“Maternal Birth Injury: The Unspoken Outcome” – with Kerry

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. 

Kerry, welcome to the podcast. Thanks for coming on. I really appreciate it. 

Kerry: Thank you so much for having me. 

Dr. Fox: It’s so nice to see you in person. We obviously spent a lot of time together over the past year throughout the pandemic, and your most recent pregnancy, for your baby born a couple of months ago now, right? 

Kerry: Yup. 

Dr. Fox: We’re gonna be talking about your first pregnancy, from 2017, of your son, and then we’ll talk a little bit about in between, and what you went through, and how you dealt with it, and then approaching the second pregnancy. 

Kerry: Perfect. 

Dr. Fox: I think the best way to start is, take us back to before your 2017 pregnancy. Who are you, what’s your story, where you live in, what concerns you have coming into pregnancy, if any? 

Kerry: I was living in New York City, and I had recently moved back here with my husband, from London, and we were ready to start our family. I did have some apprehension because I had this pre-existing condition with hypermobility, and that had led to dysautonomia. So I was a bit apprehensive, but that also meant I think it gave me an advantage in the sense that I had a lot of experience with healthcare, navigating doctors, and hospitals, and insurance. I thought, “Okay. I’m gonna find a doctor beforehand, before I even conceive. We’re gonna talk about these issues, these concerns.” Being half French, I had a lot of exposure to that whole philosophy around recovery with physical therapy, so I kind of had a sense, okay, birth can be stressful or impactful on the body, and you have to be prepared. So I felt at one side apprehensive, but also very prepared. And other than that, you know, I was just a regular 34-year-old woman working in the city and, you know, hoping for the best for a family. 

Dr. Fox: So, just so our listeners understand, let’s just talk briefly about those two conditions. So, the first you’re saying is the hypermobility condition, which you mentioned Ehlers-Danlos, sometimes called EDS. So, explain just, in lay terms, what exactly is that? What does that mean to your practically? 

Kerry: So there’s all types of EDS, and mine, fortunately, is literally just that. It’s hypermobility of the joints. The ligaments are pretty loose. So, you know, day-to-day, I think most people who have it probably would never even notice. You might just think you’re good at yoga or, you know, you can touch your toes easily. You know, for me, the implication was that it had progressed onto this dysautonomia, called POTS, so, that’s just when your autonomic nervous system has a hard time regulating things like heartbeat and blood pressure. But while it had been a very scary onset of POTS, and that’s how I learned about the hypermobility and its implications, it was controlled at that point. It was about four years in to that diagnosis. I was living a pretty normal life, if having to manage it sometimes. 

Dr. Fox: Right. And the second one, that POTS, P-O-T-S, is an acronym for a condition, but basically, you know, your blood pressure can go down, go up, your heart rate can go down, go up, and you’re not as well-regulated, as you said, as someone else would be. We don’t even realize, you know, day to day, that our heart rate regulates itself and our blood pressure, but obviously things are going amok, you realize. And what kind of symptoms would you have, if let’s say, you know, your blood pressure’s too high or too low or your heart rate, just so people understand, like, what you would be experiencing? 

Kerry: Yeah. I mean, and I don’t wanna make light of it, because I will say that I had very sudden onset of POTS when I was 30. And, you know, I was, like, bedridden for months and it was pretty traumatic, but, you know, luckily, I was able to kind of get that under control. But, you know, when you first, or when you have acute POTS, you’re dealing with, you know, you stand up and your heart rate is approaching 200 beats a minute. Now, I didn’t know what normal was, but I learned that normal is, you know, 60, 70, under 100, you can say, right. So, that means you’re gonna feel really faint, so you’re gonna possibly actually faint, but it comes with a whole constellation of fun symptoms, including, you know, GI issues, you know, headaches, chest pain, stomach aches, even brain fog to the point where you can’t remember things like your own phone number or, you know, vision issues. 

That’s the really acute stuff because, again, you’re just regulating your autonomic nervous system, which, you know, normally, hopefully, you would never even tune into. At that time, you know, I was probably having things more like episodes of sudden onset tachycardia, which is just like your heart’s going really fast, and then it would settle back down and I would get back to day-to-day life, for the most part, you know, just managing it with fluids and things like that. 

Dr. Fox: So, you have these conditions, and they’re obviously affecting your life, but overall, otherwise, you know, you’re functioning, you’re well, you’re working, you’re doing your thing, and you’re considering a pregnancy and you’re making these plans and finding doctors. And what was the messaging you received from the OB-GYN and the other specialists you were seeing about an upcoming pregnancy? Were they confident it would be pretty straightforward? Did they think it would be a disaster? Did they have no idea? What was it they were telling you? 

Kerry: There’s a lot of no idea. For the most part, everybody was optimistic. You know, I had read in the research that delivery could be an actual onset trigger for POTS. So that made me very apprehensive. I didn’t wanna be back to that state that I worked so hard to get out of, where I was bedridden, and, you know, having to take [inaudible 00:05:42] prescriptions. So that was something I hoping to avoid. So I really, really wanted to, you know, find a team that knew about how to manage this and took it seriously. And, you know, I felt like I had done that. And… 

Dr. Fox: Who was on your team? Like, what kind of specialists or doctors? 

Kerry: So, cardiologist, very much so. And then a specialist that focuses in blood pressure. So… Gosh, I don’t even know what his specialty is called, but that’s what he does, is blood pressure. And he, you know, has, like, this subspecialty in POTS. 

Dr. Fox: Right. Sometimes they are cardiologists, sometimes they’re actually neurologists, because it has to deal with the nervous system. But yeah, it sort of depends on which direction they entered the blood pressure world. If it’s on the POTS world, then maybe more neurology, but it could be cardiologist, or internal medicine doctor who has this, you know, a keen interest in it as well. It’s just someone who sees a lot of patients with POTS, basically. 

Kerry: Exactly. Because it is an intersection of systems, which can be hard when you’re trying to find a specialist, because obviously they’re siloed by these systems within the body. 

Dr. Fox: Right. And what about for your pregnancy side? 

Kerry: Right. So, for my pregnancy, I was advised by this blood pressure specialist to, you know, stay at his hospital so he can monitor me. So I actually had to shop around, because that’s not where my former gynecologist was. So, I felt like, “Okay, you know, this is my main focus. I should be prepared around this particular issue, so I will find a doctor at this hospital.” Which is a great hospital, not your hospital. 

Dr. Fox: Right, right, right. No, but that is a legitimate difficulty with things like, this because, you know, you can be in a city…you know, we’re in New York and there’s obviously many wonderful hospitals in this area. And if you have medical conditions and your cardiologist, you know, is affiliated with one hospital and your obstetrician’s another, for most of the time, it makes no difference because everything’s in outpatient. But if you ever need to get admitted to the hospital, like if you’re having a baby, right? You can either go to one or the other, you can’t go to both. And so, either you go where your cardiologist is and you don’t have an OB delivering you, or you go to where your obstetrician is, and if something happens with your POTS, you have a new cardiologist. 

And that happens with a lot of medical conditions. The ones where it’s very unlikely someone will need to be admitted to the hospital with it, it doesn’t matter as much, but when…we say the same thing, if someone’s likely to have, or has a significant chance of having a complication where they will need their own specialists, we try to get everyone in the same place. 

Kerry: Yeah. So, I started a search and, you know, it was important to me that…and this is, I have to say, this is not something that’s accessible to many women, but I did want to find somebody who would deliver me on the day, right? So that I could go through this conversation with them and not have to repeat myself, you know, in delivery. 

Dr. Fox: You mean like a smaller group or a solo practitioner? 

Kerry: Exactly, exactly. Thank you. 

Dr. Fox: Got it. Yeah. Okay. 

Kerry: Yes. So, I found that and, you know, then I was like, “Okay. I guess we’ll try to get pregnant.” 

Dr. Fox: How did it go in terms of fertility, the pregnancy? 

Kerry: So, I was very lucky, I have to say, both times, to get pregnant very easily. And the pregnancy itself, you know, both times I wound up having placenta previa, actually. The first time, the pregnancy that we’re talking about now, it did resolve, but that was really, for the most part, I was shocked by how quiet my POTS was during my first pregnancy. It didn’t really pop up until the third trimester, where, you know, you’re already dealing with a lot of blood flow issues and your legs are swollen. Like, you know, you have those sorts of issues anyway and they were just exacerbated, but it was a quiet pregnancy in terms of complications, for that moment, anyway. 

Dr. Fox: Okay. And then, what was the plan for delivery? 

Kerry: So, the plan for delivery was that given, you know, the hypermobility, as well as the POTS, we were gonna do this thing that I was told was called laboring down. I hadn’t been familiar with the phrase, but it was something where I guess you let your body do most of the pushing for you, and then you, you know, exert your own force at the end, where the baby is nearly out of the body. 

Dr. Fox: Right. Once you’re fully dilated, the baby has to, like, go down to come out, and you can start pushing right away, or you can just sort of wait, sometimes for a very long time, so that the baby naturally sort of eke its way down, and then when it’s, like, right there at the very end, then you start pushing. Some women do it routinely, or some doctors have women do it routinely. In a typical case, it doesn’t matter that much either way, but for someone who are concerned maybe pushing will be difficult on their system, or they have heart disease or something like that, we try to minimize the amount of time they’re really, like, working, you know, working out at the back half of labor. 

Kerry: And it’s a workout, as I learned 

Dr. Fox: Yeah. No. It’s a real deal. It’s serious stuff. Okay. So that was the plan. 

Kerry: That was the plan. No more than 20 minutes of pushing was the plan going in. I went into labor naturally, like, you know, just after 40 weeks. And I would say that the only thing that really surprised me in the early part of labor was just how painful the contractions were. And I thought it was pretty strange to be having such painful contractions so early on. It turns out, I would later find out that I had back labor. And I didn’t know what that was or that I was experiencing it. So, I got to the hospital and I was admitted. I saw my doctor, I got an epidural, which certainly helped with the concept of laboring down. 

Dr. Fox: Right. And that was probably part of the plan also, I assume, for the POTS, and it keeps, you know, do it slowly, so your blood pressure doesn’t change too quickly. Okay. Yeah. 

Kerry: Yeah. And, you know, everybody has their own views around this. For me, I really did want the pain relief, and I was happy to get it when I did get it. 

Dr. Fox: Good bless you. It’s all good. 

Kerry: About a day went by, and I’m just hanging out on this epidural. And then, late the next day, I’m told, or I guess I got the epidural early in the morning. So later that day, much later that day, I was told it was time to push. And so I figured, “Okay, like, we’re laboring down, I guess he’s ready to come out imminently.” And so, I start pushing, and pushing, and pushing, and pushing and, you know, it was well over two hours when my doctor then sort of without…well, not sort of, without consultation, cut a very deeper episiotomy, and my son was born thereafter. I think what I found surprising in the moments, or in the hours, of the delivery was the atmosphere in the room. 

I really wasn’t involved in any conversation of what was going on. So, you know, I had in my mind, “Okay. We’re gonna be pushing for 20 minutes. It’s been two hours. What’s going on?” And, you know, I would ask, “Is he okay? Is the pushing working? Is everything going okay?” You know, “What’s happening?” And nobody would answer. And then, you know, I would ask…I eventually asked, you know, what grade is the cut? You know, like how deep is this episiotomy? Because I was told, you know, you’re supposed to ask these things. And nobody answered me. And, you know, even with some of the pushing and the effort of it, I would kind of grunt, you know, and I was told to be quiet. And I remember in the last hour of the pushing, so, like, the second half, so, in the second half of, you know, the two hours of pushing, I began thinking to myself, “Should I say something? Should I do something?” You know, “Should I demand a C-section? Should I ask why we’re not sticking to the plan? Should I push this?” 

Dr. Fox: Yeah. I understand. Nice choice of words, but I get it. 

Kerry: Right. And, you know, I had been encouraged by my doctor previously to relax, right? “It’s gonna be handled, stop worrying, stop asking questions. It’s gonna be okay. You’re gonna be fine.” 

Dr. Fox: This was during the labor, or during the pregnancy? 

Kerry: During the pregnancy. 

Dr. Fox: And I was gonna ask, you know, you’ve had four years to reflect on this, give or take. Why do you think it is that the communication was not good in the room? 

Kerry: Gosh, you know, I have relived this night, like, every night since, and I often wonder, “Did he forget the plan?” You know, “Did he think that it just wasn’t relevant, you know, that it was his job to get the baby out?” and what I thought or was experiencing or was worried with might have been a distraction. Right? I don’t know. I pieced together, you know, from the nurses and, you know, memories here and there that thankfully, my baby was not in distress, so I can take that out of the picture as to what was going on. But what has really stuck with me was I was in distress. And, you know, my heart rate did get very high. I was having a hard time catching my breath. I didn’t feel comfortable. I was scared and tired but also, I just didn’t feel comfortable interjecting. And I really, really regret that. 

Dr. Fox: Yeah. Do you think that he didn’t buy into the plan? Meaning, you know, there’s one thing where you said maybe he forgot the plan, maybe, whatever reason, he forgot that you’re the one who’s got that whole list of thing? Hard to imagine that’s the case, but maybe, obviously. Or is it, it was always sort of, like, foreign to him and he didn’t really buy into it initially, and it was sort of like he was feeding off maybe what the cardiologist said, and, you know, thought maybe [inaudible 00:15:45] just do it the old, you know, the typical way? 

Kerry: No. Actually, I mean, it was his plan. It was his idea to do the laboring down. And I don’t know if just in the moment he was like, “Everything seems to be going fine.” 

Dr. Fox: Right. Called inaudible. Yeah. 

Kerry: And those preexisting conditions will be fine. It’s just gonna be fine. I would have to hope that that’s what it was. 

Dr. Fox: Through all that, you know, you’re having this sort of confusion, you know, during the labor, and you’re, yourself, as you said, in distress and these things are happening to you, and then your baby’s born. Did it sort of in the moment wash that away, or did it affect sort of your joy at the time of birth? 

Kerry: It did affect my joy at the time of birth. And, you know, one of the greatest stories I’ve had since is just how well I’ve managed to bond with him, given those moments, and how close we are now. But it’s hard to say this because I know that there are so many women who hope for this day, and there are complications that can happen in the other direction, for the baby. And I don’t take it lightly that I left with a healthy baby. But I don’t always look back at that day as the best day of my life. You know, that was a really difficult day for me. And I remember thinking, “I just need to keep pushing so this is gonna be over.” And I really thought, “Okay. It’s over.” And what I didn’t realize was actually was just the beginning. 

Dr. Fox: Yeah. I mean, what you describe is something that’s come up just on his podcast so often, this idea that the birth, whether the mother recalls it as a traumatic event or not, is not necessarily related to the outcome, right? You could have a perfectly healthy baby and a good outcome, but the birth could be traumatic, could be very hard to think about. And on the flip side, you could have a very, unfortunately, bad outcome, but not look back on it as a trauma of an experience. Obviously, it’s a sad event, but it’s not a traumatic experience. And it’s true with, you know, the death of a loved one. You could have a death that’s very traumatic to think back on, and you could have a death that’s not as traumatic if it sort of happens in a more “peaceful way” or this or that. And it’s separating the outcome from the experience. And those are different, obviously. They frequently go hand in hand, but not all the time, and obviously in your case, certainly not. 

Kerry: Yeah. And yeah, I remember him being passed to me, but I was just…I mean, the pictures tell a thousand words. I mean, they’re just…no one can see those pictures, because I just look like I’ve been through war. And I was, you know, I was concerned. I’d been through enough with my own body up until that point that I was concerned about being put back together, to be honest. And that’s why I’d asked, you know, how deep is the episiotomy, how many stitches? And I just was really…like to me, it wasn’t over until that was over, you know? And so I kind of remained focused on that. 

Dr. Fox: Right. When did you ultimately go home from the hospital? And tell us about your recovery. And that’s a very broad question, obviously. 

Kerry: Yeah. So, I stayed, oh, gosh, I wanna say two nights, whatever was standard for a vaginal delivery. 

Dr. Fox: Probably two nights. Yeah. 

Kerry: Nobody was remarking on anything at that point. It was no reason to keep me, and, you know, my POTS, while it did spike a little bit right after the delivery, really evened out within 48 hours, thankfully. So I was sent home with my son. And over the ensuing weeks, days, and weeks, I began to just have these really troubling urinary symptoms, basically that I had to go all the time. So much so that, you know, I went to see my OB and he did a test for UTI, and I ended up at a urologist, because I did not have a UTI. And the scan showed that I wasn’t effectively eliminating urine. I had urinary retention. And I think for some people, that can, from what I understand, that can result from anesthesia, and it goes away, but mine wasn’t going away. 

And what wound up then happening over the course of weeks and months and years, was that the act of trying to expel that urine and not being able to do it aggravated the entire pelvic region so much that, you know, I was having burning, throbbing, feelings of incomplete urination, just difficulty walking, lifting my kid, living my life, and it was like my brain was telling my body to just relax and let go and release, like I had always done, for 30 some-odd years, and you don’t even think about it. And my body just wouldn’t or couldn’t, and it was frustrated, I was frustrated, and, you know, every moment really became something of a nightmare. 

Dr. Fox: Yeah. And I mean, unfortunately, you’re set up for that because you have an issue with your autonomic nervous system, which affects your bladder, and you have an issue with your, you know, joints, and smooth muscle, and sort of your tissue, which also affects your bladder, and you pushed for three hours, which definitely impacts the bladder. Again, most people, it doesn’t, but you were sort of a setup for that, potentially. 

Kerry: And I should say what happened. I omitted this part, which was that I later found out, this is what I wasn’t understanding during the delivery, was that he was almost nine pounds, and he was sunny side up. So I occiput posterior, which apparently is a very difficult position of the baby to push out, especially for a first. 

Dr. Fox: Yeah. Geometrically, it’s not as easy. And, you know, not everyone can see this from your voice, but you’re not a very big thing. And so, a 9-pound baby in your body is disproportionate. 

Kerry: Yeah. We don’t know how he became so big. So, you know, I didn’t know that. And I think if I had known it, I would have said, “Wait a minute, what are our options here? Let’s just stop pushing for five minutes and have a conversation.” Because I knew all of what you’re saying, about these pre-existing issues, but I didn’t have an opportunity. 

Dr. Fox: So, over those course of the two or three years, you’re going through what kind of treatments for all this? 

Kerry: So, you know, I call this a birth injury. And one thing that I would say about birth injuries is, you know, nobody really talks about them. And I was thinking about this and how to describe it, and the idea of a bowling ball came to me, right? You have this sort of roughly 10-pound object. Let’s say someone throws it at you and you get injured. Then you would go see your doctor and they would be like, “Oh. You have this injury. Maybe you need some PT.” And by PT, I mean physical therapy. And, you know, just, “Here’s your CPT code and your insurance will cover it.” What I found with birth injuries is that whole process does not exist. So, you go back to your obstetrician, or at least I did in my case. I went back to my obstetrician, he saw me a few times, but he was like, “This is not my arena. This,” you know, “I’m not sure if this resulted from the birth. This is not my arena.” 

So, I was really left on my own, to go back to work, raise this kid, and then try to figure out how I was gonna piece my body and life back together. And I basically went on a tour of every urologist, gynecologist, urogynecologist that I could think of or had heard of. And again, you know, that was a journey that took a lot of time, and frankly, a lot of money. And, you know, I was fortunate. It wasn’t easy, either way, with the time or the money, but I was fortunate to be able to invest those things, and, you know, many women can’t. And I don’t think that it should be, “Oh, in order to recover from birth, you have to invest, you know, take hits to your career and your income, and all of this,” if you are lucky to have those things. 

So, I’ll just say that it was a very winding road, and I tried a lot of treatments that had a lot of side effects or led nowhere, but to go down the list, we had, you know, muscle relaxants, nerve medications, oral nerve medications, nerve block injections, lidocaine installations into the bladder, electrical stimulation of the nerves, and ultimately plasma injections. And then an enormous amount of physical therapy, which I was so grateful to know about. 

Dr. Fox: Right, yeah. The pelvic physical therapy. 

Kerry: Pelvic floor physical therapy. So, you know, all of this, over really, four years, gradually trying more and more invasive things, and ultimately, finally, really within just weeks of now, so we’re four years later, getting a diagnosis, which was pudendal nerve injury. Which then led to, also, you know, a lot of the symptoms that I’ve been describing, but there’s also ligament damage and, you know, muscle damage, and that led to pelvic floor dysfunction. So, you know, having a diagnosis can be really helpful. I learned that with POTS. That can be a very hard diagnosis to get as well. And, you know, and then finding your team, which can be hard, because it’s not a clear-cut road. 

Dr. Fox: Right. And it’s a second team now. You have a first team, you know, that was already there, and now you have a whole team related to your pelvic floor. It’s a lot of people. No, listen, when you’ve got…it’s a… What did that do to you sort of from a mental health perspective, a spiritual perspective, like, just, you know, meta, looking down on this, you know, looking at yourself, going through those years. Obviously, it’s extremely frustrating and painful and… But what did you feel about yourself at the time? 

Kerry: I felt really, you know, despondent. You know, there wasn’t any space… You know, I talk about this. Obviously, I pursued treatment, I pursued getting better, but it was very, hard because I felt uncomfortable talking to my friends about this. I mean, this is very private stuff. And I certainly felt uncomfortable talking to my employer about it. It’s not like, “Oh, I’m experiencing chronic migraines or a backache,” right? This is much more private. And, you know, that was hard, to feel like you have to go through this thing by yourself. And I remember kind of going for these walks with my family and seeing new moms on the street or in the park, and I would just always say to my husband, “She looks fine. Why is she fine? Why, you know, why is it she’s fine and… I mean, do other people give birth, and then they’re able to go to the bathroom? Is that something that happens to other people?” Like, it just became so integral to me that I had this injury. 

And I recently heard, actually, on a podcast that the Latin etymological root of the word “pudendal” means “shame.” And I really felt ashamed and disgusted by my body. And, you know, having already, as you said, managed the diagnosis, the POTS, gone through kind of the terror of a sudden onset of a chronic condition at a young age, and having it be hard to diagnose, and then getting something on the back of that when I kind of took that leap of faith to try something, to put my body through something, and then to have it fail again, I went into pregnancy as, you know, an unpregnant person, a pre-pregnant person, thinking, “Postpartum depression, postpartum anxiety. These must be these spontaneous, organic chemical phenomena that, you know, you get because of the hormones in your body.” 

But then, you look at yourself and you’re this young person pursuing a life and a career, and you have hopes and dreams, and you go into this delivery room and you come out and you’re in pain or you’re dysfunctional, or, you know, to talk about some of the other pelvic injuries that can occur, you know, your organs are coming out, or you can’t control your urine or your stool, or in my case, you know, you’re not able to pass urine effectively, or you’re in pain. I mean, you’re like, “Who am I? These are basic functions, and everyone around me seems okay with the fact that I’m living with this. There doesn’t seem to be a road to recovery.” And I was told some real fun doozies, going to see all of these doctors, you know, from the fact that it was my fault, I should have intervened on my own behalf during the labor… 

Dr. Fox: That’s a good one. That’s kind. That’s kindness all wrapped up with a bow on it. It’s your fault. Your bladder is your fault. Okay. 

Kerry: That one lingered. That one stung. It stung. It still stings. And, there, you know, the other one, which I got a lot, and I suspect a lot of women get, which is, “No matter what happened to you or what you have to deal with for the rest of your life…” 

Dr. Fox: I know where this is headed. 

Kerry: “…it is worth it, because you had a healthy baby.” And again, I wanna go back to that because not everybody has that privilege and that experience. 

Dr. Fox: Right, right. But the, “Be thankful that you’re horrifically injured, because you have a healthy baby.” 

Kerry: And I really, you know, was saying to myself, “This is, you know, the richest country, in 2017, 2018, 2019, 2020, as I’m hearing all of these comments. Why is it either-or? Why is this an either-or proposition? And why does a woman go into a hospital to deliver a baby, and come out with a chronic health condition? Like, we should be past this.” 

Dr. Fox: Right. What was some of the better messaging you heard? Proper, helpful, productive, those types of messages? 

Kerry: It was in the comradery. You know, I was introduced by a friend to a friend who actually also had a 9-pound OP baby, and also had urinary issues. Just the fact that there’s someone else out there. There’s someone else out there, you know, and pelvic floor physical therapy is, like, the nest. It’s like where people like me congregate. You know, you find that they are meeting these other people that you’re not seeing out in the real world. 

Dr. Fox: Yeah. These people are out there, and there’s lots of them. 

Kerry: Right. And, you know, the suspicion is that there’s many more than we know of, because of that shame factor. 

Dr. Fox: Well, in the world, certainly, and the U.S., also certainly, but it’s… Yeah. This is a real thing. 

Kerry: But, you know, the messages were, “We can work with this. We know what we’re doing. We can treat this.” And you just have to kind of learn to trust again, come along for the ride. 

Dr. Fox: Right. We’ve seen this. 

Kerry: We’ve seen this. Right. 

Dr. Fox: Right. I mean, that’s a big thing when you’re, as you said, sort of, you know, wandering the Earth, wondering, “Am I the only person this has happened to? Am I, you know, I cursed?” And then you find someone who says, “No. We’ve seen this. Like, it sucks that you have it. You know, it’s, like, awful, but we’ve seen it. And so, we see people get better from it,” and sort of give you that at least that people have seen it, and they know what they’re doing, and they’ve seen results. And that’s huge. I mean, that takes you to, like, “All right, at least I know what box I’m in, you know, what the deal is. And it still is horrible that I have this, but at least there’s some light at the end of the tunnel, potentially.” 

Kerry: Absolutely. And I will say that in the four years that I’ve been going through this, I’ve seen this field just really start growing. You know, there’s all kinds of kind of self-serve, online physical therapy programs for postpartum women. That’s just for general recovery, right? Because your body’s still going through a lot, even if you don’t have an injury. And then there’s a lot of, you know, of science that’s progressing in terms of treating these kind of more esoteric injuries. But, you know, my husband made a great point to me this morning, and I told him this was the day I was coming on this podcast, and he goes, “You know, women have been giving birth for millennia. Why is this cutting-edge medicine? You know, why is this considered experimental or off-label medicine,” right? We should know this by now. This should be kind of rote. 

Dr. Fox: Yeah. Well, there’s a very unfortunate history behind, you know, birth, and care to women who gave birth. And it’s, yeah, it’s not good. We’re getting better, but it’s been not good for a long time. And it used to be a similar argument that was given to you about your baby, was like, “Be glad you’re alive.” That’s sort of what it used to be with birthing. And that was true. Women died… 

Kerry: A hundred percent. 

Dr. Fox: …during childbirth, all the time. And it was a tragedy then also, but it was expected that it would happen to a fair number of women. And so, it really was, “Okay, you have this horrible thing, but, you know, at least you’re not dead.” And I don’t know if a thousand years ago, women found comfort in that. I hope they felt the same way you do now, like, “I’m not dead? Like, that’s what I get?” 

Kerry: That’s my baseline. 

Dr. Fox: Right? And so, I don’t know, maybe they thought that also, but I presume there were some who were like, “That’s not good,” but there was no help for them. And this has, unfortunately, continued. Again, I would say in the past hundred years, there’s been a steady improvement, but in some things, much faster and in some things, much slower. And too slow, obviously. 

Kerry: You know, one of my doctors said to me, “Oh, look, if you only knew all the things that could happen, you’d never do this.” And I’ve often thought about the women in centuries past, and, you know, the kind of glossing that’s happened maybe in the last hundred years, that we don’t think about this as a potentially fatal outcome, which it still is for some women, even in this country, but certainly that there’s a spectrum of outcomes, right? And I thought to myself, “Wait a minute, this is not about fear.” And I don’t wanna make anyone frightened by what I’m saying either, although I’m sure it can be taken that way. It’s about empowerment. And if we can say to a woman, “Okay, you’re gonna go into the hospital, and then in two days, we’re gonna have this helpless little person that you’ve never shown any kind of experience taking care of this person before, but we’re gonna let you take it home and care for it.” 

If we can trust in women that much, then surely we can trust in women to be involved in decisions around their healthcare and during the pregnancy and in the delivery room, and we can be there to support them, and the way that we, as a culture, you know, purport to love mothers and cherish them and we think of all they’ve done for us, to be there on the other side, to support their recovery, and understand that, you know, there’s no right way to have a baby. I’m not here to say, as we’re gonna cut into, “Oh, you should do it this way or that way,” it’s about having these conversations, and treating women like adults around their healthcare, and then supporting them in their recovery and being real about it, and just saying, like, “This is hard.” And, you know, a lot of these women are going on to have careers, and relationships, and families, and they wanna be present for their life. And we shouldn’t be relegating a mother to the sidelines and saying to her, “Well, this is, you know, what motherhood is.” Or, “This is normal,” Or, you know, “Too bad for you.” It’s not good enough. 

Dr. Fox: Yeah. Those are such amazing points. So true. I mean, really, so, so true. How did you even approach the idea of doing this again? I mean, what did it take for you to say, “We’re trying again?” 

Kerry: Do I do it again? So, fast forward to 2020… 

Dr. Fox: Spoiler alert: Yes. 

Kerry: Yes. And, you know, I had always hoped to have two children, you know, my husband and I had hoped to have two children. And I was kind of going through this postpartum period, which, you know, some people think of postpartum is like three months. For me, it’s like now we’re getting onto four years of dealing with all of this, and so much of the stress, it was not only to feel better, but because I wanted to have that other child, and I was getting older and my kids were getting gapped farther and farther apart. And I felt like, “Okay. We need to really just decide.” And I was terrified. I was scared to be pregnant. I was scared to go through birth again, but ultimately, and listen, this could have gone the other way, and I get why anyone would make the other choice [inaudible 00:36:34] in this position, I just decided, you know, “I don’t wanna be ruled by the fear of it.” And I don’t wanna let that experience, as bad as it was, be the thing that potentially holds me back from a great outcome. 

So, I shopped around again. I got two doctors this time, you being one of them. And, you know, I wanted to make sure that I had a team that recognized that these physical injuries were real, and as you’ve been saying, the emotional impact was also there. And I found that, and I decided, “Okay. Let’s just try and see what happens. You know, maybe nothing will happen. Who knows?” 

Dr. Fox: Yeah. I recall our meetings from my perspective, but I’m just curious, from your end, both when we met, but also with the obstetrician, right? Because I was part of your team, but I didn’t do the delivery. You were gonna deliver back at the hospital, where your cardiologist was, your POTS people were, which we agreed was the right thing to do, but was it different, or just a new set of people and we’re gonna, you know, sort of reboot and see if it works better with other people, or was…what was it like for you, meeting new doctors and going through your story, and all this trauma, and…to try to sort out what they think about it? Like, you could be blunt if you didn’t like me, that’s okay. Because I know we like each other now, but I don’t know what your first impression was. 

Kerry: Well, no. Clearly, I asked you to be on the team, and I was grateful that you said yes. You know, it was hard to tell the story. It was hard to go through exams and, you know, kind of, you know, get corroboration around the injuries that I kind of wish had never happened. But, you know, I felt like, “Let’s just see what happens. You know, if I don’t like any of these doctors, I don’t need to do this.” And I guess I’d come to a place in my life where I wasn’t taking any prisoners. I was like, “If I’m not satisfied with this, or if they don’t wanna look me in the face and talk about these things, then I don’t need to work with them. And I don’t need to have, you know, another child. I can make that decision. I just need be informed.” 

Dr. Fox: Right. You’re being self-empowered, in a sense. Yeah. You’re empowering yourself. 

Kerry: Well, maybe there was some of that, you know, that was coming from reliving that delivery and just saying, “Okay. I’m gonna do what I didn’t do.” So, that’s what I did. And, you know, why not do it during a pandemic, right? 

Dr. Fox: Game on. 

Kerry: I was like, “Let’s just make this as terrifying as possible.” So, in June of 2020, I did get pregnant, this time with my daughter. And I was pretty nervous the whole time. I think you and the obstetrician who delivered me had to keep me pretty cool. 

Dr. Fox: I’d come over periodically and inject you with a tranquilizer. No. 

Kerry: If only. 

Dr. Fox: It was fine. Yeah. Listen, I think you did great. You handled the pregnancy really, really well. I mean, you had difficult circumstances. I mean, as you said, traumatic birth the first time, medical conditions. You have what to be worried about, right? This is not like, you know, just a diagnosis of anxiety, which people have. It’s obviously very difficult, but you have real things in front of you, and the world is exploding with a pandemic at the same time. Let’s sprinkle that on top of it. But no, you certainly kept it together, I’ll tell you that much. 

Kerry: Well, thank you. And, you know, we decided to do an elective cesarean, and that was a decision that I was very comfortable with. In fact, most of my anxiety was about going into spontaneous labor and having to push again, and having, you know, a similar situation. And I had been told that if, you know, following my first delivery, that if I ever pushed again, I would need reconstructive surgery. I don’t know if that’s true, but it was pretty scary. 

Dr. Fox: Right, right. Right. Did people give you crap over that decision, to have…I mean, obviously, I didn’t and your doctor didn’t, and the people who sort of “mattered” in your care didn’t, but what was the message you got from others? Because again, you had a vaginal delivery before. People, “Why would you sign up for a C-section the second time?” 

Kerry: Well, you know, this comes into what I’m saying about shame, right? The people who really knew what I went through never questioned it. 

Dr. Fox: Right. Totally, like, “Oh, yeah. Good idea.” 

Kerry: You know, exactly. Please, please do that. Please do that. The people with whom I had not felt as comfortable, or maybe didn’t want to understand that this was really the outcome four years later, you know, I would get things like, “Well, you know that’s gonna be a longer recovery.” And I’m thinking, “Longer than four years? I don’t think so.” Or hopefully not. And, you know, “Don’t you wanna at least try to push? Don’t you wanna see what happens? It’s gonna be painful.” And, you know, that saddened me, because I think a lot of these circumstances are really private, and we don’t know what many people giving birth are dealing with. And they don’t really have to share that. And I just hope that, again, everybody’s given the information they need to make an informed decision, and then they can make that decision for themselves without feeling shamed, again, to use that word. 

Dr. Fox: Right. And so, you have this plan in place. I assume that must have reduced some of your anxiety about what could happen in the birth. Otherwise, how did the pregnancy go from your end? How did it feel to you? 

Kerry: You know, second pregnancies are harder. I was told that. I didn’t really buy it, but I found it was a harder pregnancy. I think some of my preexisting conditions, the hypermobility and the POTS, were more prominent, maybe because I’m older. I don’t know. 

Dr. Fox: Right. And, of course, you now have a child to take care of. 

Kerry: Yes. Also, there’s that. They’re tiring. And, you know, the circumstances were crazy, right? Where I was working from home during this pandemic, there was a lot of pressure, and I just kept trying to get to the end, because I was so worried about it. And I think what’s also interesting is if you do have a situation where you’re having a second pregnancy and a second delivery, but it is a different mode of delivery from your first, you really don’t know what to expect. 

Dr. Fox: Yeah. Whole new adventure. Yeah. 

Kerry: Right. You’re not, like, going back and be like, “Okay. Now I know what to expect.” And, you know, my poor obstetrician, I made her get on the phone with me and my husband and, like, walk us through, “Okay, this is what happens, then this is what happens, and this is what happens,” so I could really just calm down and just feel like I was prepared. 

Dr. Fox: How did the delivery go? How was that day? 

Kerry: So, I was so nervous. And I have to say that it was just a day of miracles. You know, I went to the hospital and everybody on the team…because you don’t know everybody you’re gonna meet there, right? Although my obstetrician did an amazing job, she introduced me to the anesthesiologist in advance, I got to speak with the head of nursing in advance. So, you know, everything that we had to do, we talked through, and I knew them. And, you know, I went in there and there were at least a few faces that I recognized, or at least I knew their voices. And then, you know, there’s quite a team that’s, you know, going into a C-section. I was surprised by even how scared I was on the table. Like, I was just shaking like a leaf. 

And I know this part of that was probably the medication as well, but what was so night and day was, you know, my doctor’s just there on the other side of the drape, and I’m asking her questions, right? Like, “How’s it going? Is everything normal? Is everything okay?” And she’s answering me, and she’s talking me through it. “Now I’m gonna do this, now I’m gonna do that. You may feel some nausea.” Okay. It’s anticipated. You know, all of that. And so, you know, the C-section itself, it’s not like it was a walk in the park, you know, [crosstalk 00:44:14]. I was scared. You know, it was a, you know, a kind of full-body experience, but it was definitely the right one for me. 

And, you know, yes, the recovery is uncomfortable, but there was something about it being normal, that was so meaningful to me, right? Like, “Oh, that’s the kind of pain you can expect.” And that’s what I had. And it started to go away over time, and I realized that birth can be this moment in time that actually ends. And I thought, “This is what a birth could be. This is what other people experience.” And then I started getting in my head around, “This is what every birth should be.” Right? Like, every woman should be able to go through a birthing experience where she feels…taken care of? Secure? I don’t know. Involved. 

Dr. Fox: Right. And again, you’re not saying… I know you’re not saying this, that every woman should have a birth that is a cesarean, you’re saying whatever the birth is, it should be one that she feels empowered, you know, that she’s a part of this decision. And again, plans do change, but if you’re involved and you’ve, you know, you have that sense that this is my birth, and not my doctor’s birth, that has a lasting impact, the memory of the event. There’s no question. 

Kerry: I was brought to tears by just the kind of expertise and compassion on that day. 

Dr. Fox: It’s amazing. How has your recovery been? It’s obviously been much shorter compared to the four years from before, because we’re just a few months after, but is it been sort of what you expected, or did you know what to expect, or better, worse? 

Kerry: You know, I was really nervous I was gonna go back into retention. And, you know, the urologist had prescribed all of these scans and tests, and I passed them. You know, I passed them repeatedly, and I couldn’t believe it. I was like, “Oh, my goodness. This is incredible.” Yes, you know, the incision is painful. But, again, it’s…I don’t know. There’s something about knowing that you’re gonna be in pain and then having the pain, I was able to cope with that. It was the mystery of the [inaudible 00:46:27] the first time that was so traumatizing, and then not knowing when on Earth it was gonna go away. And, you know, I will say, in a month after my surgery, I did have a flare of the nerve injury. And so, I am working through that flare now, but I’m very optimistic. I’m using all the tools I learned, or treatments that I learned, over the years. I feel hopeful. 

Dr. Fox: We’ve spoken about a lot of things, obviously, and you’ve brought out so many important points. What would you say are the takeaways you want our listeners to have, either if they’re, you know, women themselves who are, you know, pregnant or going to give birth at some point in the future, or maybe women who had a birth that they experienced as traumatic, and sort of have that lingering, or people who have family and friends who give birth, what do you want them to know? 

Kerry: Well, start with the family and friends. I think that you should just bet that you don’t know what’s going on, right? I think that’s the thing. Like, when I was going on those walks and seeing all those other moms, you know, my husband said to me, “They look at you that way. You have no idea what’s going on for them.” Right? And whether it’s a birth injury, or they’re having some, you know, mental or emotional reaction, or they’re just struggling with the transition, it’s a big transition, whatever it is, you probably don’t know, and you probably need to be there more than you think. I would say that, you know, just as a society, we need to invest in postpartum maternal care. 

And, you know, it’s a commonly-quoted thing that the baby has X many visits after birth and the mother has one. Right? And hopefully, we’re checking out those things that can lead to fatal outcomes, right? Hopefully, and that’s not happening for all women. But we also need to rejoin…or I should not say rejoin, we should join some of the other countries in this world that are having, you know, routine physical therapy checkups to make sure that you’re functioning well, that there’s no prolapse, or pelvic floor dysfunction, or nerve injury, and that you’re able to function at a basic level after going through this really significant physical endeavor. 

Dr. Fox: Or how about this? Even just ask about it. You know, just ask the question. A lot of people don’t even get asked when they see their doctor afterwards. 

Kerry: A hundred percent. 

Dr. Fox: And so they don’t even realize that they’re supposed to talk about this. I mean, that’s like the simplest step, you know, you just, “Hey, tell me about this.” You know? “How’s it going?” 

Kerry: And be prepared for the fact that it might be hard for a woman to talk about. And we need to be there for them as a society. And I would say for expectant mothers, if you have the opportunity, talk with the person who’s gonna be delivering you ahead of a delivery. You know, have a conversation. Be like, “I can take it. I wanna know what the risks are. I wanna know what the options are. And I recognize that that might change in an emergent situation.” Right? “But let’s just get on the same page.” And if you don’t feel like you’re getting that dialogue, and you can, go somewhere else, because there are people who’ll have that dialogue with you. And trust me, it’s important that you feel that you can trust what’s gonna happen in that room. 

For those who are out there who may have experienced a similar injury, or any injury, doesn’t have to be like mine, you know, I hope that this has given you a sense that you’re not alone, and that there is something you can do about it. And I do hope that over time, the postpartum care does evolve. It may take a lot from you to put your team together and to find the right treatments and to figure it all out, but don’t accept a life of pain or dysfunction because someone somewhere tells you that it’s normal, or the price of being a mom, or better than being dead. You know, you can get better, and you deserve to get better. 

Dr. Fox: It’s amazing. Kerry, thank you so much. Such an important story. I’m obviously overjoyed at how well the second pregnancy worked out, certainly as compared to the first. And, again, you do have, thank God, two healthy children, and you experienced both sides of the coin. You experienced how bad it can be and also, like you said, that joy, that bliss, you know, the amazing experience of having a baby, and you can look back on that with a much better taste than you had the first time around, which is such a hard way to live. And it’s just so wonderful to see you and to talk to you, obviously, and, you know, and it’s great. And thank you for sharing this, because it’s hard to talk about it and it’s hard to open up like this. But, for people listening, I’m sure that they appreciate it very much, so thank you. 

Kerry: Well, thanks for having me, and thanks for letting me tell the story. 

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.