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Welcome to The NICU Translated Podcast, where we break down the complex world of the NICU into clear, relatable insights for families and the professionals who support them. Hosted by Mary Farrelly—a certified NICU nurse, doula, and educator—this podcast is your go-to resource for navigating the NICU with confidence and compassion.
Whether you’re a doula looking to better support NICU families, a healthcare professional seeking deeper understanding, or a parent preparing for or living through a NICU journey, you’ll find actionable tips, evidence-based guidance, and heartfelt stories to inspire and empower you.
Each week, we’ll explore topics like:
-NICU 101: Terms, diagnoses, and medical equipment explained.
-Preemie care basics and developmental milestones.
-How to advocate for your NICU baby with confidence.
-Emotional and trauma-informed support for NICU families.
-Insights from NICU professionals and families who’ve been there.
With episodes featuring expert advice, list-style guides, and real-life interviews, The NICU Translated Podcast is here to equip you with the tools and knowledge to make the NICU journey less overwhelming and more empowering.
Subscribe now and join our community dedicated to bringing more joy and less trauma to the NICU experience—because the NICU is only the beginning.
Let’s navigate this journey together.
Mary Farrelly (00:00)
When you hear the words high risk pregnancy, it can change everything. The plan, the expectations, and often the emotional landscape of the pregnancy itself. My guest today, Cassandra Koblitz knows this from both sides, both as an L &D nurse and as a doula who helps families find calm and confidence even when birth looks different than expected. We're talking about what high risk really means, how mindset shapes the birth experience, and what support truly looks like in these moments.
Mary Farrelly (01:01)
Hi everybody and welcome back to this week's episode of the NICU Translated Podcast. I'm so excited to have my friend and nursing colleague here, Cassandra Koblitz and she's gonna talk to us today a little about the high-risk pregnancy and birth components, because we know a lot of our NICU experiences sometimes are unknown, but sometimes they also are a part of a high-risk birth and pregnancy journey. So I'm so excited to have you today, Cassandra.
Cassandra (01:29)
Thank you for having me. I'm so excited to be here.
Mary Farrelly (01:33)
So let's start at the beginning and share a little bit about your journey into this space, because you are both a nurse and a doula, which is two dual roles that I share myself. So I feel like when we first met, I was like immediately like, you get it. Like you can speak RN We understand the medical system and the complexities and the, you know, the practical side of being in that type of world, but also.
deeply recognize what's missing and the gaps that doulas can fill in that role too. So tell us about your story. How did you get to where you are today?
Cassandra (02:07)
Yeah, I have been a high-risk labor and delivery nurse for 13 years. And I worked at a high-risk facility, Level 1 Trauma Center inside Children's Hospital. So we did a lot of expected, you know, NICU stay, pregnancies, deliveries, births for seven years. And then after there, I started traveling. And when I started traveling, well, actually,
After five years of working at the bedside, went back to become a midwife because that was my long-term goal. I truly am very passionate about pregnancy, labor, birth, the transformation into motherhood. So I wanted to become a midwife. And then I quickly realized that that was not for me just because of flexibility, time management, work-life balance. And after working in the
hospital I like kind of saw that side of it so I didn't really explore much of like home birth side so I might now go back to that but we'll see. However traveling had opened my eyes a lot to how factory-based my hospital was that I had worked at for seven years and it truly just felt like I didn't get to be a nurse at the bedside like I had to
two patients sometimes, literally, I would be having a baby and after two hours, I would pass them off to the next nurse and get another labor and maybe have another baby. Like we would joke when we would have three babies in one 12 hour shift, which is just insane for nurses. But so I quickly realized that also a labor, pregnancy management, you think there's like one way to do it, but there's
Mary Farrelly (03:35)
Thank
Cassandra (03:47)
I know. I want to say 100. It's not that's dramatic, but there's many ways to do it and policies and protocols mean nothing. Can I say that as a nurse? I should not. JCAHO's coming this week. But anyway, it's true. Yeah, they're coming Monday. But yeah, so it is. It's crazy. I it opened my eyes traveling, seeing it done so many different ways and
Mary Farrelly (04:02)
JCAHO's listening.
Cassandra (04:15)
just reminded me why I do what I do. I truly strive to give my patients and my clients now, obviously. I just realized that at the bedside, I was only able to do so much and I wanna do so much more. So that's why I started Hakuna Matata Mama, and then also to decrease the amount of traumatic births because I feel like so many people are just...
into the hospital and they're like, okay, I'm here to have my baby and have done very little education. And I really, really am like passionate about education and making it hands down the best day of your life, the day you meet your baby because traumatic things can happen, but you can still have the best day of your life, the day you meet your baby, if you're prepared. And I think that that is like, that's my story, a little bit of it, but.
Mary Farrelly (05:09)
There are so many parallels to my story too. Also the 13 year mark too, but the fact that I The one one of the silver linings of being a nurse during kovat was that it started this massive wave of travel nursing So for those that are listening that do not know what travel nursing is it's when? A Registered nurse goes to a hospital for a short period of time usually a couple months sometimes a little bit longer sometimes a little bit shorter
Cassandra (05:11)
Yeah.
Mary Farrelly (05:38)
and then they go to the next hospital. So what had been happening previously before COVID is that people that worked in the healthcare system, especially if you're there for a really long time, you only know the one way that things are done. You know that the one protocol that you use for whatever it is, for labor, for inductions, for managing hypoglycemia in a newborn, in your head, it feels like the right way because it is the way that it is done. But travel nursing brought people from all different types of health systems, different ways of thinking,
and transplanted them all over the country. And so it really started to open people's eyes into realizing like there is not one way to do things. How we do it is maybe there's some merit to it, but maybe there's a different way to look at it too. And so that I think is like the under current of change and pressure that's been happening last five years for making changes. having also both of us worked in large hospitals and large mall and everything in between.
know that it is very hard to do everything that you want to do as a nurse within the constraints of bedside nursing. So the logistics of staffing, the logistics of your patient load and acuity and charting and all the things, which is really where the role of a doula can step in, like, and fill those gaps for individualized, personalized, empowered education and support.
because otherwise you kind of get put as a cog in a wheel. As a patient you enter this facility and then you put on this kind of roving cart of policies, protocols, procedures. And there are a lot of things that hospitals do well. The outcomes, at the end of the day, we're looking at, especially in the NICU, saving very critically ill babies who otherwise would not survive. But there are so many gaps in care that
are there and that families and babies can feel too that leads to this potential long lasting trauma. But I love and fully mirror the idea that empowered education is the key because people can't speak up for themselves, people can't ask for changes, people can't have the experience they want if they don't even know what's possible. So I also really loved when we were connecting how you are focused in on making the birth experience as best as possible.
even and maybe especially if you are a high risk mama or having this label slapped on you as being a high risk pregnancy as so many people who are going down the NICU journey have. So let's talk a little bit about high risk. What are some like common misconceptions that people might have about it? What does that label mean once you kind of maybe you're out of your OB appointment and now your label does high risk or maybe you went into your pregnancy and you already were like high risk? What does that look like?
Cassandra (08:00)
⁓ huh.
Mm-hmm.
Yeah, that's my true passion because I feel like it's so, it can happen at any point in your pregnancy or it can happen at the beginning. And not to fear monger people, but to educate people that it can happen at any point. And that's again, where you step in of like your NICU, you can have a baby in the NICU at any point and you're not.
People are so often like, I don't want to learn about preeclampsia or gestational diabetes. Everyone's so excited about gestational diabetes that when they pass that glucose test, they're like, ⁓ yes. But so those are some of the situations. But a lot of the times people come in and they're at their scan or they see something on the scan and they have to keep continuing to monitor. And the high risk label comes with pregnancy.
already you have normal anxieties and fears of, I doing this right? Is my baby okay? know, like constantly is my baby moving? ⁓ something happened. And like, I have a little bit of spotting in my underwear or I have more leaking. And it's constantly this heightened anxiety. That's a normal pregnancy. Now you slap that label on it of high risk and that label is so broad. Like I wish there were subcategories to it of like category one, category two, or like.
Mary Farrelly (09:40)
Ahem.
Cassandra (09:41)
Okay, no, we need more monitoring now you're category three or like, you we know that your baby has myelomeningocele. So like we have to do this or infelice or like, you know, those are like high, high risk and people who come in with preeclampsia at 29 weeks, 30 weeks with severe range blood pressures, they're very high risk, but it happens like that. So there's very little preparation that you can do. So in pregnancy, that's where like,
broad spectrum of like mindfulness and being able to cope with the anxieties and the unknowns of like, this might happen. I'm aware of it. And being aware of it is so important. Like you don't need to shun it out and like push it out of your, your mindset. Like, that's not going to happen. It's like, if that happens, I'm going to deal with it and cope with it and not deal with it. Deal with it is like a bad word. mean,
Mary Farrelly (10:22)
Thank
Cassandra (10:32)
of like truly cope with it, give it space and learn how to manage your anxieties and your fears. Managing your fears comes with education, right? Like that's so important. And then the anxiety part of it of like the coping with your nervous system and knowing how to deal, not deal, I keep saying deal, how to manage it. Yeah, yeah. How to manage it. And
Mary Farrelly (10:51)
Work through, get through.
Cassandra (10:55)
The support and connection is so important and that's what we do as doulas on the other side, Of like supporting and teaching you how to navigate the anxieties and the fears. But the high risk label can come at any point and that's where it's hard and it's hard to guarantee anything in pregnancy, right? There's no black and white, like, if we do this, this will happen. So it's very important to...
manage and know how to navigate your anxieties, your fears and roll with the unexpected and like, know, give it space, but also, you know, like be able to move forward and work with the next thing. I feel like that might be answered your question.
Mary Farrelly (11:37)
No, I love
that. One of the things that we talk through, especially when we're talking in the doula space about how to talk to your families about the NICU prenatally, even if they're not definitely gonna be in the NICU. I like to use the fire drill model idea. So my daughter's in kindergarten, she has fire drills regularly, and it doesn't mean they're manifesting a fire. It doesn't mean that now all of a sudden she's afraid of fires and she'll think about our fires.
Cassandra (12:01)
Mm-hmm.
Yeah.
Mary Farrelly (12:04)
It just means that if there is a fire, they have a plan in place. They thought it through just enough. They're not ruminating on it, but they know enough to keep each other safe and to manage it if it does happen. And so that I feel like is how one way to have these kinds of conversations that sometimes can feel a little bit overwhelming and a lot of what ifs and unknowns. And I do feel like just as you said, there's two pieces to it. There's the education so that you can kind of know in your head for different scenarios how you might want to
navigate it in a way that feels good for you, as good as possible with what's going on. And then a certain element of surrender too. there is, you know, she can do 800 fire drills and it also doesn't mean that they're never going to have a fire because she prepared so much, you know? So I feel like sometimes that also can happen in birth. There's two ways I see people sometimes going. They either go ostrich in the sand, head in the sand or whatever that saying is, like la la la la. ⁓
Cassandra (13:01)
Yeah.
Mary Farrelly (13:02)
I don't want think about any of this. I only want to focus on the end goal. And then there's other people that hyper prepare and hyper fixate and don't allow themselves to enjoy the process and to soak in those small moments and be present for it. So I feel like there's such a good middle road and I love that you work with families to kind of get them into that spot so they can have that beautiful birthday and they can still enjoy elements of their pregnancy while still feeling prepared.
Cassandra (13:12)
I'm done.
Mary Farrelly (13:30)
for the what ifs that come along with growing those tiny humans. There's so many, it's very humbling. The whole process is very humbling from someone who was, know, Naked Nurses tend to be very type A and like to have things very, and so once it's happening to you, you're like, well, buckle up, we're doing this thing.
Cassandra (13:49)
Type A women are the
most challenging, I think, because and it is truly I say that like this is the matracense or how I forgot how to say that word. I always say around mattresses, but matrescence. Yeah. But this there's nothing like it where you your pregnancy is the first stage of like learning to cope. And like we all have to have coping mechanisms like, man, this really sucks.
Mary Farrelly (13:53)
huh.
I say matrescence
Mm-hmm.
Cassandra (14:18)
but you know what, I'm gonna get through it and this is happening for a reason or I, know, everything's gonna be okay in the end, like truly manifesting and believing in that. And it's the first step to becoming a mother. And like, that's your life, right? Like you have little ones, you understand that sometimes things do not go our way no matter how hard we try. I mean, that's life, but motherhood, a lot of it, right?
Mary Farrelly (14:31)
Thank you.
life. And even
with pregnancy, there's an element of your body's changing and doing all the things, but there's still this little being in your body who has their own agenda sometimes, it seems like, and their own story that's happening in parallel to your journey into matressence and their journey into being a human, right? So it's happening at the same time. And sometimes I can get a little bit overwhelming to navigate that.
Cassandra (14:55)
Yeah.
Mm-hmm.
Totally.
Mary Farrelly (15:14)
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Mary Farrelly (16:05)
So
Cassandra (16:04)
Yeah.
Mary Farrelly (16:06)
What type of tools or mindset shifts can help families, especially those that are with this slapped on high risk label, to manage the rest of their pregnancy and even maybe their birth with this new lens of empowered surrender, if you will.
Cassandra (16:25)
Mm-hmm.
I focus highly on your nervous system and it's becoming a fad or I mean, it's not a fad. It's a good thing that more and more people are talking about it. I started with my own journey of somatic practices to help heal my trauma from being a bedside nurse and learning that like I need to take care of myself so that I can show up fully for my patients.
Mary Farrelly (16:36)
Mm-hmm.
Cassandra (16:52)
And so it started with my practice of that. And then was like, how can I bring this to the bedside for my anxious moms who are like, oh my goodness, I got sent over from the doctor's office and now I'm in the hospital and might be here long-term on bed rest for a long time. Or even now I have a calendar full of scans and I'm so overwhelmed because I have, and those are like the moms who are just, cannot add one more thing to my schedule. I'm like, oh, but you really.
who really need to so that you can cope with those appointments and with the overwhelm of it. So the thing is I focus highly on somatic practices, nervous system regulation, and trying to overcome the negative thoughts. It's okay to have them there, but also have the positive and have that be stronger. Like you can have this and that. And knowing that they can both coexist within you.
⁓ but you're able to overpower with your mindset. And it takes practice and it takes, it starts with mindfulness. So like your first step is the mindfulness. So I have a pregnancy power toolkit and it's 10 mindfulness tips to just practice something as simple as an affirmation and being able to tell yourself like, I'm capable of this, I can do this and simple things. Everybody will find their mantra and like what works for them best.
practicing that and just being aware of how you're feeling. Like if you're feeling angry, that's okay. If you're feeling sad, that's okay. And if you're feeling like very overwhelmed and I can't do this, that's okay. Like speak it, speak it out into the existence so that you hear it and you're not repeating that to yourself. Cause the mind is listening to you. So you can have that.
Mary Farrelly (18:38)
it.
Cassandra (18:39)
say it out loud and then replace, not replace it, but also say, I also can have this. Like I'm so strong and powerful and I can do this. And the nervous system, I work closely with a chiropractor right now who deals with babies and like all the way from newborn up until like toddlers. And he said something so powerful to me about how babies with like colic or, you know, like,
I'm gonna go as far as saying like ADHD, but attention issues in school or even constipation, things like that. He talks to the women about their pregnancy and they all say they had a traumatic pregnancy. It was very hard or their birth was so scary and they had a three-day labor or like, know, he kind of like goes into that and he also focuses a lot on the nervous system for these kids too. So we connected and like see eye to eye on how important it is to.
be able to manage your nervous system when you're pregnant. I think it's such a forgotten thing. And nowadays, because of these, everybody is distracting themselves. And it's a way to, your nervous system doesn't know any different. It's a way to protect you from fear. And sometimes when you scroll across that scary post of somebody who had this happen or that happen, you're like, and then you start to...
go down this negative spiral and that's the pregnancy anxiety spiral slide. And it doesn't go away until you do something to talk about it and it can live inside of you for a long time. And I think that that's another thing where people get so like about childbirth education where women are like, I'm not gonna take a class. I'm just gonna watch Instagram or TikTok. And then they're in birth and they're like, ⁓ what's happening to me? like a deer in headlights. And I think-
Mary Farrelly (20:24)
Thank
Cassandra (20:26)
They just push it out. They don't want to learn about it because you can't control it, which is fair. However, when it's happening to you, you're in that, ⁓ and it's there's there's at that moment, there is no going back of like, now I can cope with this or I I can handle this. And some women can. I'm not saying for everybody, there is no blanket statement ever. It's just one. You have to learn these tools to learn how to navigate or manage your nervous system.
and really take care of yourself. You have to take care of mom first.
Mary Farrelly (20:59)
I
feel like sometimes we, it almost feels like selfish to be curious about yourself or to spend time on yourself. It's this whole idea of everyone else's needs in front of mine. there's that whole, there's so many tropes about it. Put your oxygen mask on before you put someone else's on and make sure you're pouring from a full cup. And sometimes it can get a a little kitschy, but it is so true.
Cassandra (21:08)
Mm-hmm.
No, no, no.
Mary Farrelly (21:28)
And I see this in myself still sometimes like if I start to feel overwhelmed or ruminate or do what it is Knowing that I need to be curious about myself because as you said it's not one size fits all You have to be thoughtful about like what is my body feeling right now? What are my emotions right now? What works for me doesn't necessarily work for this person, but like let's spend some time figuring this out And those are tools that will serve you
forever, not just for birth. It'll also be that moment, you know, when your toddler won't pick up their toys and you've told them a thousandth time. There's so many moments that it will come and interplay too. And I also, that's really interesting, your conversation with a chiropractor. One of the things that we talked through in NICU Doula Academy, it's at the full NICU Doula certification program, is a
bit about trauma-informed care practices, but also not just for families, but for the babies. Because in the NICU, especially the babies are living the experience at the same time. And same with in utero. They're having lived experiences too that are imprinting in their nervous system and are impacting their organs. And there's so much that we can do to counterbalance it, right? Just like you said, you're never gonna be able to take away the hard. That's not the point.
Cassandra (22:33)
Yes.
Thank you.
Mary Farrelly (22:47)
Like we can't erase the NICU, we can't erase the potential for a more complex birth or things going in different directions, but we can balance them out. It's that like managing that coping that, okay, this happened, how do I move it through my body? One of my favorite images that I heard one time was this idea of emotional constipation. And I was like, ⁓ that makes so much sense. You know, like it gets backed up and backed up. And if you don't let it out somewhere,
Cassandra (23:03)
Mm-hmm. Mm-hmm.
Mary Farrelly (23:16)
it'll eventually cause big problems in your body too. You gotta let your emotional turns out, lack of better word. You can only ignore things for so long before they find you, whether it means that you're gonna get sick or something else will happen. It's inevitable and we think we're in control, but ultimately we're really not.
Cassandra (23:18)
Yes, yes, so true. Yeah, so true.
Yeah.
Mary Farrelly (23:38)
which is very, very humbling and eye-opening. But I love the idea of building in these balancing moments because even if you have these tools and you have the education, even when things are getting and feeling hard or overwhelming, you have this interlying knowing and confidence that like, I can do this. I, it's that I can do hard things. Like I am built for this. This is part of my story. One day I'm gonna look back on this and this is all gonna make sense. But right now it's a lot of.
Cassandra (23:59)
Mm-hmm.
Mary Farrelly (24:07)
Crap for that, for better word. But it's hard, but we're gonna get through it. Me and my baby, like we are strong people. We're going to get through this together, whatever that looks like and whatever that journey will look like too. So I love that.
Cassandra (24:09)
Yeah.
Intuition is so important. think women often are like, the monitor said this, I'm fine. Or, my doctor said that's fine. I don't, I'm fine. Like ignore it. No, listen to your body. Please. If something feels off, trust it. Believe in yourself. Like I think we, not we, a lot of people are like, the monitor says I'm okay. Or the monitor says my baby's okay. Like if you feel like something's off.
Mary Farrelly (24:25)
Mm-hmm.
Cassandra (24:52)
Speak it out, talk about it, please. That is,
Mary Farrelly (24:53)
Thank you.
Yeah, as an experienced nurse, I'm sure you feel the same way. If someone says something's wrong, I'm like, something's wrong. Like, yes, like you are right. You might not know exactly how to verbalize this or what it is, but something is off. And that trust in yourself and that inner knowing and that advocacy piece of it is so important.
Cassandra (25:05)
Mm-hmm. Yeah, yeah, yeah.
And all you have to say is something is off. Like,
please, if you feel like something's off or, I mean, even at the NICU or in labor and delivery or wherever you are and you're like, ⁓ something just doesn't feel right. That's all you have to say. Something doesn't feel right. Or like, I don't really know how I feel about that. know, like if something's proposed to you and you're like, ⁓ I don't know. I'm not sure how I feel about that. Like those words will spark a different conversation. So.
Mary Farrelly (25:32)
Mm-hmm.
Yeah, conversations are the key to feeling like you're not just being put through that system, put through this process without any say in what's going on. And that's, know, with the brain acronym that the benefits, risk, alternative, the I is intuition and also information. But it's like, what does your gut say? And that is just as important too. And especially in the NICU too, when parents have this spidey sense about their baby, they were...
Cassandra (25:50)
Mm-hmm.
Mm-hmm.
Mary Farrelly (26:15)
just detached in utero. Like they are still very intertwined and they are there. They're watching, they're monitoring. And so their level of expertise, even though it looks different, is just as valid, if not more so too. I, you don't have to be like, I know what's wrong. It can be that just like something feels off here and it doesn't, I don't know why, but my, little inner knowing is, is there for a reason. So I love that.
Cassandra (26:30)
really.
Yeah. Yeah.
Mm-hmm.
Mary Farrelly (26:43)
I also wanted to talk to you as someone who is still working very closely with women who are giving birth, how to navigate, especially for those people. So we kind of talked through the people that are not wanting to explore and educate and build their own tools up. What about those other people that are now like the hyper planners, over, not catastrophizers, but like the multiple what if, what if, what if, must be hyper planned for each scenario.
especially in birth when things go wrong. How do you kind of talk through flexibility, emotional safety, processing things when things are changing quickly? Do you have any words of wisdom to share around those types of scenarios that might come up?
Cassandra (27:25)
I really truly these are the hardest patients or not patient not even those patients clients but because it is so in the moment it's like ⁓ this is your fire drill like there's a fire started and I have to go manage that you know I mean to me I'm like thinking in a nurse I know pull aim squeeze sweep like the P.A.S.S. acronym but we have to
Mary Farrelly (27:37)
Yeah.
Cassandra (27:48)
quickly learn how to, again, regulate our emotions and our feelings and be able to trust, I think, is a huge thing and going into your intuition. So trusting your intuition, yes, alerting yourself knowing that something is wrong, but also being able to step back and look at the whole picture because
actually, I just had this happen. Mom went into her doctor's office and her blood pressure was insanely high and she's like, what's wrong? I feel fine. And her blood pressures were really, really high, severe range. had to treat her. We had to start her on magnesium and she was 35 weeks and she was heartbroken because of course she had a birth plan. She had all these things that she wanted. And in her situation, we had her on bad rest and on magnesium and some
Places like literally won't even let you get up to the bathroom. So like when you're in that situation, you're like, man, and you're immediately angry and frustrated, right? Because this isn't going how I wanted it to go. Why? And you automatically get angry and there's tons of times where I've experienced so much pushback. like, well, I'm going to do this. Actually, last week, my patient was like, I just want to sit on the birth ball. Like I'm still going to be resting, but I'm just going to be on the birth ball by my bed.
I let her do it and you know what? We ended up back in bed because I had to treat her severe range blood pressures afterwards. And it's like, see, that's why we do it. I, and I mean, in hindsight, I probably shouldn't have let her, but I strive to like, let you do, make it whatever it is that you have this grand vision of how your pregnancy and everything's going to look. And.
There are reasons why we do X, Y, or Z. We're not doing it to go against your birth plan. And in this moment, this mom, we played calm music. We had the lights dimmed. Any of those things that make you feel comfortable, you have to be able to find those things. Coping mechanisms. So many women do not, and not just women, I think it's our generation in general, we struggle with coping.
Mary Farrelly (29:37)
Okay.
Cassandra (29:58)
For a lot of reasons, I'm sure I'm not gonna go into that, but the coping mechanism is the most important. Trying to, again, go back, going back to the nervous system, but being able to take a step back and relax and big picture, like, what can I control right now? This. You can control your mind. It takes time, it takes practice, so it is hard in these emergency situations, but that's my go-to. I'm constantly like, okay, yes, we have this.
but we also have that. So going back to the power of the and. And I think that in those emergency situations, having a baby go to the NICU, I can't tell you how many term scheduled C-section babies go to the NICU. I mean, I know you know that, but like, it's so crazy because when we're like, everything was fine. What happened? And it's, it is those situations. It's so hard to cope with the traumatic thing that's happening. And I think we also need to
Mary Farrelly (30:51)
Thank
Cassandra (30:52)
to label it as traumatic. And this, I spoke with my mom, that mom that I was just talking about who had.
severe high risk, severe hypertension birth plan. We did actually do some things on her birth plan, which I think is so important to still maintain that, not be like, well, I'm here on bedrest and now I can't have that, that, that. Well, let's still look at it and what things can we do? That's where I'm working on a high risk birth plan template right now. And I think it's so important for people to still have things that will make you feel good about it.
Yes, you're on magnesium. Yes, you're on bed rest. But what can you still do? There are things that you can still do and you just have to ask. yeah, I think that's like I could keep going on, but.
Mary Farrelly (31:34)
Yeah, that's huge that
having that acknowledgement that there are scenarios and times and places where things are not going to look like what you envisioned and you're allowed to have feelings about that. You're allowed to be sad. You're allowed to be angry and grieving really because it is a loss. It's a loss of expectations and of what your vision was for what you wanted. I always say when people
Cassandra (31:47)
Mm-hmm.
Mm-hmm.
Mary Farrelly (32:02)
pee on that stick and get those two pink lines, everyone has this very specific vision in their head of that blissful birth and the oxytocin flowing and the baby right on your chest and everything just being as it should in your head. And when things don't go according to, quote, to plan, it can feel really hard, especially the curse of social media sometimes is that you oftentimes we're seeing, it's a blessing and a curse. You see all these positive birth experiences, positive birth scenarios and this like,
Cassandra (32:07)
Yeah.
Mary Farrelly (32:31)
cookie cutter
Cassandra (32:31)
huh.
Mary Farrelly (32:32)
image of what a low risk birth looks like. And I love that people have that idea and they can strive for it and they have these, especially my doula brain is like more, more, more. And for people whose birth do not look like that because not everybody's body is going to do, follow the rules and not everybody's baby is going to follow the rules. And that's where high risk practices do save lives and have better outcomes than if.
Cassandra (32:38)
Mm-hmm.
Mary Farrelly (32:58)
You you had the ostrich in the sand look and we can still do it in a way that feels good that feels like you that feels like your baby that feels safe and that feels Empowering it's such a different lens. Like I've seen it both ways. I've seen those Birds with people just feel like they can't either they're fighting it so hard that they're not allowing the safe care to be given or they're just like totally give up on it and are like
Well, I'm not allowed to have any of these pieces of things. And then you're grieving it for a really long time. So there's, again, there's this balance between people being able to see you and hear you and listen to your wishes, your dreams, your hopes, your fears, your loss, and building up a new image about what, okay, what can we do? What can we do to make this feel a little bit better, a little bit more like home, a little bit more like what you hoped and dreamed for? But it definitely is a touching or tricky spot.
Cassandra (33:56)
there has to be a space where we can both coexist in high risk pregnancies because I've seen it many times where women are fighting for that vaginal birth and the baby's losing reserve. And I look at the mom, so I'm talking about a mom who has been pushing for three hours, which this happened to me yesterday.
Mary Farrelly (34:00)
Mm-hmm.
Mm-hmm.
No.
Cassandra (34:20)
⁓
And the baby looks not great on the monitor and I'm talking to the doctor about like, okay, we still have some reserve, how long are we gonna push this out until we start talking to the patient about like, we should be heading in this direction. And in those situations where the mom is like, no, no, no, I want a vaginal birth. I absolutely don't want a C-section. I'm not doing that. Can I get another hour?
It's so hard because it's not my, I mean, I will speak up if I have to, but I feel like it's the provider's job to be talking to the patient about, your baby still has a little bit of reserve left right now. We're seeing signs that it's decompensating. And at birth, if you want to hold your baby and you want a better chance of keeping your baby with you, we should progress to a C-section now. We can keep pushing.
but your risk of your baby going to the NICU and not having that skin to skin time that you want and not being able to initiate that breastfeeding goes down. And I think it needs to be looked at in that aspect, which as somebody who has seen it so many times and not just with natural moms who want to like push to the 10th level, but it's in so many different other situations where we do have a high risk pregnancy and we are seeing fetal decompensation like
we need to be communicating to the moms about like the risk of being or like the benefits of having that skin to skin time immediately after birth and in what time frame is that? And again, we don't know any, we don't know exactly. I just say your chances go down, right? Like I can't say if we keep pushing for another hour, you won't have your baby, but I can say the chances go down
of you having that ability to keep your baby skin to skin and keep your baby on you.
Mary Farrelly (36:10)
it's so hard as doulas and nurses knowing both lenses, it's like, there's such, especially with high-risk and NICU, there's this fine line between fear-mongering and allowing the family to have truly informed consent. And fully informed consent might be saying, these are potential true risks to these decisions that you're saying. And then also shifting this idea that like, there's this,
You were like winning fought the system and you won like because I said no and I I Coming from as you said places that live strictly protocols There are so many times that you can say no to thanks and that's okay But you really need to make sure that you're doing it fully informed of the risks and whatnot because there's also been instances where people were like well if I had known that XYZ was on the table or whatever the risk was
Cassandra (36:40)
Yeah, yeah.
Mm-hmm. Mm-hmm.
Mary Farrelly (37:03)
I maybe would have made a different decision in that moment. And so it's such a tricky balance, especially in the culture that we live in right now, of this kind of dichotomy, this us versus them, the medical system versus doulas, the medical system versus patients, and there's truth to all of it, right? There's an undercurrent of truth, but nobody wins in that. There is no winner in that scenario. There's just everybody loses. No one feels good.
Cassandra (37:14)
Yeah.
Mm-hmm. Mm-hmm. Mm-hmm.
Mm-hmm.
Mary Farrelly (37:30)
going into that type of like high intensity conflict driven. I always am like, we need to go into this assuming positive intent, assuming that everyone is capable of making informed decisions, that patronizing like the doctor knows best idea is not it either. It's that we can take their medical expertise, knowledge, experiences, marry it with what you're seeing, what you're feeling and what your wishes are and have a conversation. Have a collaborative, curious conversation.
Cassandra (37:45)
Mm-mm.
Yes.
Mary Farrelly (37:59)
That's where the magic is. It's this like, he said, she said, they said, I don't know, ba ba ba ba ba ba ba. That's where people feel bad. And that's when real trauma can happen too, especially in the bar space. So I, if you're listening to this and you're either a patient, a medical professional, a dual, cause we've got all different people listening, just always, feel like remember that medical people, medical professionals are humans. We're just humans taking care of humans and we're people taking care of people. And when we remember that collectively,
Cassandra (38:09)
Mm-hmm.
Mary Farrelly (38:27)
you get a better experience. So that's my soapbox on that idea. But it is tricky to balance fear mongering with knowing the real potential outcomes. Because we've seen them all. I sometimes, I don't want to scare people. I don't want to bring my own trauma up because that's the other thing. It's hard to sometimes be like, X-IZ happened to this patient two years ago and I don't want that for you. You're smelling like this other patient that I had.
Cassandra (38:44)
Mm-hmm. Mm-hmm.
and that's ⁓
Mary Farrelly (38:55)
I don't want that for you. And also knowing that there are different people with different experiences, but it definitely is a very real scenario. And the other thing I wanted, this is not exactly what we were talking about, but I also wanted to kind of, it is in a way, tie it back into the fact that medical providers, especially have our own large bucket of trauma that we are carrying around everywhere we go.
And that that does impact sometimes our ability to offer different types of care. And so I would love to hear a little bit about what your experiences are and what worked, maybe even like one or two specific tools that you used to help you process those really more intense experiences and shifts so that you can kind of leave it both out of your own personal life and also in the care that you provide to the next patient the next day or in the next hour even as we know.
Cassandra (39:22)
Yes.
Mary Farrelly (39:45)
That happens.
Cassandra (39:47)
Such a great question, because as you said, it's so important to not bring in my own traumas, because this mom is different, this baby is different, the situation is different. I just had that. I had a patient seize on me last week, pre-eclamptic seizure, and I was like,
Mary Farrelly (39:58)
Thank
Cassandra (40:06)
Can I please not have another, ⁓ mag patient this week? And I got a mag patient yesterday and this is the patient I was talking about. And I, it was so important and I was aware of my trauma from taking care of that patient and having a nervous system, chaos, tornado, fire, whatever you want to talk about. was like, holy cow, that was a lot. going into this patient's room, I was
120 % way more cognizant and aware of all the things and like hyper like, oh, her reflexes are plus two, like I should be watching out for this or that. And it was very important for me to take a step back and be aware of those things. Because I practice the mindfulness stuff and have my own nervous system regulation practices, I am able to put myself in check and say, hey, you're like, she's different.
and this is different, her maps are lower or you know like looking at different things. There were so many different things where I had to be like, hey, but that's good, she has that or you know like we have that. And she had pushed for three hours and my other patient pushed for two hours and collectively as nurses we were talking afterwards about like preeclampsic women who are on magnesium and are still having high blood pressures like should probably labor down.
instead of pushing for extended periods of time to keep their nervous system decreased so that they're at less risk of a seizure. And I walk into the situation and I'm like, my gosh. And right away I'm like, get the doctor in here. We got to like talk about this because we shouldn't be pushing for four hours. But so that's again, a situation where I had to check myself and truly say like, it's okay that she has this and that, you know? And like for me to be like, hey,
She deserves to be able to push and try for the vaginal birth that she wants. So I think because I practice mindfulness and have like, I don't want to say mastered it, cause I'm always learning things. I think it's just so important for people to learn those things. And when you learn them in pregnancy or at any point in your life, like you, you come back to it. It is like riding a bike. So being able to literally just recognize like, I'm feeling.
Mary Farrelly (42:17)
Thank
Cassandra (42:22)
worked up or like I'm already heightened and I'm trying to protect myself but also protect the patient end of day, right? Like, but we live in the fight or flight. Like it's so important to learn about our own bodies. So then we can come back to that practice and be able to cope with wild situations.
Mary Farrelly (42:31)
I'm like.
Right.
Yeah, I mean, and this is true for doulas too, because you see and you are parallel and have even a different level of feeling, not powerless, but like a little bit, your hands are tied in a different way to have specific outcomes or maybe something that felt like it would have been not great for you, but your client is like, this is fine, I have no issues. And you're like, you know, it's that kind of like swirling mindset. So one of my...
Cassandra (42:44)
Yeah.
Mary Farrelly (43:08)
own tools, I guess, is kind of like having a moment of like gratitude almost for the bad moments. Because I'm like, that taught me so much about how I react in this scenario and how I'm going to help my next client if and when they have a scenario similarly. Reflecting on it and processing it will allow you to use the good out of that because our experience does make you better for that next patient if you let it versus letting it lead you down this.
Cassandra (43:14)
Yes.
Mary Farrelly (43:35)
fight or flight fear based way of practicing too. it's awareness as you said, it's awareness and mindfulness too. So we're wrapping up for today. I one last question for you. So if you are a parent and you're listening to this and you just found out that your pregnancy is considered high risk, what's the first thing you wish they could know right now to help them feel more grounded and empowered like today?
Cassandra (43:59)
you're not powerless. Like you still have a voice, you still have a choice, you're allowed to do all of the things. Like yes, we want you to be on magnesium, we want you to be in bed, we want you to do all of the things, but you're still end of day allowed. Like you're able to go do X, or Z within reason, of course, like it's important to understand the risks and the benefits. Like what are the risks? And
Mary Farrelly (44:25)
Mm-hmm.
Cassandra (44:27)
This is my favorite thing I tell people, like, what are my options? Always ask, what are my options? And ask, like, you have to be able to ask and speak up and say, what are my options? Like, truly, what are my other options?
Mary Farrelly (44:32)
Mm-hmm.
Because that's true, there's often things that haven't been presented yet and once you ask that question you're like, ⁓ actually we sometimes do this or I've seen this work or something like this versus just like the first line front, this is what we usually do versus like here are alternatives and things that you can do that. That good old A in brain. I love that so much. Cassandra, where can people find you and connect with you and what resources do you have for parents who are navigating high risk pregnancies?
Cassandra (44:59)
Yeah.
Yeah, I am at Hakuna Matata Mamas on Instagram. It's hakuna.matata.mamas. I know all the things, www.hakunamataramamas.com. And that's my website. And there's links there for everything that you can find. I right now have a free audio series.
When your pregnancy becomes high risk, these are the five things that you need to know. ⁓ And I truly wholeheartedly, like you are not powerless. That is the overall arching, but there are a couple of extras and you can go grab those on my actually that's on a different website. Thank you. You'll have the link in your show notes.
no worries.com backslash high risk. So
Mary Farrelly (45:59)
Awesome. Well, thank you so much for sharing your wisdom. Your patients are so lucky and clients and anyone in your life is so lucky to have you. So thank you so much and I'll talk to you soon.
Cassandra (45:59)
Yeah. Yeah.
Thank you so much, Mary.
Likewise, thank you.