Transcript
WEBVTT
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Hello, Today I have with me Ashley Martin.
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Ashley is a mother of one from Southern Missouri.
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She gave birth to her daughter in 2020 at 24 weeks and 4 days after being diagnosed with PPROM and incompetent cervix.
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At 23 weeks, Her daughter spent 104 days in the NICU.
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From her experience, she created the NICU Notebook to help families process, track and remember their experiences in the NICU.
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Ashley welcome and thank you so much for joining me.
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Hi, thank you so much for having me.
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I'm excited to be here.
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I am excited to hear the full story.
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I've heard little snippets, but I want to hear your full experience and I think your experience will really help other moms that are either going through the experience or may know that they're going through something similar in the future.
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It's a roller coaster, so I'll take you along the ride with me.
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I got pregnant in March of 2020.
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Super excited it was a planned pregnancy.
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Everything was going great.
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Six weeks rolls around, I started bleeding, so we didn't really know what to do.
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First pregnancy, of course, what do you do when you're pregnant and you're bleeding and you don't know what you're doing?
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Headed to the emergency room and, of course, the big March of 2020, covid lockdowns were beginning.
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So I will never forget having to do this on my own.
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My husband we weren't married then, but we are now we got to the emergency room.
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I walked through these sliding doors alone.
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To my right is the emergency room.
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Straight in front of me is this heavily pregnant woman so excited, husband carrying a car seat, heading to labor and delivery.
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And I'm going to find out if I'm still pregnant.
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That was a little bit more of a punch in the gut than I could handle, so I broke down.
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Nurse came to me, asked what's going on, told her, got checked in.
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We found out it was a subchorionic hemorrhage.
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I would try to explain it to you, but I'm not exactly sure how to do it.
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Well, so, still pregnant, said that the bleeding should ease up over the next few days and to contact my OB.
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By the time I had my first appointment with my OB in their office and had an ultrasound.
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This was at 11 weeks.
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The hemorrhage had healed.
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There was no sign of bleeding.
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We planned for a smooth ride from there.
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Everything was looking good, made it through our anatomy scan, found out we were having a baby girl, started thinking of names, just the whole thing that you dream of.
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Then 23 weeks rolls around and I wake up that morning and I'll be honest with you, I had really bad morning sickness to the point of I would throw up and I would have to go change clothes because my bladder would let it go.
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So I thought my bladder is not holding on well.
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Throughout the day.
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It just happened here and there.
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Pregnancy, who knows what's going on.
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Didn't think anything of it because of the urine issue.
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That evening I had fallen asleep on the couch watching TV, as one does.
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I woke up and it was still happening.
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You know what?
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I'm just going to call and make sure, called my OB's after hour number and the nurse was like well, you need to come to labor and delivery.
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We need to make sure this isn't your water.
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I'm like, oh, I'm only 23 weeks, okay, so we pack up and head to the hospital we plan to deliver at, which is two and a half hours away, and I did not take a phone charger, I did not take a change of clothes, I did not take anything.
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I was in no way prepared for what was about to happen.
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I thought they were going to say, oh, first time mom, so nervous and laugh and say this is normal and send us home.
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The doctor did a cervical check and collected the fluid and came back to the room a little bit later and said I'm sure it was positive and you are two centimeters dilated.
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Pprom, which is preterm premature rupture of membranes, and incompetent cervix, which means my cervix was dilating too soon, was the official diagnosis.
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They did an ultrasound to check the amount of fluid and check on baby girl, and she looked good.
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She didn't have a care.
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She was still rolling around doing her thing, licking her hand.
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It was so terrifying.
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Our world just stopped when she came in and said that.
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It just stopped.
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I felt sick, he felt sick, we're just.
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What do we do?
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So, of course, I was immediately admitted to labor and delivery.
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I was put in a position where my butt was higher than my top half, and given antibiotics to try and ward off any infection that may have began, since my water had been broken, and steroids for baby girl's lungs, since they would be so underdeveloped.
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And we started talking statistics and chances of survival, possible outcomes, including disabilities, that she could have.
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It didn't feel real.
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We stayed in labor and delivery for I want to say I think it was 48 hours, and when they realized she's not going into labor right now, they moved me to PCU and my OB came in.
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You know what?
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We're aiming for 11 more weeks.
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The plan was for me to stay in the hospital for 11 weeks and when I realized I'm not going home pregnant, it was heartbreaking.
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I had, just a week or two before, started to feel her move and I didn't know if that was fixing to come to an end or what was going to happen.
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So I got to hang out in the hospital by myself because in TCU, with COVID lockdowns, visiting hours were two hours a day, one person one time a day.
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So my husband would come in, we'd spend time together and then he would have to leave, and the rest of the time I was isolated, except for when the nurses would come in to check vitals, listen to me cry and try to be as reassuring as possible.
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They were amazing.
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I love those ladies so much.
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Then 10 days passed and the morning I turned 24 weeks and four days I started having contractions.
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They were very infrequent, they weren't showing up too strong on the monitor, but they did.
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Let me know about 5 am hey, you're starting to show contractions.
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We are keeping an eye on you.
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8 am I was in labor, so I was moved back to labor and delivery.
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13 hours later she was born.
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The birthing process, though with a baby that small, it was weird.
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I stalled at six centimeters for a long time and the NICU team's outside waiting ready for the word and my OB who was supposed to be delivering her had to leave.
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So I had this doctor I didn't know coming in.
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I couldn't have even told you anything about her after the fact because I was so caught up in what was happening with our daughter.
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They wanted to take me for a C-section, though, and my OB is like no, they look fine on the monitor.
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She wanted a vaginal delivery.
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We're going to try and give her that because nothing else is going the way it should be.
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They said, okay, she has until 10 pm and if she's not born by 10 pm we're going for a C-section.
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My daughter was born at 9.41 pm, so she really ran the show.
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You would think that the story would end there when you're telling about your birth, but that was just the beginning for us.
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They took her from me straight over to the side and started working on her working on getting her intubated because she was in respiratory distress.
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They were working on me because apparently I had a little bit more bleeding than they would have liked.
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So with me hollering, is she okay, is she okay?
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And I'm not responding, and my nurse coming over and giving me a shot in the thigh and the OB pulling whatever it was she was doing out, there was so much chaos it was so hard to just not sit there and just say over and over again is she okay, is she okay?
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And the next thing I know she's gone.
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All these people that had flooded in had cleared the room and it was two hours before we were able to go to the NICU.
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So there was this limbo where we didn't know what was going on.
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We're just waiting for the call on.
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Can we come see her, Is she?
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She wasn't OK, but waiting for a call.
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So finally, after about two hours, we got to go down to the NICU and see our baby girl, who was one pound 13 ounces and 13 and a half inches long, and that is something you don't expect.
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You can hear the weight and everything and you can try to imagine it, but when you see a baby that's barely bigger than your hand, I hate to keep saying it doesn't seem real, but it just doesn't.
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Let's back up a little bit.
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Did they tell you anything when they took her to the NICU?
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No, no, okay.
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I knew she was alive because when they lifted her up she looked pissed at the world and had her little fist in the air.
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That's a good sign, and this all happened during COVID.
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So I would imagine that played into some of the restrictions, because often they will either let the partner go up earlier or, if the baby is stabilized, the partner can come up for a few minutes to see where the baby is going and then they get the baby settled.
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But I would imagine that COVID played into that.
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That and with her being the size she was and everything they were, I know they had to work on her, get her intubated, get those lines in.
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I know they I think they had issues getting her lines in her umbilical that small.
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that's really hard.
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And then you said that you hemorrhaged and that they had to take something out of you.
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Did they ever say that it was like pieces of the placenta?
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I don't know and I don't know if they actually called it a hemorrhage.
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I just know the bleeding was a little heavier than they would have liked and I think they gave me a shot.
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I think it was to prevent it from getting that far.
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I couldn't find anything in my medical records other than the name of the medicine.
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Was it methogen?
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I honestly don't remember.
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I just know she said move your hand and give me a shot in the thigh.
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And I didn't even.
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I didn't even think about it until later on.
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And what was that?
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Unless, like it wasn't a natural, like you had an IV and everything right, cause that Pitocin.
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Yeah, I had an epidural.
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Okay, and Pitocin, yeah yeah.
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So Pitocin we can give through the thigh if you don't have it already going through your IV.
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But probably, if they said that you're bleeding a little bit more than they wanted, they probably give you a shot of methogen that helps your uterus get smaller so that it closes down on those blood vessels where the placenta was.
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Either they're putting a little bit of traction on the placenta to help the placenta come out, sometimes they'll do like a manual sweep of the uterus, so they'll put their hand inside and try to get any pieces of the placenta that may have adhered to the uterine lining or just aren't coming out.
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So they didn't have anything like that in the medical record.
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It was a straightforward, and the placenta was sent off to pathology and Okay, who knows.
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I don't know I just know she was going to work doing something and yeah, trying to get all the things out, yeah.
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I wasn't worried about that end when she was yeah, you're like I don't care.
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Cambridge, what's that?
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What?
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you gonna do?
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what's going on with my baby?
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So then you had a two-hour recovery and labor and delivery, and then they allowed you to go to the NICU to see your baby.
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Did you go on the way to postpartum?
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Yes, they took us down to the NICU to see your baby.
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Did you go on the way?
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to postpartum.
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Yes, they took us down to the NICU first and then took us up to postpartum, which I can tell you.
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That's where some real hard memories that I can tell you about Was it in postpartum?
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Yeah, all right, let's fast forward to that, and then we'll talk about your NICU experience.
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One of the hardest things about being in postpartum was when you have your baby downstairs in the NICU and you've just given birth, you're still on the same floor with everyone who has their babies with them.
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So next door there is a family with their baby who is crying.
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And then there's me and my husband in our room no baby.
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But that baby would cry and I would just lose it because it was so unnatural, because there was no bassinet, there was no baby, my milk wasn't coming in.
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I was just fumbling with a breast pump falling as this baby next door would cry Every little bit.
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It just kept happening.
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And then there was.
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This older woman came in to take my vitals and I think I scared her.
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She came in and was putting the blood pressure cuff on and the pulse ox and she looked up at the board and said oh, a baby girl.
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How much did she weigh?
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And I said one pound 13 ounces and she got silent.
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She took my blood pressure pulse ox off, she took my temperature, she rolled up the blood pressure cuff and put it on the cart and said really low, is she okay?
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I don't know.
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And she left and I never saw her again.
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It's like she came in but she didn't catch on that there wasn't a bassinet or a baby in the room and it didn't hit me until later on how strange of an interaction that was.
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It did not strike me in the moment of that was awkward.
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After we came home I was thinking back about the experience and it's like how did she not notice that?
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Sometimes they go to the nursery though, so she may not have known.
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That sounds like one of the texts, because they come in to take your vitals and don't always get that information, but that is something of note.
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So sometimes we'll put like little notifications on the door saying what's going on.
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NICU family would be a good notification.
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Yeah, loss and NICU would be a really good.
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Yeah, we usually do loss.
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Let's put a green sticker up.
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Yeah, they stay on labor and delivery usually because there's no reason I don't know about every hospital, but there's no reason to send a loss family up to postpartum.
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Nicu families are a little bit in between, because most of the time the hope is that the baby will reunite with the family.
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But yeah, I mean it is.
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I wish there was a better way, a bridge where it's maybe the family stays in the NICU Between the.
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Yeah, that's so hard because essentially you're going to stay there for a couple days and then you would be able to go be with your baby after that.
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So I don't know that.
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Hospitals, everything's about money, right.
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So probably the infrastructure to be able to develop a whole combined unit for NICU families and then the staff.
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I didn't see it.
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There is a hospital I can't remember which one it is they're starting to put a postpartum room connected to a small NICU room.
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Wow, I saw that on Instagram and we shared it.
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I was like that is incredible.
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That is incredible.
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I don't know, because once you're discharged, I don't know how you would get to stay.
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You can't just live for 104 days in the.
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Probably they would just Move rooms.
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Yeah, yeah, I don't know.
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No-transcript.
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Did they have that option, if necessary?
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There was a little hard fold out couch thing that we were allowed to stay on, and at the one in the second NICU we were at the first one you weren't allowed to sleep there.
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Wow, yeah.
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Yeah, the room in is specifically for if you have a child that has a lot of medical needs, then they would learn all of the things that needed to be done at home to care for them.
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So it's essentially they're able to be discharged, but with a lot of support.
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Yeah, but it's support that can be done at home and it probably is going to be done for the long term.
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So the parents would need to learn how to do that.
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But, yeah, there should be some sort of in-between.
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It is so unnatural to be separated from your baby, especially when you're recovering.
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I think part of recovery is that bonding with your baby.
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I mean, the hormones that are released by having your baby close are part of the healing process.
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So to have your baby so far away is just so difficult.
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It's hard because you go through the trauma of such an extremely premature birth and then you go through the trauma of everything you miss out on, not just like the golden hour and that first skin to skin right after birth.
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There's the missed maternity photos and the first photos and the newborn photos.
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It's just all of it.
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There's so many things that you just miss out on.
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And then you're on postpartum and again you're missing out on those first moments and also like I'm thinking about in labor and delivery.
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when someone delivers, those first two hours were just making sure that you're medically safe.
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It's not always set up for your emotional well-being anything wrong.
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We had an amazing staff, but I don't think that that wasn't the priority in the moment.
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It was making sure you make it through this, yeah, and just as a labor and delivery nurse, I can say the protocols are not conducive to emotional well-being of the patient.
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The protocols are every 15 minutes the nurse needs to check your uterus and make sure you're not bleeding.
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And make sure that're not bleeding and make sure that you're getting your medication.
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I didn't like you for that.
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Those funnel massages are awful.
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I had a bruise the size of a grapefruit.
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Oh, now, that shouldn't be that.
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I can send you a picture.
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That shouldn't be that aggressive it was rough.
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But also, if you were bleeding then that may have been necessary, but they're usually not that aggressive.
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Yes, I will.
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I tell them.
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I'm sorry, I have to be mean to you so that it's with love.
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Yes, and when I so, I've worked labor and delivery, postpartum, special care, nursery, maternal fetal medicine, I've worked in all those areas.
00:17:18.438 --> 00:17:21.442
I can tell you that once I'm on postpartum I'm not as mean.
00:17:22.864 --> 00:17:24.606
It's necessary in the first two hours.
00:17:24.606 --> 00:17:29.901
After that we just make sure that you're not bleeding and we check that your uterus is where we want it to be.
00:17:29.901 --> 00:17:39.419
We're not like and again, and this is just an education moment, right, people get confused between fundal checks, fundal massage and then postpartum fundal checks.
00:17:39.419 --> 00:17:47.671
The first hour or two hours we do push a little harder, but fundal massage is when you're like in there digging for a while.
00:17:47.671 --> 00:17:51.464
Oh yeah, because you're bleeding and because your uterus is not firm.
00:17:51.464 --> 00:18:05.238
So we do a bit of vigorous pressing every 15 minutes in labor and delivery to make sure that we've gotten all of the clots and everything out in that first two hours, but it's nothing more than like.
00:18:05.238 --> 00:18:17.641
I will dig deep and push down and then try to push the clots out and if everything feels fine and your lower uterine segment feels firm and the top part of your uterus and your fundus feels firm and you're not bleeding crazy.
00:18:17.835 --> 00:18:23.762
I'll hands off Now if we find something concerning they were still kind of massaging mine in postpartum.
00:18:23.762 --> 00:18:29.397
Oh they were, it wasn't as rough, but they were still rubbing it some in postpartum.
00:18:29.397 --> 00:18:31.761
It wasn't as aggressive.
00:18:32.604 --> 00:18:42.607
Sometimes, if you can't, find it if it's super low too, or it depends on if your uterus is anterior or tilted Posterior, Posterior, that kind of stuff.
00:18:42.607 --> 00:18:44.136
Sometimes they're harder to find.
00:18:44.377 --> 00:18:46.280
Yeah, well, maybe it was just plain hide and seek.
00:18:47.082 --> 00:18:57.420
It might've been yeah, and also they might have said that she hemorrhaged a little bit, be a little more aggressive, which that's not fun.
00:18:57.420 --> 00:18:57.740
I remember them.
00:18:57.740 --> 00:18:59.044
Yes, I had two kids and they weren't fun.
00:18:59.044 --> 00:19:03.817
They're not at all, but necessary, and hopefully people aren't being overly aggressive.
00:19:03.917 --> 00:19:07.286
That is my hope, I know probably out there, there are people that are being yeah.
00:19:08.154 --> 00:19:12.686
So then, what else about your postpartum experience was challenging for you.