What Happens when a Birth Center Birth Moves to the Hospital? Atara's Birth Story, Part I

In today's episode my guest, who is a therapist, shares her experiences of four births and all the many things she learned things like holding lightly to the birth plan as she's moved from the birth center to a hospital when her cervix is reluctant to fully dilate, holding lightly the plan to return to work three months after delivery when postpartum

Transcript

Paulette[00:00:00] Welcome to what you didn't expect in fertility, pregnancy and birth. How we think and feel about this enormous transition. Often lives in the gap between what we expected and what we actually experienced. This gap exists in part because of how we tend to talk about and portray these events on all kinds of media in a one-dimensional way. 

Everything was amazing. But it's more often the case that there are beautiful things that happen. And at the same time, really challenging things that happen. This show shares true experiences, both the easy parts and the difficult parts and how we manage what we didn't expect. The intense things that can happen in the course of this transition can impact how you see yourself, how you see your partner and how you parent. The better we understand what happened to us, the better we can manage, all the things that follow. I'm your host, Paula communica. 

I'm a writer and an economist and the mother of two girls. I met many, many challenges in this process. None of which I expected. [00:01:00] 

In today's episode my guest, who's a therapist. Shares her experiences of four births and the many things she learned along the way, things like holding lightly to the birth plan as she's moved from the birth center to a hospital, when her cervix is reluctant to fully dilate. 

And things like holding lightly to the plan to return to work three months after delivery, when postpartum is much more difficult than anticipated. 

Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you're from? 

Atara: Sure, Paulette. Hi, my name is Atara Parkinson. I'm a licensed marriage and family therapist, and I'm from California, but I currently reside in Montana. 

Oh, interesting. How's Montana treating you? 

Oh, I love it.

It's peaceful. It's beautiful. You have to be prepared for a long winter. So yeah, mindset shift, that's required. But [00:02:00] I think if you go into that, into it, knowing that, Hey, we're going to have a lot of snow, you'll be okay. You could survive here. 

Okay. Excellent. Good. So sometimes the family you create is a reflection of the family you come from, in some ways, and I'm wondering if that's the case for you.

Okay. My answer to that is yes and no. I love that question. So I will answer no first and then I'll go to yes. So no, my family is very different. I come from a smaller family , there's only two of us growing up, divorced parents. And because of all of that, a lot of disconnection my mom then jumped into working full time, long hours.

He went to childcare. And I was public school, so not a lot there and the family that I currently have is I'm the entrepreneur. My husband stays at home with the children. We homeschool. So there's a lot of time together. There's a lot of connectedness in our family, which I really [00:03:00] love. The way that I would answer yes is.

Despite all that, I did come from two really wonderful parents who were invested in who I am as a person. More than my accolades, they cared about who I was becoming and my character. And I would say that is carried over into how we parent in our household. 

Yeah. Although to some degree, we all take from our experience and either say I'm going to replicate that or I'm going to do the exact opposite.

Yeah. So it is informing the choices that you're making to say Oh, I'm not going to repeat that. Yeah. Yeah. Yeah. Yeah. Which in many ways I think a lot of us do it. I do that as well. And in many ways that's really tricky because there's no template, right? You did not grow up with it.

So you're winging it which is harder than it looks, I guess is the four word description. 

A lot of learning, a lot of learning required and humility. Yes, totally. 

Totally. You have four kids. And I'm wondering before you step into [00:04:00] pregnancy, what are you imagining pregnancy is going to be like?

Oh, Paulette, I think before my first, I thought it would be a breeze. I thought This is just, you're just growing a baby and life will just continue the way that it was before.

And clearly that was not the experience whatsoever. 

Yeah. You imagine it as a blip, right? I'm going to do this thing and then I'll go back to being myself, right? 

With no sense of the transformation on the horizon, but here we are. And so did you step into pregnancy easily? I did.

Ooh. Yes. Within context. My sister, who is my best friend, was already two babies in. And for me, that added a lot of internal pressure. Oh my gosh, we have to also have kids quickly. And probably within . six months of being married. I was like, let's do this. Let's have a kid.

And then it took roughly about six months to get pregnant. Now, in my mind, and I'm sure any mom out there trying, that feels like a [00:05:00] lifetime. But when I went to the doctor, he was like, no, I can't even do anything until a year has passed. So in my mind, it did take a long time, but In the grand scheme of things, not so much.

 I used birth control, I don't know if you did, but when you use birth control, you're imagining there's this switch you flick, I take this pill and now magically I'm not going to get pregnant, and you imagine once you go off that. The switch is flicked in the other way.

And now I will immediately get pregnant. And there's no appreciation of biology's clock. I'm with you. So many people say that, but it's surprising when it doesn't happen immediately. And so into this first pregnancy, what's the pregnancy like? 

 I was about a year and a half out of my graduate work.

So a lot high intensity, big time stress. And I had actually had a physical health crash and I was unable to get out of bed for more than two hours at a time. And so that took me on a journey of really recovering my physical health [00:06:00] and getting back on track. And in that process maybe about four months after starting healing, that's when the pregnancy happened.

Okay. Excellent. And then it's a little bit sad that you're like, Oh, I'm not feeling terrible and super tired anymore. I'll just get pregnant. How was the first trimester? 

First trimester was a lot of morning sickness. Two favorite stories about vomiting, right? In the shower and I went, Oh, great.

That'll be an easy cleanup. It was not, it did not go down the drain very well. And then, you're like, what do I even do now? Pick up the handfuls and put it, yeah, just awful. And then my other favorite was on the way to work and, just hits you. I had to pull over. Open the car door.

As I was doing that, I looked across the street to see this poor young girl on her paddish probably in high school and she looked at me like why are you stopping there? Open my door, just, throw up on the street. And I look up and [00:07:00] she's gone. She was like, I'm not having any of that to start my morning.

So lots of morning sickness and a lot of fatigue was my experience. Yeah. Yeah. 

Yeah. It's, that again is harder than it looks, right? 

Yes. And I was trying to still work full time as a therapist and you go, Oh, I just have to do it. I have to do all of these things.

And that's what it felt like for me. Yeah. 

 Like you, I was in grad school when I was pregnant and I would literally be in a computer room. I fall dead asleep on my keyboard. I wake up with the imprint of my keyboard and be like, but your body is telling you slow down, right? Right? You're trying to do this miraculous thing and we all ignore it and push through, right?

I'm 

not in my bed. I'm in some basement computer room, which that doesn't seem right. But I'm with you. That is the The way we all manage. 

Yes, yeah. I think of traditional cultures, when we were living in tribal societies, they were able to listen to their bodies, and to lay down, or take a nap, [00:08:00] or just, take a rest.

And they probably didn't even know at that point they were pregnant, right? Yeah. But yeah, we're not capable of that or also our culture doesn't give us the space to do 

 I think everyone thinks of pregnancy like you broke your arm or something. Like you're still going to work, right?

 It's just a complete misconception about all the things that are going on. But let's not get bogged down in that. So after the first trimester, you feel better? 

I did. I have that stereotypical upswing of energy in the second trimester, some excitement,, I was connecting with the baby more starting to feel stuff internally, so absolutely.

And then, I'm imagining that the real surprises happen around birth, is that right? Yeah, 

so third trimester I was at the end of summer in Southern California, so it's hot. Yeah. I remember taking a lot of time off, two or three weeks off before baby came. I thought I needed that for some reason, and now, looking back in hindsight, [00:09:00] wish I had, just went until the end and then have more time after.

And then absolutely the other surprising thing with my first was We see we have this term due date like that's set in stone and it's such BS, really we're just guessing here It's a two week period before and a two week period after really is what we're looking at There's that kind of month of time really essentially that baby could come And mine was very late, quote, unquote we were nearing the two week mark.

And then that added a lot of pressure for me because I had fought very hard in my early pregnancy for a birth center birth. I was not interested in going to a hospital but I also needed it covered by my insurance. And so we finally found someone, but they said if you go longer than two weeks after a week, you have to have a hospital birth.

And so that was an internal pressure. So he did this thing that I would not recommend anybody do, which was to take the castor oil smoothie to [00:10:00] help the process along and that did not bode well in terms of labor and delivery because he wasn't ready. 

Yeah. Also, like there, so a couple of things to talk about here. I have this podcast on the science of pregnancy and the switch that flicks to initiate labor is not fully understood. 

And and it sounds like it's a very complex symphony between, the baby releases a hormone, your body is releasing all these hormones.

There's an inflammatory process going on to get. Your cervix ready to open and your placenta ready to release. So there's so many things going on. So when you think of it in that context, there's no drink you're going to take that's going to, Nope. That's good, right? Like they're just, it's way too complicated than that.

And people are attached to things like castor oil because it causes intestinal distress and they're imagining that distress is like an inflammatory process that might literally elbow whatever [00:11:00] should be going on. There's no scientific evidence that any of that stuff works and that makes sense because we don't really understand how that works Having said that you are in a bind.

And so I am totally sympathetic to Your attempt to help yourself out to be sure baby does not understand the schedule We are on and let me inform them of what's going on here tell me a little bit about the birth center birth that you are imagining 

So I was imagining calm, peaceful low intervention, the hope was we use this term natural birth, but what I mean by that is vaginal birth.

And I wasn't interested in an epidural. I wasn't interested in any other interventions. And so that was the hope. I got a little bit of that experience. I got about 24 hours at the birth center. And what was happening during labor my midwife said is that my cervical lip wasn't melting all of the way.

And so he would come down and attempt to evacuate and would get stuck [00:12:00] on that lip. And so we tried to, physically pull that back that 

I'm not voting for that. That does not sound comfortable. Let me 

tell you, it was not fun. That was probably some of the worst pain I've ever experienced, but all that to say it was about seven hours at the end of the day of on and off pushing and to no avail.

Yep. Yeah. And eventually my very sweet midwife's head. I think it's I think we need to transfer and so we did and she bless her. She went with me and she was a support and she advocated for me as well at the hospital. It was a Yeah, go ahead. 

Are you on a time clock because your water's broken or , why are they?

Correct. Yeah, and so because they're under insurance they have a certain amount of time, 24 hours of which baby needs to come out and then they have to transfer. And so that's what happened. She went with me. We went to a teaching hospital. They were wonderful, was a very clear mental shift for me.

There was, we had lights off, calm music, the [00:13:00] energy was very calm. I was focused at the birth center to the car ride and then getting into this space where the lights were very intense. I was exhausted, completely exhausted. Everything felt very frantic. All of that didn't help.

And it's a little blurry at this point, so 32 hours total, so we went on a little longer at the hospital and what I remember very vividly was being in a squat and pushing and , we were very close and they went to get the overseeing doctor because they were like, she's right there and I leaned back and it all stopped.

It all grinds to a halt and the doctor comes in and literally goes, what happened? I thought we were there and my midwife had asked earlier if , I could birth in that squat and they said, no. And she very casually goes, she was doing real great in the squat and he goes, fine, fine. Get her back in the squat. And that's how I ended up delivering my [00:14:00] first in that process when he had come out and he was on me, I didn't notice cause I had never had a newborn on my chest, but he was, his breathing was very labored and merconium had come out in the process.

And so they were suspicious he had swallowed that. So he stayed with me for about an hour, a little bit more, and then the NICU team came in and took him to the NICU. 

That's super hard. The only thing I would have mentioned in your story is the verb notice. I'm not sure you're supposed to notice.

You don't know anything. How are you going to notice it? 

It's true. 

More like you're being educated in the moment about what it's supposed to be like, but must've been super hard to have him taken at that point. 

It was extremely difficult. a lot of shame. Like , I did something wrong. I also questioned, oh my gosh, should we not have started in the birth center?

All of that guilt starts to [00:15:00] spiral, starts to swirl. We compare it to running a marathon, right? Running a marathon, quote unquote, for 32 hours at this point now, and was up prior to that as well, because we started in the evening. So even before that, I hadn't had sleep until the night before.

So it'd been a very long time without sleep. And so I was very out of it. I was not mentally in touch with what was happening or where I was. So I was able to get some sleep after that. And then maybe a couple of hours after went and got to visit him for the first time. 

And how long does he have to stay in the NICU with a Makoni?

What do they do for him? 

Yeah they really focused on getting him some breathing treatments, oxygen. He was hooked up to a few machines, but not the whole kit and caboodle is how I'll say it when a baby is preterm, there's a lot more going on. And so in the NICU, I did get to hold him a couple of hours later, which was very good.

And then we attempted breastfeeding and that's a whole other, [00:16:00] there was a tongue tie and all of the intricacies of, like you said earlier, learning. We're learning so much as. And becoming a mom that we just don't even know we don't know. And so there was a lot of overwhelm in that space. 

Yeah.

That makes sense. The NICU, it felt to me like an other worldly place. It is intense in there and we don't think of it breastfeeding you're imagining is something you are doing, but actually you're only half of it. 

So you're doing part of it, but you can't control this partnership even though you feel responsible for it.

So that sounds really hard and tongue tie makes it sound like maybe he didn't latch well or 

correct. Correct. Yep. We were having issues latching and issues suckling with my, I think the first three as well. All had milk not come [00:17:00] in really, until I would say over 24 hours, usually about day two is when my milk would come in.

And, didn't know that there can be a process, there can be a time window. And so we would latch in and then he would suckle. But he wasn't actually getting anything for the most part. And then there's frustration and the baby's crying and your nervous system is going off in a cascade.

And I'm guessing Attar in those moments is blaming herself for no milk, even though. , the stuff that I've read published on this is 24 to 72 hours after birth. And I interviewed a doctor who studies breast cancer and breastfeeding. And she was talking about the 400 things that have to go right.

To have milk come in. So it is this very complicated chemistry between your brain and all the machinery you have grown in your breasts during pregnancy and that communication, none of which you have control over. And part of that is [00:18:00] instigated by the appropriate latch and suckling.

So without all those things working in concert, it's not going to work, but also guess what? Even though it's your body, you have no control. You can't will it into existence and very hard to be chill about that. And also Your anxiety is probably also an obstacle, right?

Absolutely. Yeah. Yeah. This mental place of, I should, and that's what I noticed in moms all the time. I should be able to do this. This should happen this way. And I laugh and I say we're just shooting all over ourselves. Yeah. 

Yeah. Yeah. A hundred percent. So how long is he in the NICU? 

So I'm very thankful.

I've talked to mamas that have spent months, right? Three, four months in the NICU. We were only in the NICU for three days. And although it felt like a lifetime. Yeah. When we were there. I want to comment real quick on caring for moms when they're in the NICU. Cause it's something I'm [00:19:00] so passionate about and I felt very much like I, he then was a priority and I.

Was ignored pretty much my mental health my physical health. Of course I was I'm searching for the word like I got was exited out of the hospital Yeah, I was fine quote unquote. So I think the word for that is 

kicked out. 

Thank you. Thank you I was kicked out exiled right from the hospital and we lived an hour and half away So I'm supposed to somehow feed this baby every two hours.

Where am I going to stay? There was no room for me. This hospital did have a Ronald McDonald center right by. And so I'm very thankful for that. But I know so many women do not have that ability. And so I'm just going to, It's let's challenge this system that ignores mothers and their needs after this baby's born.

Yeah. It's a tricky thing because I think in our experience with the NICU, those nurses [00:20:00] were amazing people and so dedicated and so competent and amazing, but there should be something else. So I guess I don't want to assign them that job because they have a job and they're killing it. And they're killing it.

But there should for sure be some other. Service. Yeah. That's provided to that recognizes the woman, not as the receptacle, but as a person going through a giant transformation. 

Absolutely. And I was thankful. So three years after with my third, we were in the same NICU and they did have a team of two practitioners, mental health clinicians that were coming in and checking on the women.

And I'm so inspired and thankful that work is starting to be done and acknowledged because absolutely the mama too is going through a major trauma and needs support. So that is shifting. 

Did that department have a name? Do you remember? 

No, they were individuals, so they weren't employed through the hospital but yeah, and you're inspiring me to reconnect and find them somewhere [00:21:00] back in my emails.

It's been a few years, but yeah, I would like to find them again and get that as a nationwide thing, you should be doing that across the country. 

Yeah. I did, interview this woman at Harvard. Who is a psychologist, working on distinguishing PTSD from postpartum depression, which she said 

they could co exist, but they're often confused and her idea was to have a unit in every hospital to attend every difficult birth situation to try to address the PTSD that may arise immediately. And I think her experience was that, treatment for those two different conditions is very different and PTSD treatment closer to the event is more effective.

And so she was like, why doesn't every maternity ward have these people on staff to attend to the roughly 30 percent or more who end up this way, right? 

So 

you are not alone in this recognition of the need. So what's [00:22:00] postpartum like that first time? 

Postpartum also very unexpected from my preconceived notion I experienced a lot of anxiety, postpartum anxiety.

I had never been an anxious person. I had never been an angry person. What we now call postpartum rage, which we know as well is a Indicator that anxiety is present. We act out in anger or rage because we feel anxious that we cannot control this situation. So sleep or lack of, I should say, was a huge wake up call.

The amount of exhaustion, how fast it goes. slow at the same time. And so these days that just seemed to drag on or run into each other, but also knowing I had this pending date of when I was supposed to go back to work and the pressure of that and feeling like, Gosh, I have to have all of this together.

I have to have all this figured out before that [00:23:00] date came to be. 

Yeah. Our system is nuts, there's no three months, it's taken you nine months to become this different thing. So to imagine, and not everyone gets 12 weeks, but if you're lucky enough to get 12 weeks, even unpaid, it's ridiculous to imagine that you will be back to some working form.

And I think even. Doctors are starting to expand their definition of postpartum. So we used to think of it as six weeks because that's the time it takes for your uterus to shrink down to its normal size, but your blood supply isn't back. The size of your heart isn't back. Your brain is still changing.

 Your blood supply, ? You have a ton of platelets running through your body. Now, everything has changed in service of growing another human. So to imagine in 12 weeks, like chop back to the office just seems wacky. 

Completely insane. That's what I'll say.

And I remember very vividly, we had a psychiatrist. I do love him. He's a great man. But I said something about mom brain. Cause I [00:24:00] forgot a file or something back at my office after returning. And he laughed at me and was like, that's not a thing. And I went, oh, really? And just the, that was one of the first times I was confronted with the misunderstanding of what has happened.

On multiple levels, physical level, a mental level, and I even say a spiritual level, right? And in my identity, I really talk with clients about moving from maiden to mother, right? And that there's this whole process that has to happen on these different levels. And then some of it includes grief.

Grieving this person who I was before for example, my memory, right? Wow. I used to be pretty efficient and on it and now my memory feels like it's shot. And I think it can be so empowering to learn my brain is literally changing and there's a reason that's happening, right? It's making space for new information, but it can feel [00:25:00] very overwhelming.

It can feel, it made me feel very insecure at times. 

Yeah, I don't know how widespread the term is, but matrescence is the name for the science behind the transformation of people into parents. And it does include a ton of now. brain changes that have been cataloged on MRI to show that there are a lot of significant changes.

And maybe we'd feel differently about it if we knew, Oh, this is just part of the process. And, we don't think of adolescents as getting more stupid, right? When their brain is changing, we think this is a transitory process. And the same thing happens to people who have given birth, ?

 It's just another way we have undersold. the transformation of pregnancy. So postpartum sounds tricky for you as it is for most of us. And what do you ease into it or how does work go or how do you manage the anxiety and the rage? 

No, I quit so it didn't go well.

It didn't go well. [00:26:00] I said I can't do this. And I quit my job and I left. I was in a full time position in a community mental health and the stress, between trying to juggle the two. Also, The anxiety I think really dictated that decision as well of can't leave my baby alone with anybody else because they're not competent enough.

They won't know what he needs. And then also this internal strife of, probably very informed by hormones. I can't leave him. I feel, physically agitated, when I'm away from him, certainly for more than a couple of hours. 

Yeah. That makes sense. And I know that especially talking to a therapist, anxiety is a real condition, but that reaction in some ways just makes total sense to me. You've been primed to take care of this baby and all these brain changes have happened. So I guess I feel like it's unfair to call it anxiety. I feel like it's I'm 

with you, but I don't know what else to call it.

Yeah. Yeah. We [00:27:00] don't even have a term. Biologically normal, appropriate what I was doing. And yet again, in our society or culture. No, you got to keep producing. You got to keep doing, you got to, it 

would be interesting to look at people, I'm sure this happens in other places, but I'm aware of it in Nordic countries where you get a year off to see how common postpartum anxiety is diagnosed there.

Good question. 

Yes. 

Just because the structure of their relationship with the new baby is so different. And whether they think of it differently, but anyway, that sounds really hard because you are caught between two conflicting things. Yeah. And does it ease at some point?

It does. So that's a little complicated in my case because at nine months, We're, eased certainly, but I know many moms can resonate with just as you learn this phase, it changes. Yeah. Yeah. maybe changes and they become this new creature. Don't get attached of new things. [00:28:00] Exactly. I love it.

And and then also at nine months I was pregnant again. 

What? No. So are you pregnant on purpose? 

Yes my husband, naively looking back, I would have waited a little longer, but my husband was very, him and his sibling were very close together. They were Irish twins, 15 months apart, 14 or something like that.

And so he's I want to have babies really close together. And I was like, yeah, sure. Okay, fine. And so we did. And my first three are each 18 months apart. And the first time it was, intentional. The second time we were like, oh, we're going to do that again. We're going to do that again.

Not so intentional. Yeah. How old are you at this point? So that's a great question. I think I had my first at 27. 

Oh, 

good. Okay. So you're 

young. Yeah. Okay. Good. 

Yes. Yeah. The next one at about 30 and then the third one, a year and a half after that. 

Okay. So for the second pregnancy, [00:29:00] do we feel a little bit more calm about it?

Cause we know how this goes. 

Yes. 

Okay. 

Definitely. Certainly more calm. Certainly more okay, I'm experienced now. I can do this. Some of that classic, can I possibly love to humans? The same amount, ? Cause I am so just enamored with my first baby, , how could I possibly love something else just as much?

And a little bit of that towards the end, I remember feeling a little bit of that conversation around Oh, I won't get time with just you really anymore and having some of the fear crop up around that. 

Yeah. It is a, zero to one is a big transition as is one to two. So that makes sense.

For this birth, are you imagining a birth center birth again? 

Same, which was the hope, which got completely squashed at 37 weeks where I had a Stroke symptom. 

Good God. What [00:30:00] happened?