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On today’s podcast, we’re going to talk with EBB Childbirth Class parent, Angela Jones, about having an uncomplicated pregnancy and birth when labeled as high risk.

Angela is a macro-level social worker, wife to her husband, Tony, and mom to her son, Alistair, and their cats, Pumpernickel and Lion-O. Angela and Tony graduated from the Evidence Based Birth Childbirth Class with EBB instructor, Victoria Michonski. Both Victoria and Heather McCullough, who is also an EBB instructor, were Angela and Tony’s doulas for Alistair’s birth. 

We talk about Angela’s birth story and her experience having an easy, uncomplicated pregnancy and birth despite being labeled as high risk for multiple reasons. We also talk about data birth outcomes for people who have multiple high-risk labels.

Content Warning: We talk about ectopic pregnancy, pregnancy losses, high-risk pregnancy complications, and perinatal morbidity.

Resources

Learn more about EBB Instructor, Victoria Michonski, here (http://www.vdoula.com/). Follow Victoria on Facebook here (https://www.facebook.com/312doulas/). 

 Learn more about EBB Instructor, Heather McCullough, here (https://www.hmbirth.com/). Follow Heather on Facebook here (https://www.facebook.com/hmbirth). Follow Heather on Instagram here (https://www.instagram.com/hmbirth/). Follow Heather on Twitter here (https://twitter.com/hmbirth). 

 Sheen, J. J., Wright, J. D., Goffman, D., et al. (2018). Maternal age and risk for adverse outcomes. Am J Obstet Gynecol. 2018 Oct;219(4):390.e1-390.e15. Click here.

Transcript

Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk with Angela Jones about having an uncomplicated pregnancy and birth when you’re labeled as high risk.

Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD, and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi everyone. Today, I’m excited to welcome Angela Jones to the Evidence Based Birth® podcast, Angela Jones, pronouns, she/her, is a macro-level social worker by day. At all other times, Angela is wife to her husband, Tony, and mom to her son, Alistair, and their cats, Pumpernickel and Lion-O. Angela and Tony graduated from the Evidence Based Birth® Childbirth Class with EBB instructor, Victoria Michonski. Angela loves reading literary fiction and used to love traveling before the pandemic. She’s joining us today to share her birth story and talk about her experience having an easy, uncomplicated pregnancy and birth despite being labeled as high risk for multiple reasons. Welcome, Angela, to the Evidence Based Birth® Podcast.

Angela Jones:

Hi, thanks for having me.

Rebecca Dekker:

It’s so wonderful to have you here and to meet you, and hear your birth story. I hope Tony may join us if he’s able. He’s on baby-watching duty right now.

Angela Jones:

Yes.

Rebecca Dekker:

Tell us, how did you and Tony find out about the EBB Childbirth Class and get acquainted with Evidence Based Birth®?

Angela Jones:

This pregnancy was very planned. I had spent about a year researching obese. At the time, I thought I wanted to use an OB, and I couldn’t really find one that I liked after a year of looking, and eventually I settled for one who I felt like she listened better than the other ones, but I still wasn’t completely happy. That said, I had a few friends that had given birth before me and they told me that a lot of our local hospitals had classes that, as they put it, were a spectacular waste of time. So, I was just like, okay, well, I am going to put together my own little course. I went on YouTube, and Rebecca, you have these videos that are the stages of labor.

When I saw them, it was just such a digestible … It was the best sort of description of what happens in the process that I had found. I was like, well, that is a part of my own course. Then, after that, I had started, so I had that in the back of my mind, and then I just started looking online, and I saw that there was Evidence Based Birth® classes in my area. And I was like, oh, well, I have to take that, because if it’s anything like those YouTube videos, that’ll be a really great fit. I’m someone who really likes data. It so good, the way that everything was just broken out, and like, this is actually what this means.

Even when you were explaining effacement, I remember when you took out the jars, and that was the best like …

Rebecca Dekker:

Oh, effacement of the cervix. So, it was like … okay.

Angela Jones:

Yeah, effacement of the cervix. That’s really how-

Rebecca Dekker:

Yeah, I think I used like a vinegar bottle and a ketchup container, right? No, peanut butter. Peanut butter jar.

Angela Jones:

Peanut butter was what it was. Yeah.

Rebecca Dekker:

Talk a little bit about your journey then, because with this pregnancy, like you said, it took a long time to get there. Can you share with our audience a little bit about your experiences before this pregnancy?

Angela Jones:

Okay. I’ve sort of an unusual situation, because every time my husband and I have tried to get pregnant, we’ve gotten pregnant right away that month. This pregnancy … But there’s something that’s happened each time. We first started trying, and I want to say, let’s see, we were … I think we had just gotten back from Japan. So, it was September, 2019, when we started trying, and we got pregnant right away, and that pregnancy ended up being an ectopic pregnancy. I knew a little bit about what an ectopic pregnancy was at the time, but it’s something that I never thought would happen to me, because if you look online, it says, oh, this is something that’s really rare.

That pregnancy was treated without me having to have surgery. There is this chemotherapy that they can do, sort of a low, specific dose. It’s called methotrexate. So, it was treated with that, and then I was told by my OB at the time that I could, as soon as I had cleared that pregnancy, as soon as my hCG levels went to below five, that I could just go again and try and get pregnant. So, I did, and I got pregnant, but my HCG levels were low in that pregnancy, and it ended up being a loss that they were not really sure what it was. That happened, and then I had another sort of like a chemical pregnancy. Anyway, at this point, my OB at the time was like, maybe you should see a specialist, even though I was getting pregnant, I would try, I could do it once, and I would just get pregnant if I said it during that time in my cycle.

When I saw a specialist, they sort of bought up some of the data about using this treatment that I had used. And they were like, oh, we actually encourage people to wait six months after that treatment.

Rebecca Dekker:

Oh, the treatment you had for the ectopic pregnancy. You had gone ahead and gotten pregnant again twice right after that.

Angela Jones:

Yes. By the time this pregnancy rolled around, it was … I got pregnant in early July of 2020. I had had all of those losses back to back, to back. By the time that had happened, I was just like, I don’t know. The specialist is like, you’re getting pregnant right away, even under those circumstances, I really don’t think it’s an issue. That had happened. But then another thing that I should mention that was sort of a backdrop for this is that I had a high BMI going into pregnancy. If you Google high BMI pregnancy, basically what you’ll find is all this information. Information, I’m doing quotes, that says, A, you won’t be able to get pregnant, which was not the case for me.

I was getting pregnant really quickly. B, if you do get pregnant, you have a series of complications. When I was in the process of interviewing OBs deciding who I was going to go with, I met a lot of OBs that were just like, ugh, I would induce you at 40 weeks, just without even really looking at my chart or seeing that I really didn’t have any health issues. I had high BMI, but that was it. I didn’t have like high blood pressure or anything, high cholesterol or anything. I exercise regularly. I didn’t really have anything other than that, sort of that label, that categorization.

I had the high BMI and then I had these pregnancy losses, and then I also have an autoimmune disorder. I had just all of these things that were labeled sort of on, so a lot of OBs were just like, we’ll definitely look at you very carefully. That’s sort of the place that I was at when I got pregnant with my son, Alistair.

Rebecca Dekker:

So, you were with an OB in this pregnancy. Was it the same one you went to when you were referred to a specialist to help getting pregnant or did you go back to your original?

Angela Jones:

I went back to my original. The specialist only really does sort of like complicated things. What I had said, my OB was like, maybe you should try IVF, because another thing is that I was 34 at the time, and I was going to be 35, and geriatric pregnancy, ooh. Basically, that’s how it was treated, like it was like such a big thing. The specialist only did really complicated things. My OB originally was suggesting, well, maybe we do IVF, that way we skip your fallopian tubes. We can check, make sure that everything’s okay because I had had these subsequent pregnancy losses. So, I was like, wait a minute. I feel like IVF is extreme. I’ve gotten pregnant relatively, not relatively, I’ve gotten pregnant quickly each time that I’ve tried.

It just didn’t seem like it made sense to me. So, I was like, when I’d had the ectopic pregnancy, I’d had it on one side. Then one of my subsequent losses, they weren’t sure if it was an ectopic, they weren’t sure if it was additional scar tissue that was left over. I’d had this procedure where they looked at my tubes after I had the confirmed, excuse me, confirmed ectopic pregnancy. My tubes were clear in that process. My OB was just like IVF, that’s probably the shortest route. And the specialist was like, hm, I don’t know. I, myself, was like, I don’t know either. It seems sort of extreme.

I also felt like, can I just wait until I’m ovulating on the other side and see how that goes? I did. I ovulated on the other side, that first month that I went to the specialist. She did an ultrasound to sort of look like in the middle of my cycle to look what was happening. She was just like, yep. I’m one of those people who I get ovulation pain on the side where I’m ovulating. So, I was super in tuned and sort of knew when it was happening. So, she’s just like, you’re good to go, try. I got pregnant right away, and I just transferred back to my OB.

Rebecca Dekker:

Okay.

Angela Jones:

Original OB.

Rebecca Dekker:

Did you feel like you were, since … Did they say you were high-risk or did they talk to you about your risk status at all during that pregnancy then?

Angela Jones:

My OB, at the time, I ended up switching to a midwife, by the way, and did not deliver with that OB, but yes, my original OB was just like, oh, we’re really going to monitor you. And every pregnant you see that you have in the future … Even if I didn’t have a high BMI or an auto-immune disorder, they would have monitored me because of the ectopic pregnancy and age, quite frankly.

Rebecca Dekker:

Okay. And how old were you with this pregnancy then?

Angela Jones:

I was 34 before, but I got pregnant at a time where I would be 35 by the time I gave birth, and that’s how they count it.

Rebecca Dekker:

Okay. You start taking the childbirth then with EBB instructor, Victoria Michonski, and what was your experience like?

Angela Jones:

It was wonderful. It was so good, in part, because I like using data to make decisions, and it really sort of, if you’re a person like that, the class is set up in a way to sort of really feed what you’d like to do. Everything was really digestible. I feel like my husband and I bonded really well over the homework. It definitely took a lot of time, so I think our Sundays were spent doing that, but it sort of forced us to have conversations that we probably wouldn’t have had until the moment that I was giving birth. Like, what type of role my husband would have during the process. I had been focused on me, me, me, me, me and I wasn’t thinking on, wait, I’m not doing this by myself, even though it’s something that’s happening to my body, and my partner can play a role in supporting us.

That was really great. I really, really, really liked the … When you go in the course, there’s this part where it talks about relative versus absolute risk, and that was a game changer for me, because it really things into perspective for me in terms of my high-risk labels. And it had me really look at data that I had seen a little bit differently. For example, some of the stuff that I’d seen about having a high BMI, it was just like your chances of gestational diabetes or this, that, the other, and it’s like, wait a minute. It’s not actually that high if you’re talking about absolute risk. That was really … I felt so empowered. I walked away from that class, and I took it at such a good time because I took it during my second trimester.

I remember, I had just made the decision to switch from an OB to a midwife, and I was also looking at sort of the experiences in the course of people who use OBs. There are so many good ones. I haven’t had a great experience, but I do know there’s a lot of great OBs, but just sort of information on midwifery care, and the midwives that I had switched to, they were so like supportive of low intervention, which is what I wanted my birth experience, versus when I was with the OB, it was like, we will do all of the interventions, and it felt really good.

Rebecca Dekker:

You mentioned you switched practices and providers. Can you talk a little bit about what led you to do that and how did you do that?

Angela Jones:

Oh, 100%. At my 20 week ultrasound, I had already had a few incidents with my original OB that sort of put me in hm kind of mode like, I don’t know if this is going to work out. If you remember, I have sort of saddled in a way, because I had already interviewed, I mean, I live in the City of Chicago, I had interviewed so many Obs, and I just pick the one that I thought was the best one out of them, but I didn’t really like any of them. In part, because I didn’t feel like they were taking me seriously as a woman. Bodily autonomy is so important to me. For example, the OB that I started this pregnancy, she would roll her eyes sometimes when I’d say things.

For example, I remember, when I went in at eight weeks for her to do a scan, they wanted to do a cervical exam. And I was like, “Why do you need to do a cervical exam? I don’t feel like I need one.” Her nurse practitioner was in there, and she was like, “Okay,” and she just left. And the OB came back and she’s just like, “Of course, I’m doing a cervical exam.” And I was just like, okay. But there was no interest in explaining to me why it was needed. She was just like, “I just need to check your cervix.” “Well, why?” “Just something we do. It’s standard.” At my 20 week ultrasound, she came in after I’d had the ultrasound with a tech and said, “We’ll need to recheck you at 36 weeks because your placenta is not where it needs to be.”

I said, “Well, is there a problem?” And she said, “No, no, no, it’s no problem. It’s just a little lower than we would like it.” And I said, “Well, why is that an issue?” And she’s just like, “We just like it higher.” I was pretty flabbergasted because I was like, this is my body. I’m asking you as a professional to explain to me why this is something that’s important and she just wouldn’t. It was sort of like, I just want you to show up and do what I would like you to do. At that point, I was thinking … I’d had started out my pregnancy with a different doula too, actually, and I was telling her that this was happening.

She said, “I don’t want to overstep, but don’t feel like it’s too late if you want to switch,” is what she said to me. And I was afraid to switch, because I was already halfway through the pregnancy. I had already interviewed all of the OBs, and she’s like, “Have you considered a midwife?” And I hadn’t. I didn’t know anything about midwifery really. I went to my first appointment with a practice I ended up going with, and I was … I remember I was crying because I was just so scared. My emotions were a little high when I was pregnant. The idea of shifting, I had already planned the hospital where I was going out.

I had already mapped up, it was five minutes from my house. I had already had sort of a vision in my head of how things were going to work. The idea of like flipping that on its head and starting something new, the midwives delivered at a different hospital. They were in a suburb of Chicago. There were things, it was farther from my house. So, I definitely went in more than a little bit fearful. The first thing that I noticed about them is they asked my consent for everything. “Would it be okay? We’re thinking that we might want to do an ultrasound just so that we have our own information, but we don’t have to, would that be okay with you?”

“Is it okay if we listened to the baby?” These are things that my OB, my previous OB never would have asked me. So, it just was automatically like, “We are here to advise you. We can give you a recommendation, and it is your choice whatever you’d like to do.” And they asked me how I was. It was just like, how are you? How’s the pregnancy going? Oh my God, the waterworks were coming though at the time. I was just like crying like, I’m so afraid to switch. I don’t know if this is for me, and I don’t know anything about midwives. One of the midwives in the practice, she was just so lovely.

She’s like, “That’s okay.” She’s like, “A lot of people switch a lot later.” She said, “I think you’re switching at a good time. This is what you want.” She had also heard like, I had heard some stories that I didn’t really. Like, at the practice I was at like, your anatomy is being cut without consent, stuff like that. When I was talking to the midwife about their practice, they were like, she let me know, “We do not cut … First off, it is a rare occasion that one gets cut. Here are the evidence-based reasons why we do this once or twice a year.” It was like fetal distress or something else I can’t remember.

I think they had cut one in a year or something like that. It was nothing like the old practice I was leaving. So, yeah, it was a good switch, but it was definitely … There were a lot of emotions in making that change for me. 

Rebecca Dekker:

What finally pushed you over the edge and was like, all right, I’m going back to the midwives and I’m not going back to the OB?

Angela Jones:

It was, when the OB would not explain … I knew I couldn’t deliver with that OB, no matter what, when they couldn’t explain something or wouldn’t explain something as simple as a low-lying placenta, which by the way, it moved up by 24 weeks, I’m like why? I just envisioned myself in labor. During my birthing time, sort of having conversations about asking questions, to having them being like, “It’s just is.” That would very much not be okay with me. I also, I have a history of sexual assault, and the way that my previous OB was interacting with me was so triggering for me. She knew this about me, but I don’t think she was making the connection of, I feel like you’re doing things to me without informing me about what’s going on, and that is bringing up stuff for me.

Rebecca Dekker:

Definitely not using trauma informed care.

Angela Jones:

100%.

Rebecca Dekker:

Which I would encourage anyone who’s listening. If you want to learn more about this, in episode 180, which is coming out a few weeks before Angela’s episode, we talk with midwife, Stephanie Tillman about why you don’t have to have a cervical exam at your first prenatal visit and why it’s so important to use trauma informed care with everyone. Yeah, so it seems like that OB was definitely not following trauma informed care at all.

Angela Jones:

100% not, and it felt like night and day when I went to the midwives, and they were just like, is it okay if we … Would you like to … We were thinking, what do you think? I had never been asked what I thought? It just felt like, wow, I can really work with this model.

Rebecca Dekker:

Yeah. Take us to the end of your pregnancy. By this point, you’d been with the midwives for a while, and you said earlier, you wanted a birth that didn’t have as many interventions. What was your mindset like at the end of pregnancy?

Angela Jones:

My mindset at the end of pregnancy. I’d had a very healthy pregnancy, no gestational diabetes. I was GBS negative. There were no complications in the pregnancy. I had, had, starting at 37, throughout the pregnancy, I’d had acupuncture, but starting at 37 weeks, my acupuncture started doing some of the, gently doing some of the induction points. I don’t know if this is why, but I had sort of started having prodromal labor at 37 weeks, and I have a family history of early full-term pregnancies. So, between 37 and 39 weeks. I was expecting to deliver during that time. On some level, I was completely ready. I had done Evidence Based Birth®, and I remember in Evidence Based Birth®, those comfort measures, I researched the heck out of them, and I had them all lined up for myself.

I took a hypnosis course. I purchased a TENS machine. My husband and I practiced the pressure points. I had them lined up for me. I felt very prepared. In terms of the type of birth that I wanted, I didn’t want to be medicated. I only wanted to have my doula and my midwife in the room. The midwives that I went with delivered in a hospital, I wanted to stay home as long as possible, probably till when I was like toward that transition portion where you’re starting to feel the urge to push.

I didn’t want to go to the hospital until then, because although the midwives were really up on the research and they were 100%, I felt like we were so aligned. The hospital was a little bit, where they delivered, was a little bit far behind in terms of the policies. For example, the hospital where I had my son still has a policy that you cannot eat when you are a birthing person. My plan was to just not go until I was at the very end. Because I was having that prodromal labor, it gave me a lot of opportunities to sort of practice my comfort measures.

So, I felt ready. I felt ready. I carried my son very well, so I was also feeling a lot of pressure. I take walks. My doula helped me find a masseuse who was fully vaccinated, and was servicing people in a very safe way, where they wear a mask. So, I was getting massages. I was like eating good food, watching dramas, reading. I was doing all of the things. So, I felt really good, and I had had all this practice. I kept on thinking that my birth time was starting, and it wasn’t. It was like a lot of practice. It was a really sweet time.

Rebecca Dekker:

Tell us about your labor. How did it begin, and when?

Angela Jones:

Okay, so it began on March 28th, 2021, when I was four weeks … 40 weeks, four weeks, when I was 40 weeks and four days into the pregnancy. Leading up to this time, I had also an Evidence Based Birth®. I had done the dates. I was eating the dates, sort of leading up. I was doing all this practice, and my husband and I had had sort of a late dinner. I remember we had pork chops, brussels sprouts and mashed potatoes. When I started having these waves, I thought, oh, no, not this foolishness again. I thought it was pajama labor again. I just basically ignored it and went about what I was doing, started using the hypnosis class that I took, sort of like an eyes open hypnosis thing. I was using that to just cope and I took a shower.

I went to bed, and at two o’clock in the morning, I woke up and things had gotten pretty intense, like so intense that I couldn’t sleep. I woke my husband and I just said, “Hey, I’m pretty sure this is it.” And he’s like, “Okay,” and he rolls over and goes back to sleep. Then I had remembered … Oh, another thing that I forgot to mention, why I thought I was going to give birth a lot earlier than I did. I lost my mucus plug at 33 weeks and four days. Yeah, and my doula let me know, “I’ve seen that people lose that early, weeks before anything happens, so don’t really count on that, but, okay.”

Back to the early morning situation where I was having waves, they were super strong. My husband went back to sleep. He can sleep through anything actually. Then I actually, I texted my doulas. My doulas were Heather McCullough and Victoria Michonski. I didn’t know who was on call, and ended up being Heather at the time. So, Heather was just like, “Okay, try to sleep.” She advised like white wine or Benadryl. Not white wine, red wine or Benadryl, and I didn’t want to do either of those things. I just figured I’d get in the shower and see what that would do.

I had one foot in the shower when I vomited with a vengeance that I hadn’t seen since my first trimester. It was like all over the bathroom. I cleaned the bathroom while I was in labor, and then I showered. The showering actually felt a little bit too intense for me. It felt like, it was just too intense. It was too stimulating at that point in my labor. I got out the shower and I just sat on the toilet. I think I used the bathroom and then I just rocked back and forth for hours. Just like coping as the waves, the contractions kept on coming, and then, at some point, I mean, I was out of my mind.

I remember my husband came in and he kind of puts his phone in my face, and I thought he was trying to let me see, because the doulas had … We had done like an evidence-based birth. At the end of it, we sort of like worked on like these little plans, and they were like, people who are not birthing people, you do the timing. Don’t make the birthing person to do the timing. I thought he was trying to let me see how close they were together.

So, I just was like, ooh, ooh. I just couldn’t even look at it. It turns out he was trying to get me to talk to Heather. Yeah. After that, he’s just like, all right, we’re going to the hospital. I was just like, why? Because I didn’t feel like I had to push. He’s just like, “I talked to Heather, she listened to you, she thinks this sounds active.” And I was like, “When did you talk to Heather?” Later, I found that phone, that was Heather on the phone. It wasn’t like him showing me …

Rebecca Dekker:

Timing?

Angela Jones:

Yeah.

Rebecca Dekker:

And Heather’s an EBB instructor too, I have to say, both Heather and Victoria. Yeah.

Angela Jones:

Yes. We went to the hospital, which I do not wish that ride on anyone. I couldn’t sit at that point. I ended up reclining the front seat all the way back and just laying on my side with the seatbelt the entire way there. We get to the hospital, and the minute I step into those fluorescent lights, that my contraction slowed down to, I think, 10 minutes each or something like that. It was nothing, like the intensity. I could talk, I could have conversations. I remember saying to Heather, “Heather, I think I’m too early. This is not what was happening at home.” And she’s like, “Well, we’re going to start it again. Don’t worry.” I tried the TENS machine, it was also too stimulating for me. I wish I had tried that in advance because it was a little too much for me.

It felt like it amplified the sensations. And then, at that point, Heather and Victoria switched off, and so I was with Victoria and then she convinced me to get into the bathtub. After we had gone on a walk and that didn’t really pick stuff up like enough, so she was like, why don’t I get the bathtub set up? Because they have one tub room in the hospital. I delivered in Evanston Hospital, and that tub is like amazing. It’s huge. My husband and I got in it. Victoria had set up like twinkle lights, all the other lights were off. It was very dim. We sat in there for hours. I rocked back and forth. I got on my hands and knees. They still were not one on top of the other, the way they were at homes.

After something like five hours, Victoria said, “How would you feel about going back home? Because these are not the type of waves that are going to bring a baby.” Ultimately, I said, “I’d be fine with that, but I want to know where I’m at.” My midwives had not done a single cervical exam on me. They hadn’t even asked because there really was no reason to. I said, “I want a cervical exam.” Because at this point, it had been, let’s see, if I just count from like two o’clock in the morning, it was about four o’clock the next day. Consistently, I’m having waves. One of the midwife checked me and she said, “You’re completely efface, but you’re only one centimeter dilated.”

Rebecca Dekker:

Oh my gosh.

Angela Jones:

It was so hard to hear, because those sensations were so intense, but it gave me a perspective. I was just like, okay. I’ll go home. I went home, all the way to my apartment, I remember that. My doula, Victoria, came with us. I remember, I just got in my bed, I put on a big t-shirt. I got in the bed, my cat Lion-O laid down next to me, and Victoria was on the other side, and she just sort of sat there with me while I just laid down on my side. When I woke up, I don’t know what time it was. I didn’t look at a clock the entire time.

Rebecca Dekker:

So, you were able to kind of sleep and rest at home?

Angela Jones:

I was told I looked restful. I felt like I was wrestling. I rested more than I did under the fluorescent lights of the hospital, but not as much as I did in the bathtub. I was laying there. I didn’t feel like I was resting though, because the sensations were so intense. It was just this active thing. I couldn’t sleep really. I just laid there with my eyes closed and sort of used hypnosis to just cope. It’s hard telling the time frame precisely, but it was very dark when things picked up with a serious intensity again. They weren’t right on top of the other, but they were probably every three, four … Between three and five minutes apart. It was that way for a while. Then I went, Victoria was trying to feed me like a Cracker. I was not tolerating any food. If I had a cracker, I throw up, what looked like a cup and a half of stuff, very little liquid.

Although, Victoria was on it. She had my water bottle, and she was just like “this is your beverage.” Her and my husband were offering it to me, and I could have like teaspoon fools. I had some fluids, but I hadn’t eaten really because I just couldn’t tolerate it. Victoria convinced me to get back in the shower. I did that. At some point, early, early in the morning, probably 24, 25 hours from the beginning, I started … It became a different experience. I couldn’t form complete sentences. Some of the things I remember saying like, I couldn’t articulate, but I would say things like hospital, hospital. Yeah, I was screaming it. Hospital. And then ambulance, ambulance.

Victoria just came and she looked at me and she said, “Yes, Angela, you don’t need an ambulance. You’re coping very well.” I would rest in between and I’d have to be, at that point, I had to be on and knees for every wave, and then I kind of collapsed. So, it was just like that for a while, and then I started realizing how tired I was physically, and I felt like I just need to eat. I need something to eat. Applesauce wouldn’t go down. I had little honey sticks and those little stingers, couldn’t do it. I couldn’t chew. It was hard to swallow anything that wasn’t like the consistency of water, and I could only do a very little bit of that. I said to Victoria, I said, “I want to talk about my medical options.”

I said, “I’m so tired. More than that, I want to know where I’m at, at this point, because I feel like that’ll help me.” We called the midwife, and she said, “Well, how about this? We see if the tub room is open, and if it’s open, we go back in.” We called, the tub room was not open. I was just like, at the time, not so much because of the sensations, but because of the lack of food and a lot of liquid, I felt like I was dying, and looking back, it was really that more than the sensations themselves. I was shaking a lot and I had prepared for this, but I thought by saying, you might shake, I was going to have a little handshake.

This was a full body, violent, I cannot move because I am shaking so hard, shake. That was something that I didn’t anticipate. It’s completely normal, but at the time, it didn’t feel like it. Around that time, Victoria, because we live in Chicago and the tow trucks here are really active, she’s like, “I think I hear a tow truck,” and sure enough, she looks out the window, her and my husband are about to get towed. So, they had to leave me in the middle of my labor and rescue the cars. Ultimately, I decided, I want to go and at least see where I’m at. When I go in and my midwife checks me, I was at a four with an easy stretch to a five. At that point, I just remember saying, okay, I can’t do another 24 hours of this.

And I fully knew it could be one hour from that point. I was already fully effaced. Victoria had said, “Why don’t we do some practice circles?” Or she’d help me try it, like a few different positions, but they were so intense. Anyway, so we get to this … My midwife said, “Okay, I have an idea. Why don’t we try an opioid?” I remembered from Evidence Based Birth®, that opioids are not great. People don’t report them as being the best pain relief, but I thought maybe I might be able to rest or something. I get Dilaudid at that point. At that point, it was about 31 hours in. Everyone’s different. For me, it did absolutely nothing.

I was told I looked very peaceful, but honestly, I was like … You hear stories about how when people are executed on death row, they give them something to paralyze them that you can’t really see what’s happening. That’s how I felt like the opioid functioned on me. I was in there, I looked really calm, but I didn’t have the energy to verbalize the way that I wanted to. So, I was just like, this is doing nothing. I do remember saying that. I said, “I want an epidural.” They basically ignored me. It was like, I had already lectured my midwives endlessly about, I don’t care what I say, I don’t want an epidural. So, they were just like, all right, let’s just let her chill for a minute. 

At that point, my water broke, and I saw that it was sort of a dark green color, and I was like, oh no, because in the hospital, I just knew for that particular hospital that they might react strongly, and it was almost … The nurse who was there, she just said to me, okay, I saw your birth plan. We might not be able to delay cutting the cord if there’s fetal distress. I was about to be like, “Yo, what if my child looks okay? I’m not consenting to you cutting the cord or something like that.” Victoria just, it’s like she read my mind, and she said, “This is a post-term baby. I think this just means his blood works.”

After I asked for it a few times, I was not … I was coping well. I was just extremely tired. In my mind, I had thought, okay, pushing, a lot of people push between two and five hours. I didn’t have the energy to push for two hours at that point. I asked for the epidural again, and they bought an anesthesiologist again, who was just lovely. She was pregnant herself, and she said to me, “Okay, just so you know, you’re still in control. We can always stop it. We can bring it up or we can reduce it. Don’t feel like this is like the end.” When she said that, I felt so empowered.” She does the epidural. It didn’t start working right away, which is another thing I was like, oh my goodness, I didn’t realize it wouldn’t start working.

I got it, and eventually, I did feel well enough to rest. Automatically though, as soon as the nurse left the room, I had been talking to my midwife and Victoria, as soon as the nurse left, I’m like, to my husband, I’m like, “Please bring me my snacks.” I ate. I think it was like some pork rinds and some crackers or something, but it felt like the best meal of my life, and I went to sleep. About eight hours later, my midwife, I was sleeping, my midwife said, “Do you want me to check you?” And I said, “Yes.” She checked. I was 10 centimeters, and my doula came back, and my midwife said, “I’d like to look again.”

And she looks, and she’s like, “Oh my goodness, your baby’s right there. Feel him.” My son had shimmied his way down in the five minutes it took her to set a few things up, and she’s like, “Do you want a mirror?” And I figured she’s going to bringing like a handheld mirror. She brings out this giant full body length on wheels, like snow white mirror. I was able to just look and see my baby’s head. It was so motivating at that point. I had slept, I’d eaten. The epidural really allowed me to do both of those things. I felt so good. I pushed him out like, in a little over 30 minutes, I felt euphoria like I’ve never felt in my life.

It’s funny because I had planned on something like completely unmedicated, I got everything that I wanted in the end. I felt so good and so empowered. I was able to push, I didn’t want to push on my back. I didn’t have to. They just said, how would you like to push? I said, I’d like to push on my side. I was able to do that. Also, I felt it. I thought I was going to be numb, and I sure wasn’t. My doula was so great. She’s like, because I wanted him out. It was like so intense. My doula said, “The fact that he’s not coming right now is a kindness on your body.” When she said that, it sort of put things into perspective.

She’s like, “Little pushes.” So, all of my strength, I like summoned all of the Pilates training I’d ever done in my life, and I did like these micro pushes, a bunch of little micro pushes to get them out, and I ended up just with like one teeny tiny … I had one stitch. It was really a great experience. When I saw him, oh, my husband was able to help deliver him. We did delayed cord clamping until the court was white. No one, it was just me, my doula, my midwife, and one nurse, along with my husband. That’s who was there. The room was dimmed the entire time.

It was just such a beautiful experience, hearing my baby cry. I will never forget that moment. I nursed him. I just stayed there for hours before anyone else even asked. I mean, the nurse came by and said, “Do you want a hat?” And I said, “Nope,” and we just did the skin to skin. Again, I nursed him and he just … We relaxed, and we talked, and we joked, and we just sort of processed the experience with my doula and midwife. It was the best time. I felt so good about it. I felt so good. I’m going to be riding that high for the rest of my life.

Rebecca Dekker:

Aw.

Angela Jones:

Yeah.

Rebecca Dekker:

It’s amazing. And what a gift that was that you were able to sleep and eat so that you could be re-energized and refreshed and can actually be present and enjoy the birth of your baby.

Angela Jones:

Yes. Oh yes. One of the things that I really got from the Evidence Based Birth® class is that epidurals are not a bad thing of themselves. They’re a tool. I think I really used it as a tool for my birth really effectively. I really didn’t want to have a really prolonged pushing phase or anything like that. It was sort of a strategic decision on my part because I thought, I really … I was thinking about pushing, and how can I get myself … I wanted to sleep and eat, and I was like, how can I do that? What can I do that’s going to allow myself to do that? I was like, okay, the opioid wasn’t it, but maybe if the epidural was, and it was. Yeah.

Rebecca Dekker:

Yeah. You talked about eating after the epidural, and a lot of hospitals that’s “not allowed.” How did you manage that? Did you only eat when medical staff weren’t in the room or were they aware that you were eating, or how did you handle that? 

Angela Jones:

Yeah, so I already felt empowered. If they were in the room, they left me for long periods of time. COVID, in some levels, was a blessing in that way. I had also let them know, no students anywhere around. I wanted the team as small as possible. And it was, it was really just my midwife, and one nurse, my doula, and my husband. Had they said something, I mean, what are they going to do? Rip the food from my hands. I mean, but basically, they were gone most of the time. It was just my people in there.

Rebecca Dekker:

So, you brought your own food supply so that you could feed yourself.

Angela Jones:

I sure did. I curated like a whole list of snacks and I was eating them as soon as I could, granted, even with the epidural, I didn’t tolerate. I was only able to eat very little bits. I still was throwing up after the epidural, but I was able to eat and take down much more than I was. I could have nothing. 

Rebecca Dekker:

I’m assuming the IV fluids they gave with the epidural might’ve helped a little bit with your dehydration as well.

Angela Jones:

Oh yeah. I didn’t want too many of them because I’ve heard they can inflate the birth weight and different things. They were pretty respectful of that too. I just had a big one and a half bags of fluid there. So, it wasn’t like a ton, because I was just like, I do not want a lot. They were very respectful, but yeah, the hospital did have the policy of no food, but I went in, I felt again, Evidence Based Birth® was so empowering. I was just like, I’m eating. The evidence supports this. There’s no way. I knew the reason why I was struggling is because I hadn’t been able to eat. Just my body wouldn’t let me. 

Rebecca Dekker:

Yeah, that’s awesome. For our listeners who want to learn more about the evidence on eating, when you have an epidural, you can go to evidencebasedbirth.com/eating, and you can see the same article that Angela read during her class. You had this amazing birth story and a healthy baby, and you got through it with no complications despite having multiple high-risk labels. Yeah, what was your experience like, how was your recovery?

Angela Jones:

Physically, I had no recovery. I felt like I could do a cartwheel the next day. I remember the nurse, when I went upstairs in the hospital to sort of stay, they first off, they told us we could leave. I was just like, I wanted to, and my husband’s like, maybe we’ll just stay just to … Let them check the baby out and stuff. So, I was like, fine. We’ll stay. Physically, I felt fine. I, even, I took a mirror and I was trying to look for where she put the stitch, but it was so small. I couldn’t really see. I didn’t really have physical pain other than my uterus contracting after. Immediately, I didn’t have that, but I will say psychologically, once I got home from the hospital, and I looked at my baby, and he just is so cute.

He’s so beautiful. I’ll grab one of his birth announcements real quick. He’s so cute. I was looking at him and thinking about why I have to protect this human being. Initially, I was a little overwhelmed with that idea, just as a Black family, and just thinking about how Black men and how little Black boys are not always treated very well. I was sort of overwhelmed with that thought. Then I started thinking about the community that my husband and I have, and all the Black men that we know that live very full lives. And just even my husband, like just how much love we have, and that sort of strengthened me through it. That part, that was a little bit difficult, but ultimately, I was able to pull through.

The part that was hard, it was the sleep deprivation. So, hearing you’re going to feed your baby every two to three hours is not the same thing as doing it. And it’s not like you fall asleep right away as soon as your baby unlatches if you’re breastfeeding, and I was, and I am exclusively breastfeeding. That was so such a challenge, and I hadn’t planned on having any postpartum support really. We just agree that my husband was going to do the cooking.

He was tired too though. We were both very tired, and I ended up sort of calling Victoria in a panic about a week and a half in, I want to say, just like, I think I made a mistake. I need help. She was booked up, but she was able to sort of connect us with an amazing postpartum doula, who even … I mean, she would just come over and hold the baby while I napped. She showed my husband a lot of things, like how to do paced bottle feeding. I was able to pump once at night, and my husband will be able to do one of the feedings so I could get about six hours at night asleep, and that made a world of a difference.

I definitely had some bumps in my postpartum journey, primarily related to just the social context of our identity and then also sleep deprivation. Other than that, it’s been great. My son is the light of my life and I just love him so much.

Rebecca Dekker:

I know you came prepared with a question for me. Do you want to ask your question?

Angela Jones:

I do want to ask my question. I am wondering, if anyone sort of in a serious way has collected, if you go in and Reddit, you’ll see lots of stories, and other websites like that, but I want to know, has anyone collected data on favorable birth outcomes for people who have multiple high-risk labels and a traditional medical model? If you look at the things that I had previous, pregnancy loss, high BMI, over 35, auto-immune disorder, it sort of is like the cocktail for don’t even try to have a baby, and I had. I mean, I think I gained 20 pounds during my pregnancy, and within seven days had completely … I lost it all.

I had literally no complications, so I’m wondering if, is there any data that doesn’t say, I mean, for me, even as a Black woman too, it’s like you are going to die if you try to have a baby in this country. That’s basically what it looks. So, I’m just wondering, not only for Black women, but just in general for people with that high risk label on them for multiple factors, is there any data?

Rebecca Dekker:

Yeah. Good question. I will tell you, as a researcher, coming from that background, my understanding is that most researchers are trying to predict bad outcomes. They don’t like to try and predict good outcomes, sadly, because they’re trying to see, what are the things that put you at risk? One of the terms that might be helpful when you’re looking for specific studies is you’re looking for prediction model. So, you’re looking at trying to predict, that’s what researchers call it, trying to predict who might have a complication. I was not able to find any studies from the framework of like, what predicts a good outcome or what percentage of people have a good outcome? They usually report what percentage of people have a bad outcome? It’s very negative, and that’s just the way it’s done, sadly.

Risk, in general, is an interesting concept, because there’s no standard definition of low risk or high-risk. I can’t go, 0.2 this is what a “high risk person” would be. There’s no definition, at least in the United States. There is a definition in the United Kingdom and perhaps some other countries, but also risk is dynamic. It can change throughout pregnancy. As times change as well, over time, they’ve added more respecters. I’m not sure if it’s really truly definable. Researchers argue whether or not high risk pregnancy is definable. But almost all the time, when they’re talking about risk, they’re referring to the risk of preterm birth and the potential for potential illness and/or death of the fetus or newborn. They’re not referring to the risk of the mother to experience illness or death, which is interesting.

Obstetrics is very focused on the outcome of the fetus, at least the research is, or the outcome of the baby. Less so focused on, what is the health of both of them together? I did found one study to use as an example. We found this study when we were looking at the research on pregnancy age 35 and older, which we’ve been talking about a lot recently, but there was a study published in 2018, and last name of the author was Sheen, S-H-E-E-N. They were actually looking at maternal outcomes. They were looking at severe maternal morbidity, in other words, the risk of severe complications for the pregnant person, and that included a long list of things like heart attack, kidney failure, eclampsia, sepsis, shock, hysterectomy, needing to go on a ventilator, along with other similarly severe health problems.

This study was focused on how risks for these severe maternal outcomes may increase with age, but they were also looking at other health factors, which they call comorbidities to see how that influences the results. So, they were trying to tease whether age alone increases the risk of maternal morbidity, or if it’s due to the health conditions or co-morbidities that increase with age. So, you’re more likely to have high blood pressure as you age, you’re more likely to have diabetes, type 2 diabetes as you age. So, they use a large database with more than 36 million US births to look at this question, and they group people into different age categories, and then they look to see how many of them experienced severe maternal morbidity.

Then they also looked to see if other health conditions you had affected the rate of severe maternal morbidity. Again, they’re trying to predict a bad outcome, but we can take the data and turn it around and look at good outcomes, so I’ll show you that in a minute. So, they found that the risk for severe morbidity was highest in people age 45 and older who were giving birth. From the years, 2012 to 2014, in the US, the risk for severe maternal morbidity was 3% for people age 45 to 54, and 1.5% for people age 40 to 44, and 1.5% for people age 35 to 39. Even after controlling for other risk factors, the risk of severe maternal morbidity did go up with age.

But when they controlled for comorbidities, the risk went down a bit for all of the age group, except for younger teens. They use something called obstetric comorbidity index, where you can score into a category of zero one, two, or greater than two. So, they looked at age and your score on the comorbidity to see if you combined age and your comorbidities, what does that do to your risk? They found out that combining older age and more health conditions does increase the risk of severe maternal morbidity. If you are age 45 and had a comorbidity score of zero, meaning essentially you’re healthy and don’t have any other conditions, your risk of severe morbidity was 3.7%.

But if your score was greater than two, you had a risk of severe morbidity of 14.4%. So, it goes from 3.7% to 14.4%. Then people in your age group, you were 35 when you gave birth? From 35 to 39, the risk of severe morbidity was 1.4% if you had a comorbidity score of zero on the scale, and 8.5% if you had a comorbidity score of 35 to 30 … Sorry, if you had a higher comorbidity score. They basically found what we call a J-shaped score in research, where younger adolescents and older adolescents have a higher risk, then people in their late 20s and early thirties have the lowest risk, and the risk goes up a little bit in the late 30s and early 40s, and then it goes up really high at 45.

The risks also get higher as your comorbidities go up. But if we turn it around, the researchers didn’t do this, but we talked about this, in EBB, you got to look at potential gains and potential losses, and often, they only present the risk, but they don’t present the chance of things going well. Right? Even if you had the highest comorbidity score and you were in the age group of 35 to 39, a severe morbidity chance of a little over 8% means that about 92% of those people won’t experience severe maternal morbidity, but that’s not how the data are presented usually, and it’s often assumed that these rates are set in stone.

But you, as an individual, have the power to raise or lower your risk by how you care for yourself and your body during pregnancy, how you nourish yourself with the foods you eat, or you’re able to eat, how you engage in physical activity, how you manage your other health conditions. Like, are they staying managed? And also, by how your health care provider cares for you? For example, we know that midwifery led care can decrease the risk of lots of different complications, including preterm birth. I really believe how we talk to people is important, because if you present a really disempowering picture, people are going to be less motivated to take care of themselves leading to an increased risk, because they’re like, well, it’s too bad.

My weight is such and such, my age is such and such, I have this health condition, so I’m doomed to have bad outcomes, but if you present realistic information and also you present some empowering information, it can help empower people to take care of themselves. So, does that help answer your question about why you don’t see a lot of these numbers presented in a more positive way?

Angela Jones:

It totally does, and I love the thing you did where you just turn the data around and sort of just looked at it from a different perspective. You’re absolutely right, that it’s not frequently presented that way. I think this sort of gives me a lens for how … I think I did this on some level with the absolute versus relative risk from EBB, but this is definitely … That’s a very powerful thing, switching it around so that you’re thinking about it that way.

Rebecca Dekker:

Yeah, and it’s not that we want people to think, oh, I’m not at risk for things happening, but you give practical real information, but you also provide people with empowering information on how we’re going to lower that risk or how we’re going to, hopefully help you be on that other side, which, if you’re looking at a seesaw or teeter-totter, I mean, that’s where most people are going to land.

Angela Jones:

Yeah.

Rebecca Dekker:

Which is exemplified by your story. You had great outcomes.

Angela Jones:

100%. Honestly, talking, like processing the experience with the midwives in my practice, they weren’t worried about me for a second. They were just like the overwhelming … The chances are that you’re going to be okay, you’re healthy. They were not worried at all despite all of the labels. I think something that one of the midwives said to me is that, “It’s just not what we see in practice,” and that was very powerful. I’d already had the baby at that point, but I was just like, I was so worried. She was just like, “It’s not what we see in practice. Most people are.”

Rebecca Dekker:

Yeah. I think if any listeners want to hear more about that perspective of midwives, not all midwives think that way, but a lot of them do. In episode 152 of the Evidence Based Birth® Podcast with Shafia Monroe, who talks about traditional Black midwifery, and she talks about that spiritual aspect of envisioning the positive outcome and how patients can feel your fear and your anxiety as the provider. So, having confidence as the provider can be important to transmit that confidence to your client too.

Well, thank you so much, Angela, for coming on the podcast. We really appreciate you sharing your story. Is there anything else you want to share with us or?

Angela Jones:

Let’s see, I guess, for Black woman who listen to this podcast, I will say, I spent so long doing research and trying to figure out a way that I could have a positive birth outcome, and I would just say, don’t let anything get in the way of the type of birth that you want to have, or the type of care that you want to have. I thought I didn’t have options, and I did. I would just encourage folks to keep on looking if they’re not happy with the options or the experiences that they’re currently having.

Rebecca Dekker:

Thank you so much, Angela.

Angela Jones:

Thank you.

Rebecca Dekker:

This podcast episode was brought to you by the Evidence Based Birth® Childbirth Class. This is Rebecca speaking. When I walked into the hospital to have my first baby, I had no idea what I was getting myself into. Since then, I’ve met countless parents who felt that they too were unprepared for the birth process and navigating the healthcare system. The next time I had a baby, I learned that, in order to have the most empowering birth possible, I needed to learn the evidence on childbirth practices.

We are now offering the Evidence Based Birth® Childbirth Class totally online. In your class, you will work with an instructor who will skillfully mentor you and your partner in evidence-based care, comfort measures, and advocacy, so that you can both embrace your birth and parenting experiences with courage and confidence. Get empowered with an interactive online childbirth class you and your partner will love. Visit evidencebasedbirth.com/childbirthclass to find your class now.

 

Listening to this podcast is an Australian College of Midwives CPD Recognised Activity.

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