“Traumatic Birth and Supporting Women Who Have One” – with Sara Shapiro

Sara Shapiro shares her High Risk Birth Story of getting pregnant with her first child three years after a liver transplant. After planning to carry to full term and have a vaginal delivery, Sara was induced at 37 weeks and had an emergency C-section despite concerns about scar tissue from her transplant. Learn more about her story in this episode.

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Dr. Fox: Welcome to “High Risk Birth Stories,” brought to you by the creators of the “Healthful Women” 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. Sarah, welcome to the podcast. Thank you so much for coming on to tell your story. 


Sarah: Hi. Thanks for having me. 


Dr. Fox: We’re gonna be talking about the birth of your son, Ari, who is, I guess, turning 4 this year, correct? 


Sarah: Yup. Yup. Almost 4. 


Dr. Fox: For full disclosure for our listeners, we were not your doctors, but we did take care of you for your second pregnancy, or Lily, who I guess is a little bit over 1. 


Sarah: Yep. 


Dr. Fox: I guess let’s just start with, when you became pregnant with Ari, tell me, you know, where you were, where you were living, how old you were, what was your story at the time? 


Sarah: Okay. So was living and working in Brooklyn. I had had a liver transplant in 2014, so that was 3-and-a-half years before I got pregnant. We had to wait three years after transplant. So we waited. Didn’t get pregnant right away. Took a few months, but got pregnant probably about, like, six to eight months after trying and was super nervous because I had the transplant and I didn’t know anyone who had a baby after transplant. 


Dr. Fox: You said you do not know anyone? 


Sarah: Yeah. I didn’t know anyone. Like, everyone I knew who had a transplant had it after they had their kids. 


Dr. Fox: Right. And did you have specific concerns about the transplant?, like, was it more the pregnancy’s not gonna go well or I’m gonna reject my liver? Like, what exactly was it? 


Sarah: I was just nervous. Like, I didn’t think I would get so far in life to, like, have the transplant, be healthy enough to carry a baby. So I was just overwhelmed, but I had, you know, a high risk team taking care of me. They told me I shouldn’t be nervous. We’ll monitor you closely, towards the end, we’ll monitor you more closely. After the first trimester, I calmed down and felt better and my pregnancy went pretty well. 


Dr. Fox: So the pregnancy was smooth and you’re married. And your husband is…? 


Sarah: Yeah. I’m married. My husband is Levi. 


Dr. Fox: Do you think he was, like, more concerned than you, sometimes that’s the case where they’re more concerned than you are, or do you think that he was just following your lead? How did that play out? 


Sarah: He was excited. I don’t think he was so nervous. 


Dr. Fox: Okay. And I assume, like you said, your doctors were very encouraging and reassuring. Obviously, they gave you the thumbs up to get pregnant, so they thought it would go well. 


Sarah: The high risk team, the OB would meet with the transplant team, like, once a month to go over everybody who had the transplant cases. So they would meet with my transplant team, like, once a month. 


Dr. Fox: Right. And they kept you on your anti-rejection meds for the pregnancy? 


Sarah: Yeah. There was one medication I had to go off of, but everything else mostly stayed the same. Like, one medication we lowered a little bit, but everything pretty much stayed the same and I went for blood work, like, once a month, but it wasn’t told to do anything differently. 


Dr. Fox: Were you telling your family and friends that you were pregnant and did they also know that you had a liver transplant? How much did everybody else in your life know about what was going on with you? 


Sarah: So most people know about the transplant. At work, I wasn’t so open about it because I started working after, so there was no reason for them to really know. I told them I was pregnant, but nothing about the transplant, just the regular pregnancy. 


Dr. Fox: What kind of work were you doing? 


Sarah: I was working for a home daycare company. Like, my job was to assign home care providers and children to different daycares. 


Dr. Fox: You’re in an office, basically. 


Sarah: Yeah. Yeah. 


Dr. Fox: You’re going along with pregnancy and you said things are going well, and what about as you’re getting closer to delivery? Was the monitoring more intense and were there any specific concerns about delivery and how you’re gonna deliver, and when you’re gonna deliver, and around the time of delivery? 


Sarah: So they wanted me to go full term. There was no, like, plan of early induction or C-section. The only thing they kept stressing, which is still, like, a mystery to me now is that they didn’t wanna do a C-section because they felt that I had so much scar tissue that it could, you know, cause damage and they were nervous to do a C-section. So they said we’ll avoid doing C-section, but they planned that I would go into labor naturally. I don’t know. I did what any other high risk pregnancy person would do. I met with the anesthesiologist. They kept telling me like, he’s small, he’s gonna fly right out of you. And nothing to worry about. I did have, like, a lot of Braxton Hicks towards the end. Seventh or eighth month, I stopped working. I just wanted to rest. That was, like, my first baby. I just wanna be, like, extra careful and I worked from home for the last month. 


Dr. Fox: So when you’re in the last month of pregnancy, can you give us a sense, what’s going on in your head at that time? So I’m just thinking, are you, like, super excited that, you know, you’ve made it this far and you’re about to have a baby and everything seems to be going healthy, even though you’ve been through so much and getting a liver transplant, or is it more, you know, nervous/worried about what’s gonna be? What what’s going on in your headspace at that time towards the end? 


Sarah: Towards the end I was definitely, like, calmer, more excited. I started to, like, buy a few things. I had my bag packed. Definitely more excited than nervous. 


Dr. Fox: How did it play out going towards the end of pregnancy? 


Sarah: So I started going…I think at that point I was going in twice a week. Once a week was, like, a regular sonogram. And then I don’t know if they did the biophysical every other week, the biophysical profile. I don’t remember. I just remember them doing it either every week or every other week. 


Dr. Fox: Most of us do it every week, so I would assume so. 


Sarah: So I was in my 37th week and I went in on a Thursday and they were doing the biophysical profile when they were looking for him to practice breathing. And it took, like, 25 minutes, half an hour. And then at around 45 minutes, sonographer called in the doctor and said, “You know, I don’t see that he’s practicing breathing. I wanna send you for a non-stress test.” So they sent me to a different floor. It wasn’t labor delivery, just a different floor. They did a non-stress test and his heartbeat looked fine. So they sent me home. They kept telling me like, don’t worry about it. I was, like, super worried at that point. But they kept telling me like, “Oh, don’t worry. Like, this is totally normal. This is totally normal.” It didn’t feel right to me. Something didn’t feel right but because they kept telling me like, “Yeah, sometimes babies just do this. Like, he’s probably just sleeping. Come back on Monday.” 


So that was Thursday. And I don’t even think I said anything to my husband about it until Saturday. Like, I didn’t even mention it. I just thought nothing of it, like, okay, maybe this is normal. And then we were at someone’s house and they were like, “Okay. So when do you have to go in again?” And I was like, “Oh, I have to go in again on Monday. He didn’t do so well on some tests I had to take, so we have to do it again.” And then, like, it started hitting me, like, “Okay, maybe I should have went in again on Friday. Like, I don’t know why they’re making me wait until Monday.” So I was, like, a little bit nervous, but, like, didn’t think too much of it. And I went in again on Monday. Again, like, didn’t bring anything with me. I don’t even think I had a charger. And again, we did the biophysical profile and he’s still not practicing breathing. 


So this time, I was 37-and-a-half weeks. They said, “Okay, you know, at this point you’re, like, really full term. We wanna send you to labor and delivery to do a non-stress test.” So they sent me to labor and delivery. Went in there and then on the non-stress test, we lost his heartbeat for like, it felt like two minutes, it probably was closer to, like, one minute and then I was getting really nervous. And it took, like, a few minutes for even the doctor to come in. 


Dr. Fox: When you say they lost the heartbeat, you mean they just couldn’t hear it or they thought that it really dropped to a super low number? 


Sarah: They thought that it really dropped. The doctor said, “Okay, you’re having this baby tonight, we’re gonna induce you.” Again, they kept telling me, like, “C-section is a really bad option. Like, if you chose C-section it would be an elective C-section and we’re not recommending it.” And at that point, like, I called my husband and said, “Okay, like, this is what’s going on. Can you come? Because we’re having a baby,” and I was freaking out. But again, they kept telling me like, “Oh, it’s fine. Everything’s gonna be fine.” So I kept, like, trying to just go with that. Like, I never had a baby before, what do I know? I guess this is normal. And then my husband was on his way. Like, my dad came to wait with me until my husband came because he was nearby. I don’t know exactly how I got induced. Like, I don’t remember the details. Like, I know I got Pitocin and I got hooked up to the epidural. Like, all of those details are, like, hazy. I don’t remember exactly. 


Dr. Fox: When they were doing that, sort of, after they made the decision to deliver and they’re either waiting to start the induction or they’re in the early parts of the induction, during all that time period, I assume the baby’s heart rate was normal and reassuring, meaning if it was, like, really scary, they would have done a C-section, but meaning during that time it was okay for them and that they weren’t concerned, correct? 


Sarah: It was okay until a little bit after I got the epidural, they kept rushing in and putting me on oxygen and still did not do a C-section. 


Dr. Fox: Got it. So it was, sort of, borderline or it was… 


Sarah: Like, he was in distress. Yeah. Like, he was in distress and I couldn’t really feel anything because I was on epidural. So I didn’t really know what was going on, but they just kept saying, “Okay, this is normal. Like, you know, he’s just in distress from the induction.” Right. 


Dr. Fox: Right, meaning temporarily. 


Sarah: Yeah. 


Dr. Fox: So they’re proceeding with the induction. And who’s there with you by that point? 


Sarah: My husband. 


Dr. Fox: Okay. So it’s the two of you… 


Sarah: My dad had left. Everything was calm, so my dad went home and it was just me and my husband. Yeah. 


Dr. Fox: So you’re there, you’re in a labor room. You’re being induced. They’re monitoring the baby. They’re monitoring you. And these things typically take a while. How long was your induction? How long did it take? 


Sarah: It took a while. Like, it was overnight, so probably got hooked up at, like, 7:00 p.m. I didn’t have him until maybe, like, 6:00 or between, like, 4:00 a.m. and 6:00 a.m. 


Dr. Fox: A little bit under 12 hours. 


Sarah: Yeah. 


Dr. Fox: Well, that’s actually pretty quick for an induction for the first baby. Okay. 


Sarah: Really? I don’t know. Because, again, my details are a little bit off also, like, I don’t know exactly. 


Dr. Fox: Well, you know the time he was born. So there you go. So tell me what happened in the end of the induction, you know, when you’re fully dilated and you start pushing. 


Sarah: Yeah. So I started pushing…it was very hard for me to push. I really did not feel a lot because of the epidural. Kept pushing, pushing, pushing, and just didn’t feel like we were getting anywhere. I was, like, starting and stopping and starting and stopping. I don’t know how long this whole thing was either. Like, I don’t know. My husband also, we just don’t know, so we’re just, like, stuck in the moment. It felt, like, for a long time though that I was pushing and eventually they said, “Okay, his head is stuck. We’re gonna try to vacuum him out.” They cut me a little bit. They tried vacuuming him. Nothing was working. At that timee, they said, “Okay, you know, we’re gonna have to do a C-section.” 


Dr. Fox: Was it your impression at the time that they were doing the vacuum because he wasn’t…like, geometrically he wasn’t fitting, you know, with the pushing, you know, baby wasn’t coming out, so they needed some more…you know, a little bit of help to get the baby’s head out, or were they coming into the vacuum saying, “Hey, we’re concerned about the baby. The heart rate is down. We need to deliver the baby quicker than you can do naturally?” Do you have a sense of which one of those it was? 


Sarah: I’m not sure. I think it was, like, a combination of both. 


Dr. Fox: What was that like? You know, you’re there, you’re pushing, you’re probably a little groggy. It’s overnight. A lot of things are not really clear. Did you have a sense of what was going on when they’re doing the vacuum or is it’s just, sort of, like, a haze? 


Sarah: So it’s such a haze. Like, at that point, I was just like, “Just get him out. Like, I don’t care. Like, this doesn’t feel right. Like, he’s got to come out now. Like, this is taking so long.” Something felt very wrong with my husband also, like he felt like he was gonna pass out. 


Dr. Fox: Oh, really? Okay. Yeah. That makes sense. 


Sarah: Yeah. He was so nervous. And then when they took me to the C-section, he was really, like, passing out. 


Dr. Fox: When they made that decision to switch from doing the vacuum to doing the Cesarean, were you relieved? Were you disappointed? Were you scared? Again, what’s going on? 


Sarah: I was relieved. 


Dr. Fox: You’re like, “This is finally gonna be done?” 


Sarah: I was like, “Just get him out. Like, just get him out already. This is taking too long.” Even just waiting for the operating room felt like forever. Like, let’s just go, let’s get him out. Something, like, just doesn’t feel right. 


Dr. Fox: Okay. And do you have a sense of why they chose to do a vacuum instead of forceps? Was it just something that that’s what they’re, like, more skilled in it or did they say, “We can do either but we think this is a better option for you?” Because they’re…you know, it’s one of these things where some people are trained in forceps and some people are not. And so the people who aren’t, they use a vacuum and the people who are sometimes you make a decision, I choose the forceps or I choose the vacuum. Do you know which one of those it was or not? 


Sarah: I don’t think they even, like, discussed that with me. I don’t know. 


Dr. Fox: So you go back to the Cesarean, you’re a little bit relieved and Levi’s gonna pass out. What was that like? Was it, like, a rushed emergency situation or, sort of, a little bit calm? What was it like moving rooms and preparing for the Cesarean? 


Sarah: Pretty rushed because they started cutting me open, like, before my husband was even ready and next to me. 


Dr. Fox: Oh, okay. So it was, like, emergent? 


Sarah: Yeah. 


Dr. Fox: All right. So probably the heart rate was dropping or something was going on. 


Sarah: Yeah. Yeah. 


Dr. Fox: I assume they just used the epidural you had, they didn’t put you to sleep, correct? 


Sarah: No, they did at the end. They put me to sleep at the end, but for the beginning, I was awake. 


Dr. Fox: Did they have a concern again because of your transplant and the scar tissue, like, did they call on the transplant team to assist with the Cesarean or only if needed? 


Sarah: It was just the high risk team. 


Dr. Fox: Okay. And so how did the Cesarean go? How’d the delivery go? 


Sarah: They had to pull him from his feet because his head was so stuck. They called it, like, a breach C-section. 


Dr. Fox: Yeah. It’s, like, an upside-down delivery basically because the baby’s so low down, basically when you make the incision on the uterus, you’re looking at the baby’s butt, so, you know… 


Sarah: Yeah. Exactly. 


Dr. Fox: Okay. Got it. 


Sarah: It was very quiet in the room. No one was really saying anything. I didn’t even know if he came out when he came out because he wasn’t crying. It was very quiet. And once they said he’s out, I started screaming like, “Why is he not crying? Why is he not crying?” It felt like a while before anyone even answered me. Everyone was very quiet. 


Dr. Fox: When he came out, I assume the pediatricians were in the room at the time. They were waiting for him? 


Sarah: Yeah. They were waiting for him. 


Dr. Fox: Okay. So they’re working on the baby. The obstetricians are working on you, and you’re asking questions? 


Sarah: Yeah. They kept saying he’s very stunned. Like, “He’s stunned, he’s stunned.” They wouldn’t really say anything else other than he’s stunned. So I was just screaming like, “Please tell me what’s going on. What do you mean he’s stunned? What does that mean?” I looked at my husband. He was, like, totally like a ghost. He saw the baby, so he didn’t wanna scare me. Like, he saw that Ari was very dark, like a purple-ish gray. So he knew something was definitely wrong, but he didn’t wanna scare me. And I was just screaming. And then finally the anesthesiologist said, “Do you want me to put you to sleep?” And I said, “Yeah, like, just put me out.” Because this was already, like, five or six minutes later. And I just really thought he didn’t make it. And I just said, “Okay, just put me to sleep. Like, why do I have to be up for this?” 


Dr. Fox: Oh…I mean, during that five, six minutes, you had no idea even if he was alive? 


Sarah: Yeah, I had no idea. They just kept saying, “He’s stunned,” so I thought that was a nice way of saying, like, he didn’t make it but they didn’t wanna scare me so they just were gonna keep telling me that they’re trying, but I really thought he didn’t make it and they were just trying to make me feel better and then they would talk to me, like, in the recovery room. So I was like, “Just put me to sleep. I don’t need to be awake for this.” And so I woke up in the recovery room and right away there was a doctor there. He, like, didn’t give me any clear…like, he told me that the baby’s alive. 


Dr. Fox: A doctor from where? From OB or from pediatrics? 


Sarah: From OB. From OB. Like, “Yeah. The baby’s there.” They were still, like, trying to figure things out. Like, my husband was…he wasn’t, like, right next to me at the time but then when they told them that I woke up, he came back. And no one really said anything to me. They were just pretty quiet. Like, “He’s alive.” They’re trying to figure it out. Like, “We don’t know exactly what’s wrong with him, but he’s not, like, doing amazing.” 


Dr. Fox: And how old…Meaning when you woke up, was it 10 minutes after he was born, an hour after he was born, 6 hours after he was born. I mean, what’s the timeframe? 


Sarah: I think it was, like, an hour. I think it was about an hour. 


Dr. Fox: Okay. So he’s in the NICU, you know he’s alive, but you don’t know the story. What did you think at that time? What was going on in your head? 


Sarah: I was just, like, devastated. Like, I waited so long for this baby, what is happening? And had no clear answers. I was still hopeful. Like, okay, he’s alive so, like, there is hope. I really felt like, okay, maybe he just needs oxygen and he’s okay. Like, there was still, like, a piece of hope, but I was like, you know, extremely nervous and, like, I just didn’t even know what to do. I’m like, “Do we call our parents now? Like, what do we even do?” Like, normally you have baby, you call your parents, you’re excited, but I didn’t even know what to do from there. I was like, “Maybe we should wait a little bit before calling parents.” We kind of just said, “Okay. We’re gonna wait. We’re not gonna, like, rush and call anyone until we, like, know a little bit more.” And my husband did say that they were looking for a cooling blanket because basically it’s like they put the baby on a cooling blanket which gives the baby hypothermia and it’s supposed to reduce brain swelling and brain damage. So they didn’t put him on it yet, but they were, like, trying to locate it and set it up for him. So that’s all I really knew at the time. 


Dr. Fox: Okay. And when was the first time you got, sort of, like, a thorough update of like, here’s the story, here’s what’s going on, here’s what we’re doing, here’s a prognosis? You know, was that later that day? Was it the next day? Was it ever? I mean, when did you have a full conversation? 


Sarah: Later that day. Like, I was still recovering. Like, I was not get up and go to the NICU, but my husband was able to go see him. And he spoke to the doctor, as he said, like, explained to him, like, we don’t know exactly what happened, but we know there could have been brain damage because he didn’t breathe for…it’s on his discharge paper that says eight minutes. I don’t know exactly how many minutes, but on his discharge paper, it says eight minutes and then he spontaneously started breathing. 


Dr. Fox: You mean the eight minutes from birth until he started breathing afterwards or do they think something happened for eight minutes before he was born? 


Sarah: I think it was, like, from birth and then eight minutes later, he started breathing. 


Dr. Fox: And then because of that, they thought he had low oxygen and potentially a brain injury so they did the cooling blanket to, sort of, lower that risk and improve outcomes. 


Sarah: Yeah. So the cooling blanket is for 48 hours or 72 hours. I think 72 hours, actually. And then they slowly warm the baby up back to normal temperature after 72 hours. 


Dr. Fox: Okay. 


Sarah: Yeah. During that time on the cooling blanket, they monitor the brain, they monitor for seizures and brain activity, so. 


Dr. Fox: That must be a pretty terrifying three days. 


Sarah: Yeah. I only saw him though on day two. Like, I had a very hard time getting off the epidural, so he was born Tuesday morning. So I don’t think I saw him really until Thursday. Yeah, I don’t think I saw him until Thursday. 


Dr. Fox: At that time, was the prognosis different? Meaning, was there any point in those first few days where they said, you know, “He’s turned a corner, we think he’s gonna be okay?” Or was it, sort of, doom and gloom? What was it like during these first few days? 


Sarah: It was pretty quiet. It was more of like, “We haven’t seen a seizure yet, so that’s good.” He was crying a lot, trying to flip over. He was moving a lot. He was able to suck on a pacifier. So all those things were, like, good signs. He was, like, fighting the cooling blanket the whole time and they said all of those things are good signs. The fact that we see that he’s able to suck on a pacifier is good. And yeah, he was also on the lights at the same time. Like, his bilirubin wasn’t good, so he was on those lights. He just looked so silly. Like, he had the glasses on, he’s on the cooling blanket in his diaper. 


Dr. Fox: It’s both horrifying and comical at the same time to see what these newborns look like with the sunglasses on under the tanning lights for the bilirubin. Wow. How long was he in the NICU? 


Sarah: So he was in the NICU for 14 days. 


Dr. Fox: For 14 days. So obviously you had gotten discharged well before he went home. 


Sarah: Yeah. So they kept me until Saturday night. Someone helped us find an apartment near the hospital, which was amazing. So we didn’t go home. We went to an apartment, like, five blocks away and I just took a cab every day to be with him, and then we would sleep really close by. 


Dr. Fox: And then eventually when he came home, were they saying, “Hey, he looks pretty good. You know, he’s gonna go home,” or, “It’s still very guarded, we have to do this and this and two months?” What was your, sort of, understanding of the time you took him home for what the expectations were? 


Sarah: Confusing. It wasn’t, like, one clear answer. They did say that everything looks hopeful and that his brain should rewire itself. There was a little bit of damage and that they didn’t think that anything would physically be wrong with him going down the line. They just said like, you know, “We’ll watch him to make sure he meets his milestones.” The developmental pediatrician who followed him in the NICU, she follows the babies until they’re 3 if they were on a cooling blanket. So we would go every six months, like, the deal was, “Hey, you’re gonna come every six months and we’ll evaluate him and kind of follow him and see how he’s doing.” But nothing like…they didn’t say anything, definitely gonna be wrong with him, you know, “You have a special needs child.” They didn’t say anything like that. 


Dr. Fox: Got it. And then when you did take him home, was it very exciting or was it very terrifying? Or I assume it’s a little both. How much of each was it? 


Sarah: It was more exciting because he really was doing well. He was eating. He was just doing really well when we brought him home. So it was terrifying, but I don’t know, we were, like, new parents and so excited that for us it was more exciting than, like, maybe, like, our parents. 


Dr. Fox: Right. And he was behaving like a newborn at that point. Yeah. 


Sarah: Yeah. He was a tired, sleepy newborn but didn’t, like, look off to us or…I don’t know. 


Dr. Fox: How was your physical recovery? We’ll get to emotional, but how was your physical recovery from, you know, you’re talking about the long labor, you had an episiotomy, you pushed for three hours, then you had a Cesarean. You know, how did that go for you? 


Sarah: It was pretty hard in the beginning, but really the only perk to having a baby in the NICU is that you get to sleep and recover. So I wasn’t getting up with a newborn every hour holding a baby. So as hard as it was and, like, now that I have another baby, I know that it was much harder, but it wasn’t as hard as coming home straight with the baby. 


Dr. Fox: Right. I guess that makes sense. So by the time you took him home, you’re already about two weeks out when you’re feeling…you’re not perfect, but you’re like…yeah, you’re like 75% yourself. And then, and also just, you know, as an update, so it’s, you know, three to four years later, how’s Ari doing? 


Sarah: He’s been great. He’s in a playgroup and he’s doing great. He’s good. Funny, happy kid. 


Dr. Fox: Yeah. Running around. Yeah. Meeting all his milestones and everything. 


Sarah: Yup. Exactly. 


Dr. Fox: Amazing. What point did you, sort of, realize that he’s like all the other boys his age? Was that very soon or did it, sort of, take a year or two until you, sort of, realized that, oh, he’s doing what he’s supposed to be doing? 


Sarah: So right away, the pediatrician that we took him to right away said like, “This does not look like a baby to me who suffered any damage and you guys should really just enjoy him and treat him like a regular baby.” And he said that to me, like, every appointment for the first year. So that really helped me because he said like, “I promise you if I see anything, like, I will tell you.” And, you know, he was meeting his milestones, he was rolling over, sitting up, like, doing all the baby things, so didn’t really…There wasn’t ever a time where I was like, “Oh, my God, like, what’s going on? He’s not doing this.” Like, he was walking by 14, 15 months. So it wasn’t ever…I guess once he was a year old, I kind of like calmed down a little bit. 


Dr. Fox: Okay. I mean, I guess that makes sense. Listen, everyone with kids are always worried about them, and obviously in this case it’s particularly concerning, but I guess h’s meeting all his milestones at a year, you’re sort of figuring, “Okay. He seems okay.” Tell me about your emotional state after birth, going through that whirlwind at the time of, you know, right before you delivery, during your delivery, right afterwards, not knowing if your baby is alive, not knowing how your baby’s doing. What was that like for you in the beginning parts after delivery? And then I wanna talk about obviously in the years afterwards. 


Sarah: Yeah. So I would say the hardest thing was the shock. Like, I had a transplant, I had major surgery, but none of that was shocking. Like, I was prepared for it. I knew how I was gonna be after, I knew it was gonna be a long recovery. So I didn’t really think that, like, anything so traumatic would happen so soon. I really thought like, okay, maybe we’ll be spared, like, a hard delivery or something else, like, because we went through, like, a health crisis already. So to me, that was like the hardest part was the shock. Like, I just couldn’t get over it at the beginning. Like, why did this happen? I can’t believe this happened. Like, it wasn’t supposed to happen. We tried to do everything we could. I had a high risk practice. I stayed healthy. I didn’t work at the end. Like, it was more of, like, a shock. I’m like, “Why did this happen?” And I kept replaying it in my head, like, a lot. 


Like, even to, like, leave the hospital, like, I met with the psychiatrist before I left. Like, I had a really hard time leaving. Like, how am I gonna leave this baby? Like, I just had him, I don’t wanna leave. So, yeah, the beginning was really hard. And then he had a circumcision when he was a month old and that was also really hard for me because I was, like, he already went through so much physically, like, just don’t want him to go through anything else again. But yeah, I would say, like, the first six months were the hardest emotionally and, like, the first birthday. 


Dr. Fox: The first birthday because it just brought back the memories of his birth? 


Sarah: Yeah. It was, like, such a bad day for me when he was born but also, like, the best day. It was, like, the best on the worst day was the day that he was born. So his birthday was like, “I just wish we could celebrate him on a different day that has nothing to do with his birth.” So it was, like, hard for me to be, like, “Happy birthday,” because I was, like, it was really not a happy birth. And it was really, like, the opposite of that. So, like, I had to come to terms with it and, like, prepare myself for the birthday. Like, we didn’t do a party or anything like that. We just, like, kept it small and then, like, two weeks later, I felt a lot better about his birthday and then I said, “Okay. Now we can do, like, a cupcake,” or something like that. 


Like, it took me, like, a little bit. My husband was, like, feeling the opposite, like, “No, we should celebrate him. Like, he went through so much, like, he should have a big birthday.” And I was like, “You know what, really, I’m not up for it right now. Like, I just…Ihell have another birthday. He’ll have a big birthday party next year or the year after.” Yeah. The beginning was really hard. I did have, like, a lot of friends who like…once you have a traumatic birth, like, people come out and tell their stories and you feel less alone. I do have, like, a lot of good friends who have, you know…Every birth has their own story and friends were very supportive and helpful and just talking about it was helpful for me. 


Dr. Fox: Yeah. I mean, listen, you just…That’s, like, the commercial for this podcast. I mean that every birth has a story and so many people have had bursts that, you know…I mean, you describe this as a traumatic birth and I think it’s hard for people to, sort of, grasp that sometimes to realize, “Hey, you know, you had a liver transplant and you’re okay and your baby’s ultimately okay, you know, how could it be a traumatic birth?” But it is, right? Because going through it is traumatic even if the outcome is good. 


And, you know, I use this example in another podcast. You know, someone was in the Vietnam war and they got out and they lived in they were okay. Like, that’s fine. That doesn’t mean they’re gonna be traumatized from the experience of war. It’s a very hard thing to go through, what it does to your brain and to your emotions. And people have a very difficult time, understandably, thinking about that and reliving it and coming back to it. And it’s not something that they always feel so, you know, peppy positive about in retrospect, because it was a really tough experience to go through. Where do you feel you are now at three years later? Do you feel the same way you did a year ago or do you feel like it’s been getting better over time to think about it and talk about it? 


Sarah: Definitely much easier. Also, because we had another baby, like, that was really healing for me to have another baby, and whatever, she has her own birth story and she was born a little bit early. But to have a baby come out that’s crying was, like, all I wanted and I got that. Thank God. So that was very healing for me to go through that and kind of feel like, okay, the second time around, we tried harder, we found better doctors. We found you guys and, you know, you guys let me come in the beginning, like, as often as I wanted to because I was really nervous with my second pregnancy and, you know, going over what happened and what we could do differently next time was very helpful. 


So all of those things kind of helped with the trauma because, you know, I have something else that happened that is positive and I could focus on that and keep doing well. And, you know, thank God. Some people don’t have that. Some people have babies who CPF, they’re a traumatic birth and they have to relive it every single day. So I know that, like, I’m super lucky in that sense that I don’t have to relive it every day. I do think about it often, but it’s different. It’s definitely not as crippling anymore. 


Dr. Fox: Right. When you look back, aside from just the experience of going through the trauma, do you think or do you feel that there’s something your doctors could or should have done differently to lessen the trauma of it? 


Sarah: I definitely think, like, it should have been a C-section earlier. Like, I don’t think I had to go through all of that labor. Again, like, I don’t know. It wasn’t really, like, ever…like, at my follow appointment, I asked them and no one really ever had, like, a clear answer for me. 


Dr. Fox: It’s so interesting that you say that because, you know, obviously we deliver a lot of women, and frequently, you know, the plan changes from a vaginal delivery to a C-section. And a lot of the times that’s a very difficult thing for women either because, on the one hand, it could be they really wanted a vaginal birth and now it’s something else or, sort of like what you’re saying, “I ultimately needed a C-section, you know, why didn’t you do it earlier? There were signs earlier.” And, you know, there’s the, sort of, like, medical decision-making that has to be discussed. Okay. But on top of it, it’s just having a conversation with women and talking about it and saying, you know, “How did you feel? What did we think?” 


And just going into that and letting you know women talk about it and just air what the concerns they have and, sort of, the regrets that they have, or the questions that they have, and actually just having that conversation. And it sometimes takes a long time you’re talking. It could be an hour or two, but I think that just that process, doing it thoroughly does help relieve some of that trauma because, you know, people, at least their questions get answered, or at least they understand what the thought process was. And I think when people have all these questions afterwards, it’s harmful to not have closure, not understand. And I think that that’s an opportunity missed by your doctors to really talk about it with you at length. 


Sarah: Yeah. It seems like it’s…like, I got a lot of blank faces. Like, it just seems, like, something went wrong and they just don’t have an answer. So, yeah. That was also definitely added to the trauma. I don’t think they were trying to hurt me, but I just don’t think… 


Dr. Fox: No, of course not. Yeah. 


Sarah: Yeah. I don’t know. I guess they’re humans and humans make mistakes. I don’t know. 


Dr. Fox: Definitely doctors are humans and doctors make mistakes, or sometimes…you know, sometimes it is a mistake and we make them. Sometimes it’s not a mistake, but just the experience is just so horrible and that has to be discussed. And I think also doctors, as humans, sometimes are very uncomfortable with confrontation with someone saying to them, “I feel that I was mistreated,” or, “I feel that you made a bad decision.” And doctors get very uncomfortable with that, with people questioning them. It’s not an ego thing. It’s emotions. You know, humans usually like to avoid confrontation. And I think that sometimes people’s natural response is to, sort of, back away and be quiet and not say much say, “Oh, you know,” and, sort of, avoid it. 


Whereas I found that actually addressing it head-on and say, “Okay. Let’s talk about that. Like, tell me what your concerns are. Tell me what you didn’t like, and let’s go back. Let’s see where I made a mistake, where I could have done better, or maybe where you could understand what I was thinking that’ll help you.” And I just think that even if there isn’t a conclusion at the end, because there often isn’t, just having that conversation is cathartic for people and it just lets people understand each other better and I just find that it lowers the tension over time and does not increase it. That’s been my experience at least. 


Sarah: Yeah, for sure. Like, a little bit of closure even if there’s no answer. 


Dr. Fox: And do you feel that there’s something that you wish you could have done differently or maybe something you wish you would’ve known then that you know now? Again, not so much as an issue of, like, blame, but just, sort of, regret like, “Oh, I wish I did this, or I wish I knew this?” 


Sarah: Yeah. Like, I think now I would definitely, like, have said like, “No, I don’t wanna leave. I don’t feel comfortable. I wanna come back tomorrow.” Like, I was there on a Thursday, they told me to come back on Monday. I would have pushed to come back Friday. And then if things weren’t fine again Friday, then I would have said like, “No, I don’t feel comfortable going home.” Like, I would have been able to speak up a little bit more. Not to say that, like, anyone knows, like, you’re just trusting your doctor and doing the best thing to do, but you’re allowed to advocate for yourself and speak up and nothing could hurt by coming back the next day or asking to stay a little bit longer. Yeah, that’s what I would suggest. 


Dr. Fox: From that birth until now, have you been very vocal about your story, your experience, have you been telling it to other people? Is it something that it took you time to be able to tell because of the trauma, or where have you been with that? 


Sarah: I’ve never been, like, shy about it. I wouldn’t like, you know, jump to talk about it with, like, someone I just met, but it comes up less now that he’s older, but it did come up a lot when he was younger. Now that he’s older, it doesn’t come up as frequently. But when he was younger, like, the first year or two, I didn’t have an issue, like, discussing it. In the beginning, it was hard for me to talk about it, but I wasn’t quiet about it. It was more like we were amazed that this happened to him and that he was doing so well, so. 


Dr. Fox: Right. It was almost like the miracle of it, like, that this child who had, you know, such a dangerous birth is now doing well and, sort of, the marvel at that. We’ve been doing these podcasts and I speak to…a lot of times when women tell their story, you know, there’s kind of two reasons, one of which is it feels therapeutic to tell it in a sense that it’s just to get something off your chest for people who haven’t done it before. But also, everyone has said there’s an aspect to it, which is, A, like you said before, I don’t want someone to feel like they’re the only one who’s gone through this, like that they’re not alone. I want them to understand that this has happened to other people and they should feel that they’re not the only person who has these feelings and had this experience. And then I know then we were going back and forth. You actually had, like, specific advice for people, A, who did go through this, but also for their, like, family and friends about how to interact with people who went through a traumatic birth. Right? 


Sarah: Yeah. 


Dr. Fox: We did this by email first. And what you sent me was just amazing. And the first thing, you had advice for parents who have a baby in the NICU. 


Sarah: Yeah. So I just wanted to say something you said, you said, A, oh, to talk about it so people don’t feel alone. That’s, like, the main thing. I felt very alone for the first six months and one day I reactivated my Facebook and I found a support group on Facebook and it was traumatic birth support group. And I was so surprised, like, all these people went through different things and I just felt so much less alone. And that was, like, the really first…like that was the first time I was able to feel less alone, feel more comfortable about it, have hope. So definitely having support is, like, a huge…at least for me, is, like, a huge help. So, yeah, that’s definitely, like, one of the main things is to know that you’re not alone. 


Dr. Fox: Yeah, that’s amazing. 


Sarah: And so first, make sure to take care of yourself emotionally. For some people that means, like, getting a therapist right away. It took me, like, a few years to get a therapist just because I wasn’t ready to talk about it. I wasn’t ready to go through it. But if someone feels like they need it at first, then for sure. Like, I definitely saw a psychiatrist in the hospital. Like, I needed a little bit of medication when my baby was in the NICU just to get through that emotionally. There are people in the hospital and doctors who can help emotionally even when you’re there. So definitely seek help, cling to your spouse. Try not to turn on each other. Like, it’s very stressful, especially for the woman who just had a baby and is feeling physically sick and not herself yet and all hormonal. Definitely try to, like, support each other if you have a spouse or a support person, anybody who can be a support to you so you don’t have to go through it alone. Very important. 


And a lot of people will ask questions in the beginning, like, our phones were just knocked up asking for updates and that became, like, really overwhelming. And that’s just like, turn it off, focus on the baby. And we started just sending out, like, an email once a day because, like, there wasn’t any major update. It was like, “Okay, he’s still in the same place as he was yesterday.” So we would just send out an email. That felt better for us. Even if people didn’t love that, you have to do what’s good for you. 


Dr. Fox: Right. I think that’s a really important point because sometimes also it just leads to so much stress because, you know, you send out an update then someone calls a friend and someone calls someone else and someone gets another doctor involved and they call their cousin and then they’re calling you and it becomes this crazy cycle of everyone saying, “What’s going on?” And then by the time you get all those calls, whatever that thing was is done, right? “Oh, no, he peed. It’s fine.” And like, “Oh…” you know, it’s just…yeah. Okay. That’s really good advice. 


Sarah: Yeah. We would wait until the end of the day, send some pictures. People love pictures, so you can send pictures. That’s always, like, a good way to not have to talk about anything. Just send pictures or don’t, or say like, “I need a day to answer. Like, I’m not up to answering today. I’m not feeling it, but, like, everything’s okay.” Or, “I got your message, I’ll answer when I can.” And also, when the baby’s in the NICU, a lot of times will feel like your baby’s not your baby because the nurse is taking care of your baby and you’re not always…you know, you’re not there overnight usually. So when you’re there, you could definitely, like, advocate for yourself and change the baby’s diaper and hold the baby if you can. Definitely, like, you’re the mom, so you can do whatever you want. Just talk to the nurse. 


  1. Fox: Right. I assume they encourage that for you to bond with the baby. Yeah.


Sarah: Yeah, they do. They do. It feels weird in the beginning, but like, you know, for the first day, like, I didn’t feel like he was my baby. Like, I was, like, changing this other person’s baby and it was just, you know, so odd. And make sure to rest. Like, when the baby’s in the NICU, like I said before, like, that’s really the time to rest. It’s really how I recovered was, you know, taking naps and, you know, checking in with the nurse. Call as much as you need to, but, you know, it’s sad to leave the baby, but really like, you know, the baby does come home and a lot of time to spend together, so just make sure to take care of yourself. 


Dr. Fox: Yeah. It’s a balance between you wanna bond with your baby as much as possible but you also have to recover as much as you can. And there’s definitely a balance between those two that’s healthy. 


Sarah: Yeah. Exactly. You know your limits. And also what was helpful was to be there during the doctor’s rounds in the morning or some doctor’s rounds, like, in afternoon when they come and see the baby and check the baby. So you could do that on the phone or you could be there in person so you have, like, a sense of what’s going on. And if you miss it, like, feel free to call the doctor, check-in and see what’s going on, get an update. Like, I don’t know. I can’t explain it, like having a baby in the NICU sometimes feels like the doctor’s not there, like, we didn’t get to speak to him. Like, I don’t know what’s going on with my baby. But the doctors are happy to speak to you. You just have to speak up and they’re happy to speak to you and update you. And you could call them three times a day. We only had good experiences with that. Yeah. Yeah. 


Dr. Fox. Yeah. I mean they know. I mean, what parent isn’t nervous when their kid’s in the NICU? Like, that’s all they deal with are worried parents, like, day and night. And so there’s no one who’s like, “Oh, my baby is fine in the NICU. It’s all good.” You know, everyone’s worried and so this is what they do. They update the parents, “Here’s what’s going on.” And they, sort of, know…you know, clearly the ones who are good at it, sort of, know how to speak to people in a way that’s both, you know, factual but not alarmist. And, you know, they’re very good at this. And the nurses too, they’re really good with updates and, you know, the big NICUs, they’re just really skilled. 


Sarah: We would call, like, a 4:00 a.m. Like, when the baby starts eating, like, you wanna make sure they have to eat for, like, 48 hours while they’re feeding. So we would call, like, all night, like, “Did he eat, did he eat?” You know, just to make that we didn’t, like, miss a feeding and make sure he’s eating, and they answered us 4:00 a.m, 2:00 a.m, whatever it was. So. 


Dr. Fox: Yeah. They’re good people there. 


Sarah: Yeah. Those are, like, my basic recommendations for parents. 


Dr. Fox: You had recommendations for non-parents or people who are friends and family of those who either had a…of women who had a traumatic birth who have a baby in the NICU. And that’s really important advice because obviously a lot of our listeners are women who’ve had babies or will have babies, but clearly, they’re not all gonna have traumatic births. So many people are listening who are gonna have a friend or family member who has this. And this is really important advice. So what are the things that you would recommend to them to try to support someone who’s going through this? 


Sarah: Yeah. So, first of all, like, when finding out, like if you hear that someone had a traumatic birth, you can definitely congratulate them. Just be a little bit calm. Like, I would get, like, congratulations with 1,000 exclamation marks when I was really suffering in the beginning or like, “Send pictures, send pictures,” and I hadn’t even seen my baby yet. So that part was like…just be a little extra sensitive in the beginning if you hear. If you don’t hear them, like…You know, I wasn’t insulted by someone saying that. You know, it’s hard to send a picture of a baby who’s, like, hooked up to so many things. So just be a little extra sensitive with that. It’s better just to say less, like, you don’t have to go into the fact that the baby’s fine, everything’s fine, asking a million questions, when the baby’s coming home, like, really parents don’t usually know that until the day the baby comes home. So, you know, asking a million questions is not helpful. 


Dr. Fox: Yeah. Updates are not a good thing to ask for. That’s not supportive. 


Sarah: Yeah. You’re ready to update someone, you’ll update them. Like, you don’t have to ask. Like, as soon as the baby is coming home, you’ll find out when you’re supposed to find out. I guess things to say are things like, “I’m sorry that this happened to you.” When you’re hearing about it, you could just say like, “That sounds horrible. I’m here to listen if you wanna talk. What can I do for you?” You know, just let the person speak and don’t, you know, ask too many details if they look uncomfortable. But if they do wanna talk, then be there to listen and, you know, you could just listen. Like, sometimes that’s just helpful, just to hear what the person went through without any advice without, you know, judging the baby based on how he or she looks like, “Oh, he looks fine. Everything’s gonna be good.” Not everyone knows that everything’s gonna be good, so just better to not say too much. 


And I felt like, didn’t wanna pass him around in the beginning. Like, I just wanted…you know, you wanna bond so much to make up for that lost time. So if you go to visit, you know, they want you to hold the baby like, you know, we’ll ask like, “Could you hold the baby?” Like, don’t go out of your way to, you know, grab the baby, pass the baby around. So be, like, a little extra sensitive. Basically, like, everyone’s happy to have support and, you know, anything supportive is helpful. 


Dr. Fox: Yeah. I think people get confused. You know, well-meaning people, obviously, who have a family or friend who’ve gone through a very difficult birth, have a baby in the NICU, you know, prognosis is uncertain, and even if the prognosis is good, they’re sort of confused like, “What do I do? Is it a happy moment? Is it a sad moment?” And I think that the important thing is all the advice you’re giving is very similar to the advice you’d get someone who had an actual loss, like a death in the family. And it’s the same idea that the point of reaching out to that person is not to cheer them up, not to make them feel better. It’s just to say, “I’m here. Like, I care about you. I’m here to sit next to you, and I’m here to listen if you wanna talk. And if you don’t, then I’ll just sit here and hold your hand.” And that’s enough. And that’s, sort of, like, the messaging. 


So when you send a text, like you said, it’s perfectly fine to say, you know, “Congratulations on the birth,” and then say, “I’m so sorry that it was so difficult for you.” And that’s it. Like, that’s enough. It’s just conveying the emotions. You know, “I care about you. I’m happy for you, but I also care about you and I’m sorry that you went through something like that.” And that’s really it. There’s nothing else that needs to be said and just to be there. And if they wanna reach out and talk, then you’ll listen. And that’s it. 


Sarah: Right. Like, a lot of times, people think that if the baby’s in the NICU, that the baby was premature, which is also traumatic for sure. So, like, a lot of people just assume like, “Oh, the baby’s early.” But just to keep in mind that not every baby in the NICU is early. Some babies are totally full-term and some babies are premies, but not every baby that’s in the NICU is a premie and other things do happen, unfortunately. It’s hard because it’s a hard balance. If you wanna be excited for that person, you know, everyone who has a baby’s definitely excited, but in the beginning there is, like, that feeling of loss. And even if it doesn’t make sense because the baby’s fine and the baby’s with you and the baby’s home, there is this overwhelming feeling of, like, that you lost something. 


Dr. Fox: There’s the mother and there’s the baby and it’s, you know, the baby could be fine and the mother could still be not so fine, again, physically, emotionally, psychologically. And I think that one of the really interesting things that you emailed to me, which I totally agree with, is it is not helpful to remind the mother, like, it’s okay that you had a tough birth because at least the baby’s okay. Like, not helpful, you know, does not cheer people up. They know the baby’s okay. 


Sarah: Right. Like, we know the baby is good and it is definitely, like, helpful. And like, you know, holding a baby is still comforting, but it’s not even, like, possible to explain. There’s just this overwhelming feeling of…you know, everyone’s gonna feel it differently, but there’s gonna be some sort of trauma even if the baby is fine. And some moms, you know, have a traumatic birth and have [inaudible 00:47:18]or had a crazy surgery after and they’re, you know, years later still recovering physically. So even if the baby’s “fine,” every traumatic birth is different and everyone’s gonna heal differently physically, emotionally. 


Dr. Fox: I would just advise people, you know, from what you’re saying is just to separate the two to say like, you can say, “I’m really happy your baby’s doing well. Your baby’s beautiful. I’m really happy your baby’s…you know, everything’s amazing.” And at the same time, say, “I’m really sorry you had such a traumatic birth. It really sucks you had to go through this. I hope you’re well. What can I do to help you?” And you don’t have to combine those and say like, “Oh, somehow they average out to normal.” It doesn’t have to be done. There’s no point. 


Sarah: Right. Yeah. And there does come a day where things feel better and, you know, at least the baby’s fine. I could say that now. And it’s helpful to me, but it took me years to say that. So, you know, everyone gets to a point of feeling better at a different point. And, you know, in the beginning, I relived his birth every single day and now, like, I’ll probably think about it almost every day but I’m not, like, reliving it and I’m, you know, doing so much better. So there’s hope that you’re gonna get to a day where you’re not thinking about it all the time and, you know, not triggered by things. Birthdays are enjoyable now. And yeah, you get to, like, fully enjoy and not have that feeling of sadness anymore. 


Dr. Fox: Wow. Sarah, thank you so much for sharing your story. It’s fascinating. Obviously, a really interesting story, but it’s also so helpful for people to hear this and to maybe understand better what you went through and what many women go through with their own childbirth. And obviously, the lessons and the advice that you give are really important for people. And I just appreciate that you were going to do this and came on to talk about it. 


Sarah: Well, thank you for having this podcast. Like, I know it will definitely be helpful. Like, I already listened to one of the other ones you ha for high risk pregnancy with the twins. All these stories will definitely be helpful for people, so thank you so much. 


Dr. Fox: 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.