What can a home birth teach you about your hospital birth? Brandy's birth story, Part II

Today I finish my conversation with Dr. Brandy Cummings, who has an advanced degree in clinical nutrition. 

We talk about 
*all the challenges of her first birth in the hospital in contrast to her home birth and what it taught her

*how both experiences led her to her mission to change the standard of care for birthing people, including some specific ideas about eating in postpartum.

We pick up where we left off last week. Brandy is in the hospital, in the pushing phase of labor with her first child.

Transcript

Brandy  0:01  
I thought in my head, I'm gonna have this home birth. I'm gonna feel some sort of redemption. I'm gonna feel like it was a do over getting the birth that I had envisioned first. It kind of was that. But as I was reflecting more on this home birth, which essentially was so smooth, it made me be so much more forgiving of myself for that first birth.

Paulette  0:31  
Welcome what you didn't expect in fertility, pregnancy and birth, how think and feel about this enormous transition often lives in the gap between what we expected what we actually experienced. This gap exists in part because of how we tend to talk about and portray these events on all kinds of media in a one dimensional way. Everything was amazing, but it's more often the case that there are beautiful things that happen, and at the same time, really challenging things that happen. This show shares true experiences, both the easy parts and the difficult parts, and how we manage what we didn't expect. I'm inter host, Paulette. I'm a writer and an economist and a mother of two girls. I met many, many challenges in this process, none of which I expected. Today I finished my conversation with Dr Brandi Cummings, who has an advanced degree in Political nutrition, we talk about all the challenges of her first birth in the hospital in contrast to her home birth, and what it's taught her, and how both experiences led her to her mission to change the standard of care for birthing people, including some specific ideas about eating in postpartum we pick up where we left off last week. Brandy is in the hospital in the pushing phase. Is a labor of her first child.

Brandy  1:44  
I think we should try to start pushing. I didn't really feel like it was time. I didn't feel any ejection reaction or anything, but I was just like, we need to get this over with. So then I proceeded to push for four hours. It was awful. It was just so much, and I was so tired, and I couldn't move my legs at this point, so I didn't have the mobility that I had at the birth center. And we had a shift change in the middle of it. So now I had a second, whole new team that I wasn't familiar with, and it was just, it was just so rough, and then there was a D cell. So then, you know, all the alarms are going off, and they were talking about a C section. D cell means the baby's heart went down, yeah, yeah, yeah. So I was like, I don't want that. So eventually, after four hours of pushing, baby came Earth side. That was lovely. I mean, we didn't know what sex the baby was going to be. Dada was a girl. Of course, we're all crying. And I did okay. I didn't have any real big side effects from the birth or or anything. So I'm trying to recover. I'm waiting for them to transfer me to the postpartum room, babies on my chest. And one of the very first things one of the nurses said to me is, oh, you have flat nipples. You're not going to be able to breastfeed. And I was just like, why would you say that at this exact moment in time I've been awake for like 60 hours. She was born at 917, in the morning, so we went all night into the next morning. Shift change was at seven, right in the middle of pushing, and I just couldn't believe she said that to me. And then we get to recovery. Of course, you cannot recover in the hospital because it's just a revolving door of people in your room. It's just ridiculous. Can you guys just meet outside and then send one person in? So then we discover that baby is jaundice and has to be on the Billy blanket, which, of course, means the eye mask. And I was just really upset about that. Just looking at my baby with the eye mask on, I was crying. I was just a mess. I was so tired and I was a mess. And my doctor came in, the doctor assigned to me, and she was immediately like, you need to get on some some antidepressants immediately. Wow. Because I was so emotional about the Billy blanket, she was like, This is too much like, if you're feeling this way now, you need to get on antidepressants

Paulette  4:42  
at the time. Did that seem like a strange thing to do or, yeah, yeah, okay. And

Brandy  4:47  
I had enough wherewithal to say, No, I'm not doing I just gave birth. I've been awake for 60 hours. Just give me a minute. Give me a minute. Yeah, fair. Okay, good, yeah. And then they also said they thought that they heard a heart murmur, and so that spun me out,

Paulette  5:06  
and that's for the baby, not for you, for the baby, yes,

Brandy  5:10  
okay, and then it's the second day. We're still in the hospital, and the nurse says Breastfeeding has failed, you're gonna have to switch to formula, which, in my head, I was just like, but I thought, your milk doesn't even really come in right away. Like, what do you

Paulette  5:31  
boy days? Yeah, this is, on average, in the first three to five days after birth, you're producing colostrum, and after that, milk starts to flow. There's some factors that can influence the timing of milk production, including things like severe stress, cesarean delivery, and it's thought maybe because of the anesthetics given while there are mixed results in the literature about whether anesthetics have an effect on breastfeeding leading after birth, especially if you have retained placenta and a few other factors. There are a lot of different variables to manage here, as breastfeeding is a complicated process between two separate people. So why is she saying your breastfeeding

Brandy  6:13  
has failed? I have no idea. As if I wasn't exhausted enough, the mama bear came out in me, so now I'm rallying, and I'm like, No, it is not time to switch to formula. And I was like, What about donor milk? And they're like, sorry, it's the weekend the milk bag is closed. And I was like, There's donor milk in this hospital. And they were like, it's only for babies in the NICU. You can't have any. So I'm like, Okay, well, you have to discharge me, because now I have to go find a lactation consultant. I have to go find milk. I have to now have this whole nother stressor and thing to do rather than just going home and snuggling my baby. And so they were like, we'll get the paperwork ready. Also during this time, I have fractured my tailbone during

Paulette  7:06  
before we get to that, are you trying to rescue the baby? And do you feel like anything's happening or okay so and the baby's not crying? I guess if the baby's crying inconsolably, I can see why they might say that is the baby having that kind of response?

Brandy  7:21  
No, maybe they thought she wasn't matching really well. Later we found out she did have a tongue tie that we had to get revised. Maybe because she had the eye thing on I don't know. I don't really know why they said that, but I had her on me and tried to laugh pretty much constantly. She was with me. This

Paulette  7:40  
seems like the second big conclusion that's been drawn based on limited evidence. First, the declaration that you need mood altering medication right after delivery, and now this assertion that breastfeeding won't be successful for you, which seems like a lot to have flying at you after hours and hours of labor and delivery.

Brandy  8:00  
Yes, so because of my tailbone being in so much pain, I couldn't really stand up by myself. Also, I just gave birth, and nobody was helping me or the bathroom or get a shower, nothing. So finally, I had a nurse help me into the bathroom because I had to pee. And one of the things that I had done during pregnancy, I had one of those henna tattoos on my belly, and I had some blood on my arm that was kind of that same kind of brown color, yeah. And so while I'm peeing, the nurse says to me, Oh, you must have had a henna tattoo on your arm as well. And I said, No, that is blood, because nobody will help me shower. I've been sitting in blood and after birth for two days, nobody's helping me. So it was the combination of the breastfeeding issues, baby being on the on the Billy blanket, plus they did a blood draw because they wanted to test for infection, because I went so long without labor starting, and that spun me out. And they comment about antidepressants and then not being able to get clean. And it was just a combination. It was just a horrible stay in the perfect storm. Yes, agreed. Oh man, it was horrible. So then we get discharged.

Paulette  9:28  
How do you make it home with a broken tailbone? And

Brandy  9:30  
what do you do for that? Nothing, okay, have a nice life. Later, I did a lot of pelvic floor PT and chiropractic care for it, but at the time, they were just like, so, yeah, I had a really hard time walking to the car. It was, it was awful. So then we get in the car, and I call a private lactation consultant, and I tell her, what time now, like we're on the clock, like baby's got to eat. Yeah. And she says, I'll meet you at your house. Oh my gosh. Okay, thank you. So she meets me at my house. She spends several hours with me, which was so kind, but also, oh my gosh, I was so tired. I've been trying to stay awake. I'm trying to listen to what she's telling me and and baby is not is not transferring very much. She's very lethargic from being jaundice, and she's just not get with it. So lactation consultant helped me find some donor milk, put me on a plan and a regimen, and she saved my breastfeeding relationship, because I, I breastfed that baby till she was almost three. Oh, wow. And I credit everything to that lactation consultant, and the fact that she just flipped her day it was like, I'll meet you at your house, you know. So we had a plan that started going, what

Paulette  11:08  
did she have to say about the nurses? Comments about flag nipples, irrelevant?

Brandy  11:12  
Oh, she was very upset for me, just my whole experience and and I'm crying, and she's just Yeah, upset for me. Okay, good. Also read the room. That's not when you make the comment like that, yeah,

Paulette  11:30  
yeah, yeah,

Brandy  11:32  
yeah. So we get on a plan for breastfeeding, and then it was like that night, baby just wasn't I felt like she was too lethargic. So I took her to the ER. She ended up being okay, but again, they were just like, she just has to eat. She needs to eat more. Again, trying to push formula on me. They did give me some donor milk, which was nice. And then we went home, and then we had an 8am appointment with the pediatrician. So it was just like a whole week of no sleep. Yeah, 00, sleep. And we got through that, my husband, at the time, was working graveyard shifts, 12 hour 12 or 16 hour graveyard shifts. And that is when I just kind of plummeted from a mental health standpoint. And I had a really hard time with postpartum anxiety. And then when she was 18 months old, and I felt like I was finally coming out of that thug now we have a global pandemic. You know, it just like it's just cat coming.

Paulette  12:44  
Wait, let's walk more slowly through the postpartum anxiety. Do you know what's going on? Do you bring it to a doctor? What's going on for you?

Brandy  12:53  
I do bring it to my doctor. The only solution they have is antidepressants again. And the people who I thought were going to be part of my village, you know, my ride or die people, they also, they kind of had an air about them, like that doctor did it at the hospital, kind of like, put your big girl pants on. This isn't harder for you than it is for anybody else. And just really dismissive. So I felt very isolated, because

Paulette  13:22  
I'm so sorry to hear that that was absolutely not what you needed that time. Did they not have any experience postpartum, or

Brandy  13:29  
they did? I don't know why they behaved that way. I felt very isolated. And my husband was gone all the time, and I joined a baby blues grew. I went to the new mom meetings. I got outside every day. I tried to do all the things, but it was just really, really tough. And I was also

Paulette  13:55  
still in a master's program. Wow, yeah, that's a lot. So it sounds like you don't end up using medication for the anxiety I didn't Okay, and how did you manage that? Just

Brandy  14:08  
employing the things I knew, just good nutrition, getting outside, moving my body. I had to stay busy. I had to be out of my house. I had to go do things, go to a mommy meetup, go grocery shopping. Just keep things moving. Don't stay in your room. Don't hole up. You know? I just had to keep working through that. And then eventually those family members came around, and we kind of mended that and talked about that. So then that helped set a little bit more support. Yeah, I think that's the biggest thing. Is just we have to have a village. We have to and what we don't

Paulette  14:46  
That's a tough hole to dig out of. Yeah, support during that period is so critical, and so not the norm here in the US, right, which doesn't seem natural in the evolutionary perspective, and doesn't seem natural in the experience itself, because taking care of a newborn is not a job for one person. No. So I'm so sorry about the rough road that started when your water broke. Yeah, that's what it sounds like, right? You went through all these things. It's so much tumult in just the labor and delivery, having to go from the midwife to the hospital and having a shift change, I want to rewrite that part with less action, right? That is a hard thing to manage on its own, and to have the team that you got which feels like they weren't entirely attuned, right? So they said all this stuff that was not appropriate, and I think it is, on the one hand, it's hard to be in the mind space of a new mom. On the other hand, in OB practice, where you're delivering babies all year with is new moms. So surely some of that should be, should be coming through

Brandy  15:55  
for the care you're getting. I felt like there's a lot of desensitization, you know, like this is their norm. They do it. Yeah, yes. You know,

Paulette  16:03  
I think that that's probably true is that they're so used to it, they don't notice it anymore, and so they don't have the softest touch for the things that require a soft touch. So I am grateful that it sounds like family and friends step back in, which is critical. And how old is the baby now?

Unknown Speaker  16:20  
She just turned six,

Paulette  16:21  
yay. Oh, my God, I love six. Six

Unknown Speaker  16:24  
is so fun. Six is so fun.

Paulette  16:27  
So is that first grade or kindergarten?

Brandy  16:29  
She she'll start first grade in September.

Paulette  16:33  
Okay, fun, really nice. Yeah. And how do you feel looking back at this now we're going to talk about how it has affected your path professionally, like emotionally? How do you feel about it?

Brandy  16:45  
It was very interesting and unexpected. In 2022 I had baby number two at home. How? So a very different experience, and at first I thought in my head, I'm gonna have this home birth, and it's gonna be very I'm gonna feel some sort of redemption. I'm gonna feel like it was a do over getting the birth that I had envisioned. And, you know, at first, it kind of was that, but as I was reflecting more on this home birth, which essentially was so smooth, it made me be so much more forgiving of myself for that first birth, which is something I wasn't expecting. Because in my head originally, I thought, Wow, look how tough you are. Look how strong you are. You did this, home birth, no medication. You did it. You did it. Look at you go. But then when I was reflecting, I'm like, no, no. That just happened. That was easy. Look at what you did in 2018 look how strong you were. Then look and accomplish then this, yeah, it's beautiful. It's lovely, but pretty easy in comparison, you know. And so I was able to allow myself so much more grace and forgiveness after going through that second birth. And it was in a way I wasn't expecting. I thought it was going to be more about redemption, you know, and getting a do over. But it wasn't. It was more about identifying and highlighting and being able to see how strong I actually was over here in that first birth.

Paulette  18:31  
That is both beautiful and there's a surprise element to hear it that that's how it went, because so many women talk about redemption in the second birth and some kind of healing, just to have the birth go the way that they intended. And I feel so sorry for younger brandy that she has to be forgiven for all the for lack of a better word, fuckery that she encountered, none of which she could control, none of which was her fault, right? I mean, you're telling the story. I can see you pausing a little bit at decision point, saying, If only I had done this, this other way, but, but even that path is unknown, right? Maybe you stayed at home and now you're in traffic, going to the hospital, and that's its own thing, right? What happens there? So to some degree, this is a hard process, right? It's hard to grow another human. It's hard to release that human from your body, obviously, made more difficult by the team around you, easier or more difficult, right? You kind of had both things, yeah, but that is an amazing takeaway, and one that I'm really glad that you shared, because earlier, younger brandy does deserve our kudos. Yeah, right, that was a really hard situation. So what about those experiences led you to the path you're on now? And why don't you tell us about what you're doing now?

Brandy  19:53  
When my first baby turned one, that's when I graduated with my master's, and before that, I already had a nutrition practice, covid. But after through all of that, from the miscarriage through postpartum, I was like, oh, no, I'm not standing for this. This. This cannot be the standard of care. I'm not doing this. So I pivoted my whole practice. I went and trademarked a word called pannatal, which defines the entire time period from preconception to postpartum. Because as I was working on this rebranding, I was Googling, I'm like, what is it called for that whole period? It's not perinatal. It's not prenatal. What is the definition of that whole period? And there wasn't one, and it just hit me in the face. I'm like, Well, this is proof positive that we are not giving this time period enough attention and care that it needs. So I created one. So pannatal is this whole time period from preconception prep till a couple years or more after giving birth. And I really started to work in that space, and I tried to be an advocate for women and connect with their providers and be a rock in their team and and listen to them and provide them care in that first trimester that they were not getting. And so that's when everything kind of pivoted for me and then more so. Now in my practice, I work with moms that postpartum phase, but more extended postpartum. I always say postpartum is forever, that process of becoming a mother forever changes us, right? Postpartum is forever, but your symptoms don't have to be and so working with moms who feel like things have never been the same, ever since I gave birth, there was a switch. You know, now I'm so tired or anxious, or I've brain fog, or my hair is falling out, or I have joint pain or something's weird with my skin, all of these things where they're hitting dead ends, kind of like how I was in my health journey and really digging deep to uncover what is driving those imbalances. Yeah. I

Paulette  22:10  
mean, that's amazing. I like every part of that story. Anyone who looks at the science of matresses becoming a mother, all the neurological changes that happen on that path, knows that it's not like after the birth you're a lot technically you are, but the process of becoming that person takes a much longer time. So I love your approach to that. And obviously one thing I like about functional medicine is that it's very individualized. So knowing that I'm still going to ask you, is there anything that you can say to postpartum women about their nutrition. That is, you know, true, true, on average, almost always true. I feel like there's not much emphasis at all placed on nutrition during postpartum, the way it is during pregnancy, right? It's like, before you're pregnant, you're you're a blob, you're nothing. Who cares? Eat whatever you want when you're pregnant, don't eat, cheat, pasteurize stuff, no sushi, no alcohol. There's like a very specific set. And then after you give birth, you're back to the blob. But that can't possibly be true, because your body has been through so much. So is there anything you can generally share for people in that phase?

Brandy  23:19  
Yeah. So if birth is relatively recent, one of the things that we see a lot in other cultures who actually take care of their postpartum moms is this idea around warming foods and how warming foods and spices promote recovery. So while you know, prepping a bunch of smoothies or things in the freezer might be easy, if possible, leaning more towards slow cooked meats, warming foods, stews, broths, these things are nourishing to our body. They're calming to our digestive system, especially in the case of stew, slow cooked and meat based broths, these also have a huge amount of important nutrients and CO factors in them, needed for tissue repair, also to support milk supply. Because, yeah, I agree to postpartum. It's like you could have some lactation cookies, and that's the extent of your nutrition. Yeah, you know, information. And then spices, too, warming spices, things like ginger, things like turmeric, you know, cloves, these big cinnamon, these things have a warming sense to them, and that is what promotes healing. In some cultures, they lock their moms up. You're not allowed to get cold ever. You're not allowed to go outside and not just eating warming food, but keeping your pelvis warm and your feet warm.

Paulette  24:53  
This idea that warming foods are helpful in postpartum seems to blend ideas from traditional cultures and nutrition science. I don't know what the basis for traditional cultural practices, but what I could warm foods and spices are about to enhance blood circulation. There is evidence that things like cinnamon, cayenne, turmeric and ginger can relax blood vessels, which can aid in the body's healing process after childbirth. Postpartum period can involve digestive challenges as the body readjusts and warming foods with spices like ginger can help enhance digestion and make it easier for the body to absorb nutrients, which is crucial for recovery and milk production.

Brandy  25:34  
I feel like that is so easy overlooked, especially in a time period where people are very smoothie happy. There's a lot of people who love their smoothies because they can dump a lot of things in them as once, a lot of supplements in them as once I get it, I get that sentiment. And if we can make sure we're focusing on the warming element, I think that that's really important. If birth is relatively recent, is

Paulette  26:01  
relatively recently six months.

Brandy  26:04  
Yeah, the warming is really important, as that wound is healing inside your uterus. So that part's going to be done by the time six months happens. But for sure, that first, you know, 12 weeks, okay? And

Paulette  26:21  
what would you say to women who, quote, unquote, want their body back and want to lose the pregnancy weight? Where on the list of to do's, do you put that?

Brandy  26:34  
I don't. So I don't focus on weight at all in my in my practice, what I am always focused on is the health of the cell. In order to have healthy organs or healthy tissues in the body, we have to have healthy cells, and then and only then do we get healthy tissues. And healthy tissues make healthy organs, and healthy organs make healthy organ systems, if we're just trying to go after the fat loss, that's much more downstream than my approach. I want to go on stream and focus on improving the health of the cell, and then the downstream effect, if weight loss is desired, is usually there, but I just never focus on

Paulette  27:17  
that. That makes sense, right? I mean, there's so much to be repaired after pregnancy that although many people are focused on losing the baby weight and in a body crazy culture, you can blame them, but that can't be the number one thing on your list, because so many other things have to happen first. You know you have to repair before you make any other

Brandy  27:40  
big changes? Yeah, and especially if, if women are coming at weight loss from a calorie in, calorie out perspective, which I do not subscribe to, because if calorie is not just a calorie, but if they are doing that and cutting back calories, that could be detrimental to their milk supply? You know, if they're still in that, in that

Unknown Speaker  28:03  
part of postpartum, that

Paulette  28:05  
sounds amazing. Well, I am so to have you on the show. Where can people find you?

Brandy  28:11  
My website is pivotal origins.com. And my Instagram handle is just at Pivotal origins. And

Paulette  28:20  
if it sounds like you're focused on the postpartum population or more

Brandy  28:24  
so now, yeah, every once in a while, I'll have somebody that that needs fertility support, and I'm always open to have a conversation with people to see if either I'm a good fit or I have quite a good network of people who can I match people up with that you mostly I'm just working with postpartum and

Paulette  28:43  
women who already have children, and the first trimester idea is such a good one. What do we do if we want help in the first trimester? If you want help

Brandy  28:53  
in the first trimester, reach out, even though you are getting the message that that doesn't happen that will see you in, you know, week 13 or whatever. That's not true across the board. There are practitioners are ready and willing and excited to help you in that first trimester. So, you know, you can reach out to me, or reach out to somebody, work with somebody, to help you create a plan to boost all of that development that's

Unknown Speaker  29:24  
happening during that time. And

Paulette  29:26  
do you think someone like an OB will give you all the nutrition guidance? Or do you think there's somewhere else you should be going for that?

Brandy  29:34  
I think probably not. I don't think that they are trained as much in that. Of course, there's unicorns. So,

Speaker 2  29:43  
I would certainly start there and ask them, and if you get some kind of response. Like, it doesn't really matter, right now, or just eat what

Brandy  29:51  
you can, because you're going to be so nauseous, just eat whatever stays down. If you're getting some sort of dismissive answer like that, then it's time to.

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