“Gabrielle’s Story, Part 2: VBAC in the Big City” – with Gabrielle Moskovitz LSW, LMSW

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 OB-GYN 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. All right, Gabrielle, welcome back to the podcast. Last week for our listeners or 30 seconds ago for me and you, we heard about the beginning of your story, who you are, what you do, and your first 4 pregnancies. Again, your two children and your two miscarriages, and with your son Caleb, sort of the more eventful pregnancy. And when we left it last week, you and me and Jake, we decided you’re coming to the city. You’re going to be seeing us.

Gabrielle: Correct.

Dr. Fox: We’re taking care of you. We’re going to make this happen. We just, this is in the story, had a very, very long conversation about the plan for this pregnancy. So, what was your mindset going into this pregnancy? Did you feel very terrified? Did you feel very confident? Did you feel very sort of, like, “How am I going to do this logistically?” What’s going on swirling around in your brain at that time?

Gabrielle: So, a lot of different things. I would say, again, the main feeling was anxiety. When I had my first miscarriage, I was like, “Okay.” Like, it was really, really bad. But I was like, “I feel like everyone has like one miscarriage.” So, I was kind of able to process that. And when I had the second miscarriage, I’m like, “No, you don’t get struck with like two bad luck.” So, this time I was like, “There’s no way I could have a third, but maybe I could.” Like, there is a higher incidence rate with women with PCOS for miscarriages. So, I did come in, to your office, like, anxious every time I had a scan. I also was trying to, like, get over my fear of driving into the city. So, logistically, it was definitely, difficult, but now I’m not scared to drive to the city. So, that’s odd.

Dr. Fox: Look at that, we cured something. All right.

Gabrielle: Exactly.

Dr. Fox: A little with, what do you call this exposure therapy?

Gabrielle: Exposure therapy. Exactly. I did it on myself. So, that was a good part. But I remember being in your office and meeting with a bunch of different doctors and saying, “Even if this all goes wrong, I’m in the best possible place to deal with it.” So, that definitely, gave me reassurance. Every doctor I met was compassionate. Everybody was really, really good with my anxiety. They were pretty reassuring. And so I just felt like I was in good hands. So, like, no matter what the outcome would be, I knew I would be taken care of.

Dr. Fox: Well, that’s nice. How did Jake feel about all this? Because he’s a doctor and we’re always, you know, skeptical of other doctors.

Gabrielle: I think at first he was like, “Why are you schlepping to the city? Like, that’s crazy.” But then he’s very economical. So, he was like, “They’re tier one insurance. They’re in the Mount Sinai Network. Yeah, definitely. Let’s go to them.” Especially when he found out…

Dr. Fox: Tell him…

Gabrielle: …that our birth would be, I think, $100 total. So, he was like logistically on board once that happened. And…

Dr. Fox: He…

Gabrielle: …also I think he met you.

Dr. Fox: …said “Baby, just Uber to the city. It’s all good.”

Gabrielle: Yeah, exactly. So, I don’t have other Ubers. He met you on that first consultation. And I remember when we left, he said, “Like, you have to go to him. Like, this is the doctor for you. Like, you need somebody that you could, you know, text or call.” Like, I almost felt like I had like a concierge medicine service with you guys or specifically with you, Nathy, where I remember like texting you. You would answer within like 10 minutes. Like, I just felt like I always had that support, even when I wasn’t physically in your office. And so for me, that like he saw that and he saw that I was handling the anxiety a lot better. And so he was like, “This was absolutely the right decision for you.” And especially there came a point in the pregnancy when they found that I had higher levels of fluid. And I remember I was at the appointment by myself and I just called Jake and in 10 minutes he walked over. So, also made it, like, the right decision.

Dr. Fox: Yeah, no, it did work out sort of coincidentally that your prenatal care and delivery were like right where he was. Because, like you say, when you’re a resident, you’re always busy. Like, it’s crazy. But to be right next to where he is, he could, you know, run off and, you know, go and see you and come back and didn’t have to. It would have been harder for him to do that if you were in New Jersey, ironically, to go figure. So, how did the pregnancy go?

Gabrielle: You tell me.

Dr. Fox: I know the answer to all these questions, but our listeners don’t.

Gabrielle: Very eventful, I would say. It wasn’t eventful in the beginning. I would say around 14 weeks. I think you guys recommended that I get the diabetes test early because I do have PCOS. And so we did the test and I didn’t think anything of it. I never had diabetes in my other pregnancies. Like, I knew people that had it, but it just wasn’t even in my mind. And I remember Jake and I were away. We went away, Upstate New York and we got a call from Dr. Shalansky. And I’m like, “This is not good when doctors call you.” And the reception was so poor, so I could barely hear her. It was like breaking up. But what I did hear was, like, “I’m so sorry, but you have gestational diabetes.” And I was a wreck, as you remember. I was like, “But what do you mean? If I failed the first hour, why can’t I just take the three-hour one like everyone else?” And it was a fight with all of you guys. I was trying to advocate. I’m like, “I can’t have diabetes. Like, why?” And I did end up doing the three-hour one. But it was still your practice as a recommendation for me to be treated, like, I had diabetes because of the size of the baby. The baby was measuring like 99 plus percentile and also because my ultimate goal was to have a VBAC. And so you really, really were trying to let me have that goal happen. And so we treated it as though we did have diabetes and I had to do the finger pricks every single day, three times a day. And I ended up having to also do insulin shots at night because my fasting levels were still high.

Dr. Fox: Was that troublesome to you logistically or more sort of like just accepting the fact that you had another diagnosis on top of all the other stuff that’s going on with you?

Gabrielle: I think at first it was logistically because I’m kind of scream-ish. I don’t like a lot of blood. So, that was hard to like…

Dr. Fox: Exposure therapy, maybe another one.

Gabrielle: Yeah, exactly.

Dr. Fox: Currently, we killed that one.

Gabrielle: That was really hard.

Dr. Fox: You don’t like needles? How about you stick six of them in you a day? All right.

Gabrielle: Yeah. Exactly. And the shots are also kind of freaky. But I think what you’re saying is, I think for me it was like I can’t catch a break. I finally get pregnant naturally, and then I have a miscarriage. And I finally then I get pregnant, actually, a second time, and there’s all these complications. So, that was really frustrating. I think that part was definitely harder for me.

Dr. Fox: Yeah. I mean, as I recall, I probably was trying to spin it that like, “Okay. Right. Yeah, it kind of sucks that you have this. But on the other hand, since we know about this, we can control your sugars and the baby won’t be huge and you’ll have a higher chance of a VBAC compared to like sort of having your head in the sand with this.” This is going to end with a positive thing. You know, start with a negative, end with a positive, that kind of thing. Yeah, I know that worked, but that’s the spin. I mean, it’s true. You know, I’m not trying to sell you something, but it’s true. Like, listen, you’d rather not have it. But if you have it and you could be totally on top of it, you’re going to likely prevent something that’s going to lead to not having a VBAC.

Gabrielle: Exactly. So, that was when I was really upset about it. I would just kind of try to envision the word VBAC, which sounds weird, but I would just try to envision that like having this baby vaginally. And that sort of like helped me get through all of the annoyances of having diabetes. And, yeah, that was complication number one.

Dr. Fox: I guess we never actually touched on this. Why? I mean, I know the answer. But why was VBAC so important to you? Because it was. Obviously, you’re not nuts, you would have a C-section if you needed one. But why was VBAC such a big goal of yours in that pregnancy?

Gabrielle: I think it was because I had a vaginal already. I think it’s different if you never had a vaginal and you had a C-section. I knew what the vaginal recovery was like. I was up and at it, like, three days after Noah’s birth. I was fine. I recovered really well. And a part of me also again, I have this issue with control. And so I felt like I couldn’t control the C-section. This baby was taken out of my body without me doing anything. I like the control aspect of I have to push when it’s a vaginal delivery. Like, I’m sort of in the driver’s seat in a sense. And so I think for those two reasons, like, VBAC was so important. But it was also like, I had two little kids at home and I couldn’t do the C-section recovery again, knowing what it was like. I didn’t have the time for it [inaudible 00:09:17].

Dr. Fox: I mean, it’s so interesting. I mean, both of those are interesting. Definitely, you know, the recovery with a successful VBAC is easier than the C-section. I don’t think your C-section recovery had you needed one, would have been as hard because it probably would have been scheduled. It was a little bit different than showing up bleeding and then labor, all this. Okay, but I think that interestingly, the control aspect and listen, this is, you know, your world. You talk about control with people every day, obviously. It’s really fascinating because if you think about it. You know, you had this loss of control with your delivery and you’re trying to sort of like regain control with your VBAC. But in order to do that, the exact same thing had to happen. You had to lose control in getting this diagnosis of diabetes and then take control of it by… You know, when you have diabetes, you’re checking your finger six four times a day and giving yourself insulin. It’s like perfect for people who love to control the situation. You know, it’s like back and forth. It’s like push and pull of like losing and regaining control. Well, I never actually thought of that parallel. I like that. It’s pretty good.

Gabrielle: Yeah, I feel like you could be a psychiatrist because that’s pretty deep for me to think of.

Dr. Fox: We call it in our business, gynecaetry.

Gabrielle: Yeah, along that.

Dr. Fox: There’s a lot of that goes on in our world.

Gabrielle: Really?

Dr. Fox: Fascinating. All right. So, here we go. So, you got the diabetes. You’re doing the finger six. You’re doing the insulin. You’re going for VBAC.

Gabrielle: We’re going for VBAC. And then I hit I think it was around 24 weeks and everything was fine. And I hit the 24-week, I went in for an ultrasound and they said that there was high levels of amniotic fluid. So, I got called into the doctor’s office and sat down with me. And she started honestly with like all of those bad news that it could be. So, I was told, you know, high fluid can indicate musculoskeletal issues with the fetus where they might have trouble swallowing, eventually. Or it could also be that you have diabetes and that the baby is getting more sugar. And so their baby is peeing more and there’s more urine. And so there’s more fluid. But, of course, like being told the bad news first, like I was harboring on that one. And I remember being in shock and I’m like, “Another thing like why?” So, she told me, “You know, you’re just going to have to come back, like, weekly ultrasounds.” And I’m like, “Great. I haven’t been to the city enough. I need to get a parking garage by your office and move in basically.”

And I called Jake immediately and was, like, hysterical. And I said, like, “You need to come meet me.” And that’s why it was so great, because like, I think 12 minutes later, he was in the office and we met with another doctor upstairs who was super reassuring. Dr. Bender, he was awesome. And he was very, very chill about the situation and sort of said, like, “It makes sense that you have this because of the diabetes. Like, it often goes hand in hand.” And I also remember calling you that evening and I’m like, “Dr. Fox, can you please talk me down or talk me off this ledge?” And you’re like, “Yeah, that’s my job. I’d love to.” And you did. And you were also pretty reassuring about it. But it was just hard because it was like another thing and another diagnosis and another reason that I had to come to the doctor once a week. So, every week when I would go in for the scan, I would be, like, nervous. And then they would say, “There’s still high fluid. It’s a little less.” And then I think, like, maybe five or six weeks later, it resolved actually. And the fluid was back to normal. So, that was great.

Dr. Fox: Which makes sense because diabetes was also better controlled by that time. You know, it takes some time to get those sugars and the effects of the sugar sort of out of your system. So, all good.

Gabrielle: Yeah, all good.

Dr. Fox: All good. It was going great.

Gabrielle: That was the end of I think that. No, actually, then one more thing happened. The baby kept measuring big, like 99 plus percentile. And I remember around 34 weeks, I went in for my weekly ultrasound, and the doctor that came in… She actually didn’t even come in. Like, somebody had called her on the speakerphone to go over the ultrasound result. And she said to me, “The baby’s really, really, really big still. I think we’re going to have to do a C-section.” And I obviously, like panicked. I called you. I drove straight from your office to a jewelry store and bought myself a bracelet because I was like, “I’m having a C-section. I need a present.” And I’m wearing it right now. So…

Dr. Fox: I deserve this.

Gabrielle: Yeah, I deserve this. So, I was distraught. And I remember speaking to you about it. And you said, like, “Listen, like you’re one of the patients that we’re talking about at our next meeting with all the doctors. Like, we’re going to really go in-depth about it and like, I’ll keep you posted.” And you did. And I think around like 36 weeks, we had an appointment with you. And you said, like, “Let’s do this. Like, let’s do the VBAC. Like, let’s try for it.” And that was one of the best days of my pregnancy. And I just felt like I could breathe again. And, like, hopefully, there’s no more hiccups in this story.

Dr. Fox: It’s interesting, it’s almost ironic because, you know, when to deliver someone is a very complicated topic in your balance and not too early, not too late, whatever. But because of your prior delivery with the abruption at 36 weeks, one of our big fears is that’s going to happen again, because, you know, thank God you had a healthy baby. But abruptions could be a real disaster. And so it’s always, even if you didn’t have the diabetes, we were going to be watching you very closely because of that. And so what do you do with someone who has a history of an abruption? When do you deliver them? Do you deliver a little bit earlier? Do you wait and see if it happens? And there’s no one way to do it. But one of the very legitimate strategies is, once you get to 37 weeks to deliver the baby. And you don’t normally deliver at 37 weeks, it’s slightly early. But that’s one thing. But for you, it almost worked to an advantage, because if we deliver at 37 weeks for that reason, it sort of is helpful to try to VBAC because the baby is 2 weeks smaller than it would have been if we waited to 39 weeks is what we typically do for diabetes. So, it’s almost like, “All right, your baby’s measuring big, but is going to be two weeks earlier. So, it’s going to be like a pound less, give or take.” And it almost like all finally fell into place for you. I was like, “You know, this may actually, be perfect. You’ll have like a big baby, but not too big. And we’ll deliver at 37 weeks and it probably will work out well.” So, just it’s, you know, had you not had the abruption, it would have been harder to justify delivering you 37 weeks versus 38 or 39.

Gabrielle: All the stars aligned, basically.

Dr. Fox: Finally. You know, you get time to catch your break gaps.

Gabrielle: Exactly.

Dr. Fox: So, all right. So, tell me how the induction and delivery went. At that point, was it very nerve-wracking during the induction because you don’t know how it’s going to end, or you sort of like, “All right, I’m here, it is what it is?”

Gabrielle: It was unbelievable. I would say, I’ve never been induced in that regard before. Like, they inserted a balloon into me and they tried to dilate the cervix. The doctor that I chose the induction with, shout out to Dr. Melka, she was awesome. She kept on checking on me. Like, I think the whole process took about 12 hours once the balloon was inserted.

Dr. Fox: Right. She did the VBAC podcast. So, she’s an expert.

Gabrielle: I didn’t even know that. Her vibe is so chill and calming. And she was like, “You’re ready to have a VBAC?” And I’m like, “Yeah, I actually am.” And I think once I was induced and I had my epidural, I was like very zen. Like, I love epidurals. And I was like, “You know what? Again, I’m in the best possible hands. So, like, hopefully, it’ll work out.” And I remember trying to fall asleep at a point. And then I woke up and I’m like, “I feel like there’s like something coming out of me.” Like, I felt something. And so I paged the nurse. And at first, I was like, “It’s 1:00 in the morning. Like, I don’t want to bother the nurse. Like, I don’t even know what I’m feeling.” And I was like, “Just go back to sleep.” So, I tried for 15 minutes and then I was like, “No, something is like coming out.” So, I paged the nurse. She came in and she was like, “Whoa, whoa, whoa, like the baby’s head is crowning. Like, you got to hold it in, lady. Dr. Melka is in another delivery. Like, you got to wait.” And then the resident came in and she checked me and she was like, “Don’t do anything. Just like try to keep it.” And they grabbed Dr. Melka eventually. And like I think it was maybe three minutes of pushing and the baby was out. And it was my easiest delivery by far. Like, essentially, he’s like split out of me and he was my biggest. He was 8, 11.

Dr. Fox: Well, at 37 weeks. It’s a good thing we didn’t wait till 39. A 34-pound kid, no. Oh, wow. That’s amazing. So, it must have been… I mean, I know the answer to this question, must have been pretty cool after he was born.

Gabrielle: It was unbelievable. It was like everything I wanted in delivery and more. She was cheerleading me on. Like, we were laughing. We were making jokes. Like, the resident was great, too. And it felt so chill. And after having such a tumultuous pregnancy and just the journey to motherhood, I felt like finally, like something was happening the way I wanted it to.

Dr. Fox: How do all of these experiences, you know, good, bad, and ugly, color your professional life as a counselor for maternal mental health?

Gabrielle: I think it just shows me. And I think it’s not only in my professional life, like, you really don’t know what other people are going through. You can see me with my three boys who are 5, 2, and 8 months. And you could think like, “This girl had it so easy. Like, she has three little kids.” You would never know on the outside of what people are going through. You would never know that I went through two losses. You would never know that I went through like pretty challenging pregnancies or placental abruptions. So, I think it also put things into perspective for me, not just as a therapist, but as a person, that don’t judge a book by its cover, and just because somebody has multiple kids they might have done IVF. They might have had losses in between. Like, you just don’t know what people are going through. And so I think it made me a more compassionate person and definitely more compassionate and empathetic towards my clients because I was in some of their shoes. And so while I wasn’t quite in the infertility category, I do understand what it’s like to go to a place and have morning monitoring, because I did that. Even though I never did the steps, I understand what it’s like to go at 6:00 in the morning to get your blood drawn every 2 days. So, I think it also helped me, like, empathize with my clients and just with people overall.

Dr. Fox: Do you in your counseling bring in your own stories? I mean, some people do, some people don’t. Some clients appreciate it, some people don’t. You know, I mean, like, how do you sort of navigate that?

Gabrielle: It’s a really good question. So, that’s all about self-disclosure, and like there’s so many different opinions in therapists, like whether we should bring it up or not. What it comes down to is, if it’s for the benefit of the client, then we should self-disclose. But if we’re just self-disclosing because like it feels good to get things off our chest, that’s not appropriate. So, it depends on the client. And again, I’m very open about my journey, meaning like, on my Instagram account, I tell my story about pregnancy loss. I write for the local Jewish newspaper. I am submitting an article again about my pregnancy loss. So, like, if you’re in this community, you know, what I’ve gone through. If you Google me, like, it’ll come up. So, I think I often self-disclose at a point, not the graphic details, but more just to show the client that I do understand what they’re going through. But at the same time, I have to be a little bit careful because I had a client, for example, that went through a pregnancy loss, and it didn’t affect her as much. Like, she was fine. And that’s okay too. Everybody experiences it differently. So, make sure to be careful to not project my own emotions of what I went through onto the client. So, that’s like, you know, that’s challenging. But I think it also helps me see that like there is no one way to react to all these things that go on in your life. Like, some people are okay with things and some people have a harder time handling it.

Dr. Fox: Yeah, no, I think that’s wise. And it’s tough to know what the right thing to do is. And it could sometimes backfire, you know, where you do just go something and they didn’t want to hear it or you don’t. And they’re like, “Wait, like, I don’t know this happened to you. Like, what are you hiding from me?” It’s tough. And, because also you’re dealing with, you know, people in the throes of emotions. And, you know, as everyone knows, it’s not always rational. It’s just, this is how people feel. When you’re like on a day-to-day basis if you’re doing maternal mental health, like what are the things you’re talking about the most? Like, what are the topics that come up the most, or the themes or, you know, just from a prevalence perspective in your practice?

Gabrielle: So, a lot of it is, I would say number one is like postpartum anxiety or depression. And so, you know, one in five women experience some kind of anxiety or depression after birth. And so that definitely comes up a lot. And so we’re working on strategies and coping tools to handle those diagnoses. And another thing that I’m very, very big in, is self-care. And self-care has this like buzz term now on like line that it’s like, “Make yourself a bath,” or, “Go get a manicure.” If that’s not like what I believe self-care is. So, I teach my clients what I call real self-care, which is like making boundaries, putting yourself first, saying no to things that you don’t want to do, you know, not going to a social event because you just don’t want to or carving out me time every single day. And so I think as moms, it’s really difficult to juggle it all. A lot of us are working or taking care of the house. We have little kids. We’re like helping, you know, do all these things in the house. And so we need to make sure to prioritize ourselves and to allow, like, time for just us. And so that’s something I really, really work on my clients with. And clients will take out their calendars and will literally write, like 15 minutes of me-time. And that’s like doing whatever you want. You can do a workout video. You can take a walk, anything that you enjoy doing. And the third thing I would say, which is sort of along those lines, is like making sure that you have your own identity other than a mom. So, while I’m Noah’s mom, I’m Caleb’s mom and I’m Avery’s mom, first, I’m Gabrielle. And that’s really, really important because it’s easy to lose yourself in the craziness of motherhood and the chaos. But at the end of the day, you have to be who you are. And so I think like those three things come up really, really often with my clients.

Dr. Fox: That’s amazing. How do people find you?

Gabrielle: So, they find me on my website, collaborativeminds.net. And they can also find me on my Instagram account at The Chef Therapist.

Dr. Fox: Gabrielle, thank you so much for coming on the podcast, two weeks in a row to talk about your story and about what you do. Obviously, it’s a joy knowing you and being a part of your journey. And also now professionally, like, we’re in the same world. So, there’s a lot of work and, you know, we all know the same people as well.

Gabrielle: Exactly.

Dr. Fox: But, really, no, thank you. I appreciate it. This is important stuff and these stories are important for people to hear and to understand and sort of the lessons that we all take from them. And it’s not easy to tell your story to the world. And I appreciate that you took the time to do it.

Gabrielle: Of course. Thank you for this opportunity.

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 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.