Ep 280: Rachel’s Birth Story – Weaning Off Anxiety and Depression Meds

Dr. Nicole (00:00:00): In this birth story episode with Rachel, she shares openly about her journey and decision to get off of antidepressants and anti-anxiety medication before she got pregnant, as well as the challenges during her pregnancy and a birth that started with her water breaking in her backyard in front of all her friends at her baby shower. 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 OB GYN, 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.

(00:00:57): This podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now, let's get to it. Hello there. Welcome to another episode of the podcast. This is episode number 280. Whether it is your first time listening or you have been here before, you know I'm glad that you're spending some time with me today. In this episode, we have Rachel. Rachel lives in Omaha, Nebraska with her husband, their son, and their cat Daisy. Rachel always wanted to be a mother, but before she could begin that journey, she felt as though she needed to confront and manage her history of depression, anxiety, and eating disorders. The tools she learned in therapy to cope with her depression and anxiety helped her come to terms with her son's birth experience, which was very different from the birth experience that she hoped for.

(00:01:56): Rachel's going to share about her long journey of getting off of antidepressants and anti-anxiety medication. She talks about how when she was pregnant, she had issues with intense back pain and insomnia. Her water broke at her diaper keg in her backyard in front of all of her friends, and that led to a birth that ended in a C-section under general anesthesia for a breach baby, and also included a surprise discovery about the shape of her uterus. So a lot going on here, folks. Rachel gets a bit emotional and teary during her story, and you can understand why this was definitely a journey and there's so much to learn from her story. I cannot wait for you to hear it. Now, quick question for you. Have you ever wanted to ask me something about pregnancy and birth? Well, if so, come join me in my next live birth plan class at the end of every one of my birth plan classes.

(00:02:58): When I do it live, I do 30 minutes of office hours q and a, and actually longer people have more questions where I answer any questions you have about pregnancy and birth. Doesn't have to be related to birth plan. It can literally be about anything. Folks ask some great questions, and it's the best opportunity you have to chat with me and get my thoughts on what's going on. So sign up for the next live birth plan class at drnicolerankins.com / birth plan. I usually do the class about once a month, so it'll happen in December, December, maybe 11th, I think is the date. Anyway, head to dr nicole rankins.com/birth. Plan to sign up and grab your spot. All right, let's get into this birth story episode with Rachel. Well, thank you so much, Rachel, for agreeing to come onto the podcast. I'm really excited to have you share your birth story today.

Rachel (00:03:59): Thank you so much for having me on. This feels kind of like an out of body experience. I've been listening to you for so long, so yeah, this is really exciting.

Dr. Nicole (00:04:09): Yeah, so why don't you start off by telling us a bit about yourself and your family?

Rachel (00:04:13): Yeah, I am Rachel. I am born and raised in Omaha, Nebraska. I live here with my husband and our 15 month old son, Cassian and our cat daisy. So they all keep me very busy.

Dr. Nicole (00:04:29): I bet. Now, in order to understand what happens with the birth, then we have to talk a little bit about what happens during pregnancy and in your case, even before pregnancy. So one of the things I appreciated when you wrote in, you talked about even before you got pregnant, you had to make the decision about getting off antidepressant and anti-anxiety medications. What was your thought process around that and how did you come to do that?

Rachel (00:04:55): Yeah, absolutely. So I was diagnosed with depression and anxiety in high school, and so I have been on medications since then. Different medications, if you're on a certain one for an extended amount of time, often you have to increase your dosage until you're at the max dosage because your brain gets used to the amount of medicine that you're on. So then it is less effective. So at the point where I was thinking about in the future, it'll be a good time to start trying to have a baby and having a baby, I was talking to my psychiatrist about it and he was like, well, so based off of the studies and what we know, it can be harmful or it can affect a fetus. If you are on antidepressants or anti-anxiety during that first trimester, it can affect their

(00:05:49): Development.

(00:05:50): And so first trimester, he said, would be where it would most affect the baby, but then also once a baby's born, they can go through some withdrawals, which can be really difficult for the baby. So he also said it can affect the baby if the mom is on medicine, but it can also affect the baby if the mom is depressed and has uncontrolled anxiety. So he said, best case scenario, you feel good, you're off of the medicine, baby feels good, but if we have to have you on some anti-anxiety or antidepressants, that'll be okay. You want to find a good balance there. So

(00:06:33): With that, it can take a while to get off of antidepressants because if you try to cut it out cold Turkey, you can go through a lot of withdrawals. So for me, that feels like that feeling when you miss a step where you're walking down the stairs, you feel like you miss a step, that kind of that little jolt. So that's how I experienced withdrawals of it would be every 30 to 60 seconds. If I were to cut it out completely, it would feel like that. So what we had to do was, okay, so my husband wanted a summer baby like him, so then I was like, okay, so if we're going to try to have a baby in between July and August, so we have to do the math backwards of, okay, I need to get pregnant nine months before then, but then it can take up to three months to slowly wean off of medicine.

(00:07:29): So

(00:07:29): We had to do extra plan, do all of this math, but once I figured out the date of when to start weaning off, we'd slowly, slowly decreased the amount. So that was something that I set up with my psychiatrist. It helped writing down for this week, it's going to be this amount, and then I'm going to cut down to another amount after that. So just slowly being patient with myself, that's kind of what we had to do with

Dr. Nicole (00:07:59): That. So it sounds like your psychiatrist presented both options and you felt like and would've supported you with both options.

Rachel (00:08:07): Yes.

Dr. Nicole (00:08:08): And you felt like for you and your family, you preferred the option of trying to get off the medication, and then how did you feel as you weaned off the medication?

Rachel (00:08:17): Yeah, it was definitely really difficult just with even going through those small steps, you can still feel withdraws and then you can kind of feel more emotional. Sometimes antidepressants mask your emotions,

(00:08:34): And

(00:08:34): So just feeling more things with that, but just trying to be patient with myself, and right at the end when I went from a small dosage to nothing, it was too much and I almost had a panic attack, so then I had to go even smaller doses. So anybody going through it, you just have to be patient with yourself.

Dr. Nicole (00:08:58): Sure, sure. And then how soon after you got off the medications did you get pregnant?

Rachel (00:09:05): Just in about two months, so it was really fast. I used the ovulation test strips and everything, so that was really helpful for us. So it is funny, it took a long time to get pregnant, but in a different way than for other

Dr. Nicole (00:09:23): People. So then in total, it was about five months then from when you started weaning yourself off the medication to when you got pregnant?

Rachel (00:09:33): Yes,

Dr. Nicole (00:09:33): Exactly. Okay. Okay. So then when you got pregnant, then, well, I mean we can get into this, but I want to know what your prenatal care was like and then also what your mental health was like. So why don't we start with your prenatal care. Did you see a physician or midwife? How did that

Rachel (00:09:50): Work? Yeah, I had a physician, an ob, so I chose her because she was really highly rated and unfortunately her schedule didn't line up with the day of the week that I was able to go for my appointments. I had a day off, so I only saw her twice. I usually saw her nurse practitioner, and I wish that I had found somebody that was able to see me, the nurse practitioner, and the physician.

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

(00:10:26): I felt like I would've gotten more answers about what I was asking, maybe I don't know, than the nurse practitioner was able to give me. And then as you start talking about it more, I didn't feel like the physician understood or recognized the pain that I was in.

Dr. Nicole (00:10:50): Oh, okay. Okay, then. So let's talk about that. What kind of issues did you have with pain?

Rachel (00:11:00): So during the first trimester, it was also with my, sorry. No, no worries. No worries. Yeah. Okay. With my mental health, I have a history. Have a history of eating disorders as well, and so the first trimester was a little bit difficult because I was only able to eat certain things, so only be able to eat ice cream or crackers, that kind of a thing. That was difficult. So I was Sorry. No, take your time. I told you. Yeah, I told you. You did. You did. And then it also frustrates me when I tear up too. I want to be able to share. Yeah. Okay. So during my first trimester, it was difficult only being able to eat ice cream and crackers and things like that, because I was like, well, I want to be healthy. I want to be healthy for my baby, and being patient with myself, that was a good exercise for me.

Dr. Nicole (00:12:10): Gotcha.

Rachel (00:12:12): Just being patient with myself, I was dehydrated in my first trimester, so I had to have an IV of fluids, and I wasn't at the point where it was where you're super, super nauseous. I can't remember. Yeah.

Dr. Nicole (00:12:26): Yes.

Rachel (00:12:28): A nurse did put that on my chart, even though, and then they left it on, even though I wasn't only threw up a few times, it was just constantly nauseous. So unfortunately, they left that on there. I did have right from the beginning, insomnia, just wild insomnia, maybe three, four hours of sleep a night.

(00:12:48): Oh, goodness.

(00:12:48): If that, which triggered my migraines, usually I have an injection, a monthly injection that helps with migraines, and then my migraine medicine, I couldn't take either of those two.

(00:13:00): Sure,

Dr. Nicole (00:13:01): Okay. Okay.

Rachel (00:13:02): So it's just kind of when it rains, it pours. I was scared to

Dr. Nicole (00:13:04): Say it is. A lot of things came at you at the same time.

Rachel (00:13:08): Yes.

Dr. Nicole (00:13:08): Yeah.

Rachel (00:13:09): Yes. So having my mental health kind of mantras or techniques to help calm me down to build me up was very important. Just having kind of that toolbox and then having a support system as well.

(00:13:28): Okay.

(00:13:29): Oh, it's so funny, all of the things that you feel something weird, like the round ligament pain, and you're like, is this normal? And you Google it and they're like, oh, yeah, it's normal. And be like, I've never heard of this. This is so weird. Okay, well, I'll just add this to the weird things that happened in pregnancy. So something that happened at the end of my first trimester was I slipped and fell at work. So I worked at a childcare and I was carrying about a six month old baby into the room, and I slipped on a play scarf on the tile, and I fell. I was holding baby, baby was fine. I fell and slipped and landed on my bottom really hard and kind of just rocked my body, and that really scared me. They did recommend that I went to the ER and I had think one contraction, and then they did an ultrasound to make sure that everything was okay, and they did give me a shot of rga, which I was scared of getting the RhoGAM in the traditional way. So I had them give it to me in my arm, and it's way more painful. Just get it in the normal way. The arm was so much worse. Right, right.

(00:14:48): Yeah.

(00:14:49): In the end of my second trimester, I also fell again at work. My boss is not happy with me. I slipped on some guacamole this time and fell. So then I had to go to labor and delivery this time, and I had a few contractions, but everything again was fine, luckily. And then I had another shot of Rogan, and around in the second trimester I noticed that my baby, and we didn't find out the gender until the end, until he was born. He was hanging out mainly on my left side, super high up, just on the left side. He rarely ever moved to the right, and I brought up that kind of concern to my nurse practitioner, and she was like, oh, that could be normal. And I just tried to put it off. It was just a little weird. At that same appointment where I brought it up, they also figured out he was breach. That's when I started to try to do all the positions of ripping him around and stuff like that. I didn't really have any hope that if he was breach, that the hospital would support me trying to deliver breach,

(00:16:09): Just because pretty recently or around that time, there was a birth in the news where the baby, they tried to deliver breach and the baby didn't survive. So I was, I was a little scared about that. I didn't want that to happen.

Dr. Nicole (00:16:28): Yeah. Okay. So it sounds like you just felt like they weren't, was it the nurse practitioner wasn't listening to you, or the doctor wasn't listening to you, or both? Were they just kind of saying, oh, this is that kind of thing?

Rachel (00:16:43): Yes, it was kind of just brushing off. It felt like I was being brushed off, and I was having a difficult time advocating for myself as well. And so I finally did see my OB again at 36 weeks, and I, yeah, I was just saying I'm in a lot of pain, and it felt like she didn't hear me.

Dr. Nicole (00:17:06): Okay. I'm sorry. Thank you.

Rachel (00:17:09): I'm glad that we can edit this too. Yeah. What ended up happening was I, since I didn't feel heard, I just didn't want to have her as my OB anymore. I didn't want to have her as my OB anymore. I was just kind of done, if I have to convince somebody to be on my side, if I have to convince somebody to be on my side, I don't want you on my team. And so I ended up, sorry. No, take your time. I decided to switch my OB at 37 weeks, and I saw this OB once, and I feel bad. I was so frustrated and upset, and I just cried for most of the

(00:18:01): Appointment,

(00:18:02): And I'm sure she was freaked out, and she was like, what is happening? Who is this in this patient? She was great. She was understanding, but basically, oh, I forgot to mention with my first ob, I had asked for some short-term leave disability for the last part of my pregnancy, and she did not want me to do that. And all she offered was an early induction, and I had told her I did not want to be induced earlier. And so again, I just felt like I wasn't being heard. So the new ob, she was like, again, she didn't want to do short-term disability, which is fine, and I didn't want to switch my OB again or anything like that. So I was just like, I guess I'm just going to be uncomfortable or in pain until I deliver, because I didn't want to take my maternity leave early because at that point, at 37 weeks, I thought I was going to be pregnant for another five weeks. I didn't think baby was going to come anytime soon.

Dr. Nicole (00:19:17): And of course, they come and they come and we'll, we'll certainly get to that part about what happened. Absolutely. So I do want to ask, did either OB or the nurse practitioner offer you, or what suggestions did they offer you to manage the pain? Was there any discussion of physical therapy or maybe trying a chiropractor or any of those things?

Rachel (00:19:38): Yes, they did suggest a chiropractor. So I was seeing a chiropractor every week at this point. So I think the chiropractor did help,

(00:19:49): But

(00:19:50): I was still in a lot of pain, and at the time, I was an infant teacher at a childcare, and so constantly standing up, sitting down with the kids, that was taking a big toll on my body.

(00:20:05): Gotcha, gotcha.

(00:20:07): And then just the weird position that my baby was in my body, it was putting a lot of weird pressure

Dr. Nicole (00:20:14): On

Rachel (00:20:14): My body.

Dr. Nicole (00:20:14): Okay. And what about physical therapy? Was that ever suggested? No. No. Okay. That just is so hard. Were you doing anything wearing a belly band or anything like that? Was that

Rachel (00:20:28): Oh, yeah. Okay. I had a belly band on and all the time I,

Dr. Nicole (00:20:33): Yes. Did it help?

Rachel (00:20:34): I think it did,

Dr. Nicole (00:20:35): Yes. Okay. But you were still just, was it pelvic pain? It was just like, I'm just curious, where the pain, or were you mostly having issues with pain?

Rachel (00:20:43): It was my lower back and still my hip joints felt like they were grinding a little bit and a little above my lower back as well.

Dr. Nicole (00:20:53): Okay, and just constant pain?

Rachel (00:20:55): Yes.

Dr. Nicole (00:20:55): Oh, goodness. Okay. That's so tough. Then to feel like you're not being hurt just adds a whole nother level of difficulty to the situation. Then you saw the new OB made peace with that, okay, I'm going to have this new person. So then what happened? And you didn't want to be induced, but then what happened with your labor birth? Let's get into that story.

Rachel (00:21:21): Sure. Yes. So it was a Saturday. It was going to be a busy day in the morning. We had a lactation course that we were taking, and then later in the day, we had a diaper keg. We were having a bunch of people over, so the lactation course took longer than I expected. So when we got home, I was running around, we were getting the house set up, I am saying running. I was waddling, waddling around telling people what to do. I'm sweating, just trying to drag heavy things around. And so once everybody was there and we were having a good time, I lost my mucus plug around six, and I was like, okay. And I went out and talked to my friend and she's like, oh, it could be another two weeks, which is

Dr. Nicole (00:22:07): True. It could be.

Rachel (00:22:08): Yes. Yeah. I was like, okay, it'll be fine. It'll be fine. And then as I was announcing the winners of the diaper keg raffle, my water broke in front of everybody in their backyard.

Dr. Nicole (00:22:22): I mean, I read that when you wrote it in, but it's still hearing you say it is. So was it obvious, just big gush, your clothes were just, was okay? Could everybody see what's your water? Just what happened?

Rachel (00:22:37): Yeah, so I was wearing a long dress and it was a dark dress, so I was the only one that knew for a second, and so I was just standing there dumbfounded. I was thinking about all these other birth stories I've heard where this does not happen, and I was looking around, and so it was a lot of my husband's coworkers who he worked in the emergency room, and so it was a lot of nurses, and I was like, okay, I'm safe here. Where's my husband? Luckily, it was early in the night, so he hadn't had too much beer was kind of sober, but he thought I was joking when I brought him over and I was like, my water broke. And he is like, ha, ha, ha. I'm like, no, I'm very serious.

(00:23:23): Right.

(00:23:25): Yes. So that was at 7 45, and the next person I told was my mother-in-Law who was right there, and she's like, okay, we'll, okay. She grabbed some towels. I was waddling into our house, and I was already getting contractions, so I was contracting, and she was wiping up after me. I was hanging out in the bathroom. I called the hospital, told them it was clear,

(00:23:49): The fluid was clear and everything, and they're like, okay, come in around in an hour if you can. So at this point, I was 37 weeks, so I had my bag partially packed. I thought he wasn't going to be here until mid August, and this is July 8th. So I put on one of my postpartum diapers. I did have all that prepped, and I was finished packing my bag. My husband was wondering what he should pack, so I gave him one of the books that has a list. So I was like, here you go, pack your stuff. I'm going to focus on me. I felt very calm at this moment, which was nice. I was calm. It kind of felt like I was the eye of the hurricane with everybody running around right around me. So I was having some contractions, and when we were about to leave for the hospital, everybody came up and were praying for us, which is sweet. So then we arrived at the hospital at 8 45, so they knew we were coming some contractions, they were getting closer together, but not actually, now that I'm remembering, it felt like about every minute I was getting a contraction. I didn't have an app downloaded. I didn't have my birth plan printed out. So in our hospital room, we were trying to set up and my husband was writing down my birth plan on a paper towel.

Dr. Nicole (00:25:25): And then did they know that it was a suspicion that the baby was breach or

Rachel (00:25:31): No? So they thought they checked him at basically my 36th appointment and they said that he had flipped

Dr. Nicole (00:25:40): Down. Okay, got it. Got

Rachel (00:25:42): It. I think I was also calm about that.

Dr. Nicole (00:25:44): Sure. Got it. Okay.

Rachel (00:25:46): I was like, okay, we're going to be able to do this the way that I wanted to.

Dr. Nicole (00:25:49): Got it. Got it, got it. Okay. Okay. Okay. So you get to the hospital and they're like, oh, yes. Obviously your water's broken and you get settled in a room and all those things, trying to write the birth plan down. So then how did things go from

Rachel (00:26:02): There? Sure. So they did a first check, and I don't even remember how many centimeters I was dilated. I just remember it was really uncomfortable and weird. I just met this person, I think they were a resident checking me. I just wanted to get off of my back. They were trying to talk to me while I was still on the bed, and I was like, I need to get up, pause what you're saying. Give me a minute, and then I need to stand up. So they checked me. They said I was progressing. They said, get unpacked, get dressed in whatever you wanted. And then the second time that they came and checked me, that same resident was like, I think that's a foot. Immediately she checked and was like, that's a foot. And I was like, you're joking. I was speak to her face, you're joking. I didn't feel him move, and I couldn't believe that from the first time that they checked 20 minutes ago

(00:27:01): That

(00:27:01): He had slipped. And so I'm not sure if when she checked the first time she thought that she was feeling ahead and she wasn't, or I'm not sure how

Dr. Nicole (00:27:11): Interesting. So why did she check so close back to back? Do you know? Remember?

Rachel (00:27:16): I do not remember, and it could have just been what felt to me like 20 minutes much longer,

Dr. Nicole (00:27:23): But still. Okay. She came back. Then what happened? Then? That probably triggered a lot of things.

Rachel (00:27:31): It did. So the resident felt, oh, that's a foot. So then whoever was in charge of her also checked and agreed that that was not ahead, that they were feeling.

(00:27:43): Okay.

(00:27:44): So then the hospital, or would you say a surgical OB or

Dr. Nicole (00:27:49): Who? Yeah, or the attending physician. Usually

Rachel (00:27:53): I believe the attending, she came in to talk options with us. So the options that we had were to just go in for a C-section right away or try an ECV, see if that would work. And she didn't think an ECV was going to work because my water had already broken,

Dr. Nicole (00:28:12): And I'm thinking the same thing in my head. You have to have some space in order to turn the baby, and without the water, then there's not as much space there. I'm also surprised that they would offer it if they felt afoot because the baby has to be tucked in so you can do the turn. I mean, obviously I wasn't there, but do you remember how dilated you were at that point?

Rachel (00:28:34): I was looking at my, I don't remember, and I was looking at the notes and they didn't write it down, so it was interesting.

Dr. Nicole (00:28:40): Okay, okay. Okay. So then what did you decide to do once she presented those options?

Rachel (00:28:46): We did decide to try for the ECV.

Dr. Nicole (00:28:49): Okay.

Rachel (00:28:50): So that set off the, okay, now it's time for an epidural. It felt very quickly that they were switching to a different timeline, different set of steps. So they came in to do my epidural at 1145 at night, so it must've been a while between getting checked or at 1145, they were working on my epidural, and it was taking a really long time for my epidural. He was messing around back there for a while and he kept saying to whoever he was with that he was having to flush and push more something because he couldn't get past something. So I had to lean over even more, which is so difficult to lean over. And then they had to push past a nerve. So it seemed like from what he was saying and whoever he was with, because I believe he was a resident, that it was taking a while, he had to tap out and somebody else had to finish it.

(00:29:53): Okay.

(00:29:55): So by the time they finished, it was just after midnight on July 9th, which was my husband's birthday. So he was like, cool, I'm going to have a birthday, a birthday buddy. And I was like, great, good for you. Okay. I have this thing, and I just stupid epidural though. So now it was time to try for the ECEV and we were at a teaching hospital as well.

Dr. Nicole (00:30:24): And I'm sorry, I should back up and say, I forgot to ask you, what did you want for your birth? Did you not want an epidural? I totally skipped over those questions. I just got like, so what did you want for your birth experience?

Rachel (00:30:36): Yeah, I did not want to have to do an epidural. My mom has a history of migraines, and then she got a migraine from her epidural with my brother, and so I was worried about that. So I really wanted to try natural labor as long as I wanted. That was in my birth plan of don't offer an epidural unless I ask for it.

Dr. Nicole (00:31:02): Got it. Got it.

Rachel (00:31:03): So I wanted to do that when I was having contractions. I did feel like I was tensing up instead of letting go,

(00:31:12): And

(00:31:12): I was already having trouble with that. So I was expecting that I would probably need some kind of assistance with the pain. At the hospital we were at, you aren't allowed to labor in the tub. You have to get out to push. So I was fully hoping and expecting to do that, but they might not have let me because my water had already broken. I didn't even get to the point of talking to them about it with how fast everything

(00:31:40): Went.

(00:31:41): So yeah, I had my comb to push into my hand for the pain. I wanted to be able to feel it and see what my body could do, but I wasn't able to.

Dr. Nicole (00:31:53): And I'm guessing they may have suggested that with doing the ECV, it's an uncomfortable process. If it doesn't work, then you will probably need to go for a C-section, so then you would need some sort of anesthesia anyway. Was that part of the discussion?

Rachel (00:32:07): Yes. She did say that if the ECV didn't work, that we would immediately go into a c-section. And then I remember from hearing different birth stories about how the e cvs were very uncomfortable or painful and how it was recommended to have an epidural with that.

Dr. Nicole (00:32:28): Okay. And then I should also ask, what had you done to prepare for your birth? What sort of childbirth? Ed, and then we'll get back to the birth story.

Rachel (00:32:38): I did birth plan, making a birth plan, which was great. Loved it until I didn't print out my birth plan. I was like, I did all of this preparation, and then I thought I had four or five more weeks. And then, so a lot of my prep didn't end up helping. We did your birth course as well, except we didn't get to finish it because we were going to finish it. Right,

(00:33:05): Right.

(00:33:06): Yes. And I read Expecting Better by Emily Oster and then part of the birth partner as well.

Dr. Nicole (00:33:13): Okay. Okay. So I mean, these babies are so tricky, and I say rude sometimes. You were supposed to stay in there a little bit longer, but things happen when they happen. Yes. Okay. Alright, so getting back to the story. So you got the epidural and then how did it go with With the ECV?

Rachel (00:33:33): Yes. I laid on my back and all of these people came in and it felt like our room was full. There were about 10, 15 people in there because they wanted, there were students, it felt like people wanted to watch the ECV happen. My husband was on my left side and I was just looking at him holding his hand while he's watching, and he said it was just the weirdest thing when they were pushing him around because they moved him because you could see everything because my water had broken,

(00:34:05): So

(00:34:06): You could see the shape of the baby. But then once they got him in position, he rotated

(00:34:13): Back.

(00:34:14): So they did that twice. His heart didn't like it, and they're like, okay, we're done. We're going. So the OB left I'm sure to scrub in. So I was like, okay, wow. Getting a C-section. And just over and over in my head I'm thinking, I don't want to c-section. I don't want to c-section. And I said it out loud and the nurse was like, oh, well, this hospital has a really good rate of VBACs. And I was like, this baby's still inside. I,

Dr. Nicole (00:34:46): I'm not there yet.

Rachel (00:34:48): I'm talking about another baby. No, I know she just was trying to find something per se, but that is not what I needed to

(00:34:57): Hear. Right, right.

(00:34:59): So I don't know if, because of his heart rate dipping a little bit and wanting to go to a, they never brought up offering for a breach delivery.

Dr. Nicole (00:35:12): Most people don't do it. It's just not something that we're trained in these days especially. So I'm not surprised. Yeah.

Rachel (00:35:19): And then on the way to the C-section, because I was laying on my back, I was still really uncomfortable and I did just push my epidural button once, so I just pushed it once. But on the way I started losing sensation, that tingling

(00:35:37): Sensation,

(00:35:38): It was getting higher and higher and higher up to my chest. And so this is the traumatic part for me was I could not breathe. My husband wasn't there, he wasn't allowed in yet, and I just felt like I couldn't breathe. I had a nurse holding my hand on one side, and I just felt like all of these people were just staring at me while I couldn't breathe. And

Dr. Nicole (00:36:13): Were you saying that you can't breathe?

Rachel (00:36:15): Yes,

Dr. Nicole (00:36:16): I

Rachel (00:36:16): Was. I was saying I couldn't breathe and I was trying to wave my other hand around to try to, I don't even clear it. It felt like I needed a claw at my throat. And the only things people were saying was, don't touch your belly, don't touch anything. And in my brain I'm like, of course. I'm not trying to touch my belly. I, I feel like I'm drowning and nobody's helping me. So that was one of my questions for you is why do you think they weren't coaching me or,

Dr. Nicole (00:36:58): Yeah, that is, oh my gosh, okay. That is so difficult. So it sounds like, I mean, you were saying, I feel like I can't breathe and Yeah, so what can happen with anesthesia is that the level can go higher and higher. And actually, even though you are breathing, a person can certainly feel as if they are not, and it's very terrifying because you feel like you can't breathe, even though you are not paralyzed. It's just that you can't feel that you're breathing. So in those instances, we really have to provide a lot of reassurance that, Hey, I know it feels like you can't breathe, but I'm watching your oxygen level. The anesthesiologist should be doing, the nurses should be doing a lot of, as things are moving around, especially the anesthesiologist, ideally we'd be saying, I can see your oxygen level is normal. I know it feels like you can't breathe. In some instances, we even have to give people anxiety medication, maybe a tiny bit just to help or sit people up a little bit because to help the medicine kind of come down mean, obviously I wasn't there, but from what you're describing, it sounds like the level was just going higher and what you're feeling is a normal response to that, what you felt is a normal response to that. And we have to help manage that. Yes.

Rachel (00:38:23): So I didn't feel like I had any support or

Dr. Nicole (00:38:28): Coaching

Rachel (00:38:29): Or hearing, here's your oxygen level. That would've helped me to see that. And so yeah, the last thing that I remember was just the oxygen mask being put on my face. So they did have to intubate me on my chart. They wrote, they said it was unclear if this sensation was due to a high spinal versus a panic attack,

Dr. Nicole (00:38:55): The high spinal is what I'm talking about. So I don't understand though why, I mean, again, we don't typically have to necessarily intubate someone unless you really aren't breathing. If it's so high that things stop. But did they say, okay, we're going to have to intubate you? Do you remember any of that? Sometimes they give you medicine that helps people forget what happened, but obviously you remember it up until up until then. So

Rachel (00:39:29): Yes, I remember up until that point, yeah, they didn't say anything. If they had said, okay, we need to work on your breathing or you're going to need to be intubated for your

(00:39:42): Safety,

(00:39:43): That would've helped me. That would've been a

(00:39:46): Goal

(00:39:47): To work on, but nope.

Dr. Nicole (00:39:50): Okay. Nothing. So then you were completely asleep for the surgery. So then what is the next thing you remember after? And then your husband couldn't be in there either?

Rachel (00:40:01): No, he was outside. He had just gotten all scrubbed up and they had told him she needs to be intubated, so you're not going to be able to be in the delivery room. A nurse did take my phone, so we have pictures, which is good. So yes, I woke up in the recovery room and Steve was holding our baby all wrapped up, all snuggled tight, and he had told them he didn't want to know until I did, boy or girl,

Dr. Nicole (00:40:33): Which

Rachel (00:40:33): Is so sweet.

Dr. Nicole (00:40:34): That is really sweet. Yeah, that is really sweet.

Rachel (00:40:38): Caspian was born at one twenty four, and then I was awake at 2 0 1, 2 0 1 in the morning.

Dr. Nicole (00:40:45): Okay. What was that like? I mean, was it surreal? What was that like for you?

Rachel (00:40:54): It was very surreal. I've never really had to have a major surgery before waking up. I didn't really remember or think about what had just happened in the or. I just was pushed online. Again, there's my husband, oh my gosh, he's holding my baby. My baby's not in my belly anymore. And just being loopy from the medicine, because when I first saw our son, I was like, oh my gosh, you used to be in my belly. I was still, I think, a little bit high from the medicine. We unwrapped him just the best present and had to see our little baby boy who shares my husband's birthday. So that was really great. So while we were in that first room before you go back to your regular room, the operating OB came in and she said that she had noticed that my uterus was differently shaped, and so she had drawn what it had looked like on a paper towel, and I was like, okay, thank you. That's very nice. There's a baby right here. I'm going to focus on this again. I don't care about babies in the future right now, here's a baby right here. So that's a different part of my story. But we also found out that Caspian had his nuchal cord wrapped around his neck four times.

(00:42:37): So while I am upset, you've talked about this too, you can have mixed feelings about your delivery. I'm so relieved he's

(00:42:49): Okay,

(00:42:50): While also extremely angry about

Dr. Nicole (00:42:53): What happened. Yeah, totally understandable. And yes, the core can be wrapped around the neck for a vaginal birth, but four times, I don't know that that would be a challenging labor babies. I can't say that I've ever seen a baby come out vaginally with a cord wrapped around their neck one time. So I'm glad that he got here safely as well. Do you remember any discussion whether that day or later about how you had to go to sleep or any discussion about that part?

Rachel (00:43:25): No. Nobody came and discussed that with me. And so that was also why I was so angry that they put in my file that they weren't sure if the sensation of not breathing was a high spinal or panic attack, especially because it felt like, from my perspective, that they're just trying to cover themselves legally. Early July is when new residents come on at our hospital. And so I felt I just would have loved for somebody to talk to me

Dr. Nicole (00:44:05): And just to talk through things

Rachel (00:44:07): To talk about it

Dr. Nicole (00:44:08): And about what happened. Okay. All right. I'm sorry. Yeah, this is, I mean, obviously this is your story, but I personally am learning so much about how important it is for us to just circle back and acknowledge what happened and offer the opportunity to answer questions, whether it's right then or whether it's a couple weeks later or both, because it can make just a huge difference in how the experience is perceived and processed, or just acknowledging that it's some trauma involved in that. I don't think we understand and recognize enough. We have a lot of focus on the baby's safe and mom is safe physically, but maybe not so much mentally in terms of how things transpired.

Rachel (00:45:00): Yes,

Dr. Nicole (00:45:01): Absolutely. Yeah.

Rachel (00:45:02): Obviously I'm still processing it, obviously. I'm still processing it 15 months later.

Dr. Nicole (00:45:07): Yeah, exactly. Exactly. So then how was the postpartum period in terms of breastfeeding and things like that? Recovery from the C-section?

Rachel (00:45:15): Yes. So after the C-section, I was super nauseous and I felt bad every time the lactation consultant came in in the hospital, she'd be like, how are you? And I'd say, I'm great. And then I would kind of throw up everywhere. Oh, God, push

(00:45:30): Your heart. Okay.

(00:45:31): I feel bad for her. She was like, okay, what is it about me that's making this happen? Yes, I wanted to breastfeed, so I worked with a lactation consultants at the hospital, and then our hospital also offers a free weekly breastfeeding support. So I went to that because he was having trouble latching. We had to use syringes to feed him, so I would let pump after trying to feed

(00:46:01): Him.

(00:46:02): We really got into a good relationship with breastfeeding because of Millworks in Omaha, it's a nonprofit lactation support, and they are amazing. They do weighted feeds. You can meet with ID CLCs, and they were really wonderful with that, but because of my history with depression and anxiety, I was fully prepared and expecting to have postpartum

(00:46:32): Depression.

(00:46:34): So just being, oh, I listened to a lot of birth stories where women had talked about that, just so that I was aware and ready to recognize those symptoms. And so what I had done was set up therapy appointments afterwards. I had set one up for right at 40 weeks, so to talk about, oh, I'm going to deliver, oh, surprise, surprise, here's my baby, the telehealth appointment. But having those already set up really helped hold me accountable for myself to not try to push my mental health to the side.

Dr. Nicole (00:47:17): Okay. Yeah, absolutely. Absolutely. And then, which is what everyone should do. You have to do some preparing for postpartum while you're still pregnant. So I hope you give yourself credit for that because that's really huge, because mom, being in the best shape that she can be is so important for the health of the baby as well, so that's really wonderful. And then did you ever think, what were your thoughts about ever, either during pregnancy or either postpartum, what were your thoughts around when or if to restart your medication?

Rachel (00:47:48): Yes. So I've always thought about my anxiety and depression not as something to be cured. It's more of like a roller coaster. So sometimes when you're really low, you need more support to get back up. And so I was just going to be open to needing medicine with taking antidepressants that can be transferred through breast milk. And so I just had to be ready and accept that a fed baby with a happy mom is the best, but luckily with breastfeeding, that helps support those extra hormones that get released during breastfeeding. Those have helped me so that I was able to breastfeed him for 13 months, and then we kind of mutually decided that we were done. Well, once he started having teeth, I was like, I'm good. I'm all done with this.

Dr. Nicole (00:48:52): Yes. Okay. Good, good. Well, how was your physical recovery from having surgery?

Rachel (00:48:57): It was difficult. I felt like I had some nerve damage at the left side of my incision, and it's kind of trying to describe what that incision feels like because there's so many layers that they go through that you just feel very vulnerable in your body, just being patient with yourself. I was very strict of not lifting heavy things, not trying to push myself too early to harm my recovery. But yeah, it was difficult. Steve would have to pick up Caspian from the bassinet when we were at night in bed. I couldn't lift him.

(00:49:47): Right,

Dr. Nicole (00:49:48): Okay.

Rachel (00:49:49): Yeah, it's a whole

Dr. Nicole (00:49:51): Nother beast. Challenging a whole nother challenge. Yeah. Yeah. So when did you go back and see your OB afterwards? Was it not until six

Rachel (00:49:58): Weeks, I believe? Yes, it was six

Dr. Nicole (00:50:03): Weeks. And was it a different person I presume than or was it the same person?

Rachel (00:50:09): It was the second ob, yes. Okay,

Dr. Nicole (00:50:11): Got it.

Rachel (00:50:12): Got it.

Dr. Nicole (00:50:12): But not the one, the

Rachel (00:50:13): Second one.

Dr. Nicole (00:50:13): Was she also the one who did your surgery?

Rachel (00:50:16): No, she was not. No, she was not on call.

Dr. Nicole (00:50:18): Okay, got it. Got it.

Rachel (00:50:19): So it was somebody else.

Dr. Nicole (00:50:20): Okay. Okay. So then did she bring up anything about what happened and how you were feeling and things like that?

Rachel (00:50:29): She asked about my support at home just to make sure that I was with supportive people and things like that. And I think because I'm an emotional person that can worry people when I don't have a long relationship with them where they're like, okay, this lady's crying and I'm concerned about her. But so she was just making sure that I had good support at home. She did talk about next steps of figuring out what was going on with the shape of my uterus. So she wanted to first do an ultrasound just because that is less extensive than an MRI. So we did do an ultrasound a few months later and they weren't able to tell what was going on. So then I did have to do an MRI in November, and seeing the MRI is wild because you can still see from July to November you could see where my c-section was, and it was very clear. It did not look healed. And so anybody that's like, well, my body's not bouncing back, this still really hurts. They slice through a lot of stuff. So just giving yourself grace is important. So

Dr. Nicole (00:51:57): Yeah, I mean, we put folks back together, but it's not exactly going to be the same, so it's not going to be the

Rachel (00:52:03): Same,

Dr. Nicole (00:52:04): And it takes some time to heal. So then what did they find with your MRI?

Rachel (00:52:08): Yeah, and tell me if I'm pronouncing this wrong, but bi corn.

Dr. Nicole (00:52:13): Yes.

Rachel (00:52:15): Bi corn

Dr. Nicole (00:52:16): Uterus. Yeah,

Rachel (00:52:17): Uterus, yes. With a rudimentary horn on the right side. So basically I have a studio apartment size uterus on the left, and then the right side is like a detached tool shed.

Dr. Nicole (00:52:31): That's a great way to put it. So, and it's hard to explain how it happens, but when we're all developing in our own mothers, the uterus starts as two pieces that fuses together. And if it doesn't fuse all the way together, then it can end with what happened with you. And sometimes we don't suspect it. You can't necessarily feel it, so it may not, it's often going to be discovered in the setting of pregnancy, although often it can be seen on ultrasound during pregnancy, but maybe how it was shaped, they just didn't quite see it. But obviously she saw something was going on when she was looking at your belly. Yeah. So it's not a common thing, but it does happen.

Rachel (00:53:14): And

Dr. Nicole (00:53:14): That's probably why the baby was breached, because they just don't have as much space necessarily to turn around.

Rachel (00:53:20): Yeah, he definitely ran out of room in there.

Dr. Nicole (00:53:22): Yeah. Yeah. So as we wrap up, so how are you feeling about things overall?

Rachel (00:53:33): Overall, I am grateful that Caspian is safe. Obviously, you can hear in my voice and seeing my face, I'm still hurting.

Dr. Nicole (00:53:44): Right? Yeah.

Rachel (00:53:45): Yeah.

Dr. Nicole (00:53:46): And how, are you still continuing to see your therapist or psychiatrist, or both?

Rachel (00:53:52): Yes, I am. I'm still seeing my therapist. And it is interesting how after stopping breastfeeding, I am seeing that going back on medication will probably be an inevitability, which is absolutely fine, but that definitely is something to watch and be aware of just for people. It is, the amount of hormones that do get released during breastfeeding is huge, and so that drop off is surprising. There's always a new part of the journey that you're going through.

Dr. Nicole (00:54:36): Definitely. Definitely. So then what is your one piece of your favorite thing, the one thing that you want people to absolutely take away and know from your story? One piece of advice.

Rachel (00:54:47): Yeah. I would say trust yourself. Always. Just take a deep breath, slow down and be kind to yourself.

Dr. Nicole (00:54:57): Yeah, that's excellent advice. Excellent advice. Well, where can people connect with you? You can say nowhere.

Rachel (00:55:05): Oh, yeah, absolutely. Instagram would probably be the best place. I have a private Instagram, but if somebody wants to send me a dm, that's fine. It's Mrs. Rachel Romero,

Dr. Nicole (00:55:19): And we will link that in the show notes.

Rachel (00:55:21): And thank you for everything that you do.

Dr. Nicole (00:55:24): Thank you

Rachel (00:55:25): For all of us.

Dr. Nicole (00:55:25): Thank you. And again, I really appreciate you coming on to share your story. I mean, when I say I have learned a lot and things that will help me be a better doctor, and I know that everybody who's listening will have learned a lot too, and just, I appreciate your vulnerability and your honesty for sharing today.

Rachel (00:55:47): I appreciate your patience with my tears.

Dr. Nicole (00:55:51): Oh, as I told you, I'm a crier. I can cry at an emotional commercial, so I'm totally like somebody who can, so I can relate in that regard. So no worries on that. So thank you again. Thank you so much.

(00:56:12): Wow. Wasn't that a lot? I so appreciate Rachel coming on to share her story. There's so much to learn from it. And after every episode when I have a guest on, I do something called Dr. Notes where I talk about my top takeaways from the conversation, and I have quite a few takeaways from my conversation with Rachel. Number one, deciding whether or not to keep taking anxiety or depression medications is really a personal decision. Both options are perfectly acceptable, reasonable, depending on your own unique circumstances. What you need is what Rachel had, and that is a psychiatrist who can present a balanced view of staying or not staying on the medications based on your unique circumstances. But really either choice is the right choice depending on your own unique situation. Okay. Number two is that pain during pregnancy is common, but we really don't want it to be normal.

(00:57:11): A lot of times we have kind of normalized pain during pregnancy. Oh, that's normal, that's normal, that's normal. And really instead what we should say, it's common, but we should work on some strategies to help people manage pain. So whether that is doing things like exercise, it's counterintuitive, but actually movement can help with pain. So whether that's exercise, like prenatal yoga, there are tons of free videos on YouTube, whether you need to see a physical therapist or a pelvic physical therapist in particular, maybe you even want to explore seeing a chiropractor for a few visits. All of those things are perfectly reasonable options and things you should explore. You don't have to accept pregnancy pain being normal, even though it is common. Alright, so I also want to talk about what to do when your water breaks. And obviously you should do what your doctor says based on your unique circumstances, because that's going to vary.

(00:58:09): But in general, if you are full term and your water breaks, if the water's clear and not bloody, then you don't necessarily have to rush to come to the hospital. You want to come sooner if you have GBS, the group beta strep bacteria so that you can get the antibiotics started to treat that. But if you don't, then you don't have to rush to the hospital. I would tell people, you can wait six hours to come to the hospital, or if labor starts, whichever comes first. Some people will say longer. Some practices will say, usually I say midwifery practices will say even up to 24 hours before you come in if your water breaks. Now if the baby is breached, that's a bit of a different story. If the baby is breached and you know the baby to be breached, if the baby is footling breach, meaning the feet are coming first, that's a situation where the cord can drop down in front of the feet.

(00:59:02): That is a true, true emergency. So if your water breaks in your breach and if your footling breach, then you definitely want to head on into the hospital. If the baby is frank breech where the butt is just sitting down, it's not as much of a rush. But again, if the baby's breech, you want to head on into the hospital. We know that there are challenges with vaginal birth. Most physicians actually these days don't know how to do breach vaginal birth. That is something that I think some practices and especially in academic centers are starting to bring back and more people have an interest in. Right now though, most people are going to do a breach birth as a cesarean birth. And this is from a study that came out a while ago. It has some floss to it, but right now the recommendation is probably going to be a cesarean birth.

(00:59:53): In episode one fifty three of the podcast, that's dr nicole rankins.com/episode 1 5 3. You can go into all the details about breach birth and how it's managed, but in general, if you have a breach baby, when your water breaks, just go ahead and head on into the hospital. But otherwise, if you're full term fluid is clear, you don't necessarily have to rush in. Okay. Okay. Next couple of things I want to say is if you are in a place like where Rachel was, where you are in an academic center where you have residents, residents, or physicians who are in training and medical students are in medical school, then go ahead and grab my free guide on questions to ask. When working with medical students, we all at some point are learners. I was a medical student at some point. I was a resident at some point, and I appreciated people giving me the opportunity to learn to be an OB GYN with them.

(01:00:50): But you want to have some clarity about how that is going to work for you. So head to dr nicole rankins.com/resources. Scroll down and you'll see the guide. It's a guide for questions to ask. Again, if you're in a situation where you're working with residents and medical students, it'll just help bring some clarity and some peace of mind about that situation. And then the last thing I want to say is if you have birth trauma, if you have a birth where things did not go the way that you intended, do take some time to process that trauma. Even if you and your baby ended up being, well, that does not mean that maybe there wasn't a traumatic situation for you and you are the only one who decides and can make that decision about whether or not something is traumatic. If you have birth trauma, if you are having feelings and things about your birth experience, it do take some time to process it, ideally with a licensed professional.

(01:01:51): In episode 2 62 of the podcast, that's dr nicole rankins.com/episode 2 6 2. I have a great conversation about birth trauma with a licensed clinical social worker and birth trauma survivor, Kaylee Summers. So do check that out for some information about processing birth trauma. Okay, so there you have it. Do share this podcast with a friend. Also subscribe to the podcast wherever you're listening to me right now. And I would so appreciated if you leave a In Apple podcast, it really helps the show to grow. It helps me to reach and serve more pregnant folks. So just take a minute, hit those stars, leave a little couple words about what you think. I really, really appreciate it and it helps me so much. Also, do come make sure you check out my live birth plan class and stay at the end for the live office hours q and a. You can sign up for the next class at drnicolerankins.com/birth plan. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.