Story #102 - Emily Goodstein, Washington DC (USA) - Postpartum Preeclampsia, Doula, Birth Advocate, Health at Every Size, Breastfeeding Journey, Postpartum Anxiety & Asking for Help
Emily Goodstein is the founder and CEO of Greater Good Strategy. When she’s not creating amazing campaigns for non-profits or “good for the world” organizations, she can be found behind the camera or instagramming! In 2013, she completed the photography for the Washington, DC Chef’s Table cookbook — using her lens to document the city’s dynamic food culture. Goodstein completed her second cookbook in 2017, Great Food Finds, Washington . Her third book, No Access Washington, DC is a behind the scenes look at hard to reach or off limits spots in and around DC. She also specializes in photographing birth, joining women for home, birth center, or hospital births to capture the day their little ones arrive. An activist at heart, Emily is a lifelong supporter and former board member of Planned Parenthood of Metropolitan Washington. She lives in DC with her partner, Ron, and their daughter, Edie.
Ron and I got married in October 2019, and I got pregnant not too long after. I was 36 and was led to believe that conception would take a while and require interventions. I was prepared for the process to take a really long time, but conceiving ended up being easy, which I know is a blessing. I remember calling friends to announce my pregnancy and learning they had suffered losses that same month. It must have been so difficult for them.
I thought I was fairly prepared for my pregnancy and birth, because I had been a birth photographer for eight years. I shot a little over twenty births and loved it, and this experience helped me understand the process. So when my time came to choose my birth team, I had a clear idea of what I wanted. At the same time, there is no way to be fully prepared for what is going to happen. In my case, it's the postpartum period that caught me by surprise and ended up being the most traumatic.
I felt great until 33 weeks. I had picked an amazing team and despite the pandemic, which complicated everything, I felt lucky to be surrounded by such competent and empowering professionals. I've struggled with my weight for most of my life. Being a size 22, I had been led to believe, by the medical establishment, that becoming and remaining pregnant would be an issue. Fatphobia and discrimination against bigger bodies are so engrained in modern medicine that I made sure my team wouldn't reconduct those stereotypes and focus just on my BMI, instead of on my overall health. There is no evidence that body size determines a birth’s outcome, but not everyone gets that.
I didn't have any complications during my pregnancy, and our main challenge was not knowing as much as we do now about COVID. I was scared to leave the apartment and didn't get to be with my community and experience the usual rites of passage. Aside from that, I had a low complication pregnancy and a pretty positive time until the end.
I regularly took my blood pressure at home due to fewer in-person appointments with the new COVID restrictions in place. Around 38 weeks, I had one borderline reading and a second during a routine midwife appointment the next day. I was then sent to labor and delivery triage. After a really good conversation about my options, we decided to go for an induction. I got "discharged" for three hours to allow me to get ready and grab my big suitcase. On the way back to the hospital, my husband and I had a lovely dinner outside at a restaurant. We had been so cautious during the pregnancy, so that meal was lovely.
I got checked in afterward, and we began the induction process not much later. It must have been 2 am on Saturday morning and our midwife, Katie, was a champion. I didn't want to be hooked up, so she got me the wireless monitor and was very invested in making everything work for me.
We had exclusively worked with her for the entirety of the pregnancy, and I felt very lucky. Her mantra was, "Health at every size," and I truly felt safe in her hands.
The first induction method with Cervadil didn't work, so we moved on to the second one (Cytotec, which you put between your gum and your teeth.) That kicked in very well. I was relieved that it wasn't as uncomfortable as I thought. Apparently, I'm also a very fast and efficient laborer! My water broke on Sunday morning, and two hours later, my contractions were very strong. I was able to think about what I needed to manage my surges, and I was able to use all the coping mechanisms I'd learned. I got to 10 cm quickly, but Edie hadn't dropped down yet because her chin wasn't in the right position. By then, I was in a lot of pain and asked for the epidural. It was a great decision because I had another three hours of pushing ahead of me, leading to a lot of secondary tears, postpartum hemorrhage, and hematoma.
But the birth itself was fantastic. I felt wrapped up in a nest of love and support. I had my doula, my husband, our midwife, and a fantastic team of nurses. People were crying with happiness, and we listened to The Indigo Girls while I pushed.
We watched my BP during the entire time, and it was only high at a few points during labor and delivery. In the end, Edie decided she was going to be born at 4:57 pm. The person she is named after was also born at that time, so it felt full circle.
I was really proud of myself for getting to 10 cm without medication. I felt like I got to experience everything, and I know that the epidural was the right choice for me at that late point in my labor.
We have these preconceptions about pregnancy and birth. You think, "I'll go to the hospital and have this baby. It'll be intense and amazing, and then I’ll come home with my baby, breastfeed her, and all will be well." In actuality, the truth is: postpartum is the wild west.
From L&D to the maternity ward, it felt like I had been dropped onto a highway.
I had a lot of blood loss during delivery. It wasn't a big gush, but more like a balloon deflating. I kept feeling fine, though. I wasn't scared, and I felt supported when I was still in L&D. Many providers came to stitch me up and check on me.
Except for the first few minutes following Edie's arrival, I didn't get to hold her again for a very long time because there was a concern about her blood sugar (and there was the possibility I'd need to be moved to an operating room for more extensive repairs). Edie's blood sugar got better after an initial dose of glucose gel. I was also not producing any colostrum at first, and I was adamant about giving breastfeeding a chance.
We were eventually wheeled out of L&D, and that's when things started to go sideways. My husband was exhausted and didn't know what to do. The nurses were not as helpful, my baby was screaming, and I couldn't get out of bed because of the epidural. Also: the toilet in our room didn't flush.
Fast forward to Monday morning: Edie got another low blood sugar reading, so I agreed to give her formula, hoping it would "fix" the issue. At her third reading, she got 44 — the passing point was 45. I was really stressed out and anxious, and my BP began to climb. One thing they would let me do during labor is to meditate before taking my pressure. It would allow me to calm down and not focus on bringing it down at all costs — which ended up being even more stressful. Doing so, most readings were at a healthy level, and it was beneficial for labor itself and for managing the surges.
But the postpartum ward was a whole other environment: people kept coming in and out, Edie's reading was too low, and I was anxious because I couldn’t breastfeed. As a nurse took my pressure, I closed my eyes and tried to relax. What I didn't know was that in the meantime, another nurse had called the neonatologist. As I was trying to calm down, the doctor came rushing in and, without introducing herself, said, "We need to get your baby to the NICU asap. I'll see you in the NICU."
I did not understand that they were not physically taking her, but merely telling me that we needed to go to the NICU. So I screamed, "Wait!!" thinking they were taking her away. As I was screaming, the nurse took my BP, which obviously ended up being very high. Then, without anyone explaining anything to me or asking for my parental consent, the nurse pushed Edie's bassinet out of the room and told me to follow her. Mind you, we were walking there, and I physically couldn’t keep up with her because I had just given birth and was in a good amount of pain.
Because of COVID, only one parent was allowed in the NICU. I was hysterically crying and my husband was immediately asked to leave. They put an IV in her arm and started giving Edie a bottle of formula. I had specifically brought a bottle from home, but they didn't use it. No one explained to us what was happening. They just did their job without any bedside manner. That was so traumatic seeing her in the little incubator. I maintain to this day that she didn't need to be there. No one laid out a plan of care, and I had no say about how and what she was fed. Later on, I learned that she could have been fed in a lot of different ways, but they simply didn't give me the option.
They made me sign the parental consent only when she was discharged, which seemed like a big joke. My problem wasn't that they took her to the NICU; it was that there was no discussion about the treatment plan and how long she would have to stay there. As if as soon as she was out of me, the care for the mother vanished.
My husband and I traded off going back and forth to the NICU. I wanted to breastfeed every three hours, but often, I'd get there and the NICU nurse would have just fed Edie a bottle, even though we had agreed on a nursing and bottle schedule. Friends and family were asking us to send a family photo... but because of the COVID NICU one parent policy, we don't have any photos of the three of us during Edie's first few days.
I don't usually pray, but every time I'd sit with her in the NICU, I'd pray for her blood sugar to get up so we could get out of there.
I was eventually discharged on Wednesday, five days after I was admitted, but Edie's discharge date was not yet confirmed. The NICU team would not tell me what their plan was or when she would be released. All they did was threaten me: "You really have to promise us you'll go to your pediatrician as soon as she's discharged."
With no concrete discharge date in place, I insisted on an update. Edie's blood sugar had been normal for a good amount of time. I was told that she would "probably be discharged on Thursday." Probably. I snapped. Found the neonatologist, removed my mask, and told her, "I'm leaving with my baby. Today." And then I stopped talking, which is really hard for me.
She sighed and said, "Fine, I'll move her test for earlier." Edie passed, and we went home with her that night.
I did a lot of work to prepare myself for the eventualities of labor and delivery, but not once did I think about how I would process a NICU stay or the first postpartum days.
Edie ultimately never lost weight and was completely fine. I thought, "Great, we made it, it can only get better from here."
After you leave the hospital, your provider, birth doula, and every support person you hired usually leave. And you are left on your own. I had seen far less documentation of the postpartum period, so it was difficult to have a clear understanding of what it entails. I also believe that people forget how hard it is because we are biologically wired to procreate, so we're never getting the full spectrum of what can happen postpartum.
Luckily, I had hired two postpartum doulas, Joya and Katie, and they came to our apartment the day after we returned from the hospital. I remember calling my rabbi and trying to do the triple feed* with my doula's help. Joya asked if I had taken my BP since coming back home, and I told her that I was still so triggered by what had happened with the nurse that I didn't want to. She said, "Let's just do it one more time. I'll make you a sandwich. Edie is sleeping, the house is calm, it's important."
The reading was off the chart. So high that Joya suggested I call my midwife, Katie, right away. I thought something must have been wrong with the cuff, but I called her anyway. She said, "It could be a lot of things, but if I were you, I'd go to the hospital." I knew I couldn't bring Edie with me if I did that, so I was reluctant. I said, "It's probably just the cuff." But Joya was listening: she asked for my phone and went into the other room to talk with Katie. When she came back, she handed me the phone and Katie said, "Joya is going to help you pack your bag: you're going to the hospital."
Minutes after being checked in, I was diagnosed with postpartum preeclampsia. They immediately started me on magnesium.
It was terrible, but not as terrible as Edie in the NICU. Katie and Joya cleared their entire schedules and cared for Edie while we were at the hospital. Had I just sat at home, I probably would have ended up having a seizure.
I pumped at the hospital. My mom would meet my husband there to pick up the milk through the revolving doors in the lobby (she wasn't allowed into the hospital because of COVID), and then she’d drop it off at our apartment building's front door. Our amazing doorwoman would grab the bag and deliver it to our doulas.
I remember leaving the hospital on Sunday with only a CVS cuff and nothing else. I remained on blood pressure medication, but I had nightmares about having a high reading. Yet on Monday morning, we still did the baby naming virtual celebration. I sent emails to 600 people and would not reschedule.
I still live with the trauma, and have many health-related anxieties: if my ankles are swollen or I have a headache, I always wonder if it's just the medication, preeclampsia, or an even worse condition. I found a new internist who's monitoring my BP more closely, but some days I'm crippled with anxiety.
Yesterday, I read something online about people who have comorbidities from preeclampsia. I was so anxious I felt I had a pit in my stomach all day.
I'm still in the "this could happen again" window, and it's scary. The only symptom I had was high BP and nothing else, so I monitor it closely. I had one borderline reading the other day, and I became so worried. Called several of my doctors and did telehealth appointments with new ones. It wasn't an emergency, but I don't feel I can trust myself.
I was so incredibly lucky to have my two doulas with me. They did everything: trash can, bloody napkins, support, food cooking... this level of service was unexpected. Gifts kept coming from our families and friends, and they would go downstairs to pick them up, open the boxes, and organize them. They sanitized bottles and did all the laundry.
One thing I remember now is that I missed her first Shabbat. I was still at the hospital on Friday night and being away from her was excruciating. It still makes me so incredibly sad. I eventually texted my family to let them know what was happening because I knew I was going to receive tons of messages saying, "Welcome Edie!" It was so triggering.
It also brought back old self-destructive talks like, "To get pregnant at your size was irresponsible. You put your life on the line." All I could think was that my body had failed me because of its size; therefore, I was failing my daughter. I had to remind myself that people of all sizes have preeclampsia. Rationally, I understand. But emotionally, it's a whole other challenge. My trauma was induced at an early age by the medical establishment and societal shaming and bullying. It's terribly hard to separate that from the experience I just endured.
It's the chicken or the egg: had I not been shamed by them, would my body be this size? Would all this stress about my BP being so high be an issue? Or even more, would my BP be an issue at all if I was a size four? I have to do a lot of self-talk: my blood pressure does not define my value as a human and a mother. I can be a good mom even though I need BP medication.
I should reiterate that the team who took care of me while I was pregnant was a dream come true. I felt like they went even farther than I did to help me go through the negative thoughts. They would preventively tell me, "This is not happening because of your body," while the postpartum team never confirmed that high BP is likely to happen to most preeclampsia people, independent of their sizes.
The absence of affirmation is what created the shame.
I worked with seven lactation consultants. I don't believe I would have survived breastfeeding if it wasn't for my determination. Most told me she had been spoiled by bottles and would not take the breast; others said they couldn't help further than all the other consultants who'd come before them. All were well-intentioned, but it took a lot of crazy perseverance: I don't carry these boobs around for no reason!
When Edie was 9 weeks old, she latched for the first time on the nipple shield and nursed. The milk transfer wasn't perfect, but it's better than pumping.
The pandemic also made this journey harder than it would have been. Many appointments were virtual, and there's only so much you can see and adjust across a screen. We also have this huge community, but no one can support us in person. It's a challenge. Most bits of advice people give when you're postpartum only apply to normal situations: ask for help, take a walk, get a pedicure... None of that can currently happen. It's incredibly isolating and debilitating. Covid moms want and need help, but most of what's usually available just isn't available right now. We're suffering alone.
I constantly have to remind myself that the pandemic will eventually end, but also that it IS happening right now. I cannot fool myself or project too much. It's not healthy. COVID is my postpartum reality, and as difficult as it is, I need to embrace that fact. We don't know when it'll change and what it’ll look like on the other side. I'm starting to forget what it feels like to be hugged. I’m hoping the future will be filled with embraces.
*Triple feeding is when a lactating parent breastfeeds, pumps and bottle-feeds at every feeding. Source: https://exclusivepumping.com/nursing-pumping-and-bottle-feeding/