Birth Story: Jensi Carlson

Dr. Jensi Carlson and her husband, Bill, live in the Madison area with their twin boys, Larry and Arnie (13.5 months). Jensi is an amazing family medicine doctor and educator. I had such an amazing time listening to her birth story and learning about the silver lining of the boys’ NICU stay.

Jensi at 32 weeks

Jensi at 32 weeks

Did you have experience with birth before you had your children?

I have been delivering babies since I graduated from residency, but all of my experiences, except for birth support for 2 of my friends, have been as the doctor, the resident, the medical student. It’s not been in the role of coach or support or family. These were all experiences where I was in a very different role.

I had heard birth stories through patients and then friends. I had heard lots of birth stories. Most of my friends had kids before me. Every year on my birthday my mom always tells me my birth story with varying degrees of detail! My parents actually struggled with infertility. I had it on good authority based on my parents’ siblings that I was going to struggle with fertility. My parents were actually married for 15 years before they had me and had gone through a lot, including heading towards IVF. By the time they had me, it was a really big deal.

What were you most nervous about?

Like I said before, I had it on good authority that we were going to struggle getting pregnant. My husband and I got married in June and we pulled out my IUD 2 weeks after the wedding. Then we went on our honeymoon. I was due to get my period at the end of the honeymoon. I took a pregnancy test because I wanted to be drinking, and I had a positive pregnancy test! It just floored me because I could not believe that was even remotely possible! My husband didn’t believe it. We had to go out and get one of the pregnancy tests that had the digital read out because I brought it in and was like “It’s got another line!” He’s like “No, it’s really faint!” And I’m like “No! Any line is a line.” That was really a surprise, but it also meant I found out super early in my pregnancy. I had just barely conceived. I hadn’t even missed a period. It was probably positive that early because of the twins. We came back from our honeymoon. We told our parents at 6 weeks because we wanted their support if we had a miscarriage. I know a lot of people don’t tell, but I’m really a fan of normalizing the fact that a lot of pregnancies end in miscarriage, and you need equal support. Then at 6 and a half weeks I started bleeding. I remember distinctly, I was giving a lecture that morning and I was like “Oh! I’m bleeding.” I finished giving my lecture and called my husband in tears. When we went for the ultrasound we were feeling about the lowest low we could feel because I was so sure. We got into the ultrasound, and we’d both already been crying a little and the ultrasound tech found the heartbeat right away! Then she found a subchorionic hemorrhage. “Oh this is great! We’ve got a reason why I’m bleeding. We’ve got a strong heartbeat.” We were feeling really relieved. And then at the end of the ultrasound she went “Huh…” which is never what you want to hear! Then she said “I just thought that this baby was really far away from their yolk sac, but there’s 2 in here.” We were floored, the lowest low and then complete relief and then I don’t even know. It wasn’t joy that we were experiencing. It was just astonishment that we were pregnant with twins. I think my mother-in-law, when my husband called, said “You’re shitting me!”

When I thought I was just pregnant I was like “Yep! I know what this is going to be.” I went home and started making a list of things we were going to need. Then, when we found out we were having twins, that’s the first time that fear really entered into the situation, knowing what to expect. I was feeling really sad about that. My husband, really early on, was looking at things about twins. He had found this video where these twins were born. They were in separate warmers and they were crying. The minute they put the babies together they calmed down. That’s what my husband saw when he watched that video. And all I could see when I watched that video was a C-section in an operating room, twins who are in separate bassinets going to the NICU instead of being put on mom’s belly. I was just hysterical for a while. Every time someone would ask me about it, I would just tear up a little bit. It even still makes me tear up a little bit! I remember talking to my friend about it and saying “All I could see were all those things that I knew were medical interventions that I really didn’t want.” It’s not that I had a fear of those things. As a physician, I felt comfortable knowing what those were, but it’s not what anyone wants. I wouldn’t call it fear. It was more just disappointment and devastation and real sadness over the things I was going to miss out on.

New parents in the NICU

New parents in the NICU

Were your fears unfounded?

Some of them, probably. I think I had a reasonable worry. One fear that was unfounded was I was really worried about the boys going to the NICU, and they did go to the NICU. For us, it gave us 2 weeks where we had a lot of support getting used to parenting twins. I’ve observed other families who had twins who’ve not gone to the NICU and gone home with these tiny barely-term babies and had to cope with that at home without that additional time. I think for me and my husband  it just gave us a little time to get used to being parents and feel more confident. That was probably unfounded. Our NICU nurses were amazing! They taught us so much about parenting and caring for babies and instilled such a sense of confidence is us. We know that nurses, home visiting nurses and birth support after birth give parents a confident start, but it’s so different to experience it yourself. Everyone should be able to have this!

I worried about not being able to have them right on me right away. Luckily Larry came out screaming, and I was able to take him right on my belly and do delayed cord clamping before he went to the warmer. That was good! But Arnie was not crying when he came out. They did try to do delayed cord clamping, but I have a very distinct memory of looking at the NICU nurse and saying “Take him!” because he was not breathing. I was like “We’re not doing this! You’re taking him to the warmer and doing resuscitation!” He ended up needing CPAP for a little while. In the moment, you know what needs to happen, so I don’t think I felt any of that in the moment.  

First night at home.jpg

How did your labor start?

I actually got hospitalized. I had gestational diabetes during my pregnancy. Well...physicians make the worst patients. We’re terrible. I really held my providers to the mat on the evidence about different things. We had some conflicts over the gestational diabetes. I also probably have chronic hypertension, so the debate over “Is this chronic hypertension? Is this gestational hypertension? Are you developing preeclampsia?” was always an on-going conversation whenever I was evaluated. I ended up being hospitalized on antepartum for preeclampsia with severe-range pressures before my delivery, so I was on antepartum for about a week. That was one of those moments of grief where I had gotten called about labs because I had just a slightly elevated blood pressure at my last prenatal appointment. I got a voicemail saying “We’re going to call your emergency contact because we need you to go to the hospital now.” I was like “I need to call my husband and my mom.” Actually, I called my mom first because I knew she would freak out more than my husband. I said to my husband “I feel fine!” In retrospect, I was probably swollen and didn’t feel fine, but I’m very good at minimizing my own symptoms. “They’ll keep me overnight. They’ll see that my blood pressures are fine, and they’ll send me home.” But when I got there my blood pressures were still elevated. I thought they were going to induce me that night, but they felt comfortable with giving me meds and letting me stay on antepartum. The issue I got induced for was that Larry, Twin B, might have had some growth restriction. He ended up being the bigger twin! I know that ultrasound is not very accurate, but it’s a lesson you have to learn. You have to go with the information you have. I had been hoping to go to 35 weeks because I’d been hoping to avoid the NICU stay, so I got induced at 34 weeks and 6 days. The night before the induction, the resident came in to examine me and I was closed. It was a bit of an uncomfortable exam. I was like “Jeez, should I give feedback to the resident about how uncomfortable that was?” Then the next morning she was like “I kind of stripped your membranes a little bit...We hadn’t talked about it, but I just did a more vigorous exam.” I was like “Ok, we could have talked about that. I would have let you do it, but…” The next morning, when they brought me down to labor and delivery, I was already 3cm dilated and contracting on the monitor. I got misoprostol for an induction.

Describe your labor:

I got to 5cm and then they came in and told me they wanted to AROM and start pitocin. 15 minutes after AROM I was like “How about we hold off on the pitocin? These are coming every minute! This is intense!” I still really wanted a lot of the things I had wanted for my previous birth. I had really not wanted an epidural. Arnie was breech and they said if I wanted to try for a vaginal delivery, I had to have an epidural because of the risk of needing to do a C-section if the breech extraction failed. I kind of labored for a while. We did walking. We did changes of position. Then I got to the point where I was like “I don’t know why I’m doing this without an epidural if I have to get an epidural anyways!” My blood pressures were going up too, and they weren’t being controlled with medicine. I got an epidural, and about 3 hours later I was like “I feel some perineal pressure. I think one’s coming!” They checked me and I was complete.

Heading to the OR

Heading to the OR

My delivery was back in the operating room, so they brought me back. I was just sitting there feeling these contractions. My husband got all gowned up and adorable with his little beard net. We got back to the operating room, and everyone was there. I could only have one support person in the operating room. My parents were at the hospital and my brother had flown in to surprise me, which was lovely because I only have 1 sibling. They were all waiting in the waiting room. I started pushing and after 2 pushes I saw all the attendings leave the room. I was like “You guys! I know what that means! It’s going to be forever! I can’t keep doing this forever!” I remember just being so crestfallen. “I know what that is!” I know when I’ve peeked my head in a room and seen someone pushing and said “You’re doing great!” and then stepped out to do more work before they have a delivery. I was pretty bummed, but I actually pushed for about a half hour. Larry came out the way I expected him to. I had seen vaginal births before. I pushed him. I pushed his shoulders. He came out. He came onto my belly. We did delayed cord clamping. And then it was like “I have no idea what’s going to happen next!” I mean, it was a breech delivery. I’d never actually seen a breech delivery because we  don’t usually do those anymore. We specifically timed the induction to make sure their were attendings that were comfortable doing a breech extraction because it was really important to me. We don’t know if we’re going to have more kids, but avoiding a C-section was on our list. Healthy mom, healthy babies was at the top of our list, but actually second was trying to avoid a C-section and having them vaginally if I could. Since I had a vertex and breech twin, that is as reasonably safe as having a C-section. It was just a matter of having a provider that’s done a breech extraction. I didn’t really know what to expect with that. They did an ultrasound on him and actually his amniotic sac had not ruptured yet, which is probably why he tolerated his twin’s labor so well. His heart tones looked pretty ok. You can tell I slip in and out of doctor mode as I think about my delivery! Anyway, they did an ultrasound and he was still breech. The resident went in and found his hips and brought him down. The attending actually was amazing! I learned so much about teaching during my labor. It was a really complex delivery and he taught so well. The resident delivered him and he was actually born breech en caul which is pretty special. Actually, my husband came back in with Larry when Arnie was partway out and all he saw was the amniotic sac and some legs, so the first thing he said when he came back in was “What the hell is that!?” He said it looked like a water balloon but there were legs! It was a whirlwind.

We had decided ahead of time, because we knew the NICU was a strong possibility, that if the babies went to the NICU my husband would go with them. The nurse went out to grab my mom. That was our decision because my husband didn’t feel like he could leave me. His words were like “I love you. I don’t even know them yet! How am I going to be able to leave you?!” I was like “You have to go with them! I’m going to be fine!” My mom came in with me and he went out to the NICU with them.

Baby Arnie

Baby Arnie

Baby Larry

Baby Larry

When were you able to visit them?

That launched into the worst 24 hours of my life because I got started on magnesium after they were born. I had a wonderful postpartum nurse who got things set up for me and brought me up to see them right after they got the magnesium started which was excellent because I was down in postpartum and was not able to see them for the next 24 hours. It was the most devastating feeling. I didn’t acknowledge how out of it I was feeling at the time because I’m “fine” and I’m always fine! I was like “I’m fine! Just let me see my babies! I’m fine!” Everyone who came in the room I was like “Can’t you just put me in a wheelchair to go see my babies!? I need to see my babies! Why are you keeping me from my babies?” I was just laying in my bed, begging to see my babies and pumping every 2 to 3 hours trying to get my milk supply in. It was a really hard 24 hours. My mom remembers all sorts of little things. She has a picture of my husband FaceTiming with me with a baby on his chest because he was up there primary parenting like a champ. He never left the babies’ side unless my mom was there with them. I was just beside myself. The minute they stopped the magnesium the nurse was like “We can get you up in a couple hours.” And I was like “No! We’re going up now!” “You need to order some food!” “No! We’re going to the NICU! That’s where we’re going. I don’t care about food. I’m going to see my babies.” That was the very first thing I did.

First time together

First time together

What was it like seeing them again?

It was emotional, but also, they didn’t feel like mine because they left and then they were gone for 24 hours. It took awhile for them to feel like mine. The hard thing about being in the hospital was that we had so many other people caring for our babies with varying levels of permission. That’s something I’ve reflected on: all the times we come into a room and don’t ask permission to examine a baby. For adults, we ask, but do I always ask a parent their consent to examine their child? Probably not as consistently has I could. It took a long time for them to feel like mine. I knew I was happy that they were there. I knew that I felt love for them, but they didn’t feel real to me quite yet.

Finally home!

Finally home!

How long were they in the NICU?

A little over 2 weeks. We were the NICU parents who camped out. My husband and I left to go to dinner once and the whole time I was like “We need to go back. We need to go back. We need to go back.” We had wonderful nurses. We had lots of prompting from the nurses that we didn’t need to stay, but it just felt like part of it. They’re ours. Why wouldn’t one of our family members be with them all the time? I would have a hard time leaving my parents in the hospital alone, and so leaving my babies just didn’t feel like something we were going to do. I know they would have taken good care of them. And we had the privilege of them being our first and having supportive colleagues. Bill actually took paternity leave as well which allowed us to be in the NICU with our babies. The number of people who had to help us...I can’t thank our colleagues enough. I expected it to some extent from my colleagues, health care professionals, a lot of women, but my husband is a lineman. He works for Waunakee Utilities and he works with all men. People don’t take paternity leave, so it was amazing to see how supportive they were! They were so great about him being a dad and about him doing what he needed to do.

Newborns

Newborns

How did you pick their names?

Lawrence Marlin Carlson. They’re both named after our grandparents. Lawrence was my husband’s grandfather and Marlon was my grandfather. And Arnold William. Arnold was my mom’s dad and William is my mother-in-law’s father. None of my grandparents were alive, but both of Bill’s grandpas are alive. Grandpa Bill turned 90 last year and Grandpa Larry is turning 90 this weekend. That’s fun that we’ve gotten them to meet the grandpas they were named after.

Colostrum for the boys

Colostrum for the boys

Was the labor what you expected?

For the most part, for me, it was. I mean, it was not the vision from before I was pregnant. Once I knew I was having 2, I think actually it went the best I could have hoped for. I got to have a vaginal delivery. My babies were really quite healthy. I was just focused on feeding and growing my milk supply. I started pumping right away. The nurses taught me some hand expression. No matter how many times you get taught or watch, it feels awkward and you never know if you’re doing it right! I was able to get a fair amount of colostrum in the first 24 hours to send up to the NICU. And after that my milk supply increased really nicely. By day 3 of life, they were all on my expressed milk. They got donor milk. We’re so grateful for the donor milk that people had donated through the Great Lakes Milk Bank! Those were big things I had wanted for my delivery and hoped for.

Bill feeding the boys

Bill feeding the boys

How did your support team help you during labor?

My husband was an enormous support, even though, if you ask him, he doesn’t think he did anything helpful. My mom and dad were there through a lot of it. I’ve got good friends Ronni and Kathleen. Kathleen was able to help support me through some of my ultrasounds. They were a great support all along. My in-laws were there and supportive. My brother-in-law and his now wife. Lots of really great colleagues. Good friends. Good colleagues.

One year olds.jpg

What would you do differently for your next births?

I had some choice in who my care providers were, but not really. They high risk groups are set up in a particular way where the amount of choice is limited. I ended up working with an OB who I picked for myself who I loved and was a dear colleague of mine. I really sought her out when I felt I was losing control of the things I had wanted for my pregnancy. Hopefully we won’t have twins again and, aside from probably a little preeclampsia again, my pregnancy will otherwise be less complex.

My husband was just a really active support for me. I think that worked well for us. Like I said, I’m pretty independent, so I think part of why he didn’t feel supportive was because I was like “Nope, I’m fine!” My boundaries of letting people in are probably pretty high. One of the things I say to people is how this pregnancy was way harder on my husband than it was on me. I think it’s really surprising when I talk to people because I would really like more kids and my husband is done because of how this experience went. All the things that happened I’d seen as a physician and were within the realm of things I felt comfortable with. And I’m also pretty assertive about my own body and willing to stand up for when I want more information or if that’s not the way that I want things to go. I think I’m pretty assertive in a health care setting. My poor husband was terrified, and he never told me how scared he was until after the babies were born. I was worried about the babies, but I never once worried about myself. He was so worried about me. I really undervalued what his experience was in that. If there’s one thing I wish had gone differently it’s acknowledging my partner’s feelings and asking for his feelings. I was just in problem-solving mode all the time, so I never thought to say “Are you ok? Are you feeling ok? Are you feeling incredibly overwhelmed with all of this?” It’s easy for me to slip into that physician mode. I wish that I had known that. I would have liked to not have the pregnancy be so hard on him.

For as much as I knew as a physician, there’s so much that I learned through the process of being a patient. I don’t think we all get that experience as we’re becoming physicians, but being a patient is a different world. I learned so much more about breastfeeding medicine. I think that I learned I wasn’t adequately preparing the moms that I worked with for breastfeeding. I had done so must pre-reading and work. I was ready to hit the ground running when those babies came. I think because birth is such a physiologic process we think that things are just going to happen. We forget that there’s always been passed down wisdom from previous generations, whether that’s wisdom from our moms or physicians, our friends, our family members, that network of people who have had birth before us. We sometimes undervalue that humans need that, that it’s not just going to happen. And we don’t know how to listen to our bodies. The minute your baby is out they get a diaper and frequently get swaddled. We talk about skin-to-skin, but sometimes you feel like you need permission to get your kid naked and put them on you. How can you expect your body to do any of the things? There are so many things our instincts would tell us to do that we don’t listen to it. We suppress our need to eat, to pee, to sleep. We suppress every other instinct every day. Why would we expect any of those instincts to come forward on the day we give birth?  The support for breastfeeding during the time after birth was something I had talked a big game about but never fully understood what that meant and what that looked like.

One year later

One year later

What words of wisdom do you have for expectant parents?

Listen to your body and trust your body. Throughout my pregnancy, I felt confident when I thought I was having one baby. Then I felt insecure about my body’s ability to handle it when I found out I was having twins. I gradually rebuilt that confidence. Then through the medicalization of my pregnancy, I started to lose my confidence. For awhile I was like “I’m good at carrying twins! I’m good at this!” My self talk was “I’m good at carrying twins. I’m going to be really good at breastfeeding!” I think sometimes, unfortunately, as health care professionals we do strip moms’ confidence away with the medicalization of something that physiologic. Listening to your body and knowing that you can do it and that you’re good at this. Pregnancy’s hard work and there are a lot of things that don’t feel good, but that does not mean that you’re not good at carrying this baby or that you’re not going to be great at delivering and great at parenting this baby. Have the confidence in your body, and if you don’t, have the self-speak to try to get there. The message that you want to be repeating to yourself is “You’re going to do this and you’re going to do great!” I think that was important for me. I know that might not work for everyone.

Thank you, Jensi!

Maggie Mehr