Arya Pretlow, MSN, CNM, IBCLC, C-IAYT: Healing Through Pregnancy Loss and Empowering Others

0:00 This episode depicts pregnancy loss. Listeners who are sensitive to this topic may prefer to skip this episode. Hello, Today I have with me Aria Pretlow. Aria is a certified nurse, midwife, an international board certified lactation consultant and a certified yoga therapist. On top of that, she is a mom and she is in the process of getting her doctor of nursing practice. Today she's going to talk about her birth journey, and if you want to work with Aria, you can go to apwellnessservicescom and message her, And that will also be in the show notes, so you don't have to remember that. Aria welcome and thank you for joining me.

0:42 Thanks, Kelly. I'm very happy to be here again. Me too, I'm excited that I have not heard this full story, so Oh, we never had enough time hanging out at the nurses station to go into detail. After like six years. I've heard bits and pieces, but not the full story. Yeah, well, it all started Upon a time a girl in a ballroom. Exactly like that. First of all, i love being able to share this story because I think it's in my experience as a provider, both at the bedside on labor and delivery and definitely as a nurse midwife it has been so helpful to you know, have a reasonable amount of sharing personal information, like you never want it to become about you, but sometimes the patient very much appreciates knowing that the person caring for them has experienced something similar, and so whenever I work with people who have had like a long journey to get that sticky embryo that they can carry all the way through to birth and then have a healthy life, birth After loss, that's always been really useful.

1:53 So being able to relate to patients and share a little bit about my own experience so that they can feel even more understood and heard and seen in the care that I provide, that has, for better or for worse, as far as my own personal history goes. That includes difficulties conceiving, it includes early pregnancy loss, it includes not one but two ectopic pregnancies And then finally, an unplanned conception that resulted in a healthy all the way term almost 42 weeks gestation and a home birth an on-purpose home birth and this healthy, amazing, now nine-year-old.

2:36 So thank you for asking me to come and talk about it, because it's not just kind of a triumphant story but also one of really it's just human-ing right, like we're just going through trying to deal with each new situation we have to face, whether it was one that we on purpose chose or not. We just are always doing the best we can. So my first pregnancy I guess we could say that I know of, because all of us technically have probably had some pregnancies that were such early losses we didn't even necessarily know it happened. But the first planned I want to get pregnant happened really easily for us.

3:17 We had been married five or six years, we had just gotten out of the military, settled in. I really had that like what we think of for our for me at least, my grandparents' generation of like you get home from war and you just want like white picket fences and your 2.3 children and your cute little dog chasing the kids or whatever. I very, very much wanted that when I got home from serving overseas in the war And we wanted to get like settled into civilian life first. And so then when we felt ready, we basically it was like, okay, we didn't really have to like chart, we didn't know, i didn't even know about any of that kind of stuff.

4:00 We just, you know, had a bunch of sex and made a baby. At that time I was late 20s, you know. So that helped, i'm sure, and I already was very enthusiastic about living in a part of the country where I knew that home birth was a feasible, relatively common and safe option in Seattle. And so I, you know, i think I was like four weeks and three days pregnant, like I had just peed on the stick The stick it was like still hadn't gone out in the trash yet, probably and I was calling midwives and being like will you be my midwife? I am pregnant. And it turned out that, even though, as a midwife, a lot of people do that, of course you're very excited and I totally get wanting to start care, but for most people there's really nothing for us to do that early.

4:52 There's really except meet you, like having meet and greet, and like we could run some labs, but there's nothing to do really in the care until a little bit further along. So I connected with a midwife and she was like, yeah, come on in and we can like confirm the pregnancy, we'll do the blood tests and everything. And so I went in and those initial labs were fine. By the time I got in to see her I was maybe like six weeks or something. So the initial labs were fine. And then the next you do the like serum quantitative to see Did your HCG go up the way it should And how's your progesterone looking, and all those things. And I got a phone call on Friday that said this isn't looking good.

5:36 And I just want to let you know, especially as we go into the weekend, that this is not a viable pregnancy and you should prepare yourself for having a loss. And I did all the things people do, i think I, you know, took long walks and cried and yelled and bargained and started bleeding by Monday And so I had what we all thought was just a, an early pregnancy loss, just a miscarriage. But about two weeks later I had a horrible pain And I had had this kind of pain in my lower abdomen throughout, like since I really early on, and you know people are just like, oh, it's growing pains.

6:18 It's kind of doing that thing people do to try to be reassuring but really it ends up dismissing the concern. And so it wasn't investigated. And knowing now what I know. I wish that I had had an early dating ultrasound because it would have identified that in fact all along. I had an ectopic pregnancy and we could have treated that condition early. But instead, because that wasn't what was done then, or perhaps with the practice I chose, about two weeks later I had this terrible, terrible pain, ended up the short-ish version of it in being diagnosed with an ectopic pregnancy And the embryo, of course, had died. It can't keep growing, but the placenta is dumb, placentas are not smart, and so it just keeps growing.

7:01 And the radiologist was like you don't have to go to the emergency department, but you absolutely have to get this treated today, which was a Friday. So we were just like what does that mean? So we called the midwife and the midwife was like well, it's not in my scope to treat it, but I'm going to send you over to this OB-GYN. So I go to the OB-GYN. It's the office full of pregnant people, all the awful things, and I was treated with something called methotrexate because I didn't want to have surgery I have. The interesting thing with ectopics is, while any kind of pelvic inflammatory disease or surgery in the pelvis increases your risk of having one most people who have one have never had either of those things.

7:48 So I had never had an STI, i had never had a procedure, i had no risk factors, except just being a person who got pregnant. And so I was like, oh, you can't take my tube. I feel like I might need that. So I chose to get methotrexate, which is a medication some people may be familiar with because we use it to treat other conditions, but it's basically chemotherapy to kill the placenta, and if I had to go back and do it again, i would have had surgery instead, because it was like two months of recovery for me because it was. It's so slow to break down the placenta And the fallopian tube is it has a little tiny bit of like diastasis action, like your guts do, and so all the way I envision it is like chunks of placenta are kind of deteriorating and it and it still has to move through the tube, and that was imagine kidney stones, right, i mean it's like it was excruciating and it would happen randomly.

8:45 So I couldn't drive and I couldn't until all of that was done and had wrapped up. So that was my entree into pregnancy And so, you know, the follow up was basically like we're going to look at your blood and make sure you know that it worked so that you don't have to get a second treatment or possibly surgery if for some reason it wasn't responsive to this drug. And then the nurses literally said things like oh you know, i just know we're going to see you in here pregnant in a few months. And I was just like how do you know? I'd like to know how you know that. I don't know that. It didn't feel good to be told that when you're still in the throes of like a very painful, physically and otherwise loss.

9:27 So that was one of those things that when I think in my practice, the things you learn not to do, you know it's like don't don't say those things You don't know, you don't know that. So it took us two more years to conceive. Again, not for lack of trying. We started temping and using taking charge of your fertility. You know, old school paper style. There weren't apps and stuff for that. This was the early odds And so I would do tofully take my basal body temperature every morning and track all the cervical mucus and all the signs and all the things, and I clearly was ovulating. It just took us like two years to do it. So we finally conceived again, had a very early loss again, so it's like 2008.

10:08 And I remember for that one it was like the Friday before Memorial Day when I started bleeding. So I had like had a positive at home pregnancy test, i don't know on like Tuesday or Wednesday, and Friday started bleeding And a given that I had quote unquote miscarried with the first one before I found out it was an ectopic, i was like, oh my God, this time I'm going to die. So we went to the emergency department. I didn't have a provider or anything, so we go to the ED and that was its own kind of wretched experience And they determined that it was not an ectopic And so it was like, okay, well, just go home, and you know you're already miscarrying, so just go home and continue with self care.

10:53 So we did that And then it was three more years until I conceived again And all along that time for me I just never wanted to do reproductive endocrinology, like I didn't want to go to fertility treatment. I just had for me this very strong feeling that either I can just do this like I don't think there's something wrong with me. I think it's either timing or I don't even know what. But I don't want to go and engineer it, i didn't want to. So and I was still in my early 30s. You know, i was kind of like it's not, i'm a healthy, youngish person. This should eventually work out. And so the third pregnancy was a surprise.

11:38 We had been trying. We would kind of go through cycles of like doing all the tracking And at some point you're like, oh my God, if I have to hear that, that fucking thermometer one more time beeping at like stupid o'clock in the morning because you got to take your temperature or you got to bed, i was like I'm just going to throw it out the window, like I'm so over it. So for our health and wellness, we would take breaks from like on purpose trying. So I think we might have even been taking a break from trying. And I had a famous last word. Again, i had a period and it was a little bit of a weird period. I can't remember specifically how, but it just was a little strange. But I remember being very relieved to have my period because we were going on a family trip to Ireland And, as a person of Irish descent, this was the first time our family was going to Ireland And it was like a pilgrimage.

12:25 We were so excited And I was like there will be fresh Guinness and there will be Like there are things that need to happen in Ireland. So I was like, Oh well, i got my period but you know, okay. And so I went and had a lovely time in Ireland and came home And I remember I was a doula at the time And I was also enrolling in midwifery school at Bastier University. So I was, i was preparing to become a licensed midwife And I went to a birth as a doula, some kind of long but lovely birth. And like the next morning it was a Saturday I woke up and I was like I feel terrible And not just like strung out from a long birth, you know, and my husband was like making some bacon we're gonna have Saturday morning breakfast And I was like I think I'm just like really hungry, like that kind of weird low blood sugar, but I feel kind of nauseous And maybe I just need to eat a little bit.

13:22 And I tried to eat just a little bit of like a muffin and threw up all over the place And I was like that's not normal. And so then I was like I don't understand what's wrong. Then my pelvis started hurting, so this really on the same side right side was my messed up side So my lower right abdomen really, really painful And I have a history of some food intolerances that cause terrible colicky gas. I have before in college, like call the hospital, been like I just don't know what to do. When they were like well, we can't tell you what to do. I mean I was in college, i didn't know. So I was like it's just gas.

14:02 And my husband was like I don't feel like gas usually makes you throw up like this. Like what's going on? I was like I don't know, but I'm not going to the hospital for gas, like that's so embarrassing. So I was like just let me take a bath, i'm just gonna take a bath. Well, now, like my cats have started following me around the house and staring at me and that way the animals doing they're like something's wrong, what's going on? And he comes up to check on me And he's like having this conversation with me of like I really think we should probably just go the hospitals. Like a mile away, it's Saturday morning is not going to be that bad, it's not like the downtown hospital, so it's gonna be fine. And I was like I just don't want to go for gas. And I compromised. I was like let's call the nurse line.

14:42 I was like we'll call the nurse line through our insurance and see what they say. And so he brings me the phone and I am in the midst of telling the nurse what I'm feeling when my last period was and she says have you ever had an ectopic pregnancy? at the same time that I'm like, oh my God, what if it's another ectopic pregnancy? And she's like, yeah, i'm going to suggest that you go into the emergency department right now. I was like, oh my God, i have to go. So we managed to get me. We didn't even call 911. We just like got in the car, me with a barf bowl, and my husband like gunning it right, like don't do that. People, people at home, just call. Like I didn't know, i didn't work in healthcare at the time. If you call 911, they can prepare the hospital to receive you And if you are in shock because you are hemorrhaging inside of your body, that's a way to help you stay alive.

15:33 We didn't know that. So we just sped and broke all the laws And we got there, got me in nothing gets you seen faster than you know, not really being able to walk and then barfing all over the waiting room. So they took me back. Of course I was hypotensive. Everything was a mess And they ran the pregnancy test And I turned. I remember that was the first time I had a symptom of pregnancy. I turned my head and, like to my husband, i got that smell of like hospital gurney, like like the cleaning products, right, that super person smell you get when you're pregnant. And I was like, if I'm pregnant I am not doing method trixate again. They are taking that goddamn tube. They can add it. All it causes me is trouble.

16:14 So, sure enough, ectopic pregnancy has ruptured, my tube is blasted, i am hemorrhaging inside. They have called the OB who's like as soon as I'm finished with the cesarean I can come and save you. And I was like I'm alive, i'm in a small hospital So they pump me full of fluids to keep me stable and do emergency surgery And basically you sign away all the things. They're like we. Honestly, what we saw was like there's a mass over your ovary. We don't even know how much of you we need to take out.

16:54 It looks like it's just a hot mess in there And we might have to take the ovary. We definitely have to take the tube. I mean it's ruined And we're not sure how much of your uterus we'll be able to preserve, because we just can't know until we open you up. Sign here, please. Okay. So it turned out that the fallopian tube was twisted, kinked and wrapped around. It had pulled the ovary over. So the ovary was fine And I got to keep it And the tube was. I mean, there was no saving the tube, so I got to keep my whole uterus. It didn't mess up the horn where the tube comes out.

17:35 But they said you know, the thing is is we can never know if this ectopic pregnancy caused your tube to be malformed like that, or if that's a result of damage from the first ectopic pregnancy, or if you just developed that way. No idea. So good luck seeing when you're pregnant. Basically It's funny. No, it wasn't funny, but basically it was like okay, well, we've done our work. You know, surgeons especially, they tend to be like, okay, well, i did great. So see you in six weeks to reassure all of us that I really did great. And then, you know, do whatever. So, okay, the recovery from that was laparoscopic surgery. The recovery from that was exponentially easier for me than the methotrexate.

18:18 I'm still awful, but it was way better than the methotrexate. So you know, we go through all of the mourning and the shock and trauma of waking up and going into shock and this knowledge that your pregnancy almost killed you. That was a big one. So we at some point are like, okay, well, look, this may or may not be a very good idea. How about if we don't on purpose try, but we're not necessarily on purpose going to try to prevent either? So I'm like 36, almost 37. And I was like I mean, i still feel like I'm fine, but at some point I'm going to know in my bones that like, oh, i'm your pregnant, like I'm going to go do other things now. So I decided for the first time to get a hysterial subpingogram to see if my remaining tube was fine or not, cause I was like if maybe my tube grew that way, then what's going on with the other side?

19:08 It just happens that both that topics were in the same side. And so I got the hysterial subpingogram, which you know, you can Google it, look it up. It's, in my experience. As awful as every story says it is, it's not. It was not a delightful experience. However, it did show that my left tube was patent, was fine, it looks straight, it looks open, it should be fine, but you will always have a higher risk of ectopic pregnancy. So I was like I mean, maybe my right tube was fine until it wasn't like I'm kind of reassured, but not super reassured. So there's a part of me that was like, yeah, you could bypass all of that and just do like IVF, right And. Or you could just do intrauterine and like there's all kinds of things you could do and just kind of bypass the whole part where the embryo has to like travel for the little blastocystals to make its way.

19:54 But I just wasn't prepared to to consider all of that. So I still very much felt like either it's a thing that will somehow work out or it's not. And so at some point we were like, yeah, we're just not even trying anymore, and if we can't have kids, i guess we're going to have money and time. So what do you want to do? So I made a few changes to my education plan and was in the midst of like doing this really hardcore chemistry with lab in an eight week summer term because I was going to shift and do not just midwifery but kind of shift to like naturopathic position I needed more chemistry.

20:37 So in the middle of that of like eight hours a day of chemistry Monday through Friday for eight weeks, i was like I feel really weird. I remember calling a friend of mine who was a midwife and I was like what if I'm pregnant? And she's like well, you should find out if you're pregnant. And I'm like but what if I am? She's like well, first, maybe you should find out. And I was like but oh my God, what if I'm pregnant? And so we had a plan which was I had maintained care with the midwife, who was also a naturopathic physician, and so she was the person I saw for my PAPs and everything. So we had already agreed that if I ever conceived again, we would get the earliest possible ultrasound, like get a dating ultrasound, make sure it's in the right place. You know, do all of the labs? And the labs aren't predictive of ectopic.

21:19 But the labs look weird And so you suspect an ectopic, right? So that is what happens with ectopics You can't diagnose based on the labs, but they don't look ripe. So my labs looked beautiful And we're like okay. And then the follow up labs still looked beautiful And we're like that seems good. And then I didn't have any of the pain that I had had before. So they were like well, we could do this five week ultrasound and just get dating and make sure it's in the right place, or you could wait another week or so and actually see the heartbeat. And I was like I want to see the heartbeat. If I felt bad or the labs had been weird, i wouldn't have waited And we had a very short threshold for like eject, eject, eject, go to the hospital.

22:04 But I was like, yeah, let's just see how viable it is. And so we went and it was, sure enough, it was an intrauterine pregnancy And that sonographer was probably the weirdest appointment that they had had in a while at least, because I just kept looking at it and being like so that's my uterus? And she was like mm-hmm. And I was like and that is the embryo is in my uterus. And she's like mm-hmm. I was like so it's not in my tube. She's like nope, or anywhere else except my uterus. She's like you're correct, and so it's going to be staying in my uterus, just like trying to process that. It was like in the right place and not trying to kill me. So from that point on once it was like this is an intrauterine pregnancy And once we got through the, is it sticky?

22:51 Is it not sticky? Just knowing it wasn't in a location that would end in a loss again. The rest of the pregnancy was completely vanilla. I was 37. So whatever some extra monitoring, i was a very healthy 37 year old and was like eh, okay, but there was nothing interesting about the pregnancy at all clinically, because the big part for me was like, can it make it down the superhigh way of your tube to actually get to the uterus and be where it needs to be? And this one did So. Then I just waited and grew. I was horribly sick for like 17 weeks And then one day was like oh, the clouds parted and I was like kind of functional again.

23:33 So that was good And I had a feeling it would probably be my only pregnancy, even what I had experienced. I was like I don't see us having the stamina to work through all of that trauma of the early stages in particular again. So I just wanted to be pregnant and enjoy it, and so that's what I enjoy. Quote, air quotes, huge air quotes for enjoy. I am not an I love being pregnant person, but I loved being pregnant that one time because things were working. And then finally, finally. So I hired the midwives that I had trained with as a community midwife, because I knew them, i knew their risk level was similar to mine.

24:13 I knew their tone of voice. I knew if she looked at me a certain way or used a certain voice like, oh, that's it, you know, i just I knew them, i trusted them, i love them And so and they were like, yes, us too. So let's do this thing. And I wanted a home birth. I had always wanted a home birth from early in my academic career. One of the first papers I wrote for a college class was the dangers of the medicalization of childbirth. That was before there was internet. I had to do all my research like at the library, with textbooks and everything, and I was like for healthy, low risk people, it's not an illness. I also am a survivor of sexual trauma.

24:55 I was like I am not going and being stuck in some weird ass gown in some weird ass bed with some strangers I don't know, putting their hands up inside of me without asking. You know like I'm not about that. So hashtag not all nurses, but a lot of them. And so it's like I'm not, i'm not willing to relinquish my bodily autonomy And I'm a perfectly capable adult who can make decisions for myself and my baby. And so I was like this is what we're doing, as long as it remains healthy and low risk. My husband was very supportive, on board, educated, i mean, as comfortable as anybody is with anybody.

25:35 They love having a baby. You know, it was like okay, as long as you feel safe and cared for. And so then my due date came And I was totally that person who was like you're healthy and things are good, i wouldn't be surprised if I go early. No, so 40 weeks go by. Now we know that the average length of gestation for a first time full term baby is 10 days past your due date. That's if your dates are even good. If your dates are good and you have a really good idea of when you conceive, so you shouldn't really expect to go into labor before 41 weeks and a half ish, but also at 37, moving on toward 38.

26:15 At that time I was like I don't want to hit the mark where, just because I'm old, i'm going to have to go get induced. I'm like the worst person to send for an injection, just personality wise. Finally, at like 41, 41 weeks. So she was due on like the fifth. For the record, the child did not decide to arrive until the 18th. She was born 10 minutes before we would have been 42 weeks gestation. So like on Monday of that week I start having prodromal labor And so every night I would have labor, early labor, regular.

27:02 It would wake me up. It was painful. I could stay in bed, but it was. I couldn't sleep, except in between, and every morning when the sun came up it would stop. I'd be like can you get me right now? By about day three I was like I'm never going to have this baby. Can I just pause and say that's why I had an induction. You're like maybe you could have been induced, But I didn't want to find out, So I was like just give me a minute. Yeah, yeah, i was like you know, i still have time, i still have time, and so I didn't love it, but it's not like I wasn't working at the time, so I would sleep during the day, when the sun was keeping me out of labor anyway, and then every night I'd be like maybe this is the night it'll stick, and it never did So.

27:45 Annoying So then it's really the moon It just wasn't the right time, I wonder I'll have to go back and look at the calendars and see what was the moon doing? Because we all know it's the moon, it's the barometric pressure, it's all the things that the earth and gravity are doing. It's all of that Working against me. It is. So you know, when you go past, especially when you're older, but really for everyone, when you go past 40 weeks, we highly recommend and the standard of care is increased monitoring. So you go for a non-stress test and you go for a BPP, and is your amniotic fluid still okay And is your baby doing the things we hope to see them do, or are they starting to like slow down? So because in that case perhaps we should just expedite this whole situation and create an exit strategy.

28:29 No-transcript. I go on Thursday for my NST and BPP and everything was great except the child would not do the full body movement. I could feel her moving inside of me. I could feel her move, but it was never. When the sonographer was like measuring that And so or it wouldn't, it didn't. It's very specific about like how how big the movement is and how long, how many seconds it lasts, and it never quite met what they were looking for. And so she she got like a passing BPP, except that it was like a zero for full body movement And my midwives were like, yeah, that's weird.

29:12 So we've consulted with our friend over at the hospital who was like yeah, that's weird. But also, you know, she's almost 42 weeks and 38. So really, how about? if she doesn't have her baby by Friday, she comes in for an induction. And I was like, yes, i hear you, i believe you, i agree with you, and that gives me like 36 hours to get the show on the road, like if I'm in labor before then I'll do it. So I was like, yeah, we'll make that plan, we'll do that tomorrow. It was like do another NST BPP and see how it is and then also plan an induction. So I was like, in the meantime I'm going to see my acupuncturist. A word about acupuncture. I do not care how it works.

29:53 All I know is that, like I don't have to understand it with my medical background and my Western science background as a yoga therapist and practitioner, there is a whole body of knowledge that that scientific method, as we know it, does not seem to be able to assess. How about that? And I'm not trained in the Eastern methods for that assessment. All I know is that every time I went for acupuncture my nausea felt better, my whatever was going on was improved, and so the acupuncturist that I worked with she was also a certified professional midwife, and so she just was.

30:34 She was like I'm done with the baby catching, but I use all that knowledge to specifically help pregnant people. And so I was like Jasmine, jasmine, i need to go in and see you. So she's like, okay, come on in. She did all. She did moxibustion, and she did like all the little things. And all I know is that night, when the pro-dramal labor started, it kept going. I stayed in labor. She even treated my husband He doesn't actually remember it, but yeah, she was like how about if I do some things to help with your stress? And he was like she did some little, whatever she did. So that time I stayed laboring, and so it was like hot diggity, this is awesome.

31:17 So, okay, that was like the big hurdle to cross. And so I had my midwife come out. You know, after, like, okay, the son is up, i've stayed in labor, send Rob back to bed to get some sleep. My mom had been visiting during this time because I had invited her to be there for the birth, and then I just kept not giving birth, and so finally, she like had to go home. So she actually was like leaving and I was finally in labor, whatever. So what are you going to do? So so we had the midwives come out, so when you're doing a home birth, we didn't have to figure out, like, when to go to the birth center, right, the whole plan was like I am not leaving here in labor, you're not getting me in a car unless something is wrong, and I have requested a change of scene and society, otherwise, no, no, it is so uncomfortable.

32:08 So I was still certainly an early labor. They came out assessed. I will never forget. I was totally like you know, had the lights dim and like all the nice like super labor e vibe, and she was like this is lovely And also too early for all this labor e stuff. I love them so much. It was like, just, you know it's very early, yet Just go do something else, go distract yourself, go go take walks, go do it's daytime, you don't need to be in here like huffing and puffing, like you're in the full blown labor when it's still very early. And I was like Oh, right, yeah, okay. It's like I had forgotten all the things and I was trying very hard not to midwife myself And so I was just like yes, okay, okay, cool.

32:53 So I call my doula, who is one of my classmates and a very dear friend And we figure out when she's going to come, and Rob makes a quick trip to the store because I was like all I want is playing. And then we figure out a time like when is the midwife going to come back to do a check? They don't need to sit there and watch you be an early labor, it's not. It's very unusual for someone to pre-sip and be like, wow, my first baby came in three hours, you know, but it happens. But I'd already been in labor for more than three hours, so it clearly wasn't happening. So at some point they came back to administer. I was GBS positive And so they came back to administer my antibiotics and we're kind of like, okay, well, we're going to go do a couple of home visits, see a couple more people, and then we'll plan on coming back and we're probably just going to hang out here all evening until this baby comes.

33:37 And I was like, yeah, okay, and so we I remember going for a walk with Alyssa, with my friends and Dula, going for a walk up and down the street and hanging out and just passing the time, having to do those annoying things like go up and down the stairs sideways to help the baby move like, which is all great And it works. But wow, now I totally get why everybody moans and groans when the Dula suggests it, because it's like I don't want to. I just want to stand here and like sway my hips. My husband was an A plus hip squeezer. Oh man, yeah, it was excellent. And I remember just taking I had a really like stupid labor pattern.

34:21 If I had been in the hospital someone would have pretty quickly put me on pit to just to manage and regulate it. Not that that would have changed, i mean, it would have just regulated it. But because it was an effective labor pattern It just isn't textbook. It would have made the providers feel better. It would have made the providers feel better Like you're not just hogging a bed right, like okay, we're doing something and this baby will eventually come out, as if it wouldn't on its own. So that was another reason why I was like I do trust my body in the process and I'm very high degree appropriate assumption. And so I was like between me and the midwife, i feel confident. If something is going sideways, we're going to make the transfer, like I'm not the person who's going to argue that transfer, i will.

35:02 I don't want to be an emergency transfer, anything weird. I don't want to get out of here and be in a place that's more appropriate for the change in my status, but until that time comes, or unless I ain't leaving, so in and out from the backyard, we have some awesome pictures of me like eating popsicles, standing in the backyard, swaying like just trying to pass the time, because it is ultimately, if we average again, when it's not an induction, and average 24 ish hours, it's a day of hard work, even a poo poo anybody's experience of it being like way worse than that by any means For me. I was not scared of the pain and I had excellent coping tools that were already proven because of the things I had experienced previously.

35:49 So I was like I know how to help my mind deal with the biggest issue, which is like how much longer and how much more can I handle? I just don't go down that path. I was like it's one at a time And all I did was accepted that it was coming and there was nothing I could do about it, and I would count up to 10 and then back down to zero And by the time I was done so was the contraction. I just lengthened it as the contractions got longer, but that way it was like okay, that one's done. That was my primary coping tool was just like oh okay, here it comes. And then I would count and get pissed at people if they try to count with me.

36:30 I was like I do know how to count. I get so mad Like you're messing up my flow, shut it Shut up, shut up, shut up, shut up shut up. So at some point I was like I have been awake for a very long time. It was probably like two in the afternoon or something. I was like I'm going to go lie down. And so everyone did the appropriate thing, which was have the conversation with me about how, if I lie down now, things might slow down. And I was like I don't give a fuck, i am tired. I am talking about like a 20 minute catnap. It's not like I'm going to go and like sleep for four hours, right, like. I wasn't that kind of tired, i just needed to like, i just needed a little downtime.

37:10 So I remember I went and laid down on we had a futon, like in a sunny office room, and I laid down on the futon just to like rest. And then Rob came in and he spooned up behind me and like gave me a snuggle And I had this surge of oxytocin. I felt the huge contraction. I heard a pop and was like my water brush And I love that story, clooney, snuggle with your you know, sweet, supportive person. I just it was like so amazing to actually experience that process. It was like feeling loved, held, safe, bonded, and then, bam, water broke You were 42 weeks And it wasn't very much water, like she just went bloop and plugged it, but it was clear.

37:59 Exactly, there wasn't a whole lot left. My BPP but, my FI was fine, just to be clear, and she wasn't a big baby. So she just kind of went bloop and settled down in there. I know she just plugged it, i guess Thankfully it wasn't, it wasn't. There was no Mac, you know. It was like, hey, well, we're just going to keep doing this. But then of course, as you would expect, things picked up And so now it's like a better labor pattern, more effective. I have not had a cervical check since earlier because it doesn't do anything And I was like A I want your hands up inside of me, i love you And I do not give you permission. B I am a trained midwife. I already know that it's not necessary and it's not going to change the plan And you can tell that things like there is a labor pattern, it is shifting.

38:45 I said they offered to check me at some point. I was, i think, at this point I was like laboring in the tub. I did not want to have a water birth. I had a wonderful like soaking tub but the edge of the tub was like an inch And, having attended many water births, i was just picturing my poor midwife trying to hang over that tub And I was like, no, and it's so hard, nobody wants to get out of the tub. I was like it must feel so nice to stay in that tub And then it's just full of blood Like ew. I didn't want to And so I was like I will labor in the tub. And then I want I like I know where I want to have my baby And I was like I will labor in this room that I have created, the first thing done The guest bedroom.

39:27 It was like that was the room So that way we could trim. Yeah, i mean well, well, that too. Yeah, it was like, and I mean I wasn't ruptured yet. But when they initially were like do you want to be checked? And I was like no, but then yeah, so it was like do you at some point? they're coming like regularly, things are good. It's been, i don't know because I wasn't paying attention, because I was trying not to midwife myself however many hours, and they're like do you want us to check you? And I looked at her and I said the funniest part of this story is that I am. I thought I only imagined saying all of these words, but I actually came out of my like you know, between contractions kind of stage and I looked at her and I was.

40:08 I said very coherently no, i do not want you to check me. You know, if you check me right now and I'm only four I will die right now. I do not want to hear that. I would rather not know and just keep doing things. When I have a spontaneous urge to push, then we can check and make sure and then we'll proceed. But no, i don't want to know. I don't want to know what my cervix is doing right now. And they were like okay, because nothing was wrong. There wasn't anything that was like. But so the, the, the, the takeaway from that, clinically speaking, is also I had seen so many people lose their hope when they're on hour 20, you know, and they get checked and they're like maybe I'm nine you know especially people who haven't done it before or been to any births like they don't know about transition, right, so they're like maybe I'm at least a seven, i'm eight, i've got to be close.

40:57 And if they have in their mind like this many hours should have resulted in this many centimeters, and your body doesn't have an algorithm like that, it doesn't. And so even if we as clinicians have a concept of an algorithm, we would like to see so many centimeters of change over so many hours of labor, depending on if you've done this before or not. Your body didn't get the manual. And so I've seen people who are having a perfectly normal course of labor and everyone is well and fine, just lose all hope and change their plans because they lost hope. And then it could be that you're seven and within an hour I've seen that have pushed a baby out. We also can't. It doesn't mean it will take 10 more hours to go, right, yeah, right, it could go so fast.

41:43 So I was like, no, because I'm doing well and I'm coping well, and that's a thing I just don't. I don't want that. That is not information I require. And so they were like, yeah, okay, at some point it must have gotten to be like maybe around 1030 or something. So that's nighttime. My husband has made coffee for everybody. I love coffee. And also I was in labor And so two or three people came upstairs with coffee mugs, steaming coffee. You know the smell of coffee. And I did that thing where I was like falling asleep between contractions. I smelled the coffee and was like it smells like fucking coffee. And whoever had like walked into the bathroom like I hate it, i hate the smell of coffee, it's.

42:26 I was so mad because it smelled so bad to me. Yeah, it's just gross. Yeah, they were just like, oh, yep, she's, she's probably transitioning now because she's mad. And then at some point I totally did the thing where you're like in between contractions, i love the endorphin rush in between contractions, i love that, like it's a lot of hard work. And you're like, wow, i really would love to be done And also clearly I'm not done yet, so let me suck it up for another contraction, just one at a time. But then the after is like oh here, let me give you a little something to help you deal until the next one. When you're laboring in a functional place.

43:09 When it's a functional labor pattern. So again I want to acknowledge that not everybody experiences that. Yes, when you're safe, feeling home and loved and things are, you know. So I'm in my tub with my peeps not in the tub with me, but like around me, you know, not drinking coffee near me anymore And I go. I was like everybody they did that. They totally froze. I'm like listening and looking at me and then I'm like it's time to get out of the tub. So over the course of a couple of contractions we get my very pregnant self And I'm like okay, you can check me.

43:50 So that was the only time I laid on my back the whole labor. So now it's probably like it must have been around 1120 or so because I only pushed for 20 minutes. So we probably around maybe 11. Spontaneous urge to push. We start getting me out of the tub onto the guest bed because I wanted to keep our bedroom all night, because that's where we quote unquote transferred to after two hours in the bedroom, So we my postpartum room was my own bedroom. That's right Across the hall. So they checked me and I was like, oh my God, this is, this is the worst position, this is horrible.

44:35 How like, just get what you need and get out, because I cannot stand being in this position. And so, and they did, and everything was great No interior lip, no, no shenanigans. It was like, okay, great. So I pushed on hands and knees That was just how I ended up and what felt really good And I pushed dear listeners, i love you all And it's not a competition What I'm about to say. You can't set a goal like this because it's not in your power. I pushed three times over approximately 18 to 20 minutes. That's just how it was for me. So it helps that I got these good birthing hips. Apparently It helps that, even though my baby was an old baby like I totally had an old lady baby with long ass fingernails, like she was all wrinkled and peeling and like old baby She was small.

45:26 She was like six pounds, six and a half ounces And, for the record, my husband is like five, eight and I am five, two and a half. We did not expect to have a ginormous baby, but at her gestational age she almost was small enough that we would have had to actually go to the hospital after she was born for low for gestational age size Cause, like a half an ounce or something, and we would have been screwed. So so she just wasn't. She was not a chunky monkey, she was not a big kid, she. I pushed real hard in a position that worked really well for me and I had like zero inhibitions about who was looking. No one was going to come walking in the room, what noise I was making, like what was coming out, right, like I didn't care.

46:12 I'd see, i'd already been at so many births and so I wasn't afraid. You know, and I had seen plenty of many times in the out of hospital setting. It's not the norm to require a repair. It happens, but most of the time we don't need it. And so I just wasn't, like I wasn't worried about if I tear they'll fix it, and also I just wasn't. Those weren't the things I was worried about. So well, i guess, after maybe the third push, so maybe it was a total of four And my husband God bless him He's just, like you know, standing back there like for 20 minutes, being like I'm ready, because he was going to be the initial hands on her And at some point my midwife goes, just go ahead and push your baby out.

46:54 And I was like, oh fuck, i don't know what she saw I do now. But at the time I was like, oh, that was the change Beast mode. And so I was like, okay, and so I did. I was like I don't know what's going on, but if she needs out, she's getting out. And again it worked out that that was something I was able to do. I remember the sound that came out of me, thinking that I sounded like a train. And it was again almost midnight And I was like I wonder if the neighbor heard that we live in a city, you know, it was like, like, just like, so loud, like a train. And I remember the feeling of the head during a fire the head, oh my God, the head right, and the head's out.

47:40 And you're like, okay, well then, what we do out of the hospital, but also the CNL It's called the baby out, it's this novel Yank a pen, no The next contraction will birth the body. I don't have to pull the baby out. It is, oh my God, no, like it's still fine, it's attached to the placenta. As long as the placenta is still attached to her, good. So you know. So of course we're watching. It's not like you just say oh, whenever it's going to happen. But I remember it being like it didn't take long for the rest of her to come out and it felt the way I describe it It's like a bowl of spaghetti somehow, but like with the biggest noodles in the world. But it was like after the head, it was just like like everything else does.

48:20 It was so such a weird feeling, and so she had a really short cord. So here's all these things that can happen in retrospect. She had a very short cord And that's that perhaps why we needed days and days of pro-dromal labor just to like help somehow shift her down a little bit more. It was like she couldn't quite cause the the effacement. She just took a really long time for her to apply to the cervix and start getting things going. And I wonder if my placenta was funnal, so maybe she just didn't really have the length that would have made it easier for her to do that quickly, and so it was like a little bit over, honestly, that part I don't know.

49:04 But she, so she had a short cord and the placenta kind of practically just fell out after her, and so what the midwife told me after the fact is in her many, many years of practice it was the bloodiest birth that she had seen. And this is where, like my husband standing back there, he's like I just thought birth was bloody. When you look at pictures of me holding her. I'm like no, it's never that. It's not no, that was no. I think, yes, yes, yep, i think that what happened was there was a gush of separation, and that's when she was like it's you need to push it out.

49:47 Make this happen now, right. Like, not that I wasn't, but it was like, yeah, go ahead and get your baby out was how she put it. Go ahead and get your baby out, like now, yeah. And thankfully I was able to because retrospectively probably I had a partial abruption because again there was no like let's wait around for the placenta to come. It was sort of just like plop, if she was out, it needed to come pretty soon. It was short enough that when I knelt back up I was on hands and knees and when I knelt back up I could only lift her to my belly button. And again, she wasn't a long baby, right. So they were like cord, cord, cord, cord, cord. I was like, okay, we managed. My doula, thankfully, took a little bit of a video I hadn't arranged for, like pictures and videos and stuff, cause again I was like I don't need no strangers up in here messing with my vibe.

50:30 So my doula and friend Alyssa, she took like this beautiful little video of both of us crying, right, we didn't know if it was a boy or a girl, and so Rob laughing and looking around, crying, laughing, and he's like is it a boy or a girl? And they were like we don't know, you have to check And I lift her away as a little bit that as I could to look and I was like it's a girl And we both are like first and wholehearted subs of relief that it was done, that everyone was safe and that also, i think, secretly we hoped for a girl but honestly, after everything we'd been through, we didn't want to know the sex cause.

51:11 We didn't care. I was like it's a baby, it just needs onesies. I don't care about the clothes or anything that people care about, i just want the baby to come out eventually. And then it was just all the gentle things of like cut the cord and help her with her first latch And you know, in a home birth they've got like these sweet little. We use a fish scale So you hold the fish scale up and you put the baby in. So you've got all the little pictures of like her little foot sticking out of the fish scale and the dog like sniffing it. She's just like at the foot of the bed and I like getting ready to get her little newborn exam and I'm like rubbing her head with my foot because I'm just we're just in our bed.

51:51 I remember one of the first things once that initial haze passes and you get that elation right And they're like whoa. And I was like can I have a sandwich? Like I don't know, i'm a sandwich. Someone brought me the most amazing sandwich I've ever had. I don't even remember what it was. It came from my own refrigerator. It's probably nothing. It's probably like butter and bread Totally. I was like I don't know what my like. And then it was like okay, usually, assuming everyone is stable, which again the expertise of the community midwife in particular, but I would say midwives in general, but especially those who scope is really just healthy, low risk birth is constantly assessing to rule out anything that's not low risk or healthy so that you can make a transfer before it's an emergency, right, like.

52:37 That's the point as far as I can. There are people who specialize in not healthy and not low risk. The difference is medicine says you can only determine that it was a healthy, low risk pregnancy retrospectively. And midwives say really, i think that you can actually look at this situation right this minute. You can't say it will continue to be healthy and low risk, but you can assess them right now, all the factors that we are able to reasonably assess, and you can say at this moment, they are still appropriate for my care. It is a healthy, low risk pregnancy and still considered appropriate for out of hospital birth. There's nothing pathological happening here, and so that difference in worldview is what makes all the difference in then the experience for the birthing person, but also everyone who's attending them.

53:25 So I mean, then it was just like she latched. We snuggled up in our bed all three of us. Oh, my gosh, i know, but they showed us it was like all the things to have, like a safe landing pad. We already had the mattresses on the floor. It was like you just put her here, no pillow, don't let the blankets go up around her face, it just. She's right here, i'm not compromised. So it was the best sleep of our lives and the last good sleep in the last nine years. Not really, it's gotten better in the last couple of years, but she's not a really great sleeper for a long time. She's not there yet.

54:05 No, it was until she was like six or seven that she pretty consistently slept well. That's been our situation, and I have a four year old, so we've got a way to go. It's a long time It is, but it just is that thing. I remember working in the hospital and being like they can't get that period of rest because we moved them at two hours and then the postpartum unit they're just like checking and that's what they have to do. Like that is the compromise you make when you go to the hospital. You do not rest in the hospital. I don't know why anybody ever suggested hospitals or places for rest, because they aren't, and most of the time postpartum that's the number one thing you need is rest and privacy and safety. And you get safety in a variety of ways, but you don't get privacy and you don't get rest because they have to check you and your baby according to hospital protocol And so you don't get that chunk, that last, final chunk of like.

54:59 Everyone goes to sleep five-ish hours and then you wake up and the rest of your parenting life begins, sometimes when I come off the elevator, the mom and the wheelchair. I'm like, okay, And now we are walking into your new life. Yeah, it's like the door's open and everything's changed. It's just like now. It's all you. You know you get a few hours here, relatively speaking, and then it's just all you. I think with an out-of-hospital birth, you already have the sense that it's all you, because the whole premise of the care is that it's always client-centered from the very beginning, and informed decision-making, a shared decision-making, and like helping people figure out what they want, what their goals are, what they need, and so you, throughout the course of your care, have this sense of I'm in charge of this And at no time or I mean there are certainly our clients who are like just tell me what to do.

55:51 You're kind of like well, Well, but you don't have to go to another room with another patient. Yeah, Yeah, all that stuff. Yeah, there's no like I'm going to do this now And I'm going to do, or we're going to. It's like do you want, do you need? it's a question instead of a like sharing information about what's next. It's like And not documenting on the script and not doing all the extra stuff. Yeah, yeah, wow, okay, i know I have some follow-up questions for you, okay, I'm ready. I'm going to be a little relevant, because your baby probably just kind of made her way into the world with, like you said, about 20 minutes, not a whole lot of pushing.

56:32 But what was it that clicked you into being able to push? Was it your years of experience and helping moms figure it out? Was it the feeling that you like the how? to push Yeah. Yeah, Yes, Like how. Where did you get those muscles? How did you coordinate all? that This is an interesting question, i know in the hospital we often are like and actually this happens a lot of times out of hospital we are like the first little while it's not that it doesn't count, but the pushing is often so ineffective until somehow they get the hang of it, whether through some verbal coaching or maybe some careful placement of fingers in the vagina to press on that spot in the posterior wall, to be like do you feel this pressure aimed toward that?

57:13 I think because I had already spent so much time at births with people helping them visualize the curve of carouss and being like okay, so you, you push into this point, sort of ish. I mean it's like how do you do that? It's like saying breathe into your belly, please don't, that's not a thing. But like, your belly rises So, um, push into that, because that's what helps them get under the pubis, right. So I think the combination of I knew the anatomy and physiology as a clinician. I also had already 20 years of yoga practice under my belt, so I had a really good sense of like you know, lift only your pinky toe like that degree of controlling my body and being able to feel and fiddle with things and probably some amount of luck.

58:00 It just I don't like the instruction to push like it's a poop. I've I've read quite a bit about how that can injure your pelvic floor And so I had already been for many years giving a pelvic floor before there was so much interest in pelvic floor PT. It was sort of left to like yoga teachers, like postpartum yoga teachers, to be like let's relearn pelvic floor stuff right And help people in their postpartum, like mommy and me yoga classes. So I also had that sense of what can happen if you push in that kind of way and had read quite a bit, in order to be a better provider, about how to like teach people to push effectively. So I think in the moment I wasn't processing any of that, i just pushed the way I had learned to teach people to push.

58:47 So can you share with us? I mean cause, here's the thing, like I had never dealt with both, i don't think that I pushed like I was pooping, but then I was told I was pooping And so therefore I was pushing effectively, just based on the anatomy of how your baby goes through. You may not be pushing like you have to poop, but you push out the poop Because that's where the poop is. Yeah, so, but I've been, i've been the neighboring tube. Yeah, exactly, it's like. It's like it's like squeezing toothpaste out of it, like if you start here and you squeeze it down, it will come out unless you cap it, yeah, and don't cap it, because then your baby won't come out Come out a different direction. It will come out one way or the other. Also it'll come out somewhere else and you don't want it to come out, yeah, so I feel like when I had, i was epiduralized with both, but I could feel kind of a little bit with the first.

59:37 Yeah, i was shortening that area and maybe it was because I had a Pilates teacher. I was shortening the area between my pubic bone and my belly button. Okay, yeah, yeah, and I don't think I puke, i don't really think I poop like that. I don't know. I mean ideally you don't have to push to poop anyway. I feel my poop right now. Right Like. That is not the life I live. That's a whole other conversation. perhaps The joy of the squatty? time We might need to talk about supplements. If that, let's talk about fiber. If you've got some ideas on how we can. Yeah, yeah, ideally you don't push to poop, so I mean there's the argument that you shouldn't.

1:00:17 My kids were mal-positioned. Yeah, oh yeah, they only have some nerve damage there. Yes, yeah, anyway, which also makes pushing harder. But it sure does. But if someone's pushing, fine and pushing like they want to poop is the way that it's going and whatever, i'm not going to mess with that. But what I do tend to say is pretend you have a spring between your belly button and your pubic bone and shorten that spring. And that's where your push is, because you're not pushing from up here. Right, you're curling around your baby and trying to inject. It's like an ejection seat. You're injecting that thing from your body, you are. But if you have a different. Well, i would say one thing is like yes, if you're in a supine position, that makes a lot of sense.

1:00:58 Yes, right Like, how are you going to get someone who's laying on their back, where I was both times? Yeah, so when you're up, yeah, because I've also I've caught babies from people standing up, right Like, oh yeah me too. I have no idea how that worked, but I mean I do. It seemed to work out a lot better. Yes, But So I think there's One thing I would say is that when people don't have an epidural, because you have So much feedback, not just pressure, but like there is so much information that your body is giving you, there's not a ton of instruction. That usually needs to happen unless during an assessment we're like we can tell this baby's catawampus, So we can tell they're in malposition and we ought to do something a little different.

1:01:42 And then it's mainly just like not push differently but be in a different position to facilitate that movement in the pelvis Right. So when you're upright, like same thing, if someone is kind of in the throne position right, Like if they stay kind of squatting, you don't necessarily have to curl Right. It's more just adjusting the pelvis, it is a lot Like feeling the And that's usually what I try to do with people anyway Yeah, because it's like your baby is going to come through somehow. But you got to kind of like just move it around until that head is just like down enough that it's just gonna come out. Yeah, and then it's a matter of like You got to be able to curve and do the Yeah, because you also need. I mean, we also have to put a fair amount of responsibility on the fetus.

1:02:26 The fetus also has work to do, right, they have to tuck their Right. Well, assuming they're positioned properly, they need to tuck their chin, and that can take them a little while. That doesn't necessarily have to do with the pushing, because I think the other thing is I'm not an advocate for, like, never push by any means. Because there's a spontaneous urge to push for reasons right, right, but also it doesn't have to be like for a certain You're complete, let's push, yeah, and it definitely shouldn't be purple pushing And you don't, yes. The things that we as a society learned needed to be done when people were being given whatever, i was gonna say ether, but not that, because then they weren't following any instructions, whatever they gave.

1:03:09 Whatever they gave, they would have just come out Right Right. But think about that. They weren't doing force ups and all kinds of awfulness on the regular, not for just cause, but nobody was pushing, they weren't adding that force, they already Their body was just doing it. And babies are delivered to people that are unconscious. Yes. Exactly. Or paralyzed, right, they can also have a baby. They're not adding force. So adding force can make it more efficient, we could say, but it's not really required. But yeah, because they don't have And they have no spontaneous urge to push And if they feel some pressure they still need you to help guide them.

1:03:52 You go with that, right, yeah, right. So in the out of hospital setting, without the epidural, the pushing just tends to be more effective anyway, because people are like I mean, probably also in the hospital, if people don't have an epidural, except even then, oftentimes they still are on their back And that very position prevents the pelvis from opening and moving in the way that it should, because you've locked the sacrum. Not my patience, right, thank you, thank you. So of course they need more help, but if, like on hands and knees, i was definitely not curling around at all. I think when people are supine, that makes sense. I can feel what you're talking about And I remember being like Curl, like when like pull Yeah The epiduralized ones, like I'll put their leg in the stirrup and turn them And I still kind of curl because, I'll be like grab onto the handlebar and like focus on that area.

1:04:46 Yeah, Like I love the squat bar thing. The squat bar, yeah, yeah, but I think So I used kind of similar stuff. I usually tried to help people, probably because it's always so interesting It's like how different people will do the same math problem. I often would get more into like, okay, so here's what's happening inside your body. I want you to imagine your pubic bone and imagine it's like a slinky your vagina, right? And so your baby needs to get through that last part, and so if you kind of help, aim somehow toward your rectum, it can help the baby make that curve And then all it has to do is just come out.

1:05:27 And somehow people who are willing to go with me are like, whoa, that totally works. And I'm like, shoot, yeah, and a lot of times I also I'll be like. The reason it feels like you have to poop is because your baby's head is pressing on the rectum and your rectum isn't smart And so it's just like pressure must be full of poop, and so right, if either you don't actually have any poop in there, it's just baby head squashing your rectum, but go with it. And if poop comes up, i don't care, we're going to clean it up. It's not a big deal. It's not my favorite thing in the world, obviously, and also it's part of labor. I have no feelings about poop anymore, just whatever Right, Like don't care. Poop is poop just is. I love it when it's not diarrhea. How about that? Like it's just Yes.

1:06:10 If we're, that's a whole different topic. If you could go back and talk to yourself at the beginning of this whole birth journey, when you decided to embark on this process, what would you want to tell yourself? Well, if the technology and education I have now had been available, then I would have wanted an early dating ultrasound in my first pregnancy That would have identified right away that I had an ectopic pregnancy In my practice, if I were still doing prenatal and intrapartum, if I were still doing the baby stuff. I would recommend that And honestly it's pretty much standard because even though it's a relatively small risk to have an ectopic, the outcomes no one wins And so the sooner you identify it the better, and so much good information to get from like now we know the dates.

1:07:03 The earlier your ultrasound, the better the dates. So, especially if you're like I don't really know when I got pregnant, fabulous You. We can just identify if this is actually something that could harm you Or if it's like, okay, things look good. Now we just have to wait and see if it stays, because we can't predict that it will end up a viable pregnancy. But we can at least say, right this minute it is viable. I would have done that And then we would have known when I started bleeding that it wasn't just a miscarriage. Yeah, mm. Mm Oh.

1:07:47 I remember how much pain I had related to this feeling of how broken my body felt, and I would encourage my previous self to relinquish that sense of responsibility for every outcome. Most people have an early at least one, oftentimes more than one early pregnancy loss. It is hardly ever because of anything anyone did. It is almost always because of a chromosomal blip. Something was not compatible with life And so it stopped growing. The embryo dies and your body is smart and it flushes. So you can try again Your body.

1:08:28 We're just mammals. We just want to make babies our bodies at least. But it's because of our wonderful neocortex. We love to try and problem solve and like what could I have done differently And what can I do differently going forward, and how can I make this not happen again And how can I safeguard And how can I protect And how can I And you can't? I wasn't doing anything wrong, but it feels like it when you're in the middle of it And I don't know that my now me advice would have even been well received by my then me advice, because it probably would just have felt like more bullshit. People say to help themselves feel better when you're suffering, but that's what I wish I could have done. It's a horrible thing to experience And also it's not because I'm doing anything wrong.

1:09:13 Yeah, thank you. Great, correct, yup. Thanks everyone. The only thing that helps potentially is to remain humble and kind of want to say like fact-based, you can say I'm so sorry this is happening.

1:09:58 That's different from I'm sorry you're having to go through this. That almost sounds like but like I was assigned it, like some kind of rewards-based program that I just got the shitty end of the stick. Like what do you mean? Like I'm sorry you're having to just say I'm sorry this is happening. Say you can say I don't know what to say. This looks very painful, like that's a fact, it looks like you're in pain and I just want you to know that I'm here. I'm just going to sit here quietly so you don't have to be alone, because all the words are just filling the space to make the speaker more comfortable and each of the words is hurting the receiver, who's already in pain.

1:10:40 That's so much better. I would rather there's nothing. No, because, and it always just reeks of I just like it's pie in the sky, like, oh, it's going to be fine. At least I have someone tell me, at least you know you can get pregnant. That was after my at least. There's never an at least. And just shut up, right. And it was because they were. They were suffering with not being able to conceive. So to them it was like, at least you know. And I was like, yeah, but my body killed my baby. Like I mean right, i was just like, are you kidding me? right now, i also am a proponent of minding your own damn business about whether people have kids.

1:11:25 What difference does it make? It's a way that people try to connect, right. But if someone, given how widespread fertility problems are, do you want me to answer truthfully? Because there was a period where I would look at people and say all my babies died Because I was so done with people asking me that shit. I just was like, what do you want me to tell you? I'm a mother of three dead babies. Like I didn't. I didn't even know what to say anymore, except that I felt all the responsibility that comes with knowing you have created life and also for reason then, that you weren't able to protect it. So that was like during my angry phase, which was a few years long, yes, and when you're grieving is ongoing for almost 10 years.

1:12:13 That's a long time So. So I think a lot of it is like don't act like, you can see the future. There was one person who said something that was hopeful, that I didn't feel like slapping them, and it was super simple. It was, for what it's worth, my sister's first pregnancy was ectopic and she was able to have two healthy babies, and it was just like oh, there are people who survive this and go on to have viable pregnancies. Okay, that was like. It wasn't like and I know you will too, because that was where it always got me. I was like how do you know? How do you know that You don't? And you and you can say things like I know you're strong and this is painful.

1:12:54 I trust you, you will somehow find your way through it. If I can help with that, please, i'm here Right, which is also different from like oh, this, this will pass and you'll be fine. Just like, this is going to be really hard, but you've managed through hard things before. Yes, yep, mm-hmm, mm-hmm, oh I'm sorry. Mm-hmm, mm-hmm. Oh yeah, which could be anybody. Yes, right, yeah, tell me about your support system.

1:13:38 Who's going to be here with you? Who's waiting for you? Is there any? it could be your dog, like I don't know. Mm-hmm. Yeah, mm-hmm, yeah, yeah, yeah, yeah, yeah, yeah, yeah, ugh, yeah, yeah, they're just waiting for you to stop talking.

1:14:22 Yeah, yeah, yeah, yeah, yeah. Mm-hmm. Yeah, i think one thing I've said to people as someone who's experienced these things as well is but also I think anyone just working in the field we work in could say this is I remember one specifically because I saw her twice. So the first time was supporting her through a loss And the second time was like a year and a half or two years later with a full term, healthy delivery And so and I got to help her with that And so we were like we were meeting again under different circumstances, But I remember, you know, she commented on remembering what I had told her when I wheeled her out after the loss And I was like we had spent a few days together, so she knew a little bit of that at least, that I had experienced loss as well, and I was like I'm really sorry that now you share this experience.

1:15:29 It's very lonely, but you are not alone And there's support from other people who've been through it. There's support for your partner, because he also has to process his experience, but that you can feel so lonely in your grief that you lose sight of the fact that A you're not the only one to happen to. This isn't what I tell people. I'm telling you right, and the listeners like A it did happen, not the whole family, it didn't just happen to you, and also that it's happening to hundreds, thousands I don't know, hundreds of thousands of people today, right now around the world And so lonely but not alone.

1:16:10 This is a horrible club to be part of, but it's also a very large one, and so when we talk about it, we help people also remember that this is like nobody wants to feel the reality of the risk of miscarriage or, you know, it's less common to have an ectopic, but anyway of pregnancy loss, and yet it's a risk we take every time we conceive, and so I think that talking about it is so important to help people understand that it happens. It happens frequently And it's not anyone's fault, and I think that's also important. It's also important as lawmakers who have no health education make decisions that impact early pregnancy loss experiences, and so it's important for everyone to understand that this is not unusual and it's no one's fault.

1:17:05 It's a thing that happens because nature and it doesn't mean anyone did anything to cause it, because in some states, i would have just died If my fetus, if my embryo it wasn't even a fetus yet still had a heartbeat, they wouldn't have let me take in the meds to terminate an intratubal ectopic pregnancy. I think what I always hope is that gestational parents particularly if they identify as women because we are, in our culture, not encouraged to really embody the strength that we have as fully developed human beings I always hope that stories like mine can help people connect with their own strength that you deserve.

1:17:52 It is your right to have bodily autonomy. It is your right to be in charge of your care. It is your right to make decisions about how you want to be treated by the people you have hired to shepherd you through this process of birthing your baby, and that you are always. I've never seen anyone who wasn't stronger than they thought they were, and so you can show up for yourself. And if you're not sure how to do that, that's what therapy is for. Right, because a duel is great. I want you to learn how to be strong for yourself And not just like the doula helped me. Yes, the doula helps you, but ideally you're helping yourself, right, i love that, aria, thank you for joining me.

1:18:39 It's my pleasure. It's always so much fun to have conversations with you. It has been very fun.