What happens when Your Birth Center Birth ends up in a C section? Kim's birth story, Part I

In today's episode I speak with a woman who worked in the field of mother and infant health before she became pregnant.

She shares the challenges she encountered in her birth--going from a planned birth center birth to a C section, what she might have done differently in that process,

and how she managed that challenge.

She also shares what led her to become a holistic sleep consultant, a story continued into the next episode.

You can find Kim here: https://intuitiveparentingdc.com/

The Responsive Family Sleep Podcast: https://intuitiveparentingdc.com/podcast

https://www.instagram.com/intuitive_parenting_dc/

https://www.facebook.com/intuitiveparentingdc

 
And some references for infant sleep:
Dr. James McKenna’s work and Baby Sleep Info Source, a wonderful website out of the UK: https://www.basisonline.org.uk/

Kim's blogpost on infant sleep:
https://intuitiveparentingdc.com/blog/2018/7/6/developmentally-appropriate-sleep-expectations-birth-to-age-5

Transcript

Kim  0:04  
And of my friends who had kids, they were all sharing this sleep shaping strategy. I'm like, that's not what I want to know. I don't want to know how we try to control sleep. I want to know what is actually biologically, developmentally normative for human babies, and I couldn't find that information. It was so hard to find, and I was just like, I have no idea. I do not know if my baby is sleeping normally or not.

Paulette  0:34  
Welcome to what you didn't expect in fertility, pregnancy and birth, how we think and feel about this enormous transition often lives in the gap between what we expected and 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 have happened. This show shares true experiences, both the easy parts and the difficult parts and how we managed what we didn't expect, the intense things that can happen in the course of this transition can impact how you see yourself, how you see your partner and how you parent. The better we understand what happened to us, the better we can manage all the things that follow. I'm your host, Paulette Kamenecka. I'm a writer and an economist and mother of two girls, and I met many, many challenges in this process, none of which I expected. In today's episode, we hear from a woman who worked in the field of mother and infant health before she became pregnant, she shares the challenges she encountered in her birth going from a planned birth center birth to a C section, how she managed that challenge and what led her to become a holistic sleep consultant. She also shares some tips on what makes bed sharing safe and unsafe in this the first part of our conversation. Hi. Thanks so much for coming on the show. Can you introduce yourself and tell us where you're from. Yeah.

Kim  2:02  
My name is Kim Holly, and I am from Washington, DC.

Paulette  2:06  
Oh, nice. So was walking into pregnancy easy? Did you get pregnant easily?

Kim  2:13  
Pretty easily. Yeah. Okay, that was very straightforward,

Paulette  2:17  
good. And what did you imagine pregnancy would be like.

Kim  2:23  
So I'm a runner, and I was pretty sure that you could just totally mind over matter to be one of those people who are like, I ran 10 miles on the day I delivered, and that's totally gonna be me. Obviously, I could laugh at myself now, right? You cannot control how your body reacts to pregnancy. Overall, I had a very straightforward pregnancy up until just about at the end, but I was definitely not the person running 10 miles the day that you had your baby. So that was for me, kind of hard to grapple with. The fact that this little human that you're growing also you're starting to learn that lesson of like you don't have control over everything, right, which I feel like we learned at some point right along the whole wanting to have kids, getting pregnant, having them way you start to learn you don't actually have control over all the different pieces. And how

Paulette  3:12  
absolutely I am a sympathetic and sorry to hear about the realization that 10 miles a day is not going to make it to the calendar of the very pregnant person.

Kim  3:22  
I mean, you read those articles, you read those articles. And I had run a marathon within the year before I got pregnant, so 10 miles at that point to me was not that long, which I know most people are like, Oh, my God, seriously, but it was a reasonable distance for me. And so I was like, Oh, that'd be so cool to be that person. No,

Paulette  3:39  
I was a runner too before I got pregnant, and I feel like it's not even that 10 miles is uncomfortable. It's that miles are uncomfortable. I think the image we have in our mind of that giant pregnant abdomen is that it's not as heavy as it

Kim  3:55  
feels. Yes, yes. And when I realized I was like, Okay, I cannot run anymore now to go borrow an exercise bike from someone so I can at least get some exercise with those very er not thrilled with this kind of moments. While

Paulette  4:09  
you're pregnant and you're in that process and you have given enough caffeine or wine or whatever is your thing, it's hard to give up the running too. I totally, I totally relate to that.

Kim  4:21  
It's such a small thing, right in the grand scheme of things, but at the end the moment, it feels like I'm losing myself. This is horrible.

Paulette  4:27  
Well, that's the thing. Is, you're making all these accommodations for someone else, and there are things that are easier to give up and things that are harder to give up. And as someone who relied on running as a mental health strategy, yes, I felt it was really hard to give up running. So I'm with you. So let's go to before birth. What are you imagining birth is going to look

Kim  4:50  
like? This song, I had very clear ideas, none of which, by the way, happened. I feel like I put all my effort into preparing for this really lovely out of hospital birth right birth center, not because it was safer, but you live in a DC row home, the walls are thin. It felt like I would feel less self conscious in a birth center setting, and they were closer to a hospital than we were in case of needing hospital support. So I spent lots of time preparing for that, and figured it's gonna be a lovely thing. I'd have my mom there, I'd have my best friend there, and all the support, and it'd be hard work. But again, I run a marathon the year before, like, it's like running a marathon, right? You feel correctly, you have the right support, and you could totally do it. And so I definitely had this very classic out of hospital birth vision in my head, and you're

Paulette  5:40  
picking out of hospital because you want to do it without an epidural, or what's driving that? And

Kim  5:45  
my mom is a midwife, and I grew up very much comfortable with home birth, but also I have a background in public health, and my focus was maternal and child health, so I know and have studied just how much hospitals can be helpful, but also just how much they over intervene and cannot be helpful, and I was low risk. So for me, especially with the landscape of the hospitals around me at the time, I wasn't going to get evidence based care in a hospital. I wasn't going to be able to walk in and have control and make decisions for myself that I knew were evidence based, because they didn't fit hospital policy, and I didn't want to spend my whole birth fighting with my providers.

Paulette  6:30  
Kim, I feel like you have come to this so well prepared to have a mom who's a midwife, to grow up in that environment, to be studying that topic. It's so ahead of the curve to have a sense of what hospital birth might entail vis a vis the hospitals near you, it's so important to do that research that never crossed my mind, never even occurred to me. The hospital shop that was not a thing on my list, your

Kim  6:55  
provider and your hospital are the biggest impacts on your birth outcomes. Yeah, yep, and that's so wrong, because it should be their own medical factors and stuff, but it's not. And that's so

Paulette  7:05  
sure, but, but, but brilliant to go into it with that knowledge. So take us to the days before the birth. How do you know you're in labor? How does all that happen? Well,

Kim  7:16  
none of this happened as it was supposed to. So again, lessons and lack of control. Go in for a midwife appointment at 39 and a half weeks, and my baby had flipped breach, and he had not been breached. And so that's not good, because, I mean, vaginal breach birth is a thing, but it comes with its own set of risks. And do

Paulette  7:38  
you need to find a special midwife who is willing to do that a priori, who will sign on to it?

Kim  7:42  
You do, and you also have to have someone who's really experienced for it to be safe. It can be safe, but it's not safe if you don't have a provider who's skilled, right? That's when it becomes dangerous. And every different birth situation has different sets of risks, right? But we did not have anyone in the area who would do a breach vaginal birth to a first time mom who has not had a baby go through their pelvis and prove that they can get a baby through their pelvis. So I didn't actually have a lot of options, and honestly, I didn't really get the support that I needed to get through that. And I one of the things that this experience taught me about myself is that I am totally somebody who shuts down and stressed like that. Put me in a debate situation, and I will debate you, left, right and center. That's great, but in an acute situation like that, I totally shut down, and so unfortunately, it didn't have a lot of support as we were navigating. Can we get him to turn what are our options? Which is why, in the future, I had to do a lot of pictures, although I'm

Paulette  8:46  
guessing my limited experience is that there's not a ton of science around turning that baby. There are things you can do, but yeah,

Kim  8:53  
there are things you could do, and sometimes they work right, sometimes they don't. I wish now, looking back this Baby of mine, he's 11. Now, I wish I had pulled my surgical notes and really dug into them, just knowing what happened with my future birth. Was my cord extra long? Was he tangled in it? What happened that he started to engage and then flipped? What was that? What was that piece?

Paulette  9:18  
It's pretty late in the pregnancy to turn at that point. Yes, it

Kim  9:21  
is. It is really late. I mean, it happens, but it is pretty late. So we didn't really have any options, and we tried some of the exercise to turn them. We went and got acupuncture and moxibustin, and we did a consult with the provider about an ECB where they externally rotate the baby. He wouldn't do it because he said his butt is too closely engaged in your pelvis, it wouldn't be effective. And so basically, good

Paulette  9:44  
to know that on the front end, because yeah, senses that that's not a super comfortable procedure. Yeah,

Kim  9:51  
yeah. So we kind of exhausted our options, and basically we have the option of a C section, which for me, was actually one of my worst fears, obviously, beyond something going wrong with the baby, that's kind of a given, but the idea of being awake during a surgery was really, really terrifying to me. Had

Paulette  10:11  
you had much experience with medical stuff in the past before this?

Kim  10:16  
No, I never. I'd never broken a bone. I never gotten stitches, yeah, so I was totally freaked out, like, super, super, super freaked out because you're weak, and they cut you open, and my brain could not, yeah, I don't know, put it all together and assimilate, right?

Paulette  10:35  
And once they've assessed that you are going to have a breach birth, then it's a scheduled C section? Yes,

Kim  10:40  
I guess with what I know now, I could have thought to wait till I went into labor and had a C section in the early stages of labor. But

Paulette  10:50  
honestly, what would the benefit of that? Then? The

Kim  10:53  
benefit is baby experiences some contractions, which is thought to make that transition from in Udo to actually you to go more smoothly, and of course, to know that they're really ready to be born. Yeah. But mind you, at this point I am like past 40 weeks. I think by time we got in for the ECB consult, I was like 40 plus one. So not super past 40 weeks, but I mean, I was, you know, it was full term, and also the idea of waiting when this is our outcome, I could not handle that anxiety wise. It was just like, if this what we have to do, then I need it to be done. Otherwise, I'm going to ruminate on it and drive myself absolutely crazy.

Paulette  11:31  
Totally, yeah, that makes sense. Yeah. Let's talk about the C section. How does it go? How do you cross the fear threshold of, oh my god, I'm awake and they're about to do the surgery. I mean,

Kim  11:43  
I was really lucky in the sense that my mom was in town visiting health after the birth, and she was my advocate with the hospital staff. And I'm also lucky that we got a good anesthesiologist. I didn't learn anything about C section procedures. I took a freaking 12 week birth class. I learned nothing helpful about how a C section goes down. So my mom's talking me through some of this stuff. And she later worked as a pediatric nurse, so she hadn't been in a hospital setting as a like birth provider in a while, but she was talking me through these different things. And anesthesiologist comes in for a consult, and she was like navigating from having my husband in the room while they placed the spinal and things like that, and talked herself into being allowed back into postdoc recovery. Yeah, good. Well done. She definitely pulled them I am a nurse medical provider card. And again, we got lucky. We had really nice staff who, instead of seeing me as this crazy person who went out of hospital birth, they were like, gosh, we know this really sucks that your birth plan got totally thrown out the window. How can we make this better?

Paulette  12:51  
But also, it's not like you're trying to have your birth in the tree in the backyard. Is not a crazy alternative, not that having it at home is a crazy alternative, but I think people in the medical space are really risk averse about that kind of stuff, so to them, it seems uncomfortable that you'd make that choice, but your choice isn't even at home. Anyway, I'm glad that they were nice too, and they should be. So,

Kim  13:15  
yeah, so I mean, so I was lucky. My husband stayed with me longer than he, strictly speaking, would have normally, and it was already standard procedure for him to be in the or, yeah, I asked for a couple different things from my birth plan, like, Can you wait to cut the cord a little bit longer than normal? And it was a little full on, like for camping, but he did wait longer than he would normally for a C section, and it was, it was the RESTful to get him out. It's weird in there it is a really bizarre feeling of pulling a pressure but they do a really good job of prepping me like you were going to feel these sensations and yes we will test you before we start cutting, and all these different.

Unknown Speaker  14:03  
Different things got I

Paulette  14:04  
mean, if it makes you feel any better, I freaked out when the anesthesiologist put in the epidural. I grabbed him by the shirt like a crazy person, and was like, I can't feel my legs. And he's like, Oh, that's good legs, I know. And I was like, what? So

Kim  14:21  
the legs, you can't feel like that. Totally freaked me out, right? Like it feels so weird, so weird. And for future bursts, I was going to things. I was like, I do not want an epidural. I do not ever want to feel like that again, right? Again. Of course, it's wonderful that we have them, and I totally get why many people choose to have them, but I was like, I never want to feel like that again. I'm going to have to be wanting to die from pain, not like, just like, such a loss of control and autonomy. For me that was, it was very it was very challenging, but providers at that point were, were really good, not so much in postpartum or immediate postpartum recovery, but you know, the staff during the actual C section was was very calming and narrating very much kind of trying to keep me in the loop and keep me grounded.

Paulette  15:12  
Okay, good. Well, that thumbs up for that process. And so what are you imagining postpartum will be like? And then, how is that similar to or different from how it actually was? Well,

Kim  15:24  
immediate postpartum, they take you to recovery, and my blood pressure was a bit high. The nurse was freaking out. Fine, obviously, she could do her job, but she kept getting very cranky with my mom, who was scooping up my son and trying to bring him to nurse, like, this baby is in my way. And my mom's worked postpartum before, and she's like, You do her blood pressure over there on her right, I hold the baby to nurse on my left. Why are you creating drama where there doesn't have to be drama, lady? So that was really challenging, because my husband got to hold my baby before I did. My mom got to hold my baby before I did. Let this baby come be skin to skin. You have a skilled person right here, willing and able to hold him on me while you do what you need to do. And so that was really challenging, just that immediate recovery time and having some providers who are less than helpful to facilitate those things that are really important, like that time to get that first feed and a healthy baby. And aside from the blood pressure issues, which got resolved a healthy mom, there's no reason that we shouldn't be together, yeah, yeah,

Paulette  16:26  
yeah, that does sound hard out. I'm very glad your mom was there.

Kim  16:29  
Me too, me too, because my husband's amazing, but he's freaked out, you know, his first time going through all this as well, and he doesn't have any particular medical knowledge. So a mom,

Paulette  16:41  
yeah, I totally agree. I don't know that it would occur to him to bring the baby to you to breastfeed while you're in recovery, right? Yeah, no, it wouldn't.

Unknown Speaker  16:48  
It wouldn't. He's

Paulette  16:49  
probably congratulating himself for remains vertical. Yeah, exactly, exactly.

Kim  16:55  
I don't envy his perspective either. Let's put it. So

Paulette  16:58  
what happens when you get home?

Kim  17:04  
Yeah, I was very fortunate. My mom was there for a while to stay with us and help. And I was also very fortunate because nursing for me was very uncomplicated. Which post C section isn't always the case? Yes, I had some significant engorgement because they super overloaded me with fluids, to the point that in the hospital, my mom was like, she's taking fluids by mouth. Can you unhook that IV bag from her? Right? Yeah, we don't need any more fluids in her. So I had a I had a lot of swelling postpartum, but other than that, I had a pretty smooth start to nursing and a really supportive pediatrician who was very encouraging while my note came in, and that went really, really well, which was good, because I felt like everything I wanted for my birth did not happen, and nursing was also very important to me. So it was, it was very healing for that to go smoothly. Good. That's awesome, yeah. But I also had no idea what to expect. All my effort and education had really been on birth, yeah, and not so much on postpartum or even beyond that.

Paulette  18:13  
So was your recovery relatively straightforward?

Kim  18:16  
Oh my gosh, for that birth, it was smooth. I took it really easy the first two weeks, like you're supposed to. I saw my OB at two weeks. This all looks beautiful. It takes longer to heal on the inside. Take it really slow. And then he walks me through. Here's how you get back to running. And I was running a month after birth. Like, easy. He was like, you do not push basic guidelines, you know, on how to know, like, what to do. Go for a fast walk, a couple fast walks. First, go do this, knowing that he dealing with a very fit, active, active runner. It was very smooth. It was honestly my smoothest recovery over my vaginal burst, which is kind of funny, but it was, it was that part was pretty straightforward.

Paulette  19:00  
I'm glad to hear it. And you know, in some ways that makes sense, because everything is intact right where the cut has been made, and that's the focus of the healing. I'm glad that that was relatively straightforward for you. And what happens next? I know we're going to get into the fact that you're a sleep consultant, and your experience created that passion in you. So how did that evolve?

Kim  19:24  
I mean, honestly, it kind of stuck up on me, right? We said I parked so much for birth. I did some preparation on nursing, but I also was like, my mom's going to be here. She knows enough, and she's one of the people who knows what she doesn't know, so she's not sure what the most up to date thing is, she's not going to just tell me whatever. But I realized that I knew what was safe sleep, because I was working at the time on a infant mortality birth outcome improvement grant program. I was a public health officer working on it, so if you lived safe sleep. It was a big part of our program. So I know what the AAP says, blah, blah, blah. I don't need to learn anything about anything else, right? And then I have an actual baby who's a human who does whatever he wants to do, yeah? And I have no idea what's normal, and just sort of skipping ahead. I remember he was about four months old, and we settled into a pattern. It was fine, and then all of a sudden he started waking up a million times more. And I just remember sitting, dragging myself downstairs, throwing myself on the couch, and my best friend was over and being like, what the actual heck is happening here? Is this a thing? Why is he waking up 20 million times a night, right? And she was like, I don't know, because she didn't have kids. So what did she know? And just being in that moment was like, I have no idea what is normal and how sleep is supposed to develop. And of my friends who had kids, they were all sharing this sleep shaping strategy and this whatever, I'm like, that's not what I want to know. I don't want to know how we try to control sleep. I want to know what is actually biologically, developmentally normative for human babies. Yeah, and I couldn't find that information. It was so hard to find. And I was just like, I have no idea. I do not know if my baby is sleeping normally or not. And in the newborn phase, I think I was so much in a daze by becoming a parent, but also our birth and my husband, at the time, was working in a really toxic job environment, so he was having a lot of anxiety struggles unrelated to becoming a parent and to be kind of handsful. And I also

Paulette  21:42  
feel like in the in the early part, you don't have any expectation, yeah, they're

Kim  21:46  
not gonna sleep, they're gonna just do whatever they do, and all over the place. And I think most people can kind of grasp that, yeah

Paulette  21:54  
and yeah exactly, yeah.

Kim  21:57  
But then I was just like, I have no idea, but it is shockingly hard. At least I'd say it still is. But it was even harder 11 years ago to find any actual good quality information on what is this supposed to look like? And so it was driving me crazy, because I don't know what I should be doing. I don't know what it's supposed to look like. I don't know what what is four months supposed to look like, compared to eight months, compared to 12 months, I wasn't finding the information, and all my friends were being like, do this strategy and that strategy. And I'm like, that's great, but yeah, that's not actually what I'm grappling with right now. Yeah.

Paulette  22:37  
So how did you address that?

Kim  22:38  
Well, I went into my pediatrician, which honestly, as a professional, often, I don't find pediatricians particularly helpful when it comes to sleep, but I had the world's best pediatrician when my son was a baby, and we'd also been dealing with bottle refusal. He didn't want to take a bottle when I went to work, so that was a whole separate conversation, and I was just venting to her about the bottle issues and the sleep issues, and she pulled in a lactation consultant who was just kind of floating around in the office that day, and was like, Well, I think we've exhausted my tips. Why don't we see if we can? You guys have a conversation. And we were chatting and talking about bottles and talking about sleep, and she was like, Look, you have a background in public health. You like research? And I was like, yeah. She was like, all right. And she gave me a whole list of people to start reading. And she was like, now I'm not telling you what to do, but if you want sources of actual biological normative information on sleep. Here's a starting point. And I was at a slow point in work, and I just binge read Biological anthropologists work and other research that they were then citing, and just really started getting into it, because our

Paulette  23:57  
Biological anthropologists studying human babies, yeah, okay,

Kim  24:02  
some of the leading researchers on maternal baby sleep are Biological anthropologists, not all of them, but some of them are in the UK and in the US,

Paulette  24:10  
okay, which is pretty cool.

Kim  24:13  
And so, yeah. So she pointed me in the direction to get started, right though, give it a comprehensive list, but she gave me a few things to start looking at, which gave me a starting point right that I wasn't finding before.

Paulette  24:28  
So that's amazing. So now you're trying to develop a foundation and what happens from there?

Kim  24:34  
I mean, for me, when it started to help me do is watch my baby more. And it's not that I wasn't before, but I wasn't watching with any sort of understanding or pattern behind it. I was just like, he sleeps when he sleeps. He doesn't when he

Paulette  24:50  
doesn't. Are you looking for cues of sleepiness? Or you're looking to track the time he's asleep? Or what are you looking for?

Kim  24:56  
For me, it was trying to make sense of what was going on with the snaps. So a little bit more more cues, but also rhythm, little looking for more of a rhythm, but also just general like, Okay, this is a normal amount of waking, and this is a normal amount of that ebb and flow of waking over time. And maybe he's having trouble falling asleep because my husband is riling him up on the mattress right before sleep, because they're playing, but they're playing super rough as part of the bedtime routine, and that isn't actually doing what we needed to do, which is, you know, true fact. And so it was giving me some ideas like, what does the body actually need to sleep well?

Paulette  25:33  
And so you're developing sleep hygiene for the babies, but it sounds Yeah, yeah. Kind of

Kim  25:38  
getting more understanding of that, as well as that understanding of how it's on average, right, how things play out over time. And for me, that was a big piece of I was like, I don't know what this is supposed to look like, knowing that every baby's an individual, of course, right? They don't follow a neat little trajectory.

Paulette  25:57  
So that sounds useful, as that will help you manage your expectation. But beyond that, what else are you doing and have you, how does that lead you to become a sleep consultant?

Kim  26:07  
I mean, for me as a parent, it made me less trust, right? And it opened up new opportunities that felt aligned with my own parenting values for how we can all get more sleep, because I understood what does a baby or an adult need to sleep? Well, biologically speaking, then I can start to shift some of the things that we were doing that weren't particularly helpful. And know, okay, it's still really normal that he's waking a couple times a night, or if we don't rile him up on the mattress before sleep, in front of our bedtime team, we need to calm things down, we're overstimulating him, and just some of these different pieces that took some of the stress away, but also gave me some ideas of things that we could do. Okay, so it felt right. I'm

Paulette  26:54  
going to stop my conversation with Kim here for today. There aren't too many of us who go into pregnancy and postpartum after having grown up with a midwife slash pediatric nurse as our mother and a degree in infant health focused on infant and maternal health, and yet, the gap between what we expect and what we actually experience exists for Kim, too, I appreciate how she managed her uncertainty about infant sleep. If you're in the position to take care of an infant, how to manage infant sleep will be a question you too have to confront, and Kim's approach is particularly interesting and informative. Thanks for listening this episode. If you know anyone struggling with an infant sleep, thanks for listening to this episode. If you know anyone struggling with infant sleep, please share this with them, and you'll hear more on this topic next week, when Kim and I dive into more specifics on infant sleep useful insights to note so that you too can manage your expectations.

Transcribed by https://otter.ai