Guest Post by Jairrah L. Godsil
Pregnancy from a Healthcare Workers Perspective
At 4:00 am, the digital pregnancy test spelled YES with a plus sign next to it. I was pregnant. At the time, I did not fully embrace this moment of motherhood. Joy and fear streamed in my thoughts, but I needed rest before my shift in three hours. Before falling back to sleep, I pondered, can I carry a baby to full-term? Give birth? Will my baby be healthy?
I work with newborns, premature infants, and children of all ages at a children’s hospital as a pediatric occupational therapist and certified breastfeeding specialist. I am well-informed on the prematurity crisis and its associated health risks.
According to the World Health Organization (WHO), prematurity can cause life-long medical conditions, morbidity, and mortality.
I was born at 33 weeks gestational age and required neonatal intensive care unit (NICU) level care immediately after birth. My parents had a traumatic experience as NICU parents. Statistically, 1 in 10 infants are born prematurely in the United States according to the Centers for Disease Control and Prevention (CDC), and the preterm birth rate increased by 4%. Black/African American women have the highest risk for preterm births. They have an alarming 50% increased risk in the United States.
Beyond the United States, prematurity affects fifteen million newborns at a rate of 5% to 18% in the world. Preterm births happen everywhere, even to healthcare workers. Preterm birth was a real risk for me as a Black woman, especially one born prematurely. What if this, what if that…the unknowns were daunting…Later that day during my shift at work, something was wrong. I was in a patients’ room and I could feel my legs buckling underneath me. I managed to safely exit the room, then nearly collapsed once I stepped foot into the pediatric intensive care unit (PICU) hallway. My work partner chased after me and braced my fall. A crowd of faces looked down at me. Nurses and doctors rushed to my aid. “Are you ok?,” my work partner and others asked. I nodded yes and mouthed, “I’m pregnant.”
My blood sugar (glucose) was low, and my blood pressure dropped. I quickly learned to prioritize breakfast and eat what my body allowed. I felt better after eating and resting, and I took the rest of the day off. My medical exam revealed that I was indeed pregnant, and we were both healthy. Overall, my pregnancy was uneventful besides my initial medical scare.
Pregnancy was a beautiful experience for me. I embraced working from home during the COVID-19 pandemic lockdown. I worked two jobs at the time, an early childhood occupational therapist at a school district and a pediatric occupational therapist at a children’s hospital. Working from home gave me the opportunity to slow down and reflect on my life goals and embrace entering motherhood.
Eight months later, my husband and I welcomed a full-term baby boy, weighing 8 pounds. He was not premature as I feared. He almost made his debut exactly on his due date (less than an hour short of it). However, he was born emergency cesarean due to fetal distress during labor. After his birth, we were both healthy. We peacefully bonded and practiced skin-to-skin immediately. He latched well and breastfed within an hour. We were both discharged home three days later in presumably good health. Everything was fine.
Postpartum Health Experience as a Patient and Medical Provider
Seven days after returning home, my pain was unbearable. I could not walk. The stabbing pain radiated throughout my entire body; every motion hurt. I vomited constantly. I remember telling my husband something was wrong. I could sense it. My instinct told me to act fast. I knew I had to go to the hospital immediately, but I did not want to leave my son behind.
My mother drove me to the hospital. Once I got there, I had a sigh of relief because I knew I was getting help. Upon arrival, an employee scanned my forehead at the entrance. "FEVER, she has a fever.” The hospital employee swept me away to a separate area because I had a fever. This happened in the mist of COVID 19, before the vaccine. I was scared. I had scans taken, blood drawn, COVID-19 testing, a urine test, and a full medical work-up. I distinctively remember my emergency room nurse asking if I was in pain. I said, “yes, 10 out of 10”. After an hour, my doctor arrived and praised me for coming to the hospital just in time to save my life. I was COVID-19 negative but suffered multiple abdominal abscesses and a brewing infection. I was diagnosed with a ruptured appendix, peritonitis, and a bowel obstruction. Not only did I need surgery to save my life, but I needed it immediately.
Two surgeries later, my surgeon disclosed my vulnerable medical status. I was at a critical point. I could not survive another surgery, but I needed one. He explained, "your body needs to fight". He did everything he could, same for my medical team. I did not realize the severity until my mom left the room crying. My husband was at home with our son because I could only have one visitor at a time due to COVID-19 protocols. The realization of death did not register. I was so worried about my son that I forgot about me.
Peritonitis or infections during or within two months postpartum are the second leading cause of maternal deaths in the United States.
African American women have the highest risk and mortality rate compared to other races or ethnicities in the United States. As a medical provider, I often considered myself last and addressed the needs of others first. My newborn son was my priority. In hindsight, I wished I had gone to the hospital sooner, but I did not want to be separated from him. The reality was, we were separated anyway.
After two weeks in the hospital, I felt distant from myself. My emotions were lost, they floated away. I was in a fragile state.
I never thought I would be here, fighting to live another day again. I felt like a living statistic for Black Women in America.
I also completely switched roles from being a provider to being a patient. I needed therapy and doctors were rounding every day, giving me an update about ME. This was a new and eye-opening experience. I felt helpless at times. I could not walk without help, eat by mouth, or do anything without maximum assistance from my nurses or family. I was embarrassed because I needed pain medication to move. My entire body was swollen and my white blood cell count was alarming. I felt isolated and alone. Time passed in slow motion. I felt like I was fighting a never-ending battle, the same thing every day. The infection would appear to decrease, then ramp back up again. One computerized tomography (CT) scan after another, bad news delivered every day. I started to lose hope. I am sure I suffered from postpartum depression at the time. Unsurprisingly, Black women also have the highest risk for postpartum mental illness.
“She needs to see and hold her baby,” my nurse advocated to the medical team. I now think of her as my angel. She arranged for a special circumstance gathering outside of the hospital walls, due to COVID protocol. My medical team strategically arranged the meeting for one hour the next day, limited to that time based on my medical condition. My IV antibiotic medications required protection from direct sunlight, so a few extra steps were taken to ensure my safety.
The Power of Touch
The moment I held my son again was divine. He was my sunshine and my breath of air. He happened to wear a onesie saying, “Mommy’s Little Sunshine” that day. My nurse was right; I needed to hold him. This meeting brought healing to me and my family. My son was my fight to live. I held him for a little longer than the one-hour limit. Everyone around me knew how powerful those moments were, so no one disrupted it. From that day forward, my body started fighting. My son absolutely saved my life.
Less than two weeks later, my doctors finally discharged me from the hospital. I still needed IV antibiotic therapy three times a day for two weeks following discharge from the hospital. Once again, I was on the other side as the patient. Home health services assisted with my medical needs. I previously worked in home health, so I knew how it worked. Even though I was well enough to return home, I encountered many challenges. I was mentally exhausted and in pain. I could not hold my son without his body pressing on my abdominal incision (it extended vertically from my lower ribs to my hips). My milk supply was low from limited opportunities to pump or breastfeed. Stress and my medical condition exacerbated my milk supply issues. Could I ever breastfeed again? Was it safe to breastfeed while on IV antibiotic therapy? How could I care for myself and my baby? How could I manage an entire year without my husband? My husband was scheduled to leave for military duty three weeks after I returned home.
Several weeks and many tears passed. Overall, I endured a month and a half lengthy battle. I was weak and dependent on my family. They helped me daily for the first few months. I was surprised by the amount of friends and family that volunteered to help us without needing to ask for it. Friends that I had not spoken to in years also helped. With support, I learned how to adjust to home life. I used pillows and blankets to protect my incision and reduce the pain when I held my son. But there were two things that hurt more than the pain when I held him. I was a stranger to my son; he cried when I held him. We lost our strong bond together, and others could soothe him better than I could. I also could not hold him the way that he wanted to be held. I felt like a failure. He cried every time I breastfeed. I had an insufficient milk supply. Supply issues and pain caused my mental health to deteriorate. After speaking to my mom, she encouraged me to seek help. Her encouragement inspired me to seek help from a lactation professional.
I called a lactation consultant from the birthing center the next day. She surprisingly told me to hold my son as best as I could skin-to-skin. She recommended to do it daily for at least three hours a day.
She said skin-to-skin would assist in increasing my supply and improve my milk ejection reflex (MER) response, also known as let-down reflex. She also said skin-to-skin would help us bond again.
Although I worked in the medical field at a children’s hospital, skin-to-skin was typically for newborns, premature infants, or critically ill infants. My son was fine, so he did not need it to survive. She said we (my son and I) needed skin-to-skin together to strengthen our breastfeeding relationship. I was astonished. Skin-to-skin outside of the hospital environment was a new approach for me. I was amazed how something so easy and natural could help with my enormous struggles.
Based on my medical condition and healing surgical incisions, I could not hold my son in the traditional skin-to-skin position without his body pressing on the incisions. As a result, I modified the position by lying on my side, facing him on his side. Side-lying was the easiest position and it hurt the least. I could easily breastfeed in that position too. I practiced skin-to-skin during convenient times of the day, after showering and at bedtime because it took too much energy to undress and re-dress both of us multiple times a day. After three weeks of power pumping, skin-to-skin, and increasing water and caloric intake, I achieved exclusive breastfeeding again. He was almost three months old. Within that time frame our bond was restored. I could soothe him better and I started to feel better too. I eventually held him without pain, and sometimes, I held him all day just because I could.
Today, my son is two and a half years old, and he continues to breastfeed daily. He is still my light. One of his favorite songs is “You Are My Sunshine.” I am thankful we are all together today.
My husband came home a year later after his military duty. We welcomed a second baby boy 9 months after his return. We were all well and thriving. I experienced skin-to-skin and breastfeeding peacefully and naturally with my second born son. He is now 6 months old. My second born son was gifted a skin-to-skin Bonsie outfit, and we fell in love with it.
Skin-to-skin was much easier to do daily without needing to plan or incorporate specific arrangements. If only I knew about these when I needed them previously. I could wear a T-shirt, robe, button up, or any other shirt, and effortlessly practice breastfeeding and skin-to-skin multiple times a day by simply opening the flap on his chest. Breastfeeding while skin-to-skin in the outfits felt natural and stress-free. Breastfeeding in side-lying is still my favorite position. It is the most comfortable position for me, and it symbolizes so much more: my motherhood journey.
Learn more about Jairrah’s courageous motherhood story on her Instagram page @jairgodsil.
Stay tuned for our next article about Jarrah's perspective on skin-to-skin contact as a patient and medical provider.
References
Centers for Disease Control and Prevention. (2022a). Pregnancy mortality surveillance system. Retrieved from https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm#print
Centers for Disease Control and Prevention. (2021). Preterm birth. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm#:~:text=Preterm%20birth%20is%20when%20a,2020%20to%2010.5%25%20in%202021.
Chantlani, S. (2022). Focusing on maternity and postpartum care for Black mothers leads to better outcomes. American Psychological Association, 53(7). https://www.apa.org/monitor/2022/10/better-care-black-mothers
Johnson, K. (2013). Maternal-infant bonding: A review of literature. International Journal of Childbirth Education, 28(3), 17-22.
United Nations International Children’s Emergency Fund. (n.d.). Skin-to-skin contact. UNICEF. Retrieved from https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/
World Health Organization. (2022). Preterm birth. Retrieved from https://www.who.int/news-room/fact-sheets/detail/preterm-birth