#75 Maternal-Assisted C-Section: Justine’s Birth

Sarah: It is a magical week of the holidays. Happy holidays, everybody. We thought that when we were looking ahead on the calendar for this podcast episode, we thought through like, what would be something really like nice and easy to listen to and hopefully maybe uplifting, maybe it doesn’t have to be uplifting, let’s be clear? What would be sort of like a lighter weight episode for this holiday week?
We promised that we would come back after Justine’s birth and debrief her actual birth experience and maybe even get into a few things maybe from the postpartum period, things she’s learning. She is technically on maternity leave, so thank you for being here, Justine, during your maternity leave. If you haven’t listened to the very first podcast episode for season five, please pause right now and go back and listen. I think what’s really fun is for us to have been sitting right here a few weeks ago and been dreaming about and there was a little bit of anxiety around. What’s your dream? What’s your hope? What’s your decision as far as what route of delivery?
I’ll give a preview that she did elect for a repeat C-section. We talked about what would be the best case scenario. We’re here today to talk through what actually happened and give you the insider scoop. If you haven’t seen on Instagram as well, we did put together a little teaser reel of her birth experience. If you’ve seen that already, you have an idea what happened, but we’re going to get into the nitty-gritty during this episode and debrief her actual birth experience. Welcome back, Justine.
Justine: Thank you. It does feel like it’s been a long time, but when did we record? It was like a week before the birth?
Sarah: Yes. End of September, early October. Yes.
Justine: Yes, because today I’m six weeks postpartum. Yes. No, it’s six weeks today.
Sarah: Congrats. Wow.
Justine: It’s in the blur. It is an absolute blur.
Sarah: I’m sure. I’m sure. How are you feeling today?
Justine: Today, I feel pretty good. I got a pretty good amount of sleep, and I’m feeling thankful that I have had this time off. It’s wild to me. I think about people in nursing school, and maybe you listening have heard of these crazy people. I know that when things are hard, we just do the things we need to do. We adapt. I remember hearing about people going on like getting their schedule T-section on Friday to be back in school on Monday. Isn’t that insane?
Sarah: Yes. No. Yes, that’s insane. That’s too much. Please don’t do that to yourself, if you can.
Justine: When you’re in those situations, you’re like, what do you do? You want to get through school. Anyways, it has been a hard postpartum. I’m very tired. I have a lot of support, which I’m thankful for, but I’m so fricking tired. Being my second kid, you’re just so worried about the first kid. Are they okay? They love each other, obviously. I don’t know if Noah likes Nathaniel, but Nathaniel really likes him.
Overall, the postpartum has been hard, but the birth was everything I could have wanted and more. I think it was a good day, so special. Would you agree it was a good day?
Sarah: Yes. Oh my gosh. Obviously, I’m going to be very mindful not to place my experience on you. I want to hear your perspective. I can give mine once you give yours. If that’s how you feel, that is that. I agree with that sentiment.
Justine: Getting into the nitty-gritty, if you listened to the previous episode, I elected for the C-section like Sarah said, and I really wanted to do like the maternal assisted, birthing person-assisted C-section where my OB hands off baby to me. I was sterilized and– sterilized. That was funny [unintelligible 00:04:03] [chuckles] I was sterilized, and then they dropped the drape. They put baby to me, and it worked and it was great. It was interesting how long it took to set up in the OR for it. Do you feel like it took forever?
Sarah: I haven’t had that thought before. No, I don’t actually, but I’m sure like laying there yourself-
Justine: I guess like I see [unintelligible 00:04:23]
Sarah: -it’s like wham, bam. Thank you, ma’am. I think they were waiting for whoever the first assist was. I don’t even know. There was like a dude because I caught– they were waiting for him and somebody else set up. They were standing there waiting for him. I don’t know if that was because of that component of it or not. I could see the whole– so I was in the room. I did end up getting in the room. They were so accommodating, and I of course was like, don’t get in anyone’s way. I was very scared because they just don’t do that at this facility.
I had the full room view. They had me like against a wall, which unfortunately, for footage sake, made for like some challenges for the footage portion.
Justine: You did so good. You did so good.
Sarah: I did good for with what I got. That’s for sure. It was as much as from my angle, I could have gotten with 5,000 people in front of me, but anyway. As we were waiting, I didn’t feel like it was particularly long, but I know they were waiting for the first assist.
Justine: That makes more sense. I think I’m used to like night shift crashes versus day shift planned. Again, I haven’t been in a scheduled case in a minute, so yes, I got there. Everything was so smooth. They were so kind. They set up my room and had presents for me. A friend of a decade was able to start my IV. She was a nursing student that day. She started my IV. She started my Foley, which if you were tracking that day on social media, I did get it in before I got a spinal because I found they don’t hurt.
I just knew that it was going to be a lot in the OR. I already knew my tech was nervous about everything going in the OR. I knew there was going to be a lot of people that I was hoping to sneak in there. I didn’t want to put that on a student to do a Foley in the OR. It can be intimidating. It’s like, let’s just do it now. My biggest worry was getting you all in there. I really wanted you all in there and obviously needed Eric in there. I wanted you in there obviously. Then my sister wanted to be in there and then like half the staff wanted to be in there.
I was like, I had to let that go of like whoever gets in, gets in. I was super thankful. The nurse that I chose was just super– like with you, Sarah, she was like, yes, come on in. You’re the photographer. Let’s go. I was like, okay. I just had no idea she was going to be that cool about it. That was awesome. Then everything was great. I will say my favorite part of getting a C-section is the spinal. I feel so good.
Sarah: What?
Justine: You didn’t hear me say that too, that your legs feel so warm and toasty?
Sarah: I remember you saying like, oh, I feel so warm. I didn’t realize that was part of your favorite part of the day.
Speaker 2: Oh yes.
Sarah: Weird
Justine: I think that I would always have pains, but everything went great. I got a different anesthesia provider that morning, was like one of the only changes. I think they were worried about telling me, but I would already known the day before. My friend had told me that the anesthesia provider I wanted was going to be in the main. Who was going to have me was actually a CRNA that I work with at night. I didn’t know he was an option, and he was so kind.
I actually told him that multiple times. I remember that. I was like, your role is so important. He was so soothing and just so good. Man, I knew that everyone’s role– I don’t know. We get so tunnel vision on whose role is important. I know now how important our role is, right? We always preach that, like our role as labor nurse is so important and so vital. During that C-section, I’m like, my role doesn’t matter. The biggest role in the OR in my mind right now is the anesthesiologist or the CRNA.
They’re at their head just talking to them. We’re not talking. We’re doing our thing. We barely say anything. If anything, we should be, but oh, it was so– I can’t wait to see him again to just be like, again, you are so important. I think about Vibha from SafePartum and what she’s doing with anesthesia and providers and education. I’m so thankful for her that she’s in this world because, yes, there needs to be kind, caring anesthesia providers with people that are specializing in OB.
Anyways, he was lovely. My anesthesia worked great. I think that it felt like they took six years to get to uterus. It took so long. Even my friend was like, yes, it took a long time, but she said they were cauterizing a lot. Maybe they’re just really trying to be mindful of the bleeding.
Sarah: That and I think there was some adhesions if I remember hearing that.
Justine: Is there? Okay. Yes. It felt like it took forever. You’ll see in the video, it’s hard to explain on verbally, I think, but I did get sterile gloves on me. I scrubbed in before entering the OR. They put sterile gloves on me. Then I had the drape up. Then my OB had said, when I saw her the week after to take out part of my incision, whatever things she did, she said, I was surprised for a second. I was like, why is her hands coming at me? They get in their routine of like what they’re doing and all of a sudden hands are coming. It was great.
They took the baby over to the warmer to do some CPAP. I was like, it was fine. We’ll talk more about that, but people were so concerned about my experience, which I’m so thankful for. I think it added more stress to their job, way more stress than I ever wanted to because they were really concerned, which, I mean great. How lucky am I?
Then, Noah came with me to the PACU, which we got that experience, which we’ve never gotten to have with my first. My mom got to be back there, and my sister, and Sarah, and my husband, and my friends who work with me. Then we went to postpartum, and yes, it was all a whirlwind. Then about– what was it? Like six hours after birth?
Sarah: Yes.
Justine: Maybe like four hours after birth, they take his blood sugar because he got cold. It was 96 or something, 96, 97, 96, I don’t know. Something cold, something they were alarming when they had to take blood sugar. Mind you, I know nothing about postpartum, so I’m learning a lot. They took the blood sugar, and it was 19, which is very low. At this point, of course, is the only time Sarah had left the room to go to the car with my husband and my sister.
Sarah: Get all your stuff.
Justine: I know, and I was like, okay. I called Eric, he didn’t answer. I called Jordi, and I was like, I need to talk to Eric, and then you guys hustled to the room.
Sarah: You whipped it into action.
Justine: Yes, he wanted to give him sweeties. We wanted to express colostrum, because I did have, luckily, a lot of colostrum at the time to just try to throw it in him, and so we did end up consenting to some sweeties, but also colostrum, and I think it was mostly the colostrum.
Sarah: We gave colostrum first, actually, as well.
Justine: Yes, that’s true.
Sarah: He got colostrum before he got the sweeties.
Justine: Yes, and he barely got the sweeties. I feel like so much of it fell out of his mouth, to be honest, but it rose a little bit. I can’t remember if they took it again, but what ended up happening was he started– he’s a loud baby. He’s a grumpy baby.
Sarah: Is he still this way?
Justine: Yes, so I wanted to tell you, he hasn’t let me sleep for six weeks, because he’s a loud baby.
Sarah: Oh my gosh, all that.
Justine: When he grunts, he sounds like a little pig, and–
Sarah: It’s stressful to listen to as a nurse. If you’re following stories that day, I did actually put on stories. Actually, I think there is a highlight, so you got to go back and see, but we’re like, what is he doing? Stop making that noise, but he began retracting in postpartum as well. That’s when it was like, oh, man.
Justine: Right. My position at my hospital right now is like a supercharge, is what they– we don’t have charge nurses. We have supervisors and whatever. I have a really unique situation where I’m really close with the NICU supervisors as well, and so that really helped the situation. The NICU CNC is what we call them, was like, I’m going to bring the NICU to her. I’m going to be in the room. I’m going to be there. I’ll watch him, because they did put a pulse ox on him, and he was satting perfect. He looked great, and it was just like–
It was hard, and so she really tried to get him to stay. She ended up getting undermined from postpartum and having to send him to NICU anyways, but I told her, I was like, I’m not going to regret him going, but I might regret him staying if something’s wrong. He went, and they didn’t have to do anything. They just took blood sugars, which by the way, I got the bill. It’s six hours, six hours total.
They took four blood sugars. They didn’t do anything else. There was no IV, no sweeties, nothing. Luckily, I have insurance, but before insurance, they always overcharge insurance, $33,000. Is that not insane?
Sarah: I cannot.
Justine: Yes, and I do, I will have to pay 500 for him even just going there. I was like, I could have taken blood sugars.
Sarah: Wow. Well, the blood sugar, by the way, we gave sweeties, and we gave so much colostrum. You had so much colostrum, and his sugar went up to, what, 40-something after? It was perfectly fine.
Justine: Right, yes. That’s right. [crosstalk]
Sarah: He was asymptomatic for the hypoglycemia.
Justine: Yes, and then the next one, I think in the NICU, it was 150 or something. Here’s the thing. Here’s where it all went haywire, was they were so adamant about giving formula. They wanted to start formula so bad in the beginning. We really didn’t want to do that right away. They asked– remember, they were like, will she take donor milk? We were like, he is like five hours old. What’s happening?
Sarah: Right, and we were hand-expressing-
Justine: So much colostrum.
Sarah: -so much colostrum, milliliters upon milliliters. The average first feed is potentially less than 1 ml hand-expressed. The size of their belly is five to eight mls. That’s the max they can take. It raised his sugar. What is going on? What is this obsession?
Justine: Yes. Again, he’s just a loud baby, and it’s freaking everyone out, which again, us included at the times.
Sarah: Yes. I mean we kept looking at each other like, oh my God, what is going on? Stop it.
Justine: Right. Again, everything was working for me. My night shift NICU nurse was one of my favorite NICU nurses, that I was like, oh, so happy, Eric. This nurse is so nice, over text. Then I found out who it was. I was like, oh yes, she’s an angel sent from heaven. Why I say that, if anyone is a NICU or wants to be a NICU, is that she comes to high-risk deliveries, and she talks so kindly to the families.
I see a lot of NICU nurses, and I know everyone’s just in their own zone and their own lane and paying attention, but they don’t even acknowledge the families. They just come in, do their thing, assess and leave. This nurse is different. It’s really nice. Then I found out later though that she really wanted labor and delivery. Then she ended up in NICU. Now she loves that she gets to do both with high risk. I was like, oh, it’s like a perfect world being in the deliveries and then being with the baby. Anyways, that makes sense to me, having that information.
Anyways, so since he went to the NICU, my husband went with him and then it was just Sarah and I. We were determined to get me out of bed into the NICU. You might’ve seen this on Instagram, but I was determined to– I wanted to do the ERAS protocol. We did, I got up at, what? six hours? It was about six hours.
Sarah: Yes. We posted on stories that us little rebels in the room. You let two of us loose in a hospital room, like we’re going to do what we want. People were like, we get them up at six hours. It was like, that was not it. The rebel, a part of it, was that we got her out of bed for the first time, just me and her, without the nurse, which as we know, is like the worst thing you could possibly do, which [crosstalk]
Justine: “Don’t get out of bed.”
Sarah: Yes, “Don’t get out of bed without me.”
Justine: I was an informed patient. You though, you were like, okay, “Are you okay?” I was like, “No, I’m okay.”
Sarah: You did a little wobble. I was like, ah, don’t do this on me. Okay, I get it. I feel comfortable. What’s the difference between me and the postpartum nurse? If you’re going to go down, you’re going to go down, but don’t go down.
Justine: You were taller than our postpartum nurse for night shift, so. Yes, that went well. I got my Foley out fast, which was nice. I felt like a human faster, but overall my pain came on way more than first time. I think maybe, Sarah, you mentioned, you’ve heard that with ERAS, right?
Sarah: Yes.
Justine: Tell me more.
Sarah: Actually, will you explain what ERAS is? I have a bunch of follow-up questions for those that are listening and are like, oh, okay, where are we going with this? We’re going there, because we’re going to learn from your experience. Okay, so we’ll link exclusive for you for now is the full birth video, because the one that we posted on Instagram was only like Instagram’s limitation of 90 seconds or whatever. The actual play-by-play where like the birth story is– I don’t know how long it is, like 10 minutes maybe?
Justine: 10 minutes, 10 beautiful minutes.
Sarah: Yes, so you can see the full experience. When this episode goes live, we’ll post when you get to be a part of your friend’s delivery, because I’m sure that we all relate to that. We can make a little reel out of it. You can see. I was in it. It was like 1:00 in the morning, and I was like, I’m not going to bed. I’m going to get her this video. I was so inspired. Oh, yay, cheering on. All right, so what is ERAS?
Justine: Yes. Enhanced Recovery After Surgery, or you might hear ERAC, Enhanced Recovery After C-section or cesarean. It is a push to get people out of bed and healed faster, have better healing. I think about this a few years ago, like five years ago, my husband was like, you guys don’t get your people out of bed fast? I have like cabbage patients walking like earlier than you have some of your C-section patients walking.
That inspired me to read up on this. Then I realized a lot of places are implementing it. You’ll go to conferences and A1 talks and stuff, and you’ll see a lot of this around. It’s becoming either– a lot of people are talking about it and a lot of people are doing it. What does it typically entail? It typically entails that you can eat up to six hours, I believe, before. You can have fluids up to two hours. They give you Tylenol before. Some places give you gabapentin or another type of medication before. For me, it was just Tylenol.
They give you this like special Ensure drink, which I loved because I was really hungry before, two hours before. Then during, they give you different modes of multimodal pain relief during the surgery. Then afterwards, you’re technically supposed to start chewing ice in the PACU, getting on fluids quicker, getting up between six and eight hours, like at least standing. Then you’re fully out, definitely before 12, but I think it was like eight to 12 hours is you’re fully. The goal being that you’ll be on less narcotics. For me, I was on lots of narcotics. [chuckles]
Sarah: Didn’t go so hot.
Justine: Didn’t go so hot. I was in a lot of pain, and I was not in this much pain with Nathaniel, I don’t think. Also, I didn’t go home, like have to take care of my household and my kid.
Sarah: Yes, but you were in that much pain in postpartum.
Justine: I was like around the clock Toradol and whatever else. I don’t even remember now, the non-narcotics. Then the next day I was like, “What can I take,” to the doctor. She’s like, I can start you on– I can give you Norco. The second night I was like, well, let’s just go walk the unit. They gave me Norco. Then I was like, okay. Then I went on a walk. I went the wrong way where I set off the alarm system. I know the way to go, and everyone was giving me a hard time.
I was like, TBH, I’m feeling a little high, and I’m still in pain. I need to go back to my room. I got off of the Norco, and I went on Percocet, which actually was way better. It made me feel like a million bucks. Then I went home with Percocets, and I’m feeling great on them. Then Noah was being sluggish and not eating as much. I was like, am I getting my kid high right now? Because I was breastfeeding, exclusively. Is it me? Then I was getting stressed about it.
Then I had to like wean myself off of Percocet, and then I’m like worried about opioid use. It was painful for a week, which is fine. Maybe in the long run, a week is fine, but it felt like a long time. I remember hoping and wishing like, man, when is this pain going to go away, and having feelings like, am I always going to be in pain, knowing I wasn’t. Getting out of your bed, not feeling well is like– You don’t realize like how easy it is to get out of bed until you can’t get out of bed. How much I take that for granted [unintelligible 00:21:44]
Yes, for me, it didn’t work the way it was intended. I didn’t get to go home night one because they were worried about his breathing, and I was in more pain. It was fine.
Sarah: In theory, like in other ways, potentially, maybe it did help with some of your recovery. We’ll never know at this point.
Justine: We’ll never know. I didn’t get a UTI.
Sarah: Fair. That comes from ERAS?
Justine: No, but like the Foley in for a long time.
Sarah: Oh, okay. I was like, how does that work? I suppose like taking it out earlier. I feel like places probably, the most [crosstalk]
Justine: This probably has nothing to do with it, but my incision looks great.
Sarah: Oh, good. You didn’t get sepsis from the maternal-assisted C-section .
Justine: I did not. No, and I didn’t get any extra– [crosstalk]
Sarah: Let’s talk through that.
Justine: I didn’t even get any extra antibiotics, people, which I was always teasing, just throw me more antibiotic if you’re worried about it. I have never been scared of this, but you were more scared of this.
Sarah: Yes, I was.
Justine: You’re more like A type clean.
Sarah: Yes, and sterile feel. I will be the person that will pull the whole thing and be like, sorry, it’s contaminated. Do not put that Foley in. Whereas like– I’ve seen other people…
Justine: Which is good.
Sarah: -a little sketch. Yes, I guess. I don’t know. I’m very A type in that way. Yes, it stressed me out.
Justine: From your direction though, when you were watching, did you ever see where you’re like, no, that’s definitely breaking or are you like, no, you’ll manage?
Sarah: I couldn’t see to be honest. I had to let it go because I wasn’t going to be the one who was ever going to raise my hand and be like, so you touched the thing, new gloves. No. Mind you, I did think though to myself, because this was the first maternal-assisted C-section I’ve been in the room for. There were components that I was like, they just need to just– first of all, I’m calling this design publicly. Okay, y’all.
If you come up with this idea, it will be documented, and it is currently November 20th right now that I came up with this idea. I’m sure I’m not the first, but I just publicly want to make that very clear. That what they need is they need a drape with arms built in where you have the clear drape. You have where you can put your arms through, like almost like an– you know like those isolation pods for super infectious diseases where you can like put your hands through and you can manipulate the sterile environment or whatever?
That you literally just put your hands through. Sure you could scrub, fine, but put your hands through, and it’s all covered. You can still grab your baby with a clear drape. They lower it enough. Then when it comes up and over, somebody else helps on the receiving end that’s actually sterile so that, if there’s a reach above the drape, then whoever’s reaching above the drape is fully scrubbed in, because for you to lay there–
This is what I saw as far as like how it went. You scrubbed. You did like a full surgical scrub, which you know how to do. The average mom or birthing person would need to be talked through that. You scrubbed, and then you came in. They gowned you up, you gloved, but like to gown and glove sterilely is an actual skill. There’s skills labs on it. You have to be trained in that.
Again, I’m going to be the skeptic of the bunch here, but my concern for the masses is that, how sterile is it? I don’t know. Flex and flow on that. Then they helped you glove. Then they draped you, but you’re standing there with your arms up, like a scrub, hands, like Grey’s Anatomy style, just laying there for however long, but you didn’t graze the sheet ever?
Justine: I don’t know, now thinking about what I did. One step was I scrubbed and then went in and got a spinal holding my hands. I was like, I think I’ve touched things.
Sarah: Oh my gosh, you’re so right.
Justine: They didn’t– whatever. Then they put the gloves on and I didn’t [crosstalk]
Sarah: I mean they put them on sterile. I watched that process. It looked like there was no contamination. Yes, you’re right. You went in, and you scrubbed and then you got the spinal, which is not it. How is OSHA [crosstalk]–
Justine: If anything, I guess they could have brought the gel in after, the portable gel, whatever that gel is that you have to scrub once a day and then the rest of the time, you gel.
Sarah: Yes. That would have been a great idea. This is why we need a protocol. Let’s be clear. This probably needs a whole thing. I will say that, when people saw that, the number of DMs of like, wait, how did they do this? What do I do for my facility? It sounds lovely, but there are some complexities, and we do care about safety. This is surgery, and you’re open. I saw your whole internals.
Justine: What’s unfortunate is like, yes, I got it because I work there. I’m so lucky for that. Ultimately, if I were to do it again and I didn’t work there, what I think is super easy and doable was skin to skin. That was doable. If I had a third, I wouldn’t need to reach. I would just be like, can we do some skin to skin?
Sarah: That was one of my questions. I’m like, how was it for you to have– like to be able to reach down and pull your baby out of you? Do you feel like that was a moment?
Justine: I think it was really neat, but honestly, if we’re thinking about it, there was so many people and things happening. There was so much pressure to it all. I think maybe I was just like me worried more about his safety versus the moment, if that make sense. Watching it on video is really nice. I could feel my moment there.
Sarah: Do feel like you gave birth because of it? Okay. As you’re thinking-
Justine: I don’t know.
Sarah: -because I hear especially when I’m– Back in the day, I would teach the prepared cesarean class. People that either had to have a C-section or they were electing for a C-section, like talked you through and how do you make the most of it and answer all their concerns and questions. The biggest thing was, and we know this from laboring with people that end up in a C-section, is that there’s this component of loss for some people of the actual birth experience.
It’s like when you give birth vaginally, there’s this it came out of me. I saw it. I was one of the first people to touch my baby. There was no separation. There was no delay. I’ve heard a lot of like the partner got to hang out, and I carried the baby the whole time. That’s lovely. There’s this little bit of like, what the heck, where was I?
Justine: Okay. I don’t think I can answer that well because I don’t know what it’s like to give vaginal birth. I think maybe if it was my second and like my first, I had given vaginal birth and I knew what that felt like. For me, it does feel like birth, but the other one did not feel like birth, if that makes sense. What I thought was interesting though, was when they took him to start the CPAP– they took him. He was over there for a while. I think they suctioned him at one point.
Sarah: Yes, they
Justine: They brought out the NICU person, blah, blah, blah. He was getting cold. He was over there for a good amount of time. I had told someone, Eric, or maybe you came over and sat with me for a while. I’m like, normally, I still wouldn’t have seen him. That’s crazy to me, that that separation is for so long. I felt fine because I already got to see him. I held him. He was on me, and then he left. That’s really sad, and everyone talks about him or her.
They’re just laying there feeling kind of shitty, if you’re being honest. You’re like, there’s a lot of pressure going on in your belly. You’re getting a little nauseous. You’re tired. It is hard I think in that, and that’s where I think we have to push for skin-to-skin if we can, even just a second of time. This is your baby. You did amazing. I’m going to bring him back. Yes, that’s hard.
Sarah: Yes. We forget that piece of the experience. I know that going into it, we talked a lot about how, for you, skin-to-skin was the top priority. Even if we didn’t do the assistancy section thing, gentle C, that that skin-to-skin was so important. Do you feel like, looking back, that’s the memory? What stands out for you with the time skin-to-skin?
Justine: Do you mean like what stands out to me over for the whole process?
Sarah: No. In that moment, like how are you feeling? When you think about your memory, does that piece stand out?
Justine: Yes, and I think I feel so happy. I’m so grateful for it too, and I wish everyone got, was the freaking video of your birth and beautiful photos. Looking back and it’s like, I have all these, like I’m looking at Eric and I look so happy. I’m just full of joy. I remember the joy, but being able to see the joy is so nice. Yes, it was a moment. I think also a little bit unfair to the story is that I’m like so tired, six weeks. I’m like, what was the birth? I don’t even know yesterday, but I’m thankful that I have my history, my video of it.
Postpartum is really hard, really, really hard. I have a lot of empathy for my coworkers that come back and myself as I go back. I can see so many faces of people I work with, that they’re like so tired all the time. I know we’re all tired at night shift and then day shift, but I’m thinking about these people that are raising these little ones and trying to pump and drying out at work. We’re not giving them enough. We’re not.
Especially from, and I’ll just say it, older nurses that are like, suck it up. I didn’t get that long. Sorry, I wish I could have pumped. I’m like, what can we do better for our coworkers and people close to us in like the first year, and what grace can we give them and help can we give them? Because they obviously have to be at work. Otherwise, why would they be working? None of us would be working if we didn’t have to work. They’re here.
I think about one story, I feel like I saw it on Instagram, was this nurse, this L&D nurse, her husband had to bring their baby at every break so she could feed him because he wouldn’t take a bottle. It’s crazy things we do to be working women in this country. It wasn’t men– the system wasn’t built for us. The system wasn’t built to work and raise a family and have hobbies and have joy.
I don’t know, I’ve been motivated to show up better for just the people that– everyone, everyone’s going through something, but right now in this baby making time in my life, I’m like, man, I didn’t show up well enough. I don’t even know what that means. Maybe even just like listening better, asking more questions, offering some food, offering another break. Can I help turn your patient? I don’t know. What can I do to make it better? I really don’t want to switch that day, but I technically can. All right. Things like that. I don’t know what that looks like.
Sarah: It makes me just think like. Of course, with this era of our lives, I feel like everyone around me is having babies and is in that newborn– and especially the two kid thing, a lot of the people around me are on their second kid, and they’re in the thick of postpartum and recovery in postpartum, like the year recovery. It just feels like the general consensus is postpartum sucks. It’s the worst season of your life.
You just have to get through it. It’s awful. You’re exhausted. You think you’re not going to remember it or like you say you’re not going to remember it, but in the moment you’re like, I will never forget this because it’s truly traumatizing. The amount of PMADs, I’m seeing postpartum depression, anxiety, OCD tendencies, it’s everywhere. I feel like, one, wow. This is like a really broad question that’s really dumb because, of course, why does it have to be like this? What’s missing now? Has it always been like this? I don’t think so.
Of course, anthropologically, we would go back to the fact that we’re just not doing life together anymore. We’re so isolated from one another, and you’re supposed to be independent, and you’re supposed to figure it out. Who are the people that are thriving in postpartum? My clients who can pay me out the nose for my services and a night nurse and a chef and a house manager and a housekeeper once a week.
They have family in town, and they’ve taken time off work. They have all the help in the world because that’s the only way to do it. They have their meals delivered for custom postpartum, whatever. I love that for them, but that is not real life. For the average person who’s off doing it on their own and their partners, if they have one, goes back to work day two, day four. One of my good friends, he left at the delivery room, and I stayed with her and he went to work.
Justine: I saw something recently of someone’s parent died, I believe. She said, please reach out to my best friend or my sister to see what I need in this time. I loved that because, instead, when people ask you what you need, you’re like, you feel like you can’t really say what you need, especially the masses versus you would be able to tell, Hannah, I would be able to tell Jordi, this is what I need, this is a list. If people reach out to you, please let them know what I need and they can decide. I thought that was really cool.
Sarah: Ooh, I love that tip.
Justine: Yes. Just like that’s going to be my sister.
Sarah: Who’s your liaison?
Justine: Who is your liaison? Pick one and, yes, have a list of– Yes, like a cleaning service. There’s so many random– like random cleaning services you can hire.
Sarah: Life changing.
Justine: Food. Food’s the one. I want to craft two meals that I could just bring easy. It feels overwhelming to bring a whole meal, and it feels lame to go buy a meal right now. It’s that home cooked meal that feels so loving.
Sarah: Well, it’s the practical stuff. Can I come do a load of– like do your laundry for the day, or throw it in the wash and I’ll come fold it and put it away for you, those simple things. Unfortunately, I think about even us texting here and there or one of my best friends, Brittany, you guys both live over an hour away. If you were down the street, I absolutely could find a moment, but I can’t find two hours and, depending on traffic, two hours each way plus being there. That’s a lot more– especially with my stupid schedule.
Even then, there would be moments that I could find. It’s just like, if you’re close by, we’ve got to remember these parents who are giving birth and recognize that we are genuinely not programmed to do it alone. You have Jordi living with you, your sister. I’ve talked about having a baby on my own and probably after move, if I’m still single, I mean I got eggs in the freezer. I do, I would start with like just some semen here and there to see if we can make it cheaper.
Justine: You know you can buy those things on Amazon, the applicators.
Sarah: Turkey baster.
Justine: Yes.
Sarah: Yes, I just like use a syringe. Does it matter?
Justine: No.
Sarah: Shove it up there. Do it myself.
Justine: Do it yourself.
Sarah: Just one night stand-ish.
Justine: With yourself?
Sarah: That’s so cute. Yes, I don’t know. Anyway, when I think about doing it myself right now, my sister and her family still live with me, and I’m like, well, if they were still living with me, then absolutely I could have a baby. Absolutely I could have a baby. It would still be entirely my responsibility, but we would decide as a family that we’re doing this. I watch their kids, and I give them lots of moments free and like, you got it? I’m like, yes, for the next couple of hours, I’m going to play and that’s my time off.
Justine: Slash, they could just– Hannah could just move back in with you for a few months if they didn’t still live with you. I think about that with Doherty. I’m like, I will move in with you. Whenever you decide to have kids, it’s going to be longer and my kids will be older. I’m moving in. I think that’s awesome.
Sarah: I did that for both of her babies because she gave birth in Minnesota, and I went back for at least four weeks. It was four and seven weeks, depending on the baby. Anyway, all of that being said, not to harp on postpartum because I know that’s not necessarily our specialty, but also we’re human beings and we have people around us having babies all the time.
Justine: Yes, just love them.
Sarah: I think that’s a really important thing.
Justine: With the way our country’s healthcare system is, they’re coming back to work a little too early, so just love on them a little. Mind you, the going back to work is exciting when you think about using your brain and talking to adults and having to take a shower and get ready. That feels good. Driving in the car in silence. When that novelty hits off? Runs out, you’re tired. Ultimately you’re going to go home and have to take care of kids. I hear all the time my coworkers that don’t have kids listening to us, who have kids, they’re like, oh yes, we don’t sleep. They go home, and they go to sleep, which I remember doing that. I went home and slept all day, right? They’re like, I don’t understand. What are you talking about? I’m like, it’s how it goes, but also it shouldn’t be how it goes. This is why we are so unhealthy too.
There’s a lot to fix, but you’re absolutely right. We need a community. My friend the other day was telling me, she’s like, I want to go back to hunter-gatherer. I just want to like pick berries with my girlfriends, maybe on the back or chit-chat and talk. My husband’s building me like a house, hunting me a lion. I’m just with my friend.
Sarah: Notebook style. That’s cute.
Justine: That was funny. Overall, my birth story was everything I wanted it to be. Even they were so worried about sending him to the NICU, but I was like, everything’s been so great and so much better than before that it is okay–
Sarah: We talked about this.
Justine: Yes. It’s okay. Go ahead and take him. Mind you, did I know it was going to be $33,000? I don’t have to pay that. Thank God. It’s wild to me. It’s such a scam, dude. That’s why my monthly dues are probably going to be more because hospitals are sending these insane bills to insurance companies. Why don’t we just not do that?
Sarah: Right, or like also individualized care where you have two nurses, plus so many of your people in and out of the room checking up on everything. I will say that the supervisor that was there, that was advocating for you, that I was so impressed by how hard she went to bat for you and just the fight that we put up and the abuse that we take for the sake of our patients. Obviously, there was a lot more stake in the game because she cares about you personally, and she knows you personally.
It’s like look at the scenario and that’s what she was advocating for. We’re looking at him. Yes, his sugar is this, but he’s also asymptomatic otherwise. He just took three of mls of a hand expressed colostrum that we got out in like literally less than five minutes. We just went to town milking you. Then they also gave the sweeties. Just like, hold on a second, throw a pulse ox on in the room, and his pulse ox is good. The rest of his vital signs are good. He’s skin to skin, slash, he’s warm right now. It’s okay.
Looking back, we know it was okay. If it wasn’t okay, you’re right, that looking back, you’re going to regret him not going versus going, but also big picture wise, we have to be individualizing that care. I have a final question for you. That is, based on this last birth experience, how do you feel like your care will change? How would you hope for nurses’ care to change based on being the patient and having experienced this whole new birth?
Justine: This happened last time too, of just talking to the patient in the OR and making a point after the birth to go over to them and talk to them, I think. That faded off for me, one, because it became like the charge, and I wasn’t as much in the OR, but two, in general when I was on the floor. I plan to go to the floor next year. I hope to be able to have more opportunities to do that. Then how do I want nurses to change? Honestly, my little spiel there of like caring for each other. I want nurses to do that.
I want nurses to let the patients do whatever the hell they want, which ultimately– As long as you’re safe, sure. It didn’t hurt anybody, and everything went well. I had a good experience. Maybe just listening to what they want and asking more questions and getting to the root of it and just being open to like a different way.
Sarah: Maybe a little inconvenience on your part for the sake of the patient.
Justine: Right, being okay with a little inconvenience and remembering, and we say this all the time, that this is one of the biggest days of their life and theirs and their partner’s life and whoever’s with them in the room. It’s just a Tuesday for us. If it all goes well, we’re never going to remember that day. We only really remember the bad ones or the really, really good ones, but we forget a lot of that. You don’t know until you know.
We had 14 of us pregnant at the same time on my unit. We’re all given birth, and there’s a lot of texts of like, I’m going to be such a better nurse. I’m going to do this different, and just ultimately empathy for being pregnant– being pregnant’s hard and the triage, the triage visits. They don’t necessarily don’t want to be pregnant anymore. They’re just miserable, or they’re just anxious. We don’t know why, but there’s a reason. That’s what you say, I know there’s a reason. We don’t know why.
Sarah: I think the other prompt, just looking at your birth, if I can chime in, because I was there, was I think you had the experience you did because you had a lot of people that actually genuinely cared about you. I’m hypothesizing here, but I would imagine that there are other patients that would come in with your exact same birth preferences, and they would be labeled crazy, too much, anxious, extra, all these things.
Justine: I was so worried about being labeled that myself.
Sarah: Right. Everyone was like, so on board-
Justine: Right, almost gave up on it.
Sarah: -yes, and above and beyond for you. That’s because they know you. While that, for your sake, I think is so beautiful. Of course I would want nothing else for that to be the case, but we know that the average Joe Schmo off the street is potentially not likely to receive the same care. Just that discrepancy in care, I think is just something that I’ve thought a lot about from your birth, not in any kind of resentful way, in more of a like celebratory way of like, this is what it should be.
What did it take from the nursing side was they knew you, they loved you. They cared about you. They had more context. They came in compassionate. There was this humanity because they’ve spent time with you. At baseline, this goes back to everything that we say all the freaking time is it comes down to that like, how much would our care change if we actually asked them about their preferences, got curious about who they are as much as you can ahead of time.
Of course, no one’s going to ever know you like they know you if you haven’t worked together. Could we just level up our care a smidge to care a little bit more about their experience? Like we said that, be okay with a little bit of inconvenience for the sake of their birthday.
Justine: Honestly, I think about my labor nurse, she didn’t have much more work to do. It was the same. It was a lot of the same, thinking about it. I would do it for anybody.
Sarah: That was that though. When we look back on your experience, I think going back to the skin to skin in the OR episode that came out last week is really, really important for us. I love that that’s already come out. We’re already thinking about it. Then you get to hear from you and your experience of like, at bare minimum, what are the practice changes that we can do to make the biggest impact? One of those to me is definitely pursuing skin to skin in the OR.
Justine: 100%. I am going to push for that. When I go back hard is my goal. Flex and pull out my energy levels. Because you need energy to push for change. I will say that to people listening, you need the energy. Your basic needs need to be met before you can go into– I wonder where policy change would be? It’s not like actualization, but it’s up there.
Sarah: No. Somewhere in there activated, like you’re activated and motivated to move.
Justine: Yes, you change for other people.
Sarah: I picture you like finding a few of your friends that pass off the podcast, whether it be this one and the skin to skin one. If this is something that you’re passionate about, find your little posse and bind together and go, how are we going to do this? What does the policy say? Let’s decide on our unit to lead by example. Let’s be the skin to skin in the OR nurses, and then jump in and start doing it and then share your wins. Share what worked. Ooh, this workflow was better than this one when I tried it.
I find that, when you put a warm blanket on them right before that, when they walk in, they get a warm blanket on their chest or like bear hugger versus not, or make sure you unsnap them at this point in the process. If they’re not able to, then they go directly on the gurney. They’re going skin to skin, which is one of my hills I will probably die on like at bare minimum. Come on guys, they do not need to be wrapped up.
I think again, just reinforcing for the season of the theme that’s come out very much is there’s a human in front of you. Remember that human. You have the potential to make such an incredible difference. There are issues with the system, but there’s also so much potential for change and so much potential that lives in our hands for starting to push the dial on some of these things that ultimately, not only hopefully create better outcomes, but also those birth experiences that so matter for these patients.
Justine: Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram.
Sarah: Now it’s your turn to go and treat at least the next, but hopefully the ones after that, treat the next patient as if it’s your favorite coworker. We’ll see you next time.