“Lesson for Life: How Communication Can Change Everything” – with Stephanie Castellano

Stephanie Castellano, a Healthful Woman listener, wrote in to share her story of delivering her twins. Because Stephanie has PCOS, she knew she had to undergo fertility treatment, which included both IUI and IVF. After getting pregnant with her twins, she faced complications including a short cervix and fetal fibronectin. Then, after a scheduled C-section, Stephanie experienced hemorrhaging that ultimately resulted in PTSD.

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Dr. Fox: Welcome to “High Risk Birth Stories,” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High Risk Birth Stories” is a podcast designed to give you, the listener, a window into life-changing experiences of pregnancy, fertility, and childbirth.

Stephanie, welcome to the podcast. Thanks for coming. So nice to meet you and to see you.

Stephanie: Yes. Thank you so much for having me. I listen to you every day when I’m on my way to work, and I just love hearing about all the different stories from the women.

Dr. Fox: It’s amazing. How did you find the podcast originally?

Stephanie: So, my son’s actually used Dr. Deena’s practice and I know she was on your podcast earlier this year.

Dr. Fox: Yeah.

Stephanie: Oh, yeah. It was posted on Instagram. So…

Dr. Fox: Right. So, Dr. Deena Blanchard, for our listeners out there, she was an early guest on the podcast and I’ve known her since she and I were little kids, which is interesting. So, you picked up the podcast there. You and I have not met before today. You sent us an email saying, “Hey, here’s my story, I wanna tell it.” And I appreciate that. That’s great. What made you think to reach out? Because a lot of people who listen to the podcast would not do that.

Stephanie: I honestly didn’t think you would contact me back.

Dr. Fox: Okay. I’ll take it.

Stephanie: I don’t think my story is that interesting, but my husband was like, “You’ve been through a lot and there’s a lot of different aspects as far as the infertility, the birth, bed rest, the post-traumatic issues.” So, I just thought if it’s helpful to me to tell my story, it could be helpful for others that are pregnant now or have been through similar issues.

Dr. Fox: When you listen to stories from other women, it’s something that you find just interesting, or do you find may be helpful or maybe some of that validating from your own story? I’m just curious as a listener, what ahs your experience been?

Stephanie: Yeah. Definitely. So, my boys are 4 now, but I feel like had I had some sort of support like this when I was pregnant or on bed rest, I would have had a lot more hope, I would have felt a little more knowledgeable going in to my C-section that these are possible things that could happen. And like you said, going through what I went through and listening to other women, I do have a lot of empathy for them. And it takes me back to that same time that I was in having difficulty. And I just think it’s really helpful to other women as well.

Dr. Fox: You said you have twin boys?

Stephanie: Yes.

Dr. Fox: They’re 4, right? And so they are Anthony, Nicholas. They turned 4, I guess a couple of months ago.

Stephanie: Yeah.

Dr. Fox: What are they up to now? Are they wreaking havoc on the world’s just destroying everything in their wake?

Stephanie: They starting pre-K in September. Yeah. They think they’re superheroes every day they dress up, they’re horrible backseat drivers. It’s just hard to imagine life without them, and even to remember life before them, it’s just ancient.

Dr. Fox: It’s pretty wild. That’s amazing. So, they’re growing up. Let’s go back to your…I guess the beginning of the story, either right before you got pregnant to the beginning of pregnancy. So, first, give us a sense of where you’re living, what’s your life situation, what’s going on with you at the time?

Stephanie: So, my husband and I were married for about two years. And before we got married, we knew right away that we wanted kids. I’m a teacher, so I was teaching fourth and fifth grade that year, mix.

Dr. Fox: You are a brave woman. Thank you for that. We appreciate that.

Stephanie: And he was at his job, which he still is at, at ABC News. So, we just felt like we were ready. We knew that we had to do some fertility treatment because I have PCOS. So, initially, we thought it was IUI, but then I had to do the prerequisite testing and everything. And I had to do the HSG where they shoot the dye into the fallopian tubes.

Dr. Fox: I heard that’s unpleasant.

Stephanie: It’s horrible. It’s okay if your tubes are okay.

Dr. Fox: Right.

Stephanie: In my case, the dye was not going through and I was in excruciating pain. I was like, “If this is labor, I do not wanna have kids.” It was bad. So, after that, they said, “Okay. You definitely need to do IVF,” which we did three cycles.

Dr. Fox: Okay.

Stephanie: So, we did a fresh cycle. I developed OHSS, which is ovarian hyperstimulation syndrome.

Dr. Fox: Yeah.

Stephanie: I didn’t need to be hospitalized, but it was rough on my body.

Dr. Fox: Did they have to, like, drain fluid out of your belly and this [inaudible 00:04:21] or no?

Stephanie: No. Thankfully. They just monitored me and they have to check your urine at home. You have to pee in that little bed thing, bed pan.

Dr. Fox: Yeah, yeah, yeah. For our listeners, that’s your ovaries swell from the size of, I don’t know, grapes to oranges, or grapefruits. They get pretty big. It’s pretty unpleasant.

Stephanie: Yeah.

Dr. Fox: It could be dangerous, but it’s certainly unpleasant.

Stephanie: We used Genesis Fertility. They were amazing. I still keep in touch with them today, we send them Christmas cards from the boys.

Dr. Fox: So nice.

Stephanie: So, that one, we did a fresh cycle. So, I wish I had let my body rest a little, but we did do the fresh cycle and that one didn’t take. Would up having 14 eggs that were fertilized. Four were actually viable.

Dr. Fox: Okay.

Stephanie: So, I had four to work with.

Dr. Fox: Four embryos.

Stephanie: Yeah.

Dr. Fox: Okay.

Stephanie: And I was 29 at the time, which I think they say is the average. So, that one, and then we froze the other three. So, then the second time we did a frozen cycle, which was way more comfortable, oh my God, and easy.

Dr. Fox: Sure. Less hormones. Yeah.

Stephanie: Yeah. But I was still doing the progesterone and oil and the estrogen and the progesterone.

Dr. Fox: Right.

Stephanie: But it was much easier.

Dr. Fox: Okay.

Stephanie: So, I felt much more relaxed. That one, we transferred one and it was a chemical pregnancy.

Dr. Fox: Okay.

Stephanie: So, I did get pregnant, but it was still early and the number was declining, the HCG number.

Dr. Fox: Did that make you feel more optimistic because it worked, and you did get pregnant, even though ultimately, it didn’t take, so to speak, or did it make you feel more pessimistic because here’s our second IVF and it didn’t succeed?

Stephanie: Yes and no.

Dr. Fox: Okay.

Stephanie: So, my doctor said, “It’s good that you did get pregnant.” Usually, the first time too, it’s foreign so your body rejects it. So, the second time, yeah, I was optimistic, but at the same time I was like, “I wonder if there’s something wrong with the eggs, chromosomally.”

Dr. Fox: Right, right, right.

Stephanie: Because I did get pregnant, but it didn’t go further than that. We had two left, and then the doctor had said, “Well, we can put the two in if you’re comfortable with that. We don’t like to put two in, but because the other two hadn’t taken, we might have a better chance, or we can do one at a time.” And then she suggested if whatever option you choose doesn’t work, then we can do the genetic testing for a new cycle.

Dr. Fox: Correct.

Stephanie: I was like, “That’s it. I don’t wanna take…”

Dr. Fox: I think we all know where this story is heading considering you have 4-year-old twins running around now.

Stephanie: Yes.

Dr. Fox: Okay.

Stephanie: I was in the zone. I’m a teacher, so I wanna do it before I go back to work.

Dr. Fox: Sure, sure.

Stephanie: And I was like, “You know what, let’s just do it. I’ll be lucky if one sticks.”

Dr. Fox: Right. Were you concerned that you might have twins, or you were like, “If I have twins, I have twins?”

Stephanie: I knew it was a possibility, but I didn’t really think that both would stick.

Dr. Fox: It was on your radar, but you thought it was pretty remote.

Stephanie: Right. The fertility center always said twins, it’s more risky, but once you get more than two babies, you need to start considering fetal reduction.

Dr. Fox: Right.

Stephanie: So, I was like, “Well, the first two didn’t really take so maybe one will stick.”

Dr. Fox: Okay.

Stephanie: After the transfer, I did the blood work, and then we found out…five days later, we did the blood work that it was a high HCG.

Dr. Fox: Okay. So, you…

Stephanie: It was in the high twos.

Dr. Fox: Okay.

Stephanie: They called me and she was like, “Well, it’s really high.” She was like, “That’s good.” And I started googling everything and I’m like…

Dr. Fox: It might be too good.

Stephanie: I think it could be…I’m like, “I think it could be twins.” My husband was like, “No. You’re crazy. No.” So, then we went for the sonogram. I don’t know [crosstalk 00:07:54]

Dr. Fox: Who’s crazy now, Anthony?

Stephanie: So, we went and they did the sonogram and instantly, they saw baby A.

Dr. Fox: Okay.

Stephanie: Which was Anthony. And my husband was joking around…

Dr. Fox: For the confusion, Anthony and Anthony. Same name.

Stephanie: Yes. Little Anthony.

Dr. Fox: Okay. Yeah. Okay.

Stephanie: So, then my husband was like, “Well, what happened to the other one?” The doctor was like, “Wait, let me see.” And he was using the wands and moved around, he’s like, “Oh, there’s the other one.” And we were just in shock, complete shock.

Dr. Fox: All right. So, you had twins?

Stephanie: Yeah.

Dr. Fox: It changes things a little bit. How did the pregnancy go? Did you at that time think, “Oh, I have to see different doctors, I have to do something different,” or compared to what you were planning to do?

Stephanie: Yeah. I was a little surprised that the doctor right away was like, “Okay. You’re gonna leave us at 10 weeks. You’ve been with us for four months, so you’re gonna leave us and you’re gonna have to find a high-risk doctor, in addition to your regular OB.” Because I think normally, the high-risk doctors don’t deliver the babies.

Dr. Fox: Some do, some don’t. In our practice, we do. But I would say around the country, probably the majority of high-risk doctors don’t do deliveries, they just do consultations, ultrasound procedures, and then an OB-GYN who’s not high-risk does the delivery.

Stephanie: I could have shopped around, I guess a little bit. It would have been nice to find someone that could have done both because just like with my two doctors having to communicate constantly when things got more high risk, it was just a lot.

Dr. Fox: Right. Right. You mean your high-risk doctor and the people who were gonna do your delivery were “low-risk doctors.”

Stephanie: Yeah.

Dr. Fox: Okay.

Stephanie: At 10 weeks, I went to my regular OB and then I’d found my high-risk doctor and I was going, I would say, every two weeks.

Dr. Fox: Sure.

Stephanie: One time would be high risk, and then the next two weeks, it would be the OB, the regular OB. So, everything went great. The pregnancy was smooth up until around 23 weeks.

Dr. Fox: And what happened?

Stephanie: I felt fine. I remember it was my February break and I was like, “Oh, I can’t wait to relax.” And we were renovating, we had a condo at the time, a two-bedroom, so we were renovating because we need to make space for the boys. And we went and the stenographer was doing the ultrasound and I was feeling a lot of pain. And I was like, “That really hurts.” And she had a scared face. She’s like, “All right. I’m just gonna call the doctor.” And that’s it.

Dr. Fox: It’s like the angel of doom is coming in.

Stephanie: Yeah.

Dr. Fox: “I’m bringing the doctor in.” All right.

Stephanie: I was like, “Oh, maybe it’s just an experience. I don’t know what’s happening.” And then they told me, “You need to come into the doctor’s office. Get dressed and come to the doctor’s office.” And he was like…his face was just white and he was like, “You need to stop working now, like today.” And I was like, “What? It’s only 23 weeks.”

Dr. Fox: Right.

Stephanie: And he had told me, “You’re gonna deliver at 38 weeks.” And I was like, “That’s a really long time.” And he’s like, “Well, the cervix is really short.” And I had never heard of that before, the cervix being short.

Dr. Fox: Right. I assume they were doing ultrasound every couple of weeks. So, you weren’t understanding why they were checking vaginally every couple of weeks [inaudible 00:10:55] the cervix.

Stephanie: They just told me the cervix looked good. So, I didn’t really ask questions.

Dr. Fox: Got it. You didn’t know how bad it was. What’s not good? All right. So, short is not good. Do you remember how short it was? I’m curious.

Stephanie: It was 2.3.

Dr. Fox: Centimeters?

Stephanie: Yeah.

Dr. Fox: Okay.

Stephanie: And then it had gone down to in the ones…

Dr. Fox: Okay.

Stephanie: …a few days later.

Dr. Fox: Oh. All right.

Stephanie: But I think being that I was a teacher and that my classroom is on the third floor and we didn’t have elevators and he was concerned.

Dr. Fox: Okay. And what did they tell you to do? So, they said you can’t work. What else?

Stephanie: Modified bed rest. So, just like we were on a third-floor walk-up. So, he was like, “If you do the stairs, just once a day.”

Dr. Fox: Okay.

Stephanie: And just try and keep your feet up. And he didn’t want me laying in bed all day, but just walking through the house is fine, but nothing strenuous, no lifting.

Dr. Fox: Right. Not bed rest, not full activity, sort of take it easy.

Stephanie: Yeah.

Dr. Fox: Got it. Okay.

Stephanie: So, I was home for about seven weeks. Oh, and I’m sorry, the fFN test we did, that had come back positive.

Dr. Fox: Positive. That’s not the good one. Okay. Yeah. No. That’s a scary situation. You have a short cervix and a positive fetal fibronectin and you’re in the middle of pregnancy with twins. Yeah. That’s risky. It can indicate a preterm birth is coming. No question about it.

Stephanie: Yeah. So that, in combination with the fFN, he was not comfortable with me working.

Dr. Fox: Did they put you in the hospital or give you steroids, anything like that or they were just gonna wait to see how you were feeling?

Stephanie: Being that I was going to the high-risk doctor now once a week and my regular OB every three days to check the cervix in the beginning, he was just comfortable with me getting the steroid shot and he said I don’t wanna hospitalize you or anything.

Dr. Fox: Right. So, you got the steroids just in case, but you didn’t have to be admitted to the hospital?

Stephanie: No. Thank God.

Dr. Fox: Okay. That’s good. Yeah. Who wants to be admitted to the hospital? That stinks.

Stephanie: So, I was home for about seven weeks, and I think they say if the babies don’t come by 28 weeks, because of the fFN tests, that pretty much they’re gonna not come early, before the 28 weeks. So, around 30 weeks, I was like, “Please, can I just go back to work? I just miss having interaction and stuff.”

Dr. Fox: Sure.

Stephanie: So, he was like, “I’m pretty comfortable with 30 weeks with you going back.”

Dr. Fox: Okay.

Stephanie: “Just don’t you the stairs,” he told me. My principal had to have another teacher with me helping me. And the kids, my students were really good about it. They were just wanting me to sit and do as little walking around.

Dr. Fox: Fourth, fifth graders?

Stephanie: Yes.

Dr. Fox: Really? That’s amazing.

Stephanie: Yeah.

Dr. Fox: Yeah, what nice students. Because fourth, fifth graders, I didn’t know that they could be so thoughtful.

Stephanie: Yeah. I had that class from the year before, so I had…

Dr. Fox: And I guess they knew you were out for so long. They were just happy to bring you back.

Stephanie: Yeah. They were just happy to have me there.

Dr. Fox: Okay. That’s sweet.

Stephanie: Everything went well. I was still…they were still put. And then I went all the way to my C-section date, which was 38 weeks and 3 days.

Dr. Fox: Amazing, 38 weeks and 3 days. And why was it a C-section?

Stephanie: So, when I met early with the doctor, around 11,12 weeks, he had said, “We do usually do C-sections for twins because it’s safer for the babies, it’s more risky for the mom.” And he said, “In terms of delivery, sometimes baby A can come out vaginally and baby B sometimes we have to do C-section.” It doesn’t happen all the time. But me, just having gone through everything with IVF, I really just wanted a smooth and safe delivery. So, I did opt for the C-section.

Dr. Fox: Did they offer you a vaginal delivery if you wanted it?

Stephanie: Yes.

Dr. Fox: Got it.

Stephanie: He said we could do it if you want.

Dr. Fox: Understood.

Stephanie: I was just nervous with all the complications with the cords and everything. I was like, “Ugh, if I have to do vaginal and C-section.”

Dr. Fox: Right.

Stephanie: Plus baby B, which was the one that was higher up, he was transverse.

Dr. Fox: Okay. And what did they say their plan would be had you opted for a vaginal delivery? And baby who was transverse, would they deliver baby B feet first or they would try to make the baby headfirst and then do a C-section if not? Do you remember?

Stephanie: I didn’t ask.

Dr. Fox: Yeah. Okay. Listen, ultimately, twins born by C-section are great, twins born vaginally are great. It’s not the biggest differentiating factor in a twin birth. For some people, it’s very important to have one or the other, obviously. But I think what happens a lot of time is when doctors present it to people, it’s usually pretty obvious which one they prefer for the doctor.

Stephanie: Oh, yeah.

Dr. Fox: So, because a lot of doctors are uncomfortable doing twin deliveries. Not because it’s harder or more work, necessarily, but it’s a tough situation. It takes a lot of maneuvering as the doctor to be comfortable with that and baby B, there’s a lot of uncertainty, is baby gonna come out vaginally, not, gonna do a breech extraction? So, a C-section is just more…like, you can map it out much more clearly. And so I think in the U.S., a lot of people with twins get told either we deliver everyone with twins by C-section because it’s safer for the babies, which is actually not true. It might be true if the doctor doesn’t know how to do a vaginal delivery, but it’s not actually true amongst people who know what they’re doing, or they get told, “Well, you can do this or you can do this.” But it’s pretty clear that they’re being pushed, “Well, you can have a vaginal delivery, but it’s more dangerous for your babies.” Who’s gonna sign up for that?

Stephanie: Yeah.

Dr. Fox: “Sure. You can have a vaginal delivery, but we may harm both your babies.” And so people are like…no one is gonna sign up for that. So, it’s tough. That happens a lot. It’s not unique. This is, I would say, the default in the U.S. I think that’s unfortunate because I think that if people know how to do twin deliveries, then you could be much more even about and say, “Listen, I think they’re both safe that your babies will be fine either way, I think you’ll be fine either way.” And there’s pros and cons to both, obviously. It’s not like one is perfect and one is bad. Some people still prefer a C-section after hearing everything. But it’s hard because that’s something you need to be really trained to do. And it’s hard to get trained to do these things because there aren’t a lot of twin deliveries. It’s a snowball effect. So, that’s me rambling on about twin deliveries. It’s a whole thing. You have to know what you’re doing with that. Okay.

Stephanie: Yeah. I think if I had had a practice like yours, I definitely would have tried for vaginal. And after hearing all the input from the other moms and on the podcast, I think I would have advocated for myself more, or just found another practice.

Dr. Fox: Right, right. And listen, you may have ended up with a C-section anyways. Who knows? It’s not one of these things where I can say, “Oh, had you done something, it would have been better for you.” Maybe not, maybe it would have been worse, I have no idea. But it’s just one of the things that happens all the time, it’s not just for twins. A lot of time with VBACs, people are just…they’re not given the option, essentially, either because they’re told flat out, “We’re not giving the option,” or the counseling is either intentionally or unintentionally so biased in one direction that the person on the end is like, “Well, why would I choose the one that sounds horribly dangerous when I could choose the one that isn’t?” And so it’s just one of these things with medicine.

Again, doesn’t mean the doctors aren’t good, or aren’t caring, or aren’t kind, or aren’t competent, it’s just one of these things. There’s so much variation in how doctors…what their skills are, what their comfort levels are, how they talk to people because everyone is human. We’re dealing with humans here, and so it’s not gonna be the same across the board. But ultimately, you come in, you have a scheduled C-section, thank God, they’re 38 weeks, they’re concerned with preterm birth and now these two big babies are gonna come out of you, which is I assume really exciting, pretty cool. Tell me about the day of the delivery.

Stephanie: It was supposed to happen at 9:00.

Dr. Fox: A.m.?

Stephanie: Yeah.

Dr. Fox: All right. You get delayed? You get bumped?

Stephanie: We did get delayed…

Dr. Fox: All right. That happens.

Stephanie: …because they said it was twins, a second doctor needed to be in the delivery room.

Dr. Fox: From their practice, you mean or…?

Stephanie: Yes.

Dr. Fox: All right. Because I mean, C-sections, there’s always two.

Stephanie: I think you’re right. It could have been another OB working in the hospital that day, but it was a Saturday.

Dr. Fox: Ah, okay.

Stephanie: And strangely, it was a ghost town. I was the only one in the pre-op room. It was kinda eerie, but I guess it was good in a way because they had a lot of attention on me. So, I was starving because I had to fast from the day before.

Dr. Fox: Yep, yep. Yep.

Stephanie: We had to wait for my doctor’s dad who’s also from the practice to come.

Dr. Fox: Right. The other doctor. Right.

Stephanie: But he also had deliveries and he was in Manhattan. So, by the time we did the epidural and everything, it was close to 3:00.

Dr. Fox: Uh-huh. Okay.

Stephanie: Yeah.

Dr. Fox: Wow. You’re hungry.

Stephanie: Yeah. Hungry, anxious, uncomfortable.

Dr. Fox: Okay. Got it. So, 3:00, you go in for your C-section. And how did it go?

Stephanie: So, they did epidural, everything was okay, the babies came out. I was actually pretty shocked at the C-section of how much it feels almost like a roller coaster because they have your arms slide down and they’re moving the babies out of you. And I was like, “Wow, it’s a roller coaster right now.”

Dr. Fox: Right. And you knew they were boys, right?

Stephanie: Yes. We did know they were boys.

Dr. Fox: Okay. And how much should they weigh, ultimately?

Stephanie: Baby A, Anthony was 5 pounds, 2 ounces, and 19 inches. Nicholas was 5 pounds, 3 ounces, 18.5 inches.

Dr. Fox: It’s a little on the small side for 38 weeks. Were they concerned about that before, or was it a surprise that they were that small?

Stephanie: Yeah. Around 37 weeks, my high-risk doctor had said, “They’re looking a little bit small and they’re not growing that much,” but she was like, “Honestly, if you weren’t scheduled for the C-section, I would say to do an induction.”

Dr. Fox: Right.

Stephanie: But she said, “You’re petite yourself, you’re 5′.”

Dr. Fox: Right.

Stephanie: And at that point, I couldn’t really even eat that much because I just had no room and I had reflux. So, she was like, “I’m a little concerned.” But they were monitoring them and they were gradually gaining a little bit of weight.

Dr. Fox: Okay.

Stephanie: Towards the end, they weren’t really gaining.

Dr. Fox: Okay. So, they’re born, and then how did the rest of the delivery go?

Stephanie: So, it was really chaotic in there because there was double of everything that would normally be. My husband cut the cord for Anthony. And then Nicholas, it was just so chaotic that someone else did it in the room.

Dr. Fox: Cut the cord, you mean on the warmer? On the operating table?

Stephanie: I think he was at the warmer. He cut the cord.

Dr. Fox: Yeah. After the babies are separated from you.

Stephanie: Yeah.

Dr. Fox: Yeah, yeah. Okay. Because they’re not gonna let him into the surgical field to cut the cord the first time.

Stephanie: No.

Dr. Fox: Yeah. Okay. I got it. Cut off the rest of the cord.

Stephanie: Yes.

Dr. Fox: I gotcha. Okay. All right.

Stephanie: And then they took them away to do the Apgar and everything.

Dr. Fox: Sure, sure.

Stephanie: And my husband went with them. Everything seemed okay. They were sewing me up and then my doctor had left and his dad was just finishing everything. I started feeling really tired. I was like, “What’s going on here?” And no one was talking to me. Everyone just seemed very nervous. And they were talking a lot of medical terms and I just was getting really nervous, and my husband wasn’t there. So, I just asked the anesthesiologist. I said, “What’s happening? I’m getting really tired. I’m getting really tired.” And she was like, “Oh, don’t worry, we’re gonna give you something to sleep.” And I just remember crying silently, but I couldn’t speak. I was just thinking in my head this can’t be the end, this can’t be the last time I saw my kids.

Dr. Fox: Right.

Stephanie: And I just saw a white light. And I remember them yelling, the resident doctor was a woman and she was yelling to my OB. She was saying, “Code H, code H, code H.” And I’m trying to figure out, what is code H? And my whole family in the meantime is waiting to see the kids and they keep hearing this code H, and they had no idea that it was me in the room. And I think code H refers to hemorrhage.

Dr. Fox: I assume it means hemorrhage. That’s not a term we use at our hospital, but I would imagine it does. It’s so interesting. They use that term to not freak people out and say, “We’re having a hemorrhage, we’re having a hemorrhage.” But since you don’t know what’s going on, you think you’re about to die.

Stephanie: Yeah.

Dr. Fox: You think code H is like chest compressions. We’re losing her, which it shouldn’t mean that. So, yeah. I guess that’s…I don’t know. I don’t know what the right thing to do is. I assume that the code H maybe to not freak out the people in the waiting area. But for you, they should probably say, “Hey, you’re bleeding a lot, we’re working on it. You’re gonna be okay. You’re gonna be fine. We’ll do what we need to do.” So, you’re not getting the communication that you’re hoping for and you think it’s over.

Stephanie: Yeah. I think it’s done.

Dr. Fox: Wow.

Stephanie: And I’m glad that my husband wasn’t there in a way, but at the same point, I felt really scared and alone.

Dr. Fox: Wow. At what point did you realize that you were hemorrhaging?

Stephanie: Not until I woke up.

Dr. Fox: Wow. Not until you woke up. So, they put you to sleep and then you wake up in the recovery room?

Stephanie: I’m not sure if they put me to sleep, or I passed out because when I had woken up, they had mentioned that my blood pressure dropped.

Dr. Fox: Okay. What ultimately did you learn happened to you?

Stephanie: So, I woke up and I remember just my legs were up and I was still in the OR and then they wheeled me out. And no one said anything to me. My doctor was just holding my hand and he said…he also, white face and he just said, “You’re very strong. You’re very strong.” And I’m like, “I don’t even know what happened.”

Dr. Fox: Wow.

Stephanie: So, then once they put me in the recovery room, again, I’m the only one there, there was no one there that day, I saw the cooler, them rush with the cooler and they hooked me up with the IV and then I realized, “Oh, it’s a blood transfusion.” So, apparently, what they had told my husband, they had called him…Once they were preparing the blood transfusion, they had said, “We’re in a red zone still. We don’t know if the transfusion is gonna take.” And he was like, “I’m with my kids. I’m feeding them.” He was like, “I don’t even know what to tell my family right now.” And he was like, “Don’t tell them anything. We just have to see if their transfusion takes, but…”

Dr. Fox: Were you still bleeding at the time, or everything was finished and they’re just giving you blood to bring you back?

Stephanie: They had stopped the bleeding. So, they gave me some sort of medication. They told me my blood pressure had dropped. They had said because I lost so much blood and then my blood pressure had spiked.

Dr. Fox: Afterwards.

Stephanie: Right. So, then they were confused. Is it preeclampsia? And then…

Dr. Fox: Some of the medications we give to contract the uterus raise your blood pressure. So, it could be that too.

Stephanie: Yes. They gave me Pitocin.

Dr. Fox: Probably they gave you a drug called methergine, which would raise your blood pressure. That’s just a guess. I have no idea, obviously. But that’s the one that can raise your blood pressure. Do you know how much blood you lost? Did they tell you?

Stephanie: They said half my blood count, I lost.

Dr. Fox: Half your blood volume. So, that’s probably 2 to 3 liters.

Stephanie: Yeah.

Dr. Fox: Wow. And how much blood transfusion did you get?

Stephanie: So, they gave me one of those bags.

Dr. Fox: Just one unit?

Stephanie: And they said they were going to check me if I needed the second one.

Dr. Fox: Right.

Stephanie: But after the one, I guess they took blood to see the platelets and everything in the plasma and they said I was okay.

Dr. Fox: What was it like recovering from that? Let’s just start with the simple part, physically. What was it like physically recovering from a C-section? Which is hard, and then when you bleed a lot, you get super-duper weak, obviously. So, what was it like?

Stephanie: I was just extremely tired. About three hours had passed before they let me actually hold the babies. And I remember I was out of it, but they said that the boys’ blood sugar was low.

Dr. Fox: Okay.

Stephanie: So, I had to like sign off on something…

Dr. Fox: All right,

Stephanie: …saying that they could have the bottle. So, my husband is still in shock that I was together and I was able…They asked him and he was like, “I don’t know what to do, ask my wife.” And I was able to say yeah, they need to eat.

Dr. Fox: Yeah.

Stephanie: Physically, I remember I couldn’t move my legs for quite some time from the epidural. So, I was just nervous about that. And I just had cramping from the Pitocin.

Dr. Fox: Okay.

Stephanie: But ultimately, they said the Pitocin they needed to do because my uterus was not contracting and my uterus was just stretched out from the size of the babies.

Dr. Fox: Right. And how long were you in the hospital? So, you delivered on a Saturday, when did you get home?

Stephanie: Yeah. I went home on Tuesday morning.

Dr. Fox: Okay. All right. That’s pretty standard, actually.

Stephanie: Because the first night I was in the PACU…

Dr. Fox: Yes. Three days. So [crosstalk 00:26:47].

Stephanie: …like the ICU for the moms and…

Dr. Fox: Sure. Sure. Sure. Yeah. The labor floor base, essentially.

Stephanie: Yes.

Dr. Fox: Okay. So, you went home three days later. And physically, was the pain terrible, or were you still very weak for a long time, or you got better on the quicker side?

Stephanie: I don’t know if this is normal, but I was so swollen.

Dr. Fox: Yeah.

Stephanie: And they were like, “Oh, it’s from all the fluids and the transfusion.” I remember because we lived on the third-floor walk-up…

Dr. Fox: Yeah.

Stephanie: …I had to walk like a child not alternating my two legs for a good month.

Dr. Fox: Yeah. So, some of that is from the transfusion and the fluids, but some of it is just being pregnant with twins. A lot of times after you deliver, there’s so much water in your body and it ends up in your legs and it takes a while to come out. It gets better eventually, but it can linger for a while. Okay. So, that’s physically. What was it like emotionally coming through that?

Stephanie: It was not easy. I feel like I was just on adrenaline the first few weeks. A normal C-section, it healed really well, but it’s hard to sneeze and cough and just get up off the bed. I was sleeping on the couch so I could be near them. But it was more I feel like of the emotional and mental toll that it took on me.

Dr. Fox: In what way?

Stephanie: People asked me about the birth and everything. I say, I just feel like it was an out-of-body experience. I was just watching myself on the table.

Dr. Fox: Right.

Stephanie: And just not knowing if I was gonna make it out of there.

Dr. Fox: Wow. Did you feel like some sort of post-trauma that you have from it?

Stephanie: Yeah. Since then, I’ve gone to therapy and they have said it’s definitely PTSD.

Dr. Fox: Right.

Stephanie: I wonder to this day, had I had another practice or maybe different doctors that were more skilled in talking to the mom while these things are happening. I hope that that never happens to anyone else again from that practice.

Dr. Fox: Right.

Stephanie: Had I just had that reassurance like, “It’s gonna be okay, you’re bleeding, this is normal,” I don’t think I would have had so much trauma.

Dr. Fox: It’s so interesting that you say that because a lot of times people will think back on a delivery that was very traumatic to them. Again, listen, thank God you’re well, your babies are well, but the delivery was very traumatic, obviously. And a lot of times people will look back and say, “Well, what if that didn’t happen? What if I just had a C-section, ‘typical C-section’ and typical recovery, how would I feel afterwards?” Because some people with everything perfect, perfect, perfect, maybe not PTSD, but they can have postpartum depression, postpartum anxiety. Again, it could have nothing to do with the difficulty of the delivery. But sometimes people say, “All right. What if the delivery was easier, would I have felt a lot better?” But it’s not what you said. It’s just like if someone had taken 10 seconds just look at you in the eyes and say, “Here’s what’s going on, here’s what we’re gonna do. You’re gonna be okay.”

And even if you then fall off to sleep, I agree, I wonder. And at that time, sometimes it’s the obstetrician, but they’re busy operating, sometimes it’s the anesthesiologist who’s right next to at your head, sometimes it’s one of the nurses. And again, I think sometimes people just forget to do that. And I’m sure that that’s what they were thinking. I don’t think that they thought you were gonna die. It just doesn’t really happen in a hospital like that, under someone’s care would it happen. I think that they all thought, “All right. She’s hemorrhaging, it’s a big deal. We’re gonna do A, we’re gonna do B, we’re gonna do C. She’s gonna pull through.” But they forgot to tell you.

Stephanie: Right.

Dr. Fox: That’s a simple, simple thing, 10 seconds. It’s remarkable. And when I have someone who’s in an emergency, let’s say they’re about to have an emergency operation and about to be put to sleep, they’re gonna have anesthesia. So, they’re gonna be knocked out the whole time. It’s so important because I know that you go to them, you hold their hands and you look at them and say, “We’re gonna take good care of you. You’re gonna be okay.” Even if it’s a simple procedure, straightforward, nothing is gonna happen. People are worried. “I’m going to sleep, Am I gonna wake up?” And so then when they wake up, just having that beforehand makes a big difference. Wow. How long has that lingered for you, this feeling?

Stephanie: Still today.

Dr. Fox: Amazing. It’s four years later.

Stephanie: Yeah.

Dr. Fox: Four years later.

Stephanie: I’m like, that’s all I needed, just that little reassurance. Yeah, I got that when I woke up, but I needed that before.

Dr. Fox: Yeah. Listen, for doctors listening, nurses, healthcare people, big lesson. But even for women listening who might be in a situation, I think it’s important. You’re allowed to say, “Hey, look at me. What’s going on? Am I gonna be okay?” And you could say that to someone and they’ll say, “Oh, yeah. This is what’s going on. Yes, you’re gonna be okay.” You can ask for that. If they tell you otherwise, that’s a bad situation. But I think that people think you’re gonna be okay. And so you can say, “I understand you’re busy, but I’m awake here. I’m not asleep. I can hear you, I can see you. Can you tell me what’s going on? And am I gonna be okay?” Because that’s what everyone is worried about. And they’ll tell you, and I think that is a big difference. That’s huge.

Stephanie: Yeah. And I think for a lot of moms too, it’s that loss of control.

Dr. Fox: Sure.

Stephanie: You’re so vulnerable, literally on a table. You don’t have the babies you just carried for nine months. And it’s just that loss of control that really scares you.

Dr. Fox: Yeah. To put your well-being in someone else’s hands, literally. And you can’t get off the table. You have an epidural, you can’t move, essentially. You’re saying your arms are physically tied down. That’s a real terrifying situation to be in. I’m glad you’re okay obviously, but I can’t imagine the fear, the terror of that happening. What have you done to…you say it’s still with you, but what have you done to get past that sensation? Is it just time? Is it just the fact that you have these boys who keep you busy, or is there anything specific that you’ve done?

Stephanie: After they were born, like I said, I went through an adrenaline stage, and then I started feeling anxiety issues, a lot of anxiety to the point where I had to go back to work in September for my class and I was like, “I can’t go back to work like this.”

Dr. Fox: Wow.

Stephanie: I feel like I never really processed the trauma myself. So, instead, I was like little things would trigger me. And we talked about the loss of control because I had that loss of control during the birth, I was constantly trying to control everything after the birth. So, everything around me, everything with the babies. One of them, Anthony had reflux, Nicholas had colic. So, I wasn’t sleeping, I wasn’t eating. I just put all of my energy into them and controlling everything, constantly calling doctors.

Dr. Fox: Yeah.

Stephanie: Like, “The medication is not working, the formula is not working.” And I was like, “I need to get help.” So, I went to a center and I saw a man for intake and he just brushed me off and he was like, “I think this is mommy blues and you’re gonna get over it and these are normal concerns.” And I just left the office thinking, first of all, why didn’t you give me a woman for intake? I’m having postpartum issues. And second of all, I know this is not myself. I don’t feel like I’m in my own skin right now. This is a horrifying feeling. So, thank God, they had another women’s counseling center downstairs from that office. And I went in there and I said, “Please, I need help. I’m so anxious, I’m not sleeping.” And they were so kind.

Dr. Fox: It’s so unusual for someone to come in and say, “I need help.” Frequently, people don’t realize and someone says, “Hey, maybe you need help.” And when someone walks in and says, “I am not right, I need help,” that is 100 out of 100, they need help. They do. They’re telling you they do. It’s the most obvious thing in the world. It’s so crazy that someone would blow you off like that.

Stephanie: Yeah.

Dr. Fox: Because again, maybe you don’t need medication, but that doesn’t mean you don’t need help. Help could just be a conversation that says, “No, maybe what you’re experiencing…” Again, if it were the case that it’s normal blues…let’s say that were the case. So, it’s not what you’re talking about. All right. You meet with someone, it’s a conversation, say, “All right. Listen, I think what you’re experiencing is pretty typical. I’m gonna be reassuring. Let’s follow up in a couple of weeks, see how you’re doing.” That’s help even if nothing actually happens. But to just say, “Goodbye, we don’t need you, you don’t need us,” that’s tough. And like you said, I was gonna mention also, that’s exactly what Dr. Deena was talking about with the postpartum anxiety, there’s this need to control what’s happening around you, and that you tie it to that you had that lack of control around the time of delivery. And it’s very insightful. It’s true.

Stephanie: I actually had brought up my concerns to my OB’s office and I was so upset. I remember calling them because I was like, “Do you guys have a referral for a therapist, postpartum issues?” And they were like, “We have to call you back. No. We have to do some research.” And I was just like, “I cannot be the only woman in your practice going through this.”

Dr. Fox: Well, just on average, it’s gonna be at least 10% just for nothing. Just for having babies, it’s gonna be about 10%.

Stephanie: So, that made me feel so much worse.

Dr. Fox: Wow. That’s unusual. All right. So, you saw someone who was helpful?

Stephanie: Yeah. I did. I saw her for quite a few months. And…

Dr. Fox: Just like as therapy, you mean?

Stephanie: Yeah.

Dr. Fox: Yeah. Okay. So, you didn’t need treatment with medication or anything?

Stephanie: They did refer me to the psych that did work with them. But honestly, he had recommended something that I didn’t really agree with.

Dr. Fox: Right.

Stephanie: And I told him if the therapy is not helping, then I will move to the medication.

Dr. Fox: Okay. That’s fair.

Stephanie: So, I did find the therapy more helpful.

Dr. Fox: Yeah. Good.

Stephanie: And I didn’t need the medication.

Dr. Fox: How long ultimately were you in therapy?

Stephanie: About four months, but I recently started up again because I am contemplating the idea of a third child. I know all these feelings have been coming back.

Dr. Fox: Yeah. Absolutely. That absolutely happens. That’s real.

Stephanie: Yeah. And this therapist has actually gone more into the actual trauma aspect of it because I don’t really have the anxiety anymore because my kids are older and those things have been resolved. But it’s more now about the trauma and just what I was experiencing during the birth and stuff.

Dr. Fox: Yeah. And we were discussing before we were recording about this idea of did you or did you not technically have postpartum anxiety or postpartum depression or was it PTSD? And it doesn’t matter, obviously. Who cares what the diagnosis is? You had what you had, and it needed therapy and it helped you get better. And there’s a real reason. But part of the reason it’s so convoluted, I would say, is because anxiety and depression are symptoms and they’re also diagnoses. So, for example, if I’m walking down the street and I see a grizzly bear, I will have anxiety. I don’t have an anxiety disorder, I don’t have a diagnosis of anxiety, but I’ll be anxious, and that’s sort of there. Same thing if the loved one dies, I will be depressed, but I don’t have depression.

And so people get so confused with that. So, you can be postpartum and have anxiety. And if it’s due to this primary anxiety problem that’s generated by the chemicals in your brain, we’ll call it postpartum anxiety, but if it’s a symptom of PTSD, let’s say, you don’t technically have the diagnosis postpartum anxiety, but you have anxiety and you’re postpartum. So, again, who cares? It’s one of these things, it doesn’t ultimately matter how it’s classified, it’s really how are you feeling, how are you functioning? And that’s where it matters in terms of therapy. I think people get so caught up in these…they didn’t meet criteria for diagnosis, or they didn’t meet criteria, whatever. What’s the difference? You have to deal with the person, not with the name of what we’re treating.

Stephanie: Right. And my therapist said, you go to one therapist, they may say it’s PTSD, you go to another therapist, it’s postpartum depression.

Dr. Fox: Yeah.

Stephanie: But the important thing is that you get help and that you work through and you get to the root of the issues, which I’ve learned through this whole experience that trauma, you go through it and you may not process it right away. For me, the first six weeks, I would say, were adrenaline. I was just happy and just trying to survive the night with twins.

Dr. Fox: Yeah. I know.

Stephanie: You have twins.

Dr. Fox: Yes, I do. They’re almost 22 and I’m still trying to survive the night with them.

Stephanie: Yeah.

Dr. Fox: It doesn’t end.

Stephanie: No.

Dr. Fox: Yeah.

Stephanie: It can take a long time to process.

Dr. Fox: Sure.

Stephanie: And still, I’m talking to you and I’m still trying to piece what happened that day. And I’m so upset. I remember the resident doctor that was fighting for me for the doctor to call the code H. And I’ve tried to find her online and she recently left her practice. So, that’s another issue, but yeah. I’ll never forget her.

Dr. Fox: Wow.

Stephanie: I won’t.

Dr. Fox: It’s so interesting. So, you’re here, you’re telling your story. It’s amazing that you’re doing it. It’s extremely helpful. I hope it’s helpful to you. But certainly, it’s gonna be helpful to many people listening. What are the takeaway points that you want people to get from your story that you’re telling today?

Stephanie: Just to check in on moms, new moms. Even if you yourself haven’t experienced trauma, it’s very common. Just because the babies, like you mentioned before, the baby or the babies are healthy. And just looking at my own sons, no one knew that anything traumatic had happened to me. So, just checking in with the mom every few weeks, are you okay? It’s different with COVID now, do you need help? But do you need me to just go get you a coffee, or do you wanna go out and just talk? Not asking specific details about the birth, but just like, how are you feeling?

Dr. Fox: Right.

Stephanie: Because had someone, I feel like, done that with me, I would have been probably getting help sooner.

Dr. Fox: I think that’s a tremendous lesson for everybody because everyone knows someone who has a baby. Even if you’re not pregnant yourself, or you’re not gonna have kids, or you’ve had your kids, or whatever it is, we have so many different people who listen, when someone has a baby, it’s joyous if everything goes well, but that does not mean that mom or dad are doing great. It could just be they’re having a hard time because they have a newborn, which is enough. But also the delivery itself could have been much more complicated or traumatic or difficult than you may imagine. People don’t always talk about it. You don’t have to get in their grill and say, “Tell me what happened.” But just like you said, “How are you doing? Do you need anything? Can I bring you a coffee? Can I stop by and say hello?” Whatever it might be.

A lot of people who listen to these podcasts are either…most of them are probably women who are either having kids, or have kids, or about to have kids. But there’s a lot of people who listen who are in the medical profession. I know a lot of med students listen to this, some of the residents listen to this. And I think that lesson, it’s so important, this idea of even when it’s hitting the fan and everything is going terrible, you have a human being there. You have a person who is terrified. They think they’re gonna die. Even though you know they’re not, they don’t know that. They don’t have the medical knowledge to know what’s going on. So, they see people running around, they’re gonna think the worst.

And you can literally change someone’s life by just looking at them. Look them square in the eye and say, “I got this. Here’s what’s happening. It’s a problem, but we know what we’re doing, we do this every day. You’re gonna be okay. You’re gonna fall asleep with a smile on your face.” “All right. It’s all good. I got it. They got it. I’ll be okay. I’ll be home with my babies in a few days,” versus you seeing the white light and thinking it’s over. I’m done for this world. And you fall asleep thinking, “My poor husband has got these babies and not have a mother.” The difference between those two experiences is literally night and day. You’re talking four years later, and you’re still traumatized by it.

Stephanie: Yeah.

Dr. Fox: Whereas as you said, potentially, that 10 seconds, you’d be totally different person right now. And so for the people listening who take care of people…it was a lesson for me too. I’m not saying I always get it right. I’m sure I do it wrong all the time, but it’s a reminder to us how critical it is to have that communication with people in those situations.

Stephanie: Yeah. You’re right. And I had the bedside manner. I was checked on every night and everything that I was there, but I just needed that little 10-second reassurance.

Dr. Fox: Yeah. again, I am certain…I don’t know who these doctors are, right. We’re not saying anyone in particular. I’m certain if I met them or knew them I’d say, oh, yeah, nice people, good doctors, good anesthesiologists, good nurses, caring people, kind people. But sometimes we forget. In the heat of the moment, we forget that step, which is part of taking care of you. So, number one, we obviously wanna make sure you live and make you’re well and healthy. But part of that is also when you wake up, you’re not traumatized for four years. All right. That’s part of being well, and we have sometimes that power in our hands to do that and it’s just a reminder that we need to. Again, I’m not preaching, this is to me as well because I’m certain that I forget to do it at times. But it’s just so important.

Thank you for coming in. Thank you for volunteering. Thank you for schlepping out to my office so we can meet in person and telling your story. I know it’s difficult to bring these things up. I hope ultimately, it’s therapeutic, but it is hard to talk about these things. But it’s just really important that people hear this and I’m just glad that you volunteered to do it.

Stephanie: Thank you so much. I hope I can help even one woman that is going through a similar issue.

Dr. Fox: Thank you for listening to “High Risk Birth Stories,” brought to you by the creators of the “Healthful Woman” podcast. If you’re interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at 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 information and entertainment only and does not replace medical care from your physician. The stories and experiences discussed in our podcast are unique to each guest and are not intended to be representative of any standard of care or expected outcomes. As always, we encourage you to speak with your own doctor about specific diagnoses and treatment options for an effective treatment plan. Guests on “High Risk Birth Stories” have given their permission for us to share their personal health information.