Ep 308: From IVF to Fast Labor: What Dr. Allison Learned on Both Sides of Birth

Speaker 2 (00:00.276)

What happens when a perinatal psychologist becomes the patient? In this episode, Dr. Allison Altman, who specializes in women's mental health and trauma, shares her deeply personal journey through infertility, IVF, and an unexpectedly fast birth. From advocating for herself during an induction to processing anxiety shaped by years of waiting, Allison opens up with insight, humor, and vulnerability.

See you

Speaker 2 (00:32.822)

Welcome to the Birth with Power podcast where knowledge is power and power transforms birth. I'm Dr. Nicole Callaway-Rankins, mom of two and practicing board certified OB-GYN with over 20 years of experience and nearly 2,000 births attended. I've seen firsthand how the hospital system can leave women feeling unheard and uncertain, but that doesn't have to be your story. Here, you'll get the knowledge, support and strategies to take charge of your birth experience.

so you can walk into the hospital feeling calm, confident, and empowered. Note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at drnaclomaragans.com forward slash disclaimer. Now let's get to it.

Hello there, welcome to another episode of the podcast. This is episode number 308, whether this is your first time listening or you've been here before, I'm so glad. You are spending some time with me today. In this episode, I chat with Dr. Allison Altman about her journey to becoming a mom after years of infertility and IVF. Allie is a licensed clinical psychologist in the Bay Area who specializes in women's mental health and trauma, particularly during the perinatal period.

She's also an avid runner and romance novel reader. We talk about how her personal experience with IVF changed the course of her professional life, what it was like being pregnant after infertility, and how she navigated a surprise diagnosis of intrauterine growth restriction in the third trimester. Allie shares the details of her fast and intense labor. And when I say fast, it was fast. The importance of advocating for yourself.

and how her psychological training helped her stay grounded through the ups and downs of birth and postpartum. This episode is filled with honesty, practical wisdom, and an insightful perspective from someone who truly understands both sides of the birth experience. You are gonna love it, so let's get into it.

Speaker 2 (02:43.096)

Thank you so much, Allison. Or should I say Dr.

Yeah, you can call me Ally, too.

For Ali, for agreeing to come on to the podcast, I am excited to have you share your personal story. So why don't you start off by having you tell us a bit about yourself and your family.

story. I'm excited to be here.

Speaker 1 (02:59.966)

Yeah, happy to. So, Dr. Altman, or you can call me Allie as all the patients I work with do. My family is my husband and me and our newly toddler, I guess I'll call her. She's a year and a half father. We call her Jojo. We live in the Bay Area and have a lot of family close by, which is really lucky to have as well.

that is nice. Yeah, that is nice. That is nice.

Yeah, I'm a psychologist. Yeah, I was like, what else about me? am a perinatal psychologist. So I'm a clinical psychologist by training. I currently work in private practice as well as at an IVF clinic at a medical center in the Bay Area. I'm working four days a week while taking care of my daughter one of those days too.

Nice, that's nice. Yeah, although sometimes often four days, it's like four long days and then, you know, so hopefully it's like not four too terribly long days for you.

No, I stopped working at 430, which is really lovely. That's like my...

Speaker 2 (03:54.538)

Okay, that is nice. Yes. Yes, that is that is nice. Okay. So in order to talk about the birth, we have to talk about a little bit about the pregnancy. And I think it's particularly relevant for you. You yourself went through infertility and IVF before you got pregnant. So what was that journey like for you?

It was long. I'll start there. Yeah, I mean, it's actually interesting and I'm sure I'll talk about this later, but I didn't, did IVF and we went through IVF prior to me specializing in IVF as a psychologist. I was just a kind of a women's health psychologist previously. So it was kind of like my own experience got me interested in it, but we took a while to conceive. It was about three or four years, I think of really kind of starting at COVID, we were trying to conceive and then we kind of took breaks here and there.

And then eventually went to IVF once we realized both my husband and I had kind of factors that were contributing to us having a harder time getting pregnant. And IVF was, I mean, it's like, I describe it as like the definition of tolerance of uncertainty. It's like there's so much uncertainty in that process. I know you've spoken with many women who have gone through it. So it's probably not new to here, but we were lucky to only do one retrieval, but I had a really hard time getting my body ready for a transfer.

So we had like four canceled transfers in a row of I would take the meds, my lining wouldn't grow, and then we would have to cancel it. Which was really hard, not understanding what was going on and kind of trying the same thing over and over. And then luckily went to a doctor who thought she knew what was going on. Turns out I actually had a diagnosis of Asherman syndrome. So I had scarring in my uterus and I needed another hysteroscopy, which was kind of surprising because I hadn't had a DNC procedure before.

But once we removed that, the transfer worked and I got pregnant with my daughter the next month. So that was a very nice kind of like, there is some type of answer as to why it wasn't working.

Speaker 2 (05:52.914)

Yeah, that is nice because often there isn't an answer as to why things aren't happening. So I'm glad that you were able to find an answer, but I'm definitely perplexed because it's not common. And usually it comes from some sort of prior instrumentation and lots of it. So it's unusual.

Well, they thought it was, and this is kind of my guess too, is I had a polyp removed with another hystereoscopy previously in the IVF process. And so that was like maybe I was the very small percentage that developed scar tissue from that. Got it. Got it.

Got it, okay, okay. And we'll get to your birth story, but I do wanna touch on a second, like that you said your own experience informed you moving into this field. Like how did that happen for

Yeah, so I... Going through IVF and when I was pregnant, I was working at a VA in women's health, which is like kind of a unique thing in and of itself because San Francisco is wonderful in that the VA's have really kind of robust female or women's clinics, the VA. And so I was doing general, I mean, women's health, I work a lot with trauma, military sexual assault was one of the main things I worked with people with on. And there's also...

increased rates of infertility among veterans. It's something that's been known for a while, but not really like the mechanisms that really understood. So my research started to kind of look into that a little bit of trying to understand why veterans with PTSD diagnoses have increased rates of infertility. And with my research, I really wanted to start treating that population too. Just kind of it came up naturally. And I ran one pregnancy and postpartum support group and absolutely loved it while I was on my internship.

Speaker 1 (07:31.758)

and was really looking for that type of just working with women kind of throughout the perinatal period was an interest I had. And then after going through IVF, I was like, oh, this is, I fully understand what it's like to be in this process. I, so I was immediately, it was like, I,

really want to work with this population. And I myself was working with a therapist throughout it and she had gone through IVF and it was so comforting to not have to explain things just to have someone who understood what it was like. And so I wanted to kind of be on the other side of that.

Gotcha, gotcha. You got more experience than you bargained for, but ended up using it to help other people, which I always think is admirable when people take their own experiences and then use it to help others. So I love that. Let's talk about then your pregnancy and your prenatal care. So you got pregnant and then got transferred from the fertility clinic over to an OB. What was your pregnancy and prenatal care like?

Yeah, I felt like we had great care. So we were at an academic medical hospital, we went to UCSF for care. I just really wanted a hospital that had a lot of experience with IVF patients. And they have their own IVF clinic there. And so it felt good to me to

to go there. And they have a really unique design where they have midwives and OBs. And I loved that aspect. And so for prenatal care, I had my own OB. for a lot of the up until I was maybe 20 or 30 weeks, I saw midwives for a lot of my appointments too and really loved that balance. am someone who I think tends towards like the most like low intervention hospital birth possible. And I that in quotations because of course like

Speaker 1 (09:10.85)

a lot happens as we talk about it, I mean, I up being induced, so it was different than I expected. But the care was great. I also came into pregnancy, I think, tending a little bit more towards anxiety based on my experiences with things not working. was so used to getting bad news in those rooms. And so I struggled, I think, with just feeling comfortable and kind of allowing myself to accept that I was pregnant for a bit.

really until I think she started moving more regularly. And so it was hard for me just I had a lot of anxiety about how she was doing. So I had more frequent appointments, I would say, than at least in beginning, my OB allowed me to come in maybe one or two more times just to get checkups to kind of have peace of mind.

That's nice. That is nice. And I can see how it can be harder to connect to the pregnancy before you start feeling things when with that disappointment. think that's something that we don't always take into account for IVF patients. So it's a nice reminder that that's something that we need to be mindful of. And I'm glad your OB supported you in like getting that reassurance.

Yeah, it's also funny because I have friends who didn't do IVF to conceive and they don't see their OB until like eight, nine, ten weeks for the first appointment. At that point, I had been going every week for just ultrasounds with my IVF doctor. And so it was a very different experience going into it. I can't imagine waiting till ten weeks to first ultrasound. But that's, of course, because of my experience.

Yeah, yeah. So did you have any problems or issues during your pregnancy?

Speaker 1 (10:42.894)

So yes, not until 32 weeks. everything was looking good. so we had our 20 week ultrasound and she was like, probably percentiles like 30, 40 percentile, my husband and I are very large people. So that kind of made sense. I was a smaller baby too. And then we...

We're offered a couple of things because it was an IVF pregnancy. So like a fetal echo, which we did. And I'm someone who loves like, if it's offered, I'll take it for more information gathering purposes. And we were offered 32 week ultrasound, just typically at UCSF, they do that for people who have gone to an IVF. So we went and didn't expect anything to be different. And then we go to that ultrasound appointment and she's measuring quite small, like had dropped from 40th percentile to averaging around

maybe eight, nine, no, it was more than 10. It was like 10 to 12 percentile. And it was the kind of thing where her head was still measuring within the 40th percentile and her abdomen measurement was lower. And so the idea was like, okay, we don't have a diagnosis of IUGR into uterine growth restriction yet, but let's have you come back in four weeks. So those four weeks, I...

There's a lot of the skills that I work with people on of just like tolerating uncertainty, reminding myself that it's going to be okay. My husband is like the calmer presence I think that I needed during that time. He wasn't worried at all. And then we go back at 36 weeks and she was even more growth restricted at that time. So at 36 weeks, she had actually dropped below 10th percentile and we got the diagnosis of IUGR. think her abdominal measurement was like in the

three or fourth percentile. And I tried really hard not to Google, but of course I did Google and read Reddit. And I listened to your podcast. I think I searched like IUGR podcast. I was worried and also reassured that it was a later term diagnosis. And so much of what I had read was like these babies thrive on the outside. Just getting them out is better. And so after that 36 week appointment,

Speaker 1 (12:51.222)

I hadn't had my own MFM previously, maternal female medicine specialist, I had an OB. And so the MFM on call came in and basically it was like, what we would recommend is getting induced in a week, 37 weeks, which my husband and I were completely like thrown off by just because we had been expecting another month. Gotcha. And trying to wrap our heads around that. And then it turns out that

She was actually basing that on information from kind of a previous hospital she was at, or she called us and said based on our specific measurements, she would recommend 38 weeks. And so there was some back and forth of, and I'm someone who, I I was trained as a researcher, so I like tried to find all of the research on PubMed and look at all of the updated guidelines, which recommended 38 weeks in monitoring. So we just had to do like every, I think it was every other, every three days, non-stress tests and Doppler ultrasounds for umbilical.

blood flow and by 38 weeks I was like I'm ready to get her out. didn't want to wait any longer. Gotcha.

Okay, okay, all right. So in that period of time, I guess, and you had a little bit of time to prepare. So what you knew were gonna be induced, what did you do to prepare for the actual birth?

watched your induction videos a lot more. And I loved I mean, I loved the birth glass because I loved the self paced kind of ability to do it at our own pace. would like watch it instead of TV at night, right together. And I before having any any growth restriction or knowing I was going to be induced, I kind of like was like, Oh, I'll watch those videos if we need to. So it was really helpful to back and understand all of the different

Speaker 2 (14:03.182)

I'm gonna have to change my birth class.

Speaker 1 (14:30.786)

types of inductions and what we could expect. And I talked to my friends because I have a lot of friends that were induced. And I really tried to just focus on like, and what I was looking for was I really wanted to do it without an epidural. And for many reasons, one being I just hate being numb. Like I'm the person at my doctor's, my dentist's, I ask if I can have things without novocaine. I just hate that sensation.

read a lot of stories online of people who were induced and were able to use hypnobirthing techniques or other things. And tried to also work on accepting that I might want more intervention than I thought was possible or that I would initially want and that was okay too. So we watched videos, made sure we had plans for who could watch our dog at that time and just kept our family informed. like, it could be any day now because every time I went for a test.

It could have

We just had bags in the car at all times.

Gotcha. Okay. All right. So you wanted to try and do it unmedicated. And that's an interesting thing that you say about not wanting to be numb. Some people don't get like, it's a really weird sensation. can feel weird. Like, you know, your limbs are there, but you can't do anything with them. I totally get how uncomfortable it can be to feel numb. So I definitely understand that. So you definitely want to try to go unmedicated. What were other things that you wanted for your birth?

Speaker 1 (15:57.28)

I initially I wanted like no inter low intervention. And so that changed with with the induction. Right. I really wanted to start with, mean, UCSF does this inherently, but like starting very low with pitocin and ramping up kind of very slowly, which was something they had. We had a doula who got to the story later wasn't actually at our birth because it happened so quickly. And but she was wonderful coming to our house beforehand and helped us practice hypnobirthing techniques. We like

and just how to communicate pain and how my husband could best support me throughout that process. And I loved that UCSF also offered nitrous oxide. I was really interested in using that as a pain management and bad like birthing tubs, things like that. Yes, in the room they do, which was really wonderful. In terms of the other things I wanted, only my husband in the room, no one else. And I had a pretty open mind otherwise. mean, my,

So they have that already.

Speaker 1 (16:56.448)

I'm the youngest of four and both my sisters had unmedicated home births. really? For the three children combined, yes. I was like the one going to the hospital, which is funny. I was trying to channel what they went through not at the hospital and them not having these interventions. Got you. I wanted to move around, which is one thing. I knew I wanted ambulatory monitoring so I could move.

Gotcha, gotcha. Okay, okay. That's really interesting that you had sisters who did home birth. Yeah, did they try to convince you otherwise?

Yeah, exactly. Or no, they know I would have never done that. I'm risk averse when it comes to that.

Gotcha, gotcha. All righty. So was there anything that you were afraid of or worried about?

I mean, I wasn't really afraid of like specific things. think maybe what I was afraid of is like the cascade of interventions. Like I didn't want to see sections. I think I was afraid of having that, but it didn't honestly cross my mind as much as I had thought. I tried just not to stress about it and think about it too much. There are things that...

Speaker 1 (18:08.512)

was afraid of. I mean, I think I was afraid of waiting too long with the IUGR diagnosis. And so my doctor would have let me go to 39 weeks with monitoring. And I think I was just like, no, I don't want to wait. Gotcha.

Gotcha. And then did you have residents and medical students at all being in an academic center? What was that like?

Yes, I had a medical student actually who was working with my OB kind of throughout pregnancy and she had asked if she could come in and being like I was that intern so many times in my training of like the one coming into appointments that I was like sure like I'm all for the training and at my birth there were I think there were one or two nurses and then there were two residents and then my OB

And then there may have even been a midwife. There were lots of people in the room and I like loved that they were all women. There was like not one man that I interacted with at all, which is like nothing against that. I just really loved that it was like such a female empowerment. You know, my husband was there, he was the one man. yeah, I was very open to having residents and I think I was like for like the better of their teaching, it's worth it to me.

Yeah, for sure. Yeah, once when you're on the other side, then when you you always, you know, you tend to be open to have students because we were all there once. So, yeah. So then let's talk about how did your induction go?

Speaker 1 (19:29.792)

It was slow, slow, slow, and then really fast. So we went in on a Sunday morning, which I actually live in the East Bay. And so it was nice to be able to schedule the drive across the bridge in the Bay Area. Because when we told people we were delivering in San Francisco, everyone would be like, are you worried about traffic? And thankfully, we got the drive over on a Sunday morning, and it was not a problem. And then I started with the Foley balloon. And I think I had two doses of misoprostol with that.

Was the Foley balloon uncomfortable to put in?

Yes, it was very uncomfortable. I had had the hysteroscopy that I had to clear the scar tissue. I did without any pain medication. I felt very similar to that. Yes, yes. I had a high dose of Advil and I went to a doctor who specializes in it and was offered pain meds and I wanted to try it without. It was three minutes, five minutes maybe, and it was fine.

Really? Was that by choice? Okay. Okay.

Speaker 1 (20:27.374)

It was painful, definitely bearable and I could say if I could stop at any time. But the Foley balloon felt very much like that. Just like that crap thing. Gotcha. That maybe speaks to how much I didn't want an epidural. It does.

Speaker 1 (20:43.896)

first hystereoscopy I was like put I was under for that which was also nice because it was like a full sleep but it was a longer recovery just because I was recovering from anesthesia. Yeah. So that was it was painful when it was put in and then it was fine and then I think they pulled it out which meant I was like two or three centimeters I forgot maybe like five hours later.

Yeah.

Speaker 2 (21:02.956)

Really? it usually stays in for up to 12 hours, so maybe it

It happened quickly. said I kind of dilated like maybe it was it was that part was actually quicker. Like I was I think I came in and maybe I was one centimeter dilated and got me to three centimeters. Not in too much time. I was expecting it. They said it could be in I think for even up to 24. I forget exactly hours. But it came out quicker than we thought. And it was actually quite relieving when it came out because it was a lot of cramping during it. And then it put my body into lever naturally. Naturally, I started having contractions on my own and I really appreciated that.

They were like, let's sit back and wait. We're not going to start pitocin. Let's just see kind of what your body does. And so really until seven o'clock that night, and I remember cause that's when it was a shift change and my OB came on, which we kind of planned because I really wanted her to be there if I could for the birth. know we can't plan, but I was having contractions, they weren't very large, but they were very close together. And so I was like,

being able to talk through them, weren't very painful, but they were worried about me starting Pitocin because of how close together they were and they didn't want them to get even more close together. So we waited, they offered to break my waters and that was the one thing I really didn't want to have before I needed to. I wanted to use it as a tool later on. Oftentimes at UCSF when they start Pitocin, they'll break your waters too. They found that to be a very effective reason and that was the one thing I just wanted to...

I have my body do that on its own.

Speaker 2 (22:30.99)

Okay. Were you worried that it was going to, what were your concerns?

I was worried that it was going to ramp up labor so fast or fast enough that I would not be able to kind of use the pain management techniques that I had been wanting to. Gotcha. And so that's, and I mean, I was worried a little bit knowing that actions can be take a long time and that the infection risk of course increases when you break your waters. And so for those reasons, I was like, let's hold off on that.

You hear all these stories around how hard it is to advocate for yourself and all the pushback you get. We were lucky that everyone was so wonderful and accepting there. We had talked to our doula on the phone and she was like, you can say no to this. You can advocate for what you want. Once we said no, they were like, great. That sounds great. The nurse who I love, I remember her so clearly, her name was also Ali, was like, you're allowed to say no and that's a totally reasonable thing. I didn't feel pressured into anything there. Awesome.

which was lovely and a really good experience. Once the shift change in my OB came on, she's like, let's start with a dose and it doesn't seem like these are really ramping up much on your own. so started with a really, really low, I mean, it was like, I think we started at a two or I don't even remember, low, dose. And then every half hour they would put it up one. And by the time I think I got to a five, my body was like in full blown contractions.

I remember it got really painful and it's like time clicking back and like, is time during this? But I think my water broke around midnight on its own. And she was born at like 3 45 in the morning. like between then I remember I was trying.

Speaker 2 (24:14.776)

So three, like three, four hours later, she was born after your wife broke? Okay. Had you been checked during any of that time?

So I didn't get checked until it was after the balloon came out. I think I was a three. And then at like 2.45, like an hour before she was there, I got checked and I was a four. So I from a four to a 10 in like 20 minutes. Like literally in 20 minutes. And that's when it was like, yeah, that's when I was screaming for the, the door.

Okay, okay, okay. your water broke. So what happened between when your water broke and 245? Like what?

was just laboring. I was laboring. was on the ball. I was using nitrous oxide. And of course, I think that I was using it. My husband says I was like hussated because I was in so much pain. And then it made me really nauseous. And so was like, this is not, I did not find it helpful. So I remember just like writhing around on the table and screaming a lot and just getting through the contractions with pressure. And then it reached a point where it was quite unbearable.

hadn't been checked since that afternoon. And so I was like, I need to be checked because I can't I was like, I can do this for a little bit longer. I can't do this for much longer. And so they checked me and I was a four. And I was like, I need pain meds. Just I don't I can't do this much longer. And it was a big thing where I was just like kind of going back and forth. And my husband and the doctor were like, get the epidural like there's no shame in getting the epidural. And so I was at that point, I think I was like,

Speaker 1 (25:45.794)

I'll take anything. And so they come in and try to place the epidural. And that is, I will say, the one thing that I asked for not to have a resident previously. I wanted it for the anesthesiologist. I was nervous about it to start. And they didn't even try to offer a resident. They always had the anesthesiologist there. And so it was like a 20-minute wait, they say, for her to come in. And then she had a really hard time placing it because I was...

every time she would start, would have a contraction and I would be like, it's coming, it's coming. my contraction started in my back. And so they were trying to keep my back stable. it was, it took a very long time.

And did they turn the pitocin off during this time or do you remember?

I don't even remember. Once she got it in, and then was like they placed the needle and then they go like push the meds and they were like, okay, it's gonna be about 20, 30 minutes until you're feeling something. And I remember very clearly being like, I have to push, I feel this. There was no question in my mind I felt like I needed to push before I felt any of the epidural. And the nurse was like, are you sure? Another couple of contractions, I like, I need to push like screaming.

And they're like, okay, let's get you checked. And so before I even feel the meds, they checked me and she was like, okay, you're out of 10. So like in the time that I had been checked and my husband was like, seriously? And I was like, my God. And so it happened really quickly.

Speaker 2 (27:09.851)

I mean, so that wasn't even, was it even an hour? what?

No, it was literally 25 minutes. said 20 minutes. Yeah. Okay. So it happened very quickly and they were like that makes sense but you were in so much I mean it makes sense why anyone in labor is in pain

Thank you much, Patti.

It was very painful. But you ramped up super, super fast. Yeah. Okay.

We were talking to our duo when I was at a four and our plan was for her to come when I was at a six, around a six. And so we never expected that it was to Next time we texted her it like a selfie of the three of us and it was like, it happened. It was just funny.

Speaker 2 (27:40.47)

Is it? Yeah.

Speaker 2 (27:45.454)

So then she's like, what? So then what? mean, OK, so it's like time to push. then were you like, yes, it is time to push. And like how long between when you realized and when when your baby was born?

Well, it's funny. So they said it's time to push and then they were like, okay, very quickly, like, let's do practice pushes. They were like, my husband, Eli, it's a good time for you to use the restroom. We'll call your OB. And my daughter, I mean, she had growth restrictions, so she ended up being really small. And that's part of the reason I think that when I started to do a practice push, they were like, we see your head. were like, so that happened. And then

Come back, come back.

Speaker 1 (28:25.998)

When they called my OB, she told me after that she didn't believe them that it was time. She's like, are you sure? Like, Ali, are you sure? Because it was just she had seen me a couple hours ago and I was nowhere close to. And I just remember that everyone came in.

And Ally's like, the head is there, like I can see it.

So she was born in, I think it was like five minutes of pushing. was like three pushes and then her head was out and then she was there.

Okay, all right. And I'm guessing based on how the hospital is, they do skin to skin and delayed core clamping.

Yeah, we had planned to my husband capture and there was no time. It happened way too quickly for that and I wouldn't let go of his hand. I almost broke his finger, but I didn't because I was squeezing so hard. And it's funny because they had given me like once they knew it was time to push, they were like, do you want the epidural? And so they gave me a little bit for pushing, but I just remember I could feel part of my right leg felt like tingly and that was like all I felt and it was like okay.

Speaker 2 (29:23.534)

So you really didn't have an epidural.

Yeah, I felt like I had like the sore back as the right after for like the two days after without the actual literal but yeah, they did. They did skin to skin immediately. And then I bled a little bit more I think than I expected. So they were searching up for a while and getting the pods out and then she needed to go to the warmer for a bit after skin to skin but then they brought her right back.

Okay, okay. Do you know what kind of tear you had?

I had a first degree. okay. So it was like very, yeah, it was like a very minor. And she weighed, she was five pounds, 11 ounces. So actually was technically like not the IUGR. Like she was just small for gestational age. Gotcha. Gotcha. She seemed tiny.

So y'all just make small babies maybe.

Speaker 1 (30:10.094)

Yeah, well, I actually got placenta pathology done and I forgot the actual what it was, but it did seem like my placenta was kind of like kicking out early. Like it was good that they got her out.

Yeah. So, okay. So looking back, some people are like, things went quick. That's great. Sometimes people are like, things went quick. It's completely overwhelming. So like, how did it feel for you? Were you glad that it went so fast or was it like things are just hitting me and I have no control over what's happening?

was glad. really wanted it to be fast, think, because in my mind, enduring that pain for a shorter period of time felt easier to me than for longer. yeah, I think I was really glad that it happened so quickly and that once it was over, it was like immediate relief. And I think also with thinking about nepoteril, I was worried about afterwards not being able to walk around and things like that. And so it felt like that was...

fairly like the recovery felt a little easier to me. But it also makes me nervous for if we do have a second kid, because I know that can be even faster. I'm like, okay, we'll plan to be close to hospital. Yeah.

I was going to say like the next time when you really start going into labor and definitely after your water breaks, you should just go to the hospital. You're the person who could potentially have a baby in the car.

Speaker 1 (31:35.594)

I know and I've read those stories and I don't want to be that person

Yeah, because that was like, like very fast. You know, I swear sometimes I always say like, we don't know, we just don't know. Like it just, like why some people, why it happened so fast, but you know, but it did. So looking back, I'm glad you feel good about it. Cause I've certainly heard some people feel like it's, it's very overwhelming because your body's doing this thing and you literally have no control over what's happening. It's just like.

the baby's coming, whether you want it to happen or not. yeah. So then what was the postpartum?

I was gonna say, feel like that's also like a good description of just birth in general. It's like releasing the control you'd want to have over it. so I feel like all the prep I did for birth like helped with maybe how quickly it went. Good.

Good, good, good. So then what was postpartum like for you?

Speaker 1 (32:29.038)

It was mostly lovely. She came, so she was born in November. And so we were pretty, I would say, cautious around just virus season with having people with young kids come visit and we asked people to mask for a bit. So I think that was maybe the hardest part is we couldn't resume normal life. And obviously you're not resuming normal life immediately postpartum. once...

I felt more comfortable when she had gotten her first set of vaccines and taking her to places and we like went to a restaurant and had more friends come over, which was really nice. It went well. Like, I mean, we actually just weaned like a month ago at 15 months. And I did not do a lot of prep beforehand. I was kind of like, I don't want too much information until we're in it. And I was feel like lucky enough that it

That's good. And how was breastfeeding?

Speaker 1 (33:21.058)

worked out really well. She was like a cluster feeding baby. So we spent like the first month of her life like on the couch, just feeding all the time. But we got the hang of it. Our pediatrician who I love kind of described it in our like prepartum visit as it's an art, not a science. And I think that really helped. And UCSF also offered great lactation support. So I used that a few times in the kind of first month.

Got it, great, great, great. And then what about any concerns about depression, post-partum depression or anxiety or were you on the lookout for that because it's your specialty?

Yes, well, very much aware of what could happen. And now I work with so much of postpartum mood and anxiety disorders. the I joined a support group pre like before having her I had set up that at two weeks postpartum, I was going to join this postpartum support group that met weekly. That was really wonderful. It was women. I mean, I think I had the youngest child but up through I think a year postpartum. And so we met weekly and kind of just shared experiences and

That was a really kind of grounding presence for me. And then I think I was just aware and I had kind of told my husband before of like things to look for, just signs. And I think it's interesting, I had more anxiety in pregnancy than I did postpartum. Oh, interesting. I think that shift of going from IVF to being pregnant and then actually having her here, was, I felt like a lot of relief in a way. And also just learning that like,

there are always going to be worries. It's like, for you when you're pregnant, you worry. Yeah, it's like it never ends. I remember having a conversation with my mom about that. How like, she's like, you worry when like, I worry about you when you're in your thirties. Like it doesn't really

Speaker 2 (35:01.696)

Yeah, I'm worrying about sending our first to college in the fall. So it's always something.

Yeah, it's always something. so like learning to shift the attitude towards those worries, I think, was useful and also kind of making sure that like, I had support and like not being completely sleep deprived. And like we took shifts and I took maps every day and I was breastfeeding so I was up more at night, I think, but trying to take care of myself and just like those basic needs.

And how much time off did you have from work?

So I was lucky enough that I took, I was like in my fellowship when I had her. And so I kept pushing the start, when I come back a little bit later. So I took five months and then I went, yeah, and then I ramped back up slowly. So I started with two days a week and then three days a week and actually just only recently went to four days a week.

Nice.

Speaker 2 (35:50.04)

wish we could all do that, but it's America, so here we go.

And it's interesting in the Bay Area because I have some friends that work at these larger tech companies that give them six months off. And I'm like, is a benefit that everyone should have. And then of course you hear about all these other countries that have like two years off.

And you're like, what? Yeah, yeah, yeah. And I want to ask a more professional question. Do you see that people who have IVF, do they have more likely have issues with depression or anxiety or more? I would think maybe anxiety even once the baby is here or do you find it gets better or is it kind of a mix? I'm just curious.

Yeah, it's a great question. I mean, I work with lot of women who during pregnancy have more anxiety. There's a group that I've been wanting to start for a while, which is just pregnancy after infertility or loss, because it's such a unique experience of pregnancy compared to people who it's just like only been joyful the whole time. So there's definitely increased anxiety there. And I think there is actually like a little bit of research to show that there are...

you're at a greater risk of postpartum depression or anxiety if you kind of have had struggles to conceive. But then again, I work with women who didn't use IVF and of course feel that kind of mood shift postpartum so often too. I think in my work, I see it more in pregnancy than postpartum, kind of as being that big connection.

Speaker 2 (37:13.206)

And then in general, do you see more depression or more anxiety? Because I feel like there's more anxiety these days. And I don't know if that's just sort of what I feel or is that what you're actually folks actually seeing?

It's funny, feel like anxiety is also the thing that's like socially acceptable to talk about a lot of times. Like I remember it's like saying like you're so stressed or so anxious about something feels I think easier almost in a way or more like understood than saying how depressed or how down or hopeless you feel. So I think in my work I probably see both, but in terms of it's interesting, cause I also like, I work with patients who have all these things and they're my age and then I talk to my friends who are also.

going through pregnancy postpartum and we talk a lot more about anxiety I think in those circles. In my work I would say it's mixed and also postpartum OCD which is a kind of a not as well spoken about either which is a concern and people come to me for as well.

Yeah. Okay. All right. Well, then as we wrap up, guess two questions. How do you feel about your birth experience? It sounds like you feel good, but what do you think?

feel good. mean, I think if you had asked me previously, like if you would be induced, that be a good thing? And I really wanted to not have an induction. And so I think it was like a shift around like, okay, accepting this. And I was talking to two of my friends this morning about like the idea of a birth plan and birth preferences and that very much shifted and I felt like I had to had to kind of change the expectations. But looking back, I felt good. think I like

Speaker 1 (38:44.214)

really loved all of the providers that I saw. have such like I think that support was so important and feeling like the birth was a good experience. And so I'm really lucky that everyone there was incredible. And I forget the other question. think it was just

No, next question is, what is your favorite piece of advice that you would give to someone who's getting ready to have a baby?

That I think would be, I think my own experience is like, try not to be tied to an outcome and also validate that it's really hard to change. it's, it can, I think sometimes it can feel invalidating of like, oh, you have a, you're safe and your baby's here. Like, why should you care about how it felt? And that's really invalidating because of course you're gonna have feelings about how the birth experience was. It's such a.

Huge, yeah, it's a huge thing that you work up to and take classes on and think about and so when it goes according to plan, it's like that's real trauma. So don't discount that. So try to validate how hard it is and then also like work on the flexibility and kind of accepting what comes because we can try to control as much as we can and birth is a perfect example of a situation that so often is out of our control.

much so. Yes, I think that's a great it's a it's a both and you can both be you know frustrated that things aren't going the way you want and you can adapt as you need to need to go. So where can women connect with you? You can say nowhere if you're not on social media or anything.

Speaker 1 (40:13.486)

I know I have, I don't have like social media for my business. have a website, drallisonaltman.com. I see patients in private practice through a practice in the Bay Area called Women's Wellness Psychiatry. Okay. So we do psychiatry and psychology for women, specifically I work with in the perinatal period. So if you have any questions, feel free to reach out.

put those links in the show notes. Well, thank you so much for agreeing to come on to the podcast. I'm so excited that you shared your story. like, like there's just so many ways that birth can unfold and just really never know. So I appreciate you coming on to provide this perspective. It's really, especially in the setting of induction. So thank you.

Yeah, happy to thank you so much for what you do. I like loved listening to your podcast all throughout pregnancy. So I'm happy to be on the other side.

yeah, thank you, thank you.

Speaker 2 (41:06.188)

Wasn't that a great episode? I appreciate her coming on and sharing her very unique perspective of being on both sides of the birth experience. Now, after every episode when I have a guest on, I do sense a call Dr. Nicole's notes, which are my top takeaways from the conversation. Here are my Dr. Nicole's notes from this episode. First up, IVF and pregnancy after infertility bring unique emotional challenges very often.

She candidly shared about how hard it was to feel safe in her pregnancy after years of infertility. And this is such an important reminder that even after that positive pregnancy test, the emotional toll of infertility doesn't necessarily just disappear. So if you are navigating this, know that it is completely normal to feel anxious and support from a therapist or a community or extra check-ins with your doctor can make a world.

of difference. Okay, number two, you can be informed and flexible. Allie came into her birth well-prepared. She's a psychologist and a researcher. So she took the time to learn her options, watch videos, read the evidence. She had a clear idea of what she'd hoped for. But when her daughter was diagnosed with growth restriction at 36 weeks, she made the empowered decision to move forward with an induction. Being informed doesn't mean rejecting medical advice.

It means understanding your options so you can make choices that align with your values and the realities of your situation. That blend of knowledge and adaptability, that is true empowerment. Okay, next up, and this one is a big one, it is okay to say no. When doctors suggested breaking her water early during her induction, Allie said no, she wanted to save that option for later in labor.

and her team respected her decision without any pushback. That is exactly how it should be. It is okay to say no as long as you and your baby are safe. And if you do get pushback, that is not okay. And then the final one, also a big one, postpartum support makes such a big difference. Allie took a proactive approach to postpartum care. She lined up a support group that started just two weeks after birth.

Speaker 2 (43:31.98)

And it made a big difference. Even though she'd experienced anxiety during pregnancy, she was able to navigate the postpartum period with more ease, thanks in part to that support that she had lined up. So set yourself up for success by setting up your postpartum support before your baby arrives, whether that is mental health care, lactation support, knowing pelvic floor physical therapist, or hiring a postpartum doula.

Having those pieces in place can make all the difference in how you feel and how you heal. And trying to find those things in the thick of having a newborn is tough. So line up that support before your baby arrives. All right, so that's it for this episode. Thank you so much for listening today. If this episode helped you, share with a friend.

and hit subscribe so you don't miss a thing and if we're not connected yet, come follow me over on Instagram. I'm on Instagram at Dr. Nicole Rankins. My DMs are wide open and I really, genuinely, truly love hearing from you. Now, do me one more favor and come on back next week and remember to trust your power and take charge of your birth.