Birth Matters Podcast, Ep 88 - An Aussie’s 2nd Unmedicated Hospital Birth

credit: Tiny Heart Photography. image shows: pregnant mom with daughter, both wearing dresses, little girl wearing a cardigan and putting a flower on her mom's belly

Lauren’s first time giving birth was pre-pandemic in Australia in a very different healthcare system. So when she and her husband Shaun relocated to the NYC area to suburban New Jersey and wanted to conceive again, she began listening to this podcast as a way to get to know the local birth environment. Today she shares her experience of having an unmedicated birth for a second time but in a New Jersey hospital. Lauren tells us she gleaned wisdom from listening to some of the birth stories shared on this podcast that helped her to more confidently advocate for herself to have the unmedicated birth she hoped for when a nurse was pushing to start pitocin. Then you’ll hear her compare and contrast the Australian birthing environment to that of the NYC area – particularly along the lines of lactation support.

Resources:

Peanut Balls

newborn baby with pink and blue striped hospital hat on , hands at face, erythromycin eye ointment on eyes, linens surrounding baby

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Episode Topics:

  • Weaning her 1st born from breastfeeding to get her cycle back, getting pregnant quickly

  • Doing Pilates during pregnancy

  • Listening to podcasts (including this one and one from Australia and the UK)

  • Wishing an OB would see her earlier than they would (in Australia they’d be seen much earlier)

  • Gestational Diabetes (GDM) diagnosis, easily managed but treated very differently in Australia versus getting labeled “high-risk” here

  • Bought time with 40 week induction

  • Scheduled membrane sweeps (at her request)

  • Going for a walk, contractions evolving

  • Getting home and contractions get stronger -- seems like really labor 

  • Doing bedtime ritual with her daughter

  • Labor gets stronger, they call babysitter and head to hospital

  • Triage monitoring

  • Wireless monitor, IV hooked up but no fluids

  • She’s very thirsty, drinks when no one is in the room

  • OB does an exam and says she’s 7cm, encourages use of peanut ball

  • Nurse does exam and they say pitocin and epidural are recommended

  • OB does exam and says she’s 10cm and ready to push

  • She starts pushing, but OB tells her she’s “not pushing right”

  • Advocating to push on her side because the contractions were more effective on her side than her back

  • OB flips her on her back for the very end when baby was crowning

  • Baby latches right away

  • 2nd degree tear, painful stitching (painful both times, first had an episiotomy)

  • Early breastfeeding, comparing/contrasting the breastfeeding support/education

Interview Transcript

Lisa: Hi, Lauren, welcome to the Birth Matters Podcast. So good to see you today.

Lauren: Hello, thank you. It's good to see you too, thanks for having me.

Lisa: So excited to hear your birth story. I've seen a little bit of the details in an email, but I really look forward to hearing even more. Sometimes, you get new details when someone shares verbally that you don't get in the writing.

Introduce yourself

Lisa: So could you please just take a moment to introduce yourself.

Lauren: Sure. So my name's Lauren and I live in Bergen County in New Jersey. I moved here almost two years ago from Australia with my husband, and we have a three-year-old daughter and a four-month-old daughter. Um, And I'm a scientist for a living.

Lisa: Oh, a scientist. Would you mind me asking, what kind of science?

I do neuroscience. So I'm researching Alzheimer's disease.

Such important research. Oh my goodness, thank you for the work you're doing!

Lauren: Yeah.

Lisa: That's really important.

Lauren: It's really interesting.

Lisa: Hmm. That's another podcast. All right.

Her second pregnancy

Lisa: So first, would you please share a little bit with us about your second pregnancy that you most recently went through and the different ways, especially since you relocated from Australia, having given birth there the first time.

What were the ways that you prepared for this journey into being a mom of two and were there different choices you made based on how things went the first time? Just any of that and how did your pregnancy go medically?

Getting her periods back

Lauren: Sure. So I guess the best thing I did to prepare was, when I moved to the US my daughter was 18 months old and I hadn't got my periods back from since I became pregnant with her. So the first thing that I did was to wean her. I had talked to a gynecologist before moving here, and that was what we kind of concluded was hopefully going to bring my cycles back, and it did. So that was, I guess, step one in my mind of preparing for the pregnancy. And it only took us a few months after that to get pregnant. So that part of it was relatively straightforward. And I guess I had a very positive pregnancy with my older daughter and positive birth, so I kind of just followed along the lines that I went with that one because it worked, right? So it made sense to do the same sort of thing again.

Picking an obstetrician

 There was a hospital about five minutes from where we were living, so I had just started with that hospital, because that made sense and looked at obstetricians that practiced at that hospital, I guess.

And we didn't really know anyone here at the time, so that really just involved, like reading online reviews of various obstetricians and picking one. So I was a little bit blind I guess, when I picked someone and went with it. And then, I guess the other thing, I didn't really do anything else to prepare for the pregnancy.

During the pregnancy, I did Pilates, which I had done before the pregnancy and generally tried to be active as much as I could, just because I don't know, I feel better when I'm active. Although having said that, I get pretty bad nausea in the early part of pregnancy, so that all goes out the window early on.

And I guess the other thing I did is, I like to listen to birth podcasts, which is how I came across you later.

Lisa: Yay.

Lauren: So I listened to a lot of podcasts while I was pregnant. And part of that was like, I felt very unfamiliar with the US healthcare system. So part of that was, I felt like it was making me a little bit more familiar with how things work here by hearing what has happened with other people here.

Lisa: And we did one of your refresher courses by Zoom, because it was COVID and also, we're in New Jersey, so it was probably more convenient anyway. It was so funny, because I was looking back when you took it with me, and for some reason had this memory that we were in person. I guess I've just gotten so used to Zoom that I kind of feel like I've been with the people in the room when I really have not.

Lauren: Yeah. Yeah, it definitely feels weird when you see people in person these days.

Other favorite podcasts

Lisa: Yeah. Yeah. Did you have other favorite podcasts that were pregnancy-related? I'm just curious.

So during my first pregnancy, well, not my first pregnancy, my first pregnancy ended in a miscarriage, but my second pregnancy with my older daughter, I listened to a podcast called Australian Birth Stories, which is very similar to yours but an Australian version, I guess.

Lisa: Oh, I'd love to tune in. I know some birth professionals in Australia, so I'm curious if I happen to be familiar with the person who hosts that, but I don't think I've found that one before, so I'll look it up.

Yeah, it was good. I liked it. And that was what made me look for one this pregnancy. I think before I found yours, I found one from the UK that I started listening to, but then I found yours and I was like, well, this is a New York one, so I stuck with it. I thought it was very good.

Early pregnancy in Australia vs US

Lisa: Oh thank you. And now, am I remembering correctly that you reached out to me pretty early, because you were told by an OB that they wouldn't see you as early as you were used to being seen in Australia?

Lauren: Yeah, yeah, that is right. So I guess when I was pregnant in Australia, what normally happens and what happened with me is like, you do your at home pregnancy test and it comes up positive, so then basically, the next thing you do is make an appointment with your GP. Which I guess here is called a primary care provider.

Lisa: Yeah, some people say GP as well.

Lauren: Okay. So with your GP, and they to do a blood test and they check your HCGs, is that the hormone levels, and just do a general run of, I don't know like iron and all those sorts of things. And I don't know what else they check; they check a few things. So that was kind of what I was used to.

And also you need a referral from your GP to go to an obstetrician in Australia. So you have to do that appointment fairly early before you go and see an obstetrician. But both times for me, the GP had sent me for like an early ultrasound before I went to see the obstetrician. The first time it was because I was going to be going overseas and she was like, this will just give you an idea of where you're up to before you go overseas.

And then the second time, I think she was conscious that I'd had a miscarriage and was slightly anxious. And I also had had a bit of pain in my side. So the doctor was like, we should really just get a scan done.

And then think I saw the obstetrician in my pregnancy with my older daughter at like seven weeks. Whereas here, when I first called the obstetrician that I'd found online they were like, we just do the appointment when you're 12 weeks, and that's what we do. So it was strange to me because it was so different. That's pretty late.

Yeah, and I'm pretty anxious, like in the first trimester, so I just wanted to talk to a doctor. I don't know, because it feels like you're doing something, even if I know can't do anything. And I didn't really know anyone here and I'd been listening to your podcast. I was like, well, this is the only person I know, I'm going to like, try emailing them and see what the go is. So I was very grateful that you replied and yeah.

And I did end up seeing a different obstetrician earlier. I can't actually remember how many weeks in it was, but yeah.

Lisa: Yeah, usually they'll at least see you once at like seven or eight weeks, you know, before that 12-week appointment.

Lauren: Yeah, yeah. And I think that's what I ended up having. And then the first obstetrician that I saw was like, she didn't actually do deliveries. So she recommended that I go to the obstetrician that I was actually originally planning on seeing. So I just went back to her from the 12-week mark.

Lisa: And I just want to be sure to say I'm so sorry for your loss with your miscarriage. I feel like people kind of just tend to be dismissive of that and there's some real pain and grief there. So anyway, I just wanted to mention that my heart goes out to you. And as you were saying, that it does play into how you feel about future pregnancies and the anxiety you feel.

Lauren: Yeah.

Lisa: Well, were there any other things about pregnancy that you wanted to reflect on?

Gestational diabetes

Lisa: The gestational diabetes perhaps?

Lauren: Yeah, I had gestational diabetes in both my pregnancies. And I guess, because this was the second time I had it, I didn't feel like it was a big deal this time. It was fairly mild for me in the sense that I was able to control it just with diet, very well. Like I never had high glucose levels, and because I knew that that's how it was for me the last time, I was fairly comfortable with that.

In my older daughter's pregnancy, I did find it a lot more stressful, until I kind of worked out the dietary modifications, and so forth. So I don't want to just say, oh, it wasn't a big deal because if someone gets it for the first time, it can be a big deal.

But it's something that can be managed and yeah, in the end it was just a matter of making a few dietary changes, and once I sort of had my head around those changes, it was fairly easy to manage.

 You did mention that it seemed like there you were treated fairly differently in Australia with that condition versus here. Do you want to touch on that?

Lauren: Yeah, sure. So I guess in Australia I got diagnosed, the test is different to start with. It's done at the same time, 28 weeks, but in Australia they do a four-hour test. So they do your fasting, they do a one-hour, sorry, two hours. Fasting one hour and two hours, in the one test and then you get diagnosed.

Whereas here, I did just a one-hour test and then I didn't pass that, so then I came back and did the three-hour test. So when I got diagnosed in Australia, my obstetrician referred me to a diabetes educator who sat down and talked to me about, first of all, the testing regime and secondly, what the diet should look like and the types of changes I could make and you know, the exercise recommendations and so forth.

But then after that, my management was pretty much the same as it would have been for any other patient. I did give my blood glucose levels to my obstetrician at all my appointments. But because they were never high, there was never anything else that really happened. So I did have an induction scheduled. I think it was the day of my due date, and I went into labor before that. So I wasn't induced, so yeah, yeah, which I was very happy about. Both times I made it before the induction.

Branded high-risk

 But here I got, I guess, branded as a high-risk patient when I was diagnosed with gestational diabetes.

Lauren: And I guess it felt weird to me because my obstetrician didn't treat me as being high-risk in Australia. And I guess I didn't know for sure that I was going to be able to control it with diet the second time round. But once we were a few weeks into it, the same foods that I was eating were having the same effect. So it felt like it was very similar to the time before. But I got referred to maternal fetal medicine, so I had like additional appointments with the high-risk obstetrician. And I also had to do from 30 or 32 weeks, I had to do weekly ultrasounds and weekly non-stress tests. Yeah, at least I know the baby's like, definitely, definitely, definitely fine, but it felt like a bit overkill. And it kind of, I didn't know if I'm just like a little bit skeptical, but it just felt like an extra thing they could bill me for in some ways.

High-risk obstetrician appointments

Lauren: Having said that, the appointments with the high-risk obstetrician, she was actually really good.

She would actually sit and just chat for 45 minutes or something, which is what I was used to in Australia. So my Australian obstetrician, the appointments were always like 30 minutes, 45 minutes, an hour, like just however long it took. She would just sit and talk to me and my husband about whatever we needed to talk to about. Whereas here, the appointments were like, I don't know, like 5 minutes, sometimes 10 minutes. And I always felt like you had to plan your one most important question.

Lisa: Right. Yeah. You have to be very efficient with your list.

Lauren: Yeah, the one good thing about a high-risk obstetrician is she would just chat about whatever you wanted to chat about.

Less overbooked maybe.

Lauren: Yeah. Yeah, I think she must have been. Because I think the obstetrician I had here, she seemed like she would have been good in a different environment and was just like, there's just too much time pressure maybe.

Lisa: Yeah, it's our healthcare system. It's just really the nature of the beast, unfortunately. And I do want to point out too, that I appreciate your sharing those two pretty different experiences with this condition, because even within the New York area and various different care providers, we see a pretty big range in terms of how they handle a milder case of gestational diabetes, such as yours, one that does not have to be on insulin.

You know, some would do what you described in Australia where it's just a little bit of an extra monitoring, but as long as it's well-managed, and there's not a concern and don't have to go on insulin, then we're really not having that high-risk label slapped on us and being treated really differently.

But it just really depends on the care provider. Yeah, I mean, even from one OB to the next OB, I would dare say that most hospital OBs all OBs guess. Most OBs tend to treat it a little more cautiously with this high-risk thing than like a hospital midwife would.

 But that's not even black and white either. You're going to see a range from one midwife to the next, and one OB to the next.

Lauren: Yeah, sure.

What does high-risk really mean?

Lauren: I did actually ask my OB at one point, like what makes me high-risk, if my blood glucose levels are the same as someone without gestational diabetes, by virtue of the fact that I've modified my diet, to me, obviously, I'm not a medical professional, but to me that makes the in utero environment for the baby, the same as it would be if I didn't have gestational diabetes.

Lisa: So what makes me high-risk? And she was just kind of like, well, you still have an underlying condition. And that was like as far as I got, which didn't really answer the question. Yeah, and that high-risk label, doesn't really tell you much in terms of like, well, the more useful thing to know, if for any kind of risk factor that someone might have is, how does that affect my pregnancy? How does that affect the protocols in labor?

How does that affect when I might be induced? How does that affect the amount of monitoring that's going to be required in my labor? Does it restrict me to the bed? You know, so I always try to reframe that a little bit and help my clients and listeners to think about that a little differently. Because high-risk, like, what does that even mean?

You know, somebody is 35 and suddenly they're slapped with this high-risk label, and that really is so nebulous. It doesn't, it's like let's get a little more specific in what kinds of questions should we ask to help us understand what this means for us. Yeah.

Yeah, and gestational diabetes is such a tricky one because I feel like there's just a lot we still need to learn about that in order to really have enough evidence to know how to manage that better we do now with the kinds of testing we do and stuff.

Yeah. All right, anything else about pregnancy or if not, you can go right into your birth story wherever you want to start.

Birth story

Lauren: Okay. Sure. So I think I mentioned I had, so my obstetrician wanted me to be induced, I don't know, around my due date, because of the gestational diabetes. So we pushed that a little bit into the following week, to buy me a little bit more time.

Membrane sweeps to avoid induction

Lauren: But the other thing we did is scheduled a couple of membrane sweeps, because I had done that in my previous pregnancy, because it was something my Australian obstetrician had recommended if I wanted to avoid like the full-scale induction.

And I did avoid it the first time, so I was like, well, let's just ask if I can do it again. And hopefully we'll avoid it again. So the first one of those was meant to be like 10 days out from the induction. But the obstetrician said my cervix was completely closed, so she couldn't do a sweep that day.

Lauren: So we scheduled like another one, I think it was four days later. So we're like six days out from the due date now. And my obstetrician was away at that time, so she got me in with one of the other obstetricians in the group, who I'd seen I reckon, once or twice during my pregnancy. So I went in that morning and I had, so this is a Tuesday morning, I had my last of the weekly ultrasounds that morning. And then after the ultrasound, I was getting the sweep and it was very different to the sweeps that I'd had in my previous pregnancy.

Lisa: Oh, how so?

Lauren: So I hear people talk about sweeps, and some people described them as uncomfortable, and some people described them as painful.

Lisa: Painful.

Lauren: Yeah, and so I was always like, I wouldn't go as far as saying painful. I reckon uncomfortable is like the accurate description here. But this one was painful. This one was definitely painful. So, yeah, I was like maybe there's sweeps and there's sweeps.

Lisa: Right, well, and then it makes you wonder if it was a difference between the technique, between one care provider and the next. Or was it, it could also have been a difference in how ripe your cervix was, how soft it was and the position of it. I don't know.

Lauren: Yeah, I put it down to the care providers, but maybe the cervix had something to do with it too. But in any event, that sweep was, I'm pretty sure what instigated labor, because it was like less than 24 hours after that, baby was born. um,

Lisa: Worked quite well. Nice. So I went home from that and that was actually my first day off work.

Post-sweep

Lauren: So I was like, kind of coming up with some plans of how I was going to spend the next week. I had up until that day, I felt like I was going to be getting close to the induction day, I didn't feel like it was imminent. But after the sweep, I had you know, the general crampy feelings, which I think are normal after a sweep, so I just assumed it was the aftereffects of the sweep. And I don't really know what I did that morning. I just pottered potted around and time disappeared, I think. So it got to like around lunchtime, I was like, oh, I should probably go for a walk, so I'm actually doing something today.

The town we live in has like a main street and stuff about five minutes from our house. So I was like, I'll just walk through the main street and grab a drink and stuff.

Mild contractions

Lauren: And, as I was kind of enjoying that, the crampiness kind of changed into, I guess I would call them like really mild contractions. So they're not painful, and I was still like, they could be the kind of contractions that just peter out, and maybe it's a bit from the sweep still, let's just not get too excited. So yeah, I went for a bit of a walk, came home and just puttered around a bit for a few hours again. And then one of the things I wanted to do on what I thought was going to be almost a week before I had the baby, was trial walking my daughter home from her daycare.

Because I thought that would be something nice to do on maternity leave. Take the baby for a walk and walk my toddler. But I'd never actually, we'd always picked the toddler up in the car, like on the way home from work or whatnot. So I was like, I'll give her a trial run, walking home from daycare. So I went and got her, and she passed the test. She was very well-behaved.

 So we had time to walk to daycare. But by the time we got home, the contractions I guess, were starting to feel a bit like maybe they're picking up a bit, like maybe they are going to end up being real contractions, but I was trying to, I guess, partly to myself, but also partly just to make sure my husband didn't get stressed. I was trying to play them down a bit at this stage, I think.

Because I also had in mind, like the evening with a toddler is relatively, you got to get through that evening crazy hours.

Lisa: Oh, how I remember those years and times.

Lauren: Yeah, we had dinner and did her like crazy play hour where she's almost psycho she ever is.

Lisa: Get all of that energy out!

Lauren: Get it out. And then, so by her bedtime, that was probably when in my head at least, I was like, yeah, these contractions are real, I think. So I kind of said to myself, I just have to get through bedtime, because I do the toddler's bedtime and she's very unreceptive to suggestions that her dad become involved in that process.

So I was like, I'll just try and keep that as normal as possible for her, and then we'll figure out what's going on after that. So I did that, and I think it was good that I did that because it wasn't exactly normal. She could tell that something was going on, like she knew, because I laid down next to her while she's falling asleep. And I like by this stage, I couldn't really just lay still. So it kind of meant that I kind of explained to her she was going to sleep, but you know, I wasn't sure, but we might be having the baby tonight.

And if we did, Stephanie, who was our friend who was looking after her would be here in the morning to take care of her and take her to school and stuff. And she took that surprisingly well. I wasn't sure how she was going to react, but she was fine. And she did eventually go to sleep and I kind of like snuck out the room very quietly and came downstairs.

So then I was kind of like, okay, now it's time to figure out what's going on. And I think it was probably about half past nine by this stage. And my husband was very much like, "do you want me to call Stephanie?" Who was like coming over to look after Matilda. And I was like, I'm not sure yet. And he was like, it's 9:30, she's probably going to bed soon. And I was like, yeah, I know we need to let her know before she goes to sleep.

Contractions progressing

Lauren: So I sat down with the app and timed some contractions, and they were, I think about three to four minutes apart, and lasting like around a minute. So, I was like, yeah, okay, I think you should probably.

Lisa: Time to go.

Lauren: Probably time to go.

Lisa: When it's your second. Everybody, listeners hear me when I am saying your second. I mean, because otherwise I would say maybe see if this is actually holding a pattern, you know, and I'm assuming they were pretty strong at this point.

Lauren: Yeah, yeah, they we're pretty strong.

Lisa: That's also key.

Lauren: I actually have your voice in the back of my head. It was probably you that made me take that seriously. Because I didn't want to get there too soon, but I didn't think you were the type of person that would encourage someone to get to the hospital too early.

So I was like, she said that this is the time to go, like, definitely go. That's your second pregnancy. And I was like, I got to listen to that, and we should probably go.

Lisa: I think when we've given birth before we tend to just be like, like putting it away, like, nah, no, no, this isn't really labor. And then like, whoa, wait. Yeah. And my body knows what to do much more quickly.

Lauren: I think the other thing with my last labor, my contractions kind of like, they started on one day and then I stopped for a couple days and then they started again. And then there was like a gradual build up, and then my waters broke. And when my waters broke, that was when they really like, it became clear that it was go time.

Or like, go to the hospital time, at that point. And this time my waters didn't break, so it was different. And I kept being like, well, my waters haven't broken yet. And obviously, like, it can be different, but last time that was kind of like a trigger for me, so I hadn't had that.

It turns out, I definitely didn't want to wait for that in the way things panned out, but I didn't know that at the time.

But yeah, so we got uh, the babysitters to come around and once she was here, we kind of just went. And the hospital's only five minutes away, so it didn't take long to get there, which is good, because car rides are fun.

Lisa: Oh man, yeah.

Got to the hospital

So then I got to the hospital, and it was really busy. So they were like, there's only one room free. So I guess I was lucky there was one room free. It wasn't the room with the tub, which is like what I had wanted. I knew they had one, so it was always a possibility. I had used the tub for most of the time I was in labor at the hospital the first time, was kind of like my primary plan. So it was quite good that we did the session with you to talk about like alternative techniques.

Lisa: Other things.

Lauren: Until we'd done that, I didn't really have a backup plan.

Lisa: Yeah.

Lauren: So yeah, it was a good idea to have a backup plan. But yeah, so they put me on the monitor, like when we first got there for, I don't know, I think it was like 20 minutes or so they just wanted me to sit in the bed and have the monitor strapped on.

COVID test

Lauren: And I had to get a COVID test, which was a million times worse than any other COVID test I've had.

Lisa: I feel like at the hospitals, they go deeper with the

Lauren: Yeah, I wasn't sure if it was like they went deeper or if it was just like, well, I'm in labor so.

Lisa: Maybe, yeah.

Lauren: I don't know. But I don't think they gave my husband a COVID test, which I thought was strange.

Lisa: A lot of them are, I assume it's because they assume you're coming from the same household, and they're not the patient, so they just figured they would test the same. That's my best guess as to why they often don't test partners.

Lauren: That seems logical, but if I was using that logic, I would test the partner.

Lisa: Good point, I hadn't thought about that. Why further torture someone who is in labor?

Lauren: That's probably something about them not being a patient

Lisa: Yeah.

Lauren: Yes. But yeah, so I had that done. The obstetrician came in and checked my dilation, and I was like four to five centimeters, she said. And then, they were kind of just going to leave me be for a while.

Lisa: Do you remember how long it took to get your COVID test back at your hospital?

Lauren: Well, they didn't even tell me ever, so I just assumed it was negative.

Lisa: Yeah. I mean, we see such a big range in how quickly or not they come back at the different hospitals, so I was just curious.

Lauren: Like 99% certain, we never got the results.

Lauren: Because I remember saying to Shaun at some point, in the postnatal ward, we never got those results, did I? And then I was like, well, no, one's really been, they've all been like saying, oh, it's fine, it's fine, like, when they walk in, and we didn't have our masks on.

So I was like, on that basis, I assumed we're negative. Or I'm negative.

Lisa: Yeah. Yeah. And the other thing that happened was I asked them, because they wanted to keep monitoring, so I asked them to put a mobile monitor on. So then they came back and did that, which was less mobile than I was expecting, because it just kept moving and like it wasn't picking stuff up.

Contractions spaced out a bit

Lauren: So the nurse was like in and out the whole time adjusting the monitor, which was like, it was what it was, I guess. I'm not sure because the other thing that happened is after that time, my contractions kind of spaced out a bit and I feel like the intensity reduced a bit as well. I don't know.

I wondered if it was because we were very preoccupied with what the monitor was doing and, I'm not sure if that was like partially why, I don't know. But it kind of just felt like it could have affected things.

Lisa: It's really common when people leave their safe, private space of their home and then transfer to this place where strangers are coming in and out. It's really common for things to slow down for a time.

Lauren: Yeah. Okay. Yeah. Well, that's kind of what happened.

Very thirsty

Lauren: So yeah, they kind of just let us be for a while, which was good, mostly because I was really, really thirsty in this labor. And I didn't know why, but I was, so I was like drinking constantly. And I'm pretty sure the hospital had a policy that you weren't supposed to drink. 

Lisa: Oh yeah, because they almost all do, which is so behind the evidence.

Lauren: Yeah, and that was one of my questions at an appointment a little bit further back in my pregnancy, and the obstetrician was kind of vague, but she was like, the hospitals are kind of discussing whether or not we should keep that policy, but they haven't gotten rid of it at this point.

So when she said that I was like, well, it doesn't really sound like it's that important then. So I just kind of didn't ask about it. I was just like, I'm just going to eat and drink when they're not in the room, and if they don't tell me not to, then I'm not doing anything wrong.

Lisa: Did you hear me cheering you on in your head?

Lauren: Yeah. But I honestly don't know how I would have. I think I ate like little bits, but you know, you're in labor, you're not eating a three-course meal. But drinking, and again, I wasn't like spilling a liter of water, but I was having small amounts of water very often. I feel like I was asking my husband, like, where's the water? Where's the water? So I really don't know how I would have coped if I didn't have that.

Lisa: Now were you hooked up to an IV? Oh they put an IV in, that was one of the things they did right at the start, but they didn't give me any fluids. Because I asked them to shut it off and not give me fluids, because I was like, well I'm not dehydrated. You were just drinking to thirst.

Yeah, so that was like, I don't know, a couple hours or so, and then the obstetrician came back and checked me, and I think I was seven centimeters at the next check. And I was kind of like, oh, that's good, like we've moved. And she was like, yeah, we've moved, we need to go further. And I was like, umm, okay.

Lisa: Well, thanks for the encouragement.

Yeah, so yeah. In my head before she checked me, I was like hoping for eight. So I was like, yeah, seven, that's pretty close. And then she suggested that I try using the peanut ball, because I think she was keen to move things. I'm not sure if I mentioned this, this was not my regular obstetrician, it was one of the partner obstetricians in the group.

Lauren: And I had seen her a couple of times during my pregnancy, and she was very business -like, get the show on the road, kind of style.

Lisa: Not a warm, fuzzy bedside manner.

Lauren: Yeah. So I kind of knew that when I knew that she was the obstetrician that was there that night. But I was like, sure, I'll give the peanut ball a go, like, got nothing against it. I'd never really thought of using one before but, I was like, why not?

Lisa: I take it the hospital actually had that in the room?

Lauren: Yeah, I mean, I don't know if it was in the room or I'm guessing they brought it in because earlier on, I for an exercise ball and they had to bring that into the room, so I'm guessing the peanut ball was the same.

But I'm actually glad she suggested it, because it was fairly late in the night by this stage. I realized once I was laying down, oh, I'm actually a bit tired. It's kind of nice to be laying down for a while. And I just watched, we had some TV shows on our tablet, so I just watched a couple episodes of Saturday Night Live and hung out for a bit on the peanut ball.

Lisa: I was just going to ask if the OB showed you, like here's a position you can do or what kind of guidance did you get?

Lauren: Someone did because I was like, what do I do? I don't remember who, was the OB or the nurse, but someone showed me what to do.

Lisa: I think that's so cool because that's really not very common. That's more common for a doula to say, hey, yeah, let's get out this peanut ball and open the pelvis. That's really cool. I like hearing that.

Lauren: Yeah. I think it was a good suggestion because my contractions had spaced out since I got into the hospital. But it did feel like it progressed quite a lot more quickly once I was on the peanut ball. So yeah, there was obviously something to it.

And I used that for a while. I did take breaks from it because I felt throughout the whole labor actually, I've kind of felt like I had to keep changing what I was doing, like I'd do something for a while and then I'd be like, I need to be in a different position. So when I was on the peanut ball, I just kind of laid on it for a while, and then I'd get up and just walk in a few circles around the room, and then switch to the other side.

Lauren: And that kind of worked for a while. So I was kind of doing that for a while and it felt like the contractions were really progressing during that period. And at some point, the nurse came in and I thought the nurse came in because she thought it sounded like I was getting close.

Because to me, that's what it sounded like. The nurse gave me a check at that point, so that was the first check that the nurse had done. But she didn't tell me how far dilated I was after she checked. So I asked her obviously, where are we up to? She was like, I don't really want to tell you because it's a subjective measure and my opinion might differ from the obstetrician's.

And I was kind of like, okay, so why did you check me then?

Lisa: Good question.

Lauren: I was a bit confused and then I thought I heard her say something quietly to my husband and then she left. So I touched my husband, I was like, what did she say? You have to tell me, I'm in labor, I need to know what's going on. And he was like, "she said, she doesn't think you progressed since the last check." And I was like, oh.

Lisa: Didn't want to hear that.

Lauren: Yeah, I didn't want to hear that. And it wasn't what I was expecting, because it felt like that time that I was on the peanut ball, it felt like the contractions had really moved on like, I felt like I was kind of getting close to my limit. And I felt like I was getting louder, and I thought the nurse had come in because she could hear me. I didn't know why she actually came in. So I kind of had those, like, what's going on thoughts running through my head. And then the nurse came back in a few minutes later and she had this bag of fluid in her hands. And I was like, what's that?

And she was like, I think we need to start Pitocin. And I was like, oh, like, why? Because I was like, it's obviously not great if I haven't progressed, but also like, there's nothing wrong. Everything was fine. It was just, I was like, doesn't that just mean we need longer?

 And then she was like, so if we start Pitocin, which we should, you might want to reconsider getting an epidural. And I was like, uh.

Lauren: And she was like, because the contractions are going to get more full-on once we start Pitocin, which I'm sure that's probably accurate, although I'm not sure was in my case.

Start Pitocin?

But she left then, which was good, because I could like just verbalize my thoughts. And I was kind of like to Sean, I don't know, this is pretty full on. I thought I was at the limit, I was like, if they're going to start Pitocin, I don't know how much longer I can go without an epidural.

Lauren: And I was like, oh, I didn't know what to do. And then I was like, I don't know how much longer I've got to go either, if I haven't progressed for the last couple hours, how much longer is this going to go on for? So then the nurse came back in, because she still hadn't told me my dilation at this point.

So I was like, I get that you don't want to tell me your assessment of how far dilated I am. Can I get checked by the obstetrician? And she was like, oh, why?

Lisa: Good for you.

Lauren: Well.

Lisa: Because you just said.

Probably want to know where I'm up to. I need to know how much further I've got to get. Seriously, for the decision for Pitocin to be based on what she just said was entirely subjective.

Lauren: Yeah. Yeah.

Like it didn't make much sense to me. And I was like, I'm not really sure what made me think of getting [checked]-- because you're in labor too, right? You're not necessarily thinking that logically, but anyway, that thought came out while she was in there and I'm glad. So the other thing she said was, if you find out how far dilated you are and you have or haven't progressed, will that affect your decision about whether or not you get an epidural?

And I was like, I don't know, because I don't know what the answer is yet. I just feel like I need the information to make a decision. So she was like, okay, I'll go and see what the obstetrician is doing. Seven centimeters already is so advanced, and it almost makes me think that the nurse missed the fact that you had given birth before, because those two factors together really leave me perplexed as to why they were thinking they needed to do Pitocin.

Yeah, because I think I kind of had it in my head that it was maybe, I don't know if this is a fair assessment or not, but my opinion, was that the obstetrician was just like, let's get the show on the road, labor and delivery is booked out tonight. Because it was like unfair, maybe there was someone like waiting to come into our room, I don't know. Because that would kind of suck too, like if you show up at labor and delivery and there's no room for you.

Lisa: Yeah.

Counter-pressure for comfort measures

 Did you say Sean did some counter-pressure techniques on you in labor? And if so, I was just curious about which ones helped you or if you remember?

 Yeah, we did. That was probably the most helpful thing that I found during, I guess the middle part of labor. So when we were at the hospital in the early stage. It was mostly when I was sitting on the exercise ball and I would kind of lean forward onto the bed and he would use the bottom part of his palm I guess, to apply pressure to my lower back.

Lauren: That was the thing that I found most helpful. And that was one of the techniques that we learned in the class with you. Like you went through like a range of techniques and we kind of picked out a couple shortlisted ones to try during labor. And then I guess it became clear once we tried a couple that we were just going to stick with that one. Because it didn't really feel like mixing it up was going to be the way to go, I just wanted to pick one and,

Lisa: Your ritual.

Lauren: That was the one. Yeah.

Lisa: Sacrum counter-pressure, yeah. I've ranked that as I think that maybe number two most popular counter-pressure technique among people I've worked with. Yeah, that one often really, really hits the spot.

Lauren: Yeah, and I was glad we had that in our toolkit, I guess, because as I said earlier, my previous plan was kind of like water, and water became unavailable.

Lisa: Yeah.

Lauren: It was good we had something else.

Lisa: Definitely.

Fully dilated

So I didn't know what was going on. But anyway, once the nurse was like, okay, I'll go see what the obstetrician is doing. And the obstetrician came straight back in. So obviously, she wasn't like easy. And then she checks me, and she was like, so you're 10 centimeters.

Lisa: Yay.

Lauren: And I was like, oh, okay. I was like, this makes more sense to me. And I don't think I said this at the time, but afterwards I was like, imagine if we just got Pitocin hooked up and then got an epidural. Like how would they have even done an epidural?

Lisa: Right.

Lauren: Yeah. But anyway, so then, that kind of went out the window and I think I remember the obstetrician saying that she just wanted to hook a Pitocin up anyway. And I think I was just like, whatever, like we're pushing. And I don't actually remember them doing it, so I'm not sure whether they did or not, because I just don't think there was really time in the end. Because then these other people came in the room. So then she was like, okay, just start pushing and we'll see how we go. So the first push, my waters broke. So that was like so different and I'd kind of forgotten about my waters by that time. And then I was like, ah, did my waters just break?

And the obstetrician was like, yeah, I think so. And I was like, okay, right, okay. And then, she was kind of like, you're not really pushing a lot.

And I was like, I don't know what that means.

And then I kind of realized the contractions have backed off again. I had moved onto my back at this stage, to get checked.

And I was kind of thinking, and I was like, that's when they backed off. they were really strong, like excruciatingly strong when I was on my side, on the peanut ball and then I moved obviously, to get checked. And since then, the contractions had backed off. I gave birth laying on my back the first time. And one of the things I wanted to try this time was something different. But when I walked into labor and delivery and saw the obstetrician, I was like, I might have to let go of that, because my contractions had backed off.

Lauren: I was like, I'm just going to ask. And she was kind of like, like what? And so she was like, you can move to your side, but that was all she was open to.

Lisa: Well, hey, it's something.

Lauren: And yeah, and in my head at the time, I was like, well look, the contractions look good on my side. So you know, sure. And they did, they did come back, like at least so that I could tell when I was meant to push on my side. So yeah, we did that, and the pushing was, I don't actually know how long it was, but it felt very short, compared to the previous time. And she did, I'm pretty sure once, it was like pretty close, she physically rolled me back to my back, because that was clearly where she wanted me.

Baby about to be born?

Lauren: I think the head came out pretty soon, so. By that stage, I didn't care, right? The baby's getting born, and I think that at the same time as she pulled me over, all these other people came into the room. So I was like, clearly the baby's about to come, that's what these people are for.

Lisa: It feels like a crowd, doesn't it?

Lauren: Yeah, because the other thing that was weird was, so last time, just to explain this bit, in Australia, instead of having nurses that have midwives in the hospital, in the labor and delivery room.

So, last time the midwife that was in the labor and delivery room had asked if I wanted a mirror to be able to see where things were up to. So I liked to see what was going on. Whereas this time that was just like, not, I didn't have one. I don't know. It wasn't mentioned, and I guess I did not.

So I didn't really know what was going on. But it was pretty obvious by what was happening, that the baby was about to be born.

It's a girl!

Lauren: And then they're all like, Stop! Stop! Stop!

And I think they got the umbilical cord out of the way or something. And then the next push, so yeah, so now it was when I found out it was a girl, because we didn't know.

So they gave her to me straight away and I think I got her, and I was like, I haven't even taken my bra off. And then yeah, Everly was the name we gave her, just like she pretty much instantaneously latched, which was different to my older daughter.

Lauren: So, yeah, she just had her first feed and that happened while the placenta was coming out and, yeah.

Second-degree tear

Lauren: And then I had a, I think it was a second-degree tear, so I had to get stitched. And I call that the worst part of labor.

Lisa: Mm. They're supposed to numb us, but it feels like they don't always, or it feels like it doesn't work. I feel like for many of us it's often painful.

Lauren: I reckon maybe it takes time to work, because I had stitches both times. But the first birth I had an episiotomy, so I was numbed before the episiotomy. And the stitching was still the worst part of labor, but it wasn't as bad as the second time and this time, because it was, I guess just a tear, she just numbed me and then started stitching straight away. So I imagine it's not, it doesn't have an instant effect.

Lisa: That makes sense.

Yeah. and

Lauren: I think that's the birth.

Episiotomy

Lisa: Do you mind my asking, with the first birth, did you feel like the episiotomy was necessary or did they give you a reason for it?

Yeah, so the obstetrician talked to me a bit about that during the pushing stage. She started off saying, "oh, it looks like we might be heading in the direction of tearing. I'm just letting you know so that you have a heads up. We'll see how it goes, but we might decide to do an episiotomy, if it looks like that's going to be the better option." So we'd had these like really long appointments all the way through my pregnancy. And she always explained things properly and I really just trusted her judgment.

Lauren: So I was kind of just like, if that's her judgment, that's her judgment.

She's the professional here, if she thinks it's necessary, it's probably necessary. So I felt like having had the tear this time, which is different obviously, because it's a second birth, but I did feel like I healed quicker this time, in hindsight. I don't know if that's because it's the second time or because it was a tear as opposed to an episiotomy.

Lisa: Maybe both, yeah. Hard to know.

Lauren: Yeah.

Lisa: Yeah. Yeah. It does seem like in general we tend to heal more quickly when we've given birth before. But I don't doubt that there is also the issue of an episiotomy, a surgical incision versus a natural tear.

Lauren: Yeah. And I guess it depends how big the tear is too. Because this one was second degree, but I assume the episiotomy was larger than like a second degree.

Yeah, and maybe if I'd have been left to tear the first time, I assume it would have been more than a second degree. But yeah, I don't know, you never know all of these things.

Lisa: Sure, and I suspect this is something you won't know the answer to, but I'm just going to ask it in case you do. Do you happen to know if this time the tearing was along the lines of the scar tissue from the episiotomy or different spot?

Lauren: Oh, no, I have no idea.

Lisa: Yeah, it's just, the reason I said I doubt that you would know this is because I feel like this is one of many areas where there's room for improvement with our care providers. I feel like when it's our body and it's kind of hardish for us to see things down there, I think it would be such better care to be told.

First of all, I'm glad you know what degree tear you had, because most care providers don't even tell us that information, which is important to know.

Lauren: Yeah, so I actually didn't get told, it was on my online because I was wondering like a couple of days after the birth, I was like, I don't know how much I tore, because I remember that it took a while to heal the first time, and I didn't know what to expect. Because I know I had a tear because I got stitched, but I don't know how much.

And then I was like, I knew obviously for my prenatal care that they put the notes in, on your online chart. So I was like, I'll just go and look, because sometimes they put these sorts of details in and sometimes, they don't, but it was in this case.

Lisa: Oh, I'm glad to know that.

Lauren: Yeah.

Lisa: Yeah, and to be told the degree, to be told exactly where, you know, was it internal? Was it external? Was it the perineal tissue? Where was it? I think those are such important details for us to be told. And I've heard so many birth stories at this point, 12 years into doing birth work, and I virtually never, I can't even think of a case where I've heard of someone being told to that level of detail, And usually not even the degree.

But that's good to know, that's a good little tip just to know for people to go onto their online portal, where they're giving birth, if that exists, and which it does in many places these days, to see if those notes were included and that could be useful information.

Lauren: Yeah, definitely, and I'd say that the whole way through, because I often found after my prenatal appointments that they'd be detailing those notes that I hadn't been told in the appointment. But once I kind of figured that out, I would always have a look at what was posted.

Lisa: Yeah. Oh, that's good, good insight. Great, well, anything else you wanted to reflect on, before we start to wrap things up?

Lauren: No, I don't think I've got anything else. I think that pretty much covers it.

Breastfeeding support AU vs US

Lisa: Would you be willing to talk a little bit about one thing you shared with me when I brought up maybe comparing and contrasting Australian maternal system versus here is, the breastfeeding support. Would you mind touching on that?

Lauren: Yeah, sure. Yeah, definitely. So that was something that was very different. Obviously, I haven't had a first pregnancy here, so I don't know if they would treat you differently if it was your first time breastfeeding. So I guess I would preface it by saying that. So in the hospital that I gave birth in, in Australia, I guess to start with the stay, the standard stay for a vaginal delivery was four nights, which was a lot longer than here. But that was probably where like the difference in breastfeeding support started, I guess, because you're in the hospital longer, so I was in the hospital when my milk came in.

Lisa: That's a huge difference.

Lauren: Yeah, yeah, and I remember this time, we were only in hospital for just over 24 hours, and I kept saying to Sean, when my milk was coming in, like, if this was my first time breastfeeding, I would have no idea whether this is normal or what's going on. Whereas in the hospital that I was in, in Australia, all of the midwives had training in breastfeeding.

So all of the midwives could help you, with looking at your latch and different techniques and so forth. But then on top of that, there were more senior midwives who were lactation consultants as well. So if you were having issues, the lactation consultants would come in.

But if you weren't having issues, even then the midwives would just be like, just let me know when you're going to feed, so I can have a look at how the latch is going, and we can just check that it's, you know, it's all looking how it's meant to look. And the other thing, my baby's just come home.

Lisa: I thought I heard her.

Lauren: The other thing that they did, and I guess, because you have more time, the midwives talked to me about different positions for breastfeeding. So to start with, we kind of went through like the standard technique and then once that was going, she was like, so you can also try feeding like this. And when my milk was coming in the first time, when you're like really engorged, I remember one of the midwives showed me a technique that was like perhaps a bit easier for the baby when you're really engorged, to get the milk out.

Whereas I didn't feel like that really existed here. A lactation consultant did come and see me, and to be fair, Emily was breastfeeding very well, so I wasn't having issues and she did seem good, but there wasn't that ongoing support.

Lauren: And then even beyond the hospital stay in Australia, the hospital had like a drop-in clinic that, just standard, you came back to once a week for the first six weeks. And that's where your baby would get weighed, whereas here we've been going to the pediatrician to get the baby weighed, which obviously serves that purpose for the baby being weighed, but at the hospital with my first, they would also get you to do a feed while you were there, because it was a lactation consultant doing the weighing. So she would check your latch, which I found really useful. My breastfeeding was actually going pretty well, so it wasn't like, I didn't experience the kind of challenges that a lot of women do.

But even though it was like, kind of going well, I still wasn't sure, I was like, I didn't know what it's meant to feel like. I don't know if the latch is right. So having the midwife check and say, yes, that latch looks good, just, I guess, gave me a lot of reassurance.

Lisa: Nice. And then you mentioned a morning tea that the hospital ran. I was like, I love this.

Lauren: Yeah, so they did, and again, it wasn't COVID, so I assume that's probably not going on at the moment. But yeah, they did a morning tea once a fortnight, and that was like, you could go to it up until the baby's crawled basically.

So they would have lots of educational talks at those morning teas, so one day someone from KidSafe came and talked about like child safety and so forth. And a first-aid person came and gave a talk.

But the other thing was that the person who was running it was always one of the midwives that was a lactation consultant. So if you had issues that cropped up later on with breastfeeding, even though you weren't officially going to the hospital, you could ask the lactation consultant while you were there.

Lisa: That's so great.

It was obviously really helpful. And I guess the other thing I would say is that my experience, in Australia, there's a public and a private system. And my experience was in a private system. The public system is different, and you're not in hospital for as long, but because you're not in hospital for as long, they send a midwife out to your house to do some latch checks and baby weigh checks in the period after you go home.

Lisa: That's great.

Lauren: Yeah.

Lisa: That's so essential, and it's something that is sorely lacking here in the US. Just lactation support is almost non-existent in terms of our official healthcare system, you know.

Lauren: I was just going to say, you kind of have to figure out how to find it separately, it seems.

Lisa: Yeah.

Yeah, I feel like in a lot of cases when breastfeeding doesn't work out, I feel like if women had more support, it would probably be more likely to work out.

Lisa: It's so true, yeah. And that part about still being in the hospital when a person's milk is likely to come in, that's huge, because that is such a big, big challenge for people. They go home and then there's no one to support them when their milk comes in, and things get more challenging often around that time.

Lauren: Yeah. And especially, because even this time you know, I was fairly confident; I breastfed before. But even so, I was still like, oh, I'm just questioning things a little bit, but I just kept thinking, imagine if this was your first time and you're like at home with no one to ask these questions to. Yeah, it must be really hard.

Lisa: Thank you for sharing those differences. Those are pretty big differences. And I hope, hey US, look at that model of care and take a few notes.

Occasionally a hospital might have some kind of support group or breastfeeding class you could go to, either when you're in the hospital or after, but we have a lot, a lot of room for improvement on that early breastfeeding support.

 I mean, not even all of our local hospitals have an IBCLC, a lactation consultant, you know, available. Many do, but they're not there 24/7.

Lauren: Yeah, okay. Ours did, and she was very good when she talked to us. But I guess just it was more just that she only talks to you on that one day that you're there.

Lisa: One day, yeah, yeah. Yeah, usually in the US, in a vaginal birth, we go home about two days later, but during COVID, they've been sending people home a full day earlier in many cases. Yeah. So it's very early to go home.

Lauren: Yeah. Yeah, the other thing with going home so early is, Emily was born on a Wednesday, so we had to take her to see the pediatrician on the Friday because they didn't want to leave it till the Monday over the weekend. So she was only like two days old and even just getting from the car to walking into the doctor's and then into the room and getting her weight, like, it's such a simple thing, it sounds like nothing, but like two days postpartum, that was like a pretty big thing.

Lisa: That's a lot, yeah, even for someone who did Pilates.

Lauren: Just in this room, like being waited on at that point.

Closing

Lisa: Well, is there anything else that you wanted to share today that you haven't gotten to share and/ or are there any final tips or insights, encouragements you would have for listeners?

Sure. I don't think I've really got any super tips, I'm kind of still trying to figure out how to parent myself, even though it's the second one. So I guess I would just say like, no one really knows what they're doing when they start out, but we all get by, and there's a million ways to do everything and I don't think any of them is right, I think the one that works for you and your baby is the right one.

Lisa: Absolutely.

Lauren: Just go with whatever's working for you and, yeah, try and ignore Google as much as possible.

Lisa: Yes, and all the parental judgment out there.

Lauren: Yeah.

 One thing that was coming back to me about your story that I would just love to emphasize, was the way that you advocated for yourself in that moment, when the nurse was saying you needed Pitocin and epidural and, many people would've just said, okay. You know, because at least here in the US it's a very paternalistic medical system, one in which for those of us who grew up here, we just tend to be like, doctor knows best, in just the whole medical system, they know best. And so we just say yes to anything, but I love that you thought to ask, could my OB do an exam, just to see where we are? So I just, I admire that, that you took that step, because it made a big difference and things could have possibly gone in a very different direction, that you advocated for yourself.

 Yeah. I remember I kept thinking afterwards, what would have happened if I didn't, if I didn't ask that. So yeah, I would definitely say to anyone, if anything pops into your head, just say it.

Lisa: Yeah, don't be afraid.

Lauren: That was a game changer, I think.

Lisa: Totally. I know that's true for sure. All right, well, thank you Lauren.

 thanks so much for taking time.

Lauren: Thank you very much.

Lisa: All right. Take care.

Lauren: Bye.