“Preterm labor in another country” – with Shaindy Zlotowitz

Shaindy wrote in to Dr. Fox to share her High Risk Birth Story and her experiences with pregnancy in both Israel and New York City, plus some of the differences in the medical systems between these two places. She tells the story of delivering and losing her first baby in Israel and, later, having a cerclage and high-risk pregnancy in New York through Covid.

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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 the life-changing experiences of pregnancy, fertility, and childbirth. 

All right, [inaudible 00:00:23], thank you for joining the podcast. I think you’re our first international guest joining us from Israel. So, you’re ahead. It’s late at night. 

Shaney [SP]: Yes, it is. Thank you for having me. 

Dr. Fox: Wonderful. So, you emailed in. We took care of you last pregnancy, and obviously, so, I know you well. And you emailed in that you thought your story would be a good one to tell on the podcast, and I totally agree. You have a really interesting story. Fortunately, the last outcome was a very good one, although it was a rocky road, as we’re gonna learn from your story. But just as a follow up, we’re talking about the birth of your daughter Hya, [SP] who was born in August of 2020, so she’s nine months old. How is she doing? 

Shaney: She’s doing great, thank God. She [inaudible 00:01:07] and a lot of personality. 

Dr. Fox: How has it been for the three of you…you, and your husband, and Hya, going back to Israel and spending your time there? 

Shaney: Definitely an adjustment. The medical system here is just very, very different. So, even when it comes to finding a pediatrician, the health system here is really different, a very different experience. 

Dr. Fox: Yeah, we’re definitely gonna talk about that, because your first pregnancy was in Israel and, you know, Israel has a socialized healthcare system. There’s very, very good doctors in Israel. I mean, there’s a very high level, you know, academically, medically. But it’s just…it’s sort of so different. And so, for Americans who are used to one system, when they’re in Israel in a different system, there’s a lot of logistics to try to figure it out. And setting aside the whole, you know, language barrier, just how to get through all of these various hoops is hard for us. 

Shaney: Exactly. 

Dr. Fox: Let’s go back to your first pregnancy, which was not with Hya, and tell us sort of where were you at the time, you know, where were you living, what was your situation when you started that pregnancy? 

Shaney: So, we were married about seven months, I believe. We were living in Israel, where I’m living right now. I found out I was pregnant accidentally. I was waiting for my period to come, and nothing was happening. And after a few days, my husband was like, “Do you think you’re pregnant maybe?” And I was like, “Okay, no. For sure not. Not a question.” 

And then, like, each day that passed, it was just getting weirder and weirder. And then, I had that [inaudible 00:02:31] coming up, and I figured, you know, I’ll take a pregnancy test. It can’t hurt. And then, it was positive, and I was very, very skeptical going in. I didn’t believe that I was pregnant. I didn’t believe, like…It wasn’t, like, sitting…like, it wasn’t real to me at all. I really, like, could not fathom that, like, I was actually pregnant, and it was actually happening. Never expected for it to happen naturally so quickly, and, like, finding out, like, by mistake the way I did. [inaudible 00:03:01] 

Dr. Fox: And so, when you ultimately went to the doctor, how far pregnant were you? Were you pretty far along, or was it very early in fact? 

Shaney: No, it was pretty early. It was probably, like, a week past when I would have found out had I been waiting to find out. 

Dr. Fox: Got it. 

Shaney: [crosstalk 00:03:16] four weeks, five days, maybe. 

Dr. Fox: Mm. Okay. And so, that obviously must have been pretty exciting, because you didn’t need any treatments to get pregnant, and here you are, you’re pregnant. So, that’s good. And how did the beginning of pregnancy go in terms of symptoms, or in terms of, like, who were you seeing? You know, what was your situation like medically? 

Shaney: I started off continuing to see the doctor I was seeing originally, and that logistically didn’t make sense. He was located too far, so I switched to [inaudible 00:03:44] private doctor. The way it works here is that most people really don’t use private doctors. They use a doctor that’s, like, under the [inaudible 00:03:53] basically, like, kind of insurance. And it’s basically covered. You have to pay pretty much nothing. 

And then, when it comes to the delivery, they use midwives, or might have a doctor on call, just in case. Personally, I am a hypochondriac, and I was very not comfortable with that. And especially because my mother did have complicated pregnancies, I felt more comfortable using a private doctor, even though it’s really not, like, the standard here. So, I was using a private doctor in the local hospital here in [inaudible 00:04:26] 

Dr. Fox: And now, when you’re using a private doctor, obviously you’re seeing the same person or group of people for your visits and pregnancy. But was that person expected to do your delivery as well, or was it just for the prenatal care? 

Shaney: Yeah. That’s really the whole concept of the private doctor, that they are present during delivery. It happens to be that the way it works here, also, is that you can go with one doctor for an appointment, and then go to another doctor for your next appointment. So, it really…it’s not really like a continuous care. It’s kind of like, you come when you come, and you don’t come when you don’t come. 

Dr. Fox: Right. 

Shaney: They’re not really, like, following up with you. 

Dr. Fox: Right. I mean, it’s sort of what’s covered under the national healthcare system is, you know, everything is covered, but when you’re going to them it’s a little bit less…I don’t know if it depends on the exact clinic, but it’s not as personalized. You go to your visits, and then also, when you show up to deliver, whoever is there to deliver you. So, you don’t really know the people. That’s the downside. On the plus side it’s, you know, part of your basic, you know, insurance that you get for the whole…you know, that [crosstalk 00:05:25] citizen. 

Shaney: Right. Right. Then, with a private doctor, it’s more familiar…like, it’s more familiar to our way about it in America, that you do have your private doctor. It’s interesting, actually, in Israel we’d contact a doctor, or a nurse, whatever, you know, if you have a question medically, you actually reach out to the doctor themselves, which I found at first, coming back to America, I found that an adjustment. 

It was weird for me not to be able to just speak to my doctor when I had a question. But really, it makes a lot more sense, because you’re much more comfortable to [inaudible 00:05:55] question. You don’t feel like you’re bothering a doctor who’s busy, and bothering a nurse who’s busy too, but [inaudible 00:06:01] 

Dr. Fox: No, I understand. You’re saying, like, on the one hand it’s nice to have direct access, you know, to a doctor on your cell phone, or email, or whatever. But on the other hand, you’re maybe less hesitant to call if you know there’s someone who their job is just to answer the phones, and the emails, and you’ll [crosstalk 00:06:16] 

Shaney: Exactly. Exactly. 

Dr. Fox: Okay. All right. That’s a good point. So, you’re seeing the doctor. And how did the pregnancy progress into the second trimester? 

Shaney: So, my second trimester was pretty symptomatic, but I was so excited about that it was fine. Like, I really [inaudible 00:06:31] every time I threw up it was like, “Okay, I’m pregnant. Great. I’m throwing up.” Like, it really was not something I was too bothered by. But I actually remember going for my first sonogram after my initial sonogram, you know, of the first real, like, there’s a baby there sonogram. 

Dr. Fox: Right. 

Shaney: And I [inaudible 00:06:53] “Do you see the placenta?” And she’s looking at me, like, “What? What did you just ask me? Why did you [inaudible 00:07:00] ask that?” And I, like, started to explain to her, you know, my mother had a placental abruption her first pregnancy, and did you see the placenta? And she started laughing. She was like, “Okay, you’re gonna be a challenging one.” 

Dr. Fox: I got my eye on you. All right. 

Shaney: Exactly. 

Dr. Fox: Okay. And then, so, and ultimately you had some issues at the end of the second trimester. Correct? 

Shaney: Yes, so going…I would say at about 15 weeks, I was in America already for the summer. I had started having cramping, a lot of back pain. At the time I was seeing your practice. I went in. I did an ultrasound. Everything looked fine, and really, I was feeling fine, except for this back pain. So I kind of just figured, you know, it’s like, I was never pregnant before. This was, like, this was just the way I’m gonna feel in pregnancy, taking a toll on my back, or I’m having a little bit of cramping. 

But it really wasn’t anything that was too concerning. My mother was more concerned because, like I said before, she did have complicated pregnancies. But [inaudible 00:08:04] we kind of told ourselves, like, we have to just trust ourselves, and tell ourselves to stay calm, and [inaudible 00:08:11]. And then, I returned to Israel at 18 weeks. Again, like, you know, my back was hurting, but really nothing crazy. 

A few days into being here, I had a stomach bug. I was vomiting out of control, like, for 24 hours, and I couldn’t keep down any water. So, my father, who’s really not an anxious person, sent me to [inaudible 00:08:39]. He suggested I go in to really just get fluid even. He was like, “I’m not comfortable with you staying home, and you’re vomiting like that, you have no fluid in you, it’s 100 degrees in Israel. Go to the hospital. Get checked.” You know, being hooked up to an IV, fluid is good for you. Definitely nothing is gonna go wrong with you going. 

Dr. Fox: Right. 

Shaney: So, I was very, very hesitant, because I was nervous to even stand up from my bed, let alone get in an ambulance, go to a hospital. But they took me in. They didn’t want to let me go for a while. I ended up being there pretty much overnight, not for any real reason, other than I kept throwing up, and I was pregnant. So, they were just, you know, keeping an eye on me. 

And the week following that, I made a visit with my private doctor, just to check and make sure it didn’t affect my, you know, the baby [inaudible 00:09:33] cervix. I knew that, like, I was definitely cramping more at the time, but I thought it was really nothing that was too crazy. I was very conscious to keep an eye on how close together my Braxton Hicks [inaudible 00:09:47] contractions were. And I wasn’t really so [inaudible 00:09:53] what was going on. So, I went to the doctor and he said, “Your cervix is good.” And that was it. 

Dr. Fox: Okay. 

Shaney: And then, I’d say probably about 10 days later, I had one of those, like, crazy, running around, doing a million errands kind of days. It’s much more intense [inaudible 00:10:12] because we didn’t have a car. So, you know, everything is like actually running uphill, downhill, you know, groceries, and [inaudible 00:10:21] than it is in America. So, it was definitely an intense day, and it was very hot outside, and I was feeling very tired and not feeling great. 

I laid down on the couch and I started noticing that I was having contractions, so I started timing it. I noticed that it was consistently 20 minutes apart for about an hour. So, okay, at the time, like, I wasn’t, like, so thrown off. It was [inaudible 00:10:50] not crazy. I started putting up supper, and I realized they were getting closer, and I really was having a hard time standing. I kept having to take breaks, and I kept running to the bathroom. 

And when they were 15 minutes apart for about, like, another hour I called my grandmother [inaudible 00:11:11], and she was like, “You know, I would be safe and call your doctor.” So, I called my doctor, and he said to meet him at the hospital. As I was driving there, I made, like, a joke to my husband, like, “Imagine if I was in labor now.” Like, really not realizing the truth to that joke. 

And I got to the hospital and my doctor met me there pretty soon afterwards, and he checked me. And, like, he really looked like…he looked like he was shocked by what he saw. He said at the time that I was at four centimeters dilated, and the [inaudible 00:11:48] itself. 

Dr. Fox: Right. And you’re, like, 22/23 weeks at this time, right? 

Shaney: Yeah. I was 22 weeks, 5 days, and I was absolutely shocked. You know, heading to the hospital, I knew that something was off. Something felt wrong. But I thought I would get there, he would tell me, you know, your, like, labor is imminent, and stay in bed, or drink [inaudible 00:12:10] hospital. But I guess I didn’t imagine him to say, you know, there is no chance of survival for this baby. The baby is on their way out now. 

Dr. Fox: Wow. 

Shaney: He told us that. My immediate reaction was, like, I guess my adrenaline kicked in, and I was able to be very together, and I…Actually, my husband, who is usually Mr. Macho, started to get emotional. So, I guess I had to be the stronger one at the time. And we called up our rabbi to ask him his opinion, because the doctor suggested [inaudible 00:12:45] to rush the process, and I didn’t feel comfortable with it. 

So, I called him up, and he agreed with us. [inaudible 00:12:54] longer [inaudible 00:12:56]. As long as the doctor says there’s no safety issues with waiting, if you feel most comfortable waiting, that’s what you should do. So, you know, the doctor said okay, but, you know, it could be tonight, it could be tomorrow morning, it could be tomorrow night. I don’t know. It’s happening. I just don’t know when. 

Dr. Fox: Okay. 

Shaney: So, we were content with our decision, and they wheeled me into what they call [inaudible 00:13:15], which is triage. Within a very short amount of time, maybe a half hour, I was at nine centimeters. 

Dr. Fox: Wow. 

Shaney: Yeah. And the labor was very, very strong, significantly stronger than anything I have felt in my subsequent pregnancy and labor. So, it was very strong, and, you know, very quickly I was at nine centimeters. And they wheeled me to the delivery room. At some point I asked for my doctor, but basically the doctor had left because I guess she felt, you know, I didn’t [inaudible 00:13:46] and it could be tomorrow night. He’s not gonna sit and wait around until tomorrow night. 

So, there was no doctor there. So, basically, we were kind of fending for ourselves because the nurses’ attitude was, like, the baby’s not surviving, so this patient is definitely not our priority right now. The hospital was very packed. And so, my husband was literally, like, I feel, like, delivering the baby. He was, like, doing a lot more than I imagined he would have needed to do if there was more, like, attention from the doctors and nurses. 

At some point, somebody that we know sent in a relative of his who was a midwife there, and she was incredible. And at some point, they called in the doctor on call, because there were some complications. The baby was breeching, and my cervix [inaudible 00:14:34] 

Dr. Fox: Mm-hmm. Yeah. 

Shaney: And basically, the baby was stuck. So basically, the delivery itself did take a while. But then, I delivered the baby, and [inaudible 00:14:45]. I had a [inaudible 00:14:46] for the placenta, and other than that, [inaudible 00:14:49] 

Dr. Fox: Did you have, at the time in Israel, other than your husband, any support? Like, any family who was there with you? I assume you have friends, obviously. But anyone who you could, like, lean upon and rely upon at that time? 

Shaney: I did not have family. I had a little sister in [inaudible 00:15:06], but she couldn’t offer much of her time. 

Dr. Fox: Right. 

Shaney: But I find that here, friends really compensate for family, because no one here really has so much family, so we kind of rely on each other a lot. And I had a neighbor who has been living here for many years, and she actually came to be in the delivery room with me at the time. 

Dr. Fox: Wow, that’s a good friend. 

Shaney: Yeah, she is really, really incredible. 

Dr. Fox: When the baby was born, was the baby born alive, or the baby did not survive the birth? 

Shaney: Actually, like, on the way out, we kept saying, the baby stopped kicking, the baby stopped kicking. It’s breech. So, you know, with the legs first. And then, at some point, it stopped. So, I guess after the delivery, that’s when the baby had passed away. Maybe it was not alive when it was born. 

Dr. Fox: Did you want to hold the baby and see the baby, or was that something that was too painful? 

Shaney: My mother…like I said, my mother had a placental abruption her first pregnancy, so she lost her first pregnancy as well, later on in the pregnancy. So, right when I knew that there was literally no chance, I immediately called my mother and asked her what she suggests. I didn’t know what the right thing to do was, and I didn’t want to regret whatever decision I made. And my mother told me, “You know, I really can’t tell you what to do, because it’s a feeling. You have to really tap into what you’re feeling, and think, like, will you regret not seeing this baby, or will you…will it be too much for you to take?” 

And I decided I didn’t want to see the baby. I didn’t to be stuck, like, holding onto something that wasn’t meant to be. Like, that was my perspective at the time. Like, I felt like if I didn’t see the baby, I would be able to…I would have an easier time detaching emotionally and moving forward. 

Dr. Fox: Mm-hmm. In hindsight, do you think that was the right decision for you? 

Shaney: For me, I think that was the best decision, yeah. 

Dr. Fox: Yeah. I mean, we talk to women in these circumstances. I think your mom gave you really good advice. I mean, ultimately, many women find that, you know, holding the baby and having that moment is something that helps them, you know, maybe heal, and have some closure, and move past. But for others, no. There’s no right answer to this, obviously. It’s…as your mom said, it’s what you’re feeling. You know yourself better than anyone knows you, and people who sort of try to push women to, you know, hold the baby when they wouldn’t want to, or push women not to hold the baby when they do, is probably not a good idea. 

What they do in the U.S. at least, or at our hospital, for women who don’t want to hold the baby…they think it’s gonna be too painful, they do take photos and footprints, and they keep a memory box in the hospital. They just keep it there. And so, sometimes women have come back a year or two later, and they say, “I’d like to see the…you know, see that now.” And they’ll have that for them. But frequently, that’s not the case. Frequently, women who don’t, you know, want to, that’s the right decision for them. 

Shaney: Yeah. I think that after the fact, I did…I would have loved to have something like that concept of a memory box. [inaudible 00:18:01] like, closure and I felt I was really ready to get pregnant again. I was more, like, I was curious. You know, I wanted to see, and I wanted to have something to hold onto without being too attached in a way that I couldn’t move forward. You know? It’s kind of the concept of moving…I wanted to move forward without forgetting. You know? 

Dr. Fox: I understand, absolutely. What was your understanding at the time from what the doctors told you of why you delivered early? Like, what happened, and what advice they had for future pregnancies? 

Shaney: Like I said, my doctor wasn’t present at the time. I actually never saw him again since. The next doctor I saw was Dr. [inaudible 00:18:45] actually [inaudible 00:18:46] America [inaudible 00:18:48] after I delivered. [inaudible 00:18:49] pathology in Israel, and everything came back clear, so they…in their mind, it was spontaneous. And [inaudible 00:18:59] she basically explained to me, either I had a short cervix, or preterm contractions, which is pretty much what every doctor going forward told me. 

When I came back to Israel, I did go, like, [inaudible 00:19:13] doctor hopping. I went around…I wanted to feel like I was [inaudible 00:19:19] by doctor before I got pregnant again. So, I went around, and I met with a few different doctors who came very highly recommended, and I discussed with them my previous pregnancy, and pregnancy going forward, and what they would suggest. 

And I kind of, in the back of my mind, had what Dr. [inaudible 00:19:36] told me. And I would, like, kind of compare in my mind, like, you know, is it lined up with what she said? And I felt very comfortable with her and what she said, so I just kind of wanted to feel like I was by a doctor that I trusted. And basically, I would say that almost all the doctors said exactly the same thing. You know? 

Dr. Fox: Right. Right. I mean, we usually don’t know why someone’s gonna deliver at 23 weeks. Occasionally, we do, but I would say that’s the exception. And so, we just sort of go, “Here’s the possibilities, and we’re gonna try to cover all of them in the next pregnancy. [inaudible 00:20:06] whether it’s your cervix, whether it’s contractions, whether it’s some sort of infection, or, you know, whatever it is, we really…yeah.” How long did it take you, and you said, “We were looking at doctors…” Did it take you a long time to recover either physically or emotionally before you were ready to try again, or were you really, like, of the opinion that you wanted to try as soon as possible? 

Shaney: So, I don’t think we tried as soon as possible. I just felt like, for myself, I knew that as soon as I held a baby, a healthy, alive baby in my hand, that’s when I would be [inaudible 00:20:36]. I felt like even getting pregnant would be one step on the way there, and it definitely was a very nerve-racking concept to me. First of all, like I said, I never expected to get pregnant [inaudible 00:20:48] so quick. So, to me it felt like taking a few steps backward [inaudible 00:20:53] pregnancy. And another thing was that I knew [inaudible 00:20:57] future pregnancy would be very nerve-racking because of the trauma that I experienced. 

Dr. Fox: Right. And was it easy for you, or difficult for you, to get pregnant again? 

Shaney: So, I got pregnant a few weeks later. Thank God, it was very easy. 

Dr. Fox: So, pretty easy. And then, when you first got pregnant, right away when it started, did it feel more scary, or did you feel some reassurance because there was a plan in place, or where was your head at at the beginning of pregnancy when you just started? 

Shaney: So, it’s interesting. At the beginning of my pregnancy with Hya, I was much calmer than I was in my first pregnancy. 

Dr. Fox: Really? 

Shaney: I guess because my trauma wasn’t associated with my first trimester. So, in my mind, I was having a healthy pregnancy and a baby for sure. You know? Like, it wasn’t something that was…something I was particularly [inaudible 00:21:51] about. 

Dr. Fox: Right. 

Shaney: I was feeling pretty good, and I think that kind of was, like, [inaudible 00:21:56] in the beginning. 

Dr. Fox: Yeah. Was it your plan to stay in Israel for the whole pregnancy, if possible, or was it your plan to come back to America at a certain point? I mean, ultimately, we delivered [inaudible 00:22:06] in America. So, I’m curious, what was your plan originally? 

Shaney: My sister got married when I was seven weeks pregnant. So, I met with Dr. [inaudible 00:22:14], and she suggested coming in at 16 weeks [inaudible 00:22:20] pregnancy. And that was really my plan, unless, you know, unless I was coming in for [inaudible 00:22:27] So, I figured, unless after [inaudible 00:22:30] I felt totally fine. That’s [inaudible 00:22:34] pretty much to stay. 

Dr. Fox: Right. So, you figured you could stay in Israel between…after the wedding, seven or eight weeks for a couple of months, and then when you came back. Because that’s also when we start doing the progesterone injections, and all the cervical [crosstalk 00:22:45] 

Shaney: Right, exactly. 

Dr. Fox: Yeah. And also, it’s gonna overlap with the time that you had the complications, so it’s gonna be so many visits and whatnot. Okay. So, that was your plan, to come back. And so, you came back, you’re 16 weeks, and that’s what we did. We started the progesterone injections and checking your cervix frequently. Right? 

Shaney: Yes. 

Dr. Fox: Okay. And then, tell us what happened around 20 weeks, when we saw that your cervix was short? Was that something that, to trigger, like, oh, I’m gonna lose the pregnancy? Or was that maybe the opposite that, oh, this is what the problem is, now we’re gonna address it, and sort of gave you some reassurance? Because it could have gone both ways, I imagine. 

Shaney: At the time, I was so nervous about the concept of a cerclage. I’m not sure why. But, I mean, that really made me very, very nervous. 

Dr. Fox: Well, it sounds pretty freaky. I mean, you know, we’re gonna sew your cervix closed. I get it. 

Shaney: Right. That’s in retrospect. It doesn’t scare me, because I know what it is. 

Dr. Fox: Right. 

Shaney: But at the time, I was very nervous about it. And, yeah, I was petrified to [inaudible 00:23:44]. I remember it was in the midst of COVID, and I had [inaudible 00:23:50] with me. I wasn’t feeling well, so I did [inaudible 00:23:53] off. And actually, I contemplated [inaudible 00:23:56] before, but I [inaudible 00:24:00] during COVID, and the [inaudible 00:24:02]. So, I kind of told myself, you know, tomorrow morning, [inaudible 00:24:07] so early anyways. I’ll just wait until tomorrow morning. 

And [inaudible 00:24:13] came in. And, you know, I had enough ultrasounds at that point to know what it’s supposed to look like on the screen when it’s not [inaudible 00:24:23] measuring the cervix. So, I seen them measuring, and I started getting very nervous. And so, I’m texting my husband and my mother, oh my God, I think it’s short, I think it’s short. Then, my knee started quivering, and I started feeling fainty. 

And I said, [inaudible 00:24:40], you know, I think I’m gonna faint. Like, I quickly said it before I fainted, and I remember her… [inaudible 00:24:47] remember hearing Dr. Fox in the background on the phone [inaudible 00:24:50] wishing them a happy Passover. And I remember you saying, “Oh, I have a sick patient. I have to go.” And then, came into my room. 

Dr. Fox: It’s an unusual thing to happen in an ultrasound, for me to say I have a sick patient, without…It’s not…you know, ultrasound is usually a very, very secure, calm, everyone does well, not a lot of injuries in ultrasound. But every now and again, people do faint. It happens, absolutely. 

Shaney: Yeah. So, I definitely felt myself blacking out. I think by the time I was getting [inaudible 00:25:22] I was pretty okay. But yes, if I remember correctly, I think you checked to make sure that my cervix was closed. And then, once that was confirmed, we went into your office to discuss cerclage. 

Dr. Fox: Right. Okay. And so, ultimately, you decided to do it, the cerclage. I don’t think it took that much convincing. It was…I mean, it’s the right thing to do at that point. 

Shaney: I don’t think you gave me much of a choice. 

Dr. Fox: No, there’s always a choice. It’s a free country. But it was the best option medically for you. I mean, because it’s…you know, based on what happened last time, and based on the findings this time, I mean, no one can tell the future. But the overwhelming likelihood is if we didn’t do the cerclage, you would have ended up in a similar situation, and that’s the problem. And it could happen even with the cerclage. I mean, the cerclage doesn’t always prevent it. But usually, if the problem is the cervix, the cerclage is gonna work. 

And that’s sort of what the data shows, that’s what our experience shows, and this is something we do. I mean, there are those who would have argued…I mean, not in our practice so much, but there are those who would have said you should have had a cerclage, you know, right away, no matter what. 

You know, it wasn’t clear what your issue was. It could have been contractions, in which case cerclage wouldn’t be right, which is why we sort of chose with you to do the screenings with the cervical lengths. But once it’s short, then everyone’s very confident that it’s the right thing to do. How did it go, the procedure, in terms of, you know, it’s scary to have a [inaudible 00:26:45] but ultimately, was it the day of? 

Shaney: Yeah. So, it was really okay. I went into the hospital alone, which was definitely nerve-racking at the time. The procedure was really okay. I had a [inaudible 00:27:01] I believe… 

Dr. Fox: Yeah. 

Shaney: And that was okay. Great anesthesiologist. I remember her name, actually. And the procedure was really, really okay. 

Dr. Fox: Wow. That’s great. And it was…I think Melka [SP] did it. Right? 

Shaney: Yes. Yeah, Melka did it, and Dr. [inaudible 00:27:17] as well. 

Dr. Fox: Oh, right. Yeah, two for one. You know, after that, sort of our thought at the time is, okay, you know, we have sort of, you know, high-risk patient, lost a pregnancy. We seem to have identified a problem. This is probably the right solution. I assume we were pretty optimistic after the cerclage went in that things should go well. Correct? 

Shaney: Yeah. I did feel much more secure. I kind of felt like the baby can’t fall out anymore. I definitely felt much more secure in that way. I did have a little bit of cramping going [inaudible 00:27:47] procedure, but I…if I remember correctly, I was told to expect it. 

Dr. Fox: Yeah. Definitely, that’s normal. But I think what’s unusual, most people when they have sort of a similar situation to you, the cervix is getting short, we put in the cerclage, and most of them do just perfectly fine until the end. And there is some percentage that, you know, maybe their water breaks beforehand, or they go into labor. 

But you seem to also have a lot of contractions, despite…you know, because the cerclage doesn’t stop contractions. It just stops the cervix from shortening. So, it seems like you had two issues at the same time. Not only was your cervix short before…then you also had contractions. We had to do a lot of dancing around medications to stop contractions for you. 

Shaney: Right. Right. 

Dr. Fox: Right. [inaudible 00:28:30] bunch of things, and it’s really…what’s so interesting about your story is, you know, the medications we use to stop contractions, you know, if you sort of look in textbooks and studies, they don’t’ seem to work, and we spoke about this. But they clearly helped you with the contractions. I mean, you weren’t…you were having them when you weren’t on the medicine, and you were having them much, much less when you were on the medicine, which itself I think is valuable, because just to be home and contracting, with your history, would have been really terrifying. 

Shaney: Right. Yeah. The medications did seem to help me. I had to at some point start going for fetal echoes because of [inaudible 00:29:05] exposure. I remember telling the…I don’t what you call them. A sonographer. 

Dr. Fox: Yeah. 

Shaney: That there was [inaudible 00:29:12] exposure, and he’s looking at me like, “Why were you exposed to that?” You know? 

Dr. Fox: It’s in the water. Yeah. No, it’s one of these things. It’s, you know, yeah, it’s a tough situation. Normally we don’t, like, routinely put women on these medications to stop contractions, and we don’t do it for people just because they have a cerclage in. Even if people come in with, you know, contractions and preterm labor, we usually just do it for a couple of days, which is what, you know, the data supports. 

But, you know, not everybody follows the data. And like, what are you gonna do when you have someone with…you know, who lost a pregnancy 23 weeks, who has a cerclage, who’s contracting, like, pretty painfully at, you know, 24, 25, 26 weeks? I mean, you can take out the cerclage, and, you know, that’s it. It’s a preterm birth, or you try. You do things that are sort of, you know, off the books, and see how it goes. 

Shaney: If I were to stand up from my couch to walk to the bathroom, I would start contracting. Like, anything I did really affected me in such a big way, and it was so…it was very nerve-racking. You know? Like, I remember I was cutting onions for a soup, and my husband said, “I don’t know if you should do that.” And then I said, “Don’t worry, I’m fine.” And about an hour later I was in agony on the couch contracting. And, like, I cut onions and I was contracting. 

Dr. Fox: Right. It’s crazy. And another thing is I remember, you know, because the medications, particularly the Indocin [inaudible 00:30:30] can have effects on the baby. You were like…you took, like, so few doses of it. It was, like, such a low dose. And the truth is, we didn’t think it would actually have any effect, because you took it so rarely. But we wanted to be as cautious as possible because it was unusual. 

But it was such a…I remember those two months were so hard, I mean, for you, because it was such a balance between not taking too much medicine, but taking enough, and it’s during all this time where if you deliver, you’re all worried. And what was…I mean, I remember on our end, like, we were seeing you every week, and we’re talking every week, and we try to figure this out. What was it like for you during that sort of, like, middle of the pregnancy period, like, 24 to 32 weeks when we were really, you know, on top of this, and seeing you every…at least every week, sometimes twice a week? 

Shaney: I was very anxious, and I…and it was definitely a lonely time, because, you know, it was in the middle of COVID, and [inaudible 00:31:24] I was really, like, staying home, trying not to move around too much. I would get out here and there, and my husband was around, of course. But I was nervous moving around too much, because I did feel, like, immediate, like, responses from my body. So… 

Dr. Fox: Right. 

Shaney: It was just nerve-racking. 

Dr. Fox: In general, would you say throughout the pregnancy you were optimistic, or pessimistic, or neither? And I’m also gonna ask you what you’re like in general, in life? 

Shaney: Okay. So, in general, I’m a very calm person. Very not anxious about almost anything, and I would say very optimistic. When it comes to health, I am a hypochondriac, so I know that that’s where my anxiety kicks in. So, I know not to be so [inaudible 00:32:12] myself when I get anxious about health-related things. I was focusing on being optimistic, but then I was also nervous to be optimistic, because I didn’t want to be let down. So, I was like…it was, like, a constant, like, struggle with myself kind of. 

Dr. Fox: That’s interesting because, I mean, my recollection, you know, as an observer, right? We spoke a lot. I saw you a lot. Was your anxiety or nervousness was completely appropriate, like, warranted. I mean, this was a…you know, this was a serious situation, as we’re saying. This was not like nothing. This was certainly not being a hypochondriac. This was a real issue going on. 

But other than that, I thought you handled it very well, I mean, under the circumstances, as it’s a very difficult place to be. And you would not, you know, notice, like, looking at you that, you know, that you said you had, you know, a lot of anxiety or being a hypochondriac. It just didn’t seem that way at all. 

I’m wondering, was there any point in pregnancy that you can remember where it sort of flipped from I’m sort of not sure how it’s gonna work out, to “I’m confident it’s gonna work out.” You know? Was there a certain gestational age where you’re like, “All right, we’re good, you know, we got to a certain point. It’s gonna be okay no matter what happens.”? Or did that not happen until you were holding your baby? 

Shaney: I think 32 weeks. At 32 weeks I was [inaudible 00:33:32] I’m gonna have this baby, and it’s gonna be okay, and I’m not sure when the cerclage is gonna come out, but I’m, you know, I’m gonna have this baby. Like, at that point I was totally calm. I was [inaudible 00:33:44] more, because I felt like because I was calmer, my body was also calmer. 

Dr. Fox: Yeah, that makes sense. And then, ultimately the cerclage went out a little bit earlier than we normally do it, and we normally would do it, like, 37-ish weeks, and yours came out I think 34 to 35 weeks, because you had more painful contractions. And at that point, we don’t want the cerclage to, like, hurt you, so we took it out. And then…but you went home after that, right? 

Shaney: Yes. Actually, I was in the hospital for a few hours, and [inaudible 00:34:14] contracting, and then it settled down, so at that point they let me go. It’s actually funny. I was only, like, 34 weeks and a few days at that point, but I was so ready to have my baby that I [inaudible 00:34:25] hospital. I was, like, almost mad at the baby. Like, “What are you waiting for? Like, you were wanting out this whole time, and now you’re stuck in?” 

Dr. Fox: Right. And then, you ultimately went into labor and delivered a few weeks later, around 37 plus weeks, right? 

Shaney: Yeah. Yep. 

Dr. Fox: That’s amazing. Full term. How about that? 

Shaney: Full term. Oh, yeah. 

Dr. Fox: And what was the birth like? How happy was that day for you? 

Shaney: You know, like, everyone has their birth plan and whatever. I didn’t think about any of that. I just wanted to get to the end of the pregnancy, healthy, and safe, and hold a healthy baby in my arms. But it was the most perfect birth. I came to the hospital. All that I cared about was that I should get there early enough to have an epidural, because I really did have a very painful labor last time, and I didn’t want to have to scream like that again. 

I got there early. I had an epidural. I went in. I didn’t feel a thing. Really, not a thing. You know, like, I was taking naps, speaking on the phone with my mother. Me and my husband were…it was almost like a date. We were sitting there and, like, just enjoying each other’s company, and waiting for the baby to come. 

And it was pretty fast. I remember Dr. [inaudible 00:35:33] told me not to expect the baby to be born for at least 7 to 10 hours, and I think it was in 3 hours I delivered. So, it was pretty quick. It was really an easy, pleasant birth, thank God. It was a very, very calm atmosphere. The doctors and nurses were amazing, and I was so happy to be there at the end, you know, like, at the other end of things, and the baby was beautiful, and everything was just great. 

Dr. Fox: Wow. Did it bring back any of the memories from the last pregnancy? Like, was there a point where it sort of was painful, or was it just total happiness? 

Shaney: So, I was nervous that I would have some kind of flashback to my previous labor, or, like, when they would hand me the baby…I was nervous that I would start thinking, you know, that my first baby [inaudible 00:36:22] baby, and I didn’t want to be that person. I wanted to be totally and completely happy and content. And thank God, I was. I really, really was. I felt like it was a whole different experience. I couldn’t even compare it, and everything about it was, like, the best that I possibly could have imagined it to be. 

Dr. Fox: That’s amazing. That’s good, because it can go many ways. People…you know, some people have the experience you did, where it just is a really happy day, and other people, there’s a lot of mixed emotions and it’s very painful, and it’s…yeah, there’s no…you know, there’s no correct way. It’s just sort of how people respond to these things. 

Was there anything over the course of your, you know, journey, particularly in the, you know, during the pregnancies, do you remember anything from, like, your family or friends that was particularly helpful to you? 

Shaney: [inaudible 00:37:08] door. Anytime a friend says hi to me, or [inaudible 00:37:12] like, that was just so helpful to have good company and distractions. [inaudible 00:37:16] parents at that time, because we don’t have an apartment in America, and my sisters and my mother were all so amazing. 

My mother-in-law…they made sure, like, I wasn’t alone too much, and they were very, very present. And that was really very helpful for me. I also found, personally for myself, I focused a lot of time on some issues. I was taking some courses online, so I found that putting my focus on accomplishing things at the time, and…as opposed to, like, just killing time and waiting for the pregnancy to pass. 

Dr. Fox: Got it. Was there anything that, you know, people did unknowingly that was very not helpful, or very hurtful potentially? 

Shaney: I didn’t want to talk about the fact that I was pregnant to anyone, you know, up until a later point. I kind of felt like if they see me, they’ll know. If they don’t see me, they won’t know. Like, this doesn’t need to be a conversation. It’s something that was nerve-racking for me, and I kind of felt like when [inaudible 00:38:18] quiet, like, I really wouldn’t talk about it a lot, and then I would randomly get texts from people like, “Hey, is it true that you’re pregnant?” Or like, “Oh, my gosh, are you scared the same thing is gonna happen that happened last time?” And like, some [inaudible 00:38:30] comments like that, and like, tried to just, like, let it…you know, let it go, and let it go over my head a little bit, because I didn’t want to harp on the negative things that people, like, coming from other people. You know, I had enough, like, fears of my own, and I wanted everybody to just try to focus on easier, happier pregnancy, and yeah, kind of, like, avoid negativity. 

Dr. Fox: Yeah. As a final question, looking back now, you know, you’ve gone through two so different pregnancies. You know? One is in another country, you know, you guys are alone with, you know, this really devastating outcome. And then, obviously a very challenging pregnancy with a lot going on. But, you know, you’re here, and you know, obviously the outcome was very good, and you have your daughter, and it’s, you know, such a wonderful thing. You know, looking back on the past couple of years, you know, what do you make of this? Like, what did you learn about yourself as a person going through all of this? 

Shaney: I definitely learned that I, like, sometimes when it comes specifically to [inaudible 00:39:34] health matters, because like I told you, like, this is the area where I do tend to get a little bit anxious. [inaudible 00:39:40] trusting that, like, I want to control what’s going on, and all we could do is just hope for the best and pray for the best. And, like, having an optimistic mindset really does help, because when you’re calm and happy, your body feels it. So, I think I learned a lot about [inaudible 00:39:58] and things can end well. 

Dr. Fox: Wow. Shaney, thank you so much for volunteering to tell your story, and it’s…you know, obviously I was a part of it, so I know it, but it’s so fascinating to me to hear it from your end, because, you know, we never…people don’t have a chance to sit down and talk like this, and go over everything, and how…you know, what did you experience, what did you feel? And it’s just so helpful for people to hear these, and to hear the stories, and, you know, what people go through, good and bad, in pregnancy, and what, you know, lessons we learn from it. 

And I think your lessons about optimism, you know, about faith…these are just really big life lessons that we learn from this experience of, you know, building our families in different ways. And it’s great that you are, you know, willing and able to share it all the way from across the globe, and I really appreciate that as well, because it’s really late now. When we started it was late, so now it’s really late. But thank you so much. 

Shaney: My pleasure. 

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 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.