The fourth trimester is the first three months of baby’s life after they are born. These first 12 weeks look very different across cultures, but I can only speak to my own experience as a working mom in America. The US is one of the only countries in the world that does not require a paid maternity leave. Jokes on me though, because I own my own business and decided what my maternity leave would look like. Originally, I decided on a 3 week leave and then to bring Hazel to work with me for as long as I could. After my unplanned C-section, I had no choice but to take off 6 weeks. My coverage doctor, Tiffany Halm, graciously agreed to extend her coverage at my office. I don’t know what I would have done without her, or my staff who really kept things afloat while I was gone! I did return after 3 weeks to see new patients and be in the office, but I did not adjust anyone until my 6 weeks had passed. I have been incredibly lucky to still have Hazel in the office with me. Some days are definitely easier than others, but she has lots of people willing to play with her and keep her entertained while I am seeing patients. (Shout out to Christina, Paxton, Rebecca and the BenchMark PT staff next door.)

My first few weeks postpartum:

I’m not sure that I suffered from postpartum depression, per se, but I was definitely depressed. If you read my birth story, it’s not hard to see why. In those early days after we got home, I was just plain upset. I was mad at so many things and so many people, including myself. My mother and sister came to help Jonathan and me after my surgery. When I look back on those first few precious weeks, I feel so much sadness for how I acted and how I did not bond with my baby. If she would cry, I would look at someone else to help her. If she needed a diaper change, I would look at someone else to do it. If she was hungry, I got frustrated that breastfeeding was so much harder than I ever imagined it would be. The physical pain I experienced was awful. I could barely get up and down, I couldn’t get into my own bed for weeks, I had horrible pain around my incision, and I could not even bring myself to look at my scar without wanting to throw up. For the first two months, I went through the motions of having a new baby. I did not feel excited or in love with her at all. In those beginning days, Hazel didn’t even feel like she was mine. She was just this strange baby living with us that I was responsible for. Since I never saw her actually be born, I questioned all the time if she was really our baby. It made me wish I knew that all along we were having a girl because then at least I would feel a little better knowing we left with the right baby. Crazy, right? It didn’t matter that she looked just like us, I questioned for months if this was really my baby. I realize now that these irrational thoughts and actions are quite common for new moms. Why is no one talking about this? I would mention it to people and they would say, “of course that’s your baby, stop acting crazy.” Ah, this is why no one is talking about this! No one wants to be called crazy when they are already feeling crazy. We’re looking for validation as new moms that we are doing a good job, that the feelings we have are normal and common, that everything is going to be ok.

The rest of my fourth trimester looked much like the first few weeks. I briefly sought help from a professional counselor to work through my feelings, but I didn’t feel like she understood me or why my birth story was important to me. I went to three sessions and decided that it was not for me. Every day, I woke up at 4:45 am to pump, get ready for work, get Hazel ready, and then we went about our day together at the office.

My breastfeeding journey:

I don’t remember the details of why the hospital gave formula to Hazel, but it was completely against what I had desired for her. I tried for months to breastfeed this child, but my supply was never adequate. I sought the help of lactation consultants, google, Facebook groups, friends that tried breastfeeding and stopped, friends that breastfed for two years, and anyone I could think of that might help me figure this out. Nothing worked. My supply was never adequate. I was embarrassed yet again. Why is my body literally failing at everything? I pumped every few hours for the first 3 months, for mere drops and ounces. My husband told me our baby was happy and healthy and to stop being so hard on myself. I couldn’t accept that I failed yet again at something I was supposed to be able to do. For 6 long months, I breastfed, pumped and supplemented with formula. I hid the fact that Hazel was supplemented to nearly EVERYONE. If we were going to be around friends, I said “don’t let them see the formula” to Jonathan. Why was I like this? Why did I feel so guilty about feeding my baby? I went to a seminar last September in Atlanta and it was really hard to sit through. The instructor didn’t “believe” that you couldn’t produce milk for your baby. I had to hold back tears for two whole days listening to how some people viewed C-sections and bottle feeding. This is exactly why I was embarrassed and tried to hide my story. Other moms are doing this! If you are doing this, please stop. We are all trying to do the best we can, and no one is better than anyone else. What you choose may not be what I choose, and vice versa, but I do promise to listen to you without judgment and support you whole-heartedly. At the end of September 2019, I hosted a birth trauma workshop at my office. The lactation Consultant Scotty, from the baby café in Fairhope, AL was in attendance. I spoke to her about my hardships with breastfeeding and she looked at me and told me my body had been through an enormous amount of trauma. I had two major surgeries within 24 hours of each other. Of course my body was not going to produce enough milk, it was focused on survival. Just like that, I was no longer embarrassed. She was right! It took validation from someone else to tell me I tried my best and some things you cannot control, for me to finally accept that I really did try my best. It is my hope that someday we do not need validation from others to know that we are doing our best.

Motherhood during the first few months feels a lot like the movie Groundhog Day. Every day is pretty much the same. There are a lot of sleepless nights, a lot of crying from both you and baby, a lot of frustration, but there’s also a new awakening of a new person, a mother. What did your fourth trimester look like? When did you go back to work? What is one piece of advice you would love to give to a new mom?

In my next post I will discuss my physical pain post-surgery and my experience with a pelvic floor PT. If you aren’t already, would you please follow me on Instagram @drnikkicottis!

Hazel’s Birth Story- 12/19/2018

Yesterday was my 35th birthday. I couldn’t help but think about my mother often yesterday as well as Hazel’s own birth day. I never really thought of my birthday as the day my mom actually gave birth to me until I became a mother myself.

When I was 32, I visited my mom in Philadelphia and attended a childbirth educator seminar. At dinner, I asked my mom to tell me about all 3 of her births. I was only 7 weeks pregnant at the time. If you’ve ever been pregnant, you know that people love an opportunity to tell you about all the things that went wrong with their pregnancy and delivery. Not my mom. She told me all of her births were fairly quick and uneventful. She even told me that she agreed with my desire to have a home birth because hers were so uncomplicated. No matter how uncomplicated a birth, you will remember that birth story forever. So now, every year on my birthday I will think of my mother fondly and the birth of myself, and how that helped to shape my mom as well as myself.

Now, onto Hazel’s birth story. It has been nearly 14 months (tomorrow) since Hazel was born and I still can’t think about her birth without tears in my eyes, and a heart full of regret and guilt. My due date was December 14th, 2018 and I had every intention of working until I went into labor or my due date, whichever came first. Looking back, I think this was the first mistake of many that I made. My body was physically exhausted, it was swollen and tired, yet I just kept pushing through. My job is very physical, I was on my feet for up to 10 hours a day. I counted down how many shifts I had left until the 14th came around. When you own your own business with no backup, what choice do you really have? I had maternity coverage set to begin Monday the 17th and desperately wanted to make it until that date. On Sunday December 16th, I went to eat with Jonathan and stated that my stomach felt weird. I got home and relaxed in the tub for a bit. A few hours later, I sat down to write my staff, Christina and Paxton, an e-mail about some things for my maternity leave, and my water broke. Just like in a movie…my water burst everywhere! It’s funny because they say, “that’s not how it really happens.” Well, for me it did. As soon as my water broke and I was not in labor, I had a bad feeling. I knew that I should already be in active labor, and I was not. I texted my midwife and she told me to try to get some rest and to head to Mississippi when my contractions were stronger and getting closer together. Well, I was nervous about having a baby on the side of the highway, so we got our stuff together and hopped in the car about three hours after my water had broken. The car ride to our hotel in Mississippi was fairly comfortable. I had contractions about every 10 minutes, but they did not feel very strong. The first night at our hotel, I did get some rest, but I labored consistently until about 3 am. When I woke up the next morning, (Monday) I felt nothing. No signs of labor at all. We decided to walk around and try to really get labor going but nothing worked. I met my midwife at 10pm on Monday evening. My cervix was only dilated 1cm. My midwife said she would try to stretch the cervix to get things moving and so that is what we did. Jonathan and I went to Wal-Mart to get castor oil and more clothes because we were only planning on a 1-2-night stay in Mississippi and we were already running out of clothes! I started feeling really sick when we were walking around, so we went back to the hotel room. I slept from about 11pm-2am. At 2am on Tuesday morning, I woke up and threw up all over the hotel room. I finally felt like we were about to have this baby. Side note: The next morning, I told Jonathan to call the hotel and tell them we would pay to have the carpet in the room cleaned since I threw up and we did not get it cleaned up very well. The girl at the hotel asked if we got all of our things out alright and Jonathan told her we did and asked why. She stated that the hotel had caught on fire at about 5 am that morning! Talk about wild and just so fitting for this entire labor and birth experience! Back to our story…My contractions were so strong, and so close together. We headed to the midwife. I will spare many of the details about my time in labor in the house, how sick I was, how often I threw up, how much I cried… but it was a LONG three days. Time just flew by, I was counting the time between contractions. The sun would rise and fall, yet I had zero concept of time or how long I had actually been there. My doula had come and gone since we were there for such an extended period of time. I kept thinking, this baby HAS to come eventually, I will give it a few more hours, but my body just never cooperated. Jonathan and I discussed several times if we should transfer, and I kept convincing him that I just needed a little more time. I was chugging castor oil diluted with coke, which made me so sick every time. (I still cannot drink coke because of this.) Nothing was helping. I was not progressing. A backup doula arrived Wednesday morning, and she was so amazing in helping us make decisions about what to do next. The final time my midwife checked my cervix, I was only 4 centimeters dilated. I felt so defeated. I burst into tears. It had been 3.5 days! Why is she not coming out? My body is supposed to be made for this! Eventually, Jonathan looked at me and told me it was time to transfer. I knew that he was right. My feet were so swollen I could not stand properly, I could not keep any food down, and I had not slept in almost four days. So, on Wednesday, December 19th, we made the decision to transfer to Gulfport Memorial Hospital in Gulfport, Mississippi. Our midwife gathered our paperwork and called and let them know that we were on our way. I looked at my midwife and cried. I told her I felt like a failure. I told her I was afraid. She encouraged us and sent us on our way as there was another birth she was attending and could not come with us. I knew that I needed rest, and I was so ready to get this baby out. I also knew we were in a danger zone of having ruptured membranes for 3.5 days and the chance of infection was likely. When we got in the car, I felt at peace with our decision. I called my Mom and told her we were headed to the hospital, she was so relieved. I know everyone was. I can’t imagine how scary it would be to know your child had been in labor since Sunday and being so far away. I told Jonathan I didn’t want anyone to come to the hospital. I think it’s because I was mostly embarrassed and that I felt like a big fat failure. I wanted a home birth so badly, and it was over. We were going to the hospital. The whole ride to the hospital, I had no contractions. Nothing. My body just stopped. At this moment, I knew I needed intervention and that we had made the right decision. I will say this though, during the drive to the hospital I truly believed this baby would still be born vaginally. I never, not even after all this time, did I think I would have a c-section.

When we arrived at the hospital, I was sick to my stomach worried about how we would be treated as a homebirth transfer. Our back-up doula, Star came with us. She is so important to our birth story. She guided us in decisions, and never made me feel badly about what we needed to do next. I am so grateful for Star, who conveniently knew our labor and delivery nurse. (Talk about a God thing!) The staff was wonderful, and I felt nothing but cared for and supported. They checked to see if I was dilated, and she told me I was 5cm. The nurse asked what I wanted, and I said, “I want Pitocin, I want an epidural, and I want to lay down.” She told me they would need to run some blood panels to make sure I did not have an infection. Turns out, I did, and this is where things would take a turn for the worse. Since I had an infection, I could not have an epidural. If you’ve ever had Pitocin contractions with no medicine…I salute you. It was awful. I wasn’t sure how I was going to do this any longer. The labor and delivery nurses let me labor for about 4 more hours, until they saw meconium. Paperwork I also had dated me 10 days before my original due date, so I was being told my baby could be huge! You are almost 3 weeks past your due date! (I wasn’t) They told me my baby’s heart rate was decelerating with contractions. I was told by my delivering doctor that I needed a C-section. I was devastated. I even used the words “I am devastated.” Followed by, “What will I do about work?” (If any of my patients are reading this, I really love y’all.) Jonathan assured me that we needed to do this, everything would be ok, and we would figure out what to do about the office. I asked the nurse if she agreed with the doctor, did I really need a c-section? She agreed, and so I consented to the cesarean. Since I had an infection, and could not have an epidural, the surgery would need to be performed under general anesthesia. I didn’t even know this was a possibility. I have never known anyone to have a C-section under general, and truthfully, I did not grasp what this even meant in the moment. I was 100% unprepared for a C-section. It meant that Jonathan could not be in the operating room with me, it meant that I would be literally unconscious for the birth of my first child, it meant I would not meet her for hours after she was born. One of the scariest parts was when they asked me if I was allergic to medication, and I truly did not know. I have never had surgery before, what if I was allergic and died? When they were taking me back to the operating room, I was terrified. I looked at Jonathan as though it may truly be the last time I ever saw his face. This may sound dramatic, but there were so many unknowns and I was never more scared of anything in my whole life.

Hazel was born via emergency C-section (and vacuum assisted) sometime around 7:00pm on Wednesday, December 19th, 2018. I don’t remember exactly how big she was, I don’t remember the exact time, but I do remember she was 19.5 inches. I say this because there is so much I do not remember about that day, this birth, this story. Much of it has been filled in by Jonathan, and I am sure some of it has been subconsciously blocked out. She was small, 6 pounds something. She was beautiful. I did not meet her until after 10:00pm. We had no skin to skin, we had no delayed cord clamping, we had no “golden hour.” Hazel’s APGAR score was a 1. She was nearly dead. The amount of guilt I feel about this is immeasurable. So many times I look at her, and think what if? What if we did not leave when we did? Would I be looking at this beautiful little girl? It’s an extremely hard pill to swallow. I thank God for the hospital staff, especially Dr. Elaine Kao who acted quickly when she was born and saved us both. I thank God for giving my husband discernment that it was time for us to transfer to the hospital and supporting me through every hard choice we had to make.

Jonathan and I decided to keep Hazel’s gender a surprise. I wanted Jonathan to be the one who told me “It’s a girl!” Well, that obviously didn’t happen either. When I came to in the recovery room, I was so out of it. I asked Jonathan if our baby was ok. Then I asked, “what did we have?” He said, “Come on, let’s go see her.” He meant to keep it a surprise but said her. I asked if we had a little girl, and he said we did. Even though we didn’t get the huge reveal we had hoped for, I love looking back on that moment of Jonathan telling me we had a little girl.

The next morning, a nurse came into my recovery room to remove my catheter. Several minutes after that, the nursery nurse came in with Hazel, and something happened with Hazel and she had thrown up green foam. I looked at Jonathan and said, “I think I am peeing on myself, it feels weird.” I asked the nurse if she could check for me. Her face turned bright white and she hit the call button repeatedly. She told me that I was hemorrhaging, and that she had to get Hazel to a doctor and nurses were on their way. Something was wrong with Hazel, and something was wrong with me. Within seconds, we had so many nurses surrounding me. This part is very hazy for me, but what I do remember is hearing them argue about their hemorrhage kit having no supplies. I remember thinking, “I am going to die. They don’t have anything they need to stop the bleeding!” I felt like I was going to pass out. My blood pressure dropped very low. Jonathan tells me that we had at least 8 nurses working on me to save my life. They put a piece of paper in front of me and told me they were taking me for another emergency surgery to stop the bleeding and that if they could not, I would require a hysterectomy. I signed the paper to consent and was once again taken for surgery. This all happened so quickly. I looked at Jonathan again not knowing if we would see each other ever again. I had to be put under general anesthetic for this surgery as well. I received a blood transfusion of over 8 units of blood and plasma and had a balloon inserted into my uterus to stop the bleeding. When I woke up this time, I was so confused. I remember hearing a child screaming and I thought “oh no, I am dead, and I went to Hell.” This sounds awful, but I was so confused! I thought for sure I was dead. I started yelling for help. A nurse calmed me down, told me my surgery was successful and I did not require a hysterectomy. Thank you, God, (and Dr. Kao) for saving not only my life, but my uterus. I was not ready to lose it. And so began the road to my recovery, and to being a mother. My mom and sister flew from Philadelphia and Phoenix immediately when they heard of my hemorrhage. I am so thankful they were here to help Jonathan and I physically and emotionally after this terrible ordeal the three of us had endured. We went home to Foley, Alabama on Saturday, December 22nd. We had spent 6 long days in Mississippi.

My recovery was hard. My depression hit instantly. I cried and cried about the birth I had lost, and the birth story I would be stuck with forever. I had terrible physical pain. Hazel and I were extremely disconnected for months. I felt tremendous guilt for putting myself, and my baby in danger. I felt guilty for putting my husband through this. I felt embarrassed. I felt mad. I still struggle with some aspects of this story every single day. I have never once said that I have given birth. There are so many things I would have done differently if I could somehow go back in time. But this is my story. This is Hazel’s story. Things could have been so much better, but I do know they could have been so much worse. We are both here. We are both thriving. If you have read this far, thank you so much.

Coming up on the next post I’ll be talking about my physical and emotional recovery from a long labor, emergency c-section, post-partum hemorrhage, additional surgery, breast-feeding difficulty and my first few weeks post-partum in general.

Was your birth like you had hoped? What went right? What went wrong? What do you wish you could change? I’d love to hear about it below.

The Fourth Trimester

The Birth Story of Hazel Jane Cottis