“Postpartum Hemorrhage right after the Postpartum Hemorrhage Podcast!” – with Elise Nelson

Elise Nelson, a Healthful Woman listener, joins Dr. Fox to talk about her High Risk Birth Story. In this episode, she tells the story of delivering her second baby in May 2021, which includes pregnancy through COVID, postpartum hemorrhage, and adjusting to taking care of a newborn and two-year-old with help from family.

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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. Elise Nelson, thank you so much for joining us on the podcast to tell your birth story. How are you doing today?

Elise: Great, thanks. Thanks for having me. It’s a pleasure to be here and have a chance to tell my story.

Dr. Fox: So we got connected because you are a listener of the “Healthful Woman Podcast” and you sent me an email how listening to the podcast sort of helped you with your birth just this year in 2021. I actually read the letter on the podcast because it was so nice. And I reached out to thank you and then also to twist your arm to come on and tell your birth story. So, you know, no good deed goes unpunished as they say. So it’s good. So, first of all, thank you for listening to the podcast. How did you find us? I’m curious.

Elise: So I believe the first time I heard you was on the “Informed Pregnancy Podcast” with Dr. Berlin. I think I heard your interview there and I liked your style. So like he has a more natural childbirth following, just, you know, given his background. And I wouldn’t say he has as many OB/GYNs on there, but I liked kind of your stance on things that seem to like support the birth women wanted, but it was also OB/GYN and hospital-based and so I thought why not check out your podcast. And so that’s how I found you guys.

Dr. Fox: And just by pure coincidence, you are currently where I am from, right? You’re in the Chicago area.

Elise: I am. Yup. I’m from the northern suburbs of Chicago…well, that’s where I live. Originally from Montana, but work brought me here. So that is where I’m at now.

Dr. Fox: Got it. Yeah. And we were discussing before that although you are not actually a big Cubs fan because you’re from Montana, if you were forced to choose, you would choose the Cubs.

Elise: Yeah. There might’ve been a slight bit of arm twisting there that happened. But, yes, if I had to pick a team, I’ll go with the Cubs. Not a Fox fan, so we’ll go Cubs. My husband, I would say, I should be a Twins fan.

Dr. Fox: Right. Because your husband, Todd, is a Minnesotan, I guess.

Elise: Correct. Yup.

Dr. Fox: Thank you for listening. Thank you for writing in. Thank you for agreeing to do this. Yeah. Let’s start. So we’re talking about the birth of your son, Brady, who was just born a few months ago, in May, correct?

Elise: Yup. He was born May 26th. Yeah.

Dr. Fox: Yeah. So let’s just start there. How’s he doing?

Elise: He’s doing well. So he’s, you know, just about two months old and I’d say we’re getting through some of the fussiness of the early newborn days and we have a slight bit more of a routine with things. So the first, probably six weeks were, you know, pretty hard with a newborn and a two and a half-year-old and figuring all that out, but he seems to be getting into a little bit more of a schedule, and health-wise he’s doing great and things are, you know, pretty good right now. I have family here and that helps tremendously. So you caught me on a week when I’ve had some help, which helps a lot.

Dr. Fox: Is it just by coincidence that you have family there? Because you said work brought you to the suburbs of Chicago.

Elise: Right. Yeah. So my family, like my immediate family all still live in Montana, my parents and my brother. And so parents have been out a couple of times and this week my brother and his girlfriend came out when our sitter was on vacation. So needed some extra help with our toddler while I take care of the baby.

Dr. Fox: Oh, I understand. So you mean when they’re out there, you mean they came out to visit you?

Elise: Exactly. Yeah, yeah. Exactly. They came out for the week. Yeah.

Dr. Fox: Right. And so, yeah. And you said you have an older son who is almost three. How has he been adjusting to a younger one around? Has he tried to murder baby Brady yet?

Elise: I wouldn’t say murder, but it has been an adjustment for sure. He was pretty attached to mom prior to Brady’s birth and, you know, it’s been hard for him to get used to me having to split my attention with another little one and not always be able to do what he wants the moment he wants it. So it’s been an adjustment. I’d say we’re still working on it. By no means have it all figured out yet, but, you know, trying our best and doing what we can to meet the needs of both kids without having too many meltdowns in a given day.

Dr. Fox: It’s not easy. I mean, my first two kids are twins and people always say like, “Oh, my God, it must be like crazy having twins.” And I was like, “It’s clearly harder than having one, but it’s probably only like 1.5 times as hard.” Because they do the same thing, right? You know, you feed them both, you bathe them both, this or that. But when you have a 2-year-old and a newborn, it’s definitely harder because the 2-year-old’s like darting out the door while you’re trying to nurse the newborn and it’s not easy. So God bless you.

Elise: Yeah. My massage therapist had twins too and she echoed what you just said where she said, you know, twins is actually easier than a toddler and a newborn. And I said, “Well, I hope it was for you because this is hard.”

Dr. Fox: Take us back to before you got pregnant with Brady. So where are you in life? Are you living where you’re currently living, and what’s your story before your second pregnancy?

Elise: It was here in North Chicago and my husband and I both work in this area. And we’ve been thinking for probably a year, we’ve been talking about, you know, whether we have a second and when the right timing was. And, of course, during that period COVID hit, so, you know, we’re in 2020 and like, you know, March is when everything sort of happened with COVID. And so I got pregnant early September, so, you know, we were kind of concerned with, should we have another one in the midst of COVID? But my husband is…he was 47 at the time. And so, you know, and I was 35. So we felt like, well, if we’re gonna do this, we’ve got to do it, because, you know, it’s not like we’ve got endless time. And so we decided to…you know, the right time for a baby and we got pregnant thankfully very easily. And yeah, I got pregnant in September. And from there the pregnancy, you know, I was quite nauseous and morning sickness or all day sickness, if you will, those first probably 16 weeks. But finally, when that let up, the rest of the pregnancy went quite well. It was just that early phase that was more difficult.

Dr. Fox: What was your first pregnancy like?

Elise: Also a fairly easy pregnancy. So I had…you know, I was, I guess 33 when I was pregnant with Kai and pretty uneventful, you know, have some of the nausea in the first trimester, but, you know, no complications, no gestational diabetes, or hypertension, or any of that and pretty active through both my pregnancies. And actually with my first, I was with an OB/GYN practice and then switched to the midwife practice that I ultimately delivered with and was very happy with them.

And then with my second pregnancy, stayed with the midwife practice and was, you know, happy with them delivering both births. So, you know, I wanted kind of a natural birth. I wanted to do it if I could do it on Medicaid, that was my plan. And so they were super supportive of that. And it was a good experience with them. And, you know, I didn’t mind being pregnant, to be honest. A lot of women hate it. I did not like the nausea, obviously, but then like once it’s over, it’s sort of like, you know, in the past, and you kind of forget about it and, you know, I didn’t mind being pregnant. It was I think kind of a special time.

Dr. Fox: So you’re saying in your first pregnancy you were originally with an OB/GYN but mid-pregnancy, at some point, you switched to the midwives for delivery because you were hoping to get something maybe a little less interventional, you know, a little more midwife-esque compared to the doctor. And that went and that went well for you. Everything was okay with the first birth?

Elise: Yeah. Everything went very well. I think I delivered him at like 39 and 4 days, so right up to the end and, you know, as we’ll talk about, I had a pretty easy birth and got there at 10 centimeters and pushed him out like 30 minutes later. And it was a pretty speedy one. So it went quite well.

Dr. Fox: The fact that your first pregnancy, you know, went so smoothly, both in terms of the prenatal time other than the nausea and the delivery itself, in the second pregnancy now, so I guess last year, number one, did that make you feel very reassured that this one would probably go okay as well or were there things about either because it was COVID or because maybe you were a couple of years older or was there anything else that maybe made you more concerned about your second pregnancy compared to your first?

Elise: COVID was definitely a concern. I wasn’t like freaked out and panicked by it, but I was certainly very aware of it and actually listened to, you know, your podcast on like the vaccine recommendations or, you know, pros and cons. I think you talked to Emily Oster as well, which I love her work also. So that was also super kind of helpful for folks. If you haven’t listened to that and you’re debating, I did get vaccinated during pregnancy in part due to the advice that I heard. COVID was there, but I wouldn’t say I was like super concerned with that. I think I felt pretty confident going into the pregnancy, you know, I had done it before. I sort of knew generally like how it felt, how my body would feel, how labor would feel. So there was a lot less kind of unknowns with, you know, the second time around.

You know, I did…I guess I should say about my first birth, I did technically have, I guess, a postpartum hemorrhage with that birth. I think I lost like a thousand milliliters of blood with my first birth, which I felt like Pitocin stopped it. And it wasn’t like a lot of intervention needed to get the bleeding under control. So a little bit of, you know, uncertainty during delivery there, but nothing major. But I think my biggest concern, honestly, was not so much with like what was happening with the pregnancy and how the births would go. I was definitely nervous about like how I was gonna get to the hospital fast enough because I had heard a second birth can go faster, you know, and we live like 48 minutes away. So I was a little worried about that. Was hoping it would sort of go as smoothly as my first birth in terms of, you know, pain level, and pushing, and getting him out quickly, and those sorts of things. And I think the thing I was most concerned about was more so the after period with having a newborn and a toddler and how that was gonna go. I was, you know, in the month or so before giving birth, like it was becoming very real and I’m like, “Wow. This is gonna be hard having a 2-year-old and a new baby.” And so was already feeling a little anxious for that. And, you know, it has been hard. So we’ll get there, but it is a challenge, I think, to work through that. And I don’t know if people talk about that enough.

Dr. Fox: Yeah. No. It’s real. I mean, trying to…you know, everyone talks about the pregnancies like, “Oh, when the baby’s born, you’re finished.” No, you’re starting. And you’re starting with a 2-year-old at home also. It’s not easy. What was the messaging you were getting from your midwives and maybe not just them, but, you know, either just in things you were reading or family and friends about the fact, in your second pregnancy, you were like over 35 and your first pregnancy, you’re under 35. We don’t do that so much. Like I don’t do that personally in my practice. I don’t put like a line in the sand, but a lot of people do. They sort of like, “All right, now you’re over 35. Like, you know, all hell’s gonna break loose.” Was that something that came up in your pregnancy or your midwife’s pretty chill about it?

Elise: I mean, I had talked with my midwife a month before we started trying and she said, you know, like, technically you’re gonna be advanced maternal age, but she’s like, you’re super healthy. You’re barely over the age cutoff and it’s, you know, she sort of gave me the same impression that I’ve heard you say on the podcast, which is, it’s sort of just a line in the sand. I think you talked about it as like related to Down syndrome risk and then they saw that start to go up, which I didn’t know that prior to listening, but they didn’t act like it was the end of the world in any way or that we needed to do like more interventions or big things. Like I went into it feeling like I’m healthy, you know, I don’t have any other health concerns. So I don’t really expect there to be problems with the pregnancy. So they didn’t make a big deal of it. You know, they offered me some of the additional tests that are covered when you’re advanced maternal age. And some of those I chose to do, some of those I chose not to do, but they always made it very much like a conversation that we could have and then decide with the both of us, like what was best. But it wasn’t like something meant to scare me. I didn’t feel scared in that regard.

Dr. Fox: No. It’s great. It sounds like you got really good advice from them and they took good care of you and sort of counseled you in an inappropriate way. That’s fantastic. So it’s ironic that your big concern in the second pregnancy was this idea of being able to get to the hospital and you ended up having a very, not bad, but sort of interesting early part of your labor, right?

Elise: Yes. Yes, I did.

Dr. Fox: So what happened?

Elise: I had Brady on the 26th, so the morning of the 26th, about midnight. It was like almost midnight on the dot, woke me up with some contractions. And they were probably, you know, starting about 10 minutes apart and I think then they were kind of averaging about 6 minutes apart and, you know, they were intense, but I wouldn’t say super intense. Like I remember them at the end. But intense enough that I certainly couldn’t sleep and I was uncomfortable and like walking around and, you know, trying to kind of work through them. So that went on through the whole night and then got up, you know, around 6:00 or 7:00 and by 8:00 a.m., they had slowed down and, you know, I went on a walk thinking, well, maybe this will speed them up and we’ll see if this is real or not, but completely fizzled out.

So, you know, from 12:00 a.m. to 8:00 a.m., strong and regular, and then they completely stopped from 8:00 a.m. until about 2:00 p.m. where I was maybe having like one an hour, if even that, and in that period, I went in to see my midwife. I had a scheduled appointment anyways to see the midwife and they hooked me up to the monitor and I had like 1 contraction in all of the 20 minutes that they monitored. Baby’s heart rate was great, so they weren’t worried about that. And then the midwife checked and I was only like 2 centimeters and 90% effaced, which was progress from the prior week, but, you know, not indicating that I was like, you know, about to push a baby out just yet. And so, you know, we just sort of said, “Well, I guess we’ll wait and see.” And the hope was I could go home and take a nap given that I’d gotten very little sleep the night before. And, you know, if it was labor, I didn’t wanna go into it exhausted.

So got home. Think I had a little lunch and laid down, maybe got a few minutes of sleep, but now as luck would have it, those contractions picked up again at the moment that I was hoping to rest. They were, you know, pretty regular, pretty strong again, starting probably about 2:00 p.m. And I think about 3:30, I called the midwife saying like, “Hey, they’re pretty strong. They’re pretty regular.” But it’s like, you know, I don’t know why things stopped again. But when I talked to them on the phone, it’s like my mind went to this analytical place and I was like describing to them analytically, like what was happening, right? And they just stopped again. So from 3:30 to maybe 5:30, I had nothing or, you know, very few contractions.

That’s when I was starting to get frustrated because I was thinking, you know, like, “I don’t wanna go through another night of no sleep and like not know if this was real or not.” And we were debating whether to have our son come home from the sitter’s or to have him stay there through the night because we didn’t know if I was in labor. So I was just mentally kind of struggling at that point with not knowing if it was happening or not and, you know, they were painful. So it’s not like I wanted to keep going through it for days on end. So talked to the midwife then around 5:30 and she was…you know, she kind of gave me a pep talk and pulled me out of the challenging place I was in mentally. And so we decided that I was doing some of the spinning babies moves where, you know, you kind of are on all fours or doing some slight inversions to try to reposition the baby because I had this fear that he was posterior.

And so we tried that. And anytime I did those things, contractions became very strong and very regular and like three minutes apart. So we’d said, let’s try one more round of that. And, you know, don’t do it more than an hour. And if it’s gonna be labor, it will be labor and if it’s like not my time, we’ll just let things be, you know, and stop kind of trying to coax it along. So I did that and sure enough, it was real labor because things really picked up from there. And, you know, I even got in the bath at home just to make sure like it didn’t fizzle out when I got in the bath because for me, I did not wanna drive, you know, 45 minutes to the hospital and then be told like, you know, you’re only 3 centimeters and, you know, we’re not gonna admit you yet. So I wanted to be sure it was really labor before we took off.

And in the bath, like things were still very strong, like two to three minutes apart and intense, lasting like a minute. And then I got to this point of feeling kind of nauseous, which I remember that from my first pregnancy and birth where I felt that and whether I was at transition or not, I don’t know, but I’d been told, you know, you might feel nauseous when you get to that phase of transition, you know, when you’re like 8 to 9 centimeters. So to me, that was my signal, like, okay, I think this is really happening. And we probably don’t have a ton of time, so like let’s get moving. Hopped in the car and it was the worst car ride of my life. It was awful 40 minutes of like torturous, very painful contractions. In my head, I think I was probably already ready to push just because I had so much pressure so low, like in my tailbone. And, you know, I think I’d probably been ready to push for like an hour before I actually did, but…

Dr. Fox: But traffic was okay?

Elise: So, you know, it was like 7:30 Chicago time.

Dr. Fox: That’s a tough time.

Elise: So it was this awful like 5:00 but it certainly wasn’t…with my first son, we had the same drive, but it was midnight that we were driving, so we had no traffic. This time we certainly had more of it and it was challenging [Crosstalk 00:19:11]

Dr. Fox: What, you got to get on the 94 to get there?

Elise: Yup, 94. Exactly. Yeah.

Dr. Fox: Wow, man. Love that road.

Elise: Thankfully didn’t hit like too much on the interstate, you know, or problems, but I was throughout the drive and my husband said he was too thinking we’re gonna get pulled over by the cops because like he was driving fairly fast. I wanted him to get there as quickly as possible given the pain I was in, so.

Dr. Fox: It’s gonna end up…yeah, your birth ends up being like the end of Blues Brothers…

Elise: Exactly. Yeah, yeah.

Dr. Fox: …where there’s 600 cop cars following you.

Elise: And he was like, “I wasn’t gonna stop.” He told me wasn’t gonna stop if the cops came. He was just going to point to me and I was like, “I’m not sure that that would have worked, but okay.” I guess we didn’t get…we didn’t get stopped. And thankfully we made it there. So after, you know, 40 minutes, which honestly seemed like 2 hours just because of the intensity of it and you’re just uncomfortable sitting in a car seat, you know, got there and got out, quickly got a wheelchair, they took me back. And personally, they didn’t have labor and delivery rooms available. They were quite full at the hospital. So they took me to kind of I guess like the recovery area where like, if you’re coming out of a C-section, they could probably take you for like an hour before you go somewhere else.

Dr. Fox: Yeah. It’s like a big room for like multiple people?

Elise: Right. With curtains.

Dr. Fox: With little yellow curtain. Okay.

Elise: Exactly. Yeah. And a very skinny, what do you call it, gurney? [Crosstalk 00:20:34]

Dr. Fox: Bed, yeah, like a stretcher. Yeah, yeah, yeah. Yeah. The labor beds are like 6-feet wide, but these stretchers just barely fit your body. Okay.

Elise: Yeah. And like some padding that kept separating, too hard plastic beneath it, it was not great.

Dr. Fox: Yeah. It’s like delivering, like, you know, military, in a tent, you know?

Elise: Yep. Yep. That was about [Inaudible 00:20:53] Yup. So pulled me back there and, you know, I was already like in pushing mode, like I just couldn’t even sort of stop myself at that point. And the nurse is trying to get monitors on, I’m like, “I can’t do this. I need to push.”

Dr. Fox: Right. Was your midwife there waiting for you?

Elise: She was. Thankfully, yes. She knew we were coming and she was, I think, there for another birth as well. So she was there and…

Dr. Fox: And this is Evanston Hospital, correct?

Elise: Evanston. Yeah. NorthShore Evanston [inaudible 00:21:22]

Dr. Fox: Good town, good hospital.

Elise: I was like ready to start pushing and she’s like, you know, go for it. She, you know, was, I think she was hoping we’d have a room, but she’s like, if you need to push here, that’s fine. And I was like, it’s gonna happen here I think.” We started pushing and, you know, I kept sort of waiting to know, or like I kept thinking she was gonna check to see, am I 10 centimeters yet to tell me if I could push, but I think she could already see, you know, the bag of water is bulging out and so she knew that I was very far along and I eventually like asked her, like, “Can you just check so I mentally know how far along I am?” And she’s like, “Yeah, you’re clearly 10 centimeters and with a few pushes you’ll have this baby out.” So I was like, “Okay.” At least I know that like this isn’t gonna be much longer. And so a few rounds of pushing like maybe 20 minutes. You know, I waited for contractions to push, and then when I didn’t have contractions, I would rest. And a couple of rounds of hard pushes, and baby was out and I was just elated to have the pain over. I was reflecting afterwards with my husband saying like there’s like nothing else in life where you’re in this intense pain and then just like seconds later, it’s completely done. You know, like the pain just completely stops. With most things like you’re in pain and it might gradually get better, but childbirth is unusual like that, how it’s…

Dr. Fox: Yeah. I would say graduation from high school. Intense pain for four years and then suddenly it’s over.

Elise: Yeah. Homework is over and then the real world of jobs happens.

Dr. Fox: And you had an interesting nuance to your birth, didn’t you?

Elise: When Brady came out, he was born fully in the amniotic sac. I think you call it in the caul.

Dr. Fox: Yeah. E-N caul, en caul.

Elise: En caul. Okay.

Dr. Fox: Yeah. It’s a fancy term for you basically delivered like a balloon of water with a baby in it. It’s pretty cool.

Elise: Exactly. Yeah. And I so wish I could have seen it. I didn’t know till after like, you know, probably 30 minutes after that that’s how he was born. My husband saw it, but I didn’t get to see it.

Dr. Fox: He’s like, “What is that?”

Elise: I don’t know what his thoughts were exactly, but I think he’d learned, you know, in our childbirth class with our first son, I think he knew that that could happen and that it was super rare, but certainly weren’t expecting it. But I did, you know, throughout pushing, I was like, well, isn’t my water gonna break, or did it already break?” And like, I didn’t know, but, you know, never broke, and yeah, he was fully enclosed. No water had broke prior to him coming out. So I think it’s like 1 in 80,000 that that happens. So it was a pretty rare event.

Dr. Fox: So you had the birth, you’re feeling a lot better. It’s like, oh, finally, you know, the pain is coming down and I guess you’re holding him or you’re with him, and then what happened?

Elise: Right after the birth, I was just like elated for it to be over and so relieved he came out and was very sweet and calm and we had time for him to nurse and call family and stuff. So we had a couple of hours where, like, it went totally normal and we were just kind of bonding and enjoying the moments together. And then, you know, I think the nurse and the midwife, they were, of course, like monitoring my blood loss. You know, they weigh those Tucks pads and see how much blood you’re losing. And so they were monitoring it because, you know, as I mentioned, I had postpartum hemorrhage with my first and they were gonna do like a shot of Pitocin right after I gave birth because I hadn’t had time to get an IV. And I said like, “No, let’s just do the IV because I don’t wanna do…” I guess I’d heard the IV is more effective than intramuscular Pitocin so I said like, “Let’s just do IV because I don’t wanna go through, you know, what we did last time.” And so we started that. They weren’t like super thrilled with how it was stopping things right away. So then they did the site attack. I don’t know if that’s the…or miss…is that the right ones, the drug?

Dr. Fox: Yeah. Yeah.

Elise: It’s like the little tablets that they use.

Dr. Elise: Yeah. Cytotec is the brand name and Misoprostol is the generic. It’s the same thing. Correct.

Elise: Yeah. So they did both of those like shortly after delivery, which I was kind of expecting given my first birth and that didn’t seem like too far out of the norm of what I was sort of expecting, you know, and then a couple hours went by and think they got me up, and like went to the bathroom, and they were checking my blood, and making sure everything was okay. And we were just about to go up to the postpartum floor when the midwife came back to just give me one final check before they moved me and she’s like, “Yeah. I don’t think this looks right. Like this still looks like too much bleeding.” And she’s like, you know, “We don’t wanna send you up there and then have it be like an emergency where it turns into a big thing,” so.

Dr. Fox: Yeah. You don’t wanna be on the postpartum floor when that happens. I mean, you can be, and they’ll take care of you, but I agree because you get monitored much closer on the labor floor after you deliver compared to when you go upstairs in the sense of just, you know, it’s meant to watch people, you know, sort of continuously whereas upstairs, like in a hospital and they check in on you as you need to. I know it was the same group of midwives. Was it actually the same midwife who delivered both babies or different midwives?

Elise: Different.

Dr. Fox: Got it. Okay. But clearly, they knew, I mean, they knew what was going on in there. So you’re there, they’re telling you’re bleeding too much, but was it ever…it was never like a hemorrhage, that like crazy amount of bleeding in one time, they were just concerned that it didn’t slow down fast enough.

Elise: Right. Exactly. Yeah. It was never like some big gush or huge amounts that came out or, you know, like my vitals were dropping or something. I was always very like conscious and coherent through it all. And, you know, like, I think on the episode I’ve heard, you know, you talked about postpartum hemorrhage maybe a couple months ago. And I keenly listened to that because of my experience with the first and I knew it was possible again with my second. So I paid a lot of attention to that episode and I remember you saying that, you know, blood loss is kind of a line in the sand. You can sort of quantify it like a thousand. It’s kind of just a line in the sand, just like 35 as an age line drawn in the sand. But, you know, I remember you talking about, you know, paying attention to people’s vitals is the key thing. And so I was like looking at the screen too and seeing what my blood pressure and pulse was and just like making sure that I didn’t…like I felt fine and making sure that that didn’t seem to be off.

Dr. Fox: It’s such an interesting coincidence because I mean, literally I just checked the date. It posted on May 17th so it’s like right before…

Elise: Oh, really?

Dr. Fox: Yeah. It’s right before you delivered. I mean, literally like the week before. That’s crazy.

Elise: Yeah. Yeah. I do remember listening to it and thinking, “Oh, this is so timely,” because, you know, I hadn’t…even though I’ve had one, I didn’t know much about it. I didn’t know much about how it was managed other than Pitocin and the Cytotec which I’ve had the first time, but I didn’t know much beyond that, what would happen if I had one again. It was very timely. And you’re right, it wasn’t a couple of months before. It was like a week before.

Dr. Fox: Well, with all those contractions, it felt like a couple months.

Elise: Yeah. Exactly.

Dr. Fox: When was that? It was like years ago? Uh, it was a week ago.

Elise: Exactly. The midwife had come in and she checked and she’s like, you know, wasn’t thinking it looked right in terms of the amount of blood. And so I think she consulted one of the residents, if I’m remembering right. And, you know, one of the OB residents came in. She was very sweet. And so they decided like they wanted to kind of manually reach up into my uterus and…

Dr. Fox: Not so sweet anymore.

Elise: Yeah. Not so sweet. See if there was like retained placenta or if they could feel anything. And so that was, you know, very unpleasant. I did not have an epidural, so…they offered it, you know, they offered to give me medication, but I didn’t want it. And I mean, it was painful, but like my cervix was still dilated so it’s not like they were reaching into my uterus with a closed cervix, but multiple rounds of that with the midwife and the resident, each taking turns, like pulling stuff out.

And so it was yeah, not the best of times, not the most pleasant. And they were fine, like they did pull out like placenta membranes from the amniotic sac. I don’t know all of what came out, but there was more than just like fluid blood, you know. There were some other stuff. But then ultimately they felt like there was something still in there that they couldn’t reach. And so they did an ultrasound of my uterus and they could see something kind of high up on the uterus that didn’t look like smooth uterus, I guess. It was like some little blip that they thought, you know, was something.

Dr. Fox: Yeah. The technical term we use is a chunk.

Elise: Okay. Chunk. Maybe not blip but chunk. Sounds correct.

Dr. Fox: There’s still a chunk inside. Yeah. We’re graphic at that point. After they put their hand up into the top of your uterus, we get graphic.

Elise: Then ultimately they decided, you know, let’s do a D&C so that they could get anything remaining out and be sure that there wasn’t some other source of bleeding. I think that was the reason for why they wanted to do that. So the midwife called in, you know, they all work under a physician. So Dr. Sally came in. We roused him out of bed to come back and he was wonderful. He came back and we did the D&C. Had to wait quite a while for a room to open and for the anesthesiologist to free up but…

Dr. Fox: Right. Right. You definitely had to get anesthesia for the D&C, right?

Elise: Yeah. They were gonna do just more of a sedative, but I ultimately I didn’t wanna be like loopy because I wanted to be back to the baby as soon as I could be and be fully with it and be able to breastfeed. And so, you know, the midwife was like, “I mean, you can do the sedative or you could do the spinal.” And, you know, I think everyone sort of felt the spinal more aligned with what I wanted, like with wanting to be able to be present with the baby as soon as I could. So we decided on that and…because honestly, probably more scared about the spinal than I was the birth. Like I just mentally had a block with like having this needle go into my spine. And, you know, the midwife’s jokes, like you got through to births unmedicated and then you’re freaking out about the spinal, which most women are like, just give me anything.

Dr. Fox: Yeah. No, it’s ironic that, you know, again, you did not have an epidural or spinal for either your births and you needed it for like a golf ball size of placenta.

Elise: Right. Exactly.

Dr. Fox: Okay. And so ultimately, other than being sort of concerned about the spinal, were you worried about like your wellbeing, your health, oh, my God, I’m bleeding? You know, like, were you worried…? Like were you going down the road, “Oh, my God, this will be a hysterectomy.” Like were you thinking about all those things or were you sort of like it’s going to go okay?

Elise: Yeah. Yeah. I’m glad you asked that because, you know, I had listened to the episode, right, where you’d walked through, like, you know, for most women, you know, the medications work and the rest of them, like a D&C or something would work and very rarely would you have to go to a transfusion or a hysterectomy. But I knew that was a possibility. So I was nervous that it could be something really serious or they couldn’t get the bleeding to stop and, you know, you’re just like hormonal and you’re not like in the most emotionally stable place after you’ve had a baby. Yeah, I was feeling really emotional with like, am I gonna see my son and my new baby again? And will I come out of this fine? And so I was scared going into it that, you know, I didn’t know what was gonna happen and it was definitely a scary time. But once I got back there and like the spinal was in and I was, you know, fully conscious, just like with most C-sections, you’re awake during it, I was awake during the D&C, and then I kind of calmed down. Like once they started the procedure and, you know, it was sort of happening then I wasn’t feeling so emotional or upset about it. But I was, you know, worried. And they did have, you know, blood on hand in case something scary happened, but they, of course, were hoping it wouldn’t go that direction.

Dr. Fox: Right. Was Todd with you during the D&C? Did they let him in the operating room or no?

Elise: No. I mean, maybe they would have let him if we’d wanted to, but, you know, I think we felt better that he was with Brady because he was holding Brady and, you know, with him while I went back. And the nice thing with having a midwife was, you know, they don’t do procedures like that. The OB they’re under does, but she still was there kind of for emotional support. So I still had her there.

Dr. Fox: Oh, yeah. She’s like your support person.

Elise: Yeah. As someone that I, you know, kind of knew and trusted and I didn’t feel alone. So that part was helpful.

Dr. Fox: Yeah. That is good. And so ultimately the procedure went well. You said you did not need a transfusion. Clearly, you did not need a hysterectomy or anything more. And after the procedure, did the bleeding just sort of like slow down and you recovered okay?

Elise: Yeah. I mean, I think they did several more medications like at the time or maybe they tried before. Like I remember you talking to me about this TRX, something you said was cool to say.

Dr. Fox: The TXA?

Elise: TXA. Yeah. There you go. Don’t know what that means, but I remember them throwing out that acronym and being like, “Okay, I heard that medication name before.” And, you know, they did antibiotics to, of course, prevent like infection because they were, you know, definitely like scooping stuff out and whatnot, but yeah, they felt like they got it all. They did another ultrasound in the operating room to make sure that, you know, nothing was visible there and they felt comfortable with it. I think they ultimately tried like every medication possible to get the bleeding to stop. But once I came out, they were much more comfortable with the amount of blood I was losing and it looked much more normal. So after I think about two hours of them monitoring it on the labor floor, you know, I went up to the postpartum floor and then finally had more of a normal experience and the excitement of everything calmed down.

Dr. Fox: How long did you have to stay in the hospital after the birth? You delivered I guess in the evening, you said, so how…

Elise: Right. So he was born at like 8:37 on the 26th. We stayed, you know, I guess technically that night and then one additional night, but we didn’t stay that long. So I guess, I mean, technically, I guess two nights we were there and then came home.

Dr. Fox: Yeah. Typical. Yeah. Very typical.

Elise: I remember with my first birth versus this one I was bleeding much less after this, I would say, probably because I did the D&C and like thought everything out. You know, like I have less bleeding with this birth after, you know, all the hemorrhage stuff was done. So I didn’t have any scary moments beyond that.

Dr. Fox: Wow. Wow. And then ultimately when you got home, as you said, physically, you’re doing okay from the birth and now you’re just, you know, you’re taking care of two little kids.

Elise: Exactly. Yeah. I think I felt like physically better after this first than I did my first, which is, you know, interesting given that I lost like 1600 milliliters of blood versus 1,000 with the first, but felt physically quite good after the birth and was…you know, had pretty good energy and like wasn’t so sore as I remember being from the first. But yeah, the hardest part was just, you know, juggling the real-life parts of it then where you’ve got a busy toddler and he is very busy and then a new baby and you’re tired and all that, you know, you just have to juggle real life and find a new rhythm, but to take some time to settle into that.

Dr. Fox: Wow. So looking back on the experience, and it’s still, you know, it’s only a couple months ago, so it’s fresh in your mind, what are some of like the takeaway messages that you learned or you’d wanna impart on somebody maybe who’s embarking on a pregnancy or a birth?

Elise: You know, one that you touched on with the advanced maternal age, you know? I feel like a lot of what’s talked about is that once you’re over that cutoff, like everything’s gonna go wrong and that really doesn’t happen for a lot of women, you know? I was 36 and had a very, just this like uncomplicated pregnancy with my second than with my first. So, you know, I would like encourage women not to be too scared by that. I think the other thing I’d say is, you know, in textbooks and all the childbirth classes and all the books that I read on birth, when you go into labor, it’s somehow supposed to start at like contractions being 20 minutes apart, and then 15, and then 10, and then 5, and like, you know, it continues at this steady pace. And for me, like it just never has really happened that way. It sort of starts and stops and, you know, so I guess I would just like hope women can hear a story of someone where like you might actually be in labor when things aren’t going in that textbook 20, 15, 10-minute style and, you know, to sort of trust your body and if you feel like it’s just really time, you know, like be talking with someone and head in.

And then, you know, I think the other thing is, you know, with the postpartum hemorrhage and, you know, that’s the reason that I contacted you, was to just say like, thanks for doing this episode because it like really gave me a lot of information and made me be able to be informed and part of the decisions being made about my care. I didn’t feel like things were just being decided for me and done to me. I felt like we were having a conversation and, you know, mutually agreeing to what was best. And so I would just, I guess, say like for the listeners, to educate themselves and, you know, listen to episodes like this, and there’s lots of other great podcasts out there as well that taught me a lot and I think helped me feel as confident as I could going into the birth and kind of a scary situation.

Dr. Fox: Thank you. First of all, your story is great. You’re a really good storyteller and it’s so compelling to hear people’s…you know, about their lives, and their families, and their births, and their pregnancies, and every single one is unique. Just like labor is unique and it’s different for everybody, so too are the experiences through this. And it’s like what you were saying about the podcast. I mean, we do these for a reason. It’s so hard for people to learn about these topics because where are you gonna go, right? I mean, you obviously can go online, you can Google it, but then so you Google postpartum hemorrhage, you get 6,000 hits, right? And then you don’t really know what’s applicable and what’s not, and what’s reliable. It’s just tough. And, you know, it just meant so much to me when you reached out and, you know, people would just say, “I like your podcast.” And, you know, whatever. And it’s really nice. But when you said it actually helped me during my birth, it just makes the whole…you know, all the editing and the recording and this, it’s so worthwhile. And here again, I don’t, you know, I don’t know you from a hole in the wall, right? You’re not a patient of mine. We’re both Cub fans. You’re a big Cubs fan, so that’s nice, but it’s just so meaningful. And I just really appreciate it. And, you know, a lot of people will listen and not get anything from it. It’ll never apply to them. And that’s cool. But for the few people who it does, it’s very rewarding to me that you were able to benefit from listening to the podcast. And I have to let Dr. Do also because she was the expert I brought on for that one. Yeah.

Elise: It’s great to be able to thank you guys in person or I guess on the Zoom for what you do. I don’t think you’re doing this to like make money or something. I think you’re doing it to kind of educate patients and just the general public. So really appreciate you taking the time to do it. And, you know, like when you go see a doctor these days you don’t always have time to ask all these questions and there’s a lot of things that happen that you wouldn’t think to ask about. And as you said with Google, you’ll probably give an anecdotal story about like a horror that happened to somebody, not like, you know, on average, with 1,000 women, most of the women who have this, it’s gonna be pretty mild. You know, you’re gonna get some other story that probably will scare you.

So yeah, I found all of the episodes. And as I said, like the COVID episode was another one where you were talking about the vaccine and you weren’t sort of saying, you should do it or you shouldn’t do it, but you expressed like this is what we know and this is what I’m counseling patients to do. You know, I was in various social media mom, pregnancy groups and shared a lot of those episodes because I would see women asking these questions about things and like saying things that, to me, looked like misinformation that they had maybe heard from a friend or from Google and I’d say like, “Hey, check out this episode because this is from a doctor who actually knows what he’s talking about.”

Dr. Fox: Who thinks he does. Yeah.

Elise: So I found it great and, you know, hopefully, some of those women in those groups listened to some of that as well because I found it very helpful.

Dr. Fox: Amazing. Well, Elise, thank you so much. Good luck raising the boys. And it’s gonna be a fun couple of years ahead of you, but…no, but it really is. It’s real…it’s hard, but it’s awesome at the same time. And it’s so much fun to watch your kids grow up and to see how different kids are, you know, one from the other, what’s similar about them, what’s different about them, and it’s the real joy in raising children is, you know, sometimes seeing how naturally unique they are and it’s fascinating. It’s a lot of fun and I’m just really happy for you guys. And again, thank you for volunteering, and thank you for reaching out. And I hope you continue to listen and stay in touch.

Elise: Yeah. Definitely. Thanks for taking the chance to hear my story. And, you know, I hope just as you hope this helps, I hope this helps someone else. Maybe hear someone else’s story and help them with their journey as well.

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 liked today’s podcast, please be sure to check out our “Healthful Woman Podcast” as well where I speak with the 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 podcasts 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.