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In this episode we talk with Emily Chandler and Taylor Washburn, EBB Childbirth Class graduates about their experiences in the childbirth class; their informed and empowered hospital birth; and how they navigated an extended hospital stay for newborn jaundice.

Emily, is a marine scientist, and Taylor, is a teacher and rowing coach in the Boston area. Together, they love hiking, biking, rowing, and taking advantage of the great outdoors. And they’re also very busy taking care of their baby. While pregnant, Emily dove headfirst into learning about pregnancy, birth, and the state of maternity care in the United States. Emily and Taylor took the Evidence Based Birth Childbirth Class with EBB instructor Chanté Perryman.

Emily and Taylor share their experiences in the EBB Childbirth Class and how that informed many of the decisions they made regarding their birth plan, including Taylor being both inspired and empowered to “catch” their baby. They also share how they used the advocacy skills learned in class to better communicate with their providers and each other. After experiencing the birth they desired, complications arose when Emily experienced difficulty breastfeeding and inadequate lactation support. Difficulty was further exasperated when their newborn was diagnosed with jaundice leading to an extended hospital stay.

Content Warnings: extended hospital stay due to newborn jaundice, “yellow baby,” difficulty breastfeeding, syringe feeding, lack of lactation support poor latch, heel pricks and bilirubin testing, treatment for elevated bilirubin, poor outcomes for Black and Brown infants with jaundice

 

Resources and References

Resources:
Access the CDC article on Jaundice here

Access the Evidence Based Birth® Signautre Articles on:

  • The Evidence on Premature Rupture of Membranes here
  • The Evidence on Group B Strep here
  • The Evidence on Pitocin® in the Third Stage here

Listen to EBB 145- Fatherhood and Advocacy in Birth with JacMichael Perryman here

Listen to EBB 244 – Evidence on AROM, AVD and Internal Monitoring here

Learn more about Chanté Perryman’s EBB Childbirth Class and services here or on her Instagram account @babydreamsmc

Learn more about the Nest Collaborative here

References: 

Here are the scientific references on jaundice for the blog article:
·      Dunn, P. M. (2003). Dr Erasmus Darwin (1731–1802) of Lichfield and placental respiration. Arch Dis Child Fetal Neonatal Ed;88:F346– 8.
·      Katheria, A. C., Lakshminrusimha, S., Rabe, H., et al. (2017). Placental transfusion: a review. Journal of Perinatology; 37:105-111.
·      McDonald, S. J., Middleton, P., Dowswell, T., et al. (2013). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD004074
·      Ashish, K. C., Rana, N., Malqvist, M., et al. (2017). Effects of Delayed Umbilical Cord Clamping vs. Early Clamping on Anemia in Infants at 8 and 12 months: A Randomized Clinical Trial. JAMA Pediatr;171(3):264-270.
·      Mercer, J. S., Erickson-Owens, D. A., Deoni, S. C. L., et al. (2018). Effects of Delayed Cord Clamping on Four-Month Ferritin Levels, Brain Myselin Content, and Neurodevelopment: A Randomized Controlled Trial.
·      Andersson, O., Lindquist, B., Lindgren, M., et al. (2015). Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr;169:631–8.
·      CDC article on Jaundice: https://www.cdc.gov/ncbddd/jaundice/facts.html

Transcript

Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk with Emily Chandler and Taylor Washburn about their informed and empowered hospital birth story.

Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD. I’m 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, and welcome to today’s episode of the Evidence Based Birth® Podcast. Today, we are so excited to welcome two graduates of our EBB Childbirth Class. Before we get started, I want to let you know that there is a content note on discussion of extended hospital stay due to newborn jaundice. Is there any other detailed content or trigger warnings, we’ll post them in the description or show notes that go along with this episode. And now I’d like to introduce our honored guests, Emily Chandler and Taylor Washburn. Emily, pronouns, she/her, is a marine scientist, and Taylor, pronouns, he/him, is a teacher and rowing coach in the Boston area.

While pregnant in 2021, Emily dove headfirst into learning about pregnancy, birth, and the state of maternity care in the United States. And together, Emily and Taylor took the Evidence Based Birth® Childbirth Class with EBB instructor Chanté Perryman. Together, they love hiking, biking, rowing, and taking advantage of the great outdoors. And they’re also very busy taking care of their baby who is now almost 16 months old. Emily and Taylor are here to share their birth story about being informed and empowered, and will also talk a little bit about newborn jaundice. Emily and Taylor, welcome to the Evidence Based Birth® Podcast.

Emily Chandler:

Thank you so much. We’re excited to be here with you.

Taylor Washburn:

Yeah, thanks very much.

Rebecca Dekker:

So can you tell me a little bit… You said you dove into learning about childbirth care when you were pregnant. How did you find out about Evidence Based Birth® and the Childbirth Class?

Emily Chandler:

I found out about it from our doula, so I decided pretty early on, and I don’t remember exactly why, that we really wanted to work with a doula. I know all the reasons why, in hindsight, that was a good thing, but I don’t think I knew them at the time. And once we settled on a doula, I asked her for information or any resources that could help us learn more about pregnancy and COVID. So that was right as vaccinations were coming out, and she directed me to one of your research updates, which was hugely helpful. And then opened the door into this whole world of information that I was desperately craving, and I quickly became a binged podcast listener, and then decided that it would be great for us to take the course together. So that’s how we found it.

Rebecca Dekker:

That’s awesome. And what was your experience like taking the class with Chanté? Was it a private class or a group class?

Emily Chandler:

It was a group class. I think there were three or four other families, and it was great to hear of their perspectives, and be able to ask questions but also hear their questions.

Rebecca Dekker:

Oh, okay.

Taylor Washburn:

Yeah, I think both of us listened to a lot of podcasts during our pregnancy. So a lot of the information was known to us, but having a community and being able to ask questions, and see that other people are going through the same thing that we are, and having the same kind of concerns, and questions, and doubts. And I think creating that community, especially during COVID when everything was remote, was really helpful for both of us.

Rebecca Dekker:

And you learned a lot from listening to the podcast. What were some things you remember from the class itself, from the videos, or from your discussion that really stuck out at you?

Taylor Washburn:

I think for me, it was just the level of preparation and thinking about our role in advocating for ourselves during the process at the hospital. I wouldn’t have been prepared for that having not gone through that class. And I think taking that class and thinking through different scenarios, and having conversations, Emily and I together, about what we wanted the experience to be prepared us to step in and say what we needed or what we wanted. But I think that was really important.

Emily Chandler:

Yeah, I think coming out of the birth class, we made a really detailed birth plan, which tends to be the direction I air. And that was really helpful, mostly as an exercise for us to make sure we talked through every possible scenario or many of them, and how we wanted to handle different interventions if they came up, and things like that.

Taylor Washburn:

And I guess I’d only add is, for me as a spouse, I think it made me feel like I actually played a really big role in what was going to happen instead of being more of a bystander. And I think that was really empowering for me and made me feel valuable.

Rebecca Dekker:

So it sounds like you both felt really informed, and then Taylor, you also felt like an active participant in the process, and you also learned some advocacy techniques, and then you had detailed understanding of like, “If this happens, then we want this, if this happens, then we want this.”

Emily Chandler:

Yeah. And the one other thing that was just fun that I would add it’s, I’d signed up for their course, I found one that worked with our schedule. It happened to be with Chanté, and I think it was the next day I was driving to work, and I was listening to the podcast that JaMichael Perryman did with you. And I put it together that I knew that name, I think because you were talking about Chanté, and I got to work and texted it to Taylor, and was like, “You have to listen to this. You’re going to love it.” And so getting to speak with him as well as part of the course was really great for both of us, I think.

Rebecca Dekker:

Yeah, he came on in episode 145 talking about fatherhood and advocacy, and birth, and I know Chanté often brings him into her childbirth classes to share his perspective and answer questions as a partner, and that’s really fun. I bet you were like, “Oh my gosh, we’re in the class with this instructor and we’re going to meet this guy.”

Emily Chandler:

Yeah, pretty much.

Rebecca Dekker:

So what did you learn from JaMichael? What do you remember about his talk with you all?

Taylor Washburn:

I mean I wasn’t thinking at all about catching our baby. He brought that up and said, “I’m just going to tell you my experience.” And that had me like, “There’s no going back.” I was so excited to be involved in that way. So he framed it in a really powerful way that made me excited about what my role was going to be.

Rebecca Dekker:

That’s awesome. So you were thinking you wanted to catch the baby after listening to JaMichael?

Taylor Washburn:

Right. It wasn’t something that ever crossed my mind beforehand. But afterwards, I was dead set-on like, this is something that I want to happen.

Rebecca Dekker:

So towards the end of your pregnancy, how are things going? What were your plans for the birth?

Emily Chandler:

I would say, overall, we had a pretty uneventful pregnancy. There were, of course, little things that came up here and there that we worked through, but I was feeling pretty good. It was mid-summer, or I guess it was early August, and I was really warm. I remember being tired of being pregnant and hot. And at about 38 and a half weeks, I knew, based on ultrasounds but also being able to touch my belly, that our baby was right occiput transverse. And I knew enough to know that that was not exactly where I wanted her to be. We didn’t know if it was a boy or girl, so I was nervous about that doing yoga, spinning babies. And then one night, we were getting ready for bed and my water broke, and I didn’t have any other signs of labor that I was aware of, then we called our doula and checked in. And-

Rebecca Dekker:

And how far along were you, 38 and a half weeks or were you-

Emily Chandler:

Yeah.

Rebecca Dekker:

Mm-hmm.

Emily Chandler:

Just about 38 and a half. I had been mentally preparing myself to have a late baby, was very surprised when that didn’t happen.

Taylor Washburn:

In fact, the night that her water broke, she had said, “Taylor, can you please just go pack your hospital bag? We’re getting close.” So I was packing my bag when all of a sudden her water broke. And-

Rebecca Dekker:

Oh my gosh. Talk about intuition, instinct.

Emily Chandler:

Yeah, the other thing before I launched too far into a birth story is I was pretty committed to the idea of having a birth with as minimal interventions as possible. Based on everything I had learned, I think I was wishing I didn’t have to go to the hospital and do it, but wasn’t prepared to change plans at that point. But I was certainly… I didn’t want any unnecessary interventions. And I can be a very strong-willed and stubborn person, and I couldn’t feel myself digging into that, and getting nervous and anxious about it, honestly, as it got closer and closer. I felt confident in my knowledge but was nervous about the things that I was going to have a hard time controlling, and was super grateful to have a partner who I knew almost as much as I did, and knew how strongly I felt about it. So that was really cool.

Rebecca Dekker:

So, take us to the next step. So your water broke, you called your doula or you reached out to your doula, what next?

Emily Chandler:

So that was about 10:00 PM and she said, “Okay. Well, this could take a little while, but things are probably going to pick up, so why don’t you try to get some rest and we’ll just check in as we need to as things start happening.” I remember waking up a couple times during the night and thinking nothing’s really happening. And that was fine. I was okay with that. I think we got up pretty early, went for a walk with our dog. I maybe felt some really faint contractions, but having never had any, and I hadn’t noticed any Braxton Hicks contractions either. I really didn’t know what I was supposed to be feeling, but I really was not feeling very much. So throughout that day, I just took it easy at home. I did some spinning babies exercises and yoga, and a little bit of curb walking, just trying to do anything to help this baby move a little bit, just knowing that she wasn’t in a position that was going to necessarily kick things into gear quickly.

And we were texting and talking with the doula throughout the day. We were well aware of the fact that a provider would want us to come to the hospital with my water having broken. We both read the EBB article on premature rupture membranes, and that was really helpful and reassuring. I knew that I was negative for group B strep. I was checking my temperature. Everything was really normal. So for the most part, we were very happy to be at home. And as the day went on, I think we started to say, “Okay, we would love to make sure everything really is okay. We think it is, but we don’t have the tools.”

Taylor Washburn:

Yeah, coming up on 24 hours since her water broke, it was dinnertime. And I think at that point, we were both a little bit nervous just because it had been so long and Emily wasn’t noticing any changes. And so that just had us doubting a little bit, and wondering if there was something going on that we obviously weren’t trained to identify. So at dinner, I called the hospital just to let them know that Emily’s water had broken. When they found out her water had broke 24 hours earlier, they said, “Oh, this is really unusual, atypical, you really need to come into the hospital.” I think at that point, we felt okay about that. We didn’t rush in. We finished dinner and got packed, and made sure that we had everything we needed. And so we got into the hospital between 10:00 and 11:00. So, just about 24 hours after Emily’s water broke.

Rebecca Dekker:

So they were making you feel a little guilt-trippy like, “Okay,” even though you knew the evidence 24 hours is not a really big deal as long as you were healthy.

Emily Chandler:

And it’s hard to say if they were making us feel guilty or we’re not real good rule breakers. So, we didn’t think-

Rebecca Dekker:

Yeah, you were feeling that pressure internally, probably.

Emily Chandler:

Yeah. We knew what the evidence was. The article was super helpful, and gave me a lot of confidence. And at the same time, we are not medical professionals and knew that someone else could check on things that we couldn’t check on.

Rebecca Dekker:

And I think it’s hard because a lot… The randomized trials and the studies on that are in situations where they’re more supportive of waiting. And so they’ll often have you come in, get checked out, go home, that kind of thing, whereas you’re just like, “Well, let’s just wait.” Because once you get there, they probably are not going to let you go home. So-

Emily Chandler:

Yeah. And so we chatted with our doula before we went in, which was great. She gave us a pep talk on interventions and inductions, and what we should expect right when we got there, which even though I knew it all, that was helpful, and I was still really nervous about it, and starting to not think necessarily as clearly as I had at other times. And so we got to the hospital and went to triage, and I should say on the ride to the hospital, I started to notice some more contractions. Again, really not painful, not regular. So, yeah. I was-

Rebecca Dekker:

Maybe just the start of something though?

Emily Chandler:

Yeah. And I think I’d felt that a couple times during the day, but never enough that I could convince myself that it was picking up or that there was a pattern.

Taylor Washburn:

And I think any time you stood up, it would go away. There was a-

Emily Chandler:

I think it was the other way around.

Taylor Washburn:

That any time you sat down, it went away.

Emily Chandler:

When I sat down, they would go away. But if I was standing up or walking later in the evening, I was like, “Okay, maybe that’s something.” But I knew the first thing they were going to do at the hospital was one to 20 minutes of monitoring, and I would have to sit down and they wouldn’t see anything. So I was nervous about all of that, but that’s what happened. And I was surprised when they said, “Oh, no. We see some contractions happening.” So that was great. I wasn’t psyched about getting cervical checks, but at that point, I also wanted some information. So I was comfortable with that. And they said that I was one centimeter and 60% to 70% effaced. The second part was a little bit of a surprise, but I didn’t expect that I would be very dilated given how things had been feeling. So that was what it was. And the on-call doctor came in who Taylor had spoken with on the phone, and basically said, “Okay, we’re going to start Pitocin.

Taylor Washburn:

The one thing on Emily’s list which was an absolutely like, “I’m not doing Pitocin.”

Emily Chandler:

Yeah. I knew that if we were going to have an induction, my preference would’ve been for some sort of mechanical like a Foley bulb or something like that to help, and they wouldn’t do that given that my water had broken. I really didn’t want to be on an IV. I didn’t want continuous fetal monitoring. I was also more comfortable standing up. So-

Rebecca Dekker:

Would you say that probably threw them for a loop a little bit?

Emily Chandler:

I guess so. I finished my 20 minutes in monitoring and I’m standing up in the room, eye-level, with this doctor and just said, “No, I’m not going to do Pitocin. What are the other options?” And so that was an uncomfortable interaction, and we never actually saw that doctor again.

Taylor Washburn:

They were scheduled to go off shift at 11, I think.

Emily Chandler:

No, she went off shift at 7:00 AM. We had a nurse change right away. We had a couple of really wonderful nurses in triage, and then who went with us into the room. And one of those nurses talked to us about different options. I said, “What can we do here? I understand that we should probably do something even though my contractions were picking up.” And she suggested we do misoprostol, and I knew what that was. I knew that I had to do it orally and I couldn’t do it vaginally, because my water had broken. And she said, “Why don’t we just do half a dose?” And I was like, “Okay, we can do half a dose.”

And that was going to come with four hours of monitoring. I was like, “This is going to be a long process. I can deal with four hours.” By the time we got checked in in our room, and they finally brought the misoprostol, I think it was 2:00 AM. It had been a long time and my contractions were already picking up. I was getting less comfortable. I was still standing, leaning over the bed. They brought me a peanut ball or a birth ball, but it was so small that for me to sit on it was really uncomfortable, given the position that the baby was in.

It quickly became clear that I was going to have a lot of back labor, so everything I felt was in my low back. So they brought the misoprostol, they hooked me up to the monitoring straps and things picked up pretty quickly from there. I will say we asked if we could have a room with a tub or wireless monitoring, and they were so busy that they didn’t have any of that available, which was… They did have it at the hospital, but that was frustrating. But-

Rebecca Dekker:

There’s nothing you could do at that point.

Emily Chandler:

Yeah, nothing we argued about. So I would say, at that point, I got pretty into the zone, but was also still expecting this to take a long time. And so I said, “All right, I’ll try and get some rest.” I said, “Taylor, you need to lie down and get some rest. We’re going to be here for a while.” And then I started throwing up a little bit, and I also was getting very shaky. And I knew that that was something that was very typical, but I wasn’t really prepared to experience it. So that felt just off-putting, I was shivering a lot.

And then after I threw up, I started to get nervous about dehydration because I really didn’t want to be on an IV, and I knew that if I was going to throw up, that would be a problem. I did take a dose of Zofran for anti-nausea, and that helped. That was great. And I think from then on, for the rest of the night, I was experiencing these contractions, uncomfortable moving around a little bit, but in the chair or lying in the bed, I was not up for standing or walking. And I was falling asleep between the contractions, they went from almost none to pretty intense and continuous. I never knew what the spacing was between them. They were… I would say every couple minutes.

Rebecca Dekker:

So the things went from nothing to something pretty active pretty quickly, right?

Emily Chandler:

Yeah.

Rebecca Dekker:

It sounds like you were having the labor shakes, so your hormones were shifting, and you were nauseous, and you were uncomfortable, and you were definitely… It sounds like an active labor at that point really quickly.

Emily Chandler:

But having not done it, I was like, “I hope this is active labor.”

Rebecca Dekker:

Yeah, you’re hoping this isn’t the early phase.

Emily Chandler:

Yeah. If anything was going through my mind, that’s what I was thinking about from 2:00 to 6:00 AM. I was like, “If this isn’t it, I don’t know how this is going to go.”

Rebecca Dekker:

And Taylor, what about you? What were you doing all this time, and what were you thinking?

Taylor Washburn:

Who knows? I was doing everything I could to support Emily. So things like counterpressure. And we had a really great group of nurses that were helping us out and giving us some advice. So our doula wasn’t there. She came in the next morning, but we really felt really, really fortunate that the staff of nurses we had, that they were providing support, but in a way that I could be really heavily involved, giving me guidance rather than doing things for us. But it was really just amazing to be part of, because as someone who identifies as an athlete, really, is like watching Emily go through this really incredible competition, this big performance where she was in the zone and working so hard, and had blocked out everything else in the room. And I don’t think either of us really knew how much time had passed, how much time was passing in between contractions. All I know is she would be working so hard in the moment that contraction was over. It was like she went really inward and was just not really aware of things around her, and was recuperating for the next effort.

Rebecca Dekker:

Resting intensely.

Taylor Washburn:

Right.

Emily Chandler:

I was falling asleep. It was very strange.

Rebecca Dekker:

Well, what else were you doing aside from counterpressure? What other comfort measures were helping? Because you didn’t have an epidural at this point, so what were you using instead?

Emily Chandler:

I remember I was sitting in a chair, rocking back and forth, and that was helping. And when the contractions picked up, Taylor was pressing down on my shoulders, and that felt really good. And then I-

Taylor Washburn:

I did a lot of rubbing your back.

Emily Chandler:

Yeah, I used a peanut ball in bed, a fair amount. And one thing that was going on this whole time is they were having a really hard time keeping the monitoring straps in a position where they could track our baby’s heart rate. And that was so frustrating to me, that at one point, a nurse put additional straps on, so they had all these straps wrapped around my belly. And every time they lost the heart rate, an alarm would go off on the machine in the room, but it wasn’t going off at the nurse’s station. So I had to call the nurses and say, “Could you come turn this off?” So that, I remember, pretty distinctly not enjoying.

Rebecca Dekker:

The wireless monitor probably would’ve helped a lot with the mobility and comfort.

Taylor Washburn:

I mean that’s something that Emily, from the moment we were planning and going through our birth plan, was something that she really felt strongly about.

Emily Chandler:

I really wanted intermittent auscultation, and I was going to have to switch providers if that was something I wanted.

Rebecca Dekker:

It’s hard because the wireless monitor is a good in-between option, but my understanding is that a lot of hospitals don’t have very many of them. They don’t want to invest in it. They get lost. They can’t find them. They’re expensive. So it’s a problem, because it might be something you’re like, “Oh, I can have this. The hospital says they have this, I want this,” and then you get there and it’s not there.

Emily Chandler:

Right. And that was the experience with the birth tub also. They wouldn’t have let me get birth in the tub. But in terms of having a tub I could have labored in, I think they had two in the hospital, and they were really busy.

Taylor Washburn:

But with the wire set up, and the fact that it kept disconnecting, I think that limited Emily as someone who likes to be standing and likes to move around a lot, and that really changed, I think, what she could do.

Emily Chandler:

Yeah, I think, if nothing else, it was also mentally confining, knowing that I couldn’t do much about it. I had to be there tied to these straps, but I also wasn’t in a position to feel like I could really push back on that. So I was like, “Okay, I’ll ride this out and then at four hours we can get rid of the straps.”

Rebecca Dekker:

Okay, so you knew it was a four-hour temporary thing?

Emily Chandler:

Yep, they told me that with the misoprostol I needed to do four hours of monitoring. And I was comfortable with that, given how long it had been and wanting to make sure our baby was okay.

Rebecca Dekker:

Yeah. And misoprostol can be a strong medication, so it’s good to keep a close eye on how your body is reacting to that and the baby. So that might explain, partly, why you were going so inward. It’s like you were trying to cope with all of this and using your mental coping strategies as well.

Emily Chandler:

Yeah. And I remember at some point, probably 4:00 or 5:00 AM, thinking, “Wow, if this isn’t it, if it’s getting a whole lot worse, I don’t know if I can do this.” The big shift change happened at 7:00 AM when we got a new nurse, and a new doctor came on call, and our doula also arrived, which was great. And I don’t really know what she did right away, I remember her coming in and she started massaging my feet, and that was amazing. And that is not something that I would ask for in other circumstances, but it was really, really great. And the nurse, my initial impression of her was she was gruff and bustling around the room, and I couldn’t really tell what she was doing. It was 7:00, so this was now an hour after I had been told I could get off the monitoring strips, and I was still on them. Taylor had a really different first impression of this nurse, which was what we ultimately came to know her as we talked a little bit about her.

Taylor Washburn:

No, I mean I was just so impressed. You’re in this hospital room and there’s all this stuff going on, and she came in, and she was just this beehive of activity where I think taking over for the previous nurses. The room wasn’t set up quite the way she would have it set up, so she was both giving lots of attention and care to Emily, but at the same time, getting the room set and prepped for the eventual delivery. And she was just in constant motion, and I was just amazed at how she was juggling all these things. And she had a pretty unique background.

Emily Chandler:

She’s been a midwife in Africa as a missionary in a previous chapter of her life. So when EBB talks about the golden ticket, I don’t think we necessarily had a full golden ticket, but I am so grateful that we had this nurse who had lots of experience outside of hospital settings, and we really did. She had her hands on me as much as Taylor or the doula did. I remember her doing this pressing her fingers into my low back and it seemed to help, and feel good at the time. She was really wonderful, and we were with her for the rest of the morning, which was great.

Taylor Washburn:

And then she would do something that was effective, and then move me into position, and she’d go and do something else, and it was just constantly there. She was really wonderful, and I think over the course of that morning, got to know us, and I think was there to support the birth that we wanted to have.

Rebecca Dekker:

That’s amazing. Did you find out how far along you were at this point?

Emily Chandler:

So around 9:00… Yeah, 9:00 AM or so. The on-call doctor came in and he wanted to do a check to see where I was. He also, when he came into the room, he said, “Oh, I’ve heard about you,” in reference to how long my water had been broken. So that put me on edge. But this doctor, I’d never met him before, but I knew that he was a provider that some good friends of mine saw. So I felt more comfortable knowing that other friends had experience with and liked was there, so that was helpful. But Taylor knew that I did not want unnecessary checks, so basically set the doctor out of the room so we could talk about whether or not we were going to give consent for a check.

Taylor Washburn:

And that was something that was emphasized both by our doula and the EBB classes, was that nothing has to happen right this moment unless it’s an emergency. You can always say, “Hey, can we have a moment to talk about it?” And so I’d, I think, felt comfortable. They asked a question saying, “Can we have a moment?” And so when he left the room, Emily was like, “Nope, I’m okay. We need some information. I want to know where we’re at.”

Emily Chandler:

So he did come and check, and then I was at nine and a half centimeters at that point. I was like, “Okay, all right. I think I can do it. I got this far, almost there.” As endurance athlete, I’m used to pushing myself and then knowing there’s just a little bit more that I can push through. And I was like, “Okay, the bulk of the work is done.” Not that I knew anything about what to expect with pushing, but I had a little bit more confidence at that point. So, yeah. I think, probably had a few more regular contractions before I was ready to push. And the pushing phase was really interesting. I came out of this zone that I had been in. I was super lucid as I knew what could happen, but the pushing was really spread out. It was almost full minutes or many of them.

And we were chatting with this nurse and getting to know her, and we had done a little bit of work with an organization that supports maternal health in Africa. And so that’s when we got talking with her about her time over there. And it was so bizarre to be having this conversation while I’m pushing our baby out, but also really wonderful. And our doula thought it was the greatest. It was really neat. But in terms of pushing, the nurse was great, recommending a few different positions. I wish that I had said, “No, I want to get up and do this standing up,” but I wasn’t having that feeling in the moment. It’s something I’d hoped to do, but I did a little bit of pushing on my hands and knees, and side-lying. And ultimately, we did a fair amount of tug of war with a sheet that the nurse set us up with before the pushing.

Actually, they had said they wanted to monitor the baby’s heart rate during the birth. And I wasn’t psyched about that, but I think they said it was because my water had been broken for so long. And I said, “Okay, fine.” And they said, “We don’t have the wireless monitor, but you can do the external monitoring,” which I had been doing and not loving, or we could do internal monitoring. And I don’t remember which EBB podcast it was, but I remember you interviewed someone about their birth story and they had had internal monitoring. And that was in my mind, and I thought that’s what I want. It’s not going to be great, but I don’t want these straps wrapped-

Rebecca Dekker:

In that way, you don’t have the straps belted around your abdomen.

Emily Chandler:

Yeah. So I think we did take a couple minutes to talk about that, and then told the doctor that’s what we wanted to do. And I wouldn’t say that was the most comfortable thing in the world, but it was certainly better than having the straps.

Rebecca Dekker:

So tell me a little bit about the pushing phase, Taylor. What were you doing? And I know you were interested in catching the baby, so did you have to quick-tell the doctor that? How did that conversation go?

Taylor Washburn:

When he first came on, we had a conversation with him about that, and he said, “Let me think about it,” and left the room, but came back in and ultimately said, “As long as things are going okay, as long as there’s not some emergency, I’m very happy to have you take part in that way.” He was really supportive of it.

Emily Chandler:

And we talked about it with our regular OB who was actually on vacation that week. So we knew we weren’t going to see her, but she had said, “Yeah, that’s fine,” basically the same thing. I don’t think he knew that. He wasn’t aware that we decided-

Rebecca Dekker:

You have on-call doctor-

Emily Chandler:

… to ask for instruction.

Rebecca Dekker:

Yeah. Didn’t have a heads-up.

Emily Chandler:

Right. But he quickly got on board with it, which was cool.

Taylor Washburn:

Yeah. And then in terms of the pushing, I was there to support as best I could when it came time. One of the techniques was we had a towel or a sheet that Emily was bearing down on, and so I was holding the other end, but it was such a strange… Because as Emily said, during the contraction, she was going so internally between contractions. But during the pushing phase, she was very social and talkative, and chatty, and having these full-blown conversations, and you would not have thought she was in the midst of delivering a baby. So there’d be these intense moments and then she was like, it was just any other day, and she was talking to the people in the room, and it was very funny.

Emily Chandler:

The other thing, I remember feeling like, “Wow, I really need to learn how to push.” Obviously, I’d never done it before, and it took me a little while to figure out how to do it effectively, which is not a surprise, but something I experienced going through it.

Rebecca Dekker:

Yeah, it’s definitely one of those things that’s hard to be like, you’re going to feel this and you’re going to do that, because it’s very much a sensational thing you have to experience. So, what happened next? How long did you push for?

Emily Chandler:

I think it ended up being about two hours, maybe a little bit more, but that sounds like an agonizing amount of time. And time still was not really moving for us, and I wasn’t super uncomfortable, so I didn’t feel like I was running out of energy, and the baby was fine. And so it was great to not feel like I was being rushed. The doctor really wasn’t in the room at all. It was just the nurse and the doula, and the two of us, which was really nice. Right around when she was born, he came back in and… I don’t know, put his gloves on and stood there. And-

Taylor Washburn:

I had this moment of like, “Whoa, wait a second. You haven’t given me instructions. I don’t know what to do. I’m not prepared this.”

Emily Chandler:

And it was great, she came out pretty uneventfully. Taylor caught her. We didn’t know if it was a boy or a girl. So Taylor had caught this baby but also, hot potato, passed her up to me really fast. And I remember seeing this little person coming at me and I couldn’t convince myself whether or not it was a boy or a girl. I was just in total shock and in disbelief that we actually had a girl. There are a lot of boys in Taylor’s family, so I was very prepared that we were going to have a boy. And we had told everybody that we wanted delayed cord clamping. That was fine. They were comfortable with that. I still don’t really have any sense of how long they waited other than I think the doctor said, “Okay, it’s been a while.” And we were like, “No, no, no. It hasn’t been long enough.”

So they waited a bit longer. She was on my chest. We were doing skin to skin. They didn’t wipe her down or anything. She was a healthy screaming little baby. Taylor did cut the cord when we got to that point. And then I think as is pretty normal, all of a sudden the room emptied out and it was just us, and the doula was making sure we were both eating. And I think we had pretty much an hour or two of almost totally uninterrupted time with just our baby right away. That, which was bizarre, but also great. Towards the end of it, I was like, “Okay, I’m ready to get up and move,” and the nurse came back in, I think, after she’d been able to grab us a bite to eat or something, because she really had not left our side since her shift started.

And so they moved us over out of the labor and delivery space to postpartum, and we were just soaking it all in like, here, we have this little person caring for her, and breastfeeding was slow to get started. If you haven’t done it before, it is a skill that we all have to learn. And there were some nurses that were more hands-on about helping me figure that out, and others who I think just assumed everything was okay. And I remember it was the middle of the night, so she was born at about 11:45 in the morning.

And I kept saying, “Oh, yeah. We’re trying to feed.” I was trying regularly, but she wasn’t really latching, and I don’t think I really figured out that that’s what was going on until that night sometime. And I remember having this wonderful little nurse who was hands all over me helping me figure out how to breastfeed and get this little baby latched. And we were making progress, learning as we both were. And then it was the next morning when the doctors or whoever came in for the pediatrician came in and said, “Oh, it looks like we have a yellow baby.” And that’s when we started learning about jaundice and that we were going to be in the hospital a little bit longer than we thought.

Rebecca Dekker:

Before we get into learning about your experience with your baby having jaundice, can we just rewind a little bit to the moment your baby came out. Taylor, what did that feel like to catch your own baby?

Taylor Washburn:

It was a really neat thing. I wasn’t prepared for it, and it’s not as simple as just like, “Here it is,” and it’s covered, and slimy. And I was so worried about, “Am I going to drop the baby?” So there was this fair amount of stress, and it doesn’t just come out super easily. So I think I was so focused on not making mistake and not dropping the baby-

Rebecca Dekker:

Not dropping the baby.

Taylor Washburn:

So I don’t think I embraced it quite like I would if there were another opportunity to do that.

Emily Chandler:

But I think there’s a fair amount of… I don’t know, pride. It’s really cool to know that you were the first person to touch that little baby when she came-

Taylor Washburn:

Right. I wouldn’t have done it any differently.

Rebecca Dekker:

You’re saying it’s one of the things you do it once and then like… But if you could do it again, you’d have more confidence, probably.

Taylor Washburn:

Right, right, right. I’ve never held a baby at that stage in its life. You’re wearing rubber gloves and just not quite sure what’s going to happen. I didn’t feel totally prepared for it, but wouldn’t have changed them a minute up.

Rebecca Dekker:

And then, Emily, how did it feel when your baby was on your chest after that whole experience?

Emily Chandler:

I think I was in a fair amount of disbelief of like, “Oh my gosh, I just did this. We just did this. There’s this little person.” I didn’t really believe it was real until she was on my chest. It was very cool to be there with her, with Taylor. She was still slimy and greasy, and I didn’t care. I was happy just to sit there with her and start getting to know this little person on the outside.

Taylor Washburn:

Well, I mean that was my favorite moment, was seeing Celia on Emily’s chest. And Emily’s just worked for almost 12 hours, and exerted herself, and she was just radiating and glowing, and you couldn’t tell that she had just gone to this really physical thing, where I think of myself, when you run a marathon or something, you finish the race, you don’t look put together, you don’t look full of energy in life. You look totally beaten down. And that couldn’t have been any further from the truth. So just for me, that was the moment, was seeing the two of them together, and just that there was this glow and this radiance which is pretty special.

Rebecca Dekker:

It is. So fast forwarding to the next morning, about 24 hours after your baby was born, you were told they had jaundice and what happened next?

Emily Chandler:

So they brought in the bilirubin cart, I guess it is, and we were basically told that we needed to try to feed her every three hours, but other than that, she should be under the lights. And they have this little blanket that they wrap them up in, that the light can still go through, and a little mask for their eyes. It wasn’t super scary. We knew that jaundice is relatively common. It’s something that happens. But, yeah. It wasn’t great. They started doing blood tests. They were pricking her heel to get blood samples, I think about every 12 hours to check the bilirubin levels.

And that was really, probably, the most agonizing part of it for us was having the blood draws because you had a spectrum of nurses and phlebotomists with different skills and different techniques for doing that. And some of them did it really effectively and some of them didn’t, or they wouldn’t get enough blood and they’d have to come back and do it again. So that was really hard. And then also, she didn’t look very comfortable in that little blanket and the little goggles or the eye mask kept coming off, and we were nervous about that whole situation. I don’t think we were ever really worried about her safety, but it was just frustrating that it was taking a long time.

Rebecca Dekker:

Did they ever tell you what her bilirubin levels got up to?

Emily Chandler:

They did, and I don’t recall them off the top of my head. I could probably look that up.

Taylor Washburn:

Yeah, they shared a lot of information with us. I think the nursing staff was really great, and we feel fortunate that how closely they worked with us. And there was a silver lining in the end. In the time that we spent in the hospital, we had really great care and we learned a lot watching the way they interacted with Celia, and the way they did things that just helped us feel more prepared when we left, when we went home.

Emily Chandler:

Yeah. So it was every day, they would check the levels and say, “Okay. Well, you’re going to be here overnight.” They did explain to us that the threshold for what is considered an issue gets higher as they get older, or maybe I have that backwards, but that the exact values they were looking for change as you get further from the time of birth. So we understood that that was part of what was happening and we were trying to feed her. So, the challenging part for me was then I would try to breastfeed her every three hours, then they would have a syringe feed her, and then they’d have me pump.

So it was this whole process, and I’ve never breastfed, I’ve never used a pump before. It all took a long time, but they wanted to make sure she was getting some nutrition to help move the bilirubin and jaundice along, but it meant that I was pumping for 15 minutes or so after every time I tried to feed her. And that launched me, or us, into a not great cycle. It was hard work in the moment, but then it also, I think, put me in a position where my milk came in really fast and there was a lot of it, which is obviously a good thing on some level, but then, it made breastfeeding harder with this tiny little baby who couldn’t latch very well.

Rebecca Dekker:

Okay. So you ended up with almost like an oversupply from overstimulating your breasts or nipples?

Emily Chandler:

Yeah, and I didn’t get any good lactation support right away. They just said, “Here’s some flanges, here’s a pump, pump.” And I was like, “Okay.” The other thing I remember is that no one told me to turn the suction down, so I also was in a lot of pain-

Rebecca Dekker:

Ouch.

Emily Chandler:

It’s pretty different.

Rebecca Dekker:

Yeah.

Emily Chandler:

And was like, “Oh my gosh, what is this? I didn’t know this is what pumps give”-

Rebecca Dekker:

Hospital pumps can be really powerful to you.

Emily Chandler:

Yeah.

Rebecca Dekker:

Yeah.

Emily Chandler:

So, yeah. It was challenging. We worked through it, and now I feel like I learned a lot. If we do it again, I wouldn’t ever sit hooked up to a hospital pump for that long with that high suction.

Rebecca Dekker:

And what day did you go home then with your baby?

Emily Chandler:

So we ended up going home on the fourth. I think we spent four nights-

Taylor Washburn:

Nights.

Emily Chandler:

… in the hospital with her. So we went in late one night. We were in the hospital, basically, for five nights, but four with her. And it felt like maybe they were keeping us for too long, but as Taylor said, there really was a silver lining to it. We had a really wonderful nurse who we ended up having for, I think, at least half of those days, if not, more. And there was something really comforting and having that familiar face, and she was a great resource.

Rebecca Dekker:

What questions do you have for me, if any, about the experience you had with jaundice?

Emily Chandler:

So, continued to be interested in birth and read it, and listen to a fair amount. And somewhere along the way, I think when our daughter was four or six months old, I came across something that said maybe there’s a link between delayed cord clamping and jaundice, and bilirubin levels. And I’ve seen that referenced on a number of academic or professional websites. And I was just wondering, I know there are so many benefits to delayed cord clamping. Are there any risks in them as it relates to bilirubin and jaundice?

Rebecca Dekker:

Yeah, so the timing of when to clamp the umbilical cord has been debated for at least the last 200 years. It first started out opposite of where it is today. They used to really believe that you don’t want to clamp it too soon or tie it off too soon. There’s actually a quote from the grandfather of Charles Darwin about how you should not clamp the cord too soon because it leaves the child weaker. And I’m sure one of the reasons you chose it is because you knew the evidence that if you delay it for at least three to five minutes, the babies get more fluid volume, more red blood cells, more stem cells. A third of their blood supply is in the placenta when they’re born, and that goes to help with the lungs. Because while the baby’s inside of you, only about 10% of their blood is flowing through the lungs after they’re born.

It’s about 50% of their blood supply, at any one point, is circulating through the lungs. So at that moment of birth, it’s important for them to have that extra blood flow. And then in the 1960s, that’s when it became popular to immediately clamp the cord to try and prevent postpartum hemorrhage. And now, we have more recent evidence when they actually studied that and they found that there is no benefit in terms of it doesn’t prevent postpartum hemorrhage in the birthing person to clamp the cord early. And I think where you saw the info about jaundice, it’s really interesting, because in 2013, there was a Cochrane review where they combined a bunch of studies on this and they included 15 studies, and there was one study in this Cochrane review that was an unpublished non peer-reviewed dissertation study from a student.

But I think that student was somehow working with the author, so they included that student’s work in there. And that single study is what found there was a higher risk of needing light therapy for jaundice. It was 4.4% versus 2.7% with delayed core clamping. But they didn’t measure bilirubin levels. It was very subjective, and it was never peer-reviewed studies. We don’t really have any idea of the quality of it. And since that point, every other research group that’s excluded that data and not used that study has found no relationship when they randomly assign babies to delayed court clamping or immediate court clamping. So it’s interesting because though that one publication then got into a lot of people’s minds as this causes jaundice. And I think the reason they think it causes jaundice is because if you go back to what jaundice is caused by, so for those of you who are listening who don’t understand, jaundice is yellowing at the skin or the eyes, or the gum, or the inner lips due to elevated bilirubin.

And almost all babies have what they call benign high bilirubin levels. This used to be called physiologic jaundice. But bilirubin comes from the breakdown of hemoglobin, which is part of your red blood cells. And because babies are born with an immature liver, the hemoglobin is not as well eliminated from the body. Most of us adults have blood levels of less than one, and it’s normal for newborns born at term to have a peak level of eight to nine, it peaks at about three to five days, and that’s probably why they were being really careful monitoring around day three. And in general, also, red blood cells in newborns, they have a shorter lifespan, so they’re breaking down more frequently, and their livers aren’t mature enough to handle it right away. So there’s this natural surge, plateau, and then decline. And that’s why it’s so important to measure or to make sure they’re not having jaundice because normal benign high bilirubin is normal, but if it gets above a certain point, it puts the baby at a higher risk for experiencing brain damage.

And so that’s what they’re concerned about. If they’re monitoring the levels, and it’s not just a little bit of mild jaundice, but the bilirubin levels are dangerously high, that’s when they want to take action to prevent brain damage. And there’s different categories of how high it gets. So the level at which jaundice needs to be treated, and the treatment I’m not going to really go into, but I can tell you what does put babies at higher risk for jaundice. And you can think about if any of these happen to you. But for listeners, RH or ABO blood incompatibility with your baby, there’s various hereditary condition, experiencing infection, having bruises or birth injuries such as might happen with a vacuum assisted delivery, a very large baby that’s born to someone with diabetes, intestinal obstruction, and then one of the more common reasons is just inheriting a tendency that makes it less easy for you to clear bilirubin from your body.

And that can actually be quite common to inherit. One of the most common is something called Gilbert’s syndrome, which about one in 10 people in the United States carry both mutations of that, and 42% carry one gene of that. So that’s a fairly common reason. And then something you were mentioning about is inadequate milk intake. So if there are feeding difficulties in the first days or the first weeks, you can have inadequate fluid intake, which slows the baby’s ability to eliminate bilirubin from their body and can cause jaundice. And this is more common with late preterm infants. So babies born around 37 weeks, you have difficulty feeding. There’s also something called breast milk jaundice, which is a specific condition, which is typically mild but requires monitoring. And it’s very poorly understood in the research, and it’s possibly related to a genetic condition, but the inadequate milk intake in the first days of life.

And then I think it’s also important to point out that jaundice, I want to make sure people know that if babies have darker skin color, jaundice is often missed or not recognized. And Black and brown babies are more likely to experience brain damage from jaundice because clinicians don’t know how to look for it. So some people get the appropriate treatment and others don’t. And so that’s something to just be aware of, for our listeners. But doctors think… All right, this is the reasoning. We think more blood is transferred to the baby with delayed core clamping, so that means the baby has too many red blood cells, they’re going to break down and cause jaundice. And when they say it like that way, it does make sense. But the research doesn’t pan out. They still have not ever found that to be true in the research, in the peer-reviewed research at least. And even UpToDate, which is a website a lot of doctors get their information from, they also claim that delayed cord clamping causes this problem, but they don’t list any scientific references for it.

That one study came out, it got into everybody’s mind, and they’re like, “Well, physiologically, it would make sense. The more blood you have, the more blood breaks down, the higher level of jaundice.” But when they actually randomly assign like flipping a coin, you get delayed core clamping, you don’t. There’s no difference in bilirubin levels. So I think you can rest assure that it was nothing that you did. It sounds, from listening to your story, it might have just been that that first 24 hours, the baby wasn’t taking in any colostrum. Does that sound like it to you?

Emily Chandler:

Yeah, that has been my assumption. And even if there were a basis to that claim about delayed cord clamping, I think we have felt totally confident that the benefits of delayed cord clamping were more important to us.

Taylor Washburn:

Right. I don’t think we’ve ever doubted any of our choices in terms what we… Everything we did, we felt very confident and comfortable in the information we had.

Emily Chandler:

And I would say, pretty well supported by the hospital staff that we worked with. Particularly, the nurses. We just had really wonderful nurses caring for us.

Rebecca Dekker:

Yeah, it sounds like you had an amazing nursing team, and then your baby got the treatment they needed when they had jaundice. It’s funny listening to your story because I felt a little bit of flashbacks. My water broke first, my contraction started in the car. I turned down Pitocin when I got there, and they were a little flustered like, “Okay.” And then my baby had jaundice as well. And mine did not need the light therapy, but we did sunlight therapy. The baby’s levels weren’t high enough to cause concern, but they said, “Just make sure you sit outside in the sun with your baby for certain periods of the day.” And it was good enough to do that. So-

Emily Chandler:

When I remember talking to my grandmother saying, “Oh, yeah. We’re dealing with jaundice, we’ll get home soon.” She was like, “Just take the baby outside. That’s what I did with your uncle.” And I was like, “I would if I could.” But I think they were also just pretty conservative with us as first time parents. Of course, we would’ve liked to go home. And it was also nice to get the support that we got in the hospital.

Rebecca Dekker:

And I just want to make sure our listeners know that if you are finding this episode because you Googled jaundice or something like that, the Centers for Disease Control has a really good article or handout for parents about the warning signs with jaundice. How to know your baby has it, and that there are warning signs if your baby’s hard to wake up or will not sleep, or is not breastfeeding or sucking well, or if they’re very fussy, they’re not having enough wet diapers, you need to get help that day. And the CDC says to get emergency help if your baby is crying inconsolably or with a high pitch, if they are arched like a bow, their head and neck, and heels are bent backwards, if they have a stiff, limp or floppy body, and if they have strange eye movements.

And I think we just need to get that information out there because I have met parents who have experienced that, where they did not get the treatment, the medical professionals dismissed it, and then babies had bad outcomes. So I think it’s important for parents to know that jaundice, most babies are going to have this benign increase in bilirubin, but if levels get high enough that there’s concern, definitely, treatment is needed. Well, Taylor and Emily, thank you so much for coming on the podcast and sharing your story, and letting us talk about your beautiful baby, and we appreciate you. Are there any final words of wisdom or advice you have for our listeners?

Emily Chandler:

I think, thank you so much for having us. This has been such an important resource for us throughout our pregnancy and having a small baby, so it’s really cool to speak with you. And then I would say, my advice would be, learn as much as you can so that you are confident and prepared to welcome a baby into the world in whatever way feels right for you.

Taylor Washburn:

Yeah, I would echo everything Emily said. I never imagined that I’ve learned so much, but with the access to podcasts and other sources of information, it’s just been so easy to learn a lot, and I think that that information really impacted our experience in a really positive way.

Rebecca Dekker:

Well, thank you again for taking the time to come share your story. We appreciate you both.

Taylor Washburn:

Thanks for having us.

Emily Chandler:

Thank you so much.

Rebecca Dekker:

Today’s podcast was brought to you by the Evidence Based Birth® professional membership. The free articles and podcasts we provide to the public are supported by our Professional Membership Program at Evidence Based Birth®. Our members are professionals in the childbirth field who are committed to being change agents in their community. Professional members at EBB get access to continuing education courses with up to 23 contact hours, live monthly training sessions, an exclusive library of printer-friendly PDFs to share with your clients, and a supportive community for asking questions and sharing challenges, struggles, and success stories. We offer monthly and annual plans, as well as scholarships for students and for people of color. To learn more, visit ebirth.com/membership.

 

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