#374 | Fibroids in Pregnancy: IUGR, Induction, Hemorrhage, and a Life-Saving Birth

In today’s episode, Cassidy Peck shares a birth story shaped by large fibroids, a late IUGR diagnosis, low amniotic fluid, and a postpartum emergency that nearly cost her life.

After years of debilitating periods and a delayed fibroid diagnosis, Cassidy conceived naturally and planned a home birth with an experienced midwife. Her pregnancy was largely uncomplicated until late third trimester, when concerns about fetal growth and fluid levels led to induction at 37 weeks.

What followed was an unmedicated induction, the vaginal birth of her 4 lb 6 oz daughter, and then a catastrophic postpartum hemorrhage caused by a fibroid that had descended into the birth canal. Cassidy required emergency surgery, two blood transfusions, and an unexpected intraoperative myomectomy that ultimately saved both her life and her uterus.

#125 | Uterine Fibroids in Pregnancy: Their Impact on Birth, Uterine Scars, and How Black Women are Affected the Most

Transcript

I'm Cynthia Overgard, birth educator, advocate for informed consent, and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

My name is Cassidy. I live in San Diego, California. I had my daughter Ivy in November of 2024. I’m self-employed. I’m a small business owner. I have a tailoring shop in Carlsbad, California, where I specialize in Levi’s and tailor any denim.

How interesting. 

I’ve got a few pairs of jeans coming your way.

Send them over. I am obsessed with vintage jeans, or any jeans. I just love repairing and tailoring them. My husband works for himself. We love basically vintage things. He restores vintage cars. We live on a big property, so we’re outside a lot. We have two small dogs, and we go to the beach as much as we can, and that’s about it.

Okay, so you’re here to tell us your birth story. Do you want to start with conception, pregnancy, whatever makes sense for you?

I think the main thing I want to highlight and talk about, which is something that before I conceived, or even five years ago, I never even knew what a fibroid was. I feel like nobody really talks about fibroids as much as maybe they need to, because I think more women suffer from them than they even realize.

Starting in 2023, I was having insanely painful periods, like debilitating. I basically called it my happy week, where I had one week where I was not bleeding, I was not in pain. When my period would hit, I was completely debilitated. The only form of relief I could get was eight hours a day in a hot bath, so I was basically spending all my time in my bathtub because it was the only relief I could get.

The pain would get so severe that I would almost vomit, almost pass out. My periods were so heavy. It was disrupting my life for so long. I don’t think I realized how much I suffered for years until I was out of it. I had to plan every event in my life around my period, which was basically two to three weeks out of the month, and I had like a week of agonizing torture.

Fast forward, when my husband and I decided that we wanted to have a baby, I contacted my OB, we did the vaginal ultrasound, and we discovered I had two very large fibroids.

Sorry to interrupt, but I’m very curious. How long did it take before you actually got this diagnosis of fibroids? How many years were you suffering with that kind of change before you figured it out?

Probably at least a year and a half to two years.

Okay.

Because a lot of doctors and OBs that I saw were leaning more toward whether I had endometriosis. I tried everything. I spoke to so many different naturopaths, I did acupuncture, I took medicine, everything I could think of. Then I finally saw a provider who said, let’s do a pelvic ultrasound, and I really don’t know why it took so long to get to that point.

That is my question. Why did you not have an ultrasound the very first time you went in? It’s crazy that wasn’t offered.

I know.

It’s not hard to diagnose fibroids.

No, it’s not. I really don’t know. I look back and it’s so confusing that I suffered for so long.

Earlier in 2023, I was finally diagnosed with two large fibroids. I had changed providers, so the first provider was my OB. He said he wanted to do abdominal surgery. There was no other option. He didn’t want to do a myomectomy or anything like that.

I was like, no, I don’t want to do that. I want other options.

Fast forward, I ended up getting Kaiser. It’s interesting because I had a really good experience with the doctors and the hospital there, which I was very shocked by, because I had heard completely different things. As we all know, it depends on the nurses you get, the OB, and everyone treating you.

And it depends on what you’re there for, whether it’s a pathological problem or something like birth, because these places can be excellent at dealing with pathology but not so great at dealing with physiology.

Which is interesting because it kind of went in two different ways, and I’ll get into that with the birth story, which was completely something I never thought I would experience in a hospital.

So I went to my new OB, and I actually really liked her. Before all of this, the reason I knew I didn’t want abdominal surgery is because I started listening to your podcast and became obsessed with birth.

I think the reason I became so obsessed is because we moved into our house in 2024, and it’s an old 1934 farmhouse. We completely gutted it, and up in the rafters, we found out from the original owner that all five babies were born in that house in the 1930s.

Wow.

That’s what I thought. We were renovating, and we pulled down this big mattress that was in the rafters, this old 1930s ticking mattress, and it was covered in blood. Our conclusion was that back then they didn’t have much, they were very poor, and we were like, that’s the birthing mattress.

It just provoked this curiosity about birth. I started diving into every podcast I could listen to. I started reading all the Ina May books, and then I found your podcast. I’ve listened to every episode, so I became very well informed.

Back to the story. I found an OB that I loved. She recommended a robotic myomectomy, which was little incisions instead of a big abdominal surgery. But I didn’t necessarily want to do that, because on the other side of it, she said the recommendation would probably be to have a C-section two to three weeks before my due date, and I just didn’t want that.

Can I just catch up here a little bit? I thought the myomectomy was to remove the fibroids.

Yes.

So was she suggesting that, and if you opted out of that, she would say then we recommend a C-section if you keep the fibroids? I don’t see where one condition ends and one begins.

There were basically two options. She said you can try to conceive for six months and see if you can conceive, and if you can, that’s great. I had told her I wanted a home birth. She said try for six months, let’s revisit it then, and at that point go forward with the myomectomy. Then after, if I got pregnant after the surgery, she recommended a C-section.

She’s suggesting a C-section, which is very common for women who have had fibroid surgery, whether it’s a major abdominal surgery or a myomectomy.

I thought the whole purpose of a myomectomy was to restore the uterus and let pregnancy and birth proceed as normal.

It still disrupts the uterus, and anytime there’s any kind of cut into the uterus, the standard recommendation is C-section.

So I decided I did not want to go forward with surgery first. I wanted to try to conceive naturally. After four months, I was pregnant with my daughter.

I didn’t even think I was pregnant. I was convinced I wasn’t because I was bleeding, and it turned out to be implantation bleeding. But because all I had done for months and months was bleed, I thought that’s exactly what it was.

I had a great pregnancy, really. Early on I only had a few weeks of being tired. I felt really good. I loved being pregnant.

Right when I found out I was pregnant, I decided I was going to hire a midwife. I did not want a hospital birth. I wanted to see if I could find a midwife comfortable with me having fibroids. The reason I thought it might be okay was because of the location of my fibroids.

I ended up going with my midwife Michelle. I still think about her all the time. She had such an impact on my life. She was wonderful. She said she had a lot of experience, almost 40 years, with women having fibroids and successful home births, so she felt very confident.

So I continued to see her as well as my OB because part of that was covered, and it was radically different experiences. I’d go to my midwife appointment and be there for an hour or hour and a half and leave on cloud nine, feeling excited and happy. I’d leave my OB appointment fearful, scared, upset. I’d be in there for 10 or 15 minutes.

Months went by, everything looked great. My midwife thought it would be a good idea to do more scans because every time she was feeling my stomach she’d say, I feel like this is the baby’s head, but I also feel like this is your fibroid.

Initially my fibroids were five and six centimeters, so a decent size. She said it would be a good idea to see a perinatologist and get more scans.

That’s something I didn’t want to do initially. I didn’t want more ultrasounds. But considering I had these large fibroids, I just felt in my gut that she was right. If the ultimate goal is a safe home birth, I obviously wanted that to be truly safe.

So I started seeing a perinatologist around seven months. I went in for a scan, and IUGR was discovered. I was devastated. She was measuring very small. She hadn’t grown much since the last scan, and they switched gears immediately. I was considered high risk. I couldn’t believe it.

I ended up doing the stress test. I passed it. I was continuously doing kick counts. It just heightened my fear and created so much anxiety going forward. I was so scared every time I went in.

Was it ever confirmed that you actually had a true IUGR diagnosis, or was your baby just measuring small for gestational age? Because they need to do a series of scans and see that growth is actually slowing. If a baby is just in the 9th or 10th percentile, that can simply be a small baby. Did you ever get to the bottom of that?

Yes. She was measuring under the 5th percentile. Then I went in for another scan around eight months pregnant, and they lifted the diagnosis because she was growing. So I thought maybe it was one of those ultrasound flukes where measurements are off.

So you had the 20-week scan and then the seven-month scan, and between those two, it showed little or slow growth and she was under the 5th percentile. That’s how you got the diagnosis. Then when you went back a month later, she had grown normally.

Yes. They lifted it. She was still small, and I thought to myself, I was a small baby. My mom had small babies. My husband was seven pounds seven ounces. I was a little over six pounds. We don’t really make big babies in my family. All my cousins were small. So I thought she was probably just going to be small no matter what.

When I went back in and they said everything looked good and that the growth was appropriate, I felt reassured.

What was interesting is that every time I went in, they were heavily focused on the baby, but I kept asking the perinatologist about my fibroids. Had they grown? What was happening with them? Why weren’t we focusing more on that too?

At that point, they had grown. I think the biggest circumference of one was 9.6 centimeters, so they had grown quite a bit. I have a very small frame, and at five months pregnant I looked almost seven months pregnant because I was so big. It felt like I was carrying three babies.

At eight months they lifted the IUGR diagnosis, and I continued planning my home birth. The midwife came out and did the whole home visit, and I was getting so excited.

Then I went in again. I really didn’t want another ultrasound. I felt like the diagnosis had been lifted, I felt good, and I didn’t want to keep doing scans. But my midwife said she thought I should do one last ultrasound because of the fibroids.

My husband had needed some convincing to feel comfortable with a home birth, and it was because of the fibroids. He did a lot of research, and the thing he kept focusing on was hemorrhage, for good reason. He was really worried about me hemorrhaging.

My midwife was so good about explaining everything she could do, what the protocol would be, how emergencies would be handled. I felt confident, and eventually he did too, though I think in the back of his mind he was still worried.

Can we explain for listeners why fibroids increase hemorrhage risk, especially based on size? Was it explained to you that the concern was the uterus not being able to clamp down effectively because of the fibroids, not the fibroids bleeding the way they did during your periods?

The interesting thing about fibroids that I never realized is that they have their own blood supply. They’re getting blood from you. They’re not like a cyst. They take what they want, get bigger, and feed off that blood supply.

The concern was that during labor or after birth, if my uterus needed to contract down, the fibroids could interfere and prevent that from happening properly, leading to uncontrolled bleeding.

It’s similar to retained placenta, where the uterus can’t contract properly around something still inside. So yes, that’s a legitimate concern.

So I decided to go forward with that last ultrasound. My midwife strongly recommended it. This was Halloween 2024.

The perinatologist looked at me and said, Your IUGR is back. She has not grown at all since your last scan. She’s measuring barely over four pounds. Not only that, I can only find one pocket of 2.2 of amniotic fluid. I can’t find more. It’s pretty empty in there. I really believe you need to be induced today. I think you need to go to the hospital today.

And I know some people would think this sounds crazy, but in my heart I needed another opinion. I wanted another scan.

So I called my midwife, and she calmed me down and said, Go see my guy out of network.

The next morning I was there at 9 a.m. for another scan, and he agreed. My fluid had dropped even further, barely a pocket of one. So basically no fluid. That means she’s not eating, not peeing, something is going on.

At that point I accepted that the IUGR was likely real because she truly wasn’t growing, and I agreed to induction. I was 37 weeks and one day.

I came home first. I had my entire home birth kit already set up. I told my husband to get it out of the room because I couldn’t bear to look at it. He packed it away.

I checked into the hospital at 4 p.m.

One thing I had told myself was that if I had to do an induction, I would do an unmedicated induction. I felt like this was the one thing I could still control in a situation that had completely gone out of my control. I did not want an epidural. I felt strongly that if I got one, I’d probably end up in a C-section because I’m very sensitive to medication, and I felt like the baby would be too.

So I went in determined: no meds.

I got a nurse named Jesse, and I want to mention him because my nurses ended up being amazing, which shocked me. I went in very negative. I’m sure he could tell I did not want to be there.

But he was so bright and kind. He said, All right, what are we doing today?

There was a whiteboard on the wall that said Tell me what you don’t want, and he wrote down every single thing I said. No vitamin K. No this, no that. Delayed cord clamping. Everything.

He asked if I might want an epidural.

I said no.

He said okay, just so you know, if you change your mind, it can take up to an hour to get one.

I said that was fine.

After that, he never asked me again about anything I had already said I didn’t want.

They started Cervidil around 5 p.m. It wasn’t horrible. Just some cramping.

Then around 1 a.m., my husband and I were finally sleeping, and I was suddenly woken up by what felt like six nurses rushing in, grabbing me, flipping me over, manhandling me. It felt violent. They were pushing my stomach, pulling me aggressively.

Apparently my baby’s heart rate had dropped to 55–60 beats per minute for almost five minutes. I had been sound asleep.

They flipped me into position quickly, and it worked. Her heart rate recovered immediately.

It was intense and terrifying, but it lasted maybe two minutes, then they were gone and I went back to sleep.

The next morning they wanted to move to the next form of induction. The Cervidil had worked, and they were deciding what to do next.

Before going in, I had talked to my midwife and asked what to expect, what she thought I should do. One thing she suggested was a Foley bulb.

They agreed to that, and I will say that was probably one of the worst parts of the entire experience, having that inserted unmedicated.

So they inserted the Foley bulb, and then we waited. I think another 12 hours passed.

The nurse came in and said they would check to see if I had dilated to three centimeters and, if so, she could remove it.

She was checking me while casually talking, and then suddenly she just popped it out without warning. In hindsight, I’m glad she didn’t tell me she was about to do that because I definitely would have tensed up, but it was intense.

So now I was three centimeters around 4 p.m.

At that point I had requested that a midwife assist my delivery, and she came in.

One thing I was heavily pressured about was GBS. I had tested positive early in pregnancy, and she was very adamant about antibiotics. Every time she came in, she pushed it. Every time I said no.

Eventually I was just exhausted from saying no.

What was funny was that Jesse, the nurse I loved, would be standing in the background clearly trying not to intervene because he knew I didn’t want it. He was quietly on my side.

I only had two nurses the entire two days I was there. Jesse would leave and Rochelle would come in. Rochelle would leave and Jesse would come back. They were honestly a godsend because they listened to what I wanted and did not pressure me.

So the midwife came in again and said she really thought it would be a good idea to get at least two doses because I had tested positive.

I finally said, look, I will agree to it, but not until I’m six centimeters, because I don’t want continuous dosing every four hours if labor drags on.

That was a great decision.

I think so too. I just knew that if I was going to do something I didn’t even want, it was going to be the absolute minimum.

Just so everyone understands, with GBS antibiotics, you’re considered covered for about four hours. If you deliver within that window, great. If not, they give another dose. So if you’re not even six centimeters yet, chances are decent you’ll still be laboring longer than four hours, meaning more doses. Waiting until active labor often makes sense.

That was exactly my thinking.

So after the Foley bulb came out around 4 p.m., I was three centimeters, and they started Pitocin.

Jesse was there, and I told him I’m extremely sensitive to medication. I asked him to please start me low.

He looked at me and said he always starts everyone at one. Other nurses start at two, but he starts at one.

He was so sweet.

So he started Pitocin at one, and things began progressing pretty quickly.

Around 5 p.m. I got the first dose, and the contractions started building. I was standing, moving around, staying as mobile as I could while still attached to monitors and the IV.

I was bouncing on the ball, leaning over the bed, standing while my husband did counterpressure.

By 8 p.m. my nurse said she thought I was progressing and asked to check me.

She checked and said, You’re at an eight.

The midwife came rushing in and immediately gave me the antibiotics because I had progressed so quickly.

I kept rocking, moving, bouncing.

Then suddenly I looked at the midwife and said, I feel like I have to poop.

She smiled and said, That’s not poop. That’s your baby.

I got onto the bed on all fours, because that felt best, and the Pitocin contractions were unbelievably intense. So painful. But I was in it. I knew I was doing it.

I honestly kind of went somewhere else mentally, because later my husband told me things I had absolutely no recollection of.

I was on all fours, and I think that’s when she really started descending.

The midwife came in so fast she was trying to put gloves on while everything was happening.

Then she asked me to get onto my side.

I really wanted to stay on all fours because it felt so much better, but I was so deep in it that I just went with it.

According to my records, I only pushed for about ten minutes, but I have almost no memory of actively pushing. I think my body was just doing it.

At that point the midwife asked if she could break my water.

She said, Your baby is right here. One more push and she’ll be here. Can I break your water?

And I appreciated that she asked.

I said yes.

Within the next contraction, she was out.

I think that bag of waters had been the one thing preventing that final descent.

She came out and they immediately put her on my chest.

Earlier, one of the nurses had asked if she could take photos with my phone, and we had said yes, so I have all these incredible photos and timestamps.

When I later checked the timestamps, they had waited six full minutes before cutting the cord, exactly what I had asked for.

She was on my belly for six minutes.

She came out completely dry. Bright pink. No fluid. No meconium. No vernix. No blood. She looked so clean.

Yes, vernix.

They placed her on my chest. She cried loudly.

She ended up weighing four pounds six ounces.

Oh my gosh.

So she actually was tiny.

Wow.

Tiny.

How many weeks were you?

Thirty-seven weeks.

So technically full term, since she was just past 37 weeks, but very, very small.

Very tiny.

Her Apgar was nine.

Wow.

Tiny but mighty.

Yes.

Then they cut the cord, tried to get her to latch immediately, and it was honestly an amazing experience.

Then about 20 minutes passed.

The nurses were doing fundal massage, which honestly needs a different name because there is nothing massage-like about it.

The midwife had repaired a couple small first-degree tears and left.

The nurses were cleaning up, and I started noticing their expressions changing.

They looked panicked.

They were frantically collecting the chux pads to measure blood loss.

One of the nurses ran to get the OB on duty.

She came in, didn’t introduce herself, didn’t say a word to me, and immediately shoved her hand inside me and started feeling around.

I was just sitting there in total shock.

My daughter had been moved off my chest.

I was thinking, who is this woman and what is happening?

Then one of the nurses leaned over and said, She’s unmedicated.

They knew I was unmedicated, but honestly that wasn’t even the point. Even if I had been medicated, basic communication still matters.

What happened? Were they concerned about hemorrhage?

Yes. I think I had already begun hemorrhaging significantly. I think when the OB was called, she was told how serious it was and came in already understanding this was an emergency. In hindsight, I understand that better. At the time, it just felt horrifying.

She probably knew exactly what was happening. In a severe hemorrhage, the protocol is often bimanual compression, where they go inside and physically compress the uterus, checking for retained placenta or anything causing the bleeding. But even in an emergency, it takes two seconds to say, You’re hemorrhaging, I need to do this.

Before I continue, I forgot to mention that I had birthed the placenta just a few minutes after the baby, spontaneously.

They wrote in my chart that it was a spontaneous placental birth, which made me laugh because shouldn’t that be the normal thing?

After it came out, I asked if I could see it, and the midwife brought it over.

It was half the size it should have been.

Later we learned the fibroids were essentially leaching from the placenta.

Was your placenta attached close to the fibroids?

Yes.

That explains everything. So you never actually outgrew the IUGR diagnosis. They just temporarily thought you had.

Exactly.

So back to the hemorrhage.

The OB is inside me, trying to figure out what’s happening. I’m nearly passing out from the pain and blood loss.

Then she looked at me very seriously and looked at my husband and said, Your fibroid is coming out of your vagina.

Apparently, the contractions had pushed one of the fibroids so far downward that she could physically feel it.

Then she said, This is very serious. I am going to need to try to save your life. First I will try to save your life, then I will try to save your uterus. I’m going to remove the fibroid and do what I can.

It was incredibly serious.

My husband was devastated and panicking.

I think I kind of dissociated. I couldn’t really comprehend what was happening. I was losing so much blood and feeling completely altered.

At that point I said, You have to give me something for the pain right now. I can’t do this.

Because I knew I was heading into surgery.

They immediately gave me fentanyl, and at that point I stopped caring about the original plan. None of that mattered anymore.

Exactly. You were heading into emergency surgery.

Yes.

They gave me fentanyl, rushed me away, and I was pretty out of it going into the operating room.

The next thing I remember is waking up the next morning.

I had lost almost two liters of blood.

The doctor later told me they didn’t initially realize just how much blood I had lost.

What’s interesting is that this doctor, the one who terrified me when she first came in, ended up being the person who saved me.

And not only her.

The second surgeon assisting was Dr. McMullen, who is the lead fibroid myomectomy specialist in all of Southern California.

That feels like pure divine timing.

Because ordinarily, if you have fibroids during a C-section, they usually do not remove them at the same time because of the bleeding risk. They leave them and deal with them later.

Exactly.

The first doctor told me she was going to try to remove the one causing the immediate crisis but probably wouldn’t touch the second one because it was too dangerous.

But because Dr. McMullen was there, she said no, we are not leaving that behind.

That’s what she does. That’s her specialty.

So they removed both.

They saved your life, saved your uterus, and got both fibroids out.

Yes.

What’s even crazier is that afterward the doctor told me they were heavily questioned because of what they did.

They had gone against protocol.

They had to go before a review board and explain their decisions, because standard protocol apparently would have involved packing the vagina, stabilizing, and managing differently.

But they insisted that if anyone else had been there, they might have followed protocol and I could have had a completely different outcome.

They believed what they did was necessary.

So I woke up incredibly weak.

I had no blood.

I had two blood transfusions.

I was on morphine.

I barely felt mentally present those first couple of days.

And I was terrified I wouldn’t have milk because of the blood loss.

But by some miracle, my milk came in the very next day, and I had plenty.

That’s incredible.

The recovery was brutal.

I was recovering from what was essentially a C-section because they had opened me abdominally.

I was recovering from a vaginal birth.

I was recovering from fibroid removal.

And I was recovering from losing nearly half my blood volume.

That is absolutely unbelievable.

And honestly, the fact that you were in the hospital probably saved your life.

Yes.

Did you get clearance for a vaginal birth in the future?

I was really worried about that.

But because of the way the surgery was done, and because Dr. McMullen is such an expert, they used an approach that preserved my future options.

Normally with fibroids the size of mine, they wouldn’t use that method.

But because she was there, she felt I could absolutely attempt a vaginal birth in the future if I wanted.

That is amazing.

I went back for an ultrasound about six months later, and everything had healed beautifully.

It really feels like a series of miracles.

It really does.

I told the doctor they had wanted to induce me the day before and I had said no.

She said, Well, we weren’t working that day.

And then she said something that really stuck with me: not every surgeon is the same.

Meaning yes, maybe someone else still could have saved my life—but maybe not in the same way.

You still very likely might have survived even with a home birth, because your midwife would have recognized the emergency, called 911, gotten transport going, possibly blood started. But you very likely could have lost your uterus if those exact surgeons had not been there.

I think that’s absolutely possible.

Knowing what you know now, would you have removed the fibroids before pregnancy?

And also, I think it’s important to acknowledge how much your own intuition shaped this outcome. Because when induction became the right choice, you knew it.

Yes.

If I would change anything? No.

Would it maybe have made for an easier birth? Maybe.

But I have my daughter.

And I don’t know if I would have her if things had unfolded differently.

So no.

I truly believe it all happened exactly the way it was meant to.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.