Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.
Devon, welcome to the podcast. How are you doing today?
Devon: I’m doing well. Thanks. I’m very excited to talk to you now. I’ve been listening to the podcast for, I think, over four years. So, I’m a big fan.
Dr. Fox: Amazing. Well, I appreciate that. Thank you for listening, and thank you for reaching out and volunteering. I always ask people who do this. What made you reach out to tell your story?
Devon: Oh, it’s a good question. My husband and I are actually thinking [inaudible 00:00:48] second baby now. And there are things about what happened the first time that I’m still trying to understand, sort of turning over. I don’t think that really ever goes…fully goes away for a lot of people. But I think the other reason is that I learned so much from other women sharing their stories, like on this podcast, from friends, from women who are willing to be really honest about what their experience was and say like, here’s what happened to me, here’s what was hard, here’s what I didn’t understand. And I personally found those stories really useful, not just emotionally, but practically in terms of knowing what questions to ask, what to pay attention to, and what I might do differently.
So, I guess I just wanted to do the same thing. And if someone were to hear this and it helps them ask a question that they wouldn’t have asked or trust something that they were feeling or just feel, I guess, alone…less alone and something hard, then that’s sort of why I’m here. I wanted to do it.
Dr. Fox: Amazing. Well, I appreciate it. And I’m sure my listeners do. So, I guess, give us a sense of going into your first pregnancy and we’ll start there. Who you are, where you are, where you are in life, like what’s going on, just so we get sort of a flavor of who is Devon.
Devon: Okay. Great. Yeah. I’m 36 years old now. At the time, it was three plus years ago. But I’m from Washington, DC, originally. I have ended up back here with my husband, Will. I work for an international public health organization, primarily in sub-Saharan Africa and Southeast Asia to expand access to quality care for women and newborns.
Dr. Fox: Great. Wow.
Devon: Yeah. I started out first in contraceptive access and safe abortion access. And over time, it shifted for newborn health. And so, right now, I’m spending a lot of time on making affordable caffeine citrate available for preterm newborns and congenital syphilis elimination to prevent stillbirth. So, I’ve been working… Yeah. That’s sort of where I’m coming from. In terms of a pregnancy standpoint, my husband and I, soon after we got married, we started trying to have a family. We’ve known each other for years. We actually dated in high school briefly, and then had a long break and…about a decade break, friendship and then kind of reconnected, lived together during COVID, got married and then were ready to start trying to build our family.
Dr. Fox: So, how did your first pregnancy go?
Devon: Yeah. We started trying to get pregnant in the summer of 2022, and I got pregnant after a few months and was really excited. I surprised Will with a card. I did the whole thing. And then in October, my grandmother was sick and I flew out to be with her in Michigan. And while I was there, I started bleeding and pretty soon realized I was having a miscarriage. And it was really sad. I knew it was normal. I knew it could happen, and it was relatively early, but I was pretty devastated.
Dr. Fox: Did you have to seek care in Michigan or did it just sort of all happen where you were staying or…
Devon: The closest thing I got to seeking care was calling my sister who’s an OBGYN.
Dr. Fox: Oh, all right. There we go. Plot twist. Sister is an OBGYN.
Devon: Yes. So, I called her. She kind of said, if you start bleeding, start filling up more than pads and then you should seek care. But that didn’t end up happening. So, I was able to kind of go through the miscarriage without additional care.
Dr. Fox: But it was just you? You were alone? I mean, Will was not with you.
Devon: Yeah. Will was there. He was with me in Michigan, but I think we were both kind of unsure about what was happening. And he was a huge support to me, but emotionally. And then I think he also kind of had his own experience of sadness sort of after I went through mine. He was kind of there supporting me. And then, yeah, we both were pretty devastated with something we’d been hoping for, and we were pretty sad when the pregnancy ended.
Dr. Fox: Yeah. But as you told me offline, you got pregnant pretty quickly thereafter.
Devon: Yes. It was sort of a surprise. I got pregnant the next month in November. I was really happy, but I was also just…I was a lot more nervous, I think, at the very beginning of the pregnancy, more guarded and anxious. I found it very hard to relax about my pregnancy. I wanted to have an appointment right away. And I also hadn’t had a period in between. So, I think I had kind of a question about whether, you know, gestational dating would be trickier.
Dr. Fox: Right. Did you ever even have a negative pregnancy test or went sort of just positive to positive?
Devon: It went positive to positive.
Dr. Fox: Yeah.
Devon: It was a little trickier. My OB then shared that, yeah, my baby’s due date was August 10th, and we kind of moved. There was a little bit of a question about it at the time.
Dr. Fox: Yeah. I mean, because it’s…we sort of traditionally use the first day of the last period. But if you had a miscarriage, it’s not going to be accurate to sort of predict when you’re going to, you know, ovulate and conceive and stuff like that. So, probably they just had to wait until the first time they could measure the baby on ultrasound with the heartbeat and sort of say, okay, based on this, we’re going to, you know, extrapolate, and this is how far pregnant you are, and this is when you’re due and all that. So, I imagine, probably had to wait until that happened to get a solid due date.
Devon: Exactly. Yeah.
Dr. Fox: So, you’re pregnant, right? This one, you know, there’s a heartbeat and it looks okay. You’re just coming off a miscarriage. Was it very emotional? Were you mostly joyous, anxious, a mixture of both? How was that first trimester for you, A, in general and B, the fact that you were just coming off a miscarriage?
Devon: Yeah. I was pretty anxious, I think. It was a mixture. I mean, I was really happy, but I kind of felt this urgency to sort of build a little bit more support for myself. So, I ended up working with a doula. I wanted someone who was going to be really comfortable and collaborative with my clinical team. And so, it was like, that was a really high priority for me. And it just…yeah. I would just say it took me a little while to relax. I was working with her. I was talking with my sister a lot. I was listening to this podcast and reading a lot. And I think those things started to help me relax a bit. I know some people feel really differently about this. For me, I’m more of like a more information is better person.
As things kind of continued smoother through the first trimester…to be smooth through the first…most of the first trimester, I was…I started to kind of relax a bit more. But I would say I was pretty anxious, and I was still feeling some grief into the first couple of months. And the nausea really didn’t help.
Dr. Fox: That makes sense. How did it go when you sort of got into this second trimester and this sort of…you know, at that point, it’s usually not 100%, but it’s pretty clear that, you know, you’re not going to miscarry, and things are going okay. Did it reduce your anxiety or did it just sort of shift to new things that could come up in the second or third trimester?
Devon: Yeah. It reduced my anxiety quite a bit because things were relatively smooth for me until about like 20, 21 weeks. And so, I was doing all the things to prepare that were fun, like thinking about the nursery and that type of thing. And I was kind of…I was sort of feeling all the symptoms of pregnancy and feeling really grateful for those symptoms. And that was…I mean, up until around 21 weeks, I was…I would say that I was just kind of…I would get most anxious, I think, getting ready to go into appointments. I would always bring…make sure Will was with me. And I was waiting to hear a heartbeat and feeling really anxious right before appointments. And then kind of after the appointment, I’d have a little bit of a period of feeling some relief.
Dr. Fox: Yeah. Did the fact you’re not in medicine, but you work sort of in that world related to newborn outcomes and this, did that make it better for you? Did it make it worse for you? Was it sort of a parallel track that didn’t have much to do with your pregnancy?
Devon: Yeah. I think it definitely impacted sort of some of my anxiety. That, plus, you know, during my sister’s residency, she and I lived together. And so, I kind of had a front row seat…
Dr. Fox: You get all the stories. Oh, my God. Yeah. That’s not good.
Devon: …to what she’s experienced. And so, yeah. I’m not a clinical person, but was definitely…I think it was always top of mind for me, all of the various things that could go wrong. And I definitely, I think, let myself sort of spiral a bit. Especially after the first miscarriage, I think that really sort of set a tone, I think, for my pregnancy, with my baby.
Dr. Fox: Okay. So, what ended up happening? Because you said everything was okay until 20, 21 weeks. So, what happened after that point?
Devon: Yes. I was at a routine visit when my OB looked like a little bit puzzled. And that’s…
Dr. Fox: That’s always reassuring.
Devon: Yeah, reassuring.
Dr. Fox: Huh. I wonder what’s going on with you here.
Devon: Yeah. She referred me to…she said she wanted to refer me to a maternal fetal medicine specialist because my baby’s measurements were a little low. I was looking small, essentially, as well. And at the MFM, his estimated weight was at 19th percentile, abdominal circumference was like at 17th percentile. And so, my MFM said, I actually…she was like, I don’t think you need to come back, which I took as a really good sign. But then at 32 weeks, my normal OB was still concerned. And so, she asked me to do another visit with the MFM. She had measured the baby. I think it was at 10th percentile for weight and 3rd percentile for abdominal circumference. And then the MFM, that same day, measured him and it was a much higher. So, like, 19th and 13th percentile. It was quite different.
Dr. Fox: Oh, interesting. All right.
Devon: And so, she said again that, you know, I didn’t…she didn’t think I needed to come back, but I could if I wanted a repeat growth assessment, and I could wait four weeks to do it. But I asked to come back. And I think the differences in the measurement is just something sort of felt a little off to me or made me nervous. And so, I just asked to come back at 36 weeks.
Dr. Fox: Okay. So, what happened?
Devon: At that point, there was actually some cause for concern. So, at that point, at 36 weeks, his weight was at fifth percentile and his abdominal circumference was below first.
Dr. Fox: Okay. Same MFM?
Devon: Yes.
Dr. Fox: Yeah. Okay.
Devon: Yes. Yeah. So, I had gone back to the MFM after a few…after the four weeks that she’d asked me to hold off on. And I had… And she told me that I had IUGR, fetal growth restriction and that also given his umbilical blood flow and he had lower amniotic fluid and I needed to deliver immediately.
Dr. Fox: Oh. So, same day [crosstalk 00:13:26] the hospital.
Devon: Well, she actually…it was July in DC. It was really hot and the hospital’s air conditioning was broken. So, she told me it was okay to go home for the night and come back first thing in the morning because they were getting the air conditioning fixed. And so, she was like, you have to come back. You have to promise me you’ll come back first thing in the morning. So, I went home knowing I’d be induced the next day. It was like, go home, pack a bag. You’re having a baby tomorrow.
Dr. Fox: Okay. All right. So, what’s going on in your mind at that time? Was it a lot of worry or…
Devon: I mean, I think that there was a part of me that was in a little bit of shock and disbelief. I don’t think I really understood, you know, what fetal growth restriction could mean for my baby. I thought he was small because, you know, I’d gone to a couple of appointments where they’re like, he’s smaller, but he’s like…he’s sort of on…he’s fine. Everything’s okay. And I remember asking her, my MFM…we’ve had concert tickets for the next week. And I was like, oh, could we schedule my induction after that? And she sort of looked at me, you know, eyes wide and was like, no, I don’t think you’re fully appreciating that. So, we were…
Dr. Fox: What concert?
Devon: It was a Jenny Lewis concert. And it was at a small venue, but it was a new venue that had just opened in DC. And they had, you know, arranged for me to have a chair at the concert. Because I was…yes. I had been pretty excited about it, but you know, having a baby was a good consolation.
Dr. Fox: Got it. Okay. All right. How did the induction go?
Devon: Well, I came back in the morning, and they started me on CERVIDIL. And I started getting contractions just a couple hours later.
Dr. Fox: Was your doula with you?
Devon: Not at this point. [crosstalk 00:15:44].
Dr. Fox: Got it. But she was planning on coming when things got…
Devon: Exactly. It got a little bit more active. For me, though, the night…at night, things got somewhat intense. I was having back to back contractions, sometimes five in a row. And my son’s heart rate just kept decelerating. So, the nurses came running in to check the monitors over and over again. And so, at around…I remember it was close to midnight. They removed the CERVIDIL early, and did some cervical checks which were very, very uncomfortable.
Dr. Fox: No epidural?
Devon: No epidural.
Dr. Fox: Okay.
Devon: Yeah.
Dr. Fox: Was that the plan or were you just waiting till a certain time to get it?
Devon: Yeah. I was just waiting until… I was waiting. I thought that I would wait until I was kind of further along in my labor just so I could try and keep moving. But then at that point, I called my doula, I also called my sister. And with my sister, I was talking through a bit more about what I wanted to do because we were planning to start Pitocin. And I was asking if I could just rest for a few hours before we did that. And they said that was okay. It was okay for me to just take a break before starting Pitocin.
Dr. Fox: Yeah.
Devon: So, Will slept. I didn’t. I was laying there listening to my son’s heartbeat. But the other thing I was…had been talking with my sister about was, I was born via emergency C-section, and I originally wanted to try and go as far as I could before getting my epidural. But my sister…with the decelerations, if I needed an emergency C-section and I didn’t have an epidural, I’d go under general anesthesia. And I was really nervous about that. So, I decided to start my epidural before starting Pitocin just right before doing that.
Dr. Fox: That makes sense. Also, it’s going to…when they start the Pitocin, it’s going to hurt more. So, it’s a good time to get an epidural. Okay.
Devon: Yeah. So, I got my epidural around 4 in the morning and then at 9 a.m. and then they started Pitocin. At 9 a.m., my new doctor came in and checked on me, and I was only 1 centimeter dilated. And she recommended breaking my water. I remember asking her about a balloon catheter, and she’d said that my cervix was too thin. She was worried it could tear. And so, she broke my water instead. I just remember being kind of confused about that because of the lower fluid that…my MFM had told me he had. So, I was curious, I guess, about why.
Dr. Fox: About breaking the water?
Devon: Yeah.
Dr. Fox: Yeah. It’s a good question and people do it very differently. There isn’t one way to practice. I mean, ultimately, when we’re inducing someone’s labor, there’s a lot of things that we can do and there’s different options, but really one of the mainstays that’s going to help people go into labor is getting to the point where you can break their water. And so, if they’re already…if someone’s coming in, they’re already 2 or 3 centimeters dilated, usually, we just start Pitocin, break their water and they go into labor. If their cervix is closed, you can’t break their water. Technically, you can’t break their water. And so, either people use something like CERVIDIL, which is a prostaglandin. There’s another one called Cytotec or misoprostol. Sometimes people use the balloon to get the cervix open.
But once those are sort of done and the cervix is open and you’re on Pitocin, generally, you’re going to break the water unless you think someone needs more of those things before you break the water. So, if your cervix is 1 centimeter dilated, you technically can break the water physically. And whether it’s worth doing more of those medications first sometimes depends on how low the head is, sometimes depends on how thin the cervix is. I guess they were saying, since it’s thin, I guess that means it’s very effaced. I don’t know if the balloon would have been dangerous to put in, but if your cervix is already very thin and 1 centimeter, once you break the water, you should most likely just go into labor.
In terms of your question about breaking the water in the setting when the water is low, when the fluid is low towards the end of pregnancy, the concern is predominantly not, oh, the baby is living in an environment with low water. The concern is why is the water low? And if your water bag is not broken, we say your membranes are intact and the water is low, the concern is maybe it’s because the baby’s not peeing so much. Amniotic fluid is baby pee and maybe it’s because the baby’s not getting enough to “drink” through the placenta. So, it could be a sign of the placenta not working well, similar to a baby being small, similar to the abnormal blood flow.
So, the thought process is, I’m assuming, you know, without seeing the numbers, my assumption is when they saw you at 36 weeks, like, hey, the baby’s measuring small, but on top of that, the blood flow looks abnormal, the fluid looks low. This isn’t just run of the mill small baby. This is probably a problem with the placenta. So, we need to deliver. So, that’s sort of the concern about the fluid being low. But anybody who’s in labor when their water breaks either on its own or we break it, the baby’s living in an environment with low fluid. And we don’t really worry about that in labor, so to speak. There can be some consequences. Sometimes you’ll get cord compression and the heart rate can drop, but it’s going to happen at some point anyways. And so, usually, you’re balancing, do I want to keep the water bag intact? Do I want to break the water? But if you’re trying to do someone…pretty much…you know, these aren’t hard and fast rules. But pretty much you’re going to break the water because it’s going to be the thing that’s going to put you into labor.
Devon: Got it. Okay.
Dr. Fox: Does that make sense?
Devon: Yes.
Dr. Fox: All right. There we go. Answered questions.
Devon: Love it. Yeah. So, I labored most of that day. And the decelerations kept happening, but he kept bouncing back. But later in the afternoon, they lasted a little longer. So, my doctor came back in, checked on me, and I was, I think, 2 to 3 centimeters. And at that point, she stopped the Pitocin and she placed an internal monitor and then ordered an amnioinfusion.
Dr. Fox: Yeah. That’s to put water back in. [inaudible 00:22:53]. Just what I was saying, when the cord gets compressed sometimes you can sort of, okay, now, we’re going to squirt some water back in the uterus to sort of relieve pressure on the umbilical cord. And so, sometimes when that’s happening, we’re thinking maybe there’s a cord around the baby’s neck or maybe there’s a cord stuck between the shoulder and the uterus…not your shoulder, the baby’s shoulder. And if you put some more fluid in, it sort of cushions that and reduces the chance of the cord getting compressed with each contraction. So, that’s a pretty common thing to do if there’s certain type of decelerations in early labor.
Devon: Got it. And then, yeah, they started slowly restarting Pitocin after that. And then my doula came around a little while after. And even with the epidural, she had me moving on the bed. So, lots of repositioning. And my new doctor who came on after shift change, who was the doctor who ended up delivering me, came in to meet me. I remember he met me and I was on all fours. I had my back to him. So, it’s kind of a funny way to meet someone. But I just remember that period, once I kind of felt him stabilize a little bit, it was like… I mean, Will actually told me this, that it was really kind of the calmest and maybe most focused he’d ever seen me. And so, it was… It just felt like there’s something kind of settled for a little bit during that period. And then I know my doctor, he ran another amnioinfusion and then he sort of ordered continuous fluid up until I started feeling the really intense pressure. And my doula and nurse called our doctor, and he came to check on me. And I think it was just…been like six or seven hours just before 11 p.m. And I was fully dilated.
Dr. Fox: Wow. Great.
Devon: I will never forget that moment because I just remember locking eyes with my doula. And I was just like, this is happening. [crosstalk 00:25:10]. Let’s go. I mean, his heart rate just dropped sort of right away at my first push. And I had… They sort of assembled the NICU team. There was suddenly a lot of people in the room. And I did, I think, six rounds of pushing of three pushes each, and his heart rate kept dropping. I kind of started to hear some urgency in my doctor’s voice. I just remember…I think I ended up popping every blood vessel in my face and chest. And I pushed out in, like, seven minutes. I was just feeling very urgent to get him into the world.
Dr. Fox: Yeah. That’s quick. That’s not a long time pushing for first babies. I mean, it helps to have a small baby. Geometry is on your side there, but that’s still quick. That’s good work. Strong work.
Devon: Thank you. Thank you. When he was delivered, though, his umbilical cord was wrapped super tight around his neck. It was one loop tight. And…
Dr. Fox: They probably were not surprised, I assume.
Devon: Yes. They cut it immediately. They put him on my chest for 30 seconds. I just remember he was so pale and, you know, his Apgar scores were…I think it was three at one minute and six at five, and he wasn’t breathing well. And so, they came and took him right away and started the positive pressure ventilation until he started breathing on his own. I think he started breathing at two and a half minutes. And I just remember he started crying a little bit, just a little. And Will and I could breathe as well. We’re holding our breaths. And so, it was a bit of a scary moment, but I just remember that the NICU doctor came up to me while they were working with him and was like just…talking me through everything. And was just super, super kind. I’ll never forget. It felt really important to hear after knowing that my baby had fetal growth restriction. But she said, the best thing for him right now is you. And she had me do a little bit more skin to skin with him before they took him to the NICU, which was great. I was really happy I was able to do that.
Dr. Fox: That’s amazing. Devon, what I think we’re going to do is actually we’re going to pause here and we’re going to continue with part two of your story in next week’s podcast. So, everyone, thank you for listening. And stay tuned next week for part two of Devon’s story.
Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.
The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.
