Ep 285: Gina’s Birth Story – When a Physician Has A Birth Related Injury

Dr. Nicole (00:00): What happens when you're a physician and you experience a childbirth related injury? Are you treated any differently? You're going to hear about that today in this birth story episode with Gina. 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. 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.

(00:59): Hello there. Welcome to another episode of the podcast. This is episode number 285. Whether it is your first time listening or you have listened before, I am so glad you're spending some time with me today. In today's episode, we have Dr. Gina Yu. Gina is an ophthalmology resident, meaning she's a physician who is training to be an ophthalmologist. She had a birth complication that made her paralyzed in her right leg. It's a complication that can happen to anyone due to poor positioning in nerve compression. It was absolutely terrifying for her, as you might imagine, to wake up from the blur of her birth to find out that she can no longer walk. She wasn't getting great answers as to what was happening and whether or not she would get better, and there wasn't a lot of online information about it either. She really wanted to share her story so that other women who experienced this don't have to live silently in fear that they may never be able to stand or walk again, and she wants her story to provide hope and also tips for what to do to recover from a complication like this.

(02:13): I really appreciate Gina coming on to share her story. I actually reached out to her to ask her to be a guest on the podcast because I read an article where she wrote about her story, and it can be hard for us in medicine to speak up about our unpleasant experiences. Sometimes it can feel like we're airing dirty laundry. I know when I first started doing this work online and social media and things like that, the podcast, I had some hesitation about sharing some of the problems and issues within our maternal healthcare system. It's almost like people accuse you of being a traitor, so to speak, but it's so important that we share the truth of what happens, share the truth, both the good and the bad. That is how we are going to be able to make things better and improve our system for everyone.

(03:07): Now, one of the things you're going to hear in the episode is how Gina had to really advocate for herself, and it's really important for you to know how to advocate for yourself. Childbirth education can be really helpful in that regard. In fact, it's absolutely crucial that you do childbirth education so that you are best able to advocate for yourself, particularly for a hospital birth. I have an online option called the Birth Preparation course, and it has helped thousands of women be able to advocate for themselves during their hospital birth experience. You can check out all the details of the birth preparation course@drnicolerankins.com / enroll. I believe so strongly in childbirth education that if you don't choose mine, choose something because it's really, really important. But of course, I'd love to have you inside the birth preparation course. So again, that's dr nicole rankins.com/enroll. Okay, let's get into the birth story episode with Gina. Thank you so much, Gina, for agreeing, and Dr. You, I should say, for agreeing to come onto the podcast. I am so excited to have you come share your story.

Gina (04:17): Great. Thank you so much for having me. I mean, I think it's such a huge inspiration to have a podcast like this, so to be on it, it's a really an honor, so thank you.

Dr. Nicole (04:25): Oh, thank you. Thank you. So why don't you start off a bit by telling us about yourself and your family?

Gina (04:29): Yeah, absolutely. So I was born and raised in Michigan in a pretty small town called Saline. It's really close to Ann Arbor where the University of Michigan is. And during my time in Michigan, I spent almost all of my time helping my family cook fried chicken. We had this fried chicken restaurant that was family owned and operated. Small business. Yeah, I was called Family Fried Chicken yp still exists, and it was amazing. It was like soul food every single day, which was fantastic, but it also, it was a lot of hard work. So it definitely taught me the value of working hard, seeing my parents well into past their sixties, working from 8:00 AM to 11:00 PM and really physically demanding, mentally demanding jobs is Yeah, it was a true inspiration for sure. And so I was actually also at that restaurant that my dad, he accidentally injured his left eye while cutting branches outside the restaurant, and he at first thought it was just going to be a simple procedure to fix it, but then it ended up being a lot more complicated than that, and now the eye is cle, which just means that it's shrunk in and kind of a physical reminder of a really difficult time in his life, and he's not able to see out of that eye at all.

(05:44): And so that really inspired me to want to go into medicine. I wanted to see if there's any way that I'd be able to help him or at least kind of figure out what happened. And that kind of led to this journey of going into medicine, getting into medical school, which was amazing that that happened. And now I'm currently doing my ophthalmology training at Stanford.

Dr. Nicole (06:05): I love that. What a beautiful story. It's always interesting to me. The more I talk to people, the more I see how so many people, what they do comes from their own lived and personal experiences. And I love when I see people who are able to take that and turn it into something positive. So that's great.

Gina (06:22): Yeah. Thank you so much.

Dr. Nicole (06:23): And you also have a little one, which is what we're talking about.

Gina (06:25): Yeah, that's exactly right. Yes, our little Jane. She is awesome.

Dr. Nicole (06:29): Alright, well let's talk about Jane. So in order to understand the birth, and I should say upfront, we're really going to focus a lot on what happened with you postpartum because you had a rare complication and things. It was a challenge, but in order to understand what went into that, I always like to talk about what happened during the pregnancy and the prenatal care piece. So what was your pregnancy and prenatal care? Did you see a physician, a midwife? How was that?

Gina (06:56): Yeah, absolutely. So I was seen by a physician and most of my pregnancy was pretty straightforward. I had insulin resistance, and so I had to have a continuous glucose monitor and check my sugars. And then towards the end of the pregnancy, there were a couple episodes of some abnormal and vaginal bleeding of unclear reasons. And so my OB was kind of telling me, I think you should maybe take it a little bit easier because I was also doing residency and residency already, as we know, can be kind of tough even when you aren't 39 weeks pregnant. So working the 80 hour weeks and we have call overnight and our call can be pretty busy, we have to cover for hospitals and we're driving all around, et cetera. And so I think all of that combined probably made for the pregnancy to be a little bit more difficult towards the end.

(07:48): And I do have to say my residency program was absolutely incredible about the whole thing too, because towards the end, my OB was saying, I think you should really take it easier, not bed resp, but at least take it easier. And I wasn't actually going to even mention it to my residency program just because I already felt, I don't know, you have that guilt of taking time off and everything. So I already felt that. And then my program director and the attendings I was working with, they could tell something was wrong and they talked to me more about it. And they were actually the ones that encouraged me to like, Hey, you should really listen to your body, listen to your

(08:26): Ob.

(08:27): And so I was able to take a little bit of time off. So for the most part, pregnancy was pretty straightforward.

Dr. Nicole (08:32): Okay. Okay. And you were happy with the prenatal care you received?

Gina (08:37): Yeah. Yeah, I was, yeah, so both. I had one OB to begin with, and then she actually ended up leaving on maternity leave. So then I had another ob, and both of them were really great. They really listened to the different concerns that I had and were very, very knowledgeable, which was great.

Dr. Nicole (08:53): Good, good, good. It's hard to answer this question because you only know being pregnant as a physician and being in training, but do you think that impacted the way you approached or thought about pregnancy?

Gina (09:05): Yeah, yeah. It's a really, really good question. I do think that, yeah, it did because about the scary things that can happen, I guess. And so it's really hard not to fixate on that or to assume or just predict that that's going to happen to you. And so every little thing that doesn't seem textbook, you think to yourself like, oh, what's wrong? What's going to happen? And so I do feel like it added an extra level of concern and anxiety. Sure,

Dr. Nicole (09:39): Sure. I can understand that. As someone who used to ultrasound myself, I

Gina (09:50): Would totally do that if I knew I

Dr. Nicole (09:52): Would totally do that. Oh goodness. So what did you do, if anything, to prepare for your birth?

Gina (09:59): Yeah, so the hospital that I gave birth at had these courses that you could take ahead of time, and it was everything from how to install a car seat afterwards to what your birth plan would be or what to watch out for, things to think about in preparation for delivery. So I was able to take those courses, which I felt was really useful, especially as a first time being pregnant, delivering, et cetera. I just wanted to be able to get as much information as I could. So I ended up using those courses, which is great.

Dr. Nicole (10:31): Gotcha, gotcha. And what were some things that you wanted for your birth?

Gina (10:35): I think ultimately what I wanted was just to have a healthy baby and as much of a healthy delivery as possible. And I wanted my husband, who was incredible and super supportive. I wanted him there. And my parents were also visiting, so they were able to come to just, just to have a smooth of a process as possible with the people that I love.

Dr. Nicole (11:02): Gotcha, gotcha. Was there anything that you were particularly afraid of about giving birth?

Gina (11:11): So having gone through my OB rotation in med school, I have seen some pretty, very painful, obviously births, but also the vaginal tears that happen afterwards or things like that. I was concerned about that. And it is actually interesting. So before everything happened, I remember briefly looking up how safe is an epidural and how safe is that portion? What are the chances of becoming paralyzed or the chances of things happening and going wrong? And I looked at that super briefly because it was extremely rare,

(11:53): Very

(11:54): Unlikely to happen. And so then I kind of just wrote it off and I was like, oh, that's not going to happen to me. And so yeah, mainly the things that I was more concerned about was what I had seen more commonly during my opioid rotation, which were like vaginal.

Dr. Nicole (12:08): Yeah, that makes sense. That makes sense. So then let's talk about what was your labor and your birth?

Gina (12:13): Yeah, the labor and birth was surprisingly a lot more straightforward than I thought it was going to be. Yeah, I thought it was going to be super duper painful and horrible experience the entire time. But the labor part was difficult until I had the epidural. And then once the epidural kicked it in, it was actually pretty smooth sailing. The actual delivery itself, I was in active laborer for like 47 minutes, and then our baby came out. Oh my, okay, Lord. Okay, wait,

Dr. Nicole (12:47): Let's back up. This is your first baby. Were you induced or did you go into labor on your

Gina (12:51): Own? Yeah, sorry. I was, I was induced. I was induced. Yeah, I was induced. And so once I was induced, it was very, very quick after

Dr. Nicole (12:59): That. Okay. Okay. Did you decide that you wanted to be induced?

Gina (13:04): Yeah, so it was partly decision with the ob. So the way that the hospital that I gave birth at works is that the OB that I was working with during my entire pregnancy was not the OB that actually delivered it was whoever the OB was on call. And so the OB that I worked with during the labor and delivery process, she had noticed that there were some variable D cells on the fetal monitoring. And so she was saying, I think we should induce. I think it'd be safer

Dr. Nicole (13:35): At this point to

Gina (13:36): Induce it was.

Dr. Nicole (13:37): Okay. And how far along were you in the pregnancy? How many weeks?

Gina (13:41): Yeah, I was 40 weeks at that point too, so it was fine.

Dr. Nicole (13:43): Gotcha, gotcha, gotcha. So what was the induction process

Gina (13:49): Like

Dr. Nicole (13:50): For you?

Gina (13:50): Yeah, it was painful. You're like, yeah, it was, I guess because everything that happened, these parts, I don't dunno if the complication that happened didn't end up happening. I think that these parts would've been more highlighted. The induction part, it was pretty beautiful. I do remember them having to do inspection or do examinations, and my husband was next to me and he was basically telling the nurse, maybe we should pause because I was squeezing his hand because it was so painful and things like that. But the actual, after they induced and they did the examination, they were saying, oh wow. Yeah, you seem ready to go pretty soon after that.

Dr. Nicole (14:40): Okay. Alright. So was the epidural placement difficult or challenging or anything like that?

Gina (14:46): I don't think it was, and that was a question that people had asked me afterwards. Do you feel like there was any sort of shooting pain or things like that? Once I had those questions, I remember thinking to myself, the only pain that I was really thinking about was the labor pain, and so I wasn't really focusing on anything else. And so then I was trying to think to myself, was there something that felt wrong during the epidural? I really don't think there was. I think it seemed like they were able to place it after one attempt. It didn't seem like there was any other complications from

Dr. Nicole (15:23): That. Okay. And then how long did you push for, you said?

Gina (15:27): Yeah, 47 minutes. Okay. Yeah, I know. I was really lucky. It was really not that bad considering first birth and everything, it really,

Dr. Nicole (15:37): Okay. And then did they put her up on your chest? Did you have skin to skin and all of those nice things?

Gina (15:42): Yeah, we did, which is really

Dr. Nicole (15:44): Nice. Okay. Then postpartum, walk me through what happened and when did you notice that something was not right?

Gina (15:53): Yeah, so postpartum. So we had delivered our beautiful baby and she was great. And at that point I was just off of that high of having delivered and everything. And then a couple hours later I could tell that the function was returning and the feeling and sensation was returning on my left leg. And I was like, okay, great. But I could tell something was wrong in my right side

(16:18): Because

(16:19): Even though my left leg, it felt like things were kind of waking up and returning back to normal, my right side, nothing was really happening. And I remember thinking internally, just something doesn't feel right, something seems wrong. And so then I ended up telling the team that I was like, it just doesn't seem normal. Something seems wrong with my right leg, especially given everything that's going fine with the left. And at first my team was like, okay, you're still pretty early off of the epidural is very, very common for things to come back unevenly. Why don't we wait? And at that point, so I had delivered around noon, and so they were like, why don't we just wait at least until tonight and see if things are progressing or improving?

(17:06): And it was interesting, they actually focused less on the leg being non-functional and more on my vitals. My vitals were kind of, they said that I was super tachycardic, my heart rate was going really, really fast and my blood pressure was really, really low. So they were focused more on the vital side of things. And then they said, oh, her mood seems different. And so all of that kind of led them to think that it was maybe something more systemic. And so they were focused focusing on that. But to me, the reason I feel like I was feeling that way or my mood was different and everything was because I was just thinking and so worried about my leg, and I could tell I knew something was wrong. I knew even though the team had said, oh, don't worry about it. I think you're going to be okay. Everything's going to be fine. I had a feeling. Yeah, I just,

Dr. Nicole (17:52): Okay.

Gina (17:53): So anyways, night comes and still nothing is improving. My left leg at this point is essentially almost back to normal, was returning function and my right leg. Still nothing was happening. So

Dr. Nicole (18:05): When you said you couldn't feel it or you couldn't move it, I mean it was just like dead weight.

Gina (18:10): Yeah, exactly.

Dr. Nicole (18:12): And nothing like your toes, your nothing.

Gina (18:15): Yeah. So I remember just thinking I would do anything, give anything just to have my tiny little pinky toe give me some sort of response and nothing was happening. So yeah, I just knew something was wrong from that point. And so that night I hadn't heard from my delivering OB yet. And so I was like asking the nurse, is she available? So we could talk. I figured that if anyone might know what could have happened, it would be her. At least we could kind of talk it through or try to figure out next steps or something. Just I understand she might not know exactly what happened either. At least try to, she would be the best person

Dr. Nicole (18:59): Because she was one, right? But she was there,

Gina (19:01): And so at least try to figure something out. And so anyways, I had asked my nurse. My nurse was saying, oh, she's busy, but she'll try to come by later tonight. I was like, fine, no problem. And then more hours came and then still hadn't come. So I asked my nurse again, she said, oh, she'll probably come tomorrow morning. Don't worry about it. Let's see if things will get better by tomorrow morning. Try to sleep it off. And I said, okay, sure. And I still remember that night having the most beautiful dream was such a wonderful dream. Sorry. No, take your time. I had this wonderful, wonderful dream that everything that happened didn't actually happen. It wasn't real. And I was able to confidently stand up and walk over to the bassinet for my baby and hug her super close, and then my husband was hugging me. We're all so happy. And so this joyous time, we were super excited. And I remember having the beautiful treatment like, oh, okay. So everything that had happened before wasn't real. This is

(20:00): Real.

(20:01): And then I woke up and then I realized that that wasn't the case. My leg still wasn't working. I wasn't functioning. Oh my, yeah, it was pretty difficult to have that realization. Sure. But

Dr. Nicole (20:16): I mean, it seems like just obviously the listeners can't see us, but looking at you, that was very vivid. It seemed like it was very clear in your mind that

Gina (20:27): Yeah. Yeah, it was just such a beautiful, I think that's what I had imagined. Sure. Right. Yeah. Imagine everything was going, but I mean, obviously I understand these are things that are out of our control, complications happen, et cetera. But I think that's what I had imagined. And so when I woke up and realized that wasn't the case, it was. And

Dr. Nicole (20:47): Had they tried to get you up to go to the bathroom, usually we try to get folks up to go, what happened?

Gina (20:53): So when I tried to use the restroom, I couldn't stand or I couldn't walk at all on the leg. And so what they ended up using was this, it was not necessarily a wheelchair, but something where I could put my knees on it and then they wheeled me to the restroom or they would wheel me to the P or things like that. So that was how I was able to go from point A to point B. And so that morning when I had woke up, I still hadn't spoken to the OB yet. And so then I had asked my nurse, do you think she'd be able to stop by just so we can talk a little bit about what might've happened? And then that's when the nurse was saying, oh, actually the OB had left for the night. She went back home, so you're going to speak with the next OB that's on call.

(21:35): And hearing that was really hard because I was like, oh, man, I wanted to speak with the OB initially who was there, right, yeah, who was there who might be able to answer some questions. And so eventually that OB did, she called me on the phone, and so we tried to talk through it, and she was saying that she wasn't sure exactly what had happened. It might've been due to positioning. Maybe I was just on my right side for too long, maybe a compression injury. And so she was saying usually these types of injuries, if they do happen, they're very, very rare, but they usually get better. And then I was like, do you think it makes sense for me to see a neurologist or see someone who might be able to pinpoint exactly where the injury was so I could try to prove it? Then she was like, yeah, sure. So they ended up consulting a neurologist, and then they also said, maybe once the neurologist sees you, if there's still an indication for imaging or other studies, then we can go from there. I said, sure, absolutely. That makes a lot of sense. And then later that morning, I ended up seeing the anesthesiologist, not the one that provided the epidural, but another anesthesiologist, and they were saying that it was likely a perennial nerve injury at that time, they thought it was still a perennial nerve injury, which it didn't end up being that, but they thought it was.

Dr. Nicole (22:47): And

Gina (22:48): So they were like, since it's a peripheral nerve injury, I don't think it's due to the epidural. Let's see what the neurologist said. I was like, sure,

(22:55): Makes

(22:55): Sense. So then I see the neurologist and the neurologist is like, this seems like it's due to the epidural and just getting all this mixed information. And he was like, I think it's going to get better. This is probably going to get better in two weeks. You'll be fine. And I was like, really? Wow. I was pretty amazed by that prognosis because nothing had gotten better after a day or two already. And so I was like two weeks. I mean, if it's going to be two weeks, that would be fantastic. That'd be

(23:22): Great.

(23:22): And then he also was, since it's due the epidural, I mean, it's possible that imaging would be helpful. So we may consider getting an MRI, but it's not necessary. So it's kind of like if you feel you would like an M mri, I think that that's really reasonable. I was like, okay, sure. If we get to later in that day, the other OB comes in, the one that wasn't during my delivery, but the one next one on call, and then she kind of runs through everything that's happened so far. And then she was like, I'll check in on you later in the day to just make sure things are still going. Okay, let's make sure. And so then she leaves. And then apparently while I was taking kind of a nap, I was a little half asleep.

(24:05): She had come in to check in on me, and then that's when she was like, oh, I think that I spoke with the neurologist, and we don't think the imaging is really indicated at this point. And so then she was like, let's not at the MRI. And then she had left and I was kind of half asleep. I was like, okay, sure. They seemed to be on it, so I'll be able to go to sleep and try to think about this more clearly once I am not quite as exhausted. So then I wake up, and then I kind of talked to my parents and my husband who were there, and I was like, so I was a little sleep deprived. I was a little sleepy when all this had happened. So what was the conversation? And they were like, oh, yeah, they had said that we're kind of just going to continue to watch it right now, not going to do any further studies. And at this point too, I had already kind of messaged some of my friends that are in neurology neurosurgery and just to get their thoughts of what could we do, what is happening?

(24:57): And they were saying the least we could do at this point is probably get an image study, get an MRI, just to make sure if it's an epidural and there's a hematoma, at least it's something that's durable or something that they could treat. And I guess since the team had thought that it was still just a perennial nerve injury, maybe that's why they didn't think it was that needed. But I spoke with the OB that was on call. She came back and I asked her a little bit more about whether it'd be possible to get an MRI to at least get an answer, an explanation of whether this is something that is more central, more treatable. Because right now it seems like there was a lot of question marks of why this happened, what we can do to fix it. And so I had talked to her about it, and it was at the point that the OB ended up becoming a little bit more, I guess I don't know what the right term, maybe reluctant or just not quite as patient with the questions that I was asking.

(26:03): And she said that the MRI was completely not indicated. It was a waste of resources. This isn't a conversation we should have anymore. And then she said, if I still wanted it, then in the reason for study, she was going to write quote per patient request because it is not indicated by this hospital. And then I asked about why that would be needed or what was the reasoning behind that. And she said, well, I'm not sure if it's going to make it so that it's, but it's not indicated in my perspective, and I don't think the hospital should have to pay for it if you are requesting it essentially is what she was saying. I'm sorry.

Dr. Nicole (26:49): Okay. Maybe you're just about to answer the question, but how in the world did that make you feel?

Gina (26:56): Oh man. Sorry, just reliving this is

Dr. Nicole (26:59): I don't mean to, I mean, I'm just

Gina (27:01): No, no, no, not at all. Yeah, I guess it was surprising to have that type of reaction. And also it was really discouraging at this point. I understand that everyone is confused about what happened, and it's hard to have these types of difficult conversations, but I at least was hoping that my team would have my back or be able to ensure that I would be getting answers to questions that we all don't know the answers to right now, or at least try our best to do that. And I think it was at that moment that I realized, Hey, I need to advocate for myself. This is not something that is going to come eat. I am going to have to for the sake of my health. And I mean at this point now I have a brand new baby and I want to make sure that I am healthy for her and everything too. And so I was just thinking maybe in the past I would've been a bit more, I wouldn't have spoken up as much, but I think because of the fact that I have this beautiful brand new baby, I was like, I need to be able to advocate at this point. And I think that was the turning point. Like, okay, this is a hospital stay where I'm going to have to ask the questions and advocate for myself because it just seems like there's going to be a bit of difficulty getting things otherwise.

Dr. Nicole (28:25): Right. And you're a physician, you would expect that. I mean, imagine what our patients go through for God's sakes.

Gina (28:32): So exactly that is what blew my mind too, because I'm thinking to myself, I am so lucky. I have the best support system. I have an amazing training program that's also supporting me. I have somewhat health literacy in this. I'm definitely not an expert any of this, but at least a little bit of health literacy and I'm able to speak up and ask these types of questions. I can't imagine the patients that we have who don't have these resources, what they must experience. And just thinking about my dad's experience as well and what he must have felt being ESL. And we didn't have health insurance not being able to have that type of backing and resources, and I had almost everything in line for me to be able to, yeah, it just, yeah, it's really,

Dr. Nicole (29:25): And the fact that it doesn't affect her whether or not you get an MR mri,

Gina (29:32): You know what I mean?

Dr. Nicole (29:33): It's not affecting

Gina (29:34): Her. I wonder why. There was a point where she even said, she actually mentioned the fact that I had more knowledge, and she was like, have you seen the studies that people that have more medical backing actually get worse care because they get all these different studies? And I was just thinking to myself, is that why? Yeah, I was a little confused and I mean, I feel bad. I'm sure she had her reasons. It's just the way that they were communicated was maybe it was partly my sleep deprived mind was not understanding what was going on, but just the way that it was communicated made it seem like they weren't on my team,

Dr. Nicole (30:16): Which

Gina (30:17): Is what is really discouraging.

Dr. Nicole (30:20): I feel like you're being kind. I think we have a cultural problem in medicine where we don't know how to center the needs of the person in front of us, and we think we know better than they do, and we are not supporting them and helping them make the best choices for themselves. We're imposing what we think is best and just we have a cultural problem. It's bad and OB or it can be, it's not terrible everywhere and a little soapbox, but it's a problem. So that's my

Gina (30:50): 2 cents. Thank you for saying

Dr. Nicole (30:52): That. Then what happened? Did you end up getting the M mri? So what happened from there?

Gina (30:56): Yeah, so from there I ended up seeing physical therapy and the sessions were essentially like, you can't walk, you can't do anything. I mean later on they gave me one of those braces for my foot because my foot was just not functioning, so it was a complete foot drop. And so they gave me one of those braces and they gave me a walker to try to learn how to walk with everything that happened. And that was another thing too. I remember thinking about how are we going to get home with this?

(31:34): We live in a small one bedroom apartment. I live on the second floor. We have an elevator. Great that I'm so thankful for that, but I was just, how are we going to fit this huge new wheelchair and how am I going to be able to walk with a walker or wheelchair through all to the bathroom or things like that. And I just remember thinking to myself, how is this going all work out? They were encouraging to try to get me to be discharged. At first, I was really worried and scared because I wasn't sure how we were going to be able to be discharged and comfortably be at home with everything that happened.

(32:09): And then speaking again about our patients, it just reminds me of the times where when I was on my internal medicine rotation, there would be patients who were really scared and worried about going home, and we tried to provide them with resources to go to rehab or things like that to be able to safely go home. But you don't really, I guess, fully understand that concern that a patient would have until you live it. And so I just think to myself, wow, just remembering all those different times patients, how scared they must have felt. So that last day that I would've been discharged anyways, if it had been a completely normal delivery, towards the end of it, we saw the physical therapist, it gave us the brace. I felt more comfortable about going home. And at that point, I just didn't want to be at the hospital anymore. They gave me as many resources as I could have, which was great. And then we just went home and hoped for the best.

Dr. Nicole (33:12): That's just hard that you just had to go and you're like, okay, well, I hope things and you have this new baby and you're sleeping, all of these things. So then what was it like when you were at home? The follow-up? Was there follow up? Yes. What were all of those things?

Gina (33:31): Right. Oh, sorry. And I actually, I didn't answer your question about whether we got the Yeah, so we didn't get the MR mri. And so when I got home, and I actually had spoken to a nurse about this during my inpatient stay as well, I was thinking I might end up going to a different hospital just to get connected and see if they think it's worth getting an MR MRI more urgently and stuff. And so that's what ended up happening. We ended up going to a different hospital. They got the MRI and I was connected with the neurologist. And it was then that they told me actually it wasn't a perennial nerve damage. It wasn't that peripheral, it was actually sciatic. And so that's why I had completely loss of function of that right leg,

Dr. Nicole (34:13): Essentially. How do they think it happened?

Gina (34:17): Yeah, so it's still not a hundred percent clear,

(34:22): To be honest. I met with the neurologist at this other hospital and she's fantastic. She was saying she's more of an expert in peripheral nerve damage associated with birth complications. And she was saying that she's seen patients very similar to mine, very similar types of injuries. And it just happens during the delivery process, just the way that I was lying or just compression of the sciatic nerve had caused this. And then I also met with a neurosurgeon who essentially said the same thing. He thinks that it was during the actual active waiver process the way that maybe my legs were kind of caused just the, I dunno how they were rested,

Dr. Nicole (35:02): Kind of pulled back or

Gina (35:03): Exactly. And so that caused damage to the sciatic nerve, and it's unclear why it was the right side versus is left or what positioning may have caused that issue. And it was a really important question for me too, because for future family planning, if we want to have another kid at this point, it's so early to even think about, I'm still reeling from everything that happened in the delivery and I'm still dealing with that complication, but for future planning, what could I do differently next time? And he essentially was saying, I know it's really hard, but while you are giving labor, try to be really cognizant of your positioning or ask the team to be cognizant of it given everything that's happened. So he had mentioned that once you had this much damage to the sciatic nerve,

(35:57): Then

(35:58): It's never going to be a hundred percent again. It's going to, yeah. So it's going to be a lot easier to injure it. And the neurologist that I saw, she did some EMG studies looking at the function of the nerve and if it would ever return back to completely normal. And at that point, she had said that there's actually, instead of it just being the myelin that was damaged, she had noticed there was axonal damage as well. So the actual nerve itself had become really severely damaged. And so that kind of made it more so that what the prognosis was going to be and

Dr. Nicole (36:31): Everything. Right. Wow. So then how have you been able to get better?

Gina (36:38): Yeah, so with this new hospital and the team that I had there, they've been able to do all these different studies, so it at least provides a little bit more answers about what I can focus on. And they also provided resources for supplements and things that I should take, which I found to be helpful. At the same time, I was a little nervous breastfeeding, so I wasn't sure how safe that would be, but it seemed like from the different studies, it seemed okay to take these different supplements. So that's one thing that I did. And then also, I was so lucky because I got into physical therapy really

(37:15): Quickly,

(37:16): And that was all my husband's doing. He searched through all the different local physical therapists that would be able to take me right away. And we found one who was specialized in neurology, and the physical therapists I worked with were amazing. They were fantastic. They were so, so good. And so that also helped a lot for sure. And then I mentioned before, but I have the best family, and just having them here through all of this supporting was really, really great.

Dr. Nicole (37:45): Oh, definitely, definitely. So what is your function like now?

Gina (37:49): Yeah, yeah. So now it is a whole lot better. I'm able to walk and I'm able to do, it's almost like all activities that I had done before.

(38:02): The first time I drove was really emotional for me because I remember when we had exited the hospital, I saw my car, which had gotten me through med school resident center. This car has been with me for a while. And I remember thinking to myself, literally 48 hours ago, I was able to drive this car, and now here I am in a wheelchair, will I ever drive this car again and will I ever be independent again? It just symbolized a lot to me being able to drive again. And so that was really, really a happy moment for me being able to drive. And I spoke with my neurologist, neurosurgeon. They had cleared me now to be able to do surgeries as well because cataract. So in my ophthalmology training, we get to do a lot of cataract surgeries. And cataract surgery requires two pedals. So both your feet being functional. And so that was another huge concern of mine not being able to do that moving forward, and they cleared me for that, which was great. So really the thing that I am working on at this point is just the pain associated with it. So I always have this underlying paraesthesia pins and needle burning sensation,

(39:08): And sometimes certain activities make it worse, sitting makes it worse. And I think it's tough too, when I'm trying to cro down and pick up my baby and play with her and things like that, and then I just get these pings of pain, then I have to stop unfortunately for that. But I'm just so grateful that I'm able to at least have the function back. That was a huge component.

Dr. Nicole (39:33): Absolutely. Yeah. And how long did it take you to get to this point?

Gina (39:37): It took a few months. So unfortunately, the two week timeline that the neurologist had initially said at the first hospital wasn't quite accurate. It took quite a long time. And right now, so now it's almost six months out, and I'm doing so much better, truly doing so much better, but still having the remnants of the pain and everything.

Dr. Nicole (40:02): And what timeframe did you return to your residency?

Gina (40:06): Yeah, so they let me take medical leave for three and a half months or so, which was huge. Oh my gosh. I am so eternally grateful for my residency to allow me to do that because that was a big worry of mine as well. What's going to happen? Will I be able to still finish my training and all that, assuming I eventually, hopefully do get better. And they were just like, don't even think about it. Focus on recovery and we will figure it out afterwards. So that was really great as well. That's good.

Dr. Nicole (40:38): That's good. And did you ever consider any legal action or anything like that?

Gina (40:43): Yeah, a lot of my friends actually asked me about that too, and my husband as well. And I was like, at this point, I just want to move forward from it. I just don't want to be tied down by this. And even though there are aspects that, like I was saying before, the communication could have been better, and I did feel like there were points where maybe things could have been done differently. I think ultimately, I'm sure that they were trying their best. I mean, it's difficult. It's hard to talk about this type of stuff, especially since they didn't really know the answers. And so I'm sure

(41:26): It

(41:26): Was probably really hard for them to try to answer questions, sorry, answer questions that they didn't even really truly know the answer for. And so I'm sure that was really, really difficult for them too. And obviously things like this can happen, complications can happen, and it can be out of people's control. I think in the future, having better communication would've been helpful.

Dr. Nicole (41:50): Absolutely. And speaking of that, what happened when you went to your postpartum checkup? Or did you go to your postpartum checkup?

Gina (41:55): Yeah, I did. Yeah. So I went to my postpartum checkup with my initial ob, who's in that same team, kind of talked to her about everything that had happened, and then mentioned that I was now converting a lot of my care to a different hospital, and she was really empathetic about the whole situation, for sure. Yeah, I think that it was mean tough for her too, because I'm sure she didn't know what happened either. And so it's hard to have a good conversation about it. Also, I think maybe in retrospect, what could have been done differently is when things don't go as planned or complications may arise, et cetera, we all know within our training that what you're supposed to do is you're supposed to talk to the patient as much as what you do know, answer as many questions as you can, or at least try to get to as many answers as you can so that we can move forward from it and learn from it and be able to do things better, or at least try to treat what had happened. And that kind of didn't feel like that took place sometimes during my care, and that was what was really disheartening for me.

(43:19): But my OB did mention that they now have new protocols to make sure that things like this don't happen again. And they do a lot of repositioning and things like that too, to kind of prevent these kind of compression injuries. And I remember thinking to myself like, oh man, does it take someone to be paralyzed for this to happen? I wonder why this wasn't already in place, but I am really happy that they were able to learn from this. Gotcha.

Dr. Nicole (43:46): And we've talked a lot about how you have taken care of yourself physically. How have you cared for yourself mentally?

Gina (43:55): Oh man.

Dr. Nicole (43:55): I don't want to project on you, but I think anybody could say that someone could experience birth trauma or feel like this was traumatic after this. So how have you taken care of yourself mentally?

Gina (44:10): Yeah, yeah, that's such an important question. Kind of what I am dealing with now too at this point now that the function has gotten better. So I got in touch with an amazing therapist who kind of helped me come to terms with everything that happened. And I think it's really easy to go down a route now where I just assume that having health anxiety just assume that things are going to go wrong. The rarest complications going to now happen to me,

(44:45): And I think it would've been very easy to go down that route. But the therapy that I had kind of helped prevent that. And it also, so on top of this complication, a whole bunch of other things happened to occur as well. My parents were visiting and my dad had gone to a car accident, and then our apartment, the ceiling was leaking, and there was just so many other things that happened, and I was like, just hitting you left instead. Exactly. Why not? Let's just add everything else. And so I think what helped was realizing that even if these terrible things happened, I am so lucky to have such an amazing support system that can help me get through it.

(45:36): And I think putting things in perspective that was super duper helpful, realizing the things that I do have and how grateful I am for that. And then also every day I would think to myself, what's one really positive thing I can do that I know will make me happy? And I look forward to that. That was something that I did as well, and just being so happy and grateful that I have a healthy daughter at the end of the day, that's really the thing that mattered most to me. And so that was also a huge thing to keep in mind.

Dr. Nicole (46:10): Gotcha. Gotcha. Well, two questions as we wrap up. How do you think your experience has shaped the way you care for patients? And then has it changed the way you think about the way we approach birth and postpartum care in the us?

Gina (46:27): Yeah, absolutely. I think for the first question, it absolutely has changed the way that I care for patients. Being able, you hope that you kind of understand what your patients are going through, but then actually being able to go through that and experiencing firsthand the different barriers that exist just to get physical or get the different resources that everyone's telling me that you need or that the patient needs. And I was really lucky to have the resources to be able to call the right people or things like that. I'm just imagining my patients who are not as technologically savvy or don't have those resources to be able to call or ESL patients that have language barriers, all these different things that my patients have to go through in order to just be able to care for themselves has definitely put things in perspective for me. And I think also it's very easy to forget the concerns of what a patient might have and maybe think about cost effectiveness or what other things that the OB may have been thinking about to decide the different medical decisions that they had made. And I really value, and I realize it's difficult, but it's just so important to have that patient-centered care and really try to focus on that as much as possible.

(47:50): Yeah, definitely.

(47:52): Yeah, and I think for your second question of what could be different in terms of prenatal postnatal care, when I gave birth, when I delivered, I already felt very vulnerable, and I felt like, I mean, you're just so exhausted. You're physically mentally exhausted after everything that happened.

(48:18): And I think if it was a very straightforward delivery, that would've been fine. It's okay. I'd go home and I'd be able to take time and care with my baby. But for those moments when that isn't the case, making sure that the patient feels heard as much as possible because you already are feeling, you're feeling vulnerable, you feel like you're already not able to fully maybe understand or voice or do the things that you normally would be able to do because you're in such an exhausted and mentally, you're mentally physically exhausted. And so I think that having that patient advocacy a million times fold for that reason is going to be so important during that postpartum care. And I think as a new mother too, you have a new perspective on things. Like I was saying before, I think before maybe I would've kind of just allowed these things to pass over and not ask the questions or not advocate for myself, because I'd be like, yeah, it's fine, but now I have a baby to take care of as well. So it's really important to try to advocate as much as possible on her behalf. Yeah,

Dr. Nicole (49:30): Definitely. Definitely. And that is our final question then. Would that be your favorite piece of advice? What is your favorite piece of advice that you want to share to someone who's getting ready to have a baby?

Gina (49:41): Yeah. Yeah, I think it is. I think it's that it's okay to want to advocate for yourself, especially now because you are taking care of not only yourself, but you're taking care of your babies. So it's okay to speak up and ask those questions, and it might make people uncomfortable or it might make conversations that are really uncomfortable and difficult to have, but it's so important for your care and for your baby's care,

Dr. Nicole (50:10): 1000%. 1000%. Well, thank you so much for agreeing to come on and share your story. This was really, really helpful, and I know someone is going to find it useful.

Gina (50:18): I really hope so. Yeah. And oh, sorry. There was actually one other thing I was going to mention. So when this was all happening, I'm pretty bedridden. I can't really do much of anything. And so I was spending a lot of time on my phone, which usually I don't recommend, but there was this one, my husband actually found it, this one Facebook group that is stories very similar to this where it was depression, nerve injuries. And I remember thinking to myself, I wish there was more resources for this, because when I initially looked, I found very, very rare one-off stories. And then I'm like, oh, great. So nobody, I don't know what's going to happen because no one has ever written or talked about this.

(50:57): And then I found the support group, this Facebook group, and I saw that there was several women, very similar experiences mine. And I think that just being able to know that there are other people who had experiences like this and were able to get through it and able to be themselves again, I think was super duper helpful. And so if anyone were to have a similar injury as this, I do think I am more than happy to help share this group or whatever. Just being able to get that support group so that they'd be able to get those resources.

Dr. Nicole (51:26): Absolutely. And I guess how can people connect with you, or if you want them to reach out to me and we can connect to you or where can people connect with you?

Gina (51:33): Yeah, absolutely. I have a Twitter, or sorry, an ex account, and I have Instagram and things like that too. And I'm happy to share them with you to put on the poster or however it would be helpful.

Dr. Nicole (51:46): Yeah, we can do it. We can put it in the show notes for the episode.

Gina (51:51): Awesome.

Dr. Nicole (51:52): Okay. Well, perfect. Well, again, thank you so much. I'm so grateful that you came on.

Gina (51:55): Oh, thank you for having me. This was really, really nice to be able to talk through this. So I really, really appreciate it, and I truly do hope that people who have similar injuries or not even just want to be able to connect and talk, I really hope that they feel comfortable to do that.

Dr. Nicole (52:17): Wow, wasn't that a great episode? Super informative. I really appreciate Dr. Yu coming on to share her story. Now, after every episode when I have a guest on, I do something called Dr. Nicole's notes, which are my top takeaways from the conversation. Here are my Dr. Nicole's notes From my conversation with Gina. Number one is we have a culture problem in medicine. It's just really not doing better, and we're getting to a point where we're actually focusing on the patient first and then building our system around patients. But right now it's just not a patient-centered experience. And this came to mind because of that experience of where her doctor was like, oh, I'm just going to write that this isn't an indicated test for this MRI. And that pushback and her wanting to get a test done to get answers that's just so unnecessary and so reflective of the issues and culture problems that we have and some of the ego involved in medicine here.

(53:21): She is having this really challenging and difficult occur, and she's being told, well, I mean, this isn't something that you need to get done while she's trying to get answers. And we don't take a minute sometimes to step back and think and realize nobody is going to make up or exaggerate not being able to walk after having a baby. Why would you do that? Especially someone who's particularly high functioning before that. So we just have a culture problem in medicine that we really have to work on so that we are truly providing patient centered care. Okay, next is you have to be ready to advocate for yourself.

(54:12): That is the reality of giving birth in our US healthcare system. That is actually the reality of getting healthcare period in the US healthcare system. I wish it was not that way, but it is okay. And hopefully you won't need to have to advocate for yourself. Something won't come up, but you don't know ahead of time when you might or might not have to really advocate for what you need to get the care that you want, whether that is in your birth or otherwise. And so the best way to be ready for that in the context of birth again, is to educate yourself. You have got to do childbirth education so you know what to expect in the system, and you can be ready to speak up if need be. And ideally, you have someone with you who can advocate for you as well. So being ready to advocate for yourself, it is not an option.

(55:15): It's not a luxury. It is something that you absolutely must do. Again, full stop. All right, next step is I love how Gina used gratitude to deal with challenging times. There is abundant evidence actually that gratitude is a really helpful strategy. It actually works to help you deal with stress, to help you deal with issues that are coming up in your life. So just take a minute and be thankful for something. Sometimes I've tried gratitude practices before, I'll be honest, and sometimes it can be like, wait, what am I grateful for today? I'm grateful for the sun that's shining. Like you're stretching for something. You want to find something that's big and amazing, but sometimes it can be small things like a good cup of coffee. Sometimes it can be like you got air conditioning, sometimes some days maybe you're not feeling grateful, but there is abundant evidence that gratitude can help with challenging times.

(56:17): So just try it. Focus on the things that are going well in your life and it can help you really to feel better. Okay, so that is it for this episode. Please share this podcast, but the friend also subscribed to the podcast wherever you're listening to me right now. I so appreciate that. And leave me a review in Apple Podcast. Those reviews are important to help the show grow, helps other women to find the show. And I love to hear what you think about the show. And do check out the birth preparation course, my online childbirth education class that helps you advocate for yourself takes that fear out of birth. That to dr nicole rankins.com/enroll and start feeling confident for your birth right now. Okay, so that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.