From PCOS to Parenthood: A Candid Journey Through Fertility, Birth, and Motherhood with Michelle Powers, CNM

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Hello, today I have with me Michelle Powers.

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Michelle is a certified nurse, midwife and the mother of two, and today she is here to share her fertility and birth journey with us.

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Michelle, welcome and thank you for joining me.

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Hi everyone.

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Thanks Kelly for having me on.

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As Kelly mentioned, my name is Michelle.

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I happen to be very privileged to work Within the birth field.

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I'm a certified nurse midwife, which means I have a master's of science in nursing, and I get the privilege to take care of women across the lifespan, which includes gynecology as well as obstetrics, prenatal care and, of course, doing deliveries within a hospital setting.

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I am the very honored mom of two boys.

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My oldest is Nate.

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He was born in December of 2018.

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And my youngest is Samuel, and he was born in December of 2022.

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So he's approaching, like she is, five months now.

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So a little bit about me and how I very much got to become a mom of two.

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I was on a perfect journey.

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I was not one of the lucky friends of ours or patients who got to spontaneously get pregnant.

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As Kelly mentioned, my infertility journey is one that's pretty expansive From the get-go.

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I had the mom when I was a teenager who said it's weird that you haven't gotten your period You're 15.

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This is strange.

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Whereas I thought it was great, who wants that?

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My friends are miserable.

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But she took me to our local pediatrician, who referred us to Duke University where I got to know somebody who was very advanced in the field for managing Polycystic Ovarian Syndrome, or PCOS.

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Now, more and more, over the past decade or so, lots more of information has come out about PCOS and its impact on the lives of women across the lifespan and across the age.

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But, most specifically, one of the things that we talk about PCOS most commonly for is infertility, or trouble getting pregnant.

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The biggest reason that happens is because, even though there are many women who have PCOS who maybe get a regular period, and there are those of us who don't But more importantly is that we do not ovulate.

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So ovulation is the process by which the body or the ovaries spontaneously release an egg, and if you, as the female partner in a relationship that is planning to get pregnant the female that is trying to get pregnant are not releasing eggs, then there is no genetic material to form an embryo or to form a pregnancy.

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You're missing half, and so, although there are more studies, medications and suggestions out there, a lot of us women with PCOS tend to seek reproductive services or infertility services.

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Being somebody who lives in the Northern Virginia area, i was very pleased to see that we had a high resource environment and high resource community.

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So I was able to get evaluated and it was not easy.

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We attempted to do some low intervention infertility work.

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First We tried intrauterine insemination, which is non-surgical It's where my partner of choice, which happens to be my husband his genetic material was, with a procedure, kind of put inside of my body so that an egg and sperm could meet to create an embryo.

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We tried that about five times, all without success.

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So during that took about a year And even before that all the testing and some weight loss and some medication attempts he had visits, all this type of work up were probably about two years into it and still not pregnant.

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There's definitely some really low lows during that time.

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Feeling especially as somebody who has the privilege to work taking care of women who are pregnant, it was really hard to see all these successful birth stories, successful pregnancy stories, when I couldn't have one of my own.

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But through that, with counseling and support from my partner and my village, we eventually decided to make the leap from IUI or intrauterine insemination to a procedure called IVF or in vitro fertilization.

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This did involve a surgical component.

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This is where, after medication that I was taking as well as injected, my ovaries on ultrasound demonstrated that I had lots of eggs that were mature And so with surgery, they took the eggs out of my ovaries and put them into their science lab And, with the genetic material of my choosing from a male partner, which again happened to be my spouse, my husband they created embryos in their reproductive lab.

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So this is where they joined the egg and the sperm outside of my body and fed these embryos, and we got daily updates about how the eggs were doing, how the embryos were doing.

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Statistically, about 50% of the eggs collected die before sperm can be successfully inserted into creating an embryo.

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So we were lucky enough to follow that statistic and they harvested 20 eggs from my body and we ended up getting 10 healthy embryos.

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That's a pretty normal statistic to get double the eggs and only have so many embryos that are healthy.

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We were very lucky to feel safe enough in our health history to not need to do further testing on the embryos, and so we froze nine embryos and that 10th embryo became our first pregnancy, and I luckily had a very safe and healthy pregnancy.

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We found that it was more that I didn't release an egg, but my uterus did okay and kept a healthy pregnancy.

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I did get hypertension with my first, and so I had an induction of labor at 37 weeks and delivered Nate.

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That was very exciting and we loved everything about it.

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And then with Samuel or Sammy, our youngest, second time around was a little bit easier less medications, no surgery, since we had frozen embryos through our reproductive endocrinologist, our infertility team, we were able to just go in a little bit of medication and tell them our desire or plan of when we'd want to have that embryo put inside of my uterus And luckily, again that worked out very successfully.

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Another healthy pregnancy.

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This time we had gestational diabetes that I needed insulin to control, and hypertension, and so again I got induced at 37 weeks and had baby Sammy.

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I did have two vaginal deliveries, one with each boy.

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I did not have any postpartum complications other than just continuing to need medication to manage my blood pressure.

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For about a month postpartum With Nathaniel, my first Nate, i had pretty severe postpartum depression.

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I sought counseling and I got put on a mood stabilizer called Lexapro.

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I am still on that medication today and I did continue that medication through the pregnancy with Sammy and that really did seem to help my postpartum course this past time.

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I think that's a lot about me.

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You're like that with a lot of information.

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Yeah.

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I want more though.

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Let's talk about your births.

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So you got induced.

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When did you find out you had the gestational hypertension?

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Yes.

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So with Nate I was 36 weeks pregnant and didn't feel great, and my husband also happens to be a family nurse practitioner.

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And so I said, hey, do you have your blood pressure cough?

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I don't feel great, i'd like you to take my blood pressure.

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So he takes it to the manual cuffs and it's mildly elevated.

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And he says, yeah, but I don't think this is the right cuff size for you.

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And I looked at him and I said 10 bucks, as I get induced in less than a week.

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In case anybody wants to know how that worked out, i was right, anyone's keeping tabs.

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And so at my 37 week visit, my first blood pressure was elevated and was met criteria.

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Now, by chance, i happened to be being taken care of by the practice that I worked for as a certified nurse midwife.

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So I went about seeing my patients on my schedule and four hours later took my blood pressure again in the office.

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It was still elevated, and so we decided that for safety, we would call up labor and delivery and see what they could do.

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And so I found out at about 37 weeks in one day, because it was a Monday And my gestational age weeks changed on Sunday And we were admitted Wednesday evening and I delivered Friday morning.

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Amazing.

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Just go on and work through that hypertension.

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Work the next day delivering babies, delivered babies and then had another half day.

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Came home, installed the car seat, grabbed some Chick-fil-A and headed in.

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Awesome, So most classic provider story ever Yeah.

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So just to clarify on the recommendations, when you have a high blood pressure that is within the range that's not severe range that needs to be treated right.

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So you have to have two that are four hours apart.

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Yeah.

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So the diagnosis of gestational hypertension is you have blood pressure readings, at least two of them, two data points where either the top number is greater than or equal to 140 and or the bottom number is greater than or equal to 90.

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So, like a 136 over 92 still rules in, a 144 over 88 still rules in.

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And the reason that we recommend having two at least four hours apart or longer, right.

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So if it was just an office visit and they were seeing you back in like a day or two again that may still rule you in is because part of gestational hypertension, and really part of hypertension and pregnancy, is that it can really call labial, right, it is not unheard of to have a pressure that is elevated and may be something that we say, oh, this meets a certain criteria we have for potentially a diagnosis, and then have two hours of normal and then all of a sudden have another one.

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And that's because it's not chronic, it's not something where your body is changing forever.

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It's being impacted by the pregnancy and the placenta and the gestational age And it's saying, hey, i'm okay, but I'm not great.

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And when that starts to happen, the safest recommendation is delivery, because that truly is the cure right Now, depending on your gestational age medication, or watch and wait, maybe a safe alternative, once your full term, which is 37 weeks or greater in your pregnancy weeks.

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at that point there's only risk right, and so the recommendation then becomes move towards delivery in a safe manner versus waiting it out.

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So then, the difference between that gestational hypertension and we need to move now is if you have one of those really severe range like potential to have a stroke or a seizure range.

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Yeah, it's usually more about mom, right?

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I mean, we know as any, as any pregnant woman who's even kind of happy about being pregnant, pregnancy is not easy.

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It is not for the faint of heart.

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But most of us at least, once we hit a certain point, the pregnancy say okay, i am excited about the outcome of this pregnancy, i am desiring a healthy outcome of this pregnancy Once there comes a point where we actually are about mom.

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At this point, although, yes, a maternal seizure the pregnant woman has the seizure or things of that nature could impact baby, babies actually tend to do okay, they're well protected It's mom who actually potentially is the greatest risk to her health.

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And we've come so far to grow a healthy baby.

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We want that baby to have its mom, we want this family intact and complete.

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And so if we are recommending either an expedited path to delivery, whether that's preterm or full term, or potentially even bypassing an induction due to significant maternal factors and clinical findings that dictate that a two to three day induction may not be safe from mom's outcomes and therefore a C-section or a surgical delivery is recommended, that all comes down to maternal health.

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And so when we're talking about that, we're talking about blood pressures that are 160 over 100 or higher, and those tend to be much more consistent.

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They tend to be it's not that you go from 160 down to 120, right, you go to 160, you're like 158.

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Woo, right, like it's not the same, where you're like, oh, i'm 138 over 98 and then I'm 112.

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Like, that's justational.

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All right, fine, mild hypertension, okay, no, when you've got your severe range pressures, there's actually some lab values that tend to dictate that there's been some other potential internal changes to mom's organs.

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And we're, for better or for worse, we're racing a clock, right?

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We know that in labor and delivery, in pregnancy, even things can change on a dime, right, we have women who have excellent fetal movement and then don't.

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We have women who are having no bleeding, and they're having bleeding, and same can go with hypertension.

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Once you've hit a certain maternal factor or eternal clinical symptom severe range pressures you're racing the clock.

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Pressures are one thing.

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Lab values on top of bad pressures are a whole different ball game, and so we're monitoring all of that.

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But the answer is that we want your family to be intact, from munchkin to mom to dad, so you can all go through the drama together, right?

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But in order to do that, sometimes we have to give recommendations that feel intense and they feel sudden and they feel severe, and especially when they say but I felt so good during pregnancy.

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I know, and I love that for you, but your body has changed its mind for better, for worse.

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Your body has said I'm so glad, you feel great and your pelvic pain isn't so bad, but your blood pressure is through the roof, so I need to come out And there's nothing to do about it.

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It's not that they ate the wrong food or they should have waited to get pregnant for six more months or anything like that.

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Right, this is a pathophysiological reaction that some women have to pregnancy, and as long as we are super close to full term or full term, we have a baby.

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Yeah, that really sums it up well.

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I was thinking about how I feel like people need to hear this over and over, and, over and over again, because I mean, there's so many factors that go into a healthy pregnancy and we have the technology to be able to intervene when necessary and thank goodness for that And it isn't always what we wanted, but the outcome is what we want.

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We want the healthy baby, we want a healthy mom.

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Right, and I think that now I'm not saying that bedside manner doesn't matter by any means.

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Oh, it does, right, and a situation is key to success.

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But, that being said, i totally understand.

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I mean, 37 weeks feels early, right, even for the person who potentially is tired of being pregnant.

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The odds are family wasn't planning to come into town, maybe the car seat isn't even purchased yet, because they thought they had two to three more weeks, right?

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Heck, first time moms assume they're going past their due date.

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So here we are, taking this presumed expectation that they have set specific things in motion by and brushing it all away, and it can feel very overwhelming to say no, i'm sorry, but you need to be admitted and we need to work towards your birth now.

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And all they think is but that wasn't the plan, right?

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Oh, i know, we know it wasn't our plan either.

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It makes you feel any better.

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It also wasn't my plan for my patients.

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But when there's no other choice, usually people come around right And again you just.

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It's that explanation of you're right, your baby is okay And I'm so glad your baby is okay, but I can't promise that you will be okay if you stay pregnant And if you're not okay.

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As the vessel, as the carrier of this munchkin, then by default, your munchkin's not okay.

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Your situation was the gestational hypertension, so you didn't have severe range, and so then, once you got to full term, the recommendation was to deliver.

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So how did that go for you?

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after having all of the experience with moms and delivery, what was your experience like?

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It wasn't terrible.

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Actually I didn't mind an induction, only the fact that I had given a what to expect on an induction spiel for the past 10 years of my life.

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It was very helpful.

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But I will also say that I deeply respect the impatience.

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I definitely had that.

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As much as it is so fruitful to do the what we call ripening stage of an induction, which feels so slow.

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It was necessary But it does.

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You feel like you're just sitting there.

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It's really tough because it feels very clinical.

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You've also been told that this is necessary for safety.

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Why are we taking our time with it?

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So there's a whole mix of emotions.

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But that part wasn't terrible.

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I did do a cervical ripening balloon.

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I didn't mind it.

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I thought it was fine At that point.

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I think it was more.

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It was either cervical ripening balloon and bounce on the ball and deal with some pressure or potentially go another six to 18 hours chilling before we started pitocin And that I just I could not mentally do that.

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I would take the pressure.

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So we did.

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So we got admitted late on a Wednesday evening.

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I was lucky enough to be about one centimeter.

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We started with ripening medication called cytotech or mesoprostol, and so I took that medicine by mouth and then they used a what we call a mechanical dilation or mechanical ripening device called a cervical ripening balloon.

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That applies pressure to the cervix and helps soften it and open it.

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with a little bit of that pressure, especially when baby's head is not really well in the pelvis yet, which is common for first time moms that what we call descent, or the head moving lower down, takes usually later in the process or the progress of labor for a first time mom, and so that balloon applies that needed pressure to the cervix, kind of start to melt it open.

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I always talk about to my patients the cervix being like that soft mound of clay on a potter's wheel right And so that soft clay.

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The idea is that with gentle pressure from your thumbs it will open into a bowl or a plate right.

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The cervix is kind of the same thing.

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If you have super cold clay that's not warmed up yet, you're not going to be able to apply just gentle pressure and get it to mold into that opening.

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You have to work it first.

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And so, similar to a cervix, we have to soften that cervix, we have to get it warmed up, we have to ripen it in order for when we start medication for contractions, which is putosin synthetic oxytocin that the cervix is ready.

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The cervix has done its job to start to soften so that as we apply kind of that pressure, we're putting pressure on the gas, we're starting to get your uterus working.

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The cervix is more agreeable to open and dilate.

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And so I did the cervical ripening and then we started putosin And then I was very nervous as a first time mom, not necessarily actually about pain.

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I also had an excessive amount of fluid, which is normal with giant babies and potentially PCOS moms, and so I had a lot of fluid and so I was very scared of having to go to the operating room after they broke my water potentially an emergency and having to go on to general anesthesia.

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So even though I was not uncomfortable yet, i opted for an epidural at about four centimeters before they broke my water so that if something happened I could stay awake during the surgery.

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So I got my epidural.

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It was excellent, best choice.

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My husband and I were very thrilled with that part of the labor.

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They then broke my water and basically from between Thursday at about 4pm when they broke my water, i made pretty decent change.

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I did get an IUPC, which is a way to monitor contractions from the inside versus the outside of my abdomen, to make sure that I had the right amount of putosin, that I needed a little bit more specific data collection to help with some unique care planning.

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And then I was obsessed As a bedside nurse.

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Kelly's going to be very offended by this, but I was obsessed with making sure I got turned every hour.

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So I would set an alarm and I would hit my nurse call light.

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Please don't do that to anyone.

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I just have neuroses, please don't be me.

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So I would set an alarm.

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And finally my husband and my bedside nurse, who were lovely, stole my phone and she set her own alarm so that I wouldn't be waking the entire room up every hour on the hour to get rotated.

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So it was big believer in my spinning babies and my movement with my peanut ball, especially after my colleague who was my doctor at the time, said oh, munchkin feels asynchritic, oh, and then I went off the rails.

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I was like oh, every 45 minutes.

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So, nope, gotta do it.

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So don't be like me.

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I promise it's fine.

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The nurses know what they're doing, trust them.

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But I loved getting moved.

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I did all the positions, side to side, upright, the whole kit and caboodle.

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And then my provider checked me and she's like okay, you're complete.

00:21:06.218 --> 00:21:06.999
You're like plus one.

00:21:06.999 --> 00:21:12.380
This is great, you're going to start pushing, i'm going to go take a shower and then we'll deliver before eight o'clock.

00:21:12.380 --> 00:21:14.576
And I said awesome, sounds great.

00:21:14.576 --> 00:21:19.922
So I brushed my teeth with my little spit bowl because I can't move with my epidural.

00:21:19.922 --> 00:21:24.558
I'd be like get ready My mom and my sister there, it's pre-COVID.

00:21:24.558 --> 00:21:26.635
Obviously We're very peaceful.

00:21:27.049 --> 00:21:29.479
I pushed twice and my nurse says you have to stop pushing.

00:21:29.479 --> 00:21:30.795
And my instinct goes why?

00:21:30.795 --> 00:21:34.659
The baby's heart rate is fine, because why else would anyone tell you to stop pushing?

00:21:34.659 --> 00:21:35.441
What's going on?

00:21:35.441 --> 00:21:38.218
And she goes you're going to have your baby without a provider in the room.

00:21:38.218 --> 00:21:39.776
And I was like but I am a provider.

00:21:39.776 --> 00:21:41.855
She was like no, not the same thing.

00:21:41.855 --> 00:21:42.638
I was like okay.

00:21:42.890 --> 00:21:50.478
So I got to sit there for another 15 minutes just chilling as my child is crowning and I'm feeling nothing because there was no one in the room.

00:21:50.478 --> 00:21:54.516
My doctor was in the shower, luckily, obviously didn't really care because it was fine.

00:21:54.516 --> 00:22:00.897
So, yes, i had two colleagues in the room when I delivered, because it was change of shift, because of course it's like 730 in the morning.

00:22:00.897 --> 00:22:04.740
So I had my night nurse, my day nurse, two docs and it was great.

00:22:04.740 --> 00:22:12.683
I was very fortunate to only push for about 20 to 23 minutes, which is very unheard of as first time mother.

00:22:12.683 --> 00:22:15.358
Again, i don't know why I was lucky enough to do that.

00:22:15.358 --> 00:22:16.292
It makes me feel better.

00:22:16.292 --> 00:22:19.674
That was not the case with the second one And so, but it was great.

00:22:20.250 --> 00:22:23.720
And he came out screaming, crying and he went straight to my chest.

00:22:23.720 --> 00:22:30.442
I had a very standard second degree laceration which they repaired very nicely with my epidural intact.

00:22:30.442 --> 00:22:33.137
So I didn't do anything but some gentle pressure, which was very nice.

00:22:33.137 --> 00:22:37.440
No abnormal bleeding went up to postpartum.

00:22:37.440 --> 00:22:39.854
He got a little friendly when listening.

00:22:39.854 --> 00:22:42.201
In case you don't know, babies are kind of stupid.

00:22:42.201 --> 00:22:45.596
They're real cute but they're real dumb And so he decided to have some breathing issues.

00:22:45.596 --> 00:22:50.457
He decided to try holding his breath, which is kind of frowned upon, and so my postpartum nurse freaked out.

00:22:50.457 --> 00:22:52.234
So he got a chest X right.

00:22:52.234 --> 00:22:53.053
It was fine.

00:22:53.053 --> 00:22:55.837
So of course Nikki was like do some skin to skin?

00:22:55.837 --> 00:22:57.269
I was like that's my plan.

00:22:57.269 --> 00:23:05.221
So he did sit into skin and then he was totally fine And we went home at 48 hours postpartum and it was great.

00:23:05.569 --> 00:23:09.198
It was everything I wanted, in the sense of I loved cuddling him.

00:23:09.198 --> 00:23:09.940
It was great.

00:23:09.940 --> 00:23:11.123
My family was amazing.

00:23:11.123 --> 00:23:12.334
It's a lot of work.

00:23:12.334 --> 00:23:33.875
I did not realize how much I didn't know, considering I had been so immersed in the birth world and the birth community for so long and had dedicated theoretically, my career, my professional life, to this, i felt very surprised by what I didn't know, and that probably was the biggest cause for my post-partum depression.

00:23:33.875 --> 00:23:38.701
I just didn't know what I would need and I thought I did.

00:23:38.701 --> 00:23:45.857
I thought it was just some support here and there and just cuddles and time away from work, and I am too extroverted for that.

00:23:45.857 --> 00:23:49.785
So I actually more visits, and not again.

00:23:49.785 --> 00:23:52.236
I didn't need them to hold the baby, but I needed people time.

00:23:52.236 --> 00:24:07.659
I needed people physically in my line of sight, and with paternity leave, as short as it is, that wasn't really a thing, and so I was quick to realize how lonely I was, and so once we figured that out it got way better, but took hitting some rock bottom there.

00:24:07.659 --> 00:24:12.121
There's only so much reality TV you can watch before you are probably close to clinically insane.

00:24:12.121 --> 00:24:22.358
And so, you know, got into counseling, made better arrangements with friends and colleagues and my family to have somebody pretty much there.

00:24:22.358 --> 00:24:28.836
And again, it wasn't that I needed someone to hold the baby, i just needed someone to interact with me as an adult.

00:24:28.836 --> 00:24:32.823
And so, you know, i learned even more about myself, for sure.

00:24:32.823 --> 00:24:36.791
But no post-partum complications after that With Sammy.

00:24:36.971 --> 00:24:47.555
On the other hand, i had some early bleeding, very much convinced myself while working me I had had bleeding while I was on call, definitely believed I was miscarrying.

00:24:47.555 --> 00:24:49.253
I was frantic.

00:24:49.253 --> 00:24:53.704
I was on with a colleague of mine and I was like you have to, son of me.

00:24:53.704 --> 00:24:55.518
She was like there's nothing I'm going to be able to see.

00:24:55.518 --> 00:24:56.765
You are six weeks pregnant.

00:24:56.765 --> 00:24:59.057
And I was like you have to, son of me, you have to tell me what's going on.

00:24:59.057 --> 00:25:13.660
Which, of course, resulted in no information because, as it should, but freaked out, had convinced myself and my village that this had not been successful and you know we were going to have to make arrangements for another transfer and you know all this stuff.

00:25:14.250 --> 00:25:25.075
So kind of trudged my way at about seven weeks, to my scheduled appointment with my infertility provider and was like this one I had a ton of bleeding, it lasted for like two days.

00:25:25.075 --> 00:25:27.396
You know, i know what you're going to find.

00:25:27.396 --> 00:25:28.934
They were like oh my gosh, you should have called.

00:25:28.934 --> 00:25:29.718
We're so sorry.

00:25:29.718 --> 00:25:32.459
Let's just, you know, confirm that there's nothing left in the uterus.

00:25:32.459 --> 00:25:34.535
I was like, of course there was heart tones.

00:25:34.535 --> 00:25:40.637
So here we are, mm-hmm, yep, i did a lot of swearing that day, as did my provider, because we were both very shocked.

00:25:40.637 --> 00:25:41.695
It was great.

00:25:41.695 --> 00:25:45.031
But, mm, yes, that was really good thing.

00:25:45.031 --> 00:25:45.993
I did my Lex pro that day.

00:25:45.993 --> 00:25:57.576
That was very strange And my first lesson in no pregnancy is the same Right, i say it so I'm blue in the face with my patients and yet I needed to apparently learn that lesson firsthand.

00:25:57.805 --> 00:26:13.035
So already starting very different with Sammy and because of my PCOS and my body mass index, there's a recommendation for an early glucose screening to make sure that I don't have either type two diabetes or what we call pre gestational diabetes.

00:26:13.035 --> 00:26:20.172
I did great, rocked it, super excited, feel like we're doing great gloriously failed my 28 week blood sugar test.

00:26:20.172 --> 00:26:26.192
I was immediately diagnosed with gestational diabetes, didn't even have to do a three hour, just really went for it.

00:26:26.192 --> 00:26:27.667
And the thumb in common.

00:26:27.969 --> 00:26:36.395
One of the symptoms or part of the metabolic triad with someone who has polycystic ovarian syndrome or PCOS is something called insulin resistance.

00:26:36.395 --> 00:26:38.270
This is where your pancreas works.

00:26:38.270 --> 00:26:40.163
It's that you make insulin.

00:26:40.163 --> 00:26:46.711
It's that your cells don't necessarily have the most intense response to insulin, so insulin is supposed to be a little bit like a lock in key.

00:26:46.711 --> 00:26:56.056
Insulin is supposed to talk to the cell, open the cell up so that sugar from the bloodstream can go into a cell, so the cell can utilize it to carry out its cellular functions.

00:26:56.056 --> 00:26:59.775
Well, with women who have PCOS, we have something called insulin resistance.

00:26:59.775 --> 00:27:06.833
It's like there's something where the key doesn't fit into the cell lock every time, whereas often or as routinely as we want it to.

00:27:06.833 --> 00:27:14.134
So more sugar stays in our bloodstream for longer, therefore potentially increasing our risk for adipose tissue or fat or a larger BMI.

00:27:14.134 --> 00:27:20.549
But it also makes it much more common for us to have gestational diabetes and pregnancy, because it's basically our natural state.

00:27:20.549 --> 00:27:27.753
Our natural state of insulin resistance is, on some level, diabetes, and so it wasn't surprising, but it was definitely different.

00:27:28.727 --> 00:27:44.818
I started with oral medication that didn't do a lot, so went to insulin pretty quickly and needed a hefty amount of it to keep things under control, even with strict diet and exercise guidelines, measuring my food, the whole thing, which was definitely different.

00:27:44.818 --> 00:27:48.836
I only needed injections in my first pregnancy to get pregnant.

00:27:48.836 --> 00:27:51.211
I definitely didn't need them any other time.

00:27:51.211 --> 00:27:52.606
So back on.

00:27:52.606 --> 00:27:58.650
Injections was fine, but different, especially having a four-year-old who's like mom, why are you giving yourself a shot?

00:27:58.650 --> 00:28:07.634
Let's have that conversation 900 times, thank God, they're so curious, and so we would have to teach Nate every day this is mommy's medicine.

00:28:07.634 --> 00:28:10.210
No, you don't need a shot, it was on replay.

00:28:11.025 --> 00:28:16.983
But part of that definitely led to some concerns for Sammy gestational diabetes.

00:28:16.983 --> 00:28:28.960
When you're on medication, the recommendation is to consider an induction of labor between 38 and 39 weeks, and that's because at some point we do worry about not only fetal size.

00:28:28.960 --> 00:28:33.573
But the other is that there's risk to maternal and fetal cardiovascular systems.

00:28:33.573 --> 00:28:34.996
When you're on that type of medication.

00:28:34.996 --> 00:28:51.973
At some point there's a risk that it stops working really well, and the more high blood sugars you have, the more likely you are to potentially have vascular damage from the pregnant woman's side, as well as potentially that sugar passing through the placenta to munchkins, veins and arteries and also potentially causing damage or trauma there.

00:28:51.973 --> 00:28:55.991
So I knew that going into it And I thought, okay, well, i'll be a couple extra days pregnant.

00:28:57.026 --> 00:28:58.412
And then blood pressure went up again.

00:28:58.412 --> 00:29:01.307
Sure, not surprising, we'll argue.

00:29:01.307 --> 00:29:01.869
It was stressed.

00:29:01.869 --> 00:29:03.769
This time We'll say it wasn't pregnancy.

00:29:03.769 --> 00:29:06.951
My own mental health This time was a little bit different with Sammy.

00:29:06.951 --> 00:29:09.092
The pressure started mild range.

00:29:09.265 --> 00:29:15.932
So for gestational hypertension, same kind of criteria blood pressures couple hours apart, meeting criteria, no problem.

00:29:15.932 --> 00:29:22.455
We kind of knew that this was coming, so we just kind of moved the date up a couple of days in order to have an induction date.

00:29:22.455 --> 00:29:24.088
My village was ready.

00:29:24.088 --> 00:29:27.332
We knew this was happening, so we got to go hang out with grandma and grandpa.

00:29:27.332 --> 00:29:28.990
My husband and I got admitted.

00:29:28.990 --> 00:29:31.973
While in labor my pressures did hit some severe range.

00:29:31.973 --> 00:29:43.656
I did not necessarily need IV hypertension medication, but I did need oral hypertension medication And I did continue it for a month postpartum as my blood pressures remained elevated.

00:29:44.224 --> 00:29:46.009
Nothing about that is abnormal, unfortunate.

00:29:46.009 --> 00:29:51.811
Only because again just feels like a lot, but that is pretty common with hypertension of pregnancy.

00:29:51.811 --> 00:30:07.390
Just because, yes, the cure is delivery, that doesn't mean that your body suddenly doesn't know that it wasn't just pregnant And so it's those pregnancy hormones and all of that that can still persist and perpetuate those elevated blood pressures.

00:30:07.390 --> 00:30:09.070
So nothing totally out of the ordinary.

00:30:09.070 --> 00:30:13.301
The next biggest thing I learned, though, with Sammy, was that gestational diabetes?

00:30:13.301 --> 00:30:20.109
especially when you have abnormal fastings, which is the first blood sugar you take in the morning after not eating anything.

00:30:20.109 --> 00:30:29.999
When those are consistently high, it can decrease the amount of surfactant, which is kind of like a lung goo that your body makes, that we all have.

00:30:29.999 --> 00:30:37.136
That babies need to make in order to help their lungs inflate and have that oxygenation exchange.

00:30:37.136 --> 00:30:43.286
So in the bronchi, in the avioli, which are the branches of the vessels inside of our lungs.

00:30:43.286 --> 00:30:49.912
That's where oxygen is exchanged from the lungs into the blood and then carried to the organs And so that surfactant helps with that process.

00:30:49.912 --> 00:31:10.545
And in a pregnancy, in a growing baby, the surfactant and Munchkin's insulin are actually made by the same pathway And so if a baby has to start potentially making its own insulin prior to delivery, its ability to make surfactant or enough of surfactant can be jeopardized or diminished.

00:31:10.545 --> 00:31:11.951
So that's what happened to Sammy.

00:31:11.951 --> 00:31:21.355
So we delivered at 37 and a half weeks vaginal delivery and other induction slower than I would have expected as a second time mom, but tell that story.

00:31:22.125 --> 00:31:23.330
But Sammy ended up going to the NICU.

00:31:23.330 --> 00:31:26.133
He initially just needed some observation in the nursery.

00:31:26.133 --> 00:31:43.355
I was taking a pretty decent nap and I kind of knock on my door from a colleague saying that the NICU provider once talked to me and lovely, lovely man, i worked with him as a nurse, midwife, knew him well And he says hey, and I thought biscuits okay.

00:31:43.355 --> 00:31:45.752
And I said hey, yourselves.

00:31:45.752 --> 00:31:52.353
And he says so remember how he made that joke that, like you wouldn't need to see me after the baby was out because you'd be full term.

00:31:52.353 --> 00:31:53.650
I said sure do.

00:31:53.650 --> 00:31:57.490
And he said I'm admitting your baby And I said okay.

00:31:57.490 --> 00:32:01.212
And so Sammy went upstairs to join the NICU crew.

00:32:01.212 --> 00:32:04.153
He was on nasal cannula oxygen.

00:32:04.153 --> 00:32:08.756
He got a nasal gastric tube for a couple of feeds because he needed so much oxygen.

00:32:08.756 --> 00:32:17.756
He was there for a total of five days two and a half days of intervention, two and a half days of no intervention to just pass all the quote, unquote tests based on their protocols.

00:32:17.756 --> 00:32:21.034
And then he finally got to come home and has been amazing ever since.

00:32:21.424 --> 00:32:26.217
But I definitely didn't expect that, you know, especially considering he was smaller than his brother.

00:32:26.217 --> 00:32:28.291
We felt like we had controlled everything else.

00:32:28.291 --> 00:32:39.518
We did not expect a respiratory transition concern, but very grateful that there was a NICU with our hospital planned birth to alleviate those concerns in the safest, best way possible.

00:32:39.518 --> 00:32:43.233
So in Sammy's induction I was similar.

00:32:43.233 --> 00:32:45.830
I was not one, and so again we started with cytotek.

00:32:45.830 --> 00:32:48.393
My blood pressures were not severe range at this point.

00:32:48.393 --> 00:32:51.670
My lab values were normal, so we felt like we had the time.

00:32:51.670 --> 00:32:53.109
So we started with cytotek.

00:32:53.109 --> 00:32:56.233
I ended up getting two doses.

00:32:56.233 --> 00:32:59.273
I yes, of course opted for the cervical ripening balloon.

00:32:59.273 --> 00:33:09.249
Again, i took the pressure and moved on And then similarly got on Potosin, had my water broken and with time and effort got to 10 centimeters.

00:33:09.585 --> 00:33:15.547
It wasn't necessarily that it was much slower, but it definitely felt slower for whatever reason.

00:33:15.547 --> 00:33:24.230
This time around My epidural didn't work And so I got an epidural at about four centimeters prior to my water being broken And I thought I felt pretty good.

00:33:24.230 --> 00:33:31.070
But then they broke my water and placed my bladder catheter and I felt it all And I just kind of ignored it.

00:33:31.070 --> 00:33:41.517
I just thought it just maybe hasn't set in right, haven't had enough time since they placed it, and as I started to dilate more and contractions came on, it really wasn't covering it.

00:33:41.517 --> 00:33:43.871
So we tried giving more and more medicine.

00:33:43.871 --> 00:33:44.673
That didn't work.

00:33:44.673 --> 00:33:46.028
We tried replacing it.

00:33:46.028 --> 00:34:03.655
That worked a little bit, and so ultimately by the time it wasn't necessarily abdomen or back pain, but it was very pelvic and hip pain and definitely felt the pressure to push the burning ring of fire.

00:34:03.916 --> 00:34:08.885
Lots of tears between myself and my partner just because it was so different With Nate.

00:34:08.885 --> 00:34:10.612
I really truly felt nothing.

00:34:10.612 --> 00:34:13.534
Pushing was such this blasé experience.

00:34:13.534 --> 00:34:14.570
The whole thing was blasé.

00:34:14.570 --> 00:34:18.454
I really was like, oh, you could probably cut me open and I wouldn't feel anything.

00:34:18.454 --> 00:34:21.090
Okay, and Sammy was definitely not like that.

00:34:21.090 --> 00:34:27.538
There was significant discomfort that led to just fatigue and processing difficulties.

00:34:27.538 --> 00:34:31.456
It was really hard to regulate myself, pet talk myself up for two reasons.

00:34:31.456 --> 00:34:32.829
One is it hadn't been my plan.

00:34:32.829 --> 00:34:40.355
My plan was not to experience an unmedicated labor course And my previous experience was just so different.

00:34:40.355 --> 00:34:42.431
I only had one experience with anesthesia.

00:34:42.431 --> 00:34:47.617
It was so excellent that anything but that I wasn't mentally prepared for.

00:34:47.617 --> 00:34:51.393
Luckily, all is well that ends well, pushed, very efficiently.

00:34:51.393 --> 00:34:56.954
Yelled at my provider After delivering him thought I might get fired because of the things I said to her.

00:34:56.954 --> 00:34:57.735
Not, her.

00:34:58.224 --> 00:35:00.271
She's not the one that's going to be upset about that.

00:35:00.532 --> 00:35:05.074
Nope, she laughed it off like the gem that she is, the treasure.

00:35:05.074 --> 00:35:11.635
But, yes, yelled at her very strongly, yep, one of the excellent night nurses yelled at her, screamed her.

00:35:11.635 --> 00:35:15.235
She got in my face and told me to calm down, which was very helpful and necessary.

00:35:15.235 --> 00:35:18.072
So, really good colleague, bonding right there.

00:35:18.072 --> 00:35:20.744
Really, yeah, it was great.

00:35:20.804 --> 00:35:28.751
But no, i mean all in all, in terms of you know, in the grand scheme of things, as I my husband is probably listening can hear, i couldn't reproduce the pain.

00:35:28.751 --> 00:35:29.934
If I wanted to, i couldn't.

00:35:29.934 --> 00:35:32.188
I couldn't talk about the emotions.

00:35:32.188 --> 00:35:41.853
For sure, i remember what, how strenuous it felt, and feeling and turning to my partner for support, even though he is, as I am well aware, working in the community.

00:35:41.853 --> 00:35:55.273
He can't do much for me, right, and so, even though he was so willing and graciously to accept that burden that I was trying to put on him, he felt just as helpless as I did, and so, although we both felt safe in the encounter, it was processing those emotions.

00:35:55.273 --> 00:36:00.349
I can feel those, i remember those moments, but I couldn't tell you what the pain was like.

00:36:00.349 --> 00:36:01.132
I couldn't describe it.

00:36:01.132 --> 00:36:05.072
Now I have no idea, you know, and that is good, i think.

00:36:05.472 --> 00:36:06.295
The halo effect.

00:36:06.434 --> 00:36:07.664
Right, i mean I.

00:36:07.664 --> 00:36:11.755
I mean I remembered on some level in a sense, that I remember I couldn't stop right.

00:36:11.755 --> 00:36:18.594
I had to push, I needed it to end, but there's nothing I could do right now that I feel like I could reproduce this, that same intensity.

00:36:18.784 --> 00:36:21.112
I feel like when I stub my toe, it gets close.

00:36:21.112 --> 00:36:23.737
Yeah, there are certain things you're like, oh yeah.

00:36:23.737 --> 00:36:27.789
Or like I have like severe diarrhea and a stub toe at the same time.

00:36:28.010 --> 00:36:29.393
Yes, So that is still true.

00:36:29.393 --> 00:36:32.597
Yeah, oh yeah, gastric, upset is probably as close as you're going to get.

00:36:32.597 --> 00:36:33.719
Yeah.

00:36:34.085 --> 00:36:36.309
But the bone pain for me is like a stubbed toe.

00:36:36.309 --> 00:36:36.911
But you can't.

00:36:36.911 --> 00:36:38.054
You can't make it stop.

00:36:38.315 --> 00:36:50.775
Yeah, but the the rectal awareness Yes, there is only only gastric upset really does put you right back in it, right, because it is sometimes that intense and that's unforgiving.

00:36:50.775 --> 00:36:54.835
But you know, again, in that sense all went very well.

00:36:54.835 --> 00:36:57.213
I was very comfortable with the management plan.

00:36:57.213 --> 00:36:59.416
I was comfortable with the induction plan.

00:36:59.416 --> 00:37:06.449
For better or worse, i knew when I was getting myself into if the epidural was not working, was not to participate in, or things I had prepped for mentally.

00:37:06.449 --> 00:37:08.512
I had prepped for the cervical ripening balloon.

00:37:08.512 --> 00:37:10.010
I had prepped for exams.

00:37:10.010 --> 00:37:14.697
I had prepped for artificial rupture of membranes or an amniotomy, which is where the provider breaks your water.

00:37:14.697 --> 00:37:16.731
I had mentally prepped for all that.

00:37:16.731 --> 00:37:19.672
I had coached my husband through all those expectations, you know.

00:37:19.672 --> 00:37:21.295
So that part had certainly helped.

00:37:21.295 --> 00:37:23.099
Now, part of it's because it's what I do for a living.

00:37:23.099 --> 00:37:26.014

From PCOS to Parenthood: A Candid Journey Through Fertility, Birth, and Motherhood with Michelle Powers, CNM

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