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 back to the podcast. For you, you didn’t go anywhere, but for our listeners, they went home for a week and now they’re back to hear part two of your story. We left off right after the birth of your son, which was after a pregnancy that was complicated by growth restriction, induction, like a touch and go labor, but fortunately, a vaginal delivery. And you were saying that he was admitted to the NICU. So, how did that go? And I have a question because last week you said, when he was born, that he was pale. Did they ultimately think he was pale because just for when he was born or was he anemic when he was born?
Devon: He was anemic. Yeah. He also had a small hemorrhage, and he had anemia as well. And then he later had an ultrasound that showed what’s called a grade 1 germinal matrix hemorrhage.
Dr. Fox: Yeah, in the brain. And did they think that that’s why he was anemic?
Devon: That’s what they thought. They thought it was really the…I think that they thought it was the scalp hematoma that he had. But one of those things, I think, was what they thought was causing the anemia.
Dr. Fox: So, not something that preceded labor where his blood got transferred into you. There’s tests for that. I don’t know if you know what I’m talking about.
Devon: No. Yeah. They didn’t mention that as a possibility.
Dr. Fox: God, did he need a blood transfusion? Was he that anemic or no?
Devon: No, he didn’t need one. They were debating that, I think, for a little bit. And they ultimately decided he didn’t need a blood transfusion.
Dr. Fox: A mild anemia, and it just improved with time.
Devon: Mm-hmm.
Dr. Fox: Okay. Good. How did his NICU course go?
Devon: His NICU course was really great. I mean, it was really hard to be discharged before he was. I think it’s sort of a grief that doesn’t… I don’t have many friends who have gone through that experience of you going home and your baby’s not going home. And I think that was hard. But our nurses at the NICU were so amazing, and our doctors, they were…they really kind of were like a soft place for us there and helped us to hold him with all of the cords and everything.
And I just remember, I think that hour in the NICU, right after he was born, like when they wheeled us up to be with him, it was the happiest hour of my life. We were holding him. He was so perfect, and our nurses made sure that we could both do that and we were able to. And, yeah, that was really special. And they also just helped us kind of get into the routine of how to do this. You know, I really wanted to try and breastfeed. His mouth was too small to latch at first. He was born, you know, just 5 pounds. And so, they helped me figure out the whole pumping schedule so that I could…we would, you know, try him at my breast, give him a bottle and then I’d pump every two to three hours around the clock and, you know, got me a shield for breastfeeding support. Yeah. He ended up coming home. It was a shorter experience at the NICU. So, just under a week he was there.
Dr. Fox: Oh. Yeah. That’s great. And you’re right. NICUs, they’re the best. I mean, they’re part intensive care doctors and nurses, part therapists, part doulas. I mean, they’re just unbelievable the range of things that they do and it’s… They really are great. And I think a lot of people have a similar experience that it is both horrifying and horrible, but also these people are great. They’re taking such good care of my baby and they’re helping us and they’re just, you know, friendly and delightful and they’re just…this is what they do. They take care of worrying parents, which is their job. It’s not just the babies. They take care of the parents. There’s no question.
Devon: Exactly. And so positive. I mean, I remember the nurse who’s…I’ll never forget. She was always…she brought so much lightness to the experience where she was making jokes about how my son was…had some serious side eye. You know, she really made a very tough experience a lot better. And the other thing is after I delivered, they sent my placenta for pathology. I remember my doctor saying it was small and it ended up being… I don’t know. I didn’t realize that it has a percentile as well, but it was under fifth percentile or something. And it had…40% was covered in a blood clot, like a hemorrhage or a localized abruption is…I think it’s what they called it.
Dr. Fox: Oh, interesting. I wonder if that’s part of the reason he was anemic.
Devon: Oh, yeah. I think that they…I think that my OB said that that might’ve had something to do with it after, now that you’re saying that. His cord was also really short, I think. It was 15 centimeters long. And so, I think that they were saying that that might have something to do with his anemia as well.
Dr. Fox: All right. Interesting. So, you found that out, but you were not…during labor, you were not bleeding or anything like that as far as you know?
Devon: No. Yeah. When my OB…when I delivered the placenta at my OB, when he looked at the placenta, he was like, let’s [crosstalk 00:05:59] what’s going on.
Dr. Fox: So, now, you’re home, your baby’s home. How are things going? Does it feel like normal yet?
Devon: Yes. I mean, he is wonderful. I mean, it wasn’t easy after coming home at first. For four months, he had an umbilical hernia that became…got stuck essentially and needed surgery. And then at one year, he had surgery for a congenital anomaly in his left thumb. So, he had a tendon transfer surgery. He’s had some developmental delays that we’ve been working through with a physical therapist and OT from that thumb anomaly, and then also some speech therapy. But he’s almost three now. And he’s working so hard. He’s learning new words. He loves trains. He loves going to the park. He loves ice cream. He’s like the best buddy in the world.
Dr. Fox: It’s amazing. How did you do after birth? I mean, you mentioned that during the pregnancy, particularly early in the pregnancy, but continuing, you had what you felt was increased anxiety. And now, you have a baby that went to the NICU and has these things coming up. Was that impacting you in the same way as a mom or was it different?
Devon: Yeah. I mean, I developed pretty severe postpartum anxiety. Yeah. The NICU environment with the monitors and the beeping, it all got into my nervous system. And I could still hear it when I was at home sometimes. I mean, sometimes I still hear it now, but the sleep deprivation made everything worse, and I was pretty hyper vigilant. I think we also…because he was born and was smaller, there was a lot of worry around his…as there is with every baby, around his growth and kind of keeping with his curve. And so, that combined with me really wanting to try to breastfeed, which I think I really wanted to do because I…there had been this part of me that had felt like with the growth restriction, that my body wasn’t a good place for him. And I wanted to try to sort of rewrite that story for myself.
But what I ended up doing was that triple feeding thing where you’re…both trying to nurse and trying to pump every three hours around the clock. I used a nipple shield for over a month, and it was just really hard on our whole family, emotionally. We were doing weighted feeds sometimes, which were a little brutal because every number feels like a verdict.
And eventually, it worked. And eventually, once we started…really, once we started getting a little bit more sleep, which wasn’t until five months, it was really tough. And then as soon as we started to kind of come out of the…a bit of the sleep deprivation, some of those things that were harder, like an early surgery on…at four months old, those seemed like things I could do without, you know, completely crumbling. But I would say it was a tough few months postpartum. I was really lucky that Will is such a great partner, but also that, you know, we have some family close by and good friends. So, there was a real support system for us.
Dr. Fox: Your sister, the OB, is she local? She lives in a different region?
Devon: Well, at the time, she was living in Okinawa. She was an OBGYN, you know, providing services to service members and their partners through the Navy. And now, she’s…
Dr. Fox: Wow. Okinawa.
Devon: Yeah. Now, she’s…
Dr. Fox: Wow. That’s “Karate Kid Part II.”
Devon: Yes. Yeah. She’s planning to…she’s moving up to Boston soon. She’ll be leaving the Navy after her service, and she’s in Boston. So, she was with me by phone during this time, but she came to visit soon after the baby was born.
Dr. Fox: Yeah. And did you…in terms of the postpartum anxiety, was it something that was self-limiting, or did you need to get treated for that, or what kind of support did you have?
Devon: Yes. I did therapy, and I engaged a…had a couple of therapists. And then I also, during my sixth week follow-up, had a conversation with my OB about starting on an SSRI at that point. I think I had…I had a lot of questions about that because of…there was a possible side effect of your baby…some babies being…some of…a side effect of them kind of being more awake in some cases was, like, the simple way that the side effect was explained to me. And I was like, well, that’s the whole problem. He won’t sleep. And so, I was a little nervous about that, but you know, it ended up being…I ended up needing both…the whole combination of things. So, yeah, sleep plus more sleep, which my husband really helped get for me. Therapy, yeah. And medication.
Dr. Fox: So, what’s going on in your head now that you’re thinking of a second one? Because you said that was sort of part of the impetus for you to come on the podcast is because now that’s…all those thoughts are swirling around, like what do I do?
Devon: Yes. Yeah. I mean, I think that…well, we…and we have been…we were in the process of trying, but it’s been a little over, I think, seven or eight months now. And so, we’re actually working with a reproductive endocrinologist now. And I’m feeling…I think having a couple of years of parenthood under my belt and also just loving it so much, I think I… I was told to sort of be a little bit more nervous around the toddler, period. But I’m loving it and I just feel like motherhood and parenthood just kind of keeps getting better. And also, I think I’ve just…it’s really changed me and sort of how I approach everything. But I think when I think about another pregnancy, you know, the thing that I feel like motherhood has taught me the most is how little control you have [crosstalk 00:12:55].
Dr. Fox: Yeah. I was saying, like when you’re talking about…with the nursing that somehow, you know, he was small because your body failed or something in you, and you’re going to fix that after with them. Yeah, that’s such unnecessary guilt. Yeah. You had no control over that, you know?
Devon: Mm-hmm. Yeah. Exactly. And thank you for saying that. I think I just feel a little bit more kind of at peace with what comes next. And I’m so…I feel so lucky that I have my son and would love to…we’d love to grow our family more and have another baby. But I think, also, I’m sort of leaving it up to fate a little bit and doing what I can, you know, working with really skilled health professionals to help us get there. Yeah. But we’ll see.
Dr. Fox: Have you met with your OB or with that MFM about sort of what happened in the last pregnancy and what you might do in an upcoming pregnancy? Are you just waiting until the time comes that you are pregnant to have the conversation?
Devon: Actually, my OB office that I was with, they’ve kind of changed their practice, and they actually don’t do obstetrics anymore. They’re sort of more focused on… And so, their whole model has changed. So, I’ve moved to a different practice. And so, yeah, we’ll kind of have that discussion, I think, you know, if and when I’m able to get pregnant again.
Dr. Fox: Yeah. It makes sense. I mean, because, you know, they’re gonna probably do something different in the next pregnancy compared to the last one, you know, whether…mostly just monitoring to see what’s going on and to see how the baby’s growing over the course of pregnancy. And maybe they’ll run some tests, maybe not. Who really knows?
But, you know, it’s interesting what you said about maybe having less anxiety moving forward because of, you know, motherhood and just your experiences. And, you know, so fascinating because when people have anything happen in their first pregnancy, whether it’s minor, major, whatever it is, and then the next pregnancy rolls around, there’s so many different ways that can go. And it’s somewhat unpredictable. Some people can have less anxiety because they sort of…they’ve done this before. They sort of understand it a little better. There’s less of the, you know, black box type of thing, uncertainty. And for others, that’s the opposite. They have a lot more anxiety because of what happened last time and they’re worried it’s gonna happen again and this and everything in between.
And so, it really is interesting to see that you…you know, you feel like it’s gonna be less for you. And it may not be. You don’t know, obviously, until you’re in it. But just that that’s sort of the impression. And that’s certainly a real possibility and it would be awesome if it’s just like a much, I guess, easier or less anxiety provoking pregnancy for you because of the experiences you have.
Devon: I think it’s also that I just have…I feel like I’ll have a little bit more confidence that I can make a decision in the moment that I feel good about, compared to how I did in my…in that prior pregnancy. I think that I felt very…because I hadn’t gone through it before, because of, I think, kind of…still at the…at least in the very beginning, still grieving the first miscarriage, I just felt very off kilter in terms of being able to really just trust that I would be able to make a good decision, you know, in the moment or I trusted my team and my…the clinicians in my team and my doctor. But I didn’t have, I think, as much sort of groundedness in my own instincts.
I do think that one thing that I…there are moments during…especially during my delivery and in the kind of later part of my pregnancy where I did trust my gut. I asked to go back at 36 weeks to see my MFM again because something had felt off to me and… They weren’t dramatic moments. They were just these sort of small decisions where I listened to something inside of myself and acted on it. But I think I just have a little bit more confidence that I have that trust in myself and that agency. So, even if I feel like I want more scans, I want, you know, whatever else, that I’ll actually be able to kind of ask for that and act on it in a way that might have been different than the time before.
Dr. Fox: Yeah. I think that all makes a lot of sense. And, you know, this, A, just experience in life gives you some of that confidence and, obviously, specifically related to pregnancy, you know, decisions you made and sort of the way you see things play out gives you that confidence as well. And that could really be…it could be really reassuring. How would you…if, let’s say, someone were coming to you for advice and there are no kids, it’s their first time, they’re about to get pregnant or early pregnancy, how would you transfer that, what you’ve learned for yourself? How would you transfer that to somebody else who hasn’t been through that? Can you? Is that something that can be done? Is there advice you could give someone that would help them that they wouldn’t need to sort of go through it themselves? Or similarly, if someone…if you could go back in time and have someone give you advice about how to, you know, think about pregnancy back before either your first miscarriage or at the beginning of that second pregnancy, what do you think might be helpful?
Devon: Yeah. And people say it a lot. We were just kind of talking about it. But I do think one thing is if someone told me, like, trust your gut and sort of enlist help in asking…you know, Will came to a lot of appointments with me. I’m lucky that I have a partner in pregnancy that could help in those moments. And my sister, you know, to sort of help gut check some of the things I was concerned about. I think that would be one thing is to…if someone were to say, you know, really listen to yourself and ask the questions that you have, I think that would be one thing.
I think the other thing around asking for help…I mean, one thing that, in my first pregnancy, I didn’t do as much of was, you know, I had…we had our doctors and nurses and my doula and my sister, but I think that I…so, I kind of built this system, these systems for support, but then there’s also accepting that help as well. And sort of allowing yourself…I’m a firstborn daughter. So, it doesn’t come super naturally to me. But there’s actually sort of letting people show up for you. And I think, the more sort of ease you allow yourself with being helped by the people around you, it takes a lot of weight off and sort of gives you space to ask…to listen to yourself and ask those questions. I think it’s also just a good lesson for parenthood to accept help, too, [crosstalk 00:21:21] during your pregnancy. It’s a good step.
Dr. Fox: It’s a good lesson in life. I mean, it’s not…it’s…obviously, these are big moments, you know, pregnancy, parenthood, but just in life, that’s really good advice. Awesome. Devon, I really appreciate it. Thank you. Thank you for sharing your story. Thank you for sharing your insight, your wisdom. Thank you for listening to the podcast, first of all. Appreciate that.
Devon: Oh. Thank you. Yeah. Thank you so much for making the podcast for me and for all of the other listeners. It’s such a…it’s honestly such a gift for someone like me who has, you know, who I said…you know, more information is better. It’s also been something that’s really inspired me. I mean, listening to the podcast and also sort of, you know, watching the nurses and doctors with my son, it’s really inspired me. I’ve been in public health, but I’m now taking prerequisites and planning to apply to nursing school. Because I want to work in pediatrics. So, anyway, thank you so much for everything.
Dr. Fox: Oh, my God. That’s amazing. All right. Look at that. Does anyone know this? Are you just dropping out in public for the first time?
Devon: No, I’ve been taking the prerequisite. A lot of people…my work knows, everyone knows. So, all good.
Dr. Fox: Oh. That’s so cool. All right. Well, listen, I look forward to having you back as Nurse Devon to talk about something…some nursing-related medical topic or whatnot. That’d be awesome.
Devon: Oh, wonderful. That’d be so great. Yeah. Maybe I’ll see you at Mount Sinai.
Dr. Fox: Thank you so much. I really appreciate it. Thanks for volunteering and telling us just a great story.
Devon: Thank you.
Dr. Fox: 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.
