weeks and was successfully induced with her vbac. This was just really of an example of how induction of vbac, it doesn't have to be complicated. It doesn't have to be stressful. We can start from a place of being calm and approaching things like, Hey, things are going to be okay, and we can definitely escalate when we need to, but we should start from that calm place. That was a great way to approach it, and this is actually how medicine should be. Okay, next up is I appreciate how she knew that her husband was not the best support person to be her advocate. She knew that very clearly, just who he is. And there's nothing wrong with that, okay? Not everyone can be an advocate. Not every partner wants to be an advocate or is comfortable in that position.

(47:13): So in her case, she got a doula who she knew could help advocate for her. And it doesn't necessarily even have to be a doula. It could be a family member, it could be a friend. You should have someone for sure who can help advocate for you if need be, but it doesn't have to your partner. It can be someone else. And in her case, she got a doula. And speaking of doulas, that was one of the things that she was controlled about her experience. I always say that birth is unpredictable. The only predictable thing about birth is that it's unpredictable, but there is still a lot that you can control in the process. And getting a doula is something that you can control. I know sometimes it can be pricey or out of reach financially. It's something you can ask for on your registry.

(47:58): Some employers are actually paying for doulas, so check if their benefits there. I believe target, if I'm not mistaken, pays for doulas and maybe some big companies. So control what you can control. She got that doula. She got a good doctor who was able to support her childbirth. Education, of course, is another way or something that you can control so that you are as prepared as you can be to navigate that unpredictability of birth. All of that is so, so important in helping you have your best birth experience. 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, and leave me a review and Apple Podcast. I sense so appreciate it. I love to know what you think about the show. And those reviews also help the show to grow. Do come join me in my free live class, make a birth plan the right way. That next live class is coming up soon. Grab your spot at drnicolerankins.com/birth plan. You don't want to miss it. So that is it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.