Dr. Samantha Do returns to discuss intrahepatic cholestasis or pregnancy, more commonly called ICP or cholestasis. She describes this as a “pregnancy specific” condition in which the liver produces excess bile. Dr. Do explains why this causes uncomfortable symptoms like intense itching as well as an increased risk for stillbirth.
“Cholestasis” – with Dr. Samantha Do
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Dr. Fox: Welcome to “High Risk Birth Stories,” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High Risk Birth Stories” is a podcast designed to give you, the listener, a window into life-changing experiences of pregnancy, fertility, and childbirth. Ashley, welcome to the podcast. Thank you so much for volunteering to tell your story. How’re you doing today?
Ashley: I am doing good. We’re getting ready for holidays and maybe looking for some snow but not too much snow. We’re doing good. How are you?
Dr. Fox: I’m good. Thank you for asking. It’s been a great month for me. My daughter got engaged just this week.
Ashley: Oh, congratulations.
Dr. Fox: Pretty awesome across the board. I am feeling a little bit my age now, or older than my age even, but it’s awesome. It’s just amazing. She’s awesome and he’s awesome and we’re just really excited about it. So, thank you. That’s great.
Ashley: That’s awesome. Wedding planning is fun.
Dr. Fox: We’ll see.
Ashley: I’m sure you’ll be very involved in all of that.
Dr. Fox: I do my best. I’m curious, what led you to volunteer your story?
Ashley: I guess you could say I’m somebody that’s always been really fascinated by pregnancy, birth, especially kind of that matrescence period, that transition into motherhood. And I, as a mental health provider, I’m very interested in perinatal mental health. And even before I got pregnant or we were even trying to get pregnant, I’m somebody that listened to birth stories and really just like talking to people about their birth experiences. I have two younger sisters. I’m one of five kids, but my two younger sisters have both had babies before me. And I was lucky enough to really be kind of intimately involved in their process and hearing a lot about their birth story.
And so when I was pregnant, especially, I found it so helpful to listen to other people’s stories. I think I started off a little bit more listening to “Low-Intervention Birth” podcast. I heard about you from your interview with “The Informed Pregnancy” podcast, which is very, I think, low-intervention inclined. And after I heard you speak, it was really, I think, a breath of fresh air because there was a lot of, you know, negative connotations towards more medicalized model and OBs and I didn’t really necessarily agree with that approach, not that his podcast said that, but, you know, other podcasts and other conversations I’ve listened to.
And it was really nice to hear you come on and sort of marry those sort of two perspectives while also recognizing how critical of a role, you know, medical professionals and hospitals and interventions play oftentimes in birth. And so I ended up listening to your podcast and just found the information you provided such a great happy medium between here’s the information, here’s where medical intervention comes into play, but also, you had this way of being really empowering to listeners of like, “Here’s the information, you can make your own informed choice with your doctors’ or midwifes’ recommendations.” But I just really liked the style of the podcast.
And then the “High Risk Birth Stories” podcast, I listened to a little bit before I had my son, but found it to be actually really reparative after I had him because I got an opportunity to listen to a couple other women’s stories that were similar to mine and also your podcast in talking about postpartum hemorrhage, which was what I ended up having, was really helpful to me putting together the pieces of my story that was really discombobulated when I first got home. So it’s sort of a long-winded explanation of why I thought it would be nice to pay it forward, just because I found it so comforting to listen to other people’s stories and also just to have your podcast as a resource. And I don’t underestimate the power of empowerment through knowledge, and I think that your podcast really does that for a lot of people.
Dr. Fox: Wow, I appreciate that. That was awesome for me, so, thank you.
Ashley: Oh, you’re so welcome. Thank you.
Dr. Fox: No. I agree. I think that, and this is true with most things in life, when you tend to hear polar opposite things, the truth is frequently smack in the middle between those two. And, you know, when I hear people talk about how horrible the medicalization of birth is, I’m like, “Pump the brakes a little on that one.” Like, we don’t have the same number of people dying in labor as we used to. So, like, really, there’s some benefit. But when I hear the other end that, oh, these people who want natural stuff are a bunch of nut jobs and etc. I’m like, “Well, no. Like, people are looking for certain things and there is a place in the middle where people can sort of decide for themselves, you know, how comfortable am I going in one direction versus the other.” And a lot of that is just personality and…
Dr. Fox: …I find that if you have, you know, number one, you have to be honest, right? Everyone has to be honest about where they come from, what their biases are, what they want. And also, what do we know and what do we not know? And I think that sometimes a lot of it just comes out of ignorance. That either on the doctor, I’m not talking just from patients, I mean, the doctors’ end, the midwives’ end, or the patients’ end. When you don’t know the facts, you don’t know what the story is, you don’t know what the risks are, you don’t really get it, it’s very hard to make a recommendation. You just dig your heels in and say, “No, I want it my way.” And I think that that’s not healthy. And so it’s what we try to do, so, thank you. I appreciate that.
Ashley: Yes, absolutely.
Dr. Fox: So we’re telling the story of your baby boy, Finn.
Dr. Fox: He’s a youngster, yes? He’s fresh. He’s newborn.
Ashley: Yes, he’s fresh. He doesn’t feel as fresh to me as he was, but he just turned three months this past week, so, I guess, in the big scheme of things, that’s pretty fresh. I feel like he’s been here forever, though.
Dr. Fox: Right. From a geologic perspective, that’s pretty new. When you think of billions of years, three months is pretty short. But yeah, no, that’s…three months is remarkable how different he is from when he was born, obviously, because they develop so quickly when they’re little. But when you think about, you know, everything that’s to come, it is early. It’s awesome. How’s motherhood going?
Ashley: It’s good. I think the first, like, seven weeks postpartum were a little bit more challenging for me and then we started to find our groove. Sleep’s definitely still a challenge and just, you know, there’s so many things that you don’t know and you don’t know that you don’t know until you’re faced with them. And that’s sort of an area that… I tend to be somebody that likes to do things that I’m good at, and when I don’t feel like I’m good at them, I struggle. So this has been a really eye-opening experience and accepting that I’m not going to have all of the answers or even maybe 10% of them most of the time. So, it’s the less about feeling, I guess, like I know everything and more about just accepting the fact that we’re just sort of guessing as every day comes.
Dr. Fox: It is one of the more terrifying parts of parenting when you realize that nobody knows what the hell they’re doing. And it’s also amazing because it’s not like nobody’s done this before, right? Everyone’s done this before. It’s that, you know, each person is different, right? The parent, you know, the mother is different, your partner is different, your relationship is different, the child is different, the circumstances are different, the world is different. So, no matter what you know, it’s always a moving target. Everything is a moving target. You have several moving targets at once. And so you always feel like you’re reacting, and that’s just life, that’s just how it is, and it’s hard.
Ashley: Totally. Yep. And my husband and I usually, you know, we’re very similar in a lot of ways but we’re also very different. And one of us usually can figure something out and this is like the first time in our 10-plus-year relationship where I’ll look at him and ask him questions like, I have no idea. And he’ll ask me, and I’m like, “I don’t know.” So we have this, it’s sort of a fun experience to just both be figuring it out together. So, all things considered, tough beginning, but we’re doing pretty good.
Dr. Fox: Amazing. So take us back to the beginning of your pregnancy within… Where are you in life? What are you doing? How was the beginning of pregnancy for you?
Ashley: We were very lucky to get pregnant really quickly. I think it only took two months. I was, gosh, 30 at the time, working, navigating COVID, which was challenging. I think I was in that really fun demographic of people my age who are, you know, on the cusp of 30 thinking about starting a family, but we wanted to do a little bit more traveling, which obviously COVID impacted. And navigating like, do we have a baby right now with COVID and not really knowing much about it? But also knowing that we wanna have multiple kids. And, you know, 30 is not old, but it’s certainly not young. So we decided that, you know, we would try and ended up getting pregnant I think quicker or at least, for me, quicker than I thought.
So that’s sort of where we were at. We live outside in a suburb outside of Boston and had just moved into our house a year prior. So we were having fun doing house projects and things like that. As far as early pregnancy goes, first trimester was tough. I had some morning sickness, which pretty much was just feeling carsick all day every day for about weeks 5 through 14. But other than that, as soon as week 14 hit, I felt great. I really loved being pregnant. I was really active during my pregnancy and didn’t have any real concerns. At my 20-week ultrasound, I had a low-lying placenta, but that resolved as it typically does at 20 weeks.
The only thing to note was, my sister, one of my younger sister who I’m very close with, with her first baby, ended up with HELLP syndrome. And so she was in the hospital for about 10 days after her first son was born, and had a lot of, I think, complications as a result of that and just a really tough beginning postpartum period. So, because of my increased family history of health, they did put me on baby aspirin just to manage that risk.
Dr. Fox: Sure. Now, you mentioned that you’re in a mental health field. What exactly do you do professionally?
Ashley: So I am a psychotherapist. So I see clients for therapy and I also was doing some more clinical operations work for the psychiatry department of the practice I work for. So I do a little bit more larger-scale clinical operations sort of work and helping with intakes and people calling in for services and then also seeing clients as well.
Dr. Fox: And were you working during pregnancy? And because of COVID, and was it in-person, was it remote? And were you seeing women who were either pregnant or postpartum or fertility? I’m just curious, were you already in that sort of world of the pregnancy mental health or was it you seeing a different, I guess, group of patients?
Ashley: So, I was very lucky to be able to work remotely via telehealth throughout my whole pregnancy, which was nice, because two-fold, obviously with COVID, it would have been really scary to go into the office. And also, I can’t imagine having morning sickness for that many weeks and having to go on the train every day into work. And as far as my caseload goes, I was not seeing any perinatal clients at the time. I was actually working, I started doing a training to get more specific perinatal mental health training or right as I found out I was pregnant, I had already signed up for a conference. So that was sort of…it was a niche that I always knew I wanted to develop, but I had just started to really commit to that when I became pregnant. I actually, during my pregnancy, was in the process of attempting to start a pregnancy and a postpartum support group at the practice I work at.
Dr. Fox: Wonderful.
Ashley: Yeah. It’s a developing interest and specialty for me, specifically, but my clientele mostly is early 20s, college students and emerging adults, which is sort of my favorite population.
Dr. Fox: I noticed a lack of a thick Bostonian accent. Are you a transplant to the region?
Ashley: I am. I am. I grew up in Connecticut, actually, so, no thick accent. It’s funny, my husband is from the Worcester area and he also doesn’t have an accent but his brother has a very thick Boston accent, more of like a Worcester accent, and his mother and parents do but he doesn’t for some reason, his other brother doesn’t. So I don’t know what’s going on with them, the difference in accents. But yeah, so that’s why I don’t have one.
Dr. Fox: All right. Great setup for who you are and you’re in the middle of pregnancy and things are going okay. What about towards the latter half of pregnancy? How was it for you? Was it still, you know, semi-smooth sailing?
Ashley: Yeah. Everything smooth sailing. I felt great. I, again, stayed really active throughout my entire pregnancy. We just were doing projects around the house, sort of enjoying it being the last couple months of just the two of us. Obviously being pretty careful with COVID. One of the other things I did have to navigate was deciding to get the vaccine, which your podcast was actually really helpful in helping me make that decision. And I ended up getting vaccinated while I was pregnant, just because of the research I had done and talking with different health care professionals. So, that made us a little bit less anxious to do some things and feel like it was, you know, life was somewhat normal, but we were pretty cautious throughout the pregnancy just because I didn’t want there to be any…any complications that came up, I could prevent them.
Dr. Fox: It’s a stressful time being pregnant during COVID because all the uncertainty. I mean, there’s uncertainty with pregnancy at baseline and people, that’s hard to navigate, especially first pregnancy, and then when COVID hits, like the whole world is uncertain. Were you seeing primarily obstetricians, midwives, a combination? What was the practice you were going to like?
Ashley: I was going to a practice that had both. I wanted to have my care primarily with midwives, if I could, but I, because of my family history, my midwife, who I really loved and trusted, really wanted me to see an OB as well just for a few appointments in case something were to happen. So I ended up meeting with an OB who was fantastic and I had a really…I felt really comfortable with the team that I had in place. I should mention that the practice I was going to was really big. So the chances of me actually having my midwife deliver my baby was slim to none, which kind of plays into the story later on. But I was prepared to have a midwife that I was seeing pretty consistently through my pregnancy, but knowing that she might not be the person that was there when I delivered.
The practice is really good about introducing you to all the midwives. So they have a virtual meeting where you got to see and hear from all of the midwives so you at least recognize them when they did come in to the hospital. So that was really nice. And all of the support I received both from midwives and OBs. We did do a lot of preparation. So I took a class through our hospital that was… My goal was to have a lower intervention birth, if possible. I was certainly not holding myself to any expectations. I was very informed after all of my listening to podcast, you can’t plan birth and I did not want to traumatize myself in any way.
So I was perfectly happy with the idea of having an epidural. That felt good, but also wanted to just arm myself with other tools if it became possible for me to avoid getting an epidural. We took a naturally focused, “natural,” I don’t love that word, but a low-intervention birth course through the hospital. We also took a breastfeeding course and an infant CPR course. So we did a lot of birth infant care preparation ahead of time.
Dr. Fox: Tell us about the story of your delivery, your labor and delivery, because that’s where everything happened, so to speak.
Ashley: Yes. So I was 38 weeks and 6 days when I went into labor. My in-laws have a house on a lake, which is very nice to have during summer pregnancy. So we ended up heading there that day. We spent a lot of time over the summer just because it was nice to be in the water, and nothing…that morning, I woke up, nothing really in particular different. It’s funny, I actually, you know, on the drive to the lake, I had forgotten that I wanted my husband, Connor, to listen to a podcast about prodromal labor, because I wanted him to prepare for the process to take a long time, which is funny because that’s not actually what ended up happening with our situation. And I ended up saying to him, “Let’s listen to this podcast on the way home so you sort of know what to expect,” which didn’t end up happening because I was in labor when we were driving home.
So we were at the lake that morning, we went on a boat ride. I was feeling a little bit off and crampy. I was having Braxton Hicks for a couple weeks prior to that time, and I had some crampiness intermittently over the last week, but nothing particularly concerning, nothing that lasted consistently. So when we got to his parents’ house, we went on the boat, it was really hot that day. And I remember sitting in the sun and sort of being like, “Maybe I shouldn’t be sitting in the sun so much.” So I ended up moving to the shade. I didn’t say anything to anyone because I wasn’t feeling great, but I thought I was maybe just dehydrating a little bit, overheating a little bit. And so, you know, nothing, again, until about 1:45 or 2 p.m. that day. I ended up losing my mucus plug there and called my midwife to ask, which was kind of a silly question, which was, “Can I still go swimming even if that happened?” I didn’t know, because I just know that that’s…
Dr. Fox: Wait. Why is it a silly question? People ask that all the time.
Ashley: Well, okay, I didn’t know if it was a stupid question or not. She said, you know, “Absolutely not. If anything, you being in water right now is probably a great thing.” I also knew that…
Dr. Fox: Just to be clear, she said, “Absolutely not a problem,” not, “Absolutely, you can’t do it.”
Ashley: Yes. Absolutely not. Yes, yes. She said, “Get in the water, go relax.” This probably doesn’t…I didn’t even think it meant anything. I knew that that could happen like three weeks before you had your baby. So I wasn’t thinking much of it. Mentioned it to my husband, wasn’t that concerned. So we spent the rest of the afternoon just hanging out at the lake floating. And then around 7:30-ish, we were eating dinner, and my husband’s family is a big joke-telling family I guess you could say. And we were laughing about something and all of a sudden I had this really intense feeling in my stomach. And I started sort of tearing up and laughing at the same time and they were all laughing at me because I couldn’t really get a hold of my laughter.
It was this really funny moment that happened, but I was also kind of in pain. And that was, in retrospect, I think the beginning of labor and the first contraction I had. So I removed myself from the dinner table after that happened and went upstairs and sort of just wanted to check in with my body and see, you know, was I having contractions. I called my sisters because they both had obviously been through labor before. And pretty quickly, after that 7:30 time, was having relatively consistent contractions. They weren’t super intense, but they were coming and going. So we decided that we should probably head home just in case. At this point, and my husband took a video of me on the drive home. I said, “I don’t even think these are contractions. I don’t think I’m in labor. This is gonna be funny when we look back in three days and I’m still pregnant.”
And so, really, I had no expectations that I was gonna be going to the hospital that night. I made my husband stop at Whole Foods because I wanted snacks and I had an Amazon return to do. I was like in no rush to get home. There was no sense of urgency. I was sort of just working my way through these contractions that weren’t particularly intense. I was having a little bit of a difficult time differentiating between the contraction and in the middle of the contractions, I was still kind of crampy. Again, there was nothing really painful occurring but it just felt like more intensity and then a little bit less intensity. So when I was trying to time them, I couldn’t tell if I was timing them correctly because I was so crampy in between the contractions, I don’t know if that makes sense.
Dr. Fox: Yeah. How did you ultimately decide it was time to go to the hospital? Did they just get worse? More painful?
Ashley: Yes. So we ended up going home and getting home around 9:00 and I felt like I wanted to clean out our freezer. So I was doing a bunch of stuff around the house. I texted work, said that I was gonna finish up some things, which was really funny in retrospect since I didn’t end up doing that. And I ended up at 9:00 or 10:00 getting in the shower, just to…because I was at the lake all day and I wanted to shower just in case, and it was actually really helpful in managing my contractions. And we ended up calling, at the urging of my sister, the midwife at around 10:15 just because they were, again, I think at this point I was sort of like, “Okay, these are not going away. They’re pretty consistent. They are still manageable, I’m able to cope well with them, but they’re not going away.”
I spent a lot of time laboring at home in the shower. We ended up leaving for the hospital around 12 a.m. And when we got there, my midwife, who actually ended up being on call, which I was very happy about.
Dr. Fox: Oh, that’s nice.
Ashley: Yeah. Before she actually went on a week-and-a-half vacation, so I felt very lucky. Met us down in triage and actually checked me and I was 8 centimeters dilated, 100% effaced.
Dr. Fox: Whoa. Oh, my God. That’s like a dream.
Ashley: Yes. It was definitely the most ideal sort of labor process up until the postpartum period. So I was very happy with that. At that point, I decided that I wasn’t going to…I was going to hold off on getting the epidural just because I was coping well. They ended up taking my blood pressure obviously at that time and it was elevated. I can’t remember the exact reading that it was, but I do remember the nurse questioning my midwife about starting an IV. And they ended up not starting me on a Hep-Lock or anything because I want to avoid that. And I ended up going up to the room, getting admitted of course, since I was at 8 centimeters and laboring in the tub, which was really helpful. My midwife was awesome and stayed with us most of the time. This whole thing was a little bit of a blur. And…
Dr. Fox: That’s okay. That’s understandable.
Ashley: Yeah. So I think I spent about 45 minutes laboring in the tub. And around 2:30, I started to feel sort of that intense pressure and involuntary pushing that I often heard about, but the actual experience of it is totally hard to explain and pretty insane to experience. So I got out of the tub around 2:30 and around about 2:40 a.m., I started to push. I was fully dilated. And they let me use the nitrous, I had to wait for a COVID test to come back, but I was able to use the nitrous for the pushing.
Dr. Fox: Right. Right. So, for our listeners, nitrous, it’s nitrous oxide, it’s like a laughing gas, so to speak. What you, you know, for when you go to the dentist, it’s really good for labor because you can control your own inhalation of it and you can’t really overdose on it. And it’s sort of a low-intervention way to treat pain in labor. So that’s great that they had it available even during COVID.
Ashley: Yeah. It was wonderful.
Dr. Fox: Some places, in our hospital we have it, but they weren’t able to use it during COVID, during sort of like the inhalation of the gases and there was concern. So that was a real problem. So I’m glad that was available to you. And you’re having like a dream labor until now, by the way.
Ashley: I am. Yes, I am.
Dr. Fox: It’s really amazing. This is great.
Ashley: Yes, yes, it is. So I ended up pushing for about, I would say 40 minutes, I think, total. And at one point, there were some decelerations with my son but he ended up being fine. They took the nitrous away from me at that point, so I could focus more on pushing. And he was born at 3:22 a.m. All was well. I got to do skin-to-skin. He was able to breastfeed. The placenta was delivered about 20 minutes later, and I had about three different tears and got some local anesthetic to manage that. And at this point, I was still feeling fine. I remember feeling really overstimulated and sort of done being poked and prodded after the stitches, which is ironic because I ended up being poked and prodded a lot more in the next couple hours. So around 4 a.m., the bleeding had started to become worse and I was passing some clots. They did an exam at that time. I think it was more of the fundal massage, is that what they call it?
Dr. Fox: Sure. Yeah.
Ashley: Upon doing that, the nurse had noticed that my uterus was what they call boggy. I know that you know this, but just, it’s a funny word for them to describe what’s called. But yes, they said that my uterus was boggy and that I was passing a lot of clots. And they started me on Pitocin at that time. Unfortunately, during my labor, they had started IV just in case I decided to get an epidural and it had become infiltrated. So they had to give me that Pitocin intramuscularly. Then they ended up doing a straight cath to see if my bladder was full and that was preventing my uterus from clamping down, and that actually didn’t seem to help. And getting straight cathed when you don’t have an epidural wasn’t the most pleasant experience.
Dr. Fox: We’re definitely moved past poking and prodding at this point.
Ashley: Yes, definitely. Yeah. And then I ended up getting misoprostol as well. I was not a candidate for the Methergine because of my blood pressure…
Dr. Fox: Right. That makes sense.
Ashley: …which at that time, yeah, had been oscillating between like 103 over 83 and 158 over 75.
Dr. Fox: I’m just trying to get a sense of what you were feeling at this time. You have this beautiful labor and delivery, you have your perfect son, everything is going great, and now you’re bleeding a lot. Are you freaking out like, “Oh my God, this is horrible,” or it’s like, “Okay, this is happening and they’re taking care of me and they have to do this. And it’s a little annoying, but I’d rather not. But okay, it’s fine.” I’m just trying to get a sense of what was the mood like for you at that time initially?
Ashley: They were really good about not panicking in front of me. I really wasn’t concerned at this time. And I also think I was just so overwhelmed by just having had this birth that it probably wasn’t even registering what was happening yet. It didn’t start to sink in until a few, I think, probably an hour later after they had done these interventions and they weren’t working. So around about 4:30 when I think that the bleeding still wasn’t pretty well-managed, the OB was called and did an ultrasound and saw that there was, I think, some retained placenta at that point. And so she offered either a D&C or manual extraction. And I think at that point, my goal was, I had had this low-intervention birth and I wanted to just be with my baby and not have to have all of these… I didn’t wanna have surgery.
So I assumed that the manual extraction would be a better way to avoid, you know, having to get, you know, go under anesthesia, have any type of additional medications be administered. In retrospect, I probably just didn’t know enough to make a really informed choice. So I opted for the manual extraction first. She attempted three times to do that, which I used some nitrous during those. That was quite intense and really not pleasant.
Dr. Fox: That stings. I mean, that’s pretty painful. Definitely.
Ashley: Yeah. It was a lot. And after the third attempt, I think she felt pretty confident that she got everything out that was inside and left and said, “Okay, things look good.” She checked on the ultrasound again and they continued to monitor. And around 5:45 a.m., I remember, this is where I think things started to get a little bit scary. So around 5:45, they did another fundal massage and checked and I remember that I passed a bunch of clots. And I could see the nurses sort of looking at each other and asking each other, “Did you weigh that already?” And sort of going back and forth to the scale.
I remember my husband starting to look more anxious and concerned at this point. But they were still really great about, I think, maintaining a calm demeanor in the room, but they called the OB back who then sort of said, you know, “I don’t really know why else you would be bleeding. I thought we got everything. And the best option at this point would be for us to go in and do a D&C.”
Dr. Fox: Right. To give you anesthesia, go in an operating room, and really, you know, clear out the uterus and evaluate what’s going on. Because they can do more obviously, because it’s not gonna hurt.
Ashley: There was a lot of conversation about what to do for anesthesia. So they offered me a spinal and then they also offered me sedation. I think I thought that if I were to get the spinal, I would be more compromised, but I don’t think I realized how compromised I was going to be afterward anyway. So I opted for the sedation but I’m actually wondering if it would have made more sense for me to get a spinal. I know in a prior podcast you did, the woman ended up getting a spinal, and now I’m thinking that would have been the better option for me. But at the time, I just didn’t know. We ended up doing the sedation. I was fully out for the entire thing. So it was no conscious sedation. I wasn’t slightly awake. I think the anesthesiologist said you might be at some point.
And so I went in, my midwife and the nurses that were with me in the delivery room actually came into the operating room with me, which was really nice. Unfortunately, at this point, Connor was, you know, not able to come with me to the operating room. And they had also said to him, “Because your son is attached to your wife as the patient, we have to take him to the nursery.” So my husband went from having his wife and his baby in this room to then both of them being taken away, and I think that was pretty traumatic for him. They did allow him eventually to have Finn in a postpartum room with him, and I think they felt really bad, but initially, they took both of us away from him, which I felt really awful about. It turns out that they ended up doing the D&C, which I guess went pretty well, and placed a Bakri balloon. Is that what it’s called?
Dr. Fox: Yeah, exactly.
Ashley: Yeah. They did the Bakri and I ended up getting a catheter put in as well and ended up with…I had to get a transfusion. I had two units transfused as a result of my blood loss.
Dr. Fox: How much blood did you lose?
Ashley: Everyone kept saying around 3 liters in the hospital. In the notes after the surgery, they said about 2.4 liters, so, somewhere between that, I think, is what I lost.
Dr. Fox: Sometimes it depends on what you’re counting. Like, sometimes they’ll say, like, three liters if you include your delivery, and sometimes they’ll say, you know, after delivery, 2.4. So sometimes it’s just like the math, what you’re adding up. But either way, 2 to 3 liters is almost half your blood volume. That’s a lot. That’s a lot to lose, and that’s why you needed a transfusion afterwards, otherwise, it could be pretty scary. So you wake up from all this and, you know, the balloon’s in place inside the uterus, presumably, you know, you’re stable and you’re recovering and they’re telling you what happened, you have to be there for a while. How long did you ultimately stay in the hospital after all this?
Ashley: So we were in the hospital for six nights. We went in on a Sunday night and we left the following Sunday morning. I ended up having a lot of issues with my blood pressure afterwards too. So I woke up actually really…I was really happy when I woke up from surgery initially, because I think I had gotten some nice sleep and didn’t really realize how compromised I was gonna be. I don’t think I knew that I wasn’t gonna be able to get out of bed for 24 hours, that I was gonna have a lot of tubing coming out of me. I had, you know, IVs in both arms. So that experience sort of sunk in after I got transferred back up to labor and delivery. At that point too, one of the nurses who was really awesome, but also really straight shooter, said to me, you know, “You might not be able to breastfeed after your blood loss,” which was pretty devastating to hear.
So we went through the process of doing a lot of pumping, supplementing with our son to keep his weight up, because we were concerned about that. And I was trying to get my supply up, which I know is really challenging once you have that level of blood loss. And things were trending in a good direction and I was going to leave the hospital that… So I had him on early Monday morning, I was going to leave on Wednesday. And by Thursday, my blood pressures were trending up again and my liver enzymes were also trending up. So they were not liking how that was looking.
Dr. Fox: So similar to your sister, in a sense?
Ashley: Yes, yes. And it’s interesting, because I don’t know, I think my blood pressures on Thursday were like 139 over 90, within that range. I’m really curious how blood loss interacts with blood pressure, because…
Dr. Fox: Oh, it does. It does. Yeah. Meaning, we have that sometimes where someone loses a lot…they have preeclampsia, so the blood pressure is high or is supposed to be high, so to speak, they lose a lot of blood and their blood pressure is low. And then as their body recovers from the hemorrhage, right? Because you lose your blood volume, either with transfusion or with time and it starts coming back to normal, then the blood pressure starts coming back up. It’s sort of unmasking the problem that’s there with the high blood pressure. And so that happens, I don’t wanna say frequently, because none of this happens too frequently, but it definitely happens that we have women who their blood pressure drops after a hemorrhage and then as it recovers, we see their blood pressure going up and up and up. And it’s not because of the hemorrhage, it’s finally, we’re getting to see them in sort of a normal volume state and that’s the blood pressure going up. So that does make a lot of sense that that happened.
Ashley: Yeah. So I’m wondering if it would have been worse.
Dr. Fox: Probably. I mean, probably just would have…it probably would have manifest earlier because, you know, you would have had it two days after delivery or three or whatever. I’m curious. I mean, obviously, you’re here to tell the tale, so you made it out okay, but I’m curious, from an emotional perspective, I wanna first focus on that week you were in the hospital and then ultimately after you go home, because those are different periods. When you’re in the hospital, you know, there is an emotional aspect and physical, but it’s a little bit different because you’re there and there’s nurses, and there’s all this stuff going on, it’s a little more hectic. And then when you go home, you have that sort of quiet time to think and reflect and a little bit more.
So I wanna start with the hospital. What’s it like? How quickly did you grasp the fact that what happened to you, had this been 100 years ago, you would not have survived? And had it been maybe let’s say 20 years ago, you would’ve had hysterectomy? Like this would be it. Which is, you’d be alive, but that’s sucks, right? To have a hysterectomy, obviously is no good. Is that something that hit you right away or did it take time sort of to reflect on both of those, because that’s a lot to process, this idea that, had I been alive in a different era, I would either be dead or with a hysterectomy right now?
Ashley: I think my nurses who were…I can’t say enough positive things about the medical team at the hospital I was at. They were fantastic. And the nurses and the doctors, for that matter, were very good about naming for me how traumatic this experience was. And not just for me, but for my husband, who I think actually had it kind of worse because he had to watch all of this unfold. I think in the hospital, I was so focused on breastfeeding and getting my supply up that I was really not processing all of the other pieces of what happened. That was sort of the last thing that I wanted control over, right? All of these other pieces sort of fell out of my control after having him and I just wanted to be able to breastfeed.
So I think a lot of the time and energy spent in the hospital was on increasing my supply. I come from a family of medical professionals, and my mom is a very straight shooter in the sense of, she said to me, you know, “I just don’t want you to have hysterectomy.” And obviously now there’s a lot of medical interventions that can be done before something like that happens. But I was very aware of how dangerous this was and I think everyone was really good about naming that for me, so that I…and talking through the process with me. And my husband and I got a chance to sort of talk through all the pieces of it in the hospital, which was really helpful because we had a lot of medical professionals to sort of answer questions and put the pieces together.
So I think it was sort of a mixed bag, right? I was definitely still in shock. I think one of the hardest things too was trying to get out of bed for the first time in the hospital and realizing how weak I was. Because again, I think I thought when I went in for surgery that I was just gonna wake up and, you know, get out of bed and take care of my baby. I had no concept of what the Bakri was gonna look like, and, you know, having the catheter in.
Dr. Fox: And losing half your blood volume. I mean, it’s not that the… I mean, the surgery, I mean, people have these operations and they, you know, if you’re having it as an outpatient for a different reason, the D&C is not the hard part, it’s the fact that you have all this hardware in you afterwards and you lost half your blood volume. That’s a real shock to the system, physical shock to the system. Literally, the term we use for when people hemorrhage is called shock, right? And we don’t mean because they’re surprised. We mean, because their body is like, it’s like getting hit by a truck. And so trying to get out of bed the first time, I mean, and we’ve…patients, you know, have had this and we’ve had women on the podcast, they say it takes like months to recover from this. It’s a big, big deal to get over this physically, forget about emotionally, it’s physically. It’s very, very taxing.
Ashley: Yeah. And it was really hard for me to grapple with the fact that I couldn’t just get up and change my son’s diaper, right? My husband had to do a lot of that in the hospital and also when we got home. So I underestimated the toll that my body had taken from the blood loss absolutely. The first time I got up, I was like, I think I cried, because I was like, “How can I feel this weak?” I think that that was when it really hit me how serious it was. And then as far as transitioning home goes, another thing I should mention too, we were just so anxious to get home that I think there was this perception of once we get home, everything will feel normal, right?
Dr. Fox: The joy.
Ashley: Then it’ll feel like, yes, right. Then it’ll feel like that postpartum experience, because it’s just still hard no matter what, but like, we’ll start to feel some sense of normalcy. And what became very clear when we got home, it was awesome to be home. My mom was there for…she stayed with us for over a week after I left the hospital. She was amazing.
Dr. Fox: Wow. Go, mom, good job.
Ashley: I know. She’s a nurse too, so it was a little bit, but…
Dr. Fox: Oh my God.
Ashley: Yes. Very perfect situation there. And I was discharged on two different blood pressure medications, had the blood pressure cuffs, and, you know, obviously, there’s a lot of…you can’t just take the blood pressure medication. You have to be strategic about it.
Dr. Fox: Yeah. It’s nuanced. Yeah, you gotta…
Ashley: Yes, exactly. So, to have her there, which was really helpful. But we were initially so excited to get home and I think once we got home, it sort of sunk in for me of, okay, now I have to grapple with all of the pieces of this that weren’t what I expected. And, you know, feeling really overwhelmed by having this tiny human I have to take care of who’s, you know, not breastfeeding great because of all of the blood loss. And I don’t feel good, I can’t carry my baby anywhere in the house because people we worried I’m gonna pass out and drop him. So a lot of those, I think, preconceived expectations about what postpartum looked like, which I think I was prepared that it was gonna be hard no matter what, I just wasn’t prepared for just how hard it was gonna be with the additional physical challenges that I had.
It was really nice to have the, you know, creature comforts and be able to be in your own bed and have your nice shower, and not be in a hospital, but also, I think it’s scary to transition home after you have so much support in the hospital back to a place where, you know, it’s just you and your husband. Thankfully, my mom was there for at least a week. But even after that, it was scary.
Dr. Fox: Did people in your, other than your mom, obviously, did your support network, family, friends, neighbors, community, whoever, did they get it? Did they understand that you had been through a trauma physically, emotionally, or was it just, you know, sort of business as usual, a new baby with them? Again, I’m not putting blame on them for that if they didn’t get it. I’m just curious, what was your impression of how they understood what you were going through?
Ashley: I had a mixed bag. I’m very lucky to have sisters that I’m close with who really understood, especially my sister who had HELLP syndrome, was in the hospital for 10 days. She fully understood what it was like to go through something like that. And then other people, you know, as I’m sure you’ve heard many times, it’s, well, how’s the baby? How’s the baby? Right? And not really focusing anything on…
Dr. Fox: But the baby is fine. All right.
Ashley: Right. Yeah, exactly. And I’m so thankful that I had a healthy baby and that, you know, thank God that was the case. So it was definitely a mixed bag. I think I had to sort of come to terms with the fact that I wasn’t gonna be able to fully share my story and experience with every person and have them fully understand it.
Dr. Fox: Now you are.
Ashley: Yes, yes, I know. But even if I did try to share the story, some people just don’t really get what that’s like if you haven’t been through it or, you know, don’t really get all the pieces to it, which is fine. So I’ve sort of just tried to keep my circle small in who I processed it with so that I felt, you know, very much heard by those people. I think my husband was also, because he went through it with me, he was, you know, a total rock star through the whole thing as far as helping taking care of Finn, right? Doing pretty much everything, and also sitting with me and talking and answering questions that I had, which I still appreciate, because I can only imagine. And we’ve talked about how traumatic it was for him to see it happen.
Dr. Fox: One of the great lessons that I’ve learned in my life, and my career, and also more acutely in this podcast is how much we underappreciate the trauma that can happen during birth, even when things work out well, right?
Ashley: Oh, yeah.
Dr. Fox: You’re alive and well, you know, no hysterectomy, your baby is alive and well, your husband is alive and well. But your baby won’t remember this, but the two of you are gonna be traumatized for life over this event. Again, you’ll be okay, right? You’ll get through it. But this is not gonna necessarily bring up, you know, happy sunshine moments when you talk about your birth. It’s gonna be like, “Holy crap, that was a crazy.” And it’s hard for people to get that. It’s understandably hard for people to get it because they just see the product. They see, you know, two healthy people at home with a beautiful baby and they’re like, “Wow, this is awesome.” And the experience of the birth is not necessarily related to the outcome, because it’s an experience like anything in life. That’s the trauma, it’s the experience, not the outcome.
And so it’s part of the reason these stories are so critical for others to hear them and to understand that and to have, you know, sort of this empathy and understanding for people, what they go through when they have a baby. It could be for other things in life too, but this is what we’re focusing on. And you know this, I mean, you’re in the world of mental health in general, you know how trauma affects people. So you’re three months out now, all right. This event happened three months ago and, you know, we’re talking about it and we’re looking back. So, number one, I just ask, how are you doing physically after this? Because you were hit by the truck and three months later, do you feel like you’re recovered physically from the event or do you still have a little bit to go?
Ashley: I do feel like I have recovered. I haven’t returned to my level of vigorous exercise that I used to do. I’ve just been really focusing on walks and listening to my body. But physically, I feel good.
Dr. Fox: How about emotionally?
Ashley: That definitely took a little bit more time. I think listening to different podcasts, I think, I said this in the beginning but I’ll say it again, I needed time to sort of integrate all of the pieces, and hearing professionals like yourself and like my midwife at my six-week appointment and other people in my life say, like, this was really traumatic, I think was really helpful for me. There’s not many experiences in your life that you can say that a day was the best and worst day of your life, right? Like, we had this amazing experience, amazing birth, our son was healthy, and this really scary thing happened in the same day. And to hear that reflected back to me, I think has been really helpful.
So I think the first seven weeks, like I said, were really hard. Breastfeeding was really hard. And I think I felt a little bit disconnected in some ways, just from the whole experience. And that’s definitely changed more recently, especially as my son has gotten a little bit more, you know, interactive, smiling. I feel very connected to him now. I always was happy he was here and loved him and was very grateful to have him, but I think it really…it took me some time to sort of settle in emotionally to the motherhood role because I felt like, number one, the birth was so quick and then there was all of this stuff that happened afterwards that happened really quickly and just was nothing I could have prepared for.
Dr. Fox: What else would you like our listeners to know from your story or to learn from it?
Ashley: I think one of the things I think about a lot is, number one, how helpful it is to be prepared with information before you go into any type of experience with pregnancy and birth. I considered myself relatively prepared for childbirth, and thought I was informed about complications that could happen. I listened to podcasts about C-sections, and preeclampsia, and health. I listened to a lot of the ones that you shared, you did on those topics, but I didn’t really think about listening to things that were off my radar like, you know, postpartum hemorrhage. And I think there’s something to be said about preparing yourself by listening to things and arming yourself with knowledge about stuff that you don’t actually ever think will happen to you.
I also think having your partner, whoever that is, your birthing partner, being as informed as you are as much as possible was so incredibly important for me. I think the experience for my husband would have been way more traumatic had he just not even known what to expect for the birth. Because I think birth is traumatic enough, right? There’s so many things that happen. And some people, I think, go into a birth experience with, you know, an ignorance-is-bliss sort of perspective, which works for some people, and that’s great. But sometimes it really doesn’t work, and I think having a partner that’s prepared and coming with you to birth classes, reading books, talking to you about your expectations, that was incredibly helpful for us.
And also, I think just how critical nurses and good providers are. I think this experience would have felt way scarier if I didn’t trust my medical team and I didn’t have a group of professionals that were, number one, actually sat and want to talk through with me what my options were, explain what was going on, name that it was traumatic, having nurses that were asking about my mood, having providers afterwards that have asked about my mood. That all was such a huge component, I think, to my recovery, both mentally and physically.
Dr. Fox: Ashley, that was amazing. Thank you so much for that. Thank you for telling your story. Thank you for that poignant wrap-up. Your story is great. It’s really important.
Ashley: Thank you.
Dr. Fox: I am so thankful that you volunteered to share it. I’m thankful that you listen to the podcast. I appreciate that very much, obviously. And I know that our listeners are really gonna appreciate hearing your story and how much we can all learn from you and from what you experienced and your willingness to share it with us.
Ashley: Sure. Well, thank you for having me, and thank you for taking time out of your busy life to do this podcast because I think it’s making a really amazing impact in a lot of people’s lives. So, I’m very appreciative.
Dr. Fox: Thank you for listening to “High Risk Birth Stories” brought to you by the creators of the “Healthful Woman” podcast. If you’re interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at firstname.lastname@example.org. If you like today’s podcast, please be sure to check out our “Healthful Woman” podcast as well, where I speak with the leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Have a great day.
The information discussed in “High Risk Birth Stories” is intended for information and entertainment only and does not replace medical care from your physician. The stories and experiences discussed in our podcast are unique to each guest and are not intended to be representative of any standard of care or expected outcomes. As always, we encourage you to speak with your own doctor about specific diagnoses and treatment options for an effective treatment plan. Guests on “High Risk Birth Stories” have given their permission for us to share their personal health information.