TRANSCRIPT EPISODE 5 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #5: 
my birth stories

Transcript

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00:01                                In this episode of the Podcast, I'm getting super personal and sharing my two birth stories. Welcome to the all about pregnancy and birth podcast. I'm Dr Nicole Calloway Rankins, a board certified Ob Gyn physician and certified integrative health coach. Every week I break down topics, share birth stories or interview experts to help you have your very best pregnancy and birth. Quick note, information is for educational purposes only and is not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

00:43                                Well hello there. As always, I am so glad to have you here today. On today's episode of the Podcast, I am going to open all the way up and share my two birth stories. Fair warning, there is some trauma and a little bit of regret involved in my birth story, so if that may bother you, you can sit this episode out. But I will say that even with the not so good aspects of my birth stories, I am grateful for what I've been able to learn from the experiences and how they have made me a better Ob Gyn, and I think you'll be able to learn something too and there's some good in the stories as well. Of course now I believe women learn from hearing the stories of other women, so birth stories will definitely be a regular part of the All About Pregnancy and Birth podcast, and at the end of the episode I will tell you how you can be a guest on the show and share your birth stories.

01:48                                Now, before I get into the episode, if you've been listening to past episodes, you know that I sponsored a giveaway of three spots in my online childbirth education class, The Birth Preparation Course. I did this as a way to celebrate the launch of the All About Pregnancy and Birth podcast. Well by the time this episode is released on Tuesday, January 28th, 2019, the contest will have ended and three lucky women will have a free spot in the course. Now those winners will have been contacted by email by the time this episode is available now. Things have been going so well with the podcast. It has been downloaded over 500 times, just after 4 episodes! So I want to keep the celebration going for a little bit. So, for a limited time, I am offering a nice discount on The Birth Preparation Course. So until Friday, February 8th, you can get 20% off the regular price of the course. The Birth Preparation Course is already well priced for what you get. At $147 dollars, you get eight hours of content. That covers everything from getting in the right mindset for your birth to the details of labor, to how to make your birth wishes to what happens in the postpartum period and so much more. Everything is online so you can go through the course on your own time and at your own pace with your partner if you want to. There's also a private community just for course members and that community is run by an experienced Doula. In the course community, you can get support from other pregnant women and I am in the course community as well doing regular Q and A sessions and of course you get lifetime access to the course. So buy The Birth Preparation Course once and you have it along with any future updates for all of your pregnancies.

04:00                                If you can't tell, I am super proud of what I created in The Birth Preparation Course and with the 20 percent discount, the course is only $119. I only discount The Birth Preparation Course three or four times a year, so this will not happen again very soon. There is a 30 day money back guarantee, so if you're not happy with the course, just let me know within 30 days and you will get a full refund. No questions asked. You can go to www.ncrcoaching.com/enroll, and use the code celebrate at checkout to receive the discount. All of this information will be in the show notes. Okay, so it is time to get to the show.

04:53                                So I'm going to start off by talking about my first birth story with my oldest daughter. Now before I get into it, I have to tell you a little bit about the backdrop of my pregnancy. So this was a little bit of a challenging pregnancy for me. I was very anxious to be honest. I was very, very anxious and it took us about six months to get pregnant and I know that that is not a long time in the grand scheme of things, but for a type A planner, impatient person like me, like I can be sometimes, it felt like forever. And then in the very beginning of my pregnancy I had an episode where I bled through my underwear through my clothes. It was quite a bit of bleeding and that was very frightening of course. And it happened at a time when my husband Falcon, yes, his name is Falcon like the bird, Falcon was out of town and it just, it really freaked me out as you can understand. So that happened and then again I was just anxious in general. I used to try and ultrasound myself to make sure things were okay and and that kind of thing.

06:16                                The anxiety never helped but it was hard for me to kind of get past it. Now I finally got to a point where I felt like I was doing okay with the anxiety. I wasn't nearly as anxious as I had been and I was going in for a followup ultrasound because at my 20 week ultrasound, you know, where they look at everything and make sure all the anatomy and everything looks okay. I had a little bit of extra fluid and they wanted to do a repeat ultrasound just to make sure the fluid was okay. Well at that repeat ultrasound and I was pretty calm for once. Well, at that ultrasound she was diagnosed. My baby was diagnosed with having a condition called Duodenal Atresia. It's a rare condition that occurs in something like one in 10,000 pregnancies and it's when the first part of the intestines are not connected to the latter part of the intestines, so babies normally swallow amniotic fluid, so all of the fluid was just kinda sitting in her stomach and the extra fluid was backing up, so I had extra amniotic fluid and this condition requires surgery after birth.

07:32                                It's also to kind of reconnect it, reconnect the intestines. It's also associated with some chromosome abnormalities, so I had that additional worry that maybe she was going to have some chromosome issues. I ended up having an amniocentesis and everything was fine with the chromosomes and we met with the pediatric surgeon and he reassured us that this was a pretty easy problem to fix. After birth, babies most of the time are born full term and they get through it just fine. So that helped to kind of reduce the anxiety. But again, I was still a bit anxious. So let's get into the story now that you have that kind of background of the pregnancy.

08:18                                So it was a Friday and a pretty typical Friday. At the time I was pregnant with my first daughter, I was doing a fellowship or a research fellowship and I was taking classes and sometimes seeing patients and on this particular Friday I must not have had to be in clinic or see patients because I was at home. So I started having contractions in the middle or late part of the morning and I had been having contractions before, so I was familiar with contractions, but they had never been terribly painful. Nor were they terribly regular. Well, this particular Friday morning, the contractions were both painful and they were getting pretty regular. So I told Falcon, I said, you know what, I feel like something's going on and we need to go to the hospital and see what's what. Now his response, and I'm laughing because he is such a magnificent husband and so completely supportive. But he was like, okay, are you sure? Because he just knew how anxious I had been during the pregnancy. So he wanted to be sure that something was really going on. And I was like, yeah, I know. I've been anxious, but these contractions are really pretty strong and I feel like we should go in to get checked out. So we get in the car and as we're riding to the hospital, Falcon later tells me that he saw me clutching the door handle really hard and kind of like shaking during the contractions. I'm not like a loud person when it comes to pain. I'm more of a quiet person. So when he saw me clutching the door handle and shaking, he knew that something was going on.

10:12                                So we get to the hospital and pull up to the entrance and pulled up to the valet entrance and Falcon let them Valet Park our car. Anyone who knows him, knows he is a car person and he never lets anybody drive his car. So that tells you how serious he was and how he wanted to make sure we got things seen as quick as possible because he let somebody valet park the car. So anyway, the car gets parked and we get checked into triage. Now triage is the area where you see pregnant women at when they're having issues and I had my baby at Duke University Medical Center. That is where I did my residency training program, so I was familiar with the place. I went back to Duke because it was where it was comfortable for me. I was still in town because I was doing my research fellowship just up the street at UNC, but I went back to Duke for my prenatal care. So we got checked into triage and triage is like, the triage at Duke at least at the time, it's like a hallway and there's three or four rooms on one side and then two or three rooms on the other and they have those glass doors like you see in the emergency room. So I got put into a room that was in the middle of the hallway and I was seen by a midwife. At that time, the midwives ran the triage unit. They may still now, I'm not sure. So I was seen by a midwife. She wasn't one who I knew because she wasn't there at the time that I was there.

11:53                                Anyway, she saw me, got me checked in, she checked me out and my cervix was one centimeter dilated, very effaced and I was contracting every three to four minutes. Now this was not good and I didn't mention this. This is the important part. At the time I was only 32 weeks pregnant. I was 32 weeks exactly that day. So at 32 weeks contracting every three to four minutes, my cervix is one centimeter and very effaced. So at that point I got kicked up to the attending physician. I was being seen by the maternal fetal medicine doctors at Duke, not necessarily because I was terribly high risk, maternal fetal medicine doctors are typically reserved for high risk pregnancies, but that's who I knew. I knew them and that's why I felt comfortable with. So the MFM, that short for maternal fetal medicine doctor came in, we went next door to the room that had an ultrasound.

12:55                                It was at the end of the hallway and it was still during the day. So the ultrasound technician was around, so did the ultrasound. And I just remember her saying, Oh, you have no cervix, like there's no cervix there. And what that means is that my cervix was very, very short, like it had no length to it. Cervical length, your cervix is normally long, like more than two and a half centimeters is reassuring that you're not going to go into labor. So when you measure the length and it's less than two and a half centimeters, which mine was, it had no length to it at all. That's a risk factor for preterm labor. And I also heard had something called funneling where you could see the lower part of my uterus kind of bulging out and coming down to a funnel at the, at the top of the cervix, also a risk factor for preterm labor.

13:56                                So I knew exactly what that meant. And I was getting pretty anxious, even more anxious and not only just anxious, but I just felt like twilight zone ish. Like what is going on, why is this happening, why are we here? That kind of thing. So the high risk pregnancy doctor at that point suggested something called Amnio Reduction, which is removing extra amniotic fluid. Because of the Duodenal Atresia, I had extra amniotic fluid around my baby and sometimes extra amniotic fluid can cause you to have contractions because it makes your uterus bigger. So she thought maybe if we take off some extra fluid then that will help decrease the contractions. I said, okay, that's fine. I guess that's reasonable to try. So what they do is they stick a needle in your belly through your uterus. I know that sounds terrible, but it's actually not that painful and drained off some of the fluid.

15:02                                So they drained off about a liter of fluid and that did not help one bit at all. I still continued to have contractions regularly, uncomfortable contractions. So I was admitted to the hospital and then the next suggestion was to get an epidural because sometimes an epidural can help slow down contractions. So I got an epidural. It was done by one of the residents, someone who I knew and trusted, but I was very suspicious that the epidural wasn't working great. Because I felt like I had a lot of motion in my legs. For those of you who have, who have either had an epidural or when you get an epidural, your legs feel pretty dense and numb and I just wasn't feeling that and I felt like I had a lot of sensation. This is going to come into play a little bit later.

16:05                                But yeah, just kind of felt like the epidural wasn't working great, but the contractions were manageable so I didn't really make much of it and think that we needed to do anything about it. So I continued to hang out during the day having contractions and then my water broke and it was the typical like giant gush of fluid. I had extra fluid anyway, so it was like fluid everywhere. It was obvious that my water broke and after that, fairly quickly I progressed to being eight centimeters dilated. Well, once I got to eight centimeters, then her heart rate, my baby's heart rate started having decelerations or drops in the heartbeat. So the normal heartbeat is between 120 and 150 beats per minute or so. And I could hear it on the monitor. So a normal heart rate kind of sounds like to du Du du Du du Du du Du du Du du do. And I could hear on the monitor her heartbeat was going to de dee dee de Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo Doo.

17:21                                So it was going down slowly and coming back up slowly with contractions and it was getting progressively worse. So the attending physician, and I'll say now even though I went to Duke because I knew the staff there, the attending who was on call was actually somebody who I didn't know because he had started after I had left Duke. Anyway, it was a very nice guy that sort of added to the anxiety of it all that this was someone who I didn't know well. He suggested that okay, you're eight centimeters, you're 32 weeks, baby's smaller. So let's go ahead and have you try and push. So before I could push, we had to get moved to the back operating room because that's where the resuscitation equipment was for preterm babies. All preterm babies all delivered in the back in the OR. So we got moved to the OR and I remember pushing and I remember giving it everything I had to try and push, but she just wasn't coming fast enough.

18:33                                I don't know if I wasn't pushing the right way, I don't know, but the decision was made to proceed with a C-section because the heart rate kept dropping and she wasn't coming quickly enough. At that point I remember there was just lots of activity around me, people moving, me being put on the bed, my arm stretched out to the side, getting strapped down for the C-section. Just a lot of activity going on and the really bright lights of the OR room. Two of my favorite nurses were there and I remember leaning over and I whispered, ask Kesha to scrub. Kesha is one of my very dearest and best friends. She's actually going to be a guest on the podcast coming up. She is a high risk pregnancy doctor. We did residency training together so Kesha was there because when I went into labor, she came to the hospital and stayed at the hospital.

19:45                                She wasn't like in my room or like personally involved in my care because she wanted to give me space, but she stayed around and she kept a close eye on things to make sure that things were going okay. I will forever be grateful for her for doing that because it made me feel very comforted to know that someone who I knew and trusted was there and kind of watching over me. So I leaned over and I said, ask Keesha to scrub, and she came in and I was all prepped and ready for the C-section. Now before you have a C-section, we do something called an Allis clamp test to make sure the anesthesia is working properly and an allis clamp is an instrument that has very sharp teeth and we pinch the woman's skin to see if she feels that pinch. If she doesn't feel the pinch, then her anesthesia is working well.

20:48                                If she does feel the pitch then her anesthesia is not working well. Well let me tell you, they did the Allis clamp test and I felt it pinch. I felt it distinctly pinch and that's where we come back to that notion that I knew that my epidural earlier probably wasn't working great. So I knew exactly what that meant, I'm an OB Gyn, that I could feel the clamp from the allis clamp. Falcon says that at the time I just kept saying, wait, wait, wait, wait, wait. I don't remember that, but he said that's just what I kept saying over and over. Just wait, wait, wait, wait, wait. But her heart rate had been dropping, so they really wanted her to be born, so they went ahead with the C-section and I felt when they cut. I just clutched Falcon's hand so, so tight and moaned and moaned and moaned.

22:01                                Now it doesn't take that long to get a baby delivered, especially since it was my first c-Section, so it was probably a minute, maybe a little bit more than a minute. But I felt it, I definitely felt it. But then after that, my sweet, sweet, sweet booka boo, that's my nickname for her, was born shortly after 8:00 PM. Now I knew that they would take her to another room because the resuscitation equipment was in another room. But I felt that I had to see her. I had to lay my eyes on her. So when she came out, I demanded show me my baby, you know, I have to see her, I have to see her. So they held her up over the OR drape. When you're in a C-section, you have this blue drape in between you and the surgeon. So I asked them to hold her up over the drape and they held her up.

23:01                                And this picture will forever be ingrained in my memory, she looked like a little monster to me. She had her face all scowled up. She had her hands up and they were like claws. And then she was like, I'm here and I am ready and I am coming for you. Like that's just how this look was she had on her face. And it just gave me a great deal of comfort to see that she came out looking like a fighter, like she was vigorous. Now, one of the reasons she was vigorous was because I had had steroids, Beta Methazone, Beta Methazone is a medication that we give. It's an injection, two shots, separated 24 hours apart to help mature a baby's lungs. And I had had steroids a week before she was born. Now usually we give steroids when we have a suspicion that someone's going to deliver early. I had been having contractions and my doctor the week before had just said, you know what, I think you should get steroids just in case just to be on the safe side. So I had gotten the steroids not knowing of course, that I was going to deliver a week, I'm sorry, a week later and a week is the optimal benefit for steroids. So I was very fortunate in that regard. So that was part of the reason that she came out vigorous and actually never needed any assistance with breathing.

24:28                                So after she was born, they showed me to her, they took her to another room and then after that they gave me what I call happy drugs. Like I remember distinctly saying, you gave me some happy drugs because I started to feel very woozy and the next thing I remember was being transferred from the table to the bed because the C-section was over and then being wheeled to the recovery room.

24:56                                Now, in the meantime of me being transferred, the surgery finished and me getting to the recovery room, Falcon had gone to the Nicu to see her and he had taken pictures. Now I am going to be honest, those first pictures of her, although that first image of her where she came out was reassuring, those first pictures of her did not reassure me. She just looked funny. Her head looked funny. It was big. It was shaped funny. Her ears look funny. I was just like, oh my gosh, my baby! And I'll put those pictures in the show notes on my website at www.ncrcoaching.com/episode5. I'll put that in the show notes. You can see what she looked like when she was born. She's a very beautiful girl now, but I have to tell you to be honest, those first pictures, I was like, uh, okay.

25:48                                I don't know. And she was just a skinny little thing. Long little thing too. So I'm in the recovery room. Surgery was over I'd at least seen her, seen pictures of her and at this point I'm going to be honest, I was so hungry. I had not eaten all day long and at this point it was well after 8:00 AM, my dear friend Kesha came through again, asked if she could bring me anything and all I wanted at that moment was some chick fil-a, so she brought me a chicken strips combo and all I ate was like one chicken strip and a few fries, but I swear to God that was the best chick fil-a I have ever had in my entire life.

26:36                                Now my hospital stay after that was uneventful and ahead of us. We had the journey of having a baby in the Nicu and who required surgery. That is a story for another day. And I was really traumatized by the C-section and the inadequate anesthesia. To this day, I am very sensitive as an OB Gyn. If a woman isn't comfortable during a C-section and I'm also very sensitive about showing moms their baby during a C-section. I just remember that overwhelming urge of just I got to see my baby, I got to see my baby, I got to see my baby and I don't want other women to feel that anxiety from that like I did.

27:19                                Okay, so let me move on to my second birth story and this one is a lot shorter. This one is from my little lady buggy, so this pregnancy was a lot easier by this time. My first daughter was a little over a year old and she was doing well, so we had gotten past the Nicu stays. She was meeting her developmental milestones. She was growing, she was doing all the things, so I was just a lot less anxious and so I really sailed through this pregnancy and didn't have any anxiety really at all.

27:54                                However, it came time to decide towards the end whether or not I should have a repeat C-ssection or I should have a trial of labor after C-section or try for a VBAC and I ended up deciding on a repeat C-section. And the reason I decided on a repeat C-section was because it was more convenient for work and I feel kind of embarrassed by that now. At the time I was the associate program director for the residency training program at the institution where I was on the faculty, and I was going to deliver during the peak of interview season to interview candidates for the residency program and I just felt like it would be a big inconvenience if I just waited to go into labor on my own.

28:53                                Like it would just inconvenience my colleagues so much and that if I could plan it and plan the day, then it would just make it easier for everyone. And I regret doing that for that reason. Having a repeat C-section for that reason. In the end, it didn't make a difference in terms of my career and I know that in hindsight that my colleagues would have been fine had I just gone into labor, they would have picked up and they would have been fine. But for some reason I felt that pressure of not wanting to inconvenience anyone and I don't know if that's just because I was young and new in my career, but again, I just kind of regret doing it for that reason and in a way I feel disappointed in myself that I didn't at least try to have a vaginal birth.

29:47                                So at any rate I made the decision that I was going to have a repeat C-section and I was still traumatized by my first C-section and that came out by me trying to control everything about this second C-section. I only wanted my doctor to do it. So much so that normally when you do a repeat C-section you do it at 39 weeks, but she was going to be out of town at 39 weeks. So I actually agreed to have an amniocentesis done at 38 weeks to make sure her lungs were ready and I can be delivered at 38 weeks by my own doctor. Again, not something I'm super proud of or I would even recommend for sure for anybody these days, but that's what I did at the time. I also chose the specific anesthesiologist who I wanted to do my anesthesia for the procedure. Now, if there is one good thing about having a repeat C-section is that this C-section was entirely different.

31:04                                Like I was laying there thinking, oh, this is what a C-section is supposed to feel like. I felt tugging, but it was not at all painful and in a way that was validating because it made me realize that I was not crazy for my first C-section, that I wasn't exaggerating things that I really did experience my first C-section with inadequate anesthesia. So I would say from this birth story, the lesson that I learned that even trying to control everything, I still ended up with some regret, surrounding my birth. And trying to control everything isn't a guarantee for anything. Now I cannot end without giving a special shout out to my husband, Falcon. He was so supportive during both of our pregnancies and births and he is still a great husband and father 13 years into our journey together.

32:10                                So that is it for my birth stories. At the end, of course I had two very beautiful girls, but again, very happy and grateful for what I learned from the experiences and I hope you were able to learn something from them too. Now, I mentioned in the beginning that I want to share your birth stories as well. You can go to www.ncrcoaching.com/birthstory and submit your birth story. You can also get that link from the podcast page or my website www.ncrcoaching.com/podcast. If you scroll down, you'll see the link to click on it and get taken to the submission form. Both of those links will be in the show notes. Now, be sure to subscribe to the podcast in iTunes or wherever you listen to podcasts, and if you feel so inclined I'd really appreciate you leaving an honest review in iTunes, it helps other women find my show

33:06                                And don't forget about the discount on The Birth Preparation Course. For a limited time, you can get 20 percent off the regular price of the course. I do not discount The Birth Preparation Course often, so don't miss out. You have nothing to lose by buying. Now, there's a 30 day money back guarantee, so if you're not happy with the course, you get a full refund within 30 days. Next week on the podcast, I am introducing expert interviews. First up is my dear friend who I mentioned in this episode, Dr Kesha Reddick. Kesha is a maternal fetal medicine doctor, and maternal fetal medicine doctors specialize in high risk pregnancies, so we're going to talk about what she does and what it means to have a high risk pregnancy. Until then, I wish you a healthy and happy pregnancy and birth.

34:05                                Today's episode is brought to you by Women's Wellness Coaching by Dr Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content, and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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