“Delivery in the Height of a Pandemic” – with Julie Weiss Mafouda

Julie Weiss Mafouda tells her High Risk Birth Story about pregnancy with a bleeding disorder, pain management without an epidural, and giving birth at the height of the COVID-19 pandemic in New York City.

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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 in pregnancy, fertility, and childbirth. Julie, thank you so much for coming on the podcast. I really appreciate you coming on to tell your story about your birth. How are you doing? 


Julie: I’m good. Thank you so much for having me, giving me the opportunity to tell my story. 


Dr. Fox: Fantastic. So we’re talking about the birth of your daughter, Sophie, who was born in March of 2020, which everybody now knows was the heart of the pandemic. 


Julie: Yes, it was. 


Dr. Fox: I wanna start at the beginning of the story in terms of your pregnancy. So, you know, give our listeners a sense of, you know, who you are? You know, what’s your family situation? Where are you physically? Where are you in life? Just, you know, before getting into the beginning of pregnancy. 


Julie: So I grew up in Long Island, in Woodmere. And I work at Mount Sinai as a physician assistant in the plastic surgery department. And I guess leading up to pregnancy, my husband, Rami [SP], is from Los Angeles, we actually dated lon- distance for a year, and then he moved to New York. A couple of months after that, we got engaged, got married, and then we moved to the Upper West Side and lived there until we had Sophie. 


Dr. Fox: That’s it. So you guys are living on the Upper West Side. And Sophie is your first child. Correct? 


Julie: So yes, we were living on the Upper West Side up until actually November. Right now, we’re actually living with my parents back in Long Island just, kind of, waiting out while COVID, kind of, figures itself out. Our lease was up, so it just made sense to, kind of, you know, figure out where our next move is gonna be. And also, maybe we try to wait out COVID a little bit longer. 


Dr. Fox: Right. So. 


Julie: Right now we’re in Woodmere with my parents since November. 


Dr. Fox: Excellent. And so going into the pregnancy, we’re in 2019 I guess it is, this is obviously pre-pandemic. And did you have any concerns going into pregnancy? That, you know, obviously, no one thought the pandemic was gonna hit but just, in general, was there anything about either your life or anything that was a concern to you before you got into pregnancy? 


Julie: Yes, for sure. When I was actually a teenager, I got tested for something called Factor XI Deficiency, because we had known that a family member of mine had it as well, so something that just to figure out if I had it as well. And I did have it. And just a little background, Factor XI is just a bleeding disorder, it’s genetic, where you basically are deficient in one of the clotting factors that you need to stop bleeding. So I knew about that pretty early on in my life. And I was always, kind of, told the two things I’ll have to ever worry about, it would be if I get my wisdom teeth out, or when I give birth. And I was a teenager, and I said, “All right, I got some time.” I still haven’t done my wisdom teeth because I’m still terrified of that but I got pregnant. 


Dr. Fox: I think most teenagers are thinking they’re gonna get their wisdom teeth out before they have a baby. 


Julie: Yes, but I was too nervous. So they’re still in there. 


Dr. Fox: Yeah, I mean, really it’s an issue of surgery or birth, and also with birth, and we’ll talk about, obviously, whether you can or can’t get an epidural, which is a big practical issue. And so going into this, you knew that you had this. Did you, because of that, go to, like, a high-risk practice for that reason, or did you just figure, I’ll deal with a hematologist? How did you work that? 


Julie: Yes, for sure. I felt that I wanted to be with, you know, a practice that…I mean, I don’t know if I was the most high risk you’ve ever seen. But I was just, you know, wanting to be in the best hands just in case, God forbid, there was an issue with anything, I would be with the right people. I did see a hematologist for, you know, even prior to getting pregnant just to make sure I was doing okay. But I wanted to be, you know, plugged in with a good hematologist and with the high-risk doctors though, as well. 


Dr. Fox: Right. And so you, Julie, you’re one of our patients. So that’s full disclosure. 


Julie: Yeah. I’m sorry. 


Dr. Fox: No, that’s okay. [crosstalk 00:04:48.363] Do you feel that the fact that, you know, you and Rami were, sort of, in the middle of the world of health care, that impacted you in a way that maybe you were more concerned about Factor XI than someone else would be or maybe less concerned than someone else would be? How did that play into it? Because a lot of people, obviously, you know, have no clue what’s going on with these things because they’re complex, but you guys have a background. So how did that play into it? 


Julie: Yeah, I think, being in the medical field…Well, Rami, is not in the medical field, he’s actually an actuary. But, you know, he hears enough from me to know enough. But I think maybe in the medical field, I definitely, like, a little more heightened. I think they always say that, you know, doctors or, I guess, people in the medical field make the worst patients because they’re thinking of everything that can, kind of, go wrong. So I think that… 


Dr. Fox: I don’t say that. I never say that. We’re the best patients. You just always see that…we just always seem to get afflicted with the worst things. You know, that’s just how it is. 


Julie: Yeah. So I think I just, kind of, was a little bit more heightened than what can go wrong. And, you know, I even did my own research on it on what my options could be, you know, if we’ll get into the epidural or not. But just if there was anything that can be done to make sure I do have, you know, the safest pregnancy. I was just reading pretty much like every journal or anything out there and Factor XI, which isn’t many, to be honest. Yeah, just I think when you had that medical background, you’re just more focused on what can go wrong. 


Dr. Fox: Yeah, I mean, Factor XI is also a tough one because, on the one hand, it’s a diagnosis you make with a blood test, right? You check someone’s Factor XI level, and it’s very, very low, or you check, sort of, the genes and you see that the genes are abnormal. But it’s also a diagnosis that, you know, sometimes people come in because they have bleeding issues. But what do you do with someone who’s never had a bleeding problem but has a very low level? Are they at super high risk? Are they at no risk? Where in between? We don’t really know that. There’s clearly people who have a very low level that is never gonna have a bleeding problem. And those people have a very low level who are going to have a bleeding problem and it’s tough, I mean it’s tough for us because there isn’t great information on this because this is one of the newer diagnoses that’s coming out. 


It’s certainly tough for you because you’re told you have this horrible bleeding disorder, you’re like, “But I’ve never bled.” You know, sort of, like, “That’s weird.” You know, and then you’re like, “Yeah, but a birth could be horrible.” You like, “Oh, why? I’m fine.” And then the anesthesiologists are stuck, you know, do they place an epidural? Do they not place an epidural? And they’re like, “It’s probably gonna be fine.” But we don’t like using the word “probably” so much in medicine, and it’s hard, and there’s a lot of uncertainty going into it. And it’s saying we recognize that and we talk about that. How did the pregnancy go in terms of, you know, first trimester, second? Other than that concern, was it basically going okay for you? 


Julie: Yeah, and everything, thanks God, was doing well in the beginning. The first trimester, I think I was most scared of being nauseous, and being at work wasn’t great when that would happen. But everything was really going well. And, you know, Factor XI was always, kind of, lingering in the back of my head. But it was always one of those things that you can’t really figure out what to do with until you’re at that time of delivery. So it wasn’t something that I was constantly thinking about. But because of the Factor XI playing a role in the actual delivery, something that Rami and I wanted to have with us as, you know, an extra layer of support at the delivery was going to be a doula. 


Dr. Fox: Right, because in case you couldn’t get an epidural, you wanted someone there to help you through because there’s gonna be painful contractions and everything. 


Julie: Exactly. I mean, we didn’t meet with OB, anesthesia, I met with my hematologist many times throughout the pregnancy, to discuss, kind of, what would be in my arsenal of, like, pain control. And my two options are pretty much like the nitrous oxide gas or the Stadol through the IV. But I knew that me being a little bit more of an anxious person, in general, felt that it was important to just have another layer of support, not just for me but for Rami as well, going through the actual labor. So we did start the process through, you know, being pregnant was to search for a doula. 


Dr. Fox: Right, and listen, that makes a lot of sense. And did people at work know you were pregnant? I mean, at what point did you tell them? 


Julie: Scrubs hide a lot. 


Dr. Fox: I, unfortunately, know that for my own life. 


Julie: Yes. So I think I told work on the later end and others would tell. I think it was around… 


Dr. Fox: Yeah, was that because you just didn’t want people at work knowing or, in general, you just didn’t tell people? 


Julie: No, I was open definitely in my, you know, personal friends, you know, family. But I think at work is just, I didn’t wanna draw that much attention to it or, you know, distract from what, you know, I was there to do every day. So you know, I told like maybe one or two people I was close with at work with. But then, you know, on the later end is when I started telling more when I think I wasn’t able to hide it as much in my baggy scrubs, it was starting to get a little bit more noticeable. 


Dr. Fox: Right, plus, I imagine working in plastics, every single person is giving you their theory on stretch marks and what to do afterwards with the belly. And, “Oh, we can do this, we can nip this, and tuck that.” 


Julie: I’m already thinking of it in a couple of years when I…on my checklist. 


Dr. Fox: You know, you said you’re an anxious person, how was the pregnancy emotionally? I mean, some people go through and it’s like pure joy, and other people, it’s pure misery, and other people, they’re worried about the whole time. It’s all normal, obviously. But how are you going through it on the emotional side of it? 


Julie: I think it was a mixture. I think anytime there was a little thing that came up or something like a little different, that we were dealing with, I definitely was a little bit more anxious or on a high alert about it. But I think, for the most part, I was doing okay. I think just when I was thinking about the actual delivery, that’s when my, you know, anxiety really kicked in. 


Dr. Fox: Right. Yeah, listen, and there’s…I mean, delivery is anxiety-provoking for a lot of people just, A, because it’s new, it’s a delivery, and B, now I’m gonna be a parent and, like, have this child to take care of. And even though that’s obviously very exciting, it’s also very scary. And on top of that, you had a lot of uncertainty regarding your delivery, you know, what’s it gonna be like? Am I gonna be in more pain? Am I gonna be able to deal with it? You know, there’s a lot of variables that are still being sorted out. And that makes a lot of sense. Just looking at the timing set. what was your due date? When were you “due” to deliver? 


Julie: Oh, I was due March 29th. 


Dr. Fox: March 29th. And so we’re talking when COVID hits, you’re in the last month of pregnancy, basically. Yeah, you’re in the homestretch. 


Julie: Homestretch for sure. 


Dr. Fox: And so just to try to set this up for our listeners because, you know, in the last month of pregnancy, we usually see people, you know, every week. And we’re talking every week, you know, about labor and about contractions and about the delivery and when to come and what to do. And then for you, obviously, on top of that, it’s gonna be you have your plan for the doula and for the nitrous and the injections and the anesthesiologist and all this. And then boom, COVID hits like a grenade in New York City. And tell me about that when it happened, what was going through just first of all your life, sort of, logistically with COVID, and B, then everything that got thrown on top of your delivery plans. 


Julie: Right. So I, like I said working at Mount Sinai, everyone started that first week or two of March, kind of, like, talks of, oh, COVID is going on in Italy. Or we’re hearing all these things, oh, there might be a case at Elmhurst Hospital, there might be a case, you know, in our own emergency room. So it was starting to hit really close to home. And I was starting to, kind of, pick up on the vibe of the hospital that, you know, things were, you know, going bad real quick. That I believe it was the second week of March, Mount Sinai came up with their announcement that you can only have one partner with you in the labor and delivery unit. Meaning one person to check in with you and you know, that one person is who checks out with you cannot leave, no one else is allowed with you. And I knew because we had our doula set up with us that that meant she won’t be able to be with us. 


And I felt like my world at that point was crashing down, little did I know what was to come. But since it was at Mount Sinai, I pretty much went to the labor and delivery floor every day to see who I can speak to, feel out what’s going on. And they were very adamant, you know, everyone was just really nervous. No one knew what was going on. No one knew what was happening with COVID. So they just were…it was pretty much on lockdown in a way that that was gonna be their rule, you can only have one person. And Rami and I started thinking, okay, you know, if our doula can’t be there, we’re gonna do extra classes with her in these next two, three weeks to make sure that we’re prepared and that everything will be okay in terms of, I guess, our original plan of our birth plan. And you know, the question of…we didn’t go so much into this yet, but the epidural or not epidural was also on our mind at that point thinking we were not gonna be able to get an epidural. So it was a lot. 


Dr. Fox: Yeah. What was it like for you just, you know, at night, the two of you are at home and you’re thinking about this. Is it just like…I mean, how much stress is there we’re talking about? I mean, everyone was stressed out just, in general, but on top of that, it must have been pretty hard. 


Julie: Yeah, I said to Rami at that time, I felt like every day I was waking up with a new challenge and a new situation to deal with. Because after Mount Sinai made that rule of the one partner, we’re like, okay, now, let’s figure out what we’re gonna do for this delivery that, again, we’re planning for something that’s so hard to plan for. So while I was on the labor floor so many times that week, I met with one of the OB anesthesiologists there, Dr. Zahn, who was amazing, and… 


Dr. Fox: Yeah, he’s been on the podcast. 


Julie: Yes, he’s unbelievable. And we met many times that week, spoke on the phone many times. And he, kind of, relooked at the original ruling of no epidural for me. And I don’t know if he spoke about the reason why no epidural. But it’s basically the concern that if I do bleed, then the site where the epidural is placed, it can cause, like, you know, bleeding around that area causing pressure on the spinal cord, and then can cause paralysis that could be, you know, irreversible. So that was our concern, as always, but Dr. Zahn was looking at my case a little bit more. You know, I was never anyone who was a huge bleeder, as they say, for Factor XI. I had extremely low levels. I must say that on my best day I think I was a 5% and normal is, like, I think 50% to 150%. 


But he called it an acceptable risk for me to go forward with doing the epidural. But again, it was something that I and Rami would have to make a decision about, but also, on Mount Sinai’s end, it would have to be the anesthesiologist willing to take on that risk. And there seems to only be, I think, in the end, maybe three anesthesiologists on the whole labor floor that he felt were okay doing it for me, and he was included. 


Dr. Fox: Yeah. That’s a really big point because it’s not just you have to say, “Okay, I’m gonna take this risk.” Everyone thought it was a small risk, obviously, but it’s not zero. And that plan was, you know, to, sort of, pre-medicate you with some factors to just, sort of, make sure that you wanted to boost them a little bit. But you need an anesthesiologist who is willing to do it. And that’s another level of stress because what if that person’s not around when you show up in labor? 


Julie: Yes. 


Dr. Fox: Right. So if you have two or three who are willing to do it…And I actually wanna ask you a question, and you can choose not to answer it because there’s a good chance he might listen to this one day. But did you at any point consider, I’m bringing the doula and leaving Rami at home? As my one special person, I choose the doula. 


Julie: It was funny because I was like, no question, like, “I’m taking my husband, like, how could my husband not be there for the birth of our first child?” But when I did tell other people about the situation, some people were like, “You know, just bringing the doula, you know, it will be fine. You know, you need to be comfortable.” And I’m like, absolutely not. It wasn’t a question for me. But don’t think other people didn’t. 


Dr. Fox: Okay, so for you, it didn’t really cross your mind but others were like, “Girl, you may wanna do that.” So okay. 


Julie: Yeah, exactly. With my situation, some were like, “Maybe you should have her there.” And I was like, “Not a question.” 


Dr. Fox: We had a podcast about this whole situation on the labor floor and the rules. And as you said, they were…someone used nice word evolving, but they were really changing all the time because new information was coming out and on top of that, you know, there’s so many variables to think about. Obviously, there’s you, the woman in labor, but then there’s also the safety of, you know, the baby, the safety of the nurses, the safety of the doctors, the hospital. And it’s just no one knew what to do. And everyone’s just trying to figure this out. And so there was a lot of movement there. 


And then the governor got involved and, sort of, made, like, rules and, you know, but no one knew that. And the timing, there was, like, a two to a four-week period where a lot of people were in a similar situation to you, obviously, everyone’s unique, but in terms of do I deliver here, do I go to a different hospital? Will I have a doula, will I not? You know, will my partner be here or not? It was just…it was a real, real mess, unfortunately, for the people going through this. So you’re trying to figure out what to do and you’re meeting with everybody. And then how did it continue to play out? 


Julie: I would say that week before I actually delivered was just every day, like I said, was a new challenge for us to come and deal with. Thinking about it all, it was traumatizing, I have to say. But we were gonna meet with our doula and have more classes so Rami would be prepped and ready to go. We were, obviously, gonna have her on Zoom and do a virtual at the same time as still coming into the practice and to having, you know, my checks of the baby to make sure everything is okay. And one of the things that did come up was that our baby was on the smaller side. That she was on the smaller side. So it was a strong recommendation that we give birth no later than our due date, which meant that I got to get on that induction schedule. And with everything going on with COVID, the entire world was trying to be induced because no one knew if the world was gonna end next week. So that was another factor that needed to be taken into account. 


So that week, we were talking with Dr. Zahn, talking with you guys at the practice trying to figure out when to get me in on that induction schedule. Like you were saying, I had to get, you know, pre…get transfused with some plasma so I had some clotting factors going into the pregnancy just for the general concern of bleeding afterwards. And on top of that, figuring out if I would do an epidural, who would I do it with anesthesia-wise because no one ever thinks that you have to go into your birth thinking of, you know, what doctor’s on call, it’s also now, what anesthesiologist is on call? 


Dr. Fox: Right. And also, nitrous got taken off the table as an option. 


Julie: Oh, yeah. That was another thing. Yeah. 


Dr. Fox: Because that’s an inhaled gas. And because they were concerned about the risk of COVID, with the oxygen tanks, and the tubing and the inhalation and, you know, gases in the room. So that was like, “No, no, no nitrous, that’s not an option.” And so that’s even one fewer thing that you have even available to you. 


Julie: Yes. Yeah, I remember Dr. Zahn telling me that week, you know, as…our plan before, kind of, even hell broke loose even more, as you could imagine, our plan was gonna be, you know, try to labor at home as much as possible with the doula and with Rami, kind of, get to the hospital when it was, you know, safe and I was instructed to and try to manage it as best I can with, you know, Stadol. If not possible, then, you know, go down the route of an epidural if an anesthesia was on call that was willing to do it. 


Then we, kind of, went into that weekend thinking, “Okay, that was our plan.” Then it was the Sunday before I was gonna give birth. And that’s really when, kind of, like all hell broke loose. I remember I was sitting, just watching TV trying to get my mind off everything. And New York Presbyterian came out saying that no one is allowed at the labor and delivery floor as a support person. And my heart just sank. And I had this feeling like Mount Sinai is next. I knew it. I had a feeling, I knew I was going in that direction. I think I reached out to you guys today. I said, “It’s happening for sure, I know it.” It wasn’t officially released yet, but I knew it was going to happen. 


And it’s so hard to verbalize that feeling of just like your heart just breaking. And that moment that I knew that I had to go that week, my due date was the end of the week, and we had an induction on for that week. And I knew my husband wasn’t gonna be able to be there. And I tried everything. I called you guys at the practice and I said like, “Get me in before Sanai makes this ruling. I need to be induced now.” I was thinking about doing those little castor oil induction. I was gonna do anything I could to try to get in before Sinai made that ruling. Distraught is just an understatement of how I felt. I just didn’t think things could get worse, and then it did. 


And it just to me, I was like, you know, even being in the medical field and knowing how important it is to give birth at a hospital and being under that care, I was just like, “I’m not going. I’m not going to the hospital. I’m just going to give birth here if that’s what’s gonna be.” Like, even with knowing my risk of bleeding and knowing what I could be facing, I was just like, “I’m not…I can’t go, how can I go? How can I be without him?” It’s very hard to think that someone who, you know, is your everything can’t be there for you for this huge moment. And I remember something that Dr. Zhan had said to me the week before this ruling actually came out. And he said, “You know, you’re lucky that they’re not saying anything about not having, you know, husbands or partners there.” And I was like, “No, they will not do that. That’s, like, barbaric, they can’t do that.” And they did. 


Dr. Fox: I mean, it’s hard for people who weren’t living, you know, in the middle that at that time, it’s hard to describe in words what it was like during those couple of weeks. I mean, you’re talking about this is when Manhattan, the streets are empty, like a ghost town, either everyone is gone or they’re not leaving their homes. So it’s, like, creepy, right? The streets are empty. In the hospitals, this is the time when all the beds are filled with COVID patients, there are people dying left and right. The staff is freaking out because they don’t know the risk to themselves. There aren’t enough, you know, protective gear, you know, for the health care workers. It is just a crazy, crazy time in the world, obviously, and in New York City, and in hospitals and health care. 


And on top of that, in our, sort of, little world of labor and delivery, there was, well, yeah, we have all these women coming in to deliver, like, they can’t…you know, you can stop an elective surgery and you can stop, you know, an annual visit maybe to your gastroenterologist, but you can’t stop birth, it’s coming. And so we had to figure out what to do in that situation. And again, people are worried about, like, literally death, like they’re really…this is a really scary time. And so they make this rule that women, you know, we have to minimize the risk to everybody, patients, staff, the world, women have to come in alone in labor. And it was just complete pandemonium. And it only lasted I wanna say about a week, maybe a week-and-a-half or something like that. 


Julie: It was like four days. 


Dr. Fox: Yeah, it was a real short time. 


Julie: Or five days, it’s… 


Dr. Fox: Yeah. Because the governor stepped in and said, “You know what, no, just forget it, it’s not gonna happen.” And also, he had to do it for all the hospitals, because otherwise, everyone would have gone to the two hospitals that let the partner in, and they would have been overrun with people. So it has to be all or none. And so there’s that four-day window, and you’re in that window. You are in that window. And so yeah, it was really horrible, obviously, that whole situation, and you’re in the middle of it. And so your world is rocked, what did you do logistically? Forget about emotionally. How did you handle that? 


Julie: New York City was just a ghost town, like you said, and I think one of our things was, like, you know, are we gonna be able to get to the hospital? Like, how am I gonna get there? But, I mean, I knew when it came down to it, like, obviously, as much as I was thinking in my anxious state that like, “I’m not going. Like, this baby can come here. Like, I’m not going there.” I knew I had to be at the hospital. So we had our induction plans for that Thursday, March 26th. And we, you know, downloaded Zoom on every device possible. We, you know, pretty much like overnighted, every, kind of, like wireless headphone possible, just in case I needed, you know, Rami in my ear for everything. And we go to the hospital that Thursday, Rami came with me in the Uber, and we go into the lobby. And I, kind of, felt like, we were entering like a high-security prison in a way and not [inaudible 00:28:05], but it was just security guards flanked on all sides of you. You know, any entrance into that hospital was just locked by someone. 


And I walked in, and they were just like, “What are you here for?” I’m like, “I’m here to have a baby.” I was just…I don’t even know what…something you never can fathom in your life, this scene. And they’re like, “Okay, you know, he has to leave you now, he can’t come with you.” And I had, like, bags with me. I was like, “Who’s gonna help me?” Like, I just couldn’t believe they wouldn’t even let him in the elevator with me to the floor, we had to say bye in the lobby. And just the idea of just, we kind of…I think one of the things that we felt was, like, as if we were committing a crime from just coming in to, like, have a baby. And, you know, we had to say goodbye in the lobby. And this nice woman helped me with my bags in the elevator and, you know, got checked into the labor floor. And that’s where that day started. 


Dr. Fox: If you could describe it, just for a second, what was that like for Rami? I mean, how do you…you know, obviously, you guys have spoken about this and you know him very well. You know, for you, obviously, you know, it’s terrifying, you’re going to deliver a baby, you’re going in alone, you have no idea what’s happening, and you’re worried. But what do you think it was like for him on that end to have to say goodbye to his wife, and like, just say, “I’ll see you in a couple of days, hopefully, with a healthy baby and healthy mom?” I mean, what was that like for him? 


Julie: Devastating. I mean, I think that that week leading up to it, I think we were both, kind of, like, comatose that week, you know, leading up to it, and we had these, like, bouts of crying and disbelief that this was happening to us. And I think for him, obviously, he was concerned for the baby and wants to make sure everything’s okay. But I think at that moment, he just really wanted to be there for me. And that was really hard. You know, as much as I can say now, like, you know, everything went well, I think, at that moment, you also don’t know. You know, it’s very, uncertain, this is our first baby, he doesn’t know how everything was gonna be for me, that I was gonna be okay, everything the Factor XI, and he was just worried and scared. And just, you know, I think it’s hard to put words to it because it’s just like a feeling that no one should ever feel, no one should ever know. 


Dr. Fox: On top of all this, do you have a specific fear of going into hospital and potentially getting COVID? I know you worked, you know, in a hospital, so maybe it was less than someone else would have been. But did you have that fear on top of it that, “Oh, my God, I might go into this building and walk out with COVID, or not walk out with COVID?” 


Julie: This is gonna sound weird, but no. 


Dr. Fox: No, I don’t think it sounds weird at all. I mean, there’s so much to worry about. There’s so much other things to worry about. I was just curious if that was on top of it or not. You know, in my experience, a lot of the women who came in for labor, like you, they were more concerned about my labor, my baby, you know, is my husband gonna be there, is my partner gonna be there? You know, all these things, and not so much the COVID part of it because there’s, like, only so many things you can worry about, like, your list is only so long, and then you run out of brainpower for these things. And that’s interesting that…again, I’m not surprised, but it is an interesting thing. Yeah. And I know you told…yeah. 


Julie: I never thought about that until you just brought that up now. 


Dr. Fox: You’re like, “Wait a second. Why wasn’t I more afraid of COVID? Oh, my God, holy crap, that would have been bad too.” 


Julie: I think leading up to it for sure when, you know, the city wasn’t shut down yet and I was still coming into the practice with Rami for my visits and, you know, everyone’s hearing about COVID, you know, in Europe, and that, I think then we were a little maybe a little bit like, “Oh, you know, should we be nervous about this?” You know, but I think because so much, like you said, was going on, we had so much other things to think about, like, acutely, it was just out of our minds of worry. 


Dr. Fox: Yeah, and I remember we spoke earlier about this, you were telling me, like, this vivid memory you had about, I guess it was like the holding area or the waiting room sitting there. Yeah. So tell us about that because that’s really, it’s just amazing. 


Julie: Yes, I think right after they checked me in, and I was in the waiting area waiting for them to take me to a labor room, I was a wreck. I was wearing a mask, crying hysterically. It was soaked from, I don’t know, mucus and tears. And I was staring at this woman sitting across from me, also just the exact same state like very pregnant, red eyes, crying, a mask on, and I’m just like…I think we just, like, looked at each other, didn’t say a word to each other. You know, you can’t see our facial expressions of like, you know, sometimes you could be like, yeah, I feel you, we are the same situation, we just, kind of, looked at each other. And, you know, I knew like, you know, she just said bye to, you know, her partner or husband, whoever her support person is, and just said bye to them in the lobby just like I did. And we’re going into the unknown. It’s just not the unknown of the baby. It’s just the unknown of giving birth in this COVID pandemic. We just don’t know what’s ahead of us. And I felt like it was a very hard-telling moment where you could just, kind of, see everything that’s going on with yourself and just someone else sitting across from you. It was pretty crazy. 


Dr. Fox: Yeah, I mean, you read someone’s eyes and you’re like, “Those are my eyes.” Like, this is the same, like, shock and fear and just complete disbelief that this is happening. 


Julie: Exactly. 


Dr. Fox: So you did get in, obviously went to the labor room, and how did that go? Number one, just logistically in terms of how were you connected to Rami and your doula, so the logistics of it? And number two, how weird was that? Like, what was the experience like? 


Julie: Oh, yeah, I had Rami on my…So he, right after he dropped me off, was in an Uber. So he was…the moment I entered the labor floor after I left him in the lobby, we were just on the phone right away. We didn’t wanna be, you know, a moment not connected. And as you know, you’re, you know, taking blood or I’ll do my vitals and putting the monitor on my stomach and everything. I still have him on and I’m just telling him everything. It’s just, kind of, like one of those moments you’re just like, “Let me describe the room to you.” And I’m just setting the scene for him over the phone. 


Again, I had to get there early than a normal induction time because I did need to get some plasma prior. So I was there around, like, 2, 3 in the afternoon, hours before my induction was set to begin. So we just at that point, it didn’t really still feel real to me. I, kind of, felt like I was, kind of, just coming to a doctor’s appointment without him in a way. But then once things got started later in the evening, then getting the epidural and starting the induction felt more real. And as soon as Rami was able to, you know, out of an Uber and was at home, he Zoomed. And we were on that Zoom call for…I would like to see the log of it, but I would have to say just until he picked me up from the hospital a couple of days later. 


Dr. Fox: Wow. 


Julie: We never got off that Zoom call. Yeah, we paid for the extra… 


Dr. Fox: The upgrade. Like, how do the two-and-a-half-day meeting, what account do I need for that? 


Julie: Exactly. 


Dr. Fox: Yeah, that’s like “The Truman Show,” you guys had at that point. 


Julie: Exactly. And I didn’t have headphones on, I just had him on my iPad, on Zoom. I had it constantly being charged, never off the charge. And I think what the beauty of Zoom is you could, kind of, bring people in throughout the call. So sometimes my doula would be on, sometimes not. We, kind of, just made that decision of when we wanted her around and not. Not because there were times we didn’t want her there, mainly because, you know, there’s times when nothing was going on. So it was just like, you know, nothing for her to be around for. 


The nurses were really, really kind and helpful about making sure everything was set up for me with the iPad because I had the table set up right next to me. And sometimes they wanted me on my right, sometimes on my left, just in terms of hearing the baby on the monitor. So every time I was switching sides, I mean, you know, my back would be Rami, and they would move the table to the other side so that he would be facing me, which was really, really helpful. Really nice to have that support there in that way. 


Dr. Fox: Wow. And so how did, ultimately, the labor and the delivery go? 


Julie: It’s sometimes hard for me to say well just because, again, I would give anything for my situation to be different and having my husband there, having Rami there. But thank God, everything with the actual labor and delivery when great. 


Dr. Fox: And when was she born? 


Julie: She was born Friday morning, March 27th, at 9 in the morning. 


Dr. Fox: That’s actually relatively on the quick side for an induction. 


Julie: For an induction, yeah. 


Dr. Fox: So yeah, I mean, for our listeners, you know, that’s pretty good to deliver at 9 in the morning, the next day when you start in the evening on a first baby. So, you know, that’s a positive. 


Julie: The induction I think started…I mean, I don’t know, maybe correct me if I’m wrong. I was like 10 or 11 the night before, Thursday night. Well, I got the epidural by Dr. Zahn, who’s amazing again. And Dr. Kaufman was the doctor on call and she was always checking in and she was great. And then I remember at like 7 a.m. Friday morning, they tell you, you know, you’ll feel it, you’ll feel when it’s time. And I felt something and I said to Rami on Zoom…there’s no one else in the room with me just Rami on Zoom. And I said, “Rami, I’m feeling it. I’m feeling it.” And he can’t run out and get someone to be like, “She’s feeling it.” So I’m pressing that nurse’s button and I’m freaking out to him because I know how the hospital works, 7 a.m. is the change in the shift, change of the guard. And I’m like, “No, this can’t happen now.” And then the nurse comes in and I’m like, “I know you’re leaving, but it’s happening, it’s happening.” And she’s like, “Yeah, yeah, okay, maybe.” Like, “No, I feel it.” 


So then Dr. Kosten [SP] comes in, and at 8 a.m. is the changing of, you know, your guard with the doctors. So, you know, Dr. Melkoff [SP] came in and it felt really nice to have Dr. Kosten there delivering and Dr. Melkoff was taking pictures for me. And I actually said to her, I was like, “I don’t want pictures. I’m wearing a mask.” And she’s like, “I’m gonna take the pictures and you can do what you want with them.” And I really wanna thank her…next time you speak to her, thank her for that because… 


Dr. Fox: Probably, like, six minutes. Yeah, no, listen, it’s one of these things. Yeah, I can just see her right there, it’s like, “I’m taking the pictures. You could delete them if you want. Give me your phone,” right? 


Julie: Yeah. And, you know, Rami and the doula were right there with me on Zoom. And, you know, they held Sophie up to him on the camera so he can see. And not many people think of this part but, you know, I feel like a big help in the delivery…or not help, a big part of the partner in the delivery room other than, you know, being support for your wife or partner giving birth, you’re also there to cut the umbilical cord if you want, and Rami wasn’t there. So I asked if I could do it just because I wanted that to be something that one of us was still able to do for her. Even though I know, it’s probably me overthinking it, but it’s just [crosstalk 00:40:03]. 


Dr. Fox: No, it’s nice. It’s sweet. I mean, you know, it’s a nice thing. 


Julie: [inaudible 00:40:06] Yeah, thank God, everything went well. And the nurses were amazing and very supportive and really great in the labor room. 


Dr. Fox: Right. And your daughter, everything was good. She’s healthy. How much did she ultimately weigh? Because I know you said there’s some concern about the size. 


Julie: Yes. She was 5 pounds, 15 ounces. 


Dr. Fox: So on the small side, as predicted. 


Julie: Yeah. 


Dr. Fox: Okay. And did you all go home the next day or on Sunday? Or when did you all go home? 


Julie: If you would have let me, I would have gone home the day after. 


Dr. Fox: I delivered at 9 and I want to go home at 9:02. Yeah. 


Julie: I would have, you know, done anything to go home that night. 


Dr. Fox: It’s the baby. It’s not the mom. They want the baby 24 hours, yeah. 


Julie: I know, I know. Right. Yes, so that was exactly what they said, “Everything’s good we, kind of, want you out of the hospital after 24 hours because of COVID.” So I went home the next day, I went home, like, a little bit in the afternoon, I was ready to get out of there. The postpartum floor, you’re just…it’s fight or flight. You know, it’s just adrenaline is kicking in. I don’t think I ate or drink anything because I was just…anytime she made a noise, a sound, a cry, a move, anything, I jumped up. I was just out of bed moving, getting her, doing…because I was alone I had no one else there. You know, not just to take care of me but to take care of her. So I knew it was, like, all me. And yeah, the postpartum situation was not something I’d ever like to experience again. I think it was very hard for those nurses to navigate not having the partner because usually, I think a lot of it, they can rely on the partner being there for the mom and for the baby. But when things were, like, questionable or something I didn’t know, you’re just paging the nurse every second. 


Dr. Fox: Right. And there’s no nursery because the babies are all with the moms, right? 


Julie: Well, I wanted that. 


Dr. Fox: Did they have a nursery? Because at one point, they closed the nursery. When you delivered, was the nursery still open? 


Julie: Yeah. 


Dr. Fox: Okay. 


Julie: I think it was open for me. Yeah, because I had her all night. But there would be times when, you know, if they were doing any sort of test or something, we brought her to the nursery. But there were times when they would bring her to the nursery, and then she wouldn’t be back for like an hour-and-a-half. And I would, like, reach out to them and be like, “Where is she?” You know, I just feel like if your partner was there, that’s something they would look into. 


Dr. Fox: Yeah, it’s hard because that’s just, it’s not…they’ve been doing it a certain way forever also, and this just like throws a whole wrench into the system. It is a very challenging situation, I mean, primarily for you, but obviously, for everyone. And then after you went home, how was your recovery physically? First of all, I’ll ask you, and then second of all just, you know, sort of, emotionally with all this? You know, the outcome was good but it’s still a pretty traumatic event at the same time. How did you, sort of, recover from all that? 


Julie: I think I remember…So Rami picked me up from the hospital and, you know, met our baby for the first time in the lobby, which I felt was pretty crazy in and of itself as well. But I remember him driving us home because we had been able to get my parent’s car at that point. So Rami was able to drive me home, not Uber. But we got home and the streets, like you were saying, were just dead, like it was just very creepy. I’ve never seen New York City streets that way. And we get home and I took a shower for the first time. And I think that’s when, like, the tiredness just, like, overcame me. And I just…like, the events of the past two days were just insane. 


I remember we were just, like, sitting in bed with the baby and we saw a notification on our phones that Governor Cuomo had changed the ruling that day to having partners in the room, labor, you know, labor room with you. I do think at that point, they still weren’t allowed to be postpartum with you, but it was the labor room with you. And I just was like…I just remember turning to Rami and, like, holding our new baby that we just, like, went through, I felt like, a war zone with and I was just like, “Can you believe it, like, our luck here?” It was insane. 


But I mean, physically, thank God, I mean, I recovered well, you know, as much as I expected, nothing out of the ordinary I think. But just now Rami and I trying to become these new parents in a COVID world, you know, no family around to see her, meet her, hold her, help us get a break for a second. We were just on it for, you know, a while, you know, just the three of us. So it was hard, I think emotionally and mentally and then just physically of, like, the lack of sleep and lack of energy just is a lot those first few weeks. 


Dr. Fox: Looking back, do you feel like you’ve recovered emotionally from this whole experience? 


Julie: Not so…emotionally and mentally, it’s still something I very much struggle with, you know, even a year later, almost a year later. I think having Sophie, there are, kind of, these, like, triggers that bring up these feelings of being alone and isolated. And, kind of, the sadness that I felt of like the loss of the birthing experience and like the postpartum experience that I wish I had. You know, in the beginning, right after I had her, everything was fresh and raw that I, kind of, break down and cry on a daily basis thinking about, you know, everything I missed out on and how difficult it was for me. You know, I feel like I was cheated out of the birth I was hoping and planning to have, which, you know, always included Rami. I feel cheated out of the maternity leave I was hoping to have, which was surrounded by family and friends, but instead, I, kind of, had this, like, forced world of just, like, loneliness and isolation because that’s what COVID created. 


Time goes on. It’s not a daily occurrence for me to have those feelings, but it can be sparked by, you know, more subtle than more overt things in life. You know, if I’m watching a TV show or a movie where there’s a husband and wife in the delivery room together and, you know, the husband’s there for his wife and meets the child after, that definitely brings up those feelings, or even when I’m at work and I’m going to see a consult on the labor floor the postpartum floor. 


So it’s, kind of, just these also different levels of that isolation, ones where I feel isolated from family and close friends because they, let’s say, had given birth since I had Sophie and I can’t really relate to their experience and they can’t really relate to me. And to be honest, I am still struggling with that jealousy of the birth that they get to experience that they had where they have their spouse with them. Even just see pictures of them all together in a hospital room together, it really brings that sadness, this overwhelming feeling of sadness for me. And you know, I’m happy for them. But it’s definitely a struggle I still feel to this day. And then separately, there’s another isolation that I felt when I was actually at the hospital alone by myself, giving birth by myself and going through it postpartum, I found myself without Rami and the person I rely on for everything. So it’s definitely still a big part of my life and I’m still trying to get through it. 


Dr. Fox: Yeah, I think that makes a lot of sense. I mean, you know, whether it’s a birth or another experience, even if it ultimately goes well, you know, you have a healthy baby, you’re healthy, the experience is traumatic, right. You can have a traumatic experience with a good outcome. And it’s not like the good outcome negates the trauma. I mean, if someone’s in war and they get out okay and they come home to their family, and they’re healthy, and you know, they weren’t shot, it doesn’t mean that the war didn’t traumatize them. 


And I think it makes a lot of sense that, you know, again, even though, ultimately, you came out on the other side, you know, okay physically with a healthy baby, that’s a very shocking experience to go through. And it is a real recovery from that emotionally and mentally. And it makes a lot of sense. Do you have a difficult time talking to people about it, like when people want to ask you your story? Because again, it’s very interesting, you know, for them, for the listener, but for you, it’s a trauma you’re bringing up. Are you able to do that when people ask you about your story? 


Julie: Not really. This is probably the most I’ve talked about it since it’s happened, other than, obviously, with Rami. But even with family and really close friends, even not talking about their experiences, just talking about my experience, it’s been really hard for me to fully express what I went through. And the reactions are very…you know, some want to just, kind of, tell me, “Okay, but it’s over, and it’s in the past, and everything’s good. And you have a healthy baby and all that’d in the past.” Or, you know, they do say, you know, obviously, “I’m sorry, and that’s rough,” and they, kind of, move past the conversation, they don’t let the conversation happen. It’s been incredibly hard for me to open up about what I went through. 


Dr. Fox: Yeah, I think that’s really understandable. And it’s not in the past. I mean, that’s the whole idea, that the trauma aspect still lives in you. So even though the event is in the past, your experience is not in the past. It’s real, and it’s in the present. And it’s all the more reason I’m so thankful that you were willing to come on and talk about it because it’s important. And it’s an important story. And I’m just really thankful that you are, you know, willing to do this and give us an opportunity to hear about it and to learn from you. And Julie, I wanted to ask you looking back on the whole experience, from the beginning until now, what have you learned from all of this? 


Julie: I definitely feel like I am stronger than I thought I could be, even though it’s still taking its toll on me. Not just physically because I had to take care of not only myself but my baby in the hospital on my own. And then obviously, afterwards, the strength it takes a physical toll on you to take care of a newborn and just [inaudible 00:50:55] ourselves, but also just stronger I was mentally and emotionally, as I said, it’s still something I very much struggle with. But it’s something that I…not to the days leading up to this full experience when I knew I was going in to basically a warzone of COVID at the hospital alone, I couldn’t even fathom what I was getting myself into and what was gonna happen what the next few months were gonna bring. 


Dr. Fox: It’s a really, really important point. It’s a great lesson. What do you think you’re gonna tell Sophie about this? You know, when she grows up, and she, you know, wants to know the stories. I’m just curious, have you thought about that? 


Julie: I do think about it. Sometimes I think about it, I don’t wanna…you know, I don’t wanna really feel bad, you know, I don’t wanna feel like this… 


Dr. Fox: The Jewish mother guilt, “You know what you put me through? You better clean your room. After that, you better clean your room.” 


Julie: Yeah, I don’t want it to come across that way at all. I mean, this was totally unprecedented like the whole situation. Right after I came home from the hospital, there was this commercial on. It was, I think, a Facebook commercial and it was this older, like, I don’t know, she was 90-something, 100-year-old lady, and she was talking about how her mom gave birth to her during the pandemic… 


Dr. Fox: The Spanish flu. 


Julie: Yes. Exactly. Every time I watched that commercial, every time I saw it, I just cried. I was like, maybe this could be Sophie one day, you know, just telling the story and just bring, like, awareness to, you know, what life was like and just, kind of, being a part of history in that way. Amazing to think back and look on all that, you know, this is something we went through and she’s not gonna remember any of it. She can tell it to whoever would wanna hear it and I think that’s special. 






Dr. Fox: …hearing it. 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 hrbs@highriskbirthstories.com. If you like today’s podcast, please be sure to check out our “Healthful Woman” podcast as well where I speak with 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 informational and entertainment only and does not replace medical care from your physician. The stories and experiences discussed in our podcasts 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.