The Labor of Choosing a Hysterectomy: Carrie

Carrie knows how bodies work. She's spent decades supporting women through some of their most vulnerable moments — and yet, nothing quite prepares you for becoming the patient yourself. In this episode, she joins Katie just two weeks after her hysterectomy to talk about the 30-year road to that operating table: the symptoms she managed, the decision she wrestled with, and the strange experience of knowing exactly what's happening to your body and still not having all the answers. Raw, real, and a little bit funny — this one's for anyone who's ever had to advocate hard for their own health while simultaneously being your own worst enemy in the process. 

This episode is best paired with a bowl of berry, coconut and rum punch served in cute vintage glasses.

Transcript

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Katie 0:00

Welcome to my podcast, Mindful Midwifery Presents: The Labor Behind Labor. My name is Katie O'Brien, and I've been a nurse midwife since 2007. I'm back at Carrie's house. It's two weeks post-hysterectomy, and she looks great. Her dogs Potato and Bertha are here for moral support This episode is about Carrie's journey on deciding to have a hysterectomy and what the surgery entailed and then how the recovery is going. We're gonna talk about what it looks like to make a life-changing medical decision and how that brings vulnerability with it, but also empowerment. Let's get started. I'm excited to have you back on the show, Carrie. You did the second episode, and it was great. And then coincidentally over this time, you happened to have this journey with having a hysterectomy, and I was excited that you agreed to go on this two weeks after your hysterectomy, essentially. Because it's nice to capture somebody in the experience,, in the middle of something. I think you have a very fresh perspective and, I wanted to go through that journey with you on, how you got to this point of having a hysterectomy, what your journey was with that, and then your recovery and then, moving forward, that kind of thing. So can we start with where did all of this begin for you? What was happening that this even started to become an option on the table?

Carrie 1:22

Okay. It's a good question, and I would say it's probably a 30-year process. And it's really interesting to talk as a patient who is also a midwife, and I think that's a muddy and very sticky place to be because sometimes I was dictating my own care, and sometimes I was relying on other people to give me care, and I wasn't necessarily going through the process in the past 30 years the right way as a patient. Meaning making appointments, following up appropriately. I was kind prescribing things for myself in a sense, like regimens and care plans, and also asking my friends and coworkers for their advice rather than having appointments. So 30 years of endometriosis and pelvic pain, that's the bottom line. And, bad, bad periods that I tried every single thing for. Ibuprofen, Tylenol, surgery, birth control pills, IUD, everything. And then ultimately, I'm about to turn 50, and I decided enough is enough, and I asked for a hysterectomy.

Katie 2:35

Were they recommending... When you finally did go to a care provider that you trusted, were they recommending a hysterectomy to you? Was it somewhat elective?

Carrie 2:44

I would say it was entirely elective. Nobody ever made the recommendation, but that might be because I never really went to anybody with really how bad it was. I never, had-- I never really I guess what I could say is that I suffered in silence for a very long time without ever really saying, "This is awful. This is terrible." Even though I knew it wasn't normal, i kind of always had my mind set that we should just deal with the pain. Even though I'm a midwife, even though I know better, even though I was trained that it's very real and that there are treatments for it, I always just, I guess, felt like I should deal with it, and I never really expressed how bad it was to anybody in an appointment setting.

Katie 3:33

It... That definitely happens across a medical journey in general. I can remember, when I was pregnant with my first, 40 weeks passed, 41 weeks passed. Nobody at any point counseled me on an induction- Yeah which is kind of funny because I, I, and I didn't ask. I was just like, "Okay." I think everybody c- like together was just thinking, "Well, at some point your baby's gonna come."

Carrie 4:00

"Okay." I think like together, was just thinking, "Well, at some point your baby's gonna come." Yeah. Well, it's the way it is, and it's really a problem, and I'm glad we're talking about this. The problem is that in modern women's health, women are made to fail at many things before they get a solution. So if you've had, for example, one miscarriage, most doctors and midwives, nurse practitioners, are gonna say, "You have to have three miscarriages before we work you up for miscarriage, thrombophilia, or a uterine problem. We're gonna make you go through this three times before we can figure out whether there's something we can do to prevent it." So that's wrong, frankly. And I understand the reasons they do that, and we really do need to take some subjectivity out of it and have real kind of protocols and standards. But to say to somebody, You have to have an IUD," or go through artificial menopause with medication, or take steroids, or take- nonsteroidals for 15 years before we give you surgery for endometriosis, since that's the only way we can really fix endometriosis ultimately. It's wrong. And because I was in the system, I knew that I was going to be made to do a million things before I ultimately got the solution.

Katie 5:25

That's true. Uh, the, the mind game you play with yourself. It's like a risk-benefit thought in your head of, "I'm gonna have to do all of these things. I'm not in the place to do all these things. Maybe my suffering isn't that bad. Maybe I can just push through it, or maybe I can try this other thing that this person told me that I was talking to yesterday." Yeah. And then you end up 30 years later.

Carrie 5:46

Right. And what ends ud- up happening is I have a hysterectomy, elective essentially, for fibroids and endometriosis. It's scheduled. I have a really excellent surgeon. The plan is it's gonna take three hours, and it ended up taking almost six hours because it was so bad. Everything was glued together. My organs were just gnarly with scar tissue and adhesions. There was even a window almost through my bladder from endometriosis adhesions. And the doctor, at the end of it all, says basically, "You shouldn't have waited. This should've been done a long time ago." And so I don't think that was anybody's fault, but a systematic fault that we all do this as women. We put ourselves last. We, especially as clinicians, are really bad patients, and I would say I was perfectly, to blame f- and guilty of putting myself at the end. And here we are. But it's over now, and I'm doing great.

Katie 6:53

great. We're particularly bad patients, but women in general are

Carrie 6:57

too.

Katie 6:57

It's, right now I am behind on every health, test category that I could be- Mm-hmm for my age bracket. Yeah. Everyone. And I'm at this point where it's actually overwhelming because I'm like, "Okay, I can start with this one place." And also I don't have anything that's so interesting- Mm-hmm that it's driving me, but that's where it starts, right? Yeah. It starts with, like, not having anything so interesting, and, oh, I'm taking... In my case, I'm taking my kids everywhere. They're going to all their things. They're- Sure. I'm checking all the boxes with them. Mm-hmm. But I'm like, eh, eh, you know, waiting on all this stuff. Yeah. And then, and then you're like, five years goes by- Mm-hmm and you're like, "I, I haven't had a dental exam in five years."

Carrie 7:41

Yes. And we're also bad at, like, taking supplements and then not listing them on our medication forms as medications that we're taking and, Part of it is too that the system, again, is just bad. It's hard to get an appointment.

Katie 7:55

That is exactly true. So I haven't had a dental exam in five years because I fired my dentist, okay? Well, not the dentist, actually. The dental hygienist. I almost wrote to the Board of Dental Hygienists, I guess. Anyway, it was a really bad experience, so I just was like, "I'm not doing this anymore." And then everybody that I get referred to that I think is gonna be better, they have a waiting list or they're not accepting new patients, and then so here I am, yes. And that's not good.

Carrie 8:23

not good. And, and we are privileged by being educated, and we have great health literacy. We have money. We have And think about all of the people who, who don't even have those things. The co-pays alone for specialty visits are, for me, $40 a pop, and I have the money, but lots of people don't. And so-- And, and, and also, like, the paperwork, Getting the hysterectomy, just as an example, I had to have a clearance from my cardiologist. The cardiologist required that I be seen within three months of having the hysterectomy. I was seen three and a half months prior, and I almost didn't get the clearance. It ended up happening because I asked for special dispensation, and they did it. A lot of people don't have the privilege of having money or having insurance or health literacy to be able to navigate this terrible system to get the appointment in the first place.

Katie 9:17

My mom is trying to, do a lot of, integrative health stuff right now, and there's so much testing, and she's, freaking out about the testing. Like, "Oh my God. Oh my God, I have all these, these places I have to go and all this blood work, and I have to do this test, and I have to do this test." And I finally said to her, I was like, "Mom, what's the worst case that happens? They have to draw more blood." You know? It's not, like, actually, like, a, like a horrible worst-case scenario, but you feel kinda like you don't know what you're doing. Every step of this process is new. You're going to a new provider for... you're going to a cardiologist to get clearance. You've never been there, so you got paperwork for them. And then, how's that experience gonna go? How much time do you have to take off? And it just, it snowballs, and it does feel very overwhelming.

Carrie 10:02

Yeah. Oh, the time having to take off too, regarding the hysterectomy. I actually kind of pushed this off a little while until the state of Delaware enacted their new law, which is to give paid medical leave and short-term disability. That didn't start until January, so I pushed this off until after January 2026 so that I would paid medical leave. That wasn't guaranteed prior to January for me, and it certainly is not guaranteed for most people. So this is, again, a systemic problem.

Katie 10:38

And so many people get hung up with FMLA that it's only gonna hit pregnant women. Mm-hmm Like, oh, that's only gonna protect them, and first of all, we should be protecting them. But even if you make that argument, it's not. Like in this case, now that it's being paid for, it will impact a lot more medical decisions than just pregnancy.

Carrie 11:01

Yeah. Absolutely. In- And to include partners- maternity leave.

Katie 11:07

Yeah. Yeah, it's huge. I, I went back to work after, I've probably said this before on the pod- pod- podcast, I went back to work at five weeks with my oldest, and- Mm I was not healed. No. I was not healed, but I couldn't afford not to go back. And there was also pressure in the environment that you were just putting your partners out because we were having to cover- Yeah completely. Yes so I made that decision, but l- l- looking back on it, like that decision was actually made for me. Right. I didn't actually make that decision. That decision was made for me by the system that didn't allow me really to have a viable other option.

Carrie 11:39

Right. And the expectation, too, that as a midwife, you would be able to bounce back faster or you... Just that we have these expectations for ourselves that we be expert pregnant women, even though that has nothing to do with our career. It's just that we don't differentiate ourselves from patients and midwives. We... Or doctors and patients. They also make really bad patients. Nurses make bad patients, um, because it's... We don't necessarily separate the two things when they're two very separate things. And that's what I was saying I was guilty of for over 30 years, sort of not separating myself from midwifery.

Katie 12:21

I have a perfect example of this. It's just stupid and funny, but I was a midwife for two and a half years before I had, my oldest, and, I brought all these clothes. I actually went out and bought clothes, Carrie, for, being in the hospital afterwards, and I bought the complete wrong sizes. In my head, I'm like, oh, all of this weight is just gonna magically fall off of me. Yeah And I'm gonna be a size, medium again, like I was before I had babies. And so I go to get my stuff out of my bag, and literally I can't even get the shorts up past, like, my mid-thigh, forget on. Terrible And I'm like, so I d- I, I didn't really have clothes to go home in. And, and I had been rounding on people for two and a half years, three and a half years. You should have known better. I should have known better, but that's the whole point, until you experience it. Right. You, you-

Carrie 13:09

And separate yourself

Katie 13:11

Yeah from, so I always look at these people now that have these great outfits on afterwards, and I'm like, "Wow, you had so much more awareness." It's tough.

Carrie 13:17

look at these people now

Katie 13:19

And I, and here I was with all this, experience in front of my eyes, and I, I couldn't even figure out what- Right clothes to bring.

Carrie 13:25

on at boards,

Katie 13:26

So did you have bad periods, from the gate?

Carrie 13:29

"Wow, I had so much more-" Foresight. Foresight. Yeah. And I, and here I was with all this, uh, experience in front of my eyes, and I, I couldn't even figure out what- Right to put on a

Katie 13:41

That's true. It's so subjective, right?

Carrie 13:42

Yes. Um, so did you have bad periods, like, from the gate? No, I think it became worse over time. I think it became worse over time. Also, hard to know what is bad. That's true. It's so subjective, right? Yeah. So the same with how bad is your bleeding. Is this heavy? What might be heavy to me might not be heavy to you. But I definitely think it got worse over time, and I certainly think that having an, a copper IUD made things worse. Because I did have one for years as my contraception, and my periods were awful with it, and they were... I was told they would be. I was told they'd be heavier and more painful, but it was bad. And I was taking so much ibuprofen that I think that probably made things worse too. I mean, nobody knows what causes endometriosis. I have no idea what caused my fibroids. My sisters didn't have the same problem. My mother didn't have the same problem. Who knows what the issue was or what the cause was, but it definitely became cumulative. And then I had surgery early on of lysis of adhesions of endometriosis. I had an endometrioma removed probably when I was 30. And, we already know that the more surgeries you have, the more scar tissue you get. So I probably all in all had three operations for a cystectomy, endometrioma, exploratory laparotomy, and a D&C. I had polypectomies. Years and years and years of multiple surgeries, for different things probably made things worse. And the fact that I never had a pregnancy probably made things worse because I had a period every month for every single month for years, and it's those, continuous menstruations that add up to worsening endometriosis. So yes, it got worse over time, but, yes, it's also always been bad.

Katie 15:32

All right. Let's talk about the surgery itself. I think a lot of women wonder about hysterectomies, and they have a lot of questions that they don't really get answers to or maybe they don't even know to ask them, and so they also might be suffering in silence. So let's talk about the actual surgery itself. W- well, let's start with how did you find your surgeon? Like, who did you decide was gonna do this procedure for you?

Carrie 16:00

I wanted to stay i- within Delaware. But I also knew I didn't really want any of my friends, coworkers, the doctors that I work with day in, day out, to do the surgery. So that limited my pool, because there's not that many OBGYNs in the state of Delaware. The reason I didn't want one of my friends to do it is because, frankly, it's private for me, and I don't really want them to see my business. But I also didn't want anything to go wrong, and they feel responsible.

Katie 16:30

Well, and to your point earlier, sometimes when you're taking care of a patient that you know really well, it's actually hard to have some of those conversations that you would just elicit from another patient. Like, you'd ask them things. But it's easy to assume that they would tell you because they're, they're more knowledgeable. So it, it is a weird dynamic. I think in this case it, it makes a lot of sense to not wanna have that dynamic.

Carrie 16:55

Exactly. It's not that I didn't trust them or think they were good surgeons. Not that at all. I just didn't want them to have to be involved.

Katie 17:04

You almost don't trust yourself with them- Exactly is what it comes to, because you want to be treated like you know nothing. And it's a little bit harder to, to do that- Right with somebody you know.

Carrie 17:14

else. So I chose also to have a robotic laparoscopic assisted hysterectomy, and I made that decision because the recovery time is much better.

Katie 17:25

Can you break that down a little bit more on what that is so-

Carrie 17:28

So Yeah.

Katie 17:29

understand that?

Carrie 17:30

so with a robotic hysterectomy, they're using robotic instruments in four incisions in your abdomen. One in your belly button, one suprapubic, and then two sort of on your sides. So they are using those instruments and looking through basically like a microscope to do the surgery using those robotic arms. And there aren't that many surgeons in Delaware doing robotic assisted, hysterectomies. They call it minimally invasive gynecological surgery. And when you simply put it in a Google search, there's really only two or three that show up. I chose to go with Christiana Hospital, and I chose to go with a female physician, and I met her only one time and hit it off really well with her. She's expert. She specializes in endometriosis. In fact, she's doing a, a grand rounds lecture on treatment of endometriosis using these techniques. So she's really an expert, and that's what I needed, is to find somebody who would treat me like a patient, not like a coworker, and who was expert in this. And, I made a great decision. She was excellent. The whole process was great. And really and truly, the recovery has been great. I'm two weeks out, and I feel probably too good some days and back to myself almost entirely. The problem with that, that is that I'm not back to myself, and I tend to push a little too hard. Yesterday I was weed whacking and tilling the garden two weeks post-op. And then last night I was a little bit sore, so once again, I was a bad patient, but I, you know, have to rein it in a little bit. Because the recovery's going so good, I, I'm wanting to jump right back to my life. In fact, I feel better than I did before the surgery, which says a lot about how I felt before the surgery.

Katie 19:27

Yeah. W- when your surgeon says that it should've been done, years ago. Yeah. A- and all those adhesions and, and so many organs were already involved for you. Mm-hmm. So now I'm sure you're feeling what it's like to not have all those organs involved.

Carrie 19:40

you know,

Katie 19:41

Yes. I think you were having trouble maybe with some urinary incontinence. Bladder. Yeah. So is that,

Carrie 19:47

So now I'm sure you're feeling what it's like to not have all those organs involved. Mm-hmm. Yes. I think you were having trouble maybe with some urinary incontinence. Bladder, yeah. So is that- So my bladder was attached to my uterine wall, and one of my big symptoms was incontinence, and it was every time I sneezed, every time I coughed, every time I laughed. It would just be spontaneous, urination.

Katie 20:04

And once again, you didn't have children. Yes. Because a lot of people think, "Oh, this is just related to childbirth and childbirth trauma," but that was not your story. Not my story. So here you are with this symptom.

Carrie 20:15

symptom. Mm-hmm. And I don't necessarily think the hysterectomy will be the total cure for that. In some cases, a hysterectomy can make incontinence worse. So I'm not saying that that's the solution. I think pelvic floor therapy is probably in order for me still. Um, but I'm hopeful that pulling the bladder away from the uterus, getting rid of the uterus, is probably going to help things quite a bit.

Katie 20:44

Well, and your fibroids made your uterus a lot bigger. Right. So that's kind of like a pregnancy pushing on your

Carrie 20:50

Yep, Exactly.

Katie 20:51

So hopefully- Yeah hopefully, fingers crossed, that is a big part of that story for you.- This is just kind of a silly question, but when was your last period prior to this, and, how long was it, and how excited are you to, like, not... Like, for one, for that to be, like, the last period. And you go into it knowing it's gonna be your last period. A lot of times women go into menopause, and they're, "Is this the last one? Isn't that the last one?" And then they can't even tell you. But you have a very definitive, "This was the last

Carrie 21:19

that to be like the last period. And you go into it knowing- Mm-hmm it's gonna be your last period. A lot of times women go in, somebody will call you and be like, "Is this the last one? Is that the last one?" And then they can't even tell you. Yeah. But you had the very definitive, "This one's the last one." Right. Yeah, so my last period was in, um, the beginning of April. My surgery was April 21st. So it was awful, horrendous, painful. So bad that in the middle of the night I actually thought maybe I was having an appendicitis or a ruptured appendix. It was so painful, and especially in one right side, that I thought I might need to go to the hospital. And this was just a normal period really And, um, it really validated my decision to have a hysterectomy because prior to that period, I had actually had second thoughts because one person said, "Why are you doing this? Can't you just wait another year or two until your periods just go away, and then you will avoid surgery?" So I did have people in my head who were telling me I didn't need the hysterectomy, just ride it out, but that last period validated the facts that I absolutely needed it. 'Cause if you are in the middle of the night considering going to the hospital for your period, then it's a bad period. Yes, I agree with that. And you could have ended up going

Katie 22:31

Yes, I agree with that. And you could have ended up going through all of that transition, and who knows how long it would've really been before you had no periods- Sure um, just to end up with symptoms that still were causing you pain. So much pain. Because your fibroids were how big? How big were your fibroids?

Carrie 22:47

Um, I th- the pathology report from my hysterectomy said multiple fibroids. It didn't list a number. There were at least five, and they were two to three centimeters each. But I also had adenomyosis. Adenomyosis is when the lining of your uterus is starting to embed into the wall musculature of your uterus, and what it does is it gives your uterus a very nodular appearance. It doesn't have a smooth surface. Internally and externally, my uterus was bumpy. Let's just say it was not round at all. It was mostly like a road with a lot of bumps in it, internally and externally. So multiple fibroids, two to three centimeters, that's not actually that big. Two to three centimeter fibroids, they wouldn't necessarily do a hysterectomy for, but the fact was that there were a lot of them, and again, who knows what's the cause? But adenomyosis alone is an indication for a hysterectomy because it's very painful, and the sad thing is it's not something that's really seen on imaging, so w- it's under-diagnosed, and people might go for a ultrasound for pelvic pain, and it's not necessarily going to pick up adenomyosis, and so they don't get the diagnosis, and they suffer.

Katie 24:14

Did you have that diagnosis before you went into surgery?

Carrie 24:18

diagnosis before you went into surgery? No. I had one ultrasound tech who I knew personally, 'cause we worked together, tell me, "I think you have adenomyosis because you have this Venetian blind sign on your ultrasound." So she told me it personally. She's like, "It looks like it to me." This was a very experienced ultrasound tech. When the ultrasound report came in, the radiologist said nothing about it. So I only got that kind of insider information from somebody who was my personal friend and coworker because I'm an inside person.

Katie 24:52

So that must have all validated your decision, too.

Carrie 24:55

decision, too. Mm-hmm. Right, and one time, back to that, I had an ultrasound done not that long ago that was completely normal. They didn't say one single abnormal thing on my ultrasound. How they could have said I had a normal ultrasound when every ultrasound to that point showed either endometriomas or cysts or fibroids or polyps, I have no idea. But it goes to show that not all your imaging is gonna be accurate. Even though they had the pictures, they are subject to the photographer or the radiology tech and the read It's not an exact science. And that's where a lot of AI comes into things, and so does robotics, because it kind of takes out the subjectivity.

Katie 25:43

So a traditional hysterectomy, I don't know, what do they call it? We'll call it traditional hysterectomy that is not robotic. Did you do research on what that looked like as far as recovery and process and-

Carrie 25:55

it tr- what would they c- just... Well, we'll call it traditional hysterectomy, that is not robotic. Um, did you do research on what that looked like as far as recovery and process and- Yeah, I certainly did do the research on that, and of course, I know some of it from working as a midwife all these years. But there's even a lot of differentiation between what you're calling a traditional hysterectomy. What are we talking about exactly? An open hysterectomy, where they're doing a vertical incision, or a laparoscopic hysterectomy, where they're going through the belly button. Are we talking about supracervical hysterectomy? Are we talking about complete hysterectomy or radical hysterectomy or removal of the ovaries? There's lots of differentiation even within the term hysterectomy, traditional versus robotic. And in my case, by the way, I asked that they keep the ovaries, take away my tubes, unless they got in there and saw that the ovaries were gnarly and needed to be removed. So ultimately, I was able to keep my ovaries, which means I do not have, hormonal menopause yet. I will still have the ovaries pumping out estrogen and progesterone, and, that's different than if they had to have them both removed.

Katie 27:08

And your ovaries looked good.

Carrie 27:09

good, like- My ovaries looked good enough to save. Good enough. Mm-hmm. Yeah, good enough to save. And so, um, there's just so much differentiation when we talk about hysterectomy. It's a massive

Katie 27:21

Yeah, that actually sounds, when you list that all out, that sounds, a little bit overwhelming kind of how to figure out what you would want and what the surgeon would want. And I know there's, there's been discussion about, for years there was discussion about whether or not even to leave the cervix and- Right all of that.

Carrie 27:39

How many times have you had patients that you've seen for annual exams with a history of hysterectomy who don't even know if they have a cervix?

Katie 27:46

That is such a great point. I'm glad you brought that up because it used to drive me crazy. I'd be like, "How do you not know if you don't have a cervix?" Because, for context, for anybody that's not in this field, if you don't have a cervix versus if you do have a cervix, that alters whether or not you need Pap smears. So that's, that's confusing, and sometimes, interestingly, when you go in to look on somebody that's had a hysterectomy, it can be a little bit hard to totally know for sure- Yeah if they've had a cervix removed or not.

Carrie 28:14

Right. Or if they just have like a, a stump or if they have a cuff. Yes. It's a complicated... And why they had to have the hysterectomy

Katie 28:24

Sure. A

Carrie 28:24

lot of people don't even know why. Right. And, even if they had their cervix removed, but it was because they had endometrial cancer, they still need to have a Pap smear of the vaginal walls. Mm-hmm.

Katie 28:36

Mm-hmm. Yeah, it's a good point too when you go down a journey with this magnitude, that you really understand what was done to your body. Yeah. And what the implications of that are, and I don't think that surgeons... Surgeons are, especially surgeons that are doing hysterectomies, in whatever way they're doing them, that's a surgeon that has a high, surgery component to their career. Meaning they could be an OBGYN, but they really do a lot of surgery. Like, your OBGYNs that are not doing a lot of surgery are not going to do hysterectomies. Like, that's just gonna be something that they don't do- Mm-hmm regularly, unless, like, they had to be... for a patient that was hemorrhaging. But short of that, that's not gonna be, like, in their wheelhouse. So you tend to have providers that are, that are very surgeon, mindsets. They're not necessarily gonna be the ones that have that, teaching aspect so as a patient, you also need to be asking the questions because they might be the most excellent surgeon in the whole wide world, but they might not be- Yeah the educator that some of the other providers are gonna

Carrie 29:42

For sure. That's absolutely true. It also falls on the patient too, to have, to understand what was happening to them, like you said before. You really need to ask the questions as a patient. Exactly. I will re- reiterate that. And I

Katie 29:57

that. And I think it can be helpful... I, I remember during, COVID, I injured my knee during m- not the, quite the exact height of COVID, but very shortly after the height of it, and they were not allowing, support people in the rooms, for your visits. And I was very bothered by that because I, one, I went to, this orthopedic clinic, and these people are coming in and they can't walk. Yeah. And it's... And, and they didn't have enough support staff to actually physically help these people walk. So I'm like, first of all, this is insanity that you can't have a support person when you can't even get in the door. Yeah. And nobody's here with a wheelchair- It's insane or... It was, it was insane just on that level. But then the second piece is that I'm not a particularly good patient. I hear what I wanna hear from people. Mm-hmm. Like, like especially when you talk about activity levels, like what you're gonna be able to do after, how your recovery should go. I, I have totally already made that narrative up in my head, okay? Mm-hmm. You could be saying something totally different, and I'm hearing like three words. That's right. Um, so it's been helpful for me to have my husband, who's exactly the opposite of that, like here, and he's very detail-oriented, so that he can tell me to, quote, "Sit my ass down" when I'm not listening to these things, Yeah. And so I think when you c- talk about a hysterectomy and all of the, this stuff, especially if you're not medical, having a second set of ears can be really helpful to be like, "Okay, this is what we had done," and, you know, all that. Right. Yes.

Carrie 31:31

Yes, without a doubt. And i don't know why I'm thinking of this now, but I think that over the years it would be to my husband that I would complain about my women's health issues. Of course, because he's my intimate partner, he's my partner, I live with him, and he's the closest one. But he would always say, "You're the women's health provider. You should know the answers to these things." So it's, so when it came to having the hysterectomy and making the decision to have the hysterectomy, it was really important for me to involve him in the decision, but also to have somebody other than myself come to my appointments with me, who could just give a different perspective. And so I chose to have my sister come with me to appointments, and bring me to my surgery, and hear from the doctor, and stay with me after my surgery. But just to take away that, "You're the midwife, you should know," that out of it and have another person with a different perspective be my support. Whether it's your partner, your friend, or your sister.

Katie 32:40

We all have our strengths- In what we're able to, to handle and, you can't put so much pressure on one relationship in your life that they're going to be the end all to you. Yeah. So sometimes I think that, yeah, it might not be your... And there's n- and there's nothing wrong with that. Right. It's just who, who's capable of, of doing that. My husband is like, he's a strange mix because My husband has a lot of medical anxiety, so there are certain things he like- Yeah can't handle, but he's interestingly pretty attentive as like a nursing role, so I don't know. It's a mixed bag. And definitely my mother would be somebody I would, typically ask as well. Yeah. But she is, she's like so natural oriented sometimes- Yeah you know, that,

Carrie 33:23

is, ugh, she's, like, so natural oriented- Yeah sometimes, you know? That- Yes, I do know. Well, I think that what, that was part of probably the delay in me getting a hysterectomy was that, um, my mother and my sisters, who were people I went to for advice, they didn't have the same problems that I had, and my mother had five children, no problems, unmedicated. She actually one time told me that, throwing up when you were pregnant or having morning sickness was made up, because she never had that experience. And so it's really hard to go to people with problems with fertility and endometriosis who didn't ever have that problem, because they're gonna come with their own expectations and advice. So it's really interesting to, how you mentioned that your, your mom is a natural-minded person. That's how my mom was, too, and probably why I put up with shit for so long, because I felt I should be able to, because my mother did and my sisters did, and a lot of other women I know did.

Katie 34:29

It's almost this weird version of midwives feeling pressure to have a natural labor. Yes. Like, I mean, an unmedicated labor.

Carrie 34:37

feeling pressure- Mm-hmm to have a natural labor. Yes. Like, and an unmedicated labor. Absolutely, or to have a pregnancy, period. Yeah. Just to be able to conceive, no problems. Yeah. No need for medical interventions. Um, and this is a really great time to talk about, that medica- medical intervation- intervention is sometimes necessary. And we went into midwifery with a certain mindset, and to be frank, sometimes it's anti-medical. But the reality is medication and medical intervention, vacuum-assisted birth, cesarean birth, infertility treatment, IVF, IUI, Clomid, s- surgery for, hysterectomy a hysterectomy. All of these things are life-saving and necessary when they're necessary. The problem is to try to figure out when is it necessary, but also accepting that sometimes things can be elective, too, and that's all right. Sometimes it's not that you have to fail a million treatments- Before you have IVF. Sometimes you shouldn't have to have three miscarriages before you get a blood workup to see why you're having miscarriages. There should be some component of choice. Again, we talked about this before in my last podcast. If you're pro-choice, you should be pro all choice, and that might even mean elective cesarean section. It's hard to take those boundaries and slice them up a little bit, and to take our opinions out of it. And sometimes nature is the best medicine, but sometimes medicine is the best medicine, and this is, something that it's taken me 30 years to come to a conclusion on. But, I will have to just also say that my own grandmother died, her name was Carrie, I'm named for her. She was 26 years old when she died post-hysterectomy, and back then in 1931, we don't... I'm sorry, 1941, we don't even really know why she had a hysterectomy. It could have been a ruptured ectopic. It could have been endometriosis. It could have been bowel adhesions. It could have been any number of things. But, we've come a really long way in medicine, but it's not always life-saving, and in my grandmother's case, she died.

Katie 37:01

That is a, a mind Yeah. That really messes with your mind, Carrie. Yeah. Named after your grandmother- Yeah who died from this procedure you just went through. Like- Yes holy hell. And, and

Carrie 37:14

and for reasons we don't really even totally know. It was probably an ectopic rupture.

Katie 37:19

That's wild.

Carrie 37:20

And people still die from those

Katie 37:22

Yeah.

Carrie 37:22

People still die from miscarriage.

Katie 37:25

I d- I don't know if you've ever seen The Knick, which, uh, I'm so bad with how to describe shows. But it's about the, the dawn of anesthesia. It's not a documentary. It's a, a drama. And the opening scene of it is- Just so intense. They're taking a woman back that has a placenta previa, which is, the placenta growing over the cervix, and they are doing surgery on her. And she dies, and they walk out, the, surgeon just walk out, and they m- mention this fact that, everybody that they've done this procedure on has died so far. It's, like, 30 women or something like that. And the one guy kills himself, the physician, like, instantaneously. Wow. And it is such a graphic moment, but it really puts into perspective how far we've come in medicine and the lives that we've lost to get where we are right now. Like, placenta previa is a death sentence. Yeah. So if you, we didn't have surgery, these women would die. This is not like a, like a, we're over-intervening here. No, like, this, this is a death sentence. Yeah. And luckily for us, it's not now because we have excellent surgeons. Yeah. And we have excellent anesthesia. But the process of how to, how that has, grown, when, when you see that scene, That's a scene that I can remember more than most any other scene from any other show. It is just so intense and so, mind-blowing Of just how far we've come. Yeah.

Carrie 38:55

And yet we still have a long way to go. We still have really bad mortality rates for infants and for mothers, for various reasons, but we have a long way to go. And I really think a lo- large part of it is that we, we have a really bad system of getting appointments and listening to women, and making people go through so many hoops and hurdles, either paperwork or insurance-wise, or, I keep saying it over again, failing at certain treatments before you give them the ultimate treatment. I think we have a long way to go, but it's-- these conversations are a big step towards it. It's very much on topic for infertility treatment right now, for example, that we do, offer young women the ability to bank their eggs, for example, because we know people are derl- delaying their fertility until after a career is started, for example. That's just one example. It used to be that you weren't allowed to do that unless you had gone through chemotherapy or were getting a hysterectomy early for cancer for something, or something. But nowadays, we have all kinds of options, but people don't know about them or even talk about them enough. We're starting to, but there's all kinds of choices for preserving fertility or for avoiding jumping through k- all kinds of hoops to get to your ultimate conclusion or decision or

Katie 40:32

But it is very pricey.

Carrie 40:34

It's expensive.

Katie 40:35

And I think that's a big problem it used to be that, the m- especially what we would define as the middle class, had relatively good insurance. If you were working, you'd have really relatively good insurance. And we really... And then the upper class was able to pay for- things, right? And then the, lower class w- they were protected by some, like, Medicaid or s- society-driven healthcare. Right. But you're starting to see with th- those that are working, these massive high-deductible plans- Yeah that really, it's like insurance but kinda not. I am intentionally on a, a high-deductible plan because I have an HSA with it. And so I'm able to bank money with this HSA, which an HSA is fantastic. But it does make you not wanna use healthcare. And so then you delay things because you're like, it's not really worth it, and this year we haven't had any, problems, so why, why would I do it right now?" Right. And so then you wait, maybe, I don't know, until- Right you hit a deductible. And so you- It's a

Carrie 41:42

good point. The deductible plus also that insurance dictates too a degree what they'll pay for and when. So they will also make the decision for you, like, "We're not going to pay for hand surgery until you do six months of physical therapy first." These are just all kinds of dictates that are based on the cost. Yeah. And ultimately, it costs more for everybody in the end when we delay things.

Katie 42:12

Yes, it does. But we're not, we're not a preventative health nation. No, not

Carrie 42:16

No, not at all.

Katie 42:17

what we, we strive to do. Mm-mm. So that is problematic. You can see how people end up in this not addressing things, in a timely fashion. And getting appointments is really becoming more and more challenging. Yeah. W- in any specialty.

Carrie 42:34

Yeah.

Katie 42:35

And that's problematic. We, we also need, like, a shout-out to more, APRNs and- PAs, like these, these levels, like how nice would it be that insurance actually made it possible or forget insurance, our system made it possible that you met with someone that went over your hysterectomy step by step by step with you- Yeah before you had your hysterectomy- Yeah and then checked in with you about a week later and went over all of the things with you. Yeah. Made sure you understood what parts of your body were actually taken out- Yeah right? And what that would,

Carrie 43:12

would, um- Affect

Katie 43:13

later- Yeah as far as testing and whatnot. But we don't value that, so we're putting that on, on a surgeon who is not... That it's really not their role. It's not really what they're, one, a lot of times good at, or two- Right what they're really being paid for. So you have these, these gaps in understanding and, and that could be solved. That's actually not rocket science how you could fix that. It's just not paid for.

Carrie 43:41

lot of times good at, or two- Right what they're really being paid for. Um, so you have these, these gaps in understanding. And, and that could be solved, and it's actually not rocket science how you could fix that. It's just not paid for. That's right. I had a great conversation pre-operatively with a nurse on the phone who gave me all of the pre-op instructions, and she was fantastic answering questions. Um, and interestingly enough, she was surprised by the questions that I had and said to me multiple times, like, "Nobody has ever asked me that." 'Cause I asked questions about like, should I do pre-op bowel prep? Should I do a post-op bowel prep, um, or bowel regimen? And I asked if I could keep my uterus, and she had never once had that question asked of her. Like, we always talk about keeping placentas, but nobody had ever asked her about keeping the plas- the uterus, um, post-op. But so great because I had a really good nurse using her time to go over all of those questions with me. But right, we need to give more props to APRNs, PAs, midwives for a lot of reasons, and one of them being that it's really hard to get appointments with doctors anymore, and we do fill in the gaps. As clinicians, mid-level or whatever you wanna call us, we fill in the gaps of getting people in, even for basic colonoscopy pre-op. It's really hard to get in with the surgeon s- uh, gastroenterologist, but it's a lot easier to get in APRN for those basic screening tests that we need to do. We fill in a major gap, and part of that is cost, and we do need to lower the cost of healthcare, and this is a great way to do it.

Katie 45:27

The term mid-level has become very offensive. Yes, it has. But the interesting thing is that when you think about it just grammatically, it's a very good word. Yeah. Right? Um, we're not nurses, we're not physicians. We're some bridge in between. But that, but I think the offensiveness of that word is actually a little bit of a narrow view- Mm because the reason we feel it's offensive is that we're not being treated professionally a lot of times. Just baseline professional,- and acknowledged for what we're capable of. So mid-level sounds offensive because it's like you're not professionally recognizing me as a

Carrie 46:05

clinician Mm-hmm.

Katie 46:07

But the interesting thing is if we could take that away and we actually were professionally treated, mid-level, like a mid-level person, is actually super important in our- Yes in our, system. Yeah. You don't need to go to a surgeon who y- takes forever to train. Okay? It takes forever to train a surgeon. Mm-hmm. Um-

Carrie 46:27

Especially these fellowship robotics- you

Katie 46:30

don't need to go to that person to tell you- Mm-hmm how to do all these things and how to prescribe some of these medications that you might need, and how to do some of this aftercare. You don't actually need that from a surgeon, right? Right. But a nurse isn't gonna be able to have the scope for some of this. So in fact, it is a mid-level position, right?

Carrie 46:50

I agree.

Katie 46:50

Um, but- Semantics. It is. You

Carrie 46:53

we get caught up in that, but the reality is that we are a middle...

Katie 46:59

Level. Level. And we should be- Yeah proud of that. Yeah. And the big problem is not that we are mid-level, right? Mm-hmm. It is that we haven't been treated- Respectfully professionally and respectfully for the role that we have that is unique to us. Yes. Right? Um, they just try to kind of shove us in one category, and it doesn't fit right. But, not that I think we need to be reverting back to the usage of mid-level per se, but I just think that w- word-wise, that, that actually works, and we should be proud of that role. We should not shy away from the fact that we are not surgeons, and we are not

Carrie 47:33

We are a stepping stone.

Katie 47:34

Yes. We are a bridge- Yeah between the two. Yes. And the bridge is so important- That's right for good patient care.

Carrie 47:40

absolutely is.

Katie 47:42

Yes. Okay. I wanna talk about, for somebody that was looking at having this procedure, like, about to go through it very soon, What did day two look like to you compared to, two weeks? Like, how did that progression, go as far as your- Post-op recovery? Yes. As far as your recovery. Okay. Like, what were you able to do? How quickly? What are you still working on?

Carrie 48:05

on? We'll start with day one of surgery. Day one of surgery, I had to get there very early in the morning, and the first thing I had to do was a pregnancy test, which is ironic 'cause I've never had a positive pregnancy test in my whole life, and we laughed like, "Wouldn't that be crazy if I couldn't get this done because I was pregnant at 49 years old with a history of infertility all this time?" I wasn't pregnant. The surgery was done. I got to go home same day. First day I cramping and obviously anesthesia-related side effects, so lots of grogginess, fatigue. Second day of surgery, or I guess you would say day one postpar- post-op, I had really bad cramping and really, really bad constipation. So I knew that was gonna be the case, and they had me doing MiraLAX and stool softeners. The cramping was fine with ibuprofen and Tylenol. Frankly, that's all I needed. Rest, ibuprofen, Tylenol, a little bit of heat, alternate ice. Things I didn't know I was going to have were really strange things. First of all, I had extreme facial swelling, absolutely insane amount of eye swelling and facial swelling, and that was because for almost six hours I was in a Trendelenburg position, which is the position where you have your head slightly lower than your feet and your heart. And they do that for this operation. They tilt the table to get a little bit of lift on your pelvic organs. So when you're six hours hanging upside down, all of the swelling goes to your face. Nobody told me that. It was intense. Um, I also had a lot

Katie 49:50

it hurt? Sorry to interrupt It was stunning- But did it hurt? Or it just-

Carrie 49:52

facial. It was not-

Katie 49:53

"Oh my God," when you

Carrie 49:54

Yeah, awful looking. Awful, awful, awful looking, like I'd gotten beat with a baseball bat in both eyes. The constipation I a- anticipated. That also is because anesth- anesthesia slows your bowel down. They're moving all of your organs around. They, give you medications like narcotics that slow your bowel motility. So constipation I knew about, but it was worse than I thought. Day one and day two and day three, I really struggled. But you aren't tol- you're told that you don't expect a bowel movement for three to five days. And some people have bowel movements every day, like myself, and so that was really a struggle, but I knew it was gonna be the case. So you get through it, but it's pretty bad, and it's almost worse in some ways than the pain.

Katie 50:43

the pain. I think th- that is an underrated pain. I tell this to women that are post-op C-section- where they're just taking all these narcotics. I'm like, "At some point, the constipation you receive from these narcotics is gonna far outweigh the benefit that they're causing." I couldn't agree more. And you need to get off of these as quickly as possible. And actually, my dad, after his double hernia repair, got so constipated, from the narcotics, and they had not given him a good bowel prep re- re- regimen. And so when I talked to him, I don't know, it was a couple days after surgery and he was, like, so constipated, maybe, like, day five. And he was taking narcotics at this point really probably to treat the constipation pain, which is just- Mm-hmm uh, something that happens to people when they're post-op, and it is so bad. So he quit all of it cold turkey. Then he's, like, withdrawing. And then he went to the bathroom, and the entire house smelled- Oh, no for, a couple hours. Oh, buddy. It was so bad. Yeah. Yeah. But then he felt so much better. Yeah. He was like, "Why didn't, why was I doing this? Why did I have these, all these narcotics and no bowel prep?" I'm like, "I don't know. Your surgeon didn't give you bowel prep, Dad." Yeah, it's something

Carrie 51:49

it's something that That I think is not talked about enough.

Katie 51:53

enough. 'Cause there's no mid- there's no mid-levels-

Carrie 51:56

Saying, "Take the MiraLAX, take the stool softener, eat fiber, have some Smooth Move tea, avoid the narcotics." I only took one Percocet for pain relief,

Katie 52:07

And you still had all that constipation, I imagine.

Carrie 52:08

still had all that constipation. And I still had all that constipation. And the other thing is they, especially with laparoscopic surgery, they blow up your abdomen to distend everything for viewing purposes with basically gas, air. So that gas has to go somewhere, and it's trapped, and it's coming up a lot of times. So postoperative, you have gas pain that is so intense, and some of that gas pain goes up to your shoulders and can feel like chest pain. If nobody tells you this, then you don't anticipate it, and you feel like you're having a heart attack because there's air i- trapped, like, near your lungs, near your rib cage, to your shoulders. My shoulders post-op and my arms were so sore, but that's also because you're strapped down for six hours in one position, and all that gas is kinda pushing up. So the other thing I had postoperatively was a lot of intense shoulder and arm pain. And the, um, last thing I should mention in terms of side effects from surgery was that you have a lot of bladder spasming because you've had a catheter for however long your surgery is, and that by itself causes some urethral discomfort. But it also causes bladder spasms. Once your bladder has to find a new place to rest inside your pelvis, you can end up with this kind of sense of urgency to pee that is just a sensation, really.

Katie 53:40

That is a very good description of all that, actually. And that affects, C-section patients too, to a lesser degree. Did they, did they tell you to move around?

Carrie 53:51

Yes. I was told to start walking immediately. First day, take a walk, go for a walk, and that really did help things. Move the air, so to speak. Also h- decreases constipation risk. I was told to resume sort of normal activities around the house at one to two weeks, believe it or not. No heavy lifting, no intense cleaning, no, vacuuming, but just basically, like, picking up and putting things down, resume it at one week. No driving for two weeks. No sex for 12 weeks.

Katie 54:25

No sex for

Carrie 54:26

It's a very long

Katie 54:27

time. It's a very long time. That's longer than

Carrie 54:29

Yeah. And that's because you h- Isn't that

Katie 54:31

that- Although isn't, isn't that interesting, though, that it's longer than a vaginal delivery? Because I think we undersell that for people that have significant repairs vaginally. Yeah. I'm always like, "Uh..." Like, if you have a really, really deep second-degree- Yeah or a third-degree or a fourth-degree, it's like, that is not gonna feel healed at,

Carrie 54:49

at- Yeah six

Katie 54:50

weeks. But anyway, um-

Carrie 54:52

12 weeks is a long time, and, you know-

Katie 54:55

But why did they tell you it was 12 weeks?

Carrie 54:57

It, because you have an internal cuff. Basically, they have to close off where your cervix was. They make a new sort of seal. If you think of it like a turtleneck, they're closing and stitching the neck of the turtleneck together, and that's up inside your vagina. There's no cervix there anymore. So you don't want that to bleed or break down or get opened up during intercourse. That's the bottom line. You could still bleed for a while after a hysterectomy, from that cuff, and so they don't want-

Katie 55:39

are you still bleeding now? Like-

Carrie 55:40

very minimally, but yes.

Katie 55:42

Okay. What, what did they tell you is the length of time you could

Carrie 55:45

Could be up to six weeks.

Katie 55:46

Okay. But it's light- It's light for you right now?

Carrie 55:49

Yes, very light. Like pink.

Katie 55:51

Yeah. Um, well, yeah, three months, but one of the things that I imagine will be so good for you is that you travel a lot. Yeah. And I have to imagine that the idea of, like, not having to worry if you're gonna be on your period again is, like- Yeah, that's

Carrie 56:07

Yeah, that's gonna be wonderful. That's great. And, uh, the idea of not having to carry all of the products with me, even though after almost being 50 years old, I still was really bad at remembering to have tampons or pads or my cup every single month. It was always a surprise when my period came, and I was unprepared. I didn't have what I needed. You know, have your period every single month since puberty and you still don't have what you need at all times is really a, a real problem. I get it.

Katie 56:36

I get it. I had to put a tracker on my phone at- I think I did that at probably about 34- Mm-hmm when I realized I was, like, a teenager coming into the office. Like, "I have no idea when my last period was. I don't know." Yeah. "I think it was in the last month." Yeah. It's terrible.

Carrie 56:52

But yeah, I'll love to travel freely without having to worry about that. Plus the stuff is expensive.

Katie 56:59

Yes. It does, HSA does cover

Carrie 57:01

Oh, that's nice.

Katie 57:02

I- that's a big, that's a big thing, HSA, FSA funds, in case you don't know that. Although, I have taken them, To Target, like, the checkout, and at one point, one of them wasn't covered, and I was like, "Why did this one not get covered?" Probably just wasn't in the system right. But interesting. Anyway.

Carrie 57:16

and I was like, "Why did this one not get covered? Probably because it wasn't the system, right?" But interesting. That's good to know. And also, we've been so lucky, I've been so lucky working in women's health all these years, that every office I've ever worked in has always had an endless supply of women's health sanitary products. So I've always had, like, sort of tampons and pads at my disposal- Oh and extra scrub pants we call them emergency pants. I would always have to change my pants during every menstruation because I would bleed through pads or tampons or my cup overflows. Every time I would be pushing with a patient while I was on my period, I would bleed through my pants because even though I wasn't actively pushing, I'm in the room for two hours, and there must be some kind of contagion to the- the process because every single time I would just overflow. Oh,

Katie 58:02

Oh, God. That's a whole nother little- side topic. One of our midwives was having to pump regularly, once they had the portable pumps, pump while patients are pushing. It's so ridiculous- Yeah when you think about it, like- Yes what we're doing to our bodies. But anyway.

Carrie 58:17

Yeah. And it's so ridiculous that even though we're in women's health, it's still embarrassing. Yeah. It's still like no one's really talking about it, and nobody really, n- there's not a single person who wouldn't be embarrassed if they bled through their pants. Yeah.

Katie 58:32

Yeah. Right. It's true.

Carrie 58:34

And it's like we all do this every month. Yep. Why is this still embarrassing? It's... Oh.

Katie 58:39

Uh, so besides no sex for 12 weeks, what's the restrictions past, the first two weeks that

Carrie 58:47

so no heavy lifting, basically. No pushing, no pulling.

Katie 58:51

For six weeks or 12?

Carrie 58:53

for me, it's four weeks, and then I'm returning to work at four weeks. That's if everything goes right. And that's because I had the robotic surgery.

Katie 59:01

Yeah, the non-robotics would be more like six weeks six weeks.

Carrie 59:05

So yeah, go back to work at four weeks. In the meantime, I'm just living my life, doing my thing, having time off and taking it easy and watching lots of, The Pit on television, and just spending time walking outdoors. I have to say, I've been really, really lucky. I've had a visit from a lot of people post-operatively have come by just to see me or call me, tons of texts. And being a midwife, having a lot of midwife friends, I'm so lucky because I've had the best post-operative... I've had, like, six midwives that have come by just to check on me. So I'm really lucky. I've had, home visits by midwives- All for the last two weeks.

Katie 59:47

I would have, come by for sure regardless, and I, but I timed my visit, very intentionally. I was like, "Well, if I come around two weeks, you'll," God, "I hope, be in not too much pain." Mm-hmm. "But not quite hitting your stride yet where, you know, you wanna be out. Like, like, you should still probably be- Yeah kind of home-based at this point." So yeah. Wouldn't I feel like I, I hit that right? Yes, you got it

Carrie 1:00:12

you got it perfectly.

Katie 1:00:13

And, there's only one

Carrie 1:00:14

and there's only one other thing I wanna talk about, which I haven't talked about, and that is the decision to wait to have a hysterectomy because of fertility. Obviously, once your uterus is out, you can't carry a baby. So I think part of my 30 years of putting up with this was the hope that maybe, just maybe, I would get pregnant, and I would be, cutting off that possibility if I had cut out my uterus 10 years ago when I was only 39 years old. So I had that always in the back of my mind as this, like, hope of all hopes. There would be a miracle that I would conceive despite the endometriosis, despite the fibroids, despite all of the reasons I couldn't get pregnant, that I would get pregnant. And then I think I had to come to that decision, like, I, even if I did get pregnant by a miracle at 49, I really wouldn't want that. So I had to wait for that, like, ending to my story, so to speak. Like, there, there's no way I'm gonna get pregnant. Let's just get rid of this uterus once and for all. So it became clear to me that it was useless, but I had to really wait for that to become clear to me. So I would be remiss to neglect to mention that obviously I waited a long time But there were a lot of reasons, and fertility hope was one of the main reasons. You know, I wanted to have a baby. I didn't have one, ultimately, and I waited till I, uh, that became absolutely clear to me before I decided to have a hysterectomy.

Katie 1:01:55

That makes total sense. I'm sure you actually had to grieve it. Oh, yeah. Like, you had to grieve that fully and come to the place of full acceptance of that grief- Yes to then be able to say, I can do this to myself." Yes. 'Cause it's very much you're do- you're making this decision. It didn't happen to you. Right. You made the decision.

Carrie 1:02:14

It wasn't that I had to have it done because I was hemorrhaging out or dying or had a rupture or anything like that, no. It was a decision that I had to come to, and yes, I had to grieve all of the reasons that I had to have it done.

Katie 1:02:31

done. Did you feel like you had to have a conversation with Jimmy about that? Did you feel like it was... Or was he just supportive enough about this the whole time that it wouldn't have mattered, you could've come to him at 39 and been like, "I'm done," and-

Carrie 1:02:45

come to him at 39 and been like, "I'm done," and- Oh, yeah. It would've been my decision ultimately. Uh, we always were talking about it all along. And again, my infertility, there was never a conclusion as to why I was infertile. Ultimately, I think there's many reasons that I was. It would've always been okay whatever I decided. To him, it would've been fine no matter what. As a midwife, really, really, really, really wanted the do nothing approach. I wanted everything to happen exactly as they were supposed to naturally, without medical intervention. That didn't happen for me, and I will say, I think that was a lesson that I really needed to learn, that sometimes you don't get what you want, whether it's a normal, healthy baby without a syndrome, or a pregnancy period, or a full-term pregnancy, or a vaginal delivery. I think that I went into midwifery really thinking that we were in control of our destinies in some way, and the lesson I learned in my life and in my career is that there's a million ways to skin a cat, and you may have to jump through hur- hurdles. You may have to take the medication. Not everybody- happens by things easily, and sometimes you have to push for 10 hours. Sometimes you have to have a cesarean. Sometimes- hysterectomy you have to is, to ha- have a hysterectomy. Sometimes you have to have IVF. Sometimes you, do all of those things, and then you still get pregnant naturally- after failing at everything else. There are still miracles.

Katie 1:04:31

We have lots of examples of

Carrie 1:04:32

in. We have so many examples. We all have a million examples, but, like, I, I, I constantly will see patients that come in the door who are a total enigma. Like, how in the world does a 375-pound woman with chronic hypertension, kidney disease, and hypothyroidism accidentally conceive? How does that happen? But it happens, and we have a, a million stories just like this. And how is it that the person who is counting the number of almonds they eat and not doing anything wrong, no smoking, no drinking, no caffeine, having sex on day 14 of every of every menstrual cycle, how does that person not get pregnant? Like, the opposite is true. But w- so many stories like this.

Katie 1:05:23

That's what, to me, really defines midwifery, like, how, how midwives often view the world. A midwife's view on the world is that it's, it's unpredictable, and there's no amount of control that you actually really have. Right,

Carrie 1:05:40

or choice. Yeah,

Katie 1:05:42

A lot of times it's true. A lot of times. And for me, it's always come down to, in my head, it's statistics. I actually really love math, and s- particularly statistics. And it's just a stats game all the time. Like, you happen to be the person that- That statistic holds for, you know? Yes. And, and it's not personal. It's not, it's not personal for the univ- it's a stat. Yeah. It's a, it's a roll of the dice. Yeah.

Carrie 1:06:10

and you always have heard me say that you can't use your own personal statistics- Right to predict- Other people's process or even your own next process. Your, I always say, your N of one, your one experience, has no bearing on your second experience. The fact that you conceived naturally, easily at age 26 means nothing for your conception- At age 29 necessarily. It's completely always going to be up in the air.

Katie 1:06:45

With my, so I only ended up having two children. I doubt that will change.

Carrie 1:06:51

ended up two

Katie 1:06:52

But, right. But, I did not feel reassured with the f- if I ever had a third even that I knew I'd have a vaginal delivery. I had two vaginal deliveries, but you, see these things. You can't count on anything. Mm-hmm. You can't count on you've had healthy children, that the next one's gonna be e- there is no promises made to you. Yeah. That's what I tell people all the time and th- nobody promised you anything. Mm-hmm. Like, really. You can't control it. But there is some beauty in letting go to that- Yeah and recognizing that.

Carrie 1:07:23

Yeah. But it's interesting too that it took me this long to kind of learn

Katie 1:07:27

And you'll probably learn it again in a different way though. I think we're, uh, I'm constantly relearning lessons. Yeah. Just a different angle- Yeah of the same lesson. Yes. Maybe that's what life's about, I guess.

Carrie 1:07:39

Yeah, I think so, for sure. Constant And there's no conclusions. There never really is a conclusion, no end to the story. Who knows still in store?

Katie 1:07:51

in store. This just kind of popped into my head, but I believe you told me recently you have rheumatoid arthritis. Do you have any thoughts on how this will affect... I always think this is so interesting too, like, a decision you make health-wise and how it affects other health things- Yeah that you have going on. Do you think your rheumatoid arthritis was related to some of the other stuff going on? Oh, yeah. And do you think-

Carrie 1:08:15

rheumatoid arthritis is an inflammatory arthritis. It's in the family of inflammation diseases, autoimmune diseases. So without a doubt, it all plays into the inflammation within my pelvis, which is essentially what endometriosis is. It all adds up. Now it makes sense. I don't know how it's going to play out now that I don't have a uterus. I definitely noticed that I was more reactive, more inflamed, more arthritic during my cycle, menstruation. And I think-

Katie 1:08:51

That could still happen though because- That could still happen- of the ovaries. Yeah because

Carrie 1:08:54

Yeah. But there's a lot of things, not just, my autoimmune history, but I've learned that hypertension and fibroids almost always go hand-in-hand. So a person who's chronic hypertensive almost always also has fibroids. That's wild to me.

Katie 1:09:10

That tracks. I, I didn't, I wouldn't have overtly been able to tell you that statistic, but thinking, it, yeah, it

Carrie 1:09:18

Yeah. It's wild to me that the systems of our body, are so connected and yet we don't really have a pulse on it yet. We don't totally

Katie 1:09:27

Western medicine definitely- Yes embraces that, right? Yeah. It's one of the big differences. Yes. Western medicine embraces that, and I think Eastern medicine, we're kind of like, "What the hell are you talking about?" And then you start having your own health journeys where everything starts kind of coming together in a way, and you're like, "Oh, I have this here and this here and this here," and it's- Yeah inflammation especially through our bodies-

Carrie 1:09:50

And I had recently heard this statistic that people with recurrent pregnancy loss, 20% of women who have recurrent pregnancy loss have an undiagnosed bleeding disorder. It makes total sense. So, there's so many things that we can link up, and I just think that it's really great that we can, when we can become more in tune with ourselves and understanding these things. There's a lot right now, for example, I'm finding about taking antihistamines for perimenopausal and menopausal complaints. And that relationship between allergen responses and brain fog from perimenopause.

Katie 1:10:35

so interesting you bring this up because I've been going down a personal rabbit hole of mast cell activation syndrome. Yes. Which I've had these symptoms that I, since I was 20, that, at least 20, I don't even know, probably longer, that I couldn't quite describe easily to people, nor, find anything, even with a Google search, that would like link these symptoms that I have. Until recently, a chiropractor friend of mine said, "Have you looked into mast cell activation syndrome?" Hmm. I had heard of mast cells, but n- I, I realized once I deep dove this that I really hadn't heard of this yet. It's POTS is in the, in the mindset of this. But that is the treatment for this syndrome.

Carrie 1:11:19

is- antihistamines Pepcid. Pepcid.

Katie 1:11:21

Yes. Mm-hmm. And so I've been going down a rabbit hole of this, so, so weird that you brought that up- It is because... And it's all, it's, it's inflammation driven. A lot of this stuff is inflammation driven. But it does track for me. I have had brain fog on the first day of my period since I can remember. Mm-hmm. Like, that is not... So if I get that i- in menopause or like perimenopause, menopause, I, that's not like actually a new symptom for me. That is something that has existed for me. Like, I don't like driving on the first day of my period. I don't know anybody else that feels that way. Mm-hmm. But I can't drive well on the first day of my period. Focus is a problem. I can't... Yes. Yeah. Like, I can't do it. And like- Yeah I can work as a midwife, but it, that's a little different. Like, driving requires, uh, well, first of all, your life is literally on the line driving. Yeah. But it requires a d- a, a certain type of focus that I have always struggled with. Yeah. Since the second I could drive, since the second I've had my periods. Yeah. And so it, it, it has been really interesting to go down this rabbit hole and be like- Yeah "Oh, yeah, this makes sense."

Carrie 1:12:20

sense." Yeah. There's so many things. That's a really good example of it and a whole other conversation. And I also just had a conversation with this woman who suffered from horrible skin rashes, absolutely terrible psoriasis, dandruff, and really bad rashes, and, could never figure out the cause or the source. It wasn't an allergen necessarily. And it turns out that she had fluoroquinolone toxicity from taking Cipro recurrently for UTIs over the course of her life. So this UTI problem had been solved, but now she has these rash problems, and it turns out it was from the treatment for her UTIs. Well, and that's

Katie 1:13:04

Well, and that's the thing that's p- so this, um, this rabbit hole I've gone down has actually been really helpful for me because sometimes providers will be like, Just take an antihistamine for whatever," right? Like they told me my child should be on allergy medicine like all year long. I'm like, "I'm not frigging doing that." I, I don't... Everything has a cause, risk, benefit profile. Everything. I don't care what you do., I usually tell women when I'm doing birth control, counseling, I'm like, "There is no such thing as a perfect birth control. There are symptoms that you trade for other symptoms." Right. "And you have to be okay with the symptom profile you have. That is the goal. Are you okay with the symptom profile?" Right? Yeah. So with this, like- antihistamine thing, I don't have real traditional allergies, so I don't like taking it all the time. But when I started reading about this, I'm like, "Oh, well this makes sense for this." Right. I now understand why I would take this. Yes. It gave me a very clear risk-benefit profile that to me- Mm-hmm the benefit outweighed the risks- Yeah that could possibly be coming. So I've noticed now that I'm taking, I really like Allegra, but I've been taking that more regularly, what it's actually treating, and it's not what people would say are overt allergy symptoms.

Carrie 1:14:16

Yeah, like one of them being brain fog, one of them

Katie 1:14:20

Yeah, headaches headaches. I've had a headache for, like, three weeks. Fatigue. Yes, yes.

Carrie 1:14:24

For, for me, I noticed, um, really strange menstrual anxiety or premenstrual anxiety. People often don't associate it, a- associate that with PMS because we think of it as like depression or cravings. But I would find my anxiety was like too much noise being a trigger or being in a restaurant where I couldn't hear the person talking across from me, I would get anxious. And there's so many things that we don't talk about in the symptom profile. Like for perimenopause or PMS or even just pregnancy or postpartum, we do not talk about these symptoms that are very vague and weird and subtle and outside of the box, but actually turn out to be pretty common, believe it or not.

Katie 1:15:13

it or not. Mm-hmm. Exactly. I do think medicine is heading that way. Yeah. So I'm super excited for that, that component. And this is one of those examples where AI kinda helped out, because I went down this rabbit hole of this mast cell, activation syndrome with AI. And I, Carrie, I have been Googling this for freaking,

Carrie 1:15:32

Googling this for freaking like

Katie 1:15:33

so long. Yeah. These symptoms, and nothing would match. And then g- AI's like, "Here. Here's the-" We've got it in our algorithm. "This is, this is, this is this, this is this." Yeah. It explains so many things in my family. Yeah. I mean, it explains so much, and then you're like, "Holy hell." Hopefully there will be good things that come out of this. Yes, yes, yes. So. I

Carrie 1:15:51

I think there will be, and I think mainly it's these conversations made public that get us to, get us to that point, get a... And having women talk about the things that are embarrassing and vulnerable, like infertility, like menstruation- like menopause, like hysterectomies, and also not shaming these cures. The hysterectomy being something that I used to think was almost shameful, like people who couldn't put up with it.

Katie 1:16:22

But also you have this, it's possibly subtle, or n- maybe not subtle, but subconscious family history where you had somebody in your family die- Yeah from a hysterectomy. Okay? Yeah. Like, death at 26. 26 years old. That is young, and that is provocative. Mm-hmm. And so people are gonna go through generations having- Yes a certain feeling about this because that's their experience with it. Yes, absolutely. And that's very raw experience. And you might not even be able to overtly say, "This is why my family feels this way," because it's gotten removed over the time that that's like just subtly become ingrained in your family culture. Absolutely. So- Yeah it makes- I think

Carrie 1:17:01

so, for sure, with lots of things.

Katie 1:17:04

So here you are thinking these things, and then this happens to you, and then it's like, "Oh, well, hold, hold, hold the phone." Yeah. So wrapping this up, what are some like quick, Bullet points of this is what I would say to a patient that I had that was, making this decision or, or contemplating making this decision. What, what's the take-homes for you?

Carrie 1:17:29

It's a hard question. Ultimately, I think people need to wait until they're really ready to make the decision to have no more children, or even the possibility, first of all, first and foremost, 'cause it is the end of that. I would also say that, you don't have to fail at a million different options before having a hysterectomy. And that, I think up to a person how long they wanna suffer through something, you know? It's personal choice. That's all. I... It's a hard question because I think it just... The timing is our decision, but also it just kind of falls into place the way it's supposed to.

Katie 1:18:15

Well, thank you, Carrie. Thank you. I am- Thank you so happy you agreed to do this. I almost was a little bit hesitant to ask you. I'm like, ooh, am I asking her something inappropriate? But, I'm really glad you agreed to it and to share your story. Vulnerability is not super easy for everyone. I think we're both pretty transparent people, so, uh, it's not the hardest thing for us. But- I still deeply value your acceptance on coming on this.

Carrie 1:18:40

Yeah. It's like walking around with blood on your

Katie 1:18:42

with blood on your pants. Right. Oh, well. Here we are. Here

Carrie 1:18:46

Here we are.

Katie 1:18:47

Just another day. Thank you for listening to Mindful Midwifery Presents: The Labor Behind Labor with my guest, Carrie, I hope you enjoyed this episode detailing how we sometimes need to make medical decisions that are difficult, and how that recovery can go, and how it does involve vulnerability. But on the other side of it, it often involves empowerment. After this episode was recorded, Carrie gathered a bunch of midwives over to her house to celebrate her newfound freedom. We happened to have a hand blessing from one of the newest midwives in the area, and gave toasts to Carrie on her uterus-free life. This was, in fact, the penultimate episode of this season. I'm excited to be in this place of having put together episodes of great midwives and their wisdom and candor. The season finale will be in two weeks, and I have Laurel and Lindsay, two of the first guests, back on for a recap of the season. We're gonna talk about things that we thought were really great about the season, and also what we're looking forward to in season two It's gonna be a fun episode, and I'm excited to close out the season on a strong note. Can't wait to share it with you in two weeks