S23 Ep10: Terror

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Speaker 15 Something Was Wrong is intended for mature audiences. This season contains discussions of medical negligence, birth trauma, and infant loss, which may be upsetting for some listeners.

Speaker 15 For a full content warning, sources, and resources, please visit the episode notes.

Speaker 15 Opinions shared by the guests of the show are their own and do not necessarily represent the views of myself, broken psycho media, and wondery.

Speaker 15 The podcast and any linked materials should not be misconstrued as a substitution for legal or medical advice.

Speaker 15 Origins birth and wellness owners and midwives Caitlin Wages and Gina Thompson have not responded to our requests for comment.

Speaker 15 Additionally, midwives Jennifer Crawford and Elizabeth Fuell have also not returned our request for comment.

Speaker 15 This season is dedicated with love to Malik.

Speaker 15 You make you know me, you don't know me well.

Speaker 15 You don't know

Speaker 15 anybody

Speaker 15 until you talk

Speaker 15 to

Speaker 15 someone

Speaker 11 Hi, I'm Brianna.

Speaker 11 I was married in 21. I got pregnant about three months after we were married.
We were excited to start our family, anticipating that this baby would come kind of around the one-year anniversary mark.

Speaker 11 I gave birth to my baby at Origins in 2022.

Speaker 11 During that time was also obviously fallout from COVID and the pandemic. I am a dietitian by trade.
I had been working in the hospital in the NICU and the children's hospital in nearby.

Speaker 11 So I was seeing the dynamics of COVID and hospital dynamics and all of the perfect storm that was happening at the time. I would describe myself as a little more holistic in my approach.

Speaker 11 I think Western medicine is an amazing miracle. It saves people's lives, but I also value the holistic side of health.
I would say I'm scrunchy. I'm somewhat crunchy.

Speaker 11 I was hoping for less of maybe a clinical setting to bring my baby into for that first pregnancy. We had tried going with an OB initially.
I didn't necessarily know anything different.

Speaker 11 I had been going there for my well woman visits, not specifically with the OB group, but with the family practice that was there under that same roof.

Speaker 11 When I met with that OB in the first 20 20 weeks of my pregnancy, those various visits, I felt that she was just so in and out the door. My first pregnancy, you know, I'm scared of what's going on.

Speaker 11 I'm scared of what's to come. I'm also really excited and want to share that emotion.

Speaker 11 She came in, she was totally cold, and I just remember being like, I have so many questions, and she's out the door.

Speaker 11 I felt bad because I felt like she was in such a rush and had to get to the next person.

Speaker 11 Ultimately, the thing that kind of tipped us over the edge was I told her there were two tests that I was willing to let her run.

Speaker 11 And then when we finally got the results, there had been like a bajillion tests run genetically that I did not care to have.

Speaker 11 And also when we got the bill, it was like hundreds and hundreds of dollars. And we had not anticipated that.
I was really furious. And that's what ultimately pushed me to finding a birth center.

Speaker 11 I personally was not comfortable going the home birth route. I totally respect people who do that.
I admire their strength and their courage.

Speaker 11 I thought the birth center would be a happy medium between the hospital setting and the home birth setting. I wanted the expertise and care of midwives.

Speaker 11 I thought they brought in a medical perspective.

Speaker 11 I think I felt more comfort knowing that and hoping that if I went to a birth center, I'd be able to build the relationship with my midwives and they would know me on the day that labor came and they would know my preferences and know my husband and all those dynamics.

Speaker 11 I toured several birth centers in part because obviously I wanted to see the setting itself, but I also wanted to meet the people that would be traveling with me through pregnancy and birth.

Speaker 11 I did the tour at Origins Dallas. I wanted to know how close we were to the nearest hospital and how fast it would be to get there if things went awry.

Speaker 11 They assured us of that during the tour, you know, that we were a three-minute ambulance ride to Baylor. They showed us the stats on their percentage of transfers.

Speaker 11 I want to say at the time it was 10%,

Speaker 11 which to me, having seen other birth center transfer rates, it was average.

Speaker 11 That gave me confidence because I didn't want them to be too low because for whatever reason in my mind, that told me that they were too risky, that they didn't want to transfer, that they kept you too long.

Speaker 11 But then on the other end, I didn't want them to be like, let's just send her to the hospital right away.

Speaker 11 I wanted to know that they were not afraid to send me, but also would try their best to do all that they could do to help me have my baby there.

Speaker 11 They basically told me that they were not afraid to call in help if needed. And that's what I wanted to hear.
They had good reviews. I went to the Yelp reviews.
I went to the Google reviews.

Speaker 11 Even my husband's chiropractor, through work, his wife was very much involved in the birth world. I asked her for recommendations of birth centers and Origins was one of them.

Speaker 11 So it was personal and public reviews I would say that I got. I selected Origins because everybody knew about them and I just figured that a place that was so well known couldn't be bad.

Speaker 11 I felt that the fact that they had a good name, from what I was hearing, spoke to how upright they were. They had a CNM on staff at the time.

Speaker 11 I thought that that meant that they were more medically minded. I knew that they had several CPMs, but they also had a CNM.

Speaker 11 I knew that there was a difference between a CPM and a CNM. My sister-in-law is a CNM.
She has a master's degree. I knew that a CNM required her to have her nursing degree.

Speaker 11 I guess I didn't know necessarily the implications of what a CPM meant. I knew that they had a certain amount of hours under their belt.

Speaker 11 And because Origins had been around so long and they had good reviews, I felt like they could have been picky and choosy about which CPMs they hired.

Speaker 11 It wasn't just like the newbies fresh out of training. I figured that they would have been more established.

Speaker 11 The fact that Origins took my insurance, I thought that that meant that they were on the up and up. You have to jump through a lot of hoops to have insurance cover you.

Speaker 11 Origins was the only one that took insurance, if I remember correctly. A lot of the other ones, had they blown me away, I think I would have considered paying the extra money to go there.

Speaker 11 But all things considered, I was actually quite impressed with Origins. I really thought that I had vetted Origins.

Speaker 11 I actually didn't transfer into Origins until 20 weeks. So I was halfway through my pregnancy.
Because I worked in Fort Worth, I preferred actually the Fort Worth location.

Speaker 11 But at the time that my baby was due, the Fort Worth location was too full. They told me that there were openings in Dallas for my delivery month.
So I went there. It was a bit of a drive.

Speaker 11 My parents were 12 hours away from where we lived, as were my husband's parents. Both of those sets of parents are in Colorado.
So my mom had planned to be there after he was born.

Speaker 11 She took the approach that, I think you guys are going to be fine. You're in good hands.

Speaker 11 You guys should have your time as a family, like your own little family for a few days, and then I'm happy to come and help out. But of course, she was like, if anything bad happens, call me.

Speaker 11 I'll be there. She was supportive of my decision, but she was probably a little nervous.
My grandma was, I think, very much against it, but she never really told me that.

Speaker 11 I assumed that she was very much against it because my cousin does home births and she really is against that. My grandma was a labor and delivery nurse back in her day.

Speaker 11 So she always says, like, you don't know what can happen to your baby within seconds. One of the nurses that I worked with in the NICU, we were pretty close like co-workers.

Speaker 11 She had been there for several years and she was a grandma, the sweetest lady ever, but she was so nervous about me going there and she really tried to dissuade me.

Speaker 11 She was the one that really vehemently was like, do not do this. I've seen such bad things happen.
Babies that end up in this NICU.

Speaker 11 But another one of my coworkers, also a dietitian, she was super supportive and she had done all of her three births at a birth center.

Speaker 15 So you go to your first appointment at Origins and I believe you saw Rachel?

Speaker 11 Yes. My husband.
did come the first visit with Origins. So we did meet with Rachel that very first visit.
She was the CNM. I only met with her once.
I remember her being very warm and inviting.

Speaker 11 And I think I made the comment to my husband after the fact that I was like, this is good. She took time to speak to my husband and ask him, you know, what he does and learn who he is.

Speaker 11 It was a very different experience from our OB visits. And I remember thinking that that was a breath of fresh air.
It was like, okay, we're in the right place.

Speaker 11 nothing invasive as far as testing or anything. She, you know, heard the baby's heartbeat on her monitor.
Yeah, that's what I remember the first visit, but Rachel Rachel left after that.

Speaker 11 I was a little nervous that they lost the CNM because I wanted that medical approach in their practice or that medical person.

Speaker 15 And technically, your insurance requires that.

Speaker 11 And I didn't know that. And that probably explains why the next person they hired on was also a CNM because Ashlyn was a CNM.
And so when she was hired on, I felt good again.

Speaker 11 Maybe the last couple months of my pregnancy, Ashlyn was on board. So I did see Ashlyn a couple times.

Speaker 11 I always looked forward to my my visits with Ashlyn because I was like, okay, this is the type of midwife I want. I do remember seeing Elizabeth a lot, and I was kind of bummed by that.

Speaker 11 She seemed nice enough. I didn't feel the same warmth, I guess, from her as maybe I did with the others.
I just didn't click with her.

Speaker 11 It seemed like she had been there quite a while, from what I had gathered. Her experience level made me feel a little more comfortable with her.

Speaker 11 I do remember thinking in the back of my mind at the time of my birth, I hope that she's not the one on call. I was really hoping for Ashlyn.

Speaker 11 I saw Elizabeth the most. Ashlyn probably was a close second.
I think I saw Jen just once or twice. My perception of Jennifer when I was there, I thought she had been a midwife for years.

Speaker 11 She acted like she knew everything. She totally acted like she ran the show.
And I felt super confident in her because she acted like that.

Speaker 11 I was blessed to have a good first pregnancy. I did not have crazy morning sickness.
Second trimester is always seemingly the easiest.

Speaker 11 I was very fatigued my first trimester and that shook me because no one ever talked about that. I had low iron at one point.

Speaker 11 Instead of just giving you like an iron supplement, at least for me, they had a regimen, which is why people go there. They have a more holistic regimen.

Speaker 11 I was on chlorophyll and sesame seed oil and various other random supplements that a traditional OB would never probably put you on. Per my lab results, it actually did help.

Speaker 11 I could see with my own eyes the numbers. It made me believe that they knew what they were doing.

Speaker 11 It affirmed my trust and that you could have the same effect health-wise doing it that way versus doing like a more pharmaceutical approach.

Speaker 11 My pregnancy was low risk and there weren't a lot of things going on. It was easy stuff like testing the baby's heart rate or I can feel the head over here and the feet here.

Speaker 11 It seemed to corroborate what I was feeling as far as kicks or where the pressure was or stuff like that. So it was quote unquote easy stuff like that.

Speaker 11 There was never anything that would have tested more in-depth knowledge per se. I really had an uneventful pregnancy.
the bigness at the end.

Speaker 11 I, you know, wanted to cry every evening that he didn't come over 48 weeks because I was like, I can't do this anymore. Like I feel so heavy and I can't breathe and I can't sleep.

Speaker 11 Those are minor complaints compared to what a lot of people have. They ask you all of the permissions, your birth plan, all that stuff before you even show up the day of your labor and delivery.

Speaker 11 And they at one point asked me if it was okay to have a student observe several months of care with origins. I said no to that question.

Speaker 11 And I honestly really just don't know why, but they go through that birth plan every time you go in. And it was the last week or two.

Speaker 11 Elizabeth asked me the student question again: Are you sure you don't want a student there? And I was like, if it's going to help them learn, I'm open to that.

Speaker 11 But I distinctly remember telling Elizabeth that I was okay with having a student there to strictly observe, literally do nothing other than just be a flam.

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Speaker 11 And she's like, yep, that's totally fine. I'll put for observe only.
That's it. Great.
Move on.

Speaker 15 Did they have you register at a hospital just in case interventions were needed?

Speaker 11 No.

Speaker 11 Hindsight's 2020. That would have been a smart thing to do.

Speaker 11 My baby was not head down.

Speaker 11 That was the big thing towards the end was, is he going to turn in time to be able to have a birth center birth? They talked about doing the aversions.

Speaker 11 They recommended all the spinning babies techniques and the stretches and the chiropractics. He didn't flip until very, very near the end.
So I I got pretty nervous.

Speaker 11 But he eventually did and he stayed head down.

Speaker 11 I knew that this baby had to come before 42 weeks. That was always the topic was what can we do to kickstart labor.

Speaker 11 You can start doing red raspberry leaf tea and vaginal suppositories of like primrose oil. I never actually got to that point.
I went into labor on Saturday the 8th.

Speaker 11 I remember waking up around like 11 at night. I woke my husband up and I was like, something's happening.
I had been having Braxton Hicks and I was like, these are strong. So maybe this is it.

Speaker 11 But I was able to sleep through it. I remember going to church the next day.
So Sunday morning. This is how I knew I was in labor because we went to church and I could hardly stand up.

Speaker 11 The contractions would hit and I tried to power through. I would grip the rail in front of me as it would happen.
And I was like, I can do it. I could do it.
There were times that I had to sit down.

Speaker 11 The contraction was just so bad. Our next door neighbor went to the same church and I remember her coming up to us at the start of the mass and she was like, do you want to bring the gifts up?

Speaker 11 And my husband, he was like, today would not be a good day. She's in labor right now.
And she looked at me and she was like, oh, okay. And her face was just in shock.

Speaker 11 I think she's probably like, why are you here? I just remember that. It was like, full, powered through that hour of mass.

Speaker 11 We called the on-call midwife, told her what I was experiencing, and she said, it's possible this is false labor. We just want to make sure that this is the real thing happening, but go take a bath.

Speaker 11 If it goes away, then we'll just wait for real labor to start i went and took a bath the contractions did seem to go away i started feeling a little bit better so i thought okay that was false labor kind of bummed out by it honestly but it was like temporary relief for a few hours which was nice but then they hit with a vengeance that late afternoon slash evening it was the worst contractions that i had felt it was gonna get much worse they were excruciatingly painful the pain was making me sick People say they get nauseous when they go into labor, so I'm sure part of it was that too.

Speaker 11 But I had puked everything out. I couldn't keep a thing down.

Speaker 11 we did call elizabeth and it was 6 30 that sunday evening so i had been in labor for nearing 24 hours by that point he called elizabeth had her on the speakerphone and he was like elizabeth i think that this is it what do we do and elizabeth nonchalantly was like do you really think so i don't know like what's the time between contractions he told her what it was I got the sense from that call hearing her that she was really skeptical of the fact that we thought that I was actually in labor and ready to go.

Speaker 11 She kind of kept pushing back.

Speaker 15 At eight days overdue?

Speaker 11 Yeah. And I remember screaming at that point.
I was like, this is so painful. I cannot take this anymore.
And that's when she was like, well, yeah, I think she's in labor.

Speaker 11 So how about you guys come in? I remember arriving to the birth center around like 6.30, 6.45-ish. And I can actually probably pull up my notes at this point.
We arrived 18.25.

Speaker 11 So that would have been right around 6.30 that evening. The birth center had two stories.
They put me in one of the bedrooms upstairs.

Speaker 11 And the first thing that I remember is they had me go labor on the toilet. So they had me sit backwards.
There was a pillow on the back of the toilet tank.

Speaker 11 They piled up pillows so I could put my face in there. They said that was one of the techniques.
So I was fine with it.

Speaker 11 But the thing that really made me nervous was that when you're sitting on the toilet too long, your legs start falling asleep.

Speaker 11 And so they specifically said when we're like practicing these positions, even during like birth class, you need to have your feet up on stools.

Speaker 11 They had me go sit on the toilet and there was no stools. And so, Elizabeth is like, Well, we need to get stools for your feet.
They were running around the birth center trying to find stools.

Speaker 11 They couldn't find stools for me to put my feet on. So, my legs are like dying as I'm dying in pain, laboring on a hard toilet, having contractions.

Speaker 11 My husbands are like rubbing my back, and they finally gave up, didn't know where the stools were.

Speaker 11 And they got a plastic sleeve of pads or maybe like adult diapers and shoved those underneath my feet. And of course, they squished down because they're like cotton.
So, that didn't help at all.

Speaker 11 And I finally got irritated. They were filling up the tub.
I don't even remember when I got into the tub. I, oh, yeah, here it says: patient ambulated from toilet to tub without assistance.

Speaker 11 That was at 1938. So that's like an hour-ish.
I was on the toilet. That was the first thing that really tipped me off.
Meanwhile, I'm still very nauseous. You know, I had my vomit bag with me.

Speaker 11 Elizabeth was not with me most of the time. When I got to the tub initially, I heard the lady in the other room screaming in pain, laboring, and Ashlyn was with her.

Speaker 11 But then very soon on, Ashlyn came into my room and was with me while I was laboring.

Speaker 11 And Elizabeth went to that other lady and delivered that baby from my understanding and did all of the newborn care and stuff. I labored in the tub.
It was the student and Ashlyn.

Speaker 11 The student was always there. Ashlyn would sometimes pop out to go check on the other lady since that baby had come already, but then she'd come back in to watch me and be with me.

Speaker 11 During this time, you know, of course, they do the Doppler to listen to the fetal heart rate.

Speaker 11 My understanding from speaking with my sister-in-law who's a CNM, you're supposed to monitor fetal tones before, during, and after contractions.

Speaker 11 There's some time points when they monitored it that they write, measured 60 seconds before, during, and after contractions, but then there's other time points where they write like 60 seconds before contractions, and there's no during and after.

Speaker 11 There's other times where it's 60 seconds during and after, so no before.

Speaker 11 My understanding is that you have to do it before, during, and after so that you can get like a good picture of what's happening while the contraction's happening.

Speaker 11 You want to know what the baby's doing before, and then like while everything's being scrunched, is he losing his heart rate? And then, like, after, is he recovering?

Speaker 11 They obviously weren't monitoring his heart rate as they should have. There was never any consistency.
It was never with every contraction. So, who knows what was happening to him in the meantime?

Speaker 11 I remember hanging over the tub. My husband was there rubbing my arm and trying to, you you know, give me affirmations.

Speaker 11 And I just remember being in so much pain and terrified every time a contraction was starting. I remember the towel was getting so wet.
And as the towel gets wet, you know, it gets cold.

Speaker 11 And I was like, I just want to be warm and I want to be comfortable. I'm wet and I'm in pain and like nobody's helping and I don't know what to do.

Speaker 11 It doesn't seem like anything's happening and no one's directing me.

Speaker 11 They write that I was on my hands and my knees in the water at 2126. So that would have been about 9.30.

Speaker 11 I remember it being three hours that we were at the birth center that I suddenly had this weird feeling that I hadn't felt before, which was kind of like this rhythmic downward motion that my body seemed to do out of nowhere.

Speaker 11 And I was like, oh, maybe my body is telling me I need to start pushing. Maybe that was a push.
Does my body naturally start pushing when it's ready?

Speaker 11 I told my husband that he had his little alarm bell clicker. She was like, whenever she starts pushing, click this thing and I'll come in.
So he clicked it. He said, hey, she wants to push.

Speaker 11 What do we do? Ashlyn said, follow your body. Your body knows what to do.

Speaker 11 2127 is when the student wrote start of pushing and then 2127 ashlyn put another comment in there discussed benefits of cervical exam patient declines at this time father of baby alerted midwife via call button was bearing down with contractions midwife ashlyn present and acting as primary provider while midwife elizabeth managed the second stage of patient cp next door after the fact they added this in that Patient grunting with contractions told to listen to her body, no coached pushing at this time.

Speaker 15 And this was added later after the fact.

Speaker 11 Yes.

Speaker 15 And do you know how much later?

Speaker 11 So the original and edited notes we downloaded on the 16th, a few days after my baby was born. The screenshots I took, it was about a month later.

Speaker 11 Their notes say that I had the urge to push at 9.30 around that time, but their edited notes, the added parts say they encouraged me not to.

Speaker 11 He said that I claimed that I no longer felt the urge to push and Ashlyn encouraged me to rest and not push unless I had the urge to.

Speaker 11 They should have been explicitly telling me not to push because I was definitely pushing with literally every contraction. They told me to call on my body, so I did.

Speaker 11 That note about having offered a cervical exam, she did offer a cervical exam. They told us so much of the time through like birth training, cervical exams are risky because of infection.

Speaker 11 So they try to limit them as much as possible. Of course, that went out of my brain at the time that I'm in labor, in excruciating pain.

Speaker 11 Ashlyn offered the cervical exam, and I remember her telling me, like, it just tells us how far along you are. She never said that there was a risk of pushing if you're not far along enough.

Speaker 11 And I thought, well, what's the point of risking an infection if you're telling me to listen to my body? It seems like that's an unnecessary risk to take. So I declined.

Speaker 11 It did say that patients feeling the urge to push. We'll offer VE again, so I guess vaginal exam.
if progress isn't made. So that note was put in there.
At 22.26,

Speaker 11 so that would have been about 10.30 at night, I transitioned to the bed. I was just feeling like things weren't happening in the tub.

Speaker 11 Right after I got on the bed, Ashlyn offered another cervical exam. And at that point, I felt like things were not progressing.
I kept asking people, like, is this normal?

Speaker 11 Is this the way it's supposed to be? I feel like we're not getting anywhere. And so I let her check my cervix then at that time.
The original note says just midwife Ashlyn checking cervix.

Speaker 11 That was a note from the student. The edited notes adds that she reports bulging bag of water.

Speaker 11 And then an additional comment that was added later said encouraged to breathe through contractions and listen to her body. The edited notes say patient requests something to make it go by faster.

Speaker 11 Midwife Ashlyn discussing risks and benefits of AROM. That's breaking water, so rupture of membranes.
She said, we can try to wait and see if it'll break naturally.

Speaker 11 I remember worrying just always about the infection risk that they talked about.

Speaker 11 And so I probably turned it down for that reason, hoping that it would do it naturally and also trying to avoid this infection that they kept talking about.

Speaker 11 But I do remember at that time she said I was really close, but I had interior lip. I had no idea what that meant.

Speaker 11 I honestly don't recall that she ever explained that to me other than the fact that she said there's a little bit of your cervix left and that's probably what the baby's catching on.

Speaker 11 So we need to wait for that. I don't know how I missed this in the birth classes, but somehow I missed the fact that your cervix needs to be 10 centimeters dilated before you start pushing.

Speaker 11 So when she said anterior lip and there's a little bit of cervix left, it didn't register in my head, my cervix is not fully dilated yet. So I just kept pushing.

Speaker 11 But also, why didn't she, as the medical professional in that circumstance, say, hey, wait, you're not fully dilated, don't push? They never explicitly told me not to push.

Speaker 11 They never told me the risks of pushing on an undilated cervix ever. I would have absolutely listened to them had they said that because I'm very risk averse.

Speaker 11 Elizabeth came in after Ashlyn checked me. She gave me this homeopathic medicine, like the pellets that they put under your tongue and said it was supposed to melt the rest of my cervix.

Speaker 11 And of course, I'm like, I don't know what that means. I don't know what this is, but give me anything that's going to help me.

Speaker 11 That did not have an effect.

Speaker 11 I was trying to take sips of water. I remember my husband had like fruit snacks and he kept trying to give them to me because he's like, you need calories.
I literally had nothing in my system.

Speaker 11 No IV, nothing. They tried doing, I don't even know what it's called, but how they shake your hips or something.
And they have all those different techniques and we were trying those things.

Speaker 11 Then at 2316, so 1115, so 45 minutes of being on the bed, laboring, pushing, she did break my water at that point, it looks like, because she notes rupture of membranes.

Speaker 11 I had been pushing for so long and in so much pain, I was like, I can't do this much longer. So let's get things rolling.
So I agree to rupture of membranes. It was midwife Ashlyn that broke my water.

Speaker 11 The comment that they added later on was oscillatated after AROM with reactive fetal heart tone. So I guess that's a good thing.

Speaker 11 I think from my understanding, that means that the baby was reacting to them pushing on me or doing whatever they were doing to make sure that he was okay after they ruptured my membranes.

Speaker 11 Ashlyn noted Meconium's status to assistant to chart.

Speaker 11 So, per the midwife's observation, I had thin meconium in my water at 11.15. They did not notify me of this.
My husband also doesn't recall like hearing her say that to the student.

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Speaker 11 And I will note that having been in the NICU, I was fully aware of what meconium and water meant. So had I heard that, I would have transferred at that point.
But I was kept in the dark.

Speaker 15 How close together have your contractions been throughout this?

Speaker 11 I mean, they were pretty regular. I continued pushing at that point.
Ashland's at the bedside. I moved back to the tub.

Speaker 15 With your broken membranes.

Speaker 11 Yes.

Speaker 15 They did not instruct you that that could cause an infection.

Speaker 11 No. 2319 is when they note kneeling in water.
So I moved back to the bath at 11.19. So three minutes after she broke my water.

Speaker 11 And then 11.19 is when they note that I stated I no longer felt the urge to push. This was added later.
A minute later, 1120, the note is report given to midwife Elizabeth at bedside.

Speaker 11 Care relinquished to her as primary provider at this time. Ashlyn signed off.
She had been with me the vast majority of that time, even though she was like in and out.

Speaker 11 She hands over care at 11.20 p.m. to Elizabeth, but she wasn't with me all the time.
She'd check in every now and again. I recall laying in the tub and thinking I was going to die.

Speaker 11 We moved to the birth stool. Elizabeth thought that having a few contractions on the birth stool would help open up my cervix more.

Speaker 11 Those were the most painful contractions ever because you're like squatty potty.

Speaker 11 I had been pushing since 9.30. Elizabeth was there the whole time I was on the birth stool.

Speaker 11 So that was one time when I was in labor that she was at the bedside, which was a comfort, but also kind of frustrating now that she was like there listening to me push, having attractions and not telling me not to.

Speaker 11 We did that birth stool for a few contractions. It was too painful.
I was like, I'm done. I need to get back in the bed.

Speaker 11 So they helped me back in, got a heat pat going on my back and continued on the bed. She'd have me do various positions.

Speaker 11 I remember at one point she had me lie on my right side with my leg hanging over the side and she would shimmy my hip and that was supposed to turn the baby because she thought that maybe he was turned the wrong direction.

Speaker 11 I don't know, trying to get his head in a position where he could engage better.

Speaker 15 Does Elizabeth seem concerned at this point?

Speaker 11 No, I never felt concerned from her. I recall at that time feeling so glad.
That was the longest stretch of time she had been with me. And I thought, okay, great.

Speaker 11 If anything's going awry, she would know because she's been here a while, actually observing it herself.

Speaker 11 There was this growing concern in the back of my mind as every minute passed, this mounting anxiety of like, when is this ending? Is there an end in sight?

Speaker 11 48 hours ago, I was pregnant laying on my couch and I felt fine. Will I ever feel like a normal person again? Will I ever not be in this pain ever again?

Speaker 11 It's an irrational fear at that moment, but I remember thinking, I can't even fathom being on the other side of this.

Speaker 15 Who's in the room with you at this point? And what is their mood?

Speaker 11 The only people that were there were my husband and Elizabeth and the student midwife. I told the student midwife that I didn't think I could do it.

Speaker 11 I told Elizabeth that, but it was always like, if you feel like you can't, okay, but like, I think you can, you're getting really close.

Speaker 11 During your tour and during your birth classes, they always say women will say, like, I can't do this. I'm done.
They claim that that's their sign that they know you're close.

Speaker 11 I don't know if that was what was going on in their heads, but I was nowhere nowhere close. Without them being in terror over what was happening to me, I just thought, okay, maybe I'm overreacting.

Speaker 11 So let's just stick it out a little bit longer. I don't want to give up.
I wish I would have advocated better for myself in that moment, but I was in labor, so I didn't advocate for myself.

Speaker 11 And my husband didn't know what to do. He was more concerned about me and the pain that I was in.
I tend to be someone who's extremely hard on myself. I wanted to have birth there.

Speaker 11 I had researched the place. You know, we had invested our money.
My husband and I had been trained to get here. We went to the birth classes.
We did all the things. I mean, that was our plan.

Speaker 11 That was my dream to give birth there. I knew other people had had good experiences.
And I thought, why couldn't I have that same good experience?

Speaker 11 Why was I going to be the minority who had to go to the hospital and transfer? And after I had invested so much time in labor, what's another two hours

Speaker 11 without the student or the midwife expressing any concern whatsoever, I thought, well, they're watching out. And if things are okay, then we're just going to keep going.
That's why I powered through.

Speaker 11 If they told me that things were bad, I would have listened.

Speaker 15 And you're trusting that they're not worried, that this is typical. This is your first birth and not theirs.

Speaker 11 Yeah. I remember at around that two in the morning timeframe, I looked over at my husband and I said, I'm going to die on this bed.
I don't think this baby's coming. I'm bleeding.

Speaker 11 I cannot stop pushing. It was so painful not to push.

Speaker 11 The pushing almost became involuntary because it was like my body's reaction to shield me from a little bit of the pain, like it'll take a little bit of the edge off.

Speaker 11 These contractions are killing me. I couldn't fathom getting out of that house.
I didn't think it was going to happen.

Speaker 15 Was it reaching the point of absolute exhaustion?

Speaker 11 I think that combined with I got my hopes up when she broke my water. I got my hopes up when she was doing the sideline techniques.

Speaker 11 The fact that we had done all those interventions and it was still two hours later and nothing progressing, I do not know what gave me the energy to say, I gotta go.

Speaker 11 But at two, whatever stroke of something hit me and I said, I cannot do this. And I said, get me checked and I want to go to the hospital.

Speaker 11 2.24, Elizabeth came in, she checked, and in the notes, the comment says, midwife explaining to patient that her cervix is very swollen.

Speaker 11 It is important that she does not continue to push until the cervix can be allowed to return to normal. Discuss that physician intervention would be best at this time.

Speaker 11 Patient agrees and expresses a desire to go to Bumpsey. And I do recall when she told me my cervix was swollen and that it probably would be a good idea to go to the hospital.

Speaker 11 I remember looking at her and being like, yeah, we're going. I'm going.
No discussion. I told her I couldn't stop pushing.
She just said to breathe through it as best as possible.

Speaker 11 You need to stop pushing.

Speaker 15 What did you feel when they told you that?

Speaker 11 Terror. I mean, it was like, what do I do? What am I doing to my baby? She never offered me an ambulance.

Speaker 11 I thought, putting my trust in them, that if it was bad enough where they thought I needed an ambulance service, they would 100% jump to the ambulance service without question.

Speaker 11 The fact that she was saying, okay, the student midwife's going to lead you to the hospital, you're going to get in your car and drive, I thought must not be a dire situation.

Speaker 11 It's going to hurt like hell walking to the car, but she must not be that concerned. So at that point, I was very much confident I wanted to transfer.

Speaker 11 Elizabeth said, okay, well, I have to write up your notes and send them over to Bumpsey and let them know you're coming. So I'm going to step out, get all that stuff together.

Speaker 11 You guys pack up your bags, get out to the car, and the student midwife, follow her, but wait in your car until I'm done with the notes because I got to make sure they're over there.

Speaker 11 Elizabeth left the room. The student midwife sat me up on the bed.
I'm on like pads and stuff sitting on the bed. So we have to get my underwear on.

Speaker 11 Totally unprepared because we didn't anticipate having to get dressed with my innards falling out. They got me like an adult diaper quick and threw that on and threw my shorts on.

Speaker 11 We have tons of bags of stuff. So my husband, you know, packed up all the bags, threw them in the car, came up and got me.
And the student midwife's there. I mean, I couldn't walk.

Speaker 11 So I crawled hands and knees out of the bedroom to the foot of the stairs. I tried my best to walk, but it just was not happening.

Speaker 11 The student midwife's kind of there just, I feel like she just didn't know what to do.

Speaker 11 I never considered that I could end up on the second floor and need to get down to the first floor and that they didn't have an elevator in that place.

Speaker 11 But in this scenario where things don't work out and you end up on the second floor, suddenly an elevator becomes really necessary.

Speaker 11 People have brought that up to me and they're like, how is that even acceptable for like ADA purposes?

Speaker 11 I got to the top of the stairs and I was like, well, I can't crawl hands and knees down the stairs. So what do I do? I tried standing and walking down the the stairs.
It wasn't happening.

Speaker 11 So, I scooted on my butt one step at a time down the steps. So, my open area is on this nasty ground, separated only by an adult diaper.

Speaker 11 Once we got to the bottom of the steps, I realized that I didn't know where my phone was. That was kind of important.
My husband ran upstairs to try to find it.

Speaker 11 The student men and wife went in with him. So, I just sat at the bottom of the stairs by myself for a few moments.
They found it, came back to me.

Speaker 11 And then, somehow, by God's grace, I was able to walk to the the car, which is out on the curb. My husband was accompanying me, obviously, leaning heavily on him.
But I did walk that stretch.

Speaker 11 We're sitting there for a few minutes because we're waiting on Elizabeth. And I remember at one point, we were like, how long does it take to write up notes and notify people? Like, we've got to go.

Speaker 11 I'm in the car puking and pushing. So my husband got out of the car to go get Elizabeth.
Trying to figure out where she was. I'm by myself in the car, unsupervised, unaccompanied.

Speaker 11 What could have happened? And no one would have been there to know. Finally, she comes out with him and get the go-ahead.
And so we take off and we're following the student midwife to Baylor.

Speaker 11 That was an excruciating ride, as you can imagine. Every little crack in the asphalt, I felt.

Speaker 15 Was the student still with you?

Speaker 11 She was not. There's the intersection where the hospital L and D corner is.
There's like a circle drive that brings you up to the doors. And so that's where we pulled in, but she just continued on.

Speaker 11 And so we probably hadn't even stopped our car by the time she was gone. She probably went back to the birth center is my guess.
It was my husband and me. That was it.

Speaker 11 But we do get there, thank God, and pulled up to the emergency L and D and again, couldn't walk. At this point, I did crawl hands and knees on the concrete to the doors.

Speaker 11 As I rolled out of the car, my husband ran in to grab somebody to notify him that we were there. So there's like two double doors.

Speaker 11 I hands and knees crawled in through the first set of doors onto like the nasty huge rug they have in the foyer. My husband was inside getting somebody and I felt a contraction coming on.

Speaker 11 I tried to stall it. I tried to breathe through it and I couldn't.
And I remember sitting there and I laugh at it now because it's just unbelievable, but I rolled over onto my butt.

Speaker 11 knees in the air and I had a contraction and pushed right on that rug in the middle of public. I mean, nobody was there.

Speaker 11 It was 2.30 in the morning, but looking back, I mean, it was fight or flight mode. I was in survival.
And then I heard someone yelling and screaming, running with a wheelchair.

Speaker 11 And they got me into the wheelchair and got me then inside. And the nurse is rushing me back to the room.
I was in such pain. And I remember screaming through the hallways, get me an epidural.

Speaker 11 I need an epidural now.

Speaker 11 But as they're rushing me back to the room, they're like, wait, we need your social security. And I just yelled it.
I was like, here's my social security number. You need it to get me the epidural.

Speaker 11 Let's do it.

Speaker 11 it says in my notes i arrived at baylor at around three o'clock i'm freaking out this whole time that i'm like killing my baby somehow or causing brain damage because i'm ramming his head against my swollen cervix all these bad scenarios are going through my head i was like y'all just get me the epidural because it'll help me stop pushing did they have to give you a cervical check before they gave you the epidural or get you on an iv or anything like that

Speaker 11 This stuff is blurry. I'm sure that I had to have IVs in.
I know that they checked my blood pressure and all the stuff, the vitals, and had to get things in order to get the epidural in place.

Speaker 11 So yeah, I mean, that stuff just takes time. They had to call the anesthesiologist.
They had to make sure that whatever boxes were checked.

Speaker 15 What time do you think you get your epidural after you get checked in and everything?

Speaker 11 I do know it was about a half an hour after we were there. It was around 3.30.

Speaker 11 I remember how terrifying it was having it placed, not only because it's a huge needle, but also because I was still having contractions and pushing through those contractions.

Speaker 11 When you have an epidural place, you have to be super still.

Speaker 11 And I was so worried that because my contractions were so close together, it was like, okay, one ended, let's do it, go before it happens again, because I was afraid I wasn't gonna be able to hold still before the next one hit.

Speaker 11 So that was also a pretty terrifying predicament, but everything was fine. We got it in place.

Speaker 11 As soon as that thing started kicking in and really doing its work, I was a different person.

Speaker 11 The nurse that took me in when I first showed up, she she kind of laughed because I was terrified before that epidural was placed. And then after it was placed, I was on a hike.
I was laughing.

Speaker 11 I was joking. I was just like raring to go.
The adrenaline, I felt amazing. I wasn't pushing anymore.

Speaker 15 Are you able to get a little bit of rest with your husband before you end up pushing? How does your progress go from here?

Speaker 11 I was. I was able to get some rest, probably a little bit of sleep.
By 7.30 that morning, I was 10 centimeters and the medical team all came in.

Speaker 11 This is the other thing that makes me irate looking back, but we didn't know at the time.

Speaker 11 My husband and I did not realize A, the danger that we were in and B, how awful the midwifery care was that we were receiving.

Speaker 11 Elizabeth told us that we needed to notify her when I was fully dilated and ready to push.

Speaker 11 I have theories as to why she had to be there and I don't think it was just all because she was an altruistic, loving person.

Speaker 11 We actually still trusted her at that point. So at 7.30, my husband called her saying that I was 10 centimeters and we were ready to start pushing.
So Elizabeth actually showed up.

Speaker 11 She arrived at 8.30.

Speaker 11 She asked if we wanted her to take pictures because I didn't have like a birth photographer or anything, but she was willing to take pictures and document. So we let her do that.

Speaker 11 I pushed from 7.30 to 10 a.m., so two and a half hours of pushing at the hospital after pushing at the birth center. My baby was born at 10 o'clock that morning.

Speaker 11 With the history of what was going on, what they knew had happened, they called in some NICU personnel. They did care for him after he was born.

Speaker 11 He was especially black and blue and purple and not breathing and didn't breathe for several minutes. I was terrified.
I knew, having worked in the NICU,

Speaker 11 that babies should cry pretty soon after birth. And I remember looking at my husband, who was standing by me holding me, as they're working on me down below.
It's like, is he crying yet? Is he alive?

Speaker 11 Everybody heard me with my worries and they were trying to calm me down, but I think that there was a general understanding that there was some fear in the room.

Speaker 11 I don't know what they did in terms of bagging and resuscitating and all that stuff, but definitely a little bit more so than what would be considered normal. His APGARs, the first one was a five.

Speaker 11 Not great from my understanding.

Speaker 11 He was brought to the radiant warmer, suctioned and stimulated. No respiratory effort.
PPV started.

Speaker 11 Infant began to have improved color and spontaneous respirations and crying prior to five minutes of life. PPV CPAP removed.
So he did improve, obviously, within the time of major concern.

Speaker 15 Are you just completely exhausted at this point?

Speaker 11 Oh yeah. Absolutely.
Also, this massive amount of fear that this moment would never come escaped. But then also, it's like starting up this new massive amount of fear of like, what just happened?

Speaker 11 What's ahead of us? Because he wasn't crying. Why was my cervix swollen? What's the implications of that? Why were there so many people called into this room? Why was the NICU team here?

Speaker 11 After the flurry of all that, we've stabilized him. The craziness had died down.
Elizabeth was chatting with us and we were being cordial.

Speaker 11 I remember she was like, well, I'm going to go grab myself a coffee and then I'll be back, but I'm going to go grab grab a coffee. I need some caffeine immediately after my 48-hour shift here.

Speaker 11 I'm going on my 10-day vacation. She let us know that she doesn't usually do 48-hour shifts, but she needed to get her time in before going on vacation.

Speaker 11 So that was definitely not something we wanted to hear because is that why you're checked out? What if she had delivered babies all day for the past 24 hours? I don't know how their workload was.

Speaker 11 And so then I came in and she's already tired maybe. Like, I have no idea where we were on that 48-hour spectrum.
So that didn't feel great.

Speaker 15 How long did she stay after your delivery?

Speaker 11 I don't think very long.

Speaker 11 I think that she stayed around and probably asked us if there was anything else she could do. Then it was like, we'll be reaching out, whatever.
That was kind of it. I don't remember much after that.

Speaker 11 I stayed in that room for a little while. They don't keep you in there that long.
Maybe a couple hours or so, and then they transfer you to the antenatal floor. And so we went there fairly soon after.

Speaker 11 We get moved to the antenatal room in pain, swollen, all the things that you don't have any way to prepare for when it's your first baby. You just have no idea.

Speaker 11 Trying to figure out nursing, trying to figure out every three-hour feeds and changing the diapers and just all the things. I mean, so much going on, zero rest whatsoever.

Speaker 11 You don't really sleep well in the hospital. You know, people are constantly in your room and out your room and checking the baby and checking you and all that stuff.

Speaker 11 So exhausted, brain fogged from from everything, trying to recoup on energy and calories and fluid.

Speaker 11 In discussions with the nurse who was so amazing, after hearing that we came from origins and our story and all that stuff, she said, honestly, we get a lot of transfers from origins.

Speaker 11 There's a lot more transfers from origins than I'd like to admit. That did not sound great.
So that started putting us on edge a bit.

Speaker 11 My OB, she was the delivery OB, and then she was the one that followed up on me until I I was discharged. I thought she was good during delivery.
I had no concerns.

Speaker 11 I actually felt quite comfortable and safe with her there

Speaker 11 when I was being discharged from the hospital. My OB came in with my discharge paperwork to go over it.
Sat down, went through everything.

Speaker 11 I had a second degree tear. She stitched it up in the delivery room.
I said to her, this is my first baby. I have no idea what's normal.
I'm a worrier and an anxious person.

Speaker 11 I just had to know for my own sanity my level of

Speaker 11 swelling and injury and bleeding, like everything down there. I wanted to know where I was in terms of the spectrum of severity because I feel pretty torn up.

Speaker 11 I feel like I'm sitting on a bowling ball. She looked at me and she said, you did push for two and a half hours.
That's kind of the max that we'll let people go to. I mean, you're pretty bad.

Speaker 11 I was like, yeah, kind of rolling my eyes, plus the six hours I pushed at the birth center. I kind of said that as an aside, like I thought that was normal.
And she stopped and looked at me.

Speaker 11 And I'll never forget that look. She just was like, wait, what? She looked at me.
She said, what do you mean you pushed at the birth center?

Speaker 11 And I said, I thought that was why my cervix was so swollen.

Speaker 11 Obviously, she wasn't given this information by origins, but at the moment that she spoke it to me, I almost took it in a way that she was angry at me. I know she wasn't.

Speaker 9 She was shocked.

Speaker 11 She said, you're not supposed to push until you're fully dilated, 10 centimeters. You weren't fully dilated when you got here.
So why were you pushing? I was like, are you kidding me? I had no idea.

Speaker 11 And she said, didn't they check you? And I said, well, I opted not to because she said there was an infection risk. She said, do you know what could have happened? You could have torn your cervix.

Speaker 11 And I later found out that if you tear a cervix, you can hemorrhage and bleed out. That's an emergent surgery.
I lost it.

Speaker 11 When she told me that, I took it kind of as a reprimand, but it was the gravity of how much Elizabeth had just let us go. And Ashlyn, why was I told to follow my body?

Speaker 11 Why was this message not relayed from Ashlyn to Elizabeth, eventually to this OB that I'd been pushing this long?

Speaker 11 And she was like, if I had known that when you came in, you wouldn't have been having a vaginal birth.

Speaker 11 I can't even describe the emotion I felt. The fire and the fury in me and the tears and I screamed.
Like I've never felt that emotion before in my life. I was so terrified and angry.

Speaker 11 I think it shocked the OB.

Speaker 11 She tried calming me down. I mean, I just realized that I literally put my life and my baby's life in danger.
That was the moment that everything changed for the rest of my life, to be quite frank.

Speaker 11 After I got over that. emotion and was able to calm down.
It was like, okay, what do we do from this point? And she said that the concern now is that we don't know what future pregnancies will bring.

Speaker 11 If there's future pregnancies, will I be able to carry a child? Do I have uterine prolapse? Are there going to be structural problems? Because I pushed so hard.

Speaker 11 I looked into what the future could hold. Every little thing that I found out, I mean, it was the concern about HIE, which was never mentioned by the NICU team or anything.

Speaker 11 Are you sure he didn't have mecodium aspiration? Are you sure that they checked him for oxygen deprivation during all that time? Like, I didn't realize all of this could have happened.

Speaker 11 We have no idea. And so, then, of course, it was the worry about my son.
Things can show up later on. Did he have some sort of brain damage? Is he going to have developmental delay?

Speaker 11 Is there something lurking that we haven't quite found yet? What else was missing in my chart that would have alluded to another problem that was a direct result of their poor care?

Speaker 11 It's just this ballooning anxiety because there was so much unknown. There was so much miscommunication.
There was so much hidden.

Speaker 11 Either Elizabeth knowingly hid that information or she was so clueless because she didn't realize I was pushing the whole time because they claimed that they thought that I was not pushing.

Speaker 11 And they went back and changed the notes once they realized that I said I was pushing the whole time. I was angry at Origins.
I was angry at them for not providing that information to the Bobi.

Speaker 11 I didn't blame her at all. She was not at fault because she wasn't given information.

Speaker 11 Something broke in me, I think, at that moment. My ability to trust other people, my ability to trust my own choices.
The guilt came and swarmed me. And they obviously were hiding something.

Speaker 11 We stayed in that antenatal unit for a couple days. I don't think we stayed the full 48 hours.
Typically, they keep you there 48 hours. All I know is I just wanted to get home.

Speaker 11 I liked being in the hospital for the care after everything that had happened, but I also just was dead tired and we had been away from home for two days since we had gone in Sunday.

Speaker 11 I believe we went home Tuesday evening late. The trip home the first time, walking in the doors.
My poor husband has to carry the baby in and then also go back and get me because I can hardly move.

Speaker 11 We were starving. I don't think we had had dinner at the hospital.
It was just so much of the discharge stuff that was happening that takes forever.

Speaker 11 So many things happening that you forget to eat and take care of yourself. And so he started making dinner, and I called my mom.
She wanted to know when we made it home.

Speaker 11 I hadn't talked to her except for maybe when we first moved to the antiparty unit. She asked how it went.
It was like this flood of emotions just overcame me.

Speaker 11 And I could hardly speak through my tears, just letting her know what I had found out and the horror of everything that had happened and what the OB had said.

Speaker 11 She was in utter horror and shock as well. She, as a nurse, couldn't believe it.
My mom, she had gotten like a cold or something at the time.

Speaker 11 So she had originally planned on not coming out for like a week. She wanted to give us our time as a new family, but she was going to fly down after that week and be with us and help me.

Speaker 11 But when this happened, it kind of was like, oh, I need to get down there sooner, but I'm sick and I don't want to get your baby sick. And so it was just.

Speaker 11 me and my husband for a few days until my mom finally recovered and was able to come down.

Speaker 11 But she she probably was appalled for several days and I'm sure very concerned about how we were doing in that time. I think she felt helpless.

Speaker 11 You're watching your child be in pain and you can do nothing about it. That's a helpless feeling.

Speaker 15 Next time on something was wrong.

Speaker 11 I went in for my two-week visit with her, already a little bit on edge. My OB comes in, her happy self, and takes a look down there.
You can't make this stuff up.

Speaker 11 And she's like, well, there's been a separation of church and state down here.

Speaker 11 That's what she said to me. And those words stick out in my mind because it was just so nonchalant and to me, insensitive because I'm in pain, I'm scared, I'm hurting.

Speaker 11 It seems like all these care providers are somehow skipping over important things. That's what you're gonna say to me after all this.

Speaker 15 Something Was Wrong is a Broken Cycle Media Production, created and produced by executive producer Tiffany Reese, associate producers Amy B.

Speaker 15 Chesler, and Lily Rowe, with audio editing and music design by Becca High.

Speaker 15 Thank you to our extended team, Lauren Barkman, our social media marketing manager, and Sarah Stewart, our graphic artist.

Speaker 15 Thank you to Marissa, Travis, and our team at WME, Wondery, Jason and Jennifer, our cybersecurity team, Dark Box Security, and my lawyer, Alan.

Speaker 15 Thank you endlessly to every survivor who has ever trusted us with their stories. And thank you, each and every listener, for making our show possible with your support and listenership.

Speaker 15 Special shout out to Emily Wolf for covering Gladrag's original song, You Think You for Us This Season. For more music by Emily Wolf, check out the episode notes or your favorite music streaming app.

Speaker 15 Speaking of episode notes, there, every week you'll find episode-specific content warnings, sources, and resources. Until next time, stay safe, friends.

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