EBB 266 – Advocating for your Newborn during an Unexpected NICU Stay with EBB Childbirth Class Graduates Priscilla and Nathan Layman

Rebecca Decker:

Hi, everyone. On today’s podcast, we’re going to talk with Priscilla and Nathan Layman about how the Evidence Based Birth® Childbirth Class prepared them for a home birth and their unexpected hospital transfer after the birth for their newborn. Welcome to the Evidence Based Birth® podcast. My name is Rebecca Decker and I’m a nurse with my PhD and 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 EBBbirth.com/disclaimer for more details. Hi everyone, and welcome to today’s episode of the Evidence Based Birth® podcast. My name is Rebecca Decker, pronouns she/her, and I’ll be your host for today’s episode. Today, I’m so excited to welcome some graduates of our EBB Childbirth Class. But before we get started, I want to let you know there’s a content note on discussion of emergency transfer to the hospital for low oxygen state in a newborn, as well as respiratory support for an infant in a neonatal intensive care stay.

If there are any other detailed content notes, we’ll post them in the description or show notes that go along with this episode. Now, I’d like to introduce our honored guests, Priscilla and Nathan Layman. Priscilla, pronouns she/her, and Nathan, who sometimes goes by Peter, pronouns he/him, are happy parents who live and work in the San Antonio, Texas area. Nathan is a pipeline engineer with Atmos International.

And Priscilla splits her time between caring for their 19-month-old daughter and providing part-time telehealth and psychotherapy services through Marker Learning and Octave Behavioral Health, as a licensed clinical psychologist. Priscilla and Nathan are graduates of the Evidence Based Birth® Childbirth Class with EBB instructor, Lea-ann Goettsch. Nathan and Priscilla, welcome to the Evidence Based Birth® podcast.

Priscilla Layman:

Thank you. We’re glad to be here.

Nathan Layman:

Yeah. Thanks for having us.

Rebecca Decker:

I know your baby is a toddler now, but take me back to your pregnancy and let us know, how did you find out about Evidence Based Birth®?

Priscilla Layman:

Do you want to take this one?

Nathan Layman:

Sure. We knew off the bat that we were going to be going with a midwife. When we were meeting with our midwife, she recommended that we get some education and training. Listed a wide range of options and Evidence Based Birth® was one of them.

After looking at the different ones, decided Evidence Based Birth® was the kind of training that we were looking for in our preparation for the birthing process.

Rebecca Decker:

Priscilla, were you both already planning a home birth at that point, or did you change your mind later on?

Priscilla Layman:

Yes. We were planning a home birth at that time, but I had siblings who had done home birth and then one sibling who had had several births in the hospital. I wanted to make sure that we had education that covered both options in case we needed to change that plan.

That was one of the things I really appreciated about EBB, was that there was this no assumptions about where your birth location would be and really trying to educate you on all of your resources.

Rebecca Decker:

What made you decide to go with a home birth midwife with your first baby?

Priscilla Layman:

Yeah. There were a lot of factors, as it is, I’m sure for most people making a decision about their birth, but I was a home birth baby. My mom had all of my sisters and I at home in the ’90s when it was not particularly popular. Several of my sisters had already had home births successfully, including with their first children. I think I had some confidence that my body was going to be able to be successful in doing a vaginal birth.

Then I really wanted the close, interpersonal relationship that midwifery care provides because I had a history of depression, and wanted to have that interpersonal relationship to support me, not only during the pregnancy but through the postpartum period as well. Just having the freedom to be able to move around, eat, do all the things without a whole lot of pressure from a hospital setting to conform to a certain type of care.

Rebecca Decker:

It was normal part of your family background?

Priscilla Layman:

Yes, absolutely.

Rebecca Decker:

Nathan, what about you?

Nathan Layman:

No, I knew very little. Nothing about the birthing process, nothing about home birth, nothing about hospital births. I had sisters who have had children before, but I wasn’t really part of that process.

I’m the youngest child in my family too, so it was all a new educational experience for me. I was willing to defer to Priscilla’s preferences and be willing to support her in this desire to have a home birth.

Rebecca Decker:

What was your experience like taking the EBB Childbirth Class then?

Nathan Layman:

For me, it was exactly what I needed to know. Basically, every step of the way, all the different options that could happen, and the positive ways things could go and the negative ways things could go.

I think it was particularly helpful hearing about a lot of the research studies that was done for me to get a perspective of outside of these anecdotal stories, which I had heard of lots of anecdotal stories.

Lots of this is what I experienced from Priscilla’s family, but I hadn’t really heard much about the wider range of research that surrounded home births. That was really useful for me to get a real grasp on what the situation was.

Rebecca Decker:

Yeah. That reminds me, so there is a module in the EBB Childbirth Class where we talk about the statistics on home birth. You were able to get an broad overview of the safety through that?

Nathan Layman:

Definitely.

Rebecca Decker:

Yeah. Priscilla, what about you? Is there anything that you felt better prepared for as a result of taking the class?

Priscilla Layman:

Yeah. I think the EBB class really lowered my anxiety about the possibility that we might have a transfer, and how we could self-advocate in the hospital environment. Ideas about what the pros and cons of different interventions were.

I think I actually came from a fear-based hospital perspective in my family culture. I think going through the class helped me to be like, “Okay. Yeah, they have pros and cons. There’s risks with them, but they also can be lifesaving and they can also be really valuable.”

It helped reduce my anxiety and helped me to feel more open to whatever birth came, whatever we ended up having. That actually played a lot into our story later on, even though it wasn’t as personally related to me.

Rebecca Decker:

Yeah, that’s interesting. You had more of a fear of hospitals in general?

Priscilla Layman:

Yeah.

Rebecca Decker:

Okay. Maybe we’ll get more into this later, but were there some of the self-advocacy tools that you just felt like, “Okay, I can do this if I had to transfer”? What were some of the techniques that you felt really good about learning?

Priscilla Layman:

Yeah. I think the awareness that we could take our midwife on speakerphone with us kind of thing, because this was during COVID, our daughter was born. Even if our midwife wasn’t able to be in the room with us, we could have her there to explain, here’s what happened, here’s what’s going on, here’s why we transferred.

I think the sections where it helped support Nathan in what his role would be as an advocate, was also really helpful for me of being like, “Okay, it’s not going to be all on me. He’s educated. He has what he needs to know, to be able to say this is what we are open to ask about risks and benefits in the room kind of thing.”

Nathan Layman:

Yeah. I think the skills that I found useful in our hospital stay, as well as during the midwife birthing, was knowing that our preferences aren’t just a matter of convenience, but they’re a matter of her wellbeing. Having the confidence to listen to hearing what she says and be able to repeat that and be able to press that, and knowing that that is something that there is some value in being able to receive.

The other bit that I think was also really useful, was the humanizing effort of all the healthcare workers, and then being able to see them as people who have their own lives. We did experience some practice of sharing cookies and tried to have some personal connection with some of our healthcare providers when we were in the hospital setting. We found that to be really, really useful for being able to for advocacy, as well as just our general comfort in a hospital setting.

Rebecca Decker:

Yeah. It really is a lot about that interpersonal connection and building those bridges. Because I think a lot of people, if they have to transfer to the hospital or they have some unexpected hospital stay, you’re really focused on you and your body and what’s happening to you.

Sometimes we forget the people in the room taking care of you are human beings also. If you build that connection, it shouldn’t be this way, but sometimes you get better care as a result. It’s kind of like a win-win. You get to know them and care for them and then they care for you as well.

Priscilla Layman:

Absolutely.

Rebecca Decker:

Yeah. You were planning a home birth with a midwife. Was there anything else you were hoping to have at this birth? Any other preferences for your laboring time?

Priscilla Layman:

Yeah. I was really looking forward to being able to use water as a coping method. We had a birthing tub that we used several times during labor to help with pain management. We ended up having the actual birth in the water, having a waterbirth, which our midwife was like, “Yeah, we might be able to do that, we might not. It just depends on how things go.”

That was a mild preference. I would like to be able to do that, because I’ve heard from others anecdotally that that can help with the discomfort of actual pushing and the laboring at that point. That was something else we were looking forward to or I was hoping would be helpful.

Rebecca Decker:

You had a tub in the house ready to inflate?

Priscilla Layman:

Yeah. Yeah.

Rebecca Decker:

Okay, awesome. Share your birth story with us. How did it begin?

Priscilla Layman:

I had prodromal labor, so it actually started at least a week before the official active labor started. Pretty intense contractions that were intermittent, particularly towards the late evening. Every evening I was like, “Okay. Maybe this is it, maybe this is it.” There was a lot of waiting and recognizing, and thinking and counting, doing contraction counting. But then when it actually did start, it very quickly accelerated to being pretty intense.

My mom was an informal doula for us. Our daughter was her 12th grandkid and she’s been at all of the births, and she had five of her own births. She had some informal support that she was bringing. She came pretty early on and it ended up being about 32 hours of labor. Again, starting pretty intense four hours in. I had my mom fooled. She thought I was in transition four hours in, and I didn’t have the baby for another 26 hours.

Rebecca Decker:

That was intense.

Priscilla Layman:

Yeah, it was pretty intense. Yeah. Our midwife’s assistant came out several times to check me and to give us some feedback on where I was at and how things were going. Then the midwife came maybe eight or nine hours in. I don’t remember exactly. Do you remember?

Nathan Layman:

No.

Rebecca Decker:

Going back to your prodromal labor, for our listeners who maybe are first time expecting parents, they don’t know what that is.

Can you explain, I know you said they were intense contractions that were intermittent? What did it feel like to have that for a week?

Priscilla Layman:

Yeah. Braxton Hicks I know are super common and those will be those practice contractions, but those tend to be like you can keep going about your day and everything’s normal, right?

Rebecca Decker:

Yeah. It’s like a tightening, it can feel intense, but it’s just a tight feeling.

Priscilla Layman:

Right. This would be like, “I have to breathe through them,” intense or a little bit more intense, and very similar to what my first hour or two of labor were actually like, the contractions that I had. That started about a week in advance, and they would be for maybe 45 seconds to 65 seconds long and maybe three to five minutes apart, for maybe an hour or a little bit over an hour. Then eventually they would just dwindle away. It was like, “Okay. Well, that wasn’t it.”

It was actually difficult for me to discern from what I was reading, this is sounding like I’m in early labor, but it didn’t progress. It didn’t actually continue on. It wasn’t that gradually increasing in frequency and duration in terms of the actual contractions. It was pretty emotionally exhausting because I’m somebody who’s super attuned to my body. I was basically having to say, “This isn’t it.” I’m going to try to ignore it and go about my day, even though it’s uncomfortable, even though it’s like, “Well, is this the day?”

Because after three or four days of this, I’m recognizing this isn’t my labor, this isn’t what labor’s going to look like for me and so I have to start ignoring it. I think it was more emotionally difficult than physically difficult. It was uncomfortable.

Rebecca Decker:

Yeah. That constant you don’t know if this is it, and should I stop everything and get ready to have a baby?

Priscilla Layman:

Right.

Rebecca Decker:

Yeah.

Priscilla Layman:

Absolutely. Yeah.

Rebecca Decker:

Yeah. Nathan, what about you for that week? Were your emotions on edge too?

Nathan Layman:

I think there was definitely some anxiety of when is this going to happen? Are we not doing enough? Are we going to need to do some natural induction method? I think there was a lot of research. I know there was a section in the EBB birth about some natural induction methods as well. I think we listened and relistened to that podcast over and over again, trying to think about this.

I think my mind was just like, “Is this ever actually going to come?” I think I was concerned about Priscilla and concerned about what was going to be happening. I think these contractions heightened that for me, rather than decrease that because it’s like, “Why is this not never progressing?”

Rebecca Decker:

How many weeks were you at this point, Priscilla?

Priscilla Layman:

40. It started right around my due date, and we delivered one day after. It was 41 and a day when she was actually born.

Rebecca Decker:

Okay.

Priscilla Layman:

Yeah. I was full term, so it wasn’t like there was anything, we weren’t at 37 weeks like, “This is going to be too soon.”

Rebecca Decker:

Yeah. You were hoping, you wanted labor to start at this point.

Priscilla Layman:

Right. Yeah.

Rebecca Decker:

Yeah. How did you tell the difference the day you went into active labor? How did you know?

Priscilla Layman:

It just didn’t stop after an hour, hour and a half, it kept going. The intensity increased even more than it had been.

The actual pressure of the contractions was stronger, it lasted longer. I had more difficulty focusing on what was going on around me, so that was.

Rebecca Decker:

Okay.

Nathan Layman:

Yeah. That evening, I remember just as we were about to go to bed, we weren’t certain that you were going into active labor either. She even had a late night snack thing right before we went to bed and we weren’t expecting it.

But within an hour of actually trying to go to bed, it was really clear this is really different and this is much more intense, and you can’t lay down and rest it out.

Rebecca Decker:

Okay. It was game time.

Priscilla Layman:

Yeah.

Rebecca Decker:

You said about eight hours in your midwife arrived?

Priscilla Layman:

She came up maybe around three in the morning and then at five in the morning.

Nathan Layman:

The assistant.

Priscilla Layman:

The assistant came.

Rebecca Decker:

The assistant, okay.

Priscilla Layman:

Then they both came once I got to, I don’t remember, maybe five centimeters?

Nathan Layman:

Yeah. I would say it was probably more like 15, 16 hours, because it was basically the following afternoon.

Priscilla Layman:

Okay, fine. Okay. I don’t remember what that number was.

Nathan Layman:

We did that first night, just you and I, and your mom, and then most of the morning. Then in the afternoon, she arrived right around one or two in the morning.

Priscilla Layman:

It also was a rainy day that day. There was a lot of rain, and so it was dark outside. It was just this 30-hour dark haze. It was hard to tell when it was morning and when it was evening.

Rebecca Decker:

What time of day it was. Yeah.

Priscilla Layman:

Yeah, exactly.

Rebecca Decker:

Yeah. Time was blurring.

Priscilla Layman:

Yeah. Yeah.

Rebecca Decker:

What happened that afternoon?

Priscilla Layman:

The afternoon, to me it was more of the same, just intense. When is this going to end? Is it progressing? It feels like I’m further along than I am and nothing.

Nathan Layman:

Yeah. A couple of bits that were present during this longer time of waiting was a lot of struggle with pain management. I think that was something that we thought we had a few techniques down for. We had learned about different presses and massages and things like that. I think I had some ideas of maybe we’ll be able to distract Priscilla from a lot of the pain with different TV or movie or music. Really, it was at a level where anything like that just added to her stress.

Another level, I think, that was challenging too is because Priscilla’s father is immunocompromised, we had some concerns with proximity of Priscilla’s mother with the midwife, who had a different vaccination status than her mother. Because of that, I think there was maybe not as much time that the assistant was spending with us. It was really just myself, Priscilla’s mom and Priscilla, and trying to figure out how to endure. Basically, we’re holding Priscilla’s hand throughout the night trying to help her handle the challenges.

Yeah. I think that was particularly challenging, because I don’t think I was aware of how long a marathon it would be, and the fact that it was mostly just trying to comfort Priscilla as she was experiencing a lot of those pains through the night. I would say that first night was probably the worst part of the pregnancy for me or the birthing process for me, because of both loneliness of just it was me and her mom with Priscilla. Not having as much of the assistant or the midwife there.

I know also, I think, just the pain of what you were experiencing, and then also just feeling you just weren’t far. Every time the assistant came and checked you, it was just like you were nowhere close.

Priscilla Layman:

I was a three.

Nathan Layman:

Yeah. I think that was really hard. Whereas, it felt like this pain that you were experiencing wasn’t really yielding any progress. It was beginning to progress, but it was very slow.

Priscilla Layman:

That was not a part of my family’s story. None of the other home births had been like that. They’d all been pretty fast.

There had been some intensity, but nothing quite this long. I just did not go into it with that mindset at all.

Rebecca Decker:

Yeah.

Priscilla Layman:

Our resources were not sufficient to help me manage the pain to the level that I would’ve preferred and that I think we were expecting.

Rebecca Decker:

Yeah.

Priscilla Layman:

Water did help some, we did some essential oils for calming and for the nausea that occurred at different points. I had difficulty eating and drinking. We did try some of that, but it was like, “Please get that out of my face.” It was a challenge for sure to endure that. Sometime in the evening, I did make some good progress and we thought we were ready to push. The assistant was in the room and was like, “Yeah, you can try pushing if you want to.”

The midwife had gone to go rest because it had been a long time. I was attempting to push for some period of time. It wasn’t until later, that we found out that I was actually only at eight at that point. My body wasn’t ready yet and so then that caused some confusion as well. We just had some misses in terms of communication and trying to figure that out, even though we had the Golden Ticket Birth Team.

I think it’s helpful, like even thinking back, we had a lot of the resources that we needed. We had done a lot of the work ahead of times, and yet there’s still curveballs in birth. You can’t predict exactly how it’s going to go. I think in hindsight, we probably would’ve asked for more from our midwife, “Can you give us some more resources?”

I might look like I’m doing the normal thing, but I’m not feeling okay with what’s going on. I think that’s some of the things we’ve talked about in hindsight that would’ve been helpful to us.

Rebecca Decker:

Reminds me a little bit of people giving birth in hospitals around that same time. I think there was people were trying to minimize exposure to other people and so you wouldn’t have as much hands-on support. Was there any mention of the baby’s position? Was the baby in a less than ideal position?

Priscilla Layman:

No, everything was good. Baby was rotated the right direction, was in a good position. There had been no real concerns leading up to the birth about positioning. There wasn’t anything that would’ve made it stall out or made it take that long.

From their tracking, both our midwife said during the birth and after the fact, that we were going at an appropriate pace. We were on the slower end, but it wasn’t like we ever truly stalled.

Rebecca Decker:

Yeah.

Priscilla Layman:

It was more just more intense maybe.

Rebecca Decker:

Just a long, slow progress.

Priscilla Layman:

Yeah. Yeah.

Rebecca Decker:

Yeah. When did you finally get to be completely dilated then?

Priscilla Layman:

She ended up having to break my water because at some point, maybe four or five hours before Phoebe was born, we were at a point where I was like, “I don’t know how much longer I can keep doing this.”

Nathan Layman:

This is the night of the second day, roughly that.

Priscilla Layman:

24 hours in.

Nathan Layman:

8:00 or 9:00 PM, kind of all the second day. Yeah.

Priscilla Layman:

Yeah. We started talking about, “Okay. Well, what are our options? Do we want to transfer to the hospital so that I can get some pain reduction so maybe I can rest? Maybe then I’ll have the energy to get through the rest of this, or do what we want to keep trying at home? What can we do to move things forward?”

She was like, “One thing we can try is we can try breaking your water and seeing if that gives you the extra nudge you need to make it the rest of the way.” We ended up doing that, which was very uncomfortable and definitely made the contractions more intense. The pressure of Phoebe dropping, because I think my waters was preventing her head from fully engaging with the cervix.

Rebecca Decker:

Putting pressure on the cervix. Yeah.

Priscilla Layman:

Yeah, exactly. Once my waters were broken, she was able to engage a little bit better and help me dilate the rest of the way. Then after that, some period of time I got back in the birthing tub and was there through her birth at that point. Once she gave me the option of, “You can go to the hospital, you have the resources, we can make this happen. It won’t be an emergency transfer because there’s nothing emergent going on.”

Baby’s fine, your body is progressing the way it should, but if you’re tired and done, you don’t have to keep doing this. I think her giving me permission in that way, but gave me a sense of, “Okay, so what do I really want?” I was able to realize my values are I would really like to have her at home if possible, so let me keep trying a little bit longer. That got me through the last stretch.

Rebecca Decker:

Just even knowing you had the choice, and then you could choose what you wanted.

Priscilla Layman:

Absolutely. That made a big difference for me emotionally anyways. I think at this point too, I had gotten into a little bit finally of a rhythm through the contractions.

It was, I don’t know, I think I was working with them maybe a little bit more at that point than I was earlier on.

Rebecca Decker:

You weren’t fighting it maybe?

Priscilla Layman:

Yeah, yeah.

Rebecca Decker:

Yeah.

Nathan Layman:

Can I add another perspective on this?

Rebecca Decker:

Yeah, certainly.

Nathan Layman:

I think maybe Priscilla and the midwife was having one conversation. I actually felt like I always had another conversation with the midwife at this time, which was about whether or not Priscilla was going to reach exhaustion, and whether or not she was going to get into a place of danger. I was asking her at what points do we have to transfer her to the hospital?

Not because she can’t handle the pain anymore, but because her body can’t handle this and she’d have to go into emergency c-section. I think that there was some concern about what would happen if she just couldn’t push anymore. This is after broke the water, after you started being in the birthing pool, things weren’t still going quite as fast as we were hoping. We started setting time goals for ourselves saying, “Let’s see where Priscilla’s at in two hours.”

We had a clock, and when the clock got to this place, depending on where we’re at that point, then we revisit the discussion. I think it made me feel really safe and secure that the midwife made clear, that if there was any point where we’re going to approach that risk, that she would notify us. We would just go to the hospital if we were anywhere close to that, but that we weren’t right now.

That Priscilla still had a little more energy in her, to be able to handle it. Once we got to some of those points on the clock, we were able to turn. Priscilla had progressed really far, and it was up to her, up to Priscilla’s choice at that point as well.

Priscilla Layman:

Yeah. Yeah. I think you’re right that in that two hour window when they checked me that next time, I was fully dilated. She was like, “Okay, we’re in the final stretch here. You can do this.” That was really helpful to like, “Okay, we made it. At least we’re really close.”

Rebecca Decker:

You made it through the longest part.

Priscilla Layman:

Yeah, exactly.

Nathan Layman:

That’s right.

Rebecca Decker:

Yeah. I think it’s good for our listeners to remember, especially those who might be thinking about a home birth or planning home birth, that it is the number one reason for transfer during labor is for first time parents who are exhausted or just needing medical pain management.

That’s perfectly normal and acceptable reason to transfer if you choose to. At the same time, you felt like you had enough reserves to keep going a little bit longer. What happened next once you reached 10 centimeters?

Nathan Layman:

The fun part.

Priscilla Layman:

Yeah. I started pushing, it did take a while. I remember at some point, the assistant was helping me to identify what muscles to use, manually engaging and interacting with me. At some point, she said something. No, I remember. She was like, “The head’s out.”

I remember it being like, “Can you just pull the rest of this out? I’m so done.” I’m like, “Can you just?” She’s like, “No, we can’t do that. That increases your risks of tearing and baby needs to come out with you pushing.” But that’s one point that stood out in my memory, just ready to be done.

Nathan Layman:

It was actually a really special time. It was really the point where it felt less like I just need Priscilla to survive this, to we’re going to do this together.

I got in the tub with Priscilla and we started getting in a rhythm of pushing and resting. I don’t know if I actually developed bruises, but there were certain parts of my neck that you would just hold and squeeze, and press into my forehead.

Priscilla Layman:

I was forehead to head.

Nathan Layman:

Yeah. It was a little intense, but it was one of those things where I felt like I’m part of this process. It was actually a really meaningful part of the experience to feel like I’m being leveraged to help push. That was really special.

Priscilla Layman:

Yeah. I think it very much felt like we were a team. There was no yelling at him or anything like that. I really felt like he was the support to me in the process.

Rebecca Decker:

He was right there with you.

Priscilla Layman:

Yeah, in all the mess.

Rebecca Decker:

Yeah. How long did you push for?

Priscilla Layman:

I don’t know. Hour and a half, hour?

Nathan Layman:

It was longer than I wanted, but less than…I think it was less than two hours. I don’t know exactly what it was.

Priscilla Layman:

I’d have to look back at my birth record.

Nathan Layman:

I think my vague, cloudy memory was the clock was getting close to midnight when you finally were starting to push. Then roughly around 1:30, 2:00 or something like that, she was born.

Priscilla Layman:

Yeah. One of the special things about her birth, is that we had chosen not to find out her gender at her 20 week.

Rebecca Decker:

Ultrasound?

Priscilla Layman:

Ultrasound. Yeah, thank you. Ultrasound. We actually got to find out at her birth that Phoebe was Phoebe and not the boys’ name that we had picked out. That was really special.

I think I was anticipating that somebody else beside me would be announcing it, but she ended up coming to me on my chest and nobody had figured out yet. I held her out and was like, “Yes, it’s a girl.”

Nathan Layman:

I was so tired, I couldn’t even tell like, “Is there someone in there?” We had the lights dimmed. Yeah, I can’t tell. You tell me, you tell me.

Priscilla Layman:

That was very fun.

Rebecca Decker:

The lights were dim in the room and you pushed your baby out underwater?

Priscilla Layman:

She was underwater, yeah. She had a double nuchal cord, so they actually had to untie her under the water in order to bring her up to my chest. She was underwater for a little bit of time, but not very long.

From what we understand, that there wasn’t any risk because they don’t take breath until they’re out of the water. To our knowledge, everything was fine with that.

Nathan Layman:

To me it felt like it was very quickly that she untangled her and brought her up. I was pretty impressed at that rope work that she was doing.

Rebecca Decker:

Then what did it feel like to have her on your chest?

Priscilla Layman:

It was such a relief and so much joy. We’re done, we’re finally done. We did it all of this time laboring, and she’s safe, she’s here. I think I had a little bit of anxiety because she was a little bit gray or a little blueish. She wasn’t the color that I imagined she would be. But all of her heart tones, they were checking her really regularly throughout the whole birth process. She had been fine and they weren’t concerned about her at all.

She colored up just fine initially and then as they were doing the checking of her and watching her over the next hour or so, as they do getting me cleaned up, got us to the bed or weighing, I don’t think they weighed her. I think they were just… Then at some point, they had to pull out an oxygen mask and start oxygen support for her, because her oxygen saturations were dropping in the room.

We had tried latching. My younger sister is a IBCLC lactation consultant, they’re national board certified. She actually arrived very quickly and was helping me figure that part of it out, which our midwife could’ve done. But she’s also, that’s like her thing, she loves that. She was excited to be able to help me with that. We did try some latching, but then it quickly became evident she was struggling with that because of the breathing piece.

Our midwife informed us at some point in, it seems like every time we take the mask off of her, her oxygen’s dropping again. We put the oxygen on, she’s maintaining, take it off, she’s dropping. That’s not normal for a full-term baby to be doing that. She was recommending we need to get her to emergency care. Go ahead, you can add some things.

Nathan Layman:

Well, so I remember her saying that we may need to bring her to emergency care. It was actually a little bit later when I was holding her with the oxygen mask on her face, and her numbers started dropping while she had the oxygen mask on her face.

That’s when it was like, “Okay.” I think there was some hope that eventually she’ll catch her breath. I think we had her on oxygen mask.

Rebecca Decker:

Transitioning to the outside world.

Nathan Layman:

Yeah. I think we actually were doing that for almost an hour of having oxygen mask on her. As long as her numbers were high and that oxygen mask was on her.

Rebecca Decker:

Kind of a wait and see.

Nathan Layman:

Yeah, it was a wait and see. But the moment that they started to drop while she had that mask on her, then that’s when we called 911.

Priscilla Layman:

Yeah. Yeah. That part of it went really fast to me. I was a little bit focused on trying to get the placenta out and did I tear? Am I going to need stitches? I’m still a little bit in my own world and was missing, I think what they said was it’s super normal for babies when they’re in this transition to maybe need a little bit of oxygen support.

I wasn’t worried until she was like, “Okay, we need to transfer her to the hospital.” I was like, “What? We’re going to the hospital, what happened?” It felt really surprising for me, that piece of it. I think it sounds like you had a little bit more warning.

Nathan Layman:

We had some gradual buildup for that decision. It wasn’t a fast decision.

Priscilla Layman:

Yeah. What she had told us in advance was and what I had read, was that midwives are allowed to provide oxygen support for a certain number of hours.

If they get to that point and the baby still needs that support, they can’t just continue indefinitely to provide that support.

Rebecca Decker:

The baby needs to be evaluated in the hospital.

Priscilla Layman:

Right, exactly. Exactly. She said there’s lots of times where we help for an hour and then baby doesn’t need it anymore and they’re fine, and they go on. They have that in their tool belt, but it’s not meant to be a longer term care. They called 911, 1:30, 2:00, at this point, it was probably 3:30 in the morning. We had an ambulance out in front of the street. The fire department, like four dudes in the house after all of this female energy other than Peter, other than Nathan.

Like four dudes come in with me and this little, tiny baby that they’re going to be taking in. They allowed me to go in the ambulance with her. I actually got to hold her in my arms on the way to the hospital, which was really helpful. I think it would’ve been really anxiety.

Rebecca Decker:

If they just took her away.

Priscilla Layman:

If they had separated, they had the awareness or I don’t know if the midwife said something or what. Maybe they were like maybe this mom isn’t actually okay and we need to take them both.

The midwife was telling them, “She’s fine. There’s nothing for her that should be a concern.” I went with her in the ambulance and then you drove behind.

Nathan Layman:

Not behind.

Priscilla Layman:

Not behind.

Nathan Layman:

They told me, “Do not try to keep up, don’t risk getting in an accident by staying behind.” Told me where they were going and for me to get there in a safe and law-abiding manner.

I didn’t drive behind you guys. I knew where to go and they quickly left me, going through red lights and all that stuff.

Priscilla Layman:

Middle of the night in the rain. Yeah. They were providing oxygen support during the transit to the hospital. Then once we got to the hospital, I think I was still under this idea that, and this was again, part of what my midwife said was maybe there’s more going on. It’s also possible that she’s one of those babies that needs oxygen support for 24 hours, and then she’s going to be fine and you’re going to be able to bring her home. I think I still was going into it with less anxiety than is typical of me.

Maybe it was still the birth endorphins of she’s here, she’s fine, everything’s going to be great. A little bit in denial maybe of what could be. We got to the hospital, we went into the pediatric ER. One of the things that looking back was a huge blessing, she was born right in the dip before Delta, so hospital rooms were not overwhelmed at this point. We were able to get in very quickly. They got us up there. They did the evaluation with all of the nurses and doctors there.

You came in around at this point as well, and they were very diligent, did all of the scans. They were able to say nothing wrong with her heart and then whisked her upstairs to the NICU. We spent five hours sitting in the lobby while she was being stabilized, which was definitely, I think for me, the hardest part being separated from her and the uncertainty of how bad is this? What’s going on? I thought this was just like she needs some oxygen support. They were able to come out and say to us, “We’re basically ramping her up.”

We started on just oxygen, then we did high-flow oxygen, and then they ended up having to intubate her. They did a regular flow intubation, and then they had to go to a high-flow intubation where they had to sedate her, basically just trying to get her stable. To this day, we still really don’t know why. She was full term, everything else was fully developed, brain and lung, brain and heart, everything was great. Just for some reason her respiratory system was not activating the way we would expect.

She needed a lot of care so that was pretty hard. At the same time, another piece of this that’s also really amazing is she was taken to the hospital where my sister was working at the time as a lactation consultant in that hospital and she was on duty that day. She actually came up while we were in that five hour waiting period, and got us setting up with pumping stuff. She was able to get me to start pumping to help protect my breast milk supply for Phoebe and start getting some of that, what’s the word?

Nathan Layman:

The golden juice.

Priscilla Layman:

The golden juice.

Rebecca Decker:

The colostrum. Yeah.

Priscilla Layman:

The colostrum, yeah.

Priscilla Layman:

Yeah. The colostrum, that was a big support that she was there and she was able to even check in. We had somebody in the hospital who had that personal connection with us, who was able to help reassure us in a way, because breastfeeding was something that was really important to me. I wanted to be able to do that. That was really another big blessing for us to have that support.

But it was pretty scary having a doctor come out and be like, “You have to sign all these forms about resuscitation and about waiving certain kinds of liability if certain bad things happen. Here’s some of the things that could happen with intubation.” We’re just like, “Do whatever you have to do to save our baby.” We thought she was healthy.

We thought everything was fine. There was no indication that we were going to be in this situation, but here we were. It was pretty tough.

Nathan Layman:

Yeah. Something that the doctor said was that they did find some blood in her lungs. They thought that maybe she got some blood in her lungs during the birthing pool process, which we asked the midwives later, “Was there any blood in the birthing pool?” They said, “No, there wasn’t any blood that we had noticed in the birthing pool.” The doctor, was basically a shrug.

He said probably the birthing pool, but didn’t really give much more other than that they found some blood in her lungs. The other bit though was they said that her lungs, well, they guessed maybe her lungs weren’t fully developed, and so maybe her lungs needed some help. Maybe that just for some reason, hadn’t developed fully in the womb period. Those were the two theories they had.

Priscilla Layman:

There was one other thing, which was her lungs were still full of fluid, and she basically wasn’t being able to cough up or expel the fluid. There wasn’t enough oxygen getting in to fully oxygenate her body. Usually, a baby is born with fluid in the lungs, because they’re literally soaking in that in utero, but they get it out on their own and she wasn’t.

That had to slowly just diffuse through her body, while they’re providing enough oxygen support to keep her brain and everything else functioning the way that you need to be. That was the other thing I remember was when they did the scans on her lungs, they were like it’s all, it’s all gray. It shouldn’t be that color.

Rebecca Decker:

Yeah. There are a certain percentage of newborns, about 1% of newborns will develop respiratory distress syndrome. It’s something that can happen in a waterbirth or not a waterbirth. I actually had the research pulled up today.

I was preparing for a presentation and in the latest study, which is the largest one today on waterbirth by Bovjberg et al in 2022. They really carefully matched more than 17,000 waterbirths with 17,000 land births.

The newborn respiratory distress was 1.49% after a waterbirth and 1.61% after a land birth so it can happen in either situation.

Priscilla Layman:

Yeah. That was what our midwife told us too.

Rebecca Decker:

There still is this misconception that waterbirth can cause it, and there can be rare case studies of things caused by a waterbirth. But from what you’re saying, it sounds like it was maybe something else going on.

Priscilla Layman:

Yeah. Yeah.

Rebecca Decker:

She was just having a really hard time transitioning to the outside world. She was doing okay inside of you the whole time.

Priscilla Layman:

Right. Yeah. She was fine as long as she had the umbilical cord connected. It was once we cut the cord that she started struggling.

Nathan Layman:

That’s a good point. I forgot about that, we did an extended amount of time with the umbilical cord.

Priscilla Layman:

Right. We wanted to allow all of the cord blood, for her to get all her cord blood back.

Nathan Layman:

We hadn’t noticed any oxygen issues during that time.

Priscilla Layman:

Right.

Rebecca Decker:

Yeah, that’s a good point. That’s good for parents to remember. When there are respiratory issues, the longer you can keep that cord intact until they get all their blood, that helps with their oxygen levels temporarily.

For sure. She was in the NICU for about a week. How did that stay progress? You said it accelerated and they had to keep getting more aggressive. Then did they eventually start weaning her off of everything or did that take a while?

Priscilla Layman:

Yeah, yeah. It felt really slow, but we were in the NICU watching other families interact with their little ones. There were other little ones that had been in there much longer than we were, and who were still there when we were leaving.

We understood that the scale of things for us might have felt slow, but it wasn’t in terms of the grand scheme of many NICU families experience. She was off high flow within 48 hours.

Nathan Layman:

Not high flow. Off fully high flow?

Priscilla Layman:

Off the high-flow intubation.

Nathan Layman:

Right. That’s high-frequency intubation.

Priscilla Layman:

Yeah, yeah. Within I think 24 hours they had switched her from the more intense one where they had to have her sedated, to the regular intubation where she was able to get other and interact, open her eyes and start to see us. We had some phenomenal nursing care, that we had a nurse who was super experienced and was pretty assertive in weaning her off of her care. Basically, she is a full-term baby. We’re going to give her, her best shot at getting out of here as fast as possible, because I think she can do it.

I think that was really reassuring for us to have a nurse who was, and it never felt like she wanted her out of there because there was another bed that somebody needed. The numbers were fine on that hospital wing. It was very much she just had a belief that Phoebe could do it and that was infectious. And really helped us to feel more hopeful and to be with her in that we weren’t able to breastfeed until maybe three or four days in. Because eventually, they did have the nasal cannula providing oxygen that way. They had to get her off of her belly button.

Nathan Layman:

Yeah. She had an intake tube for food.

Priscilla Layman:

But they were able to use my pumped milk and feed her that part of her care. That made a difference for us. We felt like, “Okay. At least she’s getting some of those good probiotics and antibodies, and things like that, that aren’t as readily accessible and in what they’re providing through there.”

Nathan Layman:

Yeah. There was a mix of advocacy wins and losses, as I think of over the time. Most of the things that I thought went really well had to do with the nurse listening to us particularly well. We wanted almost instantly as soon as we could to start doing, I can’t remember the name of it, but the therapy where you just put a little bit of breast milk in their gums.

Even if they’re not drinking it or whatever, but just putting some… And that was actually even before Priscilla was able to pump or had very much. We actually had some breast milk from her sister, who she gave to us, and we asked them to put a little bit in her gums.

Priscilla Layman:

She didn’t use Mercy’s food.

Nathan Layman:

That was not hers?

Priscilla Layman:

No, it was all mine. It was what I was pumping.

Nathan Layman:

Not the very first bit.

Priscilla Layman:

Really?

Nathan Layman:

There was one day, the very first day we wanted to get it in there. I know because it was white, it was white.

Rebecca Decker:

It was white, not gold. Yeah.

Nathan Layman:

It wasn’t that. I remember asking the nurse and the nurse is not asking any questions where it came from, just say, “Please put this on our baby.” The nurse was really, really receptive to that. The one thing that I think I was a little bit unhappy with that I asked the question with how advocacy loss, was removing the stomach tube or waiting as long as it was.

It felt like everything was just a timing thing and there wasn’t any times where I felt like we weren’t getting the care we wanted. But it always felt like the timing, it was a little bit of a struggle for the timing. Meaning they wanted to take as long as possible for everything.

Priscilla Layman:

She was in a teaching hospital, and so pretty much nothing really progressed until they did rounds in the morning. Even if she had been making progress, it was waiting until everybody came through. All the doctors and all the residents, and everybody was there to say, “Yes, we can move forward with this thing.” But they did a really good job of explaining things to us.

They didn’t mind us sitting in on those roundings as they were talking about Phoebe, until we were able to ask some questions and get a sense for what was going on. I think the EBB training that we got in self-advocacy was really helpful, because we felt some permission to be like, “We don’t know what’s going on, so why don’t we ask? What are the pros and cons and how can we help?”

Nathan Layman:

Yeah. I think we advocated for letting Priscilla have breastfeeding.

Priscilla Layman:

Skin-to-skin.

Nathan Layman:

Skin-to-skin, that took a little longer than I would’ve liked. I was a little bit satisfied with her excuse for how long to have the tube in, which was at one point I had to run around saying she has a little stomach tube in.

How long till we get that out? They said, “Well, she’s healthy enough. We don’t need it, but we like to finish the packet thing. They’re really expensive and so we don’t want to cut it halfway out because we can’t give it any other baby.”

To me, I was like that’s eight hours or six hours Priscilla can’t do skin-to-skin. It felt like a big deal to me, but I think that was one of those things where I like, “Okay, we don’t need to fight on this. I can wait some quantity of hours.”

Rebecca Decker:

Pick your battle sometimes.

Nathan Layman:

Yeah. But the fact that we were able to get that skin-to-skin. And it felt like it was actually a little bit of hassle for the nurses because they had all the different wires and cable.

Priscilla Layman:

Her monitors, oxygen monitors.

Nathan Layman:

They had to rearrange those things to allow Priscilla to do skin-to-skin and then to do nursing. It felt like that took a little bit of advocacy, but our staff was willing to do it because we were asking. I think that was meaningful.

Priscilla Layman:

It was obvious that in some ways, us being as present as we were and as in the room and in some ways we were making it harder for them. But I think they really did a good job in terms of convenience, their convenience. But they did a really good job of saying, “She needs to hear your voices and it’s worthwhile for you to be here. You can talk to her, and sing to her and touch her, and whatever.” The nurses did that.

Then they also had a social worker who came in and talked to us a little bit about the importance of us being present and real, and having our real feelings in the room with her. That was part of what she needed for her neurological development. I felt like we overall, had a really great team and felt really supported by our nursing care. Felt like we were able to make good connections with them and ask for what we needed and recognize this is hard on them, and so we’re not going to push for.

Nathan Layman:

The last bit of advocacy I remember doing, it felt like it was a high-pressure situation. It wasn’t high pressure, but it was when they were finally deciding if they were going to take her off oxygen or just do a test to take her off oxygen. I remember they were doing rounds, it was like the seventh day or something like that.

They were doing rounds and they came by. He was like, “How’s she doing?” She seemed like she’s doing all right, but maybe just to be safe, let’s wait to do the test till tomorrow. I asked, “Is there any harm in trying to do the test today? Is there any risks to that?” He’s like, “No, just want to be on the safe side.”

Priscilla Layman:

We were so ready to take her home at this point.

Nathan Layman:

Yeah. It was one of those things where I was like, “Could we consider doing a test today?” He had a long pause. A bunch of students looked up at their teacher and he says, “All right. We’ll try to test today.” It was one of those times where it felt like because we were having a back and forth exchange and it wasn’t a demand, that he was willing to say yes to. She was able to go home that day and that test was successful.

But I felt like if I had not gone through EBB, I would absolutely not have asked those questions. My experience in the hospital setting was just say, “Yes. Okay, whatever you want to do, we’ll do that.” I didn’t really understand that there was space and value in being able to go back and forth. That was one of those moments where I was like, “Wow, I’m really grateful I’ve gone through EBB to have the advocacy skills.”

Rebecca Decker:

That’s wonderful. It’s like I love it when people find that they can use their voices in all kinds of situations, that maybe previously they would’ve felt like they didn’t have the power or the status, or the knowledge to use their voice.

But once you use it in that kind of situation, just think how valuable that is for the rest of your life. Helping with elders or other family members, or your children or your children’s children. It really comes in handy to not be afraid to speak up.

Priscilla Layman:

Yeah. To ask the question, like he said. He just asked, “Are there any risks if we try it today?” He wasn’t like, “You must discharge us today.”

Rebecca Decker:

You’re trying it. I like how then it made the doctor seem like generous and friendly by saying yes. Because if he had said no, all the students would’ve been like, “Wow, he’s a jerk today.” It gave them a chance, the way you phrased it was perfect. Could we consider doing it today? Because then it’s like you’re saying you are the one to decide, I’m asking you, and they get to look generous in front of everybody. I just love that.

It’s just human interaction. I love doctors. My sister is a doctor and we joke about it all the time. There’s a little bit of an ego related to being a physician. It’s helpful when you’re respectful and also not afraid to ask for things. Perfect. Were you sleeping at the hospital the whole time or did you go home to sleep?

Priscilla Layman:

Our NICU didn’t allow you to spend the night there. They basically kicked you out for two hours a day, but then in the evening you had to be awake. You weren’t allowed to sleep in the chair there.

Rebecca Decker:

You couldn’t snooze in the recliner or something?

Priscilla Layman:

Maybe theoretically you could have, but that would’ve been like…

Nathan Layman:

They asked us not to.

Priscilla Layman:

Yeah. Yeah.

Nathan Layman:

They said, “Please go home and come back in the morning.”

Priscilla Layman:

Yeah. Yeah.

Nathan Layman:

They had pretty clear opening and closing hours. I think at six they said you can’t be in this room at this time. You can come back for 9:00 PM, or some period of time like that.

Priscilla Layman:

Yeah. There was an hour and a half every day that they would close for visiting hours. We actually would go home at night and try to sleep. They would give us updates in the morning when we came in. We were there as soon as the doors opened, and then there until almost they kicked us out. That was really nice that we got that time with her but it was really hard.

Every time we left, I cried. It was just really hard to leave her behind. But I think there was a certain amount of we’ve done all we can and we have to trust that her nurses are going to do a good job of taking care of her. It was unfortunate because I think the information we were getting when we came back in the morning, was that she was more irritable and more distressed.

Rebecca Decker:

When you weren’t there.

Priscilla Layman:

While we were not there. The first few nights, they had to provide some medication to help sooth her, so that was unfortunate. We didn’t love that. But at the same time, we also recognized if she’s getting really distressed and dysregulated, they have to do what they have to do.

I think they had OT come through and meet with us and then meet with the nurses and provide some suggestions for how to, and PT as well. Some soothing suggestions for the nurses to help manage the difficult evenings when we weren’t there.

But they only have so much capacity. When they’ve got multiple babies, they’ve got to help to be able to soothe hands-on soothing or massage, or things like that.

Rebecca Decker:

I think that’s a good point for NICU parents and parents in general to know. There is research that supports rooming in for NICU babies. I know some hospitals are starting to convert their NICUs to make that a possibility.

I hope that someday, it’ll just be like how we don’t send babies who are healthy to the nursery a lot of hospitals. Maybe someday all the NICUs, you’ll be able to stay with your baby overnight, if you wish.

Priscilla Layman:

Yeah. I think that would’ve made a difference for her. Honestly, our one parenting challenge that persists with Phoebe, like she’s super healthy, she’s super verbal, meeting all of her milestones. Everything’s really great, but sleep has been a real struggle. Part of me wonders if that first week of not having us around in the evenings contributed to that.

If that was somehow a part of her was dysregulated in the evenings, and so it’s taking her longer to meet those sleep milestones now because we’re having to repair some work in a way. I would really encourage parents if they have the opportunity to stay overnight to try to make it work.

Nathan Layman:

It was also challenging though, because you were still recovering.

Priscilla Layman:

Yeah, absolutely. I had had a long birth and I needed recovery time.

Rebecca Decker:

Yeah. You needed some sleep and probably sleep. The recliner in the hospital wouldn’t be the best way to do that either.

Priscilla Layman:

Yeah. It was COVID as well, and so only so many people were allowed to be on the list of people who could even come visit.

It wasn’t like we could just tag team with another family member or something like that and say, “Hey, go out there over the evening.” It was just more challenging.

Rebecca Decker:

What was it like bringing her home?

Priscilla Layman:

Such a relief. I think all of us slept so well that first night she was home because she was able to be with us. It was interesting because I hadn’t planned a homecoming for her because I had anticipated we’d have a home birth and she would just stay at home. It wasn’t something we had thought about, but we were able to have some people who were able to be there and greet us, have food for us, and there were flowers and things like that.

It was really joyful to bring her home. I think some parents, I’ve heard from some parents that coming home with their infant after the hospital stay is like, “Oh my gosh, now it’s real. We have to be parents.” For us, it was like finally, we get to relax and just be with her. Because we’d had a week of parenting at the hospital and him pushing me around in a wheelchair, and parking and all of this stuff to try to manage the NICU stay. That was just a really big joy and relief to have her home.

Nathan Layman:

Yeah. I’m sorry, I’m going to be having to leave during the interview.

Rebecca Decker:

Okay.

Nathan Layman:

I didn’t set parameters, but it was a really good interview, and thank you very much for inviting us onto your show.

Rebecca Decker:

Yeah. Thank you.

Nathan Layman:

Bye.

Rebecca Decker:

Priscilla, I’ll just wrap it up with you then.

Priscilla Layman:

Okay.

Rebecca Decker:

Let’s see, I just have the one last question.

Priscilla Layman:

Sorry, what was that last question?

Rebecca Decker:

I just have one last question, that’ll be it.

Priscilla Layman:

Okay.

Rebecca Decker:

Priscilla, before we go, are there any final words of advice you have for listeners who might be entering birth or parenting soon?

Priscilla Layman:

Yeah. If you have a partner, do your best to invest in that relationship, so that you guys feel like you’re a team going into it and coming through it. I can’t imagine having done that NICU stay or the birth without Nathan. It made a huge difference to have his support. We read a book called Bringing Home Baby by Gottman, which both as an individual and as a psychologist, I would strongly recommend.

Then another piece of it is make sure you have a good support team, whether that’s doula or a family, a lactation consulting. You don’t necessarily know what curveballs your birth will throw you, and so having a good support system around you really, really matters. I credit the ability we’ve had to eventually breastfeed successfully to the support of my sister. Her name is Deborah Persyn.

If anybody’s local in San Antonio and you’re needing lactation support, definitely look her up. Yeah. I think that was the biggest thing was having that partnership piece.

Rebecca Decker:

Yeah. Having a supportive birth partner and team of people you can call on for all the unexpected things that might come up. Well, thank you Priscilla and Nathan for sharing your birth story.

I think it’s inspiring to hear how you were able to both use your voices throughout the process and make informed decisions along the way. We’re really thankful you came on here to share this with us today.

Priscilla Layman:

Yeah. Thank you for giving us the opportunity to share. It was really meaningful to be able to tell our story, and we’ve even processed some of the ups and downs of that journey.

Rebecca Decker:

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

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