“Then Comes Baby, Part Two” – with Dr. Jessica Vernon

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, I’m back with Dr. Jessica Vernon, author of “Then Comes Baby.” An honest conversation about birth postpartum and the complex transition to parenthood. It’s releasing in May. You can get it now, pre-order anywhere you buy books. And last week we spoke about sort of who you are, your own experiences, how you came to writing the book, and let’s talk about the book. So, I told you before we went on that I am asked to read a lot of things and a lot of books and things about pregnancy. Okay, so I read your book. I really, really like it.

And I’m not saying that because you’re sitting here because if I did it, you wouldn’t be sitting here, frankly. So, I think that’s a pretty good sign. And, you know, it’s just my perspective is that it’s a really, really helpful book for people who are going through this either the first time or they didn’t quite like the way they went through it the first time. Either they didn’t understand something or just something didn’t go the way they wanted it to. So, that’s my read of it. So, I think it’s terrific. So, my question to you is you decide you’re going to write a book. How did you come to, “What am I going to include? Or what am I going to not? What’s going to be my tone? How much of it is sort of like medical versus personal?” Like, all those decisions that have to be made, what helped guide you through that, just your gut?

Dr. Vernon: Yeah. And first of all, thank you.

Dr. Fox: You’re welcome.

Dr. Vernon: I mean, when I got your email when you started reading the book, I was just, it felt so good to… You’re an expert. You’ve written books before, you’ve done research before.

Dr. Fox: I don’t read that much. I’m not an expert in reading. I’m predominantly illiterate, but that’s fine.

Dr. Vernon: But it means a lot from someone who is an expert in the field and also spends their days counseling people and caring for people who have experienced a lot of these things throughout their birth and postpartum period. So, I really appreciate that. And the book, how it was written, what it covered, the tone, that all evolved over time. And it basically came down to, I wanted to write the book that I wish I had when I was pregnant so that I didn’t feel the way I did when I was postpartum. And feeling that if I, as an expert in this field and who’d cared for people for over a decade, could still feel this way and be so shocked and feel so alone and feel like such a failure. What about everyone else who didn’t have any of this history and resources available to them and knowledge?

And so I looked at it in the same way that I look at talking to my patients, which I’m working with every day as they’re processing their birth and postpartum experience. I looked at it as I talked to my friends when they’re pregnant or preparing for pregnancy and how I communicate with them and support them and kind of help guide them along their journeys. And I just really wanted to be in a tone that was supportive and non-judgmental and held space for all of these possible things that can happen on your journey. And let you know that while it does suck when some of these things happen, it doesn’t mean that you’re a failure, that’s something wrong with you or your body. It just means you’re human. And these experiences that we ultimately have no control over in many ways, can go off course from what we anticipated or prepared for so often and we just need to be prepared with the right support to move on with our journey from that.

Dr. Fox: Yeah, I felt that in reading it that it was very understandable, right? It’s written in a way, it’s not overly technical, is how I would say it’s. Meaning it is technical. Meaning it explains all of the things that you would want to know about right for an induction of labor. What is this? What is this? What is this? What is this? But it’s not written as, like, a manual. It’s written very much like a conversation you would have with someone like, “All right, let me explain what’s going to happen. And here’s why we do things. You know, what to expect those types of things.” But there’s two layers, right? There’s the information aspect, which is very empowering to people to know what to expect with their pregnancy and with their delivery and postpartum and very helpful. But then there’s sort of that higher level where people sometimes mistakenly think that by having information and empowerment, that they have control.

And you mentioned because you don’t usually, right? It’s great to have information, it’s great to be empowered to make decisions, like terrific. Like, I’m 100% behind it, but that does not mean it’ll lead to the birth you plant, right? Having information won’t cause you to have a successful vaginal delivery versus a C-section. But it’ll help you process what’s happening in realtime. Because if you understand why a vaginal birth may have to turn into a C-section, or if you understand what might I expect if it turns into a C-section. Like, we said in the last week’s podcast, it can change that event from something that’s traumatic to something that’s not traumatic and maybe potentially pleasant, even if painful. And I think that that’s really the balance that you struck between information, but also like explaining that it may not go this way and that’s okay.

Dr. Vernon: Right. And anyone who is selling you a manual for if you do X, Y, and Z, you will get this outcome.

Dr. Fox: Yeah, good luck with that.

Dr. Vernon: That doesn’t apply to anything related to the reproductive journey. And it’s very scary to think that. And for a lot of us, myself included, we’re used to studying and working hard and preparing and being educated. And then things go according to plan. But that’s part of this very human experience of being pregnant and giving birth, that miscarriages happen, infertility happens, pregnancy complications happen. The birth doesn’t go the way you planned. Breastfeeding doesn’t go the way you planned. And it doesn’t mean that there’s anything wrong with you or your body. It’s just life. And the more prepared we can be for these other alternative pathways, that things could go down. It doesn’t mean it’s going to eliminate trauma. It doesn’t mean you won’t struggle and suffer in certain ways.

There are really horrendous things that happen to people. But a lot of these things that I talk to about people every day when I’m working with them for their pregnancy or postpartum and talking about mental health, are things that if we’d had these conversations beforehand or someone had spoken to them or brought these things up and prepared them for these possibilities and had them look at it with a lens of some flexibility and, okay, this is my overarching goal. And if some things change along the way, that’s okay. Then they might have processed it differently and they might have felt differently about the experience. And it could have saved them a lot of time of feeling like I did, where if things went a little off course, I felt like such a failure. And like, “What did I do wrong to get where I am? And why does it seem so much harder for me than for other parents?”

Dr. Fox: Yeah. And that’s very powerful stuff, obviously. And it’s surprising to a lot of people because for better or worse, a lot of us sort of go into this process not thinking much about it. You know, again, it’s for better or worse. Sometimes it’s better not to think too much about it. And sometimes it isn’t. But you sort of, you know, you expect to go into this and like anything else, you know, it’ll probably just go fine and this or that. But doesn’t, like, you said, life is messy. And there is maybe no better example of that than, again, trying to reproduce. Even though it happens everywhere, all over the place, the ways it can happen are so varied. And again, getting pregnant, being pregnant, delivering, having this new little critter, you know, under your care and all those things have a bajillion ways they can go. And so it’s tough. And I just really like the tone, I would say, of the book. I just thought was really helpful, at least in my opinion. So, I’m sure everyone who’s going to read it will feel the same way. You sort of started towards the end of pregnancy in this book. Why is that?

Dr. Vernon: Well, it would have been a tome if I tried to include, trying to conceive through postpartum. And that was part of the discussion and conversation as I was going through the process of what part am I going to focus on in this book. And I think there are some good resources. You just wrote this book with Emily Ulster recently talking about some of the unexpected things, and it focuses on a lot of the complications that can happen in pregnancy. And it’s wonderful.

Dr. Fox: Thank you.

Dr. Vernon: And that’s how I heard your name. And then I got your text about a patient you’ve seen of ours. So, I was like, “Oh, my goodness.” So, there are some other sources out there with information on those complications. But I felt like a lot of the stuff that I was talking to people about in my conversations when they were struggling postpartum with either trauma or anxiety or depression or a combination of everything, were things related to how the birth went and how the transition to becoming a parent went. And that’s how the whole title came about, too, is it’s like we have this whole idea that we’re going to fall in love, we’re going to get married, we’re going to get pregnant, and then the baby’s going to come and it’s going to be beautiful and bliss. And we kind of plan the birth like we do our wedding day. And so I wanted to dive into that a little bit and do it in a way that I think is really hard as an obstetrician to do when you’re talking to patients, because as an OB, if I go in and say, “You know, I love that you have a birth plan, I love that you’re empowering yourself and you have an idea about how you want things to go. But you could end up with a C-section.”

And when you say that in today’s culture and there’s so many things about doctors who are overly aggressive with interventions and wanting to give C-sections to everybody, then it can really make things go awry unless you have built a really strong connection with that patient already. And so I wanted to kind of say everything how I would say it if I had that space with the patient. And often because I’m not seeing people as much for the prenatal visits anymore. I’m seeing mostly at birth and postpartum. I’m having these conversations in the aftermath after everything’s gone different than they ever could have envisioned based on the information they had and the knowledge and experience that they had behind them. And so trying to kind of set a new stage for other people going forward so that they can be a little more prepared.

Dr. Fox: And then you set it up in sort of three parts and then a conclusion, right? So, the first part is labor and birth. And some of this is just, you know, tell us the chapters basically. But what parts of labor and birth did you feel were important to highlight or the things that people really didn’t have a great sense of what to expect?

Dr. Vernon: For labor and birth, it’s really the whole experience. I start, the first chapter goes into birth plans, which I think is the very top-of-mind thing for many people who are giving birth, what their birth plans are going to look like, how they anticipate it. And I really wanted to go through the things that might go off course with that or the things that are mandated by hospital protocols, why certain things are certain ways, what things there’s flexibility in. And if the provider recommends something that’s not on your birth plan, these are reasons why they might. Just to kind of set it up. And I really throughout, I also spoke to a lot of great psychiatrists, psychologists, trauma specialists, people who are also doing this work I do every day and looking at it with a different lens. And so kind of bringing in those voices into the conversation, starting with the birth plan about flexibility and how knowledge is so important and empowering, but also flexibility and understanding that it can go differently as, as well. And then taking it through the whole thing from spontaneous labor, where you go into labor on your own, to what happens if you need an induction, which is pretty common these days for one reason or another.

And so even if you had hoped that you would go into spontaneous labor and did everything you could to get into labor on your own, or you walked in the doctor’s office one day and they say, “Oh, your blood pressure is high, you need to go in and be induced now.” How that whole process looks if you have an induction versus spontaneous labor and the things that typically scare people about being induced and kind of debunking some of those myths and explaining some other aspects of it? And then the C-section, of course, which so many people are just completely unprepared for. I had two C-sections. My first was unplanned. No one in my family had had C-sections. I was so healthy. I worked out my whole pregnancy. I never thought I’d have a C-section, but I knew they happened. I was an OB. And so it wasn’t like the biggest deal to me when I ended up with the C-section. But I talked to people every day who are like, “I absolutely thought if I did everything right, there’s no way I would end up with the C-section.”

And so that whole process while transitioning to parenthood and going through major abdominal surgery and everything else that happens when your hormones drop and stuff really throws them off in a way that might not happen if they were prepared for the possibility of a C-section before. And then I cover a little bit about what happens after the baby’s out because really most people don’t understand that part at all. They’re like, “Why are you still in the room? The baby is here, we’re done.” And so going through that and what to kind of anticipate and the little time you have postpartum in the hospital and how to advocate for yourself during that time, because a lot of people do feel that they weren’t educated properly. They were dismissed. They might not have gotten all the resources and support they could have gotten. And also, people are really scared that something bad is going to happen to them while they’re in the hospital. And there are many valid reasons for that. And so how to empower yourself to speak up if you think that something is wrong and making sure you have the right support people around you during delivery and after can really change a lot of the process.

Dr. Fox: And then part two, which is postpartum, is really the time when you fold in and weave in your experience with the knowledge, meaning that part one is a lot more like information, right? And not as much your story. But part two, you really sort of almost like 50-50. Well, not really, but whatever and there’s a lot of it. How intentional was that? Meaning, when you said, “I’m going to write a book,” did you say, “I’m doing this so I could also tell my story?” Or did you say, “I need to do this and my story is just going to sort of like add to that so people know it happens to me as well?”

Dr. Vernon: I didn’t really have an intention when I set out on how much of my story was going to be in the book. I knew there would be aspects of it. I’ve talked a lot about my story in the past and how my lived experience led me to be so passionate about the work I do now and helping other new parents not feel the way that I felt. And I felt that it was important to weave it in, in many ways to show people that no matter where you come from, what resources you have, your past lived experience, these struggles can happen to anyone. And I think it’s also important for people reading the book and people who listen to those like us who are professionals, to also know that we’re humans and we’re people and we go through the same struggles they do. And so it’s not that we understand something that they don’t. I mean, a lot of the people that I care for afterwards are people who are in the health care system and they take care of other people as their daily job. And then they end up in these situations where they’re struggling postpartum. And so I think it’s good for people to see and hear other perspectives and stories and see like, “I’m not alone.” And it can happen to anyone, even people who seem to like have all of the resources at their disposal.

Dr. Fox: Yeah, I mean, it’s always a tough choice whether to share your own experience or whether to not share your own experience, because on the one hand, it definitely gives, like you said, that idea that it happens to everyone that also like, “I get it, you know, like not only do I get it, but I really get it. Like, I understand what you’re going through.” On the other hand, sometimes you’re worried that like maybe I’m sharing too much or maybe they’re going to view this as like, “Well, it’s about me, it’s not about you.” And that’s hard. I guess it’s a little bit easier to book, I would say because you can really craftfully decide, you know, an edit versus a conversation with patients. I don’t know like when you’re counseling patients yourself in your day-to-day job, do you bring in your own experiences to the same degree or?

Dr. Vernon: No. I don’t, because I want to provide person-centered care to each person I’m talking to. And, you know, often you get patients who are like, “Well, what would you do?” And so…

Dr. Fox: I love to question doctors.

Dr. Vernon: …for me, I have to create that balance and make sure that I’m centering their experience in what they’re going through. But I do tell people, “I have been there. I get it.” Even if the experience is vastly different, like, I’ve had these feelings and I’ve had these thoughts before. And just to let them know, it does get better. Like, I see you. I know where you are right now. It feels really terrible right now, but it will get better. And so validating their experience and kind of encouraging them and giving them hope and also, you know, asking them to treat themselves with some grace and compassion because we all deserve that. And so I kind of focus those things more. And I know and it is really hard too because obviously being someone who lives in New York, who’s a physician, I’m white. I have a lot of resources.

There are so many aspects of other people’s situations that I will never have to deal with. I’ve had moms come to me and they are just panicking because they are a black-woman and they are worried that they are going to die in birth or their baby’s going to die in birth. And that’s a real fear that I’ve never had to deal with. You know, so I definitely in day-to-day conversations do not focus myself because it is a different situation. But I do build some of those human connections and like telling them I’ve been there and I see them and I understand and you are not alone. Because I think just feeling so alone and isolated and stigmatized, I think that is a big thing that speaking to others, getting help, going to support groups, talking to other new parents, getting that validation, can really help with.

Dr. Fox: Yeah. And what’s also interesting about the section on postpartum is it really also not only is there a shift in the book going from sort of descriptive to descriptive plus personal, but it also goes really from, you know, 80% or 90% medical and the first part to postpartum, it’s 50-50 sort of medical, surgical/mental health, which is true in reality. Also, I mean, that the postpartum period is obviously there’s physical, you know, everything. The recovery is physical. But the mental health recovery and sort of new stage in your life is so profound. You’re processing your birth, you have, like you said, all the hormones and everything’s going on at the same time. And I thought the book did a really nice job that the balance of what you spoke about was matched the balance of what actually happens to people after they deliver. Like, sort of the number of words spent on physical and mental shifts, in sort of like the exact same way. I don’t know if that was intentional, or I just noticed that.

Dr. Vernon: Yeah, I think I honestly don’t feel like anything that I did in this book was intentional in that way. I think it just kind of came about how it came about. And when at first when I was writing it and I tried to, like, set the tone a certain way or do things, like this just feels forced. And I wanted it to come off really authentically. And this is how I talk to people. And this is how I explain things, whether it’s a patient or a friend. And so I wanted it to be reflective of that. And I want people to understand as they’re going into the postpartum period, obviously, there’s so much that comes into birth that is emotional as well and mental as well. And a lot of that are things that would be great for another book on privacy. But the postpartum period is just so much of it is what’s going on in our minds, as well as what’s happening to us physically.

And how we’re processing what’s going on physically in our minds and how our brain, the structure is literally changing and the hormones are changing. And so it’s just, it was really important to me to reflect all of that and not kind of underplay or be dismissive. Because you hear so many people, I’ve heard like, “Babies are born every day. Like, this is normal.” Like, you know, it’s kind of like, “Well, just get up and move on with your life. Just bounce back, right?” That’s like I hate that term bounce back because we’re supposed to go and act and look like nothing ever happened when it’s really one of the biggest changes anyone can undergo, not just physically, but mentally and emotionally as well.

Dr. Fox: People have babies every day. A lot of things happen every day that aren’t that easy.

Dr. Vernon: Yeah. Like, I don’t understand why would people keep doing it if it was that bad.

Dr. Fox: Yeah. And then part three is really interesting. And I don’t even know if Mattressen…

Dr. Vernon: Mattressen. Yes.

Dr. Fox: Mattressen. It’s so tough. I was like, “Whoa, I haven’t used that word in conversation a lot.”

Dr. Vernon: Ever?

Dr. Fox: Yeah. So, tell me about that.

Dr. Vernon: So, Mattressen is a term that a lot of people have never heard. It is something that is starting to be explained. There is actually a really good book, wrote by a British journalist recently called “Mattressen,” which goes into it a lot. And it is the process of becoming a mother or a parent. I mean, not everyone identifies as being a mother and delving into all of that and how it is just a big, if not a bigger transformation than we undergo during adolescence and how we change physically and emotionally and all the hormones. And you go through that, not in like, you know, spread out over years. You go through that like, boom, all of a sudden you’re pregnant and then you go home with a baby. And everything changes overnight. And so it’s kind of really telling society that we need to understand that this is a huge process that the person giving birth is going through. And of course, for anyone, fathers, partners, you know, anyone involved in the family, it is a huge process. But the person giving birth is really going through something more intense than they did during adolescence.

And adolescence, we talk about all the time and how crazy it is to have a teenager in your house and all the things that are going through. We don’t talk about what happens to somebody when they give birth and we don’t treat that with the weight that we should. Some cultures do. You know, in other places, there’s rituals around the new parent after they give birth, and other women in the family or in the village come over and take care of them and support them and help with the baby. They tell stories of their own births. They really surround people and support them in a way that in Western societies, we really don’t. We’re used to being very independent and being insular and living in our little family in our home. And often it’s the birth parent alone with or without a partner. They may not have any family nearby. They might not have other friends who’ve given birth. And so you’re trying to process this all in a bubble. So, I just wanted to bring that to light a little bit as far as some of the things that we need to factor in when we’re going through that time.

Dr. Fox: I thought it was really… I’m a parent, so I’ve been through it in a sense, but I never put much thought to it in the same way. So, when I was really like, I’m like, “Yeah, like that happens.” I was like, “Yes, you’re right.” Like, you said, I never really put much thought to it. And so I think that’s a really nice part of the book that you add in. It’s not just like you give birth, you have a baby. Here’s what happens around that. But just sort of your whole life is now different. Your whole identity has changed sort of in an instant. You know, your entire world is new. And that’s really fascinating. And I do love your conclusion. It’s very positive. You got this.

Dr. Vernon: Thank you.

Dr. Fox: Which is awesome. You know, with a nice exclamation point at the end, which is pretty cool. I wanted to ask you, how has this process for you in starting, finishing a book and having it ready to, you know, be read by millions and millions and millions of people, hopefully. What has it done to you personally? Like, how has it affected you either as a person or as a mom or a friend or whatever it is? And then the second question is going to be, professionally. Again, this process, because putting pen to paper and thinking about this and really focusing on things you may not sort of cerebrally focus on in the same way.

Dr. Vernon: Right. It’s been a long process and it’s been intense. And as I put in the introduction, I, at one point thought I was like, “There’s no way I’m going to get this done.” And it just really has been a labor of love because as many people as I can talk to one-on-one, day-to-day, I just really wanted to get some of this out there to other people who I’ll never see, other people who may never talk to someone about these real experiences during birth and postpartum. And so as much as I have had a lot of imposter syndrome throughout the process and fears of being judged and what are people going to say and, you know, this is just, I’m just one person. This is my perspective and based on things that I hear and see every day in my own experience. But, you know, how does that apply to everyone else and what do they take away from it? And I’ve just had to say, you know, I know it’s going to help some people and that’s what I’m doing it for. And so it’s been a long process and it’s been very humbling in a lot of ways. And then when you write the book, you realize how much more the process is after the book, of like putting it out there into the world.

But it is in my mind, hopefully, a way to connect with other people, and hopefully, they don’t feel the way that I did. But also sharing it, kind of writing it and reflecting on it, it really just brought out to me, no matter how different we are, all of us, no matter where we’re from, trying to get pregnant, being pregnant, giving birth postpartum is such a universal experience that it really can connect people and form these bonds of humanity in ways that we might not always share with people that we look at and seem so different or their experiences in their lives seem so different than us. And so I’m hoping it kind of draws that conclusion for people, too, that like when they see someone else who’s pregnant or has a little baby and they’re struggling or they could use some support, like reach out, ask how they’re feeling, give them a smile, not a judgmental look or a comment about them feeding their baby formula or whatever. You know, and just kind of help reach some of those bonds of humanity that we lose sometimes.

Dr. Fox: What a nice message. Wow, I love that. That is amazing. Wow, Dr. Jessica Vernon, “Then Comes Baby.” I recommend it. Everyone should pre-order it right now and good luck to you with the book and with your practice. And thank you for doing it and thank you for sending it to me as a pre-read. I appreciate it and I’m going to recommend it. I really like it.

Dr. Vernon: Thank you so much.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.