EBB 231 – A Joyful, High-Intervention Birth with EBB Childbirth Class Graduates Lisa Mangini and Anand Swaminathan

• Follow Lisa at @lisaquarius on Instagram and Lisamangini.com
• Find an EBB Childbirth Class at https://evidencebasedbirth.com/childbirthclass
• EBB Signature Article on doulas at https://evidencebasedbirth.com/doulas
• EBB Podcast episode 175 on the evidence on midwives https://evidencebasedbirth.com/evidence-on-midwives/
• EBB Podcast episode 186 on a high-risk pregnancy with Angela Jones https://evidencebasedbirth.com/a-positive-pregnancy-and-birth-outcome-with-multiple-high-risk-labels-with-ebb-childbirth-class-parent-angela-jones/

Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk with EBB Childbirth Class graduates, Lisa Mangini, and her husband, Anand Swaminathan, about their joyful, high-risk, high intervention birth.

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. My name is Dr. Rebecca Dekker, pronouns she/her, and I’ll be your host for today’s episode. Today, we are so excited to welcome EBB Childbirth Class parents, Lisa and Anand, to the Evidence Based Birth® Podcast. Before we interview Lisa and Anand, I want to let you know that we will mention miscarriage. If there are any detailed content or trigger warnings aside from that, we’ll post them in the description or show notes that go along with this episode. And now, we’d like to introduce our honored guests. Lisa Mangini is a writer living in Central Pennsylvania with her husband, Anand, and their young son. Lisa teaches English and creative writing at a university, and she’s in the early stages of writing a book about becoming a parent. They are graduates of the EEB Childbirth Class with EBB instructor, Jennifer Polk, and Lisa and Anand are here to share their story of experiencing a joyful, empowering, high-risk birth, with high levels of intervention. We’re so thrilled that Lisa and Anand are here. Welcome to the Evidence Based Birth® Podcast.

Lisa Mangini:

We’re so happy to be here.

Anand Swaminathan:

Thrilled to be here.

Rebecca Dekker:

So, Lisa and Anand, tell us a little bit about how you found the EBB Childbirth Class, and how you got started on that journey of educating yourselves.

Lisa Mangini:

So the story actually starts back in 2019, where I was pregnant the first time, and fairly early on in that pregnancy, I want to say maybe about six weeks in, I had a tonic-clonic seizure. Very surprised by this, as I’d never had one before. And so, I was put in touch with a neurologist. I had another seizure, I had a miscarriage, and I was really lucky that this neurologist was trained in specifically women’s and reproductive neurology. And so, we worked with her closely to sort of figure out what kind of risks I might have moving forward if we were to try to have a baby again, and she recommended Evidence Based Birth for us. And so, that’s how we found the class, and we’re so happy that she was able to recommend that resource for us.

Rebecca Dekker:

Well, I think that’s the first time I’ve ever heard of somebody finding the class from their neurologist, so that’s pretty cool. Tell me a little bit about what did you learn from your doctor and from your education? Did you learn is there a connection between the seizure disorder or the miscarriage, or how is your condition related to your reproductive health and pregnancy?

Lisa Mangini:

And so, from what we understand, it sounds like the seizure itself did not impact the pregnancy, and that pretty early on, that it was going to be unviable anyway. However, for some people, hormone levels can increase the risk of seizures for those who have underlying kind of seizure activity in their brain already, and so, we don’t know for sure, but that seems to be something that we suspect played a role.

Rebecca Dekker:

Okay. So, were you going to have to be monitored by your neurologist in future pregnancies, or what did they tell you about, would you be high-risk or not?

Lisa Mangini:

Yes. And so, before getting pregnant, she recommended that I take five times the normal dose of folate for three months prior to trying to conceive, because the medication I was on puts me at a higher risk for birth defects, specifically neural tube defects, and yeah, go ahead.

Anand Swaminathan:

Yeah, and she was really circumspect about what medications she chose, just because there’s been very little study on a lot of these anti-epileptic drugs, and pregnancy and childbirth, so.

Lisa Mangini:

Yeah, and then throughout the pregnancy, I would have to have my medication levels monitored to make sure that I was at the proper therapeutic dose, so that I wouldn’t have a breakthrough seizure, and usually, that’s pretty straightforward, but we were kind of chasing the right dose for a while, and so, I was getting blood draws like every two weeks or three weeks to make sure I was getting up to the right dose of that. So, those were some of the different interventions and monitoring that that particular condition had for us.

Anand Swaminathan:

I guess it’s kind of interesting too, in that for years, you were having these episodes that everyone thought were anxiety, or panic, or anything like that, and it turns out that actually, they were auras that were kind of unmasked in this first pregnancy.

Rebecca Dekker:

Yeah, that’s what I was wondering. So, you had your first full-blown seizure while you were pregnant, before you had the miscarriage.

Lisa Mangini:

Yeah.

Rebecca Dekker:

But you think you were having symptoms of a seizure disorder, leading up to that, you just didn’t realize it?

Lisa Mangini:

Yeah. And so, there’s a lot of overlap there between stuff like panic attacks and the types of sort of mini seizures that I was having, and so, it went undetected for, I want to say something like eight years, I started having those, and it wasn’t until I had that full-blown seizure when I was pregnant, that we sort of put the pieces together and were like, “Oh, I think this is a seizure disorder.”

Rebecca Dekker:

And so, what happened next then? You got pregnant again?

Lisa Mangini:

Yes. And so, it took a little bit of time, not in terms of conception, but just working through different kinds of preparation, right? And so, I’m dealing with this new diagnosis of a seizure disorder. I also have a bunch of other stuff that makes me high-risk, right? And so I have polycystic ovaries, I have Hashimoto’s hypothyroidism. And so, just a lot of stuff like that, where we wanted to, especially having this really crazy, surprising experience, to just sort through all of that and talk to an MFM, and just sort of make sure that we were in the right place on the right medication, all of that kind of stuff before moving forward. So, it was probably about a year, I would say, before we tried again, I think.

Anand Swaminathan:

That sounds about right. After that first surprise, we really wanted to make sure we dotted all our i’s, and crossed all our t’s, and sought out specialists ahead of time, just so we knew were prepared.

Rebecca Dekker:

So, when you were managing these different chronic conditions and then you get pregnant again, it sounds like you had some specialists lined up. How did that pregnancy go then? What was that experience like?

Lisa Mangini:

It was interesting, because I was definitely very anxious, just sort of anxious about possibly having a miscarriage, anxious about some of the conditions that could’ve come up. I was kind of threatened a lot about big babies, and gestational diabetes, and preeclampsia, because that was sort of just assumed based on my health profile. And so, there was a lot of that kind of tainting the first half of the pregnancy, but as things went along, it was actually a really great experience, because as someone with chronic illness, it was kind of amazing to see my body be able to grow this baby, and to have actually a really uncomplicated pregnancy in terms of medical things that happened to me. So, that was really healing and empowering, and so, towards the end of the pregnancy, it was actually a very good experience, despite all of that.

Rebecca Dekker:

Mm-hmm. And when your neurologist told you about the EBB Childbirth Class, how did you go about picking an instructor, and what was that experience like?

Lisa Mangini:

We were really lucky. Sort of the silver lining of COVID is that the classes were offered via Zoom, and we live in kind of a rural area. And so, Jen’s class was geographically one of the closest ones, and I think it was probably still like four hours by car, away from us. And so, that’s part of how we picked that out, and we also liked that Jen was an RN as well, and so, we thought that that additional expertise would be a nice thing to correlate with the content of the course itself.

Rebecca Dekker:

Yeah. When you were talking about all of the conditions you were dealing with, I was thinking, I was like, “Oh yeah, Jen Polk would be perfect for you, because it is helpful to have an RN who’s familiar with all of the physiology, and all those things that are going on with the different conditions.”

Lisa Mangini:

Yeah, she was really great. We enjoyed the class a lot. I want to say four different families, and just the range of different people in the class, where some people, it was their first child, some people, it was their second child. I obviously planned on having a pretty medicalized birth in a hospital setting. There was someone there who planned a home birth, so it was just a really great mix of people in the class as well.

Rebecca Dekker:

Yeah. What else did you experience taking the class? Was there anything you learned that surprised you or stuck out to you?

Lisa Mangini:

I think in general, just the sort of additional commentary that Jen could offer on the stuff that was already in the course, and particularly how she saw some of these decisions play out with some of her own patients. And so, that was really great to have just sort of more stories to go along with what the course already talked about.

Rebecca Dekker:

And Anand, how about you?

Anand Swaminathan:

Yeah. I think another thing to mention too, is that a lot of the class talks about finding the right care team and the right providers, and pretty early on, I think it was maybe 12 weeks into the pregnancy, we are in a relatively rural area, and so, the next closest hospital with a labor and delivery unit is about a 50, 55 minute drive. And pretty quickly, we, for lack of a better word, fired the local facility, and you were dissatisfied with the care you were getting and the tone of the care, and chose to go to the next closest facility, to find the right team to take care of you.

Lisa Mangini:

Yeah, no, that was huge, and also, just sort of a more advanced facility too, in case I needed more additional, just different types of care than the local hospital could offer. The local OB practice was really dismissive, where I’d go in with my very particular concerns, and they’d just sort of be shrugged off. I think one of my earliest appointments, the doctor said, “We’re just going to treat you as a diabetic,” and I was like, “I am not a diabetic,” and they’re like, “Well, you’re going to fail the glucose test,” and I was like, “I’m not super comfortable with the idea of you treating me for a condition I don’t have, so I don’t really think this is maybe the place for me to get my prenatal care, so.”

Rebecca Dekker:

You’re like, “I have enough conditions, without you giving me a diagnosis that doesn’t exist in my body yet.”

Lisa Mangini:

Yes, exactly.

Anand Swaminathan:

Yeah, and another thing that stood out to us too after, while taking the class, is that the hospital we ended up delivering at had a shared practice model. So, every shift, there was a midwife and an OB on call on the floor, which was really [inaudible]. Yeah.

Lisa Mangini:

Huge. Yeah.

Rebecca Dekker:

How did that process go then, switching your practice and the hospital? Was that easy or hard, or what was that like?

Lisa Mangini:

It was actually fairly straightforward, at least it felt fairly straightforward for us, who I’m very used to sort of dealing with juggling different kinds of medical files, and transferring doctors, and all that kind of stuff. It does take a little bit of legwork, but it was basically looking up a different practice that was associated with the hospital that we wanted to be at, making a couple of phone calls, getting my records transferred over, and that was about it. And so, just sort of something for others to keep in mind as they’re progressing in their pregnancy or planning their pregnancy, where if you are not loving the OBs that you’re working with, definitely bail on them and find a practice that’s going to treat you the way that you deserve to be treated.

Rebecca Dekker:

Mm-hmm. And I can see how that would help your anxiety then, to feel like you’re finally with a practice that is listening to your concerns. Is that how you felt the second half of your pregnancy?

Lisa Mangini:

Absolutely, yeah. And so, I don’t think I had my first appointment with the practice I ended up with until maybe 16 or 18 weeks, and just immediately, our first visit was a video call, and Anand and I were both part of it, and we ended that, and it was just like night and day, immediately just more confident in the way I was treated, the tone of voice, the thoroughness. And so, that was huge, and sort of immediately mitigating a lot of that anxiety I had from the get-go.

Rebecca Dekker:

So, towards the end of your pregnancy, after having taken the Childbirth Class, you mentioned you were planning on having a hospital birth and that it would probably be medicalized, but what other aspects of your birth were you planning?

Lisa Mangini:

I think in my situation, there was not a lot that I had planned, per se. With what we learned in the course, we sort of treated it instead of having a birth plan. It was sort of more like a birth decision tree where if A happens, then we’ll go to B, and if B happens, then we’ll choose between C and D, and that kind of thing. And so, I went into it trying to be as flexible as I could, because I didn’t know what kind of surprises I would run into.

Rebecca Dekker:

Anand, what were your hopes for the birth, as the partner and support person?

Anand Swaminathan:

My hopes were that everyone was going to come out healthy and happy, right? I mean, you hear so much about folks talking about trauma and their birth experience, and particularly in hospitals, and I just wanted everyone to come out well in all aspects, and that was really critical to me. Another thing that was really crucial, I think that came out of the class, is we were kind of on the fence about having a doula initially, and the evidence there really cemented our desire to have a doula, and we connected with this amazing collective of-

Lisa Mangini:

Amazing.

Anand Swaminathan:

… doulas, and for the birth, we had both a very experienced doula, and one who had just finished school and was doing her clinical experience time, so.

Rebecca Dekker:

Yeah. So, what did that add then to your preparation? Did you meet with your doula ahead of the birth?

Lisa Mangini:

We did. And so, we would have some consultations with her, and I have to be honest, like Anand said, I really only opted for the doula because of the evidence, because it didn’t seem something that was very me, in terms of just kind of what I thought I would want, but the evidence persuaded me. And when we met with her, I just really sort of kept sticking to really practical stuff like, “How do I prevent tearing?” Or “When will you come meet me at the hospital?” And Anand’s finally like, “You need to talk to her about your anxiety,” which is really sort of what her biggest role was in the birth, was keeping my anxiety levels down, being a big source of support, normalizing the things I was going through, right? Where because I’ve never attended a birth and I’ve never given birth before obviously, I didn’t know if my experiences would be considered typical or safe, and so, having her presence there was also really huge in keeping me calm and happy.

Anand Swaminathan:

Yeah, and I think that was really having that voice of experience. For almost 11 years now, I volunteer as an EMT on nights and weekends, and in that setting, birth, it’s always abnormal, right? It’s always the complex, complicated things that we focus on, and to have someone who could be there and has seen it all before, and helped all hundreds of women through that experience, is just huge, so.

Rebecca Dekker:

Yeah, it’s funny, with my two youngest kids, they were asking to watch birth videos last night, because it’s been a couple years since I’ve showed them any, and I think they had kind of forgotten, and they had all these questions. So, I picked out a couple videos from the library in the class that are kind of more gentle exposures to birth, and my kids got a little afraid. They were like, “Look at her, she looks like she’s in pain,” and there wasn’t even a lot of yelling or screaming, or anything like that, it was just obviously super intense for the person giving birth, and I was like, “But look at the midwife,” because the midwife is just kind of squatting there at the edge of the tub. It was a water birth, I was like, “Look how calm that midwife is. The midwife is just soothing, calm, knows everything is absolutely normal, just that kind of steady source of peace in the room,” and I was like, “Look. Look at the midwife’s face. They’re cool. They’re calm, so everything’s okay.” So, there’s something to be said for having that person, like you said, who’s been there many times before.

Lisa Mangini:

It’s so funny, because the midwife who I saw mostly for my prenatal care, happened to be the person who was there for my delivery, just by chance, and she was so calm. I was kind of [inaudible], obviously, I’m in the middle of giving birth, so I don’t remember this exactly, but Anand, do you want to share this fine story that you have of her?

Anand Swaminathan:

She was an amazing practitioner. Early on at our time in the hospital, she called it the “new building,” and I realized when I looked later, the building had opened in the 1980s. So, it gives you an idea of how long she’s been delivering babies, and when we got to the pushing phase, and she’s just kind of nonchalantly walking around, she’s humming Hail to the Chief, the Presidential Anthem, while she’s washing her hands. She takes a phone call while you’re pushing, just completely nonchalant, and meanwhile, I’m looking around the room, and the hemorrhage carts coming in, and people are preparing for the worst, and she’s just this focus of calm there.

Rebecca Dekker:

So important for both of your well-being as well. So, let’s back up just a little bit. I don’t want to get too close to the end of the birth story. Share your birth story and how it began.

Lisa Mangini:

So, I got to 40 weeks, and we decided that we were going to do a scheduled induction, again, based on the evidence of what is safest for older parents. And so, I went in at 40 and 4, I think.

Anand Swaminathan:

I believe so. Yeah.

Lisa Mangini:

And so, they told us, “Get there at six in the morning,” and we drive there in the dark and we get there, and an OB does an exam and he says, “Eh, you’re not really effaced enough. Go home and then come back, and we’ll get you some Cervidil.” And so, I come back, and a different doctor gives me an exam, and he was like, “Well, I probably would’ve let you stay.” And so, I’ve already sort of spent 12 hours at home, getting back into that head space of, “I’m about to have a baby,” and then we start the induction overnight.

Anand Swaminathan:

The ripening overnight.

Lisa Mangini:

The ripening overnight, yes, and in the middle of the night, I’m trying to get some good sleep, because sleep is also crucial in preventing seizures. And so, I need to get a lot of rest, because I’m about-

Rebecca Dekker:

So, were you doing the ripening at home, or in the hospital?

Lisa Mangini:

We were doing it in the hospital.

Rebecca Dekker:

Okay.

Lisa Mangini:

Yes. And so, I think that was part of their plan was, “We’ll ripen you overnight, so that you can rest during that, and then sort of start labor in earnest in the morning.” And overnight, I’m trying to get my last good night of sleep before I go into labor, and there is a woman in the room maybe next door, down the hall, and she’s having what sounds like the scariest experience of my life. Just lots of screaming, lots of swearing, it does not sound like a positive experience, and then just this very sort of, I don’t know, I guess old school coaching with this kind of countdown of like, “10, nine,” to the pushing. It’s like a rocket launch, right? And it just seemed so… It was not something that was great, kind of going into what I was going into the next day.

Anand Swaminathan:

And she’s shouting swear words. It just sounded like a… Yeah.

Lisa Mangini:

Yeah. I had this moment, I’m listening to this at three in the morning going, “I don’t know that I can do this.” And so, in the morning, they start dosing me with Pitocin. I’m strep B positive, so I have penicillin. I know that the course sort of talks about the evidence behind that, and it was something that I opted to do, because again, we sort of played a lot of this on the conservative side, given my circumstances. And so, I’ve got that and a saline drip, and we’re just sort of waiting for these contractions to pick up, and they start upping my Pitocin. I’m starting like, I get to be about like five centimeters, people are coming in, it’s like, “You don’t really sound like a woman in labor.” And so, we then rupture my membranes, and that really starts to get things going, but it’s still pretty slow going, and they’re just like, I’m so full of Pitocin, by the time… How much was I at?

Anand Swaminathan:

I think we got up to 40 units at one point?

Lisa Mangini:

40 units, something crazy like that.

Rebecca Dekker:

Okay. So, pretty high doses at that point?

Lisa Mangini:

Huge. Yeah. And so, we get to late in the night, there’s this really wonderful moment where the doula’s trying to help me get more comfortable, and we’re also sort of trying to help the baby descend a little bit more, and Anand and I are just sort of doing the slow dance, swaying in the hospital room, and it was just sort of another great reason to have a doula there. It gets to be maybe what, like midnight, one in the morning? I’m maybe eight and a half centimeters dilated, something like that, and the contractions are stronger, but help me with this, because this is blurry, like too close together, not consistent.

Anand Swaminathan:

Yeah. And so, I guess one thing that we skipped over here is that earlier in the evening, probably around, I think it was before eight o’clock, because I was grabbing dinner, I was out the room at the moment. Perfect timing. The midwife and the midwifery student come in, and they come to you and they say, “Hey, we want to place a scalp electrode.”

Lisa Mangini:

Yes.

Anand Swaminathan:

“We want to place an internal contraction monitor, a catheter,” and there’s actually a discussion between us about that, right? I come back and we talk about it, and we actually pull out the workbook, which we had with us from the EBB class, and start refreshing ourselves about the pluses and minuses, and we end up deciding that that’s probably the right decision, and the student actually places the devices, right? Which I think also was one of those moments where the class really came in to help us as well.

Rebecca Dekker:

Which makes sense, if you’re getting kind of these high doses of Pitocin, to have the more accurate monitoring for your uterine contractions and everything.

Anand Swaminathan:

Yeah.

Lisa Mangini:

Absolutely. Yeah,

Anand Swaminathan:

Yeah. The other thing I will say for this facility, is they did have the wireless telemetry monitoring as well, which was, I think huge for the early parts of that process.

Rebecca Dekker:

Okay. So, that’s why you were able to be up slow dancing and moving around, because you were on a wireless monitor?

Lisa Mangini:

Yes.

Anand Swaminathan:

Exactly.

Lisa Mangini:

I did have an IV tree next to me, but I did have some mobility there, which was great.

Rebecca Dekker:

Okay. And you still hadn’t gotten an epidural or anything like that at this point?

Lisa Mangini:

Not at that point. And so, what was I at, eight and a half centimeters or something like that?

Rebecca Dekker:

So, what comfort measures were you using? I mean, you got to eight and a half centimeters and an induction with lots of interventions. That’s a long way to go without any kind of pain medicine. So, what were you using to stay comfortable?

Lisa Mangini:

Mostly the doula, I think at some point that night, right? Because again, I think I was in labor for like over the course of three calendar days. So, there’s a lot of stuff that I kind of forget sometimes when I’m telling the story, but the doula was doing some, I think acupressure to help me, she used the rebozo on me, which was very therapeutic, really calming, just sort of calming things to say. At one point, I will say that I had listened to the relaxation tracks that you recorded, and there was one that I used a lot through my pregnancy, visualizing a forest, and so, I took some of the parts of that, and was just sort of repeating them in my head to sort of calm me down. So, that was also another comfort measure for me as well.

Anand Swaminathan:

Yeah. We tried different positions, which again, having the doula there to suggest positions that we actually learned in class, but to actually be like, “Why don’t we try this now?”, was really huge. You tried a TENS unit, which helped for a while.

Lisa Mangini:

Yes.

Anand Swaminathan:

Yeah.

Lisa Mangini:

Yeah.

Rebecca Dekker:

So, it sounds like you had a full toolkit of a lot of different things you could use to stay comfortable, and you were at eight and a half centimeters, and it was kind of the middle of the night, it sounds like. So, what happened next?

Lisa Mangini:

At that point, one of the midwives is coming in and talking to me, and they’re kind of persuading me for an epidural, and the thing about birthright, they say, “You could probably do it, but you just don’t know how long you have to do it for it,” and so-

Anand Swaminathan:

Was almost her exact words.

Lisa Mangini:

Yeah. And so, it’s just like, I kind of felt like I was probably getting pretty close, I felt like I could go for it, and it’s like, you don’t know if you’re going to get to full transition or to the pushing stage in 20 minutes or in six hours. And so, even if it does happen, you’ve been up for a long time, you need your rest, you’re going to be too tired to push. And so, I did get an epidural at like 1:30 in the morning, I think, just so I could get some sleep.

Rebecca Dekker:

And how many hours had you been in labor at that point, or been in the induction process?

Lisa Mangini:

They started me on the Pitocin at 6:00 AM.

Anand Swaminathan:

Yeah, six or seven in the morning.

Lisa Mangini:

Six or seven in the morning. And so, it’s one in the morning, the next day?

Anand Swaminathan:

Yes.

Rebecca Dekker:

Okay.

Anand Swaminathan:

And thankfully, again, picking a facility that has more resources, that’s a trauma center, the anesthesiologist was there in 10, 15 minutes, whereas where we are in a rural area, they’d have to call him in from home otherwise, so.

Rebecca Dekker:

Okay. And you hadn’t slept really, because you hadn’t been sleeping that night, and the night before, you’d been awake, listening to other people in labor, and doing the cervical ripening. So, at this point, were you able to sleep?

Lisa Mangini:

I was, and I mean, I think for most people, under any circumstances, hospital sleep is not great to begin with. And so, the epidural did help so that I could get enough relief from the contractions to sleep, and get maybe a good five or six hours in there. And then in the morning, definitely, the contractions woke me up. And so, I was like, “This epidural is starting to wear off a little bit, and I’ve already got it, so I might as well use it,” right? And so, I’m pushing the button, and nothing’s really happening, and so, I think it sounds like I was maybe kind of saturated, and so, the epidural didn’t quite work anymore.

Anand Swaminathan:

Yeah. Something else, that you woke up the early in the morning too, and you were only numb on one side, and something that I don’t think I was aware of from the class or even from the reading we’ve done, is because you were lying on your side, all the analgesic medicine had pooled on one side and the nurse had pointed out, “Hey, you just got to roll over, it’ll help,” which I think I wasn’t aware of, at least. Yeah.

Lisa Mangini:

Yeah.

Rebecca Dekker:

Yeah. I guess that’s another reason we talk about when you have an epidural, about moving from side to side every so often, preferably with a peanut ball, and then that would also help kind of avoid the medicine from only going to one side, but it makes sense though, you needed to sleep. So, it’s like, you don’t want to be interrupting you every 30 minutes to switch positions.

Lisa Mangini:

Right.

Rebecca Dekker:

So, you woke up with the contractions, and what happened next?

Lisa Mangini:

Help me with the ordering here. Oh, so I’m also saturated with Pitocin, right?

Anand Swaminathan:

Yes, yes. So-

Rebecca Dekker:

Okay. So, you’re desensitized to the Pitocin, because you’d been having it for so long at such high levels?

Lisa Mangini:

Yes.

Anand Swaminathan:

Yes, and we were kind of really lucky. The nurse on the day shift that morning was also a doula, and also the childbirth educator for that hospital. So, our doula, she-

Lisa Mangini:

The nurse doula. Yeah.

Anand Swaminathan:

… the nurse knew each other well. So, there was really kind of a team dynamic there that was really helpful, but they cut the Pitocin, and gave you calcium antacids.

Lisa Mangini:

Some antacids.

Anand Swaminathan:

Yeah. TUMS, which are all things to help clear that out, which I’d never heard of either, and then waited an hour and restarted from two units, and worked its way up.

Lisa Mangini:

Yeah. So, that was-

Rebecca Dekker:

Yeah, that’s really important for people to understand who are listening, that if you have Pitocin at high doses for a long time, the receptors start to, like you said, saturated, desensitize, and your uterus contractions will become irregular, or not strong, or weak, and there’s different abnormalities that can happen, and it’s really important to give your body a break from the Pitocin for an hour, like you just said, and then restart it at lower doses. It sounds like that’s what they decided to do.

Lisa Mangini:

Yeah, that’s exactly how they handled that, but of course, disheartening in the moment where we’ve been working so hard at this induction and they’re like, “Just going to shut you off. We’re going to cut you off and start over.” But I mean, of course, that was the right call, but it was not something I expected, since we’d been working so hard towards progressing that.

Rebecca Dekker:

It’s a little counterintuitive, and some providers would just keep turning it up, right? And then say, “Well, you can’t do this. We’re going to do a C-section.” So, the fact that you providers and everybody knew to turn it off and follow the guidelines, that’s really awesome.

Anand Swaminathan:

Yeah, and I guess the other thing to mention here too, is that the positioning of the baby was not great. The whole pregnancy, he’d been transverse, and just was not in a good position, and having a nurse who’s a doula, and our doula and the midwife, they were all kind of conferencing and saying, “Why don’t we try this position? Why don’t you lie in this position? Let’s try hands and knees.” Right? All that back and forth, and that kind of collaboration was really huge, I think.

Lisa Mangini:

Yeah.

Rebecca Dekker:

So, you had a break, and they’re dealing with the baby’s positions, and then they turned it back on slowly, and what was going on then?

Lisa Mangini:

At one point, we had a heart rate deceleration, and again, we wanted the heart rate monitor, just because we wanted more data to work with, and he had been really strong and super stable throughout the whole thing. And so, that one little blip really kind of spiked my panic. And so-

Anand Swaminathan:

Yeah, and it was during a cervical check. So, the midwife reached in and stimulated his scalp, and thankfully, it came right back, but it definitely gave everybody a little moment of panic. Yeah.

Lisa Mangini:

Yeah, particularly because I’ve been in labor for so long. And so, everybody kind of cleared out so that Anand and I could have a discussion, and I’m sort of sitting there thinking, “I mean, I don’t know if this is going to work. Maybe we just go for a C-section, because I’d rather just do it now, if we’re going to move into emergency C-section territory. I just want what’s safe for everybody. I don’t want it to be traumatic.” And we were really sort of talking about that, and then I think that’s when the midwife came back in and the doulas came back in, and they’re like, “Let’s just give this one more shot.”

Anand Swaminathan:

And it’s tough, because the lip of the cervix had just been stuck on his head for so, so, so long, every time they-

Rebecca Dekker:

So, you were so close to 10 centimeters, but hadn’t reached it yet, all this time?

Lisa Mangini:

It was like nine and a half or something for several hours.

Anand Swaminathan:

Yeah, for a good chunk of the day, and we later find out, and talking about the Shared Practice Model again, that there was kind of a heated nursing station conversation between the midwife who’s been doing this for decades, and the OB, who’s a relatively young OB, relatively early in his practice, he was advocating just to go to the OR and have a C-section right away, and the midwife said, “I think we’ve got this,” and I guess she won out the conversation, but.

Rebecca Dekker:

It’s so funny, those nurses station conversations that most parents never hear about, but it can be enlightening to find out that all of this was happening kind of outside your perspective, and the midwife was advocating for you, and stood up for… Yeah.

Lisa Mangini:

Yeah. No, it was really great, and I like to think too that she was doing that, because I saw her for most of my appointments, and so, she knew who I was and knew sort of my profile, and felt like she knew what would be safe for me as well, just through that familiarity with me and my background. And so, I was just really happy that she advocated for that for me.

Rebecca Dekker:

So, when did you reach 10 centimeters? When were you able to push?

Lisa Mangini:

It must’ve been pretty late into the afternoon, because once we got to the pushing stage, that baby was out in like 25 minutes.

Rebecca Dekker:

Oh, okay.

Lisa Mangini:

Yeah. So, it’s just sort of a lot of lead up.

Anand Swaminathan:

I love this. “I think she’s got this, let’s give it a try,” from the midwife, and then you push for 25 minutes.

Lisa Mangini:

Yeah. So, and I actually really expected that to be the most horrible, scary experience, because that’s I think what I was hearing in the next room over, in the middle of the night, a few nights before that, and it was just really… I don’t know, I felt really calm. I remember between pushes, just sort of asking Anand if he was okay, asking if the baby was okay. I just felt sort of in a very calm kind of zone. I felt like I had really good focus in pushing this baby out, and that really shocked me, given just how much anxiety I had surrounding the pregnancy and the birth, sort of on and off throughout the whole process, so that was kind of incredible.

Anand Swaminathan:

Yeah, and meanwhile, because you’ve been on Pitocin for so long, in the background, the room’s filling up with people and they’re preparing for massive hemorrhage and all sorts of worst case scenario stuff, but nobody kind of clued us in. I had kind of a sense, having worked in emergency medicine a little bit that there was that going on. It was such a dichotomy of sense there, and the other thing I’ll say too, is that it really was not this shouting countdown pushing, it was really directed by you, right? And they kind of got you started and afterwards, you really were directing this.

Rebecca Dekker:

And how much were you able to feel while you were pushing, because you had the epidural? What position were you pushing in? Were you able to feel much?

Lisa Mangini:

Yeah. So, I definitely felt a lot, and so, I think I felt more in terms of contraction maybe than during the pushing part of the actual birth, but it was definitely really pretty intense, so.

Anand Swaminathan:

Yeah, and I think the way the epidural was placed, you were able to move your legs the entire-

Lisa Mangini:

Oh yeah.

Anand Swaminathan:

… time with the epidural. They didn’t actually put in a full catheter until eight or 10 hours into you having it, so you had a lot of function left there.

Lisa Mangini:

Yeah. It was definitely very surprising in terms of what I expected for an epidural, where I just sort of figured I’d feel absolutely nothing and not be able to move my legs, and I was able to really reposition myself. I was definitely hands and knees on epidural. So, I don’t know how much was at play there, but definitely a lot of sensation.

Rebecca Dekker:

And then before you knew it, the pushing was done, and what was it like giving birth to your baby?

Lisa Mangini:

It was just so amazing, where it’s this culmination of all of this work, and all of this preparation, and research and diligence, and it was just really incredible, and they had me use the squat bar and just sort of have we put my feet up on it, and I’m doing tug of war with this sheet, and I have people sort of holding my legs up with me, and Anand is one of them, and it’s just this really amazing experience, and it was not at all what I expected my birth to be like. And granted, I have like a hundred things coming out of me, I’ve got the epidural, I’ve got an IV full of different stuff, I’ve got a catheter, I’ve got the scalp electrode, contraction monitor. I’m connected to a lot of stuff, and yet, I still have this really incredible sense of, my birth is normal, my birth is this kind of really deep, intense, collaborative, safe experience. It was amazing, and then sort of this snap moment of like, “Here’s your baby, he’s on your chest. You’re a parent now.” So yeah, it was just kind of wild.

Rebecca Dekker:

Why do you think you felt so powerful, even though it was such a high intervention birth? What was going on in that room that made you feel so powerful, as you were birthing your baby?

Lisa Mangini:

It’s so hard to describe, but it was just, I felt this kind of confidence in what my body was capable of, in a way that I don’t know that I’ve ever felt before, and it was just so healing and empowering, but also this kind of connectedness at the same time where, I’m sure other people say this too, where it’s a very particular, just intense kind of connection with your partner. I felt this kind of really deep trust and appreciation for my care providers there. I felt like I was genuinely safe and cared for, which is not, again, given my history and unfortunately, other people’s experiences, not always something people feel genuinely from the people who are responsible for their care. So, I think all of that is wrapped up in the positive experience that I felt.

Rebecca Dekker:

And Anand, and what about you? What kinds of thoughts and feelings were going through your head?

Anand Swaminathan:

I was just standing there holding your leg, and just standing there in awe of the amazing thing you were doing, and how unexpectedly overwhelming that experience was. I was watching the baby crown and be born, and also just in awe throughout this whole process of how you knew exactly what you needed and what you wanted, and how you communicated those needs, and how you really were the master of this process as much as you could be, and that was just wonderful to watch, and just really absolutely in awe. Right? And we get to this pushing phase and you’re just, you’re directing the pushing, at the end, the midwife said in her kind of quasi drawl, right? “Hang on, you got to slow down, or you’re going to tear something fierce.”

Lisa Mangini:

“You’re going to have one heck of a tear.”

Anand Swaminathan:

That’s exactly what she’s said.

Lisa Mangini:

It’s like, “Okay, I’m going to hold back a little bit then.”

Anand Swaminathan:

Yeah. I was just in absolute awe of what you did.

Lisa Mangini:

Aw.

Anand Swaminathan:

Yeah.

Rebecca Dekker:

It sounds like it was a bonding experience as well for both of you.

Lisa Mangini:

Absolutely.

Rebecca Dekker:

Kind of like cementing your bond.

Lisa Mangini:

Yeah.

Anand Swaminathan:

Yeah, and it was so funny, after the baby’s born and we’re all just bawling, crying, doula snapping some photos, the baby’s on your chest, right? And I’ve cut the cord and all this, and the midwife turns to your primary nurse of the day and just says, “Isn’t it nice when there’s no screaming and swearing?” Just this offhand comment between them, and just…

Rebecca Dekker:

And those birth experiences are very legitimate.

Lisa Mangini:

Of course.

Anand Swaminathan:

Absolutely.

Rebecca Dekker:

We’re not demeaning people who do have that response, but it is also, I think people think that that’s what birth has to be like, when it can present in all different kinds of ways, and it sounds like you were finding a peace during your birthing experience, and strength and calm that you didn’t necessarily expect, because you had so much anxiety. So, it’s really cool that you were able to draw on that strength and all the skills you’ve learned of centering yourself.

Lisa Mangini:

Yeah. I mean, I fully expected to have one of those kinds of births that are very loud and very animated, and I think of course, that is absolutely a valid experience to have while having a baby. I think it just surprised me that I did have that kind of different experience, and it just kind of, I expressed it differently, and that really did surprise me about myself, so.

Anand Swaminathan:

Yeah, and particularly with the depth of the anxiety you’d expressed leading on throughout the pregnancy, right? Just how concerned you were about the whole process.

Lisa Mangini:

Oh my God. I mean, I was talking to my therapist about like, “I’m afraid I’m going to die in childbirth,” like that level of anxiety. And so, it’s just like having this toolkit, having the evidence and the going forward with getting a doula, just knowing how to make informed choices, where I went for just about every intervention that the course talks about, and I was very happy with that, but I don’t know that I would’ve known how to make those decisions, had I not learned about all of them in advance. So, huge.

Anand Swaminathan:

Absolutely.

Rebecca Dekker:

Mm-hmm (affirmative). And knowing what you’re getting into, instead of being surprised or just kind of being forced into things, it’s like you chose each intervention along the way, and I think that makes a difference, having a choice.

Lisa Mangini:

Absolutely. Yeah.

Anand Swaminathan:

Yeah, and having a team of providers who give you the choice, give you the time to discuss that, and weigh the pros and cons, was huge as well too, “We’ll be back in a couple minutes, you guys can talk about it.” Right? It was huge.

Rebecca Dekker:

So, I love that you were able to share with our listeners how you can experience something like a high-risk pregnancy and high intervention birth, and still leave birth feeling empowered and strong. Do you want to share what your postpartum experience was like? Do you have any stories or info about that for our listeners?

Lisa Mangini:

I think the immediate postpartum experience was just very much a blur. Our son had elevated bilirubin, and also some signs of possible infection. And so, that was kind of stressful, and so, he was at points, kind of taken away from us. We had all of these heel sticks to get his blood drawn, and then when something would happen to it, it would like clot or something before it got taken. So, he was getting his heels stuck like a hundred times, and this is my 18 hour baby, he’s like 18 hours old. So, that was kind of difficult, but with regards to my own recovery, it was really smooth.

Anand Swaminathan:

Yeah, and with some of the medical stuff you do have, right? Pretty early on, you seemed a little bit, well, your words were, you felt drunk, right?

Lisa Mangini:

I did, because of the amount of anti-epileptic drugs that I was on. I didn’t need it anymore, because my blood volume went back to normal, I didn’t have a baby in me anymore. So, I’m on this ridiculously high dose of it, and the nurse is asking me questions, and I’m kind of slurring, I don’t really know how to express myself. I try to get out of bed and I’m thinking like, “Oh, this is maybe not safe.” So, that was the other thing, was just sort of trying to coordinate how to get my dose back down safely.

Anand Swaminathan:

Yeah, contacting your neurologist, and getting that figured out. Yeah.

Lisa Mangini:

Yeah.

Rebecca Dekker:

Oh, that’s good to know though, for someone with epilepsy or a seizure disorder, there’s that adjustment period right after you have a baby, that’s kind of important for your medication levels and stuff like that.

Lisa Mangini:

Yeah.

Rebecca Dekker:

So, Lisa and Anand, do you have any advice for people listening who are planning on entering birth or parenthood soon? Any words of wisdom?

Lisa Mangini:

If they don’t plan on taking the class, they definitely should, because that was again, really just enormous for us. Don’t be afraid to fire your doctors if you don’t love them, because it makes a difference, and I think everyone deserves to have a practitioner that takes them seriously, that genuinely is invested in their well-being, and the well-being of their baby. I think too, it was a really interesting experience for me, because pregnancy is kind of like a masterclass in taking up space, right? Where if you’re not really good at that yet, for me, at least I found it a really good excuse to get good at that, and just sort of insisting on the things that I needed, and that I knew that my baby and I needed, whereas I don’t know that I would’ve really known how to do that prior to being pregnant, and having to figure out how to advocate for myself, so.

Anand Swaminathan:

Yeah, and I think for me, after that, we were surprised in your first go around with pregnancy, right? I think being prepared in every way we possibly could and seeking out, again, taking up space, what we needed to be as confident we could be in this process, was huge, seeking out the right specialists and the right practitioners, and having that ready, and the other thing that was huge was having a doula. Right?

Lisa Mangini:

Yep. Get a doula.

Anand Swaminathan:

It was, like you said earlier, right? It was this decision made kind of based on the evidence and on the rational scientific based outcomes, but it was such an important element of how this proceeded, and just having that experienced, centering, touchstone presence was just so huge for everybody.

Lisa Mangini:

Yeah. Get a doula, even if you don’t think you want one. Seriously.

Rebecca Dekker:

I love how you say yeah, there’s the evidence, and then there’s the experience of having the doula, and you’re like, “Oh, that’s why they’re so effective, because they affect your birth in so many different ways.”

Lisa Mangini:

Yes.

Rebecca Dekker:

Yeah. Well, Lisa and Anand, thank you so much for coming on the podcast and sharing your story. I know it’s going to be really inspiring for any expectant parents out there especially who are listening.

Lisa Mangini:

Thank you so much for having us.

Anand Swaminathan:

Yeah, thank you so much.

Rebecca Dekker:

All right, everyone that wraps up our interview with Lisa and Anand. Thank you so much for listening to their story. It was really empowering and inspiring.

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