Birth Matters Podcast, Ep 96 - A Pelvic PT Delays Induction

As a doctor of physical therapy specializing in pelvic health, Nidhi is quite well-informed during her pregnancy, and had hoped to have an unmedicated birth with limited or no interventions. As her pregnancy develops, Nidhi learns she has gestational diabetes and goes on insulin and baby has an abnormal quad screen. In light of these things, her OB pushes to induce at 39 weeks, but she advocates to delay the induction until the fluid tests low a day before her estimated due date. She agrees to the induction at that point, but is thankful on the other side of birth to have bought more time because her son actually measured small at the time of birth, contrary to what often happens with gestational diabetes. Nidhi also shares about her severe tearing due to the use of the vacuum, and details her frustration with the lack of helpfulness of medical care in the postpartum period.

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Episode Topics:

Expectant mother on a trail, cradling her bump

  • Got pregnant immediately 

  • Has a genetic condition where her body doesn’t absorb B vitamins called pernicious anemia, had to get injections

  • Went into pregnancy very well-informed due to her background/expertise in pelvic PT

  • 12-14 weeks pregnant Covid shutdown happened

  • Was just feeling better and had wanted to start doing prenatal yoga and all the prenatal prep

  • Had planned to give birth at Phelps Memorial and had spoken with midwives

  • Quad screen came out abnormal, referred to high-risk OB

  • 3-4 weeks later has anatomy scan, looks good

  • 26-27 weeks - gestational diabetes positive, tried to make nutritional changes but didn’t help enough, went on insulin

  • Baby ended up actually being born underweight

  • OB was pushing for 39 weeks

  • Worked out/walk 3x/day – helped manage blood sugar & mental health

  • Hypnobirthing - Sophie Fletcher

  • Prana for Labor Yoga

  • At 38 weeks, OB tells her she wants to induce

  • She negotiates to do more monitoring and wait longer to induce

  • Blood sugar starts to improve, which reproductive endocrinologist says this could mean placenta isn’t functioning

  • At 39 weeks and 6 days induced for low fluid

  • Went into hospital evening 

  • No dilation, cervix high, given suppository Cervidil

  • The cramps didn't really allow her to rest

  • Didn’t help the cervix to ripen at all, move on to Cytotec

  • Has a hypertonic pelvic floor, had done manual therapy on herself to help with that

  • Cytotec did help more effective contractions

  • Requested to minimize pelvic exams/cervical checks

  • 3 cm dilated - doc thinks she might go into labor on her own but it doesn’t work

  • Start cytotec again, was like it was starting over

  • Feeling exhausted, getting epidural just before

  • Starting pitocin

  • Blood sugar gets low and she wants to move around but doc is afraid she’ll pass out

  • Nurse helps her to change positions within the bed

  • Lots of progress happens with the cervix, but baby stays high

  • Encouraging her to push even though baby was high and cervix 9-9.5 cm dilated

  • Preferred to labor down but doc was going to roll off shift before long

  • Feeling sharp back pain, felt no urge

  • Pushed for 6:30-8:30 but baby wasn’t coming down

  • OB goes internally and tries to help baby coming down

  • OB rolls off shift, new OB more experienced, gives her a break

  • Encouraging her to touch baby’s head to feel how to push, didn’t help

  • Requested a vacuum; OB agreed even though baby was high

  • Caused a sulcus tear inside vagina & 3rd degree perineal tear

  • Delayed cord clamping, skin-to-skin

  • Low blood sugar for her and baby right after birth

  • Postpartum pelvic healing

  • 6-week appointment was disappointing

  • Started pelvic floor PT around 8 weeks, took ~16 months to have no symptoms and see improvement

  • Issues with postpartum care - ACOG 2016 recommendation to change timing of postpartum visit to 3 weeks but it still hasn’t happened

  • Advocating to be tested for thyroiditis (runs in family)

  • Discovering anemia and getting B12 shots

  • The challenges of breastfeeding & mental health

  • Not having a lot of support from family due to Covid

  • Difficulties sleeping, feeling some anxiety due to baby being small and being told he wasn’t getting enough

  • Husband suggested seeking out a mental health therapist

  • A pelvic PT colleague recommended a therapist

  • Husband helping her get more rest

  • Tips: get a doula and pelvic PT (before and after birth)

Interview Transcript

Lisa: Hi Nidhi, welcome. How are you?

Nidhi: I'm good. Hi, Lisa, how are you?

Smiling woman looking at camera, with her arms crossed confidently

Lisa: I'm great. Thanks so much for joining me today to share your birth story. I'm really excited to have you. I'm just going to read your bio. So Nidhi Sharma received her Bachelors of Science in Physical Therapy in 2006, Masters of Science in Kinesiology in 2008, and her Doctorate of Physical Therapy from Evidence in Motion in 2014. For the past decade, she has worked in outpatient and hospital settings with a diverse population of patients.

Nidhi is an expert in the specialty field of Women's Health and is passionate about helping women maintain a healthy life. She's trained by the Herman and Wallace Pelvic Health Institute and is also a Board Certified Orthopedic Clinical Specialist. She firmly believes that an educated person is an empowered person and much less prone to future injury.

Lisa: I love that last piece and going back and looking at your birth class intake form, you highlighted that you were really hoping to focus on self-advocacy and just, you know, signing up for birth class in and of itself, it shows that you were really seeking out what you promote for your clients as well entering things in a really informed educated way. So welcome again. So glad to have you here.

Nidhi: Thank you. It's a pleasure. 

Lisa: Would you mind just introducing yourself a little bit more informally than that and just sharing, how long ago you gave birth and maybe if you remember when you took my birth class, if not I can look at my notes. I know it was virtual, and where you live, that kind of thing.

Nidhi: Yeah. so I live in Mamaroneck Westchester, and we moved to Mamaroneck, believe it or not, two days before we found out I was pregnant. 

Lisa: No way. 

Nidhi: It was like, we moved into our new apartments, oh, pregnant and I gave birth in August 2020. I think I took your class either in May 2020 or June, somewhere in that time.

My baby will be, well, my son will be almost two, he'll be two in two weeks. And so it's surreal to relive this experience today. Last time when he turned one, I did kind of journal my whole birth story. Just sort of remember it on that day, because it's his birthday, but it's like my birthing day and it feels really nice to do that again this year with you.

Lisa: Yes, I love it. I was so honored to have you in my class, with your particular expertise. I always love it when I have perinatal specialists of different kinds coming to birth class, experiencing it for themselves for the first time. And it helps keep me sharp because I asked you to please let me know, you know, how the pelvic, especially the pelvic emphasis, that is threaded throughout the class series, how that lands with you and how I can improve that.

So, it was just such a pleasure and it's been such a pleasure to get to know you and follow you on socials since then. If you have not checked out, I'll be sure to link your social and your website in the show notes, but she has so much valuable educational content on Instagram and probably elsewhere as well.

But that's the main place that I follow you. So thanks for all the great work you're doing.

Nidhi: Thank you, Lisa. All your information was so helpful. I mean, from the pelvic background, all the information was very much evidence-based, which is, you know, not something we can say for all the classes. So all the information was very evidence-based, very supportive, and nonjudgmental. So, it was very helpful.

Lisa: Thanks for saying that. 

High-Risk Pregnancy in a Pandemic

Lisa: Well, so let's get started. Would you please share a little bit about your conception and prenatal journey and the different ways that you prepared? I know we touched on birth class a little bit, but feel free to share anything else and more. Whatever you'd like to share.

Nidhi: Yeah. So we were one of those fortunate people. We got pregnant before we prepared. We thought about trying, and we just literally tried once and got pregnant. So, there was not much preparation that I did ahead of time. I do have a medical condition where it's called pernicious anemia, where my body does not absorb B12 vitamins.

So, before I planned pregnancy, I spoke to my doctor, and they gave me shots to make sure I had good levels. But that was a medical thing. And that's it. We just got pregnant very easily. We were fortunate.

Lisa: So then what was your pregnancy like from there?

Nidhi: You know, the pregnancy, from the beginning, I was like, I'm a pelvic floor PT, I've done actually prenatally, I didn't do it for prenatal care, I do so many courses just because I see so many pregnant women. So I've done a lot of work for prenatal, perinatal, postnatal, postpartum care for women.

So I knew a lot going into pregnancy. When I got pregnant, oh, I know exactly what I'm going to do. So pregnancy for me was a way to really learn that you can't really control a lot of things. And I was a young, healthy woman getting pregnant. 

I was like, okay, it's a low-risk pregnancy, I'm going to go to a birthing center, I'm going to get a midwife, I'm going to get a doula, I'm going to do yoga, I'm going to do all these things and then I'll give birth, right? 

And first thing that happened when I was three months pregnant, my morning sickness was just about settling down, so I think it was like 12, 14 weeks, is COVID. COVID happened in March and so I was just feeling better enough that I could start prenatal yoga, I'd gone twice and then just everything just shut down from there. My work shut down. It was a really difficult time to cope for most people who were pregnant, including me.

I was just entering second trimester. So it was really the time that I was starting to feel better and was wanting to go out to classes and do all these things and I was home. So all my prenatal visits were canceled, everything was virtual, didn't go anywhere. Didn't do anything. I was planning to go to, what is the name of that birthing center in Sleepy Hollow? I forget the name, Phelps Memorial. And I had taken a tour there just the week before, and I had spoken to a midwife, and I was interviewing a couple of doulas.

I had spoken to the doula and COVID happened and then I was home. But still, okay. We're still planning to do all these things that I've done. And two weeks in, they do a Quad Test, quad screen, in second trimester to screen for genetic abnormalities. One is Down Syndrome, but there are many others. And my quad screen came out abnormal. Where they say they could be a neural tube defect in the baby.

So, that kind of made me a little high risk from there on, and I was referred to a high-risk OB. We did my anatomy scan instead of 22 weeks, I think it was done at like 18 weeks or 17 weeks to see if the fetus was developing okay. 

And I went there and at that time, I was told that all the development was fine and it's possible that the test that's showing whatever was abnormal is because my placenta is not functioning well, or my placenta is bleeding.

So maybe something with placenta, that's what I was told. And she was like, we'll check again at 22, 23 weeks. But so far, the baby looks okay.

But I think from here on, there was like a sharp turn in things because, okay, if your placenta is not healthy or has a possibility of being not healthy, then you kind of can't go to the birthing center, you probably won't qualify for midwife care. And I already had a background of B12 deficiency of a genetic condition. So we gave up the idea of Phelps and this was hard for me at four and a half, five months, you know, with COVID I was indoors, not seeing my OB, and I was like, okay, now I have to go to a different hospital, and changed OB to referred to a high-risk OB. And just from coping from that was hard, just making sense of the world that it was like, you know, stop seeing your friends, stop doing all of the things that you do. But also losing that trust in your body, that your body can do all these things, which I really had, which I really had, because I was, you know, I was always exercising, I'm a physical therapist, I'm very healthy, so I had no reason to have that. 

We switched the hospital, three, four weeks later we had our anatomy scan, that's the formal anatomy scan at 23 weeks. And she said, everything looks good. This baby looks as good as it can, but we still can't ignore that you had a test that was not okay. And at that point I kind of questioned her that why can't we let go of that fear? And she said, well, we just don't like to, because placental abnormalities are not always visible until later in pregnancy. 

This was the first time they said to me that, we probably won't let you go past due. We'll probably induce you before, because placenta deteriorates after 40 weeks. And I wasn't entirely convinced about that, knowing the evidence from your classes and from other information, I don't think that's entirely evidence-based, but I went with it. I was like, there's still time to make those calls.

And then, two or three weeks later, I think it was like 26, 27 weeks when you do the gestational diabetes test, and that also came back positive. 

Lisa: Oh, my goodness. You're having quite a time of it on top of COVID.

Gestational Diabetes

Nidhi: So gestational diabetes was positive. I do have a very strong history of gestational diabetes. And again, I struggled a lot with it, because I was like, what did I eat wrong? Like why do I have gestational diabetes? My BMI is normal. Everything is good. I'm healthy. I've been exercising. I have not gained any weight. I should be gaining more weight. And, you know, one of the things that I learned from, I tried to control it, tried to eat super healthy. I'm a lifelong vegetarian and I started eating fish. At that point, I started eating fish like two, three times a day. Just fish and vegetables, that's all. Because I was told that if you can control this diabetes with diet, it's considered less risky.

Nidhi: So I'm trying to really control it, I'm trying to. I gave up carbs altogether. My numbers are very, very low throughout the day, but my morning numbers are still high. And one of the things that I really had to learn is that it's not controllable, some of it is genetic, very strongly genetic. No matter what I did, I was going to have gestational diabetes and I would have to take insulin.

There was just no way around it. I fought it for three weeks and I lost five pounds, which was scary in second trimester. And she was like, you're crazy, you're losing weight. You can't do this. Just take insulin. 

So, again, now we're in insulin dependent diabetes and other risk factors, now I was really in this very heavily monitored medical system. They were monitoring my blood, they were monitoring my proteins and all the things throughout the pregnancy. 

Smiling new parents in front of a picturesque lake; dad is holding baby boy in his arms while mom smiles at camera

One thing that's very fascinating to me is, I always felt good. After first trimester morning sickness, I always felt good. I didn't have nausea, I didn't have pains, I didn't have any of the symptoms. I had some insomnia; that was the only real symptom I had throughout the pregnancy. And so it was always a struggle to not listen to my gut which was saying you feel good, most of the time you feel good. I have energy, I'm walking, I'm exercising. And there are these numbers of diabetes and there's number of the report, but my baby looks good, his movements are good, he's moving all over, he's in the right position. So I always struggled with kind of wanting to ignore their advice, but I didn't want to because it's a medical thing.

So I started taking insulin every morning depending on how well my numbers were controlled. And I also dieted very well. I controlled my diet so that I did not need any shots during the day, I only needed in the morning. But for another eight weeks or so, at around 32 weeks, in the entire pregnancy I had only gained like 13 pounds. So at that point I was like, everyone was telling me, you don't look pregnant. You don't look that pregnant, you're entering seventh month. And I didn't really look very much pregnant. This was beginning to be concerning that, are you like growth restriction or what's going on?

And at that point, they tested and they say, no, baby's big, baby's good, baby's right size, it's just that you are losing weight. Like you're losing your own weight because you're controlling the diet so strongly. And everything is okay. 

Baby was on the right track of weight gain. In fact, in diabetes, they're always concerned about too much weight gain, like macrosomia, the baby will get too big. And that didn't happen to me at all. My baby was actually small in the end, he was considered underweight when he was born. And I lost a bunch of weight. So sometimes, I feel like that probably was a little bit of overtreatment because I didn't see the doctors all the time.

It was all done virtually. I was just kind of going by, you know, if you see this number, give yourself more insulin and more insulin. So I started at eight and I was giving myself up to 14 and 16 units of insulin every morning. So I don't know, I did what I was told because it's, you know, it's a medical condition.

Yeah. The whole gestational diabetes thing is something that I really hope that in my lifetime that we will, I don't know, get a better grasp on how to manage this and which cases of gestational diabetes don't really need to be so actively managed. I feel like we have a long way to go on that. It's very hard to pinpoint because, and the only reason I say all these things is because my sister is a year and a half older to me. Granted she got pregnant five years ago, so she was younger than I was. And she had diabetes. She gave birth in India. My mom had diabetes with both of us.

My sister had diabetes with her son, and they were managed very differently than me. They didn't check their blood sugar three times a day. They checked their blood sugar once in two weeks. And the numbers that they went by are much different than the numbers I went by.

My sister ended up having a healthier pregnancy than I did. Again, we can't compare this, because this is like sample size of one, and I also had other risk factors. If I didn't have other risk factors, maybe would've been a little more prone to checking things or asking things or getting second opinions.

Beginning of Induction Conversations

Nidhi: But I already had this quad screen and the whole thing going on. So, I felt like it was a little bit overly managed, and I didn't gain enough weight. And having said that my baby was small, but I was told at 32 weeks, like two weeks after my regular OB told me that you're not gaining weight, you need to diet less, my high-risk OB, who was just looking at my chart and seeing all these factors said, we'll induce you at 39 weeks. And I was like, why, I'm already not gaining weight? She's because baby gets too big. And I just got mad, are you even looking at me?

Lisa: That's such a like routine care, not even individualized at all. Clearly, especially in your case. 

Nidhi: Because I'm on the table, can you look at me for a second? I'm 34 weeks pregnant and I look like I'm 25 weeks pregnant. And you're telling me that my baby will be too big. Just because of all the factors. She was like, no, it's better to be safe, we always want to make sure that we get the baby out sooner rather than later when you have gestational diabetes. So there was no real reason to that. 

And then she also quoted the ARRIVE trial to me. I was trying to question her, so she was like, it's shown in research, in very valid research that induction does not lead to more cesareans, in fact, it leads to less. 

Lisa: And now there was actually an article that just came out that's showing that C-sections are on the rise, and many of us think it's because of these 39-week inductions based on that ARRIVE trial.

Nidhi: Yes. And I actually questioned her thankful to you. You had taught us in the class how ARRIVE trial should not be read in like such a simplistic way of induction. Induction can mean so many things. So I did ask her, I was like, okay, so if you induce me, will you let me go home? She's like, no, no, no, no. You're high risk, so you get admitted. You come to the hospital. I was like, well, then you are not following the ARRIVE trial. She wasn't happy about that. 

Lisa: I love that you called her on that. Cause yeah, in the ARRIVE trial they sent people home with foley balloons to labor at home for a good long time. And yeah, that's going to lead to better outcomes because we can be more patient with people laboring at home and not taking up a hospital bed. I love that.

Nidhi: Exactly. And the ARRIVE trial wasn't necessarily done for people with multiple high-risk conditions. So, the sample population didn't apply to me. I'm not saying that don't induce me, I'm just saying don't quote a study that doesn't apply to me.

Lisa: Great point.

Nidhi: But I was very thankful for that study from you, because I would have heard that, I would've thought that applies to me. And even if it applies to us, I think it's important to be informed, and how much of it applies to us?

Lisa: The nuances.

Nidhi: Yeah, exactly. So I was just going along the pregnancy, I worked out three times a day, that's really how I managed my diabetes and mental health in COVID times, because I wasn't working and not going anywhere and masking all the time. So the only real exercise I could get is walking. And I did the hypnobirthing tract very religiously. 

Sophie Fletcher, I think she has a book, HypnoBirthing, and that's the one I followed. I did affirmations. I did your class, from Prana prenatal I did their Yoga for Labor class, which was really good, I did it a few times, and kind of practiced that yoga. There are also these, I guess you can call them affirmations, but they're like mantras in Ayurveda that you read to yourself to sort of like give your body that confidence.

Because towards the end, I was really feeling 35, 36 weeks. I was really feeling, can I do this because of so much medical cloud over my head? I almost felt, I was beginning to feel I can't trust my instinct because my instinct was always that we're doing too much. That this is too much, that my body itself is fine, my baby's always active, like when they did the ultrasounds, which I was told to do two times a week after 36 weeks. My ultrasound tech would leave me for five minutes at the most. She's like, you got enough, we don't have to see you more, which usually takes 12 minutes.

So my baby was very active, my numbers were very good, but we were constantly doing a lot of things. So at 38 weeks, my OB said we're going to induce you next week. And I again said, I don't want to be induced, I don't think you have any reason to induce me. And at that point, she said something that really make me very upset. She said, after 39 weeks increases the risk of stillbirth. And I didn't see her again after that point. That particular OB, I told her I don't want to see her. I told her that, do you really have any evidence to say this? Does 39 weeks, past 39 weeks really do this?

Lisa: Good for you. Based on what? Yeah, that would be my question too.

Nidhi: Yeah. And she said, well, it's in research. I'm like, can you quote that research? And she couldn't. Really, she couldn't. She's like, well doctor, high risk OB, agrees. And I was like, well, I asked her when I saw her three weeks ago, and she said that we could go to due date. Like, I was fighting to go to due date.

I wasn't even fighting to go past. I was to be induced at 39 weeks. I was just trying to go to due date. And I was like, the high-risk OB did tell me that we can go to due date. And then she's like, I don't see the point. And I was like, well, I do. I don't know what else to tell you.

Lisa: It's your body and your baby. 

Nidhi: Unless you give me a reason, even theoretical reason to do this, I don't see any reason. And then she said that, well, your baby can get too big. 

Lisa: We're back to that again?

Nidhi: I was like, well, you're measuring my baby every week, right? And I'm coming in twice a week. How about I come in three times a week from 39 weeks or 38 weeks, and then you can get a better handle on what is going on exactly, and then we can decide.

I think at 38 weeks, they were asking me to come three times a week. I think one of the weeks, I even went four times a week. And it was easy for me because I wasn't working because of COVID and the practice is not very far from me. 

So I would go in and they would do the ultrasound, the Doppler every time to see everything was okay. 

Around 39 weeks, we were just doing these ultrasounds and my blood sugar started to get normal. Like end of 39, I was approaching due date. My blood sugar started to approach normal, and I spoke to my reproductive endocrinologist, and she said, diabetes in pregnancies because of placenta. So if placenta is working well, you will have diabetes. And so if your diabetes is suddenly getting better, it's possible, theoretically, that your placenta is not doing well. So I want you to go and get checked more frequently. 

Parents smiling at their son on his birthday; baby is in mom's lap and is being fed a piece of cake

At that point, I think I was going every day, which I was fine with. One of the times they saw that one of the mornings I woke up, I had no diabetes, it was gone. And my water was low. So at that point they said, you are still looking okay, but it's probably good to induce at this point. I was, I think, one day before my due date. 

And I got admitted that day for induction. But that was full six days later than what my OB wanted. And I do believe that it really helped my baby, because he was born at seventh percentile. And his blood sugar was very low, he needed glucose rubbed in his cheek. He was very weak to even breastfeed. My milk was very delayed because I was underweight at that point. So combined with all of those things, I think those six days gave him a lot of help. Without those six days, the pediatrician said, if you didn't have those six days, he probably would be in NICU because he would be less than 5% and that those kids do go to NICU. So I think even like, why can't we monitor the person closely and let them go? I do believe that they help me make the right choice at the right time, but that doesn't mean that you make the choice too soon because you're okay with the baby going to NICU or you're okay with me having a C-section.

Why don't we put a little more effort and monitor people so that they can hopefully get to their goal or close to it?

Delaying Induction Advice

Lisa: Yes, absolutely. Absolutely. And listeners, I just want to highlight what Nidhi is saying here, because she shared this with me in the past, and I thought it was brilliant. That one potential way to meet your care provider halfway and kind of negotiate if you're not wanting to be induced in the timing that they're recommending is to say, well, I'm willing to go in for extra monitoring.

You know, assuming you are willing to do that, that can help an OB or perhaps midwife feel a little more okay with postponing. So great negotiation tactic that I just wanted to really point out because it's really smart that you did that. And I love that you see very clearly, quite clearly for your baby, how your baby really needed that.

Who wants a baby to go to the NICU if they don't have to? 

Nidhi: Yeah. And I mean, I think they should have, even when they're saying that the baby looks small and they're saying that you are not gaining enough weight. I think they should be invested in letting me go to due date a little bit more. Like even they should be thinking that the baby might need it, I almost feel like it's in their head.

It was like, oh, we're going to do a C-section at 39 weeks and put the baby in NICU, and they will both be eventually be fine, right? That's what they're thinking in their head, instead of taking a little bit more nuanced approach to let it go, and then slowly walk this difficult or complicated path with the patient.

Lisa: I so admire you, that was really smart, and you advocated for your body and for your baby and yeah. Thank you for sharing all that.

Nidhi: Thank you.

Lisa: So does that sound like a good time to actually share the birth story and how the induction played out and everything? Jump in. 

Going in for Induction

Nidhi: Yeah. So I was admitted that day when my water was a little bit low. And by the way, my water was low, I came home, and I drank a bunch of water. And when I went to the hospital for the induction, my water was fine.

Lisa: Ha, interesting.

Nidhi: That's something I hear a lot from midwives, now that I talk to them, that, oh yeah, water is like dehydration stress, 

Lisa: Mm 

Nidhi: One of the reasons I believed that story of low water is also because my diabetes was gone. I think that was a bigger concern. Like, why is your diabetes suddenly going away? That could be a concern for placenta. And I was a little tired of fighting them too at that point.

Lisa: Understandably. 

Nidhi: So I went in for induction that night. My cervix was completely closed and high. It was no dilation, no nothing going on. So I was given a suppository that night for dilation. I started having like mild cramps that night. Didn't really sleep that night.

I did the hypnobirthing tracks and everything. Cramps started to build up. By that morning, I was kind of tired because there were just relentless cramps at that point. So that morning they checked again, and there was no dilation and nothing had changed, I was just having cramps. She said my uterus looked a little irritable, it was doing some things, but the cervix was closed and high. So she started me on Cytotec, every two hours for six doses, I think that's the protocol.

Lisa: So before that, it was probably Cervidil?

Nidhi: Yes. And I do have to mention, I have a history of a tailbone fracture.

So I do have hypertonic or tight pelvic floor. And I was preparing my pelvic floor during pregnancy. I was working internally myself to relax and stretch the pelvic floor. And I was doing relatively decent with all of that. I was feeling okay with that. So this was the first cervical check, well, second after Cervidil, and there was nothing, zero dilation.

So they started me on Cytotec. My contractions built up like every four, five minutes. They weren't very strong, but they were every four, five minutes. And so she was like, oh, maybe we won't need to do anything because this looks like you're having real contractions. I think we kept going for two hours, she gave me another dose and my contractions got closer together, to I think, three and a half, four minutes, but they weren't quite at the intensity. I mean, II was talking through them, so she was like, yeah, you're having contractions, but I don't know if you're having enough contractions. I had told them earlier that I don't want too many cervical checks because they're painful and they just make my pelvic floor unhappy.

But she, this was a very nice doctor in that group, nicest one I could have hoped for. So, she had said I won't do a cervical check unless I really need to. So they gave me the third dose, the contractions built even stronger, and they were like every three, four minutes for much of the day at this point, six seven hours.

So she said, let's check one more time. And she checked one more time and I was three centimeters dilated. And at that point, she said that let's just stop the Cytotec and let's see if you would just go into labor yourself, because it looks like you might. So they stopped the Cytotec, and I was starting to have those contractions and then two hours later, everything stopped. 

Lisa: Can I just point one thing out? I think it's really interesting and not very common that the doctor was like, let's give your body a chance. Maybe it's going to take over. Because so many hospitals and nurses and doctors get stuck on this, like, this is the way we do things, and this is the schedule, and this many hours after the Cytotec, we're going to move on to Pitocin, you know?

And so while it sounds like that didn't work, in my opinion, it was a nice thing that they're like, let's see.

Nidhi: She was very good. And I mean, I had like literally put my birth plan in their face, every visit for my pregnancy. This is my birth plan, I know I'm high risk, but this is my birth plan. They would often say like, you're high risk, birth plan doesn't matter. I'm like, it does, but like, at least listen to me.

So, she was one of the doctors who had listened and who had a conversation with me. So I hoped that she remembered that, and I brought it to the hospital as well. I told my husband to give it to the nurses. 

And the other thing that really helped was, my nurse in that hospital used to be a doula. So I got really lucky there. She used to be a doula before she became a labor and delivery nurse. So she knew, and she was like, you're doing well. I think you're going to do well. 

So with her and the doctor, I think it worked out, they gave me a little more time. But it stopped, it didn't work. 

So they started Cytotec again, and this time it almost like we were starting from scratch again. We did another four hours. So this is at this point where like all day, this is six doses or 12 hours of, you know, on and off labor. And then when we did the second Cytotec, so this was the fifth dose, contractions picked up again and she said, let's start Pitocin at this point.

I was just exhausted and just could not deal with it anymore. 

Laboring with Epidural

Nidhi: So at this point, I decided to get an epidural, which is not something I had planned. But it was COVID, I couldn't have a doula, because doulas weren't allowed in my hospital. So at this point, I was like, okay, I can't, I need to just lie down for some time.

Lisa: And about how many hours was this from the time that you had, like the induction was started?

Nidhi: More than 24 hours.

Lisa: Yeah. Yeah. Long time.

Nidhi: Yeah. So I had gotten the Cytotec, the Cervidil the night before, so all night of cramps and then from eight o'clock in the morning to eight o'clock at night is the Cytotec, and I got an epidural around nine. 9:00 PM. 

Lisa: So was the epidural before or after they started the Pitocin?

Nidhi: Before. They were like, I'm going to start Pitocin. And I was already having contractions that were four minutes apart and she was like, your contractions aren't causing the dilation that we expect. So either you're tense or you're exhausted. 

And oh, I forgot, during this time, they were giving me low calorie meals because I was supposed to be gestational diabetes, right? So they were giving me sugar free, whatever stuff all this time. They did give me a very light meal. But around 5:00 PM when they checked my sugar again, my sugar was very low. It was 45 at that point, it was like, what is going on with you? And I was like, I don't know. So they start, they gave me like this sugar water to drink, to stabilize my sugar.

And she was like, I don't think you should walk that much, because your sugar is very low, and I don't want you to pass out.

So now I'm like hooked into this monitor that I can't take anywhere. And I didn't really want to sit, lie down at all. So I was sitting on a ball, bouncing on a ball, walking around, taking the thing with me.

But when she said you, I don't think I can let you walk this much. I was like, you got to be kidding me. What can I do at this point if I can't move?

Lisa: Oh, geez. Not part of the birth plan.

Nidhi: So at this point, without constant monitoring, not allowed to move and getting Pitocin, I decided to get an epidural. I think that was the best thing to do because I couldn't really cope with the pain, every four minutes after 12 hours without an epidural. 

Half an hour before I got my epidural, I lost the mucus plug.

So it was starting to pick up, epidural around 9:30, 10. And then I took a long nap. Thankfully, my epidural was very pleasant, didn't cause any side effects at all. And I had the best nurse ever, because she turned me, she was like, you're like a rotisserie chicken.

Lisa: Yeah. 

Nidhi: I'm going to cook you on all sides.

Lisa: Which is promoting progress, I'll point out. And then also we don't want to be on one side for more than about 30 minutes or so at a time because that numbing medication can run down to that bottom leg, right? So that's great that many nurses don't have the bandwidth in our busy New York City area hospitals in particular to come in and be timing and saying rolling over.

So, but I'm really thankful to hear that your nurse was able to do that.

Nidhi: Yeah, she was very good. I mean, I was sleeping, so I don't always know, but I know that she told my husband to not fall asleep. Because she was like, I'm going to need you to help me turn her over very frequently. So I don't want to see you snoring.

Lisa: Is this still the one that was a doula? 

Nidhi: Yes.

Lisa: Okay. Yeah, it sounded like it, to me. 

Nidhi: She really helped me go overnight from 10 to 5:00 AM. I went from three centimeter to nine centimeter without much problem. And then her shift was ending around eight. And the doctor shift was also around ending around nine.

Lisa: And you're like, you can't leave. You have to stay. 

Nidhi: I was saying that to her. But she told me that, your baby's still high, like the station is still high. She didn't use the word station, but she said the baby's still high. And I don't know if you're going to have a vaginal birth. She said that to me because I was dilated but I guess needed to labor down more. 

Pushing, Exhaustion, and the Vacuum

Around 6:30 or so, I was nine centimeters when my nurse checked it, and then the doctor came in five minutes later, she was like, oh yeah, she's almost 10, we can start pushing. And I looked at her, I was like, you just said nine, like five minutes ago. And she's like, yeah, she's nine and a half maybe. So I knew I wasn't 10. And I'm looking back at this now, because in that split second, I was like, oh, okay. I have to push now. So I didn't know what was happening, but I, now I know that my nurse had said that I'm nine. And then the doctor said, she's almost 10, and then somebody questioned her and is like, no, she's like nine and a half, she's okay. We can push. And had half an hour ago, the nurse had also said that the baby's high.

So, again, looking back, I should have probably labored down a little bit more, but the doctor was like, let's push. And I'm pretty sure at this point it was because her shift was ending at 9.00 and this was 6:30, that she wanted to like, get this done. 

In the beginning, I was like, I don't really have any urge to push, can you turn down the epidural? So maybe I'll have some urge to push. So turned down the epidural, and that's when I started first feeling the labor, the active, real labor was all in my back, which I didn't have when I was starting to take the Pitocin. 

And like, I didn't have that experience the whole time, it wasn't all on my back, it was like across in the whole pelvis. Now I was feeling all in my back. I asked them to help me roll over, see if the pain will get better. And they were very compliant with my request. But at this point, my OB did say that we can't just hang out here while you're pushing.

So I'm like, I don't want to push, why don't we just let this happen a little bit longer? So she said, okay, I'm going to increase the Pitocin to see if the baby comes down a little bit more. So they, as soon as they increased the Pitocin, the baby's heart rate decreased, the baby was in a little distress.

So, she was like, no, no, no, we can't really give you that much Pitocin; your baby doesn't like it. So, long story short, when we turned on that epidural, I was hoping from my PT and pelvic background, that I would have an urge to push. At some point, I would feel something that would say I should push or where I should push.

And I didn't feel that, even if we reduced the epidural, I felt sharp pain in my back with every contraction, nothing in the front, and no urge whatsoever to push. But, so she was like, well, you can push. So at that point, I was coached to push the very traditional hospital way, hold your legs up and push.

And I tried to go on my side. I tried to squat. I tried to do all kinds of things to see if I could avoid that situation of my knees up to my chest and pushing, but I couldn't avoid it because I had no urge whatsoever. So I didn't have the option of waiting because they couldn't give me more Pitocin. I didn't have the option of pushing my way, because I couldn't really feel anything.

Even without epidural, even with epidural turned down, feeling the contraction didn't feel like anything felt like a sharp pain in the back, like not back, but backside of pelvis sacrum. So, the only option was to put my legs up and push like they asked me to push, hold your breath and push.

Lisa: And were you very externally rotated or internally rotated or, I know hospitals usually have you externally.

Nidhi: Yeah, I was I, so I had it externally rotated because I didn't think my baby was low enough to help the internal rotation just yet. I felt like I had no, my baby wasn't crowning, wasn't seen nowhere to be seen. And again, looking back, I think he was too high to even push.

It was just probably just resting and gravity that needed to happen, maybe movement rather than pushing. You know, this is retrospective, so I don't know if that was true, but that's how I feel now. 

So in the end, I pushed from 6:30 to 8:30, the traditional hospital way. My baby moved down, we could see his head, but my pushes weren't effective at all. And it felt like his head was stuck in the sacrum somewhere, I think he was not turning maybe, or he was stuck. So she put her hand in and she's tried to like massage and push that tissue away. But didn't really work that well.

Around 8:30 - 8:45 I was like, I'm exhausted, I can't push anymore. In fact, I was going to say that, you know, just do a C-section because I've had it. I've pushed, like I'm just dying here. 

So right at that time, like 15 minutes before this, the shift changed. So my nurse and my OB, I think my nurse had left earlier because when OB wasn't in charge, my nurse wasn't really doing that much.

My OB was like, okay, I'm going, I'm done. And I was like, okay. So she left and it was almost good for me, because the other OB who came was a little more experienced and she was like, you can push, I will let you push longer if you want to push. I'll let you push for an hour longer, take a break and go back to pushing if you want.

But they brought a mirror in and it's like, look, touch your baby. He's like right here, you can see his hair. You can touch his head, and can you touch his head and like guide your push? And I couldn't, I was pushing as hard as I can, it just didn't work. So at that time, I asked her, and I was like, this is C-section or vacuum. Like, these are the only options.

So I asked her, I was like, I don't want to do a C-section, would you vacuum? She's like, he's a little high for vacuum, but I'll do it if you want me to. Looking back, I don't know if I should have, but I asked her, I was like, yeah, do it. So she did a vacuum. Like I said, he was high for a vacuum. 

So, when he was pulled out, it caused a sulcus tear in my vagina, which is basically a high tear close to the cervix.

And then I had a grade three tear in the perineum, and I bled a lot because of all that internal tearing. 

But he was delivered, he came out and then she was stitching me up for another 45 minutes of all the tearing.

That was the birth. And it's almost like when I gave birth, all I wanted to say to my baby was, I'm sorry to put you through all of this, because it was like a long labor that was traumatic in many ways, even though it was supportive.

Nidhi: I don't think I felt angry after that ever, but I did feel like it was very traumatic, not just for me, but probably for him too, because he was stuck there for a long time. He was stuck at the opening and close to crowning, but not crowning and just not moving. And I was pushing again and again. So he was delivered, I asked them to delay the cord clamping, like you told us, and they did that. He was put on my chest after cord was clamped, they did do something in between, they didn't put him on me right away, but I was like yelling, like, where's my baby?

Bring him to me, bring him to me. Yeah. And my husband did look at the placenta, like you asked, to make sure... 

Lisa: Good for him. Most parents just discard that tip.

Nidhi: No, he did look at the placenta. He took real notes, he was really good, he was really good, because I told him like, I can't have a doula. I need you to be my doula.

Yeah. And then, my blood sugar was low and his was low, we were both hypoglycemic because of all the work. I had lost a lot of blood.

And it was a long recovery from there.

The Long Road to Recovery

Lisa: Yeah. I'd love to hear more about that recovery, whatever you'd like to share. And I was also curious, and then thankfully, you actually just shared it without my asking, just that you had done internal manual work. I didn't know how much of that is even physically possible, really. I was curious as if, you know, as to prenatally, if you had gone to someone else or, so that was really interesting to know.

But afterwards, what did that look like because third degree tear is a severe tear and as well as the, you said sulcus tear?

Nidhi: Yeah. So sulcus tear is like, it's this, they call it like a parallel tear from cervix down into the vagina. Because I think as they pulled him, his feet just dragged on my vagina. And I know because it was very high. I think the OB before that probably wouldn't have done the vacuum because he was high, but this OB said, I will do it if you want me to.

And I think she was very supportive in that way. And looking back, I don't know if it was the right decision, but I just didn't want to, it was like too much, I was like, okay, just whatever, do it. Yeah, so healing from third degree tear was very difficult in the beginning. I had all the things that I had ordered, for the perinatal recovery in my Amazon cart.

And that's what I tell patients to like, not order it, but actually put it in your Amazon cart. Because if you order it and then you don't have a vaginal birth, it's very disturbing when you come home.

Lisa: Oh, that's really a good point. Thank you. I haven't heard anyone ever say that, but that's a really wise insight.

Nidhi: Because I've had patients who, like I told them what to order, they ordered all of that stuff at home. And then if you need a cesarean and you come home, that's another reminder of what changed and that could be very upsetting. 

So I had in my Amazon cart and the plan was, as soon as I give birth, we'll just order it, so by the time we get home, it's all here. So I'd add all the things that you do, colace with the stool softeners is probably the most important thing in the beginning. And I'm sure you've heard about the first time you poop is like you give birth again. It's like what just happened?

Lisa: Terrifying.

Nidhi: Terrifying.

And I started working on my scar around three, four weeks postpartum, which is earlier than six weeks.

And I did that because I knew, and you can do it externally, but not internally. So, I wouldn't want anyone to do it unless you have clearance from your doctor. I started working on my scar externally. It really helped me sit. And I think this guideline will probably change in next few years because you can't really say, don't touch that scar but sit on it.

Nidhi: Like you're sitting on it, right? You're putting all your weight on it. So if you can sit on it, then you can touch it externally. I think if more women were allowed to just touch or massage their scar from the outside, not the inside, there probably will be less discomfort sooner. Because you're sitting on the scar, you're definitely stretching it, but you're stretching it with your weight rather than stretching it more gently with your hand and giving your body a chance to get used to that pressure, which was really helpful. I was in a lot of pain. My doctor told me, don't fight the pain medications, it's okay to just take a Tylenol. So I was taking Tylenol around the clock, I think for the first two weeks. And then around the third week, when the scar was really starting to dry up, I started to work on it myself. I didn't really need pain medication after that, it really helped. And I started PT for the scar right after six weeks when I had my post-op OB visit, which is another thing that was just completely disappointing.

Lisa: In what way?

Nidhi: Well, so this was the OB who had delivered me, right? She had seen the sulcus tear. She had seen the external tear. She had known my history of pelvic floor. She knew my tailbone fracture. Which by the way, I asked her, was like, was it my tailbone that the baby was stuck at? Because I do have a bent tailbone because I broke it and it bent and then it fused wrong. And, 

Lisa: Interesting.

Nidhi: And she was like, oh, I don't know. So I'm like, you were in there massaging something, what were you doing? She's like, I don't know. I don't think so. She didn't really pay attention or she didn't really, I don't know, she didn't think that tailbone affected the birth, but it does. Tailbone attaches to your pelvic floor, so it does. And sometimes I feel like OBs don't know that, which is surprising. 

They don't know that pelvic floor attaches to tailbones. Any injuries to tailbone is going to change what your pelvic floor does.

Lisa: Makes so much sense, yeah.

Nidhi: But they don't put two and two together, at all. In my postpartum visit, she didn't ask me about bladder, are you leaking? Are you in pain? If you have a third-degree tear, which is vaginal to anal, you could have a lot of symptoms, all kinds of symptoms, right? Sulcus tear, you could have so many symptoms. And she asked me nothing. She said, are you breastfeeding? I said, yes. And then she did a pap smear and she said, okay, see you next year. That was exactly it. And I didn't say anything to her, because I think I just didn't have the energy to say anything to her, although I should have probably said that, you know, you should do more. I started doing pelvic floor PT around that time, around eight weeks. Really worked on my scar, really did a lot of strengthening.

And it took more than 14, 16 months, for tissue to heal properly and for me to have no symptoms. And this is something like everyone should know, that third degree tears are predisposing you to lot more injuries, lot more complications. So if you have a high degree tear, you should absolutely ask for a pelvic floor PT referral.

Lisa: Like I used so much of the care that I know, so much of the knowledge that I know, I saw my friends who are pelvic PTs to check the strength, to see everything. And they helped me so much. I wouldn't have been able to do it without them even after knowing everything that I know. You did some manual therapy on yourself prenatally, but then you saw other PTs after. 

Nidhi: Yeah. So, I mean, seeing other PT is the ideal way. Prenatal, I wasn't seeing anyone because of COVID, and I was really scared. 

I did it myself just because I couldn't do anything else. But postpartum, because I had more access, I did see other PTs to get care. Yes. And of course, I had more injuries, so it wasn't just preventative. Now it was actually handling the tissue tightness. She didn't ask me if I had pain with intercourse. Like 80% of people are having pain with intercourse in grade three tears for a long time, which is severely affecting mental health and all the other aspects. So she didn't ask me that.

Lisa: It's huge. And part of me wonders, well maybe because if she knew you're a pelvic PT, she's like, oh, she knows all that, but that's overly optimistic. I think that there is based on everything I've heard from all of my clients who are not pelvic PTs, they just don't they, I don't know, I think they just don't get enough training on any of that in medical school. That's my best guess. And it's really unfortunate because people are then suffering in silence.

Nidhi: Yeah. One of the things that is like really annoying, and really makes me angry is I get that they didn't get the training in school, but their own organization, which is ACOG released a guideline in 2016 saying that the six-week postpartum visit should be earlier. It should be at three or four weeks.

People need more, they don't do that. To this date, they don't do that. I don't know why 2016 - 2022. What's missing?

Lisa: I'm guessing that our healthcare system with all the layers of insurance and stuff that like, it takes so long for insurance to just standardly cover that, that maybe that's why, because most people don't want to do that out of pocket. If, you know, if that's not the official standard of care and it just takes so long, that's been my guess.

Nidhi: But it is the official, if ACOG says that, then it is official, right? It's official, but it takes time for the insurance system to listen to that and be like, oh, okay, we need to change what's covered.

Okay. Maybe that's it. 

Lisa: That's what I think.

Nidhi: It could be that it could be that. And even after six weeks even if you tell them, so around three weeks, or actually, I think around six weeks, I told her I'm exhausted. she's like, oh yeah, you're a new mom, whatever. No, I'm exhausted that I can't push a stroller down the street. I'm like that exhausted. And she was like, yeah, rest and whatever, eat more carbs. So, I told her, no, I want you to refer me back to the endocrinologist that I had seen, because I have family history of thyroiditis and other things. And when I was referred out, I was severely anemic, which is again, a thing that for a woman who was underweight, low sugar, lost a lot of blood, we should expect some degree of anemia. 

Which does not happen. Like not even a single blood test happens at six weeks visit or after that, because there's no follow up after six-week visits. It's not oh, we're going to do your blood work to see everything is together. Not at six weeks, maybe at three months, maybe at six months at some point, right? So there's no follow up. Even if you have symptoms. 

So, in my family, thyroid dysfunctions have started after pregnancies. I've seen that pattern, which I see in my patients all the time. I'll see women one year after giving birth, one and a half year after giving birth who are having these like weird joint pains.

And I was like, was your thyroid ever tested after? She's like, no. Why would my thyroid be tested? Because postpartum thyroiditis is very common. 

Lisa: Very common, you're right. Can I ask you also, since you were mentioning being anemic iron deficiency, what came back to mind in thyroiditis as well, the condition you have with the lack of ability to absorb vitamin B, were you, B12 specifically. So in postpartum was that being regularly addressed or addressed in any way?

Nidhi: No, I went back to my hematologist to address that. And of course, she was like, I don't know anything about pregnancy. I don't know what you, what are you talking about? So I'm just going to check you B12 and give you B12 shots. And here, my OB is like, I don't know what B12 is, so I'm going to just check.

Mom holding baby in her lap, with a small cake and candle in front of her

I'm going to just do a pap smear. So of course there's like this disconnect and the care where people just don't know about each other, and they don't even care. Like, they don't even care to find out what it is. Fortunately, my B12 condition is very manageable in a way that if I take a very high dose of vitamin B12 and check it and get some shots, it's manageable. But it was the anemia that was really, really very difficult to manage. And I think that anemia probably predisposed me to develop some, not depression, but develop some mood disorder. 

Breastfeeding Struggles and Therapy

One or two months postpartum was really struggling with breastfeeding. I know you told us that breastfeeding will be hard, be prepared, but I don't think anyone really listens to that. 

Lisa: You're so right. We can't get it until we're in it. Really experientially. Yeah.

Nidhi: Because you're like, we're all preparing for birth, and it's birth is like a cliff and then you're like, oh, what if they just jump from there? I don't think I was really prepared for how tough the breastfeeding would be and it was tough, tough in a way that the milk was delayed, he was low (weight), but also tough in a way that I really struggled mentally. I really struggled to establish breastfeeding. And I don't really like breastfeeding that much, which is not something that people feel okay saying. So I say it very often so that everyone feels like I don't really like breastfeeding at all. 

Lisa: I didn't love it either. Overall, there were moments of sweetness with the baby, you know, but yeah.

Nidhi: But, I see so many people like really, beat themselves up and they say, oh, you did it. It must have been such a great bonding experience. I was like, but it wasn't. Like I did it, like I eat broccoli, it's good for me. So I breastfed because it's good for baby. I didn't do it for bonding. I didn't feel really, you know, I felt exhausted. And breastfeeding again and again, really affected my mental health. 

I started seeing a therapist around two months postpartum, because I just wasn't coping with exhaustion, no family, like none of my family came over. My mom met my son like two weeks ago. Now he's almost two.

Lisa: Oh my goodness.

Nidhi: Because COVID. So I had no family, I had no support and I had this really weird birth experience that I couldn't really make sense of. And then breastfeeding was just like this last thing that I was like, I can't do this anymore. So that mental health therapist really helped.

He helped me navigate this very difficult path. And I think if I didn't have that help, I would have quit breastfeeding at that point. I would not have lasted. I lasted only because of him. Talking to him really helped. May I ask, what was the point at which you realized you needed that support? 

So, I think, there was a point where my baby would sleep, you know, for two hours, three hours at a point at a stretch at night, and I couldn't fall asleep. Because I had this anxiety of, when will he wake up and I have to breastfeed again, and will it hurt? And will he get enough milk?

Because I had this constant struggle with, is he still hungry? Because he was underweight. I was told that you have to weigh him before the feeds and after the feed to make sure he got enough. Because he's too little and you're not making enough milk. So there was this constant, from his pediatrician and my OB, there was this constant pressure that if he doesn't gain this much weight by next Wednesday, he's going on formula. 

Lisa: So much pressure. 

Nidhi: Yeah, so I was weighing him before the feed, after the feed all the time. And up until 4 or 6 weeks is when the first time like he got enough and then I could also pump extra. That's when I finally felt like I was relaxed a little bit, but he was still waking up at night and I had developed this pattern of anxiety of, if am I making enough milk? Is this going to hurt? And I didn't really enjoy breastfeeding. I didn't really enjoy what it did to my body. So I was just anxious, and I was anxious and angry at my husband all the time. I was really angry at him. so he suggested that, you know, do you want to get some help? It looks like you're really struggling. And one of my friends, he's also a pelvic floor PT, suggested that you should get [help]. I mean, mental health challenges, I've seen my patients have it, I've seen how much it helps their pain, like simple back pain, pelvic pain. So I already had it in the back of my mind that if I ever need support, I'm going to just get it.

And being at home really helped, so I had time, so I got it. And it was a virtual session, so I didn't have to go anywhere. Anxiety was getting to me and getting to my sleep, I think that's when I really thought it's time.

Lisa: And how did you find your therapist? Did you already have that sort of on deck at the ready or?

Nidhi: So, one of my friends who's also a pelvic floor PT knows the therapist. So he wasn't a postpartum specialist or anything, but he was known, so it just was the easiest thing to do. So I did that. Now I know many more, very specific postpartum mental health specialists, and if I was to do it again, I would probably talk to them.

But at that time, I didn't know anyone. So I just went with the first one and he was, he turned out very helpful.

Lisa: Nice. And was that a long-term thing or short term?

Nidhi: It probably should have been long term, I stopped when I went back to work, because I didn't have time.

Lisa: Sure. 

Nidhi: But he helped me get to a point where I could function with breastfeeding. He was very non-judgmental in a way, like I'll help you get through it or help you get past it without doing it, whatever way you decide, I'll help you through that.

Therapy doesn't mean that it's going to help you breastfeed. Therapy just means it's going to help you either breastfeed or help you quit breastfeeding. So, he was very non-judgmental and helpful that way. He did help me get to a point where I wasn't having these thoughts anymore and then was sleeping better.

Nidhi: And there was also a point around eight months when my husband started taking some night shifts. So I could go out and sleep in a different room. Even if I pumped at night, I would like sleep in a different room, and I think that was a game changer. My husband insisted that he wanted, it was like, you can't do this anymore.

So you have to sleep two or three days outside by yourself. Because I always had this anxiety, when is he going to wake up again? And one, two feed. Cause my baby at four or five months, he was feeding like seven, eight times a night. He went through a phase of really significantly what is that's called, cluster feeding at night for two months. So that was really tough.

And I think that's after that he stopped and my husband took some of the nights, kind of went back to work and I think things normalized a little bit, that's when I stopped therapy. And I think I could still use therapy today.

Lisa: Oh, we all could, right? Yeah, absolutely. We need to normalize it more, for sure. But life does get busy, and it gets challenging to squeeze, you know, how many things can you schedule?

Nidhi: Yeah. I mean, you know, I'll definitely do therapy at some point again, if you can afford therapy time wise and financially do it.

Lisa: Yeah. Well, I love hearing that your husband was so supportive, even if you were angry with him at times. A couple of things that he suggested, brought up the idea of therapy and that he also looked for ways to help you get more rest. Those are big tips for partners of just supporting and encouraging in whatever way is needed.

Nidhi: Yeah. I mean, he's incredible. And to this day, we have this pattern of what is hard, like sleep time is hard for me to cope with somehow. Nighttime is my anxiety time maybe, and mealtime is harder for him to cope with. So, you know, if mealtime tantrums I handle and bedtime tantrums, he handles.

Because somehow that's our personality. So, we have bad mealtime days, and we definitely have bad bedtime days. And to this day, this sync seems to be working.

Lisa: That's great. I love that you complement each other and finding those ways in which you complement each other, and as you go into parenthood can be so needed and so valuable for your sanity and for your wellness. 

Great. Thank you so much for everything you've shared. Is there anything that you haven't gotten to share yet that you wanted to share and or are there any final tips you would give either from your perspective as a parent or from your perspective as a pelvic floor PT?

I know that was quite a bit, but whatever you would like to share on any of that.

Tips from a Pelvic Floor PT

Nidhi: So I think there's one thing I want to say to everyone, is that doing things to prevent perineal injury, pelvic floor PT, getting a doula, all of the things can really help. Doula can really help in a way that when you don't have the support, I didn't have the option of doula, but I think if I had the option of doula, things would've been very different. Because you can't really control medical conditions, you can't control the facility you're going, but if you have a doula, they can do a lot for you, around you. That can create all the change, that can create all the difference. So, definitely get a doula and get a pelvic floor PT before. One or two appointments before giving birth and definitely one or two appointments after giving birth at the very minimum.

And you will not get this automatically from your OB. You may even get one of those things that, oh, you don't really need it. Or you may get, it's very expensive, it's not helpful. And you just have to, you just have to advocate for yourself there.

Lisa: Yes, absolutely. Thank you, Nidhi. Those are great tips, ones, which you heard me advocate for in class lots as well.

Nidhi: Yes. Yes, absolutely.

Lisa: Okay, great. Well, it's lovely to see you. Thank you so much for all the wonderful insights you shared, and I'm just sending you love and admiration and hope we can see each other in the flesh before too long.

Nidhi: Yes, I hope so. I really hope so.

Lisa: And in the meantime, I'll be sending lots of clients your way, because you're fabulous. 

Nidhi: And me too. Thank you, Lisa. Thank you so much.

Lisa: Take care. Have a good one. Bye.