Ep 274: Martha’s Birth Story – Low Intervention Hopes, High Intervention Reality, and Joy Despite It All

Dr. Nicole (00:00:00): How do you feel Joy after a difficult labor and birth that didn't go at all the way you expected? You'll learn how in today's birth story episode with Martha. 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.

(00:00:57): Hello there. Welcome to another episode of the podcast. This is episode number 274. Whether it is your first time listening or you've been here before, I'm so grateful that you're spending some time with me today. In today's birth story episode, we have Martha, Martha hoped and really prepared for a low intervention birth with hospital midwives. She ended up being induced at 41 weeks and three days due to concerns about her baby's heart rate. On a non-stress test, she was in labor for 40 hours and experienced nearly every intervention that she had not wanted during that induction, some of which were hard on her and others of which were hard on her baby. She labored for about 35 hours through two nights without an epidural and used nitrous oxide for pain relief before getting an epidural about five hours before a non-emergent, but medically recommended cesarean birth.

(00:02:01): The C-section itself was not traumatic, but it was unwanted, and she experienced a lot of grief over the loss of the birthing experience that she wanted. Now, despite that emotional rollercoaster, her postpartum experience was actually quite joyful. She had a positive and successful breastfeeding journey, and she felt incredibly bonded with her baby from the second she was born. Martha's story is an example of how joyful and easy postpartum experiences are possible, even when the journey to birth is very challenging, and we are going to get into all of the details of how she was able to do that in this episode today. Now, quick reminder before we dive into the episode, I'm teaching my birth plan class live coming up soon. If you want a birth plan that actually works to help you have the birth that you want, you don't want to miss it, grab your spot in the next free live class at drnicolerankins.com / birth plan. All right, let's get into the birth story episode with Martha. Thanks so much, Martha, for agreeing to come onto the podcast. I'm excited to have you share your story and the challenges that came with it and how you overcame those challenges.

Martha (00:03:24): Thank you. Yeah, I'm excited to share.

Dr. Nicole (00:03:26): Yes. So why don't you start off by telling us a bit about yourself and your family?

Martha (00:03:30): Yeah, so I'm in my early, less early by the day, but thirties, and I live in the Twin Cities area of Minneapolis with my husband and our daughter. She just turned one. And yeah, we love living here. We love getting outside, and we recently actually just got back from our first overnight camping trip with our daughter, which is something that we loved to do before we had her, and finally got back out there and she did great. It was awesome.

Dr. Nicole (00:04:02): Oh, that's really sweet. That really sounds fun. I don't know that I could do the cold weather that I think you experienced there.

Martha (00:04:10): Yeah, we have extremes. So as cold as it is in the summer or in the winter, it's hot in the summer, and both of those come into play in my pregnancy, super cold and super hot.

Dr. Nicole (00:04:23): Gotcha.

Martha (00:04:23): Span the breadth of it.

Dr. Nicole (00:04:25): Yeah. Yeah. So speaking of your pregnancy, why don't we get into your pregnancy because in order to understand the birth, we got to understand a little bit about the pregnancy. So what was your pregnancy and prenatal care? Did you see a doctor, a midwife? How did things go during your pregnancy?

Martha (00:04:40): Yeah, so I actually, I was pretty sick during pregnancy at the beginning and then also at the end. And I was sick really early on, and I was really sick. I found out I was pregnant really early before I missed my period. We knew that we were open to pregnancy, and so I found out three weeks or whatever, and by five or six weeks I was throwing up all day every day. It was rough. I listened to your podcast on hyperemesis recently, what you had a guest on maybe a while back, but she said, this is beyond the nausea, that you can have a piece of ginger and it goes away. This is constantly being on the verge of throwing up, and that's really how it was for me. It was pretty tough, and I had to work through it too. I was fortunately working a hybrid kind of corporate job

(00:05:43): Post covid with some flexibility for working from home, and so I just worked from home as much as I could, but I was sick constantly, and we tried all sorts. We tried the unison and B six, we tried, I mean, I threw up so much ginger that I just stopped trying in the early days. It was almost manageable with diet and that, but it pretty quickly became like I couldn't keep anything down. I did try acupuncture. I tried everything I could before the next intervention, which is pretty much the theme for how my birth went also. But I did end up on Zofran. I think I was on the eight milligram dose

(00:06:27): A

(00:06:27): Couple times a day through. I stayed on it through my entire pregnancy. So yeah, on Zofran, it was more like I was throwing up two to three times a day, and I was still getting pretty sick, but it was like I could get through

Dr. Nicole (00:06:43): The

Martha (00:06:44): Day with the Zofran, those Minnesota winters. I went for long walks and just the coldest brisk cold towards the end of my first trimester when I was well enough to get out of the house, and that cold air felt so good for me, but it was tough. I described it to a friend as being hung over with the stomach flu on a ship at Sien, a storm. I was always just unsettled. It was tough. Oh

Dr. Nicole (00:07:13): My God,

Martha (00:07:14): It was really tough.

Dr. Nicole (00:07:15): Okay, well, I should say, did that make it hard for you to connect with your pregnancy?

Martha (00:07:21): I've heard that it can, and for me, not really. Pregnancy was so hard, but I loved that I was pregnant and I was tracking the size of the baby on an app with the fruits, and I was so excited to feel the baby move and start planning the nursery. I think that was one of the things that kind of got me through the sickness is in my really tough days, I would work on my registry or think about the bigger picture. Although I will say not always, I had a couple tough days. I remember I was going in, I was being monitored for dehydration and weight loss. I just couldn't keep anything down. And I was with hospital midwives, and the midwife was like, oh, do you want to hear the baby's heart rate? And I was like, well, isn't medically necessary? And she's like, no. It would just be kind of reassuring, maybe put the bright side of spin on things. I was just like, no, I felt so bad after. I was like, no, if it's not medically necessary, I just want to go home. Today

Dr. Nicole (00:08:28): Is not the day,

Martha (00:08:29): Not today. So I definitely had moments where I was like, oh my gosh, how will I ever get through this? But I still did feel connected with the pregnancy, and we were waiting to find out if we had a boy or girl until birth. We were a surprise at birth. So that was kind of another fun part of it is just wondering who this baby was.

Dr. Nicole (00:08:53): Yeah, that is fun. And you said you were seeing midwives?

Martha (00:08:56): Yes. I chose my care team actually before I got pregnant, kind of found them by accident. I wanted to get my IUD out, which is a whole separate story of having a bad experience for the IUD, but I just took the first available appointment at this women's clinic that was in the same clinic system that I go to for other care, and that was with a nurse midwife. And so that's how I got introduced to the hospital midwives, and it was a fit for me with what I wanted for birth. I wanted as low intervention as possible, and I kind of felt like midwives were a good fit for a low risk pregnancy, but still we'll also being able to birth in the hospital.

Dr. Nicole (00:09:41): Okay. How many midwives were in the group?

Martha (00:09:45): Maybe 15 to 20 a lot. There was a midwife for Oh, really? Yeah, it's like a big production here actually. They practice across, they're kind of split between two hospitals, and the one that I ended up going through had 15 to 20 midwives, I think in rotation. So it's a lot.

Dr. Nicole (00:10:05): That is a very large group. I mean, that's a large group, whether it's physicians or midwives, that's a big group of providers.

Martha (00:10:12): Yeah. Yeah, it was.

Dr. Nicole (00:10:14): Yeah. Okay. Did you enjoy and you felt like you got good care by the midwives during your pregnancy?

Martha (00:10:19): I do. I feel like I got good care. I have some mixed reviews actually,

Dr. Nicole (00:10:24): But Okay. Why is that?

Martha (00:10:26): Well, I think there were just things that kind of got missed through my pregnancy. One thing that came up at birth was that I was super anemic, and I think just going to see all these different people. I was trying to meet as many of them as I could. I kind of had one or two that I considered my primary midwives who I felt like I was more connected with, but I would go in and see these different people and they'd be interested in a different part of my chart. And one of them sent us for a follow-up growth out ultrasounds for our baby, and that was kind of not necessary, and somebody else was interested in our amniotic fluid levels, and nothing ever came of that. People would just get detailed in on one detail that they hadn't talked to me about yet. And the anemia got a little bit missed up until the very end,

(00:11:19): But

(00:11:19): I still was really happy with the care team, and I think everybody did their best.

Dr. Nicole (00:11:25): Okay. What did you do to prepare for your birth?

Martha (00:11:29): Yeah, I do. I really consume birth stories. I listened to this podcast. I listened to evidence-based birth. I listened to the birth hour. I read Ina May. I read Birthing From Within, and my husband and I took a birth class together, and by then I kind of felt like I knew a lot of it, but the birth class was still wonderful for just that we had dedicated time together to really think about the birth and what we wanted. And so it was

(00:12:01): Great.

(00:12:02): And I hired a doula team, so two with the idea that one of them would be there for the birth, and I was really prepared to say no to every intervention. And I,

Dr. Nicole (00:12:18): I was going to say it didn't exactly go that way, but let me ask you, at what point did you hire your doula team?

Martha (00:12:24): Really early. At the end of my first trimester, we hired a doula team.

Dr. Nicole (00:12:29): And then did they have a couple of visits or what did they do during the pregnancy to support you?

Martha (00:12:36): Yeah, we had a couple of video visits with them to talk through what we wanted for the birth. They came to our house at the end. The idea was to labor at home for as long as possible. And so we had just kind of went through how we're set up here and what we could do during labor here, and they sent me a lot of just resources and support, especially at the end. I went pretty far past my due date and I was just out of my mind physically and mentally, and so they were super supportive for that waiting time.

Dr. Nicole (00:13:06): Okay. Okay. Good. So what are some things that you wanted for your birth?

Martha (00:13:11): Yeah, I had an ideal. My ideal birth was like, I'm going to go into labor spontaneously, hopefully early, but I'll let it go for as long as I can, and labor at home for as long as possible, and basically show up to the hospital to have a baby. I didn't want ideally any intervention, so I didn't even want an iv. I wanted to just have this natural birth. I even at one point considered a home birth. I was like, I don't need any of the hospital interventions. I'm not going to have 'em. That was my ideal, but I just wasn't comfortable with the home birth. We didn't seriously consider it, but we live across the street from a hospital, so I was like, maybe we could do it, but I just was more comfortable in the hospital studying for myself. Low intervention, wanted to go as long as I could without pain medicine or without the epidural specifically. And in particular, just wanted to avoid the cascade of interventions that you hear about. I didn't want to end in a c-section, and I didn't want to end in an unnecessary c-section even more so I was very focused on preventing that outcome.

Dr. Nicole (00:14:30): Okay. Now, were you open to the possibility that those things could happen, or were you just like, this is what I'm going to do, this is how it's going to go? Where was your mindset?

Martha (00:14:45): I would say it evolved. So I got to the end of pregnancy, but it never, up until the end, I didn't really think about another outcome. I just envisioned myself going into labor at home and having this labor. I never thought that I would need to be induced, and that is what ended up happening. And I didn't consider what I would do if I had to be induced. I had heard all these birth stories, so I knew what the options were. I knew what could happen. I felt very aware of all the interventions that could happen and why they might be recommended, but I just didn't think that I was going to get to that place.

Dr. Nicole (00:15:21): Okay. Okay. Okay. So was there anything that you were afraid of when it came to giving birth, other than having to have all the interventions?

Martha (00:15:31): Honestly, I feel like I went into birth kind of on the lower end of the fear spectrum. I don't know. My mom had had, we have four kids in my family, I think she had all of us, or most of us unmedicated. She was like, ah, I just wanted a Tylenol. She had this easy birth or easy birth, I dunno. But I just didn't think that much about the birth itself being a problem for me. I was more worried about postpartum and healing, and I knew it was going to hurt. I knew it was going to be intense, but I wasn't afraid of it.

Dr. Nicole (00:16:07): Okay. So then what happened with your labor and birth? I guess we can start off. You said you ended up being induced. How did it come to be for that?

Martha (00:16:18): Yeah, so one thing relevant I think from end of pregnancy is that I had really severe restless legs, this kind, oh,

Dr. Nicole (00:16:27): Yeah. Tell us about that. Yeah,

Martha (00:16:31): It was awful. I have gone back and forth, and if I'd rather have the puking or the restless legs and I might take the puking, it was just hard to, I couldn't sleep at all. I would stay up. I would stay up into the early hours of the morning, most nights at the end of my pregnancy and then finally crash. It was tough. And that went on for a few months, almost my whole third trimester. That was one of the signs looking back, that I was pretty anemic. That just got missed. And we again, tried to treat it with magnesium and massage, and I did acupuncture again, all of these things, and I think it was just anemia. I was also eating so much ice I was craving, so I just ate ice all day.

Dr. Nicole (00:17:17): Do you know how low your blood count was?

Martha (00:17:20): I do. When I went into labor, it was around eight, the iron hemoglobin scale, and then when I gave birth, it was under eight. It was seven point something.

Dr. Nicole (00:17:33): Okay,

Martha (00:17:34): So it was pretty low.

Dr. Nicole (00:17:35): Yeah. Do you know if they checked it? We often check it at the same time we do the blood sugar test. Did they check it then?

Martha (00:17:41): They did, and it was around 10 then. So I think the normal range is 13 to 15, maybe a little lower for pregnancy is what told me. And then by the end, I actually had another blood test done to test for cholestasis. I had other had itchy feet related to the restless legs, and so they ran some more blood work, and it was lower then. It was around eight or nine. But at that point, I think that the midwife that I met with said that dietary supplements would be the best option for me. She's like, eat your leafy greens

(00:18:17): Cook

(00:18:17): In a cast iron skillet. I think there was some concern I was getting sick again at the end of pregnancy of me being able to actually tolerate taking an iron supplement without making myself sicker. And so it was kind of hard to manage, but nobody really knew how anemic I was until labor started.

Dr. Nicole (00:18:38): Gotcha, gotcha.

Martha (00:18:39): So I was pretty uncomfortable at the end of pregnancy. I was not sleeping well, and I was still really wanting to avoid an induction though. I wanted to just go for as long as I could. But as I got close to my due date, I started talking to the midwives of like, well, what would it look like to go post dates? They said, at 42 weeks they would need to refer me out to the OB practice. I couldn't stay with the midwife care anymore, and I didn't want to go to 42 weeks anyway. I wasn't comfortable with the risks of going past 42

(00:19:15): Weeks.

(00:19:16): And so I kind of started to think around my due date, well, if I don't go into labor on my own, I would rather be induced with the midwives than go to 42 weeks. And so we tentatively scheduled an induction for 41 weeks and four days, which was an end of Saturday at the end of the week, 41 weeks to be induced. And they were comfortable with letting me go that long. If I did non-stress tests during that 41st week, I did ask them to, I hadn't wanted to do membrane sweeping, but I did ask them to try. Once I passed my due date, I just felt like if I was going to go for induction, I wanted to feel like I'd done everything I could

(00:20:01): That makes sense to get labor started. But when they tried to sweep my membranes, she was like, so your cervix is really soft, but it's closed. I was like, oh, not dilated at all. And I hadn't had any early labor, so I didn't really expect to be, but it's just like, okay, well that's not an option then. And we tried that again actually at the 41 week appointment, and again, wasn't dilated at all. So that kind of takes us, I guess through the very end of my pregnancy, I was going out of my mind, it's just ready for this baby and exhausted and all of the things. But at 41 weeks did the first non-stress test, and we did a biophysical profile with that. That was fine. We went back at 41 weeks and three days, which was the Friday before my scheduled induction. And the night before had been really tough with the restless legs. I just remember going into that appointment being like, I've been up all night. I spent the early hours of the morning crying with my husband. It is really seeming we're heading for this induction that I don't want. And we just kind of had a cry together and

(00:21:16): Came to terms with what was happening. And he's like, well, let's get through this appointment. We'll get some dinner. We'll tuck in for rest tonight. We'll do whatever you want tomorrow and then go for this induction. And I know you don't want it, but we're going to meet our baby soon. And it's like, okay. But when we went in for the non-stress test, it wasn't as good anymore at that appointment. So 41 weeks, three days, I could kind of tell that it wasn't the movements that I was supposed to be tracking just weren't as consistent as they had been earlier in the week. And then they were seeing some variable decelerations from the fetal tracing. So our midwife was, she was one of our primary ones that we saw that day, and she's like, I think we want to induce you right away. Actually, given how the non-stress test went, I think it's your best chance at still having a vaginal birth.

(00:22:17): And

(00:22:18): I was like, right now, I was like, I just remember feeling exhausted.

(00:22:23): I'm like,

(00:22:23): You're going to send me to go to labor right now?

(00:22:27): And

(00:22:27): She's like, yes. So we did. And I think that was kind of the start of, for me, motherhood happens whether you're ready or not. And that's been such a theme for me with our daughter. It doesn't matter if you're rested, it doesn't matter if you feel ready. It keeps going at its own pace whether you want to or not. So yeah, so we headed over for induction and yeah, it was 41 weeks, three days pregnant and kicked off the labor from there.

Dr. Nicole (00:23:04): And you're tired. And this is, again, not just induction, but even that wasn't when you had thought it was going to happen. So I mean, what was your mental space? I mean, where were you going into the hospital?

Martha (00:23:28): I was accepting that it was time to get labor started. I didn't want to go to 42 weeks. I knew it was only one day early, but I was just kind of in disbelief that it was happening. But I was also excited. I was excited to meet our baby and finally got to tell friends, family, yes, we are finally going to have this baby, because of course, they'd all been so curious of like, yep, we're starting induction now.

Dr. Nicole (00:24:00): Gotcha.

Martha (00:24:01): And I had prepped some. This could be a long process, so I just remember being exhausted, but excited.

Dr. Nicole (00:24:09): Okay. Okay. Okay.

Martha (00:24:10): Alright.

Dr. Nicole (00:24:10): So then how did the induction go?

Martha (00:24:13): It was long. So it was long. They gave me, I got through triage, and I guess one piece is I kind of knew already. We had gone over birth preferences with the midwife team, and I really appreciated, they set a whole appointment to sit down and go through our birth preferences with us. And I remember the midwife reading it line by line and looking me right in the eye and being, I really felt like she was reading what we wanted,

(00:24:41): But we had kind of laid out preferences of plan a ideal birth, and then if that doesn't work, then this. But I kind of felt like we were already crossed off a few of the things from Plan A. I had actually, they have water birth possibility at this hospital, and they have these huge tubs in the middle of the room, and you can birth in water with the midwife group. And I was open to that. I had signed the waiver to do that. And already with induction, that was not going to be an option. And I hadn't wanted the IV or all these medications and just already we're into plan B has just taken it as it came. At that point, they gave me the option between starting with Cervidil or Cytotech for the ripening because I wasn't dilated at all. And they're like, it's really personal preference.

(00:25:31): And I just remember being like, how would I possibly have a preference about this? I don't know. I called my doula and she suggested, or we kind of talked through, well, cytotech is a pill. Cervidil is inserted. If you have a really bad reaction to Cervidil, it is kind of reversible in that way versus once you've taken a pill, you're kind of on the roller coaster. And that made sense to me. So I agreed to the cervidil and the midwife and the nurse kind of told me, hopefully you tuck in. Some people have mild discomfort with this and see you in the morning and we'll start your labor really in the morning. So I was like, okay. And they gave me a sedative and a Tylenol, and they were sweet dreams. And this was around seven to 8:00 PM on that Friday night. And so my husband and I weren't quite ready for bed yet. We played a game of cribbage. We had packed games in case we were induced. We weren't ready for induction, we just didn't want it. So

Dr. Nicole (00:26:38): We

Martha (00:26:38): Had cribbage with us. We played one game of cribbage, which I won. And by the end of it, which is, I mean, it takes 30 minutes, and by the end of it, I was in pain, a lot of pain. I was really antsy for the game to be done so I could just get up and move around. And the nurse came in to check on me. I was doing wireless monitoring for both fetal heart tones and uterine contractions, and the uterine contraction monitor really never picked up adequately contractions for me. And this was kind of the start of that, of it was nothing like what I thought a contraction or that early labor would feel like. And I didn't see anything happening on the monitor. And so the nurse was like, well, are you having contractions? And I'd be like, I don't think so. I'm seeing this flat monitor.

(00:27:33): I thought contractions would have a start, middle and end that peak. And this was constant, it felt like constant back pain, and it was moderate pain. I remember the nurse asking me to rate it, and in my mind I was like seven out of 10 and then out of my mouth, I was like, well, probably a three. I didn't want to acknowledge. I was like, I'm not even in labor. I kept saying to my husband, I have to get it together. I'm not even in labor. And I remember I kept digging my fist into my back. I was just really feeling a lot of pressure in my back, and it was really uncomfortable. So the nurse stayed with us and kind of realized that I was having some early contractions amidst all of this pain. There were little peaks and that seems like contractions. And so she was like, well, I'd like you to move through a labor circuit. And she set up a bouncy ball and a yoga mat and

(00:28:36): Wanted

(00:28:36): Me to lean over the top and spend 20 minutes in each position. And she was great for a labor support nurse. Amazing. But I just remember looking at her and being like, you have to be out of your mind. I've taken a sedative. I thought I was going to go to sleep, and now you're like, actually, we're going to do a labor circuit. I just couldn't believe, I could not believe what they were saying to me of, you have to go through this labor now. But eventually I was like, well, I'm not going to rest. I'm not comfortable. So I put on some noise canceling headphones and started to listen to some music. And Taylor Swift had just released one of her album. And so I put that on. I was going to be in my little zone and then not even two songs in to this. I am like, okay, I'm going to get in the zone. And the nurse came back in and she's like, well, so baby is looking really sleepy on the monitor. And this is actually something that I hadn't really heard of. In other birth stories, I'd heard of decelerations and other indicators of fetal distress, but I guess they weren't happy with the movements of the baby. They kept calling Sleepy Baby. So I don't know, they just weren't happy.

Dr. Nicole (00:29:57): It was probably the heart rate. We like to see it jump up and down, and maybe it was

Martha (00:30:00): Flatter. That's what they were showing us, this more flat monitor.

(00:30:07): And they wanted me to do an IV fluid bolus for that. And I knew that I had potentially options. I was like, well, could I do something else instead? Could I drink a juice or an ice water? And trying to just delay the interventions at that point. And she's like, well, no, we really would recommend the fluid bolus. So I was like, okay. So I agreed to that and I had to sit in bed or sit near the bed to have that done. So it was kind of disrupted in my circuit, but got through it and baby's heart rate picked up enough that I could get out of bed. And we started walking the halls that night, and it was just ramping up for me, and I couldn't really articulate to anybody what was going on. I did have moments where the pain would stop me in my tracks or that I really had to focus and breathe through, but I didn't think I was in labor. I thought that I was, I just kept saying, I am uncomfortable, and I wasn't really, wasn't in active labor. I was just having a pretty intense response to the cervidil,

(00:31:16): And it was really uncomfortable. So by around one in the morning, it's like, this isn't working for me. I need to rest. If you're going to get me into labor tomorrow, this has not been a good fit for me with the cervidil.

(00:31:33): I want to take it out. And they were pretty reluctant to do that. But a midwife and her student came in and they could see that I was really uncomfortable. They had brought in the nitrous oxide too at that point. They were like, why don't you try resting with the nitrous? And I kind of did. And I was like, I'm not going to be able to rest like this. This isn't the right medication for me. I will try something else. Just give me an hour. I need a break. I felt like I was having no break at all. And so they were like, well, why don't we check you? And they did. And it was about two in the morning, and I remember the midwife saying, the exam is unchanged. And I just really remember looking out over the parking garage and being like, I should jump off the roof, because then it was really intense. I was like, then somebody will help me. That the logic was so clear in my mind, I didn't want to die. I was just like, if I jumped off the roof, somebody then would give me the medical attention that I need. It was intense. And then just knowing that the exam hadn't changed all night and it was crushing, I just remember feeling that was the lowest point of my labor, just crushed of like, oh my gosh. But something else happened during the exam, which was that they accidentally pulled the servail out

(00:33:01): And then they were debating, can we put it back in? Do we need to start a new one? I was like, nobody's starting any new going back in. No, we're done with that. It's like, I will start Cytotech in an hour. I just want a break. And they were like, you can have the rest of the night. We'll come back in the morning, get some rest. I just wasn't handling it well, I think mentally or

(00:33:22): Physically.

(00:33:24): And so I took a shower. I got into bed, I got with the nitrous. It was really helpful, although some people had told me, maybe don't use the nitrous so early in labor if you want to use it later. It just got a little bit of conflicting advice of save your pain management tools for later in labor. And then others who were like, well make yourself as comfortable as possible. So I didn't know quite what to do. But I did end up using the nitrous that night, and I'm really glad that I did because I got into a rhythm, a breathing rhythm where I could really identify, oh, these are contractions and they are coming regularly. And I timed them on my phone and they were two minutes apart, lasting a minute for the duration of the night. That went on to six in the morning.

Dr. Nicole (00:34:14): Okay. So did you get any sleep?

Martha (00:34:17): I didn't sleep, but I will say I did have the experience of deep rest between contractions. I got myself set up where the nitrous mask was near my face, and I could kind of breathe through the peak of the contraction and then fall into a little bit of rest, but not dedicated sleep.

(00:34:39): And my contraction tracking app also kept telling me to go to the hospital. It's like, it's time to go. It's like I'm here. But yeah, it was just surreal, but I felt like I was getting on top of it and I understood what was happening. So Saturday was a lot more straightforward. The midwives came in and sat with me, and it was a new midwife, and she was like, I was kind of concerned from your overnight notes that maybe you weren't coping well, but you seem fine. And I was like, I feel fine. I was having these contractions, but I felt like I had it under control and I was ready to start the cytotech. And then over the course of the morning, I was nervous about the cyto attack, but I think they wanted me to do four doses over the course of the day every couple hours, and it was fine for me. So my contraction spaced out every five minutes, clearly identifiable mild to moderate contractions. It felt a lot more like what I anticipated early labor would be. I could move. I got out of bed. I was in the rocking, there's a rocking chair in the room. I sat in that for a while. I listened to a

(00:35:59): Podcast. My

(00:36:01): Husband was resting with me. I would have a contraction and he would kind of sit up to attention and just be with me. And then we'd go back to doing our own thing. And it was a good day. Saturday was a good day. Our doula came by, I think they didn't want to be with us the whole time because it's such a long induction, which we were fine with. We had such good care from the nurses too, who were helping us through all these things, and my husband as well. But one of them stopped by to get us set up with some activities or things to try. A nurse came in the middle of the day though, or a midwife came in and she was kind of going through my chart, and she was like, how did you get so anemic? She was giving me a lot of feedback on, you should have treated this differently.

Dr. Nicole (00:36:57): Then you're like, well, how can I treat something I didn't know about?

Martha (00:37:00): I was like, I've been under your team's care. I don't know what to say. Yeah, I don't know. They told me to eat my leafy greens. And she's like, I never would've treated it that way. And it's like, well, I just was so frustrated. I was like, well, it's a little late for that,

Dr. Nicole (00:37:14): Isn't it? Yeah, okay.

Martha (00:37:16): Yeah. What am I supposed to do?

Dr. Nicole (00:37:17): Right, right. That's frustrating.

Martha (00:37:20): It was frustrating. And then she had also reviewed what had happened overnight, and she's like, I think taking the CIL was a mistake. It's like, what

Dr. Nicole (00:37:28): Do you want me to do? Go back and

Martha (00:37:29): Thank you. I was stuck up for myself. I was like, I a hundred percent know it was the right choice for me to take the serv dil out, but I was just frustrated of, that's not helpful. But apart from that, over the course of the day, Saturday contractions gradually getting longer, stronger, closer together, you hear happens, and it kind of seems like it was going okay. But we had a couple of instances, again with sleepy baby or Fetal D cells, where I think I did one more fluid bolus that day, and then they wanted me to skip the last dose of Cytotech to try to get labor moving faster because of how I was going from the baby.

Dr. Nicole (00:38:19): Sure, sure.

Martha (00:38:21): So Saturday night, I was just barely a centimeter dilated, and it was like my primary midwife was on call again that night, and she suggested getting started with a balloon catheter. And I went back and checked some of the chart notes. I think there's a couple kinds. You can get the notes. They cook catheter. I thought it was called Foley. I don't know.

Dr. Nicole (00:38:47): Yeah, they're two different ones. They work similarly, but they're just designed

Martha (00:38:51): Differently. And I had heard of them before, but essentially the idea being an inflatable catheter that puts pressure on the cervix. And so we did that. That was placed. We had dinner, and then she came and placed at maybe around nine or 10:00 PM And again, people told me, hopefully you can just sleep through this. And again, that's not what happened. I couldn't sleep through it at all. And one of our other nurses was actually, now it's usually a good time to call the doula once you've had the balloon placed. So I just didn't know what to expect.

(00:39:29): Sure.

(00:39:31): Having it placed was pretty intense. Not something that I would want to repeat if possible, but for me, it was pretty intense to have it placed. I've used the nitrous oxide during the placement procedure, and then once it was in my labor, picked up really quickly and really at a new level. The previous night, I was like, well, that really was a three. This is actually a seven. It was like, okay, these are intense. These contractions are long. They are strong. They are taking a hundred percent of my focus to get through these contractions. Our nurse who was on that night was awesome. She gave me an aromatherapy patch, and they tried to fill up the tub for me to labor in, but there wasn't any hot water, I guess. Yeah. My husband tried to fill it up with a picture of hot water from the coffee station, but it didn't work. So we tried. I labored with the nitrous. Our doula did come, but those contractions were really intense, taking a hundred percent focused to just breathe through them. And the balloon came out around one or two in the morning. So it was intense, but it was kind of fast. I was prepared for it to be in overnight, but it came out earlier, which meant that I was between three to four centimeters dilated, and at that point I'd been there for over 24 hours. So that felt like a huge win. I remember everybody celebrating this balloon this out, so they turned on the Pitocin at that point,

(00:41:19): And that really took my labor to the upper level of what I could handle. I would say these contractions were like, I remember telling the midwife, these are getting to be a 10 out of 10. This is really intense.

(00:41:32): And they were

(00:41:33): On top of each other. I would have 30 seconds in between, and they were long, and they really required me to vocalize through. I honestly wasn't prepared for that of, I kind of felt like I had to vocalize through. I couldn't get air in. I just would have to moan through these contractions. My husband said it was somebody coming up for air being like a huge gaspin at the end. Interesting. Hard. It was one of the things I felt unprepared for. It's just like I just thought I'd breathe through my contractions, and I never thought what would happen if that didn't feel accessible to me. And I'm definitely somebody who's forgotten the actual pain of labor. I really couldn't recall it, but I remember the feeling of feeling crushed almost. I just, my crush hurt like a weight all around me. That's how it really felt being so squeezed, and I felt it a lot in my back. They were intense.

Dr. Nicole (00:42:45): Okay. Okay. Okay.

Martha (00:42:46): And around four in the morning is when I started, I remember starting to say, I don't want to do this anymore. And this was a level of labor that I thought would happen closer to transition of end stages of labor. Birth is close, and I wasn't close, and I knew that I wasn't close,

(00:43:07): And I just couldn't imagine continuing to labor like that for, and you're not supposed to do the labor math, but it was kind of clear that it wasn't picking up quickly enough for dilation. I knew birth wasn't close, and I was like, I don't want to do this all day into even Monday. Maybe it's now Sunday morning, this baby might not even be born today. I started talking to my husband, my doula about an epidural, agreed to a cervical check. Let's confirm what's going on. If there hasn't been progress, I'm ready for the pain relief.

(00:43:47): And

(00:43:48): So we did that check just before five in the morning, and I was still four centimeters. Yes. Everything else was the same too. Fetal position hadn't changed, a face hadn't changed. I had labored all night and nothing had changed. And I was like, yep, epidural. I'm ready. So got the epidural. I was pretty scared to get the epidural, but the anesthesiologist was incredible, and I just felt like I was going to move during it. And he acknowledged, she's like, can we turn the Pitocin down? These contractions are on top of each other. And the nurse was like, it's off. It's been off. I just had a huge reaction to the Pitocin and no dilation from it. It just didn't work for me, I guess, or I didn't give it enough time or anyway.

Dr. Nicole (00:44:41): So did the epidural provide some relief then?

Martha (00:44:44): A hundred percent was, I felt nothing after that epidural. It worked. I remember it working immediately and I fell

Dr. Nicole (00:44:53): Asleep. I was here to say, you were probably exhausted.

Martha (00:44:56): I was exhausted. And finally just got some relief. So just fell asleep. And then through the course of that morning, nurses came in and got me in different positions. I got the epidural probably, I think it was like 35 hours into the induction. And then by mid-morning, we were just getting stuck. We were starting to have late decelerations on the fetal heart rate. And every time we turned up, the Pitocin and the Pitocin never got past a one or a two dose. I was always on a very low dose of Pitocin. I just had a big response to it, and it was really hard on the baby. And so we kind of got stuck where we couldn't turn up the Pitocin and my body wasn't close to being able to push this baby out. So they started to talk to me about a C-section, and I was just devastated. I really wanted this experience of pushing out my baby, and I had kind of prepared for this whole thing and that feeling of it just sinking in of this experience that I thought I would have. I am not going to have it, and I'm going to have to do this, which I'm terrified of. But I also knew that we were stuck.

(00:46:19): I couldn't, couldn't get labor to progress.

Dr. Nicole (00:46:22): Oh, did they ever try and break your water?

Martha (00:46:24): They did. Yep. Saturday morning, we broke my water. I had to have the internal monitor placed too for contractions early in the morning because yeah, my contractions were intense. Once they placed the internal monitor, I think they were tracking it two minutes long. They were substantial, but not producing any dilation during

(00:46:49): That

(00:46:50): Either, and just stressing out the baby. So yeah, we broke water, and I really felt that point that I was on the cascade of interventions, that it was like, this is everything I wanted to avoid. That's all happening. But I didn't know anything else that I could have done either. I just felt like we were stuck. So they sent in an OB to consult with us, and we knew that we were going to head for a C-section, and we were crying. And she came in, and sometimes I get, and I talk about her, which is funny, because I didn't really like her. I just didn't find her very likable, unfortunately.

(00:47:37): But

(00:47:38): She delivered our baby. And so I have a lot of respect for how she handled it at the same time. But I remember her coming in and being, no more tears we're about to have a baby. And it was like, okay, okay. Exactly. No more tears we're about to have a baby. And I didn't love that, but I also think it was kind of what we needed. That energy was what we needed to get through it. And she came and she sat right next to me and explained what was going on. And I think majorly to her credit, she was like, this isn't an emergency. We're just stuck. If birth were imminent, we could crank up the Pitocin and try to get this baby out, but it's not, and we have no way to get you there at this point. So c-section is the safest mode of delivery.

(00:48:34): And she explains that they had a clear drape so they could lower the drape, and I could see the baby be born. And I actually told her, I actually don't want that. I was like, I don't want to see that. I was so scared. And she was like, we'll, just see how we feel when we're in there. Let's just see how it goes. She didn't say, okay, we won't do it. She was like, we'll see how it goes when we're in there. So got prepped and got taken back, and I was scared. And I think my husband was really scared, but just kind of had to do it. Anyway, so the epidural was perfect. I didn't feel anything.

Dr. Nicole (00:49:14): Oh, good.

Martha (00:49:16): Our doula, our other doula came for the C-section as well. And it was quick. It was quick uncomplicated procedure. She did comment on my anemia as we were going into surgery. She was like, oh, didn't eat your leafy greens. I see.

Dr. Nicole (00:49:32): I swear to God, I'm going to slap somebody in this hospital if they say one more thing about anemia.

Martha (00:49:38): Exactly. Oh my gosh. And I just think my husband really defended me in that moment. I was like, look, I really have been trying. And he's like, look, Martha has had a very difficult time. He had just finally was like, we're done hearing about the anemia. And so I appreciated that. But of course, oh my gosh, one more person at the edge of this huge surgery being like, oh, I guess you didn't need enough of leafy greens. And it's like, lady, I have been trying so hard. But, so we went back for the C-section, and it was just a few minutes. I think we started 1115, and our daughter was born at 1129. They asked

Dr. Nicole (00:50:20): Us, oh, how did you find out if it was a boy or girl?

Martha (00:50:23): Yeah. So they asked us to call it on the way back to the or and we both said that we thought it was a girl. And then my husband was able to call it when the baby was born, and that's because they did drop the drape. The OB did not listen to my preferences, and it was the best thing. It was the best preference that had to be ignored because I mean, it was just as she had described it to me, I could clearly see that my daughter was being taken out of my body, but I couldn't see anything gory. And it was amazing. I saw her eyes open for the first time. It, it's incredible. It was such a good decision. I'm really happy that they did that for me, and I just couldn't believe it. That was like, oh, it's been you this whole time. And my husband was like, it's a girl. And yeah, it was just kind of, it's world shifting. Your baby is there and you're looking right at them. And in that moment, really nothing else matters.

(00:51:29): Gotcha.

(00:51:30): So yeah, so they cut the cord and they got her cleaned up. She had meconium on her. I had asked them, I was like, they asked if we had wishes they could honor for us during the C-section. I was like, oh, well, we wanted to keep her NICs on. And the nurse was like, honey, she's not going to have any verex on her. She's 12 days late. She's probably going to be covered in her own poop. And I was like, oh, okay. Was. Which was fine. Yeah. I was so prepared for all these crunchy things. And she's like, that's not the reality.

Dr. Nicole (00:52:05): Did they do skin to skin in the or?

Martha (00:52:07): They offered to, but I had another moment where it's like, I couldn't believe that they were trying to give me this baby. I was like, I loved her so much. You do not hand me that baby. I'm not ready. No. They're like, mom, do you want to hold your baby? And I was like, no, Martha, no. Whatcha talking about, no, I'm exhausted. I've been through this whole thing. They offered a few times. They really were so supportive. But every time, and then I was throwing up at the end of the surgery, I was really shaky. And the throwing up part, the nurse was trying to come for me, and I was like, I've got this part down. I've been throwing up this whole pregnancy.

Dr. Nicole (00:52:48): Okay.

Martha (00:52:49): Yeah. So,

Dr. Nicole (00:52:51): Okay. So the surgery itself wasn't too terrible?

Martha (00:52:54): No, it was fine. I had a perfect epidural. I couldn't feel anything. I felt sick at the end, but it was fine. I was anxious for it to be done because I was very nervous to have, I dunno, just knowing that you're open on the table and stuff.

Dr. Nicole (00:53:11): Sure, sure.

Martha (00:53:12): I was anxious for it to be done, but it went fine. No complications and minimal blood loss, which was good because I didn't have a lot extra.

Dr. Nicole (00:53:20): Yes, yes. And then I guess quickly as we're getting up on time, how was the postpartum experience for you?

Martha (00:53:27): It was incredible. I was really well supported. I did have high blood pressure postpartum that got flagged at a home visit. A couple days after we got home from the hospital, they sent a nurse out. Oh, really? Yeah, it was part of our care. It was awesome. I had really good care. I was seen at home by a home nurse at five days postpartum, two days after the hospital, and then I had a attend postpartum.

Dr. Nicole (00:53:57): Was that part of who, was that part of your insurance or that's what your practice, where'd that come from?

Martha (00:54:04): It was covered by my insurance and part of my practice, it was, I don't know exactly what the billing is, but it's part of their standard services is a whole, I wonder if

Dr. Nicole (00:54:15): It's something in your state that I've

Martha (00:54:17): Never seen. Maybe. Okay. It could be. I know that I have other friends here locally at least, who were offered this. I've never heard about if this happens other places, but I've had friends who have declined to the visit. They're like, no, I'm good. But we opted into it. I mean, we had to pay the outof pocket piece of it,

(00:54:35): But

(00:54:36): It was covered by insurance and it was, yeah, home health visit for me and babies. So

(00:54:42): It was awesome. The nurse weighed our baby and checked out our sleep setup and also found out that I had postpartum high blood pressure. And that was definitely a scary day. We had to go. We ended up in the er. My blood pressure was 1 63 over one 15. It was high. It was scary. We were really scared, but it was ultimately treatable. It wasn't preeclampsia. They did blood work. I had a full workup done. We had to take our five day old back to the hospital, and it was intense. But I healed and I'm off the blood pressure medications now. I was only on 'em for a month and resolved. And yeah, I like to say that I had this really difficult pregnancy, but my postpartum was so joyful. It wasn't easy. The healing physically and mentally was really tough,

(00:55:43): But I just felt so supported. I had my husband and family and friends, and I found a new mom's group that I went to and a yoga practice that I was doing with my baby, and I just felt supported that I could really heal and get through it. And we did have a successful breastfeeding journey as well. And I know that that was a big fear of mine of after a c-section, what will be possible or easy for me. And I didn't do skin to skin until an hour after she was born. I didn't spend that early time with her. And we had a successful breastfeeding journey. Anyway, she was on the boom for nine months, and then I pumped for a year and it went really well. Anyway, so

Dr. Nicole (00:56:34): I mean, I'm just amazed at how, because mean, quite honestly, to me, it seems like almost nothing with the way that you were intending, whether it was, I mean, you weren't hoping to puke your guts out the whole time. The restless leg anemia and people repeatedly bringing up anemia during your labor and then the induction and then the pain. I mean, even postpartum having to take your baby back to the hospital five days afterwards, that's not fun either. So I mean, do you think it was the support that just helped you kind of keep going through what are, and I think it's wonderful, but I'm hoping, what can you share that you felt helped you best cope through the challenges?

Martha (00:57:31): I think it was the support, because it really was like I almost had a harder time, I think mentally after the birth and physically. And I needed my husband's help getting out of bed, all of that stuff that comes with a C-section, he helped me with every breastfeeding feed. I couldn't even move her from one side to the other. I didn't have the core strength. And he helped me with every feed in those early days. And the midwives came to round on us after birth and one of them said, you should process this birth together. And separately, I had a therapist. She's like, it's a lot. It's not just a medical procedure. You've been through a lot. Make sure you take the time to really process it. And it has been a lot. I really felt like everybody's placating me in the early days here. Like, oh, you did so amazing. You've been through so much. And I just felt like they were doing lip service to me of, you don't know. I felt like a failure kind of. I didn't have this physiologic

(00:58:37): Birth

(00:58:38): That I had wanted, and it took me a while to kind of get past that. But I was so supported that I have so many positive memories from the postpartum period. And I'll say that I read a book a few months ago, actually, my daughter is about nine months old, but it's called Eve, and it's nothing like what it sounds like, but it's a natural history of human evolution through the lens of the female body. And I just like that kind of content in general. So I listen to this audio book and it makes a really strong case that midwifery, obstetrics would've been an early adapted skill or trait in human biology. Because of the way we give birth. We've kind of always needed help. And that really helped me reframe that birth intervention isn't unnatural. This is part of being human, is having help through this part of life. And it always has been that way because I would have a lot of intrusive thoughts of like, well, what if we were in the wild? Would we both just be dead? Or maybe we both would've been fine and none of this had to happen. And I would get kind of stuck in that kind of thinking. And reading this book really helped me reframe that piece of it. So understanding that intervention is okay. It overused, but it's part of being a human.

Dr. Nicole (01:00:13): Yes. I love that. I love that. Then, so then as we wrap up, what would you say is your one favorite piece of advice that you would tell other women who are about to have a baby?

Martha (01:00:23): Well, I always say I would never give advice to a pregnant person because I would never want advice. But I will say that after birth, skin to Skin is regulating for both of you, for both baby and the parent. And it was almost like a medicine for me of when I would feel so really overwhelmed. My husband would be like, okay, skin to skin. And it really is co-regulating. It's not just for your baby, it is for you too. And that continued well after we came home from the hospital of having that skin to skin was just so helpful for me.

Dr. Nicole (01:01:02): Sure, sure, sure. Well, Martha, thank you so much for agreeing to come on and share your story. I mean, just so many just points and things to take into account and just the way you navigate it, what was very challenging is just really admirable. And I know people are going to learn from hearing your experience. So thank you.

Martha (01:01:22): Thank you so much for having me.

Dr. Nicole (01:01:30): Well, of course, wasn't that a great episode? I so appreciate Martha coming on to share her story today. Now, after every episode when I have a guest on, I do something called Dr. Nicole's notes where I talk about my top takeaways from the conversation. And here are my Dr. Nicole's notes from my conversation with Martha. Number one, hyperemesis nausea and vomiting in pregnancy. It can be no joke. And if you want to learn more about strategies to deal with hyperemesis, then listen to episode two 19 of the podcast. I interviewed someone from the Hyperemesis Education and Research Foundation. They have so many research backed strategies and ways to approach hyperemesis and nausea and vomiting in pregnancy. So do check that episode if you're having trouble, it's dr nicole rankins.com/episode 2 1 9. Number two is you can want a low intervention birth and still be in the hospital.

(01:02:34): I get incredibly frustrated when I see doctors say, well, if you don't want us to do anything, why are you in the hospital? You can want to be in the hospital because you know that is the location of all of the advanced technologies. That's where there's going to be a nicu. That's where there's going to be an operating room. That's where there's going to be medications and things available in the event of emergency. Now, just because you don't want those things obviously to happen, you may feel better and more at ease being close to those things if need be. So if you hear any pushback about Why don't you want us to do anything or why you're here, if you don't want us to do anything, please ignore that. Please tell them that you are in the hospital because you want to have access to things if needed, not because you are expecting that something has to be done. You can absolutely have a low intervention birth in the hospital. Okay.

(01:03:37): Okay, next couple things. I just really wanted to fight someone about the repeated comments about her anemia so unnecessary and just absolutely ridiculous. I'm really, really sorry that she had to deal with that. That was completely unacceptable. And then the final thing I'll say is that postpartum help, I've said this before, it's like a broken record at this point. It's so important in this country, but also so very, very lacking. Yes, you need to educate yourself during pregnancy and birth. All of that is very important, but preparing for the postpartum period is really important as well. And having that help and support available is important. So whether that's friends or whether you have family member there, you can definitely consider hiring a postpartum doula. I've seen lots and lots more folks, if they don't use a birth doula, they're using a postpartum doula. And I think there's a misconception about postpartum doulas that, oh my gosh, I can't afford it.

(01:04:31): I can't do this. But you'd be surprised at how you could potentially work out things like where they come maybe just once a week. They don't necessarily have to come every day. They can come once a week and provide a lot of support and education. So do check out potentially having a postpartum doula as well to help you fill in the gaps with that postpartum support. All right, so there you have it. Please share this podcast with a friend and subscribe to the podcast for, are you listening to me right now? Also leave a review in Apple Podcast. I love to hear what you think about the show. It also helps the show to grow and it helps other women to find the show as well. Do come join me live at my next free birth plan class. Sign up, grab your spots. Spots are unlimited. Grab your spot 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.